This is the first message/thread I have read here & I think it is terrible to see OTRs and COTAs "going at" each other like this!  I have been fortunate to never have an OTR feel this way about my skills/abilities and hope I never do!!  As far as the COTAs not doing what is asked... I agree with the person who said you, as the OTR, are the one respnsible to guiding the COTA with the follow through of the goals you write.  I have been a COTA for 11 years, but have not practiced full time (just PRN) for over eight.  That said, I do feel like a new grad in alot of ways.  The OTR where I work took me under her wing, so to speak.  She was very patient and understanding and willing to answer all my questions.  Unfortunately, she left to start her own seating/positioning business... but I can only hope our new hire will be as great.

I do think thera-band and thera-putty have thier place, but personally I would love to get back to more functional activities, like the computer - but my quesiton would have been more about documentation.  How do you document that so that you are reimbursed.  We, as OT professionals, know it has a place... but from what I understand, insurance companies are not responsive to that.  I have an Alzheimer's resident now who spent a lifetime doing needlework, so I purchased a color-coded plastic canvas activity at a craft store and that is one of our on-going "FMC, cognitive-skills development, meaningful activities".  I do it because I know it engages her and she feels capable again... I just pray it will not be a denied service!

We can go back and forth forever about who should do what.  Maybe alot of COTAs would like to be OTRs, but the bottom line is not everyone can do that.  I personally wanted to be a veterinarian, but my single mom could not afford vet school or for me to move away and have two houses to support.  To get a college education at all I had to go to a 2-year community college on a Federal Pell Grant.  I didn't have alot of opportunities, but I tried to make the best of the ones I did have.   I chose OT because it was more "creative and crafty" with my main goal to work in a psych. setting (unfortunately, they don't utilize COTAs in psych. around here).  I chose OTA because it offered a good career, making pretty good money, and I could help people.  Would I choose it again, I don't know - but I do know my patients deserve the best treatment that our team (OTRs, COTAs, PTs, PTAs, and SLPs) can give them.  We can't do that if we are bickering amoungst ourselves!

Tim,

I am a new OTA grad. From my understanding, isn't it your job to provide guidance for your COTA's? Something else you must not have obtained in your higher level education. I am truly sad that something has lead you to such negative outlooks towards OTA's.

 Please do us all a favor, learn to RESPECT your OTA's......we are needed much more than you think.

I think that is great you went back to school yvonne but all OTRs have their masters degree, they is something that has just been implemented into the universities within the past couple of years.  So, not everyone has the "extensive" education as you claim to have.  I also agree with another writer.... experience gains more presence then does education.  Anyone can write essays and reports and do oral presentations about anything anywhere, it does not make you a better therapist.  I have always had a good experience within the field and I have also been a manager of a rehab dept.  So I dont see how education would make me any better/further in my career, again, it is about experience and personality.  All I say is that "assistant" should not be part of the title, we work very hard in our treats and planning.... I never have seen it as assiting anyone, I have always seen it as working together toward the same goal.

FYI,  in our program, we do have kineselogy, A&P 1 and 2, some neuroscience, but nothing with any cadavener.  So our program, must be advanced.  The name assistant does not bother me..  I know what my role is.  We have even gone over evaluations, so we have an idea of what OT's do.  Thank you

Jane

It was not my goal to sound condescending to any COTA's out there. I was one, and I respect and value every COTA I have worked with and am currently supervising. Maybe I am upset because this seems to have become a pissing contest on whom is better or more of value in our profession with some misinformation along the way. It never bothered me when I was a COTA to be called an assistant because I was not treated or made to feel that way. There is a place for all of us in our profession and instead of arguing amongst each other we should be coming together and fighting for the "Tri alliance" and the Physical Therapy association who is rapidly encroaching on our profession.

I shall now spell check, because I do not want to be harassed for my spelling. (this is a forum and I am not writing a thesis. Blackberry's are very difficult to type with)

After reading all the posts, I have to laugh. I can remember this being a hot button issue in the mid 90's when I graduated as an OTR. Im sure it was way before that. Good points made by those experienced OTAs. Clinical experience definitely counts for something depending on the setting, There are some areas that require extensive classroom time.   Now that COTAs are attending the same seminars as OTRs over the years I can see a rough parity forming in some areas. I started my OT career attending a COTA program and switched over to a OTR program. The difference was HUGH!!! That doesn't take away from the clinical experience a COTA gathers over the years.

It reminds me of the relationship that doctors have with nurses. I just mean that often its the nurse that really directs the care of patients in a skilled nursing setting since the doctor checks in so infrequently. Their experience with the indiviual is sometimes so complete they even determine what medications are most effective for particular symptoms.

