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Occupational Therapy Standards of Practice – Flashcards

Paula Corcoran

7 July 2022

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Payers note that services received by the client must be

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skilled and medically necessary for services to be reimbursed

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CARE

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Clarity Accuracy Relevance Exceptions

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Occupational Profile

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The initial step in the evaluation process that provides an understanding of the client's occupational history and experiences, patterns of daily living, interests, values, and needs. The client's problems and concerns about performing occupations and daily life activities are identified, and the client's priorities are determined

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COAST method for writing goals

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C- client O-occupationa A- Assistance level S- Specific conditions T- Timeline

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SOAP format for progress notes

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S- subjective information from client O- objective information from intervention session, such as measurements, observable data, and any quantifiable data such as goniometric or strength measurements A- Assessment; includes OT's interpretation or analysis of the information of the previous sections of the note, therapist's judgement P- Plan; includes the estimated frequency and duration of OT services, anticipated intervention strategies to be used. Should relate to previous sections of note

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DAP format for notes

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Description Assessment Plan (similar to SOAP, except S and O sections are collated together into the D section)

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Narrative format for notes

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May include pertinent information in a logical order of the writer's choosing but not is a specific format as in SOAP or DAP notes

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BIRP format for notes

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B- behavior of client I- intervention provided R- Response of client to intervention P- plan for continued intervention

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PIRP format for notes

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P- purpose or reasons or intervention I- intervention provided R- Response of client to intervention P- plan for continued intervention

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SIRP format for notes

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S- situation I- intervention provided R- Response of client to intervention P- plan for continued intervention

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OASIS

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Outcome Assessment Information Set -Must have for home health clients who have medicare or medicaid This assessment helps provide guidance for the services the client requires and helps determine the client's eligibility to receive home health and helps determine payment for services

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Family Educational Rights and Privacy Act of 1974

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this act "identifies the confidentiality requirements of a student's educational record", including occupational therapy documentation completed on students

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Medicare Part A

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Hospital Insurance part of medicare

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Medicare Part B

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Supplementary Medical insurance part of medicare. It covers some of the costs for outpatient care, such as physician visits and occupational therapy services, some home health services, and some supplies and equipment -Generally, most people pay a premium each month to cover the cost of Medicare Part B. -Medicare Part B covers 80% of the cost for medically necessary outpatient physical therapy, occupational therapy and speech-language pathology. The client pays any deductible not met and 20% of the Medicare-approved costs

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Outpatient Occupational therapy Payment

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Is based on the Medicare Physician Fee Schedule, which takes into account CPT codes used during the provision of services -Medicare Part B-covered OT services are not to exceed a certain dollar amount or "cap" for services.

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Durable Medical Equipment (DME)

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defined as "reusable medical equipment such as walkers, wheelchairs, or hospital beds" Medicare generally covers 80% of the approved cost of DME, and the client pays the remaining 20%

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Medicare Part C

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is the Medicare Advantage Plan "offered by a private company that contracts with Medicare"

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Medicare Part D

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added "prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans

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TRICARE

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is part of the Military Health System and provides "coverage for active-duty service members, retirees, their families, survivors, and certain former spouses"

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Medicaid

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The general eligibility requirement is income under a certain level general eligibility and coverage vary state to state. People with disabilities are eligible in every state. Medicaid covers "early and periodic screening, diagnosis, and treatment for people younger than 21 years of age (which includes access to OT)

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State Children's Health Insurance Program (CHIP)

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funded by both federal and state governments, but administered by each state CHIP provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage

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Individuals With Disabilities Education Act

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is a law ensuring services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities

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IDEA Part B

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covers children and young adults with disabilities ages 3-21

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IDEA Part C

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Covers infants and toddlers ages 0-2

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The Medicare Catastrophic Coverage Act

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allows related services, such as medically necessary physical or occupational therapy to be billed to Medicaid through the school system under certain circumstances

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Anti-kickback statute

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This statute "makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program." Violators may have to pay fines may be imprisoned, or both.

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HMO

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a prepaid organized delivery system where the organization and the primary care physicians assume some financial risk for the care provided to its enrolled members

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PPO

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the people who belong to it are able to go directly to a specialist without going through the primary care physican

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POS health care system

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similar to some of the HMOs, but it sometimes allows people to refer themselves to physicians who do not belong to the network

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Dynamical Systems Theory (DNS)

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DNS is an "analysis of systems or organizations that change." This theory is said to be "based upon chaos, complexity, and dynamical systems"

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Chaos Theory

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The theory relates to mathematics and discusses how minute changes can cause large outcomes or effects

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Complexity Theory

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The theory involves the "knowledge and understanding that transcend linear systems to include a multifaceted worldview"

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Transformational leadership

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a stye of leadership characterized by motivating others to reach their highest potential and providing inspiration to others to work effectively together to meet the goals of the organization or group

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Transactional Leadership

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a leadership style in which leaders clarify role and task requirements and provide followers with positive and negative rewards contingent on successful performance

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Paralinguistics

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the study of nonverbal communication

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Kinesics

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relates to body language

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Proxemics

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the study of space, including the use of personal space during communication

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Dyad

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related to in-person communication with a second person

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Resolving Conflicts Evidence-based strategies for resolving conflicts:

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1. Encourage active communication 2. Use "I" statements 3. Use effective listening 4. Use joint problem solving 5. Achieve a solution mutually agreeable to all 6. Stay positive 7. Avoid uncontrolled emotions 8. Comment on the idea rather than attacking people personally 9. Try to come to a resolution 10. Stay focused on the topic at hand 11. Be aware of nonverbal communication

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Four key ways to assist with organizational change

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-Recognize when change needs to occur -Take steps to plan for the needed change -Begin to implement the change - Spend time evaluating the change and the results of the change

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The rationale for continuing competence is as follows

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-It reduces the risk of providing ineffective or harmful services to clients - It improves client quality of care - It improves job promotion opportunities - It facilitates personal professional growth - It meets regulations and requirements (36 hours professional development units every 3 years to maintain certification)

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State regulatory boards for occupational therapy

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may also require licensure, certification, or registration to provide occupational therapy services in the state

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License renewal

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State regulatory boards also require OT practitioners to renew their license, certification, or registration at specific intervals. One condition of renewal often required relates to continuing competency.

