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Intro to OTA 111, Chapter 7 notes
Terms in this set (65)
The OT Process can be divided into what 3 components?
Evaluation (developing an occupational profile & analyzing occupational performance)
Intervention (intervention planning, implementation & review)
Outcomes ( measurement of outcomes - determining success in reaching desired target outcomes & planning future actions with the client; and to evaluate the service program (program evaluation.)
The OTR is responsible for what?
The OTR is ultimately responsible for all aspects of the process and the occupational therapy assistant works under the supervision of the OTR.
assessment refers to what?
(Assessment refers to the specific tools, instruments, tests or interactions that are used during the evaluation process.)
describe what evaluation is
Evaluation is the entire information-gathering process used to make intervention decisions for clients receiving OT services. The results of the evaluation provide a baseline for measuring intervention outcomes.
Evaluation is conducted to do what 3 things?
1. Determine what the client wants and needs to do
2. Determine what the client can do and has done, and
3. Identify those factors that act as supports or barriers to health and participation.
What are the 2 steps in the evaluation stage?
When is a referral appropriate?
Referral is appropriate when there is a reasonable expectation that the client will benefit from OT.
Who can refer?
Client may self-refer, or be referred by physicians, other health professionals, teachers, family members, caregivers, employers, insurance companies, industry or state and local agencies.
-Note, physician referral is necessary for reimbursement from most third party payers.
Is referral ever not appropriate?
OTR/COTA Roles in Referral:
OTR (and not the COTA) accepts and responds to a referral and may refer clients to other resources.
OT practitioner (OTR and the COTA) may educate referral sources about the scope of OT services and the process of initiating services.
define the screening process
In some cases the OTR determines whether the referral is appropriate by conducting a "screening" which consists of chart review; brief interview of the client, family, caregiver or referral source, or brief observation.
The screening is hands-off and is intended to determine whether further evaluation and/or OT intervention is warranted.
OTR/COTA Roles in Screening:
The OTR is responsible to conduct the screen and communicate screening results & recommendations.
Nationally the COTA may contribute under supervision to screening and communicating screening results and recommendations, but not in MA!
In MA, occupational therapy assistants may not perform what?
initial screens, evaluations, or re-evaluations.
know the difference between the AOTA and MA position.
determine whether it pertains to MA regulations. COTA practice is quite different in other states including RI! The NBCOT certification (Board) exam is based on national practice, not state-specific regulations!
What is the general Policy on PTA and OTA Involvement in Patient Screens & evaluation?
-begins with the initial point of contact
-via medical record or interview with patients or caregivers.
-Performance of an initial screen or an evaluation is the role and responsibility of the PT or OT and it is NOT the role or responsibility of the PTA or OTA
-Patients receiving rehab must receive regular re-evaluations.
-re-evaluation is the role and responsibility of the PT or OT
During re-evaluations, what do the OT and PT consider?
-assessment data from all sources including chart histories and verbal comments of the PTA or OTA.
-In the re-evaluation, the OTA may contribute to the collection of additional evaluative data, as deemed appropriate by the OT.
-The PT or OT maintain responsibility for documenting the re-evaluation.
What is the rationale behind the policy?
-The Board endorses collaborative practice.
-the interests of patients are well served by input from all involved in the treatment of a patient, i.e. to produce the desired effect
-Commonwealth's statutes and regulations and professional standards of practice allow for the delegation of selective forms of treatment to PTAs and COTAs.
-responsibility for treatment initiation, modification, and termination remains with the PT and OT
definition of screening
-Screening is a process of gathering and integrating information to determine the need for further examination or intervention.
-based on a problem-focused, systematic collection and analysis of data to identify individuals in need of PT or OT intervention or other health care services.
-A screen is a process involving patient observation, chart review, and discussion with nursing staff.
-The purpose of a screen is to determine if an initial evaluation by a PT or OT is indicated.
assessment is defined as what?
Assessment is defined as the measurement or quantification of a variable (e.g., tub transfers; dressing as part of an ADL assessment) or the placement of a value on something.
evaluation is defined as what?
Evaluation is defined as a formal interpretation of patient status that will determine whether or not PT or OT is indicated; establish diagnoses; prognosis; and identify the interventions to achieve goals.
RE-EVAL DETERMINES WHAT?
Re-evaluation determines whether treatment should continue; reestablishes or modifies goals, and changes treatment plans accordingly.
The Board considers what 3 clinical protocols to be evaluation procedures?
-An initial evaluation, re-evaluation, or discharge evaluation (including Page 3 referrals)
-Care plans (including monthly plan of care)
Regardless of the setting, OT assumes what generic responsibilities during evaluation?
-the OT initiates and directs the evaluation, interprets the data, and develops and documents the intervention plan.
