OCCUPATIONAL THERAPY ASSISTANT PROGRAM

FACILITY FIELDWORK MANUAL

LEVEL I

TABLE OF CONTENTS
Page Number	Section or Topic
	PROGRAM INFORMATION
1.	LATI OTA Program Mission & Philosophy
2.	LATI OTA Program Philosophy continued
3.	LATI OTA Program Objectives
4.	LATI OTA Program Curriculum Outline
	LEVEL I FIELDWORK INFORMATION & POLICIES & PROCEDURES
5.	Fieldwork Process Overview
6.	Guide to Fieldwork Titles & COE guidelines for Level One
7.	COE Guidelines for Level I
8.	LATI Fieldwork Policies & Procedures (confidentiality & insurance)
9.	LATI Fieldwork Policies & Procedures (immunization, travel, housing, personal business, attendance, assignments, grading, & grade appeals)
10.	LATI Fieldwork Policies & Procedures (dress & student grievance)
11.	LATI Fieldwork Policies & Procedures (supervisor grievance)
12.	Guide to LATI Forms
13.	Appendix A
	Supervisor Evaluation of Student (3pages)
	Student Evaluation of the Fieldwork Experience (2 pages)
	Supervisor Grievance Form (1 page)
	Accommodation Request Form (1 page)

MISSION STATEMENT

The mission of the Lake Area Technical Institute Occupational Therapy Assistant Program is to provide an entry-level education in occupational therapy, which meets, established standards and prepares students to be competent, well rounded, and adaptable practitioners. The program seeks to instill each student with a drive for continuing growth and a realistic level of confidence in order to be successful in their profession.

The program will provide a broad-based education and includes:

· development of interpersonal skills for therapeutic relationships

· critical and ethical decision making

· practice skills needed for rural settings

· an understanding of diversity

· opportunities for professional advocacy.

PHILOSOPHICAL THEMES

OCCUPATIONAL THERAPY ASSISTANTS (OTA) PRACTICE INDEPENDENTLY BUT WITHIN ESTABLISHED ROLE PARAMETERS

We believe that OTA’s receive educational experiences that allow them to practice in an independent manner and to make appropriate treatment decisions based on sound clinical reasoning. The term “partnership” best describes the relationship between an OTA and their supervising Occupational Therapist (OT). It is a relationship in which collaboration is professionally emphasized and legally required. The establishment of service competency with a supervising OT can allow an OTA to continue to expand their professional knowledge.

THE CONCEPT OF OCCUPATIONS IS THE HEART OF OCCUPATIONAL THERAPY (OT) PRACTICE

We believe that “occupations” are the center of our practice philosophy, as the title of our profession signifies. Occupations are the activities and tasks that facilitate intrinsic motivation for each unique individual. They are activities or tasks that an individual likes to perform, wants to perform, or has to perform in their life. Occupation as a modality for treatment is as diverse and as complex as each individual we treat. The unique ability of the occupational therapy practitioner, particularly the OTA, is to analyze and modify activities to be meaningful and satisfying to the participants. By articulating the meaning of occupations, the purpose for interventions is clear to the individual receiving the occupational therapy service.

INDIVIDUALS HAVE A RIGHT TO FULL PARTICIPATION IN THE TREATMENT PROCESS

We believe that OT recognizes the importance of each service recipient’s participation in the team process. Within the context of a treatment team, an OTA should foster the need for a humanistic approach to an individual’s situation or condition. This includes encouraging all recipients of OT services and caregivers be actively engaged in decisions regarding their physical, mental, social, and spiritual well being.

IN SCHOOL, IN THE CLINIC, AND IN THE COMMUNITY WE MUST FOSTER AN ENVIRONMENT THAT PROMOTES CREATIVITY

We believe that OT is a profession of creativity. By fostering an educational setting, which emphasizes creativity in students, the program aims to promote that creativity in clinical practice. Instilling a confidence in students to express their creativity assists them to carryover to practice. The practice of occupational therapy is only limited by the practitioner’s imagination.

1.

DIVERSITY IS IMPORTANT TO UNDERSTAND AND ACCEPT

We believe that each individual is unique and that diversity contributes to that uniqueness. Students, faculty, clinical educators, and patients are also from diverse backgrounds with unique qualities and characteristics. Accepting, understanding, and appreciating diversity is a key element in providing complete occupational therapy to the individual for whom we provide services. In order to be truly, fully, and completely competent, diversity has to be one of the basic elements which is addressed in treatment.

