Assessments and the OTA

By law, OTs and OTAs are legally able to assess patients.  This comes from the AOTA website 

"An occupational therapy assistant contributes to the screening, evaluation, and re-evaluation 

process by implementing delegated assessments and by providing verbal and written reports 

of observations and client capacities to the occupational therapist in accordance with federal 

and state laws, other regulatory and payer requirements, and AOTA documents."

         The difference between the OT and the OTAs role is the matter of interpretation.  The OTA is not legally qualified to interpret the results to create a plan of intervention.  The OTAs role in assessment is to simply complete the assessment given to them by the OT and give the OT the results afterward.  This law does not address the experience or aptitude that the OTA may have.  He or she simply cannot interpret the results.

        The question that this blog addresses, however, is should OTAs be able to assess patients.  I do feel that, if the OTA has completed a thorough competency with the exact assessment that he/she has been asked to do, then he/she should be able to carry out the assessment.  It is the OTAs responsibility to make sure that he/she is competent and feels comfortable with the various assessments that are used in the practice where they are working.  If OTAs are not allowed to perform assessments, the backlog that already exists in this area (especially in the school systems) would become worse, delaying treatment to many and even denying treatment to others.  That would be, in my opinion, an injustice to the many school-age children that desperately need treatment for SI problems, handwriting problems and difficulties related to birth defects such as CP.  Many of these children will not receive services at all if they do not receive them at school.
       However, I tend to side with the NCBOT on the issue of interpretation.  I think that it takes much more education and understanding to interpret the results of an assessment.  Maybe after many years of OTA experience, one could understand how to interpret the assessments, but in the big picture, I feel that this should be left to the OTs.
       I guess, overall, I agree with the rules of the AOTA and the NCBOT, that OTAs can perform assessments in which he/she has passed competency, but cannot interpret the results or plan the intervention based on the results.

Assessments?

Should OTAs be allowed to do assessments, particularly with peds? Why or why not?
Interesting question, OTAs should be allowed to do assessments even pediatric assessments. These assessments are not any different than any other assessments in which we have established service competency. Service competency is determined when the OT approves the way the OTA administers the assessment consistently, Service competency allows the OTs to concentrate on other matters while feeling confident that the OTA can safely and accurately perform their duties.

During my research of this topic I did not find a lot of conversations about not letting OTAs perform assessments. Most of the conversations were whether OTAs can initiate evaluations, and the vagueness of the state laws, and the interpretation of OTAs duties that vary from state to state. Check out an interesting blog from the AOTA website (http://otconnections.aota.org/forums/t/9869.aspx?PageIndex=1)

So it does not seem that COTAs are not willing or have a problem performing the assessments, the real question that comes to my mind does OTs have a problem allowing us to do assessments? Does performing the assessments infringe on their rights and responsibilities? Would OTs feel that the COTAs are “taking over”? I could not find anything online to support these questions/thoughts but what do you think?

Question of the Week.....there is never an easy answer

So the question is should OTA's perform assessments on clients? It is easy to answer this question in an OTA sort of mind because that is what I will be soon. I am going to try something different and answer this question with an OT hat on. If I was an OT and my license was supporting an OTA, I would make sure that I felt confident that my OTA was competent and experienced giving certain assessments. Doesn't this sound familiar?? Service competency, right? I believe the OT/OTA relationship is based on trust and communication. You don't have to best friends, but best working friends. The two should work together and communicate about clients, problem solving, and treatments. OTA's have strenghts and weaknesses just like OT's. If the two can work together and communicate effectively then a stronger working relationship is sure to present itself. Assessments are tools for OT's to use to evaluate and set up a treatment plan. OTA's can be an important part of this process if there is service competence, experience, and knowledge behind the individual. Many assessments are standardized and this can make this test an easy task for OTA's. As it stands OTA's are allowed to give assessments but at the same time, OT can decided that an OTA is not ready to give a certain assessment. Experience and shadowing can increase an OTA's scoop of practice and help and OTA gain confidence in themself and the OT. I found this blog on the internet and I think it helps express what I have said above. I especially like the following line, "There must be a certain level of trust and confidence within both the OT and COTA in interacting with each other in order for the relationship to work optimally. If the trust is not there, then the communication will falter. The OTR and COTA must realize that this working relationship is not a case where one necessarily supersedes the other, but rather that they are both able to learn and contribute to each other's clinical and book knowledge". How true this statement is.

