Rehabilitation Frameworks

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Introduction

Rehabilitation is a goal-oriented process that enables individuals with Impairments, Activity Limitations and Participation Restrictions to identify and reach their optimal physical, mental and social functional level through a patient-focused partnership with family, rehabilitation providers and the community. Rehabilitation focuses on abilities and aims to facilitate independence and social integration, and includes prevention of injury/illness recurrence and/or secondary conditions.

Rehabilitation Frameworks provide guidance document to to support clinicians, managers and planners to improve access to quality, sustainable rehabilitation services. Framework outline the key elements foundational top rehabilitation services and promote a shared understanding of rehabilitation through provision of a common language and definitions for concepts relevant to rehabilitation and serves as a guide for planning, managing and delivering consistent and preferred rehabilitation approaches to meet patient, client and community needs. There are a range of different frameworks that underpin rehabilitation services within different contexts including Competency Frameworks, Standards of Practice and Models of Care.

The International Classification of Functioning, Disability and Health (ICF) Model produced by the World Health Organization (2001) is foundational to most rehabilitation frameworks, taking a biopsychosocial approach to health that is patient-centered and recognises the many factors that influence health. The model encourages rehabilitation providers to look at how health conditions interact with contextual factors (both internal and external to the individual) to impact the individual’s daily activities and their participation in society. Adopting this model will assist rehabilitation providers, researchers and administrators to shift practice to focus more on function and will give guideposts for planning and evaluating rehabilitation service

Competency Frameworks

Competency frameworks, which comprise organized statements that communicate the expected or aspired performance of a particular workforce, can be valuable resources in addressing workforce challenges in many settings. These challenges generally relate to a shortfall of workers, deficiencies in quality of care, and a mismatch between workforce capabilities and population needs. Competency frameworks can help address these challenges at the individual, institutional, service and system level. Rehabilitation Competency Frameworks define the core values and beliefs shared by the rehabilitation workforce, and encompasses the competencies, behaviours, knowledge and skills required to perform the range of activities and tasks involved in rehabilitation practice and service delivery.

• Regulatory or accreditation bodies use competency frameworks to communicate the standards expected of a profession. When applied to pre-and post-service education and enforced through audits and other mechanisms, they form a integral component of quality assurance.

• Education institutions use competency frameworks for articulating the outcomes of their courses. They can be used to shape the learning outcomes of courses, and to ensure that the knowledge and skills taught by the institution are aligned with population needs.
• Services use competency frameworks in workforce planning and human resource management. In the context of planning, they enable services to successfully align their staff competencies and activities with population needs and service objectives and help to identify knowledge and skill gaps and performance deficiencies. In the context of human resource management, competency frameworks define performance excellence and provide a benchmark against which workers are assessed. They are also integral to establishing individual and service-wide development priorities.
• Ministries of health can apply competency frameworks in workforce evaluation and planning, such as in conduct competency gap analyses.

WHO Rehabilitation Competency Frameworks

The Rehabilitation Competency Framework is a model that communicates the expected or aspired performance of the rehabilitation workforce across different countries and settings to enable quality care and service delivery.

The Rehabilitation Competency Framework comprises of five domains centered around core values and beliefs which sit at the heart of the framework. This core help shape the behavior of a rehab worker and their performance of tasks across all the RCF domains.

The four core values are;

1. Compassion and empathy
2. Sensitivity & respect for diversity
3. Dignity & human rights
4. Self-determination.

The four core beliefs are that rehab should be;

1. Person centred,
2. Collaborative,
3. Available to anyone who needs it and
4. Functioning is central to health.

The Five Domains are:

1. Practice
2. Professionalism
3. Learning and Development
4. Management and Leadership
5. Research

The domains collectively capture how the rehabilitation workforce behave in order to perform effectively (competencies), and what they do (activities). Competencies are broken down into behaviours; and activities into tasks. Each is described across four levels of proficiency. Each domain also describes the knowledge and skills that underpin the activities and competencies. These include core knowledge and skills, as well as those that are specific to an activity. The components of the RCF along with the competencies, activities and tasks are explored in detail within the framework document.

International Standards of Practice

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Models of Care

Models of Care often have their origins in care management for chronic conditions. These models share many components because they seek to address the multiple determinants of health that are common across conditions. The Chronic Care Model, is an organizational approach to caring for people with chronic disease in a primary care setting, provides an excellent framework to understand the rationale for the common components across models of care. The system is population-based and creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team.

Resources

• Mills JA, Middleton JW, Schafer A, Fitzpatrick S, Short S, Cieza A. Proposing a re-conceptualisation of competency framework terminology for health: a scoping review. Human Resources for Health. 2020 Dec;18(1):1-6.
• Le Deist FD, Winterton J. What is competence?. Human resource development international. 2005 Mar 1;8(1):27-46.
• Bruno A, Bates I, Brock T, Anders on C. Towards a global competency framework. American Journal of Pharmaceutical Education. 2010 Apr 12;74(3).
• World Health Organization. Global strategy on human resources for health: workforce 2030.