AOTA OT Standards of Practice_Official Doc.pdf

PROFESSIONAL STANDARDS Standards of Practice for Occupational Therapy...

PROFESSIONAL STANDARDS Standards of Practice for Occupational Therapy Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 T his document defines minimum standards for the practice of occupational therapy. According to the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF–4), occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations (i.e., the client) for the purpose of enhancing or enabling participation.... Occupational therapy services are provided for habilitation, rehabilitation, and promotion of health and wellness for clients with disability- and non–disability-related needs. These services include acquisition and preserva- tion of occupational identity for clients who have or are at risk for developing an illness, injury, disease, dis- order, condition, impairment, disability, activity limitation, or participation restriction. (American Occupational Therapy Association [AOTA], 2020c, p. 1) Occupational therapy practice addresses the physical, state laws (AOTA, 2020a). To practice as an occupational cognitive, psychosocial, sensory–perceptual, and other therapist, the individual trained in the United States aspects of clients’ performance in a variety of contexts to support their engagement in occupations that affect 䊏 has graduated from an occupational therapy program physical and mental health, well-being, and quality of life accredited by the Accreditation Council for Occupa- (AOTA, 2011, p. 1). tional Therapy Education (ACOTE®; 2018) or prede- The Standards of Practice for Occupational Therapy cessor organizations; are requirements for occupational therapists and 䊏 has successfully completed a period of supervised occupational therapy assistants for the delivery of fieldwork experience required by the recognized edu- occupational therapy services. The Reference Manual of cational institution where the applicant met the aca- the Official Documents of the American Occupational demic requirements of an educational program for Therapy Association, Inc. (AOTA, 2018b), contains occupational therapists that is accredited by ACOTE documents that clarify and support occupational therapy or predecessor organizations; practice, as do various issues and supplements of the 䊏 has passed a nationally recognized entry-level exami- American Journal of Occupational Therapy. These nation for occupational therapists; and documents are reviewed and updated on an ongoing 䊏 fulfills state requirements for licensure, certification, or basis for their applicability. registration. To practice as an occupational therapy assistant, Education, Examination, and Licensure the individual trained in the United States Requirements 䊏 has graduated from an occupational therapy assistant All occupational therapists and occupational therapy program accredited by ACOTE or predecessor assistants must practice within compliance with federal and organizations; AOTA OFFICIAL DOCUMENT 1 The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3 PROFESSIONAL STANDARDS 䊏 has successfully completed a period of supervised 䊏 Discontinuation of services: Occurs when the client fieldwork experience required by the recognized ends services after meeting short- and long-term educational institution where the applicant met the goals or chooses to no longer receive services academic requirements of an educational program for (AOTA, 2020c, p. 28). occupational therapy assistants that is accredited by 䊏 Evaluation: “The comprehensive process of obtaining ACOTE or predecessor organizations; and interpreting the data necessary to understand the Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 䊏 has passed a nationally recognized entry-level exami- person, system, or situation.... Evaluation requires nation for occupational therapy assistants; and synthesis of all data obtained, analytic interpretation of 䊏 fulfills state requirements for licensure, certification, or that data, reflective clinical reasoning, and consider- registration. ation of occupational performance and contextual factors” (Hinojosa et al., 2014, as quoted in AOTA, AOTA (2019) supports licensure of qualified 2020c, p. 76). occupational therapists and occupational therapy 䊏 Intervention: Process and skilled actions taken assistants. State and other legislative or regulatory by occupational therapy practitioners in collabo- agencies may impose additional requirements ration with the client to facilitate engagement in to practice as occupational therapists and occupation related to health and participation. occupational therapy assistants in their area of The intervention process includes the plan, jurisdiction. implementation, and review (AOTA, 2020c, p. 78, Table 12). Definitions 䊏 