Supervision and Delegation of Assistants and Aides
Who may do what
The OT assistant performs occupational therapy services under the supervision of a licensed OT, implementing the intervention plan the OT developed. Aides or unlicensed personnel perform non-skilled, supportive tasks and may not deliver skilled OT services or make clinical decisions. The central exam concept is that the OT retains responsibility for the evaluation, the plan, and the outcomes; the assistant carries out and reports.
Supervision concepts
Know the distinction between direct (on-site, in-person) and indirect (available by phone or other means) supervision, and that the level required depends on the setting, client acuity, and the assistant's competence. Supervision is not merely paperwork: it includes observation, consultation, and review of the assistant's work. A frequent trap is a scenario where the assistant "updates the plan" or "discharges the client" - those are OT responsibilities.
Delegation traps
- Delegating an initial evaluation to an assistant.
- Letting an aide perform a skilled transfer or modality while the OT is off-site.
- Assuming supervision frequency is fixed by rule alone, ignoring client-specific factors.
- Confusing supervision of an assistant with supervision of a student; the requirements differ.
Rule of thumb
If the task requires clinical judgment, interpretation of findings, modification of the plan, or discharge decisions, it stays with the OT. If the task is carrying out an established plan or non-skilled support, it may be delegated within supervision requirements.