• Abstract and Figures
• Public Full-text

FORM 249 (Booklet)

HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA

PROFESSIONAL BOARD FOR OCCUPATIONAL THERAPY AND MEDICAL ORTHOTICS/PROSTHETICS

Policy Guideline for

TRAINING, PRACTICE AND SUPERVISION

Occupational Therapy Auxiliary and Technician

Categories 2

2004 TABLE OF CONTENTS

This document has been compiled in such a way that sections A, B, C and D may be used as stand alone documents.

A. POLICY GUIDELINE FOR TRAINING AND PRACTICE OCCUPATIONAL THERAPY AUXILIARY AND TECHNICIAN CATEGORIES...... 1

Introduction...... 1 Description of Terms: Occupational Therapy Auxiliary and Technicians Categories....1 Policy Statement...... 1 Admission Requirements...... 3 Presentation of Courses...... 3 Laddering and Career Path Development...... 4 Agreement between Professional Boards - Background Information...... 5 Current Personnel on the Register (Including Community Rehabilitation Workers/Facilitators)...... 6 Appendix I: Learning Mobility (Vertical and Horizontal)...... 7 Appendix II: Implications for Current and Planned Training Courses...... 8 Appendix III: Two-year Community Rehabilitation Workers/Facilitators (CRW/CRF) Courses...... 9 Appendix IV: The Auxiliary Practitioners Committee of the Board...... 10 Appendix V: Current Projects of the Board (In View of Mandate)...... 11

B. SCOPES OF PRACTICE FOR OCCUPATIONAL THERAPY AUXILIARY, OCCUPATIONAL THERAPY TECHNICIAN, COMMUNITY REHABILITATION WORKER AND OCCUPATIONAL THERAPIST...... 13

C. SUMMARY OF CORE SKILLS, DUTIES AND LIMITATIONS OF PRACTICE FOR MID LEVEL WORKERS IN OCCUPATIONAL THERAPY (OT AUXILIARY/OT TECHNICIAN)...... 55

Core Skills...... 55 Outline of Duties of Mid Level Workers in Occupational Therapy...... 56 Limitations of Practice...... 56

D. THE SUPERVISION OF MID LEVEL WORKERS IN OCCUPATIONAL THERAPY (OT AUXILIARY/OT TECHNICIANS...... 59

Section 1: Terminology, Clarification of Concepts, General guidelines and Requirements for Different Levels of Performance and clinical Contexts

General Provisions...... 59 Description of Occupational Therapy Personnel...... 59 Competency Levels - Mid Level Workers in Occupational Therapy...... 61 Types of Supervision...... 61 Description of Programmes...... 61 Levels of Supervision as Indicated for Different Clinical Settings and Auxiliary Staff Competency Levels...... 62 Supervision Requirements as Appropriate for Different Experience/Performance Levels of Staff...... 63 Control/Regulation of Supervision...... 64 Additional Guidelines for Supervision...... 65 Summary of Responsibilities, Rights and Limitations...... 66 Reference List...... 67 ii

Section II: Guidelines for Training of Occupational Therapy Students in Supervision

Introduction...... 68 Guidelines for Training of Students...... 68 Core Supervisory Skills...... 69

Section III: Guidelines for When Occupational Therapy Supervision is not Available...... 70

E. SUMMARY OF GUIDELINES FOR AND RESPONSIBILITIES OF EMPLOYING BODIES...... 71

Summary of Provisions...... 71 Responsibilities of the Employer...... 71 (A) POLICY GUIDELINE FOR TRAINING AND PRACTICE OCCUPATIONAL THERAPY AUXILIARY AND TECHNICIAN CATEGORIES

Introduction

The aim of the Board in providing for the registration of mid level workers is to ensure that occupational therapy and rehabilitation services reach as many people as possible. The Board is particularly concerned about communities in the country with no access to rehabilitation services of any type, as well as the limited number of services that are available in institutions due to severely limited numbers of occupational therapy staff. The utilisation of mid level workers is aimed at overcoming this shortcoming. While there is no intention to provide inferior services to the disadvantaged and poor through the use of a lesser qualified person, it is clear that many community needs are well catered for through the type of cost efficient and effective services offered through well trained mid level workers.

The training and development of mid level categories of practitioners can however not be considered as separate from that of the graduate occupational therapist. From both a political and professional perspective it is imperative that all training becomes integrated within the foreseeable future. It is however acknowledged that much discussion and negotiation still needs to take place, particularly within training centres and between training centres and the Board.

Description of Terms: Occupational Therapy Auxiliary and Technician categories

 These categories of workers are trained and appointed to assist the occupational therapist in the provision of therapeutic and rehabilitative services. These services must be provided under the supervision of a registered therapist. The primary function of the occupational therapy auxiliary is to implement prescriptions by the occupational therapist, whereas the occupational therapy technician implements prescriptions and standard protocols. Levels of autonomy and responsibility differ according to training and experience.  The occupational therapist, according to promulgated legislation, retains overall responsibility and accountability for treatment received by each patient.  Both the occupational therapy auxiliary and occupational therapy technician are classified as mid level practitioners /workers.  The Board has adopted the terminology of Occupational Therapy Auxiliary (OTA) for the person with a one-year training certificate and Occupational Therapy Technician (OTT) for a person with a two-year training diploma or equivalent.

Policy Statement

a. General

 Issues regarding the training, supervision and career pathing of the auxiliary and technician categories of practitioners are of major concern to the Professional Board for Occupational Therapy and Medical Orthotics / Prosthetics.  In the absence of the more cost effective multi-skilled mid level health practitioner in the community, the Board regards the Occupational Therapy Technician (OTT) to be the type of mid level worker best suited to address community needs, due to the training role and scope of the occupational therapy profession and outcomes of training. These practitioners are / will be able to deal effectively with the vast majority of cases requiring rehabilitation in community settings, as well as be able to provide Occupational Therapy 2

services in institutional settings. The Board consequently supports a substantial increase in the OTT staff complement in all provinces at both the community and institution levels.  It is the view of the Board that these practitioners have an important role to play in health service delivery in general and form an integral part of both the profession of occupational therapy and the occupational therapy service at all levels of health care provision.  Regulations determine that all functions be performed under the supervision of a suitably qualified health professional. In the case of the OTA, this will of necessity be an occupational therapist, whereas in the case of the OTT, working particularly within community settings, this should preferably be an occupational therapist, but may of necessity be a physiotherapist or a speech therapist.

b. Training - Occupational Therapy Auxiliary / Technician

 Training has to date equipped the OTA practitioners to practise in mainly a hospital / institutional setting, whereas the OTT will be equipped to practise in both the institutional and community settings, both rural and urban.  Training programmes should be of such a nature that the practitioner is able, on qualifying, to function in all fields (physical and psychosocial) of professional practice, and all levels of service provision.  Training programmes must, as from 2007, be structured as follows: . A two-year diploma or equivalent with no exit after one year. . The training of the two categories, namely Occupational Therapy Auxiliary and Occupational Therapy Technician will be collapsed into one integrated two-year training course with exit as Occupational Therapy Technician. The one-year course will be phased out over a three-year period (i.e. by 2007, implying that the last intake for the one year training will be in January 2007). The Occupational Therapy Auxiliary register however will remain to accommodate the approximately 500 Occupational Therapy Auxiliaries currently registered and those still in training, or are waiting to be trained. . The person who completes the two-year diploma will register as an Occupational Therapy Technician with the Health Professions Council of South Africa. . The course may be offered as an integrated two-year course or otherwise as two separate one-year courses, culminating in the attainment of a diploma or equivalent qualification. The minimal content covered will however be essentially the same. . The diploma or equivalent training programme will comprise a mix of occupational therapy discipline-specific basic and advanced knowledge and skills, community development and community based rehabilitation (and related topics), as well as certain generic skills. The general recommendation is that the weighting of these components over the two-year training period will be 70% discipline-specific, 20% community development and rehabilitation, with 10% of time to be allocated to the attainment of generic skills, i.e. attainment of adequate knowledge and skills to sufficiently understand, identify and to be able to refer appropriately to other disciplines. It also allows for limited “multi-skilling” as approved by different Boards (see Policy Document of Board). The ratio is however flexible to accommodate regional or local needs. The “discipline specific” component includes both generic information and skills, (e.g. human body, health, disability, organisation, administration and communication) as well as specific discipline related knowledge and skills (e.g. theory of occupational therapy, principles and procedures). The “community component” includes PHC, CBR theory and procedures and community development. 3

NOTE: Considering a possible 40-week (35 hours per week) academic year with a total of ±2700 hours over a two-year period, which, after deducting 1000 hours compulsory clinical practical work; leaves approximately 1700 hours to other training. Considering these hours as 100% (training) the proposed ratios, as indicated above are, 70% = ±1190 hours (discipline specific), 20% = ±340 hours (community) and 10% = ±170 hours (generic skilling).

. In situations where the local needs dictate, and different health professional / rehabilitation professionals are not available or accessible, the OTT will be able to attain additional skills through approved programmes of multi-skilling (cross training) as identified by the different Boards. (Guidelines provided in Policy Document on Multi-Skilling.)

Refer to Appendices II and III for implications for current and planned courses.

Admission Requirements

 Persons with the one-year occupational therapy auxiliary training must be given the opportunity and support to upgrade their training to the two-year equivalent. This should be a priority project for all training centres.  Grade 12 (standard 10) has been approved as minimal requirement for all new intakes of students.  Persons already in the system / appointed in a mid level worker (OTA/SASA) position, with a grade 10 (standard 8) certificate will, as a special dispensation, have to commence training by January 2007. Such persons will however only be able to complete the occupational therapy auxiliary certificate course, due to tertiary institute admission requirements.

Presentation of Courses

 The trend is for courses to be offered at tertiary training institutions. The Board believes that it is neither in the interests of the public, the OTA/OTT or the profession to offer exclusively institution-based courses, as these may limit both skills and mobility of such individuals. All courses offered must, however, be controlled (and the discipline specific aspects taught) by a registered occupational therapist(s) with appropriate human, material and financial resource allocation.  Courses should equip the practitioners to practise in all fields of practice of the profession, and in both institutional and community settings. Different courses must produce mid level workers with comparable skills, knowledge and attitudes. Courses should focus on the social model of health care provision, whilst taking cognisance of certain aspects the medical model.  All courses require accreditation by the Board and an application should be submitted timeously. [Format available].  All courses will be evaluated by the Board on an ongoing basis to ensure that graduates meet the requirements of the profession and of the standards and outcomes determined by the Board.  The requirement of 1000 hours of clinical practical experience will be applicable to two years of training (i.e. 500 hours per year or spread over the two year period to suit training requirements).  Credit bearing short courses should be introduced in terms of continuing professional development for occupational therapy auxiliaries / technicians who do not wish to pursue a degree course, but wish to develop additional skills and knowledge. 4

Laddering and Career Path Development

 The Board supports the principle of career path development of auxiliary and technician categories into the degree course training and full professional participation.

 The current curriculum structure of degree courses in occupational therapy however do not currently facilitate entry into full degree courses, except via the standard route of a four- year degree course, or the accelerated degree course as offered by University of Cape Town.

 A proposed laddering system, whereby an OTT can, under certain circumstances, gain entry into the full degree course, was agreed to by the Board at its May 2003 meeting. This proposal outlines two routes to the attainment of a B/BSc degree in occupational therapy.

. Route A - Direct entry into and completion of four-year B/BSc degree - as for regular students in occupational therapy, in compliance with university entrance requirements.

. Route B - Recognition of Prior Learning route, which recognises

(a) Diploma or equivalent Occupational Therapy Technician training

plus

(b) Appropriate primary / basic sciences (i.e. anatomy, physiology, psychology [chemistry / physics for BSc degree]) credits (possibly one year). The primary and clinical sciences may be offered in a specially constructed / fast track occupational therapy degree course or bridging course.

(c) Clinical competence (determined through clinical evaluation)

Where (a) plus (b) plus (c) could give suitable candidates entry into the degree course (suggested at third year level) and thereby enable candidates to continue and complete the degree according to the formal route (years 3 and 4). The current occupational therapy course structures and entrance requirements would however need to be considered. See Appendix I for diagrammatic representation

. Graduate occupational therapy training programmes must make allowance for articulation with OTT diploma training through credit bearing modules and/or recognition of prior learning and thereby enable suitable candidates with a diploma to enter into the professional degree course. Qualifications must accordingly comply with NQF regulations and principles (see Box).

NQF regulations indicate, inter alia, that a qualification shall:  provide learners with an applied competence and a basis for further learning  add value to the qualifying learner by providing status, recognition, enhancing marketability and employability  provide benefits to society and the economy.

NQF principles require that qualifications will:  facilitate articulation (portability and flexibility)  ensure access to education and training  promote quality of education and training

 develop individual learning 5

 reflect democratic participation.

Supervision

Several aspects are of concern to the Board, which include: . The limited availability of supervisors and implications of limited or lack of supervision for service provision to patients.

. The apparent limited training of occupational therapy students to equip them to supervise effectively, and subsequent limited supervisory skills.