Occupation: Everyday personalized activities that people do as individuals, in families, and with commu- The following definitions are used in this document: nities to occupy time and bring meaning and purpose 䊏 Activities: Actions designed and selected to support to life. Occupations can involve the execution of the development of performance skills and perfor- multiple activities for completion and can result in mance patterns to enhance occupational engagement various outcomes. The broad range of occupations (AOTA, 2020c, p. 74). is categorized as activities of daily living, instru- 䊏 Assessment: “A specific tool, instrument, or system- mental activities of daily living, health manage- atic interaction... used to understand a client’s ment, rest and sleep, education, work, play, occupational profile, client factors, performance leisure, and social participation (AOTA, 2020c, p. skills, performance patterns, and contextual and 79, Table 2). environmental factors, as well as activity demands 䊏 Outcome: Result clients can achieve through occupa- that influence occupational performance” (Hinojosa tional therapy intervention (AOTA, 2020c, p. 80, et al., 2014, as quoted in AOTA, 2020c, p. 74). Table 14). 䊏 Client: Person (including one involved in the care of a 䊏 Reevaluation: Reappraisal of the client’s performance client), group (collection of individuals having shared and goals to determine the type and amount of change characteristics or common or shared purpose, e.g., that has taken place (AOTA, 2020c, p. 82). family members, workers, students, and those with 䊏 Screening: “Process of reviewing available data, similar interests or occupational challenges), or popu- observing a client, or administering screening instru- lation (aggregate of people with common attributes ments to identify a person’s (or a population’s) poten- such as contexts, characteristics, or concerns, includ- tial strengths and limitations and the need for further ing health risks; Scaffa & Reitz, 2014, as cited in assessment” (Hinojosa et al., 2014, as quoted in AOTA, 2020c, p. 75). AOTA, 2020c, p. 83). 2 AOTA OFFICIAL DOCUMENT The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3  PROFESSIONAL STANDARDS 䊏 Transition: Movement from one life role or experience 7. An occupational therapy assistant is responsible for to another. In occupational therapy, transitions are providing safe and effective occupational therapy serv- actions coordinated to prepare for or facilitate a ices under the direct and indirect supervision of and in change, such as from one functional level to another, partnership with the occupational therapist and in from one life stage to another, from one program to accordance with laws or regulations and AOTA official another, or from one environment to another. documents (AOTA, 2020b). Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 8. An occupational therapy practitioner maintains current Standard I. Professional Standing and knowledge of legislative, political, social, cultural, soci- Responsibility etal, and reimbursement issues that affect clients and the practice of occupational therapy. 1. An occupational therapy practitioner (occupational ther- 9. An occupational therapy practitioner is knowledgeable apist or occupational therapy assistant) delivers occu- about evidence-informed practice and applies it ethi- pational therapy services that reflect the philosophical cally and appropriately to provide occupational therapy base of occupational therapy and are consistent with services consistent with best practice approaches. the established principles and concepts of theory and 10. An occupational therapist demonstrates professional practice. The cornerstones of occupational therapy and clinical reasoning to evaluate, analyze, and diag- practice are as follows: core values rooted in occupa- nose occupational challenges (e.g., issues with client tion, knowledge of and expertise in the therapeutic use factors, performance patterns, and performance skills) of occupation, professional behaviors and dispositions, and therapeutic use of self (AOTA, 2020c). These cor- and provide occupation-based interventions to nerstones identify the distinct knowledge and skills of address them (ACOTE, 2018; AOTA, 2020c). the occupational therapy practitioner. 