AOTA FIELDWORK DATA FORM
Introduction:
The purpose of the Fieldwork Data Form is to facilitate communication between occupational therapy
(OT) and occupation therapy assistant (OTA) academic programs, OT/OTA students, and fieldwork
educators. Fieldwork Educators and Academic Fieldwork Coordinators (AFWC) jointly complete the
Fieldwork Data Form to describe the fieldwork setting where students may have placements. While
much of the information may be completed by the Fieldwork Educator, there will be additional
information best obtained through AFWC interview of the fieldwork education coordinator at the site.
The AFWC will find opportunity to document fieldwork related Accreditation Council for Occupational
Therapy (ACOTE) Standards that support the ACOTE on-site accreditation review process. In addition,
OT/OTA students will find valuable information describing the characteristics of the fieldwork setting, the
client population, commonly used assessments, interventions, and expectations and opportunities for
students. The Fieldwork Data Form has been developed to reflect the Occupational Therapy Practice
Framework terminology and best practice in occupational therapy to promote quality fieldwork
experiences. It was developed through the joint efforts of the Commission on Education (COE) and
Education Special Interest Section (EDSIS) Fieldwork Subsection with input from many dedicated AFWCs
and Fieldwork Educators.
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AOTA FIELDWORK DATA FORM
Date: 08/9/2015
Name of Facility: Vanderbilt University Medical Center
Address: 1313 21st St Ave S. Rm 1004 Oxford House
FW Level II
City: Nashville
State: TN
Zip: 37232-4675
FW Level I (if different)
Credentials:
Contact Person: Lynette O’Brien
Contact Person:
Credentials:
OTR/L
Phone: 615-343-6354
Phone:
E-mail:
E-mail: lynette.m.o.brien@vanderbilt.edu
Director: Heather Skaar, PT,
Manager: Kelly Floyd, MS, OTR/L
Web site address:
http://www.mc.vanderbilt.edu/root/vumc.php?site=rehabilitations
ervices&doc=26342
Corporate Status:
For Profit
Non-Profit
State Gov’t
Federal Gov’t
OT Fieldwork Practice Settings (ACOTE Form A #s noted) :
(Double Click on boxes to check)
Hospital-based settings
Community-based settings
In-Patient Acute 1.1
Peds Community 2.1
In-Patient Rehab 1.2
Behavioral Health Community 2.2
SNF/ Sub-Acute/ Acute LongOlder Adult Community Living 2.3
Term Care 1.3
Older Adult Day Program 2.4
General Rehab Outpatient 1.4
Outpatient/hand private practice 2.5
Outpatient Hands 1.5
Adult Day Program for DD 2.6
Pediatric Hospital/Unit 1.6
Home Health 2.7
Peds Hospital Outpatient 1.7
Peds Outpatient Clinic 2.8
In-Patient Psych 1.8
Student Requirements/Prerequisites (check all that apply)
(Double Click on boxes to check)
CPR
type required: Adult
Medicare / Medicaid Fraud Check
Criminal Background Check
Child Protection/abuse check
Adult abuse check
Fingerprinting
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ACOTE B.10.6
First Aid
Infection Control
training
HIPAA Training
Prof. Liability Ins.
Own transportation
Interview
Preferred Sequence of FW: ACOTE Standards B.10.6
Any
Second/Third only; 1st must be in:
Full-time only
Part-time option
Prefer Full-time
School-based settings
Early Intervention 3.1
School 3.2
Other area(s)
please specify:
Health requirements:
HepB
MMR
Tetanus
Chest x-ray
Drug screening
#_____Panel
TB/Mantoux
Age Groups:
0-5
6-12
13-21
22-64
65+
Number of Staff:
OTRs: 19
COTAs: 7
Aides: 3
PT: 23
Speech: Unknown
Resource Teacher: 0
Counselor/Psychologist:
Yes: Numerous
Other: N/A
Physical Check up
Varicella
Influenza
Please list any other requirements:
**Vanderbilt has a Health Screening
form that must be completed. Please
see the rehab services website for this
form**
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Aspects of Occupational Therapy’s Domain addressed in this setting (check all that apply) Double Click on boxes to check
*Refer to the OT Practice Framework –II (2008) for descriptions and definitions…available through AOTA
Areas of Occupation
Activities of Daily Living (ADL)
Instrumental ADL
Rest and Sleep
Education
Work
Play
Leisure
Social Participation
Client Factors
Values, Beliefs and Spirituality
Body Functions
Body Structures
Performance Skills
Sensory-Perceptual Skills
Motor and Praxis Skills
Emotional Regulation Skills
Cognitive Skills
Communication and Social Skills
Context and Environment
Cultural
Personal.
