Building a Dynamic OT-OTA Team In Any Practice Setting

Transcription

1 Building a Dynamic OT-OTA Team In Any Practice Setting Cecille Corsilles-Sy, PhD, OTR/L Juliann Trumm, MPH, OTR/L WOTACON Tacoma, WA October 9, 2015

2 Introductions & Demographics Join our instant survey smart phone, tablet, laptop O Open your web browser O Kahoot.it 2

3 Participant Objectives 1. Review Standard of Practice, regulatory guidelines, and state laws related to roles, responsibilities and supervision of occupational therapy practitioners. 3

4 Participant Objectives 2. Develop a framework for service competency relevant to the OT practitioner s practice area. 3. Identify strategies that will build a culture of collaboration in intra-and interprofessional practice teams. 4

5 Relevant Guidelines O WA State Legislature: WAC Standards of Supervision O AOTA s Guidelines for Supervision, Roles & Responsibilities During the Delivery of OT Services O AOTA s Documentation Guidelines 5

6 Relevant Documents O AOTA s Occupational Therapy Standard of Practice O Occupational Therapy Code of Ethics O Recommended: O Institution s Philosophy O Institution s Mission Statement 6

7 Washington State Laws O WAC (Title, Chapter, Section) O Standards of Supervision O (1) Licensed OTAs must be supervised by regular consultation with an OT licensed in the state of WA. Regular consultation must be documented and the documentation kept at a location determined by the supervising OT or OTA. O (others are not relevant to OT-OTA supervision but relevant to using OTAs for skilled care vs. as OT aide) 7

8 Documentation of Supervision O Patient file: Weekly notes and Summaries O Interdisciplinary meeting notes O Professional Development Plans O Performance Evaluation O Personnel File 8

9 Supervision (AOTA Guidelines, 2004) O A cooperative process O Two or more people participate in a joint effort to establish, maintain, and or elevate a level of competence and performance O Based on mutual understanding between the supervisor and the supervisee about each other s competence, experience, education, and credentials 9

10 Supervision (AOTA Guidelines, 2004) O Fosters growth and development, promotes effective utilization of resources, encourages creativity and innovation, and provides education and support to achieve a goal 10

11 Supervision (AOTA Guidelines, 2004) O Within the scope of occupational therapy practice, supervision is a process aimed at ensuring the safe and effective delivery of occupational therapy services and fostering professional competence and development 11

12 Levels of Supervision (Ryan s OTA, p. 586) O Close supervision- direct, on-site, daily contact O General Supervision - frequent face-to-face mtgs. at worksite & regular communication by telephone, written documents or electronic conference O Medicare: Initial direction and periodic inspection of actual activity, but supervisor need not always be present on premises during performance of services 12

13 Levels of Supervision (Ryan s OTA, p. 586) O General Supervision cont. O AOTA recommendation- use only after service competencies have been established O Authors (Ryan and Sladyk) recommend that contact by OT may be less than daily but should be 3-5 contact hours per week for full time OTA 13

14 OTA Levels of Performance & Supervision O Entry level- less than 1 year, close supervision required, competent with entrylevel services with close supervision O Intermediate 1-3 years, competent with entry-level tasks, variety of ADL in tx, may be developing more advanced skills in a specialized area 14

15 OTA Levels of Performance & Supervision O Advanced Level O 3 or more years of experience and has achieved intermediate level O Demonstrated advanced level skill that may be in clinical, educational, or administrative 15

16 Supervision Considerations O Regulatory requirements O Practice setting O Competency level O Experience O Education and credentials O Complexity of client needs O Number & diversity of clients O Service Competency 16

17 COTAs as Supervisors O After 1 year- can supervise a FW I and FW II OTA O O O O students After 1 year- can supervise a FWI OT students Intermediate (1-3 yrs)- supervise OT Aides and volunteers As intermediate and advanced COTA - can supervise entry-level and intermediate COTA, respectively. Advanced-level- can provide administrative supervisions (in addition to all of above) 17

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19 What is the scope of practice for OTAs?

20 OT Process of Service Delivery O Referral O Screening and evaluation O Intervention Planning O Intervention Implementation O Re-evaluation O Discharge/Discontinuation 20

21 Standard of Practice OT O Accepts/responds to referrals O Directs/responsible for all aspects of screening, Evaluation, and Reevaluation OTA O ---O Contributes to the screening, evaluation, and re-evaluation; implements delegated assessments 21

22 Standard of Practice OT O Analyze and interpret results O Completes and documents evaluation results O Recommends additional services, refer to other services OTA O O Contributes to documentation of evaluation O

23 Standard of Practice O OT/OTA communicate results to appropriate person, group, organization, population O OT/OT educate referral source on OT services, initiation of service 23

24 Standards of Practice Definition O Assessment: Specific tools or instruments used during the evaluation process O Can be administered by OTA 24

25 Standards of Practice Definition O Evaluation: Process of obtaining and interpreting data necessary for intervention. This includes planning for and documenting the evaluation process and results. O It is not within the scope of practice for OTAs to interpret assessment results 25

26 Standard of Practice: Intervention Planning OT O Responsible for selecting, measuring, documenting, & interpreting expected outcomes O Modifies intervention plan throughout tx process OTA O Can collaboratively work with OT but largely the domain of the OT O

