The Occupational Therapy Practitioner Roles, Responsibilities, and Relationships Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

OTA Curriculum See handout 1 – BPCC OTA Short Course Descriptions

COTAs In Leadership Roles Rehabilitation Directors in Nursing Homes Regional Directors in Companies Case Managers Marketing Liaisons COTA Program Directors for Colleges Clinical Instructors for OTA students Program Coordinators for SCI, CVA , etc University Instructors

Activity Director OTAs are well qualified and can function independently Typically employed in group homes, assisted living facilities, long-term care Responsible for planning, implementing, and documenting an ongoing program of activities Cognizant of regulations set forth by Medicare, state health departments and licensing agencies

Standards of Practice for the National Association of Activity Professionals Classifies activities as: Supportive activities Comfortable environment Providing maintenance -Purpose is to provide opportunities to maintain physical , cognitive, social, emotional, and spiritual health Exercise groups, games, creative writing Empowering activities-geared toward promoting self-respect, self-expression, personal and social responsibility Self-respect, self-expression, social responsibility

Levels of Performance- not determined by years of experience Entry Development of skills Intermediate Increased independence Mastery of basic role functions Ability to respond based on experiences Participation in education of personnel Advanced Refinement of specialized skills Understanding of complex issues Contribution to the profession Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

OT practice AOTA provides guidelines that define the OT scope of practice, standards of practice, role delineation, supervision, and documentation STATES use these guidelines to develop LAWS and provide legal definitions for these areas Other regulatory agencies, such as Medicare and Medicaid (CMS), also have regulations (laws) that supersede these guidelines

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Service Delivery The Standards of Practice for Occupational Therapy- defines the minimum requirements for OT practitioners working in service delivery, developed by AOTA – Guidelines often used by states in formation of licensure laws and supporting regulations for OT practice Standards are delineated into 4 areas: Professional standing and responsibility Screening, evaluation, and re-evaluation Intervention Outcomes Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Standard 1 -Professional standing and responsibility Reflect philosophical base AOTA standards, policies, guidelines, state and federal regulations Maintain licensure, registration, licensure Code of Ethics and Standards of Continuing Competence Knowledge of legislative, political, social, cultural, and reimbursement issues Knowledgeable about evidenced-based research

Standard 2 -screening, evaluation, re-evaluation Analyzing and interpreting evaluation data – OT Contributes to process, performs assessments – OTA Completes, documents evaluation results – OT Contributes to documentation – OTA

Standard 3 -intervention stage Overall responsibility for documentation and implementation – OT Select, implement and modify therapeutic activities – OTA Modifies intervention plan throughout process and documents responses and changes to treatment – OT and OTA

Standard 4 - Outcomes Documenting changes and discontinuing services Transition plan, follow-up services Safety and effectiveness Discontinuation plan or transition plan is prepared by the OT, with contributions from the OTA

AOTA Fieldwork Performance Evaluation For the Occupational Therapy Assistant Student I. FUNDAMENTALS OF PRACTICE 1. Adheres to AOTA Code of Ethics and site’s policies and procedures 2. Adheres to Safety regulations; prevention of accidents 3. Uses sound judgment in regards to Safety II. BASIC TENETS OF OT 4. Clearly communicates the philosophy of OT; use of occupation 5. Communicates Roles of OT and OTA 6. Evidenced-based Practice; Makes informed practice decisions based on research

III. EVALUATION/SCREENING 7 III. EVALUATION/SCREENING 7. Accurately gathers relevant data/information for occupational profile in collaboration with and under the supervision of the OT 8. Administers assessments; establishes service competency in assessment methods (interviews, observations, assessment tools, chart reviews) 9. Assists with interpreting assessments in collaboration with OT 10. Reports results accurately that reflects the client’s status and goals 11. Establishes client-centered and occupation- based goals in collaboration with OT

