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FWEds are encouraged to contact the AFWC if a student demonstrates significant performance declines, attendance issues, or well-being concerns.

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Level II Fieldwork and Occupational Therapy Students

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Level II Fieldwork and Occupational Therapy Students

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OT Fieldwork Education:  Value and Purpose

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OT Fieldwork Education:  Value and Purpose

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Podcasts - A Framework for Occupational Therapy Fieldwork

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Podcasts - A Framework for Occupational Therapy Fieldwork

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Work Squared - Bonus Episode - Mental Health

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Podcast · Michael Salemi · This podcast is designed to be an easy to access guide for fieldwork educators and students on how to create and execute a well structured learning experience for occupational therapy students each episode is short and easy to digest. Thank you for listening, and please reach out to me at OT fieldwork@wne.edu if you want to learn more or just to connect with us

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Student Perspectives of the Effective Behaviors of Occupational Therapy Level II Fieldwork Educators

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Student Perspectives of the Effective Behaviors of Occupational Therapy Level II Fieldwork Educators

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The AOTA Self-Assessment Tool for FWEd Competency - SAFECOM

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The AOTA Self-Assessment Tool for FWEd Competency - SAFECOM

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REAP the Rewards:  A successful Level II Fieldwork Experience for Fieldwork Educators and Students

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REAP the Rewards:  A successful Level II Fieldwork Experience for Fieldwork Educators and Students

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Occupational therapy (OT) and occupational therapy assistant (OTA) students participate in the delivery of occupational therapy services under the supervision of occupational therapy personnel in a variety of fieldwork sites. The following provides information about the way in which the Centers for Medicare & Medicaid Services (CMS) interprets how and whether the Medicare program should provide payment for services provided by students.

For those settings that serve Medicare patients, it is important to be aware of both new and existing Medicare payment policies. CMS has published specific criteria relating to how and when the program will pay for services when the student participates in service delivery. When developing fieldwork plans for sites that serve Medicare patients, you should consider two issues:

1. Whether Medicare payment rules specifically allow students to participate in the delivery of services to Medicare beneficiaries, and

2. Which type and level of supervision the Medicare program requires.

If seeking reimbursement for services when the student participates in service delivery, you should review the following:
Medicare coverage of services when a student participates in service delivery

The following sets out for each Medicare setting whether Medicare payment rules specifically allow or restrict coverage of services provided by students and which type and level of supervision Medicare requires to raise the services provided by students to the level of covered "skilled" occupational therapy. Practitioners should take care to ensure an appropriate level of supervision, regardless of whether CMS has issued a specific rule regarding students.

Inpatient hospital and inpatient rehabilitation facility (IRF)-Medicare Part A

CMS has not issued specific rules, but in the excerpt here referencing skilled nursing facilities (SNFs), CMS mentions other inpatient settings. In the Final SNF PPS Rule for FY 2012 (76 Fed. Reg. 48510-48511), CMS stated: "We are hereby discontinuing the policy announced in the FY 2000 final rule's preamble requiring line-of-sight supervision of therapy students in SNFs, as set forth in the FY 2012 proposed rule. Instead, effective October 1, 2011, as with other inpatient settings, each SNF/provider will determine for itself the appropriate manner of supervision of therapy students consistent with state and local laws and practice standard s." See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Services provided by therapy students may count toward the IRF the three-hour rule/intensity of therapy services requirement. In 2018, in response to AOTA advocacy, CMS confirmed in writing that " CMS has not changed its policy with regard to the [Conditions of Participation] and the provision of healthcare services by students in hospitals, including therapy students providing rehabilitative services in hospitals and IRFs. " CMS further emphasized that proper supervision must be provided for student services to be recognized as counting toward the intensive rehabilitation program requirements.See our Joint Statement on Use of Students in Hospitals for AOTA's position on this issue.

Skilled nursing facility (SNF)-Medicare Part A

The minutes of therapy services provided by OT and OTA students may be recorded on the Minimum Data Set (MDS) as minutes of therapy received by the beneficiary. See the MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual), Chapter 3, Section O "Therapies" for details. It is AOTA's policy that OTAs may supervise OTA students, not OT students.

The MDS 3.0 RAI Manual, Chapter 3, Section O includes the following guidance for therapy students:

Therapy Students

Medicare Part A-Therapy students are not required to be in line-of-sight of the professional supervising therapist/assistant (Federal Register, August 8, 2011). Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line-of-sight supervision. Additionally all state and professional practice guidelines for student supervision must be followed.

Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All time that the student spends with patients should be documented.

For "individual therapy," the RAI manual states:
When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

Because of advocacy by AOTA, CMS recognized Recommended Guidelines by AOTA, APTA, and ASHA: AOTA, APTA, and ASHA worked together to develop suggested guidelines for CMS to incorporate into its guidance on student supervision. CMS recognized the guidelines and posted them on its website after issuing the FY 2012 SNF PPS final rule (Federal Register, August 8, 2011). In the final rule, CMS stated, "we appreciate the detailed supervision guidelines that several of the trade associations have developed, which we recognize as playing a significant role in helping to define the applicable standards of practice on which providers rely in this context."

Hospice-Medicare Part A

CMS has not issued specific rules. AOTA recommends that the approach for Part A inpatient settings be followed for hospice providers. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Home health-Medicare Part A

Regulations (§484.115) specifically cite definitions for "qualified personnel," which do not include students. However, CMS has not issued specific restrictions regarding students providing services in conjunction with a qualified OT or OTA. Services by students can be provided (as allowed by state law) as part of a home health visit, when the student is supervised by an OT or OTA in the home. AOTA recommends that the approach for Part A inpatient settings be followed for home health agencies. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Medicare Part B-Private practice, hospital outpatient, SNF, CORF, ORF, rehabilitation agency, and other Part B providers including home health agencies when providing Part B services

Under the Medicare Part B outpatient benefit, the services of students directly assisting a qualified practitioner (OT) are covered when the type and level of supervision requirements are met as follows:

Students can participate in the delivery of services when the qualified practitioner (OT) is directing the service, making the skilled judgment, responsible for the assessment and treatment in the same room as the student, and not simultaneously treating another patient. The qualified practitioner is solely responsible and must sign all documentation.

The following is guidance to the entities that pay for Medicare benefits contained in the Medicare Benefit Policy Manual, Chapter 15 -see Section 230B:

1. General

Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under "line of sight" supervision of the therapist; however, the presence of the student "in the room" does not make the service unbillable. Pay for the direct (one-to-one) patient contact services of the physician or therapist provided to Medicare Part B patients. Group therapy services performed by a therapist or physician may be billed when a student is also present "in the room."

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following scenarios:

* The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

* The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner is not engaged in treating another patient or doing other tasks at the same time.

* The qualified practitioner is responsible for the services and as such, signs all documentation. (A student may, of course, also sign but it is not necessary since the Part B payment is for the clinician's service, not for the student's services).

Medicare Part B SNF: The MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual ), Chapter 3, Section O provides specific guidelines for services provided by students:

Therapy Students

Medicare Part B-The following criteria must be met in order for services provided by a student to be billed by the long-term care facility:

- The qualified professional is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

- The practitioner is not engaged in treating another patient or doing other tasks at the same time.