11. An occupational therapy assistant demonstrates pro- 2. An occupational therapy practitioner is knowledgeable fessional and clinical reasoning to address occupa- about and delivers occupational therapy services in tion-based interventions, client factors, performance accordance with AOTA standards, policies, and guide- patterns, and performance skills (ACOTE, 2018; lines and state, federal, and other regulatory and AOTA, 2020c). payer requirements relevant to practice and service 12. An occupational therapy practitioner obtains the cli- delivery. ent’s consent before and throughout the occupational 3. An occupational therapy practitioner maintains current therapy process. licensure, registration, or certification as required by 13. An occupational therapy practitioner is an effective law or regulation. advocate for the client’s intervention and accommoda- 4. An occupational therapy practitioner abides by the tion needs. AOTA 2020 Occupational Therapy Code of Ethics 14. An occupational therapy practitioner is an integral (AOTA, 2020a). member of the interprofessional collaborative team 5. An occupational therapy practitioner abides by the and works to ensure the client-centeredness of the Standards for Continuing Competence (AOTA, 2015) service delivery process. by establishing, maintaining, and updating profes- 15. An occupational therapy practitioner providing client- sional performance, knowledge, and skills. centered services demonstrates cultural humility, rec- 6. An occupational therapist is responsible for all aspects ognizes gaps in cultural knowledge and maintains a of occupational therapy service delivery and is account- constant process of learning, understands differentia- able for the safety and effectiveness of the occupational tions between and within cultures, acknowledges therapy service delivery process (AOTA, 2020b). implicit and explicit bias, and recognizes power AOTA OFFICIAL DOCUMENT 3 The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3 PROFESSIONAL STANDARDS dynamics in the delivery of services (Agner, 2020; 4. An occupational therapist initiates and directs the AOTA, 2020d). screening, evaluation, and reevaluation process and analyzes, interprets, and synthesizes the data in accordance with federal and state laws, other regula- Standard II. Service Delivery tory and payer requirements, and AOTA official 1. An occupational therapy practitioner provides skilled documents. Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 occupational therapy services through a direct service 5. An occupational therapy assistant contributes delivery approach when interventions are completed in to the screening, evaluation, and reevaluation direct contact with clients and families during in-person process by administering delegated assessments meetings, group sessions, and telehealth and mHealth of occupational performance and by reporting interactions (AOTA, 2020c). assessment results to the occupational therapist 2. An occupational therapy practitioner may provide skilled in accordance with federal and state laws, other occupational therapy services through an indirect regulatory and payer requirements, and AOTA service delivery approach. Such services include con- official documents. sultation to entities such as teachers and school sys- 6. An occupational therapy practitioner uses evidence- tems, participation on multidisciplinary teams and com- based, standardized, and/or structured assessment munity planning agencies, and advocacy on behalf of tools and protocols and conducts needs assessments their clients (AOTA, 2020c). during the screening, evaluation, and reevaluation pro- 3. An occupational therapy practitioner is responsible for cess (AOTA, 2018a). ensuring client safety throughout the occupational ther- 7. An occupational therapist completes, documents, apy process and service delivery. and synthesizes the results of the occupational 4. An occupational therapy practitioner is responsible for therapy evaluation. An occupational therapy assis- the continual evaluation of the effectiveness of occupa- tant may contribute to the documentation of evalu- tional therapy processes and service delivery within the ation results. An occupational therapy practitioner practice setting. abides by the time frames, formats, and standards established by practice settings, federal and state laws, other regulatory and payer requirements, Standard III. Screening, Evaluation, external accreditation programs, and AOTA official and Reevaluation documents. 1. An occupational therapist is responsible for all aspects 8. An occupational therapy practitioner communicates of the screening, evaluation, and reevaluation screening, evaluation, and reevaluation results within process. the boundaries of client confidentiality and privacy 2. An occupational therapist accepts and responds to regulations. referrals in compliance with state or federal laws, other 9. An occupational therapist recommends additional regulatory and payer requirements, and AOTA official consultations or refers clients to appropriate documents. resources when the needs of the client can best be 3. An occupational therapist, in collaboration with the cli- served by the expertise of other professionals or ent (person, group, or population), completes both an services. occupational profile and an analysis of occupational 10. An occupational therapy practitioner educates current performance to evaluate and identify the client’s and potential referral sources about the scope of occu- needs, supports, and barriers to occupational pational therapy services and the process of initiating performance. occupational therapy services. 