. The limited awareness of occupational therapy practitioners of rules and guidelines for supervision of OTA/OTTs. All OTA/OTTs must receive an appropriate level of supervision. This is the legal responsibility of the occupational therapist. The employing body has the responsibility to make provision for such supervision. Training centres for occupational therapists must, as a matter of urgency, address the issue of training of students to effectively supervise auxiliary staff.

Guidelines for supervision are available from the Board (Revised 2003).

Agreement between Professional Boards - Background Information

A Task Team established by the Professional Boards for Occupational Therapy and Medical Orthotics / Prosthetics; Physiotherapy, Biokinetics and Podiatry; and Speech Language and Hearing Professions (in ±1997) have, for the past approximately seven years, held several discussions and workshops to reach consensus on the content of what was at the time planned to be a multi-skilling second year for Assistants (Auxiliary staff), designed for occupational therapy, physiotherapy and speech therapy assistants on completion of a one-year discipline specific course. The plan was for the OTT/PTT of Speech and Learning Therapy to attain skills and knowledge for limited practice within the scopes of the other two professions.

It is important to note that the Boards were unable to conclude this exercise as envisaged, due to various other developments, differences of approach / policy of the task team and the Boards, representations from stakeholders and practical considerations.

Agreement (between the Boards) was however reached in terms of the weighting of content of the second year of training of 60% discipline specific, 20% community and 20% multi-skilling *. The multi-skilling (now generic skilling) component of the second year would focus largely on developing skills to identify and refer cases appropriately to other health professionals. The remainder of the time would be allocated to advanced discipline specific training and community development and rehabilitation.

At the meeting of the Professional Board on 20 May 2003, the Board resolved that the policy document, as compiled by the Chairpersons and other representatives of the three Boards, and supported by the Education Committee of the Board, be endorsed. The principles are accordingly reflected in this document, with modification in terms of the weighting (see pages 3-4), with a view to offering the two-year diploma or equivalent training.

The Boards consequently resolved to endorse the discipline-specific, rather than the multi-skilling route, although the multi-skilling route is believed, in principle, by our Board to be the best option for provision of efficient and cost effective rehabilitation services to large numbers of the population. It has however not proved to be a professionally or practically viable option. Input from various stakeholders, practical considerations, lack of clarity from the National Department of

* The term multi-skilling has, for purposes of clarity in terms of the training of the OTT, been changed to generic skilling, which makes provision for appropriate referral but not practice within the scope of another profession. 6

Health and differences of professional opinion have culminated in the approach as outlined in this document.

Current Personnel on the Register (Including Community Rehabilitation Workers / Facilitators)

Occupational therapy auxiliaries and technicians already registered with the Board under policies different to those described in this policy statement, or who are currently undergoing training, will be registered according to those policies. These mid level workers were trained and registered in good faith (including those with cross discipline skills who were registered with the Professional Board for Occupational Therapy and Medical Orthotics and Prosthetics) according to the agreement between this Board and that of Physiotherapy, Biokinetics and Podiatry and Speech and Language Professions – a decision made mainly due to the fact that the majority of the skills of these mid level workers fell into the discipline of Occupational Therapy. It is recognised that not all of the previous generation of mid level workers were trained to work in all settings and with all categories of clients. The Board does recognise that there may be a need in some instances for employers to offer in-service training to personnel who may wish to change their place of employment. For example those trained in a chronic psychiatric setting who wished to work in an acute physical setting or those trained to work in the community who wished to work within a hospital setting. 7

Appendix I LEARNING MOBILITY (VERTICAL AND HORIZONTAL)

ROUTE ROUTE (B) (A) PhD Prior Convent- learning ional route route to qualify as an Masters Degrees OT

Exit B/BSc OT

Year Year Occupational Therapy IV V IV

Year Year Occupational Therapy III IV III

Year Primary / Basic Sciences or Year III Bridging Course II

CPD - to include Admission via an entrance accredited examination and/or clinical short courses competency - skills training

Year I Year Exit CPD Occupational Therapy BSc/BA II Diploma Technician OT

Year Occupational Therapy Exit Certificate I Auxiliary (Intake up to January 2007) 8

Appendix II

Implications for Current and Planned Training Courses

One-Year Occupational Therapy Auxiliary Courses

 The one-year courses need to be phased out by December 2007 (last intake January 2007). This can be offered as the first year of the two-year diploma or equivalent. This can be offered as the first year of the two-year diploma or equivalent.

 Courses for students currently in the system need to be completed, whilst unqualified staff in the system, in possession of a grade 10 (standard 8) certificate must be given the opportunity to do the one-year certificate course. The suggested time frame will allow a three-year period for such training to be completed.

 As from January 2007 all courses offered should be two-year diploma (or equivalent) courses as described elsewhere in the document.

 Persons already in possession of an OTA certificate and HPCSA registration, retain their qualification and registration. Such persons with a grade 12 schooling certificate need to be given the opportunity to convert the certificate to a two-year diploma, should they wish to do so. Training centres need to make provision for such conversions.

 Job descriptions / levels of responsibility for the OTA and OTT are, and will remain, as described in Scopes of Practice and competencies documents. 9

Appendix III

Two-year Community Rehabilitation Worker / Facilitators (CRW/CRF) COURSES

 Current courses registered by the Board should ensure that they meet the Scopes of Practice for OT Technician as laid down by the Board (October 2003) by January 2007. All courses should be submitted for approval to the Board and approved prior to this date. (It is recommended that this is done prior to April Board Meeting of previous year.)

 The multi-skilling component of these courses must be revised to comply with policy as outlined by the Board (2003) on multi-skilling.

 Persons with an approved CRF/CRW training will continue to be registered with either the Professional Board of Occupational Therapy and Medical Orthotics / Prosthetics or the Professional Board for Physiotherapy, Podiatry and Biokinetics.

 It should be noted that the Department of Health has not yet reached a decision about the introduction of a multi-skilled mid level worker. 10

Appendix IV

The Auxiliary Practitioners Committee of the Board

 The Committee functioned during the term of office of the previous Board and was reinstated by the current Board (1999-2003), after a stakeholders meeting held in October 2002.  The Committee has the following membership: . 2 Representatives from the Board . 2 Representatives from the OTA/OTT categories. (These persons were nominated by the Occupational Therapy Forum in each of the regions and two members elected at the October meeting.) . 1 Representative from OTASA . 1 Co-opted representative from the two-year training courses . Co-ordinators from current training centres will be invited to attend the meetings.  The Committee reports directly to the Board and has the following mandate, within the current policy parameters, as determined by the Board, namely to deal with and report to the Professional Board on the following matters relating to Auxiliary Staff: . the development of a national strategy for training of auxiliary / technical practitioners . accreditation of courses, setting of standards and guidelines for training . guidelines for supervision of auxiliary / technical practitioners . career pathing for the different categories of auxiliary / technical practitioners . defining of a scope of practice based on the outcomes of training. 11

Appendix V

Current Projects of the Board (In View Of Mandate)

1. To develop a national strategy for training, career path development and supervision (largely completed). 2. Review scopes of practice* of the Occupational Therapy Auxiliary (Assistant), as different from that of the Occupational Therapy Technician and from the current category of community rehabilitation worker / facilitator (completed). 3. The clear differentiation of outcomes* for training of Occupational Therapy Auxiliary and Occupational Therapy Technician to serve as minimal standard for training and reflective scope of practice (completed, integrated with (2) above). 4. Development of guidelines for supervision of auxiliary practitioners, both for supervisors and for purposes of training occupational therapy supervisors (completed). 5. Review of scopes of practice, as these differ for different levels of experience and responsibility (new graduate, senior, principal levels) (completed). 6. Accreditation of courses (current and planned), and setting of standards and guidelines for training (ongoing). 7. Negotiation with Department of Health on various matters relating to Auxiliary / Technical Staff (ongoing).

* This will be done in preparation for the establishment of the SGB.

Approved October 2003 12 13

(B) SCOPES OF PRACTICE FOR OCCUPATIONAL THERAPY AUXILIARY, OCCUPATIONAL THERAPY TECHNICIAN, COMMUNITY REHABILITATION WORKER AND OCCUPATIONAL THERAPIST

A 1) Exit level outcome 2) Basic principle underlying determination of scopes of practice 3) Outline - knowledge bases B Occupational Therapy Procedures (direct service provision / intervention with client) C Project / Service Development and Management D Resource Person E Core Skills F Supervision - Activities which may be conducted without direct supervision G Lifelong Learning H Problem Solving and Clinical Reasoning I Research

NOTE:

 This schedule has been drawn up to clarify scopes of practice of primarily the OTA and OTT/CRW levels of workers, and also to differentiate these from OT. It thus reflects both current and proposed outcomes of training. It should be noted that OTA and OTT competencies are part and parcel of the registered Occupational Therapy Competencies and the document should be read as such.  Terminal competencies, as well as specific competencies in terms of aspects listed above have been integrated into one document.  The Wits OTA/OTT course competencies and training module information; occupational therapy terminal competencies, as drawn up by Robin Joubert as part of her PhD research; UDW OTA course, CORRE programme and input from stakeholders, were, with grateful thanks, used to compile this document. The OTA Column reflects the current situation for the one-year OTA training. This one-year training will be phased out or practitioners will be given the opportunity to add to their current training an additional year to bring them in line with the two-year diploma of the OTT. The OTT Column reflects the proposed two-year diploma or/ equivalent training. This is envisaged as the only other training course that will be available for occupational therapy apart from the present degree courses for occupational therapists. The CRW column reflects competencies held by the CRW/CRF trained staff currently. It is envisaged that these groupings be given the same option as the OTA’s to qualify as OTT staff. 14

OTA OTT CRW OT A(1) Exit Level . The qualifying . Will be able to apply core . Will be able to apply core . Be able to competently analyse, Outcome learner will be knowledge of the functioning of the knowledge of the functioning of integrate, synthesise and apply the able to apply core human system, health, disease and the human system, health, appropriate fundamental and knowledge of the occupational performance to people disease and occupational specialist knowledge about a wide functioning of the who are activities healthy, or who performance to people who are diversity of relevant medical, social human system, have impairments, disability and activities healthy, or who have and occupational sciences and health, disease occupational dysfunction within the impairments, disability and theoretical constructs which include: and occupational context of the client treatment occupational dysfunction within  A holistic view of the performance to within the hospital and community. the context of the client biopsychosocial and people who are treatment within the community environmental components activities healthy, which promote or impede human or have occupation. impairments,  The knowledge of how to assess disability and biopsychosocial, environmental occupational and occupational components dysfunction within which either promote or impede an institutional the adequate performance of setting. human occupation and concomitantly also the well-being and quality of life of individuals, groups or communities with occupational dysfunction or are at risk of acquiring occupational dysfunction.

A(2) Principle OTA is able to use . Follows prepared protocols, makes . Follows prepared protocols, . Organisation and planning of underlying standard protocols, or choice as to suitable protocol. makes choice as to suitable programme, designs new Scope of specific prescription of protocol. procedures, protocols, deals with all Practice OT treatments, for . Adaptation according to cases, acute and long-term; sick / straightforward circumstances or life situation. . Adaptation according to disabled. Treatment of persistent, routine cases, follows circumstances or life situation. complex / multiple disorders. instruction under direct supervision of OT, deals with acute and chronic conditions. Requires supervision, daily, on site in setting with acute cases. 15

OTA OTT CRW OT . Deals with long-term cases, using  Mainly deals with long-term OT drawn up guidelines, consults cases in the community, drawn with supervisor when encountering up guidelines, consults with unusual, non-routine complex supervisor when encountering cases. Treatment of acute cases in unusual, non-routine complex hospital needs additional cases supervision. . Does not make . Makes decisions linked to . Makes decisions linked to problem- or diagnosis or a patient’s problems diagnosis or a patient’s problems diagnosis-specific based on available protocols and based on available protocols and decisions as guidelines - as related to short, guidelines - as related to short, applied to a medium and long term / routine medium and long term / routine patient. Can make cases. cases. decisions on non- condition related activities (e.g. a general recreational programme for population or ward - can decide on different activities for a recreational programme). . Accountable to . Accountable to OT / Supervisor . Accountable to Supervisor . Retains liability for all OT interventions provided. A(3) Outline Basic knowledge of: Basic knowledge of: Basic knowledge of: Knowledge . Human . Human development, life stages, Human development, life stages, Base development, life impact on occupational impact on occupational stages, impact on performance. performance occupational performance.

