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What is in a title... OTA/OTR

Last post 08-23-2018, 5:11 AM by Euna Isabel. 73 replies.
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  •  11-04-2007, 7:19 PM

    What is in a title... OTA/OTR

    I have been a Certified Occupational Therapist assistant/L for over 10 years now, I very much enjoy what I do.  We as "assistants" treat our patients to help them achieve goals set and monitor it.  We as "assistants" provide the professional techniques needed and proper training to help and guide patients to reach their highest potential.  We as "assistants" are trained and provide all sorts of modalities, with orders of course.  We as "assistants" write weekly/daily notes, when in a SNF/hospital setting regarding the progress or lack of with our patients.  We as "assistants" can provide cognitive testing and recommendations.  We as "assistants" perform home assessments and write ups of recommendations, we as "assistants" train OTRs (and vice versa).  Basically, the only difference between Cotas and OTRs is that OTRs can write evals and monthly notes and we are told we are not allowed to by the state.  How can an OTR write a montly note on a patient they know nothing about, nor have never treated?  The answer is that we as "assistants" tell them what to write and they sign their names to it.  So why are we called "assistants", who are we assisting?  I understand that OTRs have 2 more years of education behind them but experience can also be equivalent.  We are also told that we work under the OTRs license, I have a hard time accepting that since we have earned our own to stand by and protect us, does that mean our license means nothing?  We work side by side, with the same goal, in which is to treat our patients to the fullest and to the best of our abilities.  I find being titled an "assitant" to be demeaning and insulting.  I strongly feel that the "assistant" title should be dropped and give the Cotas the diginity that they have worked hard for and earned.  Dont get me wrong, I have complete respect for OTRs and what they do as professionals, I just think the title alone needs to change.
  •  11-13-2007, 2:36 PM

    Re: What is in a title... OTA/OTR

    Hello! I have about 10 years experience as a COTA/L. I have been full time in a public school system for 7 years now and work with an excellent OTR/L. We make a good team and I respect and value her input. I will agree with miski that we as "assistants" carry a huge amount of responsibility and also the majority of the treatment delivery. I also agree that with the way things are often set up, the OTR is kind of out of the loop as she/he is often used for testing purposes and distant supervision of COTA s only and rarely gets to see the clients on caseload. I love my position and chose not to further my degre because I like treating rather than testing. I would vote in favor of being called something other than an assistant as it is misleading and does minimize our value as proffesionals. I think a term such as technical level  OT therapist might be more acceptable. 
  •  11-16-2007, 4:15 PM

    I must disagree with this premise

    I have been an OTR 12 years now, and I have had some real problems with the use of COTA's, as currently seen in most adult and geriatric facilities. The problems include: 1. The lack of sound education in cognitive, neuro-rehab,  and mental health components of Occupational Therapy 2. The desire by facilities for extensive billable minutes of treatment, which often precludes the cota from doing extensive one-on-one treatment.

    1. It has been my experience that about 75% of the cota's that I have worked with over the years have not been able  to follow through on some of the non-adl type goals that were written. For example, in my current facility, I recently had a patient who is having a hard time coping because of some personal and health issues, I provided a 'coping survey' handout to the cota and wanted him to do some quiet treatment with this resident.  The cota  just didn't 'get it', and this was never done. On another occassion, I wanted a different cota to have a resident use the computer for fine motor, eye-hand coordination, and self-esteem, as he is a young man who was fully employed until the cva, and he used the computer a lot. She inferred that she would not want to do this, and so it was never attempted. With some cotas, there is no comfort level in cognitive tasks, neuro treatment, mental health issues like self-esteem/ coping, etc.

    2. Due to the need for 'billable minutes' many cotas are content to do table-top activites that seem silly or irrelevant to the person. They do theraband or 'rep' type of treatment, that is really PT,  because these activites can be done with several at a time and the patients are dovetailed into therapy. The PT works on the legs and the OT works on the arms...which is how most people view therapy. This is less of a cota issue than it is a facility issue, but the use of cotas has diminished the real aspect of OT regarding treatment provided.

    There is a need to better educate cotas regarding the 'holistic' aspect of OTand I would like to see the use of cotas limited to no more than 75% of any resident's total weekly treatment. But, this will never happen. ST does not have this issue as they do not use assistants. If the person who posted this wants to get the education and become an OTR, that is great. We need more therapists who can promote the profession and think 'out of the box'.

