Fox GERI 7 Carnegie Plaza Cherry Hill, NJ 08003
P: 1 877 407 3469 F: 1 877 407 4329 W: foxgeri.org
Real World
Implementation I:
Best Practices in
Staffing, Training &
Certification
Mimi Jacobs, PT, GCS, OCS
Fox GERI
Fox Rehabilitation
STAFFING
FOX REHAB OVERVIEW
Text • Fox GERI partnered with Fox Rehabilitation and CARAH
to translate the ESP
• Fox GERI/Fox Rehabilitation is headquartered in Cherry
Hill, NJ a suburb of Philadelphia
• Fox Rehabilitation is a private practice providing physical,
occupational and speech therapy services to the older adult
in their home, assisted living or adult medical day center
• Fox Rehabilitation currently employs 110 Occupational
Therapists across 5 states in the mid-Atlantic region
STAFFING
THE BIG QUESTION
Text
How do you translate an evidence-
based intervention to 110 OTs across
5 states?
How do you climb Mt. Everest?
STAFFING
OUR ANSWER
Text A PILOT TRANSLATIONAL PHASE
Year 01:
• 15 OTs
• Geographical area immediately surrounding
headquarters
Year 02:
• 15 OTs
• Expanded geographical area within 75 miles of
headquarters
STAFFING
YEAR 01
Text • Began internal marketing as soon as possible
• Request for volunteers sent out to 28 OTs
• 17 responded
• 15 met our established baseline criteria
Employed at Fox Rehabilitation >6 months, baseline
score on internal ongoing quality assurance
measures such as internal documentation chart
audits
• Both novice and experienced clinicians
STAFFING
YEAR 02
Text • Of the 15 OTs who participated in Year 01:
• 6 participated in Year 02
• 8 did not participate due to staff turnover, company
promotions, participation in other projects and
medical leave
•Request for volunteers sent out to 30 additional OTs
• 12 responded
• 9 new OTs were added to the project in Year 02
• Both novice and experienced
STAFFING
STAFF COMMITMENT
Text
All OTs participating in this project signed a “Commitment
Letter” which outlined:
• Description of the project
• The short term and long term vision of the project
• Responsibilities and expectations of the OT
• Responsibilities and expectations of
Fox Rehabilitation
• Responsibilities and expectations of Fox GERI
• Responsibilities and expectations of CARAH
STAFFING
PILOT PHASE RECAP
Text
Pilot translational phase prior to full implementation to
identify and address:
• Adoption issues
• Sustainability issues
Over 2 years:
• 24 OTs volunteered and received training
• Currently 17 (70%) are continuing its use
• OTs ranged in years of education and clinical
experience
TRAINING
Text • Critical to translation was the development of training,
monitoring, coaching and documentation processes that
balanced company structure, culture and reimbursement
requirements with fidelity to ESP
• While ESP builds on OT skills and knowledge, it is
distinct from traditional practice and requires a minimum of
20 training hours in assessments, protocols and treatment
principles
• To assure success in translating ESP and fidelity to the
original intervention tested, we developed a comprehensive
training program
TRAINING
YEAR 01
Text In the research setting, interventionalists received days of
face-to-face training to deliver ESP
Translational Problem:
As a private practice, this training structure was
unacceptable for financial reasons (lost revenue, salary
costs, etc)
Solution: Modify the training structure
TRAINING
YEAR 01
Text
On their own time:
• OTs repeated the Fox Rehabilitation internal
training “Dementia Module” for all new hires (2 hrs)
• OTs completed selected readings (4 hrs)
Participated in a 2 day(16 hrs )face-to-face training (Fri/Sat)
TRAINING
YEAR 02
Text Based on feedback from Year 01 – the training program
evolved for Year 02
Year 02
• Fox Rehabilitation Dementia Module (2 hrs)
• Selected Readings (4 hrs)
• Self Paced Web Based Training (8 hrs)
• 1 day face-to-face Training Session (8 hrs) (Saturday)
TRAINING
YEAR 02
Text
Ongoing coaching / supervision and fidelity evaluation
occurred via:
• 3 individual call ins over a 5 month period
• 6 monthly group conference calls
○ Discuss new information / updates on project
○ Celebrate success
○ Brainstorm solutions to challenging cases
TRAINING
COMPANY WIDE
Text • Within the geographic territories of trained OTs: all OTs not
participating in project, all PTs and all SLPs received training on
“What is ESP” and “How to identify a patient/caregiver dyad
appropriate for ESP / How to refer a patient/caregiver to receive
ESP”. This was repeated every 6 weeks to reinforce the
material and reach staff new to the practice
• All OTs, PTs and SLPs, company wide, now receive training on
basic concepts of caregiver training
• Administrative teams including customer intake, compliance,
chart auditing, billing, accounts receivable, and marketing all
received training on “What is ESP” and “How it affects my
specific job”. Training repeated every 6 weeks
CERTIFICATION
Text
CARAH is continuing to develop the criteria of ESP
certification. Fox is providing feedback to CARAH on
possible models of the certification process