Occupational therapy programs tables of content

Case Study 1
A mother with a developmental disability is seeking information and skills training to help enable her to care for her newborn infant. The occupational therapy practitioner, in partnership with the mother, devises adaptive techniques and helps the mother locate funding sources that will provide monies to purchase the assistive devices she needs. The occupational therapy practitioner also addresses the mother’s concerns regarding normal development and provides suggestions on how she can facilitate her child’s development, given her limitations.
Case Study 2
A consumer who has a major depressive disorder and cerebral palsy requests assistance in learning cooking skills. The occupational therapy practitioner works with the consumer in his home to teach him adaptive techniques, both physical and cognitive, to perform these tasks independently. While in the process of working, the consumer reveals that part of his anxiety associated with these tasks stems from the fact that he does not feel that his roommate does his share of household tasks. This leads to the development of a new goal to work on assertiveness and communications skills to remedy this situation.

Case Study 3
A consumer who is paraplegic contacts the local Center for Independent Living wanting to learn to fix her wheelchair. She is referred to a skills course taught by the occupational therapy practitioner on wheelchair maintenance and repair. The occupational therapy practitioner also works with consumers to help them hire and train personal care attendants and, at times, teaches the personal attendants to perform activities of daily living skills and techniques for their employer, the consumer.
Case Study 4
A 75-year-old male has sold his house and moved into an apartment in a retirement community. He has impaired vision and mobility problems. In his efforts to continue to live independently, he contacts the independent living center and an occupational therapy practitioner comes to his house. The occupational therapy practitioner assesses the environment, defines the needs of the client, and makes recommendations for adaptation in the house and daily routines to maximize his safety and function.
The occupational therapy practitioner works with community agencies and businesses to assess and advocate for architectural accessibility. The occupational therapy practitioner can recommend necessary renovations to help these businesses comply with federal legislation regarding accessibility.
Summary
Occupational therapy practitioners fork for consumers in helping them to achieve their goals of living as purposefully and independently as possible. The American Occupational Therapy Association submits this paper in support of the independent living movement for all individuals with disabilities and offers the services of the occupational therapy practitioner who is qualified to assist individuals with disabilities toward achieving independence.•
Reference
Frieden, L., & Cole, J. A. (1985). Independence: The ultimate goal of rehabilitation for spinal cord-injured persons. American Journal of Occupational Therapy, 39, 734-739. Prepared by Robin Bowen, EdD, OTR, with contributions from Robin Jones, COTA, ROH, and Doris Shriver, OTR, FAOTA, for The Commission on Practice (Jim Hinojosa, PhD, OTR, FAOTA, Chairperson).
Approved by the Representative Assembly June 1993.
This document replaces the 1981 paper entitled “Occupational Therapy’s Rose in Independent or Alternative Living Situations” (American Journal of Occupational Therapy, 35, 812-814), which was rescinded by the Representative Assembly in June, 1991.

Position Paper: Occupational Therapy and the Americans with Disabilities Act (ADA)

The American Occupational Therapy Association (AOTA) applauds the Americans With Disabilities Act (ADA) (Public Law 101-336) as landmark legislation passed by Congress to promote the integrations of individuals with disabilities into the mainstream of society. Since its inception, the professions of occupational therapy has worked to foster independence in individuals with disabilities through the teaching and modification of independent living skills, work behaviors and skills, and compensatory strategies to minimize the limiting effect physical or mental impairments may have on the life of an individual.
The ADA prevents discrimination against individuals with disabilities by extending to them the same civil rights protection guaranteed under the law to individuals on the basis of race, creed, sex, national origin, and religion. Furthermore, the ADA provides comprehensive civil rights protection for individuals with disabilities in the areas of employment, public accommodations, transportation, state and local government services, and telecommunications, and the power to enforce these rights. The AOTA supports these mandates and urges all occupational therapy practitioners to embrace opportunities to empower individuals with disabilities in the following five areas specified by the ADA:
Employment

