Collaboration Between the Occupational Therapist and the Occupational Therapy Assistant

Donna Costa, DHS, OTR/L, FAOTA Brenda K. Lyman, OTR/LBarbara Kloetzke, BS, COTA/L

UOTA ANNUAL CONFERENCE – September 22, 2012

Outline:

Introductions Collaborations Student U of U and SLCC collaborations AOTA supervision guidelines Utah DOPL OT Practice Act Questions and comments from audience Evidence OTA admission requirements

& curriculum OT admission requirements

& curriculum

Two Levels of Practice in the Occupational Therapy Profession

Registered occupational therapist MS or OTD entry level

Certified occupational therapy assistant AAS entry level

Requires collaboration and working together

What Is Collaboration?

“ to work jointly with others or together especially in an intellectual endeavor

“ to cooperate with or willingly assist an enemy of one's country and especially an occupying force

“ to cooperate with an agency or instrumentality with which one is not immediately connected”▪ (Merriam-Webster)

Collaborative Practice Means…

“Key characteristics of collaborative practice are similar to those of effective teamwork and include: a common purpose, professional competence, interpersonal skills, trust and respect, shared decision-making, and, a shared value of interdependence.”

▪ (Jung, Salvatori, & Martin, 2008)

Student Collaborations

In-classroom case studies

CarFit technician training and service project at the Salt Lake County Senior Expo

Ukraine OT service mission

Frank Kronenberg lecture on social justice and book signing

UOTA fall conference

volunteer projects

How does Collaboration Work in the Clinical Setting?

Collaboration Team approach Partnership▪ Communication▪ Trust▪ Competencies▪ Knowledge base

Cooperation Implies a hierarchy Supervision▪ Giving instructions▪ Getting instructions▪ Understanding roles

and responsibilities

Types of Communication

Communication between OT practitioners is essential to best practice and teamwork Vital to ensure reimbursement Vital to meet licensing requirements Completed in various ways▪ May depend on the experience /competence

of the practitioner

A Must Read:

Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (AOTA, 2009)

http://www.aota.org/practitioners/official/guidelines/36202.aspx?ft=.pdf

Supervision Guidelines

Guidelines set by AOTA AOTA Supervision guidelines

designed to: Provide a definition Outline parameters Assist in providing effective services(AOTA, 2009)

State licensing or reimbursement agencies supersede AOTA guidelines

From the AOTA Supervision Document:

“3. The occupational therapy assistant delivers occupational therapy services under the supervision of and in partnership with the occupational therapist.

“4. It is the responsibility of the occupational therapist to determine when to delegate responsibilities to an occupational therapy assistant. It is the responsibility of the occupational therapy assistant who performs the delegated responsibilities to demonstrate service competency.

“5. The occupational therapist and the occupational therapy assistant demonstrate and document service competency for clinical reasoning and judgment during the service delivery process as well as for the performance of specific techniques, assessments, and intervention methods used.” (AOTA, 2009)

What Is Service Competency?

"Service competency" of an occupational therapy assistant in performing evaluation tasks means the ability of an occupational therapy assistant to obtain the same information as the supervising occupational therapist when evaluating a client's function.

“Service competency of an occupational therapy assistant in performing treatment procedures means the ability of an occupational therapy assistant to perform treatment procedures in a manner such that the outcome, documentation, and follow-up are equivalent to that which would have been achieved had the supervising occupational therapist performed the treatment procedure.

“Service competency of an occupational therapist means the ability of an occupational therapist to consistently perform an assessment task or intervention procedure with the level of skill recognized as satisfactory within the appropriate acceptable prevailing practice of occupational therapy.” (MN OT Statutes)

From the AOTA Supervision Document:

“Evaluation 1. The occupational therapist directs the evaluation process. 2. The occupational therapist is responsible for directing all

aspects of the initial contact during the occupational therapy evaluation, including f. Determining specific assessment tasks that can be delegated

to the occupational therapy assistant. 3. The occupational therapist initiates and directs the evaluation,

interprets the data, and develops the intervention plan. 4. The occupational therapy assistant contributes to the

evaluation process by implementing delegated assessments and by providing verbal and written reports of observations and client capacities to the occupational therapist.

5. The occupational therapist interprets the information provided by the occupational therapy assistant and integrates that information into the evaluation and decision-making process.”

From the AOTA Supervision Document:“Intervention Planning 1. The occupational therapist has overall

responsibility for the development of the occupational therapy intervention plan.

2. The occupational therapist and the occupational therapy assistant collaborate with the client to develop the plan.

3. The occupational therapy assistant is responsible for being knowledgeable about evaluation results and for providing input into the intervention plan, based on client needs and priorities.”