27 Standard of Practice: Intervention OT O Responsible for overall development, documentation, and implementation of intervention based on evaluation, client goals, best available evidence, professional and clinical reasoning OTA O Selects, implements, and modifies intervention consistent with OTA s demonstrated competency, intervention plans, needs of practice setting 27

28 OTA: Intervention Implementation O Can make changes on level of assistance within the same therapeutic goal O OTAs cannot create new goals within an established treatment plan, but will communicate with the OT the need for changes 28

29 OTA: Documentation O Initial Evaluation report- OTAs can contribute to data, sign the section of their contribution or a statement of the collaboration can be made prior to OT s signature 29

30 OTA: Documentation O Contact note/ Daily note can be completed by OTA following institutional standards WITHOUT a co-signature O Progress Note /Weekly Note frequency depends on institution and/or funding source, practice setting. OTAs often write this note and is co-signed by OT especially for need of updating treatment goals 30

31 OTA: Documentation O Re-evaluation, Transition Notes, Discharge or Discontinuation Note O OTA can contribute to gathering of data but an OT will need to analyze, interpret and sign these documents with statement on the collaborative process 31

32 Service Competence O Implies that the OT and OTA can perform the same or equivalent tasks and obtain the same results. O Supervisor s responsibility to establish supervisee s level of service competency O More easily established with frequently used assessments and interventions (Ryan & Sladyk, p. 586) 32

33 Stages of Competency Development O Variety of methods can be used: observation, videotaping, independent test-scoring, co-treatment O Exposure Competence Immersion Comparable results O Competency standards- setting specific 33

34 Documentation of Service Competency O Include in employee personnel file O Competencies at different intervals (determined by demands of setting) O Service competency should be documented for frequently administered assessments and intervention O Service competency should be documented for each service area 34

35 Sample Competency Level 1. Little or no experience- needs supervision 2. Some Experience- may require supervision or assistance 3. Competent, Experienced- can perform without supervision 4. Competent, Experienced- able to assess competency and teach others 35

36 Group Activity O Break into groups based on practice area and practice setting O Hospital-based (Acute/Inpatient/Out-patient) O Skilled Nursing Facility O Mental Health (Inpatient/Outpatient/Community) O Pediatrics (School District/Outpatient) O Outpatient Hands O Home Health 36

37 Group Activity: Service Competency O Assessments O Most common Functional assessments O ADL/IADL O Physical Dysfunction O Cognitive/Communication O Psychosocial (Ryan and Sladyk, 2005) 37

38 Group Activity: Service Competency O Assessments O Most common Functional assessments O ADL/IADL/Home Eval/Adaptations O Work/Driving O Leisure/Play/Social Participation O Rest/Sleep 38

39 Group Activity: Service Competency O Standardized Assessments O Neuromotor Dysfunction O Sensory/Processing O Cognitive/Communication O Psychosocial O Mental health O Environment/access 39

40 Group Activity: Service Competency Intervention: Occupation-based O ADL/IADL O Home programs O Groups O Leisure O Work 40

41 Group Activity: Service Competency Intervention: Therapeutic Activities O Strengthening/ROM/Endurance O Activity tolerance O VP activities O Group intervention 41

42 Group Activity: Service Competency Intervention: Preparatory O Physical Agent Modalities O Neuromuscular facilitation O Pain management 42

43 Group Activity: Service Competency Intervention: Prevention O Environmental Adaptation O Ergonomics O Splinting O Health & Wellness O Stress Management O Home Exercises/programs 43

44 Group Activity: Service Competency Specialty Interventions O Return to driving intervention O Seating and positioning O Assistive Technology O Sensory Integration O Equipment- specific O Funding- specific 44

45 Sharing Results O Each group to report on their results O Present in order of practice setting O OT Process: O Assessments O Intervention 45

46 Under and Over Utilization of OT/OTAs O Results from limited knowledge of distinction in roles & responsibilities O Limited knowledge of funding source requirements O Underutilization O Overutilization 46

47 Strategies to Build Collaboration O Increase knowledge of role distinction O Allow for sufficient orientation O Establish a plan for service competency O Include collaborative work in Performance Evaluations O Establish professional goals to include studies in inter and interprofessional practice 47

48 Review/Summary O Licensed OTA s must be supervised by O O O O O regular consultation with an OT and this should be documented (WAC & AOTA) Levels of supervision (Ryan s) OT vs OTA scope of practice Documentation co-signatures Service competency Under and over utilization of OTA s 48

49 Question and Answer 49

50 References O WA State Legislature: WAC Standards of Supervision O Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services. AJOT. November/December 2004, Vol. 58,

51 References O Guidelines for Documentation of Occupational Therapy. AJOT. November/December 2013, Vol. 67, S32S38. O Standards of Practice for Occupational Therapy. AJOT. November/December 2010, Vol. 64, S106-S111. O Occupational Therapy Code of Ethics (2015). AJOT. September 2015, Vol. 69, p p8. 51

52 References O Sladyk, K., Ryan, S. E., eds. Ryan s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. 5th ed. Thorofare, NJ: Slack Inc;