Public accommodations

State and local government

Public transportation

Telecommunications
Employment
Historically, occupational therapy practitioners have played a significant role in assisting individuals with disabilities to enter into or return to the work force. Under the employment provisions of the ADA, the occupational therapy practitioner continues to maintain a significant role in this area. Occupational therapy practitioners’ understanding of everyday functional abilities and the demands that work places on individuals with disabilities enables them to assist consumers, employers, human resource professionals, risk and safety managers, occupational health personnel, and supervisors in developing reasonable accommodations to allow a person with a physical or mental disability access to the work force.
Occupational therapy practitioners’ training and expertise in the areas of job-site analysis, combined with their knowledge of work, human performance, and function, places them in a unique position to assist employers in implementing the ADA. The occupational therapist performs a job-site analysis to identify the essential and marginal functions of a job, and the job’s environmental, cognitive, and psychological considerations. The job-site analysis provides a basis for the development of job descriptions written in specific functional terms. These job descriptions, based on the job-site analysis, become a working document that allows employers to provide accurate, job-specific information to job applicants and the human resource staff.
The occupational therapist may work as a consultant to teach human resources professionals how to use the functional job description as a tool during the interview process. Occupational therapy practitioners’ education and understanding of sensorimotor, cognitive, psychosocial, and motor dysfunction, and how these affect the individual, place them in an excellent position to sensitize coworkers and supervisors to use proper disability etiquette to interact with, supervise, and work effectively with persons with disabilities. As consultants, occupational therapy practitioners may play a key role in dispelling the myths, misconceptions, stereotypes, and fears about disabilities found in the workplace.

To meet the new challenges presented to individuals with disabilities by the ADA’s employment provisions, occupational therapists can work with employers to assess the occupational performance of individuals to determine their ability to perform the essential functions of a given job, with or without reasonable accommodations. Where accommodations are required to facilitate job performance, occupational therapists may recommend appropriate adaptive equipment, auxiliary aids, job restructuring, task adaptation, schedule changes, or work site or workstations modifications to enable these prospective or returning employees to perform the essential functional of their jobs.
Occupational therapy practitioners can play a key role in employer’s determination of whether an individual poses a direct threat to himself or herself or others in the workplace. Where a direct threat is found, occupational therapy practitioners can suggest reasonable accommodations to reduce the risk of harm. Employers, risk and safety managers, and human resources directors who wish to develop injury prevention programs that comply with the ADA will also benefit from the occupational therapist’s consultation. This may include developing post-offer, job-related employee screenings and evaluations for high-risk injury positions.
Working in concert with individuals with disabilities, including work-related injuries, occupational therapy practitioners develop strategies to prepare the individual for employment. Through job-seeking skills training, clients are taught what to expect during the interview process, which reasonable accommodations to suggest and how to suggest them, and what their rights are during the application and interview process.
Public Accommodations
The occupational therapy practitioner facilitates compliance with the ADA’s public accommodations provisions by working with architects, engineers, businesses, other professionals, and the consumer to determine the accessibility of places frequented by the general public and specified in the ADA, such as stores, theaters, health clubs, restaurants, hotels, office buildings, physicians’ offices, and hospitals. Where inaccessible facilities, programs, goods, or services are identified, occupational therapy practitioners, on the basis of their knowledge of the functional abilities of individuals with disabilities, suggest adaptive equipment, auxiliary aids, policy changes, alternative methods of service provision, and environmental adaptations to make the facilities, programs, goods, or services accessible and usable. By promoting compliance with the ADA, the occupational therapy practitioner expands the individual’s access to public accommodations in the mainstream of independent living.

State and Local Government Services
In the area of state and local services, the occupational therapy practitioner can consult with program staff from local governments to assist in integrating individuals with disabilities into the various services provided by the government agencies. For example, if a county provides a summer day camp for children through its parks department, an occupational therapy practitioner can develop a program to allow children with disabilities an equal opportunity to participate in the same camp program. Occupational therapy practitioners can also assist local governments to acquire auxiliary aids or adaptations needed to make other programs and services accessible to individuals with disabilities. Occupational therapy practitioners can serve as a resource for government task forces and departments providing consultation for ADA compliance in the areas of employment, accessibility, and communication.
Public Transportation
The ADA requires public transportation systems to provide more access to individuals with disabilities. On the basis of their knowledge of accessibility requirements, auxiliary aides, and functional mobility limitations of individuals, occupational therapy practitioners can assist public and private transportation system planners with providing access to buses, taxicabs, trains, airplanes, and subway systems. For example, occupational therapy practitioners can assist with making terminals accessible and suggesting that schedules be made available in alternative formats.
Telecommunications
The ADA’s telecommunications provision requires that establishment of interstate and intrastate telecommunications relay services for individuals with hearing and speech impairments. Occupational therapy practitioners can assist telecommunications companies in assessing the need for information relay systems and can provide information about assistive device acquisition and training issues related to individuals with disabilities.
In summary, occupational therapy practitioners play a key role in educating the public as well as individuals with disabilities about their rights and responsibilities under the ADA. The occupational therapy practitioner’s understanding of work and task analysis, knowledge of the functional limitations of disability, and experience with adaptive equipment provision and environmental adaptation places the practitioner in a unique position to serve as a resource in ADA-related matters. The AOTA supports the fundamental purposes of the ADA and encourages its members to assist the public in complying with its mandates to promote the entry of individuals with disabilities into the mainstream of independent living.•

Reference
Americans With Disabilities Act of 1990 (Public Law 101-336), 42, U.S.C. § 12101. Prepared by Barbara L. Kornblau, JD, OTR, DAAPM, for the Commission on Practice (Jim Hinojosa, PhD, OTR, FAOTA, Chairperson).
Approved by the Representative Assembly June 1993.
This document was originally prepared as a White Paper (October 1991 to June 1993) for the American Occupational Therapy Association and was revised as a Position Paper for the Commission on Practice.