From the AOTA Supervision Document:

“Intervention Implementation 1. The occupational therapist has overall responsibility

for implementing the intervention. 2. When delegating aspects of the occupational therapy

intervention to the occupational therapy assistant, the occupational therapist is responsible for providing appropriate supervision.

3. The occupational therapy assistant is responsible for being knowledgeable about the client’s occupational therapy goals.

4. The occupational therapy assistant selects, implements, and makes modifications to therapeutic activities and interventions that are consistent with demonstrated competency levels, client goals, and the requirements of the practice setting.”

From the AOTA Supervision Document:“Intervention Review 1. The occupational therapist is responsible for

determining the need for continuing, modifying, or discontinuing occupational therapy services.

2. The occupational therapy assistant contributes to this process by exchanging information with and providing documentation to the occupational therapist about the client’s responses to and communications during intervention.”

From the AOTA Supervision Document: “Outcome Evaluation: 1. The occupational therapist is responsible for

selecting, measuring, and interpreting outcomes that are related to the client’s ability to engage in occupations.

2. The occupational therapy assistant is responsible for being knowledgeable about the client’s targeted occupational therapy outcomes and for providing information and documentation related to outcome achievement.

3. The occupational therapy assistant may implement outcome measurements and provide needed client discharge resources.”

Utah Licensure Act

All state’s licensure acts supersede AOTA guidelines

Utah’s licensure act very old—prior to both the OTA and OT programs development

Sunset to come in 2015

Utah Statutes:

58-42a-305. Limitation upon occupational therapy services provided by an occupational therapist assistant. (1) An occupational therapist assistant shall

perform occupational therapy services under the supervision of an occupational therapist as set forth in

Section 58-42a-306. (2) (a) An occupational therapist assistant may not

write an individual treatment plan or approve or cosign modifications to a treatment plan.

(b) An occupational therapist assistant may contribute to and maintain a treatment plan.

Utah Statutes: 58-42a-306. Supervision requirements.

The supervising occupational therapist shall perform the following functions:▪ write or contribute to an individual treatment plan;▪ approve and cosign on all modifications to the treatment plan;▪ perform an assessment of the patient before referring the patient to a

supervised occupational therapist assistant for treatment;▪ meet face to face with the supervised occupational therapist assistant as

often as necessary but at least once every two weeks, to adequately provide consultation, advice, training, and direction;

▪ meet with each patient who has been referred to a supervised occupational therapist assistant at least once each month, unless otherwise approved by the division in collaboration with the board, to further assess the patient, evaluate the treatment, & modify the individual's treatment plan;

▪ limit supervision to not more than 2 occupational therapist assistants unless otherwise approved by the division in collaboration with the board;

▪ remain responsible for patient treatment provided by the occupational therapist assistant.

Questions or Comments?. . .

What Does the Literature Say?

Only a total of 8 articles have been written in both the OT and PT literature about intra-professional collaboration between the OT/OTA and PT/PTA

If we expect practitioners to work together, then then they need they need to be educated together!

First Article - Dillon: Thomas Dillon (2001) interviewed OT/OTA teams in PA , OH,

and WV. Dillon said that the essence of the relationship between OTs

& OTAs cannot be learned by reading articles on professional role delineation and supervisory guidelines.

Supervision of OTAs by OTRs is an ongoing process that should mutually enhance the enhance professional growth of each individual; both parties have their own set of responsibilities.

Themes that emerged in this study included the necessity of effective two-way communication, the need for mutual respect, and the importance of professionalism.

First Article – Dillon (cont.):

“Both OTRs and COTAs expressed that effective intra-professional relationships enhance the quality of occupational therapy services provided and strengthen their desire to practice in the field.” ▪ (Dillon, 2001, p. 1)

Second Article - Scheerer:

Carol Scheerer (2001) described a partnering model used in Ohio between an OT and OTA program in the classroom. “Partnering between the OT/OTA team needs

to become a habit so that future practitioners can use it as part of their daily occupation. To develop this partnership, practice needs to be embedded in the educational curriculum of future occupational therapy practitioners.”

Second Article – Scheerer (cont.):

Scheerer paired students from an OT and OTA programs in a series of classroom learning activities.

The first sessions involved learning about each other’s curriculum, role delineation, and then applied the AOTA Standards of Practice to a hypothetical case

The second set of sessions focused on working on cases together in OTS/OTAS pairs, and then used a Scattergories game format to identify one-word descriptors of an “ideal” OT/OTA relationship.

Second Article – Scheerer (cont.):

In the third and final set of sessions, OT and OTA students were assigned to work as team to complete joint assignments related to a group process course.

