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Working with OTAs in a Private Community-Based Practice


Quinn is an occupational therapist and owner of a private practice. She receives referrals mainly from insurers and lawyers for clients after motor vehicle accident or personal injury. Quinn has several occupational therapists working for her as contractors, but as the demand for services grow, she is considering hiring an occupational therapy assistant (OTA).

Quinn is not as familiar with the use of OTAs in the private sector where the work is community-based, so she reviewed the Standard for the Supervision of Students and Occupational Therapy Assistants, 2023 ( and followed up with a call to the Practice Resource service to discuss the following questions.

Practice Questions and Discussion

1. Can the occupational therapist send the OTA to the client’s home to meet the client first?
The initiation of the OT service cannot be assigned (Standard for the Supervision of Students and Occupational Therapy Assistants, 2023 (, indicator 6.2). The occupational therapist must meet the client first to:

  • Obtain consent for OT service
  • Complete an assessment and service plan
  • Determine suitability for the involvement of the OTA
  • Obtain consent for the involvement of the OTA, and to clarify their roles and responsibilities (Standard for Consent, 2023 (, indicator 2.6).

2. Can the OTA work alone in the client’s home, or does the occupational therapist always have to be present?
Occupational therapists should consider several factors to determine whether an OTA can be working independently with a client in the home or community environment. These include:

  • Client related risk factors, such as the client’s health condition and medical stability
  • Competencies of the OTA, such as their knowledge, skill and judgement. Additional training or skill building may be required to meet the needs of the client population and practice setting.
  • Type of tasks assigned, as occupational therapists may need to modify the tasks assigned to manage risks.  
  • Environmental risk factors, such as the availability of back up supervision and supports, and the presence of other individuals or caregivers in the home.

Occupational therapists are accountable for the service provided and must have a clear supervision and communication plan in place to manage any risks to client care and safety.

3. Is virtual supervision of the OTA permitted?

The occupational therapist needs to determine if client care can be delivered safely by the OTA under this model of supervision. There can be limitations with virtual supervision, such as being unable to provide any hands-on assistance or modifications during a treatment session or physically assist with any safety issues. There may also be challenges related to internet connectivity or camera angles. These types of limitations may require assigning lower risk treatment activities, for example assigning seated activities so that the client can be fully visible on camera or to minimize the risk of falls. Virtual supervision may require more frequent check-ins with the OTA with clear emergency and back up supports in place to manage any risks.

4. Do OTA notes need to be co-signed by the occupational therapist?

The Standard for Record Keeping, 2023 ( indicator 4.4 states that occupational therapists must “review the record keeping completed by occupational therapy assistants to confirm that it is accurate and follows appropriate College Standards and workplace policies. Document this review.”. There is no College requirement for occupational therapists to co-sign OTA notes, however employers may have this as a requirement based on the needs of the practice setting.

5. Does the individual need to be a graduate of an OTA educational program?

The College does not have a requirement that the OTA needs to graduate from an OTA program. The hiring organization may decide to have this as a prerequisite for the role, but this is at the discretion of the organization. Employers can also decide to have other requirements for the OTA role to suit the needs of the practice setting.

6. Can I hire an OTA as a contractor?

The College does not set employment or hiring guidelines for organizations or occupational therapists who are employers.  Occupational therapists are encouraged to seek accounting or legal advice for their business practices. Regardless of the business arrangements, the accountabilities for service delivery must be clear and follow College guidelines.

7. Are OTAs regulated to practice in Ontario? Where can they get support?

OTAs are not regulated in Ontario. OTAs can join either the Canadian Association of Occupational Therapists (CAOT) or the Ontario Society of Occupational Therapists (OSOT) for professional association support and resources. 

8. Does an OTA need their own malpractice insurance?

As OTAs are not regulated, any liability insurance requirements for the OTA will be at the discretion of the employer or organization. Occupational therapists can contact insurance providers to inquire about coverage for their OT services that are delivered by an OTA.


After the call with the Practice Consultant, Quinn meets with her team of occupational therapists to discuss how an OTA can be supervised and used effectively in their practice setting. She will also reach out to the professional associations for additional resources as she begins to develop policies and processes to integrate an OTA into her company.


As the practice of occupational therapists evolves, so do the opportunities to collaborate with OTAs to provide OT service. It is important to emphasize that occupational therapists are accountable for the OT service and therefore must have a clear supervision and communication plan in place to manage risk and ensure the safe delivery of care by the OTA.

In addition to following the Standards of Practice, OTs can access resources provided by the professional associations to support collaborative efforts between occupational therapists, OTAs and employers.



If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1-800-890-6570/416-214-1177 x240 or [email protected].

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