As COVID-19 evolves, the provincial and federal government continue to update their resources.

We encourage you to regularly review the websites of the Ministry of Health and Public Health Ontario (PHO) for the most accurate, up-to-date information. Please see the links below.


  • Ministry of Health dedicated website for the health workers and health employers. The site provides sector-specific guidance for the health sectors and health professionals including resources on COVID-19 symptoms, screening, and testing, signage for health care settings, mental health, and long-term care and retirement homes. As the Ministry of Health’s guidance documents are regularly updated, please access through the Ministry website to make sure you are viewing the most current version.

Emergency Orders


Health sector organizations can call the Healthcare Provider Hotline for policy guidance related to COVID-19, urgent situations and information on Ministry programs: 1-866-212-2272 (toll free). Please be aware, the Hotline is unable to provide clinical advice regarding the management of cases.

Office of the Chief Medical Officer of Health and Minister’s Orders


Get the latest directives from the Chief Medical Officer of Health and Minister’s Orders on the Ministry website, including the following list of documents. Please access through the Ministry website to make sure you are viewing the most current version.

Public Health Ontario


Public Health Ontario also has a dedicated webpage for health workers and health employers, providing valuable Infection Prevention and Control resources, including recommendations on the appropriate level of personal protective equipment (PPE) to be worn by health workers

Government of Canada


The Government of Canada equally has a dedicated COVID-19 webpage for health workers, and has issued various resources to help health workers provide safe and effective service delivery during this pandemic, including:

Health Workforce Matching Portal (Formerly COVID-19 Health Care Provider Recruitment)


Ontario is seeking those with experience in providing health care to help provincial efforts to prevent and control the spread of COVID-19. 

The Ministry of Health is looking for: health care providers who may be working part-time and want to and are able to increase their work hours, former health care providers who are retired and are prepared to return to employment, or anyone who is inactive with their regulatory college or registered but not currently employed.

If you are interested, please register with Ontario’s Health Workforce Matching Portal: onhealthworkforcematching.ca

Resources



Mental Health Resources



[Updated June 18, 2020] COVID-19 Return to Work Guidance for Occupational Therapists V2

[Download PDF: English | French]

As the government is allowing deferred, non-essential and elective health services to resume, practices that reopen must:

  • implement the operational requirements outlined by the government;
  • follow the College's guidance on return to work and infection control practices;
  • have access to personal protective equipment.
The updates to the Return to Work Guidance for Occupational Therapists reflect the changes made to the Ministry of Health’s COVID-19 Operational Requirements: Health Sector Restart to ensure alignment with the government’s recommendations as this pandemic evolves. The key changes address how visitors to the occupational therapist’s place of employment are to be managed, including active and passive screening measures affecting visitors, what the occupational therapist should do if they have returned from travel in the past 14 days, as well as additional infection and prevention control recommendations when preparing your place of employment for in-person service delivery.

Occupational therapists may wish to review the following suggested resources:

The College is working with government to respond to the global pandemic in the best interest of the public. Directives from the Ministry of Health and the Premier’s office are reflected in College positions.

If you have further questions about this, contact our practice line at 1.800.890.6570 ext. 240, or practice@coto.org. The College is committed to providing information and clarification and the best possible service during this difficult time.



[Posted June 11, 2020] Video: Conversations with the College
Gradual Reopening: COVID-19 & Occupational Therapy 


What does the Ontario government’s announcement about resuming healthcare services mean for occupational therapists?

What services should be delivered in person at this time? What are some important considerations for OTs offering remote services?

As the province gradually reopens, we know that occupational therapists have a lot of questions about how to resume practice safely and responsibly during the pandemic. The College has developed another video resource to help answer some of these questions and guide you as the province restarts deferred, non-essential and elective healthcare services.



You can also download the presentation. It includes links to helpful resources and information, including the College's Return to Work Guidance.

For more webinars and videos, please visit the College YouTube channel.

If you have questions, contact our practice line at 1.800.890.6570 ext. 240, or practice@coto.org. Our Practice Team is receiving a high volume of calls and emails during this pandemic and we appreciate your patience.


Updated June 11, 2020


1. [NEW] What does the government’s announcement about the resumption of deferred, non-essential and elective healthcare services mean for occupational therapists?

The government announcement means that occupational therapists - with very specific conditions and considerations in place to reduce the spread of COVID-19 - may begin to gradually resume in-person services. Occupational therapists are in the best position to determine which services to resume remotely (online, by telephone, or other virtual means) and which can safely resume in-person.