Physical
Social
Temporal.
Virtual
Performance Patterns
Habits
Routines
Roles
Activity Demands
Objects used and their properties
Space Demands
Social Demands
Sequencing and Timing
Required Actions
Required Body Functions
Required Body Structures
Rituals
Most common services priorities (check all that apply)
(Double Click on boxes to check)
Direct service
Meetings(team, department, family)
Discharge planning
Client education
Evaluation
Intervention
Consultation
In-service training
Billing
Documentation
Types of OT Interventions addressed in this setting (check all that apply): * ACOTE Standards A.5.3, B.10.1, B.10.3, B.10.11, B.10.13, B.10.15, B.10.19, B.10.20
Areas of Occupation addressed in this setting - within client’s own environmental context (check all that apply):
(Double Click on boxes to check)
Activities of Daily Living (ADL)
Bathing/showering
Bowel and bladder mgmt
Dressing
Eating
Feeding
Functional mobility
Personal device care
Personal hygiene & grooming
Sexual activity
Toilet hygiene
Rest and Sleep
Rest
Sleep
Sleep preparation
Sleep participation
Instrumental Activities of Daily Living (IADL)
Care of others (selecting/supervising
caregivers)
Care of pets
Child rearing
Communication management
Community mobility
Financial management
Health management & maintenance
Home establishment & management
Meal preparation & clean up
Religious observance
Safety procedures & emergency maintenance
Shopping
Leisure
Leisure exploration
Leisure participation
Education
Formal education participation
Informal personal educational needs or interests
exploration
Informal personal education participation
Work
Employment interests & pursuits
Employment seeking and acquisition
Job performance
Retirement preparation & adjustment
Volunteer exploration / participation
Social Participation
Community
Family
Peer/friend
Play
Play exploration
Play participation
Types of Occupational Therapy
Interventions: (Double Click on
boxes to check)
Occupation-based Intervention –
client engages in client-directed
occupations that match identified
goals
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Preparatory Methods – practitioner selects
directed methods and techniques that prepare
the client for occupational performance.
Education Process – imparting knowledge and
information about occupation, health and
participation that does not result in actual
performance of the occupation/activity
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Consultation Process – using knowledge and
Purposeful Activity- client
engages in specifically selected
activities that allow the client to
develop skills that enhance
occupational engagement
expertise to collaborate with the client
Method of Intervention
Direct Services/case load for entrylevel OT
One-to-one:
Outcomes of Intervention
Advocacy – efforts directed toward promoting
occupational justice and empowering clients to seek
and obtain resources to fully participate in their daily
life occupations
Occupational performance
Theory/ Frames of Reference/ Models of Practice
Biomechanical
Adaptation
Cognitive - Behavioral
Health & Wellness
Cognitive Disability
Participation
Model of Human Occupation (MOHO)
Prevention
Occupational Adaptation
Quality of Life
Person/ Environment/ Occupation (P-E-O)
Home
Role Competence
Person-Environment-Occupational Performance
Another medical facility
Self-Advocacy
(PEOP)
Home Health/Inpt/SNF
Occupational Justice
Rehabilitation
Small group(s):
Large group:
Discharge Outcomes of clients
Sensory Integration
Social Learning Theory
OT Intervention Approaches
Stages of change/Transtheoretical Model
Create, promote (health
promotion)
Establish, restore, (remediation)
Other (please list):
Maintain
Modify, (compensation,
adaptation)
Prevent, (disability prevention)
Please list most common screenings and evaluations used in your setting: No screenings, but an informal facility developed evaluation is used.
Therapists at times will use the MOCA, SLUMS, Short Blessed during an eval/tx.
Identify safety precautions important at your FW site
(Double Click on boxes to check)
Medications
Post-surgical (list procedures)
Contact guard for ambulation
Fall risk
Other (describe):
Swallowing/ choking risks
Behavioral system/ privilege level (locked areas, grounds)
Sharps count
1:1 safety/ suicide precautions
Please list how students should prepare for a FW II placement such as doing readings, learn specific evaluations and interventions used in your
setting: Each student is encouraged to contact his/her FE prior to the start date to obtain information about your specific patient populations(s).