 Basic anatomy . Basic anatomy and physiology of Basic anatomy and physiology of and physiology of relevant human systems relevant human systems relevant human systems 16

OTA OTT CRW OT Outline . Historical . Historical background, core . Historical background, core . Extensive knowledge base in terms Knowledge background, core concepts and principles of OT, concepts and principles of OT, of basic clinical, applied clinical and base concepts and knowledge of human occupation, knowledge of human OT subjects as indicated in current (Continued) principles of OT, occupational performance, occupation, occupational training curricula. knowledge of classification of occupations, performance, classification of human individual characteristics and socio- occupations, individual occupation, political factors influencing human characteristics and socio- occupational activity. Plus knowledge of political factors influencing performance, contribution of occupation to human activity. Plus knowledge classification of wellness, life skills and healthy life of contribution of occupation to occupations, style. wellness, life skills and healthy individual life style. characteristics and socio-political factors influencing human activity

. Mental and . Environments conducive to health . Mental and physical health and physical health activities impact on disorder / and activities disability. impact on disorder / disability. . Factors in community contribution . Factors in community to health / disorder / disability contribution to health / disorder / disability . Context of life of client - impact on occupational performance. . Context of life of client - impact on occupational performance. . Impact of disease on communities 17

OTA OTT CRW OT Outline . Causes, key . Causes, key symptoms, medication . Causes, key symptoms, Knowledge symptoms, and OT rationale and treatment of medication and OT, PT and base medication and common conditions that cause Speech and hearing treatment (Continued) OT treatment of occupational dysfunction and are of common conditions that common dealt with within OT cause dysfunction conditions that . Extended range of conditions cause . Extended range of conditions encountered in community, occupational encountered, especially in all OT settings, content and use of dysfunction and settings, including community, protocols for treatment are dealt with settings, content and use of within OT. protocols for treatment. . Covers remedial . Covers promotive, preventive, . Covers promotive, preventive, and rehabilitation remedial and rehabilitation remedial and rehabilitation programmes programmes programmes . Extensive activity . Community structures, socio- . Community structures, socio- skills (knowledge, political factors impacting on political factors impacting on execution, communities communities organisation and control) . CBR community entry . CBR community entry . Identified core . Introduction to health policies . Introduction to skills health policies . Awareness of health care . Knowledge of health care delivery . Knowledge of health care delivery systems systems, including the District delivery systems, including the Health System and hospital based District Health System. care. . Introduction to other sectors of service delivery such as Education, Labour and Social Welfare B OT PROCEDURES . Interpret referral . Interpret referral from OT, . Interpret referral from . Understand and interpret all referrals Referral from OT and be multidisciplinary team, public health multidisciplinary team, public from public health workers / team  Interpret able to workers, recommend relevance for health workers, and suggest members. Interpret status of patient, referral understand OT and suggest intervention. intervention. relevance to OT prescription correctly. 18

OTA OTT CRW OT . Refer to . Make . Demonstrate full understanding of . Demonstrate full understanding . Referrals based on extensive other health recommendations own limitations and role, when of own limitations and role, knowledge, condition, OT role, workers / to OT for referral referring to other health workers, when referring to other health contribution of other professionals / agencies to other health make appropriate referrals. workers, make appropriate agencies. professionals referrals where indicated. Assessment . Basic personal . Basic assessment of all . Basic assessment of all . Be able to apply appropriate . Assess management performance areas (personal performance areas (personal standardised and non-standardised performance assessment - management, work and leisure) management, work and leisure) assessment methods and areas through through using procedures as through using basic procedures techniques as follows:  Personal observation during prescribed by OT. and observation. Management activity . Basic assessment of . Write report on observations in participation, input performance components. client’s record. to OT, may use . Write assessment results on checklist. appropriate forms and report in . Report client’s record accurately. . To individuals in order to collect  Work . Except where . With specific reference to home . Assess capability of carrying data about factors related to their placed in work industry and informal sector. out home industry and informal physiological, psychosocial, area, then, sector occupation occupational and environ-mental according to status in order to provide a holistic guidelines, report to picture of the client’s needs, OT strengths and priorities and as such form the basis upon which  Leisure . Basic use of leisure . Basic use of leisure time, apply . Facilitate use of leisure time, appropriate treatment intervention time, activities activities clock apply activities clock programmes are planned and clock implemented. . Diagnostic Does not do . Through general activity . Through general activity assessment participation - makes participation - makes . Small groups in order to assess recommendation to OT in terms of recommendation to therapist. common needs and priorities daily life skills not diagnosis. 19

OTA OTT CRW OT . Assessment . Not specifically . Basic, using functional activities. . Basic, using functional activities . Be able to screen large numbers of of done, deduction Conclusions made by deduction. and other basic assessments. individuals or communities in order performance through Conclusions made by to determine the impact of disability components observation, may deduction. upon the occupational performance complete checklists of affected members within the group / community and determine which of these members require further assessment and/or determine which members of the group / community may require promotive or preventative programme intervention to avoid occupational dysfunction . Be able to carry out a situation analysis within a variety of contexts in order to plan effective intervention programmes for client groups identified in various institutions, facilities, services and organisations. . Be able to effectively record, analyse, interpret and prioritise data gathered from all situations described above and as a result be able to compile and plan aims and objectives for intervention. . Discharge . Not done - But . Contributes to discharge . Carries out a discharge assessment inputs to OT on assessment. assessment. Consults therapist. clinical observation.

. Assessment . Inputs to supervisor . Inputs to supervisor therapist, . Assess success of of success of therapist. include in reports. intervention – reports to intervention. supervisor. 20

OTA OTT CRW OT . Assessment . Inputs to supervisor . Inputs to supervisor therapist . Assesses for referral to other, for referral to therapist. reports to supervisor. other

. Screening Does not screen . To identify client’s need of OT and . To identify client’s need of other services or facilities through therapy form OT, PT and the use of identified screening Speech therapist and other tools. services or facilities through the use of identified screening tools and community appraisal techniques. (Services such as school, church, women’s groups, social work services.) . Identify persons in need of home based care

. DG . Does not do, But . Does not do, But input to OT on . Does not do but refers to . Comprehensive, plus assessment input to OT. performance during all aspects of appropriate people and helps recommendation, also analysis of . Monitor and assessment / treatment. client to apply for appropriate cause of disability and long-term report on client . Help client to apply for appropriate grants. impact. performance grant. . Provides a report on ability at during all aspects home of intervention. Treatment . As prescribed by . As prescribed by OT with input . Formulates Aims and . Use the professional knowledge Planning OT with input from from OTT in terms of adaptation in objectives. Reports to base of treatment and professional . Aims and OTA in terms of terms of culture, home situation, supervisor for confirmation. support structures for developing Objectives adaptation in behaviour in OT as observed by occupational therapy protocols for terms of culture, OTT client populations within the health, home situation, educational, welfare and private behaviour in OT . Plus consultation with OT services. as observed by OTA . Plan, develop, design and implement . Principles . Contribute to integral treatment programmes for: . . . Approach determination of According to protocol, adapted to According to protocol, adapted  Individuals or groups (e.g. new priorities for client’s needs / situation to client’s needs / situation development  Any form of physical and/or intervention. . Contribute to formulation of al) . Formulates psychiatric disorder which results priorities for intervention, . Duration priorities, duration, frequency, in occupational dysfunction . Frequency 21

OTA OTT CRW OT . Sequence of and sequence of intervention in consultation with supervisor. . treatment  Short- medium- and long-term durational requirements . Focus of treatment  Institutional, hospital, health services and ward, clinic and/or . Selection of . Select activity to . Select according to protocol . Select treatment activity or community contexts in a PHC treatment directive from OT, guidelines. exercise according to protocol and district health services activity give input on guidelines setting. alternatives / modifications . Selection of . Only as prescribed . According to protocol and training . According to protocol and treatment by OT and if trained experience. training experience. techniques to use . Assist with planning of preventive . Plan preventive and promotive and promotive programmes, using programmes, using guidelines. guidelines.

Implementation Preparation . Preparation area . Prepares areas for treatment . Prepares area for treatment. . Implements all aspects of treatment / activities for . According to protocol selected for . Adapt to client needs / lifestyle as described for OTA. OTT. treatment patient . Demonstrate in depth Evaluates, reviews and develops . Demonstrate in . Adapt to client needs / lifestyle knowledge and skill in a new protocols depth knowledge variety of everyday activities . Apply the appropriate therapeutic and skill in a suitable for use in therapeutic / skills, knowledge and principles for: variety of rehabilitation / promotive /  Activity analysis, selection, everyday activities preventive programmes. structuring, presentation, client suitable for use in . Has knowledge of relevant handling and precautionary therapeutic / material, tools, equipment and measures within any programme rehabilitation / . Demonstrate in depth knowledge of procedure and be able to use context and within the unique promotive / relevant material, tools, equipment these effectively and efficiently socio-cultural and idiosyncratic preventive and procedure and be able to use in execution of activities context of the client. programmes these effectively and efficiently in suitable for use in the execution of activities community. 22

OTA OTT CRW OT . Demonstrate in . Prepare activities for use during . Prepare activities for use depth knowledge treatment during treatment of relevant material, tools, equipment and procedure for use of activities and be able to use these effectively and efficiently in execution of activities . Prepare activities for use during treatment . Assist OT to . Assist OT to select and . Select activities suitable for  Apply certain specialised select creative, recommend creative, constructional patient’s level of occupational techniques and/or make use of constructional or or unconstructive activities suitable performance, culture and specialised equipment to enhance unconstructive for patient’s level of occupational therapeutic and rehabilitative treatment and occupational activities suitable performance, culture and needs performance. for patient’s level therapeutic and rehabilitative needs . Prepare area for of occupational . Prepare area for therapeutic therapeutic activity that client performance, activity that client will do with OT will do in the community. culture and . Select physical methods therapeutic and for intervention in ROM and rehabilitative muscle strength problems needs. . Select appropriate . Prepare area for communication methods therapeutic activity that client will do with OT. Teaching . Effectively teach . Effectively teach appropriate . Effectively teach appropriate appropriate activities to clients and family activities to clients and family activities to clients members members and family members. 23

OTA OTT CRW OT Common . Deal appropriately . Deal appropriately with common . Deal appropriately with incidents with common incidents and behaviours (e.g. common incidents and incidents and epileptic seizure, uncooperative behaviours (e.g. epileptic behaviours (e.g. patient, incontinence, etc.) seizure, uncooperative patient, epileptic seizure, stemming from client’s illness / incontinence, etc.) stemming uncooperative circumstances from client’s illness / patient, circumstances incontinence, etc.) stemming from client’s illness / circumstances Precautions . Implement . Implement relevant precautions . Implement relevant relevant during intervention precautions during precautions interventions during intervention . Implement . Implement prescribed intervention . Implement prescribed prescribed appropriately and effectively, intervention appropriately and intervention particularly as this applies to the effectively, particularly as this appropriately and different performance areas, applies to the different effectively, including children’s play and select performance areas, including particularly as this appropriate intervention protocols in children’s play and select applies to the consultation with OT. appropriate intervention different protocols in consultation with . Provides rehabilitative programme performance Supervisor for individual client areas, including . Provides rehabilitative children’s play. programme for individual client.

. Assist OT to . Assist OT to provide therapeutic . Provide basic therapeutic provide and rehabilitation programmes and rehabilitation therapeutic and for individual clients and groups programmes for individual rehabilitation clients and groups programmes for individual clients 24

OTA OTT CRW OT  Know common  Know common types of illness  Know common types of types of illness and disability (both acute and illness and disability (both and disability chronic, physical and psycho- acute and chronic, physical (both acute and social) and be able to identify and psychosocial) and be chronic, factors leading to / contributing to able to identify factors physical and such illness / disability (e.g. leading to / contributing to psychosocial) sensation mobility; cognitive, such illness / disability (e.g. and be able to conative, neurological or sensation mobility; cognitive, identify factors affective impairments) conative, neurological or leading to / affective impairments) contribution to such illness / disability (e.g. sensation mobility; cognitive, conative, neurological or affective impairments) . Be able to . Be able to develop a helping . Be able to develop a develop a helping relationship with patient and care helping relationship with patient relationship with providers and care providers patient and care . Assist OT with more complex providers . Be able to deal with common treatment techniques, e.g. pressure behaviours / problems resulting . Be able to garments, vocational rehabilitation. deal with common from patient’s impairment, during behaviours / . Be able to deal with common treatment sessions also problems resulting behaviours / problems resulting from responses to illness and disability patient’s impairment, during from patient’s . Correctly interpret and implement treatment sessions also responses to impairment, during a treatment referral and plan a illness and disability treatment sessions treatment by selecting a protocol also responses to . Correctly interpret and implement a illness and treatment referral and plan a disability treatment by selecting a protocol . Correctly interpret and implement a treatment referral 25

OTA OTT CRW OT . Effectively teach a . Effectively teach a patient . Effectively teach a patient patient appropriate appropriate activities, implementing appropriate activities, activities, appropriate teaching methods as implementing appropriate implementing indicated by diagnosis, problems, teaching methods as indicated appropriate level of performance by diagnosis, problems, level of teaching methods performance as indicated by diagnosis, problems, level of performance . Understand, . Understand, implement and . Understand, implement and implement and monitor the application of appropriate monitor the application of monitor the precautions on an ongoing basis appropriate precautions on an application of ongoing basis appropriate precautions on an ongoing basis . Be able to judge . Be able to judge patient’s . Be able to judge patient’s patient’s performance and adjust activity / performance and adjust performance and situation / teaching method during activity / situation / teaching adjust activity / treatment to better suit needs of method during treatment to situation / teaching patient and his/her treatment better suit needs of patient and method during his/her treatment treatment to better suit needs of patient and his/her treatment . Assist OT to . Assist OT to select and grade . Grade activities of daily select and grade appropriate treatment activities. living independently appropriate Grade activities of daily living treatment independently activities 26

