CLAS: NATIONAL CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICE STANDARDS 

The US Dept. of Health and Human Services has developed national standards to advance health equity, improve quality, and help eliminate health care disparities.

Principal Standard
Principle 1:

Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Governance, Leadership and Workforce
Principle 2:

Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.

Principle 3: 
Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.

Principle 4:
Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

Communication and Language Assistance
Principle 5:

Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.

Principle 6: 
Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

Principle 7:
Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

Principle 8:

Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability

Principle 9:

Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations.

Principle 10:

Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.

Principle 11:

Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.

Principle 12:

Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.

Principle 13:

Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.

Principle 14:

Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.

Principle 15:

Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

Resource: https://www.thinkculturalhealth.hhs.gov/clas/standards

SHARE YOUR EXPERIENCE

Read through the CLAS standards and think about what you have observed in your fieldwork site. In order to respond to the prompts below, it may be necessary to discuss this topic with your supervisor, an administrator or other resource in the organization or department to get a complete picture of how these standards are being implemented.

• Identify 2 standards you feel you can comment on based on clinical experience.

• Discuss examples of how the organization you are doing fieldwork in addresses the standard. 

• Give examples of how the OT or rehab department addresses the standard.

CULTURAL AWARENESS

Due to an increased exposure to different cultures through work, travel, community, it is necessary for us to develop a respect and appreciation for cultures different from our own. Health care workers must learn to communicate with cultural sensitivity to work effectively with clients, families, colleagues, and support personnel.

WHAT IS "CULTURE" ?

Margaret Mead described culture in the following way:

Abstractions from the body of learned behavior, which groups of people who share the same traditions transmit to their children and, in part, to adult immigrants who become members of the society. It covers the arts and sciences, religion and philosophies to which the world culture has historically applied, but also the system of technology. The political practice, the small intimate habits of daily life, such as the way of preparing and eating food, or of hushing a child to sleep as well as the method of electing a prime minister or changing the constitution.

This definition is quite inclusive and illustrates the impact a client’s culture will impact their response to illness or disability. Complex concepts do not have the same meaning in all cultures. 

Good health to someone in the US means the absence of bacteria or viruses. In China, good health means harmony between yin and yang. 

People learn to express symptoms of distress in ways that are acceptable to others in the same culture. 

In India, stress related disorders are often suspected when a client’s primary complaint is an upset stomach. In the US, stress is often associated with headaches and a great deal of advertising money is spent each year on headache relief medication.

As part of socialization, one learns that certain complaints about distress are acceptable and elicit understanding and others are unacceptable. Understanding the cultural basis for the client’s symptoms becomes more critical for accurate evaluation of the presenting problem leading to an accurate clinical diagnosis.

Individuals can experience cultural challenges in a number of situations, even when in their own country or environment. Some examples include:

• Traveling to another country 
• Meeting people of different sexual orientation 
• Talking to people of a different generation 
• Meeting others with different political views 
• Talking with people who practice a religion 

Cultural differences pose a challenge in daily life and are magnified when the individual becomes a “patient”. The health care environment is challenging, often viewed as overstimulating and fast paced. All features which can create anxiety in the best of times. The challenge is considerable when there exists a language difference between the client and the health care providers. The purpose of procedures and interventions many not be understood. Education provide to prevent recurrence may not be clear to the client. The ability to communicate symptoms or symptom relief may not be expressed by the client.

The concept of touch can be challenging for some cultures. There is a great deal of touch required to perform many therapy interventions and medical procedures. Most direct care is provided by women. This can create issues with a client whose culture perceives the role of women differently. Even the expression of pain or a lack of ability related to a condition can be perceived as weakness in some cultures and therefore the health care provider may not have all the information they need to proceed. It is obviously a complex situation to navigate and understand. 

The US began acknowledging cultural differences in 1975 with PL 94-142 and the 1986 its revision of PL 94-457 mandating public schools provide education to children from the ages of 3-21 regardless of handicap. It specified that ancillary health services (OT, PT, etc.) be provided in a “culturally competent” manner. When a majority of these health care providers are Caucasian and not bilingual, challenges exist in meeting this mandate. The lack of diversity will likely worsen as entry-level educational requirements continue to increase for these professions.