You may be instructed to familiarize yourself with specific diagnoses, evaluations etc.
Target caseload/ productivity for fieldwork students:
Documentation: Frequency/ Format (briefly describe) :
(Double Click on boxes to check)
(Double Click on boxes to check)
Productivity % per 40 hour work week: Not calculated. See
comments below.
Caseload expectation at end of FW: 7-8 patients a day
Hand-written documentation:
Computerized Medical Records:
Time frame requirements to complete documentation: Same day as
the evaluation or treatment.
Productivity % per 8 hour day: 18 units a day during the last 2
weeks of the clinical to meet entry level functioning
expectation in this setting.
# Groups per day expectation at end of FW: None
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Administrative/ Management duties or responsibilities of
the OT/ OTA student:
Schedule own clients
Supervision of others (Level I students, aides, OTA,
volunteers)
Budgeting
Procuring supplies (shopping for cooking groups, client/
intervention related items)
Participating in supply or environmental maintenance
Other:
Student work schedule & outside study
expected: (Double Click on boxes to
check)
Schedule hrs/ week/ day: 40+ hours a week
Student Assignments. Students will be expected to successfully
complete:
Research/ EBP/ Literature review
In-service or project determined between the student and FE.
Case study
Participate in in-services/ grand rounds
Fieldwork Project ( describe):
Field visits/ rotations to other areas of service
Observation of other units/ disciplines
Other assignments (please list): Either a case study, in-service or
project is expected of the student. FE will assist the student in the
determination of appropriate assignment.
Describe level of structure for
student?
Room provided
YES
Describe level of supervisory
support for student?
High
High
Moderate
Moderate
Low
Low
NO
Do students work weekends?
YES
Meals
YES
NO
NO
Do students work evenings?
YES
Stipend amount: 0
NO
Describe public transportation
Acceptable Dress Code for the site: Solid
colored scrubs and tennis shoes. No lab coat.
A name tag will be provided.
available: MTA bus at no
charge; shuttle bus free of
charge from satellite parking
lot
Describe the FW environment/ atmosphere for student learning:
Supervisory patterns–Description (respond to all that apply)
1:1 Supervision Model: At times the student may be supervised by another therapist (ie. Your FE is on vacation or out sick)
Multiple students supervised by one supervisor:
Collaborative Supervision Model:
Multiple supervisors share supervision of one student, # supervisors per student:
Non-OT supervisors:
ACOTE Standards Documentation for Fieldwork (may be completed by AFWC or FWII student interview of FW Educator)
Please answer as many of these as you can. When possible, the AFWC may interview you to answer questions.
1.
Please complete the Occupational Therapy Staff Profile form (see last page) ACOTE Standards B.7.10, B10.12, B.10.17 (Double Click on boxes to check)
Will the student(s) be supervised by a currently licensed or credentialed occupational therapist who has a minimum of 1 year of practice
experience subsequent to initial certification, and is adequately prepared to serve as a fieldwork educator?
Yes
No
2. The fieldwork agency must be in compliance with standards by external review bodies. Please identify external review agencies involved
with this fieldwork setting and year of accreditation: (Double Click on boxes to check)
JCAHO
Dept of Health
Year of most recent review: 2015
CARF
Dept of Mental Health
Other (specify)
Summary of Outcomes of OT department review: Not available
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3. Describe the fieldwork site agency stated mission or purpose. ACOTE Standards B.10.1, B.10.2, B.10.3, B.10.4, B.10.14, B.10.15
Vanderbilt University is a center for scholarly research, informed and creative teaching, and service to the
community and society at large. Vanderbilt will uphold the highest standards and be a leader in the



quest for new knowledge through scholarship,
dissemination of knowledge through teaching and outreach,
creative experimentation of ideas and concepts.
In pursuit of these goals, Vanderbilt values most highly


intellectual freedom that supports open inquiry,
equality, compassion, and excellence in all endeavors.
Credo
We provide excellence in healthcare, research and education.
We treat others as we wish to be treated.
We continuously evaluate and improve our performance.
Credo Behaviors
I make those I serve my highest priority, I respect privacy and confidentiality, I communicate effectively, I conduct
myself professionally, I have a sense of ownership and I am committed to my colleagues.