OTA OTT CRW OT Programmes . Effectively . Effectively implement sessions . Effectively implement implement and programmes directed at the sessions and programmes sessions and improvement of performance of directed at the improvement of programmes activities within the different performance of activities within directed at the performance areas the different performance areas improvement of performance of activities within the different performance areas . Make appropriate . Make appropriate recommendations . Modify and grade treatment as recommendations for modification / grading of per protocol in ADL for modification / sessions / programmes grading of . Modify and grade treatment as per treatment protocol in ADL . Observe . Observe and evaluate patient . Observe and evaluate and evaluate performance correctly during patient performance correctly patient treatment sessions and report to OT during treatment sessions. performance correctly during treatment sessions and report to OT. . Be able to . Be able to recognise causes . Recognise impact of recognise causes and effect of long term community attitudes on the client and effect of long institutionalisation and be able to and be able to decrease or limit term implement measures and the effect institutionalisation programmes to decrease or and be able to eliminate the impact of implement institutionalisation measures and . Recognise impact of programmes to community attitudes on the client and decrease or be able to decrease or limit the effect eliminate the impact of institutionalisation 27

OTA OTT CRW OT . Plan and prepare . Plan and prepare activity groups . Plan and prepare activity Activity Groups activity groups groups  Know therapeutic benefits and  Know therapeutic benefits and  Know management of task centred management of task centred therapeutic groups, as related to age, culture, groups, as related to age, benefits and disorder and levels of culture, disorder and levels of management of performance task centred performance groups, as related to age, culture, disorder and levels of performance  Be able to  Be able to interpret referral interpret referral correctly correctly

 Prepare for  Prepare for group as requested by  Prepare for group as indicated group as OT or indicated by protocol by protocol requested by OT  Together with  Together with OT, select  Select appropriate activities OT, select appropriate activities for task for task centred group appropriate centred group and/or make activities for task suggestions for appropriate centred group activities and/or make suggestions for appropriate activities  Plan and  Plan and prepare task centred  Plan and prepare task centred prepare task activity group as part of a activity group centred activity programme as delegated to OTT Also implement: group as part of Also implement: a programme as  support groups  support groups delegated to  social / leisure groups  social / leisure groups OTA  community development  income generation projects; show forums / programmes entrepreneurial skills  income generation projects; show entrepreneurial skills 28

OTA OTT CRW OT . Conduct task- . Conduct task-centred groups . Conduct task-centred groups centred groups  Introduce, conduct and close task  Introduce, conduct and close  Introduce, centred group effectively -as task centred group effectively conduct and appropriate for different -as appropriate for different close task diagnostic, age, culture and diagnostic, age, culture and centred group different levels of performance different levels of performance effectively -as appropriate for different diagnostic, age, culture and different levels of performance  Show  Show awareness of group  Show awareness of group awareness of process and be able to execute process and be able to group process task and maintenance functions execute task and maintenance and be able to functions execute task and maintenance functions  Be able to  Be able to function effectively as  Be able to function effectively function both group leader and co-leader as both group leader and co- effectively as leader both group leader and co- leader  Effectively  Effectively facilitate client’s  Effectively facilitate client’s facilitate client’s participation in group activity participation in group activity participation in group activity  Record session  Record session and client  Record session and client and client responses in therapy files responses in therapy files responses in therapy files 29

OTA OTT CRW OT Assistive . Assistive . Assistive devices and . Assistive devices and devices devices and equipment equipment equipment  Be able to describe a wide  Be able to describe a wide variety  Be able to variety of assistive devices of assistive devices describe a wide  Identify person with disability variety of  Identify person with disability who who may benefit form assistive assistive devices may benefit and report to OT. devices  Assist OT to  Assist OT to provide equipment provide  Provide equipment and and assistive devices to clients equipment and assistive devices to clients assistive devices  Including mobility aids to clients.  Identify person with disability who may benefit and report to OT  Provide assistive  Provide assistive devices devices according to protocol. (commercial or department manufactured) appropriate to referral  Provide assistive devices  Provide assistive devices (commercial or department (commercial or department manufactured) appropriate to manufactured) appropriate to referral referral  Make  Make appropriate assistive device  Make appropriate assistive appropriate neatly and accurately according to device neatly and accurately assistive device referral. Make / provide according according to own evaluation / neatly and to own evaluation, according to guideline accurately OT protocol. according to referral 30

OTA OTT CRW OT  Maintain  Maintain assistive devices and  Maintain assistive devices and assistive devices equipment according to equipment and equipment department protocol according to department protocol  Assist client to  Assist client to effectively use /  Assist client to effectively use / effectively use / apply assistive device (standard apply assistive device. apply assistive device / protocol). device (standard device / protocol  Assist client to use according to  Assist client to use according his/her particular problems to his/her particular problems  Make  Make recommendations to OT in  Make standard adaptations. recommendation terms of adaptations. Standard without supervision s to OT in terms cases - make adaptations without of adaptations supervision  Assist client to  Assist client to maintain assistive  Assist client to maintain maintain device in good order assistive device in good order assistive device in good order  Assist OT to  Assist OT to repair assistive  Repair assistive devices repair assistive devices and repair ADs devices  Use appropriate  Use appropriate technology to  Use appropriate technology to technology to manufacture equipment for manufacture equipment for manufacture patients - with OT guidance patients equipment for patients - with OT guidance. 31

OTA OTT CRW OT . Prepare for use . Prepare for use of therapeutic Does not do of therapeutic apparatus apparatus  Prepare OT apparatus /  Prepare OT equipment for use in treatment as apparatus / appropriate in this respect equipment for  Supervise application use in treatment  Supervise application . Assist OT to: . Assist OT to: . Effectively organise and Effectively organise Effectively organise and implement implement special events for and implement special events for persons of various persons of various ages and special events for ages and cultural groups, with a wide cultural groups, with a wide persons of various variety of commonly occurring variety of commonly occurring ages and cultural disorders, disabilities, residing within disorders, disabilities, attending groups, with a wide institutions or attending clinics or health clinics or health centres, as well variety of commonly centres. as specifically in community occurring disorders, setting / context disabilities, residing within institutions or attending clinics or health centres

 Be able to,  Be able to, together with OT,  Be able to, select appropriate together with select appropriate events for events for population / OT, select population / situation. In familiar situation. appropriate setting and a structured events for programme, do without OT population / supervision according to situation department plan 32

OTA OTT CRW OT  Plan and  Plan and organise administrative,  Plan and organise organise financial, logistical and other administrative, financial, administrative, practical arrangements, following logistical and other practical financial, departmental guidelines arrangements, following logistical and departmental guidelines other practical arrangements, following departmental guidelines  Implement  Implement effectively and  Implement effectively and effectively and successfully successfully successfully  Be able to  Be able to effectively involve a  Be able to effectively involve a effectively wide variety of patients, as well as wide variety of patients, as involve a wide colleagues in an event and ensure well as colleagues in an event variety of that the event is maximally and ensure that the event is patients, as well therapeutic maximally therapeutic as colleagues in an event and ensure that the event is maximally therapeutic  Follow up,  Follow up, record and finalise all  Follow up, record and finalise record and aspects after the event all aspects after the event finalise all aspects after the event . Assist OT to . Assist OT to plan and, where . Plan and, where possible, to plan and, where possible, to provide equipment provide equipment and make possible, to and make adaptations to the adaptations to the home provide home / work environment environment equipment and make adaptations to the home / work environment 33

OTA OTT CRW OT  Make adaptations to home without  Make adaptations to home supervision (with consultation) with consultation  Understand  Understand environmental  Understand environmental environmental barriers and their implications for barriers and their implications barriers and their persons with disabilities for persons with disabilities implications for persons with disabilities  Assist OT to  Assist OT to plan, recommend  Undertake (where relevant) plan, and undertake (where relevant) adaptations to a client’s home recommend and adaptations to a client’s home undertake (where relevant) adaptations to a client’s home  Implement a  Implement a referral for an  Implement a referral for an referral for an adaptation as received from the adaptation as received from adaptation as OT an OT received from the OT . Carry over of . Carry over of therapeutic / . Carry over of therapeutic / therapeutic / rehabilitation programmes from rehabilitation programmes rehabilitation institution into community and from institution into programmes implement basic programmes in community and implement from institution the community basic programmes in the into community community

 Show basic  Show basic understanding of  Show in depth understanding understanding of community structures, of community structures, community organisation and procedures for organisation and procedures structures, entry for entry organisation and procedures for entry 34

OTA OTT CRW OT  Show  Show understanding of concept of  Show understanding of understanding of and implementation of community concept of and implementation concept of and outreach programmes of community based implementation rehabilitation programmes of community outreach programmes  Show skill to implement outreach  Show skill to implement programmes community based programmes  Be able to  Be able to conduct appropriate  Be able to conduct conduct activities for groups / individual appropriate activities for appropriate treatment in community setting groups / individual treatment activities for (e.g. at day centre / clinic) as well in community setting (e.g. at groups / as within the home day centre / clinic) as well as individual within the home  Profile community resources for treatment in treatment  Profile community resources community for treatment setting (e.g. at day centre)  Assist disabled client to integrate  Assist disabled client to into his home and family and live integrate into his community effectively at home and with family and live effectively at home and with family Termination and Follow Up  Does not do.  Does not do Treatment terminated  Treatment terminated by CRW . Terminate Treatment by OT based on recommendation in consultation with therapist. terminated by OT from OTT (in consultation) based on input from OTA

. Follow up  With guidance.  With guidance. Monitor Progress  Monitor Progress and report  Research on efficacy of intervention. Monitor Progress and report back to OT back to Therapist and report back to OT 35

OTA OTT CRW OT Recording of: . Assessment  Through clinical  Use protocols of department /  Use protocols findings observation, use centre of checklist provided by OT . Treatment  Provided by OT,  Select a plan from protocol, consult  Select a plan from protocol, . Record comprehensively plan must give input OT and record progress. consult therapist and record progress. . Treatment  Record sessions  Record sessions conducted  Record sessions conducted . Monitor OTA and OTT, does follow provided conducted according to protocol according to protocol up. according to protocol . Statistics  According to  According to requirements of  According to requirements of . Analysis and planning according to departmental department or employing authority employing authority statistics. requirements . Client /  Indicate progress,  Record response and progress,  Record response and progress, All information received patient appropriateness indicate appropriateness, indicate appropriateness, response of intervention, intervention, make intervention, make recommendations recommendations recommendations  Filing  Record in OT  Record in OT patient files (OT  Record in patient files Record information patient files (official). records patient files (OT Department, clinic, health setting) Retain overall responsibility. Department)

Reporting . Verbal  To OT,  To OT, colleagues, formally and  To colleagues, formally and colleagues, informally informally formally and informally . OT file  Contribute to  Files report report 36

OTA OTT CRW OT . OTT file  Can contribute  Keeps up to date records  CRW file Reports on all aspects of assessment and intervention analysis and consequences and long term plan . Medical file  Make entry with  Make entry with co-signature of OT  Does not do co-signature of OT . Ward Round  Does not report  Does not report at formal ward  Does not report at ward at ward round, round. Contributes to case round Contributes to discussion, information toot. case discussion, information to OT. . Authorities  Does not do  Report to authority on identified . Reports To authorities and aspects community structures . Client  Consults on  Consults OT as needed except- for  Consults Client and care giver . Care instruction / non-routine cases, unfamiliar extensively Vicariously responsible for quality and provider guidance from cases; done as part of treatment content of information reported. OT, help with routine interpretation for client /caregiver

Programmes . Assist OT to plan . Organise and implement according . Organise and implement Plan, organise, present promotive . Promotive and provide to guidelines for mental and according to guidelines for programmes as required by situation - health promotion physical health in consultation with mental and physical health in supervise implementation. programmes: OT. consultation with therapist. Contribute to community promotive . Demonstrate . Show expertise in planning and . Show expertise in planning and programmes. basic knowledge presenting health promotive presenting health promotive and programmes. programmes. understanding of criteria for and characteristics of mental and physical health 37

OTA OTT CRW OT . Be able to use and present . Be able to use and present prepared material and protocols on prepared material and protocols health promotion and healthy on health promotion and lifestyle to clients of the OT healthy lifestyle to clients and department and their families, and their families, and also prepare also prepare material and protocols material and protocols on health on health promotion and disability promotion and disability preventions as needed for such preventions as needed for such programmes. programmes. . Contribute to health promotion . Contribute to health promotion events in various settings (school, events in various settings community) (school, community) . Conduct health promotive events . Conduct health promotive (in consultation with OT) events. . Run groups to advocate rights of . Run groups to advocate rights disabled people of disabled people

. Preventive Assist OT to plan Assist OT to plan and provide Plan and provide preventive Preventive disability, also at risk groups and provide preventive programmes for at risk programmes for at risk preventive individuals and groups individuals and groups programmes for at . Demonstrate basic understanding . Demonstrate a good risk individuals and of principles and procedures understanding of environments groups underlying the planning and supportive to health and welfare Demonstrate a basic implementation of preventive and be able to identify factors understanding of programme which place members of the environments group / community at risk of supportive to health developing a disability / disorder and welfare and be able to identify factors which place members of the group / community at risk of developing a disability/disorder 38

