Occupational therapy programs tables of content

OCCUPATIONAL THERAPY

PROGRAMS

Section 30

COTA SUPERVISION GUIDE

This guide has been developed by the AOTA Practice Division to address member requests for information regarding the roles and responsibilities of the Certified Occupational Therapy Assistant. It attempts to answer commonly asked questions and to provide useful reference documents which include information related to COTA practice issues.

CONTENTS

COTA Advisory Committee Listing 1986-1989........................................................1

COTA Questions and Answers:

COTA in Home Health..................................................................................2

COTA in School System...............................................................................3

COTA in Private Practice..............................................................................5

COTA as Activities Director..........................................................................6

Note Writing/Countersigning........................................................................7

Evaluation/Re-evaluation.............................................................................8

Supervision requirements for the COTA......................................................9

Issue of supervising OTR on leave of absence..........................................10

Entry-Level Role Delineation for OTRs and COTAs..............................................11

COTA References.................................................................................................23

Guide to Classification of Occupational Therapy Personnel.................................24

Guide for supervision of Occupational Therapy Personnel...................................48

Excerpt from Medicare Coverage for Occupational Therapy Services.................52

COTA Cost Effectiveness and Productivity Information........................................53

COTA Background Information.............................................................................54

This packet was developed by the Practice Division, AOTA.
We would like to acknowledge the contribution of Janet Barney, OTR, in the development of this guide during her student affiliation in the Practice Division, AOTA.
We hope this reference service is of benefit to you. You are free to reproduce this guide if you wish to distribute it for educational purposes.

October 1986; Revised 7/87

Q. May COTAs write notes in medical charts, and if so, must they be countersigned by an OTR?
A. COTAs are qualified to write notes in charts, and neither AOTA guidelines nor

federal laws specify that the notes must be countersigned by an OTR. Counter-

signing, however, is a recognized method of documenting supervision and

demonstrates compliance with the supervisory requirements of state and federal

laws and regulations regarding COTAs. Tangible evidence of one method of

supervision may be the countersignature of an OTR on a COTA’s note.

One exception to the general guidelines outlined above applies to documentation

in the school system. School System Guidelines recommend that all notes written

by the COTA for inclusion in the Individualized Education Program (IEP) be

countersigned by the OTR, due to the fact that these are official documents and

are subject to subpoena.

Q. What are the parameters within which a COTA may function regarding evaluation

and re-evaluation?
A. According to the Entry Level Role Delineation for OTRs and COTAs (1981), the

COTA may contribute to the evaluation process under the supervision of the OTR. The COTA may assist by 1) interviewing the client, family and significant others using a structured format as determined by the OTR, 2) observing the client while

engaged in individual and/or group activity to collect general data and report back

to the OTR. The specific tests which the COTA is permitted to administer is left to

the discretion of the supervising OTR, however, it is strongly recommended that a

high degree of interrater reliability be established between the OTR and the COTA

on these specific tests. When an OTR delegates an evaluation task to a COTA,

there must be a high degree of confidence that the COTA will perform the task in

the same manner an OTR would have obtained if doing it alone. Interrater relia-

bility is critical because the OTR is legally responsible for outcomes of all tasks

that are performed in the provision of Occupational Therapy services. It should

also be kept in mind that following the evaluation process, the COTA reports

objective data only and does not make any interpretations. It is the OTR’s

responsibility to establish the goals and treatment plan in collaboration with the

COTA when this is possible. The same parameters apply to the re-evaluation

process.

Q. Are there any standards which state the type of clinical supervision and the

number of hours of supervision a COTA needs and do the standards change

from one setting to another?