4. A. INTEGRATION OF CURRICULUM THEMES (ACADEMIC PREPARATION)
Please identify the extent of opportunities that students will have to incorporate
the following themes in occupational therapy practice during the fieldwork
experience
1 = No opportunity
2 = Limited opportunities
3 = Some opportunities
4 = Many opportunities (with most clients)
5 = Consistent opportunities (for all clients)
1
2
3
A. CLINICAL EXCELLENCE
B. SCHOLARSHIP
4
5
X
X
C. LEADERSHIP
X
D. SERVICE
X
Please check all that apply (below) to identify “supports” to practicing curricular themes above: (Double Click on boxes to check)
Supports for clinical excellence:
Students are encouraged to enable the client to participate in meaningful and purposeful occupations through best practice
Students are encouraged to implement clinical reasoning, utilization of evidence, currency in practice, clinical skills and client-centeredness
Other: (please describe)
Supports for scholarship:
Professional development through scholarship is valued by the fieldwork facility and practitioners who serve as role models
The facility’s environment promotes professional development through scholarship
Time is allotted for activities that promote scholarship
Other: (please describe)
Supports for service:
Employees/students are encouraged to be involved in service to strengthen community
Students are encouraged to be advocates for the clients served
Other: (please describe)
Supports for leadership:
Students are encouraged to collaborate with other disciplines
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Students are encouraged to understand clients of different cultures as this is a leadership imperative
Other: (please describe)
4. B. Describe how psychosocial factors influence engagement in OT services? (Double Click on boxes to check)
Discouraged or depressed may not want to participate.
Encouragement/attention from therapist prompts greater participation
Depressed may try to withdraw from activities/staff/treatment
OT is hopeful the patient may exhibit good effort and energy.
Positive feelings contribute to greater compliance.
Other (please explain)
4. C. Describe how you address client’s community based needs in your setting? (Double Click on boxes to check)
Refer to social worker/case manager when appropriate
Provide resources/catalogs/written information for needed equipment, supplies as appropriate
Provide names/written materials for community support groups as appropriate
Refer to appropriate facility community groups when needed
Instruct client in finding appropriate resources
Provide referral to other community services as needed
Other (please describe)
5.
Please describe the FW Program & how students fit into the program. (Double Click on boxes to check) ACOTE Standards B10.2, B.10.3, B.10.5, B.10.7,
B.10.13, B.10.19, B.10.20, b.10.21
Fieldwork Program has been in place many years with multiple schools and therapy levels (OT and OTA)
Fieldwork Program is relatively new and still evolving – currently takes students from OT or OTA schools.
Fieldwork Program just took first fieldwork student from OT or OTA school.
Students provide learning opportunity to staff therapists to implement supervisory relationships and skills.
Students provide a link to various educational institutions to keep up with changes/developments in the field.
Providing fieldwork experiences is an obligation and responsibility for current practitioners.
Providing fieldwork experiences assists OT/OTA practitioners with continuing education credits.
Fieldwork students can provide updates in the literature for evidence based practice that is helpful to the facility/practitioners.
Fieldwork students can provide more one-on-one time with clients due to lower caseloads and the learning environment.
Fieldwork students are generally helpful to the overall operation of the facility once oriented and adjusted to population.
Supervision of students is expected of practitioners.
Supervision of students is rotated among practitioners on a regular basis.
Students are not accepted unless a practitioner indicates interest/willingness to take a student.
Other (Please Explain)
6.
Describe the training provided for OT staff for effective supervision of students (check all that apply). (Double Click on boxes to check)
ACOTE Standards B.7.10, B.10.1, B.10.3, B.10.12,B.10.13, B.10.17, B.10.18, B.10.19, B.10.20, B.10.21
Supervisory models
Training on use of FW assessment tools (such as the AOTA Fieldwork Performance Evaluation - FWPE, Student Evaluation of Fieldwork
Experience–SEFWE, and the Fieldwork Experience Assessment Tool–FEAT)
Clinical reasoning Discussions and how to teach clinical reasoning to students
Reflective practice
Comments:
7.
Please check off any training or resources that fieldwork educators at your site have available to support their role in
supervision of students (e.g., print resources, continuing ed. coursework, online materials, workshops, etc.)
