Adapting the WHO Rehabilitation Competency Framework to a specific context

Adapting the WHO Rehabilitation Competency Framework to a

specific context

A stepwise guide for competency framework developers

Version for field testing

Adapting the WHO Rehabilitation Competency Framework to a

specific context

A stepwise guide for competency framework developers

Version for field testing

Adapting the WHO Rehabilitation Competency Framework to a specific context: a stepwise guide for competency framework developers. Version for field testing

ISBN 978-92-4-001533-3 (electronic version) ISBN 978-92-4-001534-0 (print version)

© World Health Organization 2020

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iii

CONTENTS

Acknowledgements iv

1. Introduction 1

2. Potential applications of a competency framework 2 3. Good practices when developing a context-specific rehabilitation competency

framework 3

4. Key considerations when developing a context-specific rehabilitation

competency framework 4

5. The process of developing a competency framework modelled on the

rehabilitation competency framework 5

Annex 1. Template for a workplan 15

Annex 2. Template for recording competency framework contributors 17 Annex 3. Template for competency framework structure 19

Annex 4. Template for a feedback form 22

iv

ACKNOWLEDGEMENTS

The World Health Organization (WHO) extends its gratitude to all those whose dedicated efforts and expertise contributed to this resource. This guide, Adapting the WHO Rehabilitation Competency Framework to a specific context, was developed with the oversight of Dr Alarcos Cieza, Unit Head, Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, WHO. Jody-Anne Mills, Rehabilitation Programme, WHO, was responsible for the coordination and development of the guide; Siobhan Fitzpatrick, Pauline Kleinitz and Elanie Marks provided valuable input to its development.

The following international rehabilitation professional associations were instrumental in identifying members of the RCF Technical Working Group: Harvey Abrams, Courtesy Professor, Department of Communication Sciences and Disorders, University of South Florida, United States of America; Maria Gabriella Ceravolo, Department of Experimental and Clinical Medicine, “Politecnica delle Marche” University, Italy; Alison Douglas, Director of Standards, Canadian Association of Occupational Therapists, Canada; Rochelle Dy, Associate Professor, Physical Medicine and Rehabilitation, Baylor College of Medicine/Texas Children’s Hospital, United States of America; Pamela Enderby, President, International Association of Communication Sciences and Disorders (IALP), United Kingdom of Great Britain and Northern Ireland (United Kingdom); Rachael Lowe, Founder and CEO, Physiopedia, United Kingdom; Joseph Montano, Professor of Audiology in Clinical Otolaryngology, Weill Cornell Medicine, United States of America; Ashima Nehra, Professor, Neurosciences Centre, All India Institute of Medical Sciences, India; Rhoda Olkin, Professor, California School of Professional Psychology at Alliant International University, United States of America; Claire O’Reilly, World Physiotherapy, Republic of Ireland;

and E. Mary Silcock, Professional Advisor, Occupational Therapy Board of New Zealand. Biographies of each member are available online.

The development of the Rehabilitation Competency Framework was made possible through the support of the United States Agency for International Development (USAID).

1

1. INTRODUCTION

This guide complements the Rehabilitation Competency Framework (RCF) and proposes a methodology for adapting the RCF model to a specific context, such as for a particular profession, specialization or setting.

Adapting the RCF involves extracting the relevant content and customizing it for the context and intended application. Once adapted, the context-specific framework can be implemented, such as to support education and training, regulation, or performance appraisal (see Section II).

The RCF was designed to provide an organizational structure and language for developing rehabilitation competency frameworks that can be applied regardless of the intended audience or application. However, in order to be fit for purpose, every competency framework should reflect local values and beliefs, the scope of practice of the target audience, and the level of specificity required for its potential applications.

There is no one universally agreed way of approaching competency framework development; however, applying certain good practices, factoring in key considerations, and adopting a systematic process of content development can help ensure a positive outcome. This document offers these practices and considerations and guides competency framework developers through the phases and steps of adapting the structure and content of the RCF to a specific context. Templates to support the development process can be found in the annexes.

Figure 1. Progression from the RCF to implementation of a context-specific competency framework

Context-specific competency

framework

Workforce planning

Performance appraisal

APPLY

Adaption guide

This guide provides a systematic process for adapting the RCF to a specific context

Competency- based education

Regulation and accreditation

ADAPT

Curriculum guide

2

2. POTENTIAL APPLICATIONS OF A COMPETENCY FRAMEWORK

Competency frameworks can serve a range of purposes. Historically, they emerged with two distinct aims:

to support the development of capabilities (generally the primary concern of the education sector), and to help define standards of performance (generally the primary concern of the labour sector). Currently, many competency frameworks aim to achieve a hybrid of both, yet each requires specific characteristics. Table 1 summarizes some of the common applications of competency frameworks that relate to either or both aims, and the requirements of a framework intending to be applied in each way.

