Occupational therapists (OTs) routinely include occupational therapist assistants in their delivery of occupational therapy services to optimize service delivery. The purpose of
the Standards for the Supervision of Occupational Therapist Assistants is to ensure that OTs in Ontario are aware of the minimum expectations for the supervision of occupational therapist assistants when assigning occupational therapy components.
Titles for Occupational Therapist Assistants (OTA)
The term occupational therapist assistant (OTA) is a descriptor for service providers, who are assigned occupational therapy service components under the supervision of an OT. The term occupational therapist assistant relates to the role as one of assisting and attaches accountability to an OT.
The specific tasks assigned to the OTA must be part of the overall occupational therapy service. The OTA must work under the direction and supervision of an OT and the OT must assume responsibility and accountability for the ongoing quality of occupational therapy service delivery. Student OTs and volunteers are not considered to be OTAs.
OTAs may have various titles such as support person, rehabilitation coach, rehabilitation support worker, rehabilitation assistant, rehabilitation therapist, occupational therapist assistant (OTA) or occupational therapist assistant/physiotherapist assistant (OTA/PTA).
There is considerable variation in OTA training and education. Some OTAs have completed post-secondary programs specific to the knowledge, skills and abilities required to assist an OT in the delivery of occupational therapy services, while others may have completed on-the-job training that is specific to occupational therapy. Regardless of the OTA’s training, it is the accountability of the supervising OT to ensure the OTA is competent to safely, effectively and ethically deliver the assigned occupational therapy service components.
Situations Where the OT is Not Accountable for the Actions of the OTA
In some settings OTAs may be required to perform additional tasks that do not fall under the responsibility of the OT. The OT is not professionally accountable for the actions of the OTA in the following situations:
- When the OTA is acting as an assistant to another regulated health professional, for example, administering a mobility plan that was assigned by a physiotherapist;
- When the OTA is working on activities with the client that were not assigned by the OT, for example, an assistant may run a group as part of the overall facility program, which is not part of the occupational therapy program;
- When the OTA deliberately performs occupational therapy service components that have not been assigned by the OT or are outside the parameters of care set by the OT1;
- When the OTA is performing administrative activities required by an employer who is not the OT.
In many cases, the OT is not responsible for OTA performance management; however, if the OT becomes aware of OTA performance issues impacting the provision of safe occupational therapy service, the OT
must take steps to address the issue which may include:
- Discussing the concern with the OTA;
- Reporting the concern to the OTA’s respective manager;
- Discontinuing assignment of some or all OT plan components to the OTA until the issue is resolved.
Consultation Recommendations and OT Accountability for Implementation
In some occupational therapy practice environments, OTs assume the role of a consultant. For these Standards, consultation is described as the process of identifying problems, providing recommendations, education and/or training or facilitating problem-solving regarding a specific issue with a client, another care provider, or groups of individuals or organizations, on a time-limited basis
2. In this consultation role, the OT
does not assign occupational therapy service components and is not directly responsible for the implementation or outcome of their recommendations.
When assuming a consultation role, the OT is accountable for the recommendations they make, however, they are not accountable for the implementation of the recommendations or the individual carrying out the recommended activities. Individuals who carry out recommendations based on an occupational therapy consultation are not acting in an OTA role. For example, an OT may consult to an educational assistant (EA) on appropriate positioning techniques that the EA can use when working with a student in the classroom. Another example is consulting with a personal support worker (PSW) or family member on environmental adaptations to support bed mobility. In these examples, the EA, PSW or family member would not be considered an OTA. The OT would not have the responsibility for supervising and monitoring the care provided by others following the consultation service.
OTs must be clear on the distinction between situations that involve the use of OTAs and situations when they are fulfilling a consultation role and must make this distinction clear to all stakeholders, including clients, employers, OTAs and other health care providers. The OT remains accountable for the quality of the consultation provided and, when relevant, should consider who may be responsible for implementing the recommendations.
1 If the OT knew or ought to have known that the OTA was performing occupational therapy services that were not assigned by the OT or are outside the parameters of care set by the OT, then the OT has an obligation to stop that from occurring, failing which the OT might very well be seen to be accountable for the OTA’s actions.
2 CAOT, 2009