• Accountability
• Competency
• Supervision of Students
• Consent
• Use of Title
• Record Keeping
• Professional Boundaries
• Risk Management
• Controlled Acts
• Role Emerging Placements

The purpose of this document is to ensure occupational therapists (OTs) in Ontario are aware of the minimum expectations for the supervision of Student Occupational Therapists, Student Occupational Therapist Assistants, and students from other health professions. These Standards apply to students seeking work experience in occupational therapy practice. As one component of their responsibility and commitment to the profession of occupational therapy, OTs actively participate in the education of student occupational therapists through fieldwork supervision. In the interest of public protection and the ongoing development of the profession of occupational therapy, the College of Occupational Therapists of Ontario supports OTs as student supervisors and emphasizes their supervisory responsibility for safe and ethical practice. In assuming the role of student supervisor, the OT remains fully accountable and responsible for the quality of care provided to clients.

• The following standards describe the minimum expectations for OTs when providing supervision to students.
• The performance indicators listed beneath each standard describe more specific behaviours that demonstrate the standard has been met.
• While it is not expected that all performance indicators will be evident all the time, it is expected that they could be demonstrated if requested.
• It is expected that OTs will always use their clinical judgement to determine how to best meet client needs in accordance with the standards of the profession.
• It is expected that OTs will be able to provide a reasonable rationale for any variations from the standard.

In the event of any conflict or inconsistency in these Standards for the Supervision of Students with any other College standards, the Standards with the most recent issued or revised date prevail.

College publications contain practice parameters and standards which all OTs practising in Ontario should consider in the care of their clients and in the practice of the profession. College Standards are developed in consultation with OTs and describe current professional expectations. College Standards may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.

Pursuant to the Regulated Health Professions Act, 1991 (RHPA), the College is authorized to make regulations in relation to professional practice. Ontario Regulation 95/07: Professional Misconduct establishes that “contravening, by act or omission, a standard of practice of the profession or failing to maintain a standard of the profession” constitutes grounds for professional misconduct.

To ensure public protection, OTs are accountable for the occupational therapy services provided by students under their supervision. OTs will balance the need to encourage students’ autonomy and learning with a level of supervision appropriate to the occupational therapy components assigned, and the knowledge, skill and clinical reasoning of the students. OTs are accountable to the College for the supervision and the assignment of tasks to students.

Standard 1

The OT supervising students will assume professional responsibility and accountability for the safe, appropriate, and ethical care provided by students.

      Performance Indicators

To provide a valid learning experience and evaluation of the student, the OT must have the competency to perform the assigned OT service components. OTs who move into a new area of practice must determine if they have an appropriate level of competence and experience to facilitate student learning. OTs may consider sharing responsibility for student supervision, if appropriate, when providing student supervision for the first time.

Standard 2

The OT will have a minimum of one year of occupational therapy practice experience and have the competency to supervise any activity that is assigned to a student.

      Performance Indicators

In preparing the student for direct client service, OTs may consider activities such as: discussing client factors, providing appropriate education materials, and practising assessments/intervention sessions prior to involving them in client care. OTs may also utilize strategies such as direct observation, case conferencing, and debriefing following the student’s direct activity with the client.

Standard 3

The OT will provide students with an appropriate level of supervision based on the student’s competence, level of education, and the type of occupational therapy service that the student will perform.

      Performance Indicators

OTs will comply with the Standards for Consent for all occupational therapy services provided by any student under the OT’s supervision. Clients should be made aware that some service components may be provided by a student. The OT must ensure client consent for student involvement is obtained prior to the student engaging in the delivery of any occupational therapy service.

Standard 4

The OT will comply with the Standards for Consent when assigning occupational therapy service components to students.

      Performance Indicators

Using a title that prominently identifies the role of the student in oral and written communication ensures accurate representation of the student and prevents the public from misinterpreting the accountability of the student. The approved title “Student Occupational Therapist” or “Student OT” ensures the clear identification of the student role.

Standard 5

The OT will ensure students under their supervision use the approved title.