Assessments by OTAs

I found some research information regarding OTAs and assessments. The first research study I found was done by an OT student at UNC. She researched and wrote a thesis on novice OTAs and critical thinking skills. The thesis concluded that novice OTAs did not have the necessary critical thinking skills to be accurate in assessing clients. This thesis might be biased and only studying novice OTAs from a southeastern NC OTAs who graduated in 2006/07 and was not specific to the pediatric population. More experienced OTAs might be more effective in using critical thinking skills for assessments.

The next research study I found was a case study of an OTA with 16 years experience and the OTA's ability using critical thinking skills. The case study concluded, although the OTA was very skilled at performing interventions, the OTA was not very effective with critical thinking. This research was only documenting one OTA and may not reflect the experiences and abilities of other OTAs.

I was not able to find any research supporting OTAs completing assessments. OTAs are trained on basic assessment and can perform assessments if the OT deems it appropriate. OTs receive more training on the evaluation of assessment and how to interpret and determine therapy plans based on the assessment results.

Some assessments are fairly easy to do and require basic critical thinking skills like ROM and MMT. Other assessments require more critical thinking skills and have an added element of recording the client's behavior which make the assessments much more difficult to do like pediatric and cognitive assessments.

Although I have been trained to do assessment I think that performing an assessment with any element of interpretation and then relaying the information to the OT might lead to some miscommunication. I think some nuances of the assessment might be lost in the transfer of information to the OT. Lack of communication of small details could affect the outcome of the assessment. In addition, unless I did pediatric or cognitive assessment on a regular basis, I feel I would not be the best clinician to the the assessments. I would be competent to do uncomplicated assessment like ROM and MMT without much room for personal interpretation. I would prefer to leave more complex assessment up to the OT who has more training and expertise. Of course, the OT can determine what I am able to do with service competency and I would be more than willing to do whatever is asked of me.

Yes or No, how can I explain it?

As I was sitting here trying to discuss the differences between an OTA and an OTR to Drew, I myself was trying to figure out the main differences. I said, "the main difference is that the OT can interpret the results of an evaluation." So can you do assessments he asked. Well yes I guess that I can, if the OT can give me service competency, I can do some assessments. He asked, then why do they have OT's? OT's are our supervisors. They are our sounding boards. They tell us because they have little more education, if what we are doing is right or if we need to make changes to our treatments. They interpret our findings and diagnose the problems and then create a plan for which we work off of.
So, should we be doing assessments? Of course. If we have service competency, why not. We are helping out our OT's to get some things done, and they can interpret what we have assessed and plan the goals. I think it is a perfect process. We can't work without them and they can't work without us, easily that is. I love my job and I want to advocate for what we can do. I will try as hard as I can for our profession to allow us to do what we can. With service competency and experience, I believe that we can do assessments. Easy as that.
As I was looking over job responsibilities in job postings for COTA's, most of them described the responsibilities as "assisting the therapist in assessments", general statements, nothing too specific describing what "assisting" meant. I guess it is just up to the therapist and company that you work for what "assisting" means.
I have attached one of the job postings for others to review and interpret:
http://impaqrehab.com/Documents/COTA%20%20job%20Description%20.pdf

Assessing...It's what we do naturally!

Every since I have been introduced to the world of OT I have heard some kind of debate regarding if OTAs should be able to do an assessment or not. Now that I am a bit more familiar with the roles of a COTA I say %100 "Yes", BUT I also think it should depend on the COTA. Things like is the COTA knowledgeable of the what they are going to assess? Also how are their documentation skills? Its one thing to be able to assess a situation or a client in a certain situation, but are you able to report what was seen? As an OTAS it is in my heart to want to chant "...anything you can do I do too", but the reality is that is not true. Most OTs have 4 more years of education and training than OTAs, so they have to pick up something in those years that qualifies them to do more regarding therapy than OTAs. Also we must keep in mind the fact that the OTs have to protect their licensure, so naturally they might be a little hesitant. However on the other hand...as my title says assessing is what we do naturally. Every time we work with a patient something is being assessed. Whether it is how safely a patient is doing a task, how cognitively apped one is to live alone, how safe a client's home is for independent living...the list can go on and on. When we were given this topic to blog about, I immediately thought of a mentor I had last summer. She is a COTA and has been working in the OT field since the late 80's. She started out as an OT aide then went to school and became a COTA and has been for some years now. While I shadowed her at her job there were numerous times when entry level OTs were seeking advice and information from her! Also I recently met another COTA who has been at her place of employment for 23 years and she has been practicing OT longer than that. Now if that's not 2 COTAs that are capable of doing an assessment I don't know who would be! Surely they both are familiar with the type of assessments given at their jobs because they have been there long enough to know how to effectively administer it.

