Date: September 26, 2014 To: Speaker, Representative Assembly From: Julie Kalahar, MS, OTR/L Chair, OTA Education Ad Hoc Committee Re: Report of the

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1 Date: September 26, 2014 To: Speaker, Representative Assembly From: Julie Kalahar, MS, OTR/L Chair, OTA Education Ad Hoc Committee Re: Report of the OTA Education Ad Hoc Committee 1

2 American Occupational Therapy Association Ad Hoc Committee to OTA Entry-Level-Degree Requirements Final Report to the Representative Assembly September 26, 2014 CHARGE: The Ad Hoc Committee was charged by the Speaker to investigate the strengths, weaknesses, opportunities and threats of changing the occupational therapy assistant entry level degree from the current associate degree to either: 1) Elevate the entry level degree exclusively to the bachelor s degree, or 2) Include both the associate degree and bachelor s degree as options for OTA education. MEMBERSHIP*: Julie Kalahar, MS, OTR/L Chairperson; Educator in OTA program in technical institution Mary Kay Arvin, OTD, OTR, CHT Member, Educator in OTA program in 4-year public institution; Author of original motion Tara Franks, BA, COTA Member, OTA practitioner Doreen Olson, MS, OTR/L Member, Dean in technical institution Penny Rogers, MAT, OTR/L Member, Educator in OT program in public institution Ada Boone Hoerl, MA, COTA/L Member, OTA who is educator in OTA program in community college Carol Doehler, MS, OTR/L, FAOTA Member, Educator in OTA to OT transition program in private not-for-profit institution Renee Ortega, MS, COTA/L, R-DMT Member, OTA Practitioner/ Educator; Member of the Commission on Education Diane Hill, COTA/L, ROH RESIGNED 11/15/13 Member, OTA Practitioner Michelle Sheperd, Ed.D, OTR JOINED February, 2014, OTA educator in private for-profit institution Neil Harvison, PhD, OTR/L, FAOTA AOTA Staff * Members were appointed by the Speaker in collaboration with the President. 1

3 SUMMARY OF PROCESS AND KEY FINDINGS: The committee met frequently over the last 18 months to address the charge. The first step was to identify the potential strengths, weaknesses, opportunities and threats of changing the occupational therapy assistant entry level degree. STEP 1: IDENTIFYING THE POTENTIAL STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS OF CHANGING THE OCCUPATIONAL THERAPY ASSISTANT ENTRY LEVEL DEGREE. The members of the Representative Assembly shared the following questions related to moving the entry-level degree in an addendum to the charge statement: Legal concerns: o What is the impact to licensure laws? o Will there be supervision changes? o What will be the impact on role delineation?: There could be unclear lines between OT and OTA within the clinic causing funding and reimbursement issues. With so many OTs in practice having a bachelor's degree there may be some confusion about credentials. Institutional / Educational concerns: o Will institutions housing OTA programs being able to change to bachelors? o Would it change the quality of the OTA educational experience? o Will faculty shortages prevent a move? o What is the impact on credit load? o What is the impact on diversity in the profession? Economic concerns: o What are the costs incurred when adding additional time? Surveying Internal Stakeholders: To ensure that all of the issues and questions related to changing the entry-level degree had been identified, the Ad Hoc Committee surveyed other key internal constituent groups: (1) OTA Program faculty (n= 342) (See attachment 1); (2) OTA Students (n= 1,134) (See attachment 2); (3) OTA Practitioners (n= 1,195) (See attachment 3); and (4) Employers of OTAs (n=210) (See attachment 4). Participants in the surveys were asked: Are you in favor of changing the entry level degree requirement from an associate degree to a bachelor s degree for the Occupational Therapy Assistant? It was not surprising that with exception of the employer s group the majority of respondents in each group (over 50%) answered NO. The group with the highest negative response was the faculty members. 2

4 OTA Faculty OTA Students OTA Practitioners Employers Number Percent Number Percent Number Percent Number Percent Yes 66 19% % % % No % % % % Undecided 54 16% % % % Skipped Total The follow-up question asked respondents: If you answered no to the above question are you in favor of offering both the associate and bachelor's degree as options for Occupational Therapy Assistant entry level education? The majority of the faculty (59%) responded NO. In the case of the students and practitioners the responses were not as decisive. OTA Faculty OTA Students OTA Practitioners Employers Number Percent Number Percent Number Percent Number Percent Yes 55 20% % % 69 50% No % % % 49 36% Undecided 58 21% % % 20 14% Skipped Total Thematic analysis of the open ended responses identified the following reasons in favor of transitioning to a bachelor s entry-level degree were most frequently cited: Increased content and additional time allocated for teaching and learning will expand the opportunity to expose students to content and skills needed for entry level practice today. Expanded role for OTA in practice. Improved access to higher education for laddering and job recognition. Credit for work completed. Improved thought processes about treatment and quality of the OTA. Increased pay for school based OTAs. Thematic analysis of the open ended responses identified the following reasons against transitioning to a bachelor s entry-level-degree were most frequently cited: Limited access (diversity) to the profession. A degree higher than an associate would be cost prohibitive. Colleges, both existing and emerging, may be negatively impacted. Health care services, reimbursement and overall cost may be affected. Associate degree OTAs competing with bachelor s OTAs. 3