SEEKING PERSONAL AND PROFESSIONAL GROWTH IS LIFE-LONG

We believe that students enter the program with a variety of experiences and grow, both personally and professionally, as a result of the didactic and fieldwork experiences in the program. Learning the “how to” of therapeutic relationships will tap on the students’ individual characteristics and help them to further develop knowledge, skills, and abilities. In addition, learning that starts in the classroom will extend throughout life to allow the student to remain current in practice, continue to gain competency, and be able to interact as a professional.

The result of this life-long growth process for the OTA includes an expectation, a commitment and a confidence to participate in opportunities to advocate for OT.

DISABILITIES IMPACT THE INDIVIDUAL’S WHOLE LIFE AND THEREFORE THE WHOLE LIFE NEEDS TO BE THERAPEUTICALLY ADDRESSED

We believe that holistic treatment is at the opposite end of the spectrum from reductionistic treatment. The whole life of the individual, including their context must be part of the therapeutic process. From a holistic standpoint, any change in one system of an individual will result in changes in other systems as well. Changes can be the result of such things as aging, injury, disease, and poor lifestyle choices. The individual’s whole life must be evaluated with treatment planned and interventions carried out to address changes.

OT IS A CARING PROFESSION

We believe that OT is a profession dedicated to the idea that a caring attitude toward others is paramount. The ability to recognize the inherent worth of others’ needs is essential. OTA education and training should strive to instill an awareness of the intrinsic and extrinsic value of a caring attitude. A caring attitude is best demonstrated by acting in an ethical and responsible manner, practicing flexibility and adaptability, as well as displaying empathy and compassion.

THERE IS A REASON FOR EVERYTHING THAT OT DOES

We believe that OT sometimes looks simple but the clinical reasoning behind the decisions that OT practitioners make is very complex. OT addresses not only the biopsychosocial components of the individual but the spiritual and environmental factors as well. Education in OT emphasizes the uniqueness of OT and treatment methods, which are particular, reasoned, and specific.

OT CAN BE FUN – FOR LEARNING, FOR PRACTICE AND FOR THE INDIVIDUALS WHO RECEIVE OT SERVICES

We believe that occupational therapy can be fun. The practitioner’s experience with a wide variety of activities and their attitude toward their profession can dramatically influence the motivation of the individuals they treat. When a practitioner is energized and motivated to perform occupational therapy treatment, an individual will be motivated to participate in the process. If the practitioner engages the individual and demonstrates interest in them, the individual will influence their health.

We also believe that students who are happy and enjoy the learning experience are going to have better attitudes, be healthier, and carry that into school or practice. They are less likely to burn out from the stress of school and/or clinical requirements.

PROGRAM OBJECTIVES

1. Explain the role and value of occupational therapy in various settings.

2. Define the scope and practice of the Occupational Therapy Assistant within various practice settings.

3. Adhere to school, program, and fieldwork policies and procedures.

4. Manage time wisely in classroom and fieldwork settings.

5. Display respect for self and others.

6. Modify behavior in response to constructive feedback.

7. Communicate personal and professional needs to supervisor.

8. Demonstrate effective problem solving skills.

9. Maintain treatment area, equipment, supplies, and department records.

10. Collect pertinent information from written data sources (e.g. charts, records), interviews, and observations as part of the OT process.

11. Correctly administer assigned assessments under the direction of an OT.

12. Collaborate with an OT in planning an intervention program.

13. Select appropriate activities to meet established goals.

14. Implement treatment programs as per the treatment plan and adjust intervention techniques according to needs of the client.

15. Communicate with client and/or caregiver regarding the intervention plan and strategies.

16. Utilize principles of group process when working with groups.

17. Communicate changes in client status, treatment, and/or progress with supervisor.

18. Report factual information in written and verbal form to supervisor and team members.

19. Establish and maintain a therapeutic relationship with recipients of OT services.

20. Attend to safety needs in all educational environments.

21. Display professional behavior in classroom and fieldwork settings.

22. Orient client and/or caregivers to nature and purpose of the occupational therapy program.

23. Maintain confidentiality.

24. Maintain accurate written records.

25. Provide quality services in a variety of practice settings, within the scope of practice, adhering to applicable rules and regulations, and within the professional Code of Ethics.

26. Participate in identifying research investigation topics and analyze articles relevant to topic.

27. Participate in continuing education opportunities to promote continued professional growth, sustain learning, network with other occupational therapy practitioners, and develop professional behaviors.

