The Occupational Therapy Practitioner: Roles, Responsibilities, and Relationships

The Occupational Therapy Practitioner

Roles, Responsibilities, and Relationships


I like helping people.

Okay, so maybe that sounds a little simplistic, but it is true. I like solving problems, connecting people with resources, working with an individual eye to eye, and setting and meeting goals. I like looking at not only the “forest,” but also the “trees,” and seeing each “tree” for the individual that he or she is and recognizing the unique and special characteristics that each person has to offer. I like treating a person with respect and dignity, and through the knowledge and skills that I possess as an occupational therapist, helping that person to achieve a life that is purposeful and meaningful to him or her, not by my definitions, but by what he or she defines as important. I like looking at the whole person, not just a body part or specific function, but as a precious asset to society, complex and dynamic. I like the look on someone’s face when he or she realizes that he or she can accomplish far more than he or she ever thought he or she would be able to do before working with an occupational therapist. I like when “can’t” becomes “can” and “doesn’t” becomes “done.”

I like helping people; I love being an OT.


Industrial Rehabilitation Consultant

ErgoScience, Inc.

Birmingham, Alabama

When a student graduates from an accredited educational program and passes the National Board for Certification in Occupational Therapy (NBCOT®) exam, there is a basic level of competence that is assumed, and a state license (in states that have licensure) is granted. At this point, the practitioner is considered to be an entry-level practitioner. This is an exciting point in time for OT and OTA students, with many career opportunities and experiences for learning. In this chapter, we first discuss the various roles in which an OT practitioner may function. The responsibilities of the entry-level OT practitioner in service delivery are outlined, along with guidelines for supervision. Next, we describe relationships found in service delivery and how the OT practitioner can work effectively within those relationships. Finally, we discuss how the entry-level practitioner develops knowledge and skills to maintain competency and advance in the profession. By understanding the available roles and responsibilities and their requirements, the entry-level OT practitioner can control the direction of his or her career.

Professional Roles and Career Development

It is important to understand what is meant by professional roles and relationships. Crist explained that roles specify positions or sets of stipulated job-related responsibilities.13 Each role carries with it specific expectations for job performance and responsibilities. An individual’s ability to function in a role is based on educational preparation, professional boundaries and responsibilities, and prior experience in the role.13 As in life, most people working in organizations have multiple roles. The connection of different roles to one another is a relationship. Working organizations are made up of many relationships. The combination of roles and relationships defines expectations in the organization and clarifies interactions.13

Direct client care is the role most commonly assumed by the OT practitioner who is just entering the field. However, there are an additional 10 roles identified by the profession that can potentially be held by OTs and OTAs. These include consumer educator, fieldwork educator in a practice setting, supervisor, administrator in a practice setting, consultant, academic fieldwork coordinator, faculty, academic program director, researcher/scholar, and entrepreneur. Each of these roles and a description of its major functions are shown in Table 7-1. Often, OT practitioners function in more than one role—at times within the same job. For example, an OT may provide direct client services and perform the functions of an administrator; an OTA may hold positions as both a faculty member and clinician.

Table 7-1

Occupational Therapy Roles

Role Major Function
Practitioner—OT Provides quality occupational therapy services, including evaluation, intervention, program planning and implementation, discharge planning–related documenta-tion, and communication. Service provision may include direct, monitored, and consultative approaches.
Practitioner—OTA Provides quality occupational therapy services to assigned individuals under the supervision of an OT.
Educator (consumer, peer) Develops and provides educational offering or training related to occupational therapy to consumer, peer, and community individuals or groups.
Fieldwork Educator (practice setting) Manages Level I or II fieldwork in a practice setting. Provides OT students with opportunities to practice and carry out practitioner competencies.
Supervisor Manages the overall daily operation of occupational therapy services in defined practice area(s).
Administrator (practice setting) Manages department, program, services, or agency providing occupational therapy services.
Consultant Provides occupational therapy consultation to individuals, groups, or organizations.
Academic Fieldwork Coordinator Manages student fieldwork program within the academic setting.
Faculty Provides formal academic education for OT or OTA students.
Academic Program Director Manages the educational program for OT or OTA students.
Researcher/Scholar Performs scholarly work of the profession, including examining, developing, refining, and evaluating the profession’s body of knowledge, theoretical base, and philo-sophical foundations.
Entrepreneur Entrepreneurs are partially or fully self-employed individuals who provide occupa-tional therapy services.

Note: Many jobs involve more than one role, and job titles vary by setting.

Adapted from American Occupational Therapy Association: Career exploration and development: A companion guide to the occupational therapy roles document. In COTA Information Packet: A Guide for Supervision, Bethesda, MD, 1995, AOTA.