5 Potential issue and conflicts of role delineation with a bachelor s trained OT versus bachelor s trained OTA. Not clear on the benefits versus costs. Open Forum at the 2014 AOTA Conference in Baltimore Three members of the Ad Hoc Committee held an open forum at the AOTA conference in Baltimore to present the information that had been gathered to that date and gather any additional information or questions from internal stakeholders. Participants, representing the four stakeholders previously identified, were able to meet in small groups and submitted questions and information to the presenters. The issues identified in the forum were consistent with those identified through the surveys. Conclusions: In conclusion, the survey of internal stakeholder groups and the open forum identified issues for and against a move to the entry-level bachelor s degree for the OTA that were consistent with those identified by the members of the Representative Assembly. The next step undertaken by the committee was to collect evidence to address some of the major themes identified as potential strengths, weaknesses, opportunities and threats of changing the occupational therapy assistant entry level degree. STEP 2: COLLECTING EVIDENCE TO ADDRESS SOME OF THE MAJOR THEMES IDENTIFIED AS POTENTIAL STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS OF CHANGING THE OCCUPATIONAL THERAPY ASSISTANT ENTRY LEVEL DEGREE. Evidence was collected through review of the literature, online resources and interviews of key resource staff. 1. Impact of a change in entry-level degree on state licensure: The AOTA Policy Division compiled a summary of state licensure requirements related to the practice of occupational therapy assistants. A full summary of the licensure/registration and education requirements for OTAs in all states, District of Columbia and Puerto Rico was provided (See attachment 5). In most states the statute(s) refer to a candidate for licensure (or equivalent) as an occupational therapy assistant graduating from an Accreditation Council for Occupational Therapy Education (ACOTE) accredited program and do not dictate entry-degree level. The following eight states do specify an Associate/2-year degree requirement in the practice act (6 states) or state regulations (2 states). 4

6 Statute: Arkansas Connecticut Illinois Pennsylvania Texas Utah Regulation: New Jersey New York Findings: Up to eight states could potentially require changes in their statutes should the entrylevel requirement change to a bachelor s degree. 2. Impact of a change in entry-level degree on supervision requirements: A change in the entry-level degree to bachelor s degree for the OTA would not necessarily require a change in supervision requirements in the state practice acts. For example, physician assistants require a minimum of a bachelor s degree (many hold master s degrees) as the entrylevel requirement. Yet despite the higher degree they are required by state regulations to be supervised by physicians. Like the OT/OTA professional relationship, this requirement varies by state but overall is very similar to the requirements for OT/OTA supervision (American Academy of Physician Assistants, 2010). When asked to rank the benefits of changing the entry-level degree requirement, 60% of employers and 46% of practitioners identified supervision requirements may be altered to include the need for less supervision as an identified strength for offering the entry-level degree for the OTA at the baccalaureate level (See attachments 2 & 3). However, any changes in the supervision requirements would need to address the concerns raised by survey respondents of the possible blurring of role delineation between the OTA and OT. Findings: Any changes in supervision requirements would require changes to state licensure statutes related to the practice of occupational therapy assistants. Should the profession choose to move to the bachelor s entry-level degree requirement the issue of potential changes in supervision requirements would need to be considered in the context of the breadth of practice of the OTA and implications for opening state practice acts. 3. Impact of the changes in breadth of entry-level practice in OTA: A recurring theme amongst respondents to the surveys was whether the change in the entrylevel degree was really necessary to ensure that entry-level practitioners were prepared for practice. One question that was asked was whether the breadth of practice had changed 5

7 requiring increased content in the entry-level preparation. The committee reviewed the content domains in the National Board for Certification in Occupational Therapy (NBCOT) Blueprint report (NBCOT, 2013). Updates to the Blueprint are made after Practice Analysis Studies have been completed. These changes reflect the current practice at the time of the study. NBCOT typically completes Practice Analysis Studies every 5 years. For the 2009 and 2014 Blueprint reports NBCOT identified 3 content domains. The percentage of the practice related to each domain is reflected in the table (See table 1). Table 1: Blueprint Report NBCOT 2009 & Domain 1: Gather information and formulate conclusions regarding the client s needs and priorities to develop a client-centered intervention plan Domain 2: Select and implement evidence-based interventions to support participation in areas of occupation throughout the continuum of care Domain 3: Uphold professional standards and responsibilities to promote quality practice % 33% 60% 47% 8% 20% Prior to 2009 there were 5 domains identified in the report and these are reflected in the table below (see table 2). Table 2: Blueprint Report NBCOT 1999 & 2004 Domain 1: Evaluate the individual/group to determine needs and priorities for occupation-based interventions Domain 2: Develop intervention plan that addresses the occupational needs of individuals/groups Domain 3: Implement occupationally meaningful interventions with individuals/groups that support participation in relevant environments * 12% 16% 22% 15% 50% 56% Domain 4: Provide OT services that address the occupational 9% 5% performance needs of populations Domain 5: Manage, organize, and promote OT services 7% 8% Findings: The data would indicate that in the most recent Exam Blueprint (NBCOT, 2013) the percentage of time spent by OTA practitioners has increased in Domain #2: Select and implement evidence-based interventions to support participation in areas of occupation throughout the continuum of care. 6