OCCUPATIONAL THERAPY ASSISTANT

CURRICULUM OUTLINE

Revised: 01/02

First Year - Fall Semester
Course Number	Course Title	Clock Hours	Credits
	General Education Requirements:
CSC 100	Introduction to Computers	28	1
ENGL 101	Composition	48	3
PSYC 101	General Psychology	48	3
SPCM 101	Fundamentals of Speech	48	3
	Related Courses:
MA 115	Medical Terminology	42	1.5
ANAT 142	Anatomy	48	3
	Occupational Therapy Requirements:
OTA 100	Introduction to Occupational Therapy	56	2
OTA 105	Crafts and Activity Analysis	84	3
	Total Credits	402	19.5
First Year - Spring Semester
Course Number	Course Title	Clock Hours	Credits
	Related Courses:
PHGY 210	Human Physiology	64	4
PSYC 251	Abnormal Psychology	48	3
AED 100	Automated External Defibrillator	14	.5
	Occupational Therapy Requirements:
OTA 111	Kinesiology/Neurology for Occupational Therapy Assistant	140	5
OTA 120	Human Development 0-21	56	2
OTA 125	Human Development 0-21 Lab	84	3
OTA 131	Activities of Daily Living	84	3
OTA 215	Assistive Technology and Occupational Therapy	56	2
	Total Credits	546	22.5
First Year - Summer Session
Course Number	Course Title	Clock Hours	Credits
	Occupational Therapy Requirements:
OTA 135	Group Dynamics	56	2
OTA 140	Ethics and Issues in Occupational Therapy	56	2
OTA 150	Fieldwork I-A	40	.5
OTA 155	Fieldwork I-B	40	.5
OTA 200	Adult Human Development	28	1
OTA 205	Adult Human Development Lab	84	3
	Total Credits	304	9
Second Year - Fall Semester
Course Number	Course Title	Clock Hours	Credits
	General Education Requirements:
MATH 100	Applied General Math	48	3
SOC 100	Introduction to Sociology	48	3
	Occupational Therapy Requirements:
OTA 145	Occupational Therapy in Mental Health	84	3
OTA 210	Pathophysiology	84	3
OTA 220	Physical Disabilities	56	2
OTA 225	Physical Disabilities Lab	84	3
	Total Credits	404	17
Second Year - Spring Semester
Course Number	Course Title	Clock Hours	Credits
	Occupational Therapy Requirements:
OTA 231	Special Topics in Occupational Therapy	28	1
OTA 236	Fieldwork II-A	330	5.5
OTA 241	Fieldwork II-B	330	5.5
	Total Credits	688	12

Credit Breakdown:

80 credits required for graduation

General Education Courses = 16 • Related Courses = 12 • Occupational Therapy Courses = 52

Lake Area Technical Institute

OTA Program

Fieldwork Program Overview

New Site Information

• After initial contact is made, relevant information is exchanged between the potential site and the OTA program..

• Upon, reviewing the information, a fieldwork agreement is send to the potential site to be signed and returned to the OTA Program or if the site has their own agreement form the process is reversed.

Fieldwork Agreements:

• Level I agreements are automatically renewed and formally reviewed every three years
• Level II agreements or contacts are for a three-year time period and may updated with an addendum (LATI’s agreements can be modified to comply with fieldwork site criteria).

Fieldwork Requests;

• Every year, the OTA program will send out a form that requests each site to list available students placements for specific dates. This form includes a provision allows each fieldwork site to accept or deny a student placement for the listed dates.

Placements:

• Level I Placements:

Level I placements are one week in length and are scheduled for late spring and mid summer. The first placement is termed Level IA and the later one is termed Level IB. The fieldwork coordinator sends out request for placements in late winter or early spring. After placements have been secured, the fieldwork coordinator sends out an student information packet to the site. This packet contains forms that provide proof of professional liability, childhood immunization, a negative TB test and CPR certification within the past 12 months, as well as a student signed confidentiality form. The information packet also includes proof medical insurance and a hepatitis B immunizations or a student signed waiver.

· Level II Placements

Level II placements are two months in length and are scheduled for midwinter (January) through late spring (May). The are termed Level IIA and Level II B. Request for placements are typically sent out to fieldwork site in late summer or early fall. After placements have been secured, the fieldwork coordinator sends out an student information packet to the site. This packet contains forms that provide proof of professional liability, childhood immunization, a negative TB test and CPR certification within the past 12 months, as well as a student signed confidentiality form. The information packet also includes proof medical insurance and a hepatitis B immunizations or a student signed waiver.

Dataforms:

• A fieldwork dataform is an AOTA form that gives the LATI OTA Program pertinent facility information AOTA requires that it be updated annually. The academic fieldwork coordinator generally sends out new data forms to the fieldwork site in the spring or summer of each year. These dataforms may be completed by completing a hardcopy or utilizing a computer disk and/or email.

