A COTA� who passed the initial NBCOT exam has decided not to be recertified through NBCOT. What events will result from this decision?
The COTA may practice occupational therapy in a state that does not require certification, but the COTA's credentials will change to OTA.
NBCOT recertification is not required for occupational therapy assistants, and some states allow occupational therapy
A COTA� working at an outpatient clinic begins to provide occupational therapy intervention for a new client that the OTR� evaluated yesterday. During the first intervention session with the COTA�, the client asks, "Will Medicare pay for this?" How should
Medicare Part B covers 80% of allowable costs after the yearly deductible.
A COTA® is conducting a cooking group for people with schizophrenia. The COTA 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 rema
The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session.
A COTA® is writing a professional development plan. The COTA has identified personal needs for growth after completing a self-assessment. What step should the COTA take NEXT in developing the professional development plan?
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) asce
A COTA® 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 During a team meeting that includes the client, the COTA says that the physical therapist is using outdated approaches that are ineffective. One o
Fidelity: requires that a COTA treat other professionals with respect, discretion, and integrity.
- Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, r
Which of the following statements about occupational therapy assistant fieldwork is accurate?
According to the ACOTE� guidelines, other health care professionals can supervise Level I occupational therapy students.
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 the COTA� to review. How should the COTA� proceed?
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
A client who is currently receiving occupational therapy services has become unemployed and lost access to health care insurance. The COTA® works with the OTR�; to explore the options of providing pro bono services to ensure that the client continues
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
A COTA® receives a small thank-you gift from a client at the end of the client's treatment session. The COTA still has several treatment sessions left with this particular client. The COTA does not report receiving the gift because the gift seems too
Justice: requires that occupational therapy professionals provide services in a consistent and unbiased manner and report all gifts as directed by employer, state, and federal guidelines.
-Principle 4J of the Occupational Therapy Code of Ethics (2015) sta
An OTA student arrives at a facility for Level II fieldwork and discovers that the planned OTR�; supervisor has to take an unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. The student asks the COTA about
An OTA Level II fieldwork student may be supervised only by an OTR or COTA with more than 1 year of experience. Because neither an OTR nor a COTA with sufficient experience is available to supervise the student onsite, the student cannot complete fieldwor
Believing that treatment was not medically necessary, a third-party payer has denied payment for occupational therapy services. What step should the COTA® take to appeal the denial of payment?
None; appealing payment decisions is outside the scope of practice for COTAs.
Although a COTA may assist with documentation, appeals for payment of services must be written by an OTR�; or a representative of the treatment facility.
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?
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 before the COTA� is directed to ca
A COTA� is working toward service competency for adaptive feeding equipment instruction. How would an OTR� BEST establish service competency for the COTA�?
Compare outcomes by rating the same client's performance with the adaptive feeding equipment.
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 th
An OTR�; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal b
Having a long-term goal reference discharge for the timeline is appropriate; however, the specific discharge date should be included.
A COTA� has been teaching visual scanning techniques to a patient who has a CVA. When documenting progress, what information is BEST to include in the Objective section of a SOAP note?
The Objective section provides concise information that reports what was observed and what occurred in the session
-reporting the assistance levels and the techniques used for dressing is appropriate for the Objective section.
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?
Because of their training and education, COTAs 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� i
According to the Occupational Therapy Practice Framework, which of the following elements is part of the domain of occupational therapy?
Habits and routines fall under the domain of occupational therapy.
Which phrase BEST depicts a client factor, according to the Occupational Therapy Practice Framework: Domain and Process?
Neuromusculoskeletal functions falls under the broad category of client factors in the Framework.
A supervising OTR� hires two newly graduated COTAs 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 COTAs?
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.
Which statement BEST describes how a COTA� assists with performing an occupational therapy evaluation?
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 deliv
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 th
The purpose of a screening is to determine whether a client would benefit from an occupational therapy evaluation or services.services
A COTA� has been working on the cardiology unit of an acute care hospital for 5 years. An OTR� has just begun working on the cardiology unit and will be responsible for supervising the COTA�. What is the BEST type of supervision for this COTA�?
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.
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 formulat
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
An OTR�; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal b
Because the goal contains no specifications for adaptive equipment or modified techniques, it is appropriate to assume that the client will not require special conditions for the completion of this goal. Given that the client is attending a predischarge h
A COTA® 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 COTA omits
Veracity: requires that the COTA 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 COTA's license
A COTA® observes that another occupational therapy staff member at the same facility seems to provide more resources to clients of a particular ethnic background. The COTA does not share this observation with the supervising OTR�;. By not reporting t
Justice: requires fair, equitable, and appropriate treatment of clients and other individuals and groups with whom occupational therapy practitioners interact.
- Justice requires the impartial consideration and consistent following of rules to generate un
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?