- The qualified professional is the person responsible for the services and, as such, signs all documentation. (A student may, of course, also sign but it is not necessary because the Part B payment is for the clinician's service, not for the student's services.)

- Physical therapy assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy assistant students while providing services within their scope of work and performed under the direction and supervision of a qualified physical or occupational therapist.

For "individual therapy," the RAI Manual states:

When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

AOTA continues to work with a coalition of organizations to advocate for additional government support for educating allied health providers and to develop long-term solutions to the problems caused by Medicare's limitations on reimbursement when students participate in service delivery.

Contact regulatory@aota.org with any questions related to Medicare Requirements for Student Supervision.

For those settings that serve Medicare patients, it is important to be aware of both new and existing Medicare payment policies. CMS has published specific criteria relating to how and when the program will pay for services when the student participates in service delivery. When developing fieldwork plans for sites that serve Medicare patients, you should consider two issues:

1. Whether Medicare payment rules specifically allow students to participate in the delivery of services to Medicare beneficiaries, and

2. Which type and level of supervision the Medicare program requires.

If seeking reimbursement for services when the student participates in service delivery, you should review the following:
Medicare coverage of services when a student participates in service delivery

The following sets out for each Medicare setting whether Medicare payment rules specifically allow or restrict coverage of services provided by students and which type and level of supervision Medicare requires to raise the services provided by students to the level of covered "skilled" occupational therapy. Practitioners should take care to ensure an appropriate level of supervision, regardless of whether CMS has issued a specific rule regarding students.

Inpatient hospital and inpatient rehabilitation facility (IRF)-Medicare Part A

CMS has not issued specific rules, but in the excerpt here referencing skilled nursing facilities (SNFs), CMS mentions other inpatient settings. In the Final SNF PPS Rule for FY 2012 (76 Fed. Reg. 48510-48511), CMS stated: "We are hereby discontinuing the policy announced in the FY 2000 final rule's preamble requiring line-of-sight supervision of therapy students in SNFs, as set forth in the FY 2012 proposed rule. Instead, effective October 1, 2011, as with other inpatient settings, each SNF/provider will determine for itself the appropriate manner of supervision of therapy students consistent with state and local laws and practice standard s." See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Services provided by therapy students may count toward the IRF the three-hour rule/intensity of therapy services requirement. In 2018, in response to AOTA advocacy, CMS confirmed in writing that " CMS has not changed its policy with regard to the [Conditions of Participation] and the provision of healthcare services by students in hospitals, including therapy students providing rehabilitative services in hospitals and IRFs. " CMS further emphasized that proper supervision must be provided for student services to be recognized as counting toward the intensive rehabilitation program requirements.See our Joint Statement on Use of Students in Hospitals for AOTA's position on this issue.

Skilled nursing facility (SNF)-Medicare Part A

The minutes of therapy services provided by OT and OTA students may be recorded on the Minimum Data Set (MDS) as minutes of therapy received by the beneficiary. See the MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual), Chapter 3, Section O "Therapies" for details. It is AOTA's policy that OTAs may supervise OTA students, not OT students.

The MDS 3.0 RAI Manual, Chapter 3, Section O includes the following guidance for therapy students:

Therapy Students

Medicare Part A-Therapy students are not required to be in line-of-sight of the professional supervising therapist/assistant (Federal Register, August 8, 2011). Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line-of-sight supervision. Additionally all state and professional practice guidelines for student supervision must be followed.

Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All time that the student spends with patients should be documented.

For "individual therapy," the RAI manual states:
When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

Because of advocacy by AOTA, CMS recognized Recommended Guidelines by AOTA, APTA, and ASHA: AOTA, APTA, and ASHA worked together to develop suggested guidelines for CMS to incorporate into its guidance on student supervision. CMS recognized the guidelines and posted them on its website after issuing the FY 2012 SNF PPS final rule (Federal Register, August 8, 2011). In the final rule, CMS stated, "we appreciate the detailed supervision guidelines that several of the trade associations have developed, which we recognize as playing a significant role in helping to define the applicable standards of practice on which providers rely in this context."

Hospice-Medicare Part A

CMS has not issued specific rules. AOTA recommends that the approach for Part A inpatient settings be followed for hospice providers. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Home health-Medicare Part A

Regulations (§484.115) specifically cite definitions for "qualified personnel," which do not include students. However, CMS has not issued specific restrictions regarding students providing services in conjunction with a qualified OT or OTA. Services by students can be provided (as allowed by state law) as part of a home health visit, when the student is supervised by an OT or OTA in the home. AOTA recommends that the approach for Part A inpatient settings be followed for home health agencies. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Medicare Part B-Private practice, hospital outpatient, SNF, CORF, ORF, rehabilitation agency, and other Part B providers including home health agencies when providing Part B services

Under the Medicare Part B outpatient benefit, the services of students directly assisting a qualified practitioner (OT) are covered when the type and level of supervision requirements are met as follows:

Students can participate in the delivery of services when the qualified practitioner (OT) is directing the service, making the skilled judgment, responsible for the assessment and treatment in the same room as the student, and not simultaneously treating another patient. The qualified practitioner is solely responsible and must sign all documentation.

The following is guidance to the entities that pay for Medicare benefits contained in the Medicare Benefit Policy Manual, Chapter 15 -see Section 230B:

1. General

Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under "line of sight" supervision of the therapist; however, the presence of the student "in the room" does not make the service unbillable. Pay for the direct (one-to-one) patient contact services of the physician or therapist provided to Medicare Part B patients. Group therapy services performed by a therapist or physician may be billed when a student is also present "in the room."

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following scenarios:

* The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

* The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner is not engaged in treating another patient or doing other tasks at the same time.

* The qualified practitioner is responsible for the services and as such, signs all documentation. (A student may, of course, also sign but it is not necessary since the Part B payment is for the clinician's service, not for the student's services).

Medicare Part B SNF: The MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual ), Chapter 3, Section O provides specific guidelines for services provided by students:

Therapy Students

Medicare Part B-The following criteria must be met in order for services provided by a student to be billed by the long-term care facility:

- The qualified professional is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

- The practitioner is not engaged in treating another patient or doing other tasks at the same time.

- The qualified professional is the person responsible for the services and, as such, signs all documentation. (A student may, of course, also sign but it is not necessary because the Part B payment is for the clinician's service, not for the student's services.)

- Physical therapy assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy assistant students while providing services within their scope of work and performed under the direction and supervision of a qualified physical or occupational therapist.

For "individual therapy," the RAI Manual states:

When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

AOTA continues to work with a coalition of organizations to advocate for additional government support for educating allied health providers and to develop long-term solutions to the problems caused by Medicare's limitations on reimbursement when students participate in service delivery.

Contact regulatory@aota.org with any questions related to Medicare Requirements for Student Supervision.