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NBCOT certification renewal

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NBCOT certification allows occupational therapy practitioners to use its certification marks (OTR/COTA). Occupational therapy practitioners are not requires by NBCOT to rectify. However, if practitioners choose not to rectify, their credentials would be change to OT and OTA. Occupational therapy practitioners should verify whether their state regulations mandate NBCOT renewal to practice in the state

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Disciplinary Actions

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State regulatory boards are responsible for ensuring the safety of consumers and discipling practitioners for ethical or practice issues.

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National Provider Identifier (NPI)

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This unique number consists of 10 digits, and each health care provider and practitioner who bills for services must obtain one

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Health Information Privacy

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OT practitioners must take care to protect the identifiable health information of consumers. HIPAA regulations gives consumers the right to obtain or review their medical records and limits disclosure of information

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Joint COmmission

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The purpose of this accrediting body is "to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." -The commission assesses accrediting on a voluntary basis for hospitals or certain other health care entities

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CARF International

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This organization is "an independent, nonprofit organization focused on advancing the quality of services you use to meet your needs for the best possible outcomes"

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Americans with Disabilities Act (ADA)

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-prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications -Under ADA, businesses of 15 or more employees are requires to provide reasonable accommodations

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Strategies for reducing malpractice risk and reducing the risk of harm to clients include the following elements:

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-ensuring staff are providing adequate supervision for those who need it -Educating employees and staff in methods to keep their clients safe from harm and encouraging continuing education related to safety -Having employees perform a peer review of other's occupational therapy treatment sessions -Documenting occupational therapy sessions accurately and in a timely manner -Using effective communication between occupational therapy practitioners and clients and treating occupational therapy clients with respect

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Anti- Kickback Statute

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is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business.

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Stark Law

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Physician self-referral is the practice of a physician referring a patient to a medical facility in which he has a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics of the practice allege an inherent conflict of interest, given the physician's position to benefit from the referral. They suggest that such arrangements may encourage over-utilization of services, in turn driving up health care costs. In addition, they believe that it would create a captive referral system, which limits competition by other providers.

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False Claims Act

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also called the "Lincoln Law" is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal Government's primary litigation tool in combating fraud against the Government Persons filing under the Act stand to receive a portion (usually about 15-25 percent) of any recovered damages. As of 2012, over 70 percent of all federal Government FCA actions were initiated by whistleblowers. Claims under the law have typically involved health care, military, or other government spending programs, and dominate the list of largest pharmaceutical settlements.

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Strategic Planning

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The process of ensuring that an organization's current purpose, aspirations, goals, activities, and strategies connect to plans and support its mission

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Mission

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An organization's core, underlying purpose, or basis for its existence, focus, and actions

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Vision

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The ideal state or ultimate level of achievement to which and organization aspires

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SWOT analysis

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A process that identifies and analyzes the organization's strengths and weaknesses and describes the opportunities and threats that may have an impact on its ability to grow and prosper Strengths Weaknesses Opportunities Threats

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Cash Flow

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The monetary flow of the organization (money that comes into the organization and that is used by the organization for expenses)

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Budget

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A specific way to allocate where the organization's money is spent, how much money is allotted for various expenses, and the money that comes into the organization

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Startup costs

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The costs associated with opening a business

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Operational costs

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The ongoing costs of operating the business (e.g., utilities, rent, equipment)

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5 primary steps in evidence-based practice

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1. develop a question to study 2. Peruse and search the literature for evidence 3. Critically evaluate the evidence that is found 4. Apply the research findings to practice 5. evaluate the implementation of the research to practice

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Levels of Evidence

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Level I: Randomized controlled trials Level II: Cohort Studies Level III: Case control studies Level IV: Case report Level V: Other

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Marketing involves 4 main strategies

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Product Price Location of Services Promotion or communication of product's information to consumers

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Education for All Handicapped Children Act of 1975

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This legislation provided "equal access to education for children with physical and mental disabilities"

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Individuals with Disabilities Education Act of 1990

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This legislation provided for services for those younger than 3 years old

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Americans with Disabilities Act of 1990

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This legislation provided rights to people with disabilities

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Health Insurance Portability and Accountability Act

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This legislation protects consumers' private health information

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Balanced Budget Act of 1997

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This legislation, along with several others, resulted in changes to the reimbursement of occupational therapy and related services under Medicare

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Patient Protection and Affordable Care Act of 2010

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This piece of legislation is also known as health care reform. It creates many changes in the health care system that will be phased in over several years

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Program Evaluation

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Examines the therapeutic process and forms the basis for program improvements

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Continuous Quality Improvement

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A management process that evaluates the arrangement of people, equipment, and procedures in a series of tasks intended to repeatedly produce a desired end result

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Reliability

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indicates how well an assessment produces consistent scores over time and across raters. Several different types of reliability exist (intrarater, interrater, etc.)

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Validity

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indicates the degree to which an assessment measures what it states it measures. Several types of validity exist (e.g., content, construct)

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Methods to establish service competency include

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-direct supervision, such as "observation or cotreatment, return demonstration of techniques or skills, review of documentation, testing for knowledge and its application, and discussion of cases to ascertain clinical reasoning and judgement

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Direct supervision

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face-to-face and includes observation, modeling, cotreatment, discussions, teaching, and instruction

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Indirect Supervision

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occurs by phone or written or typed communication and receiving feedback amor others (clients and their family members, other staff members)

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A client who is currently receiving occupational therapy services has become unemployed and lost access to health care insurance. The treating OTR®; has received permission to provide pro bono services to ensure that the client continues on the path to recovery. What ethical principle likely informed the OTR's decision in this situation? A. Veracity B. Justice C. Fidelity D. Autonomy

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The principle of justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement for clients. The client lost access to occupational therapy services as a result of the structure of health care insurance and its link to employment, so the occupational therapist made a decision to facilitate the client's access to a needed resource.

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A client did not attend the occupational therapy session because of an illness. According to the Guidelines for Documentation of Occupational Therapy, what is the BEST type of documentation to note nonattendance in a timely manner? A. Reassessment report B. Service contact C. Plan of care D. Monthly progress report

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Service contact would be the best type of documentation because it can be completed as soon as the nonattendance occurs.

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An OTR®; who passed the initial NBCOT exam has decided not to be recertified through NBCOT. Which consequence will result from the OTR's decision? A. The OTR will not be allowed to practice occupational therapy in the United States. B. The OTR's practice opportunities and credentials will remain unchanged. C. The OTR may practice occupational therapy in a state that does not require certification, but the OTR's credentials will change to OT. D. The OTR may practice occupational therapy in a state that does not require certification, and the OTR's credentials will remain unchanged.

