1. The OT/OTA Relationship
Supervision, Roles, & Responsibilities
of the OT & OTA

2. Who am I?
Kelly Brandon, MS, LOTR

3. What is an OTA?

4. Educational Requirements
ACOTE Standards
OTA –
Associate degree level (min requirement)
Baccalaureate-degree-level
Bridge option
What does the “C” mean?

5. OT/OTA Relationship Dynamic Collaborative
Parallel professions meant to support one another
Partnership
Team

6. 10 Tips to Building a Strong OT/OTA Relationship - Niccole Rowe, COTA/L
1. Use AOTA documents as a resource to grow in understanding the relationship.
 Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services 
2. Understand your state laws.
Differs from state to state
Research the laws in your state, understand and apply them and read them.
Use resources from your state board to help you understand and decode
Ask questions!

7. 3. Understand that it’s a two-way street. Reciprocal relationship
10 Tips to Building a Strong OT/OTA Relationship - Niccole Rowe, COTA/L
3. Understand that it’s a two-way street.
Reciprocal relationship
Both should put forth effort – cooperatively, legally, ethically
4. Put that ego down.
Be humble and open to learning and sharing regardless of experience, accomplishments, degrees, and/or certifications

8. 10 Tips to Building a Strong OT/OTA Relationship - Niccole Rowe, COTA/L
5. Embrace strengths and weaknesses.
Self-awareness is key – understanding of strengths and weaknesses
6. Be Honest.
Trust is essential.
Client safety comes first.

9. 10 Tips to Building a Strong OT/OTA Relationship - Niccole Rowe, COTA/L
7. Always be appreciative.
Express gratitude – even for the everyday things
8. Communication is key.
How are we perceived by others? Was that our intention?
What is my communication style? Match your message to the other person’s style

10. 10 Tips to Building a Strong OT/OTA Relationship - Niccole Rowe, COTA/L
9. Don’t be possessive.
“my OTA” or “my OT”
10. Celebrate your love of this amazing profession.
Share your excitement with one another
Build each other up
Get involved and stay involved
Advocacy

11. OT & OTA Partnership
The occupational therapy service delivery process involves evaluation, intervention planning, intervention implementation, intervention review, & outcome evaluation.
The occupational therapist must be directly involved in the delivery of services during the initial evaluation & regularly throughout the course of intervention & outcome evaluation.

12. OT & OTA Partnership (evaluation)
OT initiates & directs the evaluation, interprets the data, & develops the intervention plan.
The OTA contributes to the evaluation process by implementing delegated assessments & providing verbal & written reports of observations & client capacities to the OT.
The OT interprets the information provided by the OTA & integrates that information into the evaluation & decision-making process.

13. OT & OTA Partnership (Intervention Planning)
OT has overall responsibility for the development of the occupational therapy intervention plan.
OT & the OTA collaborate with the client to develop the plan.
OTA is responsible for being knowledgeable about evaluation results & for providing input into the intervention plan.

14. OT and OTA Partnership (Intervention Implementation)
Overall responsibility for Implementing the intervention and ensuring that all documents/records are accessible to OTA
Provides supervision during the intervention
OTA
Responsible for knowledge of client’s occupational therapy goals
Selects, implements, and makes modifications to therapeutic activities with demonstrated competency levels.

15. OT & OTA Partnership (Intervention Review)
OT is responsible for determining the need for continuing, modifying, or discontinuing occupational therapy services.
OTA contributes to this process by exchanging information with & providing documentation to the OT about the client’s responses to & communications during intervention.

16. OT & OTA Partnership (Outcome Evaluation)
OT is responsible for selecting, measuring, & interpreting outcomes that are related to the client’s ability to engage in occupations.
OTA is responsible for knowing about the clients targeted occupational therapy outcomes & for providing information & documentation related to outcome achievement.
The OTA may implement outcome measurements & provide needed client discharge resources.

17. LA - §4925 -OT Responsibility -
Prior to the administration of occupational therapy by an occupational therapy assistant, the supervising occupational therapist shall, in accordance with AOTA standards of practice as may from time to time be amended:
perform an evaluation;
identify and establish occupational therapy needs, goals and an individual program plan;
ensure that the documents created pursuant to §4925.C.1 and §4925.C.2 are made part of the client's record and accessible to the occupational therapy assistant prior to his or her the first treatment session with the client; and
be available for a client care conference.

18. What is Supervision?
a 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
Based on mutual understanding between the supervisor & supervisee about each other’s competence, experience, education, & credentials (AOTA, 1999a).

