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Alabama OT Survey

Updated: March 21, 2020

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Scope of Practice

How is the practice of Occupational Therapy defined in Alabama?

The practice of occupational therapy means the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings. Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life.

What does the practice of occupational therapy include?

Evaluation of factors affecting activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

    • Client factors, including body functions, such as neuromusculoskeletal, sensoryperceptual, visual, mental, cognitive, and pain factors; body structures such as cardiovascular, digestive, nervous, integumentary, genitourinary systems, and structures related to movement; values, beliefs, and spirituality.
    • Habits, routines, roles, rituals, and behavior patterns.
    • Physical and social environments, cultural, personal, temporal, and virtual contexts, and activity demands that affect performance.
    • Performance skills, including motor and praxis, sensory-perceptual, emotional regulation, cognitive, communication, and social skills.

Methods or approaches selected to direct the process of interventions such as:

    • Establishment, remediation, or restoration of a skill or ability that has not yet developed, is impaired, or is in decline.
    • Compensation, modification, or adaptation of activity or environment to enhance performance, or to prevent injuries, disorders, or other conditions.
    • Retention and enhancement of skills or abilities without which performance in everyday life activities would decline
    • Promotion of health and wellness, including the use of self-management strategies, to enable or enhance performance in everyday life activities.
    • Prevention of barriers to performance and participation, including injury and disability prevention.

Interventions and procedures to promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

    • Therapeutic use of occupations, exercises, and activities.
    • Training in self-care, self-management, health management and maintenance, home management, community/work reintegration, and school activities and work performance. (iii) Development, remediation, or compensation of neuromusculoskeletal, sensory-perceptual, visual, mental, and cognitive functions, pain tolerance and management, and behavioral skills.
    • Therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process.
    • Education and training of individuals, including family members, caregivers, groups, populations, and others.
    • Care coordination, case management, and transition services.
    • Consultative services to groups, programs, organizations, or communities.
    • Modification of environments, including home, work, school, or community, and adaptation of processes, including the application of ergonomic principles.
    • Assessment, design, fabrication, application, fitting, and training in seating and positioning, assistive technology, adaptive devices, training in the use of prosthetic devices, orthotic devices, and the design, fabrication and application of selected splints or orthotics.
    • Assessment, recommendation, and training in techniques to enhance functional mobility, including management of wheelchairs and other mobility devices.
    • Low vision rehabilitation when the patient or client is referred by a licensed optometrist, a licensed ophthalmologist, a licensed physician, a licensed assistant to physician acting pursuant to a valid supervisory agreement, or a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician.
    • Driver rehabilitation and community mobility.
    • Management of feeding, eating, and swallowing to enable eating and feeding performance.
    • Application of physical agent modalities, and use of a range of specific therapeutic procedures such as wound care management, interventions to enhance sensory-perceptual and cognitive processing, and manual therapy, all to enhance performance skills.
    • Facilitating the occupational performance of groups, populations, or organizations through the modification of environments and the adaptation of processes.

Services specifically excluded from the scope of practice

N/A

Telehealth

The Alabama Board of Occupational Therapy currently does not have rules or policy on telehealth.

Referral Requirement

Is a referral required to provide OT services?

Yes.  No occupational therapy treatment programs to be rendered by an occupational therapist, occupational therapy assistant, or occupational therapy aide shall be initiated without the referral of a licensed physician, a licensed chiropractor, a licensed optometrist, a licensed assistant to a physician acting pursuant to a valid supervisory agreement, a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician, a licensed psychologist, or a licensed dentist who shall establish a diagnosis of the condition for which the individual will receive occupational therapy services.

In cases of long-term or chronic disease, disability, or dysfunction, or any combination of the foregoing, requiring continued occupational therapy services, the person receiving occupational therapy services shall be reevaluated by a licensed physician, a licensed chiropractor, a licensed optometrist, a licensed assistant to a physician acting pursuant to a valid supervisory agreement, a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician, a licensed psychologist, or a licensed dentist at least annually for confirmation or modification of the diagnosis.

Exceptions to the referral requirement?

Occupational therapists performing services that are not related to injury, disease, or illness that are performed in a wellness or community setting for the purposes of enhancing performance in everyday activities are exempt from this referral requirement.

Occupational therapists employed by state agencies and those employed by the public schools and colleges of this state who provide screening and rehabilitation services for the educationally related needs of the students are exempt from this referral requirement.

Role of the Occupational Therapist

Only a licensed occupational therapist shall:

    • Prepare a written initial treatment plan prior to implementation by the occupational therapy assistant, initiate or re-evaluate a client or patient’s treatment plan, or authorize in writing a change of a treatment plan
    • Delegate duties to a licensed occupational therapy assistant, designate an assistant’s duties, and assign a level of supervision; and
    • Authorize a patient discharge.

Occupational Therapy Assistants

Which services are OTAs allowed to practice?

The occupational therapist shall ensure that the occupational therapy assistant is assigned only those duties and responsibilities for which the assistant has been specifically educated and which the occupational therapy assistant is qualified to perform.

Are there specific services that OTAs are prohibited from practicing?

A licensed occupational therapy assistant shall not:

    • Evaluate or develop a treatment plan independently;
    •  Initiate a treatment plan before a client or patient is evaluated and a written treatment plan is prepared by an occupational therapist;
    • Continue a treatment procedure appearing harmful to a patient or client until the procedure is reevaluated by an occupational therapist; or
    • Continue or discontinue occupational therapy services unless the treatment plan is approved or re-approved by a supervising occupational therapist.