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NBCOT recertification is not required for occupational therapists, and some states allow occupational therapists to practice without being recertified by NBCOT; however, choosing not to renew NBCOT certification means a change in credentials from OTR to OT.

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An OTR® working at an outpatient clinic receives a physician's order for occupational therapy evaluation and intervention for a new client. After the OTR® completes the evaluation, which billing codes for services are appropriate to put into the documentation system? A. International Classification of Diseases (ICD) B. CPT™ C. Children's Health Insurance Program (CHIP) D. The Diagnostic and Statistical Manual of Mental Disorders (DSM)

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CPT codes are used to denote procedures and services completed in the outpatient setting.

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According to the Scope of Practice, which BEST describes an intervention strategy consisting of instructing a client in one-handed homemaking strategies? A. Health promotion B. Maintenance C. Prevention D. Compensation

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One-handed home making techniques are generally considered compensatory strategies because the person would be learning to compensate for the inability to use both hands for homemaking.

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An OTR®; has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the OTR says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the OTR has violated an ethical principle and wants to discuss the matter with the OTR after the meeting concludes. Which principle will the team member discuss with the OTR in relation to the OTR's comment? A. Beneficence B. Autonomy C. Justice D. Fidelity

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The principle of fidelity requires that an OTR treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the OTR has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams."

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According to the Occupational Therapy Practice Framework, which of the following elements is part of the domain of occupational therapy? A. Occupational profile B. Habits, routines C. Intervention plan D. Outcomes

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Habits and routines fall under the domain of occupational therapy.

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Which phrase BEST depicts a client factor, according to the Occupational Therapy Practice Framework: Domain and Process? A. Communication and interaction skills B. Home management abilities C. Neuromusculoskeletal functions D. Personal habits and routines

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Neuromusculoskeletal functions falls under the broad category of client factors in the Framework. Explanations of Incorrect Answers A: Communication and interaction skills are performance skills rather than client factors. B: Home management abilities fall under the areas of occupation. D: Personal habits and routines fall under the category of performance patterns.

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An OTR®; is conducting a cooking group for people with schizophrenia. During the group, one of the clients tells the OTR, "I've seen some people from the government watching me this week." Where and how should the OTR document this information in a SOAP note? A. The OTR should document the client's statement in the S section of the note. B. The OTR should include the client's statement as data from the treatment session in the O section of the note. C. The OTR should include the client's statement as part of the treatment session evaluation in the A section of the note. D. The OTR should use the client's statement as the basis of future treatment planning in the P section of the note.

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The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience.

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According to the Standards of Practice for Occupational Therapy, which of the following is a requirement to practice as an OTR® in the United States? A. Completing licensure, certification, or registration requirements B. Passing state licensure examination for occupational therapists C. Graduating from a private occupational therapy program D. Successfully finishing an independent fieldwork experience

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Some states require licensure, some require certification, and some require registration for practicing as an OTR®.

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An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the specific conditions (or S) under which this client is supposed to complete the occupation? A. The client will complete the occupation in the hospital's kitchen with adaptive equipment. B. The client will complete the occupation at home with no adaptive equipment. C. The client will complete the occupation at a community transitional facility using modified techniques. D. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques.

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Because no specifications are given for adaptive equipment or modified techniques and the client is attending a predischarge hospital cooking group, it is appropriate to assume that the client will not require special conditions for the completion of this goal and that the occupation will be completed in the hospital's kitchen.

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A student occupational therapist arrives at a facility for Level II fieldwork and discovers that the OTR®; supervisor has to take an unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. What options does the student have for appropriate fieldwork supervision at that facility? A. The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. B. The student may be supervised by an OTR who works at another facility. C. The student may be supervised by an entry-level COTA who works at another facility. D. The student cannot complete fieldwork at the facility because adequate supervision is not available.

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A Level II fieldwork student may be supervised only by an OTR with more than 1 year of experience. Because an OTR with sufficient experience is not available to supervise the fieldwork student onsite, the student cannot complete fieldwork at the facility.

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An OTR® completes an intervention session with a client and documents it using the SOAP note format. In which section would the OTR® write "Client is making excellent progress toward goals and has met short-term goal 1"? A. O B. S C. P D. A

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A stands for the assessment part of the SOAP note. The data were interpreted by the OTR®, who used professional judgment to determine the progress the client made toward the goals.

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A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is performing a screening before initiating the evaluation. Which is the MOST likely reason for completing the screening? A. To complete the occupational profile and become acquainted with the client B. To meet the client and conduct a standardized interview before the evaluation C. To complete the assessments to save time during the evaluation process D. To identify whether the client may benefit from occupational therapy services

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The purpose of a screening is to determine whether a client would benefit from an occupational therapy evaluation or services. Explanations of Incorrect Answers The other three options would be completed during the evaluation process.

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Which strategy is MOST appropriate strategy for resolving conflicts in the workplace? A. Listening effectively when others are speaking B. Using emotions during the conversation C. Commenting on staff's strengths and weaknesses D. Describing how the conflict will be resolved

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Listening effectively helps ensure that each person feels heard and understands what others are saying.

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Which is the BEST example of an occupational therapy client population according to the Occupational Therapy Practice Framework? A. People who have arthritis B. A group of people C. A school system D. A health club

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People with arthritis are considered a group of people who have similar problems (arthritis) and can be considered an occupational therapy client population. Explanations of Incorrect Answers B: This does not meet the definition of population, because it does not describe a specific group of people within the community. C, D: These are considered organizational clients rather than a population, because they are businesses.

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A COTA® has established service competency for administration and scoring of the Mini-Mental State Examination. Which supervision is the MOST APPROPRIATE for the OTR® to provide? A. Close supervision on an ongoing basis to ensure maintenance of service competency B. Minimal supervision to periodically recheck that service competency is maintained C. Supervision on an as-needed basis per the COTA®'s request to fine-tune service competency D. None, unless otherwise indicated by the facility, state law, or licensing changes

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B. Minimal supervision to periodically recheck that service competency is maintained Once service competency is established, the supervising OTR® should periodically recheck to ensure maintenance.

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An OTR®; is developing a professional development plan. The OTR has identified personal needs for growth after completing a self-assessment. What step should the OTR take NEXT in developing the professional development plan? A. Review progress toward current professional development goals and objectives. B. Determine available resources for meeting goals and objectives. C. Determine what learning needs to occur. D. Set new goals for professional development. Submit Answer

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C. Determine what learning needs to occur. The steps in developing a professional development plan are to (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities. Thus, after identifying personal needs for growth by means of a self-assessment, the next step an OTR would take would be to determine what learning needs to occur.