OCCUPATIONAL THERAPY

PROGRAMS

Section 27

Standards of Practice

Standards of Practice

for Occupational Therapy

Preface

These standards are intended as recommended guidelines to assist occupational therapy practitioners in the provision of occupational therapy services. These standards serve as a minimum standard for occupational therapy practice and are applicable to all individual populations and the programs in which these individuals are served.

These standards apply to those registered occupational therapists and certified occupational therapy assistants who are in compliance with regulation where it exists. The term occupational therapy practitioner refers to the registered occupational therapist and to the certified occupational therapy assistant, both of whom are in compliance with regulation where it exists.
The minimum educational requirements for the registered occupational therapist are described in the current Essentials and Guidelines of an Accredited Educational Program for the Occupational Therapist (American Occupational Therapy Association AOTA), 1991a). The minimum educational requirements for the certified occupational therapy assistant are described in the current Essentials and Guidelines of an Accredited Educational Program for the Occupational Therapy Assistant AOTA, 1991b).
Standard I: Professional Standing

An occupational therapy practitioner shall maintain a current license, registration, or certification as required by law.

An occupational therapy practitioner shall practice and manage occupational therapy programs in accordance with applicable federal and state laws and regulations.

An occupational therapy practitioner shall be familiar with and abide by the AOTA’s (1988) Occupational Therapy Code of Ethics.

An occupational therapy practitioner shall maintain and update professional knowledge, skills and abilities through appropriate continuing education or in-service training or higher education. The nature and minimum amount of continuing education must be consistent with state law and regulation.

A certified occupational therapy assistant must receive supervision from a registered occupational therapist as defined by the current Supervision Guidelines for Certified Occupational Therapy Assistants (AOTA, 1990) and by official AOTA documents. The nature and amount of supervision must be provided in accordance with state law and regulation.

An occupational therapy practitioner shall provide direct and indirect services in accordance with AOTA’s standards and policies. The nature and scope of occupational therapy services provided must be in accordance with state law and regulation.

An occupational therapy practitioner shall maintain current knowledge of legislative, political, social, and cultural issues that affect the profession.
Standard II: Referral

A registered occupational therapist shall accept referrals in accordance with AOTA’s Statement of Occupational Therapy Referral (AOTA, 1989) and in compliance with appropriate laws.

A registered occupational therapist may accept referrals for assessment or assessment with intervention in occupational performance areas or occupational performance components when individuals have or appear to have dysfunctions or potential for dysfunctions.

A registered occupational therapist, responding to requests for service, may accept cases within the parameter of the law.

A registered occupational therapist shall assume responsibility for determining the appropriateness of the scope, frequency, and duration of services within the parameters of the law.

A registered occupational therapist shall refer individuals to other appropriate resources when the therapist determines that the knowledge and expertise of other professionals is indicated.

An occupational therapy practitioner shall educate current and potential referral sources about the process of initiating occupational therapy referrals.

Standard III: Screening

A registered occupational therapist, in accordance with state and federal guidelines, shall conduct screening to determine whether intervention or further assessment is necessary and to identify dysfunctions in occupational performance areas.

A registered occupational therapist shall screen independently or as a member of an interdisciplinary team. A certified occupational therapy assistant may contribute to the screening process under the supervision of a registered occupational therapist.

A registered occupational therapist shall select screening methods that are appropriate to the individual’s age and developmental level; gender; education; cultural background; and socio-economic, medical, and functional status. Screening methods may include, but are not limited to, interviews, structured observations, informal testing, and record reviews.

A registered occupational therapist shall communicate screening results and recommendations to appropriate individuals

Standard IV: Assessment

A registered occupational therapist shall assess an individual’s occupational performance components and occupational performance areas. A registered occupational therapist conducts assessments individually or as a part of a team of professionals, as appropriate to the practice settings and the purposes of the assessments. A certified occupational therapy assistant may contribute to the assessment process under the supervision of a registered occupational therapist.