For those settings that serve Medicare patients, it is important to be aware of both new and existing Medicare payment policies. CMS has published specific criteria relating to how and when the program will pay for services when the student participates in service delivery. When developing fieldwork plans for sites that serve Medicare patients, you should consider two issues:

1. Whether Medicare payment rules specifically allow students to participate in the delivery of services to Medicare beneficiaries, and

2. Which type and level of supervision the Medicare program requires.

If seeking reimbursement for services when the student participates in service delivery, you should review the following:
Medicare coverage of services when a student participates in service delivery

The following sets out for each Medicare setting whether Medicare payment rules specifically allow or restrict coverage of services provided by students and which type and level of supervision Medicare requires to raise the services provided by students to the level of covered "skilled" occupational therapy. Practitioners should take care to ensure an appropriate level of supervision, regardless of whether CMS has issued a specific rule regarding students.

Inpatient hospital and inpatient rehabilitation facility (IRF)-Medicare Part A

CMS has not issued specific rules, but in the excerpt here referencing skilled nursing facilities (SNFs), CMS mentions other inpatient settings. In the Final SNF PPS Rule for FY 2012 (76 Fed. Reg. 48510-48511), CMS stated: "We are hereby discontinuing the policy announced in the FY 2000 final rule's preamble requiring line-of-sight supervision of therapy students in SNFs, as set forth in the FY 2012 proposed rule. Instead, effective October 1, 2011, as with other inpatient settings, each SNF/provider will determine for itself the appropriate manner of supervision of therapy students consistent with state and local laws and practice standard s." See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Services provided by therapy students may count toward the IRF the three-hour rule/intensity of therapy services requirement. In 2018, in response to AOTA advocacy, CMS confirmed in writing that " CMS has not changed its policy with regard to the [Conditions of Participation] and the provision of healthcare services by students in hospitals, including therapy students providing rehabilitative services in hospitals and IRFs. " CMS further emphasized that proper supervision must be provided for student services to be recognized as counting toward the intensive rehabilitation program requirements.See our Joint Statement on Use of Students in Hospitals for AOTA's position on this issue.

Skilled nursing facility (SNF)-Medicare Part A

The minutes of therapy services provided by OT and OTA students may be recorded on the Minimum Data Set (MDS) as minutes of therapy received by the beneficiary. See the MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual), Chapter 3, Section O "Therapies" for details. It is AOTA's policy that OTAs may supervise OTA students, not OT students.

The MDS 3.0 RAI Manual, Chapter 3, Section O includes the following guidance for therapy students:

Therapy Students

Medicare Part A-Therapy students are not required to be in line-of-sight of the professional supervising therapist/assistant (Federal Register, August 8, 2011). Within individual facilities, supervising therapists/assistants must make the determination as to whether or not a student is ready to treat patients without line-of-sight supervision. Additionally all state and professional practice guidelines for student supervision must be followed.

Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All time that the student spends with patients should be documented.

For "individual therapy," the RAI manual states:
When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

Because of advocacy by AOTA, CMS recognized Recommended Guidelines by AOTA, APTA, and ASHA: AOTA, APTA, and ASHA worked together to develop suggested guidelines for CMS to incorporate into its guidance on student supervision. CMS recognized the guidelines and posted them on its website after issuing the FY 2012 SNF PPS final rule (Federal Register, August 8, 2011). In the final rule, CMS stated, "we appreciate the detailed supervision guidelines that several of the trade associations have developed, which we recognize as playing a significant role in helping to define the applicable standards of practice on which providers rely in this context."

Hospice-Medicare Part A

CMS has not issued specific rules. AOTA recommends that the approach for Part A inpatient settings be followed for hospice providers. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Home health-Medicare Part A

Regulations (§484.115) specifically cite definitions for "qualified personnel," which do not include students. However, CMS has not issued specific restrictions regarding students providing services in conjunction with a qualified OT or OTA. Services by students can be provided (as allowed by state law) as part of a home health visit, when the student is supervised by an OT or OTA in the home. AOTA recommends that the approach for Part A inpatient settings be followed for home health agencies. See relevant state law for further guidance on supervision for the services to be considered occupational therapy.

Medicare Part B-Private practice, hospital outpatient, SNF, CORF, ORF, rehabilitation agency, and other Part B providers including home health agencies when providing Part B services

Under the Medicare Part B outpatient benefit, the services of students directly assisting a qualified practitioner (OT) are covered when the type and level of supervision requirements are met as follows:

Students can participate in the delivery of services when the qualified practitioner (OT) is directing the service, making the skilled judgment, responsible for the assessment and treatment in the same room as the student, and not simultaneously treating another patient. The qualified practitioner is solely responsible and must sign all documentation.

The following is guidance to the entities that pay for Medicare benefits contained in the Medicare Benefit Policy Manual, Chapter 15 -see Section 230B:

1. General

Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under "line of sight" supervision of the therapist; however, the presence of the student "in the room" does not make the service unbillable. Pay for the direct (one-to-one) patient contact services of the physician or therapist provided to Medicare Part B patients. Group therapy services performed by a therapist or physician may be billed when a student is also present "in the room."

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following scenarios:

* The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

* The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner is not engaged in treating another patient or doing other tasks at the same time.

* The qualified practitioner is responsible for the services and as such, signs all documentation. (A student may, of course, also sign but it is not necessary since the Part B payment is for the clinician's service, not for the student's services).

Medicare Part B SNF: The MDS Version 3.0 Resident Assessment Instrument Manual ( MDS 3.0 RAI Manual ), Chapter 3, Section O provides specific guidelines for services provided by students:

Therapy Students

Medicare Part B-The following criteria must be met in order for services provided by a student to be billed by the long-term care facility:

- The qualified professional is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.

- The practitioner is not engaged in treating another patient or doing other tasks at the same time.

- The qualified professional is the person responsible for the services and, as such, signs all documentation. (A student may, of course, also sign but it is not necessary because the Part B payment is for the clinician's service, not for the student's services.)

- Physical therapy assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy assistant students while providing services within their scope of work and performed under the direction and supervision of a qualified physical or occupational therapist.

For "individual therapy," the RAI Manual states:

When a therapy student is involved with the treatment of a resident, the minutes may be coded as individual therapy when only one resident is being treated by the therapy student and supervising therapist/assistant (Medicare A and Medicare B). The supervising therapist/assistant shall not be engaged in any other activity or treatment when the resident is receiving therapy under Medicare B. However, for those residents whose stay is covered under Medicare A, the supervising therapist/assistant shall not be treating or supervising other individuals and he/she is able to immediately intervene/assist the student as needed.

AOTA continues to work with a coalition of organizations to advocate for additional government support for educating allied health providers and to develop long-term solutions to the problems caused by Medicare's limitations on reimbursement when students participate in service delivery.

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Medicare Requirements for Student Supervision | AOTA

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Guidance regarding Medicare payment for services provided by occupational therapy and occupational therapy assistant students in fieldwork sites.

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COE Guidelines for an OT FW Experience - Level II

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COE Guidelines for an OT FW Experience - Level II

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Introduction

Empower Others with Your Master's in Occupational Therapy Degree (MOT) from Saint Francis University

When anyone struggles to do activities that many of us take for granted, their ability to live a full life is impacted. Students in our Master of Occupational Therapy (MOT) program get hands-on experience empowering individuals to live their best lives. They do this by studying how they can help individuals improve their ability to perform the basic activities of daily living.

