peer assessor with occupational therapist

The College regularly assesses the practice of occupational therapists. If the assessment finds gaps in an occupational therapist's knowledge, skills, and judgment, the College works with them and provides tools and resources for meeting the Essential Competencies and Standards of Practice.

Peer and Practice Assessment: Registrant Selection Based on Risk

The College will be piloting the new risk-based selection process for registrants to participate in a peer and practice assessment on a rolling basis. This means that each month from December 2020 to April 2021 registrants will be notified by email if they will be participating in a peer and practice assessment.

Why is the College conducting these on a rolling basis?

As the College continues to enhance all aspects of the Quality Assurance program, we are working hard to build up our capacity to support our changing program needs. The College has recruited new peer assessors and will be training them to conduct the peer and practice assessments in 2021. Running the assessments on a rolling basis allows the College time to prepare new peer assessors and continue to balance all other program priorities.

Learn more about the upcoming competency assessment process here.

What if I am selected but cannot participate?

If you are selected but feel you have good reasons why you cannot take part in a peer and practice assessment at this time, contact the Manager, Quality Assurance program as soon as you can:

Seema Sindwani, Manager, QA
In Toronto: 416-214-1177, ext. 227
Toll-free: 1-800-890-6570 ext. 227

Requests for deferral are granted on a case by case basis.

View the Request for Deferral Form.

What is involved in peer and practice assessment?

  1. The occupational therapist completes a questionnaire. This gives the College and the peer assessor general information about the occupational therapist’s practice and role. The peer assessor does not have any other advance information about the occupational therapist.

  2. The peer assessor reviews up to 5 of the occupational therapist’s discharged charts.

  3. The peer assessor interviews the occupational therapist virtually. The interview questions are based on cases and situations that the assessor has reviewed in the charts. Here is an example of some questions an assessor might ask about a case where a client has been referred to the occupational therapist:

    Describe the steps you took to determine the appropriateness of this referral. How did you screen the referral? How did you determine you had the knowledge, skills, and judgment required to accept the referral? How did you explain your scope of practice and role to the client?

How long does the assessment take?

Occupational therapists should plan to set aside about five hours for the assessment.

Does the College cover any costs related to the peer and practice assessment?

No. As members of a regulated health profession, occupational therapists have a responsibility to demonstrate they are meeting the Essential Competencies and Standards of Practice and that they have the knowledge, skills, and judgment to practice competently.

Who are the College’s peer assessors?

These are experienced occupational therapists who work in various practice areas, including acute care, vocational rehabilitation, mental health and addiction, and paediatrics. They have been trained by the College to conduct peer and practice assessments.

There are nine peer assessors, located in Kitchener, Guelph, Toronto, Etobicoke and Barrie.

Do occupational therapists need to tell their employer they are taking part in a peer and practice assessment?

No. Occupational therapists are not required to inform their employer, although some may have to so that they can get access to discharged client charts. Employers are required by law to provide this access for peer and practice assessments.

Occupational therapists can ask the College for a letter to give to their employer requesting access to discharged clinical records.

What happens after a peer and practice assessment?

The peer assessor prepares a report for the College’s Quality Assurance Committee. Based on the report, the Committee decides whether the occupational therapist is practicing competently and meeting the Essential Competencies and Standards of Practice. The Committee can take any of the following actions, which are ordered from the least serious to the most serious:

  1. Take no action

    If the Committee has no concerns about an occupational therapist’s practice, the Committee does nothing further and the competency assessment process is concluded.

  2. Take no action but provide a recommendation

    If the Committee has no concerns about an occupational therapist’s practice, they may still recommend a voluntary activity such as reviewing the Standards for Record Keeping. At this point the process is concluded.

  3. Issue a Specified Continuing Education or Remediation Program (SCERP)

    If the Committee finds there are gaps in an occupational therapist’s knowledge, skills, or judgment, they will require the occupational therapist to participate in a form of education or remediation called a SCERP.

    For example, the Committee may direct an occupational therapist to review a College standard, such as the Standards for Consent. The occupational therapist must then write a reflective paper in which they think about how to improve their practice. In this example, the paper should outline how the occupational therapist will incorporate an informed consent process into their practice.

    The reflective paper would have a due date and would be reviewed by the College.

    The purpose of a SCERP is to give the occupational therapist the opportunity to show that they have engaged in a learning process and improved their practice. This aids the occupational therapist’s own professional growth and protects the clients they serve and people they work with.

    SCERPs ordered by the Quality Assurance Committee are not posted on the College’s Public Register.