A. In April 1985, the Representative Assembly approved the document entitled

Guide to Classification of Occupational Therapy Personnel. The Guide discusses entry, intermediate and advanced level COTAs based on the number of years of experience. For each level there is a section on supervision dealing with both Clinical and Management/Administrative. The Guide indicates that the entry level COTA needs close clinical supervision (i.e., daily direct contact on-site). For both the intermediate and advanced level COTAs, general clinical supervision (i.e., less than daily), is indicated. The document also indicates that the nature and freque­ncy (including number of hours), varies with patient/client populations as well as types of work settings such as acute care verses long term care. The COTA working with the acutely ill or with individuals who are making rapid changes will require more OTR supervision due to the frequent need for evaluation and re-evaluation and the resulting needs for the revision of treatment plans. In long term care settings such as nursing homes where patients/clients are more stable, less supervision would be required. Where supervision is not on-site on a regular basis, on-site supervision at least monthly is recommended. The Guide to Classification of Occupational Therapy Personnel also states that both entry-level and experienced COTAs are supervised by experienced OTRs when providing occupational therapy services.
Medicare Guidelines for the coverage of occupational therapy services states that “the implementation of the plan may also be carried out by a qualified occupational therapy assistant functioning under the general supervision of the qualified occupational therapist,.” The Medicare Guidelines defined general supervision as “(...required initial direction and periodic inspection of the actual activity; however, the supervisor need not always be physically present or on the premises when the assistant is performing services...)” . In states where there is licensure, many licensure acts include a very general statement about supervision guidelines regarding COTAs.
In all instances supervision is an instructional and learning process. It is the responsibility of the supervisor to provide supervision as it is the responsibility of the person being supervised to obtain supervision. Supervision should be appropriate to the requirements of the job and the needs of the individual who is supervised.
Source: “I’m Glad You Asked”, Occupational Therapy Newspaper, August 1986.

Q. What provisions or changes need to take place if the OTR who supervises the

COTA is on vacation or leave absence?
A. When the supervising OTR is on vacation or on a leave of absence (such as maternity leave) treatment initiation based on a new referral cannot begin until an OTR has completed the evaluation and established the goals and treatment plan. In order for new referrals to be acted upon in these situations, arrangements to employ a temporary and/or a consulting OTR need to be made. If this is not possible, the COTA may continue to treat only those patients who have already been evaluated and for whom goals and a treatment plan are in place. For this situation, provisions should be made to have an OTR be on call to assist the COTA. In acute settings where a patient’s status may change rapidly and require a re-evaluation and changes in the treatment plan, an OTR must be available to carry this out before the COTA can resume treatment. In all cases the rules and regulations pertaining to state licensure laws should be reviewed, as law supersedes AOTA policy.

Entry-Level OTR and COTA Role Delineation

The Entry-Level OTR The Entry-Level COTA

1. Referral: the initiation or acknowledgment of a referral may be before initial screening or after. A referral for occupational therapy services must be based upon the provisions as outlined in the AOTA Statement of Referral.

A. Responds to request for service, whatsoever its source. A. Responds to a request for service by relaying information or

formal referral to supervising OTR.

B. Initiates referrals when appropriate. B. Initiates referrals for independent livinbg/daily living skills

intervention.

C. Supervises documentation and filing of referrals according to department standards. C. Enters case as appropriate to standards of department and

profession when authorized by supervising OTR.

D. Delegates case to COTA, as appropriate, according to standards to department and profession.

2. Occupational Therapy Assessment: Occupational therapy assessment refers to the process of determining the need for, , nature of , and estimated time of treatment, determining the needed coordination with other persons involved, and documenting these activities.

A. Screening: determine client’s need for occupational therapy services: may occur before or after referral.

Collect data:

Identify type and sources of information that are needed

Obtain and review information and identify pertinent details about client; or plan and supervise data collection.

Explain overall occupational therapy services to client, family, and significant others.

Analyze data:

Organize data

Summarize data

Interpret data

Formulate recommendations

Document and report occupational therapy screening data, interpretation, and recommendations.

B. Evaluation: obtain and interpret data necessary for treatment. This includes planning for and documenting the evaluation process and results. OTR is respon­sible for the evaluation process.

Select appropriate area(s) to evaluate

Independent living/daily living skills

Physical daily living skills

Grooming & hygiene

Feeding/eating

Dressing

Functional mobility

Functional communication

Object manipulation

Psychological/Emotional Daily Living Skills

Self-concept/self identity

Situation coping

Community involvement

Work

Homemaking

Child care / parenting

Employment preparation

Play/Leisure

A. Screening: determine client’s need for occupational therapy services in collaboration with OTR: may occur before or after referral.

Collect data:

Obtain and review information as determ­ined by OTR and identify pertinenet detai­ls about cleint.

Explain overall occupational therapy serv­ices to client, family and significant others

Observe and interview client, family, and significant others using a structured guide to obtain general history and infomation.