4 AOTA OFFICIAL DOCUMENT The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3  PROFESSIONAL STANDARDS Standard IV: Intervention Process 7. An occupational therapist modifies the intervention plan throughout the intervention process and documents 1. An occupational therapist has overall responsibility for changes in the client’s needs, goals, and performance. the development, documentation, and implementation 8. An occupational therapy assistant contributes to the of the occupational therapy intervention plan based on modification of the intervention plan by exchanging the evaluation, client goals, best available evidence, information with and providing documentation to the Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 and professional and clinical reasoning. When delegat- occupational therapist about the client’s responses to ing aspects of the occupational therapy intervention to and communications throughout the intervention. the occupational therapy assistant, the occupational 9. An occupational therapy practitioner documents the therapist is responsible for providing appropriate super- occupational therapy services provided within the time vision (AOTA, 2020b). frames, formats, and standards established by the prac- 2. An occupational therapist ensures that the intervention tice settings, agencies, external accreditation programs, plan is documented within the time frames, formats, federal and state laws, other regulatory and payer and standards established by the practice settings, requirements, and AOTA official documents (AOTA, agencies, external accreditation programs, state and 2018a). federal laws, and other regulatory and payer require- ments (AOTA, 2018a). 3. An occupational therapy practitioner collaborates with Standard V. Outcomes, Transition, and the client to develop and implement the intervention Discontinuation plan to facilitate engagement in occupation on the basis 1. An occupational therapist is responsible for determining of the client’s needs and priorities, safety issues, and outcomes of the occupational therapy intervention and relative benefits and potential harms of the interventions selecting appropriate outcome measures to identify the and service delivery. client’s ability to engage in their desired occupations. 4. An occupational therapy practitioner coordinates the 2. An occupational therapist is responsible for implement- development and implementation of the occupational ing and interpreting outcome measures and document- therapy plan of care with the intervention provided by ing progress toward occupational performance, other professionals, when appropriate. engagement, and participation. An occupational ther- 5. An occupational therapy practitioner uses professional apy assistant is responsible for implementing delegated and clinical reasoning, best available evidence, and outcome measures and reporting results to the occupa- therapeutic use of self to select and implement the most tional therapist. appropriate types of interventions. Types of interven- 3. An occupational therapist is responsible for document- tions implemented may include occupations and activi- ing changes in the client’s performance and capacities ties, interventions to support occupations, education and for transitioning the client to another type or inten- and training, advocacy, group interventions, and virtual sity of service or discontinuing services when the client interventions (AOTA, 2020c). All interventions are used has achieved identified goals, reached maximum bene- to facilitate engagement in occupation. 6. An occupational therapy assistant, in collaboration fit, or does not desire to continue services. with the occupational therapist, selects, imple- 4. An occupational therapist prepares and implements a safe ments, and makes modifications to occupational and effective transition or discontinuation plan based on therapy interventions consistent with demonstrated the outcomes of the intervention and the client’s needs, competence levels, client goals, and the require- goals, performance, and appropriate follow-up resources. ments of the practice setting, including payment 5. An occupational therapy assistant contributes to the tran- source requirements (AOTA, 2020b). sition or discontinuation plan by providing information and AOTA OFFICIAL DOCUMENT 5 The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3 PROFESSIONAL STANDARDS documentation to the occupational therapist related to the PracticeAct/Model%20Definition%20of%20OT%20Practice%20% 20Adopted%2041411.pdf client’s progress toward goals, needs, performance, and American Occupational Therapy Association. (2015). Standards for appropriate follow-up resources. continuing competence. American Journal of Occupational Therapy, 6. An occupational therapy practitioner facilitates the tran- 69(Suppl. 