WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
PROGRAM IN OCCUPATIONAL THERAPY
FIELDWORK MANUAL
First Year Students
2012 – 2013
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FIELDWORK PERSONNEL
Academic Fieldwork Coordinator (AFC)
Jeanenne Dallas, MA, OTR/L (JD)
dallasj@wusm.wustl.edu
office number: 314-286-1623; Room 1521
Fieldwork Assistant
Leise Amann (Leise)
amannl@wusm.wusm.edu
office number: 314-286-1639; Room 1522
FIELDWORK EDUCATION
Fieldwork education is a crucial part of professional preparation and is best integrated as a
component of the curriculum design. Fieldwork experiences should be implemented and
evaluated for their effectiveness by the educational institution. The experience should provide
the student with the opportunity to carry out professional responsibilities under supervision of
a qualified occupational therapy practitioner serving as a role model. The academic fieldwork
coordinator is responsible for the program’s compliance with fieldwork education
requirements. (ACOTE, C.1.0)
LEVEL I FIELDWORK
The Accreditation Council for Occupational Therapy Education (ACOTE) (2011) for
occupational therapists states that:
The goal of Level I fieldwork is to introduce students to the fieldwork experience, to apply
knowledge to practice, and to develop understanding of the needs of clients.
Level I fieldwork shall be integral to the program’s curriculum design and include
experiences designed to enrich didactic coursework through directed observation and
participation in selected aspects of the occupational therapy process (C.1.8).
Qualified personnel for supervised Level I fieldwork include, but are not limited to,
occupational therapy practitioners initially certified nationally, psychologists, physician
assistants, teachers, social workers, nurses and physical therapists (C.1.0)
The Academic Fieldwork Coordinator (AFWC) will ensure that at least one fieldwork experience (either
Level I or Level II) has as its focus psychological and social factors that influence engagement in
occupation (C.1.7).
FWI OBJECTIVES
Level I fieldwork objectives for students in the Program in Occupational Therapy at
Washington University School of Medicine follow are listed below.
The student will (ACOTE 2011 standards are identified):
1. Adhere to the AOTA Code of Ethics during fieldwork education (ACOTE B. 9.1).
2. Develop personal and professional abilities, competencies, and behaviors on fieldwork.
3. Demonstrate effective oral communication skills and therapeutic use of self on fieldwork
with clients and health care professionals in group and individual settings (B.5.7)
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4. Develop client observational skills (B.4.1).
5. Experience the occupational therapy process and the role of occupational therapy in the
fieldwork setting (C.1.8).
6. Identify the purpose of common medical equipment/supplies in the fieldwork setting.
7. Perform medical record review, apply medical terminology, and maintain written records as
required of fieldwork setting (B.4.3, B.4.10).
8. Understand the occupations of individuals and apply the PEOP curriculum model in the
fieldwork setting (B.2.11, C.1.8).
9. Apply academic knowledge and practice skills learned in the classroom on fieldwork under
the supervision of a trained professional (C.1.9).
10. Identify personal knowledge and skills that need further development and direct further
learning and growth (B.9.4).
11. Begin to understand the role of other professionals on the team at fieldwork site (
12. Identify interest areas for further fieldwork, research, and practice.
13. Demonstrate proficiency in medical terminology.
Students complete Level I fieldwork experiences during the fall and spring semesters
of the first year and the fall semester of the second year of the occupational therapy
program. These experiences are designed to orient the student to various practice settings
and the types of clients served by occupational therapy.
SELF DIRECTED FIELDWORK I (FWI) PLAN
Each student will be placed (by the FW Assistant) in 2 FWI experiences, each being 40 hours
long (either concentrated during one week or extended through the semester) during the MS
curriculum semesters - Spring semester of the 1st year and Fall semester of the 2 nd year.
Each student will plan another 60 hours of FWI or experiential time to be completed
throughout the 5 semesters of classes. These hours must be completed and documentation
turned in by April 1st of the 2nd year Spring semester. This plan pertains to both MS and OTD
students.
Per ACOTE (2011) standards, ALL experiences that are considered FWI must to be in sites
that the WUOT Program has an active FW contract with. Some of the self directed
experience hours may be in sites that we do not have a contract. This is for the FW
Coordinator and the Assistant to monitor.
Per ACOTE (2011) standards, an OT supervisor for FWI is preferred, but not required.
FWI Requirements for the ASSIGNED FWI Experiences
40 hours of a Physical Disabilities/Rehabilitation experience
This requirement is intended to give all students exposure to hospital or medical while on FWI.
A weeklong (or extended) FWI I in this area of practice will be scheduled for students by the
FW Assistant
A list of contract sites is available on the FW database. Students will have training early in the
first semester as to how to access and navigate the database (see page 6).
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Options include: hospitals (acute inpatient, inpatient rehab), skilled nursing facilities,
outpatient, home health, etc.
Ideally, the FW Assistant will try to schedule this physical disabilities experience as the
student’s first FWI in the Spring of 1st year.
20 hours minimum of a Psychosocial/Mental Health (MH) experience
1. There are two ways to fulfill this requirement: A weeklong FWI scheduled by the FW
Assistant – this can be scheduled in the Spring of year 1 or Fall of year 2. A weeklong FWI
would be 40 hours (this fulfills the 20 hour minimum requirement).
2. IF this requirement is not completed as a weeklong FWI, the student will have to complete
the required 20 hours in one of the semesters during the curriculum. The student will
identify his/her preferences for a site from a list of given choices. The FW Assistant will
assign students to a contracted St Louis site that has agreed to take students for this
experience.
A list of contract sites for either of these options is available on the FW database. Students
will have training early in the first semester as to how to access and navigate the database.
As with all FWI’s, there may not be an OT on the site. An OT supervisor is preferred, but not
required for FWI. Many MH sites do not have an OT on site; the student will be supervised by
another professional.
Students will turn in FWI site/city preferences for the FW Assistant to use when scheduling the
FWI week-long experiences. The students will be oriented to this form and procedure during
the first month of the curriculum.
A Professional Behaviors Document (PBD) evaluation completed by the supervisor of the
student will be required for the assigned FWI experiences. Other assignments will be listed in
the fieldwork course syllabus.
Self Directed Hours:
60 hours of experiential time to be completed throughout the 5 semesters of classes.
 These hours MUST BE completed by April 1st of the 2nd year Spring semester. There
will be NO exceptions granted.
Students will develop a Self Directed FWI Plan, including learning goals, by the end of the Fall
semester of the first year.
This plan will be documented on the Self Directed FWI Plan and Record. It will be the
student’s responsibility to report on the status of the Self Directed Plan each semester.
 See the form for details on how this will be turned in.