8 4. Impact of the Affordable Care Act (ACA) on the breadth of OTA practice: An AOTA Policy Brief on the impact of the ACA on OTA practice was reviewed by the Ad Hoc Committee (AOTA, n.d.). The brief noted the following in relation to the role of the OTA in the changing healthcare delivery models: OTAs in every state will see an increase in the number of potential clients as formerly uninsured persons gain access to health insurance that covers occupational therapy services. In states that elect to expand Medicaid eligibility, even more people will have access to occupational therapy services, which in most cases will have to be covered as essential health benefits. That could increase the demand for OTAs to provide those services. OTAs will be able to provide habilitative services, which will have to be covered to some degree for most of the newly insured population, even if such coverage has often been excluded by private health insurance in the past. OTAs may have new opportunities to participate in the care delivery models of the future such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). ACOs exist with different structures, but are generally systems of health care providers designed to improve patient outcomes, lower costs, and share in the resulting savings. An increased emphasis on integrated, team-based, coordinated, and interdisciplinary care models will present new opportunities for OTAs to demonstrate the value of occupational therapy services to produce improved patient outcomes at lower cost. Opportunities to promote the value and role of occupational therapy services in prevention, wellness, chronic disease management, and other areas. Findings: It would appear that the changes in health care delivery following implementation of the ACA could require increased content in the entry-level OTA preparation. 5. Impact of the growth in content required by accreditation for entry-level OTA programs: A review was conducted of the content requirements for an entry-level OTA program accredited by ACOTE between the 1991 ACOTE Essentials (revised 1995) and the current 2011 Standards. During this time span the standards were revised in 1998 and in A table with a full listing of the standards is provided in Attachment 6. The content requirements are written as expected student outcomes. Faculty members are responsible for developing learning activities and evaluation methods to document that students meet these outcomes Essentials: 43 content requirements 1998 Standards: 66 content standards 2006 Standards: 86 content standards 2011 Standards: 88 content standards 7

9 In addition to the growth in the number of standards it was noted that 32 of the standards present in the 1998 standards that were still present in the 2011 standards had been edited over this period of time to reflect a higher level of knowledge and skill using Bloom s taxonomy. The mean credit load for OTA programs nationally is 76 credits while the national average for associate s degree programs is credits. Findings: The content requirements of the ACOTE Standards for the entry-level OTA programs has increased significantly over the last 10 years in the number of competency based skills and the level of knowledge and skills required. It was noted that the credit load for OTA programs exceeds the average for an associate s degree across the country. There would appear to be a change in the breadth of practice during this period requiring increased content in the entrylevel curriculum. 6. Impact of a change in entry-level degree and the capability of Institutions to provide Bachelor s-level Programs: The following table reflects the Carnegie classification of the accredited OTA programs. The majority of the programs are housed in public 2 year colleges (68%). Table 3: Carnegie Classification of Host Institutions Carnegie Designation # % Assoc/PrivFP: Associate's--Private For-profit 14 8% Assoc/PrivFP4: Associate's--Private For-profit 4-year, Primarily Associate's 3 2% Assoc/PrivNFP: Associate's--Private Not-for-profit 3 2% Assoc/PrivNFP4: Associate's--Private Not-for-profit 4-year, Primarily Associate's 1 1% Assoc/Pub2in4: Associate's--Public 2-year colleges under 4-year universities 4 2% Assoc/Pub4: Associate's--Public 4-year, Primarily Associate's 2 1% Assoc/Pub : Associate's-- Public 2-year colleges % Bac/Assoc: Baccalaureate/Associate's Colleges 5 3% Bac/Diverse: Baccalaureate Colleges--Diverse Fields 3 2% Master's Colleges and Universities 14 8% Special Focus Institutions- 5 3% Source: Carnegie Foundation More than 20 states have enacted legislation to allow 2 year community colleges to grant bachelors degrees. The most recent was the California Legislature that approved legislation on August 21, 2014, that would allow 15 of the state's community college districts to issue fouryear degrees. The rationale for the change was stated as: "In cases where businesses, health care organizations and other industries now require a bachelor's degree at their entry level, it is imperative that community colleges step forward to ensure the competitiveness of our students." (Inside Higher Education, August 22, 2014). 8

