Standard for the Supervision of Students and Occupational Therapy Assistants
Occupational therapists who supervise students or occupational therapy assistants remain professionally accountable for clients receiving safe, appropriate, and ethical care. In all aspects of supervision and assignment, occupational therapists are to consider clients’ best interests, the practice setting, and the risks associated with the service components.
The terms “occupational therapy assistant” and “occupational therapist assistant” may be used interchangeably. These Standards uses the term “occupational therapy assistant” as a descriptor for service providers who are assigned occupational therapy service components under the supervision of an occupational therapist. These Standards also apply when supervising and assigning activities in a similar situation to other support staff.
The specific tasks assigned to the occupational therapy assistant must be part of the overall occupational therapy services. The occupational therapy assistant must work under the direction and supervision of an occupational therapist, who must assume responsibility and accountability for the ongoing quality of occupational therapy service delivery. Student occupational therapists and volunteers are not considered to be occupational therapy assistants.
Occupational therapists are expected to:
1. Create an appropriate environment for those being supervised
1.1
Avoid supervising anyone with whom they have a current or former relationship (for example, a family member, friend, or close personal connection).
1.2
Maintain professional relationships at all times per the Standard for Professional Boundaries and the Prevention of Sexual Abuse.
1.3
Recognize the power differential between the supervising occupational therapist and the supervisee.
1.4
Model respectful behaviours toward supervisees. Provide a safe and inclusive environment for them.
1.5
Create an environment where supervisees are comfortable and able to raise concerns about unfair, unsafe, or culturally inappropriate experiences. Have a clear process for reporting such problems.
2. Have competence and availability for supervision
2.1
Allocate the time needed for supervision and assignment.
2.2
Assign only components of client care that the occupational therapist is competent to perform.
2.3
If supervising is a new practice activity, seek the support of a mentor or colleague.
3. Be accountable for the services and the supervisees
3.1
Balance the need to encourage autonomy in supervisees with the level of supervision appropriate to the situation.
3.2
Be clear who is assigning and responsible for specific service activities, including when there are multiple supervisors (multiple occupational therapists or other professionals).
3.3
Ensure that supervisees have and maintain the knowledge, skill, judgement, education, and competence to perform all assigned services.
3.4
When assigning activities, comply with organizational policies and ensure that client safety is maintained.
3.5
Never assign any controlled act that is being performed by the occupational therapist, whether authorized by the Occupational Therapy Act (for example, psychotherapy) or delegated by another regulated health professional.
3.6
Monitor clients’ response to the services being provided by a supervisee. Discuss any concerns with clients.
3.7
Have a process in place for back-up supervision when the occupational therapist is not available.
4. Stop assignment when appropriate
4.1
Stop the assignment if no occupational therapists are available to provide supervision or to oversee the occupational therapy services.
4.2
Stop the assignment if the supervisee’s involvement is not effective or is unsafe.
4.3
Stop the assignment if the client withdraws consent to receive services by a supervisee.
5. Contribute to the learning and development of students
Supervision of Students
Having students on placement and acting as student preceptors is a valuable opportunity for occupational therapists to serve as role models and to share practice knowledge. Contributing to the learning of students is outlined in the Competencies for Occupational Therapists in Canada (2021).
5.1
Before mentoring and overseeing students, have one year of practice experience.
Traditional Supervisory Placements
In traditional supervisory placements, where occupational therapists are on-site and working directly with the students they are supervising,
5.2
Ensure that sufficient orientation and training are provided. This includes orientation to the facility, organizational policies, and assigned clients or tasks.
5.3
Understand the student’s progression within the educational curriculum, including
- The program requirements and expectations
- The student’s current learning needs, previous clinical experiences, and perceived areas for improvement
5.4
Ensure that a documented learning contract is in place. It should outline goals and activities appropriate to the student’s competence.
5.5
Put in place and apply a process of observation, instruction, evaluation, and feedback throughout supervision.
5.6
Prioritize tasks assigned to students based on each student’s learning needs, not the needs of the supervisor or organization.
5.7
Before co-signing, review all documentation completed by students to ensure that it adheres to the Standard for Record Keeping.
Non-Traditional or Role-Emerging Placements
For non-traditional or role-emerging placements, where the occupational therapist preceptor is off-site and provides consultation and direction to students who have a separate, on-site supervisor who is not an occupational therapist,
5.8
Have an adequate level of comfort and competence to supervise in such a setting, considering the amount and type of supervision that can be reasonably provided.
5.9
To ensure accountability, create a communication and supervision plan. Outline roles and expectations. Collaborate with the on-site supervisor, placement site, students, and educational institutions.
5.10
Identify how client consent will be obtained.
5.11
Determine who will manage client records as well as the client personal information and personal health information generated by students for the required retention period. Make a plan to review and co-sign student documentation where client services have been provided.
5.12
Develop a plan with the on-site supervisor to address emergency situations or issues of safety involving students and clients.
6. Clearly define roles and responsibilities when supervising occupational therapy assistants
6.1
Know the appropriate activities that can be assigned, and ensure that occupational therapy assistants can competently complete them.
6.2
Never assign the following activities to occupational therapy assistants:
- Initiation of occupational therapy services
- Aspects of assessment requiring the occupational therapist’s clinical judgement
- Interpretation of assessment findings
- Interventions where ongoing analysis and synthesis are necessary to closely monitor and guide client progress
- Communication of occupational therapy recommendations, opinions, or findings requiring clinical judgement
- Decisions involving discharge
6.3
Establish appropriate limits for occupational therapy assistants’ participation in intervention planning, goal identification, and progressing or modifying an intervention.
6.4
Establish a supervisory plan for providing services, including the following:
- Roles, responsibilities, and methods of supervision
- Expectations for reporting by assistants to the occupational therapist
- Activities that will be assigned to assistants
- Activities that assistants can carry out if the occupational therapist is unavailable to provide direct supervision.
6.5
Follow the Standard for Record Keeping when supervising and documenting the activities of occupational therapy assistants.
Accountability for Non–Occupational Therapy Assistants
In some practice environments, occupational therapists act in a consulting role. In this role, the occupational therapist does not assign occupational therapy service components. Therefore, because the individual carrying out the recommended activities is not acting in an occupational therapy assistant role, the occupational therapist is not directly accountable for that individual. Nor is occupational therapist accountable for the implementation or outcome of the recommendations.
Occupational therapists must be clear on the distinction between situations that involve the use of occupational therapy assistants and situations when the occupational therapist is fulfilling a consultation role. The occupational therapist remains accountable for the quality of the consultation provided.
