About OT & the Profession

OT Practitioners

Many individuals & groups shape OT Practice

• Who are OT Practitioners?

  • People who completed all OT education & fieldwork requirements - graduated from accredited program

  • Passed national board exam, entry-level competency, & ethics

  • Maintain competency & ethical behaviors over time

  • OT Practitioners Include:

    • Registered & Licensed Occupational Therapists (OTR/L)

    • Certified & Licensed Occupational Therapy Assistants (COTA/L)

  • These are NOT OT Practitioners

    • Occupational therapy aides

    • Rehabilitation aides

• How to become an OT practitioner

  • Admitted into an accredited OT education program

  • Complete all academic, ethical, & professional behavior components

  • Complete Fieldwork

  • Be eligible to take national board exam

  • Pass NBCOT exam

  • Apply for & obtain state licensure

• Entry-Level OT Education: Accredited Entry-Level Program

  • The OT education program must be accredited by the Accreditation Council for Occupational Therapy Education (ACOTE)

    • ACOTE wants to ensure quality OT education so that practitioners are well prepared

      • ACOTE develops accreditation standards for OT & OTA programs

        • Delineated what needs to be learned 

      • ACOTE verifies that OT education programs implement all standards

• Entry Level OT Education: Guides the transition from student to OT Practitioner

  • Prepare you to meet demands required of an OT general practitioner 

    • Academic standards → Knowledge 

    • Broad technical standards → essential performance skills for practice

    • Ethical & professional behavior standards 

  • Goal is to ensure you will act in best interest of clients

• Entry Level Education

  • Occupational Therapist

    • Education must be at         

      • Master Level

      • Doctoral Level

  • Occupational Therapy Assistant

    • Education must be at 

      • Associates Level

      • Bachelor's Level

• Complete Fieldwork (FW) in OT

  • Definition: FW are structured learning experiences that are formally administered by academic programs in partnership with facilities that offer training experiences

  • Purpose of fieldwork education is to provide students with opportunities to apply knowledge, skills, & attitudes learned in classes by putting them into practice

  • Example: this parent-infant group allowed OT’s to practice

    • Making skilled observations

    • Administering & scoring parts of developmental evaluation 

    • Communicating with parents & infants

• Two Types of OT Fieldwork

  • Level I Fieldwork

    • Goal: deepen your learning by providing experiences to apply what you learned in courses

    • Fieldwork provides opportunities to practice; observation, communication, inter-professional teamwork & some clinical skills

    • Level I Experiences vary

      • Often supervised by non-OT

    • Level I Fieldwork is NOT!

      • Intended to make students independent practitioners

      • Designed to have students develop specialized skills

      • Counted for credit toward level II 

  • Level II Fieldwork in USA

    • Goal: To develop competent entry level generalist practitioners

    • OT students must

      • Complete a minimum of 24 weeks full work equivalent (FTE) experience at FW site

      • Be supervised by an occupational therapist with > or = 1 year of experience

    • OTA students must

      • Complete minimum of 16 weeks FTE at site

      • Be supervised by an occupational therapist or OT assistant with > or = 1 year of experience

• Important Terms to Know for Fieldwork

  • Academic Fieldwork Coordinator (AFWC): Is the University educator who manages clinical education (fieldwork) aspects of your education

  • Site Coordinator: administrative functions is liaison with school

  • Fieldwork Educator (FWE)/Practice Educator: must be an OTR/L or COTA/L. Provides onsite learning experiences & supervises students on level I and level II fieldwork

  • Site Educator: Is a person from another profession onsite (not an OTR/L or COTA/L). Can provide onsite learning experiences & supervise students for level I fieldwork.

  • Fieldwork Performance Evaluation (FWPE): Assessment that evaluated students’ performance on level II fieldwork.