Students will be oriented to this process during the first semester of the curriculum.
Students should plan for ~20 hours of Self Directed experiences in semesters 2 - 5 in
order to complete the requirement of 60 hours by the end of the curriculum
Students will spend a minimum of 10 hours at the site in order to count the experience as a
Self Directed FWI experience.
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Approval of the Self Directed Plans
Students will complete their 1st year Spring FWI Plan and discuss it with their advisor
sometime during the Fall semester of the students’ first year.
 It would be best to meet with the Advisor during the first month or two of the semester.
 The Advisor will review the form with the student and sign the form.
The Spring FWI Plan will be due before Thanksgiving Break (the exact date will be
communicated to the students by the FW Coordinator).
Students will return the completed Spring FWI plan to the FW Assistant; the Academic FW
Coordinator (AFWC) will review the plan and will bring any concerns to the attention of the
student.
The FW Coordinator will have final approval authority for all Self Directed Plans.
After the AFWC has approved the Self Directed Plan, a copy of the Plan will be returned to the
student to refer to and use at the end of the planned semester to record his/her FWI
experiences.
The Advisor will NOT need to approve FWI plans following the initial FWI plan developed
during the first semester of school.
LEVEL I FIELDWORK SITE SELECTIONS
Site selection for the two one-week placements:
Washington University Program in OT has contracts with over 400 fieldwork sites around the
country. Sites include, but are not limited to hospitals, community agencies, schools, private
practices and outpatient programs. The Program in OT is NOT seeking new Level I or II
fieldwork sites at this time; students must pick from the sites available.
The fieldwork database lists all of the sites and their area of practice. Many sites reserve slots
for Level I fieldwork each semester, which is also noted on the fieldwork database. Students
will only be placed in sites which have not declined a reservation (denoted by “0” on the
database). The Program in OT keeps hard copy (in the FW Assistant’s office) and electronic
files for each fieldwork site From WUOT webpage: Click on Resources; Log on to Citrix
for students; click on OT Depts on Medulla (G:)/medulla.medpriv.wucon.wustl / otdepts
/ Students/Fieldwork / FW Data Forms.
A Fieldwork Data Form is included in these files, along with other information on the site. The
Fieldwork Data Form describes the level of experience of the supervising therapists, types of
clients served, models of practice, and methods of intervention. Students should review the
information and search the internet for other information about the site.
Student evaluations from FWII experiences are saved on the network folder for the site.
Students should read these to find out more about the site from the student’s perspective.
Students must not contact the site directly for information at the phase of choosing the
fieldwork sites.
After reviewing the database and hard copy or electronic files, students identify and rank their
top three areas of interest for practice or pick their top four sites and geographic areas on a
FW Preference Sheet distributed to the students mid to late fall. The form must be turned in
on time, or the student will forfeit the right to indicate a choice for the semester.
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Every attempt will be made to place the student in sites based on his/her areas of interest;
however IDENTIFICATION OF INTERESTS DOES NOT GUARANTEE PLACEMENT.
The Academic FW Assistant arranges the fieldwork Level I assignments. The Assistant will
consult with the Academic FW Coordinator (AFWC) for these placements. Level I placement
assignments will be distributed as soon as possible so the student can make travel and
housing plans. Students who have questions regarding fieldwork sites or the selection
process should schedule an appointment with the AFWC.
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Instructions for accessing the Fieldwork Database
Go to: http://www.ot.wustl.edu
Click on: Resources
Click on Citrix (students)
The screen will show “Citrix Access Gateway”
User name is: otstudenttest, the password is: Windows1
and the domain is: MEDPRIV (this takes a while to load)
Under Web Sites (middle column), click on: Filemaker Pro Link
The screen will show “Instant Wed Publishing”
Click on: FIELDWRK (you may have to do this step twice)
Account Name: Student
Password: Explore1
The Fieldwork Student Menu Screen will open up. (If the Fieldwork Main Menu opens up –
click on the “Student Menu” button at the top right hand corner.)
1. For current reservations: click on the Level I 2012/2013 button or other pertinent field that
you want to check.
To review past reservations: click on Level I for prior years
2. To find a specific site by site name, city or state
 Go to the magnifying glass at the left / top of the screen (Find Mode)
 The fields on the screen will disappear
 Move the cursor to the field you wish to search, i.e. city, state, practice area
 Click on that field
 Type in the site name, city or state (whatever the field is that you are searching
 Move the cursor to the left of the screen and click on the “Perform Find” button
 Your search will finish in a moment or two. (You will know how many “hits” you have
by the number on the left side of your screen, stated “Found Set”)
3. To sort through your “found” files
 Find the notebook icon on the left or top side of the screen (with arrows)
 Click on the right / left arrows to scroll through the found set.
4. To find other information, follow the directions above and type in the correct field the
information you are looking for. For example: under benefits/housing, type “>0” and
“Perform Find” and all sites with information regarding housing will be found.