Table 1. Examples of applications of competency frameworks for rehabilitation and their corresponding characteristics

Application Key characteristics of competency frameworks Supporting rehabilitation

education and training, such as through guiding curriculum development

• Have a focus on the competencies and behaviours learners should develop, but also consider the activities and tasks they may need to perform

• Typically include different levels of proficiency, or milestones, that should be achieved at different stages of education and training or of career development

• Define the knowledge and skills that underpin the competencies and behaviours

• Are forward-looking, or aspirational in expectations of performance Supporting professional

regulation, accreditation or licencing for rehabilitation

• Have a focus on activities and tasks that rehabilitation workers should be competent in performing, but also consider the competencies and behaviours that enable rehabilitation workers to perform effectively

• Typically define a single level of proficiency required to be considered as competent

• Capture existing or current expectations of performance Supporting performance

appraisal of rehabilitation workers

• Include both competencies and activities, with clear performance indicators (examples of how these would be demonstrated in a particular real-life scenario)

• May include different levels of proficiency that capture where a person’s performance sits along a continuum, or a defined level of proficiency, whereby a person is deemed either competent or not

• Typically include performance indicators relevant to the context in which competencies and activities will be demonstrated

• Capture existing or current expectations of performance

When developing a competency framework modelled on the RCF, it is important to consider carefully how the framework will be used and what it requires in order to serve its purpose. Without such consideration, competency frameworks can be criticized as reductionist, because they fail to capture the critical yet less tangible capabilities (e.g. competencies) of a worker; or ineffective, because they fail to adequately define the observable and measurable expectations (e.g. activities) of a worker. The RCF includes both competencies and activities, and either or both may be used in a context-specific framework according to its intended audience and aims.

3

3. GOOD PRACTICES WHEN DEVELOPING A CONTEXT-SPECIFIC REHABILITATION COMPETENCY FRAMEWORK

The following practices help ensure that the competency framework is acceptable, applicable, and taken up as intended:

ADOPTING AN INCLUSIVE APPROACH

It is important that the stakeholders for whom the competency framework will have relevance – including those from different sectors, institutions and population groups – are engaged in the development process.

Engagement may be in the form of representation within a working group or consultation process, for example, and should be proportional to the implications of the framework for each stakeholder/population group. While gathering input from a wide range of sources requires time, and possibly additional resources, it is fundamental to creating a quality framework, ensuring buy-in, and the ultimate uptake of the end product.

PLANNING IMPLEMENTATION FROM THE OUTSET

An inclusive approach is one way of supporting implementation of the competency framework; however additional mechanisms, such as the following, should also be considered:

• Access: House the framework on platforms and publish it in formats that are readily accessible. Some formats and layouts present challenges for readers with visual or cognitive impairment, and it may be necessary to have multiple formats/layouts available. It is also beneficial to consider which translations of the framework may be needed to enable access to all potential users.

• Endorsement: The endorsement of a competency framework can impact how it is perceived and the authority it exerts. Consider who should endorse the competency framework (what logos it will hold, for example), and what implications this may have for the development process.

• Promotion: It is important that people are made aware of the competency framework and what it means for them. Launch events, social media, academic journals, and professional newsletters are some examples of platforms for promotion and dissemination.

MONITORING IMPACT

While it can be challenging, attempt to monitor the impact of the competency framework. Determine indicators of success (such as uptake or compliance), what data are required to measure this, and how feasible it is to collect.

Quantitative data, such as number of downloads, number of institutions, service providers, or professional bodies adopting the framework, etc. can provide some crude information regarding uptake, and audits may be used to monitor compliance. The latter in particular requires careful consideration of assessability in competency framework design, such as the inclusion of performance indicators and how these are reported. Qualitative feedback can also provide rich information for design and quality improvement of future iterations of the framework.

4

4. KEY CONSIDERATIONS WHEN DEVELOPING A CONTEXT-SPECIFIC REHABILITATION

COMPETENCY FRAMEWORK

Those whom the competency framework targets, and how they will be using it, has significant implications for its design and content, particularly impacting:

THE GRANULARITY, OR SPECIFICITY, OF THE CONTENT

The more specific the content, the less generalizable it is and the more frequently it may need to be updated.

However, some applications of competency frameworks call for a certain level of detail, without which they lack useability.

THE SCOPE OF THE CONTENT

The specialization and breadth of the intended audience, as well as the roles they perform, will impact which domains, and which activities and tasks within the domains, are included in the competency framework.

CONTEXT-SPECIFIC VALUES, BELIEFS AND TERMINOLOGY

The RCF defines core values and beliefs and has endeavoured to use terminology that can be broadly adopted.