    Tim Mancino, OTR/L 

  •  11-21-2007, 12:07 PM

    Re: I must disagree with this premise

    I'm a COTA student myself and hope that my opinion is valid due to my limited knowledge, but I must agree with Tim a bit.  The amount of education a COTA receives is minimal as well as the amount of information that is thrown at us in that short time in school.  Luckily in my program the teachers do spend much more time focusing on the holistic aspect and always make sure that what ever approach/modality we use is always an adjunct for a meaningful approach to occupation.  They stress greatly that our approach to therapy is always client centered.

    That being said I am currently on my level I clinical and am in a long term care setting.  Sadly due to funding in this facility I’m not seeing much that can be used to be more specific to the client’s personal needs.  We just have to make do with what little we have.  I do also see that clients are thrown into large groups where a couple of therapeutic exercise is thrown at them and after 20 mins they are shipped off.  I do realize that the exercise is important, but the clients aren't being educated on the importance of the exercise and I think that they would benefit much more from individualized treatment.

    It’s a shame, but money seems to always dictate treatment, rather then the need and the true outcome of long term goals.

    -Dan, SOTA

    Florida - OTA Student - Grad Date 05/12/08
  •  11-21-2007, 3:30 PM

    Re: I must disagree with this premise



    My name is Jane and I am a second year student in Maine for COTA's.  We are taught that OT is much more than activitites that include crafts and thera bands.  We are taught to treat the client with holistic values, which means we treat the client as a whole person.  I haven't worked out in the field as of yet, but I do look forward to working with OT's and PT's. We are taught that we all work together. 

    As for the COTA's who said they would not do the actitivities you stated aren't doing their job.  That doesn't speak for all of us.  Some of us are willing to be there for the client for whatever they need. We have taught mental health skills, neuro skills and cognitive skills. Not as much, but we have touched on the subjects. 

    Some of the students in my class went to the Conclave in Pittsburg and stated that they heard about alot of things that we were taught in school.  These classes were for OT's.

  •  11-21-2007, 3:59 PM

    Re: I must disagree with this premise

    Tim sorry but it sounds like you have come across some bad COTA's.  I think some colleges train differently as well.  I have to disagree with your statement.  I have been a COTA for 11 years and am able to provide any kind of tx given not the stale stagnant basic exercises. I myself find OTR's not as educated or informed on new material  as they should be and I dont care how much more education an OTR has, experience out does any education.  I myself worked toward a psych major as well and have a good understanding about cognition and neuro.  We learn from each other and I think its a shame that the bashing of COTA's still occurs.  The only thing my OTR does is come in spend 15 minutes w/ the pt on eval and then they are mine from start to end.  It is I that holistically gets this patient back home or improves their quality of life in the NH setting, it is I that works on the contracture to make them better.  Anyone can come up with goals , try applying them.  I have seen many OTR's that can write a good story but cant even apply what they write.  Or they come in once a week and make a havoc and think they know the pt.  Spend every day with a pt and then see if you can see through the eyes of the COTA.
  •  11-21-2007, 6:08 PM

    Re: What is in a title... OTA/OTR

    as an OTR (7 years) who was a COTA for 13 years I must disagree with you.There is a BIG difference between the two titles and it is NOT only 2 years of higher education. As a COTA you earn an associates degree and as an OTR now you have to have a masters level degree. I had to complete my Bachlors degree in Health science and then begin the road to my masters in OT. COTA's do not have kiniseology, Nueroscience, extensive anatomy and physiology I and II with a cadaver, Managerial classes, just to name a few. This gives the OTR a better picture of what may be going on with a client, student, consumer etc.. and the ability to explain to a patient what is going on, the disease process and how it is affecting thier function. I have not run across any COTA's that can do that and that is why we perform the evaluations.

    As a COTA I felt the same as you. So I went back to school to become an OTR. If being an "assistant" bothers you go back to school, because a change in the title is not going to make a difference one bit. What are you going to do when universities change the requirements and you have to have a Doctorate in Occupational Therapy? What will be the difference between the COTA and the Doctor of Occupational therapy?