-OT is responsible for:
a. Determining the need for service,
b. Defining the problems within the domain of occupational therapy that need to be addressed,
c. Determining the client's goals and priorities,
d. Establishing intervention priorities,
e. Determining specific further assessment needs, and
f. Determining specific assessment tasks that can be delegated to the OTA
g. The OT interprets the information provided by the OTA and integrates that information into the evaluation and decision-making process.
Regardless of the setting, OTA assumes what generic responsibilities during evaluation?
The OTA contributes to the evaluation process by implementing delegated assessments and by providing verbal and written reports of observations and client capacities to the OT
Regardless of the setting, OT's and OTA's assume what generic responsibilities during Intervention Planning (i.e. Treatment Planning)?
1. The OT has overall responsibility for the development of the OT intervention plan.
2. The OT and the OTA collaborate with the client to develop the plan.
3. The OTA is responsible for being knowledgeable about evaluation results and, for providing input into the intervention plan, based on client needs and priorities.
Regardless of the setting, OT's and OTA's assume what generic responsibilities during Intervention Implementation?
1. The OT has overall responsibility for implementing the intervention.
2. When delegating aspects of the OT intervention to the OTA, the OT is responsible for providing appropriate supervision.
3. The OTA is responsible for being knowledgeable about the client's OT goals.
4. The OTA selects, implements, and makes modifications to therapeutic activities and interventions that are consistent with demonstrated competency levels, client goals, and the requirements of the practice setting.
Regardless of the setting, OT's and OTA's assume what generic responsibilities during Intervention review?
1. The OT is responsible for determining and documenting the need for continuing, modifying, or discontinuing OT services.
2. The OTA contributes to this process by exchanging information with and providing documentation to the OT about the client's responses to and communications during intervention.
Regardless of the setting, OT's and OTA's assume what generic responsibilities during the Outcome Evaluation?
1. The OT is responsible for selecting, measuring, and interpreting outcomes that are related to the client's ability to engage in occupations.
2. The OTA is responsible for being knowledgeable about the client's targeted OT outcomes and for providing information and documentation related to outcome achievement.
3. The OTA may implement outcome measurements and provide needed client discharge resources.
Name the 1st general principle for Supervision in the OT Process
1. Supervision involves guidance and oversight related to the delivery of OT services and the facilitation of professional growth and competence.
-It is the responsibility of OT's and OTA's to seek the appropriate quality and frequency of supervision to ensure safe and effective OT service delivery.
Name the 2nd general principle for Supervision in the OT Process
2. To ensure safe and effective OT services, it is the responsibility of OT's and OTA's to recognize when supervision is needed and to seek supervision that supports current and advancing levels of competence.
Name the 3rd general principle for Supervision in the OT Process
The specific frequency, methods, and content of supervision may vary by practice setting and are dependent on:
a. Complexity of client needs,
b. Number and diversity of clients,
c. Skills of the OT and the OTA,
d. Type of practice setting,
e. Requirements of the practice setting, and
f. Other regulatory requirements.
Name the 4th general principle for Supervision in the OT Process
Supervision that is more frequent than the minimum level required by the practice setting or regulatory
agencies may be necessary when:
a. The needs of the client and the OT process are complex and changing,
b. The practice setting provides OT services to a large number of clients with diverse needs, or
c. The OT and OTA determine that additional supervision
is necessary to ensure safe and effective delivery of OT services.
Name the 5th general principle for Supervision in the OT Process
A variety of types and methods of supervision should be used.
-Methods may include direct, face-to-face contact and indirect contact.
-Examples of direct face-to-face contact include observation, modeling, co-treatment, discussions, teaching, and instruction.
-Examples of indirect contact include phone conversations, written correspondence, and electronic exchanges.
Name the 6th general principle for Supervision in the OT Process
OT's and OTA's must abide by agency and state requirements
regarding the documentation of a supervision plan and supervision contacts. Documentation may include:
a. Frequency of supervisory contact,
b. Method(s) or type(s) of supervision,
c. Content areas addressed,
d. Evidence to support areas and levels of competency, and
e. Names and credentials of the persons participating in the supervisory process.
Name the 7th general principle for Supervision in the OT Process
-The person providing supervision related to professional growth, such as leadership and advocacy development, may differ from that needed to provide occupational therapy services.
-the frequency, method, and content of supervision, should be responsive to the supervisee's advancing levels of professional growth.
Explain Supervision Outside the Delivery of Occupational Therapy Services
-The education and expertise of OT's and OTA's prepare them
for employment in arenas other than those related to the delivery of OT services.
-In these other arenas, supervision may be provided by non-occupational therapy professionals.
what are the guidelines For Supervision Outside the Delivery of Occupational Therapy Services?
1. The guidelines of the setting, regulatory agencies, and funding agencies direct the supervision requirements.
What should the OT and OTA do Outside the Delivery of Occupational Therapy Services?
The OT and OTA should obtain and use credentials or job
titles commensurate with their roles in these other employment arenas.
