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Scope of Practice and Controlled Acts

Each regulated health care profession has its own definitions about what its professionals can and cannot do when providing services to patients and clients.

The province’s legislation defines:

  • the scope of practice for the profession, and
  • the controlled acts (certain activities and procedures) professionals are permitted to do, in whole or part.

Scope of Practice

A scope of practice describes what a health care practitioner is permitted to do, provided they have the required knowledge, skills and judgment, when they are a registered member of a profession.

For occupational therapists (OTs), the legal basis for practice comes from the Occupational Therapy Act, 1991. The Act sets out what occupational therapists are trained, competent and authorized to perform:

“The practice of occupational therapy is the assessment of function and adaptive behaviour and the treatment and prevention of disorders which affect function or adaptive behaviour to develop, maintain, rehabilitate or augment function or adaptive behaviour in the areas of self-care, productivity and leisure.”

This definition is broad enough to cover a range of activities related to assessment, intervention and prevention. The definition includes a range of procedures, action, processes, roles, and responsibilities that an occupational therapist can safely and effectively perform. The College interprets scope of practice to consider an occupational therapist's education, competencies and ongoing professional development.

Controlled Acts

In health care, certain activities and procedures have higher risk, so not everyone is allowed to perform them. These are called controlled acts.

Under Ontario law, only authorized health care professionals can perform the 14 controlled acts. Different health care professionals may be permitted to perform certain controlled acts, in whole or part.

There are three ways a professional may be able to perform controlled acts.

  1. They could be granted that authority. For example, occupational therapists have the direct authority to perform the controlled act of psychotherapy. This is the only controlled act that occupational therapists have direct authority to perform. More information is available in the College Standard for Psychotherapy.
  2. They could perform the controlled act under an exemption in the legislation. For example, occupational therapists may perform the controlled act of acupuncture due to an exemption. More information is available in the College Standard for Acupuncture.
  3. They could be transferred the authority. A health care professional who has the authority to perform a certain controlled act can transfer that authority to another health care professional. That’s called delegation. For example, a physician could delegate the splinting of a fracture to an occupational therapist.

An occupational therapist can only perform a delegated controlled act if:

  • it falls within the scope of practice of occupational therapy;  and;
  • the occupational therapist has the knowledge, skills and abilities to carry out the act.