Trinity Washington University

Master of Occupational Therapy

Fieldwork Manual

2016-2017

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TABLE OF CONTENTS

I. SECTION I: MASTER OF OCCUPATIONAL THERAPY CURRICULUM

i. Fieldwork Overview……………………………………………4

ii. Trinity Mission…………………………………………………5

iii. Trinity Philosophy……………………………………………...5

iv. Course Sequence and Descriptions…………………………….6

II. SECTION III: FIELDWORK POLICIES AND PROCEDURES

i. Contract/Site Selection Process………………………………...9

ii. Student Assignment Process…………………………………..10

iii. Communication………………………………………………..12

iv. Placement Conflict Statement…………………………………12

v. Special Accommodations……………………………………...13

III. ROLES AND RESPONSIBILITIES

i. Academic Institution/AFWC…………………………………..13

ii. Clinical Facilities and Fieldwork Educators…………………...14

iii. Students Responsibilities………………………………………15

iv. Medical Requirements…………………………………………16

v. Criminal Background Check and Drug Screen………………..16

vi. Liability Insurance……………………………………………..17

vii. Maintaining Confidentiality – HIPAA………………………...17

viii. Dress Code……………………………………………………..18

ix. Contacting the Site……………………………………………..19

V. SECTION V: FIELDWORK LEVEL I

i. Description……………………………………………………..17

ii. Hours and Requirements……………………………………….19

iii. Student Learning Objectives…………………………………...20

iv. Grading and Evaluations……………………………………….20

v. Attendance Policies…………………………………………….21

vi. Forms…………………………………………………………...22

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VI. SECTION VI: FIELDWORK LEVEL II

i. Description…………………………………………………….21

ii. Hours and Requirement………………………………………..22

iii. Student Learning Objectives…………………………………..22

iv. Grading and Evaluations………………………………………23

v. Attendance Policies……………………………………………24

vi. Forms…………………………………………………………..25

vii. Procedures for Students at Risk for Failure……………………25

VII. APPENDICIES

i. Definition of Terms and Abbreviations

ii. Student Acknowledgement Form

iii. Level I Student Data and Preference Form

iv. Level I Student Fieldwork Performance Evaluation

v. Level I Fieldwork Timesheet

vi. Level I Student Evaluation of the Fieldwork Experience

vii. Level II Student Input Form

viii. Personal Data Sheet

ix. AOTA Fieldwork Performance Evaluation for the Occupational Therapy Student

(FWPE)

x. AOTA Student Evaluation of the Fieldwork Experience (SEFWE)

xi. AOTA Fieldwork Data Form (to be completed by site)

xii. Fieldwork Site Criteria Form (to be completed by site)

xiii. Fieldwork Educator AOTA Resources

xiv. Fieldwork Educator Acknowledgement Form

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SECTION I: MASTER OF OCCUPATIONAL THERAPY CURRICULUM

Fieldwork Overview

Fieldwork (FW) experience is a requirement to becoming an occupational therapy practitioner. Students

are provided the opportunity to integrate classroom knowledge and practice OT skills learned in OT lab.

According to the Accreditation Standards for a Master’s-Degree-Level Educational Program for the

Occupational Therapist (ACOTE, 2013):

Fieldwork education is a crucial part of professional preparation and is best integrated as a component

of the curriculum design. Fieldwork experiences should be implemented and evaluated for their

effectiveness by the educational institution. The experience should provide the student with the

opportunity to carry out professional responsibilities under the supervision of a qualified occupational

therapy practitioner serving as a role model. The academic fieldwork coordinator is responsible for the

program’s compliance with fieldwork education requirements (ACOTE, C.1.0).

The fieldwork experience is collaborated between the university and fieldwork site, and is designed to

promote development of clinical reasoning skills, reflective, client-centered practice, and adherence to

ethical standards. Occupational therapy (OT) students are provided with opportunities to apply

theoretical principles attained through didactic coursework, to clinical practice through observation,

practice of assessment and intervention, under the supervision of a qualified occupational therapy

practitioner.

Fieldwork placements provide opportunities to interact with clients, families and professionals in diverse

practice settings. Through instruction, feedback, and hands-on participation in the occupational therapy

process, students gain the skills necessary to address the occupational needs of clients and develop into

the role of occupational therapy practitioner.

The Trinity MOT program recognizes the important role that fieldwork and related clinical experiences

play in the education of occupational therapists. Trinity’s MOT program requires 69 graduate credits

and involves five semesters of full-time study, with Level I fieldwork integrated throughout the

curriculum beginning semester two year one. Level I fieldwork supplements classwork through four,

30-hour placements in hospital, rehabilitation, school, and community settings, totaling 120 hours of

Level I Fieldwork.

Upon completion of coursework, students enroll in two 12-week, full-time Level II fieldwork

placements in traditional or emerging practice settings, totaling 480 hours each. Level II fieldwork is a

prerequisite to sit for the National Board for Certification of Occupational Therapy (NBCOT) Exam,

and vital to becoming an occupational therapy practitioner.

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Mission

Trinity Washington University’s Master of Occupational Therapy program aims to develop competent,

caring, and committed generalist practitioners who exemplify core values of respect, justice, and service

that are reflective of the occupational therapy profession and Trinity, and are prepared to meet the

occupational needs of diverse populations in our community. Our blended learning program is

committed to:

Offering high-quality hybrid professional education to a diverse student population

Providing classroom, clinical and community experiences that enrich student learning and

prepare students for current emerging practice settings in their communities

Establishing strong clinical partnership with the local and global community

Vision

As we develop the Master of Occupational Therapy program at Trinity, we envision building a

community of faculty, students and alumni with strong ties to the OTA and health profession programs

at Trinity, and to the community of Washington, DC. We want our program to be recognized for:

The quality of our faculty, program of study, and clinical experiences;

The professional preparation and quality of our graduates; and

Our contributions to promoting access and health through consultation, collaboration, research,

and service.

Philosophy

The Trinity MOT program is designed to meet the missions of the University and the OT program. The

educational goal is to train clinicians who embody the core values of Trinity and the profession of

occupational therapy, and who possess the necessary skills for success in entry-level practice. Educating

future professionals is a complex process, and current models of medical education suggest that

occupational therapy education must combine academic knowledge with training in clinical skills and

professional identity in order to prepare graduates for entry-level practice (Harden, Sowden & Dunn,

1984). The MOT program combines foundational knowledge about occupation, occupational therapy

and biomedical and sociocultural contributors to health and disability, with practical and fieldwork

experiences that develop clinical skill, support evidence-based practice, and build professionalism.

Innovative teaching and professional mentoring support a learning environment to educate strong, caring

clinicians who contribute to the practice and profession of occupational therapy.

Students must be prepared to invest considerable time and effort outside of class, and to participate

actively in classroom discussions, assignments, practicums, simulations and clinical placements.

Students who invest in learning will be challenged to become self-directed learners, reflective and

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critical thinkers and creative problem-solvers, which is the ultimate goal of all graduate and professional

education (Knowles, et al., 1998). These skills and a commitment to lifelong learning are needed for

occupational therapy practice in current practice settings, and will provide the skills needed to expand

occupational therapy into emerging settings and new communities and populations.

Course Sequence and Description

Semester I: Fall Year 1

OTM 520 Foundations of OT Practice

This course introduces students to the core foundations of occupational therapy and occupation-

based practice. Topics include the history of the profession, occupation and occupational science,

and theoretical bases and frames of reference that guide OT practice. Students gain skills in

articulating the domain and roles of the profession and describing the practice of OT as defined in

the OT Practice Framework. The official documents of the AOTA and major OT theories will be

introduced.

OTM 521 Occupational Development Across the Lifespan

This course covers occupational development from infancy to older adulthood. Key developmental

changes in motor, cognitive, social and emotional domains will be examined, and the processes

through which people acquire performance skills, values, roles, and habits will be explored. The role

of the environment in development and the transactional nature of developmental change will be

emphasized. Students will learn to distinguish between normal development and aging, and

pathology, and to articulate the importance of a lifespan perspective to OT practice.

OTM 522 Functional Anatomy and Kinesiology

This course will provide an overview of human clinical anatomy, clinical kinesiology, and

biomechanics as they relate to occupation. Students will study the skeletal and muscular system,

develop an understanding human movement in functional activities and skills, and examine the

impact of musculoskeletal conditions on occupational performance. Observation, palpation and basic

clinical skills will be introduced.

OTM 525 OT Process I: Basic Skills

This practicum course introduces the foundations of professional practice and uses problem-based

learning, group assignments, simulations and discussion to develop and practice key clinical skills,

including observation, activity analysis, clinical reasoning and therapeutic use of self.

Semester II: Spring Year 1

OTM 532 Functional Neuroscience: Sensory-Motor Foundations of Occupation

This course provides an overview of the structures and functions of the central and peripheral

nervous systems with an emphasis on occupational performance, along with the impact of

neurological disease and injury on occupational engagement. Learning experiences include the

application of neuroscience principles to assessment and treatment, and lab experiences with peers

on assessment of impairment and human performance.

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OTM 533 Research to Practice I

This course focuses on the scientific process, the role of research in a profession and the skills

needed to access, read and consume research to inform clinical practice. The concept of evidence-

based practice will be introduced.

OTM 624 Interventions with Adults

This course covers occupational therapy for individuals in early, middle and late adulthood who

have physical disabilities or health problems that interfere with occupational performance. Theories

and frames of reference related to physical dysfunction will be presented, and students will learn to

select, grade and modify treatment activities for clients with a variety of diagnoses and impairments.

Course includes a Level I fieldwork placement in a health facility serving adult clients with

physical disabilities.

OTM 625 OT Process Treatment Planning and Documentation

This practicum course provides opportunities for students to practice key clinical skills, and develop

skill in assessment, treatment planning and implementation and documentation with adult clients.

Course includes problem-based learning assignments and hands-on lab experiences and simulations

with peers.

Semester III: Summer Year 1

OTM 614 Psychosocial/Behavioral Foundations and Interventions

This course covers psychosocial and cognitive aspects of occupational performance, reviews

common behavioral conditions that limit occupational performance, and examine the role of OT with

individuals and groups with cognitive and behavioral disorders. Students learn theories of OT in

mental health and develop skills needed for assessment, intervention and documentation. Traditional

and evidence-based interventions will be presented. Course includes a Level I fieldwork

placement in a mental health facility or community setting. Students will have the opportunity to

observe and participate in the therapeutic process with individuals and/or groups with behavioral

and/or cognitive impairments.

OTM 615 OT Process III

The practicum course covers the use of therapeutic media in treating behavioral disorders. Group

dynamics and principles of group leadership will be introduced. Students will learn and practice

skills used in behavioral health. Problem-based learning, peer activities and simulation will be used

to enhance learning.

Semester IV: Fall Year 2

OTM 534 Pediatric Interventions

This course focuses on OT practice with infants, children and adolescents with health conditions or

disabilities that interfere with occupational performance and/or participation. Students will learn

about common conditions and diseases and develop clinical skills in assessment, intervention, and

documentation. Course includes a Level I fieldwork placement in a pediatric setting. This

fieldwork is designed to enrich the didactic and lab content of the course by providing opportunities

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for observation and participation with pediatric clients, families and professionals in a clinical

setting.

OTM 535 OT Process II

This course will build on the skills introduced in OT Process I. The focus is on developing critical

thinking skills, and applying them to assessment and treatment planning. Standardized and

unstandardized measures and methods will be presented and students will gain practice with selected

assessments. Course includes problem-based learning activities and hands-on and simulation

experiences with peers.

OTM 623 Research to Practice II: EBP

This course continues the process of using research in clinical practice introduced in Research to

Practice I. The focus is on understanding research methodologies (qualitative and quantitative

designs), level of evidence, critiquing studies, and the process of using research to guide clinical

decision-making.