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 rol
An OTR�; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The COTA® is assisting the OTR in writing the following goal for one group member using the COAST method: "The client will cook a meal b
Cook an entr�e using a recipe that has four steps."
The occupation part of the goal should contain specific and measurable information that relates to the problem statement written for the client.
Medicare
Federal program initiated in 1965 as part of the Social Security Act
covers most adults 65+; some people with disabilities younger than 65 and people who have end-stage renal disease
Reimbursement for OT services is Medicare Part A, B and C
Medicare A
the "hospital insurance"
-it covers part of the expenses for inpatient stays in hospitals, short-term stays at skilled nursing facilities, hospice, and some services in home health.
Medicare B
considered the "supplementary medical insurance"
-it covers some of the costs for outpatient care, such as physician visits and OT services, some home health services and some supplies and equipment
Medicare C
is the Medicare Advantage Plan "offered by a private company that contract with Medicare
Medicare D
added "prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee for Service Plans, and Medicare Medical Savings Account Plans
Medicaid
this program involves a partnership with the state and federal government. Specific requirements for eligibility and coverage vary from state to state
it covers services provided in nursing facilities, including OT for individuals age 21 and older
A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services." Which principle is this statement part of
Principle 1, Beneficence, involves the commitment to benefit others and to be concerned with the well-being and safety of service recipients.
A COTA� continues to work with and charge for services with a client after all goals are met and there is no further need for occupational therapy services. The supervising OTR� discovers this and meets with the COTA to explain why this behavior is unethi
Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services.
-Beneficence hold personnel accountable to integrity for goals related to treatment.
-Principle
When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions?
Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission.
A participant in a research study who has provided informed consent tells the COTA� that she wants to withdraw. Which ethical principles require the COTA to bring the conversation to the attention of the primary investigator (PI)?
The ethical principle of Autonomy relates to the participant's right to end any participation in a research study for any reason.
- Informed consent in research allows a person to stop participating in a research study. Because the COTA is not the PI, the
To ensure appropriate and professional management of ethical complaints, what does the AOTA Ethics Commission strive to do?
Confidentiality guidelines are set and strictly enforced by the Ethics Commission and are applied to all parties involved in the complaint.
A COTA� has discontinued occupational therapy services with a client. A month after the completion of services, the client and the COTA see each other unexpectedly at the local grocery store. They both express interest in dating the other person. They sta
Principle 2:
-Nonmaleficence, states that occupational therapy personnel shall intentionally refrain from actions that cause harm.
-Principle 2C states that practitioners shall avoid engaging in any sexual relationship or activity with recipients of servi
What principle of the Occupational Therapy Code of Ethics (2015) guides occupational therapy practitioners to accurately represent their credentials, qualifications, education, experience, and training to all service recipients, students, employees, resea
Principle 5, Veracity, requires accurate representation of credentials, qualifications, education, experience, and training in all forms of communication
Which role is the AOTA Ethics Commission charged with?
Issuing advisory opinions is one of several roles the AOTA Ethics Commission is charged with.
A client with Parkinson's disease has experienced a significant decrease in participation in activities in the home. The initial evaluation from the OTR� states that this decrease in activity is related to the client's postural instability and the caregiv
Use of specific cueing methods and clear verbal and visual instructions may facilitate improved motor movements for activity participation.
A client is expressing concern about an intervention that is being used in the occupational therapy plan. What actions should the COTA� take in this situation?
-Occupational therapy practitioners have an obligation to clearly explain interventions that are being provided and to explore available alternative options.
-All available interventions must have risk and benefits explained within reason. Information pro
An OTR� in a skilled nursing facility is responsible for upholding applicable Medicare regulations during supervision of the COTA�. Which ethical principle is the OTR upholding in this situation?
The OTR is upholding the principle of Justice, which requires occupational therapy practitioners to be aware of policies set by regulatory agencies, such as the Centers for Medicare and Medicaid Services. An OTR must provide appropriate supervision for OT
Which client factor is likely affected in a client in the hospital-based setting with Guillain-Barr� syndrome?
Because of the painful sensations that are intially reported with Guillain-Barr� syndrome, the client's tolerance for tactile input and current sensory abilities will likely influence interventions with the client.
An OTA� is concerned about the unethical behavior of another OTA. What regulatory bodies could the OTA consider in seeking guidance about reporting unethical conduct?
-The AOTA Ethics Commission allows occupational therapy practitioners to call or write about possible violation of ethics. After discussion, a formal complaint may be made to the Ethics Commission if needed.
-The state's licensure laws provide guidance to
A person with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is having difficulty in the transition to a new adult foster care home. An OTR� and COTA� are contracted to make four home visits to assess the client and p
Recipients of occupational therapy services have the right to refuse services. As noted in the principle of Autonomy in the Occupational Therapy Code of Ethics, "Occupational therapy personnel shall respect the right of the individual to self-determinatio
For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities?
Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks.
A COTA� is engaged in a casual discussion with a colleague about a client. The COTA conveys that the client is rude and obnoxious but deserves to be treated equally. What is the ethical basis for the COTA's concern?
In the Occupational Therapy Code of Ethics (2015), Principle 4, Justice, states, "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services.
What main neuromusculoskeletal feature is a client with multiple sclerosis likely to exhibit that a COTA� should consider during intervention?
Intention tremor is commonly seen in people with MS
A Complainant is a person filing an ethical complaint with the AOTA Ethics Commission. What condition must a Complainant fulfill?
Established procedures for filing a complaint mandate identification in writing of the person against whom the complaint is being filed.
A COTA� is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities?
Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue.
Which of the following should a COTA� consider as a likely need for a client during the early stages of Parkinson's disease?
People in the early stage of Parkinson's disease are at risk for decreased interest in social and leisure activities and resulting isolation
The Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." What principle does this statement directly relate to?
This statement is used in Principle 6, Fidelity, of the Occupational Therapy Code of Ethics (2015).
According the ethical principle of Justice, a COTA� is obliged to be aware of certain laws such as the Americans With Disabilities Act (ADA). A COTA who is also a rehab manager in a long-term care facility has an incoming fieldwork student who is requesti
Reasonable accommodation for employees with disabilities is required under the ADA, so it is appropriate to attempt to accommodate the fieldwork student. Determining whether the site can accommodate the request, consulting with management as necessary as
An occupational therapy practitioner has identified a situation that is causing an ethical conflict. What should the occupational therapy practitioner do next to address the ethical conflict?
Once an ethical conflict or dilemma is identified, the practitioner should affirm the situation by discussing with trusted colleagues and reviewing the Occupational Therapy Code of Ethics and state regulations. The practitioner can the determine the pros
Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations?
Reimbursement constraints is one of the top ethical concerns leading to moral distress in occupational therapy practitioners.
-Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the h
A COTA� has been told by the OTR� that a client is scheduled for daily occupational therapy because the department needs to increase billing units for the month. The COTA does not think that daily occupational therapy services are necessary. What actions
-When a practitioner identifies an ethical dilemma, he or she should gather all relevant facts. In this situation, that would include reading the initial evaluation plan to learn more about the client's needs and the rationale for establishing a frequency
What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age?
Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized.
What is the purpose of the Disciplinary Council as described in the Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards?
The Disciplinary Council provides a forum for the person against whom the ethical violation charge has been made to respond to the charge. Witnesses and evidence can be presented.
For clients with a neurodegenerative disease who are experiencing fatigue that impedes occupational performance, which recommendation is BEST?
Environmental accommodations allow clients to maintain their current lifestyle as much as possible while preserving energy for occupational performance.
A newly certified COTA� is working a first job on an inpatient rehabilitation unit. The OTR� instructs the COTA to teach a bath bench transfer to a patient while the OTR goes to another room to evaluate a new patient. The COTA never completed a bath bench
-Beneficence involves demonstrating concern for the safety of clients. The COTA has not established competency in completing bath bench transfers and therefore should take steps by requesting supervision and training to complete this transfer for the firs
Why does the Occupational Therapy Code of Ethics (2015) encourage occupational therapy practitioners to use evidence-based evaluations, interventions, and therapeutic equipment whenever possible?
-Principle 1F (Beneficence) states that practitioners shall "take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exis
Which of the following symptoms would a COTA� expect to see with a client with Guillain-Barr� syndrome in the acute inflammatory phase?
Because ascending paralysis is typical of Guillain-Barr� syndrome, observations during sessions consistently focus on the constellation of symptoms including pain, fatigue, and swallowing problems.
A COTA� is working with a client in the acute phase of Guillain-Barr� syndrome. Which client action demonstrates the ability to direct care?
A client in the acute phase of Guillain-Barr� syndrome may not be able to participate directly in activities; statement of the need to change position in bed reflects an awareness of needs and ability to request assistance.
A COTA� observes that a client with Parkinson's disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing?
Eliminating clothing fasteners is a task modification that decreases the level of performance difficulty. This strategy is also the most readily manageable option for this client, because of the progressive loss of fine motor function.
An OTA student on Level II fieldwork came to the fieldwork site drunk and attempted to treat clients. The student was reported by the supervisor and found in violation of the NBCOT� Code of Conduct. What is the most severe sanction the student could recei
Ineligibility for certification is the most severe discipline because the student would be unable to become certified as a COTA�.