As the career of an OT practitioner progresses, he or she may wish to advance within the service delivery path or transition into a role outside of service delivery. This is referred to as career development. How the individual develops in a career will depend upon previous choices about roles and relationships.13

There are three ways in which career development occurs in occupational therapy: vertical movement within a setting, lateral movement across settings, and maturation within a role.13 In vertical movement within a setting, the practi-tioner moves up in the organization to progressively higher positions. For example, a practitioner may move to the role of fieldwork educator, then department supervisor, and eventually manager of a rehabilitation clinic. A lateral movement across settings might involve an expert clinician transitioning to the role of a clinical instructor in a university setting. The third means of career development is the maturation of the individual within a specific role from entry level, to intermediate level, to an advanced level, for example, from entry-level clinician to advanced clinical specialist.

Levels of Performance

OT practitioners perform at one of three levels: entry, intermediate, or advanced. An individual’s level of performance is not based on years of experience in the field because this is not a valid indicator of performance. Instead, the practi- tioner’s level of performance is based on attaining a higher skill level through work experience, education, and professional socialization.9

Table 7-2 describes the levels of performance and demonstrates how a practitioner’s career may develop as knowledge and skill increase. The entry-level practitioner is expected to be responsible for and accountable in professional activities related to the role. In states with licensure laws, entry-level practice is defined by the licensure law and supporting regulations. The intermediate-level practitioner has increased responsibility and typically pursues specialization in a particular area of practice. The advanced-level practitioner is considered an expert, or a resource, in the respective role.

Each individual progresses along this continuum at a different pace. Some individuals never progress past the entry level in a particular role, or a person may transition to a new role, wherein his or her level of performance is classified at entry level. For example, an individual who has worked as an OT at the advanced level may transfer into an administrative role at the entry level. An OTA at the intermediate level may transition to the role of an entry-level faculty member. Even at the entry level, individuals in both situations may need to acquire additional knowledge and skill to satisfactorily perform the new job functions. It is also possible for an individual to function in two roles at different levels. For example, an OTA intermediate-level practitioner may assume new responsibilities as a fieldwork educator. In the new role, this OTA would initially perform the job function at the entry level.

For any type of role advancement or transition, the OT practitioner must be aware of what the expectations are for the new role and prepare accordingly. Methods to achieve role advancement or transition are discussed later, in the section on professional development.

Specialized Roles

There are specialized roles in which OT practitioners can function; however, these roles are typically outside of the profession. These include roles such as case manager, supervisor of other allied health care professionals, consultant, and activity director. These roles are advanced-level positions for OT practitioners. We discuss the role of activity director in the following section because it is a role that the OTA can function in without supervision.

Activity Director

The role of activity director is one for which the OTA is well qualified and can function independently.21 Activity directors are typically employed in group homes, institutions for people with mental retardation, assisted living facilities, and long-term care facilities for older persons. In these types of facilities, residents may withdraw and become isolated. The activity director is responsible for planning, implementing, and documenting an ongoing program of activities that meet the needs of the residents. The activity director needs to be aware of and adhere to regulations for activity programs and personnel that have been set forth by Medicare, state health departments, and licensing agencies.

The Standards of Practice18 for the National Association of Activity Professionals classifies activities that are provided to the client as supportive, providing maintenance, or empowering. Supportive activities are commonly provided to individuals who do not have the cognitive or physical ability to participate in a group program. The purpose of these activities is to promote a comfortable environment and to provide stimulation to those individuals. Examples include placing meaningful objects in the person’s room and providing background music. Maintenance activities are those that provide opportunities for the individual to maintain physical, cognitive, social, emotional, and spiritual health. Examples of maintenance activities are exercise groups, games such as shuffleboard, creative writing, and choir. Empowering activities are geared toward promoting self-respect, and they offer opportunities for self-expression, personal responsibility, and social responsibility. Writing a facility newsletter or forming a council dedicated to resolving residents’ issues are examples of empowering activities.18 Detailed information on the role of the OTA as an activity director can be found in Ryan’s Occupational Therapy Assistant.21

Roles and Responsibilities During Service Delivery

The Standards of Practice for Occupational Therapy6 defines the minimum requirements for OT practitioners working in service delivery. The standards are delineated into four areas: (1) professional standing and responsibility; (2) screening, evaluation, and reevaluation; (3) intervention; and (4) outcomes. These standards are summarized in Table 7-3 and printed in full in Appendix B.