However, the values and beliefs should be modified or complimented according to what is important and meaningful in the specific context. Similarly, the terminology may need to be modified if it does not reflect that used by the intended audience.

THE ORIENTATION OF THE FRAMEWORK

Competency frameworks can either portray current accepted practice, or be forward-looking and describe the practice to which they aspire. Whichever is appropriate depends on the intended application of the framework; current accepted practice may be necessary for frameworks that support performance appraisal, while aspirational frameworks may be useful when being applied to help develop curriculum or regulation or licencing standards, for example.

5

5. THE PROCESS OF DEVELOPING A

COMPETENCY FRAMEWORK MODELLED ON THE REHABILITATION COMPETENCY FRAMEWORK

Figure 2 below illustrates the process of adapting the RCF to specific context in five phases, each with a number of practical steps.

Figure 2. The phases of adapting the RCF to a context-specific framework

PHASE 1. PLANNING

Investing in robust planning helps to ensure an efficient and effective development process, and ultimately impacts the quality of the end product. The following steps can help facilitate the planning process:

STEP 1. INFORMATION GATHERING

Prior to launching into the development of a competency framework modelled on the RCF, it is worth gathering information through a needs assessment that will inform key considerations, such as those described in section IV above. Information-gathering may involve key informant interviews, desk reviews, or both. In particular, information should be sought on the following:

• Existing relevant competency frameworks and standards: Do they exist? Do they need to be replaced, or simply updated? What are their strengths and weaknesses?

• Relevant legislation, policies, regulations and guidelines: It is important that competency frameworks align with seminal guiding resources, which can also help shape the content of the framework.

Planning

Step 1. Information gathering

Step 2. Prepare a workplan Step 3. Confirm availability of resources Step 4. Establish a core working group and assign clear leadership or coordination roles

Step 5. Define core values and beliefs that reflect the context

Step 6. Extract relevant competencies, behaviours, activities and tasks from the RCF

Step 7. Expand the content to the level of specificity required

Step 8. Extract relevant knowledge and skills and expand as required Step 9. Amend terminology and language according to the context

Step 10. Compile a list of peer reviewers Step 11. Develop ways to guide the mode and type of feedback desired

Step 12. Respond

to feedback Step 13. Implement

a strategic dissemination plan

Drafting Review Finalization Dissemination

PHASE

1

PHASE

2

PHASE

3

PHASE

4

PHASE

5

6 Adapting the WHO Rehabilitation Competency Framework to a specific context

• The health and demographic profile of the population: This information reveals the needs of the population the workforce will encounter and should be equipped to addressed. Shaping a competency framework around population needs is central to developing a socially responsible workforce.

• Sociocultural–political context: For competency frameworks to be accepted and adopted, they need to be relevant to the social context in which they are being applied.

• The needs and preferences of key stakeholders: This information is crucial to ensuring that the competency framework will be relevant to, and taken up by, the stakeholders within the field.

STEP 2. PREPARE A WORKPLAN

Workplans can be presented in a variety of ways, but should generally include the objectives of the project, milestones and tasks towards their achievement, details of task allocation (e.g. who is doing what), a timeline, and budget. It is useful to define as many of the characteristics of the competency framework as possible within the workplan. Such characteristics include audience, scope, applications, orientation and any key cultural factors that need to be considered in the content of the framework. The workplan may be revisited throughout the development plan and adjusted as needed. An example workplan template is provided in Annex 1.

STEP 3. CONFIRM AVAILABILITY OF RESOURCES

Once the workplan has been confirmed, it is worth checking that the human and financial resources required for completion of the project within the defined timeline are available. Financial costs may be incurred through consultant fees, working group meetings, and the production and dissemination of the completed framework.

When the competency framework is to be housed on a digital platform, ensure that costs associated with embedding the features required for navigation and content extraction are considered, as well as those for the ongoing management and maintenance of the site.

STEP 4. ESTABLISH A CORE WORKING GROUP AND ASSIGN CLEAR LEADERSHIP OR COORDINATION ROLES

It can be useful to develop a competency framework that includes the perspectives and input of a range of individuals, thus establishing a core working group that can be relied upon to support the development of the framework can be a useful approach. The composition of the group and their commitment will shape the development process and greatly impact the end product; therefore careful consideration should be given to who is included. This may depend on a range of factors, but representatives of the following stakeholders may be considered:

• Subject matter experts

• Educationalists/academic institutions

• Regulatory bodies

• Professional associations

• User-groups, such as disabled people’s organizations or patient groups

• Minority groups

• Indigenous representatives or other autonomous governing peoples who will be subject to the framework

• Service developers or managers

When inviting members to participate in the core working group, consider sharing the workplan or concept note, and a terms of reference document that outlines the mandate of the group, modes of participation (e.g.

virtual meetings, face-to-face workshops, email correspondence, etc.), time commitment, and if/how they will be remunerated and acknowledged for their contributions. A template for compiling a list of core working group members, as well as other contributors, can be found in Annex 2.