Organize data:

Summarize own data

Record and report own data to OTR
B. Evaluation The COTA contributes to the evaluation process under the supervis­ion of the OTR.

Introduction

This role delineation is intended for internal use by the American Occupational Therapy Association, Inc. as a guide to assist members in the practice of their profession. The role delineation may be used to assist in the development of entry-level educatio­nal Essentials and certification criteria, but may not be used (except with the written permission of the AOTA) to draft legal documents of any kind such as licensure bills or private contracts.
The contents of this document are not to be construed as entirely original, but represent a compilation of resource materials and professional judgment. Resource documents use were:

AOTA Entry Level Functions of the Registered Occupa­tional Therapy Assistant and Occupational Therapy Aide, AOTA: 1972.

Task Inventory for Entry Level Occupational Therapy Personnel in Direct Service Roles: NIH contract No. 72-4172; AOTA; June 1973.

Phase I-Delineation of the Role of Entry Level Occupational Therapy Personnel: Contract #231-76-0052: AOTA; July 1, 1976-February 1, 1973.

AOTA Standards of Practice for Occupational Therapy Services for the Developmentally Disables Client: clients with Physical disabilities: in Mental Health Programs; and in a Home Health Program: AOTA: January 1979.

Essentials of an Accredited Educational Program for the Occupational Therapist: June 1972; and Essentials of an Approved Educational Program for the Occupational Therapy Assistant; April 1975.

AOTA Resolution #533-79 (Funding for 518-77). #535-79 (Role Delineation Concept and Use). #552-79 (Stra­tegy to Education Independent Health Professionals). #551-79 (Position on Proficiency Testing for Individuals Outside the Field of Occupational Therapy), and proposed Resolution “J”-1980 (Strategy for Determining the Place of the COTA in the Profession of Occupatio­nal Therapy).

Entry Level Study Committee Memo; AOTA; April 7, 1980.

Essentials Review committee Report: Recommendation #1: AOTA: 1980.

9. Components and Interrelationships of a Competency Assurance System.

10. AOTA Uniform Terminology for Reporting Occupational Therapy Services: AOTA: 1979.

The following principles/concepts were used in the development of the role delineation document:

1. OTRs must be able to do all COTA roles and functions.

2. The role delineation reflects present and future practice of occupational therapy.

3. The role delineation reflects entry-level practice only and may be used only for that level when used to deve­lop educational Essentials or certification requirements.

4. Entry-level is defined as the first year of practice.

5. Entry-level COTAs must receive direct supervision by an OTR during the first year of occupational therapy practice. COTAs are encouraged to participate in continuing education programs provided by agencies and professional associations and to pursue other continuing education opportunities.

6. Entry-level OTRs are certified for general practice and are able to independently provide services. Entry-level OTRs are encouraged to pursue continuing education, consultation and other collaborative activities n their professional role.

7. Employers should provide appropriate personnel for the supervision of new graduates.

8. The role delineation addresses tasks and not “professional” behavior that reflects ethical or value judg­ments.

Refer to the Role Delineation Glossary and AOTA Uniform Term­inology System for Reporting Occupational Therapy Services for definitions of terms used in this document.

Entry Level/Role Delineation Committee:

Jay Bullock, OTR Gladys Masagatani, OTR Nancy Predergast, OTR

Sr. Miriam Joseph Cummings, OTR Linda McGourty, OTR Sally Ryan, COTA

Jeanne Madigan, OTR Nancy Moulin, OTR Javan Walker, Jr. OTR
AOTA Staff

Madelaine Gray, OTR

Carole Hays, OTR

Stephanie Presseller, OTR

Entry-Level Role Delineation

For OTRs and COTAs

The American Occupational Approved by

Therapy Association, Inc. Representative Assembly
1383 Piccard Drive March 1981

Rockville, MD 20850

The Entry-Level OTR The Entry-Level COTA

Sensorimotor components

Neuromuscular

Reflex Integration

Range of Motion

Gross and Fine Coord.