What type of supervision is required?

A supervising occupational therapist shall supervise a licensed occupational therapy assistant as follows:

    • Supervision should be “Direct” at the discretion of the supervising occupational therapist.
    • Supervision should be “Close” if the occupational therapy assistant has less than 12 months of experience.
    • Supervision should be at least “General” if an occupational therapy assistant has more than 12 months of experience.
For occupational therapy assistants employed by state agencies and those employed by public schools and colleges of this state who provide screening and rehabilitation services for the educationally related needs of the student, the “Direct” and “close” supervision mandate based on work experience does not apply. In these instances, supervision should be at least “General”.

The following levels of supervision are minimal. An occupational therapist must assign an increased level of supervision if the occupational therapy assistant is new to a practice setting or particular skill. An occupational therapist must assign an increased level of supervision if necessary for the safety of a patient or client.

    • All occupational therapist(s) who delegate to occupational therapy assistants must participate in the supervision of that occupational therapy assistant.
    • Occupational therapy assistants working part-time should have no less than one hour of direct supervision per calendar month, and meet all other supervision requirements within this section. h. Occupational therapy assistants who work with more than one employer must notify the board of the supervisor(s) for each employer.
    • The occupational therapist shall ensure that the occupational therapy assistant is assigned only those duties and responsibilities for which the assistant has been specifically educated and which the occupational therapy assistant is qualified to perform.

An occupational therapist may assign an increased level of supervision if necessary for the safety of a patient or client. The levels of supervision are:

    • Direct Supervision: the supervising occupational therapist is in the immediate area of the occupational therapy assistant while performing supportive services.
    • Close Supervision: the supervising occupational therapist provides initial direction to the occupational therapy assistant and daily contact while on the premises at least 50% of the occupational therapy assistant’s direct patient care hours per month.
    • General Supervision: the supervising occupational therapist has face-to-face contact with the occupational therapy assistant at least once every 30-calendar days, with the supervising occupational therapist available by telephone, electronic, or written communication.

Supervision ratios

An occupational therapist may supervise up to three (3) full-time occupational therapy assistants, but never more than two (2) occupational therapy assistants who require “direct” level of supervision. The total number of supervised occupational therapy assistants, occupational therapy personnel on a limited permit, and non-licensed occupational therapy personnel (including any occupational therapy students, occupational therapy assistant students, licensee applicants required to perform a perceptorship, and/or aides) may not exceed five (5) without prior Board approval.

Does the supervising physical therapist need to co-sign documentation created by the OTA?

N/A

Occupational Therapy Aides

A person who assists in the delivery of occupational therapy, who works under direct on-site supervision of an occupational therapist or occupational therapy assistant, or both, and whose activities require an understanding of occupational therapy but do not require professional or advanced training in the basic anatomical, biological, psychological, and social sciences involved in the practice of occupational therapy.

What can an aide do?

Any duties assigned to an occupational therapy aide must be determined and appropriately supervised by a licensed occupational therapist and must not exceed the level of training, knowledge, skill, and competence of the individual being supervised. The licensed occupational therapist is totally and wholly responsible for the acts or actions performed by any occupational therapy aide functioning in the occupational therapy setting.

Duties or functions which occupational therapy aides may perform include, but are not limited to:

    • Routine department maintenance task;
    • Transportation of patients/clients;
    • Preparation or setting up of treatment equipment and work area;
    • Taking care of patient's/client's personal needs during treatment;
    • Clerical, secretarial, administrative activities.

What is an aide expressly prohibited from doing?

Duties or functions which occupational therapy aides shall not perform include, but are not limited to:

    • Interpret referrals or prescriptions for occupational therapy services;
    • Perform evaluative procedures;
    • Develop, plan, adjust, or modify treatment procedures;
    • Act on behalf of the occupational therapist in any matter related to direct patient care which requires judgment or decision making.
    • Act independently or without supervision of an occupational therapist.

An aide/support personnel may assist in the delivery of occupational therapy; however, may not provide direct patient treatment.

Care rendered independently by an occupational therapy aide/support personnel shall not be charged as occupational therapy.

What type of supervision is required?

Direct Supervision: The supervising occupational therapist or occupational therapy assistant is in the immediate area of the aide while performing supportive services.

Continuing Education

How many CE hours are required for therapists?

An Occupational Therapist must obtain 1.5 CEUs (or 15 contact hours) annually or 3.0 CEUs (or 30 contact hours) biennially. No more than 1/3 of continuing education credits may be administration/management/academic related with the remainder related to direct patient treatment. No more than a 1/3 hours can be generated by the therapist’s professional presentations.

What are the CE requirements assistants?

An Occupational Therapy Assistant must obtain 1.0 CEU (or 10 contact hours) annually or 2.0 CEUs (or 20 contact hours) biennially. No more than 1/3 of continuing education credits may be administration/management/academic related with the remainder related to direct patient treatment. No more than a 1/3 hours can be generated by the therapist’s professional presentations.

How long is the continuing education period?

Biennially.

Due date for CE requirements

60 days prior to the expiration of the license.

Are there any specific course requirements?

N/A

Can extra CE credits be carried over to the next period?

N/A

How long to CE records need to be maintained?

N/A

Reference

Ala. Code §34-39-3

Ala. Admin. Code § 625-X-8-.01

Ala. Admin. Code § 625-X-8-.03

Ala. Admin. Code § 625-X-5-.02

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