An occupational therapy practitioner shall educate the individual, or the individual’s family or legal guardian, as appropriate, about purposes and procedures of the occupational therapy assessment.

A registered occupational therapist shall select assessments to determine the individual’s functional abilities and problems as related to occupational performance areas: occupational performance components; physical, social, and cultural environments; performance safety; and prevention of dysfunction.

Occupational therapy assessment methods shall be appropriate to the individual’s age and developmental level; gender; education; socioeconomic, cultural, and ethnic background; medical status; and functional abilities. The assessment methods may include some combination of skilled observation, interview, record review, or the use of standardized or criterion-referenced tests. A certified occupational therapy assistant may contribute to the assessment process under the supervision of a registered occupational therapist.

An occupational therapy practitioner shall follow accepted protocols when standardized tests are used. Standardized tests are tests whose scores are based on accompanying normative data that may reflect age ranges, gender, ethnic groups, geographic regions, and socioeconomic status. If standardized tests are not available or appropriate, the results shall be expressed in descriptive reports, and standardized scales shall not be used.

A registered occupational therapist shall analyze and summarize collected evaluation data to indicate the individual’s current functional status.

A registered occupational therapist shall document assessment results in the individual’s records, noting the specific evaluation methods and tools used.

A registered occupational therapist shall complete and document results of occupational therapy assessments within the time frames established by practice settings, government agencies, accreditation programs, and third-party payers.

An occupational therapy practitioner shall communicate assessment results, within the boundaries of client confidentiality, to the appropriate person.

A registered occupational therapist shall refer the individual to the appropriate services or request additional consultations if the results of the assessment indicate areas that require intervention by other professionals.

Standard V: Intervention Plan

A registered occupational therapist shall develop and document an intervention plan based on analysis of the occupational therapy assessment data and the individual’s expected outcome after the intervention. A certified occupational therapy assistant may contribute to the intervention plan under the supervision of a registered occupational therapist.

The occupational therapy intervention plan shall be stated in goals that are clear, measurable, behavioral, functional, and appropriate to the individual’s needs, personal goals, and expected outcome after intervention.

The occupational therapy intervention plan shall reflect the philosophical base of occupational therapy (AOTA, 1979) and be consistent with its established principles and concepts of theory and practice. The intervention planning processes shall included:

Formulating a list of strengths and weaknesses.

Estimating rehabilitation potential.

Identifying measurable short-term and long-term goals.

Collaborating with the individual, family members, other caregivers, professionals and community resources.

Selecting the media, methods, environment, and personnel needed to accomplish the intervention goals.

Determining the frequency and duration of occupational therapy services.

Identifying a plan for reevaluation.

Discharge planning.

A registered occupational therapist shall prepare and document the intervention plan within the time frames and according to the standards established by the employing practice settings,, government agencies, accreditation programs, and third-party payers. The certified occupational therapy assistant may contribute to the formation of the intervention plan under the supervision of the registered occupational therapist.

Standard VI: Intervention

An occupational therapy practitioner shall implement a program according to the developed intervention plan. The plan shall be appropriate to the individual’s age and developmental level, gender, education, cultural and ethnic background, health status, functional ability, interests and personal goals, and service provision setting. The certified occupational therapy assistant shall implement the intervention under the supervision of a registered occupational therapist.

An occupational therapy practitioner shall implement the intervention plan through the use of specified purposeful activities or therapeutic methods to enhance occupational performance and achieve stated goals.

An occupational therapy practitioner shall be knowledgeable about relevant research in the practitioner’s areas of practice. A registered occupational therapist shall interpret research findings as appropriate for application to the intervention process.

An occupational therapy practitioner shall educate the individual, the individual’s family or legal guardian, non-certified occupational therapy personnel, and non-occupational therapy staff, as appropriate, in activities that support the established intervention plan. An occupational therapy practitioner shall communicate the risk and benefit of the intervention.

An occupational therapy practitioner shall maintain current information on community resources relevant to the practice area of the practitioner.

A registered occupational therapist shall periodically reassess and document the individual’s levels of functioning and changes in levels of functioning in the occupational performance areas and occupational performance components. A certified occupational therapy assistant may contribute to the reassessment process under the supervision of a registered occupational therapist.

A registered occupational therapist shall formulate and implement program modifications consistent with changes in the individual’s response to the intervention. A certified occupational therapy assistant may contribute to program modifications under the supervision of a registered occupational therapist.

An occupational therapy practitioner shall document the occupational therapy services provided, including the frequency and duration of the services within the time frames and according to the standards established by the employing facility, government agencies, accreditation programs, and third-party payers.