Occupational therapy programs tables of content



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Prevention refers to skill and performance in minimizing debilitation. It may include programs for persons where predisposition to disability exists, as well as for those who have already incurred and disability. This includes but is not limited to:
Energy Conservation refers to skill and performance in applying energy-saving procedures, activity restriction, work simplification, time management, and/or organization of the environment to minimize energy output.
Joint protection/body mechanics refers to skill and performance in applying principles or procedures to minimize stress on joints. Proce­dures may include the use of proper body mechanics, avoidance of static or deforming postures, and/or avoidance of excessive weight bearing.
Positioning refers to skill and performance in the placement of a body part in alignment to promote optimal functioning.
Coordination of daily living activities refers to skill and performance in selecting and coordinating activities of self-care, work, play/leisure, and rest to promote optimal performance of daily life tasks.
Reassessment refers to the process of obtaining and interpreting data necessary for updating treatment plans and goals. This frequently involves administering only portions of the initial evaluation, documenting results, and/or revising treatment.
Development of standards of quality treatment service refers to the development, implementation, evaluation, and documentation of departmental policy and procedures for the purpose of assuring standardized and quality treatment. This policy includes but is not limited to those procedures governing standards of occupational therapy practice, health and safety, infection control, and ethical behavior.
Chart audit refers to the evaluation of documentation based on criteria developed within the facility, the profession, Health Systems Agency (Health Planning Act), and/or Professional Standards Review Organizations for a specified geographical area.
Occupational therapy care review refers to the ongoing evaluation and documentation of the quality of care givers. Three review programs may be included in the care review process: preadmission screening, concurrent review and retrospective studies.
Inservice education refers to the participation of regularly employed occupational therapy personnel (e.g., OTR, COTA, OT Aide, or OT orderly) in regularly scheduled classes, in-house seminars, and special training sessions, either in or outside the facility.
Accrediting reviews refer to those activities that are necessary to routinely document the meeting of the standards of a recognized accrediting body such as State Department of Health, Joint Commiss­ion on the Accreditation of Hospitals, Commission on Accreditation of Rehabilitation Facilities; or other accreditation procedures, voluntary on mandated by state or local law, and/or by the administration of a particular institution.


ROLE DELINEATION GLOSSARY
1. structured assessment: an assessment instrument or form that is constructed and organized to provide guidelines for content and process of the assessment; e.g., Interest Inventory.


standardized assessment: an assessment that provides for measurement against a criterion or norm. The assessment must be done according to the testing protocol; e.g., ROM assessment; Southern California Sensory Integration Tests.
non-standardized assessment: an assessment that provides information but with no precise comparison to a norm; e.g., Social History.
therapeutic activities in occupational therapy: self-care, work, home management, child care, educational, play/leisure, and cultural activities that have been selected and adapted to meet specific occupational therapy goals.
significant others: refers to persons, excluding the individual’s family and health professionals, who have an important relationship to the individual.
OT Program: refers to the delivery of occupational therapy services to a client.
OT Service: refers to the organizational structure and system within which occupational therapy programs are provided.
Level 1 Fieldwork: is that which occurs as an integral part of didactic course of work.

COTA REFERENCES
Early, M. B. (in press). Mental health concepts and techniques for the occupational therapy assistant. New York, NY: Raven Press.
Hirama, H. (1986). Occupational therapy assistant: A primer. Baltimore, MD: Chess Publications.
Ryan, S. E. (Ed.). (1986). The Certified Occupational Therapy Assistant, roles and responsibil­ities. Thorofare, NJ: Slack.
NOTE: Guidelines for Occupational Therapy Services in School Systems Approved by the 1986 Representative Assembly (RA) contains general information on COTAs working in school systems. Available through AOTA Products.
The Commission on Practice (COP) School Systems Task Force has developed a document entitled: The Roles of Occupational Therapist and Occupational Therapy Assistants in Schools approved by the 1987 RA. The document will be available through AOTA Products in September 1987.

