Current through September 24, 2024
The Board adopts, as if fully set out herein, and as it may
from time to time be amended, the current "Guidelines for Supervision, Roles,
and Responsibilities During the Delivery of Occupational Therapy Services"
issued by the American Occupational Therapy Association but only to the extent
that it agrees with the laws of the state of Tennessee or the rules of the
Board. If there are conflicts with state law or rules, the state law or rules
govern the matter. Information to acquire a copy may be obtained by contacting
either of the following:
American Occupational Therapy Association
4720 Montgomery Lane
Bethesda, MD 20824-1220
Telephone: (301) 652-2682
T.D.D.: (800) 377-8555
Fax: (301) 652-7711
Fax On Request: (800) 701-7735 (for a specific document)
Internet: www.aota.org
Board of Occupational Therapy
227 French Landing, Suite 300
Heritage Place, MetroCenter
Nashville, TN 37243
Telephone: (615) 532-3202 ext. 25135
Telephone: (888) 310-4650 ext. 25135
Fax: (615) 532-5164 Internet:
www.state.tn.us/health
(1) Supervision of an Occupational Therapist
on a limited permit must include initial and routine inspection of written
evaluations, written treatment plans, patient/client notes and routine
evaluation of performance. The supervision must be conducted in person, by a
licensed occupational therapist and must be as follows:
(a) Routine supervision with direct contact
every 2 weeks at the site of treatment, with interim supervision occurring by
other methods such as the telephone, conferences, written communication, and E
-mail.
(b) Supervision must include
observation of the individual treatment under a limited permit in order to
assure service competency in carrying out evaluation, treatment planning and
treatment implementation.
(c) The
frequency of the face to face collaboration between the person treating under a
limited permit and the supervising therapist should exceed direct contact every
2 weeks if the condition of the patient/client, complexity of treatment,
evaluation procedures, and proficiencies of the person practicing under the
limited permit warrants it.
(d)
Therapists must maintain documentation of each supervisory visit, and must
identify a plan for continued supervision. Records must include, at a minimum,
the following information:
1. Location of
visit; a method of identifying clients discussed
2. Current plan for supervision (daily,
weekly, bi-monthly)
3.
Identification of type(s) of interventions observed. These include but are not
limited to:
(i) Interventions
(ii) Training
(iii) Consultations
4. Other supervisory actions. These include
but are not limited to:
(i)
Discussion/recommendation for interventions and/or goals
(ii) Discussion/training in
documentation
(iii)
Demonstration/training in intervention techniques
(iv)
Assessment/re-assessment/discharge
(v) Additional Comments
5. An agreement statement signed and dated by
both parties, that the supervisory visit did occur and met the needs of the
supervisor and supervisee.
6. It is
the responsibility of the supervising occupational therapist to provide and the
limited permit holder to seek a quality and frequency of supervision that
ensures safe and effective occupational therapy service delivery. Both parties
(supervisor and supervisee) must keep copies of the supervisory records. Visit
records must be maintained for three (3) years, and must be provided to the
Board and/or its representative, upon request.
(e) A co-signature by supervising
Occupational Therapist is required on evaluations, treatment plans, and
discharge summaries.
(2)
Supervision of an Occupational Therapy Assistant on a limited permit means
initial direction and routine inspection of the service delivery and provision
of relevant in-service training. The supervising occupational therapist must
provide additional supervision, if the patient's required level of care is
beyond the level of skill of an entry level Occupational Therapy Assistant on a
limited permit. This decision is based on client's level of care, OTA caseload,
experience and demonstrated performance competency. Supervision of an
Occupational Therapy Assistant on a limited permit must include initial and
routine inspection of patient notes and routine evaluation of performance. The
supervision must be conducted in person by a licensed occupational therapist
and must be as follows:
(a) The Occupational
Therapist shall be responsible for the evaluation of the patient and
development of the patient/client treatment plan. The Occupational Therapy
Assistant on a limited permit may contribute information from observations and
standardized test procedures to the evaluation and the treatment
plans.
(b) The Occupational Therapy
Assistant can implement and coordinate intervention plan under supervision of a
licensed Occupational Therapist.
(c) The Occupational Therapy Assistant can
provide direct services that follow a documented routine and accepted procedure
under the supervision of the licensed Occupational Therapist.