The size of the personal space or “bubble” varies by culture and situation. Many sources identify personal space is about 24” on either side, 27” in front and 16” behind for an average westerner. Americans typically have larger personal space boundaries than those from other cultures.

Under certain circumstances people can accept having their personal space entered without experiencing discomfort (i.e. crowded subways, public events, romantic encounters). In business settings people typically maintain more personal space between them in vs. in social situations. Personal space boundaries between a man and a woman usually remain larger than those between two women. People who live in highly populated areas often have a smaller area of personal space than those who live in less populated areas. People of higher status or wealth usually have a larger area of personal space.

What does this all mean to the health care provider? It illustrates the need to assess the client on a number of levels in order to be able to establish rapport and provide care. It is simply not enough to know what country the client is from and what their diagnosis is. Each client will respond differently to you, your touch and your personality. It is up to you to assess the best approach with each client by looking at them holistically and as individuals with unique needs.

UNIVERSAL ASPECTS OF HEALTHCARE

1. The health care provider applies a name to a problem.
2. The qualities of the health care provider are important.
3. The health care provider must establish credibility through the use of symbols and trappings of status that are familiar to the culture.
4. The health care provider places the client’s problems in a familiar framework.
5. The health care provider relies on a set of techniques meant to bring relief.
6. Interactions between the client and the practitioners occur at a special time and place.

CULTURE SHOCK

This is a common term used frequently when someone is “out of their element”. More seriously, it is the stress experienced when individuals cannot meet their everyday needs in a new culture as they could in their native culture. Familiar patterns of behavior learned through socialization of a culture no longer work in the new culture. The individual must observe others to learn new behaviors to become more effective in the new environment or context.

Elements of Culture  

CULTURAL COMPETENCE

This refers to the attitudes, behaviors, and policies of a system or organization in a cross-cultural situation. It is critical to recognize the importance of culture, assessment of cross-cultural relations, and understand the dynamics of cultural differences. There is a great deal of information about cultural features which can help health care providers modify the delivery of services to meet culturally unique needs.

Health professionals must be sensitive to clients’ beliefs, attitudes and behaviors regarding their illness, injury, or disability. In order for optimal healing to occur, there must be a fit between the expectations, beliefs, behaviors and evaluation of the outcome between the client and professional.

Beliefs: What people think is true

Attitudes: How people feel about something

Behavior: What people do

THE CONCEPT OF PERSONAL SPACE

We define personal space as the area surrounding an individual. Crossing or entering someone else’s personal space creates discomfort when the physical intimacy exceeds the relational intimacy. Too much space can cause discomfort and indicate rudeness as well.

NON-VERBAL COMMUNICATION

This refers to the exchange of information which does not require verbal or written forms of language. This includes gestures, facial expressions, and posturing. There are few cultural universals regarding non-verbal signals, however, all cultures have them. The therapist must avoid drawing conclusions regarding nonverbal behaviors without having more knowledge. For example, in the US, men will generally stand away from a woman when they first meet. Should the distance decrease, it will be interpreted as a sign of interest. In Latin cultures, this distance between a man and a woman when speaking does not convey a special interest.

SHARE YOUR EXPERIENCE

Think about a time when you treated a client of a different culture than yours.

• Describe ways you altered your behavior or approach in some way to make the situation more comfortable or effective.
• Describe how the session was more challenging. 
• What did you do to address these challenges.
• Discuss the effectiveness of your strategies.
• Describe what you learned about the client's culture from this encounter.

CLINICAL REASONING: PART 2

In the first part of our discussion about clinical reasoning, we explored types, stages and influences upon clinical reasoning. We also looked at what the therapist must consider and utilize in  order to be effective and make sound, clinical decisions. Now we will explore what can go wrong if the therapist is not diligent in being objective in examining data, fails to "hear" what the client is saying, and neglects to remain focused upon the needs of the client. 

CAUSES OF COMMON CLINICAL REASONING ERRORS

Pre-Assessment Hypothesis Generation

An accurate pre-assessment image (made prior to seeing the client) allows the experienced therapist to filter virtually every observation and interaction through a screen making each item on the evaluation useful in determining the client’s level of function.