Later, they worked together as a collaborative research team, with the OTA students serving as research assistants to the OT students.

All students reported benefitting from the hands-on learning

“Practicing interaction, teamwork, and collaboration as students should provide a lifetime habit of partnering as practitioners.” (Scheerer, 2001, p. 204)

Third Article – Jung et al, 2008:

Jung, Salvatori, & Martin from Canada described a fieldwork study in which 7 pairs of OTS and OTAS were jointly assigned to FW placements. “Student participants all agreed that

working together in a clinical setting not only enhanced their understanding of each other’s roles., including similarities and differences, but also fostered the development of competence and confidence in one’s own skills and abilities as well as one’s partner.” (Jung, Salvatori, & Martin, 2008, p. 48)

Third Article – Jung et al, 2008 (cont.): “Pairing OT and OTA students in collaborative

fieldwork placements…has not been common practice. Nevertheless, there is increasing evidence that such collaborative learning experiences can generate positive learning outcomes that include :

(a) learning about the roles of OTs and OTAs, (b) emulating real world practice by pairing

student OTs and student OTAs to provide client care, and

(c) expanding opportunities for collaboration and teamwork” (Jung et al, 2008, p. 43)

Third Article – Jung et al, 2008 (cont.):

The students in this study reported that they learned the importance of developing a working relationship through shared learning, effective communication, and mutual trust and respect.

“Through understanding each other’s roles and effective communication there emerged a sense of teamwork and genuine interest in collaborating on a comprehensive client plan that ultimately complemented the delivery of occupational therapy services.”▪ Jung et al, 2008, p. 48)

Fourth Article Jung et al, 2002:

Jung, Sainsbury, Grum, Wilkins, & Tryssenar from Canada (2002) reported on a joint clinical learning experience. “The strength of this collaborative model

included: Allowing students to learn

about the roles of OTs and OTAs Emulating real world practice

by pairing the student OTs and student OTAs to work together to provide client care.” (p. 96)

Fourth Article Jung et al, 2002 (cont.):

“The importance of collaborative learning which included ideas about partnership and teamwork was evident.

Learning together led to feelings of respect and trust about the different knowledge and skills each brought to the client as well as the different responsibilities each had in the care of the client.” (Jung et al, 2002, p. 99)

Fifth Article – Matthews et al:

Matthews, Smith, Hussey, & Plack (2010) reported on a 4 week joint placement between PTs & PTAs in NC & SC They noted ongoing “misperceptions regarding

the roles among both PTs and PTAs that may have impeded a preferred PT-PTA relationship.” (p.50)

Students kept reflective journals and 14 jurors reviewed these for themes

Experience was designed to provide an authentic experience needed to enhance the students knowledge, skills, and attitudes of working together.

Fifth Article – Matthews et al (cont.):

A 2:1 model was used with recommendations: Establish clear expectations of collaboration not

competition Provide structured feedback Develop clear learning contracts Clarify individual student roles Establish ground rules to facilitate the

collaborative learning experience, and, Pair students in the later phases of their

educational preparation so that PT students will fell better prepared to delegate patient care to the PTA

Fifth Article – Matthews et al (cont.): More than 50% of PT surveyed in 1992 reported

that they received no information during their professional education on the role of the PTA.

Consequently, studies done in the 1990s indicated that both PTs and PTAs had erroneous perceptions on their respective roles.

PTs were noted to be either overly restrictive or permissive in working with PTAs .

Similarly, PTAs also varied between being overly restrictive or permissive when interpreting their job roles and responsibilities.

Fifth Article – Matthews et al (cont.): “To facilitate effective teamwork of PT and PTA

practitioners, it may be helpful to not only educate students about the legal and education requirements of each role, but also to provide them with the skills, attitudes, and abilities needed to effectively communicate and interact with each other in clinical practice. Designing an educational experience that pairs PT and PTA students in clinical students in the clinical setting may provide the authentic experience needed to enhance their knowledge, skills, and attitudes.”▪ Matthews, Smith, Hussey, & Plack, 2010, p. 51

Sixth Article – Jelley et al:

Jelley, Larocque, & Patterson (2010) in Canada reported on a pilot study pairing PT and PTA students on a 5 week placement “Unfortunately, PT and PTA students get little or

no experience in working together as a team during their education, despite the fact that in the workforce, PTs and PTAs are expected to practice collaboratively. It should also be noted that a lack of familiarity with scope of practice, significantly reduces the ability to work collaboratively.”

Does this sound familiar?

