|NBCOT is the Board that administers the national examination for OT and OT Assistants. The Board verifies your examination results and your NBCOT number becomes your Oregon license number. Although you do not need to have NBCOT certification to be licensed in Oregon, your employer may require the national certification. You can only use the OTR if you are certified. Otherwise you can use OT/L meaning you are licensed in Oregon. For an OT Assistant you can only use COTA if you are certified. If you are not, you use OTA/L meaning you are licensed in Oregon. For proper credential use, you must not combine educational credentials with certification credentials. For example, use MS, MOT, OTR. This would indicate that MS and MOT is awarded by the education institution. OTR is awarded by NBCOT for certification purposes. For a doctorate, you would use DOT, OTR which indicated you have a doctorate in OT from the education institution and the national certification as an OT. You should check with your employer to see if you must be certified by the national board for your employment. The web site for NBCOT is at www.nbcot.org
DMV REPORTING: DRIVING ASSESSMENTS; DRIVING TRAINING; CAR ADAPTATION
Occupational Therapists do driving assessments at various facilities in the State of Oregon. In Oregon, the DMV is very specific about what the minimum skills are needed in order to drive. Occupational Therapists assess in three areas: visual, cognitive and physical. With that assessment the OT can say whether the person has the skills and abilities to drive. The driving assessment is not covered by Medicare and is self paid since it is not deemed "medically necessary" to drive.
The driving assessment is not an on-road test. However, it is a place to start. The Occupational Therapist should find out if the person has a valid driver's license or if the license has been suspended. The patient's doctor may have sent in the mandatory reporting form, and if so, the patient's license would automatically be suspended for a period of time. Then the person needs to take the DMV road test before they can return to driving. If the person passes the driving assessment but is not confident to get behind the wheel, they can be referred to a local driver's training school where they can get behind the wheel.
A good resource is the Oregon Driver's Education Center in Portland. Their web site is www.drivereducationcenter.com
or call 503-297-4813 or Salem 503-581-3783 which offers on-road driving assessments. If the person needs modifications to their car, that is a whole specialty area.
There is also this document about Best Practices developed for therapists who submit a volunteer form to the DMV about their patients:
Change in Oregon law: OTs have civil immunity for Voluntary Reporting of Impaired Drivers
January 1, 2014, civil immunity will be extended to physicians and health care providers, including Occupational Therapists, reporting patients who are unsafe to drive under DMV's voluntary reporting program, due to the passage of HB 2195. More information can be found at: www.oregon.gov/ODOT/DMV/Pages/At-Risk_Liability.aspx
Depending on the type of information contained in the report, DMV may immediately suspend driving privileges if the person is a risk to safety. However, a driver will normally be advised that they will be given 60 days to take and pass a vision, knowledge, and drive test. In some cases, a driver may be asked to provide current medical information.
Reports can be made using DMV's Driver Evaluation Request
(Form 735-6066), or on your agency or organization letterhead. You may ask DMV to keep your name confidential.
For more information contact the Driver Safety Unit at (503) 945-5083.
Keep in mind that often when health care professionals recommend that a client no longer drive, the client may not agree and will keep driving. Filing a report provides extra precautions. It is important to tell clients that you will file the report or recommend that the physician file the report. You do not have to disclose a diagnosis. Rather, it is best to describe impairments noted such as poor short-term memory, confusion, inability to follow complex commands, poor problem solving, inability to process information and respond in a timely and accurate manner, or problems with performing activities of daily living due to cognitive impairments. If the impairments are physical limitations it is appropriate to discuss adaptive driving devices and training in use with the client. If the impairment is visual performance, then a referral to an eye care professional is appropriate. Referrals for other services are appropriate for outstanding problems that may respond to remediation or medication.
Discuss the reporting system with physicians. Some physicians will want to file the report themselves while others will delegate reporting to the occupational therapists. Best practice requires that clients and their families are made aware of these processes before a driving evaluation is administered. If the evidence is derived from only cognitive assessments, then the client and family need to be educated on how these assessments correlate to driving ability and therefore, the rational for reporting to the DMV.