      Performance Indicators

OTs will comply with the Standards for Record Keeping ensuring documentation performed by students includes their name and identifies them as a student in the clinical record.

Standard 6

The OT will maintain professional accountability for record keeping and documentation of occupational therapy service provided by students in accordance with the Standards for Record Keeping.

      Performance Indicators

OTs are responsible for establishing and maintaining professional boundaries while interacting with students. All students should be respected and treated in a professional manner. OTs have a responsibility to provide an objective evaluation for the student and therefore must take care to ensure relationships with students remain professional.

OTs have a responsibility to ensure students understand the expectations regarding professional boundaries when providing occupational therapy services to clients. When a student is providing occupational therapy service, the OT must be aware of student-client interactions and ensure professional boundaries are maintained.

Standard 7

The OT will ensure that professional boundaries are maintained in the supervision of all students and in accordance with the Standards for Professional Boundaries.

      Performance Indicators

OTs are responsible for minimizing and managing any potential risk of harm to the client and student during the delivery of occupational therapy services. Issues of safety and risk management should be considered when determining an appropriate ratio of students to occupational therapists.

Standard 8

The OT will ensure that risks are managed to minimize any potential risk of harm to the client, the student, the supervisor and others in the provision of occupational therapy service.

      Performance Indicators

The Guide to Controlled Acts and Delegation outlines the controlled acts that may be performed by, or delegated to, OTs. Delegation is a term used in the Regulated Health Professions Act, 1991 (RHPA) to describe the transfer of the legal authority to perform a controlled act or a component of a controlled act to a person, regulated or unregulated, who is not normally authorized to perform the act.

 

Students are not permitted to perform any controlled acts independently. Students can only perform controlled acts under the direct supervision of an OT, including controlled acts that have been delegated to the OT.

 

OTs have direct access to the controlled act of psychotherapy and access to the controlled act of acupuncture by exemption. Delegation of these acts is not required. Student OTs may be included in the delivery of controlled acts as part of their student placement. OTs must use their clinical judgement to determine when or if it is appropriate for students to be included in the performance of a controlled act.

Standard 9

The OT may include the student occupational therapist in the performance of a controlled act that has been delegated to the occupational therapist, or to which the OT has direct access.

      Performance Indicators

A role emerging placement is in a setting that does not typically provide occupational therapy services. In this type of placement, the student is coordinated and supervised by an off-site OT who is not employed in the setting. OTs may supervise a student who is providing occupational therapy services in a role emerging placement. While the supervising OT is accountable for the occupational therapy services being delivered, the student can be assigned to an on-site supervisor who is not an OT to address on-site concerns.

 

Clinical vs. Non-Clinical

 

Placements can be categorized as clinical or non-clinical. A clinical placement is a placement where there is direct client contact. A non-clinical placement is a placement where there is no client contact. OTs need to consider how the standards of practice apply to a clinical or non-clinical role emerging placement.

 

Prior to accepting a student in a role emerging placement, the OT should determine the type of occupational therapy service that will be provided. For example, there may be higher risks associated with students providing direct service to clients where there has been no pre-established OT role, than a non-clinical placement where there is no direct client interaction.

 

The OT agreeing to supervise a student in a clinical role emerging placement must assess the level of risk to clients and the amount of supervision that can reasonably be provided. Important issues to consider include safety, record keeping, and consent. The supervising OT should clarify these issues through discussion with the student, site supervisor, educational institution and the organization where the emerging role placement will occur.

Standard 10

The OT, when supervising a student occupational therapist in a role emerging placement, will collaborate with the placement site, student, and educational institution to ensure there is appropriate accountability for the delivery of safe, effective, and ethical occupational therapy.

      Performance Indicators

Legislative References:

Occupational Therapy Act, 1991

Regulated Health Professions Act, 1991

College References:

Essential Competencies of Practice for Occupational Therapists in Canada, 3^rd ed. (2011)

Guide to Controlled Acts and Delegation (COTO, 2017)

Standards for Consent (COTO, 2017)

Standards for Record Keeping (COTO, 2016)

Standards for Use of Title (COTO, 2017) 

Standards for Professional Boundaries (COTO, 2015)