Supervising Assistants, Students, and Aides: Upholding Your Ethics in a Challenging Health Care Environment

Editor’s note: This text-based course is a transcript of the webinar, Supervising Assistants, Students, and Aides: Upholding Your Ethics in a Challenging Health Care Environment, presented by Kathleen Weissberg, OTD, OTR/L.Learning ObjectivesAfter this course, participants will be able to define terminology including direct supervision and general supervision.After this course, participants will be able to describe Medicare guidelines for supervision and billing related to students and therapy aides.After this course, participants will be able to define best practice initiatives from AOTA related to supervision of assistants in practice.After this course, participants will be able to list key concepts from state practice acts that relate to supervision and ethics.After this course, participants will be able to identify best practice guidelines to common ethical dilemmas.Kathleen: Thank you very much for that introduction and thank you all for joining in today. I appreciate you being with us. A lot of this information is dry so I want to get through as much as we can and get to some scenarios that I think will pull it all together for us.By way of introduction I think the best way to start is just to say that AOTA has really pulled together some prudent ways to exercise supervision of assistants, aides students in practice and within the scope of OT practice, I think we have to recognize that supervision as a process that is aimed at ensuring the safe and effective delivery of therapy services and fostering professional competence and development and you'll hear me say that a couple different times, safety is paramount. We always have to put our patient first no matter what the relationship is. In addition and we'll talk about this, supervision is a co-operatve process in which two or more people are participating in this joint effort to establish, maintain, to elevate their level of competence and performance and it's really based on mutual understanding between the supervisor, the supervisee about each other's experience or education credentials so it fosters our growth, our development and if done the right way, it is such a rewarding experience for both the supervisor and the person who's being supervised and quite frankly, the patients who are in our care. With that, let's go through our objectives for today. We're gonna define some terminology including what is meant by direct supervision and general supervision. I'm going to describe the medicare guidelines for supervision and building related to students and therapy aides because medicare is one of our primary pair sources around the country and even if it's not a primary pair source where you're working, we find that a lot of insurance companies will follow medicare best practice guidelines so it's really important to know what those are. We'll talk about what best practice initiatives from AOTA are out there related to supervision of assistants in practice. You'll be able to listen to key concepts from the state practice acts that relate to supervision and ethics and finally, identify best practice guidelines to common ethical dilemmas. Let's start off by talking about what is the role of the occupational therapist. Again this is a little dry and boring so I apologize but the role of the OT, the OT is responsible for all aspects of screening, evaluation and reevaluation. The OT is the person who accepts and responds to referrals obviously in compliance with any state or federal laws, any other regulatory or payer requirements and of course in compliance with anything that comes from AOTA. The occupational therapist will collaborate with the client and evaluate that client's ability to participate their daily life tasks, their roles, their responsibilities and the like. The occupational therapist will initiate and direct the screening process, the evaluation process and the re-evaluation process. Keep in mind that the OTA obviously the assistant can also participate in this. They will contribute to that process by perhaps administering delegated assessment by providing verbal and written reports of observations and client capacities and reporting those facts to the therapist. We'll talk about this but the OTA can certainly perform standardized tests and measures but if you look at the guidelines, the OTA technically cannot interpret those which to me sounds crazy. I'll tell you that everything I've learned about my practice I think I've learned from my assistant but the reality is while they can perform them, it still comes back to the therapist to analyze those results and to document those results and figure out what the course of treatment will be based upon those. As we go into the intervention process, remember too that the occupational therapist has the overall responsibility for the development, the documentation, the implementation of that plan and will obviously delegate the aspects of that plan to the OTA as appropriate and also provide appropriate supervision to the assistant who might be carrying out those interventions. The occupational therapy assistant would select, implement and make modifications to the therapeutic intervention that would be consistent with their competency and with their delegated responsibilities. So what are we saying there? We're saying that the OT and the OTA will together collaborate on the treatment plan and things will be delegated and as those things are delegated they will obviously be within the scope of practice of the assistant, within their competency, within their skill set obviously. There should be an exchange of information between the OT, between the OTA to modify the intervention plan because the reality is once that plan is set up often times it is the OTA who carries it out so that's the person who reports back communication about the intervention whether it's effective, not effective etc. Continuing on as we look at the transition and discharge and outcomes, the occupational therapist is responsible for selecting, measuring documenting and interpreting the expected and achieved outcomes. The occupational therapist is responsible for documenting changes in the client's performance and documenting whether or not the person has achieved their goals, reached their maximum benefit, needs to continue or needs to be...