On campus program with direct-entry, provisional and graduate admissions paths

The SFU LEARNING EXPERIENCE

Occupational Therapy the Saint Francis Way

The best occupational therapists are compassionate, well-rounded and experienced in a variety of specialties. The occupational therapy program at SFU offers a multidisciplinary approach, research and fieldwork opportunities, and the expertise of practicing faculty to help you become the best occupational therapist you can be. All of our OT faculty are doctorally prepared in a variety of specialties and are committed to guiding you toward your future path.

The OT Student Experience

Our accelerated occupational therapy program helps you get into the field faster, but there are still plenty of opportunities for growth, exploration and community-building during your years at SFU. In your pre-professional phase, you'll take introductory occupational therapy courses and bond with your cohort through coursework, clubs, and other campus activities. In the final 2 years of study, the professional phase, you'll take classes solely dedicated to OT while completing your own research project and gaining practical experience during fieldwork opportunities.

Get experience working with some of the most cutting-edge technology used by occupational therapists in clinics today, including a driving simulator, the Bioness Integrated Therapy System, 3D printers and scanners, and more.

The Department of Occupational Therapy is proud to be a Gold-Level member of AOTA's 2022-2023 Student Membership Circle.

OT Admissions Requirements

The Master of Occupational Therapy program at Saint Francis University is an accelerated 3+2 program with the primary entry point being as a freshman. Students enroll as freshmen in the occupational therapy (OT) major in one of two paths (Full or Provisional).

Admission Criteria for High School Students

Graduated from an approved secondary school or submission of a state-approved GED.
Full OT Acceptance:

Submitting test scores:

Completed work equal to a standard academic high school coursework

SAT = 1080 or greater/ACT = 21 or greater

Minimum High School GPA: 3.0

10 hours of OT observation

Test Optional:
Completed work equal to a standard academic high school coursework with a minimum of the following:

4 units of English

3 units of Social Studies

3 units of Math (one of which is Algebra with a "B" or greater)

3 units of Science (one of which is Biology with a lab and a "B" or greater; recommended courses include Advanced Biology, Anatomy & Physiology, Physics, Chemistry)

Completion of additional courses or internships that demonstrate advanced knowledge or skill in the healthcare environment. (such as: 1 unit of Psychology, Sociology, and/or Medical Terminology, Advanced Science courses, internships in a healthcare field.

Minimum GPA: 3.4 or greater (based on 4.0 scale)

Recommend any of the following: campus visit, OT department visit, interview, classroom visitation, meeting with any of the OT faculty, or virtual visit with any of the OT faculty.

10 hours of OT observation

Students are encouraged to submit a letter of recommendation that can attest to their ability to be successful in a healthcare field.

NOTE: the Occupational Therapy program at Saint Francis University requires students to take BIOL111 and BIOL111 Lab at Saint Francis University as a full-time, on-campus, first-year student. If the student has dual enrollment or AP credits for BIOL111 (or its equivalent), they will be transferred in as free elective credits (BIOL800).

Other
Students who do not meet either of the above criteria, but who qualify for admission to the University, may select a major consistent with their academic profile. Options include: Interdisciplinary Healthcare Studies-Pre-Allied Health, Exploratory (Health and Human Services), Public Health, Psychology, Social Work, etc.

Students must meet the following criteria in order to progress into the professional phase of the program:

Demonstrate a minimum 3.0 cumulative grade point average in all major and core curriculum requirements by the end of the spring semester of Year Three of the Pre-Professional phase of study.

Demonstrate completion of all general education core and collateral courses as prescribed:

Demonstrate completion of OT 201, OT 301, OT 302, OT 310 (with a grade of "C" or better) or their equivalent as determined by the Department Chairman.

Demonstrate a minimum 2.75 overall collateral courses grade point average in each Collateral Courses:

BIOL 111- Biology I, 4 Credits

BIOL 111 L- Biology I Lab, 1 Credit

BIOL 205- Anatomy & Physiology I, 3 Credits

BIOL 205L- Anatomy & Physiology I Lab, 1 Credit

BIOL 206- Anatomy & Physiology II, 3 Credits

BIOL 206L- Anatomy & Physiology II Lab, 1 Credit

PSYC 101- Introduction to Psychology, 3 Credits

PSYC 201- Research Methods and Statistics I, 3 Credits

PSYC 202- Research Methods and Statistics II, 3 Credits

PSYC 205- Psychopathology, 3 Credits

PSYC 209- Developmental Psychology, 3 Credits

PSYC 305- Memory & Cognition, 3 Credits

PSYC 314- Biopsychology, 3 Credits

PUBH 101- Introduction to Public Health, 3 Credits

SOC 101- Introduction to Sociology, 3 Credits

OT 201-Introduction to OT II or equivalent*, 1-3 Credits

OT 301- OT Seminar I or equivalent*, 1 Credit

OT 302- OT Seminar II or equivalent*, 1 Credit

OT 310- Occupation and Movement or equivalent*, 3 Credits

Please consult the departmental handbook for detailed information about internal policies and standards.
**Note: Professional courses are open to Occupational Therapy majors only.

Eligible Students holding an earned baccalaureate (bachelor's) degree with the necessary prerequisite coursework may be admitted to the first year of the professional curriculum based on space availability.

Occupational Therapy Degree Admissions Requirements

Applicants for Graduate Admission are required to submit the following to the Department of Occupational Therapy in order to be considered for admission:

1. A completed Application Form with a $30 (non-refundable) application fee to the Department of Occupational Therapy. Please make check payable to Saint Francis University.

2. Evidence of a completed baccalaureate degree from a fully accredited institution.

3. Official transcripts from each college/university attended indicating an overall minimum QPA of 3.0. Transcripts must be submitted from the college/university to the Saint Francis University Department of Occupational Therapy in sealed envelopes, or they will not be considered official.

4. A completed Collateral Check List

with the noted Collateral Requirement Courses completed with a minimum grade of "C" in each course.

1. Descriptions for the Collateral Requirements are provided in the application packet. Applicants who believe they have taken an equivalent of the course(s) must provide the appropriate course descriptions and/or syllabi with their application so that the Department of Occupational Therapy can make a determination of equivalency.

2. Please note that applicants must have no greater than six (6) credits of collateral coursework outstanding at time of application. Requirements include:

BIOL 111- Biology I, 3 Credits

BIOL 111 L- Biology I Lab, 1 Credit

BIOL 205- Anatomy & Physiology I, 3 Credits

BIOL 205L- Anatomy & Physiology I Lab, 1 Credit

BIOL 206- Anatomy & Physiology II, 3 Credits

BIOL 206L- Anatomy & Physiology II Lab, 1 Credit

PSYC 101- Introduction to Psychology, 3 Credits

PSYC 205- Psychopathology, 3 Credits

PSYC 209- Developmental Psychology, 3 Credits

SOC 101- Introduction to Sociology, 3 Credits

Introductory Statistics, 3 Credits

Medical Terminology, 1-3 Credit

5. Documentation of 50 hours (minimum) of volunteer or paid experience in Occupational Therapy. A copy of the Documentation Form for Occupational Therapy Observation Volunteer/Paid Employment Experience is provided in the application packet.