OTM 630 Policy, Advocacy and Ethics

This course introduces federal, state and local regulations that affect healthcare and examines the

effect on occupational therapy practice and access to reimbursement for services. Professional

ethics, professional responsibilities, organizations, and the OT role in advocacy are also explored.

Semester V: Spring Year 2

OTM 620 Administration, Management and Leadership

This course introduces concepts of management and administrative roles, functions and tasks in

healthcare and community settings, and examines the supervisory responsibilities of the OTR to

OTA practitioners. The second half of the course examines topics and issues related to program

development and leadership.

OTM 632 Special Topics in Occupational Therapy II

This series of stand-alone weekend seminars will address specialized topics in adult, pediatric and

mental health practice areas. Content includes use of physical agent modalities, splinting and

cognitive interventions.

OTM 634 Interventions for Participation, Health and Aging

This course provides an overview of occupational therapy with older adults and the growing practice

area of community health and wellness. Content includes age-related changes and their impact on

occupational performance and participation, and the factors associated with productive aging.

Students examine community resources and interventions related to wellness, health and aging in

place, and learn assessment and intervention approaches for elderly clients in a variety of settings.

Course includes a Level I fieldwork placement in a geriatric setting.

OTM 635 OT Process IV: Environments and Technology

This course examines environmental, assistive and rehabilitative technologies that are used by

occupational therapists. Students will learn to assess environmental barriers and design

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environmental modifications to improve occupational performance, and to use technology to allow

clients to access and control their environment and engage in occupation.

Semester VI: Summer Year 2

OTM 691 Level II Fieldwork I

This is the first of two required, 12-week supervised fieldwork experiences. Students work with the

AFWC to arrange placement. By the end of the 12 weeks, students must demonstrate the ability to

evaluate, treat, document and discharge clients as required for entry-level practice in the same or

similar setting. Passing score on the AOTA FW form is required for graduation.

Semester VII: Fall Year 3

OTM 692 Level II Fieldwork 2

The second 12-week supervised fieldwork placements must provide a different experience and/or

setting than OTM 691. Students work with the AFWC to arrange placement. By the end of the 12

weeks, students must demonstrate the ability to evaluate, treat, document and discharge clients as

required for entry-level practice in the same or similar setting. Passing score on the AOTA FW form

is required for graduation.

OTM 694 Professional Seminar V: School to Practice

This course addresses the practical aspects of becoming an entry-level practitioner, including

NBCOT examination preparation, licensure, participation in state, national and international

organizations, and strategies for developing and maintaining professional competence. Students

must complete the NBCOT Exam Prep course and practice exam to complete this course.

SECTION II: FIELDWORK PROCEDURES

Contract/Site Selection Process

In order for a student to be placed at a facility or site for fieldwork, every site must have a current,

signed contract with Trinity Washington University, which includes the MOT program as a student

affiliate. The contract is an agreement that outlines the respective responsibilities of the University and

the fieldwork site. Each contract must be reviewed and signed by the University administrators and by

the fieldwork site’s designated representatives, to reflect a fully executed contract.

The contract process can take 6 months to one year to complete. Unexpected circumstances may further

delay or prevent the contract from being completed. The Occupational Therapy Department cannot

guarantee that a contract being pursued to meet a student’s request will be completed despite the efforts

and timely request of the Academic Fieldwork Coordinator AFWC).

The Occupational Therapy Department evaluates and selects fieldwork sites on a continual basis. Site

selections are based on the site’s ability to effectively meet specific educational objectives, provide

adequate supervision and a variety of experiences, enabling the student to be prepared as an entry-level,

generalist occupational therapist. The selection and monitoring process includes communication and

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discussions via site visit, email and/or phone. The fieldwork site and university share information that

includes a site data form, course syllabi, and fieldwork objectives.

Current fieldwork site agreements are maintained in an electronic database. The AFWC solicits and

requests reservations from facility sites based on the number of students that need to be placed. The

AFWC confirms a current contract and the number of placements that the facility will provide for

Trinity OT students.

Student Assignment Process

The placement process is ongoing, and scheduling with fieldwork sites that have current contracts

occurs year round. All eligible students are encouraged to participate in the selection process by

indicating their interest in a particular setting or site. However, there is NO GUARANTEE that the

student will be placed at a requested or preferred site, as placements are based upon availability.

Requests for placements are made to facilities, which either accept or reject the request. The AFWC has

the final say in placement decisions.

Students may contact facilities to inquire if the site has a student program and is accepting students.

However, all fieldwork sites are considered a resource of Trinity’s OT department, not the individual

student. Therefore, students are not to contact currently or prospectively contracted sites in order

to establish personal fieldwork placement. If a student discovers or has knowledge of a new facility,

in-state or out of state, that may be appropriate for Level I and/or Level II fieldwork placements the

student is to give that information to the AFWC who will make the appropriate contacts to establish a

contract if the site is deemed compatible and able to provide an experience consistent with ACOTE

Standards and Trinity curricular objectives.

Students should be aware that a contractual agreement may takes six months or more to execute. Upon

execution of that agreement, the site becomes a part of the department’s pool of fieldwork sites, and as

such, is open to all students for consideration.

The following criteria are used for assigning students to fieldwork sites:

a) The site ability to provide the student with a different type of setting than they have already

experienced

b) Student request regarding geographical area and setting

c) Interest and compatibility with site

d) Factors of the learning environment such as, whether the student would benefit from a slow

versus fast paced environment

e) Student current cumulative GPA may be used where more than one student is interested in a

site

f) A drawing or lottery may be implemented, where students choose available fieldwork site

names and are given a time frame to trade sites with other students. After which, they must

provide confirmation via email to the AFWC by the specific deadline.

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Students who live out of state/outside of the District of Columbia metropolitan area, and who wish to

return to their home state must submit the name and contact information for facilities in their local area.

The AFWC will contact those sites to inquire about fieldwork opportunities. However, due to a limited

number of available sites outside of the area, students must be flexible, and provide alternative locations

within the Greater DC metropolitan area, and must be prepared to complete their fieldwork experiences

within the DC Metropolitan area. If Trinity Washington University already has a contract with a

fieldwork site that is in a region requested by a student, that site will be used. Students are welcome and

encouraged to review the list of facilities with whom the Trinity MOT program has contractual

agreements. The list of contracted agencies and sites may be found in Moodle under the Master of

Occupational Therapy Student Resource page. Students may contact the AFWC for further information

about sites.

When a student is assigned to a site, the student receives an email with the dates of the fieldwork

experience, location, site contact, and other relevant information. The student is asked to respond to the

email indicating their acceptance of the placement. Students must note that not accepting a placement

could potentially delay or prevent that student from meeting the fieldwork requirements for the

associated course.

Level I Fieldwork Assignment: Trinity’s MOT program incorporates four Level I Fieldwork

experiences into the curriculum. Each fieldwork rotation or experience requires a minimum of 30 hours

per site, totaling a minimum of 120 hours of Level I Fieldwork.

Beginning Semester 1, Year 1: The AFWC will discuss and explain the purpose and types of Level I

fieldwork experiences available. Students complete a Fieldwork Preference Form, indicating preference

in geographical area and site preference, if known. Students must be prepared to complete Level I

fieldwork within the Greater DC Metropolitan Area.

Level II Site Assignment: Students submit their geographical area in Semester 1, Year 1. This

information may be updated as needed.

Beginning Semester 4, Year 2: Students complete a Student Input form indicating geographical area and

interest in settings and sites. All students are required to complete one Level II fieldwork

assignment in an adult physical rehabilitation setting, which may include but are not limited to

inpatient hospitals, outpatient rehabilitation, skilled nursing facilities (SNF), long-term care and assisted

living facilities. Student Input forms are due to the AFWC by September 1 (approximately)

Beginning Semester 5, Year 2: Students participate in a fieldwork meeting to introduce:

o AOTA Level II Fieldwork Evaluation

o AOTA Student Evaluation of Fieldwork Experience

o Student requirements for Level II

o Facility requirements for Level II

o Student/Supervisor Review Form

o Sample Level II Fieldwork Objectives Form

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Once fieldwork sites have been assigned, students will not be allowed to cancel or change sites except in

the event of extenuating or emergency situations. This will require evidence of the emergency and

approval from the AFWC and program director.

In the event that a fieldwork site is cancelled, the AFWC will meet with the student to determine an

alternate plan. Every attempt will be made to place the student in a similar or “like” facility. However,

student placement will be made based on site availability. The student should be aware that this might

result in delayed placement, which could postpone the date of graduation.

Placement Conflict Statement

Students may not be placed in nor participate in fieldwork at any site or under any supervisor which may

be construed as a conflict of interest. This includes, but is not limited to the following:

Any facility in which the student has been an employee within the last five years prior to

beginning level II fieldwork.

Any facility in which the student has prior associations or relationships which include, but are

not limited to, relatives/family members (by blood, marriage or adoption), friends, civic

associations, or employment.

Any facility in which the student or family member(s) have a stake or ownership.

Communication

Trinity’s Occupational Therapy Department is committed to promoting successful fieldwork experiences

by maintaining effective communication with fieldwork educators and students. The department utilizes

formal and informal communication systems to build partnerships with colleagues in the community.

The Academic Fieldwork Coordinator (AFWC) is responsible for both verbal and written

communications with clinical coordinators and educators. There is an ongoing commitment to evaluate

and inform the fieldwork element of the program with collaboration on student objectives and

assignments, clinical visits and through the student evaluation process.

Open and effective communication between the student, FE and AFWC are critical to a successful

fieldwork experience. When feasible, the AFWC will make arrangements for an onsite visit during

Level II experiences. If this is not possible, the AFWC will contact the student’s clinical fieldwork

supervisor via telephone at least once during each Level II Fieldwork experience. The outcome of the

site visit and/or telephone conversation will be documented on the student’s Fieldwork Communication

Form.

Placement Conflict Statement

If a minor concern or issue arises while participating in fieldwork, the student and fieldwork educator

(FE) are encouraged to address it immediately between the two parties. However, the AFWC is

available via email or telephone to assist with problem solving and offer suggestions for alternative

communication strategies. In order to maintain effective and open communication, the student, FE and

AFWC should operate within the following guidelines:

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1. During Level I and Level II Fieldwork, minor concerns or problems should be immediately

addressed between the student and FE.

2. It is imperative that the AFWC be contacted by the student AND FE, about any concerns or

issues that cannot be immediately resolved, or that may affect the student’s successful

completion or passing of the fieldwork experience. The AFWC will assist in resolving the

matter and will take steps to advise the student and/or FE about how to proceed.

3. If the student or FE contacts the AFWC with concerns prior to attempting to work out the issues

with the other party, the AFWC will actively listen, and then direct the student or FE back to the

other party with suggestions for problem solving and/or alternative communication strategies.

4. If the student and/or FE are not satisfied that the issue or concern has been resolved during their

discussion, then the assistance of the AFWC should be requested.

5. The AFWC is available to assist both parties individually or together to think through problems

and concerns, suggest alternative communication techniques, and to develop viable solutions.

In cases where a site visit is possible, the AFWC will be available to meet with the student and the FE at

the fieldwork site. If this is not possible, a telephone or on-line conference between all parties will be

arranged.

Special Accommodations

Student with an identified disability may request reasonable accommodations from a fieldwork

placement facility. Students with a disability need to inform the AFWC well in advance of the need for

accommodations on fieldwork, and the student must also contact Trinity’s Office of Disabilities to

discuss accommodations. Students are not required to inform the facility of their disability. The student

must give express written permission for the AFWC and/or faculty to discuss that student’s disability

with a placement facility or fieldwork educator.

SECTION III: ROLES AND RESPONSIBILITIES

Academic Fieldwork Coordinator (AFWC)

The Academic Fieldwork Coordinator (AFWC) is a full-time employee of the Trinity’s MOT program,

and is responsible for the Level I and Level II Fieldwork process, which includes coordination of

contract agreements and student clinical placements. The AFWC is responsible to:

1. Provide leadership and direction regarding ACOTE Accreditation fieldwork requirements.

2. Initiate and maintain contracts between clinical facilities and the MOT program to ensure that

any placement at a clinical fieldwork site is covered by a legal agreement.