10 Findings: The majority of the OTA programs are housed in state funded institutions that have historically not supported bachelor s degree programs. However, there has been a trend nationally to allow community colleges to grant 4-year degrees for health related professions. It is not clear how many of the OTA programs housed in public institutions would have the capability to offer a bachelor s degree. 7. Impact of a change in entry-level degree and state mandated credit limits on associate degrees: A number of states have been mandating credit limits on associate degree programs to control costs. A survey was distributed to publicly funded OTA programs in 44 States. Programs from 39 states responded to the survey. The following table summarizes the responses. The typical limits were in the credit range. Seven states with credit limits allow waivers with justification and several states planning mandates will likely make waivers possible. Table 4: States Limiting Credit Load for Associate s Degrees No credit limit or plan 16 36% Credit limits 11 25% Planning credit limit 12 27% No response 5 12% Findings: The trend to limit credit load on associate degree programs in state funded institutions offers a challenge to OTA programs as the content requirements and competencies required for entry-level practice has increased. 8. Impact of a change in entry-level degree and impact on costs to student: The following table reflects the total number of credit hours and total length of study in months required by institutions for a student to meet the OTA program degree requirement. Table 5: Credit Load and Months Credits Months Min Max Mean Median N=122, (1+1 programs include pre-requisite requirements) The average associate s degree can require successful completion of 60 to 64 credits in prescribed courses. However, it is typical in health related professions to require more credits. The mean credit load for accredited OTA programs is 76 credits. The average credit load for a bachelor s degree in the United States is credits (USDE, 2003). 9

11 The additional costs to students will vary based on whether the school is public versus private and the additional credit load required. Findings: There is no doubt that there would be increased debt incurred by the students. Due to the multiple variables it is not clear what the average increase would be to the students. 9. Impact of a change in entry-level degree on salaries: The Bureau of Labor and Statistics reports that in May 2012, the median annual wage for occupational therapy assistants was $53,240 (retrieved September 1, 2014 from The US Census Bureau reports that in 2009 the average salary for females with an associate s degree was $33,432 and the average salary for a female with a bachelor s degree was $43,589 (retrieved September 1, 2014 from While it is evident that higher degrees generally demand higher salaries, it would appear that the current salaries for OTAs reflect the workforce demands more than the entry-degree level to the field. Findings: It seems unlikely that transitioning to a bachelor s entry-level degree will lead to major changes in salary. OTA graduates currently receive salaries exceeding the national average for graduates with bachelor s degrees. 10. Impact of a change in entry-level degree on diversity of student population: The current data reported by entry-level programs indicates greater diversity in the OTA versus OT programs. Table 6: Race & Ethnicity 2014 Data Survey Amer. Indian Asian Black Pacific White Other Doctorate Master's OTA 0% 6% 4% 0% 86% 5% 0% 6% 5% 0% 82% 7% 1% 4% 10% 1% 78% 7% Doctorate Master's OTA Hispanic Non-Hispanic 4% 96% 6% 94% 10% 90% 10

12 As the current OTA entry-level is mandated at the associate s-degree level, it is impossible to study the direct effect on OTA students. However, the profession of respiratory therapy currently offers both associate s and bachelor s level programs and has been exploring the same question of shifting to a bachelor s entry level requirement. A recent study bybecker and Nguyen (2014 reported on a secondary analysis of data collected from the 2009 AARC Respiratory Therapist Human Resource Survey. This study explored relationships between the choice of entry-level associate or baccalaureate education and variables of gender, race, salary, career advancement, and job satisfaction. The study found there were no differences between therapists with entry-level associate and baccalaureate degrees in gender, race, number of additional healthcare credentials, numbers of life support credentials, wages, delivering respiratory care by protocol, and job satisfaction. There were significantly higher percentages of advanced academic degrees, desire to pursue a higher academic degree, registered respiratory therapist credentials, total National Board for Respiratory Care credentials, and leadership roles for therapists with baccalaureate entry-level degrees. The authors concluded that current entry-level associate and baccalaureate degree graduates have similar gender and race proportions and that this finding challenges concerns that an entry-level baccalaureate degree would decrease the diversity of the respiratory therapist workforce. Findings: While we have no definitive data on the impact on diversity, a recent study in a similar profession does suggest that there would not be a significant impact to diversity for transitioning to a bachelor s entry-level degree. 11. Impact of a change in entry-level degree and faculty resources: The aggregate data submitted by the accredited OTA programs in March 2014 was reviewed. While the percentage of full-time vacancies has remained consistent at 7-8% over the last 5 years, the percentage of the faculty hours accounted for by adjunct faculty has grown from 24% in to 38% in (AOTA, 2014). It is assumed that the additional classes for the bachelor s requirement would require increased faculty when there is an existing shortage. 11

