OT 4.02(2)(a) (a) Screening, evaluating, developing, improving, sustaining or restoring skills in activities of daily living, work or productive activities, including instrumental activities of daily living, and play and leisure activities.
OT 4.02(2)(b) (b) Evaluating, developing, remediating, or restoring sensorimotor, cognitive, or psychosocial components of performance.
OT 4.02(2)(c) (c) Designing, fabricating or training in the use of assistive technology, upper extremity orthotic devices and lower extremity positioning orthotic devices.
OT 4.02(2)(d) (d) Training in the use of prosthetic devices, excluding gait training.
OT 4.02(2)(e) (e) Adaptation of environments and processes, including the application of ergonomic principles, to enhance performance and safety in daily life roles.
OT 4.02(2)(f) (f) Application of physical agent modalities based on a physician order as an adjunct to or in preparation for engagement in treatment. Application is performed by an experienced therapist with demonstrated and documented evidence of theoretical background, technical skill and competence.
OT 4.02 Note Note: An example of standards for evaluating theoretical background, technical skill and competence is the position paper on physical agent modalities issued by the American occupational therapy association (AOTA). AOTA may be contacted on the web at www.aota.org, and by mail at American occupational therapy association, P.O. Box 31220, Bethesda, MD 20824-1220.
OT 4.02(2)(g) (g) Evaluating and providing intervention and case management in collaboration with the client, family, caregiver or other involved individuals or professionals.
OT 4.02(2)(h) (h) Educating the client, family, caregiver, or others in carrying out appropriate nonskilled interventions.
OT 4.02(2)(i) (i) Consulting with groups, programs, organizations, or communities to provide population-based services.
OT 4.02 History History: CR 02-026: cr. Register December 2002 No. 564, eff. 1-1-03.
OT 4.03 OT 4.03 Standards of practice. Occupational therapists and occupational therapy assistants shall adhere to the minimum standards of practice of occupational therapy that have become established in the profession, including but not limited to the following areas:
OT 4.03(1) (1)Screening.
OT 4.03(1)(a)(a) An occupational therapist, alone or in collaboration with an occupational therapy assistant, when practicing either independently or as a member of a treatment team, shall identify individuals who present deficits or declines in occupational performance areas and performance components.
OT 4.03(1)(b) (b) Screening methods shall take into consideration the occupational performance contexts relevant to the individual.
OT 4.03(1)(c) (c) Screening methods may include interviews, observations, testing and records review to determine the need for further evaluation and intervention.
OT 4.03(1)(d) (d) The occupational therapist or occupational therapy assistant shall transmit screening results and recommendations to all appropriate persons.
OT 4.03(2) (2)Referral and physician orders.
OT 4.03(2)(a)(a) Evaluation, rehabilitation treatment, and implementation of treatment with individuals with specific medical conditions shall be based on an order from a physician, dentist or podiatrist.
OT 4.03(2)(b) (b) Referrals may be accepted from advanced practice nurses, chiropractors, optometrists, physical therapists, physician assistants, psychologists, or other health care professionals.
OT 4.03(2)(c) (c) Although a referral is not required, an occupational therapist or occupational therapy assistant may accept a referral for the purpose of providing services which include consultation, habilitation, screening, client education, wellness, prevention, environmental assessments, and work-related ergonomic services.
OT 4.03(2)(d) (d) Physician orders shall be in writing. However, oral referrals may be accepted if they are followed by a written and signed order by the referring physician within 72 hours from the date on which the client consults with the occupational therapist or occupational therapy assistant.
OT 4.03(2)(e) (e) Physician order or referral from another health care provider is not required for evaluation or intervention if an occupational therapist or occupational therapy assistant provides services in an educational environment, including the child's home, for children and youth with disabilities pursuant to rules promulgated by the federal individuals with disabilities education act, the department of public instruction and the department of health services, or provides services in an educational environment for children and youth with disabilities pursuant to the code of federal regulations.
OT 4.03(3) (3)Evaluation.
OT 4.03(3)(a)(a) The occupational therapist directs the evaluation process upon receiving a physician order or referral from another health care provider. An occupational therapist alone or in collaboration with the occupational therapy assistant shall prepare an occupational therapy evaluation for each individual referred for occupational therapy services. The occupational therapist interprets the information gathered in the evaluation process.
OT 4.03(3)(b) (b) The evaluation shall consider the individual's medical, vocational, social, educational, family status, and personal and family goals, and shall include an assessment of how occupational performance components and occupational performance contexts influence the individual's functional abilities and deficits in occupational performance areas.