Occupational therapists must:

comply with all government, Ministry and Public Health directives Meet the operational requirements prior to gradually resuming in-person service delivery Work with employers and partners to ensure conditions are met Where applicable, review and implement the recommendations in the College return to work guidance

The goal of restarting deferred, non-essential and elective healthcare services is about moving towards a ‘new normal’ with occupational therapists resuming their practices a in controlled and gradual manner while ensuring they have taken the necessary precautions to protect themselves, their staff, their clients, and the public at large.


2. [NEW] I have already introduced remote services to my practice. What are some of the important considerations I need to keep in mind?

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To reduce the risk of contracting or spreading COVID-19, occupational therapists are encouraged to deliver remote (online, by telephone, or other virtual means) service when possible. When determining what services are appropriate for remote delivery, occupational therapists need to implement a risk assessment and exercise their professional judgment. Considerations include:

Effectiveness

Assessing the necessity of clinical interventions based on the unique circumstances and healthcare needs of each of client (examples of questions the occupational therapist will need to ask are: Can the client privately access and safely operate the technology being used to enable the remote service delivery? Does the client have a physical, cognitive, or sensory deficit preventing their ability to proceed with safe or effective remote service delivery? What is the client’s overall comfort and capability with using virtual technologies?). Does the virtual technology being used allow for effective communication between the client and occupational therapist, safe occupational therapy interventions, and can the occupational therapist form an accurate professional opinion to make necessary health care decisions?

Privacy and Confidentiality

Will remote service delivery impact the client’s privacy or prevent the protection of the confidentiality of personal health information? Is the virtual platform compliant with relevant privacy legislation, such as the Personal Health Information Protection Act (PHIPA)? What privacy or confidentiality risks are present when using virtual technologies and how will these risks be communicated to the client to ensure informed consent is obtained?

Risk

What are the other limitations of the remote service delivery and how will they impact the overall care provided? For example, will an OT’s inability to observe the client’s non-verbal cues negatively impact the occupational therapist’s ability to form a reliable professional opinion? What plans can be put in place to manage potential adverse events which may occur during the remote service delivery, such as technical issues or a client medical emergency?


[NEW] 3. What services should be delivered in-person?

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The College recognizes that there are some occupational therapy services that cannot be safely and effectively provided remotely. When this arises, occupational therapists may proceed to provide in-person services provided that all safety conditions outlined by the government are met. This includes implementing a hierarchy of hazard controls and having sufficient personal protective equipment (PPE), to protect you and your clients from the risk of contracting and spreading COVID-19 and, the anticipated benefits of the services outweigh the potential risk to the client and occupational therapist. It is recommended that where possible, occupational therapists limit the number of in-person visits for safety of the client.

Decisions related to the gradual restart of services should be made using fair, inclusive and transparent processes for all clients following the principles articulated in Directive # 2 (May 26, 2020):

Proportionality - the capacity of individual healthcare providers, offices and clinics to offer services. Minimizing Harm to Patients - Prioritizing services that can result in more significant harm if delayed and which mitigate the greatest risk of harm. Equity - That all persons with the same clinical needs should be treated in the same way unless relevant differences exist, and that special attention is paid to actions that might further disadvantage the already disadvantaged or vulnerable. Reciprocity - monitoring the health care status of clients who do not yet appear to require services immediately so that if their health status changes, required services are provided.

When assessing if the service should proceed in-person, there will be many factors the occupational therapist should consider. We have compiled some of the main factors below:

the client’s current needs and how these may change over time whether the client has some characteristics that result in a high risk for their health and safety any poor or negative outcome which may result if the service delivery is not provided in-person or is delayed too long the benefit of providing the service, both from the occupational therapist’s clinical perspective and the client’s perceived benefit of receiving the care Whether or not social distancing can be maintained during the service delivery PPE availability Alternate healthcare providers or facilities able to provide the service in a safer, more suitable environment Any additional associated risks to clients who may need a caregiver or another individual to assist or accompany during the session Whether there is a COVID-19 outbreak in the setting or community the service delivery is to take place in Can Infection Prevention and Control (IPAC) measures be adequately followed, for example, can the equipment used during the service delivery be adequately cleaned?


4. [NEW] Are there additional consent considerations for remote (online, by telephone, or other virtual means) service?