3. Maintain information regarding Trinity courses and fieldwork to be available for students and

clinical instructors to review, as needed.

4. Maintain files of current information on fieldwork facilities annually, and/or when major

changes occur.

5. Establish and maintain relationships with on-site fieldwork educators through email, phone and

visits to fieldwork sites, as possible.

6. Collaborate with fieldwork educators to establish fieldwork parameters, i.e. requirements,

timeframes, and schedule.

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7. Collaborate with fieldwork educators to define measureable objectives for fieldwork education.

8. Schedule students for occupational therapy fieldwork, in collaboration with fieldwork facility,

assigning only students who have satisfactorily met the academic requirements.

9. Collaborate with students and faculty to coordinate placements that best fit each student’s

professional development needs.

10. Document learning outcomes and assessment data.

Clinical Facilities and Fieldwork Educators

The Clinical Coordinator/Fieldwork Coordinator (CC/FC) is an employee or representative of the

facility, designated as the contact person for student placements. This person may or may not oversee

the day-to-day clinical experience of the student.

The Fieldwork Educator (FE) is an employee or representative of the facility, responsible for direct

supervision of the student. The FE is responsible for instructing and training at the fieldwork site in

accordance with the current AOTA and ACOTE standards, educational goals, and policies and

procedures of the facility.

1. Ensure that fieldwork educators have a minimum of one year of experience and meet licensing

requirements of the state in which they practice (required by AOTA)

2. Ensure that fieldwork educators are adequately prepared to supervise a student. Facility will

contact the AFWC for resources as needed.

3. Provide updated information about the facility and education program. This includes philosophy,

purpose, types of clients, assessment measures, treatment theories and techniques, learning

experiences available, measurable objectives, rules and regulations of the facility, and methods

of evaluating students (these are included in the AOTA Data form).

4. Share responsibility to ensure there is a current memorandum of understanding or clinical

affiliation agreement between the facility and the Trinity Washington University MOT

Department.

5. Collaborate with the AFWC in providing site specific objectives related to the Student Fieldwork

Performance Evaluation

6. Provide students with a thorough orientation to the facility including policies and procedures,

rules, regulations, medical requirements, general expectations and channels of communication

for the facility.

7. Communicate fieldwork objectives and assignments as necessary to successfully complete the

fieldwork experience.

8. Provide a learning experience that is progressive in expectation and the level of supervision, as

appropriate.

9. Assign patients/clients appropriate to the student’s level of education and experience

10. Provide regular coaching and instruction to the student to optimize his/her performance. Weekly

formal feedback and goal setting with student is recommended.

11. Evaluate student at midterm. If there is a problem, this should be discussed with the student as

soon as possible, documenting evidence of the problem. This should be forwarded to the

AFWC, along with a plan for addressing areas of concern.

12. Notify the AFWC of serious issues as soon as possible.

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13. Trinity encourages open communication and works with the facility and student to resolve

clinical fieldwork issues. In the event that a student’s performance in relation to patient

treatment is unsatisfactory, and/or the student is unable to function satisfactorily to meet the

measureable objectives of the fieldwork experience, the student’s fieldwork may be terminated

by the facility and/or the occupational therapy department.

14. Upon completion of fieldwork, evaluate student performance using the designated Student

Performance Evaluation. Student performance will be communicated to Trinity Washington

University, Master of Occupational Therapy Program in a timely manner. The fieldwork

educator will submit original forms, appropriately dated and signed according to the timetable

established for that rotation.

Students Responsibilities

Students are expected to be active during the learning process, and have the following responsibilities to:

1. Maintain and show proof of up-to-date immunizations, medical requirements and CPR

certification as outlined by the facility and/or academic program. Students should be prepared to

provide up-to-date personal information as required by the facility (i.e. additional background

check, nicotine and/or drug test, health information, etc.)

2. Demonstrate professional behaviors, which begin in the classroom, and extend to the fieldwork

experience. These professional behaviors include:

a. Regular and prompt attendance

b. Attentiveness and engagement in academic and clinical instruction

c. Professional presentation in attitude and dress

d. Showing respect for peers, instructors, and other professionals

e. Working cooperatively with all persons without bias or prejudice

f. Receiving feedback, and modifying behaviors as a part of the learning process

3. Contact assigned fieldwork sites confirming the date of the fieldwork experience with the

fieldwork educator, according to the timetable established by the academic program. Students

must also confirm all fieldwork site requirements (for example: work schedule, dress code,

medical requirements, parking, etc.).

4. Arrange and maintain own transportation for duration of each fieldwork experience.

5. Adhere to ethical standards of AOTA, the academic institution and the clinical facility which

include but are not limited to:

a. Abide by the legal rights of the client confidentiality according to HIPAA. Students must

respect the confidentiality of privileged information about patient/clients and facility to

family members, friends, or others who should not have access to this information.

b. Maintain appropriate, and professional relationships with clientele

c. Show clients respect and consideration, without bias toward race, creed or gender.

6. Comply with the rules and regulations of the facility assigned. Such regulations may include

dress, behavior, and attendance.

7. Consistently observe universal precautions, infection control procedures and all safety protocols

outlined by AOTA, the fieldwork facility and academic institution.

8. Accept supervision and constructive criticism and maintains flexibility

9. Take initiative for own learning by seeking evidence and asking for assistance as necessary.

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10. Complete assignments on time from the academic program and the clinical/fieldwork site

11. Participates in meetings and professional development opportunities and documents such

experiences

12. Complete accurate evaluations of self, the facility, and the fieldwork experience.

13. Submit midterm and final performance evaluation, Student Evaluation of the Fieldwork

Experience (SEFWE), collaboration forms and assignments to the AFWC.

14. Demonstrate competency by the end of fieldwork experience as evidenced by a passing grade on

the Student Fieldwork Performance Evaluation (FWPE) form.

Medical Requirements

Students are ultimately responsible for keeping the following records current and accessible for use

during fieldwork rotations. Some FW sites require additional certifications or immunizations along with

the below requirements. It is the personal and financial responsibility of the student to ensure

compliance with all fieldwork site health requirements. Information regarding site requirements may be

obtained from the AFWC and should be confirmed with the site during the student’s initial contact with

the fieldwork educator. Students enrolled in the MOT program at Trinity Washington University are

required to present proof of the following requirements via Castlebranch.

Current CPR certification: American Heart Association Basic Life Support for Healthcare

Providers. No fully online courses (renewal every 2 years)

PPD or Tine tuberculin test (annually)

Influenza (annually)

Proof of health insurance (annually)

Physical Exam on University Health Form, which includes (Immunizations)

Immunizations (measles, mumps, rubella, varicella) completed by a doctor and proven

through titer results

Hepatitis B vaccination series or signed declination form

Adult T-Dap (tetanus, diphtheria, and pertussis) vaccination

Polio vaccine

Student Statement of Responsibility

Students must upload all documents into their Castlebranch account via

www.my.castlebranch.com, and maintain a fieldwork binder that includes copies of up-to-date

immunization record, CPR certification, liability and health insurance, and background check.

Students should be prepared to submit these documents to their fieldwork site as requested.

Criminal Background Check & Drug Screen:

A criminal background check will be required prior to Fieldwork I and Fieldwork II

experiences. Students need to go to www.castlebranch.com. Follow the instructions and

input the code specific to Trinity Washington University’s MOT program. Select a method

of payment. Castlebranch.com accepts Visa, MasterCard, and Money order. This background

check will cover national database review, OIG review, and a residency history. If your

17

particular fieldwork site requires additional types of review, please contact the AFWC who

can assist you in the background check process.

State law may require some sites to require an adult/child abuse clearance before students are

allowed into the clinical setting. If required, any associated fees will be the responsibility of

the student.

Liability Insurance:

Liability insurance is required for Level I and Level II Fieldwork Students. Trinity Washington

University carries liability coverage for students participating in fieldwork.

Maintaining Confidentiality – HIPAA Guidelines for Fieldwork students:

According to AOTA the following are guidelines for students participating in Level I and Level II

Fieldwork:

“Per HIPAA guidelines, students cannot report this information in fieldwork assignments such as

case study presentations:

Name

Location – includes anything smaller than the state, such as street address

Dates – all, including date of birth, admission and discharge dates

Telephone numbers

Fax numbers

Electronic email addresses

Social security numbers

Medical record numbers

Health plan beneficiary numbers

Account numbers

Certificate or license numbers

Vehicle identification numbers and license plate numbers

Device identifiers and their serial numbers

Web Universal Resource Locators (URLs)

Internet Protocol (IP) address numbers

Biometric identifiers, including finger and voice prints

Full face photographic images and any comparable images

Any other unique identifying number, characteristic, or code.

For written reports, the following information can be shared:

Age (age 90 and over must be aggregated to prevent the identification of older

individuals)

Race

Ethnicity

Marital status

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Codes (a random code may be used to link cases, as long as the code does not contain, or

is not a derivative of, the person’s social security number, date of birth, phone/fax

numbers, etc.).

Students, as well as therapists, often keep “working files” in their desk. This is still allowed under

HIPAA guidelines, however this information must be locked in a file cabinet when not in use, and must

be shredded when no longer needed.”

HIPPA Guidelines for Fieldwork (2015). Retrieved from http://www.aota.org/Education-

Careers/Fieldwork/Supervision/HIPAA.aspx

Dress Code

For Level I Fieldwork, unless otherwise instructed by the site, students are required to wear the

approved Trinity Washington University OT student polo shirt and black khaki style pants to the

fieldwork site. This is available for purchase at the on-campus bookstore.

For Level II Fieldwork, students follow the professional dress policy of the fieldwork site unless the

student is notified otherwise. Students must be properly and modestly dressed. Cleanliness,

professionalism, tasteful presentation and safety are the primary considerations for your appearance.

1. All clothing should be clean, neat, and unspotted.

2. Perfume/aftershave (if worn) must be mildly scented, not excessive. Any obvious scent has the

potential to be offensive or cause an allergic reaction in a sensitive patient/coworker.

3. Fingernails should be kept clean with filed, smooth edges. Long nails that could gouge a

patient’s skin or that could be broken in the course of work are unacceptable. No brightly

colored, flashy polish/designs or chipped nail polish.

4. Long hair must be tied back during patient care. Front and sides of long hair may be pulled back

if that is sufficient to prevent hair from falling forward.

5. Appropriate leg and foot covering, as deemed by the facility will be worn.

6. Tops should be of opaque fabric (not see-through), fit properly, not too tight or too loose, and

long enough to remain tucked in with movement (i.e. no bare midriffs). T-shirts may not be worn

that convey a casual appearance; they may not have imprinted wording. For men, collared shirts,

and even ties may be appropriate, depending on the setting.

7. Pants should fit properly, loose enough to allow for mobility but not to present a safety hazard by

getting caught in equipment. Denim jeans or comparable jean styles, leggings, shorts, or

skintight stretch pants are typically not acceptable.

8. Skirts and dresses may be worn at appropriate length, not more than 1” above the knee and have

no slits above the knee.

9. Jewelry should be simple and minimal to avoid snagging on patient clothing, scratching patient’s

skin or getting entangled in equipment.

10. Piercings – other than ears – should not be visible while working with clients.

19

Contacting the site

Each student is responsible for contacting the facility to inform them that they will be arriving for Level

I or Level II fieldwork. Students should introduce themselves, and inquire about any documentation to

be completed prior to arriving, dress code, travel and parking, and any further instructions.

Taking on Level I and/or Level II students is a tremendous responsibility. At the end of your fieldwork

experience, it is appropriate to write a letter of “Thanks,” to your clinical instructor to show your

appreciation for their time and dedication.

