Supervision and Delegation of Occupational Therapy Assistants and Aides
Who may do what
The supervising OT owns the occupational therapy process: initial evaluation, problem identification, goals, intervention plan, reassessment, and discharge. An OTA may implement delegated interventions, collect data, and report change; the OTA may not independently evaluate, interpret findings, set or change goals, or design the plan. An aide may perform non-skilled tasks such as transport, setup, clerical work, and inventory; an aide may not deliver skilled occupational therapy or be billed as an OTA.
Supervision in practice
Board rules set the supervision level and documentation. At minimum, supervision is not "no supervision": the OT must be available for consultation, review the plan and progress, and ensure the OTA's work stays within the delegated plan. Some tasks or settings may require direct, on-site supervision. The OT remains responsible for the service even when the OTA carries out the visit.
Worked example
An OTA sees a patient and decides to increase the resistance band because the patient tolerates it. Reasoning: if the OT's plan contains a progression parameter and delegates that decision, the OTA may follow it; if the plan does not, the OTA must contact the OT for a plan change. The OTA cannot create a new goal or independently alter the plan.
Traps
Treating an aide as an OTA; assuming a phone call once a month satisfies supervision; letting an OTA complete the initial evaluation; and failing to document supervision. The exam often tests the boundary between "implementing a delegated plan" and "making an OT decision."