6. Current Course Enrollment Form if currently enrolled at another college/university. Upon completion of the coursework, an official transcript must be sent to the Department of Occupational Therapy.

7. Two professional recommendation (at least one from an Occupational Therapist) using the Professional Recommendation Forms provided in the application packet. These recommendations must be submitted to the Department of Occupational Therapy directly from the references in sealed envelopes.

8. A brief typed essay (300 words or less) responding to the prompt: "Describe your personal characteristics that you believe will lead to your success in the occupational therapy profession."

9. International students must send their transcripts to an international agency where the transcripts will be converted to the American academic scale. We recommend World Education Services, 1-800-937-3897. In addition to meeting the requirements for admission, international students must submit satisfactory scores from the Test of English as a Foreign Language (T.O.E.F.L.), administered by the Educational Testing Service, Princeton, New Jersey. Applicants whose native language is English are exempt from this requirement. International students should apply for admissions and the required testing well in advance in order to ensure evaluation of their credentials in a time frame which is equitable to themselves and the Graduate Admissions Committee.

Candidates should apply for admission by November 15 for the following summer semester.

Saint Francis University is NOT currently a participating school in the OTCAS. All applications and materials are managed through the SFU OT Department.

The Graduate Admissions application process is closed for the 2021-2022 season.

Applications for 2023 will be accepted beginning on September 1, 2022.

Admission Criteria for Transfer Students

Students requesting transfer either within the University or from external institutions are required to follow the "Transfer Policy" process as well as have a transfer evaluation completed (see below).
Transfer Evaluation

Student requests meeting with the OT Department.

Transfer evaluation is completed by the OT Department to determine which cohort student best aligns with.

Transfer evaluations will be completed on an ongoing basis convenient to the OT Department:

the results will be communicated to the student, along with the other requirements (interview, hours of observation, personal statement).

Note: BIOL111 and BIOL111L will be considered to transfer in at the transfer level.

The OT Department will evaluate students on a semester-by-semester basis and offer admission (full or provisional) based on results of the transfer evaluation and space in the cohort.

If a student is not accepted into the OT major in the semester they inquire, they may inquire the following semester; however, there is no guarantee and no preference will be given to that student.

If an acceptance into OT is not offered, it is the responsibility of the student to determine a major consistent with their preferences. They may collaborate with Career Services or the Center for Academic Success for assistance in this process.

Provisional Occupation Therapy Student

The Accreditation Council for Occupational Therapy Education, ACOTE, permits the SFU Occupational Therapy program to enroll 40 freshman OT students. When you submit your $100 tuition deposit, one of the 40 spaces in the OT cohort is reserved for you.
While the majority of the 40 spaces in the freshman cohort are reserved for fully accepted OT students, ten of the spaces are reserved for provisional OT students.

Transition from provisional OT student to full OT student
In order to be considered a full OT student by the end of the freshman year, you must:

Achieve a minimum of a 3.0 cumulative grade point average

Earn a C or better in BIOL111, BIOL111Lab, and PSYC101

Complete 10 hours of OT observation

Complete an interview with a representative of the OT program

Experienced OT faculty who love to teach

Our Occupational Therapy faculty have expertise in telemedicine, alternative medicine, pediatrics, geriatrics, neuro rehab, sensory processing, cultural adaptability, therapeutic intervention, playground accessibility, and nutritional therapy. All SFU Occupational Therapy faculty are doctorally prepared.
Department Chair: Dr. Lorie Rowles, OTD, OTR/L lrowles@francis.edu 814-472-2749

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Occupational Therapy (OT) | Saint Francis University

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We use cookies to enhance your experience. By using our site, you agree to our web privacy policy. Introduction When anyone struggles to do activities that many of us take for granted, their ability to live a full life is impacted.

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Practice Advisory:  Services Provided by Students in Level II Fieldwork Settings.

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Practice Advisory:  Services Provided by Students in Level II Fieldwork Settings.

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Saint Francis University Fieldwork Sites - Copy

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Mapping Review of FW Education Literature

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Mapping Review of FW Education Literature

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Mapping Review of Fieldwork Education Literature

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Student Psychosocial Well-Being and Burnout During Level II Fieldwork

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Student Psychosocial Well-Being and Burnout During Level II Fieldwork

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SFU MOT Level II Fieldwork Behavioral Objectives

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SFU MOT Level II Fieldwork Behavioral Objectives

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Level II Fieldwork Behavioral Objectives

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Managing student mental health challenges

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Managing student mental health challenges

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Exploring OTS and Entry-Level Practitioner Perceptions of Mental Health Accomodations

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Exploring OTS and Entry-Level Practitioner Perceptions of Mental Health Accomodations

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OTS Characteristics Influencing Level II FW: An Exploratory Student of Mental Health, Confidence, and Mindful Self-Care

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OTS Characteristics Influencing Level II FW: An Exploratory Student of Mental Health, Confidence, and Mindful Self-Care

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University Support Services for Students 

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SFU Center for Well-Being

UPMC Workpartners at Saint Francis University

PO Box 600

117 Evergreen Drive

Loretto, PA 15940

814-472-3211

814-472-3210 (Fax)

counseling@francis.edu

LifeSolutions SAP/ EAP National Service Center 1-800-647-3327

Workpartners I the people activation company

120 Lytton Avenue, Suite 200

Pittsburgh, PA 15213

Crisis counseling is available through the Cambria County hotline at 1-877-268-9463.

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Free AOTA CE Course:  Cultural Humility for OT/OTA Educators

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Free AOTA CE Course:  Cultural Humility for OT/OTA Educators

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Free American Occupational Therapy Association

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Fieldwork Experience Assessment Tool (FEAT)

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Fieldwork Experience Assessment Tool (FEAT)

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Top 10 Questions to Ask Your Fieldwork Educator Before Day 1

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Top 10 Questions to Ask Your Fieldwork Educator Before Day 1

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FWEds Expectations of Level II OT Students

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Fieldwork Educators’ Expectations of Level II Occupational Therapy Students’ Professional and Technical Skills

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Top 6 Tips for Navigating Relationships with Fieldwork Educators

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Top 6 Tips for Navigating Relationships with Fieldwork Educators

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Metropolitan Occupational Therapy Education Council of NY _ NJ- pediatrics

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AOTA Level II Fieldwork Performance Evaluation for Student

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AOTA Level II Fieldwork Performance Evaluation for Student

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SFU MOT Curriculum Design and Fieldwork Education

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SFU MOT Curriculum Design and Fieldwork Education

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Webb's Depth of Knowledge and FW education

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Fieldwork Performance Evaluation (FWPE) Rating Scale

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Fieldwork Performance Evaluation (FWPE) Rating Scale

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2023 ACOTE Fieldwork Education Standards (C)

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2023 ACOTE Fieldwork Education Standards (C)

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Level I FW Student Evaluation of the Fieldwork Experience (SEFWE)

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Level I FW Student Evaluation of the Fieldwork Experience (SEFWE)

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Inclusive Teaching and Learning for OT Experiential Education

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Inclusive Teaching and Learning for OT Experiential Education

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Resources and links for OTA and OT students about level I and level II fieldwork

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Level II Student Evaluation of the Fieldwork Experience (SEFWE) and Educator (SEFWEd

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Level II Student Evaluation of the Fieldwork Experience (SEFWE) and Educator (SEFWEd

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Level II Fieldwork Student Success Plan/Learning Contract

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National Board for Certification in Occupational Therapy

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Key Concepts in OT Theory: A Comprehensive Overview

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Explore the foundations of occupational therapy theory and its significance. Learn about OT theory and models of practice that guide effective treatment.