IV. INTERVENTION 12. Plans Intervention in collaboration with OT (establishes methods, duration and frequency) 13. Selects Relevant Interventions that promote engagement in occupation 14. Implements Interventions effectively 15. Activity Analysis: grades activities to motivate and challenge client 16. Therapeutic Use of Self; effective interaction 17. Modifies Intervention Plan according to patient status in collaboration with OT

V. COMMUNICATION 18. Verbal and Nonverbal Communication with clients, caregivers, families, colleagues, service providers and the public 19. Written Communication; clear and accurate documentation (legible, proper spelling and grammar)

PROFESSIONAL BEHAVIORS 20. Self-Responsibility; professional competence, seeking learning opportunities and interactions with supervisor(s) 21. Responds to feedback 22. Work Behaviors (initiative, preparedness, dependability and work site maintenance 23. Time Management 24. Interpersonal skills (cooperation, flexibility, tact, empathy) 25. Cultural Competence; respect for diversity factors

COMPARE Primary differences between OT and OTA Fieldwork performance evaluation OT must satisfactorily: Interpret evaluation results Document results of evaluation and client’s response to intervention Articulate clear, logical rationale for evaluation and intervention process Demonstrate management of OT services

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Supervision OT can function independently in delivering OT services after initial certification and applicable state licensure. OTAs require supervision from an OT to deliver OT services Defined as “cooperative process in which two or more people participate in a joint effort to establish, maintain, and or elevate a level of competence and performance.” The supervisor is an individual “who has some official responsibility to direct, guide, and monitor the supervisee’s practice.” Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Supervision- AOTA Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services Provides a definition of supervision and parameters for supervision But OT practitioner must adhere to state and federal regulation, the Occupational Therapy Code of Ethics, and the policies of the workplace Vary considerably from place to place Outside accreditation bodies and third party payers also have specific requirements

Levels of Supervision Direct or continuous – supervising therapist is in the immediate area at all times; required for OT and OTA students, limited permit holders and OT aides Close - Daily, direct contact at the site of work Routine - Face to face contact at least every 2 weeks at the work site, with interim supervision through methods of telecommunication General – Initial direction and face to face contact with the supervising therapist at least once a month, interim supervision as needed by telecommunication

Supervision Considerations Regulatory requirements Practice setting Competency level Experience Education and credentials Complexity of client needs Number and diversity of clients Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Documenting Supervision The supervisory contacts should be documented Frequency of supervisory contact Methods or types of supervision Content areas addressed during the contact Evidence to support areas and levels of competency (service competency documentation) Signatures and credentials of the individuals participating in the supervisory process

Documenting Supervision Co-Signatures – Co-signatures by supervising OT is a way to document that supervision has taken place co-signature required for all OT and OTA students and persons holding temporary license; OTAs do not necessarily have to have their documentation co-signed; co-signatures depend on state and federal regulations, third-party reimbursement and policies of practice setting

Service Competency- SEE HANDOUT 3- LSUHSC Service Competency Mechanism to ensure that services are provided with the same high level of confidence Defined as “the determination made by various methods, that two people performing the same or equivalent procedures will obtain the same or equivalent results – interrater reliability Examples???? Independent scoring of standardized tests Observation Videotaping Co-treatment It is recommended that the acceptable standard of performance be met on THREE successive occasions between the OT and OTA

Service Competency NOTE: If the task assigned by the OTR to the COTA or the aide is not determined as appropriate through service competency or is not backed by the education, skill, or expertise of the profession, then ethical boundaries have been breeched.

Service Competency NOTE: If the task assigned is not allowed by the funding source, allowing the task to be done by anyone other than the approved practitioner is fraud.

Service Competency The assistant may want to have a file of service competencies from his/her previous supervisor when changing jobs or locations to let the new supervisor have a better understanding of the assistant’s background and skill level. An easy way to keep up with service competencies is have it in the personal file with Human Resources which will keep the records confidential.

Service Competency Development of service competencies . The Header: Company name etc. The staff that the competency is addressing. For example therapist/practitioner, rehab tech., CNA, etc The competency subject matter. For example is it a competency addressing thickened liquids (thin, nectar, honey), hip precautions, transfers, etc.) Date Names of both the employee and the supervising employee with signatures for both.