13 Table 6: OTA Faculty Numbers Total Percent Per Program Vacancies Vacancies as a % of total Core Full Time % % Core Part Time 66 7% % Adjuncts % % Total % Preliminary data from the Faculty Workforce Survey indicates that the majority of faculty in OTA programs hold a bachelor s degree or higher. The majority of faculty members who are OTA hold bachelor s degrees. Table 7: Preliminary Data from the Faculty Data Survey Associate Degree 10 3% Bachelor Degree 81 27% Masters Degree % Doctoral Degree 34 11% Other, please specify 4 1% Findings: Historically, ACOTE and many institutions require that faculty hold a degree higher than the degree granted by the program. This would add a significant burden to the current faculty if the degree were to be required at the bachelor s degree level. The preliminary review of the data does make it clear that adequate qualified faculty would be available. 12

14 12. Review of degree changes in other professions: Nurse:* o Associates or higher o Accredited- yes o License- Yes Physical Therapist Assistant* o Associates o Accredited- yes o License- yes Clinical Medical Assisting: o Associates minimum o Accredited- yes o License- No Medical Office Management: o Associates minimum o Accredited- yes o License- No Radiologic Technology: o Associates minimum o Accredited- yes o License- Yes Pharmacy Technician: o Certificate / Associates o Accredited- yes o License- Yes Veterinary Technology: o Accredited- yes o 199 AAS level o 22 Bachelor s level Respiratory Therapy* o Associates or higher (Bachelor s) o Accredited- yes o License- Yes Findings: The nursing, physical therapy assistant, and respiratory therapy professions are actively exploring the implications of moving to a minimum of a bachelor s entry-level requirement. 13. Implications of offering two entry-level degrees: The stated purpose of the national certification exam and entry-level education is to assure the stakeholders and recipients of occupational therapy services of the competence of entry-level 13

15 practitioners (Source: The existence of two entry-level degrees (associate s and bachelor s) as the requirement for eligibility to sit for a single certification exam and licensure to practice as an occupational therapy assistant creates inconsistencies and raises the question of how can two different degree levels meet the single requirement for competent practice? At the occupational therapy level the existence of two entry-degree levels has raised a number of concerns: Many prospective occupational therapy students and practitioners contact AOTA and express confusion when choosing educational pathways to the profession. To put it simply, they do not understand why there are two degree options. There is a single set of student learning outcomes and competencies established through certification for entry-level practice. It seems that either one degree level is under qualified or one level is over qualified for entry-level practice. Regulatory authorities have questioned the profession s need to have two entry degree levels for the occupational therapist. Shouldn t there be different student learning outcomes if there are two degree levels? If so, wouldn t the higher degree have more skills at entry-level? Employers have similar questions when two entry-level degrees exist for a profession. Do I need doctorally prepared new graduates or do I need master s prepared? What is the difference? Why should I pay more for a doctorally prepared occupational therapist if I can pay less for a master s level? The argument remains that other health care professions (e.g., nursing) have more than one entry-level degree, so why can t occupational therapy assistants? The committee found that professions with more than one entry level are in the minority, primarily for the reasons stated in the post about single entry level to a profession. The majority of professions either have a single entry-level degree or are in a period of transition to achieve this goal. The profession that is most frequently identified is nursing, and they continue to debate the same issues facing occupational therapy ( Findings: While there may be some benefits to the two entry-level-degree model, they do not outweigh the inconsistencies created when there are two different degree levels qualifying graduates for a single set of entry-level competencies. 14

16 Key Recommendations: Recommendation 1: Following a thorough review of the issues and stakeholder feedback, the Committee is recommending that the entry-level degree requirement for the occupational therapy assistant remain the associate s degree at this time. The Committee recognized that there are a number of factors and key data supporting a move to the bachelor s degree including expanded breadth of OTA practice, increased content requirements, and emerging practice models. However, the Committee noted that there was not sufficient evidence that the institutions sponsoring the existing OTA programs would be able to successfully make the transition at this time and if the key stakeholders (e.g., students, higher education providers, clinical providers, etc.) can afford the associated increased costs. Recommendation 2: The Committee is recommending that there be only one entry-level degree as a pre-requisite for the single national certification exam for the occupational therapy assistant. Recommendation 3: The Committee is recommending that the Association develop and implement a plan in the next 2 years that articulates clearly defined strategies to ensure that the profession is prepared to succeed if the profession should choose to move to a bachelor s requirement for the entry-level degree for the occupational therapy assistant. This plan should at a minimum address the following: Expectations of practice for an OTA in the next decade, Impact of any changes in entry-level degree requirements for the OT (e.g., doctoral requirement) on OTA practice, Growth in content to address changes in practice, Readiness of host institutions to support a transition to the bachelor s requirement, The trend in community colleges to offer limited Bachelor degrees, Faculty workforce including occupational therapy assistants with post-baccalaureate degrees (Note: Accreditation typically requires faculty to have a least one degree higher than the degree granted by the program), Impact of regulatory changes associated with the Affordable Care Act and impact on reimbursement, and The potential impact of increased costs on key stakeholders (i.e. students, employers, etc.) 15