19. Supervision
The OTA delivers occupational therapy services under the supervision of and in partnership with the OT.
Louisiana law specifies supervision of an OTA by a supervising OT in any clinical setting.
Occupational therapists and occupational therapy assistants are equally responsible for developing a collaborative plan for supervision. The occupational therapist is ultimately responsible for the implementation of appropriate supervision, but the occupational therapy assistant also has a responsibility to seek and obtain appropriate supervision to ensure proper occupational therapy is being provided. (AOTA, 2014)

20. AOTA Definitions of Supervision
"Supervision" means the periodic review and inspection of all aspects of occupational therapy services by the appropriate licensed (certified or registered) occupational therapy practitioner.
"Continuous supervision" applies to aides and means the occupational therapy supervisor is in sight of the aide who is performing delegated client-related tasks.
"Close supervision" means daily, direct contact at the site of work and applies only to occupational therapists with initial skill development proficiencies or occupational therapy assistants, as appropriate, for the delivery of occupational therapy services.
"Routine supervision" means direct contact at least every 2 weeks at the site of work, with interim supervision occurring by other methods, such as telephonic, electronic, or written communication and applies only to occupational therapy assistants.
"General supervision" means at least monthly direct contact, with interim supervision available as needed by other methods, and applies only to occupational therapists with increased skill development and mastery of basic role functions or occupational therapy assistants, as appropriate, for the delivery of occupational therapy services.
"Minimal supervision" means supervision provided on a less-than-monthly basis to occupational therapy assistants when performing non-clinical administrative responsibilities.

21. Types of Supervision (LA definitions)
Client Care Conference ―a meeting between the supervising occupational therapist, who must have previously evaluated and/or treated the client, and an occupational therapy assistant to discuss client progress or lack thereof, client issues, revision of goals, initiation, modification or termination of an individual program plan, assessment of utilization of additional resources, discharge and any other information which may affect a client's plan of care. Except when specifically required in this Chapter to be conducted by face to face conference, such meeting may be undertaken by telephone or other means of telecommunication which allows for simultaneous interactive discussion between the supervising occupational therapist and occupational therapy assistant.
Close Client Care Supervision ―face to face observation of an occupational therapy assistant administering occupational therapy to a client, accompanied or followed in a timely fashion by verbal discussion of client goals, the individual program plan and other matters which may affect the client's plan of care. – LSBME
Face to Face – direct communication between the OT supervising client care and an OTA, which is conducted in the physical presence of one another

22. OT & OTA must document a supervision plan & supervision contacts
OT & OTA must document a supervision plan & supervision contacts. Documentation should include:
Frequency of supervisory contact
Method(s) or type(s) of supervision
Content areas addressed
Names & credentials of the persons participating in the supervisory process
See Sample Supervision Log

23. OCCUPATIONAL THERAPY SUPERVISION LOG
Date
Time
(start/finish)
Meeting type
(i.e face to face/phone/ /
combination)
Themes/Topics
(For example, ethical issues; case discussion; skill development; personal development plan/goals; stress management). More detailed confidential records of supervision sessions may be kept in a separate file.
Signed
(By supervisor and supervisee)

24. The Specific Frequency, Methods, & Content of Supervision May Vary by Practice Setting & Are Dependent on:
Complexity of client needs
Number & diversity of clients
Skills of the OT & the OTA
Type of practice setting
Requirements of the practice setting
Other regulatory requirements
See AOTA Guidelines for Supervision, Roles and Responsibilities

25. Roles & Responsibilities
The OT is responsible for all aspects of occupational therapy services delivery and is accountable for the safety & effectiveness of the occupational therapy service delivery process.
The OT & the OTA are responsible for collaboratively developing a plan for supervision.

26. Roles & Responsibilities
The OT determines when to delegate responsibilities to other occupational therapy personnel.
The OT must have previously evaluated and/or treated any client being seen by an OTA he/she is supervising
It is the responsibility of the occupational therapy personnel who perform the delegated responsibilities to demonstrate service competency.