Development of Competencies for Practitioners and Aids

Development of Competencies for Practitioners and Aids For Example Date Stat Home Health Subject: Amputee Program Name of the Employee Name of the Supervising Employee Entry Level: Practitioner identifies signs and symptoms of skin break down for the residual limb and identifying company policy. Intermediate: Practitioner demonstrates residual limb wrapping for BKA and AKA for conical shaping in pre-prosthetic stage Advanced: Practitioner provides in-service with demonstration and on proper techniques of functional transfer for AKA and BKA to new staff members.

Supervision of OT Aide Defined as an individual who supports the OT and OTA by performing specifically delegated tasks Depending on state laws the OT or OTA can supervise but OT is legally and ultimately responsible No required training other than “on the job,” supervision should remain close Non-client related tasks – Examples Client-related – Examples Aides do not act as primary service providers of OT in any setting.

LOUISIANA legal definitions of practice, delineate specific responsibilities for the OT and OTA related to role delineation, supervision, documentation, and advanced practice

LOUISIANA STANDARDS OF PRACTICE- see handout 4- Chapter 49 LA General Provisions Service Competency- initially evaluate and document the OTA’s service competency Annual service competency thereafter Date of evaluation, description of tasks evaluated, name, signature and LA license number of supervising OT Maintain documentation in each clinic If OTA is supervised by more than one OT, only one OT is required to perform eval but each supervising OT’s name, signature and LA license must appear on evaluation

LSBME Notification of Supervision Requirement- SEE HANDOUT 5- Verification of Supervision Notice to Occupational Therapist: Therapist responsible for the supervision of an OTA, must notify the Board office within 10 days of any change in that supervisory status. The therapist is held responsible for supervision of the OTA until official notice is received at the board office. Failure to notify the Board could subject the therapist to legal and disciplinary measures. Notice must be in writing over the therapist signature. (No Telephone Notices Will Be Accepted) The same procedure is required for the therapist when he/she assumes the responsibility for an assistant.

LSBME Notification of Supervision Requirement Notice to Occupational Therapist Assistants: OTA’s are required to notify the Board office within 10 days of any change in supervision. Should the OTA change from one supervisor to another supervisor such as during job changes all parties must notify the Board office in writing of the changes. Failure to notify the Board could subject the OTA to legal and disciplinary measures. Notice must by in writing over the OTA signature. (No Telephone Notices Will Not Be Accepted) Be sure that the OTA and the OT supervisors (former and present) send notification to the Board Office.

Louisiana Practice Act Critical Points of Care Subchapter B. Standards of Practice §4925. Supervision of Occupational Therapy Assistants An OTA shall not administer OT to any client whose physical, cognitive, functional or mental status differs substantially from that identified by the supervising OT’s individual program plan in the absence of re-evaluation by, or an immediate prior client care conference with, the supervising Occupational Therapist

Louisiana Practice Act In a clinical setting other than HOME HEALTH: OTA with less than 1 year of experience shall receive close client care supervision for not less than one of every four, or 25+% of those clients to whom he or she has administered OT during an average weekly case load Client care conference shall be held with respect to each client to whom the OTA administers OT OTA with 1-2 years experience – close client care supervision for not less than 10% of clients seen on weekly basis OTA with more than 2 years experience shall receive a client care conference with respect to each client to whom the OTA administers OT

Louisiana Practice Act School system, Long-Term Psychiatric and Non-Skilled Nursing Home Facility In addition to previous requirements, clients in these settings shall be re-evaluated or treated by the supervising OT not less frequently than the earlier of once a month or every 6th treatment session

Louisiana Practice Act Home Health Previous terms and conditions NOT applicable OTA must have at least 2 years experience Each client seen by OTA shall be re-evaluated by OT not less frequently than the earlier of once every two weeks or every ____ treatment session Face to face client care conference shall occur not less than once every two weeks Conferences shall be documented by the supervising OT in a supervisory log and maintained by or at the home health entity