17 Bibliography: American Academy of Physician Assistants (2010). State law issues: Ratio of PAs to supervising physicians. Author: Alexandria, VA. Retrieved from August 1, 2014 American Occupational Therapy Association (n.d.) Health Care Reform and the Occupational Therapy Assistant. Author Bethesda: MD. Retrieved from: /media/corporate/files/advocacy/health-care-reform/overview/hcr_ota.pdf American Occupational Therapy Association (2014). Academic Programs Annual Data Report: Academic Year Author: Bethesda, MD. Retrieved from /media/corporate/files/educationcareers/accredit/ annual-data-report.pdf Becker E. A., & Nguyen, X.T. (2014). The Current Impact of Entry-Level Associate and Baccalaureate Degree Education on the Diversity of Respiratory Therapists. Respiratory Care. Jul 1. pii: respcare Inside Higher Education (2014). California legislature approves bachelor's degrees at community colleges. August 22, Retrieved from: National Board for Certification in Occupational Therapy (2013). Examination blueprint: COTA. Author: Gaithersburg: MD. Retrieved from August 1, U.S. Department of Education, National Center for Education Statistics. (2003). A descriptive summary of bachelors degree recipients 1 year later, with an analysis of time to degree, NCES , by Ellen M.Bradburn, Rachael Berger, Xiaojie Li, Katharin Peter, and Kathryn Rooney. Project Officer: James Griffith Washington, DC: Retrieved from August, 1,

18 Attachment 1: AOTA- OTA Degree Ad Hoc Committee- OTA Faculty Survey How long have you been in your position as a faculty member for the OTA program? Answer Options Percent Count Less than 1 year 9.9% years 17.5% years 28.9% years 14.3% years 9.1% years 14.0% years 6.1% 21 answered question 342 skipped question 0 In what region of the country is your program located? Answer Options Percent Count Northeast 25.4% 87 Midwest 31.0% 106 West 5.8% 20 Southwest 7.6% 26 South 30.1% 103 answered question 342 skipped question 0 How much time is required for the student to earn the associate degree at your institution? Include pre-requisite coursework as well as professional coursework. Select only one. Answer Options Percent Count 1 year 0.0% years 4.7% years 28.4% years 46.2% years 17.3% 59 > 3 years 3.5% 12 answered question 342 skipped question 0 17

19 Your program is housed in: Answer Options Percent Count Public institution 69.6% 238 Private not for profit institution 12.0% 41 Private for profit institution 18.4% 63 answered question 342 skipped question 0 Are you in favor of changing the entry level degree requirement from an associate degree to a bachelor s degree for the Occupational Therapy Assistant? Answer Options Percent Count Yes 19.3% 66 No 64.9% 222 Undecided 15.8% 54 answered question 342 skipped question 0 If you answered no to question #5; are you in favor of offering both the associate and bachelors degree as options for Occupational Therapy Assistant entry level education? Answer Options Percent Count Yes 20.1% 55 No 58.6% 160 Undecided 21.2% 58 answered question 273 skipped question 69 Does your academic institution offer any bachelors degree programs? Answer Options Percent Count Yes 36.8% 126 No 63.2% 216 answered question 342 skipped question 0 18

20 Select from the list provided the identified strengths with offering the entry-level degree for the OTA at the baccalaureate level? (check all that apply) Answer Options 19 Percent Count Additional time allocated for teaching and learning will expand the opportunity to expose students to content and skills needed for entry level practice 62.1% 164 today The community may demonstrate greater respect for the graduate as an educated person with increased 47.0% 124 recognition with an earned undergraduate degree The role of the OTA practitioner may expand with increased responsibility and marketability made 44.7% 118 available. Supervision requirements may be altered to include the need for less supervision 31.8% 84 Improves the professional presence for all OT professionals 42.0% 111 Provides for an easier transition to Master s level or Doctoral level programs for the Occupational 62.5% 165 Therapist Receive credit for number of years required to complete the associate degree at many community colleges whose time frame for the completion of the 27.7% 73 associate degree is 3 years versus the 4 year baccalaureate degree Improves the chance for laddering and job recognition 32.6% 86 Other (please specify) 44 answered question 264 skipped question 78 Comments: The community at large does not understand the role delineation and standards of OT practice anyway, but we must first work on AOTA, AOTF, WFOT and MOT/OTDs (including students) etc. to recognize and RESPECT the value of OTAs. Do not agree Students currently have the option of transferring earned credits to a 4 yr+ institution and going on for their BS degree on a part time basis while working as a COTA. At least 1/3 of our students already have a BS or BA degree in another field, but do not feel academically or financially prepared to work towards a master's OT degree at this time. Since the OTA program is limited by the state as to a max of credit hours (including pre-requisites), I fail to see how additional teaching/learning time in OT related courses would be gained. As a long time employer in multiple types of settings, I see little evidence that the first four items above reflect reality. Do not agree with proposed transition as this would not correspond to OTA responsibilities. Honestly I don't feel any of those responses justify a baccalaureate level and find them to be degrading! If a program is sound, it will ensure content and skills are met. Changing a degree to earn respect does not ensure respect. Education and advocating is the effective means to gain respect. The roles of COTAs and OTRs differ from setting to setting and practitioner's experience, a degree will not ensure this. Supervision is based on competency level of all OT practitioners so I'm not sure how this would