• Entry-Level Certification for OT Practitioners

  • Earn National Registration or Certification 

    • Apply to NBCOT to take exam

      • Meet all eligibility requirements

        • Graduate from accredited OT or OTA program

        • NBCOT Character Review

    • NBCOT “Board” exam

      • Registration exam is for occupational therapists

        • If you pass, you become an OTR

      • Certification exam is for occupational therapy assistants

        • If passed, he/she becomes a COTA

  • Apply for & be awarded state licensure

    • After a person has passed the OTR or COTA exam, then he/she may apply for state licensure

    • Currently you must apply for a license in each state you wish to practice, this may change…

    • Once a person is granted a license, then he/she is eligible to practice in states where they are licensed

  • OTR/L or COTA/L

• Differences in OT/OTA Standards of Practice

  • OTR/L is ultimately responsible for OT Process; evaluation and intervention outcome

    • Need communication with and supervise COTA

  • You both must understand your respective skill levels, strengths, and challenges

  • Take home points

    • OTR/L & COTA have related and differing roles

    • OTR/L and COTA are a team

    • Communication, collaboration, and supervision are essential

    • OTR/L is ultimately responsible for COTA

    • OTR/L needs to provide supervision

Competence and Professional Development

• Professional Competency in OT

  • Being competent results from…

    • Specific knowledge of practice standards with 

    • Knowledge of current practice, with skills & abilities  needed to perform; relevant tasks, functions & roles

    • Knowledge of how the above affect client outcomes as well as

    • Understanding how your own performance compares with the specific criterion established by the OT profession

  • Competency is…

    • The actual performance of competence

    • A professional obligation and a lifelong process for all OT practitioners

  • Adhere to..

    • Standards of practice

    • Ethical codes

    • Codes of conduct

• Initial (entry-level) competence

  • Refers to a broad set of skills that OTR/COTA generalists

  • Typically seen in those with less than one year of experience

  • OTR & COTA have different requirements for competence related to their differing roles and functions (see table 70-1 for details)

  • Initial competence in OT is demonstrated by having particular:

    • Knowledge

    • Critical thinking/reasoning skills

    • Interpersonal skills

    • Performance skills

    • Ethical practice skills

• Standards of Practice

  1. Differ for OTR/L & COTA

  2. When these can be found

     1. Initial competence (entry level standards)

        1. NBCOT matrix

        2. AOTA Official Documents

        3. ACOTE (B standards) discuss what different levels of OT Practitioners are supposed to be able to do

  3. Standards of Practice & Continuing Competence

     1. National

        1. AOTA Standard of Practice 

           • 1. Educational, Examination & Licensure Requirements 

           • 2. Standard I. Professional Standing and Responsibility

           • 3. Standard II. Service Delivery

           • 4. Standard III. Screening, Evaluation, and Reevaluation

           • 5. Standard IV. Intervention Process

           • 6. Standard V. Outcomes, Transition, and Discontinuation

     2. State: each differs slightly

        1. Virginia Board of Medicine

• Continuing Competence

  1. Ethical obligation tied to OT’s core ethical principles of

     1. Beneficence (to do good) - requires taking action to benefit others; to promote good, prevent harm

     2. Nonmaleficence - refrain from causing harm, injury, or wrongdoing to recipients of service

     3. An ongoing process: make a commitment to intentional, lifelong learning & professional development

  2. OT practitioners need to show evidence of ongoing professional development to maintain credentials

     1. Our job as practitioners to know requirements & track professional development activities

     2. National Level - NBCOT requires renewal of registration/certification every 3 years*

        1. Earn professional development units

        2. (*Maintaining registration /certification is not mandatory to practice OT)

  3. State level - state regulatory boards have requirements for licensure

     1. While the specific requirements for professional development and frequency of renewal vary from state to state most specify required professional development activities

• Why Remaining Competent is Essential

  1. OT practitioners need to adapt

     1. To changes in the field

        1. New scientific developments: new clinical evidence, & new technologies

        2. Frequent changes to  health/ education/ human service policies 

        3. Changes within practice settings

        4. Emerging needs of clients

     2. To institutional changes

     3. To changes in your own life course/career changes

        1. New positions (jobs)

        2. New roles in current job (e.g. promotion to supervisor)

        3. New interests/needs in own life

  2. OT practitioners are obligated to remain competent so that we “do good” for clients & cause no harm

     1. Use interventions that are safe, effective, evidence-based, and cost effective

     2. Advocate for consumers/clients of OT in larger policy venues

     3. Proactively contribute to knowledge

  3. Professional development helps us remain competent

• Professional Development Process

  1. Awareness of standards (these change)

  2. Self-Reflection: Clarify interests, roles, functions & tasks  

  3. Evaluate self against professional standards  (knowledge, attitudes, skills & habits)

     1. State Level: State Regulatory Boards have licensure requirements 

     2.  National/Professional Requirements  

        1. AOTA Standards for Practice (AOTA 2021b) 

        2. AOTA’s Standard for Continuing Competence * (2021)

        3. National Board for Certification in Occupational Therapy 

        4. State-level mandates

        5. Employer requirements

        6. Specialty or advanced-level practice credentials 

  4. Create a professional development plan consisting of goals, strategies & activities that will help you meet these goals