(Double Click on boxes to check)
Site Specific Student objectives (please attach)
Training in supervision process (agency in-services)
Facility’s Student manual
Release time and/or reimbursement for continuing
education
AOTA Certificate in Fieldwork Education Program
Mentoring opportunities (e.g., in 1:1 or Group Format)
Training or in-service provided by GOTEC, Regional, State or individual Academic Programs
Use of online resources such as: AOTA (http://www.aota.org/Educate/EdRes/Fieldwork/Supervisor.aspx) GOTEC, Regional, State
Associations, or individual Academic Programs
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Supervision Process (Double Click on boxes to check)
What is the nature and frequency of supervision meetings:
Formal
Informal Frequency:
daily
weekly
other
What is the model of supervision utilized at your site:
1:1 Supervision Model
Several Students: 1Therapist (Collaborative model)
Several Therapists: 1 student
Supervisory Methods to promote reflective practice:
Journaling
Processing verbally
Student Self Assessment/Self Appraisal (log/form)
Written activity analysis
Probing questions
Other: Interdisciplinary group supervision meetings
Describe record keeping of supervision sessions:
Co-signed documentation of daily/weekly supervision
All informal/formal notes maintained by FW Educator
Records kept when student not meeting expectations
Other:
8. Please describe the process for record keeping supervisory sessions with a student, and the student orientation process to the agency, OT
services and the fieldwork experience. (Double Click on boxes to check)
ACOTE Standards B.7.10, B.10.1, B.10.3, B.10.12, B.10.13, B.10.17, B.10.18, B.10.19, B.10.20, B.10.21
Meet with student to review policies, procedures & forms during first week assigned to facility.
Introduce student to staff and give tour of facility.
Provide Student Fieldwork Manual of assignments, policies, procedures etc. for the facility.
Send student to employee orientation, all or parts depending on relevance or as required by facility.
Review Fieldwork Educator’s case load to help student understand populations and interventions being implemented.
Meet with student at designated time every week to review clients, therapeutic interventions and other questions or concerns.
Meet with student at various non-scheduled times to review clients, therapeutic interventions and other questions/concerns.
Wait for student to initiate request to meet with fieldwork educator.
Supervisory sessions have topic planned for each meeting with student.
Supervisory sessions do not have topic planned but depend on student’s questions/concerns.
Supervisory sessions address concerns about student performance with possible methods to change/enhance performance.
Sessions with student are documented by fieldwork educator.
Sessions with student are documented by student.
Sessions with students are not documented.
Sessions with student are documented if problems with performance arise.
Other:
9. Describe funding and reimbursement sources and their impact on student supervision. (Double Click on boxes to check)
ACOTE Standards B.10.3, B.10.5,
B.10.7, B, 10.14, B.10.17, B.10.19
Facility receives funding through Medicare.
Facility receives funding through Medicaid.
Facility receives funding through private insurance/private pay.
Facility provides charity care.
Facility receives funding through other sources – grants, tax allocations, etc.
Impact on Student Supervision:
Funding source does not affect OT/OTA student supervision.
Funding source restricts some activities for OT/OTA students. (Circle which group of students affected)
Funding source prohibits activities provided by OT/OTA students. (Circle which group of students affected)
Funding source requires fieldwork educator to be on premises to provide supervision of OT/OTA students.
Funding source requires fieldwork educator to have line-of-sight supervision of OT/OTA students.
Other (Please Explain)
10. Please include a copy of the FW student objectives, weekly expectations for the Level II FW placement. Please
attach to this form or mail to the Academic Fieldwork Coordinator.
Please see out rehab services website for objectives.