Sixth Article – Jelley et al (cont.):

“An unexpected benefit reported by participants was the value of learning through the interview process and by writing in journals. This finding is consistent with those of past research, since the reflective journals kept by participants were deemed useful both by participants and researchers in understanding the shared placement experience.”

“A teacher cannot do the learning for a student but can only support and encourage a learner.” (Jelley, Larocque, & Patterson, 2010, p. 76)

Seventh Article - Higgins:

Higgins described her experience with supervising OT and OTA students in MA

“Although collaboration among practitioners is an everyday occurrence, collaboration among students is not. The OT/OTA collaborative model of student education provides opportunities that parallel those in the working environment while promoting positive fieldwork experiences, enhanced clinical reasoning development, and continued personal and professional educational opportunities.” (1998, p. 41)

Eighth Article – Rindflesch et al:

Rindflesch, Dunfee, Cieslak, Eischen, Trenary, Calley & Heinle report on the collaborative model of clinical education used at Mayo Clinic (Rochester, MN) which they have named the Mayo Collaborative Model of Clinical Education (MCMCE)

Used by both OT and PT since 1930 (PT) “The collaborative model does not merely mean that

there is more than 1 student supervised by each clinical instructor. In this model, students collaborate with each other, share learning experiences, adopt the role of teacher in addition to the student role, and take on some of the responsibility for their legal and ethical supervision.” ▪ (2009, p. 133)

Eighth Article – Rindflesch et al (cont.): Students at the Mayo Clinic are asked to teach their

peers about patients and conditions they have encountered and must use evidence-based practice.

When students graduate from their respective programs, they will not likely have a 1:1 mentor.

“The collaborative model encourages students to develop helpful habits that emulates what it will be like for them when they become licensed.” (p. 136)

SLCC OTA Admission Requirements:

MATH QUALIFICATIONS (one of the following) • Accuplacer college level math score of 43 (valid for 1 year) • ACT math score of 23 (valid for 1 year) • MATH 1010 (C grade or better)

ENGLISH QUALIFICATIONS (one of the following) • AP English credit (must be listed on SLCC transcript) • CLEP English credit (must be listed on SLCC Transcript) • ENGL 1010 Introduction to Writing (C grade or better)

HUMAN ANATOMY • BIOL 2320-2325 (B grade or better within the past 5 years)

COMMUNICATIONS • COMM 1010 (C grade or better) Students must complete COMM 1010;

HUMAN GROWTH AND DEVELOPMENT • PSY 1100 (C grade or better)

INTRODUCTION TO OCCUPATIONAL THERAPY • OTA 1020 (B grade or better; can only be taken twice)

RECOMMENDED BUT NOT REQUIRED – MEDICAL ASSISTANT • MA 1100 (C grade or better)

SLCC OTA Admission Requirements:

1. Completed Application Packet for Program. 2. HESI (Health Education Systems, Incorporated) A2 exam. 3. Proof of Immunizations and CPR Health Care Provider

certification with AED, First Aid; must be included with application.

4. Background check through SLCC’s authorized vendor. In addition, it will be the responsibility of the student to contact the licensing board and seek advice regarding eligibility for licensure and requirements needed to progress in this profession, if the criminal background check discloses issues of concern.

5. Complete 25 hours of community service and submit one letter of recommendation.

6. Complete proctored essay after admissions prerequisite courses and the additional admissions criteria are verified.

SLCC OTA Curriculum:

First Year: FALL SEMESTER SPRING SEMESTER Functional Anatomy3 OT Professional Issues 2 Func. Anatomy Lab 1 OT Modalities II Lecture 2 OT Modalities I 2 OT Modalities II Lab 1 OT Modalities I Lab 1 Phys. Dys. II 3 Phys. Dys. Lecture 3 Phys. Dys. II Lab

1 Phys. Dys. Lab 1 Pediatric FW I 2 Phys. Dys. FW I 2 Pediatric/Adol.Lecture 3 OT Domain/Process 2 Pediatric/Adol. Lab

1 Total Credits 15 Total Credits 15

SLCC OTA Curriculum:

Second Year:FALL SEMESTER SPRING SEMESTER OT Prof. Issues II 2 Fieldwork II 6 OT Modalities III 2 Fieldwork II 6 OT Modalities II Lab 1 Psychosocial Behavior 3 Total Credits 12

Geriatrics 3 Psych/Geri. FW I 2

Total Credits 13 Total Number of Credits in Program 55

U of U Admission Requirements:

Human Development through Lifespan or Developmental Psychology through the Lifespan - 1 lifespan course equivalent. 

Physics or Kinesiology or Biomechanics- one course in general/college physics or physics of the body, kinesiology, or biomechanics with lab preferred

Human Anatomy with lab - taken within the past 5 years. Human Physiology - one course.

