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North Carolina Occupational Therapy Assistants

Supervision Definitions

"Supervision" is the process by which two or more people participate in joint effort to establish, maintain and elevate a level of performance to ensure the safety and welfare of clients during the provision of occupational therapy. A variety of types and methods of supervision may be used. Methods may include direct face-to-face contact and indirect contact. Examples of methods or types of supervision that involve face-to-face contact include observation, modeling, cotreatment, discussions, teaching, instruction, and video teleconferencing. Examples of methods or types of supervision that involve indirect contact include phone conversations, written correspondence, electronic exchanges, and other methods using telecommunication technology. Supervision is structured according to the supervisee's qualifications, position, level of preparation, depth of experience and the environment within which the supervisee functions. A change in practice setting may require a change in level of supervision until service competency has been established. Levels of supervision are:

"Close supervision" requires daily, direct contact at the service delivery site (where intervention plan is provided).

"General supervision" requires at least monthly direct contact, with supervision available as needed by other methods.

"Direct supervision" means the Occupational Therapy supervisor must be within audible and visual range of the client and unlicensed personnel and available for immediate physical intervention. Direct supervision is required for unlicensed personnel.

Definition of a OTA

Occupational therapy assistant. - An individual licensed in good standing to assist in the practice of occupational therapy under this Article, who performs activities commensurate with his or her education and training under the supervision of a licensed occupational therapist.

What type of therapist supervision is required?

Occupational therapy assistants at all levels require supervision by an occupational therapist. The specific frequency, methods, and content of supervision may vary by practice setting and are dependent on the complexity of client needs, number and diversity of clients, demonstrated service competency of the occupational therapist and the occupational therapy assistant, type of practice setting, requirements of the practice setting, and other regulatory requirements. Based on this the following apply:

    • Occupational therapy assistants with less than one (1) year experience and occupational therapy assistants new to a particular practice setting require close supervision;
    • Occupational therapy assistants with more than one (1) year of experience require general supervision; and
    • Supervision that is more frequent than the minimum level required by the practice setting or regulatory agencies is necessary when the needs of the client and the occupational therapy process are complex and changing, the practice setting provides occupational therapy services to a large number of clients with diverse needs, or the occupational therapist and occupational therapy assistant determine that additional supervision is necessary to ensure safe and effective delivery of occupational therapy services.

Notification of Supervision Change

Occupational therapy assistants and supervising occupational therapists must notify the Board office in writing of any change in ceasing or assuming supervision. The occupational therapist is responsible for supervision of the occupational therapy assistant until official notice that supervision has ceased is received at the Board office. Failure to notify the Board may subject both the occupational therapist and occupational therapy assistant to disciplinary action. Notices must be signed. Telephone or email notices shall not be accepted.

Documentation of Supervision

Evidence of supervision must be recorded on a supervisory log or in the documentation.

Documentation of supervision is the responsibility of both the occupational therapist and occupational therapy assistant. Documentation must include the frequency of supervisory contact, method(s) or type(s) of supervision, content areas addressed, and names and credentials of the persons participating in the supervisory process.

Supervision must reflect a review of all aspects of the occupational therapy assistant's practice. In any situation, the occupational therapist is ultimately responsible for all delegated services.

Effectiveness of the supervision shall be regularly evaluated by both the occupational therapist and the occupational therapy assistant.

Signature Requirements

Co-signature on occupational therapy service documentation, even if mandated by statute or rule, does not accurately satisfy supervision requirements.


N.C. Gen. Stat 90-270.67

21 NCAC 38.0901

21 NCAC 38.0904

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