The occupational therapy service delivery process involves evaluation, intervention planning, intervention implementation, intervention review, and outcome evaluation. Regardless of the setting in which occupational therapy services are delivered, the OT and the OTA assume the following generic responsibilities during evaluation, intervention, and outcomes evaluation.
Occupational Therapists are:
•Responsible for all aspects of OT service delivery
•Accountable for the safety & effectiveness of OT services
Occupational Therapy Assistants are:
•Able to deliver OT services under the supervision & in partnership with an OT
|GENERAL||The OT is responsible for all aspects of occupational therapy service delivery and is accountable for the safety and effectiveness of the occupational therapy service delivery process.||The OTA delivers occupational therapy services under the supervision of and in partnership with the occupational therapist.|
|The OT must be directly involved in the delivery of services including during the initial evaluation and regularly throughout the course of intervention and outcome evaluation.|
|It is the responsibility of the OT to determine when to delegate responsibilities to OTA.
|It is the responsibility of the OTA who performs the delegated responsibilities to demonstrate competency.|
|The OT accepts and responds to referrals in compliance with state laws or other regulatory requirements.|
|EVALUATION||The OT initiates and directs the screening, evaluation, and re-evaluation process and analyzes and interprets the data in accordance with law, regulatory requirements, and AOTA documents.
|The OT is responsible for directing all aspects of the initial contact during the occupational therapy evaluation, including:
a. determining the need for service
b. defining the problems within the domain of occupational therapy that need to be addressed
c. determining the client’s goals and priorities
d. establishing intervention priorities
e. determining specific further assessment needs
f. determining specific assessment tasks that can be delegated to the occupational therapy assistant
|The OT directs the evaluation process.|
|The OT initiates and directs the evaluation, interprets the data, and develops the intervention plan.||A screening is the process by which a person’s OT needs are assessed. Whether or not an OTA can complete a screening depends on the information required from the screening. An OTA can state or write observations but cannot make an evaluation or determine a need for occupational therapy services. This must be determined by an OT.
The OTA may, if directed by the occupational therapist, and deemed competent, perform designated assessments to contribute to the evaluation, but may not interpret data. The interpretation of assessment results and the overall evaluation is the responsibility of the occupational therapist
|The OT interprets the information provided by the OTA and integrates that information into the evaluation and decision-making process.|
|INTERVENTION PLANNING||The OT has overall responsibility for the development of the occupational therapy intervention plan.|
|The OT and the OTA collaborate with the client to develop the plan.||The OT and the OTA collaborate with the client to develop the plan.|
|The OTA is responsible for being knowledgeable about evaluation results and for providing input into the intervention plan, based on client needs and priorities.|
|INTERVENTION IMPLEMENTATION||The OT has overall responsibility for implementing the intervention.|
|When delegating aspects of the occupational therapy intervention to the OTA, the OT is responsible for providing appropriate supervision.||The OTA is responsible for being knowledgeable about the client’s occupational therapy goals.|
|The OTA selects, implements, and makes modifications to therapeutic activities and interventions that are consistent with demonstrated competency levels, client goals, and the requirements of the practice setting.|
|INTERVENTION REVIEW||The OT is responsible for determining the need for continuing, modifying, or discontinuing occupational therapy services.||The OTA contributes to this process by exchanging information with and providing documentation to the OT about the client’s responses to and communications during intervention.|
|OUTCOME EVALUATION||The OT is responsible for selecting, measuring, and interpreting outcomes that are related to the client’s ability to engage in occupations.||The OTA is responsible for being knowledgeable about the client’s targeted occupational therapy outcomes and for providing information and documentation related to outcome achievement.|
|The OTA may implement outcome measurements and provide needed client discharge resources.|
The OTA’s role in the evaluation process
Evaluating the client is the primary responsibility of the OT, and that analyzing and interpreting all evaluation data must be carried out by the OT. However, if permitted by the relevant state practice act, the OTA may provide additional information on the client’s performance or administer some standardized assessments once service competency has been demonstrated. Service competency is defined as “the ability of the OTA to obtain the same or equivalent results as the supervising OT in evaluation and treatment”.
OTA students are given general exposure to a variety of standardized and non-standardized assessments in their academic preparation. However, it should not be assumed that an entry level OTA is competent in administering standardized assessments until he or she can successfully demonstrate the ability to follow protocols correctly and obtain consistently accurate information for the OT. Even when an experienced OTA is assigned to work with an unfamiliar OT, the process of establishing service competency in assessments must be completed again. This can be accomplished in several ways, including jointly reviewing the assessments that are used at the facility, having the OTA observe the OT during administration of the assessment, having the OTA practice administering the assessment to the OT, and videotaping a practice assessment for the OT/OTA team to review.
Practice acts may differ from state to state, and they supersede AOTA official documents, so occupational therapy practitioners should check their state practice act for what role the OTA may take in the evaluation process in their state. In addition, OTA involvement in the evaluation process is limited when using assessments such as the Sensory Integration Praxis Test or the Assessment of Motor and Process Skills, which require training to administer that is available only to OTs.
Model State Regulation for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Service. The American Occupational Therapy Association.
The Occupational Therapy Assistant’s Role in the Evaluation Process.
Standards of Practice for Occupational Therapy – AJOT (http://ajot.aota.org) November/December 2005, Volume 59, Number 6.