21 change it. Professional presence...your actions, ethics and standards speak for them self, not your credentials. Several masters programs have the bachelor s degree built in already. Your performance as a clinician improves your chance for job laddering and job recognition. A bachelor's in OT is not required as a bachelor's in various backgrounds will accomplish the same result. Most of these answers are hypothetical. Entry level skills, laddering, job recognition, easier transition, and professional and community presence. It will provide less of an educational gap between OTA's and OT's Our community college is in full support of moving OTA to a bachelor s degree and wants us to be the first and model program for the college in hopes to also move nursing and PTA eventually. I genuinely do not feel any of the above statements are valid arguments for exclusive BS degrees for COTAs. We need to think about defining the role of the OTA since many companies appear to be having more OTA staff and less OTR for financial reasons. They need to know more and it is a challenge to get the information into the associate degree. The exam study guide is more complex for the OTA and the students need to know more information to pass this test In most clinical jobs in our area, having a Bachelor's degree would only have a small and insignificant effect on laddering/job recognition. It would allow for the OTA to move more quickly into full-time faculty jobs at the community college level, so that would be a benefit for those who are interested in teaching. However, 1/2 of my students already have a BS, when they enter the OTA Program. They could have chosen to get a Master's but didn't. If the Bachelor's level OTA could work more independently, it might be strength in pediatrics or in private practice. However, in skilled nursing, most of the OTAs are only getting face-to-face supervision every 10 visits anyway. Our graduates already have to be really independent in most settings, because the supervision is poor. As I've said, 1/2 of my graduates already have a BS, so the transition to Master's isn't that difficult. Most just don't want the debt. Many of our students who didn't have a BS have gone on to graduate from a bridge program after their OTA degree is complete. It is hybrid, so they can still work and live at home. We have a new OT program starting in our city and our graduates are declining to apply because it isn't a bridge program. If you want to move more people into higher level degrees, my opinion is that increasing the number of bridge programs for OTA to OT transition is a better option than adding the BS. I personally would move to Doctorate level, if I had a cheaper and easier way to do it. I can't afford any more degrees, but I'm certainly qualified and very interested in continuing my education. My salary is not keeping up with the amount of student loans I've already gotten. Our profession would have a better professional presence if we had a stronger professional reputation. We have low levels of participation in AOTA, poor state level awareness and participation, poor participation in evidencebased practice at a clinical level. Adding a Bachelor's Degree will not change this. I teach an intense EBP section in the OTA Program, but I bet not half of the graduates are using it clinically. Why? Because they aren't working in environments that support quality. They are working in environments that need them to work fast and productively. Most of my graduates have 95% productivity standards in long term care. This applies to OT, COTA, Master's, Bachelor's, or AA. We need to find out what the "common" OT practitioner wants and needs and work towards that, instead of worrying about looking better for everyone else or appealing to the needs of those who want to be elite. Adding degrees is not the answer. Adding degrees helps those in education and those who want to do research. It is not a clinical answer for anything. The amount of requirements is challenging in the timeframe for the associates level. I value the opportunity to enter our profession at the associate level, however in today s environment that could be the requirements for an aide. The emphasis for going to a bachelor's degree should not be related to easier laddering. That just diminishes the role of the OTA. 20

22 Unless it comes with a significant pay increase my students will not be able to afford it despite any theoretical social benefits. Given the ACOTE standards for the OTA Program, I believe the degree should be awarded at the baccalaureate level; however, at my university, even if that were true, additional coursework would be primarily in the general education coursework so we would not have additional time allocated for OTA education, as stated in the first response alterative in Q8. All response alternatives above are contingent on too many variables to outright identify them as strengths. skill/competency level --needs more time to develop and increased expectations regarding competency to address needs in a holistic manner- the conditions and situations people we serve are more complex Although the bachelor's degree would allow more time for providing curriculum content, there is no evidence that the current associate's level is not preparing practitioners adequately for current and future practice. With the (appropriate) focus on evidence-based practice, the decision to dramatically alter our entry-level educational system should be based on evidence. I don't see how we can increase responsibility of the OTA unless we change supervision laws to not necessary, but then why even have the OTA level?? I don't feel any of the above will happen with a change to a BA/BS I believe the 5 semester program, if arranged efficiently, provides ample time to teach content needed for entry level practice, the community generally has a great respect for therapists and does not differentiate an assistant and therapist unless cued by therapy personnel, there is no need to expand the role of the OTA, supervision requirements allow for consistent communication and problem solving as well as oversight which provides maximum benefit for the patient, with training and good role models all OT's should present as professional regardless of level of degree, I do not know of any OTA's who have had difficulty transitioning into a master's level program (and I know many who have done so), OTA's receive substantial return on their investment of 2-3 years, I know OTA's who transition into DOR positions without difficulty (job recognition/laddering) is not degree specific. Will improve the quality of students also looking to enter the profession as many choose the field and tell me this was "a quick way to make money." This would allow more time for general ed in health sciences, bringing a more qualified and better educated student to the core OTA classes. All of the options above devalue the level of the OTA. They appear to be saying that having a higher degree will gain recognition however the issue is the work assistant not the degree. I am not in favor of a name change, however I do not feel it is the degree that causes the issue of recognition. In addition, NOT ALL OTAs want to become OTs. Currently in the program that I teach in we have 8/20 students who have baccalaureate degree. Although additional time is the one benefit I could potentially recognize, I am not convinced that this time would lead to better outcomes for the entry-level OTA practitioner. What "evidence" of outcomes supports this move or justifies the need for this move? OTA faculty will increase their knowledge base and research contributions by continuing their education. I understand that an instructor/afwc should be expected to hold the same degree or one higher than the majority of students in the program. However when an instructor/afwc stays current through CE, and clinical experience; love teaching students about OT, and pass that passion on to future practitioners, it is unfortunate to require they obtain a higher degree, especially when they have been dedicated, and efficient in the role. Finances and time may not allow this. Hopefully this will be 21