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Which legislation provided rights to children and adults with disabilities? A. Patient Protection and Affordable Care Act (2010) B. Americans With Disabilities Act of 1990 C. Health Insurance Portability and Accountability Act of 1996 D. Individuals With Disabilities Education Act of 1990

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The Americans With Disabilities Act is legislation granted rights to people with disabilities to prevent and avoid discrimination

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Which statement BEST describes how a COTA® assists with performing an occupational therapy evaluation? A. The COTA® may perform delegated assessments and provide reports of a client's capabilities to the OTR®. B. The COTA® is not legally allowed to contribute to any part of the evaluation process. C. The COTA® may perform the chart review and report findings and any initial observations of the client to the OTR®. D. The COTA® may analyze the standardized and nonstandardized test results and translate those results to help with goal setting.

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A. The COTA® may perform delegated assessments and provide reports of a client's capabilities to the OTR®. According to AOTA's Guidelines for Supervision, Roles, and Responsibilities, the OTR® performs the evaluation and directs all parts of the evaluation process. The COTA® may contribute to the evaluation process by performing delegated assessments and delivering reports of observations and client capacities to the OTR®. The OTR® analyzes the feedback from the COTA® and incorporates that information into the evaluation process.

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A COTA® who spent 2 years working on the orthopedics unit of an acute care hospital is now working on the neurological floor. How is appropriate supervision BEST described? A. The OTR® and COTA® decide to set up supervisory visits on an as-needed basis. B. The COTA® requires minimal supervision owing to his or her 2 years of experience C. The OTR® and COTA® agree that close supervision is best at this time. D. The OTR® and COTA® decide that continuous supervision is needed.

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More frequent supervision may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed as a result of changes in work demands, such as in caseloads or populations served. In this case, a COTA® who has experience working with patients with orthopedic conditions may require more close supervision when working with clients with myriad health conditions.

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A COTA® is shifting roles within a skilled nursing facility to become the manager of the therapeutic recreation department. In which way does supervision from the OTR® change? A. Supervision is no longer needed. B. Supervision is on an as-needed basis. C. The OTR® and COTA® meet monthly to discuss clients. D. The OTR® and COTA® meet quarterly to discuss clients.

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A. Supervision is no longer needed. Because of their training and education, COTA®s are often well equipped to handle other careers, such as managing a therapeutic recreation department. Because this position does not entail providing occupational therapy services, supervision from an OTR® is not needed.

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An OTR®; has gone out on a date with a client that the OTR is still treating. A colleague of the OTR finds out about the date and wants to report the incident as a breach of ethics. What ethical principle will the OTR be reported as violating? A. Beneficence B. Autonomy C. Justice D. Nonmaleficence

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The principle of nonmaleficence requires that occupational therapy professionals refrain from behavior that could cause harm. The well-being of the client could be jeopardized by a personal relationship with the OTR, which by its nature cannot be therapeutic. The example in the question is about professional boundaries and the objective recommendations or actions by the OTR that could be influenced by a dual relationship. Dual relationships with clients are inappropriate and unethical, whether they are romantic in nature or simply involve taking on a family member as a client.

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An OTR®; is supervising an occupational therapy student for Level II fieldwork. The OTR comments that the student did not gather complete information regarding a client's occupational history. Which student response is appropriate? A. "How can my occupational histories be more comprehensive?" B. "I respectfully disagree with your opinion." C. "I did the best I could to be thorough." D. "I thought I asked the client the questions you told me to ask."

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A. "How can my occupational histories be more comprehensive?" Receiving feedback requires being open to the ideas that are presented, asking for clarification, acknowledging mistakes, and avoiding becoming defensive. This response suggests openness to feedback and a willingness to seek solutions and make changes in the future.

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A newly certified OTR® wants to provide occupational therapy coverage on an "as-needed basis" at a medical center burn unit. What should the OTR® expect the facility to provide in order to promote continuity of care for these services based on best practice standards? A. Funds to attend professional development classes to learn about evidence-based burn care B. Availability of burn-care protocols currently used for patients with thermal injuries C. Options for establishing service competence for completing clinically based processes and procedures on the unit D. Written communication from the primary therapist in advance of the coverage date outlining patient care routines

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C. Options for establishing service competence for completing clinically based processes and procedures on the unit Service competency will support that the newly certified OTR® and existing practitioners in the burn unit are performing functions similarly and achieving the same outcome.

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Under what circumstances is a COTA® allowed to administer the Kohlman Evaluation of Living Skills to a new patient in an inpatient acute psychiatric hospital? A. After an OTR® has directed the COTA® to initiate the evaluation process B. When the OTR® is unavailable to administer the assessment C. When the OTR® is in the room while the COTA® administers the assessment D. When the COTA® has demonstrated competence in administering the assessment to the OTR®

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D. When the COTA® has demonstrated competence in administering the assessment to the OTR To administer an assessment, a COTA® must demonstrate to the supervising OTR® competence in administering the specific instrument. The supervising OTR® is responsible for ensuring that the COTA® is competent in each task he or she is directed to carry out. Explanations of Incorrect Answers A: The OTR® initiates the evaluation and directs the COTA® to complete components of the evaluation, such as administering an assessment. B: The COTA® is permitted to administer an assessment as long as the OTR® has initiated the evaluation and the COTA® has demonstrated competence in administering the specific assessment. C: Direct, full-time, in-sight supervision is not mandated under AOTA supervisory guidelines.

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An OTR®; is worried that occupational therapy services will not be approved by a third-party payer for a particular client. Given previous experiences with the third-party payer and knowledge of what services the payer typically allows, the OTR omits some information from the documentation so that the client's services appear more reimburseable. What ethical principle has the OTR violated by adjusting the documentation in this way? A. Beneficence B. Veracity C. Justice D. Nonmaleficence

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The principle of veracity requires that the OTR provide accurate and objective information in representing the work of the profession. Veracity requires timely, accurate documentation of services provided. Any deviation is both unethical and illegal. The OTR's license may also be in jeopardy.