Without a pre-assessment image, the inexperienced therapist is essentially without a filter. He may be aware of problem areas in the realm of perception and cognition, but have difficulty predicting how impairment will affect function and deciding upon the most effective treatment approach. If a pre-assessment image is inaccurate, and the therapist recognizes it promptly and revises plans accordingly, negative impact may be avoided or minimized.

It is important to realize that every diagnosis has a range in the severity and frequency of symptoms experienced.  The individual may have other medical issues which may impact the condition listed and their ability to cope with the situation.

Initial Assessment Hypothesis Generation

When the therapist arrives at an explanation of the nature of the disability before all the data are collected, a bias could affect how further data obtained is perceived and utilized.

As a result, contradictory cues suggesting a different hypothesis may be overlooked and important information may not come to light or may be discounted in the interpretation of the findings.

This may be attributed to the tendency to “chunk” or compartmentalize information in memory in order to remember it better. In recognizing a few items from a particular information “chunk”, a therapist may go on to assume that other elements associated with the “chunk” are present as well, leading to a clinical reasoning error.  The therapist must be vigilant in maintaining focus upon the client in front of them versus grouping that individual with others having a similar condition or situation.

The use of standardized assessment tools when possible can help ensure information is gathered uniformly and not limited to anticipated findings. Avoid relying solely on the medical record for all pertinent and accurate information as clients often look and function very differently from the way their medical diagnoses suggest they might. The hypotheses formed prior to first meeting the client must be held as just that – a hypothesis to be proven or not.

Use of a Standard Evaluation

Therapists often follow a standard client evaluation which can be useful in reducing certain types of clinical reasoning errors. However, these evaluations can’t possibly cue the therapist to symptoms or the functional consequence of a condition, particularly if the condition is a rare one.  Without a working knowledge of conditions, therapists run the risk of making clinical decisions based on information from these evaluations which is too detailed, not detailed enough, or irrelevant.

It is important to understand why the client is being referred to OT, as this will guide the direction of the evaluation vs. the evaluation form guiding the process. Become familiar with or develop functionally based assessment tools vs. those driven by diagnosis. The DC plan may be used to guide data collection for the evaluation process.

Failing to Meet Client Needs

This often occurs when activities are pulled out of a file drawer or closet and given to almost any client without much preparation, without a focus upon goals, or without direct observation of the client when completing these activities.  

This is frequently seen when clients are placed into groups to address organizational productivity needs vs. the needs of the client. When therapists rely on treatment options like these, the focus is often placed on one particular area (i.e. UE strength or ROM).The therapist fails to consider the full scope of the client’s issues, areas being addressed by other disciplines  (i.e. PT, speech). This leads to the client being asked to engage in tasks which fail to meet their needs in a meaningful way.

An experienced therapist might too easily assume that a case is “routine” and this practice is best practice or will work when planning time is short. An inexperienced therapist might be too consumed with procedural details to notice unique or intricate details of the case, or have an insufficient number of cases to compare in order to detect a difference.

The therapist must remain alert to the client’s experience of the disability to avoid this type of clinical reasoning error. It is critical for the therapist to cultivate listening skills, empathy, and appreciate most clients have a limited experience with therapy and place blind trust they are receiving what they need.

The therapist must be receptive to nonverbal cues such as the client’s level of participation in treatment and facial expressions during a particular activity. When responses are less enthusiastic than anticipated, it is important to understand why that is in terms of the client’s own values and beliefs.

Goal Conflicts

Clinical reasoning is most problematic for practitioners of all skill levels of skill when the client’s goals or wishes conflict with the practitioners’ values or with realistic societal allowances. For example, a client who sustained a TBI and now experiences seizures, wishes to return to work as a truck driver.

Clients must be active participants in goal setting to help ensure engagement in the process.  The client must “own” treatment goals in order for participation and progress to occur. Clients must be allowed to make informed choices and may require additional information for the process to be realistic. They may need additional information from the MD, RN, specialists, etc. in order to view the situation more clearly.

Abbreviated hospital stays affect the amount of time clients are given to progress to their desired level of independence and are sometimes discharged at functional levels less than hoped. Therapists’ ideas of appropriate goals to prepare for discharge within that time frame may differ from the client. Concerns exist when therapists and caregivers have many serious concerns about the client’s level of function but the client does not.