SECTION IV: FIELDWORK LEVEL I

Description

Trinity Washington University’s Level I fieldwork program is an integral part of the Master of

Occupational Therapy (MOT) curriculum and is consistent with the university philosophy. In addition

to coursework, it includes classroom and community learning experiences designed to introduce

students to the fieldwork experience, to apply knowledge to practice and to develop understanding of the

needs of the client, through directed observation and participation in the occupational therapy process.

Per ACOTE Standards, “The goal of Level I fieldwork is to introduce students to the fieldwork

experience, to apply knowledge to practice, and to develop understanding of the needs of the client,”

(ACOTE, 2011). Level I fieldwork experiences provide the student with opportunities to translate in-

class learning into concrete observation skills, professional behaviors and supervised therapeutic

interactions. During level I fieldwork, students are not expected to develop independent performance,

but to develop observation skills and prepare for participation in Level II fieldwork. The fieldwork

experience may occur within a variety of settings, servicing a variety of populations, including those in

daycare centers, schools, hospice, shelters, and community mental health and rehabilitation centers.

Qualified personnel for supervision of Level I fieldwork include, but are not limited to, occupational

therapy practitioners, and may include psychologists, physician assistants, teachers, social workers,

nurses, and physical therapists (C.1.0).

Level I fieldwork shall be integral to the program’s curriculum design and include experiences designed

to enrich didactic coursework through directed observation and participation in selected aspects of the

occupational therapy process (C.1.8).

Hours and Requirements

Based on the course outline, students begin Fieldwork I in the spring semester of the first year. Students

are assigned to 4 Level I fieldwork practicums, in adult physical rehabilitation, psychosocial, pediatric

and community-based settings. Level I fieldwork is scheduled in one-week concentrated intervals, but

are subject to change based on site and fieldwork educator availability. Students may participate alone

or in pairs at a particular site, and are required to fulfill 30 hours of observation with limited supervised

participation at each fieldwork site, for a total of 120 hours of Level I fieldwork.

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Student Learning Objectives

Level I fieldwork objectives for Trinity MOT students are as follows:

1. Apply the AOTA Code of Ethics and Ethics Standards, Core Values and Attitudes of

Occupational Therapy Practice, and AOTA Standards of Practice in the fieldwork setting.

2. Ensure patient safety and confidentiality, including consistent use of standard precautions,

observance of relevant Health Insurance Portability and Accountability Act (HIPAA)

regulations, and effective patient care skills as appropriate to the setting and scope of

practice.

3. Demonstrate appropriate professional behaviors, including the ability to self-critique

performance and accept feedback from peers, fieldwork supervisors, and course instructors.

4. Identify roles and value of various disciplines of the inter-professional care team in the

delivery of care.

5. Develop comfort and skill in communicating with clients, caregivers and members of the

care team.

6. Demonstrate respect and appreciation for patients, clients and populations with diverse

backgrounds, and consideration of psychological and social factors that influence

engagement in occupation.

7. Demonstrate therapeutic use of self, including the awareness of the affect of one’s

personality, insights, perceptions, and judgments upon interactions with clients and families

in individual and group settings

8. Effectively communicate relevant observations through oral and written means, incorporating

professional terminology.

9. Gather appropriate data from client observation, client/caregiver interviews, other

professionals, and review of client records to understand occupational needs.

10. Demonstrate beginning skills in interpreting evaluation findings to plan and implement

contextually relevant evidence based interventions that utilize occupations and activities to

support individuals’ occupations, performance skills, performance patterns, and environment.

Grading & Evaluations

Level I Fieldwork is an integral component of each of the following courses:

OTM 624 Interventions with Adults (Semester 2)

OTM 614 Psychosocial Interventions (Semester 3)

OTM 524 Pediatric Interventions (Semester 4)

OTM 634 Interventions for Aging (Semester 5)

Grades are issued on a scale of A, B, C, F and are calculated based on a combination of practicum

assignments and evaluation. Students complete assignments and journal entries related to fieldwork

within the associated course. At the end of the fieldwork experience, the fieldwork educator will

document the student’s performance using the Level I evaluation form. The student will also complete

an evaluation of the fieldwork experience, and return this form to the AFWC. The points achieved for

assignments and evaluations will account for 25-33% of the grade in the associated class. Assignments

21

may include a reflective journal, discussion board, intervention plan, AOTA Data Form for a specific

site, or other assignments. A description of assigned coursework can be found in the associated course

syllabus.

The results of the evaluation are discussed with the student, including areas of strength and areas in need

of further development. The overall score on the evaluation form determines the student’s grade for the

fieldwork experience. Students who receive a grade of F in any course will be automatically dismissed

from the program. Students dismissed from the program may reapply after 12 months following the

MOT program dismissal. Reapplication does not guarantee readmission to the program.

Attendance Policy

Attendance for Level I Fieldwork is mandatory. Days and time missed for holidays, inclement weather,

or illness must be made up. Failure to make up this time results in automatic failure of the course.

Emergencies will be handled case by case.

Fieldwork Forms

Fieldwork forms can be obtained from the AFWC or department administrative assistant. Forms will be

provided for use during the fieldwork preparation process, prior to initiation of each FW experience.

Level I Fieldwork Forms include:

Level I Fieldwork Objectives

Level I Objectives Review Form

Student Performance Evaluation

Timesheet

Student Fieldwork Site Evaluation

SECTION V: LEVEL II FIELDWORK

Description

Level II Fieldwork Practicum experience takes place following the completion of didactic coursework,

and is designed as the final stage in the integration of academia and clinical practice. The goal of Level

II fieldwork is to develop competent, entry-level generalist occupational therapy practitioners. This

involves an in-depth experience in delivering occupational therapy services to a variety of clients across

the life span, and in a variety of settings, over a 24-week time period.

Level II fieldwork is designed to promote clinical reasoning skills, to enable ethical and reflective

practice and to develop the student into a competent occupational therapy professional, under the

supervision of a licensed and certified occupational therapist acting as educator and role model.

22

Per ACOTE, Level II students must be supervised by a currently licensed or otherwise regulated

occupational therapist. The therapist must have a minimum of 1 year full-time of practice experience,

after initial certification and be adequately prepared to serve as a fieldwork educator. (C.1.14)

Hours and Requirements

Trinity students begin Level II Fieldwork in Year 2, Semester Six (6), and are required to complete two

Level II Fieldwork experiences in accordance with the Accreditation Council for Occupational Therapy

Education (ACOTE) Standards.

Eligible students must register for the following classes to participate in the Fieldwork II experience:

OTM 691 Level II Fieldwork 1

OTM 692 Level II Fieldwork 2

All students are required to complete their preparation for professional service by spending twelve (12)

weeks full-time in two significantly different clinical settings, for a total of twenty-four (24) weeks, 480

hours of Level II Fieldwork.

Level II fieldwork experiences must be concluded within 24 months following completion of academic

coursework.

Student Learning Objectives

1) Demonstrate entry-level competencies for the particular practice setting by the end of

the fieldwork experience as defined by achieving the minimum passing score or above

on the AOTA Level II Fieldwork Evaluation.

2) Consistently demonstrate integrity, adhering to the AOTA Code of Ethics and fieldwork

site policies and procedures at all times.

3) Implement and practice safety regulations and precautions, anticipating potential

hazards, and exercising sound judgement in regard to safety of self and others during all

fieldwork tasks.

4) Articulate clear and logical rationale for the selection of assessment tools and methods

for the evaluation process.

5) Clearly and confidently articulate the values and beliefs of the OT profession, and assert

the value of occupation as a method and desired outcome of OT to clients, families,

significant others, colleagues, service providers, and the public.

6) Demonstrate competence in evaluation and assessment of clients through appropriate

information gathering, selection and administration of assessment tools, and

interpretation of assessment results.

7) Incorporate and apply evidence from current research, professional literature,

assessments, experience, and expert clinicians to inform practice.

8) Devise and Implement realistic, attainable, functional, appropriate client-centered goals

based on individual needs and strengths.

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9) Demonstrate ability to select, plan and implement appropriate therapeutic

interventions to enhance safety, health and wellness in the participation of valued

occupations.

10) Demonstrate ability to design, implement and modify interventions centered on the

person (including psychological, social and cognitive factors), environment and

occupation, as client-centered care is planned and implemented.

11) Demonstrates awareness and ability to adjust or modify assessment and intervention

procedures based on client needs, behaviors, and cultural factors.

12) Demonstrate clinical reasoning to evaluate and determine the appropriate point in the

therapeutic process to modify treatment and transition clients from one service level or

frequency to the next, based on clinical reasoning and empirical evidence.

13) Submit correct and complete documentation of evaluations and progress notes in a

timely manner, according to the policies and procedures of the fieldwork facility, local,

state, and reimbursement agencies. Documentation must effectively communicate the

need and rationale for occupational therapy services.

14) Demonstrate professionalism and positive work behaviors through timeliness,

preparedness, dependability and maintenance of work site.

15) Demonstrate an active role in the learning process and supervisory relationship by

taking initiative, seeking and responding positively to feedback, modifying behaviors,

taking responsibility for own competence and self-reflection.

16) Demonstrate professionalism and positive work behaviors through verbal and non-

verbal communication with clients, family members, significant others, facility staff,

professionals and the public.

17) Demonstrate respect for diversity, including socio-economic, cultural, spiritual, and

lifestyle choices of others.

18) Demonstrate skill in the delivery and management of OT services including the appropriate use of OT aides, OTAs, collaboration with other team members and management of administrative procedures. 19) Assume a full client caseload, as defined by the fieldwork site, by the end of the fieldwork experience

Grading and Evaluations

Fieldwork grades are assigned by the AFWC, and are issued as a “P”=Pass or “F”=Fail, based on a

combination of the student’s performance on fieldwork, completion of the site evaluation and other

assignments assigned by the Department of Occupational Therapy.

Each Level II experience will be graded using AOTA’s Fieldwork Performance Evaluation for the

Occupational Therapy Student (FWPE) completed by the fieldwork educator at mid-term and at

the end of fieldwork. The student must also evaluate each level II fieldwork site using the Student

Evaluation of the Fieldwork Experience (SEFWE) form.

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A midterm evaluation of the student’s progress is provided by the FE in writing and verbally. The FE

and student sit down to identify and discuss the student’s strengths and weaknesses. Suggestions are

offered so that the student will reach the goal of “entry-level practitioner” by the end of the fieldwork

experience. In the event that the student receives an unsatisfactory grade at midterm, the student and the

Fieldwork Educator will report the grade immediately to the AFWC to identify problem areas and

design a plan to improve the student’s performance during the second half. Evaluation of the student’s

performance must also take place during the final week of fieldwork using the FWPE.

Midterm Passing Grade (P) = 90 or above

Final Passing Grade (P) = 122 or above

At the time of the student’s review, the student will also share the completed SEFWE with the

Fieldwork Educator.

Form Submission: It is required that an original AOTA form be mailed directly to the AFWC in a

sealed envelope with the FE’s signature across the back. However, it is requested that the grading page

also be faxed to the AFWC first so that the deadline for grade entry can be met.

Along with the evaluations, students will be given other assignments by the OT Department, which must

be completed prior to the student receiving a Pass or Fail in the class. Any student who does not

complete all of the assignments will receive an “I”. Students will be given details regarding the

assignments prior to fieldwork in the Syllabus for OTM 691 and OTM 692.

Assignments: Site-specific content and assignments will vary according to site requirements and

population served. Student assignments include participation in discussion boards, site evaluation, and

midterm self-evaluation. A description of assignments can be found in OTM 691 and OTM 692 syllabi.

Attendance Policy

All students are required to complete 12 weeks (480 hours) per Level II placement. Students are

expected to schedule specific days and hours with the Fieldwork Educator, and to comply with the

Fieldwork placement’s attendance policies and procedures for routine workday scheduling and absences.

If the fieldwork site has more stringent make up policies, the student is required to adhere to those.

Students should clarify their facility’s policy for “calling-in” due to illness, and for late arrivals (ex.