Student Objectives:

• AOTA requires that each fieldwork site have a documented set of student objectives. Basically, the objectives identify what the fieldwork site expects the student to learn during their placement. Sample objectives that are to be utilized as guides are available from the academic fieldwork coordinator.

GUIDE TO FIELDWORK TITLES

Academic Fieldwork Coordinator: This is the representative from Lake Area Technical Institute’s Occupational Therapy Assistant Program who organizes fieldwork contracts and addresses issues relevant to LATI fieldwork experiences. Any questions regarding fieldwork should be directed to:

Randy Breske, COTA/L

Fieldwork Coordinator

Occupational Therapy Assistant Program

Lake Area Technical Institute

230 11^th Street NE

Watertown, South Dakota 57201

Phone: 800-657-4344, ext. 372

Email: bresker@lati.tec.sd.us

Primary Fieldwork Educator: The individual who serves as the contact person between the facility and the LATI OTA program. This individual coordinates the placement of and must have at least one-year experience.

Clinical Supervisor: The individual who serves as the direct supervisor of the student. This person can be an OT, OTA, or other qualified professional.

COMMISSION ON EDUCATION
GUIDELINES FOR OCCUPATIONAL THERAPY FIELDWORK - LEVEL I

Definition and Purpose

The AOTA Standards describe the goal of Level I Fieldwork "to introduce students to the fieldwork experience, and develop a basic comfort level with an understanding of the needs of clients." Level I Fieldwork is not intended to develop independent performance, but to "include experiences designed to enrich didactic coursework through directed observation and participation in selected aspects of the occupational therapy process."

Services may be provided to a variety of populations through a variety of settings. Experiences may include those directly related to occupational therapy, as well as other situations to enhance an understanding of the developmental stages, tasks, and roles of individuals throughout the life span. Day care centers, schools, neighborhood centers, hospice, homeless shelters, community mental health centers, and therapeutic activity or work centers are among the many possible sites. Level I Fieldwork may also include services management and administrative experiences in occupational therapy settings, community agencies, or environmental analysis experiences. Populations may include disabled or well populations; age-specific or diagnosis-specific clients.

Qualified personnel for supervision of Level I Fieldwork may include, but are not limited to, academic or fieldwork educators, occupational therapy practitioners initially certified nationally, psychologists, physician assistants, teachers, social workers, nurses, physical therapists, social workers, etc. The supervisors must be knowledgeable about occupational therapy and cognizant of the goals and objectives of the Level I Fieldwork experience.

1. Objectives

Objectives of Level I Fieldwork may vary significantly from one academic institution to another. These variations occur as a result of differences in individual academic institutional missions, programmatic philosophical base, curriculum design and resources, etc. As a result, the individual academic institutions should provide information regarding the specific didactic relationship and should provide objectives for the experience. Fieldwork educators should determine if the resources of their facilities are adequate to meet the objectives of the educational institution, and then apply the objectives to the fieldwork setting.

COE Guidelines Level I continued

Fieldwork objectives should reflect role delineation between professional and technical level students as specified by The Guide to OT Practice, AJOT, Vol.53, No.3. In the event a facility provides Level I Fieldwork experiences to both levels of students, separate objectives and learning experiences should be utilized, as developed by the academic program faculty. Students should be evaluated using these objectives.

In instances where students will have a prolonged/consecutive fieldwork experience in the same facility, the objectives should also reflect a sequential orientation and move from concrete to conceptual or from simple to more complex learning activities. In the event that the student will rotate through a variety of settings it is recommended that a master list of objectives be developed that demonstrate a developmental learning continuum and indicate which objectives/learning experiences have been provided in previous experiences.

Schedule design of Level I Fieldwork will depend on the type of setting and the curriculum of the academic institution. Options include, but are not limited to, full days for one-half a term, full days in alternating weeks for one term, half days for one term, or one week.

Academic Institution

• Identify course content areas to be enhanced by Level I Fieldwork experiences.
• Develop general goals that clearly reflect the purpose of the experience and level of performance to be achieved.
• Assure that objectives reflect the appropriate role of an OT or OTA student.
• Sequence the objectives from concrete to conceptual or from simple to increasing complexity.
• Identify facilities that may be able to provide the necessary learning experiences.
• Share the objectives with the fieldwork educators and ask them to identify those objectives that could be met in their facility.
• Discuss and coordinate fieldwork administration issues, such as scheduling, work load, report deadlines, etc.
• Collaborate with fieldwork educators to clearly identify the skill levels necessary for successful completion of Level I Fieldwork experience.
• Develop an evaluation form and protocol.