5. The process of developing a competency framework modelled on the rehabilitation competency framework 7

PHASE 2. DRAFTING

At the drafting phase, the RCF can be used to establish the structure and build the content of the competency framework. The following steps describe a systematic approach to the drafting phase; however these can be modified to suit different situations.

STEP 5. DEFINE CORE VALUES AND BELIEFS THAT REFLECT THE CONTEXT

Core values and beliefs are central to the RCF and crosscut all competencies and activities. They result from broad consensus from rehabilitation professionals and users with the view that they could be widely applicable.

However, it is important that the values and beliefs are critically reviewed in the context of the competency framework being developed, modified or built on, as appropriate.

STEP 6. EXTRACT RELEVANT COMPETENCIES, BEHAVIOURS, ACTIVITIES AND TASKS FROM THE RCF

KEY TERMS Competencies:

The observable ability of a person, integrating knowledge, skills, values and beliefs in their performance of tasks. Competencies are durable, trainable and, through the expression of behaviours, measurable.

Behaviours:

Observable conduct towards other people, or activities that express a competency. Behaviours are durable, trainable and measurable.

Activities:

An area of work that encompasses groups of related tasks. Activities are time limited, trainable and, through the performance of tasks, measurable.

Tasks:

Observable units of work as part of an activity, which draw on knowledge, skills, attitudes and behaviours. Tasks are time-limited, trainable and measurable.

The RCF distinguishes between competencies (how rehabilitation workers behave) and activities (the tasks rehabilitation workers do). When adding or modifying RCF competencies and activities in the development of a context-specific framework, the characteristics of each, summarized in the table below, may help determine which is which.

COMPETENCIES ACTIVITIES

Associated with a person Associated with work (role requirements and scope of practice)

Durable (persist through different activities) Begin and end

Expressed as behaviours Encompass tasks

Relevant to all rehabilitation workers Relevant to some rehabilitation workers and not others, depending on their occupational role

Example:

Communicates effectively with the person, their family, and their healthcare team

Example:

Conducting rehabilitation assessments

The approach with which RCF competencies, behaviours, activities and tasks are extracted from the RCF will depend on the characteristics of the competency framework being developed, in particular whether it will describe multiple levels of proficiency, or a single level. The RCF describes behaviours and tasks over four levels

8 Adapting the WHO Rehabilitation Competency Framework to a specific context

of proficiency (although some are constant across all or some levels). Competency framework developers should select the level or levels appropriate to the context, and, if necessary, modify the description according to the agreed expectations of the worker (see Figures 2 and 3). Where a competency framework describes multiple levels of proficiency, these can be labelled as desired, such as “graduate”, “novice” “post-graduate”, “expert”, or similar.

While it may be more common for the level(s) selected to be consistent within a domain, this does not necessarily need to be the case. It is also likely that a competency framework will describe different level(s) across the different domains. For example, the competency framework may describe the behaviours and tasks of Level 3 in the Practice domain, and behaviours and tasks of Level 2 in the Management and Leadership.

Competencies and behaviours

The RCF competencies and the behaviours are intended to be relevant in any context, regardless of profession, specialization or setting. Nevertheless, they should not simply be copied into a context-specific framework. It may be appropriate, for example, to only include those competencies and behaviours that should be emphasized in a certain context. In such instances, it is useful to provide an explanation in the introductory text and make reference to the RCF as a source for a more comprehensive list of competencies and behaviours.

Figure 3. Example of extracting competencies and behaviours from the RCF COMPETENCIES BEHAVIOURS

The rehabilitation

worker: Level 1 Level 2 Level 3 Level 4

C3. Communicates effectively with the person, their family, and their healthcare team

C3.1 Recognizes the communication needs and practices of the person and their family, such as those related to age, education, culture, health condition or language

C3.2 Adapts communication to frequently encountered needs and practices, including through the use of interpreters, assistive technology, and relevant accommodations

C3.2 Adapts communication to a range of needs and practices, including through the use of interpreters, assistive technology, and relevant accommodations

C3.2 Spontaneously adapts communication to a range of needs and practices, including through the use of interpreters, assistive technology, and relevant accommodations

C3.2 Spontaneously adapts communication to complex needs and practices, including through the use of interpreters, assistive technology, and relevant accommodations C3.3 Speaks clearly and concisely, using terminology and language appropriate to the person and their family