5. To find First Come First Serve sites, follow the directions above and type in FCFS in the
COMMENTS field.
6. REMINDER: look at the bottom of the screen to see if Level I or Level II is checked. IF
Level III is checked…that is NOT an OT FW site, that is a Doctorate Apprenticeship only
site!
7. STUDENTS ARE NOT ALLOWED TO CONTACT FW SITES DIRECTLY!
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LEVEL I FIELDWORK POLICIES AND PROCEDURES
The Program makes arrangements for fieldwork placements with the designated contact staff
of each fieldwork site. An information packet, including fieldwork objectives, student health
record, student assignments, procedures, evaluation forms and handouts related to
objectives, is forwarded to the Fieldwork Educator at the site.
In the FW class in the spring semester of the first year, students are oriented to fieldwork
objectives, procedures, and related protocols. Students are instructed to contact their
Fieldwork Level I Educator (after the placement has been made) to confirm arrangements
regarding schedules, location, expected attire, etc.
Students are responsible for meeting site specific requirements as outlined on the Fieldwork
Database. Such requirements may include, but not limited to, drug screenings, police
background checks and CPR certification. Students who do not fulfill these site-specific
requirements will not be allowed to attend fieldwork and will not pass the course.
Requirements not routinely offered by Wash U. may be at the expense of the student. Inform
the FW Assistant as to what these may be….we will explore either charging the costs to
WUOT or reimbursing students.
Each student is responsible for transportation and housing expenses while on FWI.
Unless other arrangements are made, each student is expected to be on-site for 40 hours as
agreed upon by the fieldwork site. Students will follow the schedule of the fieldwork site; 40
hours are required, but in some cases fewer hours may be acceptable with the permission of
the AFC. In that case, students must perform at least 35 hours minimum. Students on an
extended FWI will be expected to complete 40 hours.
Each student is to complete all assignments for each fieldwork experience including those
assigned by the Fieldwork Educator, AFC, and instructors for other courses in the curriculum.
Submit all assignments on time to the appropriate party.
At the end of the fieldwork experience, the Fieldwork Educator will document the student’s
performance on the Fieldwork Professional Behaviors Document (see p. 15). The results are
discussed with the student, including performance-related strengths and areas in need of
further development. The student will return the Professional Behaviors Document to the AFC.
If problem areas are identified, discussion with the AFC and a remediation plan will follow.
Students will complete an evaluation form of the fieldwork experience, which is exchanged
and discussed with the Fieldwork Educator during the performance review. The student will
return this form to the OT Program following FW.
Attendance at fieldwork is mandatory. Sessions missed for inclement weather, illness, etc.
must be made up. Failure to make up this time results in automatic failure of the course.
Emergency situations will be handled on a case by case basis.
PLACEMENT POLICY
The Program in Occupational Therapy will provide the student with fieldwork experiences in
settings that have been deemed appropriate for placement and that have expressed a
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willingness to fulfill the responsibilities for Level I Fieldwork supervision. Students will only be
placed in sites that have a signed Affiliation Agreement (contract) with Washington University.
SITE SELECTION POLICY
Every effort will be made to offer students exposure to different types of clients in a variety of
practice settings. This is in effort to assist the student in achieving a level of comfort and to
integrate knowledge and skills effectively.
RESERVATION REQUESTS
Students are NOT to contact a site requesting a placement for fieldwork Level I or Level II
unless given permission by the AFC.
If a student makes a direct request to a specific site for a personal placement through
any means without permission, that site will no longer be an option for that student.
TIME ALLOTTMENT POLICY
The time allotted the Level I Fieldwork experience is 40 hours. In some cases the minimum
will be 35 hours at the fieldwork site. The hours are to be fulfilled by mutual agreement of the
Fieldwork Educator and the student at the beginning of the designated fieldwork assigned
period. The student and the Fieldwork Educator shall schedule weekly times for extended
experiences (available spring of 1st year, and the fall semester during the 2nd year) for
students whose schedule allows. All extended experiences are within driving distance in the
St. Louis area.
FIELDWORK ASSIGNMENT POLICY
Students are required to keep a fieldwork journal during their experience. Refer to the
Fieldwork and Professional Competence syllabus for criteria/format.
Students may have assignments from other classes while on fieldwork. The fieldwork site
may have specific objectives and assignments for the student.
It is the students’ responsibility to complete all assignments in the designated time frame. If a
student is having difficulty completing the assignment, he/she should discuss this with the
appropriate party (Fieldwork Educator, Instructor, or AFC). The student’s fieldwork
performance will be evaluated on the Fieldwork Professional Behaviors Document.
CONTACTING A LEVEL I PLACEMENT
Concentrated fieldwork experience: Contact site at least two weeks prior to the FW week or
when the AFC or Assistant has said to contact the site.
Extended fieldwork experience: Contact the site immediately upon receiving the
assignment. It is the student’s responsibility to set up the FW schedule with the site.
Determine a mutually agreeable time and day to attend fieldwork.