DYSPHASIA AND DYSPHAGIA:
Dysphagia is a condition related to abnormal eating and swallowing. The new AOTA guidelines in Section C 12 state that "the treatment of eating, feeding and swallowing" are part of the OT's scope of practice.
Dysphasia is a condition related to abnormal speech and language such as expressive or receptive speech difficulties. This is generally an area for speech/language therapists. To see the AOTA 2017 document on Eating, drinking, and swallowing click here.
Evaluation or practice by OT without physician prescription
Can an OT evaluate without a physician prescription?
Occupational therapists are not required to have a physician's prescription to evaluate and treat patients in Oregon when the OT is using a modality defined in the Oregon Statute. However, reimbursement agencies may require prescription for reimbursement.
The Definitions for Occupational Therapy is in the Statute ORS 675.210 to 675.340:
"Occupational therapy" means the analysis and use of purposeful activity with individuals who are limited by physical injury or illness, developmental or learning disabilities, psycho-social dysfunctions or the aging process in order to maximize independence, prevent disability and maintain health. The practice of occupational therapy encompasses evaluation, treatment and consultation. Specific occupational therapy services includes but is not limited to: Activities of daily living (ADL); perceptual motor and sensory integrated activity; development of work and leisure skills; the design, fabrication or application of selected orthotics or prosthetic devices; the use of specifically designed crafts; guidance in the selection and use of adaptive equipment; exercises to enhance functional performance; prevocational evaluation and training; performing and interpreting manual muscle and range of motion test; and appraisal and adaptation of environments for people with mental and physical disabilities. The services are provided individually, in groups, or through social systems.”
Oregon Administrative Rule dealing with Unprofessional conduct states:
339-010-0020 Unprofessional Conduct
… (2) Unprofessional conduct relating to professional competency includes: . . .
… (d) Failing to obtain a physicians referral in situations where an OT is using a modality not specifically defined in ORS 675.210(3); [emphasis added]
The OT and OTA must have the education and experience to perform the occupational therapy services.
therapy" means the analysis and use of purposeful activity with
individuals who are limited by physical injury or illness, developmental or
learning disabilities, psycho-social dysfunctions or the aging process in order
to maximize independence, prevent disability and maintain health. The practice of
occupational therapy encompasses evaluation, treatment and consultation.
Specific occupational therapy services includes but is not limited to:
Activities of daily living (ADL); perceptual motor and sensory integrated
activity; development of work and leisure skills; the design, fabrication or
application of selected orthotics or prosthetic devices; the use of
specifically designed crafts; guidance in the selection and use of adaptive
equipment; exercises to enhance functional performance; prevocational evaluation
and training; performing and interpreting manual muscle and range of motion
test; and appraisal and adaptation of environments for people with mental and
physical disabilities. The services are provided individually, in groups, or
through social systems."
Therapy Licensing Board has received inquiries relative to the scope of
occupational therapy practice as defined in ORS 675.210.
The development of
medical advances are continually evolving in order to provide more
comprehensive services to consumers, and services of occupational therapists
are expended into new and alternative models of service delivery systems.
Occupational therapists are sometimes asked to provide services which are not
clearly defined in the practice act (i.e. irrigate supra pubic catheters,
suction a classroom student, feed with nasa gastric tube, etc.), and the Board
has the responsibility to generally supervise the practice of occupational
therapy in this state under ORS 675.320 (10). The Occupational Therapy
Licensing Board therefore has established a position statement to further
interpret the Practice Act as follows:
It is the opinion of
the Occupational Therapy Licensing Board that procedures which are intrusive to
the body be considered medical and/or nursing services unless they are part of
a planned program to teach the client new self-help skills, and are developed
as part of a long-term plan to help a client reach an increased level of
modalities may be used by occupational therapy practitioners when used as an
adjunct to/or in preparation for purposeful activity to enhance the
occupational therapy performance and when applied by a practitioner who has
documented evidence of possessing the theoretical background and technical
skills for safe and competent integration of the modality into an occupational
therapy intervention plan.