C3.4 Actively listens, including using, interpreting, and responding appropriately to body language C3.5 Manages the environment to support effective communication, taking into consideration noise, privacy, comfort and space

5. The process of developing a competency framework modelled on the rehabilitation competency framework 9

COMPETENCIES BEHAVIOURS The rehabilitation

worker: Level 1 Level 2 Level 3 Level 4

C4. Adopts a rigorous approach to problem-solving and decision making

C4.1 Seeks support to identify personal, environmental, and health factors when conceptualizing problems and identifying solutions

C4.1 Identifies personal, environmental, and health factors and seeks support to use them in conceptualizing problems and identifying solutions

C4.1 Considers personal,

environmental, and health factors when conceptualizing problems and identifying solutions

C4.1 Considers complex personal, environmental, and health factors when conceptualizing problems and identifying solutions

C4.2 Seeks support to consider information from multiple sources when solving problems and making decisions with the person and their family

C4.2 Considers information from multiple sources when solving problems and making decisions with the person and their family

C4.2 Integrates information from multiple sources when solving problems and making decisions with the person and their family

C4.2 Integrates complex information from multiple sources when solving problems and making decisions with the person and their family C4.3 Seeks support to identify innovative

approaches to addressing challenges with a person and their family

C4.3 Identifies innovative approaches to addressing challenges with a person and their family

C4.3 Identifies innovative approaches to addressing complex challenges with a person and their family

In the example provided in Figure 3, the competency framework developers are creating a framework with a single level of proficiency. All competencies and behaviours from the domain are extracted (those boxed in red), but behaviours are chosen from different levels, based on what is expected from the workforce.

Activities and tasks

While the competencies and behaviours of the RCF are core to all contexts, the activities and tasks are not.

Competency framework developers will need to extract only those activities and tasks that are appropriate to their context. It is possible that entire activities may be excluded, or only certain tasks within an activity. The RCF activities and tasks are designed to provide an organizational structure for the vast majority of rehabilitation work, however in some contexts, it may be appropriate to add additional ones.

10 Adapting the WHO Rehabilitation Competency Framework to a specific context

Figure 4. Example of extracting activities and tasks from the RCF ACTIVITIES TASKS

Activities and

tasks include: Level 1 Level 2 Level 3 Level 4

A3. Conducting rehabilitation assessments

A3.1 Obtaining a basic health, environmental and personal history, clearly relevant to the needs of the person and their family

A3.1 Obtaining a comprehensive health, environmental and personal history, which reflects an in-depth understanding of the scope and complexity of determinants of health and well-being

A3.2 Observing whether a person may be at a risk of harm to themselves and/or others and seeking support to respond appropriately

A3.2 Assessing whether a person is at a risk of harm to themselves and/or others and implement protection strategies where appropriate

A3.3 Conducting routine and basic assessments of body structures and functions according to protocols and/or direction

A3.3 Independently conducting routine and basic assessments of body structures and functions

A3.3 Independently conducting assessments of body structures and functions, adjusting for specific factors, such as age, language, culture or impairment

A3.3 Independently conducting advanced and specialized assessments of body structures and functions, adjusting for specific factors, such as age, language, culture or impairment A3.4 Identifying typical barriers and facilitators in

the person’s environment A3.4 Analysing barriers and facilitators in the person’s environment

A3.4 Analysing complex barriers and facilitators in the person’s environment A3.5 Conducting basic assessments of the

person’s performance in relevant activities and their participation in meaningful events and life roles, through observation and interview

A3.5 Conduct in-depth assessments of the person’s performance in relevant activities and their participation in meaningful events and life roles, using critical task analysis and interview A6. Implementing

rehabilitation interventions

A6.1 Providing the person and their family with routine education and training to promote self- efficacy and self-management

A6.1 Providing the person and their family with customized education and training to promote self-efficacy and self-management

A6.2 Providing routine assistive products and guiding the person and their family in their use, making minor adjustments according to needs

A6.2 Providing and guiding the person and their family in the use of assistive products, constructing and/

or modifying them according to needs

A6.2 Providing specialized assistive products and guide the person and their family in their use, constructing and/

or modifying them according to needs A6.3 Facilitating prescribed or routine

modifications to the person and their family’s environment to improve safety, access and functioning

A6.3 Identifying and facilitating innovative modifications to the person and their family’s environment to improve safety, access and functioning

A6.4 Using prescribed and/or routine preventative, restorative and compensatory exercises, techniques and physical modalities

A6.4 Using and prescribing preventative, restorative and compensatory exercises, techniques and physical modalities

A6.4 Using and prescribing specialized preventative,

restorative and compensatory exercises, techniques and physical modalities A6.5 Administering prescribed pharmacological agents A6.5 Administering

and prescribing pharmacological agents as authorized

5. The process of developing a competency framework modelled on the rehabilitation competency framework 11

In the example provided in Figure 4, the competency framework developers extracted only the activities and tasks relevant to their workforce. Some tasks from selected activities are excluded (A3.4, A3.5, A6.3 and A6.5) as they are not relevant to the role of the workforce concerned. Again, tasks are selected from different levels, based on what is expected or required from the workforce.