“Call your FE in the OT Department 1 hour prior to your expected time of arrival, if you are ill).

Students must also contact the AFWC at the University if they have missed any days at the fieldwork

site. Students need to be aware that there are NO “official” sick days, vacation days or other forms of

leave during the Level II Fieldwork rotations. Any absence for whatever reason MUST be made up

during the fieldwork assignment, which will often mean extending the fieldwork rotation. Make up time

can be coordinated with the fieldwork educator. Prolonged absence for any reason may result in

termination of the fieldwork placement. The AFWC will review the circumstances of the prolonged

absence, and the student may be reassigned based on site and FE availability.

25

Forms for Level II Fieldwork

Fieldwork forms can be obtained from the AFWC or department administrative assistant. Forms will be

provided for use during each FW experience during the fieldwork preparation process prior to initiation

of each FW experience. Level II Fieldwork forms include:

Student Input Form

Personal Data Sheet

Midterm Review Form

Fieldwork Performance Evaluation (FWPE)

Student Evaluation of the Fieldwork Experience (SEFWE)

Procedures for Students at Risk of Failure

In the case that a student is at risk of not meeting the minimum requirements needed to pass a fieldwork

experience at any time, the following procedure should be followed:

Student Responsibilities:

1. Meet with the FE at a specific time to discuss the concerns as soon as possible.

2. Contact Trinity’s AFWC as soon as possible, to make him/her aware of the concerns.

3. If the student does not meet the minimum requirements to pass the Level II Fieldwork

experience at the midterm, the FE may consider writing a performance contract and timeline for

the continuation of the fieldwork (see below). The student is responsible for generating a written

plan for addressing the contract objectives developed by the FE that includes strategies and

timelines for achieving the performance expectations. Copies of these documents should be

provided to the AFWC.

Fieldwork Educator (FE) Responsibilities:

1. Review the evaluation with the student and advise the student that he/she is in danger of

failing/not meeting the minimum requirements needed to pass the fieldwork experience.

2. Notify the AFWC via email and/or telephone as soon as possible.

3. Email a scored copy of the fieldwork evaluation form and any other documentation to the AFWC

prior to or immediately following reviewing the information with the student.

4. Develop a written contract, with timelines of what the student needs to do in order to remediate

the problem behaviors and continue in the fieldwork experience. Email a copy of the contract to

the AFWC.

5. Have the student write an improvement plan for achieving the objectives that include strategies,

an action plan, and time line. Email a copy of the contract to the AFWC.

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References

Accreditation Council for Occupational Therapy Education. (2012). 2011 Accreditation Council for

Occupational Therapy Education (ACOTE) Standards. American Journal of Occupational Therapy, 66,

S6-S74.

American Occupational Therapy Association. (2010). Occupational therapy code of ethics and ethics

standards. American Journal of Occupational Therapy, 64, S17-S26.

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VI. APPENDICES

28

APPENDIX i.

DEFINITION OF TERMS AND ABBREVIATIONS

29

Definition of Terms and Abbreviations

Academic Fieldwork Coordinator (AFWC) – University’s representative responsible for

negotiating contracts and placements

Affiliation Agreements – contractual agreements between Trinity Washington University, The

Trinity Washington University Occupational Therapy Program, and the clinical sites and

facilities. An executed agreement must exist prior to the start of any student’s fieldwork

education experience.

Clinical Coordinator (CC) – the fieldwork site’s representative responsible for negotiating

contracts and placements, and overseeing the student’s experience at the facility. Other common

titles include: Fieldwork Coordinator, Education Coordinator, and Internship Coordinator. The

CC may serve as fieldwork educator (FE)/clinical instructor (CI).

Fieldwork Educator (FE)/(CI) - the fieldwork site’s staff member at the clinical site, assigned to

supervise and provide training to the student. Other common titles include: Clinical Instructor,

Clinical Supervisor, and Student Supervisor. The FE/CI can also serve as the CC.

American Occupational Therapy Association (AOTA) – the organization that professionally represents occupational therapists in setting policy, procedures, standards, and serves as a government liaison. AOTA URL: www.aota.org.

Accreditation Council for Occupational Therapy Education (ACOTE) – the accrediting body that sets forth the standards for Occupational Therapy education programs. ACOTE URL: www.acoteonline.org.

National Board for Certification in Occupational Therapy (NBCOT) – the accrediting agency that provides certification for the occupational therapy profession. NBCOT serves the public interest by developing, administering and continually reviewing a certification process that reflects current standards of competency in occupational therapy practice. NBCOT URL: www.nbcot.org

Fieldwork Data Form (FDF) – an AOTA document utilized to share clinical site demographics (i.e. practice setting, scope of practice, level of supervision, site-specific requirements) with the University. This document may be found at: www.aota.org/~/media/Corporate/Files/.../Forms/FW%20Data%20Form.docx

Fieldwork Performance Evaluation (FPE) – a standardized form approved for use by ACOTE to assess the student performance on Level II Fieldwork at mid-term and at final. The rating scale and score used determines whether a student has successfully completed the Level II Fieldwork experience.

Student Evaluation of the Fieldwork Experience (SEFWE) – a document completed by the student and fieldwork educator, to provide information about the specific fieldwork experience at an affiliating site.

30

Appendix ii.

Student Acknowledgement Form

31

Acknowledgement of Receipt and Review of Trinity

Washington University Occupational Therapy Program

Fieldwork Manual

I, ____________________________________, have read and understand the Fieldwork Policies as

outlined in the Fieldwork Manual. I agree to follow and take responsibility for my actions as outlined in

the Fieldwork Manual.

If I choose to take courses of action other than those outlined, I will accept full responsibility for any

consequences as a result of those actions.

_______ I have downloaded/received a hard copy of the Fieldwork Manual for my reference throughout

the year.

_______ I know that I can find this Fieldwork Manual within the Student Portal (Moodle) and on the

Trinity website.

Student Signature Date

32

Appendix iii. Level I Student Data and Fieldwork Preference Form

33

Level I Student Data & Fieldwork Preference Form

Name of student: Expected year of graduation: Expected degree: Address: Telephone no: Trinity email address: Transportation: Do you require accommodations (as defined by ADA): _______ no ________ yes (if yes, were there any reasonable accommodations that you successfully used in your academic coursework that you would like to continue during fieldwork? If so, list them below. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Fieldwork Preference: Indicate below the name and location of site (city and state). Please note, site assignment is based on current contract and availability.

Semester 2: Year I (Adult Physical Disability) Semester 3: Year II (Mental Health) 1.

1.

2.

2.

3.

3.

4.

4.

5.

5.

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Appendix iv. Level I Student Performance Evaluation

35

Trinity Washington University Master of Occupational Therapy

Level I Student Performance Evaluation

Student Name: ______________________________________________________________________________________

Site Name: ___________________________________________________________________________________________

Fieldwork Educator(s) ______________________________________________________________________________

Fieldwork Educator phone #:________________________________ email address______________________

Type of facility/patients/Clients:

________________________________________________________________________________________________________

This evaluation is to be used to assess the Level I student’s performance at your fieldwork site. Please keep in mind that Level I practicums are integrated into the course related to the fieldwork setting. The student should be graded as a Level I student with basic knowledge of the occupational therapy process. Students should not be expected to perform as an entry-level therapist. The goal is to provide students with feedback and coaching to correct issues in preparation for Level II internships. Students are encouraged to get as much “hands on” experience as possible in accordance with what is safe and appropriate as determined by the Fieldwork Supervisor. On the last day of fieldwork, please discuss grading with the student, sign and give a copy to the student to submit to instructor for grading. Also email or fax to Dr. Kim Sands at SandsK@Trinitydc.edu or (202) 884-9308. (3)-Meets Standards: Performance is consistent and student meets or exceeds standards for Level I Fieldwork. This rating represents a good, solid performance. (2)-Needs Improvement Performance is progressing, but work may be inconsistent and occasionally unacceptable. Student may modify behavior following feedback. (1)-Unsatisfactory: Performance is weak. Work is frequently unacceptable. Student does not modify behavior following feedback.

3 2 1 N/a Comments

1 Attends regularly and on time 2 Demonstrates professional and well-groomed

appearance

3 Observes rules and regulations of the facility/department

4 Demonstrates behaviors consistent with AOTA Code of Ethics

5 Demonstrates motivation to learn, actively participates in clinical experience

36

6 Asks appropriate questions and seeks guidance to improve

7 Accepts constructive criticism and uses feedback to modify behavior/performance

8 Demonstrates awareness of personal strengths and weaknesses

9 Demonstrates empathy and support of others

10 Demonstrates awareness and understanding of psychological and social factors that influence engagement in occupation

11 Demonstrates awareness and respect for clients and populations with diverse backgrounds

12 Demonstrates ability to organize, prioritize and follow through with responsibilities

13 Respects and maintains confidentiality

14 Adheres to universal and safety precautions

15 Accepts change and manages stressors in a positive and constructive way

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16 Identifies and articulates written and/or verbally the role of OT in the practice setting

17 Participates thoughtfully in discussions

18 Effectively uses verbal and non-verbal communication with clients, family and caregivers, staff and supervisor

19 Communicates relevant observations through oral and written means, incorporating professional terminology

20 Demonstrates adequate observation skills related to occupational performance and able to discuss observations appropriately with supervisor

21 Identifies pertinent information from the practice setting (charts, interview of client, staff, etc.) in order to identify client occupational needs

22 Demonstrates adequate written communication skills, uses proper grammar and spelling

23 Demonstrates basic knowledge of diagnoses encountered

24 Begins to develop therapeutic use of self, being attentive and aware of verbal and nonverbal behaviors during interactions with clients

25 Uses clinical reasoning to identify appropriate assessment tools and/or therapeutic activities based on client factors and occupational performance needs (i.e. physical, environmental, psychosocial, cognitive and cultural)

Total (Add each column to obtain score) Total Score (75) _________________________________ (Minimum score 55 to pass) Did the student complete a minimum of 30 hours of onsite observation/participation ______ Yes ______ No

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Recommendations/Comments:______________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Student Signature: ________________________________________________ Date:_____________________________

Supervisor Signature: ______________________________________________ Date:_____________________________

1

Appendix v.

Level I Fieldwork Timesheet

2

Trinity Washington University Master of Occupational Therapy

Fieldwork Timesheet Student name:

_______________________________________________________________________________

Site name:

________________________________________________________________________________

Fieldwork Educator:

________________________________________________________________________

Dates:

One-week concentrated __________________ Weekly extended____________________

Rotation: LI: ___ Adult Physical Rehab ___Mental health ___Pediatrics ___ Aging/Geriatrics

Required: Minimum 30 hours

Date of Visit Time Hours

Total Number of Hours: ________________________________________ Student: _____________________________________________________ Date: ________________________________________________________ Supervisor: _________________________________________________ Date: _________________________

3

Appendix vi.

Level I Student Evaluation of the Fieldwork Experience

4

Trinity Washington University Master of Occupational Therapy

Student Evaluation of Fieldwork Experience – Level 1

The Student Evaluation of Fieldwork Experience is an important tool for the fieldwork educator, university faculty and other students. This evaluation provides information vital to each program. Information from the student is one method utilized in evaluating the effectiveness of academic preparation as well as the value of the fieldwork learning experience. Student’s Name: _______________________________________________________________________ Site Name: _____________________________________________________________________________ Site Address: __________________________________________________________________________ Name/Credentials of Supervisor: ____________________________________________________ Supervisor’s Years of Experience: _________ Dates of Fieldwork: ____________________________ # of Hours: _____________________ Level 1 Rotation: Physical Rehab ________ Psych ________ Peds ________ Comm ______________ Supervision

1. Supervisor provided adequate orientation

5 4 3 2 1

2. Supervisor effectively provided positive reinforcement

3. Supervisor effectively provided constructive feedback

4. Supervisor provided opportunities to review and discuss client/patient information

5. Supervisor provided opportunities to discuss the clinical reasoning behind OT process

6. How were you oriented to the Level I student responsibilities?

7. Describe the type of setting and population served.

5

8. Describe the treatment approaches demonstrated in this program.

9. Supervision was provided by (OT, PT, social worker, etc.)

10. Describe the level of interaction with your supervisor. Was this adequate to meet your learning needs?

11. Describe the opportunities you had to participate in assessment.

a. Interview (tools used or informal)

b. Chart review

c. What opportunities did you have to observe or participate in assessment of performance in an area of occupation (ADL, IADL, leisure, education, work)?

d. What opportunities did you have to observe or participate in assessment of client factors or

performance skills (MMT, sensory, cognitive, developmental, etc.)