I have included the link to a blog posted by a COTA and he is discussing the same issue. Although his is pertaining to home assessments he and I feel the same about the topic as a whole. I totally agree with him when he stated that we make recommendations on a daily basis for our clients. I'm thinking that came about when discussing interpreting the findings of the assessment, but again we do that on a daily basis anyway! Sure we need to always keep our supervising OT abreast of what we are doing w/ our patients but where does one draw the line so not to come across as self doubting or even incompetent? Bottom line is yes I think COTAs should be able to do assessments IF they prove able to do so.

http://community.advanceweb.com/blogs/ot_3/archive/2011/05/05/home-health-assessments

OT assessments

Should OTAs be allowed to do assessments, particularly with peds?

Considering we have had exposure to & practiced with many types of assessments, recently the Miller Functional & Participation Scales in peds, the answer would be yes, OTAs should be allowed to do assessments... as long as service competency is proven. I believe we will be qualified to do assessments once we get into the workforce & prove service competency. Service competency means that regardless of whether the OT or OTA performs an assessment, the skill level is equivalent & the outcomes are the same.

Standardized assessments have very specific instructions for administering & scoring. Non-standardized assessments have guidelines for administering & scoring, but they are more subjective & rely more on clinical skill, judgement & experience. Service competency would confirm that the OTA is capable of performing the assessments & getting the same results as an OT.

Also, according to AOTA's Standards of Practice, an OT "initiates and directs the screening, evaluation, and re-evaluation process and analyzes and interprets the data..." and an OTA "contributes to the screening, evaluation, and re-evaluation process by implementing delegated assessments and by providing verbal and written reports of observations and client capacities to the occupational therapist...". OTAs doing assessments would help out the OTs, giving them more time to complete evaluations on more clients.

OTAs & Assessments

We were recently asked the question….”Should OTA’s be allowed to perform assessments on pediatric clients?” My answer to this would have been different 2 years ago than it is today. When I started thinking about going back to school for OT I did my research about the differences between OT and OTA programs beyond the obvious Masters vs. Associates degree. What I kept hearing and seeing was that OTAs basically can do everything but the initial evaluations. I knew there had to be more it than that.

As I continued my research, I understood it that the OTs were directing the patient care, intervention planning, interpreting data, writing goals, determining the need for services and much more. OTAs role is to help carry out this process. Yet I still had this belief that OTAs cannot be a part of the evaluation/assessment process and that made sense to me!

Well I started the OTA program and within the first 2 semesters I hear more about assessments and find that we even have a class called Assessment Skills! I really had to take a step back and figure out the rules and regulations of OT/OTA practice. The first thing I had wrong was that I thought the words assessment and evaluation were one in the same. The words are sometimes used synonymously in the field, but have different implications for OT practice. Assessments are more often than not standardized tests with specific instructions for administration and scoring. An evaluation is the columniation of many assessments or gathered information which is interpreted so that the client may receive the appropriate plan of care. As I understood more of what those terms meant, I started to get a better grip of the role of the OTA.

According to the North Carolina Board of Occupational Therapy, “The OTA contributes to the evaluation process by implementing specifically delegated assessments for which service competency has been established and documented.” Service competency is defined as, “the determination, made by various methods, that two people performing the same or equivalent procedure will obtain the same or equivalent results. In test development, this is known as interrater reliability. The same concept can be applied to professionals working together in the service provision process. It stems from the assumption that he OT employs currently acceptable practices. (American Occupational Therapy Association, 1990)

So according to state laws, in collaboration with the OT, OTAs are permitted to perform assessments as long as service competency has been established and documented.

Being a student, I have yet to experience official service competency during fieldwork practices and I’m interested to see how it works. I’m sure we will experience this during fieldwork II in the spring semester when we are hands on with patients. Until then, I will keep learning as much as I can so the process will be smooth when I get there J

Click on the title for the official roles and supervisory documents from North Carolina Board of Occupational Therapy…

Should COTAs Be Allowed To Perform Assessments? Of Course!!!