HINT: Although logical to sequence activities and tasks in the order that reflects how they are performed, a competency framework is not a protocol or practice guideline; its objective is not to describe the steps involved in completing an aspect of work or when a certain approach should be taken. Rather, the activities and tasks should describe what aspects of work need to be taught (i.e. what a person needs to be trained to do); they can be assessed or measured, or indicate successful performance.

STEP 7. EXPAND THE CONTENT TO THE LEVEL OF SPECIFICITY REQUIRED

Because the RCF is designed to be broadly generalizable, it may not describe behaviours and tasks to the level required for a specific context. The online interactive version of the RCF expands on the tasks for Practice domain activity 3 (assessment) and 6 (intervention) for 20 different health conditions (available 2021). Competency framework developers can extract additional content from the relevant health conditions for these tasks, but may also wish to expand on other tasks, or include content for different health conditions or for specific population groups, for example. This content can be drawn from a variety of sources such as interviews, focus groups, surveys, job descriptions, task analyses, clinical practice guidelines, curricula, or regulatory standards documents, among other sources. It can also be informed or validated by formalized consensus building approaches, such as a survey or Delphi study.

HINT: When adding or modifying competencies, behaviours, activities and tasks, ensure each has a single focus. It can be easy, and may seem more efficient, to compound multiple behaviours or tasks within one statement; however this can complicate the application of the framework, especially in the context of measurement/performance appraisal.

STEP 8. EXTRACT RELEVANT KNOWLEDGE AND SKILLS AND EXPAND AS REQUIRED

KEY TERMS Knowledge:

The informational base of competencies and activities.

Skill:

A specific cognitive or motor ability that is typically developed through training and practice.

As with competencies and activities, knowledge and skills pertinent to the context of the framework being developed can be extracted from the RCF and expanded as appropriate. The RCF includes core knowledge and skills for each domain, which are intended to be relevant for all contexts, as well as activity-specific knowledge and skills. When approaching knowledge and skills, it is worth first confirming that they are necessary for the intended audience and applications of the competency framework, and what level of detail is required.

Competency framework developers requiring a greater level of detail than that provided in the RCF can use existing knowledge and skill statements as subheadings and expand on each, add new statements, or both.

STEP 9. AMEND TERMINOLOGY AND LANGUAGE ACCORDING TO THE CONTEXT

Once the relevant content has been extracted from the RCF and expanded or modified as required, competency framework developers should ensure that the terminology and language are suitable for the target audience.

The RCF uses simple language that is clear and conducive to translation, however every context is different, and it is critical to uptake that the competency framework is understood and acceptable to its audience.

12 Adapting the WHO Rehabilitation Competency Framework to a specific context

PHASE 3. REVIEW

Having a draft iteration of the competency framework reviewed by a broader pool of relevant stakeholders is fundamental to ensuring the content is fit for purpose. It also serves to raise awareness and to promote a sense of ownership by the target audience.

STEP 10. COMPILE A LIST OF PEER REVIEWERS

Use a structured template to compile a list of the peer reviewers (see Annex 2). Include variables of interest, such as profession, specialization, nationality, gender, etc. so that you can determine objectively whether the composition of the group is suitable and adequately captures the range of relevant stakeholders.

STEP 11. DEVELOP WAYS TO GUIDE THE MODE AND TYPE OF FEEDBACK DESIRED

It can be useful to guide peer reviewers towards the aspects of the competency framework for which feedback is sought. Competency framework developers may specifically seek feedback on the following criteria:

• Readability: Does the structure, layout, and style of the competency framework make it easy to navigate the content? How easy is it for the reader to understand the content? Is there ambiguity around any statements?

• Accuracy: Is the content correct, and does it reflect the consensus of the target audience?

• Applicability: Will the competency framework serve its purpose effectively? Does it have the characteristics required for it to be useable for all its intended applications?

• Acceptability: Will the competency framework be acceptable to all potential audiences, including across cultures and demographics groups?

There is no one correct way to gather feedback, but consideration should be given to how it will be distributed, received and analysed. It may be appropriate to simply request that peer reviewers consider the key criteria in their feedback, but it can be more effective to send a feedback form or survey along with the draft competency framework. Consider gathering both quantitative feedback (e.g. through including Likert scales for ranking the feedback on the criteria) and qualitative feedback (e.g. through including free text fields, conducting interviews or holding focus groups). Annex 4 provides a template for a peer review feedback form.