competency rules under OAR 339-010-0020 state that the OT may be in violation
of the professional conduct under (2) “Unprofessional conduct relating
to professional competency includes:
(a) Engaging in any
professional activities for which licensee is not currently qualified;
(b) Failing to
(c) Failing to
provide a comprehensive service that is compatible with current research and
within an ethical and professional framework;
(d) Failing to obtain
a physician's referral in situations where an OT is using a modality not
specifically defined in ORS 675.210(3)
(e) Failing to
provide professional occupational therapy based on evaluation of
patient’s/client’s needs and appropriate treatment procedures…".
You do not need
a doctor’s referral to evaluate and treat in Oregon if the service is found in
the Oregon statutory definition and if you have the training, skills and
experience. However, keep in mind that reimbursement agencies may require
the doctor’s referral for reimbursement.
RESNA is the Rehabilitation Engineering and Assistive Technology Society of North America which has set standards for certain wheelchair purchases. Their certification is for practitioners (assistive technology practitioners – ATP) an OT and PT will be rescinded: December 7, 2007 , the DME Program Safeguard Contractor (PSC) medical directors announced that the Centers for Medicaid and Medicare Services (CMS) will rescind the requirement in the LCD for power mobility device evaluations to be performed by a RESNA-certified ATP, which was to become effective April 1, 2008 . Instead, the three medical directors for the PSCs said the current evaluation requirement would remain in place: Patients must have "a specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features." See more information under RESNA or http://www.numotion.com
Use of Aides by OT and OT Assistants:
The current rules on Use of Aides in OAR 339-010-0055 outlines the responsibility of the Occupational Therapist or OT Assistant in how Aides are used to assist the OT practitioner. It is clear that the therapist must do the patient assessment, the evaluation, and establish the plan of care. The OT or OT Assistant may utilize an aide if the aide is within sight or sound and be immediately available.
Facilities write their own protocols on how specific rules and guidelines will be followed. An aide can use modalities when appropriate, when properly trained and when directed by the therapist. The aide can prepare the area and perform non treatment tasks as noted in the rules.
In other instances, for example, when using thermal modalities such as heat and ice, the aide can prepare the area but can only apply any heat or ice as specifically directed by the therapist who is within sight or sound and it is not the first time the modality has been used with that patient.
Other examples may be for ultrasound, and electric modalities. After the therapist does the assessment, the aide can perform only within the parameters set by the therapist, who is within sight or sound, and it is not the first time the modality has been used with that patient.
An aide cannot perform such tasks as iontophoresis or phonophoresis, and cannot apply medication but only clean the medication from the patient or remove the electrode after conclusion of the treatment.
The aide must have the appropriate training. The OT Licensing Board does not specify what that training must consist of and does not require a certain amount of hours the Aide needs for on the job training. The Board leaves the specifics of the hours and requirements for Aide training to the facility which can define training in their own protocols.
The Board notes that if an issue came up before them about appropriate supervision, the Board would look to documentation to show that the aide had the specific education, training and experience to perform the task. The facility may include specific hours or a “test” requirement. The facility may document this training in their records and keep the documentation for a minimum of 5 years after termination of the Aide’s employment at the facility.
The OT Licensing Board reviewed the Q and A for OT Assistants in signing notes, discharging patients or signing a discharge Order. To clarify the role of the Assistant this is an updated policy from the OT Licensing Board.
VOLUNTEER SERVICES in Occupational Therapy
Any occupational therapist working in Oregon must be licensed in Oregon whether they are providing services for free or as volunteer. If the occupational therapist is working in an institution or an agency of the federal government they do not have to be licensed in Oregon. See ORS 675.220(1)(a).