12. What opportunities did you have to observe and/or participate in interventions related to development of preparatory techniques (strength, ROM, cognitive training, coping skills, etc.)?

13. What opportunities did you have to observe or participate in actual practice of performance in areas of occupation (i.e. dressing, eating, leisure, education, work, etc.) that were meaningful to the client?

14. What opportunities did you have for documentation?

15. After reviewing the Level I course objectives outlined in the Fieldwork Manual, choose two objectives that were met and provide an example.

___________________________________________ ______________________________

Student Signature Date

6

Appendix vii. Level II Fieldwork Student Input Form

7

Level II Fieldwork Student Input Form

This form will be used to assist the Academic Fieldwork Coordinator in placement for level II fieldwork. Please note that this form applies to BOTH level II placements

Note: Each student will ultimately be assigned to two internships, one of which must be primarily oriented towards treatment of adult physical dysfunction. This could include inpatient, outpatient, rehab, acute care, skilled nursing or similar settings. Hand therapy and some pediatric rotations are recommended to occur following the student’s adult physical dysfunction experience. Name: Phone: Email: Preferred Placement Location (City and State), note: if outside the DMV area, please indicate specific areas where you are able to go Please indicate your top three placement SETTINGS in order of preference (i.e. adult – can specify outpatient, inpatient acute, skilled nursing facility, etc.; peds, mental health, geriatrics, etc.) and your rationale for the request (i.e. I want to work in peds because I have worked with kids in developmental programs, etc.). 1. 2. 3.

Related Work or Volunteer History: If you have any specific places and/or contacts you would like me to look into, please indicate those here- include your rationale for the request: Please note: Fieldwork sites are not guaranteed; however every effort will be made to secure sites for all students. Occasionally sites are unable to maintain their commitments and students may have to postpone the start of a fieldwork experience until another placement can be arranged. Kim Sands, OTD, OTR/L Sandsk@trinitydc.edu 202-884-9672 Office Hours: Tuesday 4:00 – 6:00, Wednesday 1:00 – 3:00

8

Appendix viii.

Personal Data Sheet

9

PERSONAL DATA SHEET

This form is completed by the student and is sent to the student’s Level II

fieldwork educator prior to the start of the fieldwork experience.

10

PERSONAL DATA SHEET

FOR STUDENT FIELDWORK EXPERIENCE

PERSONAL INFORMATION

Name _______________________________________________________________________________________

Permanent Home Address ______________________________________________________________________

____________________________________________________________________________________________

Phone number and dates that you will be available at that number

Phone Number _____________________________ Dates __________________________________________

Name, address, and phone number of person to be notified in case of accident or illness:

____________________________________________________________________________________________

____________________________________________________________________________________________

__________________________________________________________________________

EDUCATION INFORMATION

1. Expected degree (circle one)

OTA:

Associate Baccalaureate Masters Doctorate Certificate

OT:

Baccalaureate Masters Doctorate Certificate

2. Anticipated year of graduation ________________________

3. Prior degrees obtained _______________________________

4. Foreign languages read ______________________________ spoken ___________________________

5. Do you hold a current CPR certification card? Yes _____ No _____

Date of expiration ________________________

HEALTH INFORMATION

1. Are you currently covered under any health insurance? Yes _____ No _____

2. If yes, name of company _________________________________________________________________

Group # _________________________________ Subscriber # _________________________________

3. Date of last Tine Test or chest x-ray: _____________________________

(If positive for TB, tine test is not given)

PREVIOUS WORK/VOLUNTEER EXPERIENCE

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Over. . .

PERSONAL PROFILE

1. Strengths:

2. Areas of growth: _______________________________________________________________________

_____________________________________________________________________________________

3. Special skills or interests:

4. Describe your preferred learning style:

5. Describe your preferred style of supervision:

6. Will you need housing during your affiliation? Yes _____ No _____

7. Will you have your own transportation during your affiliation? Yes _____ No _____

12

8. (Optional) Do you require any reasonable accommodations (as defined by ADA) to complete your

fieldwork? Yes _____ No _____. If yes, were there any reasonable accommodations that you successfully used in

your academic coursework that you would like to continue during fieldwork? If so, list them. To promote your

successful accommodation, it should be discussed and documented before each fieldwork experience.

FIELDWORK EXPERIENCE SCHEDULE

CENTER

TYPE OF

FW SETTING

LENGTH OF FW

EXPERIENCE

Level I Exp.

Level II Exp.

ADDITIONAL COMMENTS

AOTA Commission on Education (COE) and Fieldwork Issues Committee (FWIC)

Amended and Approved by FWIC 11/99 and COE 12/99 fieldwork\miscell\persdatasheet.1299

13

Appendix ix.

Fieldwork Performance Evaluation for the Occupational Therapy Student

(FWPE)

14

15

16

17

18

19

20

21

Appendix x.

AOTA Student Evaluation of the Fieldwork Experience

(Level II)

22

STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE) Purpose:

This evaluation serves as a tool for fieldwork sites, academic programs, and students. The main

objectives of this evaluation are to:

Enable the Level II fieldwork student who is completing a placement at the site to evaluate

and provide feedback to the supervisor and fieldwork setting;

Enable academic programs, fieldwork sites, and fieldwork educators to benefit from student

feedback in order to develop and refine their Level II fieldwork programs;

Ensure that all aspects of the fieldwork program reflect the sequence, depth, focus, and scope

of content of the curriculum design;

Provide objective information to students who are selecting sites for future Level II

fieldwork; and

Provide a means of evaluation to ensure that fieldwork is performed in settings that provide

educational experiences applicable to the academic program.

This form is designed to offer each program the opportunity to gather meaningful and useful

information. Sections outlined with thick black double borders are designed to be customized by your

program as needed. Pages involving evaluation of individual fieldwork educators have been positioned

at the end of the form to allow academic programs to easily remove these pages before making them

available for student review, if they choose to do so.

23

STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE) Instructions to the Student: Complete this STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE (SEFWE) form before your final meeting with your fieldwork supervisor(s). It is imperative that you review the form with your supervisor and that both parties sign on page 1. Copy the form so that a copy remains at the site and a copy is forwarded to your Academic Fieldwork Coordinator at your educational program. This information may be reviewed by future students as well. The evaluation of the student (FWPE) should be reviewed first, followed by the student’s evaluation of the fieldwork experience (SEFWE), allowing the student to be honest and constructive. Fieldwork Site _____________________________________ Site Code ________ Address ___________________________________________________________ Placement Dates: from _________________________ to _______________________ Order of Placement: [ ] First [ ] Second [ ] Third [ ] Fourth Living Accommodations: (include type, cost, location, condition) Public transportation in the area: Please write your e-mail address here if you don’t mind future students contacting you to ask you about your experience at this site: ______________________________________ We have mutually shared and clarified this Student Evaluation of the Fieldwork Experience report. _______________________________________ ________________________________________ Student's Signature FW Educator's Signature _______________________________________ ________________________________________ Student's Name (Please Print) FW Educator’s Name and credentials (Please Print) FW Educator’s years of experience ____________

24

ORIENTATION Indicate your view of the orientation by checking "Satisfactory" (S) or "Needs Improvement” (I) regarding the three factors of adequacy, organization, and timeliness.

TOPIC Adequate Organized Timely NA

S I S I S I

1. Site-specific fieldwork objectives

2. Student supervision process

3. Requirements/assignments for students

4. Student schedule (daily/weekly/monthly)

5. Staff introductions

6. Overview of physical facilities

7. Agency/Department mission

8. Overview of organizational structure

9. Services provided by the agency

10. Agency/Department policies and procedures

11. Role of other team members

12. Documentation procedures

13. Safety and emergency procedures

14. Confidentiality/HIPAA

15. OSHA—Standard precautions

16. Community resources for service recipients

17. Department model of practice

18. Role of occupational therapy services

19. Methods for evaluating OT services

20. Other

Comments or suggestions regarding your orientation to this fieldwork placement: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CASELOAD List approximate number of each age List approximate number of each primary category in your caseload. condition/problem/diagnosis in your caseload

Age Number Condition/Problem Number

0–3 years old

3–5 years old

6–12 years old

13–21 years old

22–65 years old

> 65 years old

25

OCCUPATIONAL THERAPY PROCESS Indicate the approximate number of screenings/evaluations you did; also indicate their value to your learning experience by circling the appropriate number with #1 being least valuable and #5 being the most valuable.

REQUIRED Yes No

HOW MANY

EDUCATIONAL VALUE

1. Client/patient screening 1 2 3 4 5

2. Client/patient evaluations (Use specific names of evaluations)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

3. Written treatment/care plans 1 2 3 4 5

4. Discharge summary 1 2 3 4 5

List major therapeutic interventions frequently used and indicate whether it was provided in group, individually, Co-Treatment, or consultation. List other professionals involved.

Therapeutic Interventions Individual Group Co-Tx Consultation

Occupation-based activity, i.e., play, shopping, ADL, IADL, work, school activities, etc. (within client’s own context with his or her goals)

1.

2.

3.

26

4.

Purposeful activity (therapeutic context leading to occupation)

1.

2.

3.

4.

Preparatory methods, i.e., sensory, PAMs, splinting, exercise, etc. (preparation for occupation-based activity)

1.

2.

3.

4.

THEORY—FRAMES OF REFERENCE—MODELS OF PRACTICE Indicate frequency of theory/frames of reference used

Never Rarely Occasionally Frequently

Model of Human Occupation Occupational Adaptation Ecology of Human Performance Person–Environment–Occupation Model Biomechanical Frame of Reference Rehabilitation Frame of Reference Neurodevelopmental Theory Sensory Integration Behaviorism Cognitive Theory Cognitive Disability Frame of Reference Motor Learning Frame of Reference Other (list)

FIELDWORK ASSIGNMENTS List the types of assignments required of you at this placement (check all that apply), and indicate their educational value (1 = not valuable ------- 5 = very valuable)

27

Case study applying the Practice Framework 1 2 3 4 5 N/A

Evidence-based practice presentation:

Topic:

1 2 3 4 5 N/A

Revision of site-specific fieldwork objectives 1 2 3 4 5 N/A

Program development

Topic:

1 2 3 4 5 N/A

In-service/presentation

Topic:

1 2 3 4 5 N/A

Research

Topic:

1 2 3 4 5 N/A

Other (list) 1 2 3 4 5

ASPECTS OF THE ENVIRONMENT

1 = Rarely 2 = Occasionally 3 = Frequently 4 = Consistently

1 2 3 4

Staff and administration demonstrated cultural sensitivity

The Practice Framework was integrated into practice

Student work area/supplies/equipment were adequate

Opportunities to collaborate with and/or supervise OTs, OTAs, and/or aides

Opportunities to network with other professionals

Opportunities to interact with other OT students

Opportunities to interact with students from other disciplines

Staff used a team approach to care

Opportunities to observe role modeling of therapeutic relationships

Opportunities to expand knowledge of community resources

Opportunities to participate in research

Additional educational opportunities (specify):

How would you describe the pace of this setting? (circle one) Slow Med Fast

Types of documentation used in this setting:

Ending student caseload expectation: _____ # of clients per week or day

Ending student productivity expectation: _____ % per day (direct care)

SUPERVISION

What was the primary model of supervision used? (Check one) One supervisor: one student One supervisor: group of students Two supervisors: one student One supervisor: two students Distant supervision (primarily off-site)

28

Three or more supervisors: one student (count person as supervisor if supervision occurred at least weekly)

List fieldwork educators who participated in your learning experience.

