Supervision and Delegation: OT–OTA Relationships, Supervision Levels, and Documentation
Supervision and delegation test the OT–OTA relationship: who evaluates, who implements, who documents, and how much oversight is required. The exam expects you to protect the OT's accountability even when tasks are shared.
Role boundaries
The OT completes the initial evaluation, interprets findings, establishes goals and the plan of care, selects interventions, and makes discharge decisions. The OTA implements delegated interventions, collects data, and contributes to documentation. An OTA may not independently evaluate, interpret standardized assessment results, or change the plan. Unlicensed aides may perform only non-skilled tasks and do not become OTAs by experience.
Supervision levels and documentation
Direct supervision means the supervising OT is on-site and immediately available. General supervision means the OT is available by phone or other telecommunication and provides periodic on-site oversight. The required level depends on client acuity, setting, task complexity, and the OTA's competence. Documentation must identify the OT's plan, the OTA's interventions and client response, and the OT's review. The OT signs or co-signs as required by the setting and Board rules.
Worked example
An OT delegates a transfer-training session to an OTA. The OTA notices new shoulder pain and wants to change the plan to strengthening. The OTA may document the pain, stop or modify within delegated parameters, and contact the OT. The OT must reassess and revise the plan; the OTA cannot independently add a new goal.
Traps
Do not say an OTA 'supervises' the OT. Do not treat delegation as transferring liability; the OT remains accountable. Do not let an aide perform a skilled intervention simply because the aide is experienced.