GUIDE FOR SUPERVISION OF

OCCUPATIONAL THERAPY PERSONNEL
INTENT:
The intent of this document is to clarify the supervisory relationships and responsibilities between the registered occupational therapist and the certified occupational therapy assistant as applied to the professional practice of occupational therapy. This document is not intended to describe supervision as it relates to general administration. The purpose here is to help promote and maintain the actual practice of occupational therapy through quality supervision.
The American Occupational Therapy Association holds and maintains the principle that those persons not trained and qualified as occupational therapists are not acceptable to supervise occupational therapy practice, although it is recognized that the occupational therapist may be administratively supervised by various professionals (i.e., MD’s, facility administrators, etc.).
Occupational therapy should be practiced in accordance with the established American Occupational Therapy Association Standards of Practice. Refer to the Guide to Classification of Occupational Therapy Personnel, April, 1985, for information related to supervision.


GENERAL PROVISIONS
Quality supervision is a mutual undertaking between the supervisor and the supervisee that fosters growth and development; assures appropriate utilization of training and potential; encourages creativity and innovation; and provides guidance, support, encouragement and respect while working toward the goals of the facility.
Supervision is a process in which two or more people participate in a joint effort to promote, establish, maintain and/or elevate a level of performance and service. The supervisor is responsible for setting, encouraging and evaluating the standard of work performed by the supervisee.
Supervision should be provided in varying types of patterns as determined by the supervising registered occupational therapist in the demands of service (i.e., facility standards, legal guidelines, diagnosis’ served, techniques used, case load). The method should be the one most suitable to the situation. Methods of supervision should be determined prior to the supervisory/supervisee entering into such a relationship and should be periodically reevaluated for effectiveness.
DESCRIPTION OF OCCUPATIONAL THERAPY PERSONNEL
The Occupational Therapist. Registered must:
be a graduate of an accredited occupational therapist educational program and have successfully completed the therapist level of field work requirements as stipulated in the Essentials of An Accredited Educational Program for the Occupa­tional Therapist.

have successfully completed the Certification Examination for Occupational Therapist, Registered, and

have paid the AOTA certification and registration fee for Occupational Therapist, Registered.


The ENTRY O.T.R. has less than one year of experience, and

the EXPERIENCED O.T.R. has more than one year of experience.


The Occupational Therapy Assistant must:


be a graduate of an AOTA approved occupational therapy assistant educational program and have successfully completed the field work requirement as stipulated in the Essentials of an Approved Program for the Occupational Therapy Assistant,

have successfully completed the Certification Examination for Occupational Therapy Assistant (new requirement for occupational therapy assistants completing academic and field work requirements after October 31, 1976), and­

have paid the AOTA certification and registration fee for Certified Occupational Therapy Assistant.


The ENTRY C.O.T.A. has less than one year of experience, and

the EXPERIENCED C.O.T.A. has more than one year of experience

The Occupational Therapy Aide is trained through apprenticeship or inservice assignments.


PATTERNS OF SUPERVISION OF OCCUPATIONAL THERAPY PRACTICE


PERSONNEL

IS SUPERVISED BY

SUPERVISES

Entry Level OTR

May not be required*

Experienced OTR



OT aide; COTA; volunteers; Level I Fieldwork Students

Entry Level COTA

Entry OTR

Experienced OTR

Experienced COTA


OT aide; volunteers

Experienced OTR

May not be required*

Experienced OTR



COTA’s; aides, students, OTRs; volunteers­

Experienced COTA

Experienced OTR

Entry COTA



COTAs, aides, volunteers, OTA students (general supervision)

*Entry level OTRs are certified for general practice and are able to independently provide services. The entry level OTR is encouraged to pursue continuing education, consultation and other collaborative activities in their professional roles.


TYPES OF SUPERVISION
Close supervision requires daily, direct contact on site.
General supervision in which frequency of contact is less than daily. Frequency and manner of contact is determined by the supervising OTR, with on-site contact occurring at least monthly. Interim supervision should occur in some manner (example - via telephone, written report, group conference).

Roles and Functions Papers


Entry-Level Role Delineation for

Registered Occupational Therapists

(OTRs) and Certified Occupational

Therapy Assistants (COTAs)

Preamble

The American Occupational Therapy Association, Inc. (AOTA) has the responsibility to define entry-level practice as it projects and represents ideal service provisions.