OTA OTT CRW OT . Demonstrate . Plan and implement preventive . Demonstrate good basic programmes together with OT and understanding of principles and understanding of as per protocol procedures underlying the principles and planning and implementation of procedures preventive programme underlying the . Plan and implement preventive planning and programmes according to implementation of protocol preventive programme . Implement preventive programmes together with OT . Provide ongoing . Provide ongoing monitoring and . Provide ongoing monitoring and monitoring and adjustment of such programmes adjustment of such adjustment of programmes such programmes

. Remedial  Provide  Carry over according to Comprehensive intervention plan, remedial referral. implement, modify, review, refer to implementation OTA/OTT. with supervision, in hospital (acute) setting (refer to IMPLEMENTATIO N)

. Rehabilitativ  Medium and  Formulate programme based on  Formulate programme based on Acute, medium and long term, e long term and protocols, consult with OT. protocols rehabilitation - plan, manage, implement, acute settings monitor. (refer to  Show expertise in disability  Show expertise in disability Refer to OTA/OTT IMPLEMENTATIO prevention. prevention N) under supervision 39

OTA OTT CRW OT C PROJECT . Have an understanding of basic AND SERVICE management and administrative DEVELOPMENT  Develops protocols as indicated.  Develops protocols as principles which will provide the AND Examples: starting a crèche, food indicated. graduate with the ability to MANAGEMENT  Does not do garden, disabled peoples group, Examples: starting a crèche, adequately manage his/her own time income generating group, food garden, disabled peoples and the administrative tasks required Project recreational group at the clinic group, income generating of the service / practice within which Development group, recreational group, he/she will work. And facilitate group action within . Project development for region / Management community where placed. district. Multiple projects using . Needs different people to assist with project analysis development. . Negotiate  Does not do . Assists OT and team (institution /  In community where placed with community setting) structures . Formulate  Does not do,  Assists OT and team  Together with stakeholders in project gives ideas community. . Obtain  Assists OT / team  Assists OT and team, undertakes  Do funding proposal in resources identified tasks consultation with Authority . Management  Assists OT / team  Assists OT and team. Takes  Management of resources of resources responsibility for identified resources Project  Implement and manage projects . Monitor projects by OTT. Development together with people with a  Implements and manages . Be able to continuously evaluate the and disability / team projects together with people effectiveness of own and other Management  Assist with  Report back to OT / Authorities, with a disability / team. interventions against expected . Implement implementation consult with OT outcomes in order to modify, grade, and manage under supervision. continue or terminate intervention. project . Evaluate /  Gives  Monitor and evaluate  Monitor and monitor input input to OT / Authorities evaluate input to Authorities

Service Development . Does not do  Does not do but can be  Does not do but Comprehensive promotive, preventive, Comprehensive called upon to give inputs, share can be called upon to give remedial and rehabilitation service, promotive, knowledge and experience inputs, share knowledge and looking at health needs of district, region, preventive, experience country remedial and rehabilitation 40

OTA OTT CRW OT service, looking at health needs of district, region, country. Management Able to apply the following management . Management principles: of services, . Organise and manage his/her time, resources: daily activities, work environment, . Management  Junior OTAs and  Junior OTT, OTA . Does not do stress and resources responsibly of people student OTAs and effectively. . Delegate to, facilitate and guide the . Volunteers  Assist volunteers  Recruit, train and assist volunteers  Recruit, train, monitor in work of auxiliary staff and elicit their when involved in involved in OT programmes (as per consultation with Therapist assistance in implementing the OT programmes guidelines) various treatment programmes. under direction of . Co-ordinate volunteer services, offer OT, organise for training programmes, overall assistance with supervision. activities . Develop protocols for patient . Management  OT remains  OT remains responsible, OTA to  Therapist remains responsible, populations using professional of finance responsible, OTA manage certain tasks; input to OT CRW to manage certain tasks; information bases. to manage certain input to Therapist . Record, analyse and organise tasks; input to OT information / data effectively and . Tools,  Control, repair  Control, repair within OT  Control of resources in terms of perform the necessary administrative Equipment, within OT department or allocated area for project / client (e.g. to make tasks essential in the management of Materials department or which OTA is responsible assistive devices) client treatment or programme implementation and service / allocated area for  Control of resources in terms of departmental management. which OTA is project / client (e.g. to make . Interpret and act appropriately on responsible assistive devices) referrals and be able to refer clients appropriately when necessary. . Consultation with different support services and structures. . Overall management, accountable to authorities

. Time  Mana  Manage own time  Manage own time  Plans OT service Management ge own time effectively, organise daily schedule effectively, organise daily together with OTA/OTT effectively, schedule organise daily 41

OTA OTT CRW OT schedule. . Control  Take  Take care of  Take care of . Supervision of staff / programmes / care of equipment equipment and materials. Manage a equipment and materials. resources and materials treatment area, prescribed group, Manage a treatment area in the attend to allocated tasks, follow household, prescribed group, appropriate procedures to obtain attend to allocated tasks, follow and distribute resources appropriate procedures to obtain and distribute resources

 Management  As allocated,  As allocated according to guidelines  Draw up guidelines for use by of Area according to OTA/OTT, overall management. (Hospital, guidelines e.g. tuck shop, beauty parlour) . Organisation Organises events Organises events e.g. Sporting Organises events e.g. Sporting  Organisation of overall plan of of events e.g. outing, sports events - disabled people, teenagers; events - disabled people, events for one or more settings, train involving day within within institutional / community; teenagers; within the community staff to conduct, monitor. groups of institution / facility setting. Contribute to professional patients / (see Contribute to professional meetings meetings populations - IMPLEMENTATIO Make supervisor aware of personal Make supervisor aware of including N for details) needs. personal needs. follow-up Contribute to monitoring professional meetings. Makes supervisory OT aware of personal needs. D RESOURCE  Contribute to and develop OT . Provide information on:  Develop self as resource person.. PERSON  Provision of basic resources . Health, Welfare and Social . Provision of information  Provide information on: Services disability grant and information about disability / Health, Welfare and Social pension application, available disorder. Services disability grant and ADs and wheelchairs, assist persons to apply for grants. 42

OTA OTT CRW OT . Collect  Provide printed pension application, available ADs . Identify community resources  Develop system / structure and information information and wheelchairs, assist persons to for treatment. management for resource provision. of resources, apply for grants. . Identify disabled person’s  Develop support networks how to  Identify community resources for needs to therapist  Consultation with Caregivers. access (e.g. treatment.  Monitor system. Be able to identify, education,  Identify disabled person’s needs to access and utilise appropriate pensions) OT. human and material resources within . Advise / the specific treatment or home consult on environment of the client or group of disability clients and caregivers and teach / management empower to be able to independently and services. access and utilise these resources. E CORE SKILLS . Demonstrate . Demonstrate departmental . Demonstrate knowledge of, and 1 Activity skills departmental knowledge of, and expertise in, skill in, execution of a selection knowledge of, and execution of a wide variety of of constructional and creative expertise in, constructional and creative activities, using a variety of execution of a activities, using a wide variety of materials emphasising scrap wide variety of materials including scrap materials, materials, as suitable for constructional and as suitable for different age groups, different age groups, culture, creative activities, culture, gender performance levels gender performance levels and using a wide and treatment purposes. treatment purposes as suitable variety of . Demonstrate skills in use of for a community setting. materials relevant tools, materials, equipment . Demonstrate skills in use of including scrap and procedures as these relate to a relevant tools, materials, materials, as comprehensive range of activities. equipment and procedures as suitable for . Assemble and maintain resource these relate to the selected different age files containing patterns, materials, range of activities. groups, culture, etc. . Assemble and maintain gender resource files containing performance patterns, materials, etc. levels and treatment purposes. 43

OTA OTT CRW OT . Demonstrate . Demonstrate ability to organise, . Demonstrate ability to organise, skills in use of control, order and develop activities control, and develop activities relevant tools, for treatment and recreational for treatment and recreational materials, purposes purposes equipment and procedures as these relate to a comprehensive range of activities. . Assemble and maintain resource files containing patterns, materials, etc. . Demonstrate ability to organise, control, order and develop activities for treatment and recreational purposes

2 Contribute to . Understand and . Understand and actively contribute . Understand and actively . Work effectively with others as a effective actively contribute to effective teamwork contribute to effective teamwork member of a team, group teamwork to effective . Work effectively within a . Work effectively within a organisation or community within a teamwork supervisory relationship supervisory relationship multi- inter- or intra-disciplinary context depending on the specific . Work effectively . Work effectively within the . Work effectively within the situation within which he/she works. within a management structure of the team. management structure of the supervisory team, as well as community relationship structure. . Work effectively within the management structure of the team. 44

OTA OTT CRW OT . Promote OT and . Promote OT and role of OTA within . Promote role of the CRW within 2 Contribute to role of OTA within rehabilitation of individual and rehabilitation of individual and effective rehabilitation of groups of patients. Promote OT and groups of clients. Promote teamwork individual and role of OTT within community team rehabilitation and role of CRW (Continued) groups of and within community structures within community team and patients. within community structures.

. Conduct self in an . Conduct self in an ethically . Conduct self in an ethically ethically responsible manner in all dealings responsible manner in all responsible with colleagues/ clients dealings with colleagues/ clients manner in all dealings with colleagues / clients 3 Communicate effectively and . Communicate . Communicate effectively with . Communicate effectively with Communicate effectively: establish a effectively with colleagues at all levels, both within colleagues at all levels, . using verbal and non-verbal skills helping . using audio-visual methods in oral, colleagues at all and outside of OT department . Develop and maintain an relationship diagrammatic and written levels, both within . Develop and maintain an empathetic helping relationship presentation form and outside of OT empathetic helping relationship with with clients and their families. . listening and interpreting with acuity, department clients and their families. . Show respect for patient’s sensitivity and discernment to what is . Develop and . Show respect for patient’s rights at rights at all times. being said at all levels of maintain an all times. communication. empathetic helping relationship with clients and their families. . Show respect for patient’s rights at all times. . Respect diversity . Respect diversity of culture, values . Respect diversity of culture, This communication occurs of culture, values and resources. values and resources. . on a professional level with and resources. . Communicate clients’ needs and . Communicate clients’ needs members of the team, group, . Communicate responses effectively and and responses effectively and organisation or community in which clients’ needs and objectively to OT objectively to Supervisor he/she may work . on a therapeutic, facilitatory level responses . Maintain appropriate levels of . Maintain appropriate levels of with clients, groups or clients and/or 45

OTA OTT CRW OT Communicate effectively and confidentiality confidentiality their caregivers effectively objectively to OT . Use appropriate professional . Use appropriate professional . with resource persons such as (continued) . Maintain terminology. terminology. employers, suppliers, etc. appropriate levels . Assist therapist by interpreting / . Assist therapist by translating of confidentiality translating as needed. as needed. . Use appropriate professional . Demonstrate effective telephone terminology. skills. . Demonstrate effective . Assist therapist by . Understanding and follow lines of telephone skills. interpreting / communication. translating as . Understanding and follow lines needed. of communication.

. Demonstrate effective telephone skills. . Understanding and follow lines of communication. 4 Use of basic . Demonstrate . Demonstrate knowledge and skill in . Demonstrate knowledge and first aid knowledge and terms of CPR, wound care, skill in terms of CPR, wound skill in terms of infection control, universal care, infection control, universal CPR, wound care, precautions, and also advanced precautions, and also advanced infection control, first aid first aid universal precautions

5 Conduct self Demonstrate sound . Demonstrate sound understanding . Demonstrate sound . Demonstrate sound understanding in a understanding of of professional, ethical understanding of professional, of professional, ethical professional professional, ethical responsibilities, be able to apply ethical responsibilities, be able responsibilities, be able to apply and ethical responsibilities, be ethical principles in everyday to apply ethical principles in ethical principles in everyday manner in able to apply ethical dealings with in patients, care everyday dealings with in dealings with in patients, care givers dealings with principles in everyday givers and colleagues patients, care givers and and colleagues clients, dealings with in colleagues caregivers, colleagues and employers 46

OTA OTT CRW OT patients, care givers . Practise effectively within a . Practise effectively within a . Practise effectively as supervisor and colleagues supervisory relationship supervisory relationship within a supervisory relationship . Practise . Show thorough understanding of . Show thorough understanding effectively within a the scope, role limitations and core of the scope, role limitations supervisory skills, as applied to OTT and core skills, as applied to relationship CRW . Show thorough understanding of the scope, role limitations and core skills, as these apply to the OT Auxiliary . Behave in a . Behave in a manner which shows . Behave in a manner which . Behave in a manner which shows manner which respect for other persons; shows respect for other respect for other persons; shows respect for demonstrate professional and persons; demonstrate demonstrate professional and other persons; personal integrity at all times and professional and personal personal integrity at all times and demonstrate demonstrate accountability for integrity at all times and demonstrate accountability for action professional and action demonstrate accountability for personal integrity . Adhere to profession’s code of action at all times and conduct, ethical rules and . Adhere to profession’s code of demonstrate regulations conduct, ethical rules and accountability for regulations action . Adhere to profession’s code of conduct, ethical rules and regulations 47

OTA OTT CRW OT . Adhere to the profession’s code of conduct, ethical rules of the professional council and use disability, educational and employment legislation to the benefit of people with disability. . Assign value to and apply human occupation as the primary means of achieving health objectives and as the primary end in promoting well- being and quality of life for individuals, groups and communities. . Understand and respect the need for lifelong learning and be able to put this into practice through appropriate opportunities for continuing professional education. Respect and always consider the cultural values of the client in the selection of occupations / activities. . Show an awareness of the scope of the profession in order to be able to explore career and educational opportunities. . Demonstrate an understanding of the possible

. career choices available to an occupational therapist.