Ask for the contact person listed on the assignment form or the Student Coordinator

Introduce yourself, tell them what school you are from and confirm dates with the site’s
Fieldwork Coordinator/contact person.

Ask for the name of your supervisor for the fieldwork experience and the contact
information.

Ask specifics for the fieldwork: parking, location of center, hours, dress code, etc.
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

Confirm requirements specific to that site: CPR certification, police background
check, drug test, etc. These are listed for each site in the database and on the FW Data
Forms.
If you do not receive an answer via email in a week, try again OR call the site!
CRITERIA FOR CHANGING SITES AFTER CONFIRMATION
If a student cannot perform the fieldwork at the site they are placed at, the student must
contact the FW Assistant or AFWC immediately. Requests for changes based on personal
needs will be considered on an individual basis. Proof of hardship may be required.
The following are examples of acceptable reasons for requesting a change in your confirmed
FWI site:
- Severe illness of family member
- Student health difficulties that require a specific accommodation
- Recommendation by physician
- Recommendation by CAPES
- Judiciary commitments
The following reasons will not be considered if requesting a change in confirmed FWI site:
- Student changed their mind
- Change in marital status (engagement or marriage)
- Needs of pets
- The site’s work schedule or location does not match student preference
It is assumed that students will take into consideration all personal needs as well as
all financial and family responsibilities prior to identifying their fieldwork preferences (location
or site).
ILLNESS OR INJURY WHILE ON FIELDWORK
If you become ill or are injured while on fieldwork, seek medical attention immediately. Our
contract with each site ensures that they will arrange emergency medical care while you are
on their site; however, the site is not responsible for the cost. Refer to your Student Health
Insurance manual for further coverage questions.
Once your situation has stabilized and your immediate family has been contacted, you must
notify the OT Program (the AFWC) and Student Health. This is especially important in cases
of exposure to body fluids. The student, OT program and Fieldwork Educator will assist in
determining continuation of your fieldwork experience in cases of severe illness or injury.
ATTENDANCE POLICY
Students are expected to attend all scheduled fieldwork experience hours. Students must
report to fieldwork as scheduled unless illness or extenuating conditions arise. Students must
report absences in advance to fieldwork site supervisor and inform AFC or Fieldwork Assistant
the day of the absence.
Extended Fieldwork I experiences require additional planning and time commitments during
the academic schedule. Extended fieldwork hours must be logged on the FWI Tracking Form
and confirmed by the Fieldwork Educator (see p. 18). Any absences require prior contact with
the student’s Fieldwork Educator and reporting to the AFC. Every effort must be made to
make up absences at the convenience of the fieldwork site; therefore absences must be made
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up in most instances. Students on an extended FWI will be expected to complete 40
hours.
If all hours scheduled for the FWI are not satisfactorily completed, the experience will be
considered a failure. Extenuating circumstances must be reviewed with the site Fieldwork
Educator and the AFC. It’s the students’ responsibility to ensure all hours are scheduled.
ADVANCEMENT POLICY
Advancement to succeeding fieldwork experiences is dependent upon satisfactory completion
of the fieldwork experience and achieving the minimum score as identified on the Professional
Behaviors Document.
EVALUATION OF STUDENT PERFORMANCE ON FIELDWORK I
The Professional Behaviors Document (at end of this manual) is completed at the end of the
Level I fieldwork experience. The supervisor is encouraged to give ample feedback on this
evaluation. If any time during the experience the student is concerned that a passing grade
will not be received, he or she should discuss immediately with supervisor and AFC. Below
are minimum passing grades for Level I fieldwork:
Semester 2 Level I Fieldwork: “Meets Standards” performance on at least 60% of
the items (min. of 22) and Unsatisfactory performance on 0% of the items
Semester 3 Level I Fieldwork: “Meets Standards” performance on at least 70% of
the items (min. of 25) and Unsatisfactory performance on 0% of the items
FIELDWORK DOCUMENTATION
Documentation returned to the AFC at the end of the fieldwork experience includes:

Fieldwork Professional Behaviors Document,

Student’s Evaluation of Fieldwork Experience,

FW Journal (can be emailed)

Completed Time Log ( if on extended fieldwork)
Refer to course syllabus for due dates of these documents.
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HIPAA
Refer to http://secpriv.wusm.wustl.edu for complete information on HIPAA.
Every student has completed HIPAA training at WUOT and is to comply with the HIPAA
policies of the organization and Washington University while on Fieldwork Level I, II or OTD
Apprenticeship. Students violating HIPAA while on Fieldwork Level I, II or OTD
Apprenticeship will face sanctions from the organization and the university. The level of
violation of HIPAA will be determined by the organization and WUOT.
Students found in violation of HIPAA will be brought to the CAPES committee and will face
disciplinary action as determined by WUOT and the CAPES committee.
Sanctions for Non-Compliance with HIPAA Policies
Washington University and its member organizations (collectively, “Washington University” or
“WU”) are committed to conducting business in compliance with all applicable laws,
regulations and WU policies. WU has adopted this policy regarding sanctions for violations by
workforce members of the Health Insurance Portability and Accountability Act of 1996
(“HIPAA”).
This Policy covers all workforce members within Washington University covered entity
component parts whose actions or failures to act violate WU HIPAA policies. Workforce
members include employees (both faculty and staff), appointees, volunteers, trainees
(includes OT students) and other persons whose conduct, in the performance of work for
Washington University, is under the direct control of the University whether or not they are
paid by the University.
Sanctions for violations of HIPAA policies may include, without limitation, verbal counseling,
written warning, suspension, and discharge. Sanctions may also be applied for failure to
report a known or suspected HIPAA violation.
Factors in determining appropriate disciplinary action may include, but are not limited to:
 Whether the breach was intentional or inadvertent

The nature of the breach, including whether the breach involved specially protected
information such as HIV, psychiatric, substance abuse, or genetic data

The magnitude of the breach, including the number of patients and the volume of
protected health information accessed or disclosed

Workforce member’s motive in accessing or disclosing protected health information

Whether the workforce member has committed prior HIPAA violations

Workforce member’s response or conduct during investigation

Harm to the breach victim(s)
Investigation and Disciplinary Process:
Potential violations of the WU HIPAA Policy should be reported to the WU HIPAA Privacy
Office. The HIPAA Privacy Office will notify the HIPAA Security Office if a violation of a HIPAA
Security Policy is involved.
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A workforce member who becomes aware of a potential violation should immediately notify
his/her supervisor and/or the HIPAA Privacy Office.
Reports may also be made anonymously to the HIPAA Privacy Office (866-747-4975) or the
WU Compliance Hotline (314-362-4998).
Upon notification of a potential violation of a WU HIPAA Policy, the HIPAA Privacy Office will
investigate, review and assess the alleged violation. The investigation may necessitate,
among other things, workforce member interviews, computer audit trails, telephone log
reviews, etc. The HIPAA Privacy Office will determine whether and what
sanctions are appropriate in consultation with relevant administrators from the workforce
member’s department or other business unit, Human Resources and/or the Office of the
Executive Vice Chancellor & General Counsel, and the HIPAA Security Office if the matter
involves a breach of the HIPAA Security Policy.
Disciplinary actions will be documented in writing and maintained in the appropriate personnel
record. Disciplinary action may be appropriately delayed if the action could adversely affect or
compromise patient care.
Last Revision Date: October 7, 2010
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STUDENT EVALUATION OF FIELDWORK EXPERIENCE: LEVEL I
The Student Evaluation of Fieldwork Experience is an important tool for the fieldwork
instructor, faculty and other students. This evaluation provides information vital to each
program. Information from the student is one method utilized in evaluating the effectiveness
of academic preparation as well as the value of the fieldwork learning experience.
AGENCY NAME:__________________________________________________
AGENCY ADDRESS:_______________________________________________
CONCENTRATED or EXTENDED EXPERIENCE (circle)
COURSE (circle):
Spring
Fall
1.) Describe the orientation to the program, its facilities and staff? Was this adequate?
Any suggestions to offer?
2.) How were you oriented to the Level I student responsibilities? Was this adequate?
Any suggestions to offer?
3.) Describe the treatment approaches demonstrated in this program.
4.) Describe the client population that you observed.
5.) Supervision was provided by whom? i.e., PT, Social Worker, etc.
6.) Describe the level of interaction with your supervisor. Was this adequate to meet
your learning needs?
7.) Were you adequately prepared by the Program to meet the objectives of this fieldwork?
 If yes, what courses or information was most helpful