Of course I, an OTAS, would think that OTAs should be performing assessments, but I can also understand why an OT would not want an OTA to do it. I mean the whole treatment plan and goals could be made according to what the results of the assessment are, and if an assessment isn't done correctly the OT's license could be in jeopardy. Wow, that's a big risk to take for someone, especially if the OT doesn't really trust the OTA to perform the assessment.

I feel like gaining trust from your supervisor doesn't just come by proving service competency of assessments. I think it comes with time. Your supervising OT needs to repetitively see you come to work on time, be professional, ethically and morally, use your therapeutic use of self and basically just do a good job everyday.

After all the competencies we have had to go through, I hope I'm allowed to perform assessments in the real world. I wouldn't like to be at a job where my supervisor didn't trust my judgment. In fact, after proving service competency and still not being allowed to perform assessments, I would probably find another job. I wouldn't want to be at a job where I didn't feel trusted or respected.

If COTAs were allowed to perform more assessments, more clients would be able to receive OT services. The school system is overflowing with kids that need assessments. I wish OTs would trust COTAs more. I mean, "Aren't our instructors just as competent as yours?" Just because COTAs obtain their degrees from a community college doesn't mean that we don't know what we're doing. Give us a chance!

I have included a link for new grades of any kind. It gives some great suggestions on how to gain trust and competence from your supervisor. I love the suggestion of "tooting your horn" subtly." I have too often heard individuals bragging about what they can do. Stop bragging and start showing your supervisor what you can do and be confident!

Peds assessments

This week our topic is to discuss whether or not OTAs should be allowed to give peds. assessments. OTAs can give MMT and ROM assessments, what is so different about peds. assessments? Most assessments follow a step by step protocol/procedure so if you practice enough eventually you'll get great at it and it'll come naturally. I think that as long as the OTA proves to be competent then they should be able to give assessments. To prove competent I think that the OTA needs to sit next to the supervising OT and give an assessment on a child. The OT will take notes on how the OTA does and then they will each go and score the assessment. They can then talk about the notes that the OT took and they can compare their scoring booklets, any discrepancies can be discussed. In the beginning yes this will take more time than just having the OT do it but in the long run more children will get services b/c after the OT does the eval. she can move on to the next kid who needs an eval. while the OTA does assessments with the 1st kid. I'm not 100% sure I want to works in peds. anymore (shocking, I know) but if I did I think I would be able to prove myself competent, I would just need to practice more.

I've provided a link to an AOTA article regarding OT in the schools. The first part of the article discusses what "OT practitioners" do in the schools. On the 2nd page of the article is states, "Occupational Therapists complete assessments..." It then goes back to discussing what practitioners can do. It is interesting to me b/c that is the only time OTAs were separated from OTs in this article.

Assessments--To do, or not to do?

This week we were asked to give our thoughts on assessments. Should we as OTA's, be able to give the M Fun assessments to our little friends in kindergarten and first grade. I do believe we showed that we could administer this test successfully. As we have all demonstrated this past week, giving the assessment is the easy part. It was great to sit down with my first grade friend, and administer the test. He was excited to participate, and I believe that he gave it his best effort. He was focused much of the time, and I only saw a brief period of frustration as he tried to fold the dog in the origami portion of the assessment. Other than that, he seemed to enjoy doing all of the activities contained in this assessment.
Now, going back and grading the assessment was, in and of itself, frustrating beyond measure. I was quite shocked at the amount of reading, and more reading, and then reading some more to figure out how and where to find certain numbers. It seemed to me that I could have spent days going over each section and then hopefully remembering what went where!
If we are going to be administering these assessments, after establishing service competency with our OT's, I for one, will be doing alot more practicing on my own. I surely would not want to be out in a school setting with my supervisor, and have them wait for the assessment results. I would probably have to offer to send them to dinner, then a movie, and then a late night snack before I got the results posted to where they needed to be!!!!
In my opinion, we as OTA's could be of a huge benefit in a public school setting. The amount of children needing OT services is huge, and the wait list, even longer. I have seen first hand the child who had his handwriting assessed one month, and the OT was not seen again for months. This just proved to me the shortage of OT's and OTA's in the public school system. We could add so much as far as targeting the needs of our little folks. Even though we would have to travel from school to school, it seems a small price to pay to help these kids to achieve so much. What seems so simple as helping to increase hand strength, or working to get the correct grasp on a pencil, is huge to these kids. The foundation is set at a very young age, and if we could get in there early, we could have a huge impact on a successful outcome. Our little ones would benefit greatly from early intervention, but the shortage of OT's and OTA's in the school systems is not helping this matter. For those that want to pursue a path within the school systems, I have to say, the road does not sound like it will be easy. From what we hear, the jobs are few and far between. I am hopeful that someone somewhere, will take a closer look at the challenges that are facing our little people. I am equally hopeful that the budget restrictions will ease enough that OTA's will be seen as critical parts of the puzzle. From what I hear, there are quite a few OTA's that would love to work on a daily basis with the little folks. Anyone up to advocating for this?!?!?!?!
I have included a picture that I am sure shows what I looked like as I was trying to figure out the whole grading thing!!!! Just click on the title!