  5. Systematically implement your plan

  6. Evaluate the effectiveness of your plan & document findings- revise if/when needed

  7. Submit findings as needed

• Ongoing Process for Professional Development

• AOTAs Standards for Continuing Competence

  • This document is designed to help OT practitioners by identifying keys to maintaining professional competence

    • Knowledge

    • Professional Reasoning

    • Interpersonal Skills

    • Performance skills

    • Ethical practice

• Resources for Professional Development

  • Professional Development Tools

    • AOTA: AOTA Learn

      • Continuing education

        • Conferences, events

        • Online & in person

      • Digital badge program

    • NBCOT

      • Self-Assessment

      • Navigator

      • Certification Renewal Activities Chart

      • Digital badges

    • External to OT profession…

      • Association of Hand Therapists

      • Assistive Technology Practitioner

      • Driver Rehabilitation Specialists

    • Portfolio Assignment: go into your

    • Professional Development folders:

      • Complete the NBCOT self assessment & use it to identify areas for growth.

      • Consider your own interests in OT to write goals for yourself within the OT Program and for your first few years of practice.

      • Use the certification renewal activities chart to identify strategies that support your ongoing professional development

      • Look at the AOTA, VOTA, WFOT & at NBCOT websites & chapter 70 in your Willard & Spackman text to identify resources that you may use to support your professional development.  

• Specialty & Advanced Practice

  • Within the OT Profession

    • Advanced practitioners possess a higher level of practice expertise resulting from engaging in theory-informed evidence based practice

    • AOTA offers…

      • Board certifications of advanced practice

      • Specialty certifications

  • Outside OT Profession

    • OT practitioners are eligible to apply for specialty certifications offered by other organizations

      • Certified hand therapist

      • SIPT certification

• Supervision

  • Spend time in controlling and directing functions

  • Oversee employees’ performance and productivity in daily work

  • Is supervisee…

    • Successfully accomplishing work

    • Demonstrating continuing professional development

  • Can be in the form of

    • Formal

    • Informal

    • Mentoring

    • Supervisory process: ongoing, orderly, & interactive

• Supervision is essential for growth

  • Administrative supervision

    • Focuses on monitoring performance  & ensuring that the supervisee’s work performance & professional development meet objectives & standards of the employer 

  • Clinical supervision

    • Provides support, training & evaluation of professional performance 

    • Aimed at assisting the supervisee develop discipline specific skills 

  • Functional supervision

    • Occurs when a specific aspect of work or function is delegated to a specific person to provide specified training in that aspect or those skills

      • E.g. an OT who specializes in AT might provide supervision to a new employee 

• Supervisors in OT & Supervisory Patterns

  • Roles

    • Provide feedback

    • Evaluate performance

    • Address work performance problems

      • Behavior problems

      • Performance problems

      • Inter-personal work issues

• Supervision Considerations

  • Methods of supervision: are selected to meet the supervisee’s needs & demands of the work site

    • Line of sight: supervisor is present when employee performs job & actually observes performance

    • Indirect supervision: occurs after the job was performed. It includes communicating with the supervisee, looking at records, or receiving reports from others about the supervisee’s performance. 

    • Tele supervision: uses communication technology to provide supervision 

      • *be mindful of adhering to state regulations

  • Frequency of supervision

    • Supervisor’s skills

    • Supervisee’s skills

    • Nature of the work

    • Expectations & requirements of the work setting

    • Expectations & requirements of external regulators

• What if I change practice areas or leave OT temporarily?

  • Sometimes OT practitioners decide to change practice areas

  • Other times OT practitioners decide to take time off of practicing OT

  • AOTA has guidelines for re-entry

    • Formal self-assessment & create professional development plan

    • Complete formal learning related to OT

      • 12 hrs./each year out of practice

      • At least 24 hours occur within the 24 months directly preceding return

      • 3 hours of ethics &  3 hours relate to laws & regulations for OT

    • Update knowledge of OT profession by reviewing AOTA official documents

    • If OT is out of practice for more than 3 years, need to get 10 hours of supervised practice for every year away

      • 10 hours per year you are out of practice