Anthropology - one course. Abnormal Psychology - one course. Sociology or Health Ed or Special Ed or Gerontology Statistics - one course. Medical Terminology - one course. Studio Arts Course - one course in an area of arts or crafts

(painting, pottery, knitting, woodworking, etc).  50 hours of observation of an occupational therapist in 2

different settings GPA of at least 3.0 on a 4.0 point scale.

U of U Admission Requirements:

Required tests GRE - Graduate Record Examination

Must be taken so those scores are available to the Division by the admissions deadline of the year of application.  GRE test scores are only valid for 5 years.

Primary consideration will be given to applicants with an analytical writing score of 3.5 or higher. 

English Proficiency TOEFL ▪ Students must achieve a score of at least  90-91 (Internet

based) or 575 (paper based) or 233 (computer based) on the TOEFL if English is not the first language. 

IELTS ▪ Students must achieve a score of at least 7.0 on the IELTS if

English is not the first language.

U of U Curriculum: FIRST YEAR - FOUNDATIONS - Total No. Of Credits =

42 5030 The Body as a Component of Occupation 5060 Conditions That Impact Occupation 6010 History & Foundations of OT 5090 Neuroanatomy 6020 Occupation: Group and Communication 6030 Occupational Performance & Psychosocial Issues 5000/6000 Research in OT 6800 Professional Seminar I 6040 Creative Occupations & Analysis 6050 Developing OT in the Community 6060 Foundational Theories in OT 6820 Professional Seminar II

U of U Curriculum: SECOND YEAR – AREAS OF PRACTICE (Credits = 44)

6120 Occupation & Practice (Pediatric)-Theory I 6140 Occupation & Practice (Pediatric)-Skills I 6160 Occupation & Practice (Pediatric)-Evaluation 6830 Professional Seminar III 6920 Applied Research 6220 Occupation & Practice (Adult)-Theory II 6240 Occupation & Practice (Adult)-Skills II 6260 Occupation & Practice -Evaluation II 6840 Professional Seminar IV 6940 Directed Research Elective 6400 Fieldwork II

U of U Curriculum:

THIRD YEAR – (Total No. of Credits = 26) 6320 Technology as Part of Occupation 6340 Occupational Aging & Wellness 6700 Leadership & Mgmt in Practice 6960 OT Grad Project 6850 Professional Seminar V Elective 6440 Fieldwork II

Total Number of Credits in Program = 112

U of U Electives:

6350 Disability Studies 6500 Family Perspectives on Early Intervention 6520 Occupation/Adult Neuro Rehab 6530 Cognition 6540 Mind-Body Interventions in Health & Wellness 6720 Immigration & Resettlement 6730 Thai/Burma Study Abroad 6860 Disability Studies Forum 6930 Special Topics: Experiential Learning in Ukraine 6950 Independent Study 6970 Clinical Problems 6980 Special Workshops

References:

Dillon, T. (2001). Practitioner perspectives: Effective intraprofessional relationships in occupational therapy. Occupational Therapy in Health Care, 14 (3/4), 1-15.

Matthews, H., Smith, S., Hussey, J., & Plack, M. (2010). Investigation of the preferred PT-PTA relationship in a 2:1 clinical education model. Journal of Physical Therapy Education, 24 (3), 50-61.

Scheerer, C. (2001). The partnering model: Occupational therapy assistance and occupational therapy students working together. Occupational Therapy in Health Care, 15 (1/2), 193-208.

Cohn, E., Dooley, N., & Simmons, L. (2001). Collaborative learning applied to fieldwork education. Occupational Therapy in Health Care, 15 (1/2), 69-83.

References:

Jung, B., Salvatori, P., & Martin, A. (2008). Intraprofessional fieldwork education: Occupational therapy and occupational therapist assistant students learning together. Canadian Journal of Occupational Therapy, 75 (1), 42-50.

Jung, B., Grum, R., Wilkins, S., & Tryssenar, J. (2002). Collaborative fieldwork education with student occupational therapists and student occupational therapy assistants. Canadian Journal of Occupational Therapy, 69, 95-103.

Jelley, W., Larocque, N., & Patterson, S. (2010). Intradisciplinary clinical education for physiotherapists and physiotherapist assistants: A pilot study. Physiotherapy Canada, 62, 75-80.

References:

AOTA, 2010. Accreditation Council for Occupational Therapy Education (ACOTE) Standards and Interpretive Guidelines.

AOTA, 2009. Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services.

AOTA, 2007. The Importance of Occupational Therapy Assistant Education to the Profession.