It is often necessary to identify a compromise between the therapist, client and family. Communication and respect are key components in facilitating this process. Establishing a good rapport with the client will help increase willingness to engage in the process. When negotiating common ground, the therapists must make it clear the intention is to serve the client’s best interests. The therapist should clearly state the anticipated results of therapy should the client identify unrealistic goals.

Ex. “I can’t promise the function in your arm will recover 100%. We will work towards that goal and I will help you to learn to do many of the tasks you did before in a new way.”

Mismatching Stories

This refers to the tendency of health care providers to form conclusions to the client’s story reflective of their personal beliefs vs. those of the client. Therapists use a variety of means to elicit client stories while subconsciously constructing their own descriptions regarding the client’s premorbid lifestyle, values, and occupational performance.

Understanding the client story is a dynamic process requiring the therapist to make adjustments as more information is provided by the client. When a therapist’s approach to the client does not reflect what the client is telling the therapist, trust will evaporate quickly.

When clients subscribe to unconventional beliefs and values about wellness, and how best to achieve it, it is almost inevitable stories will not match despite being compassionate and respectful. The therapist must respect the client’s experience even when cognitive deficits exist. Personal experience is no less potent to the individual with cognitive impairments than it is to anyone else.

Engaging in a brief but meaningful discussion related to how the client is feeling about their situation will help all parties remain focused on the true picture. Clarification of information and tailoring communication style to the client’s needs will go a long way to help avoid errors.

SHARE YOUR EXPERIENCE

Describe a situation where you may have misjudged a client, failed to utilize some information they gave you, or lost focus upon the client's goals. 

• What information did you have but may have discarded and why?
• What occurred that made you recognize the process had gotten off course?
• What steps did you take to get the situation back on track?

CLINICAL REASONING: PART 1

Clinical reasoning is a higher-level cognitive process required by therapists to solve complex problems and make sound decisions meet the needs of the client. The therapist must access relevant knowledge and explore past clinical experience in order to apply it effectively to the situation. 
The therapist is then able to identify the best path or direction in which to proceed with the client.

The thought process involved in clinical reasoning is unique to each therapist and situation. However, most therapists relay on data available to them, best practice knowledge, and impressions to help them. 

TYPES OF CLINICAL REASONING

Procedural Reasoning

Used when addressing the client’s disability and various means of reducing it. Also used in learning and performing actual therapy techniques. 

Examples include:

       What do I know about this diagnosis?                                            

       How does the diagnosis affect client function?

       How will team members be addressing with the client?                 

       What is the recovery process and time frame?

       What techniques work best to improve function?

Interactive Reasoning

Used to understand the client as a whole as well as to understand his illness experience. Helps to establish a sense of trust with the client.

Examples include:

       What is the client’s point of view regarding the disability?              

       What are the client’s goals?

       What is the client’s environment?                                                    

       Is the treatment going well?

Conditional Reasoning

Represents a higher level of thinking about the client within the social contexts of family, community, etc., both prior to and with the disability. It is described as “future oriented” as it enables the therapist to envision a client’s likely course following dc. 

Examples include:

       What is the client’s social environment?                                        

       Who are the “key players”?

       How does this social network support or hinder client progress?  

       What did the client do prior to the illness/injury?

       What are the client’s roles within the family, community, etc.?      

       What does the client hope to continue to do?

Narrative Reasoning

Refers to the way in which therapists talk and think about their clients. It seeks to discover the human motivations for action and relationships between events. Therapists will create and tell stories about clients as a way of developing an understanding and envisioning a future for them.

Pragmatic Reasoning

This enables the therapist to identify how other influences may affect client progress and care.  