Name Credentials Frequency Individual Group

1.

2.

3.

4.

5.

29

ACADEMIC PREPARATION Rate the relevance and adequacy of your academic coursework relative to the needs of THIS fieldwork placement, circling the appropriate number. (Note: may attach own course number)

Adequacy for Placement Relevance for Placement Anatomy and Kinesiology

Low High 1 2 3 4 5

Low High 1 2 3 4 5

Neurodevelopment 1 2 3 4 5 1 2 3 4 5 Human development 1 2 3 4 5 1 2 3 4 5 Evaluation 1 2 3 4 5 1 2 3 4 5 Intervention planning 1 2 3 4 5 1 2 3 4 5 Interventions (individual, group, activities, methods) 1 2 3 4 5 1 2 3 4 5 Theory 1 2 3 4 5 1 2 3 4 5 Documentation skills 1 2 3 4 5 1 2 3 4 5 Leadership 1 2 3 4 5 1 2 3 4 5 Professional behavior and communication 1 2 3 4 5 1 2 3 4 5 Therapeutic use of self 1 2 3 4 5 1 2 3 4 5 Level I fieldwork 1 2 3 4 5 1 2 3 4 5 Program development 1 2 3 4 5 1 2 3 4 5

What were the strongest aspects of your academic program relevant to preparing you for THIS Level II fieldwork experience? Indicate your top 5.

Informatics Occ. as Life Org A & K Foundations Level I FW

Pathology Neuro Administration Theory Peds electives

Env. Competence Research courses Prog design/eval Consult/collab Older adult elect.

Interventions Evaluations Adapting Env Human comp. Community elect. Social Roles History Occupational Sci Other:

What changes would you recommend in your academic program relative to the needs of THIS Level II fieldwork experience?

___________________________________________________________________________________________________________________________________________________________________________

SUMMARY

1 = Strongly disagree 2 = Disagree 3 = No Opinion 4 = Agree 5 = Strongly agree

1 2 3 4 5

30

Expectations of fieldwork experience were clearly defined

Expectations were challenging but not overwhelming

Experiences supported student's professional development

Experiences matched student's expectations

What particular qualities or personal performance skills do you feel that a student should have to function successfully on this fieldwork placement?

___________________________________________________________________________________________________________________________________________________________________________ What advice do you have for future students who wish to prepare for this placement?

Study the following evaluations:

___________________________________________________________________________________________________________________________________________________________________________

Study the following intervention methods:

___________________________________________________________________________________________________________________________________________________________________________

Read up on the following in advance:

___________________________________________________________________________________________________________________________________________________________________________ Overall, what changes would you recommend in this Level II fieldwork experience?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please feel free to add any further comments, descriptions, or information concerning your fieldwork at this center.

__________________________________________________________________________________________________________________________________

31

___________________________________________________________________________________________________________________________________________________________________________________________________

32

Indicate the number that seems descriptive of each fieldwork educator. Please make a copy of this page for each individual.

FIELDWORK EDUCATOR NAME:___________________________________ FIELDWORK EDUCATOR YEARS OF EXPERIENCE: __________

1 = Strongly Disagree 2 = Disagree 3 = No opinion 4 = Agree 5 = Strongly agree

1 2 3 4 5

Provided ongoing positive feedback in a timely manner

Provided ongoing constructive feedback in a timely manner

Reviewed written work in a timely manner

Made specific suggestions to student to improve performance

Provided clear performance expectations

Sequenced learning experiences to grade progression

Used a variety of instructional strategies

Taught knowledge and skills to facilitate learning and challenge student

Identified resources to promote student development

Presented clear explanations

Facilitated student’s clinical reasoning

Used a variety of supervisory approaches to facilitate student performance

Elicited and responded to student feedback and concerns

Adjusted responsibilities to facilitate student's growth

Supervision changed as fieldwork progressed

Provided a positive role model of professional behavior in practice

Modeled and encouraged occupation-based practice

Modeled and encouraged client-centered practice

Modeled and encouraged evidence-based practice

Frequency of meetings/types of meetings with supervisor (value/frequency):

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

___________________________________________________

General comments on supervision:

33

AOTA SEFWE Task Force, June 2006

34

Appendix xi.

AOTA Fieldwork Data Form

(To be completed by site)

35

AOTA FIELDWORK DATA FORM

Introduction:

The primary purpose of the Fieldwork Data Form is to summarize information regarding the program at

a fieldwork site. Occupational therapy (OT) and occupational therapy assistant (OTA) students will find

valuable information describing the characteristics of the fieldwork setting; the client population;

commonly used assessments; interventions; and expectations and opportunities for students. The

Fieldwork Data Form has been developed to reflect the Occupational Therapy Practice Framework:

Domain and Process, 3rd Edition (American Occupational Therapy Association [AOTA], 2014)

terminology and best practice in occupational therapy to promote quality fieldwork experiences. The

data gathering processes used in completion of this form entails a collaborative effort that facilitates

communication between OT and OTA academic programs, students, and fieldwork educators. This form

may be completed by the combined efforts of the fieldwork educator, the OT or OTA student assigned

to the site for fieldwork, and/or the Academic Fieldwork Coordinator (AFWC) from the program.

Fieldwork sites are encouraged to update the form annually and provide a copy to the educational

program(s) where they have a current memorandum of understanding (MOU).

The secondary purpose of the Fieldwork Data Form is to document the connection between the

curriculum designs of a given OT or OTA educational program with its fieldwork component. The

AFWC will use the data entered on the form to document fieldwork related Accreditation Council for

Occupational Therapy (ACOTE) Standards (ACOTE, 2012). The standards are outlined in Section C of

the 2011 ACOTE standards and are denoted on the form. Educational programs can revise the form to

suit the needs of their respective fieldwork programs.

The Fieldwork Data Form was developed through the joint efforts of the Commission on Education

(COE) and the Education Special Interest Section (EDSIS) Fieldwork Subsection with input from many

dedicated AFWCs and fieldwork educators.

36

AOTA FIELDWORK DATA FORM

Date:

Name of Facility:

Address: Street: City: State: Zip:

FW I FW II

Contact Person: Credentials: Contact Person: Credentials:

Phone: Email: Phone: Email:

Director: Initiation Source:

FW Office

FW Site

Student

Corporate Status:

For Profit

Nonprofit

State Gov’t

Federal Gov’t

Preferred Sequence of FW: ACOTE Standards B.10.6

Any

Second/Third only; First must be in:

Full-time only Part-time option

Prefer full-time

Phone:

Fax:

Website address:

OT Fieldwork Practice Settings:

Hospital-based settings Community-based settings School-based settings Age

Groups:

Number of Staff:

Inpatient Acute

Inpatient Rehab

SNF/Sub-Acute/Acute

Long-Term Care

General Rehab Outpatient

Outpatient Hands

Pediatric Hospital/Unit

Pediatric Hospital Outpatient

Inpatient Psychiatric

Pediatric Community

Behavioral Health Community

Older Adult Community Living

Older Adult Day Program

Outpatient/hand private practice Adult Day Program for DD

Home Health

Pediatric Outpatient Clinic

Early Intervention

School

Other area(s)

Please specify:

0–5

6–12

13–21

22–64

65+

OTRs:

OTAs/COTAs:

Aides:

PT:

Speech:

Resource Teacher:

Counselor/Psychologist:

Other:

Student Prerequisites (check all that apply)ACOTE Standard C.1.2 Health requirements:

CPR

Medicare/Medicaid fraud check

Criminal background check

Child protection/abuse check

Adult abuse check

Fingerprinting

First aid

Infection control

training

HIPAA training

Prof. liability ins.

Own transportation

Interview

HepB

MMR

Tetanus Chest x-ray Drug screening

TB/Mantoux

Physical Check up

Varicella

Influenza

Please list any other requirements:

Please list how students should prepare for a FW II placement such as doing readings, learning specific evaluations and interventions used in

your setting: ACOTE Standards C.1.2, C.1.11

Student work schedule and outside

study expected:

Other Describe level of structure for

student?

Describe level of supervisory

support for student?

Schedule hrs/week/day: Room provided yes no High High

Do students work weekends? yes no Meals yes no Moderate Moderate

Do students work evenings? yes no Stipend amount: Low Low

Describe the FW environment/atmosphere for student learning:

37

Describe available public transportation:

Types of OT interventions addressed in this setting (check all that apply):

Occupations: Client-directed occupations that match and support identified participation level goals (check all that apply): ACOTE Standards C.1.8, C.1.11, C.1.12

Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) Education

Bathing/showering

Toileting and toilet hygiene

Dressing

Swallowing/eating

Feeding

Functional mobility

Personal device care

Personal hygiene and grooming

Sexual activity

Rest and Sleep

Rest

Sleep preparation

Sleep participation

Care of others/pets

Care of pets Child rearing Communication management

Driving and community mobility

Financial management

Health management and maintenance

Home establishment and management

Meal preparation and clean up

Religious / spiritual activities and expression

Safety and emergency maintenance

Shopping

Formal education participation Informal personal education needs or interests exploration Informal personal education participation

Work Employment interests and pursuits

Employment seeking and acquisition

Job performance

Retirement preparation and adjustment

Volunteer exploration

Volunteer participation

Play

Leisure Social Participation

Play exploration

Play participation

Leisure exploration

Leisure participation

Community

Family

Peer/friend

Activities: Designed and selected to

support the development of skills,

performance patterns, roles, habits,

and routines that enhance

occupational engagement

Practicing an activity

Simulation of activity

Role play

Examples:

Preparatory Methods and Tasks: Methods,

adaptations and techniques that prepare the

client for occupational performance Preparatory tasks

Exercises

Physical agent modalities

Splinting

Assistive technology

Wheelchair mobility

Examples:

Education: describe

Training: describe

Advocacy: describe

Group Interventions: describe

Method of Intervention

Direct Services/Caseload for entry-

level OT

One-to-one:

Small group(s):

Large group:

Outcomes of Intervention

Occupational performance improvement and/or

enhancement

Health and Wellness

Prevention

Quality of life

Role competence

Participation

Theory/Frames of Reference/Models of Practice Acquisitional

Biomechanical

Cognitive/Behavioral

Coping

Developmental

Ecology of Human Performance

Model of Human Occupation (MOHO)

Occupational Adaptation

38

Discharge/Outcomes of Clients (%

clients)

Home

Another medical facility

Home health

OT Intervention Approaches

Create, promote health/habits

Establish, restore, remediate

Maintain

Modify, facilitate compensation, adaptation

Prevent disability

Occupational Performance

Person-Environment-Occupation (PEO)

Person-Environment-Occupational Performance

(PEOP)

Psychosocial

Rehabilitation frames of reference

Sensory Integration

Other (please list):

Please list the most common screenings and evaluations used in your setting:

Identify safety precautions important at your FW site

Medications

Postsurgical (list procedures)

Contact guard for ambulation

Fall risk

Other (describe):

Swallowing/choking risks

Behavioral system/ privilege level (locked areas, grounds)

Sharps count

1 to 1 safety/suicide precautions

Performance skills, patterns, contexts and client factors addressed in this setting (check all that apply): ACOTE Standard C. 1.12

Performance Skills:

Motor skills

Process skills

Social interaction skills

Performance Patterns:

Person:

Habits

Routines

Rituals

Roles

Group or Population:

Habits

Routines

Rituals

Roles

Client Factors:

Values

Beliefs

Spirituality

Mental functions (affective, cognitive, perceptual)

Sensory functions

Neuromusculoskeletal and movement-related

functions

Muscle functions Movement functions Cardiovascular, hematological, immunological, and

respiratory system functions

Voice and speech functions; digestive, metabolic, and

endocrine system functions;

Skin and related-structure functions

Context(s):

Cultural

Personal Temporal Virtual

Environment:

Physical

Social

Most common services priorities (check all that apply):

Direct service

Discharge planning

Evaluation

Meetings (team, department, family)

Client education

Intervention

Consultation

In-service training

Billing

Documentation

Target caseload/productivity for fieldwork students: Documentation: Frequency/Format (briefly describe) :

39

Productivity ( %) per 40-hour work week:

Caseload expectation at end of FW:

Productivity (%) per 8-hour day:

Number groups per day expected at end of FW:

Handwritten documentation:

Computerized medical records:

Time frame requirements to complete documentation:

Administrative/Management Duties or Responsibilities of the

OT/OTA Student:

Student Assignments. Students will be expected to successfully

complete:

Schedule own clients

Supervision of others (Level I students, aides, OTA, volunteers)

Budgeting

Procuring supplies (shopping for cooking groups,

client/intervention-related items)

Participating in supply or environmental maintenance

Other:

Research/EBP/Literature review

In-service

Case study

In-service participation/grand rounds

Fieldwork project (describe):

Field visits/rotations to other areas of service

Observation of other units/disciplines

Other assignments (please list):

OPTIONAL DATA COLLECTION: The question includes in this section may be used by academic programs to demonstrate compliance with the Accreditation

Council for Occupational Therapy Education (ACOTE) Standards documentation for fieldwork.