This document describes ideal entry-level practice, unlike a role-analysis, which describes current practice. An entry-level role delineation should be used as a guideline for typical entry-level practice and should not be considered a scope of practice statement. By definition, entry-level is less than 1 year of practice.
Any health care profession must periodically exam­ine the way it describes entry-level practice. The last role delineation was adopted by the Represen­tative Assembly in March, 1981. Rapidly changing health care environments. Essentials (AOTA, 1983/1989c, 1983/1989d) revisions, and changes in health care provision resulted in the decision to review, revise, and update the 1981 document.
This document reflects the increasing importance of values, attitudes, research, and ethics as impor­tant practice components. The increase in specifi­city of task between this document and the 1981 document is a response to multiple requests for a more graphic picture of the expectations of entry-level OTRs and COTAs. As assessment tools, therapeutic intervention techniques and work settings change rapidly. Tasks are stated generically and are meant to apply to all areas of clinical pract­ice.
Although successful completion of the American Occupational Therapy Certification Board’s Certifi­cation Exam permits the new OTR access to inde­pendent practice (with regulation, as required), guidelines are given on entry-level OTR supervision and service competency as necessary. It is considered the professional responsibility and therefore a component of practice of the OTR to seek this supervision according to principles of ethics and clinical judgment. Supervision of the COTA by an OTR is required professionally and legally. Although the level of this supervision may vary in individual cases and settings, guidelines are also given for COTA supervision and service competency. These guidelines were established to provide support for individuals requesting supervis­ion, for individuals providing supervision, and as guidance to employers regarding staffing patterns.
This description of entry-level COTA and OTR practice can be used by regulatory boards, emplo­yers, educators, and practitioners. It is the intent that this document be used to develop job descript­ions, guide curriculum development and revision, develop fieldwork objectives, and as a self-asses­sment tool for individuals entering or returning to practice.
As demands of the health care system continue to change, so will expectations of entry-level practiti­oners. Periodic review and updates of this entry-level role delineation are essential and will occur on a regular basis.
1. Purpose
This document provides a description of ENTRY-LEVEL PRACTICE. The contents of this document are not to be construed as entirely original, but represent a compilation of resource materials and professional judgment. Application is intended as a foundation for practice and education enviro­nments. REGULATORY AND REIMBURSEMENT SOURCES MUST BE TAKEN INTO CONSIDER­ATION WHEN USING THIS DOCUMENT.


2. Introduction
A. Definition of Occupational Therapy

Occupational therapy is the use of purposeful activ­ity with individuals who are limited by physical injury or illness, psychosocial dysfunction, develop­mental or learning disabilities, poverty and cultural differences, or the aging process, in order to maximize independence, prevent disability, and maintain health. The practice encompasses eval­uation, treatment, and consultation. Specific occu­pational therapy services include teaching daily living skills; developing perceptual motor skills and sensory integrative functioning; developing play skills and prevocational and leisure capacities; designating, fabricating or applying selected orthot­ic and prosthetic devices or selective adaptive equipment; using specifically designed crafts and exercises to enhance functional performance; administering and interpreting tests such as manual muscle testing and range of motion; and adapt­ing environments for persons with handicaps. These services are provided individually, in groups, or through social systems (AOTA, 1981/1989a).


B. Definition of Entry-Level Practice

Entry-level OTRs and COTAs are persons with less than 1 year of experience (AOTA, 1981/1989­b).


C. Levels of Practice

The OTR and COTA have important but distinct roles in the practice setting. In addition to respons­ibility to the consumer, both have a responsibility to each other as the service provision process is carried out. The OTR is responsible for all facets of the occupational therapy process and, therefore, professionally supervises the COTA’s activity. Both the OTR and the COTA are responsible for performing work within their established levels of competence. Through the communication process, they share mutual responsibility for clarifying competencies and responsibilities (AOTA, 1987).