If no, why not and what would have been helpful
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STUDENT EVALUATION OF FIELDWORK EXPERIENCE: LEVEL I
8.) Rate this fieldwork site, based on your personal experience
1
2
3
4
5
6
7
8
9
poor
10
excellent
9.) Rate the supervision you received, based on your personal experience
1
2
3
4
5
6
7
poor
8
9
10
excellent
10. Would you recommend this site to another student?
ADDITIONAL COMMENTS:
Fieldwork Supervisor:__________________________________________________
Signature
Date
Student: ________________________________________________________
Signature
Date
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FW Professional Behaviors Document
The student exhibits:
Meets Standards
Personal Integrity
1
2
3
4
Displays personal honor and integrity.
Demonstrates dependability and reliability.
Follows the AOTA Code of Ethics.
Respects authority and follows the chain of command.
Respect of Others
5
6
7
8
9
Respects diversity.
Demonstrates empathy and support of others.
Demonstrates awareness of how behavior affects others.
Demonstrates respect of others' values and beliefs.
Demonstrates appropriate etiquette.
Time Management & Organization
10
11
12
13
14
Attends regularly and on time.
Keeps time commitments or notifies in advance.
Acts proactively, plans ahead, proposes solutions.
Prioritizes tasks and commitments.
Demonstrates preparedness.
Personal Responsibility for Growth
15
16
17
18
19
20
21
Embraces responsibility for behavior and learning.
Demonstrates awareness of strengths and weaknesses.
Display an appropriate level of confidence.
Demonstrates flexibility in coping with change.
Seeks feedback and guidance to improve.
Uses feedback to modify behavior.
Manages stressors in positive and constructive ways.
Interpersonal Communication Skills
22
23
24
25
Listens to others' opinions and disagrees with tact.
Seeks clarification as needed.
Handles conflict constructively.
Uses appropriate verbal and non-verbal communication.
Cooperation & Collaboration
26
27
28
29
Contributes full effort to achieve team goals.
Pools resources and works efficiently within a group.
Is proactive and anticipates needs of others.
Assists with resolution of problems.
Professional Communication Skills
30 Participates thoughtfully in discussions.
31 Is attentive and aware of verbal and nonverbal behaviors.
32 Communicates in a concise manner.
33 Demonstrates correct grammar, spelling, punctuation.
Adherence to Policies
34 Adheres to laws, such as HIPPAA and confidentiality.
35 Follows OT Program guidelines on dress and hygiene.
36 Conforms to safe work standards and precautions.
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Needs
Improvement
Unsatisfactory
For any item rated "Unsatisfactory" or "Needs Improvement",
Please write an example of the behavior should be included below, with recommendations or goals.
Item # and Example:
Recommendation or Goal:
Item # and Example:
Recommendation or Goal:
Item # and Example:
Recommendation or Goal:
Item # and Example:
Recommendation or Goal:
Comments:
Print supervisors name:
Preparer's Signature:
Date
Student's Signature
Date
Rev. 08/10
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Level I Extended and Self Directed Fieldwork Experiences Tracking Grid
Washington University School of Medicine
Program in Occupational Therapy
Student Name: ___________________________________
Site: ___________________________________________
Supervisor Name (please print):_____________________________________
Date
Number of
Hours
BRIEF description of what you did
during the time spent at the site
Total:
I confirm that the student completed the hours and activities as recorded above.
Supervisor’s signature:
_____________________________________________
Supervisor
________________
Date
The student is required to return this form to the FW Assistant with the Self Directed
FWI Record
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LEVEL I and LEVEL II FIELDWORK POLICIES AND PROCEDURES
OFF SCHEDULE STUDENT PLACEMENT POLICY
From time to time some students may be off the “regular” fieldwork schedule for either Level I
or Level II placements. This may occur because of individual student need and/or by design
of their academic program. “Off-schedule” is defined as those experiences occurring at a time
other than the pre-designated times identified at the beginning of each academic year
(optional 3rd Level II experiences are included in this definition).
If a student has been placed “off-schedule,” the scheduling of their fieldwork placements will
be:
Level I: Students will complete the Level I Fieldwork Preference Sheet and the AFC will
request off schedule placement from fieldwork site. Specific timeframes, geographic areas
and practice areas are not guaranteed. The Program will attempt to accommodate student
requests, but the student may need to complete the fieldwork experience in areas/sites not
requested.
Level II and Doctoral Apprenticeship: If a student is unable to perform Level II Fieldwork or
Doctoral Apprenticeship during the prearranged fieldwork times, the AFC will request off
schedule placement from the student’s preferred sites. This will automatically be performed for
the first Level II for doctoral students. The Program will attempt to accommodate student
requests, but the student may need to complete the fieldwork experience at alternative sites.
Many fieldwork sites prefer to follow the AOTA’s suggested Level II Fieldwork timelines, but
some sites will make exceptions for doctoral placement.
REQUESTS TO CHANGE THE TIMING OF LEVEL I AND LEVEL II
All requests for changes in the Level I experience are made directly to the AFC.
Students are not to contact sites individually to request a change.
Level I: Level I concentrated experiences are scheduled by the FW office and published
annually on the Academic Calendar.
Students will complete their fieldwork at the pre-scheduled times unless:
1.) They meet the criteria for changing sites outlined previously
2.) A site has requested students during the spring break or
3.) The change in time is deemed necessary by the AFWC.
Level II / Apprenticeship: Students may request to have the dates of their scheduled Level II
or Apprenticeship experience modified.
Requests should be submitted in writing to the AFWC and should include:
1.)
The name of the student
2.)
Date of the request
3.)
Requested dates to be changed (beginning and ending date)
4.)
The name of the Level II program assignment
The Program will contact the site for the student OR give the student permission to contact the
site and request the date modification.
It is the fieldwork site’s prerogative to change the date of the experience or not. The
student will be notified of request acceptance or denial.
19
ACCOMMODATIONS ON FIELDWORK
Students with disabilities who require accommodations need to work with the AFC well in
advance of the Fieldwork I and II placements to identify the specific reasonable
accommodations needed in the fieldwork setting.
Fieldwork placements will be made in sites that can meet the student’s accommodation
needs.
If new needs arise on fieldwork that suggest further accommodations are necessary, the
student should request these accommodations from the fieldwork site and notify the AFC.
** Refer to the Student Manual on the Policy for Students with Disabilities.
REQUIREMENTS FOR LEVEL II FIELDWORK & DOCTORAL APPRENTICESHIP
Each MSOT student must successfully complete 2 (12 week) Level II Fieldwork experiences
in order to complete the requirements for graduation from the Washington University Program
in OT.
Each OTD student must successfully complete 2 (12 week) Level II Fieldwork experiences
and one 16 week (640 hours) Doctoral Apprenticeship experience in order to complete the
requirements for graduation from the Washington University Program in OT.
MSOT and OTD students may complete an optional third Level II Fieldwork experience
(common sites are National Institutes for Health and AOTA).
The Level II fieldwork & Doctoral Apprenticeship experiences are credited courses (6 credit
hours each). All MSOT or OTD Academic work (including papers) MUST be completed prior
to starting FW experiences. Failure to do so will result in the student not being able to begin
FWII on schedule.
OT593A Fieldwork II
This course provides fieldwork experience under the supervision of an occupational therapist.
Students’ participation includes in-depth experience in delivering occupational therapy
services to clients including evaluation, treatment and intervention. Students have the
opportunity to practice in a variety of clinical or community based settings. During the
fieldwork process, students are expected to assume increasing responsibilities related to
patient or client care. The fieldwork experience is designed to promote clinical reasoning,