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Occupational Therapy Theories: Essential Models and Frameworks for Practice

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Explore key occupational therapy theories and models, their applications in practice, and the evolving nature of theoretical frameworks in the field.

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The occupational therapy discipline is built on several foundational theories that are fascinating, but also drawn out and extremely challenging to digest. So, we have decided to assist OT students and practitioners by providing summarized highlights of the OT frames of reference all in one location.

But first, let's get past some confusing terminology. What is the difference between theories, models, and frames of reference? Furthermore, what is the role of all these constructs in OT evaluation and intervention? Here is a short explanation to clear up the confusion.

Theory

A theory is a well-backed explanation of why something in the natural world is what it is or operates the way it does. For example, PEO frame of reference is based off the theory that there is an existing interaction between person, environment, and occupation. Researchers use theories to develop and test hypotheses in hopes to further build valid and reliable constructs or models.

Model

A model is a purposeful representation of reality in approximation to a theory. Sometimes, the terms "model" and "frame of reference" are used interchangeably in occupational therapy, which is seen in describing the Occupational Adaptation (OA) model and the Biomechanical model. Conceptual models (such as the Intentional Relationship model) are not included in this article. In OT, the model is a mode for which therapists can use to organize their thinking, skills, and vocabulary for their profession.

Frame of Reference

A frame of reference is considered a guidance tool for practical application. Mosey (1989) defines frames of reference as "integrated collections of theoretically based information, organized in such a way that they provide guidelines for problem identification and remediation as it relates to specified elements of the profession's domain of concern". So, an OT would use a frame of reference as a "how-to" device for evaluation and intervention.

With that, let us proceed with the OT frames of reference currently in use by our profession or are still heavily discussed in school.

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1. Acquisitional Frame of Reference

The overall goal of the Acquisitional Frame of Reference is the acquisition of skills and behaviors used to optimize performance within a given environment using the teaching-learning process. Children need to acquire functional behaviors in order to be successful in their environment.

Therapists use positive and negative reinforcement strategies to help children shape and achieve target skills and behaviors, and then eventually generalize the mastered skills and behaviors for everyday use. The primary example is teaching children appropriate skills and behaviors to complete activities of daily living.

Target population: Children; all disabilities

2. Behavioral Frame of Reference

The main feature of this model is the use of behavioral modification, a technique used to shape behaviors, to increase adaptive behaviors, and to reduce maladaptive behaviors. OTs who use behavior modification in practice generally target persons who need social skills training, so children and individuals with psychiatric disorders.

This frame of reference uses elements such as stimuli (unconditioned, conditioned), reinforcement, extinction, backward chaining, systematic desensitization, and token economy as forms of intervention to achieve target behaviors that improve performance.

Target population: People across the entire age span; all disabilities

3. Biomechanical Frame of Reference

The Biomechanical Frame of Reference is a remedial approach to intervention that focuses on impairments that inhibit functional performance. Goals include using therapeutic and occupation-based activities such as ADL training to remediate existing impairments (i.e. movement-related), to prevent further deterioration (i.e contractures, muscle atrophy), and to provide compensatory/adaptive strategies for loss of movement.

Impairments that affect functional movement and joint range of motion may include reduced muscle strength or decreased muscle endurance due to multiple medication conditions (i.e. stroke, injury, etc.). From the Biomechanical frame of reference emerges assessments and interventions for static and dynamic orthoses, passive/active range-of-motion, ADL performance, work hardening, and nerve gliding.

Target population: People across the age span; physical and neurological disabilities

4. Biomechanical Frame of Reference for Positioning Children for Function

The overall intent of this frame of reference is to assist the development of postural reactions in individuals who are unable to maintain typical postural alignment via automatic muscle activity. The underlying theory is that sensory stimulations develop from interaction with the environment and that autonomic motor responses, such as equilibrium, are needed for typical posture.

Intervention techniques may include gravity-eliminating activities, using external supports, and providing proximal body stability to improve distal participation with the use of prescribed assistive devices. The overall goals of intervention are to improve client's participation in functional daily activities.

Target population: Children; disabilities which impair movement

5. Cognitive-Behavioral Frame of Reference

This frame of reference focuses on five interrelated aspects of life experience: behaviors, thoughts, emotion, physiological responses, and the environment (social and physical). Beck's (1976) hierarchical levels of cognition is a unique feature of this FOR, starting from the most accessible thoughts (automatic thoughts) and moving up the cognitive to "beliefs" (conditional beliefs) and then "core schema" (absolute beliefs).

Interventions that stem from the Cognitive-Behavioral FOR include cognitive behavior techniques such as deep breathing, systematic desensitization, activity diaries, and graded activity scheduling for person's with impacted cognitive function (i.e. anxiety, phobias, etc.). Often times, this FOR is used in conjunction with other occupation-based models to further establish details about a client's/patient's functional needs.

Target population: People across the age span; all disabilities

6. Compensatory Frame of Reference

The Compensatory Frame of Reference uses just that...compensatory techniques to improve occupational performance. This includes adopting the use of assistive devices/equipment to facilitate independence despite dysfunction. This FOR also includes the use of environmental modifications to living areas and using splints where appropriate.

For appropriate use of this model, the therapist and patient have concluded that dysfunction is permanent and irreversible. The compensatory FOR does include a little snippet regarding cognitive compensation such as memory and concentration techniques. Oftentimes, educational models are used in conjunction with this model to assist the client in understanding the purpose and proper use of assistive devices and techniques to compensate for dysfunction.

Target population: People across the age span; all disabilities

7. Developmental Frame of Reference

The Developmental Frame of Reference suggests that human development happens in a pattern of sequence from infancy to adulthood. The underlying theory is that people are dynamic, and that individual behavior is influenced from mastery of previous stages in development (i.e. learning how to walk is dependent on mastery of static standing).

The Developmental FOR acknowledges 6 adaptive skills areas: sensory integration, cognitive skill, dyadic interaction skill, group interaction skill, self-identity skill, and sexual identity skill. Each are is mastered at age-appropriate times in lift and healthy development of all of these areas is essential to achieve healthy coping behaviors and forming relationships.

Therapists work on assisting persons to develop these skills and to master milestones at age-appropriate intervals and to prevent the development of maladaptive behaviors and skills.