Examples include:

       Reimbursement and time with client                                               

       Ability to provide individual vs. group treatment

       Organizational expectations for productivity and accountability    

       Staff support, family support

LEVELS OF COMPETENCE

The development of clinical reasoning skills can take many years and there exist different 
levels of competence:

Novice   

Learning the skills of assessment, diagnostics and treatment planning

Advanced Beginner  

May not see whole picture but is refining skills and picks up on additional cues

Competent  

Able to identify more clearly, determine significance of cues which contributes to a broader understanding and improved ability to individualize treatment

Proficient  

Sees the “whole”; easily able to modify plans during treatment

Expert 

Knows the rules, uses intuition and is able to rely on past clinical situations to process imagined outcomes for clients 

THOUGHT PROCESS OF CLINICAL REASONING

The following information addresses pieces of the process therapists rely upon to get to the point where they feel ready to make the best decision with examples of each to illustrate each area.

Pre-Assessment Image           

This perception is based upon the client’s age, diagnosis, gender, previous functional level. This will influence the therapist’s expectations of the client, an idea of what to expect regarding the client’s abilities and disabilities. How the therapist interprets this information will be affected by experience with clients of similar medical and demographic backgrounds.

The OTA is working with Jenny, a 32-year-old mother of 2, diagnosed with a L CVA involving the middle cerebral artery. Though the OTA never worked with such a young stroke patient, he expects this patient will gain function more quickly than an 80-year-old individual with the same diagnosis. The OTA also expects the patient will be motivated to work hard in therapy to be able to care for her children.  

Cue Acquisition             

This occurs when the therapist is engaged in the process of gathering data related to the client’s current functional status and occupational roles. It requires the therapist to use honed skills of observation, as some cues may be subtle and require further exploration.

The clinical image created based on this information guides the therapist in deciding which cues to attend to and which to disregard.

The OTA notices Jenny has a history of Type II DM, s/p a R radial fx 15 years ago, and underwent an appendectomy 7 years ago. The therapist mentally disregarded the surgical and fracture events as insignificant. The information about DM is significant however, and the OTA makes a special note of that as it will likely impact feeding and meal prep activities, as well as health management I-ADL tasks.

Hypothesis Generation       

Occurs when data are organized and assumptions made. The therapist begins to organize data into explanations for the pattern of deficits observed. Often more than one explanation is generated.

When the OTA first meets Jenny, he notices Jenny’s arm hanging off to the side of the wheelchair, she does not attempt to use it to shake his hand when he extends his hand to her, and she does not say hello but nods instead. The OTA thinks Jenny is unable to shake his hand due to abnormal tone vs a visual perceptual issue. When she does not say hello he thinks it is likely due to expressive aphasia. He does wonder if she may be depressed due to her loss of function and independence and will monitor that as he works with her.  

Cue Interpretation and Hypothesis Evaluation                       

The therapist continues to gather cues and categorize each according to the hypothesis it supports or refutes. It contributes to the identification of an action plan using best evidence as a basis for treatment and guides the next steps in the plan.

When observing Jenny wash her face, the OTA notices she only washes the left side of her face using her left hand. The OTA wonders if Jenny is doing this due to visual perceptual issues or due to hypotonicity affecting coordination…or both. He decides to incorporate some weight bearing preparatory activities before continuing with the grooming task to help normalize tone. Following this, he notices Jenny initiates using her right hand more automatically when brushing her teeth. 

Next time, we will address factors which can contribute to errors in clinical reasoning which could impact treatment outcomes.

SHARE YOUR EXPERIENCE

Describe a situation where you needed to "tease out" what was going on with a client.

Discuss the two primary options you needed to choose between in order to move forward with the patient? 

What information did you use or need to obtain to make your final decision about the best course of action?

Describe the end result and any changes you would make next time you find yourself in a similar situation.

ROLES OF THE OTA

The OTA is a vital member of the treatment team. The role of the OTA and type of involvement is influenced by:

• The scope of practice of the state services are being provided

• The competency and experience of the OTA

• Third-party payer policy

• The policy of the organization

• The relationship between the OT and the OTA

The OTA has many roles within a department. They contribute to patient care and the daily functions of a department in a variety of ways.

Evaluation and Assessment

Though the evaluation is the primary responsibility of the OT, the OTA can contribute to the evaluation process by gathering information for the occupational profile and conducting specific assessments identified by the OT.

Group Treatment

This is a common function of the OTA. The type of group being run will vary considerably based on the population being served. For example, a group may address goal setting with individuals on an inpatient mental health unit with depression. The group activity may be a gross-motor obstacle course for children with sensory processing issues. The goals and the needs of the patient influences group activity selection. Reimbursement issues can also impact the use of group activity in certain settings.