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Yes. Overall, the process for obtaining consent for remote services remains the same as in-person service. Occupational therapists are expected to obtain informed consent from their clients or substitute decision-maker (SDM) when remote services are offered and provide an opportunity for clients to ask questions about the service. Consent discussions should include such things as the nature of the service and withdrawal options and alternatives. There are additional considerations to include when discussing remote methods of service delivery including:

who will attend remotely and what each participant’s role is? risks and benefits and any limitations of participating in remote service information about the privacy and security features of the platform

As a reminder, client/SDM consent can be given verbally. Obtaining written consent is not a College requirement but may be a requirement of the practice setting or organization. Consent must be documented in the clinical record as outlined in the Standards for Consent and consent checklist. In addition to the required consent, when discussing remote services an occupational therapist can make suggestions to encourage the comfort and effectiveness of the overall experience. For example;

provide a brief orientation to the features of the platform discuss what to do in case of emergency or unexpected event encourage privacy of sessions, for example, use of headphones, private areas of house, using mute option to minimize disruptions and maintain privacy


5. [NEW] What happens if I can’t physically distance during the service delivery?

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We recognize that for various reasons, such as client safety or environmental set up, you may not be able to maintain a distance of two metres during the service delivery. When this occurs, you may still decide to proceed with in-person services.

To do so, you need to:

Have a sound and ethical rationale based on clinical judgment Have completed the risk assessment Ensure you meet the other specific requirements outlined in the operational requirements set forth by the government

As part of the consent process the occupational therapist should also explain to the client/SDM/parent/guardian the reason for not maintaining the recommended physical distance.When proceeding with in-person services the occupational therapist must ensure they wear the appropriate level of personal protective equipment (PPE). PPE includes gloves, gowns, and facial coverings. Determining the appropriate level of PPE involves carrying out a risk assessment based on the nature of the interaction between the occupational therapist and the client when considering the likely modes of transmission of the infection. It appears the likely mechanism of transmission of COVID-19 is through direct large aerosol droplets or indirect contact of contaminated surfaces. If the government has not issued specific PPE requirements applying to your practice, the client has not screened positive for COVID-19, and you are not performing an aerosol generating medical procedure, at a minimum, you should wear a surgical/procedural mask throughout the service delivery and the client should be asked to wear a mask to the appointment and for the duration of the interaction, where tolerated.


6. [NEW] Do I need to wear a mask while providing occupational therapy services? What type of mask should be worn?

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Yes. Occupational therapists should follow the recommendations of the government and public health organizations for use of masks. At a minimum, occupational therapists should wear a surgical/procedural mask when providing in-person services with or within 2 metres of clients. These types of masks are made using multiple layers creating a barrier to prevent droplets from an infected source form contaminating the skin and mucous membranes of the nose and mouth of the wearer, or to trap droplets expelled by the wearer, depending on the intended use. If your personal protective equipment supplies allow, the mask should be changed after each client interaction and must be changed whenever it is damp, humid, damaged, or soiled. Occupational therapists must wash their hands before and after touching, adjusting, putting on, or removing their mask.


7. [NEW] If I don’t have the appropriate personal protective equipment (PPE), can I continue to provide in-person services?

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No. The College’s Standards for Infection Prevention and Control require occupational therapists to use their knowledge, skill and judgment when taking steps to protect themselves and others from infection. If having assessed the risk you determine PPE is necessary, but the appropriate level of PPE is not available to you, you should not provide in-person services. If in-person services are required but for the availability of PPE, you should explain the reason the service is being canceled or deferred to your client, why remote service delivery is not a safe or effective option, and if available, document those reasons in the client’s record. Consideration should be given to the possible need to refer the client to another occupational therapist who has the appropriate level of PPE available, and the required knowledge, skill and judgment to deliver the service, depending on the risk posed to the client of deferring or cancelling the service.

All occupational therapists should review Public Health Ontario's Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19. The government is recommending that healthcare professionals and their employers source PPE through their regular supply chain. PPE allocations from the provincial stockpile will continue. PPE can also be accessed, within the available supply, on an emergency basis through the established escalation process through the Ontario Health Regions. The Ontario government has also developed a Workplace PPE Supplier Directory to help businesses secure PPE and other supplies.


8. [NEW] The government requires that a point of care risk assessment (PRCA) be carried out in advance of all client interactions. What is this type of assessment?

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The government is requiring all health care workers to perform a point of care risk assessment (PCRA) before every patient interaction. Public Health Ontario has indicated that a PCRA assesses the task, the client and the environment and describes it as “a dynamic risk assessment completed by the [health care worker] before every patient interaction in order to determine whether there is risk of being exposed to an infection. Performing a PCRA is the first step in Routine Practices, which are to be used with all patients, for all care and for all interactions. A PCRA will help determine the correct PPE required to protect the health care worker in their interaction with the patient and patient environment.”

The College does not endorse or recommend a certain PCRA and would recommend that occupational therapists collaborate with colleagues or professional groups to share information on various PCRA tools.


9. [NEW] Do I have autonomy to determine which services to provide remotely (online, by telephone, or other virtual means) and which to provide in-person?