It seems as though we are all able to keep our professionalism in the workplace and work together as OTAs and OTRs knowing what needs to be done, but I also sense from reading all these responses that there is much animosity regarding title and "control".  I strongly suggest that the association should re-thinkand change how the program is run within the schools and in addition restructure the title for OT "assistants" its about time!  LPNs and RNs with different levels of degrees are treated the same they are all nurses working together.  It is up to the association to change this and fix the problem that should not exist in the OT world.  Its not a competition.

Morgan, This is my first time reading this forum.  Good for you on your answer to the many opinionated OTR and COTA's out there.

Yes, It is true that we do not have as many years of college education.  But, as I have learned over almost 8 years of being an COTA/L that college education does not give the needed education that you get when you get out there in the trenches, be it long term care, hospital, school base.  Respect and being professional is the number one element needed in the partnership between the OT and COTA.

Education does not stop when we graduate.  It is a integral part of continuing education that we all need for our liscenses.

I encountered on my very first clinical a OT that asked me "why in the world, do you want to be an OT therapist?"  I have encountered many burned out OT's, some downright mean and nasty ones and some that are only looking at the paycheck, not the quality of their work or working relationships with the COTA.  I respect my ability to work along side my OTR' and I don't know one who is not overworked.  The one thing I know for sure is that this is a great profession and anyone, just out of school needs to get some experience with how healthcare works and for the OTR and COTA's out there who don't seem to have anything positive to say, maybe it's time to rethink why you wanted to make Occupational therapy your career.  Burn out can happen and the patients suffer and you do not represent this occupation fairly.

---

Cheryl

Hi Tim,

It sounds as though you have had a few negative experiences working with COTAs. But I feel that it's unfair and inaccurate to base your opinion of the entire COTA population as un-skilled and un-trained on this. I am an experienced COTA/L and if given the goals mentioned in your letter I would have not only been competent  but also very pleased with your approach to achieving improved function and psychosocial health and well being. I worked as a team with one particular OTR/L years ago, in an acute setting. Her evals. and goals were very reflective of the person and not the diagnosis or disability. Functional gains as well as improved self esteem and motivation were the result of using intrinsic motivation, values and prior role functions in treatment. I think that some OTA programs are better than others and the program I was in stressed the holistic approach and prepared us well to deliver OT and not PT services. I will agree with you that some COTAs are better trained than others but don't you think that as the supervising OTR, it would have been a great moment for you to communicate with the COTA and take that opportunity to improve things rather than not intervene and then write off all COTAs as incompetent? Not only would this have benefitted you and the COTA, but also the client under your care.   

Yvonne, You are mistaken. I graduated 12 years ago  and the OTA program did have AP 1 and 2,  Kineisiology 1 and 2 as well as a strong psych, cognitive therapy component to it. Programs differ as do COTAs and OTRs. When they work together as a team the result can be and in my case is, excellent!

I am not at all insulted by being called an "assistant". I went to school to become and OT Assistant. I work as an Assistant. I'm proud to be an Assistant. Yes, once we get to know our supervising Therapist they give us more responsibility. I don't have a problem with that. They are OTR's and they have completed the education and taken the state board exam to become OTR's. I follow the rules and regulations dictated by the state. If I want to do anything more I could always go to school to become and OTR. Which isn't very likely at 52 yrs. Old! hee hee.

I work in hand therapy with an OTR that I've worked with for 15 years. I am blessed to have the relationship I have with my collegue!  I don't know what all the quarelling is about.  As an Assistant you can take it pretty far professionally. We get paid quite well, considering we only have 2 years schooling! And I'm lucky that people treat me according to my 25 years of experience! To put it short I am basically respected.

If I find an OT that has a different viewpoint or we don't get along I go somewhere else. Most of the time it's a matter of ethics. That's the worst thing that leads me away. Now let's stop all the "nitpicking" and work as a TEAM.

---

PAM

All is true but we have also taken the board exam and have earned our license to back us up and support us.  We have rehab managers to manage and supervise all of us, so why is it we need OTRs to dictate and tell us who to see, how many hours and why, that is what the manager is for.  I have also been lucky to have a great working relationship with the OTRs, COTAs, RPTs and PTAs I work with, but I am the one that is called for my opinion on patients treatment status and also the one to train the other professionals on the modules.  So again, why are we called assistants?  I am proud of what we do and our knowledge, but we are certified, we take the exam for our license to protect us, not the OTRs license and we take the same seminars/training classes as all the others, equally.  I do not understand why it is not renamed and give us our respect as we have earned.

I thought I would post the roles and responsibilities as stated by the AOTA. I got the information on the AOTA website. Please take time to print it out/read it. It is lengthy but well worth the time. It is very informative and can help us all work together as a team knowing our roles and resposibilities. There is also a section on supervision.