. Demonstrate a positive attitude towards the need for professional research and the role of the occupational therapist in it 48

OTA OTT CRW OT 6 Exercises . Basic ROM exercises . Basic strengthening exercises . Use of walking aids . Use basic gait training techniques . Apply basic pain relief measures 7 Communi- . Use of communication boards . cation . Screen for speech and hearing problems . Identify clients who need alternative and and/or augmentative communication methods and refer. . Assistance with feeding F ACTIVITIES . Planning and . All of OTA activities mentioned . Screening to identify disability . Plan, design of protocols / strategies WHICH MAY BE provision of . Screening to identify disability and and conduct basic functional CONDUCTED diversional conduct basic functional assessment. WITHOUT programmes to assessment. . Conduct basic health education SUPERVISION groups of people / and prevention programme (Area of individuals . Conduct basic health education and prevention programme . Selection of intervention independence) . Recreational programme according to groups . Activity teaching ― protocols available ― basic physical and . Wheelchair psychological problem. repairs . Wheelchair training (according to protocol) 49

OTA OTT CRW OT . Conduct a basic . Selection of intervention . Wheelchair training interview to obtain programme according to: . Transfers background and ― protocols available . Pressure care lifestyle ― basic physical and information psychological problem. . Run groups (task centred skills training) . Handle everyday . Wheelchair training behaviours and . Rehabilitation - routine . Pressure care incidents, e.g. intervention epileptic seizure, . Run groups (task centred skills . Decide on relevant assistive uncooperative, training) devices and make them / select depressed . Rehabilitation - routine intervention / provide incontinent, blind, . Decide on relevant assistive . Conduct stress management at deaf clients; devices and make them / select / promotive / preventive level provide basic provide patient care and . Conduct stress management at apply first aid (as promotive / preventive level trained) . Train clients to transfer effectively . Do basic AIDS counselling . Do basic first aid . Apply advanced first aid . Apply advanced first aid . Make assistive . Plan and organise environmental . Plan and organise devices according adaptations environmental adaptations to pattern, . Develop activities programmes protocol. together with OT structures / community members 50

OTA OTT CRW OT . Fulfil . Implement income generation . Entry into and consult with administration projects (general population / community duties diagnostic groups / special needs). . Develop activities programmes . Management of . Health promotion programmes together with community meeting(s) (planned with OT) members / structures . Setting up of . Preventive programmes (as per . Activity based exercises. support group and guidelines) . Implement income generation ensuring effective projects (general population / function diagnostic groups / special . Organise events needs). according to . Health promotion programmes monthly / annual plan . Preventive programmes . Implement RO, . Develop support groups / stimulation networks in community. programmes . Basic Physiotherapy . Implement techniques such as passive income movements. generation projects (general population) . Implement recreational programmes G LIFE LONG . Understand need . Understand need for lifelong . Understand need for lifelong LEARNING for lifelong learning and importance of learning and importance of learning and professional accountability. professional accountability. importance of . Take responsibility for own . Take responsibility for own professional learning. learning. accountability. . Keep up to date with professional . Keep up to date with . Take knowledge and skill. professional knowledge and responsibility for . Actively participate in CPD as skill. own learning. required by HPCSA. . Actively participate in CPD as . Keep up to date required by HPCSA. with professional knowledge and skill. . Actively 51

OTA OTT CRW OT participate in CPD as required by HPCSA. H PROBLEM . Competently . Competently identify and deal with . Competently identify and solve SOLVING AND identify concrete problems that occur in context of problems that occur in context CLINICAL problems that prescribed treatment of individual / of intervention of individual / REASONING occur in the group or community setting using group and community using context of structured procedure for problem structured procedure for prescribed solving. problem solving. treatment for . Consult with OT / supervisor on . Consult with supervisor on individual and problem resolution procedures problem resolution procedures groups, and refer selected, evaluates outcomes. selected, evaluates outcomes. to OT for assistance. . Deal effectively with routine problems. I RESEARCH . Assist OT in . Assist OT in collection of basic . Assist in the collection of basic Able to carry out the following activities collection of basic demographic survey information for demographic survey information related to research: demographic research purposes. for research purposes. . Identify practice areas requiring survey information . Keep comprehensive records and . Keep comprehensive records research. for research statistics as required for research. and statistics as required for . Select, plan and implement the purposes. research. appropriate quantitative and/or . Keep qualitative methodology. comprehensive . Collect, organise, analyse and records and critically evaluate data and/or elicit statistics as appropriate expertise when / where required for necessary. research. . Collaborate in research activities and/or projects where there is more than one researcher. . Access appropriate funding and resources with which to implement research projects. 52

OTA OTT CRW OT J The following The following activities may not be The following activities may not be LIMITATIONS activities may not be undertaken by OTT without the undertaken by CRWs without the OF PRACTICE undertaken by OTA necessary training, experience or necessary training, experience or without the necessary consultation with the supervision consultation with the supervising training, experience or occupational therapist: therapist: consultation with the supervision occupational therapist: . Interpret referrals . Interpret referrals for occupational for occupational therapy therapy

. Undertake . Undertake (administer / interpret) . Undertake (administer / (administer / standardised tests as identified for interpret) standardised tests as interpret) use by occupational therapists. identified for use by standardised tests Undertake in depth, assessment occupational therapists / other as identified for procedures - unless adequately professional groups. Undertake use by (formally) trained (e.g. for work in depth, assessment occupational ability) procedures - unless adequately therapists. (formally) trained (e.g. for work Undertake in ability) depth, assessment procedures - unless adequately (formally) trained (e.g. for work ability) . Plan, institute and . Plan, institute and modify treatment . Carry out electro therapy modify treatment programmes - unless done in . Use joint manipulation programmes - consultation with an occupational techniques unless done in therapist or according to protocol . Provide treatment for acute consultation with respiratory problems an occupational . Order mobility aids therapist or according to protocol 53

OTA OTT CRW OT J . Provide speech therapy LIMITATIONS . Order hearing aids OF PRACTICE (Continued) . Make a diagnosis. . Make a diagnosis. ▪ Make a diagnosis. . Use specialised . Use specialised techniques such . Use specialised techniques techniques such as: such as: as:  socio-emotional group work  socio-emotional group work  socio-emotional  evocative techniques  evocative techniques group work  sensory integration  sensory integration  evocative  perceptual testing and treatment  perceptual testing and techniques planning treatment planning  sensory  design, modify, fit for splints and  design, modify, fit for splints integration pressure garments and pressure garments  perceptual testing and treatment planning  design, modify, fit for splints and pressure garments

 neurophysiologi  neurophysiological techniques  neurophysiological cal techniques (except for basic principles used techniques (except for basic (except for basic to position client during activities). principles used to position principles used . Record patient / client progress in client during activities). to position client medical records of treatment unless . Record patient / client progress during instructed to do so, with the report in medical records of treatment activities). being countersigned by the unless instructed to do so, with supervising occupational therapist the report being countersigned R ▪ by the supervising therapist ecord patient / client progress in medical records of treatment unless instructed to do so, with the 54

OTA OTT CRW OT report being

J countersigned by . Give interpretive information to . Give interpretive information to LIMITATIONS the supervising patients / clients, relatives or other patients / clients, relatives or OF PRACTICE occupational staff, unless in consultation with the other staff, unless in (Continued) therapist supervising occupational therapist consultation with the . Give interpretive supervising therapist information to patients / clients, relatives or other staff, unless in consultation with the supervising occupational therapist . Discharge . Discharge planning, unless in planning, unless consultation with the supervising in consultation occupational therapist with the supervising occupational therapist . Independent . Independent decision making . Independent decision making decision making regarding department policy regarding department policy regarding department policy . Independent . Independent evaluation of . Independent evaluation of evaluation of occupational therapy students therapy students occupational therapy students . Occupational . Occupational therapy auxiliary staff . CRWs may not establish a therapy auxiliary may not establish a private practice private practice staff may not establish a private practice 55

(C) Summary Of Core Skills, Duties And Limitations Of Practice For Mid Level Workers In Occupational Therapy (Ot Auxiliary / Ot Technician)

1) Core skills 2) Duties 3) Limitations of practice

NOTE: The Standards Generating Body of the Professional Board, which will be established in 2004, will compile EXIT LEVEL OUTCOMES for training of Auxiliaries in Occupational Therapy. This document will serve as a reference document for the Standards Generating Body.

1. Core Skills

The following core skills are traditionally part of the Scope of Practice of Occupational Therapy Mid Level Workers, which includes the OT Auxiliary and OT Technician categories, and such persons may be expected to demonstrate practical competence and show evidence of appropriate knowledge to support such skills.

a) Basic Core Skills as Applicable to All Areas / Fields Of Practice

 Accurate interpretation of referrals / guidelines / instructions from supervisor.  Provide (implement) effective, appropriate intervention on referral and as prescribed by the occupational therapist (OTA) or according to protocol (0TT).  Effective and appropriate patient handling skills (everyday incidents / behaviours).  Accurate and astute clinical observation and report back (as relevant for level of training).  Effective communication skills (to include reporting).  Comprehensive activity skills and knowledge (as applicable to OTA/OTT).  Effective and efficient handling of task centred groups (to include structuring, running of group, acting as group leader, dealing with problems arising in the group}.  Effective and efficient basic management skills of record keeping, filing, time management, inventory and stock control and storage of stock.

b) Skills Related to Departmental Tasks

 Efficient and effective assistance of occupational therapists with preparation for individual and group treatment.  Competence in giving instruction and teaching within an occupational therapy setting.  Effective liaison with the occupational therapy staff and other relevant persons.  Efficient organisation of special events (e.g. sports day).  Accurate costing of material / activities.  Correct use and effective maintenance of tools and equipment (in good working order).  Appropriate maintenance of supplies of consumables.  Effective maintenance and care of departmental environment and facilities. 56

c) Activity / Treatment Modality Related Skills

 Application of basic first aid (OTA) and advanced first aid (OTT).  Wheelchair training, management and maintenance.  Transfer training.  Pressure care.  Reality orientation.  Execution / organisation / control / therapeutic application of constructional and non- constructional activities.  Management of low level stimulation / activation programmes  Manufacture of standard assistive devices and assistance in construction of assistive devices / equipment as outlined by the occupational therapist (OTA) or according to protocol (OTT).  Management of occupational therapy areas, e.g. beauty parlour / activity area / income generation project.

2. Outline of Duties of Mid Level Workers in Occupational Therapy a. Carry out functions as related to core skills (above) as designated by the occupational therapist. b. Contribute to the provision of an effective and efficient occupational therapy service. c. Assist occupational therapists with planning, implementation and evaluation of individual or group activity programmes. d. Prepare and maintain an optimal therapeutic environment (e.g. lighting, safety, seating, cleanliness and tidiness). e. Operate and maintain machinery and equipment and arrange for repairs / replacements in accordance with the knowledge and skills of auxiliary staff. f. Undertake administrative duties as may be designated by the supervision occupational therapist. g. Participate in occupational therapy in-service training as required. h. Participate in occupational therapy staff meetings as required. i. Participate in appropriate Continuing Professional Development activities.

3. Limitations of Practice

Limitations of Practice are determined by content of training received and are enforced for the protection of the patient.

The following activities may not be undertaken by mid level workers in occupational therapy without the necessary training, experience or consultation with the supervision occupational therapist: a. Interpret referrals for occupational therapy. 57 b. Undertake (conduct / interpret) standardised tests as identified for use by occupational therapists. Undertake in depth assessment procedures - unless adequately (formally) trained and accredited. c. Plan, institute and modify treatment programmes - unless done in consultation with an occupational therapist or according to protocol (OTT). d. Make a diagnosis. e. Use specialised techniques such as:  socio-emotional group work  evocative techniques  sensory integration  perceptual testing and treatment planning  design, modify, fit for splints and pressure garments  neurophysiological techniques (except for basic principles used to position client during activities). f. Record patient / client progress in medical records of treatment unless instructed to do so, with the report being countersigned by the supervising occupational therapist. g. Give interpretive information to patients / clients, relatives or other staff, unless in consultation with the supervising occupational therapist, or when specially trained to do so. h. Discharge planning, unless in consultation with the supervising occupational therapist. i. Independent decision making regarding department policy. j. Independent evaluation of occupational therapy students. k. Occupational therapy auxiliary staff may not establish a private practice.