OT 4.03(3)(c) (c) Evaluation methods may include observation, interviews, records review, and the use of structured or standardized evaluative tools or techniques.
OT 4.03(3)(d) (d) When standardized evaluation tools are used, the tests shall have normative data for the individual's characteristics. If normative data are not available, the results shall be expressed in a descriptive report. Collected evaluation data shall be analyzed and summarized to indicate the individual's current status.
OT 4.03(3)(e) (e) Evaluation results shall be documented in the individual's record and shall indicate the specific evaluation tools and methods used.
OT 4.03(3)(f) (f) Evaluation results shall be communicated to the referral source and to the appropriate persons in the facility and community.
OT 4.03(3)(g) (g) If the results of the evaluation indicate areas that require intervention by other health care professionals, the individual shall be appropriately referred or an appropriate consultation shall be requested.
OT 4.03(3)(h) (h) Initial evaluation shall be completed and results documented within the time frames established by the applicable facility, community, regulatory, or funding body.
OT 4.03(4) (4)Program planning.
OT 4.03(4)(a)(a) The occupational therapist is responsible for the development of the occupational therapy intervention plan. The occupational therapist develops the plan collaboratively with the client, and may include the occupational therapy assistant and team working with the client, including the physician – as indicated.
OT 4.03(4)(b) (b) The program shall be stated in measurable and reasonable terms appropriate to the individual's needs, functional goals and prognosis and shall identify short and long term goals.
OT 4.03(4)(c) (c) The program shall be consistent with current principles and concepts of occupational therapy theory and practice.
OT 4.03(4)(d) (d) In developing the program, the occupational therapist alone or in collaboration with the occupational therapy assistant shall also collaborate, as appropriate, with the individual, family, other health care professionals and community resources; shall select the media, methods, environment, and personnel needed to accomplish the goals; and shall determine the frequency and duration of occupational therapy services provided.
OT 4.03(4)(e) (e) The program shall be prepared and documented within the time frames established by the applicable facility, community, regulatory, or funding body.
OT 4.03(5) (5)Program implementation.
OT 4.03(5)(a)(a) The occupational therapy program shall be implemented according to the program plan previously developed. The occupational therapist may delegate aspects of intervention to the occupational therapy assistant dependent on the occupational therapy assistant's demonstrated and documented service competency.
OT 4.03(5)(b) (b) The individual's occupational performance areas and occupational performance components shall be routinely and systematically evaluated and documented.
OT 4.03(5)(c) (c) Program modifications shall be formulated and implemented consistent with the changes in the individual's occupational performance areas, occupational performance components and occupational performance contexts.
OT 4.03(5)(d) (d) All aspects of the occupational therapy program shall be routinely and systematically reviewed for effectiveness and efficacy.
OT 4.03(6) (6)Discontinuation of services.
OT 4.03(6)(a)(a) Occupational therapy services shall be discontinued when the individual has achieved the program goals or has achieved maximum benefit from occupational therapy.
OT 4.03(6)(b) (b) A comparison of the initial and current state of functional abilities and deficits in occupational performance areas and occupational performance components shall be made and documented.
OT 4.03(6)(c) (c) A discharge plan shall be prepared, consistent with the services provided, the individual's goals, and the expected prognosis. Consideration shall be given to the individual's occupational performance contexts including appropriate community resources for referral, and environmental factors or barriers that may need modification.
OT 4.03(6)(d) (d) Sufficient time shall be allowed for the coordination and effective implementation of the discharge plan.
OT 4.03(6)(e) (e) Recommendations for follow-up or reevaluation shall be documented.
OT 4.03 History History: CR 02-026: cr. Register December 2002 No. 564, eff. 1-1-03; correction in (2) (e) made under s. 13.92 (4) (b) 6., Stats., Register November 2011 No. 671.
OT 4.04 OT 4.04 Supervision and practice of occupational therapy assistants.
OT 4.04(1)(1) An occupational therapy assistant must practice under the supervision of an occupational therapist. Supervision is an interactive process that requires both the occupational therapist and the occupational therapy assistant to share responsibility for communication between the supervisor and the supervisee. The occupational therapist is responsible for the overall delivery of occupational therapy services and shall determine which occupational therapy services to delegate to the occupational therapy assistant or non-licensed personnel based on the establishment of service competence between supervisor and supervisee, and is accountable for the safety and effectiveness of the services provided.
