Building Critical Thinking in Unregulated Care Providers to Support Sustainable Community Placements

Background: Community service providers are often tasked with transitioning individuals out of hospital and maintaining their safety and quality of life in the community. Many community-based organizations rely on an unregulated care provider (UCP) model, with limited access to regulated health care providers (RHCPs). Clients are living longer with chronic conditions, requiring a higher demand for more sophisticated community-based care, but without regular access to RHCPs.

 

Approach: This presentation outlines a case study from Head Injury Rehabilitation Ontario (HIRO), which piloted two models to address this challenge. HIRO’s Clinical Roadmap was co-designed in 2019 with professionals, family members, and persons with lived experience of acquired brain injury; recommendations included inserting clinical guidance for the primarily UCP care model.

 

Over the last several years HIRO has been implementing the model; initially, HIRO trialed a consultative model where an Occupational Therapist (OT) completed goal assessments for individuals with acquired brain injury (ABI), and delegated implementation to UCPs. Outcomes were limited due to gaps in critical thinking and confidence among UCPs, and a lack of ongoing clinical oversight resulting in little sustainability.

 

In response, HIRO launched a second pilot embedding weekly access to OT to both support client assessment, and deliver structured critical thinking training to 19 UCPs across 8 sites. This training emphasized goal-oriented reasoning, adaptive implementation, and collaborative care planning - all skills within the public domain and not requiring regulatory authority. Qualitative analysis of outcomes for clients and staff, and quantitative review on staffing ratios and levels of supports, are underway and intended to be completed for January 2026.

 

Results: Preliminary findings indicate higher measures of client satisfaction, and improved goal attainment by clients. This has resulted in increased client independence, consequentially requiring less staff support particularly during morning routines. Secondary findings indicate increased staff job satisfaction, potentially contributing to stay intentions in a difficult human resources market. While final quantitative and qualitative analyses are forthcoming, early evidence supports the feasibility and impact of investing in critical thinking development among UCPs.

Implications: This case study at HIRO challenges the assumption that high-quality care must rely solely on RHCPs, and highlights a scalable model for optimizing unregulated workforce capacity in community settings. Clear role distinction between regulated tasks and skills versus public domain skills (e.g. critical thinking, escalation chains, and risk management) allows for enhanced workforce development to support sustainable community placement. Other community settings that have a primarily unregulated workforce would benefit from this work, and/or RHCPs may be inspired to better utilize their unregulated colleagues.