59

(D) The Supervision Of Mid Level Workers In Occupational Therapy (Ot Auxiliary / Ot Technician)

SECTION 1: Terminology, Clarification of Concepts, General Guidelines and Requirements for Different Levels of Performance and Contexts

SECTION II: Guidelines for Training of Occupational Therapy Students as Supervisors

SECTION III: Guidelines for Supervision when an Occupational Therapist is not available

Section I

Terminology, Clarification of Concepts, General Guidelines and Requirements for Different Levels of Performance and Clinical Contexts

Purpose of the Document

The purpose of this document is to clarify the supervisory relationship between occupational therapists and mid level workers in occupational therapy.

1. General Provisions

Quality supervision is a mutual undertaking between the supervisor (OT) and the supervisee (OT Auxiliary / Technician) that -

 fosters growth and development;  assures appropriate utilisation of training and potential;  encourages creativity and innovation; and  provides guidance, support, encouragement and respect while working towards the goal of the facility.

Supervision is a process in which two or more people participate in a joint effort to promote, establish, maintain and/or elevate a level of performance and service. The supervisor is responsible for setting, encouraging and evaluating the standard of work performed by the supervisee. The supervisor is defined as one who ensures that tasks assigned to others are performed correctly and efficiently.1

2. Description of Occupational Therapy Personnel

Occupational Therapist (Supervisor), who:

1 The American Journal of Occupational Therapy. Glossary: Standards for an accredited Educational Programme for the Occupational Therapist and Occupational Therapy Assistant. 2002 56/6 668. 60

 Must be a qualified occupational therapist.  Must be registered with the Health Professions Council of South Africa (HPCSA).  Will be required to supervise all categories of OTA/OTT as indicated below.

Occupational Therapy Auxiliary (OTA) (Supervisee), who must -

 have successfully completed a training course (minimum one year) recognised by the Professional Board of Occupational Therapy and Medical Orthotics / Prosthetics (hereafter the Board) and the prescribed period of clinical practical work, in a full-time capacity or the equivalent in a part-time capacity, in an Occupational Therapy Department approved by the Board  be registered or registerable with the Health Professions Council of South Africa (HPCSA).

Occupational Therapy Technician (OTT) (Supervisee) who may have completed any of the following training options:

 A recognised trade or other formal qualification, as well as a relevant course in OT Assistance, as recognised by the Board. (This reflects initial training provided 1985-1989.)  A recognised 2-year diploma or equivalent or recognised 2-year Community Rehabilitation Worker / Facilitator training course. All OTTs must show evidence of having completed the required number of hours of clinical practical work under supervision of an OT or, where relevant, another suitably qualified health professional. In a full or part-time capacity, in an occupational therapy department or other department / facility as approved by the Board.

Staff must be registered or registerable with the Health Professions Council of South Africa (HPCSA).

Student OTA/OTT (Supervisee) who must

 be enrolled in a recognised training course which is registered with the Health Professions Council of South Africa (HPCSA).

Other Staff in Occupational Therapy Departments (Supervisees)

 This category includes persons allocated / seconded to an occupational therapy department, who perform various prescribed duties allocated by the occupational therapist, but who have not been trained in occupational therapy and are not eligible for training for various reasons.  Such persons may be employed as general assistants, nursing assistants, porters, seamstresses and still fall within the institutional structure of the categories they are trained for or employed as.

Trainee Occupational Therapy Mid Level Worker (Supervisee) who is -

 a person working in an OT department, undergoing informal training, whilst waiting to be admitted to formal training as an OTA/OTT, and who performs various prescribed duties as allocated by and under close supervision of the OT.  in a full-time post, which, on completion of a recognised OTA/OTT course, will be converted to an OTA/OTT post. Persons who are in possession of a matriculation certificate with English and at least one of the following subjects: biology, physical science, physiology or maths, are eligible for training as an OTT. 61

3. Competency Levels - Mid Level Workers in Occupational Therapy

Student A person undergoing training as an auxiliary (OTA/OTT). Entry level A person who has successfully completed a recognised training course, including the required period of clinical practical work, and who is registered with the HPCSA and who has less than three years of experience. (Junior OTA/OTT). Intermediate The same as above, except that the person has more than three years of experience. The person starts to seek new knowledge, has gained skill through experience and can be given additional duties / responsibilities as relevant to OTA or OTT level (senior and principal OTA/OTT). Advanced A person who has undertaken additional relevant study (need not have been presented by an occupational therapist), who carries additional departmental responsibilities, and who is highly competent in the execution of a variety of duties / tasks as delegated. The OTA/OTT would have gained expertise in a certain area of performance / practice as relevant to OTA or OTT (chief OTA/OTT). Untrained (but This category caters for: with many years of a. Those individuals who may have spent many years in an occupational experience) therapy department, and who provide a valuable, albeit limited, service, but who, for various reasons, are not able or suitable for formal training. Individuals on this level will need to be assessed and supervisory needs determined on an individual basis. b. Those individuals eligible for, and awaiting, training as OTA/OTTs.

4. Types of Supervision

Supervision occurs along a continuum that includes:

Close supervision Daily, direct contact at the supervisee’s place of work (i.e. face-to- face, on-site, daily). Routine supervision Direct contact (face-to-face) at least once a week at the supervisee’s place of work, with interim supervision occurring by other methods, such as telephonic and/or written communication. Other methods could also include visits by the supervisee to the supervisor’s place of work. General supervision Monthly direct contact, with interim supervision provided by other methods.

NOTE: Please refer to point 10: Additional Guidelines for Supervision.

5. Description of Programmes

Remedial / Acute These types of programmes are typical for short-stay patients in psychiatric or general hospitals or short stay psychiatric units at general hospitals, or community centres. Aims of treatment are reviewed, intervention adjusted, often on a daily basis. Treatment is aimed at the 62

alleviation of symptoms, return to optimal health and prevention of disability. Rehabilitative Patients are in the rehabilitation phase of treatment, due to the development of a disability, and aims of treatment and programmes may be planned for one to three weeks at a time. Routine rehabilitation programmes (protocols) may be implemented. Maintenance Patients are in long-stay institutions or on programmes which are planned for a month of more at a time. The aim of treatment need not be varied often and the person’s condition does not change significantly; the person’s present level of functioning needs to be maintained. The person may no longer be an in-patient of an institution. Promotive The programmes may be offered in all settings and are geared to enhancing or improving mental and physical health and general coping skills in persons who are well, and may include health promotion sessions. Preventive The programmes are geared towards protection of at risk groups / populations. The aim is to prevent disease or disorder and will include health promotion, improvement of living conditions, nutritional programmes, HIV/AIDS education, substance abuse, education, etc.

6. Levels of Supervision as Indicated for Different Clinical Settings and Auxiliary Staff Competency Levels

Remedial / Rehabilitation Maintenance Promotive* Preventive* Acute

Student or trainee Close Close Routine Close Close supervision supervision Supervision / supervision supervision General Supervision Close Close Routine supervision supervision / Supervision / Entry level Close initially Close initially Routine General supervision Supervision Close Routine General Routine Routine Intermediate level supervision Supervision Supervision Supervision Supervision Close supervision / Routine Routine Routine General Routine Supervision Advanced level supervision Supervision Supervision Supervision (depends on routine type) cases Close Routine / Untrained but with Close / Routine Close Close supervision General experience Supervision supervision supervision Supervision

* Supervision is determined by complexity of programme and context - indications are broad guidelines only, repetition and experience will decrease supervision requirements.  The more acute the patient, the closet the supervision (remedial) needed.  Intervention for multi-disability / diagnoses, treatment resistant, or unusual cases, requires direct supervision and occupational therapist input (remedial and rehabilitative).  The more repetitive and routine the programme, the less supervision needed once the staff member has proved his/her competency (maintenance). 63

7. Supervision requirements as Appropriate for Different Experience / Performance Levels of Staff

Supervision is described as relevant to direct services to client (i.e. treatment of client and contact with care providers).

Clinical Supervision Requirements According to Performance Levels

OTA OTT CRW Student or . Constant instruction and . This category includes . To be supervised trainee training while carrying (a) the person who has according to training out tasks in structured completed the OTA requirements / job supervision programme course and is doing the requirements (close supervision) 2nd year and (b) the . Trainees, awaiting person doing the 2-year trainees and persons diploma equivalent. working in OT but not . Trained OTA eligible for training are (a) will work in capacity included in this category as previously trained / and require this level of experienced whilst taking supervision throughout on OTT responsibilities their work under supervision and guidance of OT. (b) supervised according to training requirements / job requirements Junior . Very structured . Structured supervision . Structured supervision (entry level supervision (with plan . Guidance from OT as . Guidance from OT as less than 3 and specific sessions needed needed years) . Supervision on a direct . Takes responsibility for . Takes responsibility for basis insightful and regular insightful and regular . Feedback to supervisors feedback feedback at pre-arranged times on . OT prescribes treatment . OT prescribes treatment all tasks programmes in close programmes in . OT prescribes treatment consultation with OTT consultation with staff programmes and (draw up treatment member and together delegates to OTA/OTT programmes together they draw up treatment with OTT) programmes to ensure . OT to ensure appropriate protocols selected and choice and used appropriately implementation of . General supervision in protocols community settings - . Routine supervision where appropriate except for acute cases . Routine except for acute . Write own feedback cases reports Senior . Structured supervision . Requests supervision . Requests supervision . Guidance from OT as and guidance from OT and guidance from OT (Senior at needed . Takes responsibility for . Takes responsibility for all levels . Takes responsibility for all tasks with insight and all tasks with insight and may insightful and regular interpretation of interpretation of supervise feedback treatment programmes - treatment programmes - advanced functions independently functions reasonably and junior independently in OTA/OTT/ community setting CRW) 64

OTA OTT CRW . OT prescribes treatment . Experienced OTT uses . Experienced CRW uses programmes in close assessments to draw up assessments to draw up consultation with OTA treatment programmes treatment programmes (draw up treatment for routine cases, selects for routine cases, selects programmes together protocols, plans projects protocols, plans projects with OTA) and then consults with and then consults with . Routine supervision supervising OT who will supervision OT who will except for acute, non- make final decision make final decision routine cases . Supervision will vary . Supervision will vary according to programme according to programme and settings. (See p and setting. D(9))

Chief . Requests supervision . Supervises project / . Supervises project / and guidance from OT areas / programmes with areas / programmes with . Takes responsibility for input from OT. input from OT. all tasks with insight and . General supervision . General supervision interpretation of usually where needed. usually where needed. treatment programmes - Routine supervision Routine supervision functions independently except for acute, except for acute, . Experienced OTA uses problematic cases. problematic cases. assessments to draw up treatment programmes for routine cases and then consults with supervision OT

8. Control / Regulation of Supervision

8.1 The control and prescription of the type and extent of supervision is determined by regulations and guidelines of the Professional Board for Occupational Therapy, Orthotics and Prosthetics of the Health Professions Council of South Africa, as well as guidelines provided by The Occupational Therapy Association of South Africa (OTASA).

8.2 The implications of these control / regulatory provisions of the Professional Board and the Occupational Therapy Association of South Africa are that:

 The occupational therapist retains ultimate accountability for the occupational therapy services offered.  The occupational therapist is obliged to provide effective supervision (this includes appropriate referral and supervision as determined by the competency level of the OTA/OTT and the clinical or community setting).  The employing body is obliged to provide a registered occupational therapist as supervisor.  Mid Level Workers are obliged to work under the supervision of a qualified occupational therapist and may not establish a practice for their own account. Such mid level workers may however be employed by an occupational therapist in private practice.  As in the case with the qualified occupational therapist, the OTA/OTT may not undertake any acts for which they are not adequately trained or experienced.  The Professional Board of the HPCSA’s Code of Conduct and Ethical Rules apply equally to registered occupational therapists, OTAs, OTTs and CRW/CRFs. 65

9. Additional Guidelines for Supervision

1. The scope of this document does not allow for detailed description of administrative, educational and supportive / management functions. These are however considered to be an integral part of the supervisory process. 2. The type and method of supervision and the number of hours of supervision to be provided is determined by the ability of the supervisee to safely and effectively provide those interventions delegated by the occupational therapist, i.e. the competency level of the supervisee, and the type of programme(s) offered by the clinical setting. 3. Supervision may be provided through direct on-site supervision (the preferred method), supervision by telephone, fax, electronic means (e-mail), written reports, report-back sessions and/or group conferences and meetings, also in-service training sessions. 4. Direct on site supervision is the preferred method of supervision and may never be totally replaced by other methods. Direct on site supervision minimally requires observation of treatment, feed back, general discussion of treatment of each client, review of programmes and any other activities. Such a session may thus require a three-hour face to face contact session, particularly on sites where the supervisor is not in full time employment at the site, and this should be allowed for. 5. Supervision of organisational and developmental aspects of performance may be done on a monthly basis, with well established programmes, this may be done three-monthly (absolute minimum). 6. The types, methods and hours of supervision needed should be determined before the individuals enter into a supervisor-supervisee relationship and should be re-evaluated regularly for effectiveness. Supervision may not be summarily terminated. 7. The type of clients and clinical setting should determine the OT : OTA/OTT ratio. The following ratios are a guideline:

. Acute / Remedial 1 OT : 1 OTA/OTT . Rehabilitation 1 OT : 5 OTAs/OTTs . Maintenance 1 OT : 10 OTAs/OTTs . Promotive 1 OT/PT/S&HT : 5 OTAs/OTTs . Preventive 1 OT/PT/S&HT : 2 OTAs/OTTs

8. Time and finance (transport) should be made available to allow for adequate supervision. Supervision must be acknowledged as an integral part of the functions of the occupational therapist by both the employing body and the supervisor. 9. If the type of supervision as indicated in the table on page D(8) cannot be adequately met, or a supervisor is not available, the occupational therapy service will of necessity, after a prescribed period, have to be discontinued. (Also refer to guidelines for supervision when an OT is not available.) 10. Occupational therapy auxiliary staff may, should an OT not be available, or not in full time employment at the site, be administratively supervised by others, e.g. medical superintendent, principal, matron, but only a registered occupational therapist may supervise occupational therapy practice (clinical supervision). As an interim measure, the OTA/OTT may be supervised by a suitably qualified practitioner registered with the HPCSA for a maximum period of six months. 11. The employing body should introduce a system for monitoring and ensuring that supervision is provided by an occupational therapist. 66

12. In-service training of occupational therapists to ensure quality supervision should be ongoing as part of Continuing Professional Development (CPD) activities provided.

