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.