Phone:781-647-5556
MAOT,Inc.
57MadisonRoad
Waltham,MA02453
Fax:781-642-9742E-mail:
June29, 2015
PeterM.Kelly,Esq. BoardCounsel
BoardofRegistrationinAlliedHealthProfessionals
1000WashingtonStreet,Suite710
Boston,MA02118-6100
DearMr.KellyandBoardmembers:
ThecommentsbelowaresubmittedonbehalfoftheMassachusettsAssociationforOccupationalTherapy,Inc. (MAOT)anditsmembers,regardingtherevisionof regulationsgoverningthepracticeofoccupationaltherapy.
WerecognizethattheBoardofRegistrationinAlliedHealthProfessionalsestablishesrulesandregulationsto ensuretheintegrity andcompetenceoflicenseesandisresponsiblefortheirenforcement. Itfulfillsthisfunctionfortheultimatepurposeofpreventingharmtoconsumersandprotectingthepublic. Inthepastfewyears,members ofMAOThavebeenactivelyinvolvedinreviewingthestatuteandregulationsforoccupationaltherapy(OT).Theseregulationshavenotbeenrevisedsincetheimplementationoflicensure in1984.Theyareoutdatedandnolongerreflectcurrentpracticeorterminology.Theoccupational therapyprofessionhasundergonetremendous growthandchangeasaresultofevolvinghealthcaresystems,research,andadvanceswithinhealthcareeducation andpractice.
Therefore,asyouengageintheprocessofreviewingproposedchangesandmakingrevisions,werequestthatthe Boardrecognizethatthescopeofoccupationaltherapypracticereachesbeyondthetraditional"medicalmodel". Asaresult,itisimportanttorealizethatcurrentpracticemodelsformanyoccupationaltherapypractitionersincludedeliveryofservicessuchasearlyintervention,school-basedandafterschoolprograms,mentalhealthdaytreatment/behavioralhealthprogramsandhomelessshelterstochildrenandadultsincommunity-basedsettings. Practitionersarealsoengagedinhealthpromotion andprevention activities, forexample,aginginplaceinitiatives, homemodification,ergonomics,etc, Aboveall,duringthereviewandrevisionprocess,it is criticaltoensurethat eachdisciplinerepresentedwithintheAlliedHealthBoard,(OT,PTandAT)isdefinedasaseparateand distinct profession,reflectingitsownindividual-needsandpracticepatterns.
SpecifictoOccupationalTherapy,thefollowingpointsintheexistingregulationsneedtobeaddressedandareof particularimportancetopublic(consumer)health,safetyandwelfareaswellastopractitionercompetence:
I. Overalllanguagewithintheexistingregulationsneedsto beupdatedtoreflectcurrentprofessional
terminologyandthe"mostcurrentversionsofofficialprofessionaldocuments", a. OrganizationalNameChanges
i.AmericanOccupationalTherapyAssociation(AOTA)
ii.AccreditationCouncilforOccupationalTherapyEducation(ACOTE)
iii.NationalBoardforCertificationinOccupationalTherapy(NBCOT)no longerAOTCB
b. Referencedocumentsshouldinclude:
i. Occupational TherapyPracticeFramework:DomainandProcess
ii. ScopeofPraeticeDocuinent
iii. StandardsofPracticeforOccupationalTherapy
iv. OccupationalTherapyCodeofEthicsandEthicsStandards
v. Guidelinesfo.rSupervisionRoles,andResponsibilitiesDuringtheDelivery of
OccupationalTherapj'Services
vi.ACOTEStandards
2. Additionofcontinuingeducation/professional developmentrequirementsforoccupational therapistsandoccupationaltherapyassistantsforlicensurerenewal.Thisisacriticalcomponentto maintainingcompetentpractitionerswithinevolving healthcareservicedeliverysystemsandisin linewithrequirementsofvirtuallyallotherstates.Professionaldevelopmentactivitiesmustbe relatedtoprimarypracticearea(s).Inaddition,aminimumofonecredithourshould_include continuingeducation/trainingin"Ethics,witheachlicensure renewalcycletoensureprotectionof consumersandpractitioners.
*Itisofnotethatofthefiftystates,forty-fourhavecontinuing educationrequirementsfor license. renewalandsixdonot(Hawaii,Maine,Michigan,NewJersey,Utah,andMassachusetts). Itis
alsoofconcernthatwithintheDivision ofProfessional Licensure, therearethirtyboards.Ofthese
thirtyboards,twenty-threehavecontinuingeducationrequirements, threeareunderdevelopment, andfourdoNOThaveanyrequirements(Barbers,Cosmetologists, LandscapeArchitects,and AlliedHealthProfessionals).Itismuchmorecritical,giventheservicesthatOTprovides,that therebecontinuingeducation(professiona1developmentrequirementsinplacetoprotectthe consumer.
3. Theregulationsrelativetothe roleoftheOccupationalTherapyAssistant(OTA)needtosupport theirappropriateroleinthedeliveryofOTservices. TheOTAworksunderthesupervision,andin collaboration, withanoccupationaltherapist. ThedocumentGuidelinesforSupervisionRoles,and ResponsibilitiesduringtheDeliveryofOccupationalTherapyServicesarticulatestheOTA'srole withintheOTservicedeliveryprocess. OneareathatiswithinthescopeoftheOTAskillsand knowledge, buthasbeenprohibitedinMassachusetts,istheabilitytoparticipateinthescreening process.Ascreeningisahandsoff,non-billabledatacollectionprocessthatisusedtodetermineif
afulloccupational therapyevaluationisindicated.Currently,non-licensed personnelconduct screensforreferraltooccupationaltherapyasinkindergartenscreeningsforexample.Giventhat manyOTAsprovideservicesbeyondthetraditionalmedicalmodel,inthecommunity,regulations shouldnotrestricttheabilityoftheOTAtoeffectivelyfulfilltheirroletomeettheneedsofthe clientstheyserve.
