O - Washington Occupational Therapy Association

Building a Dynamic
OT-OTA Team
In Any Practice Setting
Cecille Corsilles-Sy, PhD, OTR/L
Juliann Trumm, MPH, OTR/L
WOTACON Tacoma, WA
October 9, 2015
Introductions &
Demographics
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Participant Objectives
1. Review Standard of Practice,
regulatory guidelines, and state laws
related to roles, responsibilities and
supervision of occupational therapy
practitioners.
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Participant Objectives
2. Develop a framework for service
competency relevant to the OT
practitioner’s practice area.
3. Identify strategies that will build a
culture of collaboration in intra-and
interprofessional practice teams.
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Relevant Guidelines
O WA State Legislature: WAC 246-487-135 –
Standards of Supervision
O AOTA’s Guidelines for Supervision, Roles &
Responsibilities During the Delivery of OT
Services
O AOTA’s Documentation Guidelines
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Relevant Documents
O AOTA’s Occupational Therapy Standard of
Practice
O Occupational Therapy Code of Ethics
O Recommended:
O Institution’s Philosophy
O Institution’s Mission Statement
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Washington State Laws
O WAC 246-847-135 (Title, Chapter, Section)
O Standards of Supervision
O (1) Licensed OTAs must be supervised by
regular consultation with an OT licensed in
the state of WA. Regular consultation must
be documented and the documentation kept
at a location determined by the supervising
OT or OTA.
O (others are not relevant to OT-OTA supervision but
relevant to using OTAs for skilled care vs. as OT
aide)
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Documentation of Supervision
O Patient file: Weekly notes and Summaries
O Interdisciplinary meeting notes
O Professional Development Plans
O Performance Evaluation
O Personnel File
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Supervision
(AOTA Guidelines, 2004)
O A cooperative process
O Two or more people participate in a joint
effort to establish, maintain, and or elevate
a level of competence and performance
O Based on mutual understanding between
the supervisor and the supervisee about
each other’s competence, experience,
education, and credentials
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Supervision
(AOTA Guidelines, 2004)
O Fosters growth and development,
promotes effective utilization of
resources, encourages creativity and
innovation, and provides education
and support to achieve a goal
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Supervision
(AOTA Guidelines, 2004)
O Within the scope of occupational
therapy practice, supervision is a
process aimed at ensuring the safe
and effective delivery of occupational
therapy services and fostering
professional competence and
development
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Levels of Supervision
(Ryan’s OTA, p. 586)
O Close supervision- direct, on-site, daily
contact
O General Supervision - frequent face-to-face
mtgs. at worksite & regular communication
by telephone, written documents or
electronic conference
O Medicare: Initial direction and periodic
inspection of actual activity, but supervisor
need not always be present on premises
during performance of services
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Levels of Supervision
(Ryan’s OTA, p. 586)
O General Supervision cont.
O AOTA recommendation- use only after
service competencies have been
established
O Authors (Ryan and Sladyk) recommend
that contact by OT may be less than daily
but should be 3-5 contact hours per week
for full time OTA
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OTA Levels of Performance
& Supervision
O Entry level- less than 1 year, close
supervision required, competent with entrylevel services with close supervision
O Intermediate – 1-3 years, competent with
entry-level tasks, variety of ADL in tx, may be
developing more advanced skills in a
specialized area
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OTA Levels of Performance
& Supervision
O Advanced Level
O 3 or more years of experience and has
achieved intermediate level
O Demonstrated advanced level skill that may
be in clinical, educational, or administrative
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Supervision Considerations
O Regulatory requirements
O Practice setting
O Competency level
O Experience
O Education and credentials
O Complexity of client needs
O Number & diversity of clients
O Service Competency
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COTAs as Supervisors
O After 1 year- can supervise a FW I and FW II OTA
O
O
O
O
students
After 1 year- can supervise a FWI OT students
Intermediate (1-3 yrs)- supervise OT Aides and
volunteers
As intermediate and advanced COTA - can
supervise entry-level and intermediate COTA,
respectively.
Advanced-level- can provide administrative
supervisions (in addition to all of above)
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What is the scope
of practice for
OTAs ?
OT Process of Service Delivery
O Referral
O Screening and evaluation
O Intervention Planning
O Intervention Implementation
O Re-evaluation
O Discharge/Discontinuation
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Standard of Practice
OT
O Accepts/responds to
referrals
O Directs/responsible
for all aspects of
screening ,
Evaluation, and Reevaluation
OTA
O ---O Contributes to the
screening, evaluation,
and re-evaluation;
implements delegated
assessments
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Standard of Practice
OT
O Analyze and interpret
results
O Completes and
documents
evaluation results
O Recommends
additional services,
refer to other
services
OTA
O -------O Contributes to
documentation of
evaluation
O -------
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Standard of Practice
O OT/OTA communicate results to appropriate
person, group, organization, population
O OT/OT educate referral source on OT
services, initiation of service
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Standards of Practice
Definition
O
Assessment: Specific tools or instruments
used during the evaluation process
O Can be administered by OTA
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Standards of Practice
Definition
O
Evaluation: Process of obtaining and
interpreting data necessary for intervention.
This includes planning for and documenting
the evaluation process and results.