PHASE 4. FINALIZATION

A competency framework can be finalized when the developers are satisfied that the objectives have been met, and that peer reviewer comments have been responded to adequately.

STEP 12. RESPOND TO FEEDBACK

Satisfying peer review feedback can be an iterative process that may involve a number of rounds as drafts progress. There may not always be full agreement on all statements, even after multiple rounds of feedback, and it can be beneficial, practically, to set a cap on the number of times the competency framework is distributed for peer review. This cap should be proportional to the state of consensus, i.e. if there is broad disagreement on the statements, it may take more rounds than if there is a general agreement.

5. The process of developing a competency framework modelled on the rehabilitation competency framework 13

PHASE 5. DISSEMINATION

STEP 13. IMPLEMENT A STRATEGIC DISSEMINATION PLAN

Without an effective dissemination strategy, the value and impact of the competency framework may not be fully realized. There are numerous ways of promoting the end product and ensuring it reaches its intended audience. These may include:

• Holding a launch event, such as a webinar with key speakers

• Publishing an academic article

• Promoting on social media

• Having the competency framework endorsed and promoted by relevant organizations and institutions

• Publishing accompanying resources to support its application

• Holding workshops, including through virtual platforms, to educate stakeholders on the framework and its applications

• Removing financial barriers to access

Once disseminated, endeavour to monitor the impact of the competency framework (see section III), and review and update at set intervals, such as every five years, as appropriate.

14 Adapting the WHO Rehabilitation Competency Framework to a specific context

15

ANNEX 1. TEMPLATE FOR A WORKPLAN

There is no one correct way to structure a workplan; however the following proposed headings signpost key aspects that should be considered, or defined, prior to commencing development of a competency framework based on the RCF. These headings set out a detailed workplan that can be used as a reference throughout the development process, and which might also be shared with donors and/or core working group members for transparency.

BACKGROUND

• Describe the topic and scope of the competency framework

• Describe the rationale for the development of the competency framework

• Summarize any important historical, political or cultural factors pertinent to the development of the competency framework

• Note any seminal resources, such as existing standards, guidelines or policies identified through the information gathering process

• Highlight any significant stakeholder needs or preferences identified through the information gathering process

OBJECTIVES

Describe the intention behind the competency framework, i.e. what it is hoped to achieve.

TARGET AUDIENCE

Describe who the competency framework applies to. This could be a specific discipline, specialization, workers within a particular setting or at a particular stage of their career (e.g. graduates), or a combination of any of these.

APPLICATIONS

Define how the competency framework is intended to be used (see section II).

KEY CHARACTERISTICS

Describe the components that will be included in the competency framework, e.g. core values and beliefs, competencies, behaviours, activities, tasks, knowledge and skills, as required, based on the intended applications of the competency framework.

STAKEHOLDERS

List the stakeholder groups who will be engaged in the development of the competency framework (the specific individuals can be listed in the template provided in Annex 2). For example, representatives from specific professional associations, institutions, regulatory bodies, specialist groups, patient advocacy organizations, etc.

16 Adapting the WHO Rehabilitation Competency Framework to a specific context

METHODOLOGY

Provide a detailed description of how the competency framework will be developed, including how it will be informed by or adapted from the RCF. Consider using the phases and steps in section V as subheadings.

MILESTONES AND TIME FRAME

Define the key stages of the development process and the anticipated time frame for each; these may include:

• Core working group identified

• RCF content extraction complete

• Draft 1 complete

• Round 1 peer review

• Round 2 peer review

• Final draft complete

• Production

• Dissemination

Consider using a Gantt chart to visualise the time allocated to achieving each milestone.

BUDGET

Define costs associated with competency framework development, such as personnel, production, workshops, printing, etc. Note whether resources are currently available, and/or what may still need to be obtained.

DISSEMINATION STRATEGY

Describe what strategies will be used to ensure that the competency framework, once completed, has the greatest possible reach and impact (see Phase 5 in section V).

IMPACT MONITORING

Describe methods for monitoring uptake and use of the competency framework once disseminated (see section III).

REVISION

Define the intervals at which the competency framework will undergo review and revision. This may be every 5 or 10 years, or more frequently depending on the field/context.