ROLES AND RESPONSIBILITIES OF THE OCCUPATIONAL THERAPIST AND THE

OCCUPATIONAL THERAPY ASSISTANT DURING THE DELIVERY OF

OCCUPATIONAL THERAPY SERVICES

General Statement

The focus of occupational therapy is to facilitate the engagement of the client in occupations that

support participation in daily life situations in context or contexts. Occupational therapy

addresses the needs and goals of the client related to areas of occupation, performance skills,

performance patterns, occupational context, activity demands, and client factors.

1. The occupational therapist is responsible for all aspects of occupational therapy service

delivery and is accountable for the safety and effectiveness of the occupational therapy

service delivery process. The occupational therapy service delivery process involves

evaluation, intervention planning, intervention implementation, intervention review, and

outcome evaluation.

2. The occupational therapist must be directly involved in the delivery of services during the

initial evaluation and regularly throughout the course of intervention and outcome evaluation.

3. The occupational therapy assistant delivers occupational therapy services under the

supervision of and in partnership with the occupational therapist.

4. It is the responsibility of the occupational therapist to determine when to delegate

responsibilities to other occupational therapy personnel. It is the responsibility of the

occupational therapy personnel who perform the delegated responsibilities to demonstrate

service competency.

Guidelines for Supervision, Roles, and Responsibilites

The American Occupational Therapy Association

5. The occupational therapist and the occupational therapy assistant demonstrate and document

service competency for clinical reasoning and judgment during the service delivery process

as well as for the performance of specific techniques, assessments, and intervention methods

used.

6. When delegating aspects of occupational therapy services, the occupational therapist

considers the following factors:

c. The complexity of the client’s condition and needs

b. The knowledge, skill, and competence of the occupational therapy practitioner

c. The nature and complexity of the intervention

d. The needs and requirements of the practice setting

Roles and Responsibilities

Regardless of the setting in which occupational therapy services are delivered, the occupational

therapist and the occupational therapy assistant assume the following generic responsibilities

during evaluation, intervention, and outcomes evaluation.

Evaluation

1. The occupational therapist directs the evaluation process.

2. The occupational therapist is responsible for directing all aspects of the initial contact during

the occupational therapy evaluation, including:

a. determining the need for service,

b. defining the problems within the domain of occupational therapy that need to be

addressed,

c. determining the client’s goals and priorities,

d. establishing intervention priorities,

e. determining specific further assessment needs, and

f. determining specific assessment tasks that can be delegated to the occupational therapy

assistant.

3. The occupational therapist initiates and directs the evaluation, interprets the data, and

develops the intervention plan.

4. The occupational therapy assistant contributes to the evaluation process by implementing

delegated assessments and by providing verbal and written reports of observations and client

capacities to the occupational therapist.

5. The occupational therapist interprets the information provided by the occupational therapy

assistant and integrates that information into the evaluation and decision-making process.

Intervention Planning

1. The occupational therapist has overall responsibility for the development of the occupational

therapy intervention plan.

2. The occupational therapist and the occupational therapy assistant collaborate with the client

to develop the plan.

3. The occupational therapy assistant is responsible for being knowledgeable about evaluation

results and for providing input into the intervention plan, based on client needs and priorities.

Intervention Implementation

1. The occupational therapist has overall responsibility for implementing the intervention.

2. When delegating aspects of the occupational therapy intervention to the occupational therapy

assistant, the occupational therapist is responsible for providing appropriate supervision.

Guidelines for Supervision, Roles, and Responsibilites

The American Occupational Therapy Association

3. The occupational therapy assistant is responsible for being knowledgeable about the client’s

occupational therapy goals.

4. The occupational therapy assistant selects, implements, and makes modifications to

therapeutic activities and interventions that are consistent with demonstrated competency

levels, client goals, and the requirements of the practice setting.

Intervention Review

1. The occupational therapist is responsible for determining the need for continuing, modifying,

or discontinuing occupational therapy services.

2. The occupational therapy assistant contributes to this process by exchanging information

with and providing documentation to the occupational therapist about the client’s responses

to and communications during intervention.

Outcome Evaluation

1. The occupational therapist is responsible for selecting, measuring, and interpreting outcomes

that are related to the client’s ability to engage in occupations.

2. The occupational therapy assistant is responsible for being knowledgeable about the client’s

targeted occupational therapy outcomes and for providing information and documentation

related to outcome achievement.

3. The occupational therapy assistant may implement outcome measurements and provide

needed client discharge resources.

SUPERVISION OF OCCUPATIONAL THERAPISTS AND OCCUPATIONAL

THERAPY ASSISTANTS

Occupational Therapists

Based on their education and training, occupational therapists, after initial certification, are

autonomous practitioners who are able to deliver occupational therapy services independently.

