GUIDELINES FOR THE SUPERVISION OF ASSIGNED OCCUPATIONAL THERAPY SERVICE COMPONENTS (2003)

This document outlines important guidelines for occupational therapy services assigned to persons other than occupational therapists or occupational therapy students. It does not refer to services provided by the occupational therapist in a consultant role. (see glossary of terms). The document is intended to be reviewed in its entirety for a comprehensive overview of this issue. Therefore, parts of the guidelines should not be used without the context provided by the entire document.

RESPONSIBILITY FOR PROVISION OF OCCUPATIONAL THERAPY SERVICES

Occupational therapists are the primary service providers for occupational therapy. Occupational therapists are graduates of accredited university occupational therapy programs in Canada. They have the required skills and knowledge to provide an evidence-based approach to help others identify, engage in and achieve their desired potential in their occupations (CAOT,2002).

Occupational therapists are regulated in each Canadian province. They are accountable to a provincial regulatory body which is responsible for governing occupational therapy practice in that jurisdiction. Any existing provincial guidelines and regulations which outline supervisory responsibilities for support personnel should be adhered to at all times.

Occupational therapy services are 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. 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. This may refer to family caregivers, teaching assistants, support personnel in occupational therapy or technical support workers.

Appropriate supervision is crucial to ensure the quality of client services and is an essential component in the effective management of occupational therapy service delivery. All occupational therapy services must therefore be supervised by a qualified occupational therapist.

SUPERVISORY RESPONSIBILITIES OF OCCUPATIONAL THERAPISTS

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 and the development of job descriptions, policies and procedures, which reflect the appropriate requirements for effective supervision and make certain 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 three steps of the supervision process are followed for the provision of occupational therapy services:

1. Task Identification and Analysis

Occupational therapy tasks or service components, which may be assigned, are identified by the occupational therapist. The conditions for assignment of a service component include:

• The client understands and consents to the provision of the service component by an individual who is not an occupational therapist
• The occupational therapist establishes the competency of the service provider to provide the service safely and effectively
• The service provider acknowledges accountability to the supervising occupational therapist in completing the assigned task.
• Supervision of the service provider is available by an occupational therapist.
• The assignment of the task will not compromise the quality and outcome of the occupational therapy service.

There are service components which should not be included as responsibilities of support personnel and are stated in the Project Summary Report: Profile of Performance Expectations for Support Personnel in Occupational Therapy in Canada (CAOT, 2002). CAOT recommends the following occupational therapy service components should not be assigned to persons who are not occupational therapists:

• Interpretation of referrals
• Initial interviews/assessments
• 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

The assignment of the service components is documented in the client record by the occupational therapist. Where required and appropriate, the service provider records the completion of the assigned tasks.

2. Development of 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. (2003)Project Summary Report: Profile of Performance Expectations for Support Personnel in Occupational Therapy in Canada. Ottawa, ON: author

Canadian Association of Occupational Therapists. (2002) Profile of Occupational Therapy Practice in Canada. Ottawa, ON: author. Retrieved from the World Wide Web on January 19, 2003.

Canadian Association of Occupational Therapists. (2003) Position Statement on Support Personnel in Occupational Therapy. CJOT (70):2.

GLOSSARY OF TERMS

assignment
The process by which an occupational therapist designates another service provider,, other than an occupational therapist, to deliver specific occupational therapy service components. The recipient of the service components is a client of the occupational therapist. The occupational therapist has the ongoing responsibility for the the provision of the occupational therapy service.

consultation
The process of providing expert advice, education and/or training or facilitating problem-solving regarding a specific issue with another service provider, on a time limited basis. The consultant occupational therapist is not assigning occupational therapy service components and does not have continuing responsibility for supervising the quality of the ongoing service of the provider.

occupational therapy service component
Any task related to the delivery of the occupational therapy service.

occupational therapy support personnel/workers
Any service providers who are not qualified occupational therapists but are knowledgeable in the field of occupational therapy through experience, education and/or training and directly involved in the provision of occupational therapy services under the supervision of an occupational therapist.

qualified occupational therapist
An individual who is registered 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.

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.