It is highly recommended that the entry-level OTR practice in a setting in which supervision is provided by an experienced OTR. In this situation, the OTR is able to obtain consultation and guidance as experience is gained. In certain situations, the OTR may be required to establish service compet­ency in more complex aspects of the service provi­sion process. Depending on prior preparation and experience, these may include assessment and treatment interventions related to such areas as prosthetics, sensory integration, augmented communication devices, or management and supe­rvisory functions. It is the OTR’s responsibility to practice in an environment which she or he is competent or has immediate access to guidance from an experienced OTR.
It is also highly recommended that entry-level COTAs practice in a setting in which they may obtain close supervision as they gain experience in testing and treatment and demonstrate service competency in more complex areas. Initially, the COTA may contribute to the occupational therapy process and, after establishing service competency, may take full responsibility for some compo­nents of the service provision process. It is prefer­able that the entry-level COTA be supervised by an experienced COTA under the direction of the OTR. If an entry-level COTA or experienced COTA pract­ices in a setting in which supervision is provided by an entry-level OTR, this OTR must use sound professional judgment in obtaining consultation on delegation of responsibility, establishment of service competency, or provision of supervision as dictated by the setting, specific treatment situation, or COTA’s experience level.
3. Supervision

Supervision is a process in which two or more people participate in a joint effort to promote, esta­blish, maintain, or elevate a level of performance and service. The supervisor is responsible for setting, encouraging, and evaluating the standard of work performed by the supervisee (AOTA,

1987­).
Quality supervision is a mutual undertaking between the supervisor and the supervisee that fosters growth and development; ensures the appropr­iate use of training and potential; encourages creativity and innovation; and provides guida­nce, support, encouragement, and respect, there­by promoting the goals of the individual and the facility.
In a setting in which both the COTA and an OTR are employed, the OTR and the COTA must cooperate in order to provide the best service. Admin­istrative and service supervision of the OTR and COTA may differ, depending on the employment pattern used. When an agency is contracting services, it is usually responsible for supervising the personnel providing therapy services. Supervision procedures should be carefully coordinated between the agency contracting for therapy services and the agency providing the personnel.

­

When OTRs and COTAs are employed directly by the agency, supervision is determined by the administrative structure of the agency. In this situ­ation, supervision falls into two categories; admini­strative supervision and service supervision.


Department managers, agency administrator, or other supervisory personnel can perform administrative­ supervision of the OTR and the COTA. The OTR and the COTA are accountable to these persons for such things as work assignm­ent, work schedule, payroll, sick leave and vacation, and permission to attend in-service meetings and conferences. These persons are also respon­sible for the OTR’s and COTA’s annual performance evaluations. The OTR contributes to the evaluation of the COTA by sharing with the admin­istrator specific information regarding the COTA’s overall job performance and effectiveness in carry­ing out therapy goals.
An OTR carries out service supervision. An exper­ienced OTR should supervise an entry-level OTR, which is the preferable situation for the beginning therapist. Although a COTA is typically supervised by an OTR, if regulations permit, an experienced COTA may supervise an entry-level COTA. This occurs under the direction of an OTR after the supervising OTR has ensured service and job competencies. The OTR, however, has ultimate overall responsibility for service performance. The supervising OTR determines levels of supervision based on service needs. The supervising OTR should consider the following when identifying supervision levels:


1. Current occupational therapy practice standards and guidelines.

2. Therapy needs within appropriate life environ­ments.

3. Complexity of evaluation and intervention methods used.

4. Proficiencies of the supervisee.

5. Regulations, policies, and procedures of the department or the agency.

6. State laws and regulations.

7. Reimbursement requirements.

Methods of service supervision should be determined before the supervisor and supervisee enter into such a relationship and should be periodically reevaluated for effectiveness.