The occupational therapist is responsible for all aspects of occupational therapy service delivery

and is accountable for the safety and effectiveness of the occupational therapy service delivery

process. Occupational therapists are encouraged to seek supervision and mentoring to develop

best practice approaches and promote professional growth.

1 Occupational therapy personnel include occupational therapists, occupational therapy assistants, and occupational

therapy aides (AOTA, 1999a).

Guidelines for Supervision, Roles, and Responsibilites

The American Occupational Therapy Association

2

Occupational Therapy Assistants

Based on their education and training, occupational therapy assistants must receive supervision

from an occupational therapist to deliver occupational therapy services. The occupational therapy

assistant delivers occupational therapy services under the supervision of and in partnership with

the occupational therapist. The occupational therapist and the occupational therapy assistant are

responsible for collaboratively developing a plan for supervision.

General Principles

1. Supervision involves guidance and oversight related to the delivery of occupational therapy

services and the facilitation of professional growth and competence. It is the responsibility of

the occupational therapist and the occupational therapy assistant to seek the appropriate

quality and frequency of supervision to ensure safe and effective occupational therapy

service delivery.

2. To ensure safe and effective occupational therapy services, it is the responsibility of the

occupational therapist and occupational therapy assistant to recognize when supervision is

needed, and to seek supervision that supports current and advancing levels of competence.

3. The specific frequency, methods, and content of supervision may vary by practice setting and

are dependent upon the

a. complexity of client needs,

b. number and diversity of clients,

c. skills of the occupational therapist and the occupational therapy assistant,

d. type of practice setting,

e. requirements of the practice setting, and

f. other regulatory requirements.

4. Supervision that is more frequent than the minimum level required by the practice setting or

regulatory agencies may be necessary when

a. the needs of the client and the occupational therapy process are complex and changing,

b. the practice setting provides occupational therapy services to a large number of clients

with diverse needs, or

c. the occupational therapist and occupational therapy assistant determine that additional

supervision is necessary to ensure safe and effective delivery of occupational therapy

services.

5. A variety of types and methods of supervision should be used. Methods may include direct

face-to-face contact and indirect contact. Examples of methods or types of supervision that

involve direct face-to-face contact include observation, modeling, co-treatment, discussions,

teaching, and instruction. Examples of methods or types of supervision that involve indirect

contact include phone conversations, written correspondence, and electronic exchanges.

6. Occupational therapists and occupational therapy assistants must abide by agency and state

requirements regarding the documentation of a supervision plan and supervision contacts.

Documentation may include the

a. frequency of supervisory contact,

b. method(s) or type(s) of supervision,

c. content areas addressed,

d. evidence to support areas and levels of competency, and

e. names and credentials of the persons participating in the supervisory process.

Guidelines for Supervision, Roles, and Responsibilites

The American Occupational Therapy Association

3

7. Supervision related to professional growth, such as leadership and advocacy development,

may differ from that needed to provide occupational therapy services. The person providing

this supervision, as well as the frequency, method, and content of supervision should be

responsive to the supervisee’s advancing levels of professional growth.

 

 

 

 

 

 

 

Hello! I am a Pediatric COTA/L who worked for the school district for 3 years and have been working for the past 2 years at a private pediatic specializing in early intervention. I completely agree with you in the role we play and our title being minimized. I work with 3 OTR's- one of whom I play the much more responsible role of treating, implementing treatment plans, and coordinating and educating meetings and such with parents and caregivers. She does not possess the skills appropriate to treat our clients. In the many cases we share, my clients have regressed due to her lack of knowledge and treatment base. Even though she does have a higher degree than me, I feel as though my skils and knowledge are much more than hers. I am very frustrated at this point and have discussed it with my superiviors and/or bosses. Any advice?

I can relate to you Jennifer, it is frustrating and that is why this topic is very big on this forum right now.  I have the same experience and it is frustrating because people just see it as a title and just assume the OTR is the one who knows more, when in fact that is not always the case.  It is frustrating to be called an assistant when we are supposed to be working side by side equally.  I also thank you Yvonne for placing a copy of the AOTA description of OTR and OTA you have just helped me in explaining why things need to change!  What that states and what exactly is happening out there is not the case.  I do not take orders from an OTR, nor do they take orders from me, we discuss patients and ideas with each other and go from there.  The rehab manager is the one who should be giving orders, changes, making the schedules, etc....  we are all professionals and should be treated as such.  You have people in the same level who have bachelors and Masters degrees, are they treated different?  Is an accountant with a bachelors called the assistant to an accountat with his masters or CPA?  Is a LPN nurse an assistant or treated differently then an RN nurse? 

Again.... what is in a title??