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Yes. Occupational therapists are responsible for making this determination as it relates to each of their clients. While consideration about the method for providing the service should be given to the client’s and other stakeholder’s preferences, such as third-party payers, if self-employed, you are ultimately responsible for carrying out the necessary risk assessment and determining how the service can be provided safely and effectively.

If working for an organization, you should also refer to any guidance prepared by your employer as it relates to which services are to be provided in-person and which are to be provided remotely. Follow-up with your supervisor, manager or professional/clinical practice lead with any concerns or if clarification of your employer’s direction is required.


10. [NEW] Do I need to document the rationale for providing in-person vs remote service in my clinical notes?

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Yes. However brief, any decision point regarding client care should have an accompanying rationale. Documentation helps trace the clinical story and is available to access should the need arise in the future. As a legal document the clinical note is a source of evidence intended to officially record events, decisions, interventions, and plans made during the OT-client relationship.

The College is not prescriptive in detailing the process for documentation and allows for flexibility among occupational therapists. For example, an occupational therapist could be provide a brief explanation in the initial clinical entry or there could be a reference to a guiding document, for example, a decision tree or organizational process.

Ultimately the College recognizes the balance between what is needed and what is reasonable given the circumstances.


11. [NEW] Can I adapt my assessments and interventions to accommodate for physical distancing or remote services?

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Possibly. If an occupational therapist is considering adapting a standardized assessment tool for remote services, they should confirm if the tool can be modified to maintain validity, integrity, and clinical utility.

For other formal assessments that have been developed by an individual occupational therapist, clinical team or organization; clinical judgment will have to be applied to determine if the assessment can be modified for use in a physical distance scenario or if the service is being offered remotely. During these unprecedented clinical circumstances, the College will rely on an occupational therapist’s sound and ethical judgement and decision-making processes when using new or existing assessment and intervention methods.

It is important to have a discussion with the client or family to ensure they are aware of any limitations of the assessment due to these circumstances and how this may impact the service or clinical considerations.


12. [NEW] Can occupational therapy assistants (OTAs) be supervised virtually?

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Yes. In terms of supervising OTAs who are providing services through telepractice, the OT would follow the Standards for the Supervision for Occupational Therapist Assistants. Once the occupational therapist has determined that virtual can is an appropriate method of service delivery for the client, an occupational therapist will maintain accountability by taking the following steps:

Make an occupational therapy plan of care outlining the use of telepractice and assigning care to the OTA. Ensure the OTA demonstrates competency to deliver occupational therapy services via telepractice. Establish there is supervision and communication plan in place between the OT and OTA when services are delivered through telepractice (similar to if services were delivered in-person). Follow the expectations as outlined in the Standards for Supervision of Occupational Therapist Assistants.


13. [Updated June 11, 2020] Can I provide telepractice (remote service) to a client who has moved to another province?

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Yes. However, the jurisdiction for the provision of occupational therapy services is defined by the location where the client resides - even if they reside there temporarily.

An occupational therapist wanting to provide remote out-of-province service will:

1) Determine if the service can be safely and effectively provided remotely (online, by telephone, or other virtual means).
2) If yes, contact the regulatory College in the province of the client to request temporary registration. Most provinces are waiving fees and expediting the process.
3) Upon receipt of temporary registration, and consent from the client, an OT can begin the clinical process of providing the service virtually.


14. [Updated June 11, 2020] Can I offer clinical care using alternative methods like virtual and/or phone sessions?

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Yes. Any services which can be safely and effectively provided remotely (online, by telephone, or other virtual means) is encouraged at this time.

Please refer to the College Guidelines for Telepractice in Occupational Therapy.

With new technologies emerging, the College does not recommend or endorse specific online platforms for virtual care. It is expected that occupational therapists take reasonable steps to investigate the security and privacy features that these platforms offer.

Documentation requirements for virtual sessions are still the same as face-to-face visits.The occupational therapist would indicate in the clinical record that the session was performed virtually or by phone and if others participated in the session, for example, family members. Length of session may be useful to record as well as any online resources that are used during the session.

If an occupational therapist proceeds with the virtual care, we recommend they consider the potential risks and how they can be mitigated in advance, for example, unavailable or disrupted technology, or unforeseen clinical issues that emerge during virtual session.

Client consent discussions can be adjusted to include some additional risks/benefits specific to how the services are being delivered. See Standards for Consent for your reference.


Occupational therapists are reminded to follow infection prevention best practices (see the College Standards for Infection Prevention and Control). Please contact our Practice Resource Service for any questions by phone at 1.800.890.6570 ext 240, or by email to practice@coto.org. The College will continue to update this web page. Please be sure to check the Ministry’s COVID-19 website, the Ministry website for healthcare providers, and Public Health Ontario.