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ANNE X 2 . T EMP LA TE FOR RE CORDI NG COMP ET EN CY FR AME W ORK CON TR IB UT OR S

This template can be used in the planning phase to monitor contributors, define their roles, and ensure the process is inclusive of all relevant stakeholders. The template can be modified as needed, including amending the roles, adding rows, and adding columns for factors of interest (nationality, profession, gender, etc.). Project lead(s) NameAffiliationEmailRole (examples) Project coordination Secretary/stakeholder communication Technical writer Core working group Role (examples) • Provides expert opinion on competency framework content, structure, language, and scope to ensure that its intended aims are achieved • Help identify peer reviewers and support the constructive responses to feedback • Support dissemination of the competency framework NameAffiliationEmailAreas of specialization

18 Adapting the WHO Rehabilitation Competency Framework to a specific context

Peer reviewers NameAffiliationEmailAreas of specialization

CH EC KLIS T:

Have the following stakeholders been represented in the development process? (Note that not that every stakeholder included in the list will be relevant to all situations, nor will the list be exhaustive.) Consider additional stakeholders relevant to the context of the competency framework. Subject matter experts Educationalists/academic institutions Regulatory bodies Professional associations User-groups, such as disabled people’s organizations, or patient groups Minority groups Indigenous representatives or other autonomous governing peoples who will be subject to the framework Service developers or managers

19

ANNEX 3. TEMPLATE FOR COMPETENCY FRAMEWORK STRUCTURE

While there is no one correct way to structure a competency framework, the following outline offers a starting point that aligns with the RCF:

FRONT MATTER

The front matter of a competency framework may include the following sections:

• Foreword or Preface

• Acknowledgments

• Glossary

• Executive summary

BACKGROUND

The background section may include similar content to that of the workplan (see Annex 1). It can be useful to also include key questions, such as what it is; why it was developed; who and what it can be used for; and how it was developed.

CORE VALUES AND BELIEFS

The core values and beliefs can be extracted from the RCF and modified for the context (see section V).

DOMAINS

Competencies, behaviours, activities, tasks and knowledge and skills can be extracted from the RCF and modified for the context (see section V). This structure is based on a competency framework that defines only one level of proficiency but can be modified to include multiple levels (as with the RCF) if required. Rows can be added and deleted according to the number of statements included; the number of rows included in the template is arbitrary and does not suggest a recommended number of statements.

DOMAIN X

COMPETENCIES BEHAVIOURS

C1. C1.1

C1.2 C1.3

C2. C2.1

C2.2 C2.3

C3. C3.1

C3.2 C3.3

20 Adapting the WHO Rehabilitation Competency Framework to a specific context

ACTIVITIES TASKS

A1. A1.1

A1.2 A1.3

A2. A2.1

A2.2 A2.3

A3. A3.1

A3.2 A3.3

KNOWLEDGE

Core knowledge

Activity-specific knowledge A1.

A2.

A3.

SKILLS

Core skills

Activity-specific skills A1.

Annex 3. Template for competency framework structure 21

A2.

A3.

Repeat for each domain of the competency framework.

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ANNEX 4. TEMPLATE FOR A FEEDBACK FORM

The following can be used as the basis for a feedback form or used to inform the content of a feedback survey.

Competency framework developers should consider what additional criteria may be relevant for their context and modify the form accordingly. This form uses a Likert scale and free text fields to gather a combination of quantitative and qualitative feedback.

INSTRUCTIONS:

Please score the following criteria 1–5, where 1 indicates “strongly disagree” and 5 indicates “strongly agree”, by ticking the corresponding box, and adding an explanation of your responses and any additional feedback in the free text box.

CRITERIA 1. READABILITY

1 2 3 4 5

The framework structure is logical and clear It is easy to find the information I am interested in The information is easy to understand

The focus of each statement is clear

Please provide any comments or suggestions regarding the readability of the competency framework

CRITERIA 2. ACCURACY

1 2 3 4 5

The core values and beliefs are appropriate to the context of the framework The core values and beliefs are true for the workforce of interest

The statements are comprehensive

The behaviour and task statements are described at the appropriate level The activities and tasks cover the scope of work adequately

Please provide any comments or suggestions regarding the readability of the competency framework

Annex 4. Template for a feedback form 23

CRITERIA 3. APPLICABILITY

1 2 3 4 5

The behaviours are described at the appropriate level of specificity to be useful for the frameworks intended purpose

The tasks are described at the appropriate level of specificity to be useful for the frameworks intended purpose

The knowledge and skills are described at the appropriate level of specificity to be useful for the frameworks intended purpose

The framework includes all the components needed to be fit for purpose

Please provide any comments or suggestions regarding the readability of the competency framework

CRITERIA 4. ACCEPTABILITY

1 2 3 4 5

The language used is inclusive of all population groups

The terminology aligns with that used in practice by the workforce of interest The content aligns with existing frameworks, guidelines, and policies The development process has engaged all relevant stakeholder groups

Please provide any comments or suggestions regarding the readability of the competency framework