professionalism and competency. Duration is 12 weeks.
OT 593B Fieldwork II
This course provides a second fieldwork experience under the supervision of an occupational
therapist. Students’ participation includes in-depth experience in delivering occupational
therapy services to clients including evaluation, treatment and intervention. Students have the
opportunity to practice in a variety of clinical or community based settings. Because this is the
second of two fieldwork II experiences, students are expected to build on their first fieldwork
and assume increasing responsibilities related to patient or client care. The fieldwork
experience is designed to progressively build competencies in clinical reasoning,
professionalism and entry-level skills. Duration is 12 weeks.
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OT 793C Doctoral Apprenticeship (OTD students only)
This course provides a customized doctoral experience specific to the OT doctoral pursuit of
the student. Students may participate in research, policy, clinical practice*, advocacy,
teaching, etc. Students are expected to achieve specific goals established by the student, the
site supervisor, and the doctoral chair. Duration is 16 weeks (640 hours).
*If pursuing a clinical experience, the ACOTE standards for a FWII have to be followed
and a clinical contract has to be entered with the site.
Prerequisites for Fieldwork Coursework
 Level II Fieldwork: Must successfully complete all first, second year and 3rd year (for
OTD students) coursework, including all Masters or Doctoral Project requirements,
prior to first Level II experience.
 Doctoral Apprenticeship: Must successfully complete the two Level II fieldwork
experiences (OT 593A & B) and all third year coursework, including all Doctoral Project
requirements, prior to the Doctoral Apprenticeship experience.
 Exceptions to the timing of the second FWII and Apprenticeship will only be made as
developed and approved by the Associate Director of Professional Programs.
Timeline Requirements
All students must successfully complete the required Level II Fieldwork and/or Doctoral
Apprenticeship experiences within 12 months of completing academic coursework.
Failure to successfully complete the Level II Fieldwork and/or Doctoral Apprenticeship
experiences within the 12-month period will result in dismissal from the Program.
The Doctoral Chair, student and the AFC will coordinate efforts to ensure that the FWII and
the Apprenticeship is completed by the December date to qualify for graduation.
 This may mean adjusting the 2nd FWII dates to accommodate for the 16 weeks of
Apprenticeship; the Doctoral student staying at WU to work in his/her Doctoral lab for
some time to count towards Apprenticeship dates prior to the 2nd FWII;
 OR another acceptable means of completing the required weeks before the end of the
year.
Unforeseen circumstances may require a Leave of Absence that will allow the 12-month time
frame to be extended. The Committee on Academic and Professional Evaluation of Students
(CAPES) will determine the impact of a Leave of Absence on the 12-month time frame for
completion of the Level II Fieldwork and/or Doctoral Apprenticeship experiences. A Leave of
Absence during Fieldwork must be approved by the CAPES. Refer to Student Handbook for
further information.
21
LEVEL II FIELDWORK OBJECTIVES FOR WASHINGTON UNIVERSITY
Fieldwork is an integral part of the educational experience. It is during this time that the student
gains the opportunity to operationalize their knowledge and be mentored in the process. It is
also the first time the student has responsibility for their own clients in which they demonstrate
behaviors and ethical decision-making and use the evidence available of person, environment
and occupational factors that help clients achieve their own goals. It is our objective for the
students to engage in and demonstrate the capacity to practice in a way that support their
clients in achieving quality of life through occupation. The following objectives should set the
tone for the fieldwork experience.
Students will (ACOTE 2011 standards are identified):
1. Demonstrate the ability to perform assessment and treatment planning processes
consistent with the AOTA Practice Framework using the Models of Practice consistent with
their educational preparation (ACOTE B.4.1, B.4.2, B.4.3, B.4.4).
2. Administer and interpret occupational performance based assessments at the individual
outcome, program evaluation and program development levels in a skillful manner (B.4.4,
B.5.1, B.7.5, and B.7.6).
3. Use evidence to inform practice on a consistent manner; including evidence based on
experience, expert practitioners, from controlled studies, and from descriptive literature
(B.8.3, B.6.6).
4. Work collaboratively with team members and occupational therapy assistants to plan,
implement, and terminate interventions that address the occupational goals of the client
(B.4.5, B.5.22, B.5.25. and B.5.27).
5. Implement interventions centered on occupation, participation and environment as clientcentered care is planned and implemented (B.5.0, B.5.1).
6. Provide services focused on consumers and family to enable the client’s occupation and
maximizing occupational performance once discharged (B.5.28).
7. Advocate for those who may be vulnerable or at risk with secondary conditions (B.2.9).
8. Use occupational histories to create occupational profiles to guide client-centered care
(B.4.4).
9. Demonstrate a sensitivity to and inclusion of culture in the design of interventions (B.4.7).
10. Plan and implement assessment and intervention plans that demonstrate a balance of the
person, occupation and environmental factors (B.5.1, B.5.2).
11. Transition clients from one service level to the next to insure an outcome of full
participation and well being in addition to occupational performance goals (B.5.25, B.5.29).
12. Document occupation-based care plans, progress notes, goals and knowledge of billing
methodologies that support occupational-based practice (B.4.10, B.5.32).
13. Treat a full client caseload, as defined by fieldwork site, by the end of experience.
14. Submit correct and complete documentation in a timely manner, according to policies and
procedures of fieldwork site.
15. Consistently report to site on time.
16. Follow all policies and procedures as instructed by the fieldwork site and Washington
University Program in Occupational Therapy.
17. Demonstrate initiative when exploring new learning opportunities.
18. Actively participate in the supervisory process.
19. Utilize treatment approaches that demonstrate in depth knowledge of the various frames of
reference in Occupational Therapy practice.
20. Demonstrate entry-level competencies for the practice setting.
21. Demonstrate professional behaviors consistently.
22. Achieve all additional objectives set by the specific fieldwork site.
22
LEVEL II FIELDWORK POLICIES AND PROCEDURES
INTERVIEWS PRIOR TO LEVEL II PLACEMENT
Several facilities require an in-person or telephone interview prior to agreeing to take the
student for a Level II placement.
It is the student’s responsibility to arrange and complete these interviews in the timeline
required for placement.
The Fieldwork Assistant will communicate with students to make sure the interviews are
arranged.
The student will set up and complete telephone interviews independently. Students should
present themselves appropriately and be prepared for the interview. Students who do not
complete the required interview will not be considered for placement at that site.
NEW LEVEL II CONTRACT REQUEST
New FIELDWORK CONTRACT Requests will not be ACCEPTED!
CONTACT WITH FW SITES
Students are NOT allowed to contact FWII sites for any reason unless approved by the AFC.
The AFC will be cc’d on all correspondence that the student has with the site after approval is
granted.
FIRST COME – FIRST SERVE FIELDWORK SITES
Sites that prefer to place Level II fieldwork students on a First Come-First Serve (FCFS) basis
are noted on the FW Database in the comments section of the sites by the notation “FCFS”.
Students should check the database late in the Fall semester to determine if any of the sites
he/she would like to go for FWII are listed as a FCFS site.
The student will have to complete the F-1, F-2 and F-3 forms by the due date (early in the
Spring semester) to request a FCFS FWII placement. If only one student requests a particular
site, that student will be placed there (as long as there is still an available spot at the facility).
*This procedure will be explained by the AFC in the fall semester of the first year.
NOTE: If the site(s) you are considering for a Level II FW is not listed as a FCFS site, you will
not complete the FW forms and turn in requests until the fall semester of your second year
(see General FW Level II Match Process on page 23).