10. Summary of Responsibilities, Rights and Limitations

10.1 The Occupational Therapist Supervisor

LIMITATIONS RIGHTS / EXPECTATIONS

. Exploitation of Auxiliary staff by requiring The supervisor can expect: them to do tasks which they are not experienced to do, or which are of an . Implementation of prescription for unnecessarily menial nature. intervention . Loyalty . Must abide by ethical principles, rules and regulations. . That OTA/OTT will not perform acts for which he/she does not have the necessary training and experience . Co-operation with OT and team . That OTA/OTT will comply with ethical principles and rules

RESPONSIBILITIES

. Effective communication . Introduction of staff enrichment programmes . Improvement of work situations / conditions and creation of a situation which is conducive to supervision . Ensure that OTA/OTT has the necessary competence to take on tasks delegated and, where, indicated, train staff until required level of competence is attained . Monitor conditions of work . Organisation and provision of in-service and continued professional development training . Involvement of auxiliaries in OT and OTASA activities and events . Personal support to OTA/OTT . Vicarious liability for tasks done by OTA/OTT. Accountable for all OT interventions

10.2 Auxiliary Staff

LIMITATIONS RIGHTS / EXPECTATIONS

. Cannot go into private practice The OTA/OTT can expect . Cannot work without OT supervision . Adequate training . Must abide by Ethical Principles, Rules . Effective supervision by an OT and Regulations . Opportunity for development . To do only what he/she is trained / experienced to do, and not 67

be exploited . Reasonable working conditions . Adequate employment conditions

RESPONSIBILITIES

. To obtain supervision . To treat patients without bias with regard to colour, creed, religion, disorder, politics or social economic conditions . Execute OT prescriptions effectively and efficiently . Report back to OT . Show loyalty to employer and the profession . Maintain HPCSA registration and comply with Continuing Professional Development requirements . Undertake further study and self development

The content of the above section of this document (Section D Supervision of Auxiliary Staff in Occupational Therapy - Section I) is based largely on a document compiled by Mrs C Holland and Mrs D van der Reyden on behalf of the Support Staff Committee of OTASA, June 1999. It has been extensively revised through inputs by Professional Board members and members of the Auxiliary Staff Committee of the Professional Board (November 2003).

Reference List

1. American Occupational Therapy Association. Guide for Supervision of Occupational Therapy Personnel. American Journal of Occupational Therapy 48(11) 1045-1046. 2. American Occupational Therapy Association. Supervision Guidelines for Certified Occupational Therapy Assistants. American Journal of Occupational Therapy 44(12) 1089-1090. 3. American Occupational Therapy Association. Entry Level Role Delineation for OTRs and COTAs. American Journal of Occupational Therapy 44(12) 1091-1102. 4. American Occupational Therapy Association. Guide for Supervision of Occupational Therapy Personnel. Official Position Paper. American Journal of Occupational Therapy 35(12) 815-816. 5. Ryan S E (Ed). The Certified Occupational Therapy Assistant, Roles and Responsibilities. Slack Inc 1986. 6. South African Association of Occupational Therapists. Supervision of Qualified Support Staff. Unpublished document, June 1989. 7. South African Medical and Dental Council. Notice 533 of 1984 and Notice 534 of 1984. Rules for the Registration of Occupational Therapy Technicians and Rules for the Registration of Occupational Therapy Assistants. 68

Section II

Guidelines for Training of Occupational Therapy Students in Supervision

1. Introduction

 The supervision of mid level workers in occupational therapy1 has been identified as an area of concern by the Board requiring increased attention by training centres for both occupational therapists and occupational therapy auxiliaries.  Supervision of mid level workers is accepted as an undisputed component of professional practice. With the ratio of Occupational Therapist to Occupational Therapy Mid Level Worker currently registered in South Africa being roughly 4:1, it is very likely that the majority of occupational therapists will need to supervise such workers.  Uncertainty exists at a clinical level about the scope of practice of the various categories of mid level workers, as well as different levels of responsibility, as relevant to different levels of experience, hence the need for documentation of this nature.  The requirement for provision of supervision by occupational therapists is contained in the regulations of the Health Professions Council of South Africa and is therefore a legal duty, in the same way that the occupational therapy mid level worker is obliged to accept that he/she must function within a supervisory relationship with the occupational therapist.  Legally, supervision is defined as “being asked to tell another person what and how to do a task and retaining ultimate responsibility for such person’s actions”2. The occupational therapist thus remains vicariously liable for the actions of mid level workers. This means that the occupational therapist is ultimately accountable for the quality of treatment received by his/her patients regardless of when the implementation of the intervention has been delegated to an auxiliary.  It is important to note that occupational therapists and mid level workers in occupational therapy need to comply with the same ethical principles (beneficence, non-malfeasance, autonomy and justice) and ethical rules, as well as Continuing Professional Development requirements.  Supervision is part of the duties of the occupational therapist, which means that time must be allocated for this purpose and certain procedures followed.

2. Guidelines for Training of Students

On completion of training, students should:

2.1 Have in depth knowledge of and insight into the supervisory relationship and supervisory process. It is also important that students develop an appropriate attitude towards mid level workers. 2.2 Be aware of legal requirements around supervision and HPCSA regulations, and implications of vicarious liability 2.3 Be able to cope effectively with the supervision of OT mid level workers in at least one context and/or area of professional practice. It should where possible include

1 For purposes of this document, the term Auxiliary Staff / Auxiliaries is used to denote all categories of support staff, i.e. Occupational Therapy Auxiliary Assistants, Occupational Therapy Technicians, Community Rehabilitation Workers / Facilitators. 2 MA Dada, DJ McQuoid Mason. Introduction to Medico-Legal Practice. 2001,. 24-25 69

psychiatric institutions, and/or general hospitals, and/or community settings and/or non- governmental organisations. 2.4 Be familiar with minimal requirements / outcomes for training of all categories of mid level workers. (Documents available from Professional Board.) 2.5 Be familiar with scopes of practice of each category of mid level worker, as well as levels of responsibility, as these relate to years of experience and limitations of practice. Students should be aware that mid level workers are not to be used exclusively for translation and menial departmental tasks and may not take ultimate responsibility for intervention. 2.6 Students should be aware of general content of training and possible expectations of mid level workers in terms of knowledge and skills (particularly core skills) and appropriate levels of decision making. (Refer to document on Scopes of Practice available from the Professional Board.) 2.7 Students should be aware of types and levels of supervision and how these relate to different programmes (e.g. remedial or rehabilitative), diagnostic groups and types of settings. 2.8 Be sensitive to areas which may impact on the supervisory relationship, such as gender, age and cultural differences which may exist, as well as vast differences in years of experience between occupational therapist and occupational therapy mid level workers. Students should also be familiar with the context within which the mid level worker functions and the stressors inherent in the situation.

The management component of the occupational therapy course should be taught in such a way that the supervisory relationship within occupational therapy is specifically addressed. Students should also be made aware of grievance and disciplinary procedures and relevant labour legislation.

3. Core Supervisory Skills

It is accepted that all occupational therapists will be trained in basic management and organisation and will be familiar with management functions and clinical governance, principles and guidelines (standards of practice, quality assurance). The qualified occupational therapist should have the following core supervisory skills as these relate to mid level workers in occupational therapy.

3.1 Clearly differentiate between the roles and skills of the occupational therapist and the occupational therapy mid level worker. 3.2 Effective and appropriate referral and prescription to the auxiliary for intervention - both written and verbal. 3.3 Effective communication skills including management of input and feedback sessions. 3.4 Effective delegation and transfer of knowledge and skills to others. 3.5 Organisation and planning of a structure within which to supervise. 3.6 Effective conflict management skills 3.7 Skills to conduct a meeting. 3.8 Effective time management 3.9 Effective negotiation skills

Prepared by Dain van der Reyden with inputs from M Concha and Auxiliary Staff Committee members L Lester and J Blows. (November 2003, approved by Board January 2004) 70

Section III

Guidelines for when Occupational Therapy Supervision is Not Available

The resigning occupational therapist is obliged to make an effective alternate arrangement for supervision as per the guidelines set out in these documents. This requirement is in keeping with the occupational therapist’s duty to provide ongoing treatment and the principles of beneficence, non-malfeasance and justice.

1. The resigning occupational therapist should inform the superintendent / employing body and head of rehabilitation services of the HPCSA requirement of ongoing supervision. 2. The occupational therapist should ensure that the necessary structures are in place for continuation of supervision, this may include:  A part time occupational therapist supervisor (specifically employed for this purpose).  Identifying a suitably qualified (registered with HPCSA) health practitioner within the setting who may provide interim supervision for a period of no longer than six months.  Part time supervision by an employee of another institution / organisation in the district / region. 3. The unsupervised OTA/OTT should, if arrangements in part 2) above prove to be unsatisfactory:  Contact the superintendent and inform him/her of the HPCSA requirement.  Contact the union for assistance to ensure that supervisory requirements for ongoing employment are fulfilled.  Contact an occupational therapist within the vicinity to act as mentor (e.g. from training centre / OTASA).  If adequate supervision is not provided, the OTA/OTT must additionally inform the provincial Occupational Therapy Forum, the Professional Board (Manager or Chairperson) and Professional Association (through Exco to Ethical Committee) of the situation. 4. Should the above not be successful, the OTA/OTT needs to inform the medical staff / management that the provision of a comprehensive occupational therapy service is not longer possible (this implies refusal to accept referrals).

Prepared by Dain van der Reyden, M Concha, L Lester and J Blows (Auxiliary Staff Committee, Professional Board) (November 2003, Approved by Board January 2004) 71

(E) SUMMARY OF GUIDELINES FOR AND RESPONSIBILITIES OF EMPLOYING BODIES

The employing body should take cognisance of the information as contained in the following sections of this document.

Section B: Scopes of Practice - as relevant for category of staff employed (pages (B)2 - (B)38 )

Section C: Summary outline of duties, responsibilities and limitations of practice of mid level workers in occupational therapy (pages (C)2 - (C)5)

Section D: The supervision of Auxiliary Staff in Occupational Therapy (in its entirety)

Summary of Provisions

 Occupational Therapy Auxiliaries and Technicians may be employed by governmental, non- governmental or community-based organisations or by occupational therapists in private practice.  Should the prospective employing body be a non-governmental organisation, approval must be obtained from the Professional Board prior to such appointment.  All trained OTAs/OTTs are obliged to register with the Health Professions Council of South Africa and must comply with the ethical rules, professional conduct guidelines and continuing professional development requirements as these apply for occupational therapists.  OTAs/OTTs are obliged by law to work under supervision of a registered occupational therapist, likewise, occupational therapists are obliged to supervise OTAs/OTTs employed / allocated to their department / area.

Responsibilities of the Employer

1. To provide adequate supervision for mid level workers in occupational therapy by a registered occupational therapist. This includes ensuring the ongoing supervision of auxiliary staff in the absence of a supervising occupational therapist. See D - Supervision - Section III Guidelines for when Occupational Therapist Supervision is not Available (p (D) 19). 2. To request evidence of registration with HPCSA on an annual basis. 3. To, where necessary, make arrangements for / facilitate appropriate training to enable staff to comply with requirements for registration. 4. To provide detailed descriptions of duties for each employee - these must be in keeping with the role and scope and code of ethics of the profession and reflect training, experience and appropriate level of responsibility. 5. To create sufficient posts to ensure an effective and appropriate occupational therapy service and to establish a staff structure which allows for the promotion and development of staff. 6. To support the supervising occupational therapist in the fulfilment of his/her supervisory duties.

Queries may be addressed to the Professional Board for Occupational Therapy and Medical Orthotics / Prosthetics. 72

Document prepared by D van der Reyden, M Concha, L Lester and J Blows (Auxiliary Staff Committee -Professional Board) (November 2003)

--- OOO ---

Prof Board Forms/F249 OCP Policy Guide for Train and Prac OCP Aux Tech Cat (Booklet) 2004-07-16

Load more

  76

Copy Link