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Occupational Therapy Staff Profile
1. Lynette O’Brien, OTR/L graduated from Indiana University with 22 years of experience
2. Katie Crouch, MS, OTR/L graduated from Gannon University with 5 years of experience
3. Brittany Work, OTD, OTR/L graduated from Belmont University with 7 years of experience
4. Shane Wood, MS, OTR/L graduated from Belmont University with 14 years of experience
5. Buffy Hyman OTR/L graduated from TWU with 21 years of experience
6. Scott McLaurin, OT/L University of AL with 21 years of experience
7. Caleb Templeton MS, OTR/L NSCC (COTA) & Belmont (OT) with 10 years of experience (5.5 as a COTA)
8. Cari Safford, OTR/L graduated from TN State University with 14 years of experience
9. Taylor Campbell MS OTR/L graduated from LSU with 1 year of experience
10. Julia Jones MS, OTR/L graduated from Eastern KY University with 11 years of experience
11. Brooke Gentry, MS, OTR/L graduated from Milligan University with 5 years of experience
12. Jim Lassiter, OT/L graduated from TN State University with 21 years of experience
13. Paige Fusilier graduated from University of Texas Medical Branch with 6 years of experience
14. Sarah Brodie MS, OTR/L graduated from Washington University in St. Louis (new grad)
15. Holly Thomas, MS, OTR/L graduated from Winston-Salem University with 3.5 years of experience
16. Kelsey Bigham MS, OTR/L graduated from Washington University in St. Louis with 2 years of experience
17. Ashley Day MS, OTR/L graduated from University of St. Augustine with 1 year of experience
18. Domenic Bruzzese, OTD, MA graduated from University of S. California with 4 years of experience
19. Sally Lindsey COTA/L graduated from Nashville State Tech College with 29 years of experience
20. Carrie Natte COTA/L graduated from NSCC with 3 years of experience
21. Leslie McCabe COTA/L graduated from St. Louis Community College with 8 years of experience
22. Jill Stewart COTA/L graduated from NSCC with 3 years of experience
23. Amanti Allsam COTA/L graduated from Brown Mackie College with < 1 year of experience
24. Cindy Montalbo COTA/L graduated from NSCC with 3 years of experience
25. Elise Huener COTA/L graduated from with years of experience
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VANDERBILT UNIVERSITY MEDICAL CENTER
DEPARTMENT OF REHABILITATION SERVICES
OCCUPATIONAL FIELDWORK LEVEL II STUDENT OBJECTIVES
Upon completion of the student’s Level II Occupational Therapy affiliation at Vanderbilt University Medical Center the
student will demonstrate the following professional skills and behaviors:
I. Fundamentals of Practice:
1. Adheres to the AOTA Code of Ethics and policies & procedures.
Student will demonstrate honesty for billing for time spent with the client.
Student will be aware of the need to ask for assistance and supervision when needed.
Student will demonstrate professional behavior and adhere to the dress code.
Student will adhere to the AOTA Code of Ethics and HIPPA guidelines (pt. confidentiality, handling of patient
information etc).
Student will respect client’s privacy, wishes and values (cultural, religious etc).
2. Adheres to safety regulations:
Student will create and maintain a safe working environment.
Student will thoroughly review the client’s chart prior to treatment.
Student will utilize hospital infection control precautions and procedures.
Student will follow hospital policies in response to an emergency situation.
Student will take appropriate steps when a hazardous situation is identified.
Student will choose activities that are age appropriate and safe for all clients including those with
physical/emotional/cognitive deficits. Student will use proper body mechanics and demonstrate proper use of devices
(walker, lifts etc).
3. Uses safety in judgment in regard to self and others:
Student will be knowledgeable about the use of restraints.
Student will provide safe supervision and handling of clients during therapy.
Student will demonstrate the ability to monitor vital signs and act appropriately to changes.
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Student will demonstrate the ability to safely manipulate IV poles, lines, tubes, drains, monitors, and catheters, as well
as to adhere to MD orders (ROM, dressing changes, splints, weight bearing, NPO etc) and precautions.
Student will demonstrate the ability to safely transfer clients from one surface to another.
II. Basic Tenets:
4. Articulates the values and beliefs of OT to clients, families etc:
Student will demonstrate the ability to articulate the values, beliefs of OT to clients, family, and colleagues.
5. Clearly, confidently and accurately articulates the value of occupation as a method and desired outcome:
Student will use occupation as a primary treatment method and as a means to an end.
Student will be able to articulate the rationale behind use of a selected activity.
Student will explain why an activity was chosen to utilize with a client.
6. Clearly, confidently and accurately communicates the roles of the OT and OTA:
Student will verbalize the differences in role delineation to clients, families, colleagues.
7. Collaborate with client and family throughout the OT process:
Student will set and discuss goals with the clients and families.
Student will establish treatment priorities with clients and families.
Student will review progress towards goals with clients and families throughout the OT process.
Student will explain the value of a chosen activity with respect to clients own occupations.
III. Evaluation and Screening:
8. Articulates a clear and logical rationale for the evaluation process:
Student will be able to articulate the reasoning for the OT evaluation to the CI, client and family.