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An OTR® is presenting an inservice to case managers about the benefits of occupational therapy for patients who have respiratory disorders. What should be the PRIMARY focus of this presentation? A. Differences between occupational therapy and respiratory therapy B. Specific occupational therapy protocols for patients who have respiratory disorders C. Revenue-generating potential of occupational therapy services D. Impact of occupational therapy services on patients' abilities to function at home

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D. Impact of occupational therapy services on patients' abilities to function at home Presenting intervention outcomes is important in establishing program justification such as expanding occupational therapy services to include patients who have respiratory disorders.

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A client is wearing a splint secondary to having had a flexor tendon repair of the third and fourth digits 2 weeks ago. The client is registered to compete in a motorcycle race during the upcoming weekend. The client informs the OTR® that the splint must be removed in order to properly grasp the motorcycle's hand clutch. What INITIAL action should the OTR® take in this situation? A. Schedule a follow-up appointment for the week following the race to reassess the client's status. B. Discharge the client from occupational therapy due to noncompliance with the post-surgical protocol. C. Fabricate a temporary splint for the patient to use during the motorcycle race. D. Explain the consequences of the client's decision on the overall post-surgical outcomes.

answer

D. Explain the consequences of the client's decision on the overall post-surgical outcomes. Clients have the ultimate responsibility for decisions about their daily needs, and occupational therapy services and the practitioner can help the client make an informed decision.

question

An OTR®; is supervising an occupational therapy student for Level II fieldwork. The OTR notices that the student did not gather complete information regarding a client's occupational history. Which comment BEST represents effective feedback from the supervising OTR regarding this error? A. "You missed some information when you were recording the client's occupational history." B. "In the future, you need to ask better questions about the client's occupational history." C. "In the future, you may want to use a checklist to ensure that your occupational history interviews are comprehensive." D. "You should practice doing occupational history interviews."

answer

C. "In the future, you may want to use a checklist to ensure that your occupational history interviews are comprehensive." Effective feedback is descriptive and specific rather than evaluative and general. This feedback provides specific information about the problem (a lack of comprehensiveness) and also offers a description of how to solve the problem in future attempts (by using a checklist).

question

What law allows in-school occupational therapy services to be provided? A. Individuals With Disabilities Education Improvement Act of 2004 (IDEA), Part B B. Medicare Part C C. Health Insurance Portability and Accountability Act of 1996 (HIPAA) D. TRICARE

answer

IDEA provides for special services, including occupational therapy, to be provided to children with disabilities in the school.

question

A COTA® working on an inpatient rehabilitation unit has had two patients fall in the past month. The supervising OTR® has concerns about the COTA®'s safety awareness during certain interventions. Which approach is the BEST for the OTR® to take to address these concerns? A. Speak with the rehabilitation manager about possible disciplinary action. B. Review the documentation of the two patients who fell and discuss their cases thoroughly with the COTA® to determine the causes of the falls. C. Ask the COTA® whether more thorough supervision is needed and then proceed to provide close supervision. D. Collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback.

answer

D. Collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback. Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary. Explanations of Incorrect Answers A: This unnecessary step would put the COTA®'s job at risk; more appropriate solutions exist before going to this type of extreme measure. B, C: These approaches offer more indirect supervision; moreover, C is not appropriate because whether the COTA® says yes or no, more supervision is warranted because of the OTR®'s safety concerns.

question

The Resident Assessment Instrument, part of the Minimum Data Set, is completed in which practice setting as part of Medicare's requirement? A. Hospice B. Outpatient C. Skilled nursing facility D. Hospital

answer

Completing the instrument is part of the Medicare regulations for skilled nursing facilities.

question

A client with hip osteoarthritis has been referred for an occupational therapy assessment and treatment. What can the OTR® have a COTA® contribute to the assessment and treatment process? A. Identify whether the client will need occupational therapy. B. Decide which evaluations should be completed. C. Select and implement therapeutic activities. D. Interpret from the outcome whether client is able to engage in occupations.

answer

COTA®s can select and implement therapeutic activities that meet client goals.

question

An entry-level COTA® begins working at a long-term care facility and needs direct continuous supervision. Which statement BEST describes this type of supervision? A. The COTA® and supervising OTR® are in the rehabilitation gym, and the OTR® observes the COTA®'s performance. B. The COTA® and OTR® meet at the end of each day to discuss the COTA®'s caseload and review documentation. C. The supervising OTR® is in the facility but in another area. D. The COTA® e-mails or texts the OTR® questions throughout the day as needed, and the OTR® reviews the COTA®'s documentation regularly.

answer

A. The COTA® and supervising OTR® are in the rehabilitation gym, and the OTR® observes the COTA®'s performance. Direct supervision offers the COTA® firsthand information on the COTA®'s performance as a result of in-person observation. Continuous supervision means the COTA® is in sight of the supervising OTR®.

question

According to the Standards of Practice for Occupational Therapy, which of the following tasks is within the standards of practice for a COTA®? A. Contributes to intervention plan modification. B. Documents evaluation results. C. Determines when services should be discontinued. D. Revises intervention plan.

answer

A. Contributes to intervention plan modification. The COTA® is able to contribute to modification of the plan, can document intervention, and can select and implement intervention.

question

An OTR®; is looking for evidence to support a new mental health intervention. In searching the literature, the OTR finds several pieces of Level IV evidence but no evidence at Levels I, II, or III about the intervention. What can the OTR conclude about the evidence regarding the efficacy of the new mental health intervention? A. The literature contains enough evidence to justify the efficacy of the intervention. B. The literature does not contain enough evidence to justify the efficacy of the intervention. C. The literature does not contain the level of evidence necessary to justify the efficacy of the intervention. D. The literature contains the level of evidence necessary to justify the efficacy of the intervention.

answer

C. The literature does not contain the level of evidence necessary to justify the efficacy of the intervention. The levels of evidence are as follows: Level I, systematic reviews, meta-analyses, and randomized controlled trials; Level II, two-group, nonrandomized studies (cohort, case controls); Level III, one-group, nonrandomized studies (pretest-posttest designs); Level IV, descriptive studies that analyze outcomes (single-subject and case designs); and Level V, case reports and narrative literature reviews. Only evidence at Level I and Level II can make claims about efficacy. Because the literature review found only Level IV evidence, the OTR cannot draw conclusions about the efficacy of the new mental health intervention under consideration. Explanations of Incorrect Answers A, B: Whether enough evidence exists to support the efficacy of the intervention is irrelevant. The literature review did not yield any Level I or II evidence, which are the only levels of evidence that address efficacy. Thus, the OTR's conclusion should relate to the type (level) of evidence found through the literature review. D: The literature review did not yield the correct type (level) of evidence needed to make claims about the intervention's efficacy.

