Management and Administration for the OTA: Leadership and Application Skills

Chapter 7: Supervision

Key Vocabulary

• Service competence: The formally documented process by which the OT assesses and determines that the OTA is competent in specific areas of occupational therapy practice.
• Immediate supervision: Supervision characterized by the supervising OT providing face-to-face observation while maintaining close physical proximity to the OTA.
• Direct supervision: The supervising OT is present at the site where the OTA provides occupational therapy services and is within speaking distance of the OTA.
• Close supervision: The supervising OT gives initial guidance and maintains daily contact at the site where the OTA is delivering services.
• Routine supervision: Initial guidance provided by the supervising OT, who periodically reviews all aspects of the OTA's services at least every two weeks and engages in interim supervision through telephone, electronic, or written methods.
• General supervision: This occurs when the supervising OT provides initial guidance, conducts reviews of OTA services at least every 30 days, and provides interim supervision through various methods.
• Entry-level practitioner: An OT or OTA starting to develop their occupational therapy skill set, particularly during their first year of practice or in a new area of practice.
• Intermediate-level practitioner: An OT or OTA who has begun to master their occupational therapy skill set following one to three years of practice.
• Advanced practice practitioner: An OT or OTA who is enhancing their skills and integrating specialized skills into practice.

Case Study Overview

• Scenario: An OT evaluates a client with a right total hip replacement and assigns an OTA to administer the Allen cognitive levels assessment, for which service competency has been established.
  • Evaluation data: Client displays good memory, judgment, attention span, and safety awareness but requires maximum assistance with lower body dressing, bathing, and toileting tasks.
  • OTA's Role: Treated the client on the first day, documented services, and collaborated with the OT by reviewing treatment plans and presenting updates on the client's progress.
  • Family Interaction: The client's daughter brings new information about the home environment (multi-story home), prompting a re-evaluation of goals.
  • Supervision Process: OT cosigns OTA's documentation and updates treatment goals proceeding through the series of therapy sessions. The OTA is also responsible for discharge preparation.
• This case provides multiple examples demonstrating how the OT supervises the OTA throughout the treatment process.

Definition of Supervision in OT

• Supervision: Defined as a cooperative process involving at least two parties, working jointly to establish, maintain, or enhance competence and performance levels.
  • Mutual understanding is essential between the supervisor and supervisee regarding each other's competence, education, and credentials (AOTA, 2014).
  • The OTA’s services extend from the supervising OT's licensure. The OTA must deliver skilled services under an OT’s supervision.
  • Additional benefits of supervision as noted include fostering growth, effective resource utilization, creativity, innovation, education, and support towards achieving goals.
  • Reference: AOTA’s guidelines for supervision and role delineation, established every five years.

Levels of Supervision in OT

Table 7-1: Levels of Supervision in Occupational Therapy

• Direct supervision: Supervising OT is on-site and within speaking range.
• Immediate supervision: Offers face-to-face observation, maintaining close physical distance.
• Close supervision: Initial guidance and daily on-site contact.
• Routine supervision: Initial guidance with periodic reviews (no less than every 2 weeks) via various methods of communication.
• General supervision: Initial guidance, with reviews at least once per 30 days through various means as well.
• Minimal supervision: Provides oversight on an as-needed basis, potentially occurring less than monthly.

OTA as a Supervisor

• Intermediate-Level Practitioners (1-3 years of practice): Focus on mastery of occupational skills and can assume supervisory roles involving:
  • Volunteers, OT aides, and various levels of fieldwork students.
  • Opportunities in leadership roles, such as serving as rehab directors, regional managers, or on professional organizations committees.
  • Involvement in these avenues develops leadership skills crucial for career advancement.

Professional Organizations Impacting Supervision

• AOTA: Offers resources regarding leadership development, certification programs, and volunteer opportunities.
• NBCOT: Involves setting professional practice standards for Certified Occupational Therapy Assistants (COTAs) regarding supervision and documentation.
• State licensing agencies: Engaged in legislative advocacy regarding occupational therapy practice acts and regulations.

Key Documents in Supervision

• Important resources from AOTA.org include:
  • Occupational Therapy Code of Ethics and Ethical Standards
  • Occupational Therapy Practice Framework, 4th Edition (OTPF-4)
  • Documentation and Guidelines on OT Services
  • Standards for Continuing Competence
  • NBCOT Professional Practice Standards

Practical Considerations in Supervision

1. Prior to intervention, ensure availability of a licensed OT for proper supervision.
2. Discuss any client concerns and intervention planning as needed.
3. Ensure service competence when employing higher-level skills in therapy.
4. Adhere strictly to the scope of practice for OTA.
5. Properly document therapy sessions and ensure notes are cosigned in compliance with appropriate policies and regulations.
6. Verify completion of progress notes appropriately and on time.
7. Confirm licensing and supervision compliance according to state regulations including supervision ratios.
8. Example from Oklahoma Medical Board: An OT cannot supervise more than four occupational therapy assistants simultaneously.

Understanding Service Competence

• Service Competence: Validation that the OTA performs competently in specific therapy areas as assessed by the supervising OT, and can be a requirement of standardized assessments, provided state regulations allow.
  • Importance of collaboration between OT and OTA for competence documentation and ongoing supervision.
  • Keeping records of service competency training and outcomes as a critical component of effective supervision.

The Collaboration in Supervision

• Building a collaborative relationship between OT and OTA is vital for successful client outcomes.
  • Continuous information flow about client progress: Essential for adapting goals and interventions and enhancing treatment efficacy.
  • Dynamic cooperation leads to improved client goal attainment, ensuring all parties involved are informed and aligned.

Continued Professional Development

• Continued Competency: The ongoing requirement to remain updated on clinical skills throughout one's career is essential. Sources for continued education may involve:
  • Professional organizations, face-to-face courses, webinars, and academic coursework.
  • Compliance with professional development unit requirements by state licensing boards and NBCOT is crucial.

Multiple Licenses and Collaboration with Other Professions

• OTAs may maintain multiple licenses (e.g., massage therapy) but must clarify practice roles to clients and ensure compliance with state regulations.
  • Oversight by a licensed OT is mandatory, even if other professionals oversee in a rehabilitation context.
  • When functioning in a dual role, clear communication about which services are provided and under what authority is critical.

Roles of OTA/Entrepreneur and Supervision

• OTAs can pursue roles such as:
  • Program director, fieldwork coordinator, clinical educator, or community educator among others.
• Important for OTAs engaging in entrepreneurial ventures to understand and adhere to supervision mandates to protect their licensure and career trajectory.
  • Contracting or hiring an OT for supervision in entrepreneurial settings is permissible.

Questions?

• Topics of interest may include specific scenarios involving OTAs, supervision strategies, or clarifications regarding roles within occupational therapy.