3), 6913410055. https://doi.org/10.5014/ajot.2015.696S16 sition or discontinuation process in collaboration with American Occupational Therapy Association. (2018a). Guidelines for documentation of occupational therapy. American Journal of the client, family members, significant others, other pro- Occupational Therapy, 72(Suppl. 2), 7212410010. https://doi.org/ Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 fessionals (e.g., medical, educational, social services), 10.5014/ajot.2018.72S203 and community resources, when appropriate. American Occupational Therapy Association. (2018b). The reference manual of the official documents of the American Occupational Therapy 7. The occupational therapy practitioner ethically reports Association, Inc. (23rd ed.). AOTA Press. outcomes to payers and referring entities as well as to American Occupational Therapy Association. (2019). Policy E.9: Licensure. relevant local, regional, and national databases and In Policy manual (2019 ed., pp. 66–67). registries, when appropriate. American Occupational Therapy Association. (2020a). AOTA 2020 occupational therapy code of ethics. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410005. https://doi.org/10.5014/ References ajot.2020.74S3006 American Occupational Therapy Association. (2020b). Guidelines for Accreditation Council for Occupational Therapy Education. (2018). 2018 supervision, roles, and responsibilities during the delivery of ® occupational therapy services. American Journal of Occupational Accreditation Council for Occupational Therapy Education (ACOTE ) Standards and Interpretive Guide (effective July 31, 2020). American Therapy, 74(Suppl. 3), 7413410020. https://doi.org/10.5014/ Journal of Occupational Therapy, 72(Suppl. 2), 7212410005. https:// ajot.2020.74S3004 doi.org/10.5014/ajot.2018.72S217 American Occupational Therapy Association. (2020c). Occupational therapy Agner, J. (2020). Moving from cultural competence to cultural humility in practice framework: Domain and process (4th ed.). American Journal of occupational therapy: A paradigm shift. American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/ Occupational Therapy, 74, 7404347010. https://doi.org/10.5014/ 10.5014/ajot.2020.74S2001 ajot.2020.038067 American Occupational Therapy Association. (2020d). Occupational American Occupational Therapy Association. (2011). Definition of therapy’s commitment to diversity, equity, and inclusion. American occupational therapy practice for the AOTA Model Practice Act. https:// Journal of Occupational Therapy, 74(Suppl. 3), 7413410030. https:// www.aota.org//media/Corporate/Files/Advocacy/State/Resources/ doi.org/10.5014/ajot.2020.74S3002 Authors Revised by the Commission on Practice, 2020: Shelley Coleman Casto, MS, OTR/L, CPST Charlotte Davis, MS, OTR/L Julie Dorsey, OTD, OTR/L, CEAS, FAOTA, Chairperson Elizabeth “Liz” Griffin Lannigan, PhD, OTR/L, FAOTA Lizabeth Metzger, MS, OTR/L Julie Miller, MOT, OTR/L, SWC Amy Owens, OTR Krysta Rives, MBA, COTA/L, CKTP Caitlin Synovec, OTD, OTR/L, BCMH Wayne L. Winistorfer, MPA, OTR, FAOTA Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison Adopted by the Representative Assembly Coordinating Committee (RACC), February 2021 6 AOTA OFFICIAL DOCUMENT The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3  PROFESSIONAL STANDARDS Note. These standards are intended as recommended guidelines to assist occupational therapy practitioners in the provision of occupational therapy services. These standards serve as a minimum standard for occupational therapy practice and are applicable to all individual populations and the programs in which these individuals are served. This revision replaces the 2015 document Standards of Practice for Occupational Therapy (previously published and copyrighted by the American Occupational Therapy Association in the American Journal of Occupational Therapy, 69(Suppl. 3), 6913410057. https://doi.org/ 10.5014/ajot.2015.696S06 Downloaded from http://research.aota.org/ajot/article-pdf/75/Supplement_3/7513410030/73808/7513410030.pdf by Lenoir-Rhyne University, Lesly James on 16 September 2024 Copyright © 2021 by the American Occupational Therapy Association. Citation. American Occupational Therapy Association. (2021). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3004 AOTA OFFICIAL DOCUMENT 7 The American Journal of Occupational Therapy, November/December 2021, Vol. 75, Suppl. 3