  4. Require another peer and practice assessment

    If the Committee needs more information to make a fair decision, they can order another peer and practice assessment.

  5. Impose terms on an occupational therapist’s practice

    If the Committee finds that an occupational therapist’s lack of knowledge, skills, or judgment could pose a risk to the public, it can place restrictions on the occupational therapist's practice. These terms are placed on the occupational therapist’s practice and posted on the Public Register.

    An example of restricted practice would be requiring the occupational therapist to be supervised when they perform certain tasks. Another example would be requiring the occupational therapist to remain in a certain area of practice until they show improvement.

    The occupational therapist would also participate in a specified continuing education or remediation program (SCERP).

  6. Refer the occupational therapist to the Inquiries, Complaints and Reports Committee

    The Committee may find that the occupational therapist has engaged in professional misconduct. This could happen, for example, if the occupational therapist did not respond to the College after repeated attempts to have them take part in the Quality Assurance program, or they did not comply with the orders of the Quality Assurance Committee.
How does the Quality Assurance Committee make decisions?

The Committee reviews all the information from the peer and practice assessment. If a Committee member believes they may know the occupational therapist and have a conflict, they must declare this and not take part in the discussion.

In making decisions, the Committee takes into account:

  • the level of risk to the public
  • whether the occupational therapist responded to the College in a timely manner throughout the process
  • the occupational therapist’s history with the College, as this may show where the occupational therapist has ongoing challenges.
The Committee may also compare the occupational therapist’s case to other decisions they have made to ensure they are being fair.

In 2019 decisions issued by the Quality Assurance Committee included:

  • Review of the Standards for Record Keeping
  • Review of the Standards for Consent
  • Implementation of the Conscious Decision-making approach when considering options and risks when making professional decisions; and
  • Reminders of proper designation for use of the protected title of occupational therapist: OT Reg. (Ont.)

Demystifying the Quality Assurance Program: With Special Focus on the Peer and Practice Assessment

Responses to Questions from the January 12, 2021 Webinar:

[Download a PDF of the FAQs]
  1. How many registrants will be participating in the upcoming risk-based selection peer and practice assessments?

    The Quality Assurance Committee approved the selection of 50-75 registrants for a peer assessment before May 31, 2021. Registrants are to be selected on a gradually, with the next scheduled pull for March.

  2. How will registrants be notified?

    Registrants will receive a letter by email. The College will request the registrant acknowledge receipt of the letter.

  3. You mentioned that there are 18 risks in the 3 areas. Can you further explain them?

    Please visit the College’s website for additional information on the risk areas.

  4. Do you require the entire patient file to review and do the peer and practice assessment?

    No, however, in addition to your own assessment documents, progress notes etc. you are required to provide any information that supported your decision-making with the client (i.e.reports from other health care providers etc.). If you are selected you will receive instructions on how many files you are required to prepare and how to best organize these for the assessor.

  5. As the process to screen registrants before an assessment is being developed, will all those chosen now, proceed directly to the peer and practice assessment?

    Yes, all registrants chosen before May 2021 will participate in a peer assessment.

  6. From what I understand, the College is not planning to let OTs know how many risk indicators they have. Is this still the case?

    All the risk indicators are derived directly from each registrant’s annual renewal form as well as their own QA self-assessment. As such, each registrant will be able to understand their own risk areas. Consult the website to understand what indicators apply to you and your risk category.

  7. Are the peer assessments just for clinical occupational therapists right now?

    No, both clinical and non-clinical occupational therapists are being selected. There are two different assessment processes for clinical and non-clinical occupational therapists, but both are based on the Essential Competencies of Practice. The main difference is that there is no record review during the assessment for non-clinical practitioners.

  8. Given the COVID-19 pandemic context, will the process be adapted?

    Yes. All peer and practice assessments are now completed virtually. This includes the record review and the behavioral interview.

  9. For occupational therapists working in a setting with electronic medical records, how is the record review done?

    Instructions on how to prepare records are provided at the time a registrant is selected. In summary, however, registrants are asked to obtain five records for discontinued clients, to organize them chronologically by dates of service, and transfer them into a PDF format. These are then to be sent to the assessor’s confidential College email using password protection and / or encryption.

  10. Does the College have consent and authority to access client records?

    Yes. The College is allowed, as per the Regulated Health Professions Act, to obtain client records for the purposes of regulating the profession. A letter to this effect is provided to selected registrants with their package, so they can give this to their employer or records departments if required.