9. Selects relevant screening and assessment methods while considering such factors as
priorities, contexts, theories and evidence-based practice:
client’s
Student will obtain the client’s occupational profile and determine appropriate occupational performance areas (motor
skills, process skills etc) to assess during the evaluation.
Student will identify precautions associated with apparent client deficits.
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10. Determine client’s occupational profile and performance through appropriate assessment methods:
Student will demonstrate the ability to interview clients and family members.
Student will demonstrate the ability to obtain information through skilled observation of the client.
Student will integrate the client’s occupational profile and integrate into the treatment plan.
11. Assess client factors and context(s) that support or hinder occupational performance:
Student will identify through observation or interview any client factors and contexts that support or hinder
occupational performance.
12. Obtains sufficient and necessary information from relevant sources and records prior to and during the
evaluation process:
Student will perform a thorough chart review to obtain all pertinent client information prior to the evaluation.
Student will be aware of the importance of thorough data collection prior to the evaluation.
13. Administers assessments in a uniform manner to ensure findings are valid and reliable:
Student will be knowledgeable about the importance of an accurate assessment of the client.
Student will demonstrate an understanding of the modified FIM language to evaluate clients current level of function.
Student will choose appropriate standardized tests and consult with the supervisor about the results.
14. Adjusts/modifies the assessment procedures based on client’s needs, behaviors and culture:
Student will demonstrate the ability to adapt/adjust him/herself based on the client’s response (verbal, body language,
vital sign changes etc) during the evaluation.
Student will demonstrate the ability to modify his/her communication (verbal and nonverbal) with the client based on
their reaction to therapist, educational level, cognitive status and emotional status.
15. Interprets evaluation results to determine client’s occupational performance strengths and challenges:
Student will determine current modified FIM levels and set goals based on the results of the evaluation.
Student will interpret data gathered through the evaluation to identify client’s occupational performance strengths and
challenges.
Student will determine challenges to therapeutic intervention based on gathered evaluation data.
16. Establishes an accurate and appropriate plan based on the evaluation results:
Student will assist the client to identify personnel goals and integrate them into evaluation.
Student will write realistic obtainable goals while clients are in the hospital.
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17. Documents the results of the evaluation process:
Student will provide documentation in the medical record that is accurate based on the results of the evaluation.
Student will determine an appropriate discharge disposition.
V. Intervention:
18. Articulates a clear and logical rationale for the intervention process:
Student will complete thorough treatment plans for clients.
Student will verbalize to CI, clients and/or family members the rationale as to why a certain activity/task was chosen
during therapy.
Student will communicate to CI an understanding of the concept of a graded activity.
Student will communicate clearly and concisely when interacting with clients, family members and other members of
the interdisciplinary team.
19. Utilizes evidence from published research and relevant resources to make informed intervention decisions:
Student will identify relevant material to therapy intervention(s) and share with CI.
20. Chooses occupations that motivate and challenge clients:
Student will identify activities that challenge and motivate the client.
Student will identify treatment activities to obtain client goals.
21. Selects relevant occupations to facilitate clients meeting established goals:
Student will choose activities that maximize the client’s occupational performance and allows for ongoing assessment.
22. Implements intervention plans that are client-centered:
Student will use appropriate frame of reference in the development of the treatment plan.
Student will demonstrate the ability to formulate accurate and appropriate treatment plans.
Student will recognize the importance of the involvement of client’s family members in the treatment process.
Student will incorporate appropriate activities into treatment based on client’s age.
23. Implements intervention plans that are occupation-based:
Student will incorporate purposeful and meaningful activities into the treatment that are based on the client’s
performance skills, context, activity demands etc.
24. Modifies task approach, occupations and the environment to maximize client performance:
Student will demonstrate the ability to modify/adjust an activity to adapt to a change in client during the therapy
session.
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25. Updates, modifies, or terminates the intervention plan based upon careful monitoring of the client’s status:
Student will demonstrate clinical reasoning skills to solve problems during therapy session.
Student will consult with the team and CI regarding the client’s progress and concerns.
Student will grade/modify activities to achieve goals.
Student will demonstrate the ability to identify when a client has reached a plateau in therapy and appropriate for
discharge.
26. Document’s client’s response to services in a manner that demonstrates the efficacy of intervention:
Student will accurately document client’s FIM scores, ROM and strength grades etc. as well as progress throughout
treatment sessions.