OTAs doing assessments?

Our assignment this week is to blog about whether OTAs should be allowed to do assessments, particularly with peds? My answer is yes. Yes, if we have established, demonstrated and documented service competency with our supervising OT. The reason I say yes is, I am pretty sure I want to work within the school system and I would love to be able to help out the OT with assessing students. We just finished practicing giving an assessment to a student in the county where I attend community college. I did the assessment with a first grader. I know now that it is going to take practice to be able to establish service competency! But, that is also part of being a student. The actual assessment wasn't very difficult, but the scoring took quite a bit of time. The scoring brings up another issue. I think my student would have been able to do more had he not been in a room with other students. But then again, when I am able to obtain service competency, I will be doing a much more efficient job at administering the assessment, and maybe being in a room with other students won't matter.
The county I live in serves ~8,009 students in grades PK-12, with 15 students for every full time teacher. The county has one OT. What a help OTAs could be to the OT! In this school system, 13% of all students have an IEP, that's over 1,000 students. That is a lot of students who need help with various things. I'm sure the OT would love to have several OTAs to help her manage some of the workload. Who could be better at helping her than OTAs?!
If you click on my title, there is a website with a list of assessments for all ages. Check it out fellow students of OTA, we can do this!!

OTA Assessments?

Should OTAs be doing assessments in Peds?

Recently we had the opportunity to do a standardized assessment on a child at our FW assignment. I learned a lot from doing it, and now that I have finished all the paperwork and can take a step back from it all, these are my overall thoughts.

I think that having standardized test is a great idea, the same exact activities, done in the same way, scored the same etc. It is not that hard for an OTA to learn and perform this test just as an OT would, and do a competent job with reliable results. I can see that in a real job, an OTA could establish competency quickly and easily. The glitch to me, came in when it came time to interpret the results. I think a lot of us had a hard time accepting the results of our tests and the implications of these scores. We looked at the numbers, the percentiles and established in black and white what percentile our student fell into, but I think each of us quickly realized that it was not all just that easy. Numbers don’t tell the whole story. For example, how do you factor in the fact that a child could easily have completed an activity for a perfect score, but just refused to do so and got a 0 because really, she was just having a bad day and didn’t “feel” like doing that activity. On paper it looks like she was lacking that skill and in interpreting that result, we would tend to analyze that skill category and name her deficit, but in actuality, to be fair, we would have to try to document a bad day, what category is that?

A lot of us had questions like that and as we discussed things like this randomly, I realized that this kind of depth of knowledge and understanding was not just a matter of experience, that maybe this had a bit to do with the level of learning and training that separates an OTA from an OT.

I love the idea of competency, it means “I can handle this, I have the skill and intelligence to deal with this situation”, but as I have learned from past professional experience, going out and really trying to do what you have learned teaches you how much you don’t know (yet). When it comes to interpreting results, it’s not just a matter of stating facts, it’s a matter of using both what we learned in class and what we have experienced in practice. Realistically there is a pretty big difference between what we have learned in 1.5 years and what an OT with 6 years and maybe many years of practice, knows and understands.

We have learned that professionally we are allowed to perform assessment tests if we have established service competency, but we have to allow the OT that supervises us and therefore our clients to interpret the results of this assessment. I think that is logical, practical and fair for our clients. As I gain knowledge I may feel comfortable making suggestions to my supervisor but in the meantime I respect my level of ability.

The following link explains this scope of practice, particularly under the heading "Supervision and the Collaborative Process - Scope of practice." http://www.aota.org/Practitioners/Ethics/Advisory/OTOTA.aspx