title: The development of expertise in pediatric rehabilitation therapists: changes in approach, self-knowledge, and use of enabling and customizing strategies.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Thames Valley Children's Centre, London, Ontario, Canada. gking27@uwo.ca
authors.forename: Gillian
authors.initials: G
authors.lastname: King
authors.forename: Melissa
authors.initials: M
authors.lastname: Currie
authors.forename: Doreen J
authors.initials: DJ
authors.lastname: Bartlett
authors.forename: Michelle
authors.initials: M
authors.lastname: Gilpin
authors.forename: Colleen
authors.initials: C
authors.lastname: Willoughby
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Tucker
authors.forename: Deborah
authors.initials: D
authors.lastname: Strachan
authors.forename: Donna
authors.initials: D
authors.lastname: Baxter
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003071:Cognition; D003657:Decision Making; D004644:Emotions; D006801:Humans; D007407:Interviews as Topic; D009788:Occupational Therapy; D026761:Physical Therapy Specialty; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011998:Recreation; D012046:Rehabilitation / Q000193:education; D012189:Retrospective Studies; D012649:Self Concept; D013066:Speech-Language Pathology; D013647:Task Performance and Analysis; D013850:Thinking; D014743:Videotape Recording