The development of expertise in pediatric rehabilitation therapists: changes in approach, self-knowledge, and use of enabling and customizing strategies.

PURPOSE

To examine the clinical decision making of novice, intermediate, and expert pediatric rehabilitation therapists from various disciplines.

METHODS

Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the 'think aloud' technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach.

RESULTS

Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge.

CONCLUSION

With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.