1. Please identify any externalany external review agencies that accredit / recognize this FWthis FW setting and year of accreditation/

recognition. Examples: JCAHO, CARF, Department of Health, etc.

Agency for External Review: (name)

Year of most recent review:

Summary of outcomes of OT Department review:

Agency for External Review: (name)

Year of most recent review:

Summary of outcomes of OT Department review:

Agency for External Review: (name)

Year of most recent review:

Summary of outcomes of OT Department review:

2. Describe the fieldwork site agency stated mission or purpose (can be attached).

3. OT Curriculum Design Integrated with Fieldwork Site (insert key OT academic curricular themes here) ACOTE Standards C.1.2, C.1.3,C.1.7, C.1.8,

C.1.11,C.1.12

a. How are occupation-based needs evaluated and addressed in your OT program??

b. Describe how you seek to include client-centered OT practice. How do clients participate in goal setting and intervention

activities?

c. Describe how psychosocial factors influence engagement in occupational therapy services.

40

d. Describe how you address clients’ community-based needs in your setting.

4. How do you incorporate evidence-based practice into interventions and decision making? Are FW students encouraged to provide

evidence for their practice? ACOTE Standards C.1.3, C.1.11

5. Please describe the FW Program and how students fit into the program. Describe the progression of student supervision from novice to

entry-level practitioner using direct supervision, co-treatment, and monitoring, as well as regular formal and informal supervisory

meetings. Describe the fieldwork objectives, weekly fieldwork expectations, and record keeping of supervisory sessions conducted

with student. Please mail a copy of the FW student objectives, weekly expectations for the Level II FW placement, dress code, and

copy of an entry-level job description with essential job functions to the AFWC. ACOTE Standards C.1.1, C.1.2, C.1.3, C.1.4, C.1.8, C.1.9

6. Please describe the background of supervisors by attaching a list of practitioners who are FW educators including their academic

program, degree, years of experience since initial certification, and years of experience supervising students) ACOTE Standards C.1.9, C.1.14,

C.1.17, C.1.19

7. Describe the training provided for OT staff for effective supervision of students (check all that apply). ACOTE Standards C.1.9, C.1.15,

C.1.16

Supervisory models

Training on use of FW assessment tools (such as the AOTA Fieldwork Performance Evaluation–FWPE, the Student Evaluation of

Fieldwork Experience–SEFWE, and the Fieldwork Experience Assessment Tool–FEAT)

Clinical reasoning

Reflective practice

Comments:

8. Please describe the process for record keeping of supervisory sessions with a student, the student orientation process to the agency, OT

services, and the fieldwork experience. ACOTE Standards C.1.2, C.1.3, C.1.10

Supervisory Patterns–Description (respond to all that apply)

1:1 Supervision model:

Multiple students supervised by one supervisor:

Collaborative supervision model:

Multiple supervisors share supervision of one student; number of supervisors per student:

Non-OT supervisors:

9. Describe funding and reimbursement sources and their impact on student supervision.

STATUS/TRACKING INFORMATION SENT TO FACILITY:

Date:

ACOTE Standard C.1.6

Which documentation does the fieldwork site need?

Fieldwork Agreement/Contract?

OR

Memorandum of Understanding (MOU)?

Which FW Agreement will be used?: OT Academic Program Fieldwork Agreement Fieldwork Site Agreement/ Contract

41

Title of parent corporation Parent Corporation (if different from facility name):

Type of business organization (Corporation, partnership, sole proprietor, etc.):

State of incorporation:

Fieldwork site agreement negotiator: Phone: Email:

Address (if different from facility):

Street: City: State: Zip:

Name of student: Potential start date for fieldwork:

Any notation or changes that you want to include in the initial contact letter:

Information Status ACOTE Standards C.1.1, C.1.2, C.1.3, C.1.8,

New general facility letter sent:

Level I Information Packet sent:

Level II Information Packet sent:

Mail contract with intro letter (sent):

Confirmation sent:

Model behavioral objectives:

Week-by-week outline:

Other information:

Database entry:

Facility information:

Student fieldwork information:

Make facility folder:

Print facility sheet:

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Appendix xii.

Fieldwork Site Criteria Form (For Fieldwork Sites)

43

Trinity Washington University Master of Occupational Therapy

Fieldwork Site Criteria Form for Level II Experiences Name of Center: ____________________________________________________ Date: _____________________________________________________________

Criteria

Response

Current accreditation Body/date____________________________________________________

_________

Yes No

Provide a variety of diagnoses, aligned with the curriculum and content of the academic institution

Yes No

Provide a variety of therapeutic activities and interventions when treating patients/clients (occupation-based, purposeful, preparatory methods)

Yes No

Specific and appropriate variety of OT evaluations and assessment tools

Yes No

Documented treatment plan for each patient/client

Yes No

Hold client/patient care conferences to evaluate patient/client programming

regarding intervention needs How often:

Yes No

Stated philosophy regarding service delivery

Yes No

Administration and staff supportive of OT fieldwork

Yes No

Agency’s primary belief or philosophy about fieldwork education

Follows

AOTA

Independent

Statement

Opportunities for verbal presentation (e.g. in-services, clinical rounds, evaluation conferences)

Yes No

Are staff involved in National and State professional organizations?

Yes No

44

Please name:

Are you willing to conference before fieldwork placements?

Yes No

Will a tour of the fieldwork site be provided?

Yes No

Will the fieldwork site provide Trinity with documentation of student

orientation/ expectations?

Yes No

Environment accommodates student needs (lockers, desks, space)

Yes No

Identifiable behavioral objectives and requirements for fieldwork placement

for student training available and linked to AOTA Fieldwork Evaluation

Yes No

Are there adequate OT supplies and equipment available to student?

Yes No

Does the OT student have full access to client records? ___Online, ___ in- facility

Yes No

Appropriate qualifications of supervisor

Does the fieldwork supervisor have one or more years of clinical experience as an OTR or in their respective professional field?

Yes No

Is the fieldwork supervisor NBCOT certified and/or licensed to practice in the state?

What type of supervision will be provided for the student? Check all that apply:

______ Supervision provides protection of consumers and opportunities for appropriate role modeling for student in occupational therapy practice

Yes No

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______ Supervision is initially direct then decreases to less direct as

appropriate to the setting, client and student needs, as determined by the fieldwork educator

______ Caseload for student is increased as affiliation progresses, with end goal being competencies of an entry-level therapist

______ Daily to weekly supervision to meet student’s needs

Will this level of supervision be given for the entire fieldwork experience?

Yes No

Will the student have access to resources to guide client care?

Type: ___library, ___OT protocols, ___other

Yes No

Types of practice areas in this facility:

___Geriatrics/ Productive Aging _____ Rehab

_____Work and industry _____ Mental Health

_____Children & Youth _____ Other, please specify _____Health & Wellness

Does your facility provide intervention in emerging practice areas:

_____Telemedicine _____Driving program (teens with disabilities)

_____Autism children or adults _____Chronic disease management _____Mental Health

_____Low vision _____Community mobility, older driver

_____Hand transplants, bionic limbs _____Technology

_____Cancer/ oncology

What is the format for student evaluation?

Are you willing to discuss student performance if problems arise before

midterm?

Yes No

Yes No

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After

midterm?

Will the OT student be given the opportunity to explore the management

aspect of OT? How?

Yes No

Modified from AOTA’s COE Guidelines for an Occupational Therapy Fieldwork Experience:

Level II

47

Appendix xiii.

Fieldwork Educator AOTA Resources

48

Fieldwork Educator Resources AOTA – The AOTA website has an abundance of resources to help program coordinators and clinicians develop education programs and the necessary skills to provide fieldwork education and supervision. We encourage fieldwork educators to review and utilize the many tools available. COE Guidelines for an Occupational Therapy Fieldwork Experience – Level II – http://www.aota.org/~/media/Corporate/Files/EducationCareers/Educators/Fieldwork/LevelII/COE%20Guidelines%20for%20an%20Occupational%20Therapy%20Fieldwork%20Experience%20--%20Level%20II--Final.pdf Steps to Starting a Fieldwork Program – http://www.aota.org/Education-Careers/Fieldwork/NewPrograms/Steps.aspx Recommended Content for a Student Fieldwork Manual - http://www.aota.org/education-careers/fieldwork/newprograms/content.aspx Sample Level II Site Specific Objectives - http://www.aota.org/Education-Careers/Fieldwork/SiteObj.aspx Incorporating EBP into Fieldwork Education - http://www.aota.org/Education-Careers/Fieldwork/incorporate-ebp.aspx Fieldwork Educator Self-Assessment – Self assessment tool for FW educator competency - http://www.aota.org/~/media/Corporate/Files/EducationCareers/Educators/Fieldwork/Supervisor/Forms/Self-Assessment%20Tool%20FW%20Ed%20Competency%20(2009).pdf Understanding the OT/OTA Fieldwork Performance Evaluation (FWPE) – http://www.aota.org/Education-Careers/Fieldwork/Supervisor/Inservice.aspx Student Supervision OT/OTA Student Supervision and Medicare Requirements – must log in as a member, to AOTA website t access this content http://www.aota.org/~/media/Corporate/Files/Secure/Advocacy/Reimb/Coverage/ot-ota-student-medicare-requirements.pdf Fieldwork Educator Certificate Workshop - http://www.aota.org/Education-Careers/Fieldwork/Workshop.aspx

49

Appendix xiv.

Fieldwork Educator Acknowledgement Form

50

Trinity Washington University

Master of Occupational Therapy

Acknowledgement of Receipt and Review of Trinity

Washington University Occupational Therapy Program

Fieldwork Manual

My signature acknowledges:

1. I have received a copy and/or understand I may access the fieldwork manual via Trinity website

under the section “Fieldwork Educators”.

2. I understand that the Trinity Fieldwork Manual has been made accessible to me as a resource for

supervision of Trinity Master of Occupational Therapy fieldwork students.

3. I am aware that it is my responsibility to review the fieldwork manual, and that I may consult the

AFWC, Dr. Kim Sands, if I have further questions regarding Trinity’s fieldwork program or

regarding COE guidelines for supervision (found at the link below): http://www.aota.org/~/media/Corporate/Files/EducationCareers/Educators/Fieldwork/LevelII/COE%20Guidelines%20for%20an%20Occupational%20Therapy%20Fieldwork%20Experience%20--%20Level%20II--Final.pdf

Clinical Coordinator/Fieldwork Educator Signature Date