23 considered especially for academic fieldwork coordinators, (many are OTAs) whose main role is not teaching core classes, but maintaining relationships between the field sites and faculty. These types of interpersonal relationships and ability to handle stress of placements cannot be learned. With the centennial vision approaching, and we strive toward being a unique and holistic therapy, I think it best if we make our own way, that fits our philosophy and not worry about PT. I think then we will be respected, recognized, and will stand apart in a very positive way. I don't believe that any of these apply with a change in degree requirements. All of the above are possible strengths without the guarantee that any will occur. I see the change in the entry level of the OTA simply fallout from the move to doctoral level entry for OT's. I am not in favor of this for any reason. All options other than the one selected are hypothetical. The current OTA program is a robust program, meeting the needs of he graduates and the community. I do not think the move to bachelors is prudent or necessary. Therefore, None of these options appear to strengths. At this time of incredible uncertainty about healthcare reform coupled with protracted economic growth, to consider adding student debt without expected salary increases is irresponsible. I do not see ANY strengths or purpose in the entry level for the OTA at the baccalaureate level! My students could not afford to get a bachelor degree and would rather graduate in 2 years and have an AS degree and start working. I do not want OTA ti be offered at the baccalaureate level. I do not see any problems with how it is now and do not see any strength from moving to a bachelor s degree. I The OTA should be able to perform evaluations similar to how OTs were trained at the baccalaureate level. The job title would need to go back to just OT and not OTA. This comment is both positive and negative: Having worked with and managed OTAs for more than 40 years, in 10 states, and in clinical settings covering the full scope of OT practice, I am concerned that this would eliminate some of our best OTA practitioners. Many have excellent clinical skills, but poor academic ones. They have learned to use techniques and evidence based practice, but do so best in non-academic settings. Supervision is based on the Practice Acts of each state so that is not reasonable to expect. Increase the number of bridge programs versus adding Bachelors. Does AOTA feel that today's OTA grads are NOT prepared for entry level practice as prescribed by ACOTE standards and state licensure acts? Most students who come to our OTA program have no desire to gain a higher level of status--they want to work-in the day to day-with clients. I do not believe we should change this educational degree just because of outside perspective and status brokering. How is it broken? Who does it benefit-4 year colleges or the clients and students served? OTAs support OT service in a manner that does not depend on education alone-but on the diversity they bring and share. Professional presence is within the practitioner--education of technical skills alone does not accomplish this. This is in alignment with the Centennial Vision. I am not opposed in general to the discussion or the change if all of OT community sees the need. It may be the future for OT. I have seen many changes (+ and -) in my 35 years of practice. I do believe there are many unintended consequences to this change and desire a complete and transparent discussion with al stakeholders (this survey is a start). Anything that changes my profession, which I love dearly, I take seriously. This will change OT forever. I want a clearly articulated purpose from the OT community first 22

24 before we begin. Would changing to baccalaureate allow COTAs to use credentials in non-traditional and emerging practice areas without OTR supervision? Select from the list provided the identified concerns with offering the entry level degree for the OTA at the baccalaureate level? (check all that apply) Answer Options Percent Count Access will become limited for those seeking a degree in the occupational therapy profession 74.1% 246 Cost will increase causing higher debt and possibly a reduced applicant pool 87.7% 291 Diversity of applicants may be diminished 64.5% 214 Colleges, both existing and emerging, may be negatively impacted by an increase potential faculty shortages of qualified people and increase in tuition 65.7% 218 costs Potential for closure of program currently housed in community colleges authorized to offer only an 80.1% 266 associate degree program Health care costs may be impacted whereby consumers may pay more for services 45.2% 150 The role delineation between the OTA and OTR will become blurred 51.2% 170 Loss of jobs in emerging and current practice arenas currently hiring OTAs as cost effective means to 55.1% 183 deliver OT services Other (please specify) 72 answered question 332 skipped question 10 23