V. Management of OT Services:
27. Demonstrates through practice or discussion the ability to assign appropriate responsibilities to the OTA:
Student will articulate the role delineation between the OT and COTA’s.
Student will work collaboratively with the COTA’s (if a COTA is assigned to the work area).
28. Demonstrates through practice or discussion the ability to actively collaborate with the OTA:
Student will work collaboratively with the COTA’s (if a COTA is assigned to the work area).
29. Demonstrate understanding of the costs and funding related to OT services:
Student will be knowledgeable about the steps to order adaptive equipment (reacher, sock aid etc).
Student will ensure that client care time is used productively and prioritize daily responsibilities.
30. Accomplishes organizational goals by establishing priorities, developing strategies and meeting deadlines:
Student will complete documentation in a timely manner (write up evaluations and treatment notes in < 30 minutes) on
a daily basis.
Student will utilize down time constructively (ie. Work on project or in-service, perform literature search etc)
31. Produces the volume of work in the expected time frame:
Student will demonstrate the ability to function as an entry level therapist by the end of week 9/beginning of week 10
and maintain that status through the end of week 12. This includes the evaluation and/or treatment of up to 7 inpatient
acute clients a day in addition to the paperwork.
Student will adjust his/her work pace to accommodate this requirement.
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VI. Communication:
32. Clearly and effectively communicates verbally and nonverbally with clients, family members:
Student will demonstrate active listening skills when working with clients, family members and when talking with
his/her CI.
Student will develop the therapeutic use of self and maintain a good rapport with clients and family members.
Student will give clear, concise and effective directions to clients and family members.
Student will be aware of his/her nonverbal body language and make adjustments as needed when working with clients
and family members.
Student will establish boundaries with clients and family members when necessary.
Student will provide appropriate support, feedback and validation to clients during therapy session.
33. Produces clear and accurate documentation:
Student will utilize approved abbreviations.
Student will write clear and concise information (ie. Precautions, barriers to tx, past and current level of function,
occupational profile etc) in his/her documentation.
34. All written communication is legible:
Student will produce computer generated documents with the use of proper punctuation, grammar and spelling.
35. Uses language appropriate to the recipient of the information:
Student will be able to use technical and/or non-technical terms when needed depending on the audience.
VII. Professional Behaviors:
36. Collaborate with the supervisor to maximize the learning experience:
Student will take the initiative to seek out his/her CI for feedback on performance, assistance, concerns or questions.
Student will accept constructive feedback and modify his/her behavior as needed.
Student will come to his/her clinical prepared, be self-directed and seek out learning opportunities.
37. Takes responsibility for attaining competence by seeking out learning opportunities and interactions with
supervisor:
Student will develop personal goals to be addressed during his/her affiliation.
Student will collaborate with his/her CI to arrange observation of therapist in other areas of the hospital.
Student will independently seek out learning opportunities to acquire knowledge.
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38. Responds constructively to feedback:
Student will articulate an understanding of constructive feedback provided by the CI.
Student will demonstrate a positive and professional change in his/her behavior(s) in response to the CI’s suggestions.
Student will demonstrate the ability to generalize feedback to other situations.
39. Demonstrate consistent work behaviors including initiative, preparedness etc:
Student will not utilize a cell phone to talk or text or get on the internet for personal reasons throughout the day,
except during his/her lunch hour.
Student will arrive on time on scheduled days and arrange for make-up days.
Student will maintain a clean and organized work area.
40. Demonstrates effective time management:
Student will complete all assignments independently and in a timely manner.
Student will complete all documentation on a daily basis.
41. Demonstrates positive interpersonal skills (ie. Flexibility, empathy etc.)
Student will demonstrate a positive attitude and interactions with clients, family members, other staff etc.
Student will demonstrate the ability to be empathetic when working with clients.
Student will demonstrate the ability to be flexible in the dynamic acute care environment.
42. Demonstrates respect for diversity factors of others:
Student will acquire a translator when needed.
Student will show respect and act in a professional manner when working with clients with different lifestyle choices,
socioeconomic status, spiritual beliefs etc.
References:
USI and facility site objectives form
OSU and facility site objectives form
“New FWFE” objectives from “Using the Fieldwork Performance Evaluation Forms: The Complete Guide” by
Karen Atler, AOTA Press, 2003, P. 42-46.
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