Occupational Therapy

Practice Guidelines

Supervision

There are several situations in which occupational therapists (OTs) serve as supervisors including, for example, administrative and clinical supervision in agencies and organizations, supervision of persons gaining experience for licensure purposes, supervision in training situations, and, the supervision of occupational therapy assistants. The supervisor is ultimately responsible for quality control and can be held accountable for the professional services being provided by the person being supervised. While there are differences in the various forms of supervision, occupational therapists who provide clinical supervision are engaged in the practice of occupational therapy. When an occupational therapist is serving as a supervisor, here are a few things to consider:

• When an occupational therapist agrees to serve as a supervisor, there are specific areas that should be addressed before entering into the supervisory relationship so that all parties understand their duties and obligations. The nature and terms of the relationship should be spelled out in advance, including:
  
  
  • The supervisor's ultimate responsibility to the person receiving supervision
  • The limits of confidentiality, including, but not limited to, the mandate for reporting child abuse
  • The limits of what the supervisor can do if he or she has questions about the nature or quality of the practice being supervised
  • The information that the supervisor can report to the supervisee's employer in an employment setting
  
  
• Supervisors should recognize that they could be held accountable for the services provided by the supervisee. The misconduct of a supervisee could be the basis for charges brought against the supervisor where supervision is not adequate.
  
  
• If a supervisor is involved when a professional service is performed, it is wise to inform the recipient of the occupational therapy service of the supervisor's involvement and to get his or her consent. This will help to avoid future complications, including issues of confidentiality.
  
  
• It is wise to keep records of each supervisory session. The records should include compensation arrangements, if appropriate. The documentation of the supervision should be made available, on request, to institutions, licensing agencies and others who require this information for verification purposes and have the legal authority to obtain it. Before sharing these records, however, where necessary, it is important to get the consent of the supervisee.
  
  
• When the supervisor's signature is required on a record or insurance form, the occupational therapist should be fully aware of the ramifications of that signature. Supervisors should consult with the insurance company or their attorney if there are questions about completing insurance forms for supervisees who work in agency or private practice settings as employees.

Supervising occupational therapy assistants (OTAs):

Education Law and Regulations of the Commissioner of Education require that occupational therapy assistants receive direct supervision. OTAs must work under the supervision of a licensed OT. In certain settings, a licensed physician may supervise an OTA. OTAs should receive supervision in all aspects of their work, including carrying out initial assessments, treatment and assessments to terminate services. The occupational therapist supervisor must meet with and observe the occupational therapy assistant on a regular basis to review the implementation of treatment plans and to foster professional development. The amount and type of supervision provided should be based on the ability level and clinical experience of the occupational therapy assistant and the setting in which the occupational therapy assistant is providing the services.

Good practice suggests that the occupational therapist supervisor participate in the services delivered by the OTA including:

• Initial Evaluation
• Intervention Planning and Goal Setting
• Final Evaluation /Discharge

Additionally, the supervisor should periodically assess each patient's progress, and review and sign treatment notes and reports prepared by the occupational therapy assistant.

Supervising students or applicants for licensure:

When occupational therapists act as supervisors for persons gaining experience for licensure, the supervisee should not directly pay the supervisor. The supervisor should not accept payment directly from the supervisee for supervision that would lead to course credit in academic programs or licensure. When a supervisor accepts payment directly from the supervisee in these situations, it could be considered a conflict of interest and a dual relationship.