4. TheroleofOccupationalTherapy"Aides"shouldbeclearlydifferentiatedfromthatofthe OccupationalTherapyAssistant(OTA)andshouldneverbeincludedinthesamestatementor paragraphdelineatingroleswithintheregulations. OT"Aides"providesupportiveservicesto the occupationaltherapistandtheoccupationaltherapyAssistant.Theyarenotprimary serviceprovidersofskilled occupationaltherapyinanypracticesetting.Again,theAOTAofficial document GuidelinesforSupervision,RolesandResponsibilities duringtheDeliveryof OccupationalTherapyServicesprovidesguidance forthelimited, appropriateuseof aides.
5.Thereareavarietyoftypesofmethodsofsupervision.Appropriatesupervisionrequirementsshouldbeconsistentwithofficialprofessionaldocuments,TheGuidelinesforSupervisionRoles, andResponsibilities duringtheDeliveryofOccupationalTherapyServicesandtheOccupational TherapyCodeofEthicsandStandards,aredesignedtosafeguard consumersandpromoteethical andlegalpractice.
' '
a. OccupationaltheraPy"aides••shouldreceivedirectsupervisionfromanoccupational therapistoroccupationaltherapyassistant.
b. Theoccupationaltherapyassistantworksinpartnership withandundertheoccupational therapist:collaboratively,theyareresponsiblefordevelopingaplanofsupervision
basedonrequiredservicecompetencyforthesetting,thediagnosticcasemix,the
expertiseandcompetenceoftheOTA,etc.Theoccupationaltherapist shouldmeetwith theOTAonaregularbasistoensureopportunityfortimelyreviewand feedbackto directthedeliveryofappropriateoccupationaltherapyservicesprovidedbythe occupationaltherapyassistant.Supervisioncanoccurinpersonorthrough virtual/technologicalmethods.
6. Currentregulationsrequirethattherebean"OTon-site"forOT/OTAstudentstoparticipatein theirrequiredLevel2fieldworkplacements,amandatoryrequirement forcompletionoftheir academicprograms. Thisregulationhasprohibitedfull-timeLevel2placementopportunitiesin settingswheretheremaybeonlypart-timeOTpractitioners,orinsettingsthatarecommunity basedoremerging(non-traditional)practiceareaswhereanOTpractitionermaynotberegularly
employed. TheACOTEstandardsthat addressLevel2fieldworksupervisionplaceahighvalueon theprotectionofclients. Forexample,thefollowingtwostandardsaddressthesupervision requirementsoftheLevel2Fieldworkexperience:
a. C.l.l6Ensurethatsupervisionprovidesprotection ofconsumersand opportunitiesforappropriaterolemodelingofoccupationaltherapypractice. Initially,supervisionshouldbedirectandthendecreasetolessdirect supervisionasappropriateforthesetting)theseverityoftheclient'scondition andtheabilityofthestudent.
b. C.Ll7Ensurethatsupervision providedinasettingwhere nooccupational therapyexistincludesadocumentedplanfortheprovisionofoccupational therapyservicesandsupervisionbyacurrentlylicensedotherwiseregulated occupationaltherapistwithatleast3yearsfulltimeoritsequivalentof professionalexperience.Supervisionmustincludeaminimumof8hoursof directsupervisioneachweekofthefieldworkexperience.An occupational.therapysupervisormustbeavailable,viaavarietyofcontactmeasures,tothe studentduringallworkinghours.AnOn-sitesupervisordesigneeofanotherprofession1nustbeassignedwhiletheoccupationaltherap_ysupervisorisoffsite.
Inadditiontotheaboveacademicstandardswhichexplicitlyarticulatethe needforsupervisory requirementsforprotectionoftheclient,theOTstudentswhoparticipateincommunitybased settingshavemoretraining,competencyandsupervisorysupportthansome ofthehiredemployees whoareunskilled/undertrainedwhichposesapotentialforharmtoconsumers.
Itisourunderstanding thatupdatedregulationsforOTwerevotedonandapprovedbytheBoardofRegistrationin AlliedHealthProfessionalsonMay28,2014,wellbeforeExecutiveOrder562wasissuedonMarch31,2015. Itis unclearastowhytheapproved/updated regulationswerenotacteduponinatimelymanner.
Weappreciatethisopportunitytoprovideinformationthatwehopewillassistyouinyourdeliberationsandlook forwardtofurtherinputuntiltheprocessiscomplete. Werecognizethisisonlyapreliminarysteptothe promulgationprocess,howevergiventhatthecurrentregulationsaresignificantlyoutdated;itisinthebestinterest
ofbothconsumersafetyand professionalstandardsthattherevisionprocessisexpedited. Welookforwardto
workingwiththeBoardofRegistrationinthiscollaborativeeffort.
Sincerely,
MichelleSavrann,President,MAOT
KarenHeflei·,GovernmentRelationsRepresentative,MAOT
cc:
NancyLowenstein,OTR/L,Secretary ChrysPeralta,OTR/L,Member ThomasDarisse,COTAIL,Member