question

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which sentence represents the MOST measurable formulation of the occupation (or O) element of this goal? A. "The client will cook an entrée and side dish." B. "The client will cook an entrée using a four-step recipe." C. "The client will cook chicken soup." D. "The client will cook independently."

answer

B. "The client will cook an entrée using a four-step recipe." The occupation element of the goal should contain specific and measurable information that relates to the problem statement written for the client.

question

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the assist level (or A) needed for this client? A. The OTR intends for the client to complete the occupation with moderate assistance. B. The OTR intends for the client to complete the occupation independently. C. The OTR has not clearly communicated the assist level. D. The OTR intends for the client to complete the occupation with minimal assistance.

answer

C. The OTR has not clearly communicated the assist level. The assist level must include information about the physical and verbal assistance the client requires to complete the occupation. As written, this goal does not include such information.

question

An OTR®; is conducting a cooking group for people with schizophrenia. The OTR writes the following information in a progress note after a treatment session: "Paranoia and delusions continue to limit the client's independent living skills. Client remains unable to move through a task from beginning to end without being distracted by delusional thoughts." Where in a SOAP note would the OTR document this information? A. In the S section B. In the O section C. In the A section D. In the P section

answer

The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session. Explanations of Incorrect Answers A: The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. B: The O, or objective, section records measurable data obtained during the treatment session. D: The P, or plan, section outlines the frequency and duration of continued treatment for the client.

question

Which of the following statements about occupational therapy fieldwork is accurate? A. A health care professional other than an OTR® can supervise occupational therapy students on Level I fieldwork. B. Payers are not able to regulate the supervision of occupational therapy students. C. Initial suggested supervision for Level II occupational therapy students is indirect. D. An OTR® or COTA® can supervise an occupational therapy Level II fieldwork student.

answer

According to the ACOTE® guidelines, other health care professionals can supervise Level I occupational therapy students.

question

According to the Standards of Practice for Occupational Therapy, which BEST describes the role of the COTA® in client outcomes? A. Develops a transition plan. B. Contributes to discontinuation plan. C. Reduces the intensity of services. D. Interprets achieved outcomes.

answer

The COTA® is able to contribute information to a discontinuation plan but is unable to independently discontinue a client from occupational therapy services. Discontinuation falls under the role of the OTR®.

question

Which type of payer provides health coverage for the military? A. Children's Health Insurance Program B. TRICARE C. Medicare D. Federal Employees Health Benefit Program

answer

TRICARE provides health coverage for the military.

question

An OTR®; is conducting a cooking group for people with schizophrenia. The OTR writes the following information in a progress note after a treatment session: "Client participated in a 60-minute group cooking session in the hospital kitchen to address attention and task completion secondary to delusional thinking." Where in a SOAP note would the OTR document this information? A. In the S section B. In the O section C. In the A section D. In the P section

answer

The O, or objective, section records measurable data obtained during the treatment session. Explanations of Incorrect Answers A: The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. C: The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session. D: The P, or plan, section outlines the frequency and duration of continued treatment for the client.

question

The Children's Health Insurance Program provides coverage for which group of people? A. Children who are disabled and are able to be mainstreamed into a regular school classroom B. Children and families whose income is too high for Medicaid but too low to afford private insurance C. Children whose parents are disabled and are unable to work and therefore afford health insurance D. Children ages 0-3 who are disabled and living in a long-term care residential facility

answer

The Children's Health Insurance Program covers children and families who are unable to afford private insurance but unable to qualify for Medicaid because their income is too high.

question

A COTA® has been assigned to treat a new patient. The OTR® has evaluated this patient but has not yet written the necessary documentation for review. How should the COTA® proceed? A. Do not treat the patient and document in the chart that intervention is on hold pending completion of the evaluation. B. Review the chart to understand the patient's condition and ask the patient what needs to be addressed as part of treatment. C. Cotreat with the physical therapist to gain information on reason for admission and special issues, and document accordingly. D. Discuss with the OTR® reason for admission, precautions, and goals, and proceed, documenting the supervisory visit.

answer

D. Discuss with the OTR® reason for admission, precautions, and goals, and proceed, documenting the supervisory visit. The COTA® may not proceed with intervention implementation until the COTA® has a conversation with the OTR® to learn more about the patient. To choose appropriate therapeutic activities and interventions and modify them as needed, the COTA® must be knowledgeable about the client's goals. In the documentation, the COTA® should describe the discussion with the evaluating OTR® that occurred before treatment. Explanations of Incorrect Answers A: Skipping the treatment session could affect billing or reimbursement for the site and is unfair to the patient, who is expecting treatment. B, C: The COTA® must have specific supervision from the evaluating OTR® before proceeding with treatment.

question

An OTR® who supervised an occupational therapy assistant student in the student's final Level II fieldwork in an acute psychiatric hospital hires the student for a COTA® position. The student plans to sit for the NBCOT® exam in 2 weeks. How should the OTR® supervise this new employee? A. Supervise the new employee as a COTA®/L because the employee has completed all courses and fieldwork B. Always provide direct, face-to-face supervision for the new employee C. Supervise the employee consistent with national and state guidelines on uncertified employees D. Ask the new employee to initiate an occupational therapy assessment

answer

C. Supervise the employee consistent with national and state guidelines on uncertified employees Only after passing the NBCOT® examination can an occupational therapy assistant use the COTA® designation.

question

An OTR®; is reviewing electronic client charts before a group treatment session. While reviewing the charts, the OTR receives an urgent phone call and must leave the computer station momentarily. How can the OTR ensure that the charts remain protected during the OTR's absence from the computer? A. Minimize the chart windows. B. Turn off the computer's screen. C. Cover the chart windows with other program windows. D. Close the chart windows and log off the computer.

answer

D. Close the chart windows and log off the computer. The Health Insurance Portability and Accountability Act requires that documentation be kept confidential and accessible only to individuals who are involved in a client's treatment. Even during a brief absence, charts should be returned to their original secure location if there is any possibility that another person may come into contact with them.

question

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® conducts the evaluation and begins to formulate the client's goals. Which short-term objective would be MOST appropriate for improving independence in homemaking? A. Client will demonstrate one-handed homemaking techniques to the therapist in 5 days. B. Therapist will teach client five one-handed homemaking techniques for meal preparation. C. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. D. Using an adaptive cutting board, client will peel and cut up five vegetables.