(d) The Occupational Therapy Assistant can
adapt activities, media, environment according to needs of patient/client under
supervision of the licensed Occupational Therapist.
(e) Documentation provided by the
Occupational Therapy Assistant while on a limited permit must be co-signed by a
licensed Occupational Therapist.
(f) Therapists must maintain documentation of
each supervisory visit, and must identify a plan for continued supervision.
Records must include, at a minimum, the following information:
1. Location of visit; a method of identifying
clients discussed
2. Current plan
for supervision (daily, weekly, bi-monthly)
3. Identification of type(s) of interventions
observed. These include but are not limited to:
(i) Interventions
(ii) Training
(iii) Consultations
4. Other supervisory actions. These include
but are not limited to:
(i)
Discussion/recommendation for interventions and/or goals
(ii) Discussion/training in
documentation
(iii)
Demonstration/training in intervention techniques
(iv)
Assessment/re-assessment/discharge
(v) Additional Comments
5. An agreement statement signed and dated by
both parties, that the supervisory visit did occur and met the needs of the
supervisor and supervisee.
6. It is
the responsibility of the supervising occupational therapist to provide and the
limited permit holder to seek a quality and frequency of supervision that
ensures safe and effective occupational therapy service delivery. Both parties
(supervisor and supervisee) must keep copies of the supervisory records. Visit
records must be maintained for three (3) years, and must be provided to the
Board and/or its representative, upon request.
(3) Supervision of an Occupational Therapy
Assistant with permanent licensure means initial direction and inspection of
the service delivery and provision of relevant in-service training, according
to the level of supervision the occupational therapy assistant requires. It is
the responsibility of the occupational therapist and the occupational therapy
assistant to seek the appropriate quality and frequency of supervision that
ensures safe and effective occupational therapy service delivery. This decision
is based on client's level of care, OTA caseload, experience and demonstrated
performance competency.
(a) The frequency of
the face to face collaboration between the Occupational Therapy Assistant and
the supervising Occupational Therapist should exceed direct contact of once a
month if the condition of the patient/client, complexity of treatment,
evaluation procedures, and proficiencies of the person practicing warrants
it.
(b) The Occupational Therapist
shall be responsible for the evaluation of the patient and the development of
the patient/client treatment plan. The Occupational Therapy Assistant may
contribute information from observations and standardized test procedures to
the evaluation and the treatment plans.
(c) The Occupational Therapy Assistant can
implement and coordinate intervention plan under the supervision of the
licensed Occupational Therapist.
(d) The Occupational Therapy Assistant can
provide direct services that follow a documented routine and accepted procedure
under the supervision of the Occupational Therapist.
(e) The Occupational Therapy Assistant can
adapt activities, media, environment according to the needs to the
patient/client, under the supervision of the licensed Occupational
Therapist.
(f) Therapists must
maintain documentation of each supervisory visit, and must identify a plan for
continued supervision. Records must include, at a minimum, the following
information:
1. Location of visit; a method of
identifying clients discussed
2.
Current plan for supervision (daily, weekly, bi-monthly, monthly,
other)
3. Type of supervision
provided. These include but are not limited to
(i) in person
(ii) phone contact
(iii) electronic contact
4. Identification of type(s) of interventions
observed. These include but are not limited to:
(i) Interventions
(ii) Training
(iii) Consultations
5. Other supervisory actions. These include
but are not limited to:
(i)
Discussion/recommendation for interventions and/or goals
(ii) Discussion/training in
documentation
(iii)
Demonstration/training in intervention techniques
(iv) Assessment/re-assessment/discharge
(v) Additional Comments
6. An agreement statement signed
and dated by both parties, that the supervisory visit did occur and met the
needs of the supervisor and supervisee.
7. It is the responsibility of the
supervising occupational therapist to provide and the occupational therapy
assistant to seek a quality and frequency of supervision that ensures safe and
effective occupational therapy service delivery. Both parties (supervisor and
supervisee) must keep copies of the supervisory records. Visit records must be
maintained for three (3) years, and must be provided to the Board and/or its
representative, upon request.
(4) Supervision of occupational therapy
students and occupational therapy assistant students.