O It is not within the scope of practice for OTAs
to interpret assessment results
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Standard of Practice:
Intervention Planning
OT
O Responsible for
selecting, measuring,
documenting, &
interpreting expected
outcomes
O Modifies intervention
plan throughout tx
process
OTA
O Can collaboratively
work with OT but
largely the domain of
the OT
O -----
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Standard of Practice:
Intervention
OT
O Responsible for
overall development,
documentation, and
implementation of
intervention based on
evaluation, client
goals, best available
evidence,
professional and
clinical reasoning
OTA
O Selects, implements,
and modifies
intervention
consistent with OTA’s
demonstrated
competency,
intervention plans,
needs of practice
setting
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OTA: Intervention
Implementation
O Can make changes on level of assistance
within the same therapeutic goal
O OTAs cannot create new goals within an
established treatment plan, but will
communicate with the OT the need for
changes
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OTA: Documentation
O Initial Evaluation report- OTAs can contribute
to data, sign the section of their contribution
or a statement of the collaboration can be
made prior to OT’s signature
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OTA: Documentation
O Contact note/ Daily note –can be completed
by OTA following institutional standards
WITHOUT a co-signature
O Progress Note /Weekly Note –frequency
depends on institution and/or funding
source, practice setting. OTAs often write
this note and is co-signed by OT especially
for need of updating treatment goals
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OTA: Documentation
O Re-evaluation, Transition Notes, Discharge
or Discontinuation Note
O OTA can contribute to gathering of data but
an OT will need to analyze, interpret and sign
these documents with statement on the
collaborative process
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Service Competence
O Implies that the OT and OTA can perform the
same or equivalent tasks and obtain the
same results.
O Supervisor’s responsibility to establish
supervisee’s level of service competency
O More easily established with frequently used
assessments and interventions
(Ryan & Sladyk, p. 586)
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Stages of Competency
Development
O Variety of methods can be used:
observation, videotaping, independent
test-scoring, co-treatment
O Exposure
Competence
Immersion
Comparable results
O Competency standards- setting specific
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Documentation of Service
Competency
O Include in employee personnel file
O Competencies at different intervals
(determined by demands of setting)
O Service competency should be documented
for frequently administered assessments
and intervention
O Service competency should be documented
for each service area
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Sample Competency Level
1. Little or no experience- needs supervision
2. Some Experience- may require supervision
or assistance
3. Competent, Experienced- can perform
without supervision
4. Competent, Experienced- able to assess
competency and teach others
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Group Activity
O Break into groups based on practice area
and practice setting
O Hospital-based (Acute/Inpatient/Out-patient)
O Skilled Nursing Facility
O Mental Health
(Inpatient/Outpatient/Community)
O Pediatrics (School District/Outpatient)
O Outpatient Hands
O Home Health
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Group Activity:
Service Competency
O Assessments
O Most common Functional
assessments
O ADL/IADL
O Physical Dysfunction
O Cognitive/Communication
O Psychosocial
(Ryan and Sladyk, 2005)
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Group Activity:
Service Competency
O Assessments
O Most common Functional
assessments
O ADL/IADL/Home Eval/Adaptations
O Work/Driving
O Leisure/Play/Social Participation
O Rest/Sleep
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Group Activity:
Service Competency
O Standardized Assessments
O Neuromotor Dysfunction
O Sensory/Processing
O Cognitive/Communication
O Psychosocial
O Mental health
O Environment/access
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Group Activity:
Service Competency
Intervention: Occupation-based
O ADL/IADL
O Home programs
O Groups
O Leisure
O Work
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Group Activity:
Service Competency
Intervention: Therapeutic Activities
O Strengthening/ROM/Endurance
O Activity tolerance
O VP activities
O Group intervention
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Group Activity:
Service Competency
Intervention: Preparatory
O Physical Agent Modalities
O Neuromuscular facilitation
O Pain management
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Group Activity:
Service Competency
Intervention: Prevention
O Environmental Adaptation
O Ergonomics
O Splinting
O Health & Wellness
O Stress Management
O Home Exercises/programs
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Group Activity:
Service Competency
Specialty Interventions
O Return to driving intervention
O Seating and positioning
O Assistive Technology
O Sensory Integration
O Equipment- specific
O Funding- specific
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Sharing Results
O Each group to report on their results
O Present in order of practice setting
O OT Process:
O Assessments
O Intervention
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Under and Over Utilization of
OT/OTAs
O Results from limited knowledge of
distinction in roles & responsibilities
O Limited knowledge of funding source
requirements
O Underutilization
O Overutilization
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Strategies to Build
Collaboration
O Increase knowledge of role distinction
O Allow for sufficient orientation
O Establish a plan for service competency
O Include collaborative work in Performance
Evaluations
O Establish professional goals to include
studies in inter and interprofessional
practice
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Review/Summary
O Licensed OTA’s must be supervised by
O
O
O
O
O
regular consultation with an OT and this
should be documented (WAC & AOTA)
Levels of supervision (Ryan’s)
OT vs OTA scope of practice
Documentation – co-signatures
Service competency
Under and over utilization of OTA’s
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Question and Answer
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References
O WA State Legislature: WAC 246-487-135 –
Standards of Supervision
http://leg.wa.gov/
O Guidelines for Supervision, Roles, and
Responsibilities During the Delivery of
Occupational Therapy Services. AJOT.
November/December 2004, Vol. 58, 663667.
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References
O Guidelines for Documentation of
Occupational Therapy. AJOT.
November/December 2013, Vol. 67, S32S38.
O Standards of Practice for Occupational
Therapy. AJOT. November/December 2010,
Vol. 64, S106-S111.
O Occupational Therapy Code of Ethics (2015).
AJOT. September 2015, Vol. 69,
6913410030p1-6913410030p8.
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References
O Sladyk, K., Ryan, S. E., eds. Ryan’s
Occupational Therapy Assistant: Principles,
Practice Issues, and Techniques. 5th ed.
Thorofare, NJ: Slack Inc; 2005.
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