answer

C. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. This answer includes all the components necessary for a measurable goal (client, measurement, what client will achieve, condition required to achieve the goal, and how long it will take the client to achieve the goal). Explanations of Incorrect Answers A: This goal is missing the measurement aspect of the objective. B: This item would be part of the intervention plan rather than a goal. D: This goal is missing the assistance level and the estimated time it will take for client to achieve the goal.

question

What is the primary focus of the Joint Commission? A. Researching new methods of intervention B. Improving health care services C. Relicensing OTR®s and COTA®s D. Identifying an organization's strengths and weaknesses

answer

B. Improving health care services The Joint Commission's focus is more on improving health care services by facilitating effective and safe services.

question

Which part of original Medicare covers stays at hospitals and inpatient rehabilitation facilities? A. A B. D C. B D. C

answer

Medicare Part A covers stays at these facilities. Explanations of Incorrect Answers B: Medicare Part D added a prescription drug benefit and is not part of original Medicare. C: Medicare Part B is part of original Medicare but covers outpatient care. D: Medicare Part C or Medicare Advantage is not part of original Medicare.

question

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which phrase represents the MOST measurable formulation of the client (or C) element of this goal? A. "The client will complete all steps of cooking a meal." B. "The client will understand how to cook a meal." C. "The client will know how to cook a meal." D. "The client will do all parts of cooking a meal."

answer

A. "The client will complete all steps of cooking a meal." Goals should describe what a client will be able to do after successful occupational therapy intervention. Accordingly, goals should be written using measurable action verbs such as demonstrate, perform, and complete.

question

A supervising OTR® hires two newly graduated COTA®s who have different learning styles. One prefers visual learning, and the other prefers a more hands-on approach. Which approach is the BEST way for the OTR® to supervise both COTA®s? A. Demonstrate tasks and have both COTA®s return the demonstration. B. Provide written instructions and protocols and discuss them. C. Have both COTA®s role-play clinical scenarios. D. Have one COTA® perform new tasks and the other observe.

answer

D. Have one COTA® perform new tasks and the other observe. This approach best addresses the different learning styles of each COTA®; the COTA® who prefers kinesthetic learning can perform the new task and the visual learner can observe

question

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is determining the appropriate intensity of therapy services for this client. Which intensity is MOST appropriate? A. 3 times per week B. 45-minute sessions C. 4 weeks D. Once a month

answer

B. 45-minute sessions This answer is the only one that relates to intensity. Explanations of Incorrect Answers A, B, D: These answers relate to frequency or duration rather than intensity.

question

An OTR®; is treating a client for agoraphobia and feels frustrated that the client is not making faster progress. The OTR discusses the client's case with a work colleague over lunch at a fast-food restaurant. The OTR does not use the client's name but does verbalize verbatim statements made by the client. What can you conclude about the ethical nature of the OTR's conversation? A. The OTR behaved ethically: Confidentiality was preserved by omitting the client's name, and the OTR shared information only with a colleague who also works at the treatment facility. B. The OTR did not behave ethically: Confidentiality was not preserved, because the OTR shared specific details in a public place without the client's permission. C. The OTR behaved ethically: By seeking feedback from a colleague without mentioning the client by name, the OTR demonstrated a desire to find solutions that would enable successful treatment. D. The OTR did not behave ethically: By seeking feedback from a colleague in a public location instead of a private one, the OTR did not preserve confidentiality.

answer

B. The OTR did not behave ethically: Confidentiality was not preserved, because the OTR shared specific details in a public place without the client's permission. Ethical standards, as well as the Health Insurance Portability and Accountability Act, prohibit the sharing of confidential information regardless of the form of communication. Principle 6A of the Occupational Therapy Code of Ethics (2015) states that "occupational therapy personnel shall preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws." Information sharing is only permissible between people who have decision-making responsibilities or when the OTR believes that a client is in imminent danger.

question

In which practice setting is the Outcome and Assessment Information Set (OASIS) completed to help identify the payer for services? A. Home health B. Skilled nursing facility C. Psychiatric hospital D. Outpatient

answer

OASIS is a form that helps provide information about reimbursement of services in a home health setting.

question

An OTR®; wants to find an evidence-based rationale for using a sensory integration intervention with at-risk youths. What must the OTR do FIRST to construct an evidence base for practice? A. Access available databases to search the literature for evidence regarding sensory integration and at-risk youths. B. Evaluate whether peer-reviewed articles from five journals support using a sensory integration intervention with at-risk youths. C. Develop a question to guide a literature search for information regarding a sensory integration intervention with at-risk youths. D. Apply existing evidence about sensory integration to practice with at-risk youths.

answer

The first step in systematically integrating research evidence into practice is writing an "answerable" question that can guide a literature review.

question

An OTR® has just begun working on the cardiology unit of an acute care hospital and will be responsible for supervising the COTA® who has been on this unit for 5 years. What is the BEST type of supervision for this COTA®? A. Continuous B. Minimal C. Routine D. Close

answer

B. Minimal The COTA® has been working on the unit for 5 years and likely sees very similar types of patients. Therefore, the COTA®'s knowledge and professionalism likely do not require frequent supervision.

question

An OTR® working at an outpatient clinic receives a physician's order for occupational therapy evaluation and intervention for a new client. During the first appointment with the OTR®, the client asks, "Will Medicare pay for this?" How should the OTR® answer? A. Medicare Part B covers 80% of allowable costs after the yearly deductible. B. Medicare Part B covers 20% of allowable occupational therapy services. C. Medicare Part A covers 100% of allowable services after the deductible. D. Medicare Part A covers 50% of the allowable amount for the services.

answer

Medicare Part B covers 80% of the occupational therapy services in outpatient settings after the yearly deductible.

question

An OTR® is providing consultative services to develop a new occupational therapy department as part of a comprehensive rehabilitation program for a rural regional medical center. When reviewing the impact of the macroenvironment on the organization, what MUST the OTR® consider? A. Local and national legislative acts and regulatory policies that affect service delivery models B. Internal resource availability, and service delivery goals of the organization C. Corporate culture, supply availability, and organizational staffing policies that relate to quality care D. Organization's vision statement, governance, and internal auditing processes and procedures

answer

A. Local and national legislative acts and regulatory policies that affect service delivery models The macroenvironment includes the external environment including policy, funding, and political services that impact provision of services.