(a) Supervision of occupational therapy
students and occupational therapy assistant students shall be consistent with
the standards of the Accreditation Council for Occupational Therapy Education
(ACOTE) for such supervision.
(5) Supervision of an unlicensed person shall
be as follows:
(a) There shall be close
supervision with daily, direct contact at site of treatment, which demands the
physical presence of a licensed physician, Occupational Therapist or
Occupational Therapy Assistant, whenever the unlicensed person assists in the
practice of Occupational Therapy.
(b) There shall be personal instruction,
observation and evaluation by the licensed physician, Occupational Therapist or
Occupational Therapy Assistant.
(c)
There shall be specific delineation of tasks and responsibilities by the
licensed physician, Occupational Therapist or Occupational Therapy Assistant
who is responsible for reviewing and interpreting the results of care. The
licensed physician, Occupational Therapist or Occupational Therapy Assistant
must ensure that the unlicensed person does not perform duties for which he is
not trained.
1. A licensed physician,
Occupational Therapist or Occupational Therapy Assistant may delegate to
unlicensed persons specific routine tasks associated with nontreatment aspects
of occupational therapy services which are neither evaluative, assessive, task
selective, or recommending in nature, nor which require decision-making or
making occupational therapy entries in official patient records, if the
following conditions are met:
(i) The licensed
physician, Occupational Therapist or Occupational Therapy Assistant accepts
professional responsibility for the performance of that duty by the personnel
to whom it is delegated. In the case of duties delegated by a OTA, the licensed
physician, Occupational Therapist or Occupational Therapy Assistant who
supervises the technician will be responsible; and
(ii) The unlicensed personnel do not perform
any duties which require licensure under this act; and
(iii) The licensed physician, Occupational
Therapist or Occupational Therapy Assistant ensures that the unlicensed
personnel have been appropriately trained for the performance of the
tasks.
2. Tasks which
may be delegated may include:
(i) Transporting
of patients;
(ii) Preparing or
setting up a work area or equipment;
(iii) Routine department maintenance or
housekeeping activities;
(iv)
Taking care of patients' personal needs during treatments; and
(v) Clerical, secretarial or administrative
duties.
(d)
Appropriate records must be maintained to document compliance.
(e) The intensity of the supervision is
determined by the nature of the task to be performed, the needs of the
consumer, and the capability of the unlicensed person.
(6) Supervision parameters
(a) Supervision is a collaborative process
that requires both the licensed occupational therapist and the licensed
occupational therapy assistant to share responsibility. Appropriate supervision
will include consideration given to factors such as level of skill , the
establishment of service competency (the ability to use the identified
intervention in a safe and effective manner), experience and work setting
demands, as well as the complexity and stability of the client population to be
treated.
(b) Supervision is an
interactive process that requires both the licensed occupational therapist and
the licensed occupational therapy assistant or other supervisee to share
responsibility for communication between the supervisor and the supervisee. The
licensed occupational therapist should provide the supervision and the
supervisee should seek it. An outcome of appropriate supervision is to enhance
and promote quality services and the professional development of the
individuals involved.
(c)
Supervision of occupational therapy services provided by a licensed
occupational therapy assistant is recommended as follows:
1. Entry level occupational therapy
assistants are persons working on initial skill development (less than 1 year
of work experience) or who are entering new practice environments or developing
new skills (one or more years. of experience) and should require close
supervision.
2. Intermediate level
occupational therapy assistants are persons working on increased skill
development, mastery of basic role functions (minimum one -three years of
experience or dependent on practice environment or previous experience) and
should require routine supervision.
3. Advanced level occupational therapy
assistants are persons refining specialized skills (more than 3 years work
experience, or the ability to understand complex issues affecting role
functions) and should require general supervision.
4. Licensed occupational therapy assistants,
regardless of their years of experience, may require closer supervision by the
licensed occupational therapist for interventions that are more complex or
evaluative in nature and for areas in which service competencies have not been
established.
5. Certain
occupational therapy assistants may only require minimal supervision when
performing non-clinical administrative responsibilities.
Authority: T.C.A. §§
4-5-202,
4-5-204, 63-13-102, 63-13-103,
63-13-108, 63-13-202, 63-13-203, 63-13-205, 63-13-206, 63-13-207, and
63-13-216.
