July / August 2000 Table of Contents
In this Article
Responsibility for Occupational Therapy Service Provision
The Supervision Process for Assigned Occupational Therapy Services
Occupational therapy services may be provided by an occupational therapist or components of the service may be assigned to another individual such as an occupational therapy support worker or other service provider. Appropriate supervision is important in ensuring quality of client services and is therefore an essential component in the effective management of occupational therapy service delivery.
The guidelines in this document outline important considerations for the supervision of occupational therapy services assigned to persons other than occupational therapists or occupational therapy students. This document does not refer to services provided by the occupational therapist acting in the role of a consultant (see glossary of terms). The document is intended to be reviewed in its entirety for a comprehensive overview of this issue. Parts of the guidelines should not be used without the context provided by the entire document.
Responsibility for Occupational
Therapy Service Provision
The occupational therapist has the ultimate responsibility for occupational
therapy service provision. This responsibility is implicit in the occupational
therapist's agreement to provide services to the client (Cosman &
Heinz, 1996). The responsibility of an occupational therapist for the
supervision of assigned occupational therapy services remains the same
regardless of the individual to whom the service component is assigned.
All occupational therapy services must therefore be supervised by a qualified
occupational therapist.
Occupational therapists in most provinces of Canada are accountable to a provincial regulatory body which has the responsibility of governing the practice of occupational therapy in that jurisdiction. Any existing provincial guidelines and regulations which outline supervisory responsibilities should be adhered to at all times.
Supervisory Responsibilities
The role of the occupational therapist in the supervision of persons providing
assigned client services includes overseeing the quality and quantity
of work carried out to ensure expected outcomes of service are attained.
As well the occupational therapist may assist with the appropriate allocation
of time and resources to effectively meet client needs.
All persons providing occupational therapy services must receive site and service specific training to have an understanding of the intent and procedures for the occupational therapy intervention. The complexity of this training varies according to the nature of the assigned task, the skill level of the service provider and the service requirements. It is the responsibility of the occupational therapist to collaborate in the design and implementation of this training.
An occupational therapy service should only be considered operational if all occupational therapy client service provision is supervised by a qualified occupational therapist. An employer providing occupational therapy services must ensure adequate time is available for supervision, for developing job descriptions, policies and procedures which reflect the appropriate requirements for effective supervision and for ensuring that a standard for service quality and effectiveness is maintained.
The Supervision Process for
Assigned Occupational Therapy Services
Although the methods and frequency of supervision vary, the same steps
of the supervision process are followed for all persons to whom occupational
therapy service provision is assigned.
1. Task Identification and Analysis
Occupational therapy tasks or service components which may be assigned
are identified by the occupational therapist.
Conditions for assignment of a service component include:
a. The client understands and consents to the provision of the service component by an individual who is not an occupational therapist
b. The occupational therapist establishes that the service provider is competent to provide the service safely and effectively
c. The service provider acknowledges accountability to the supervising occupational therapist in completing the assigned task.
d. Supervision of the service provider by an occupational therapist is available as required.
e. The assignment of the task will not compromise the quality and outcome of the occupational therapy service.
CAOT articulated a list of tasks which should not be included as responsibilities of support personnel in the Discussion Paper on the Role and Use of Supportive Personnel in the Rehabilitation Disciplines (CAOT, 1989). This list has been reviewed and revised to reflect current occupational therapy practices and service environments. CAOT recommends the following occupational therapy service components should not be assigned to persons who are not occupational therapists (COTO, 1996):
- interpretation of referrals
- initial interviews
- interpretation of assessment findings
- intervention planning (including goal identification)
- interventions which require continuous clinical judgment to closely monitor and guide client progress
- modification of intervention beyond limits established by the supervising occupational therapist
- discharge decisions
Parts of an assessment process may be assigned if explicit criteria are outlined for that process.
The above list may not be inclusive for all settings. The professional judgment of the occupational therapist must be exercised in assigning occupational therapy service components.
The assignment of the service components is documented in the client record by the occupational therapist. As appropriate, the service provider records the completion of the assigned tasks.
2. Development of a Supervision Plan
A supervision plan which outlines methods and frequency of service supervision
must be determined prior to the assignment of a task and re-evaluated
at regular intervals for effectiveness. The type and amount of supervision
is dependent upon the complexities of the service component(s) to be assigned,
the needs of the client population to be served and the competencies of
the service provider. Supervision must be ongoing, involve regular contact
with the supervising therapist and involve a combination of methods such
as observation of interventions and/or client-worker interactions, record
reviews and informal or formal meetings. Input may be obtained from other
health professionals. Face to face contact is always required at regular
intervals. Mechanisms to access the supervising occupational therapist
must be identified, particularly for emergency situations.
3. Monitoring and Evaluation of Task Completion
Completion of assigned tasks is regularly monitored and evaluated by the
occupational therapist as outlined in the supervision plan. Evaluation
considerations include attainment of client and/or program outcomes, client
and other stakeholder satisfaction with services and cost efficiency of
service provision. Results of the evaluation are documented by the occupational
therapist, including any variances in the completion of the assigned service
from the instructions provided by the therapist. In follow-up to the results
of the evaluation, any required action to ensure appropriate service is
provided to the client to achieve desired service quality and outcomes
is initiated by the occupational therapist e.g. modification of the task,
modification of the instructions, withdrawal of the assignment of the
task.
References
Canadian Association of Occupational Therapists. (1989). Discussion
Paper on the Role and Use of Support Personnel in the Rehabilitation Disciplines.
Toronto, ON: author.
College of Occupational Therapists. (1990). Statement on Supervision in Occupational Therapy. London: author.
College of Occupational Therapists of Ontario. (1996). Practice Guideline: Assigning of Service Components to Non-Registrants. Toronto, ON: author.
Cosman, R.W., Heinz, C.L. (1996). Professional Responsibility of Occupational Therapists. Ottawa, ON: Canadian Association of Occupational Therapists.
Saskatchewan Society of Occupational Therapists. (1995). Delivery of Occupational Therapy Service: How do Occupa-tional Therapist Assistants Assist? Saskatoon: Author.
assignment
The process of designating a person who is not an occupational therapist
with the responsibility of delivering specific components of occupational
therapy service. The recipient of the occupational therapy intervention
is a client of the occupational therapist. The occupational therapist
has ongoing responsibility to monitor the provision of the occupational
therapy service.
consultation
The process of providing generic information, education and/or training
to a service provider who is not an occupational therapist. The recipient
of the intervention of the service provider is not considered to have
received occupational therapy and is not a client of the occupational
therapist. The occupational therapist does not have continuing responsibility
for the supervision and follow-up of the service provision.
controlled acts
Activities or procedures defined in legislation in some Canadian jurisdictions
which can be performed only by specific regulated health professionals
as result of a significant risk of harm e.g. communicating a diagnosis,
setting a fracture.
delegation
A term defined in legislation in some Canadian jurisdictions as the transfer
of authority from one practitioner to another for performing a designated
controlled act.
qualified occupational therapist
An individual who is licensed or certified by a provincial regulatory
body as an occupational therapist or in the absence of a provincial/territorial
regulatory body, meets the requirements for individual membership in CAOT.
occupational therapy support personnel/workers
Any workers who are not qualified occupational therapists but are knowledgeable
in the field of occupational therapy through experience, education and/or
training and are directly involved in the provision of occupational therapy
services under the supervision of an occupational therapist.
supervision
A process in which two or more people participate in a joint effort to
promote, establish, maintain or increase a level of performance and service.
One person is identified as having ultimate responsibility for the quality
of service.
July / August 2000 Table of Contents
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