The following criteria are used to determine whether the services provided are related to the delivery of occupational therapy...
a. State practice acts;
b. Regulatory agency standards and rules;
c. Domain of OT practice; and
d. Written and verbal agreement among the OT, the OTA,
the client, and the agency or payer about the services provided.
Example: at the Commission for the Blind "Rehab teachers" who are trained COTAs but not working in a COTA role.
DEFINITION OF AN AIDE
An aide, as used in OT practice, is an individual who provides supportive services to the OT and the OTA
RESPONSIBILITY OF AN AIDE
-Aides do not provide skilled OT services.
-An aide is trained by an OT or an OTA to perform specifically delegated tasks.
-An aide first must demonstrate competency to be able to perform the assigned, delegated client and non-client tasks.
who is responsible for the aid?
-The OT is responsible for the overall use and actions of the aide.
IN THE Supervision of Occupational Therapy Aides...
1. The OT must oversee the development, documentation, and implementation of a plan to supervise and routinely assess the ability of the OT aide to carry out non-client-and client-related tasks.
-The OTA may contribute to the development and documentation of this plan.
IN THE Supervision of Occupational Therapy Aides...
The occupational therapy assistant can supervise the aide.
NON-CLIENT RELATED TASKS FOR AIDES...
Non-client-related tasks include clerical and maintenance activities and preparation of the work area
CLIENT RELATED TASKS FOR AIDES...
Client-related tasks are routine tasks during which the aide may interact with the client.
WHAT factors must be present when an OT or OTA delegates a selected client-related task to the aide?
a. The outcome anticipated for the delegated task is predictable.
b. The situation of the client and the environment is stable and will not require that judgment, interpretations, or adaptations be made by the aide.
c. The client has demonstrated some previous performance ability in executing the task.
d. The task routine and process have been clearly established.
When performing delegated client-related tasks, the supervisor must ensure that the aide...
a. Is trained and able to demonstrate competency in carrying out the selected task and using equipment,if appropriate;
b. Has been instructed on how to specifically carry out the delegated task with the specific client; and
c. Knows the precautions, signs, and symptoms for the particular client that would indicate the need to seek assistance from the OT or OTA.
The supervision of the aide needs to be documented. What documentation is included?
Documentation includes information about frequency
and methods of supervision using the content of supervision and the names and credentials of all persons
participating in the supervisory process.
general supervision is viewed as...
general supervision=cooperative process two or more people establish, maintain, or elevate a level of competence and performance
-mutual understanding of each others competence, experience, education and credentials.
-fosters growth and development, effective utilization of resources, encourages creativity an innovation, and provides education and support to achieve a goal.
supervision of OT's...
-based on education and training, after initial certification, OT's deliver OT services independently.
-OT's are responsible for OT service delivery and accountable for safety and effectiveness of OT service delivery process.
-OT's are encouraged to seek supervision and mentoring to develop best practice approaches and promote professional growth.
supervision of OTA's...
-based on education and training, OTA's must receive supervision from an OT to deliver OT services.
-OTA's deliver OT services under the supervision and in partnership with OT's.
-OT's and OTA's are responsible for collaboratively developing a plan for supervision.
the focus of OT therapy is to support what?
the clients health and participation in life through engagement in occupation.
What makes OT unique?
unique use of occupation in a therapeutic way
occupational therapy addresses what for the client?
the needs and goals of the client related to engaging in areas of occupation and considers the performance skills, performance patterns, context and environment, activity demands, and client factors that may influence performance in various areas of occupation.
roles and responsibilities of the OT
-responsible for all aspects of service delivery
-safety and effectiveness of OT service delivery process
-service delivery process involves evaluation, intervention planning, intervention implementation, intervention review and outcome evaluation
When is the OT directly involved in the delivery of services?
during the initial evaluation and regularly throughout the course of intervention and outcome evaluation
the OTA delivers services under the supervision of and in partnership with who?
who delegates responsibilities to the OTA?
the OT, and it's the OTA's responsibility who performs delegated responsibilities to demonstrate service competency
The OT and OTA demonstrate and document what?
they demonstrate service competency for clinical reasoning and judgment during the service delivery process as well as for the performance of specific techniques, assessments, and intervention methods used.
When delegating the aspects of OT services, the OT considers the following 4 factors...
-complexity of the clients condition and needs
-knowledge , skill and competence of the OT practitioner
-Nature and complexity of the intervention
-needs and requirements of the practice setting
It is expected that OT services are delivered how?
in accordance with applicable state and federal regulations, relevant workplace policies, the occupational code of ethics and continuing competency and professional development guidelines.
THIS SET IS OFTEN IN FOLDERS WITH...
OTA 101 chapter 9
OTA 101 Chapter 11
Intro to OT, 111, mid-term
OTA 127 SOAP notes
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