Care Conference Reporting

In many settings the OTA will attend care conference meetings and report on the progress of a patient. Many of these meetings will include a number of other professionals (i.e. teacher, MD, RN, SW, SLP, PT), family, and caregivers.

Community Outings

In some settings the OTA will be involved in organizing community outings. This might include attending a career fair with a group of at-risk teenagers; going clothing shopping with a young woman who sustained a SCI needing to learn how to manage daily tasks from a wc; going to the grocery store with a man with COPD learning how to incorporate energy conservation techniques into daily activities.

Co-Treatments

There are times it is necessary for two disciplines to work with a patient simultaneously due to the acuity of the patient’s status. This must be performed judiciously and only when absolutely necessary. It may be required when the patient’s condition is complex and another set of skilled hands and eyes are required in order for therapy to occur.

For example, OT and PT may co-treat a patient with an involved patient with a newly acquired TBI and spinal fracture in order to get the patient into a wheelchair for the first time.

Individual Treatment

This is the primary function and experience of the OTA and involves providing direct OT service to the patient. This occurs in most treatment environments and requires the OTA to have strong clinical reasoning, interpersonal, observation skills. This tends to be what most therapists identify as the most rewarding part of the job.

Inventory and Equipment Management

Though not a glamorous part of the profession, all departments must maintain inventory of supplies and the condition of equipment to ensure safety and efficiency. This is typically a function of everyone in the department though the OTA may be more directly involved in ordering equipment and following up when equipment needs to be serviced.

Family/Caregiver Training

In many clinical settings, the OTA will be involved in providing education to the patient’s family and/or caregivers. This is an important part of part of facilitating continuity of care for the patient. This requires the OTA to understand the patient’s diagnosis, goals, plan of care, and possess strong communication skills.

Home Evaluations

The OTA may go to the patient’s home to assess the environment for safety and accessibility concerns, which may affect a successful transition home.

Inservice Training

In most departments, there is the expectation all staff will contribute to the education of the department and within the organization. The OTA will also be expected to attend inservices offered.

The OTA may be involved in training a shift of CNAs on a sensory protocol to use with an elderly resident with dementia to help her remain calm. A school system may want all new teachers to learn about how OT can help students succeed in the classroom and socially.  

Participation on Committees

In many settings, committees and teams form to address need areas or improve the quality of service provided. The focus of these committees might be to improve efficiency and timeliness, address a need area identified as a result of policy change, or design new programs to offer patients, for example.

The OTA may be directly involved in these planning committees and have a direct impact on creating policy and program which could positively impact OT service delivery.

Orientation Training

The OTA may represent the OT department in new employee orientation at a departmental or organizational level. This might involve discussing the role of OT in rehab to new hires or orienting a new therapist to the rehab department.

Quality Improvement

The OTA may be involved in quality improvement functions within a department. Organizations often require each department to monitor compliance with its policies. The OTA may be involved in collecting data to assess the degree of compliance to policies in place.

This might involve reviewing documentation in client records to determine is all therapists are documenting they have reviewed the wearing schedule and care of splints with each client. A rehab department may be asked to document the amount of time they spend looking for intact equipment to justify the need for new equipment. The OTA may review incident reports addressing resident falls to explore the need for fall prevention training in the facility.

Scheduling

The OTA may be involved in scheduling his/her schedule or that of the department.

Supervision

Many OT departments work with volunteers or have student programs. The OTA may be involved in providing direction and supervision to rehab aides, volunteers, or OT/OTA students. This role will be directly related to the competency and experience of the therapist to ensure required skills are in place.  

SHARE YOUR EXPERIENCE

Please address the following questions based on your experience in the clinical site you are currently in.
Provide examples of how the OTA is involved in:

• documenting patient progress, services provided, and adherence to reimbursement requirements.

• the process of collecting information for the department’s quality improvement process.
• patient care coordination and case management activities
• transition services for patients
• advocacy for change in service delivery and policy development for the department or organization.
• addressing new practice area service provision or development
• marketing of OT service