First Come First Serve Level II Fieldwork Procedure
Late in the fall or early in the spring semester of the first year and the fall semester of the
second year students should conduct a search in the FW database for sites that have
requested and/or have a history of taking Level II students on a First Come First Serve
(FCFS) basis. See FW database instructions on page 6.
Students should review the information on the sites, discuss with family, significant others,
etc. before submitting requests
23








Students must complete all FW II placement forms (F1, F2, F3) and review with their
academic advisor (1st yr MS and OTD students; 2nd yr MS students) or doctoral chair (2nd
yr OTD students)
Turn in requests by due date given by the AFWC (typically early in the Spring semester)
If you are turning in an F-3 form with FCFS choices for both quarters, identify which
quarter you want placed in first
If only one student is interested in a site, that student automatically gets that site if the site
is available and agrees and if approved by the students faculty mentor
If more than one student is interested in a site, a name will be picked at random for
placement, if that site is available
If a student submits for more than one site, and receives a placement, consideration will be
given to other students prior to a second placement for that student
If an interview is required, the student must set this up and successfully complete it prior to
confirmation of placement. The placement will be considered “pending” until the interview
is completed and the site informs us that they will accept the student.
FCFS sites may be requested after the due dates, we will contact the site to see if the
placement is available.
FCFS RULES
 Students cannot cancel a site chosen through the FCFS process
 FCFS can only be changed through an exchange process with another student – not
cancelled. This will be only done with the permission of the AFWC.
 This process is ongoing – meaning the deadline given is when we start placements.
Students can turn in requests anytime after that date until mid-September, but requests
received by the due date will be given priority.
CONSIDERATIONS
 Think carefully about your choices; be sure that this is what you want because there are no
changes unless made by the site. Think about emotional support available in the area,
finances, etc. prior to making your decision.
 A change in marital status or planned housing in the city of your choice will not be grounds
for changing a FCFS placement.
 Search the database for FCFS notations every year as sites may be added to this category
each semester.
GENERAL FIELDWORK LEVEL II MATCH PROCESS
 During the summer session, the AFWC will send instructions to the students (both 2nd year
and 3rd year students) to begin looking at FWII sites. Students will be given a deadline to
turn in the F forms, typically early October.
 MSOT students and second year OTD students are assigned random numbers in the fall
that determine the ordering of the match.
 First Level II is assigned to students by increasing match numbers and second Level II is
assigned to students by decreasing match numbers.
 FCFS students are placed into the random order of matches, not separated out
 FCFS students will be placed for their remaining fieldwork in the first round of matches,
they will not be held until second round
 Second year OTD students are in the general Level II match for 3rd quarter. Sites will be
contacted to see if they are available for an off schedule placement due to the early return
to classes in the fall. The individual site determines if they can accommodate the adjusted
Level II dates
24