  •  11-21-2007, 10:17 PM

    Re: What is in a title... OTA/OTR

    Well said Yvonne.  I agree with everything you wrote. 


    My mom is a COTA with over 30 years experience and is excellent at her job.  We frequently discuss "OT stuff."  I have been an OT for 6 years and very much appreciate and respect the COTAs I work with; we work as a team to provide the best treatment possible for our patients.  My additional education and training enables me to provide the COTAs with more in-depth assessment of the person and larger medical/clinical, psycho-social, and environmental picture.  I provide training to them in a variety of treatment strategies... even when they have many more years experience than me, including my mom.  Also, when we have training for new equipment/technologies/strategies/modalities, etc., I "catch on" quicker and apply them easier and explain things more in-depth for my patients due to my additional education.  I think clearly the higher level of education makes a big difference.  Thanks! Heather

  •  11-21-2007, 10:29 PM

    Re: What is in a title... OTA/OTR

    As an OTR/L, I think the level of training a COTA(based on the COTA's I have worked with) gets needs to be revised(true to some OT's too) As a foreign trained therapist, we are required to do fieldwork experience for 1 year total in different areas of practice. The student is not given an option to choose which clinic or setting she will do the field work. The student has to complete all field work in all clinical settings and has to maintain a certain grade level as evaluated by the designated clinical instructor. Each setting requires that the student carries a full caseload and he/she is graded by the results of the treatment plan he/she creates, ability to carryout certain treatment techniques required by the facility, 3 major written and practical tests as given by the CI and the supervising rehab MD, and special oral presentation given to a panel of rehab staff, students and resident doctors. A thesis which is rehab oriented is the final requirement and is ppresented to school selected rehab specialists' doctors and student. Any questions can be asked by anybody during the presentation. If any of the above has not been met, the student is given 2 weeks to complete all requirement or you will not graduate at all. There are no second or third chances given to anybody. Basically as OTR/L's we have more training and experience under our hats even before we graduate I think our curriculum is about at par with getting a doctorate degree.(that's only entry level OT program which is 5 years.) I have been in the business for 12 years with experience spanning all areas of practice, and in those 12 years I have only worked with one or two COTA's that I can actually trust with carrying on the treatment plan up to my specs. As of now I choose to carry my own caseload and do my own plan of care. I have worked so hard to obtain my license as an OT and I am not willing to risk it for somebody else.
  •  11-22-2007, 12:16 AM

    Re: I must disagree with this premise


    Hi Tim,

    I just thought I would share with you that speech therapists do use assistants. I recently discovered SLPA's working in the school district I work for.  I listed a brief portion of a recent article below.  I do not know the legal/educational requirements of a SLPA, but just interesting to know they are out there.

    Tiffany K. Sampson, OTR/L


    Supervision of Speech-Language Pathology Assistants: A Reciprocal Relationship 

    cite as:McCreedy, V. (2007, May 8). Supervision of speech-language pathology assistants: A reciprocal relationship. The ASHA Leader, 12(6), 10-13.

    by Vicki McCready

    Supervision in speech-language pathology has added a different dimension in recent years, as speech-language pathology assistants (SLPAs) have emerged as support personnel in educational and health care settings as well as in private practices.

  •  11-22-2007, 12:40 AM

    Re: What is in a title... OTA/OTR

    Absolutely amazing that you can just tell someone to "go back to school"--making huge assumptions that the person is in a position to be able to go back to school.  They may be hampered by financial or personal responsibilities (i.e. children, aging parents) or they may CHOOSE to be a COTA.   I guess being "holistic" only applies to our clients and not to each other. 

    Absolutely amazing that for all your upper level education, you make such generalized and scathing statements about COTA's.  Do you do the same to your clients?  You haven't "run across any COTA's that can do that" so I assume you are either working with entry level COTA's or narrow-minded, arrogant, self-aggrandizing (redundant, but it bears repeating) COTA's who arrive on the scene with these attitudes or are mentored by OTR's with these attitudes.  Hmm...choice #1, #2 or #3????

     Absolutely amazing that with all that "education," you would think one would be able to spell correctly and not be an embarrassment to the profession.