Two levels of service supervision are identified. Both levels may apply to supervision of the COTA (or the OTR if that situation exists) when that person is providing therapy services. Close supervision requires daily, direct, on-premises contact. Preferably, as part of the process, any note that the COTA enters into permanent records should be co-signed by the OTR. This promotes the acquisit­ion of knowledge and skills specific to job require­ments.
Close, general, or no supervision of the OTR is determined by service competency. The experienced OTR and the entry-level OTR together esta­blish levels of supervision. When an entry-level OTR practices independently in an unsupervised setting, it is that therapist’s professional and ethical responsibility to seek consultation as needed.
General supervision of the COTA is used only after service competencies have been determined by the supervising occupational therapist. Contact by the supervising therapist may be less than daily, but should be a minimum of 3 to 5 direct contact hours per week for the full-time COTA; time would be prorated for the part-time COTA. When licensing laws, state regulations, treatment settings, or agencies require more stringent standards for supervision, they must be followed. This supervis­ion may be a combination of record reviews, obse­rvations of interventions, informal or formal meetings, or shared assessments and interventions.
In some circumstances, a COTA may receive both types of supervision based on the level of service competency. In the supervisory process, the OTR must be reachable by telephone. It is recommen­ded that the OTR be in the same geographical area and that there be no more than 1 ½ hours of travel time between the OTR and the COTA. If there are more than 1 ½ hours of travel time betw­een them, a contingency plan for handling emerg­encies shall be established. These guidelines reinforce the fact that the OTR is ultimately respo­nsible for the health and safety of each individual in the provision of the occupational therapy services.

In extenuating circumstances, when the OTR is absent from the job, the COTA may continue carry­ing out established programs for up to 30 calendar days under agency supervision while appropriate occupational therapy supervision is sought, except where regulatory or established guidelines supers­ede this guideline. For an entry-level COTA, it is understood that programs to be continued include routine activities where service competency has been established. Intervention that requires ongo­ing interpretation is discontinued. Prior tot he absence of the OTR, all documentation should be up to date and all intervention plans should be in order.


The supervisor and supervisee have a mutual responsibility to understand each other’s educatio­nal backgrounds and role competencies and resp­onsibilities in order to work effectively as a team. This understanding will help define a base to estab­lish acceptable service competency. Once service competency has been established, the COTA may be able to work under general supervis­ion rather than close supervision (AOTA,

1987).
4. Service Competency


Service competency is the determination, made by various methods, that two people performing the same or equivalent procedures will obtain the same or equivalent results. In test development, this concept is known as interrater reliability. The same concept can be applied to professionals working together in the service provision process. It stems from the assumption that the OTR emplo­ys currently acceptable practices.
When an OTR delegates an assessment or interv­ention task to a COTA, there must be a high degree of confidence that the COTA will obtain the same information or result as the OTR. Service competency is critical in the working relationship between the OTR and the COTA because the OTR is ultimately responsible for the outcomes of all tasks performed in the occupational therapy service provision process. If a high degree of confid­ence cannot be assured, the OTR must question the appropriateness of delegating that task.
In a setting in which an entry-level OTR is supervised by an experienced OTR, service competency may be established in the same manner for more difficult procedures or procedures in which the entry-level OTR has no experience. If an entry-level OTR is working independently without superv­ision, it is highly recommended that an experi­enced OTR be hired on a part-time consultancy basis or that the entry-level OTR establish a mentor relationship with an experienced OTR.
Standards and methods for establishing service competency vary depending on the task. It is more difficult to obtain clinical competency in observations and other techniques that require a variety of parameters to be rated simultaneously. Service competency can be obtained in many ways that are compatible with the service provision process.
Examples of Service Competency
For standardized or criterion-referenced tests that do not require special training courses, both the OTR and the COTA can learn the procedures outl­ined in the manuals. By observation, it can be determined whether the test procedure is being completed in a standardized manner.
For standardized or criterion-referenced tests or for observational recordings, the OTR can administer the test while both the OTR and the COTA indepe­ndently­ score the performance to establish that the scoring results are the same.
Videotaping is another useful tool for establishing service competency. Two OTRs or an OTR and a COTA can watch the same performance, rate the performance independently, and compare findings for agreement. This is a time-effective tool, beca­use videotapes that the experienced practitioner has already prepared and scored can be used to check the skills of the entry-level practitioner; each therapist can schedule the check when it is conve­nient.
When scoring occurs after the testing (e.g., for the Beery Developmental Test of Visual-Motor Integrat­ion [Beery, 1967]), a folder containing test protocols and score sheets can be set up. Each person can score the test protocol independently. Results can then be compared and agreement tabulated.
When service competency must be established for intervention procedure
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