Target population: People across the age span; all disabilities

8. Frame of Reference for Development of Handwriting Skills

This frame of reference helps therapist's focus their examination of function in five areas of handwriting for kids: proximal posture, components (i.e. ocular motor skills, attention, and visual-perceptual skills), use of writing tools, grasp, and handwriting. Distal control (hand) cannot be achieved without good proximal control (spine).

The end-goal is to produce handwriting that is readable and completed within an appropriate time interval. Therapy assessment includes inspecting legibility, spacing, and letter size for school-based handwriting.

Target population: Children; disabilities that impair handwriting

9. Frame of Reference for Motor Skill Acquisition

Based on key principles for the learning theory, this frame of reference focuses on helping learners acquire motor skills for functional participation. Primary terms include ability, characteristics of the task, required skills, the environment, and regulatory conditions (from which emerges the continuum between closed and open tasks).

Closed tasks are performed in environments that are stagnant with little variability such as brushing one's hair or teeth. Open tasks are performed in environments that are in motion and that require variability in movement with each demand (i.e. competing in an athletic sport like football or basketball). Acquiring a motor skill involves active problem-solving, self-evaluation, and planning based on the therapist's (or facilitator's) feedback.

Target population: Children; developmental disabilities

10. Frame of Reference for Neuro-Developmental Treatment (NDT)

The Neuro-Developmental Frame of Reference is used by therapists to treat posture and movement-related impairments commonly seen in cerebral palsy and post-stroke. Its intervention approaches are rooted in kinesiology and biomechanics. Key elements of the NDT frame of reference include: alignment, planes of movement, range of motion, base of support, postural control, weight shift, mobility, and muscle strength.

As opposed to compensatory ideologies, NDT postulates that impairments to function can be changed or remediated. There are no current standardized tools stemming from this FOR since evaluation of each person is particularly unique.

Intervention strategies include therapeutic handling, graded application of manual forces, and directional cueing to promote newly learned movements. Learning new movements in therapy is for the purpose of enhancing participation in functional tasks.

Target population: People across the age span; neurological (CNS) impairments

11. Brunnstrom Frame of Reference

The Brunnstrom Frame of Reference, or Movement Therapy, is considered the opposite of NDT. The approach uses primitive synergistic patterns in order to improve motor control, posing that damage to the central nervous system causes a person to regress to less mature movement patterns. Therapists teach the patient to voluntarily control motor patterns during recovery using limb synergies.

The process of recovery includes 7 stages: flaccidity, spasticity, gained voluntary control through synergies (increased spasticity), patterns outside of synergy develop (decreased spasticity), complex movement combinations form (further decreased spasticity), disappearance of spasticity, normal function in restored.

Target population: People across the age span; movement-related disorders

12. Proprioceptive Neuromuscular Facilitation (PNF) Frame of Reference

The Proprioceptive Neuromuscular Facilitation Frame of Reference focuses on specialized flexibility training. A combination of stretching and muscle contraction are used to increase range-of-motion (often in short-term effects) for functional performance. Therapeutic measurements include passive range of motion, active range of motion, peak torque, and muscle strength. PNF is used to increase muscle elasticity while preventing or minimizing risk for injury.

Target population: People across the age span; disabilities and damage to muscle

13. Occupational Adaptation Model (OAM)

The Occupational Adaptation Model is considered an OT frame of reference which combines the use of a self-perceived meaningful activity (occupation) and a person's adaptive response to overcome an occupational challenge. The key term popularly referred to in therapy from this FOR is "relative mastery" or assessment of mastering a skill based on the client's perspective.

A person's interaction with the environment develops competency in occupations by having him/or her overcoming environmental demands thus mastering their chosen activity. During intervention planning, clients are asked to select meaningful activities that they wish to master in consideration to their environment and roles. Despite OAM being referred to as a model, it is still considered an occupational therapy frame of reference.

Target population: People across the age span; all disabilities

14. Occupational Adaptation Frame of Reference

The Occupational Adaptation Frame of Reference is not necessarily the same as OAM. There is a heavier focus on the adaptation process experienced by the individual when they come across occupational barriers or challenges. Three key terms for this FOR include person, the occupational environment, and the interaction between the person and the occupational environment.

The person is comprised of sensorimotor, cognitive, and psychosocial systems. The occupational environment includes areas such as work, play, leisure, and self-maintenance. This interaction fosters the need for mastery in occupational performance. Occupational adaptation begins with the occupational challenge and how the person perceives the challenge in order gauge performance.

This FOR emphasizes the use of sub-processes within this interaction including the adaptive response generation, the adaptive response evaluation, and the adaptive response integration. All of these sub-processes lead up to creating an appropriate occupational response to the occupational performance, leading to occupational adaptation.

Target population: People across the age span; all disabilities

15. Frame of Reference for Visual Perception

The Frame of Reference for Visual Perception emphasizes a top-down approach (impact on occupational performance first before identifying underlying deficit) to identify and to provide adaptive/compensatory strategies for visual perceptual deficits that limit functional occupational performance.

Rooted theories include education, developmental psychology, cognition, and Warren's developmental hierarchy of visual-perceptual cues that include areas such as oculomotor control, visual fields, and visual acuity. However, this FOR poses that not all visual-perceptual deficits are dependent on this hierarchy and that one deficit doesn't necessarily impact other deficits.

Visual perception can be learned from practice and life experience with the incorporation of cognitive and receptive skills. Therapists incorporate both remedial and adaptive interventions to enhance functional participation.

Target population: People across the age span; disabilities impairing visual perceptual skills

16. Psychodynamic Frame of Reference

The Psychodynamic Frame of Reference has its roots in Freud's theories of ego and its roles in developing and maintaining healthy relationships. Conflicts occur when there is a breakdown in the ego defense mechanism. Therapy focuses on two approaches: explorative and supportive.

Explorative interventions aide in surfacing conflicts from the unconscious mind to the conscious min in order to resolve the issues and to promote expression of feelings. Supportive interventions keep conflicts hidden in the unconscious while strengthening the ego defense mechanism. The goal of both approaches is to enhance typical psychosocial development and social interaction.

Target population: People across the age span; psychological disorders

17. Psychoanalytic Frame of Reference

Not to be confused with the Psychodynamic Frame of Reference, the Psychoanalytic Frame of Reference is based on the Vivaio model (MOVI) which emphasizes recognizing constant emotions that exist in the relationship between the patient, therapist, and "doing". Each of these three elements communicate and effect each other to create what is referred to as a dynamic transference or unconscious connection with past or present relationships).

MOVI is comprised of 7 interconnected components: Evaluation, the interaction process, the space and time settings, choice and play, materials and transformations, sensory experience and though, and nonhuman environment. OTs benefit from this FOR by using it as a means to assess the meaning of "doing" and the unconscious elements of the therapeutic relationship.

Target population: People across the age span; all disabilities

18. Psychospiritual Frame of Reference

The Psychospiritual Frame of Reference focuses on spirituality and the expression of it in occupation and related behavior as it relates to health and well-being. Spirituality is considered a construct of six dimensions: becoming, meaning, being, centeredness, connectedness, and transcendence.