Third year OTD students will be assigned a number and placed for their 2 nd Level II prior to
placing MSOT and second year OTD students.
 The placement dates may have to be adjusted to accommodate timing of the OTD
Apprenticeship. This will have to be communicated with the AFC and the FW Assistant
rd
3 year OTD students will work with their Doctoral Chair to design a 4th quarter Doctoral
Apprenticeship experience that fits within their study concentration.
PLACEMENT PROCESS FOR LEVEL II FIELDWORK
The following procedure will be followed to ensure a good match for the Level II Fieldwork
experiences and comply with the ACOTE standards.
Level II Fieldwork Goals & Learning Needs: Form F-1
Choosing a Level II setting which meets the student’s entry-level skill set and can provide an
environment which meets the student’s learning needs and accommodations is critical to a
successful experience and clinical growth. Students must identify their learning needs, skill
development needs, and accommodations by honest self-reflection and record these on Form
F-1. Students must identify their fieldwork goals. The fieldwork goals should be recorded on
Form F-1. This form will be used in picking fieldwork sites and should be brought to a meeting
with the advisor/doctoral mentor for fieldwork site approval (see Form F-3 below).
Advisor / Doctoral Chair Level II Approval Document: Form F-2
After choosing several sites which meet your learning needs, skill development needs,
accommodation needs, fieldwork goals, and are from a variety of life span and settings, set up
a meeting with your research chair to discuss your choices. Do this early!
List the sites on Form F-2 and include a short reason each site is a good fit. Bring site printouts from the FW Data Base, the site folder, information from the internet on the site, and
Forms F-1, and F-2 to the meeting with your mentor. Information can be emailed to the
mentor ahead of time for the mentor to review. Present all of this information to your mentor
and discuss your choices thoroughly. The advisor or doctoral chair will rate the fit of each site
and provide brief comments on Form F-2. If there are not enough sites that are deemed a fair
or good fit by mentor, the student must find new sites, meet with advisor/doctoral chair and
complete Form F-2 again. Set up your initial meeting early enough to allow for this additional
meeting time if needed.
Most sites require that the Pediatric FWII placement be the second of the two FWII
placements. This is also strongly suggested by the WUOT program.
Level II Preference Form: Form F-3
The student lists their placement preferences in rank order for the 3rd quarter (June to
September) FW and the 4th quarter (September to December) FW on Form F-3, including
previously secured FCFS sites. Only sites deemed a fair or good fit by faculty mentor can be
placed on this form. Sites must represent a variety of life span ranges and treatment settings.
If you are turning in an F-3 form with choices for both quarters, identify which quarter you want
placed in first.
25
Level II Fieldwork Goals & Learning Needs: Form F-1
Student Name:_________________________________ Date:_____________
Think about what you want to accomplish on your FWII’s. What do you need on your FWII’s?
How do you learn best? What type of supervision works best for you?
The following are my learning needs, skill development needs, and accommodation or special
needs for FW II:
1._______________________________________________________________
2._______________________________________________________________
3._______________________________________________________________
4._______________________________________________________________
5._______________________________________________________________
6._______________________________________________________________
The following goals (min. of 3) represent my Fieldwork Level II priorities in rank order:
1._______________________________________________________________
________________________________________________________________
2._______________________________________________________________
________________________________________________________________
3._______________________________________________________________
________________________________________________________________
4._______________________________________________________________
________________________________________________________________
5._______________________________________________________________
________________________________________________________________
Student’s Signature________________________________Date______________
I reviewed these with the student and have made my recommendation:
Advisor / Doctoral Chair ____________________________ Date______________
26
Faculty Mentor Fieldwork Approval: Form F-2
Student Name:____________________________________Date:_____________
Student’s Level II fieldwork placement choices & reasoning of fit with Goals/Learning Needs.
Bring site information to meeting with faculty mentor!
1. Site Name/Location:___________________________________________________
Student’s Reason for choosing site: _________________________________________
______________________________________________________________________
2. SiteName/Location:____________________________________________________
Student’s Reason for choosing site: _________________________________________
______________________________________________________________________
3. Site Name/Location: ___________________________________________________
Student’s Reason for choosing site: ________________________________________
______________________________________________________________________
4. Site Name/Location: ___________________________________________________
Student’s Reason for choosing site: _________________________________________
______________________________________________________________________
5. Site Name/Location: ___________________________________________________
Student’s Reason for choosing site: _________________________________________
______________________________________________________________________
6. Site Name/Location: ___________________________________________________
Student’s Reason for choosing site: _________________________________________
______________________________________________________________________
Students Signature_________________________________
27
F-2 continued
Note to faculty: Student should bring information on each site to the meeting!
Faculty Mentor’s Approval & Comments for each site:
Site #1:
Good Fit
Fair Fit
Poor Fit
Comments:____________________________________________________________
_____________________________________________________________________
Site #2:
Good Fit
Fair Fit
Poor Fit
Comments:___________________________________________________________
_____________________________________________________________________
Site #3:
Good Fit
Fair Fit
Poor Fit
Comments:____________________________________________________________
______________________________________________________________________
Site #4:
Good Fit
Fair Fit
Poor Fit
Comments:____________________________________________________________
_____________________________________________________________________
Site #5:
Good Fit
Fair Fit
Poor Fit
Comments:___________________________________________________________
____________________________________________________________________
Site #6:
Good Fit
Fair Fit
Poor Fit
Comments:___________________________________________________________
____________________________________________________________________
Additional Comments:___________________________________________________
_____________________________________________________________________
Advisor / Doctoral Chair’s Signature____________________
28
Date______________
Level II Preference Form: F-3
Student Name: ________________________________ Date: _____________
List your Level II Fieldwork choices in rank order for each FW experience.
*OTD students need to only choose 3rd quarter sites.
June to September (3rd quarter)*
1.__________________________________________________________
2.__________________________________________________________
3.__________________________________________________________
September to December (4th quarter)
1.___________________________________________________________
2.__________________________________________________________
3.__________________________________________________________
Student’s Signature____________________________________Date_________________
29
PLEASE PRINT THIS PAGE, SIGN AND TURN IN TO LEISE AMANN
DUE DATE: Sept 21, 2012
Washington University School of Medicine
Program in Occupational Therapy
I, ________________________________, have read and understand the Fieldwork Policies
as outlined in the Fieldwork Manual. I agree to follow and take responsibility for my actions as
outlined in the Fieldwork Manual.
If I choose to take other courses of action than those outlined, I will accept full responsibility
for any consequences as a result of those actions.
____ I have downloaded a copy of the FW Manual for my reference throughout the year.
____ I know that I can find this FW manual on the Student Drive and on the WUOT
website.
Student Signature
Date
30