Table 7-3

Responsibilities of the Occupational Therapist and Occupational Therapy Assistant During the Delivery of Occupational Therapy Services

Service Occupational Therapist Occupational Therapy Assistant
Evaluation Directing the evaluation process.
Directing all aspects of the initial contact during the evaluation, including need for service, defining the problems within the domain of occupational therapy, determining client goals and priorities, establishing intervention priorities, determining further assessment needs, and determining assessment tasks that can be delegated to the OTA.
Initiating and directing the evaluation, interpreting the data, and developing the intervention plan.
Contributing to the evaluation process by implementing delegated assessments.
Providing verbal and written reports of observations and client capacities to the OT.
Intervention planning Overall development of the occupational therapy intervention plan.
Collaborating with the client to develop the plan.
Collaborating with the client to develop the plan.
Being knowledgeable about evaluation results and for providing input into the intervention plan, based on client needs and priorities.
Intervention implementation The overall implementation of the intervention.
Providing appropriate supervision when delegating aspects of intervention to the OTA.
Being knowledgeable about the client’s occupational therapy goals.
Selecting, implementing, and modifying therapeutic activities and interventions that are consistent with demonstrated competency levels, client goals, and the requirements of the practice setting.
Intervention review Determining the need for continuing, modifying, or discontinuing occupational therapy services. Contributing to this process by exchanging information with and providing documentation to the OT about the client’s responses to and communications during intervention.
Outcome evaluation Selecting, measuring, and interpreting outcomes that are related to the client’s ability to engage in occupations. Being knowledgeable about the client’s targeted occupational therapy outcomes and providing information and documentation related to outcome achievement.
Implementing outcome measurements and providing needed client discharge resources.

Adapted from American Occupational Therapy Association: Standards of practice for occupational therapy, Am J Occup Ther 64(6):415–420, 2010.

It is important to remember that these standards are guidelines developed by the American Occupational Therapy Association (AOTA) that support the Scope of Practice for Occupational Therapy.8 They are often used by states in the formation of licensure laws and supporting regulations for occupational therapy practice. State licensure laws provide a legal definition of practice for that state and may delineate specific responsibilities for the OT and OTA related to role delineation, supervision, documentation, and advanced practice (see Chapter 5). The OT practitioner must provide services in accordance with the laws or regulations of the state in which he or she practices. Other regulatory agencies, such as the Centers for Medicare and Medicaid Services (CMS), also have regulations that supersede these guidelines.

The first standard delineates requirements related to professional standing and responsibility for all OT practitioners. Key points related to Standard I are that the OT practi-tioner: (1) deliver services that reflect the philosophical base of occupational therapy; (2) be knowledgeable about and deliver services in accordance with AOTA standards, policies, and guidelines, and state and federal regulations; (3) maintain current licensure, registration, or certification as required; (4) abide by the AOTA Occupational Therapy Code of Ethics,4 and Standards for Continuing Competence;5 (5) maintain current knowledge of legislative, political, social, cultural, and reimbursement issues; and (6) be knowledgeable about evidence-based research.6

The second standard outlines the practitioner’s responsibilities during screening, evaluation, and reevaluation. An OT accepts and responds to referrals and initiates the screening, evaluation, and reevaluation process. The OT is responsible for analyzing and interpreting the evaluation data. The OTA contributes to the process by performing assessments that have been delegated by the OT. The OTA communicates verbally or in writing to the OT his or her observations of the assessment and the client’s abilities. The OT then completes and documents the evaluation results. The OTA contributes to the documentation of the evaluation results. The OT recommends additional consultations or refers clients to appropriate sources as needed.6

Practitioner responsibilities during the intervention stage of service delivery are described in Standard III. The OT has the overall responsibility for documentation and implementation of the intervention, based on the evaluation, client goals, current best evidence, and clinical reasoning. The OTA can select, implement, and modify therapeutic activities (consistent with his or her demonstrated competency, delegated responsibilities, and intervention plan). The OT, with contributions from the OTA, modifies the intervention plan throughout the process and documents the client’s responses and any changes to treatment.6

Requirements and responsibilities related to outcomes are delineated in Standard IV. The OT selects, measures, documents, and interprets outcomes that are related to the client’s ability to engage in occupations. The OT is responsible for documenting changes in the client’s performance and for discontinuing services. A discontinuation plan or transition plan is prepared by the OT, with contributions from the OTA regarding the client’s needs, goals, performance, and follow-up services. Either practitioner facilitates the transition process in collaboration with the client, family members, and significant others. The OT evaluates the safety and effectiveness of the occupational therapy processes and interventions; the OTA contributes to this evaluation of safety and effectiveness.6

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on The Occupational Therapy Practitioner: Roles, Responsibilities, and Relationships
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