A client needs a wrist orthosis. The OTA� is aware that the guidelines from the client's insurance company indicate that reimbursement is not provided for equipment and that the insurance company considers the wrist orthosis equipment. What should the OTA
The OTA is faced with an ethical dilemma of providing an orthosis when there is no payment for the orthosis and the client needs the orthosis. Considering the pros and cons allows the OTA to identify the positive and negative situational variables involve
An order came in for a hand orthosis for a new client. The OTR� who completed the evaluation asked the newly graduated COTA� to fabricate the orthosis. The new COTA had not made an orthosis on a client before and requested assistance from the supervising
Beneficence relates to occupational therapy practitioners having concern for the safety of clients. The newly graduated COTA needed to establish a level of competence by working with the OTR to demonstrate proficient orthotic fabrication.
What MUST a client have in order to provide informed consent of occupational therapy services?
-A client must have sufficient knowledge for making decisions related to care.
-A client must be capable of understanding information that is presented about the occupational therapy services.
-A client must be able to voluntarily and freely make choices
A COTA� is working with a client with Guillain-Barr� syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase?
In the recovery phase of Guillain-Barr� syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity.
An OTA Level II fieldwork student gives an inservice to the occupational therapy staff at the fieldwork site. The next month, the OTA student attends a continuing education session that an OTR� from the site is conducting for physician assistants. The stu
Veracity relates to being fair to colleagues, such as giving credit for other's ideas and avoiding plagiarism.
A client provides a gift to every person in the department, including the COTA� who worked with the client. This gift is consistent with cultural practices of the client and is valued at less than $5.00. Which ethical principle BEST helps determine whethe
The guiding ethical principle is Principle 4, Justice. The amount of the gift is minimal, and the gift was given to everybody. It is appropriate to accept the gift. This scenario did not create a situation in which objectivity or boundaries were compromis
A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cookin
The caregiver should be trained in skills for assisting the client with ADLs because the client will require greater assistance for tasks as symptoms progress.
A COTA� suspects that her supervising OTR� is falsifying treatment session documentation in order to comply with documentation deadlines. If true, this constitutes a breach of Veracity and Justice. What is the BEST next step the COTA take?
Approaching the person directly is most appropriate; it is the most respectful approach, and the COTA may be incorrect about the OTR's behavior
Which action relates to the ethical principle of Justice?
-Offering pro bono services relates to ensuring that clients are treated fairly and equally.
-The principle of Justice requires occupational therapy practitioners to refrain from accepting gifts from clients that may influence the therapeutic relationship
An OTA� is working with a client in an area of practice for which the OTA has not demonstrated competence. The client requires a seating and positioning evaluation for a wheelchair. This is not an area for which the OTA has any experience. The OTA asks th
Beneficence includes actions intended to benefit others. Concerns for safety for service recipients are beneficial actions. Taking care to make sure that decisions are made which relate to training and competence.
A client with an acquired brain injury does not have private funds to pay for skilled occupational therapy services. The client does not have access to Medicaid. As a result, the client chooses to discontinue therapy. Which ethical principle requires the
The practitioner should help the client locate other forms of funding, but if the client is unable to secure reimbursement, the client has the right to refuse treatment secondary to the burden of cost
Code of Ethics and Ethics Standards: Ethical Principles
-Principle 1, Beneficence: "Occupational therapy personal shall demonstrate a concern for the well-being and safety of the recipients of their services"
-Principle 2, Nonmaleficence, states, "Occupational therapy personnel shall refrain from actions that
Code of ethics and ethics standards: core concepts
1. Altruism: The individual's ability to place the needs of others before their own
2. Equality: The desire to promote fairness and interaction with others
3. Freedom: The desire of the client must guide interventions
4. Justice: relating in a fair and im
Entry Level
Less than a year
Intermediate Level
One - up to three years
Advanced Level
Three or more years
Continuous Supervision
Direct & ON SITE at all times
Close Supervision
DAILY, direct contact
Routine Supervision
Direct contact at least EVERY TWO WEEKS with interim supervision as needed
General Supervision
Direct contact at lease EVERY MONTH with interim supervision as needed
Minimal Supervision
On an as-needed basis
For an entry-level COTA, the requirement is to have..
Close supervision
For an intermediate level & advanced-level COTA, the requirement is to have...
General supervision
The entry level COTA can supervise...
Aids & volunteers
The intermediate-level COTA can supervise...
Aids
Volunteers
Level 1 OT students
Level 1 OTA students
Entry-level OTAs
The advanced-level COTA can supervise...
All of the levels, including all-level OTAs
Directing:
High direction, low support; tells the supervisee what to do, where to do it and when/how to do it, then closely monitors the actual performance
Supportive:
Low direction, high support; listens, encourages, facilitates the supervisse in decision making and performance
Coaching:
High direction, high support; appropriate when knowledge and experience are limited. For example: new grads, staff changing areas of practice
Delegating:
Low direction, low support; used with experienced staff
T/F
"No one style is correct or best in every situation
True