Louisiana Practice Act A supervising OT and OTA shall bear equal reciprocal obligations to insure strict compliance with these obligations, responsibilities and provisions

MEDICARE

Medicare - OTA Supervision GENERAL supervision required in all settings except private practice ) which requires DIRECT State/local requirements must be followed if they are more stringent Services are billed by OT and are OT’s responsibility OTA may not: provide evaluation services, make clinical judgments or decisions OTA may contribute to elements of the Progress Reports and write Treatment Notes The supervising OT must write/sign the Progress Reports and Discharge notes

MEDICARE GUIDELINES -highlights Medicare Part A Home Health care SNF IRFs Inpatient hospitalization Inpatient psychiatric care Hospice Long-term care hospitals

Medicare Part A - SNF Student supervision – line of sight Supervisor cannot be engaged in any other activity or treatment except documentation OTAs may supervise OTA students

Medicare Part A - IRFs OTA may not replace OT at weekly team meetings

Medicare Part B Hospital Outpatient Care Private Practice Physician Office Services Clinic, Rehabilitation, or Public Health Agencies Comprehensive Outpatient Rehabilitation Facilities Skilled Nursing Facility Outpatient Services Home Health Care

Medicare Part B OTAs require DIRECT supervision OT and OTA STUDENTS Services not billable UNLESS: the qualified professional is present and in the room for the entire session The qualified professional is directing the service, making the skilled judgment, and is responsible for assessment and treatment The practitioner is not engaged in treating another patient or doing other tasks at same time (including documentation) The qualified professional is the person responsible for the services and signs all documentation (students can sign as well but not necessary)

Facilitation of the Therapist/Assistant Role No one communicates Let’s open the channels

Facilitation of the Therapist/Assistant Role Mentoring Strategies First Step: Therapist and assistant be knowledgeable with Standards of Practice which gives a general guide to role delineation. Second Step: Therapist and assistant be knowledgeable with your state practice act to narrow down the scope of the role more specifically. Third Step: Practitioner Know what your role is and the role of assistance and support staff. Stay within your role. Create an environment that others can feel comfortable asking questions and offering input. Be truthful. No one knows everything. Refer to the expert. If another professional has more experience or knowledge refer to them.

Facilitation of the Therapist/Assistant Role Mentoring the Practitioner What is a mentor? A mentor serves as a guide to the new practitioner entering the practice or entering new employment to ensure orientation, service competency and to develop professional growth for success within the work force.

Facilitation of the Therapist/Assistant Role A good mentor will motivate you to grow both clinically and professionally. A good mentor will guide you in situations that may be uncomfortable, but will help you develop your skills as a clinician.

Facilitation of Therapist/Assistant Roles Guidelines for Mentoring Clinician who has completed a minimum of one year of employment with the company. Preferably 2-3 years of experience. Meetings Week 1 Daily Week 2 and 3 Twice a Week Week 4 and up Weekly (or as needed)

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. OT/OTA Partnership Mutual respect and trust Solid knowledge base related to the practice of OT and guidelines for supervision Understanding of different Learning styles Communication Active listening Ability to give and receive constructive feedback Assertiveness and tact Ability to resolve conflicts Facilitate problem solving and clinical reasoning Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. OT/OTA Partnership Time and place for supervision Written agenda Active participation by both parties Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Professional Development NBCOT® - OTR and COTA can be used and must be renewed every 3 years (36 PDUs) Specialty certification – for OTs and OTAs provided by AOTA in driving and community mobility; environmental modification; feeding, eating, and swallowing and low vision – minimum 2000 hours experience as an OT or OTA and 600 hours of delivering OT services in the certification area over last 3 years Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Conclusion Lifelong learning and professional development are OT and OTA responsibilities. The OT and OTA have a collaborative partnership in which they plan, implement, and document frequency and methods of supervision Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.