All dimensions are interconnected, and if there is limitations in one or more dimensions that spiritual occupation is negatively impacted (i.e. spiritual deprivation, community spiritual deprivation, spiritual latency, etc.). Activities are categorized under human occupation as "spiritual occupation" which can include examples such as meditation, prayer, scripture-reading, singing, etc.

Target population: People across the age span; all disabilities

19. Rehabilitative Frame of Reference

The Rehabilitative Frame of Reference focuses on facilitating patients to fulfill meaningful activities and social roles in a competent manner. The underlying assumption for this FOR is that clients/patients have impairments that are not likely to be remediated or are permanent in nature, whether it's due to physical deficits or lack of motivation for remediation on the client's part.

The clients are encouraged to focus on abilities that remain and to attain their highest level of function through adaptation, compensation, and environmental modifications. Interventions that stem from this FOR include energy conservation, work simplification, and home modifications.

Target population: People across the age span; all disabilities

20. Sensory Integration Frame of Reference

The Sensory Integration Frame of Reference, originating from the work of Dr. Jean Ayers, focuses on how individuals' sensory systems (auditory, visual, gustatory, interoceptive, tactile, vestibular, proprioceptive) interact with and integration information from the environment. Sensory integration is broken down into abilities such as sensory modulation, sensory discrimination, sequencing, self-regulation, postural and ocular control, and praxis.

Desired outcomes of intervention include the individual successfully participating in meaningful daily tasks. SI requires a particularly structured therapeutic environment in order to grade sensory input intensity dependent on the unique needs of each client (typically children).

Target population: Children; persons with sensory processing disorders

21. Social Participation Frame of Reference

The Social Participation Frame of Reference emphasizes the power of emotion and its purpose to motivate children in social engagement. Children adoptive and regulate emotions in response to what they have learned interacting with parents and/or caregivers from an early age.

Children with disabilities may present with a decreased ability to modulate physical, physiological, and cognitive (i.e. attention) processes related to emotional regulation which affects social participation. Temperament of a child may change structured routines at home which further complicates their abilities to participate in regular social activities.

The social participation FOR has seven areas of social functioning: temperament adaptation, emotional regulation, family habits and routines, environmental supports, social participation in school, environment for peer interaction, and peer interaction.

Target population: Children; physical and mental disabilities

22. Cognitive Disabilities Frame of Reference

The Cognitive Disabilities Frame of Reference is based on Piaget's stages of cognitive development in cognitive behavioral theory. Cognitive disability is considered a limitation in sensorimotor-based actions that originate from structures of the brain that cause impairment in routine task behavior.

There is the notion that cognitive behavior is based on biological factors that can be improved or changed. Once maximum cognitive level has been accomplished, then therapists put into place compensatory techniques for biological, psychological, and environmental factors. Cognitive performance is broken down across a 6-level continuum (Allen's Cognitive Levels). Task performance involves attention, motor actions, and conscious awareness.

Target population: People across the age span; cognitive disabilities

23. Model of Human Occupations (MOHO) Frame of Reference

Although it is described as model, past and current OT literature also considers the MOHO a frame of reference. This makes sense since it is filled with intervention and evaluation techniques that are of the most used among therapists today.

Initially based on the Occupational Behavioral Model by Mary Reilly, MOHO was further developed and introduced to the OT profession by Gary Kielhofner. Humans are considered open systems that go through growth and development through ongoing interaction with their environment.

This interaction is broken down into 4 phases: input, throughput, output, and feedback. Through these phases come self-maintenance and change. This open system also includes 3 subsystems: volition, habituation, and performance.

Target population: People across the age span; all disabilities

24. Role Acquisition Frame of Reference

Rooted in learning theory, the Role Acquisition Frame of Reference addresses how individuals learn life skills that help them function within social environments. OTs address and teach clients/patients about how to learn and adopt new social roles, to transition between multiple roles, and to adapt to changes in current roles.

Learning is considered a fluid process that starts with the client's current level of function and becomes more mastered and advanced as he/she becomes more skilled. Behavior is an adaptive response to our social, cultural, and physical environments which provides positive and negative reinforcements to shape overall behavior.

Target population: People across the age span; all disabilities

25. Spatiotemporal Adaptation Frame of Reference

A fairly unknown concept in OT, the Spatiotemporal Adaptation Frame of Reference is considered a process by which a person discovers and absorbs new information from the environment which forms into a developmental sequence. This process involves four components: assimilation, accommodation, association, and differentiation.

The primary focus is on motor-based behaviors which assists the child in other developmental areas of his/her life. Through adaptation, the child can attain a higher level of function in meaningful tasks such as play, work, and self-care.

Target population: Children; physical, mental, and developmental disabilities

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All of the occupational therapy frames of reference in this article showcase only a small representation of the complexity each one truly presents.

We highly recommend that both OT students and practitioners read through full descriptions of each frame of reference when necessary. This could be in preparation for the NBCOT, refreshers for CEU credit, and for appropriate use in your own research and course development.

References

Cho, M. (2020). OT Theories and Models. OT Theory. https://ottheory.com/theories-and-models.

Occupational Therapy Frames of Reference. (2020). Occupational Therapy (OT). https://occupationaltherapyot.com/occupational-therapy-frames-of-reference/.

Mosey, A.C. (1992), updated in 2020. Partitions of Occupational Science and Occupational Therapy. American Journal of Occupational Therapy, 46: 851-853. https://doi.org/10.5014/ajot.46.9.851.

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25 OT Frames of Reference: A Quick Overview for Students and Practitioners - myotspot.com

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The occupational therapy discipline is built on several foundational theories that are fascinating, but also drawn out and extremely challenging to digest. So, we have decided to assist OT students and practitioners by providing summarized highlights of the OT frames of reference all in one location. But first, let's get past some confusing terminology.

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Special Interest Sections Academic Education Special Interest Section (AESIS) members are interested in OT education and include fieldwork educators, academic fieldwork coordinators, and students.

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Use of Formal and Informal Strategies to Manage Stress During Level II OT Fieldwork

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Use of Formal and Informal Strategies to Manage Stress During Level II OT Fieldwork

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Building Stress Resilience and Wellbeing

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Building Stress Resilience and Wellbeing

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Strategies for Managing Fieldwork Burnout

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Students on Level I and Level II fieldwork rotations often experience barriers to their success, such as poor communication between the student and fieldwork educator, lack of confidence or inflated confidence by the student, limited resources or equipment available to the student, high productivity with limited time to process client sessions, and difficulty matching the student's learning style with the fieldwork educator's approach to supervision (Grenier, 2015). In

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Strategies for Managing Fieldwork Burnout: Fostering More Self-Awareness, Setting Clearer Objectives, and More | AOTA

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Students on Level I and Level II fieldwork rotations often experience barriers to their success, such as poor communication between the student and fieldwork educator, lack of confidence or inflated confidence by the student, limited resources or equipment available to the student, high productivity with limited time to process client sessions, and difficulty matching the student's learning style with the fieldwork educator's approach to supervision (Grenier, 2015).