27. Service Competency – see example
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

28. Service Competency Example – See handout example

29. Occupational Therapy Assistant Service Competency Sample
Occupational Therapy Assistant
Service Competency Sample
1) The service competency is to be completed by the supervising Occupational Therapist before utilization of an Occupational Therapy Assistant.
2) The supervising OT shall cause such documentation to be maintained by the OTA and at each clinic, facility or home health agency at which an OTA practices under his or her supervision.
3) The supervising OT shall annually conduct a service competency evaluation to assess the OTA’s performance during the preceding year.
Excerpted from Rule 4919.
 Instructions
The supervising OT is to complete the Competency and Method of Determination sections. The OTA is to complete the Self-Assessment section. Any comments should be included in the right column or on a separate page to be attached and signed by both practitioners.
 Competency – To determine OTA competency within each skill:
 = OTA must exhibit mastery of skill three consecutive times.
X = OTA has not exhibited mastery in this skill (OTA has only performed skill once, twice or non-consecutively)
N/A = Skill not applicable to this practice setting.
Method of Determination – The way in which the OTA was determined to have competency
O (Observation) = The OT supervised the OTA performing the skill on a client.
D (Demonstration) = The OTA performed the skill on another therapist.
S (Special Training) = The OTA received formal training in skill such as in a continuing education course or certification course.
Self-Assessment – Used by the OTA to self-evaluate his or her competency in each of the skill areas. Instructions are the same as the Competency section.

30. Method of Determination
Occupational Therapy Assistant
Service Competency Evaluation
Adult Facility
Competency: , X, or N/A
Method of Determination: O = Observation, D = Demonstration, S = Special Training Self-Assessment (to be filled out by the OTA): , X, or N/A
Competency Standard
Competency
Method of Determination
Self-Assessment
Comments
Fundamentals of Practice
Follows universal precautions
Adheres to identified client precautions and contraindications
Recognizes personal strengths and limitations
Uses treatment modalities within level of ability and experience
Adheres to all HIPPA guidelines
Adheres consistently to AOTA Code of Ethics
Transfers:
Follows procedures of safe transfers to all surfaces
Practices proper body mechanics when transferring client
Clearly communicates with client during transfer
Positioning:
Demonstrates ability to properly and safely position clients
Evaluations/Assessments:
Reliably administer Manual/Functional Muscle Testing
Accurately measure Range of Motion
Vital Signs: B/P, Pulse Ox
Able to administer site-specific evaluation tools: (List below) 
Modalities:
Knowledge of use and precautions for use of modalities: (List below)
Splinting:
Able to fabricate splints listed below:
Equipment:
Knowledge of proper use of equipment listed below: (Ex: w/c, AFO, stander)
Home Modifications:
Recommends necessary modifications to client & caregiver
Adaptive Equipment:
Knowledge of a variety of adaptive equipment. (Hip kit, button hook, etc.) Equipment listed below:
Ability to instruct clients in use of adaptive equipment
Intervention Planning:
Collaborates with OT to develop Plan of Care
Intervention Implementation:
Ability to adapt activities to fit client’s needs
Protocols:
Knowledge of protocols used in setting: (List below)

31. ___________________ __________________ __________
Documentation:
Collaborates with OT to develop client centered, measurable goals.
Records accurate progress notes in a timely manner
Client Information:
Gathers relevant information from client observation
Gathers relevant information from client interview
Client/Caregiver Education:
Able to effectively communicate treatment program information to client and caregiver.
Areas for further improvement/Comments:
___________________ __________________ __________
Supervising OT signature) License # Date
__________________ __________________ _________ Years of experience _______
OTA (signature) License # Date
Facility Name & Type: ________________________________________________________________

32. Service Competency - Frequency
Initial – prior to utilization of an OTA to implement tx or any part of program plan, the supervising OT must evaluate and document the OTA’s service competency
Annual – annually conduct and document

33. Service Competency- Documentation
Date
Description of tasks
Name, signature and LA license number of supervising OT
If OTA has multiple supervisors, service competencies performed by one supervisor will satisfy requirements provided each tasks are the same and supervisor’s name, signature and LA license number appear on evaluation (service competency form)
Supervising OT shall ensure such documentation is maintained by the OTA and at each clinic, facility or home health agency where the OTA practices under his/her supervision

34. Service Competency - notes
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.
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.