OT 4.04(2) (2) Supervision of an occupational therapy assistant by an occupational therapist shall be either close or general. The supervising occupational therapist shall have responsibility for the outcome of the performed service.
OT 4.04(3) (3) When close supervision is required, the supervising occupational therapist shall have daily contact on the premises with the occupational therapy assistant. The occupational therapist shall provide direction in developing the plan of treatment and shall periodically inspect the actual implementation of the plan. The occupational therapist shall cosign evaluation contributions and intervention documents prepared by the occupational therapy assistant.
OT 4.04(4) (4)
OT 4.04(4)(a)(a) When general supervision is allowed, the supervising occupational therapist shall have direct contact with the occupational therapy assistant and face-to-face-contact with the client by every tenth session of occupational therapy and no less than one time per calendar month. Direct contact with the occupational therapy assistant is for the purpose of reviewing the progress and effectiveness of treatment and may occur simultaneously or separately from the face-to-face contact with the client.
OT 4.04(4)(b) (b) The occupational therapist shall record in writing a specific description of the supervisory activities undertaken for each occupational therapy assistant. The written record shall include client name, status and plan for each client discussed.
OT 4.04(4)(c) (c) "Direct contact" means face-to-face communication or communication by means of telephone, electronic communication, or group conference.
OT 4.04(5) (5) Close supervision is required for all rehabilitation, neonate, early intervention, and school system services provided by an entry level occupational therapy assistant. All other occupational therapy services provided by an occupational therapy assistant may be performed under general supervision, if the supervising occupational therapist determines, under the facts of the individual situation, that general supervision is appropriate using established professional guidelines.
OT 4.04 History History: CR 02-026: cr. Register December 2002 No. 564, eff. 1-1-03; CR 08-050: am. (3), renum. (4) to be (4) (a) and am., cr. (4) (b) and (c) Register January 2009 No. 637, eff. 2-1-09.
OT 4.05 OT 4.05 Supervision of non-licensed personnel and therapy aides.
OT 4.05(1)(1) An occupational therapist or occupational therapy assistant must provide direct supervision of non-licensed personnel at all times. Direct supervision requires that the supervising occupational therapist or occupational therapy assistant be on premises and available to assist.
OT 4.05(2) (2) When an occupational therapist or occupational therapy assistant delegates to non-licensed personnel maintenance or restorative services to clients, the occupational therapist or occupational therapy assistant must be in the immediate area and within audible and visual range of the client and the non-licensed personnel.
OT 4.05(3) (3) An occupational therapist or occupational therapy assistant may delegate to non-licensed personnel only non-skilled, specific tasks which are neither evaluative, assessive, task selective nor recommending in nature, and only after ensuring that the non-licensed person has been appropriately trained for the performance of the task.
OT 4.05(4) (4) Occupational therapists and occupational therapy assistants must exercise their professional judgment when determining the number of non-licensed persons they can safely and effectively supervise to ensure that quality care is provided at all times. A limit of 2 is recommended.
OT 4.05(5) (5) Any duties assigned to non-licensed personnel must be determined and appropriately supervised by an occupational therapist or occupational therapy assistant and must not exceed the level of training, knowledge, skill and competence of the individual being supervised. The licensed occupational therapist or occupational therapy assistant is responsible for the acts or actions performed by any non-licensed person functioning in the occupational therapy setting.
OT 4.05(6) (6) An occupational therapist or occupational therapy assistant may delegate to non-licensed personnel duties or functions other than maintenance or restorative services to the clients, including but not limited to the following services:
OT 4.05(6)(a) (a) Transportation of clients.
OT 4.05(6)(b) (b) Preparation or setting up of treatment equipment and work area.
OT 4.05(6)(c) (c) Attending to clients' personal needs during treatment.
OT 4.05(6)(d) (d) Clerical, secretarial or administrative duties.
OT 4.05(7) (7) Duties or functions that an occupational therapist or occupational therapy assistant may not delegate to non-licensed personnel include, but are not limited to, the following:
OT 4.05(7)(a) (a) Interpretation of referrals or prescriptions for occupational therapy services.
OT 4.05(7)(b) (b) Evaluative procedures.
OT 4.05(7)(c) (c) Development, planning, adjusting or modification of treatment procedures.
OT 4.05(7)(d) (d) Acting on behalf of the occupational therapist or occupational therapy assistant in any matter related to direct client care which requires judgment or decision making.
OT 4.05 History History: CR 02-026: cr. Register December 2002 No. 564, eff. 1-1-03.
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