question

Believing that treatment was not medically necessary, a third-party payer has denied payment for occupational therapy services. What step should the OTR®; take to appeal the denial of payment? A. Write an appeal letter that explains the client's need for the occupational therapy services that were provided. B. Correct technical errors in previously submitted documentation. C. Write an appeal letter that requests reconsideration of previously submitted documentation. D. Ask the payer whether a different intervention would better fit the payment guidelines.

answer

A. Write an appeal letter that explains the client's need for the occupational therapy services that were provided. If the client's treatment was medically necessary, an OTR's appeal letter should describe and explain the rationale for providing services. The letter should also include a direct request to overturn the decision to deny payment.

question

An OTR® is working in an outpatient setting and observes a COTA® setting up electrical stimulation on a patient with a significant cardiac history, including a pacemaker. What action should the OTR® take? A. Discuss the situation with the COTA® after the session to learn the rationale for performing this treatment. B. Alert the rehabilitation manager to the situation at the OTR®'s earliest convenience. C. Stop the COTA® from proceeding, check the evaluation and treatment plan and, if needed, review physical agent modalities and appropriate use. D. Ensure that the COTA® is using the proper settings and frequency.

answer

A pacemaker is a contraindication for using electrical stimulation. Thus, this treatment is inappropriate and should be stopped immediately. Perhaps the COTA® misread the evaluation and treatment plan or did not have the appropriate understanding of physical agent modalities; therefore, supervision around this area should occur.

question

A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish service competency? A. Review the COTA®'s documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discuss the outcomes with the COTA®. B. Observe the COTA® educate clients on how to use adaptive feeding equipment to ensure the COTA® instructs clients in the same manner as would the OTR®. C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. D. Collect information from various sources, including other therapists, the COTA®'s documentation, and feedback from clients, to determine competency.

answer

C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR® would and achieves the same outcomes" (Youngstrom, 2009, p. 943). In this example, both the COTA® and OTR® observe the same client performing a task and rate that performance in a similar manner. Comparing outcomes helps to ensure clients receive care of equal quality.

question

A COTA® decides that a client has returned to the previous level of function and continued occupational therapy services are no longer needed. Which is the BEST way to discharge this client? A. The COTA® sets a last treatment day, provides a home exercise program, and reviews progress with the patient while completing the discharge note. B. The COTA® alerts the OTR®, and the OTR® reviews the documentation, discusses the patient's progress and response to intervention, and collaborates on a last treatment day. C. The COTA® notifies the OTR®, who meets with the patient to discuss potential discharge from therapy, and the OTR® proceeds with the discharge. D. The COTA® sets a last treatment day, provides a home exercise program and home safety packet, and reports final notes on functional levels to the OTR®.

answer

B. The COTA® alerts the OTR®, and the OTR® reviews the documentation, discusses the patient's progress and response to intervention, and collaborates on a last treatment day. The OTR® judges a client's need to continue, modify, or stop occupational therapy services, based on information and documentation from the COTA® about the client's feedback and performance during the intervention process. This choice best depicts the roles of the COTA® and OTR® in the discharge planning process. Explanations of Incorrect Answers A, D: It is inappropriate for the COTA® to discharge a patient without first collaborating with the OTR®. The OTR® is ultimately responsible for determining the need for continuing or discontinuing occupational therapy services. C: The COTA® provides valuable input into the client's readiness.

question

What MUST be addressed as part of the intervention plan for children who meet eligibility for services under the mandates of the Individualized Family Service Plan (IFSP) component of the Individuals With Disabilities Education Act (IDEA, Part C)? A. Needs of both the child and the family B. Rationale for providing one-on-one sessions C. Activities for achieving curriculum-based goals D. Reasonable accommodations beneficial to the child

answer

A. Needs of both the child and the family The IFSP must contain what services (including frequency, intensity, and method of delivery) are needed to meet the needs of the infant or child and family.

question

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." How should the timeline (or T) part of this goal be modified to be made MORE measurable? A. It should specifically reference the anticipated discharge date. B. It should list the number of weeks in which the goal should be accomplished. C. It should list the number of sessions that are sufficient to address the goal. D. It does not need to be modified.

answer

A. It should specifically reference the anticipated discharge date. It is appropriate to have a long-term goal reference discharge for the timeline; however, the specific discharge date needs to be included.

question

An extremely agitated patient is admitted to an inpatient psychiatric hospital late on a Friday afternoon. Because nursing is short staffed, the nurse on the unit requests that the patient attend an occupational therapy group being led by a COTA® that evening. The COTA® calls the OTR®, who is working at a location far from the unit, for guidance. The OTR® is unable to return to the unit in time to evaluate the client before the session. What is the BEST course of action the OTR® should direct the COTA® to take? A. Allow the patient to attend the group B. Do not allow the patient to attend the group C. Cancel the group and evaluate the client D. Allow the patient to attend the group with the understanding that the OTR® will complete the evaluation on returning to the unit

answer

The COTA® is not permitted to initiate treatment of a client; the OTR® must do the initial assessment of the client. Allowing the patient to attend a group session would be an ethics violation and liability risk.

question

A COTA® in an acute rehabilitation facility has been working with a client for four consecutive sessions. The COTA® learns that the client has two cats at home for which the client is the sole caregiver. Which option BEST describes the COTA®'s role in making pet care a goal? A. The COTA® can write this IADL goal into the next progress note and alert the OTR® to the change in the plan of care. B. The COTA® cannot add a goal once the evaluation has been completed. C. The COTA® can discuss this possible IADL goal with the OTR® to determine its appropriateness and how to address it as an intervention. D. The COTA® can write this IADL goal into the daily treatment note and update the OTR® on the addition.

answer

C. The COTA® can discuss this possible IADL goal with the OTR® to determine its appropriateness and how to address it as an intervention. Ultimately, the OTR® is responsible for creating the intervention plan, but the OTR® and COTA® partner with the client to develop this plan. After the evaluation is completed, new information may arise, such as learning that a client is responsible for pet care at home. The COTA® has valuable client-centered information that can help to adjust the intervention plan in a meaningful way.

question

Why is it important to review the validity of an assessment tool before using it? A. It identifies whether two OTR®s using the tool with a particular client would have the same results. B. It determines the extent to which the tool measures what it is intended to measure. C. It measures the amount of change that occurs over a period of time in an individual. D. It describes the outcomes that would be achieved by using specific intervention strategies.

answer

The validity of a tool indicates whether the tool actually measures what it is expected to measure.

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