35. OT/OTA Supervision
Louisiana – Supervision laws vary state to state

36. LA - OTA Supervision - 4925 (exceptions: Home Health and Early Intervention)
1a. A COTA whose experience is less than one year should receive close client care supervision in each clinical setting for not less than one of four or 25% close supervision for each client on an average weekly caseload. In addition, a client care conference should be held in respect to each client on the caseload.
Close client care supervision – face to face observation
Client Care Conference- meeting/discussion between OT and OTA to discuss client; may be indirect unless specifically stated otherwise

37. LA OTA Supervision - 4925 (exceptions: Home Health and Early Intervention)
1b. A COTA whose experience is more than 1 yr but less than 2yrs = close client care supervision for 10% or one of ten clients. Plus client care conference is held for each client on the caseload.
Close client care supervision – face to face observation
Client Care Conference- meeting/discussion between OT and OTA to discuss client; may be indirect unless specifically stated otherwise

38. LA OTA Supervision - 4925 (exceptions: Home Health and Early Intervention)
1c. COTA experience 2 or more years= client care conference for each client on the caseload.
Client Care Conference- meeting/discussion between OT and OTA to discuss client; may be indirect unless specifically stated otherwise

39. LA - OTA SUPERVISION – School System, Long-Term Psychiatric and Nursing Home Facility Settings
In addition to previously stated requirements (4925), clients shall be re-evaluated or treated by the supervising OT not less frequently than the earlier of once a month or every sixth treatment session

40. LA OTA Supervision – Home Health -
4925 does not apply
OTA shall have had not less than two years practice experience
Each client shall be re-evaluated or treated by the supervising OT not less frequently than the earlier of once every two weeks or every sixth tx session
Face-to-face client care conference not less frequently than once every two weeks to discuss all clients the OTA is treating; supervision must be documented on supervision log

41. LA OTA Supervision – Early Intervention setting
Section 4925 does not apply
OTA must have two years practice experience
Each client shall be re-evaluated or treated by the supervising OT not less frequently than the earlier of once a month or every sixth tx session
Client care conference shall occur not less frequently than the earlier of once every month or every sixth tx session to discuss all clients treated by OTA – all conferences must be documented on supervision log

42. What is TWO YEARS practice experience?
Hands-on administering of OT (not including FW); 3200 of documented work as an OTA

43. Important! LA - §4925
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 or immediate client care conference
Example?

44. Temporary License
Pending examination – valid for 3 months from date of issuance or until date of certification exam results (whichever is longer)
Renewable only once in LA
Can take test up to four times in LA before having to submit file to board (LSBME)
OT – on-premises direction and immediate supervision by a licensed OT for not less than two hours each week
OTA – on-premises direction and immediate supervision by a licensed OT for not less than 25% of average weekly caseload ***

45. Supervision Requirements for supervising OT and OTA students
The supervising therapist/assistant is required to have a minimum of 1 year full-time (or its equivalent) of practice experience as a licensed or otherwise regulated occupational therapist or occupational therapy assistant prior to the onset of the Level II fieldwork.

46. Supervision requirements for the OT Student
Level I OT students can be supervised by an OTA or OT or any other licensed professional (psychologists, physician assistants, teachers, social workers, physicians, speech language pathologists, nurses, and physical therapists).
Level II OT students can ONLY be supervised by an OT with a minimum of 1 year experience to be qualified as a Level II fieldwork educator.

47. Supervision requirements for the OTA Student
OTA students can be supervised by an OTA or OT for Level I or any other licensed professional (psychologists, physician assistants, teachers, social workers, physicians, speech language pathologists, nurses, and physical therapists).
OTA students can be supervised by an OTA or OT with at least one year of clinical experience for Level II

48. Supervision for Aides
Aides are not primary service providers of occupational therapy in any practice setting and do not provide skilled occupational therapy services.
An Aide is trained by an OT or OTA to perform specifically delegated tasks, but must demonstrate competency first.
The Aide must know the precautions, signs, & symptoms for the particular client

49. Supervision for Aides
The OT is responsible for the overall use and actions of the aide.
The OTA can supervise the aide, according to the AOTA Model State Regulation for Supervision, Roles, and Responsibilities
During the Delivery of Occupational Therapy
Services
The OT must oversee the development, documentation, and implementation of a plan to supervise and routinely assess the ability of the OT aide to carry out client and non-client-related tasks

50. MUTUAL OBLIGATIONS AND RESPONSIBILITIES
A supervising OT and OTA shall bear equal reciprocal obligations

51. Sources
Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services [pdf file]. (2014)." American Journal of Occupational Therapy 58.6 (2004): 1-7. Print. An Overview of State and Regulatory Supervision Requirements for Occupational Therapy Assistants (n.d.): Web. < Louisiana Revised Statutes Title 37. (n.d.). Retrieved October 16, 2015, from Rowe, N. (n.d.) 10 tips to building a strong ot/ota relationship. Retrieved from Title 46 Professional and Occupational Standards. (n.d.). Retrieved October 16, 2015, from Adapted from power point created by OTA students Alexis Mckenzie, Reneyshea Rhodes, & Randy Simmons