Strength & Endurance

Sensory Integration

Sensory Awareness

Visual-Spatial Awareness

Body Integration

Cognitive components

Orientation

Conceptualiza­tion/Comprehension

Concentration

Attention Span

Memory

Cognitive Integration

Generalization

Problem solving

Psychosocial components

Self-management

Self-expression

Self-control

Dyadic Interaction

Group Interaction

Plan evaluation methodology
Explain evaluation plan to client, family, significant others, and other health professionals.
Interview clients, family and significant others for infor­mation about:

Medical history and current health status

Developmental milestones

Social and family history

Self-care abilities

Academic history

Vocational history

Play history

Leisure interests and experiences

Future plans and goals

Accessibility of home environment

Accessibility of work or school system

Accessibility of community support system
Observe client while engaged in individual and/or group activity to collect data and report on: (refer to areas in Section 11.B.1 for specifics in each area)

Independent living/daily living skills

Sensorimotor skills

Cognitive skills

Psychosocial skills
Admniister standardized and non-standardized asses­sments in the following areas: (refer to areas in Section 11.B.1 for specifics in each area)

Independent living/daily skills and perfor­mance.

Sensorimotor skills and performance

Cognitive skills and performance.

Assist OTR by interviewing clients, family, and signific­ant others using a structured format as determined by OTR for information about:

Family history

Self-care abilities

Academic history

Vocational history

Play history

Leisure interests and experiences

Assist OTR by observing the client while engaged in individual and/or group activity to collect general data and report on: (refer to areas in Section II.B.1 for specifics in each area)

Independent living/daily living skills

Selected sensorimotor skills.

Gross and fine coordination

Strength and endurance

Tactile awareness

Cognitive skills

Psychosocial skills.

Administer structured tests as directed by the OTR to collect data on:

Independent living/daily living skills and perf­ormance.

Sensorimotor skills and performance in the following areas of:

Gross and fine coordination

Tactile awareness

Cognitive skill and performance in the area of orientation.

Psychosocial skills and performance

Therapeutic adaptations

Orthotics

Prosthetics

Assistive/Adaptive Equipment

Analyze and synthesize evaluation data:

State evaluation findings

Analyze, interpret, and synthesize scores or results of tests and assessments.

State client’s assets and deficits.

Document evaluation data and interpretation
Report evaluation data
Develop recommendations as to the continuation or discontinuation of occupational therapy and/or referral to other types of service.

4. Summarize, record & report own evaluation data to OTR supervisor.

5. Report evaluation data as determined by OTR
6. Make recommendations to the OTR supervisor as to the continuati­on or discontinuation of occupational therapy services and/or referral to other type of service.

III. Program Planning: Planning refers to the identification of achievable program goals and the methods to those goals

Develop long- and short-term goals (in collaboration with client, family, and significant others) to develop, improve, and/or restore the performance of necessary functions; compensate for dysfunction; and/or minimize debilitation, in the areas of: (refer to areas in Section II.B.1 for specifics in each area)

Independent living/daily living skills and perf­ormance.

Sensorimotor skills and performance

Cognitive skills and performance

Psychosocial skills and performance.

Refer client to experienced OTR for specialized evaluat­ion and services. Examples of specialized eval­uations are employment preparation, evaluation (prevo­cational testing), sensory integration evaluation, prosth­etic evaluation, driver’s training evaluations.

Select occupational therapy techniques, media, and determine sequence of activities to attain goals in all areas.

Analyze components which make up tasks and activities.

Adapt techniques/media to meet need, capacities and roles of the client.

Discuss occupational therapy goals and methods with client, family, significant others & other staff.

Document & report program plans.

Coordinate the program with staff and other services.

Determine point of termination



Assist OTR with the development of long-and short-term goals (in collaboration with client, family, & significant others) to develop, improve and/or restore the performance of necessary functions; compensate for dysfunctions; and/or minimize debilitation, in the areas of:

1. Independent living/daily living skills & perfor­mance.

Sensorimotor skills & performance in the following areas:

Gross & fine coordination

Strength & endurance

Range of motion

Tactile awareness

Cognitive skills & performance

Psychosocial skills & performance
Assist OTR in selecting occupational therapy techniques, media, and in determining sequence of activities to attain goals in areas designated above:
Analyze activities in the following areas:

Relevance to client’s interests & abilities

Major motor processes

Complexity

Steps involved

Extent to which it can be modified or adapted

Adapt techniques/media, under the superv. Of OTR, to meet client needs.

Discuss occupational therapy program goals and methods with clients, family, significant others and staff

Document and report program plan as directed by OTR.