OTA/OT Partnership Case Scenario
Brian is the Director of Occupational Therapy (OT) in a school system. He had been the only OT for a period of one year prior to the certified occupational therapist (COTA), Chris, being hired.
Referrals
When questions arose regarding whether it was appropriate to refer a particular student to OT, Brian was the one who discussed it with the teacher or any other team member. However, Brian had made a point to discuss the criteria for referral with Chris so she could educate others on indications for referrals in general, as well as the process e.g. the need first to refer the child to the Committee on Special Education in order to obtain approval for an OT Evaluation. Brian or Chris educated team members regarding OT's role in an educational setting treating children who have deficits in performance skills, performance patterns, client factors as well as addressing adaptations in regard to activity demands to promote occupational performance in the areas of education, activities of daily living, and social participation.
Evaluation
Brian typically utilized standardized assessments in addition to clinical observations and child/parent/teacher interviews when developing the Occupational Profile and Analysis of Occupational Performance of the child. When standardized testing was inappropriate Brian wrote a descriptive report based on observations and interviews. Brian's evaluation findings addressed the child's Motor & Praxis Skills, Sensory-Perceptual Skills, Emotional Regulation Skills and Cognitive Skills as well as pertinent aspects related to Client Factors, Contexts, Activity Demands and how these impacted on the child's performance in Areas of Occupation.
Chris was responsible for administering two standardized visual perceptual tests, if indicated, and for assessing the child's ADL skills needed for functioning in a school setting. She was then responsible for recording these findings, and then providing Brian with the information to integrate into his formal assessment. Upon completion of the evaluation, Brian would share the evaluation findings with Chris, the teacher, and significant others.
Intervention
Depending on the child's needs, either Chris or Brian would treat the child. If the child demonstrated sensory integrative processing deficits, Brian would co-treat with Chris. Brian obtained his certification in SI and this was a new area of treatment for Chris. When Chris felt comfortable with the treatment techniques utilized she took over the sessions.
Brian and Chris participated in completing re-assessments, and together they formulated long and short term goals for children already on program.
Chris learned so much from Brian's clinical expertise in the area of sensory integration dysfunctions and treatment interventions that Brian invited her to participate in a presentation to the kindergarten teachers. Brian and Chris decided they would do their first in-service together, and Chris then would give the next in-service to the second graders.
Supervision
Chris enjoyed the manner in which Brian and she structured supervision. They would meet weekly to discuss the caseload, the student's progress, and to review and sign off on Chris' notes. During these meetings they would adjust student goals as needed. They compared the child's performance and behavior in groups to individual treatment sessions and to the classroom setting. They found sharing of the information assisted in: substantiating observations, decreasing services and in planning for discharge. Brian and Chris always planned for discharge at least a month ahead with the parents and the teachers. Since they were both familiar with all the children on the caseload, either could cover during the other's absence or attendance at meetings. The sharing of the information also added to the efficiency in Brian's completing the end of the year IEP Progress Reports for annual team meetings.
Administrative Duties
One of Chris's jobs responsibilities was also to tally the numbers of and the types of OT service provided. Brian then summarized a monthly and bi-yearly report. As a result of Brian's mid-year report he demonstrated a need for an additional OTA two days per week. Chris was pleased she would be responsible for assisting Brian in the orientation and training of the OTA when hired.
Quality Improvement
Brian and Chris had also instituted a continuous quality improvement program. Once a month they would pull four records and monitor the timeliness for responding to referrals, evaluations, and collaboration that occurred with parents, teachers, and other team members. These were compared to profession's, federal and state standards for school systems Chris focused on reviewing these aspects of the OT services, while Brian focused on analyzing the appropriateness of the interventions and the length of services. They would discuss their findings, adjust their established program guidelines, analyze outcomes, predict future needs and develop program proposals. Brian wrote the administrative reports reflecting the efficiency and effectiveness of the program, and was again able to substantiate a need for another OTA, 3 days a week.
Developed: J. Garbarini
Revised: 2/08
OTA/OT PARTNERSHIP
1. What national and state credentials should this OT and OTA have? (See Readings: Moyers & Dale, Appendices A, B, E and attached 2 pages)
2. What are the roles of the OTA and the OT?
3. What duties were delegated?
4. How would you describe the characteristics of this team?
5. What goals did they establish for themselves?
6. How did this team compliment each other?
7. How would you predict they handle conflict?
8. What were the advantages of the team method regarding client care?
9. What aspects may get in the way of the team process?
10. What level of skill is exemplified by the OTA and OT in the following areas, and what level of supervision is indicated for each (see attached guide page 4)?
OTA: OT:
In Sensory Integration In Sensory Integration
In Activities of Daily Living Other
In Visual Perception Assessments