  •  11-22-2007, 12:52 AM

    Re: I must disagree with this premise

    Tim:  Funny, but your description of the COTA sounds EXACTLY like the OTR I work with.  Didn't you learn not to generalize in college (or did you sleep through that class).  So much for OTR/COTA collaboration...if your "attitude" catches on, you'll set the profession back quite a few years.  Perhaps it is just immaturity and there is still hope for you.  Unfortunately, I think the real shame is that you actually "treat" people--I truly feel sorry for them.
  •  11-22-2007, 7:46 AM

    Re: I must disagree with this premise

    Tim: I have been a COTA for 14 years and in those years I have been a traveling therapist for 4 years, an independent contractor for 1 year and a salaried employee for the remaining years and have worked in a major hospital, many SNFs, out-pt clinic, home care and group homes for MR population. I have done hand splinting and attended a workshop for dynamic splinting. I have used E-stim taking several workshops. I am the chairman of the safety committee at the facility I presently work at and hold positions at the local and state level for AOTA.
    A COTA is the major source for the "Zero Lift" policy that the NYS Dept. of Labor is now implementing. A COTA is on the AOTA board and COTAs have been state association presidents and other notable positions. And, Let's not forget Sally E. Ryan, COTA.
    Tim, how much supervision are you providing? How much experience have your COTAs? What exactly are your expectations? You have the additional education. Use it.
    I have had some fantastic OTR supervisors. If they gave me a task that I wasn't familiar with they would instruct me. After all...they had the additional education. But, having worked in construction and worked as a stagehand in Manhattan, they actually have listened to me and have asked for advice. 
    How about checking the background of the COTAs that you work with. Maybe they can help you?
  •  11-22-2007, 9:45 PM

    Re: What is in a title... OTA/OTR


    I can tell by your post that you are angry. I was angry many years. I was a Cota for ten years. I worked for many OTR's , some good some who thought they were good...

    I ended up going back to school (two years as you call it) to get my OT degree.

    The good part about being an OTR is you are in charge. You say "this is what that patient needs to work on..."

    The good part about about being a Cota, you are responsible for your actions.

    As an OTR, you are responsible for your actions and the Cota's actions as well. Unless that Cota does something that is not within your POC, you are responsible. Now, relate that to any other aspect of life. How many people in life do what you ask them to do????

    Don't make this a pissing game between you and that OTR. This is about the patient!!! Not who is the superior one! If you have an immature OTR, sit her down and say to her " how can I help you to help make your job easier"? How can we help this patient?

    You are there to help her, whether you like it or not. If she comes in once a month to do sup visits, you need to tell her if the goals she set were met, realistic, not met and why? If you have additional goals that are realistic, ask her what she thinks about them,  if they are good, she is not going to reject them.

    You and the OTR need to work in the favour of the patient. This is not about you and the OTR. We went to school to help people not to play a pissing game.

    Since I graduated as an OT,  I tell the Cota I work with: tell me what this patient needs! I want her to feel more comfortable telling me what she thinks because she is my "right hand". I am not an octopus and cannot keep up with all the patients, the way our system is we need extra hands and feet.

    If you do not like being a Cota, go back for an OT degree. It is not easy but well worth it!

    If you decide not to go back to school, become the best advocate for your patient. You are not there to show dominance but to help your patient. If you focus all your energy on being superior to your OT, you are lacking good patient care. Ask yourself why are you doing this????




    Tracey Palmer
  •  11-23-2007, 11:14 PM

    Re: What is in a title... OTA/OTR

    I have been an OT for a little over 2 years now. I have been a supervisor for all three levels of COTAs (supervision for entry, intermediate, and advanced level COTAs.) I respect the COTA's opinions, instincts, and experience at all levels. I never feel and have never felt I am better than any of them. We are coworkers. They see things I don't get to see. As the supervisor for an entry level COTA, I have a duty to make her feel welcome and nurture her interest in the field, as well as provide direction and experience for her. As the supervisor for an intermediate level COTA, I respect and honor the comradeship and experience. I have a duty to pay attention and provide guidance as needed. As the supervisor for an advanced level COTA, I have the duty to provide guidance and give input where asked. My only concern is that the only advanced level COTA I have worked with had a hard time with input from anyone. She was offended if someone gave advice or direction. Respect works both ways. Make sure you're giving the respect your coworkers (OT or COTAs) are due.


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