Fieldwork Education Center

• Evaluate administrative aspects of the program to determine the feasibility of providing education experiences of high quality while maintaining the effectiveness of services. Some considerations are: providing the necessary supervision, scheduling learning experiences, and staff attitudes toward.
• Review objectives and learning experiences with academic representatives to assure that they address the Level I Fieldwork objectives of the program.
• Review the evaluation form and associated protocols and seek any necessary clarification prior to its implementation.
• Review the Level I Fieldwork objectives and the evaluation form to determine if the learning experiences can be provided at your fieldwork agency and if they are compatible with the philosophy of the program.
• In collaboration with the academic program faculty, identify, and design, if possible, specific learning activities which will meet Level I objectives.
• Those agencies providing fieldwork for both the professional and technical level student should have different learning experiences designed to clearly reflect role delineation.

AOTA Commission on Education (COE) and Fieldwork Issues Committee (FWIC)
Amended and Approved by FWIC 11/99 and COE 12/99

Last Updated 12/01/1999

LEVEL I FIELDWORK EXPERIENCE POLICIES AND PROCEDURES

FIELDWORK CONFIDENTIALITY POLICY

The LATI OTA program faculty, clinical faculty, and student shall respect the right for confidentiality of clients/patients and fellow professionals. Information, which promotes effective client/patient care or student education, may be shared with appropriate individuals. Personal information and/or prejudicial remarks that could diminish the quality of client/patient care or student education are in violation of this confidentiality policy and may violate state and federal privacy law.

The LATI OTA Academic Fieldwork Coordinator:

May	May Not
Communicate the level of supervision the student needs at the fieldwork facility.	Communicate clinical or academic performance level at other fieldwork sites.
Communicate types of fieldwork settings that the student has previously experience.
Communicate the type of clinical experience that student needs at the facility.

The Primary Fieldwork Educator/Clinical Supervisor:

May	May Not
Communicate to the LATI Academic Fieldwork Coordinator the student’s strengths, weaknesses and performance level.	Communicate the student’s ability to co-workers, peers, patients, family, friends, or others that are not directly involved in the student’s education process.
Communicate to their own supervisor/manager the performance abilities of the student, as appropriate.

The Students:

May	May Not
Have access to the written evaluation of the site through the Academic Fieldwork Coordinator.	Communicate to others (outside the OTA Program) any confidential information observed at the fieldwork site. This may include: ü Patient information ü Facility information ü Professional conduct of employees/contractors of facility/business
Communicate to the LATI Academic Fieldwork Coordinator the strengths and weaknesses of their fieldwork experience.	Communicate any prejudicial remarks about previous fieldwork facilities.

INSURANCE POLICY

Health Insurance:

Each OTA student enrolled in the OTA program is required to have health insurance or sign a waiver indicating that they will be responsible for any cost incurred from an illness or injury during the course of the academic or clinical periods of the program. The students must be able to show proof of their insurance upon request from the academic or clinical facility.

Professional Liability Insurance:

All students attending a fieldwork placement must have professional liability insurance. The student must be able to show proof of this insurance upon request from the academic or clinical facility.

8.

IMMUNIZATIONS POLICY

Students are required to provide documentation of immunizations that are required by LATI or the fieldwork site Immunization documentation includes but is not limited the following:

• Childhood immunizations
• Current TB test
• Hepatitis B immunization or signed waiver.

TRAVEL POLICY

OTA students are responsible for making his/her own travel arrangements.

HOUSING POLICY

OTA students are responsible for securing their own housing arrangements for living accommodations during fieldwork experience.

PERSONAL BUSINESS POLICY

OTA students should avoid making appointments for personal business during the time they are scheduled for fieldwork.

ATTENDANCE POLICY

During a Level I Fieldwork experience the student is expected to attend the entire week and be punctual. The students have been told that they are a guest in the facility and they should be respectful and appreciative of the staff’s time. An absence due to medical emergency or family emergency must be reported to the LATI OTA Academic Fieldwork Coordinator and the Primary Fieldwork Educator at the earliest opportunity. The Academic Fieldwork Coordinator will make arrangements to make up for the lost time.

Assignments

For the Level I Fieldwork experience the student is expected to complete specific assignments. The Academic Fieldwork Coordinator will grade these assignments. The Primary Fieldwork Educator may also assign facility specific/practice specific homework to the student.

GRADING POLICY

Upon completion of the Fieldwork I –A or Fieldwork I – B course, the Primary Fieldwork Educator will evaluate the student and the student will hand in assignments. The Academic Fieldwork Coordinator will then assign a Pass/Fail grade to the student based on the evaluation and the assignments. The student must achieve at least 30 points on the Fieldwork Level I Evaluation Form, 80% on the assignments and submit the site evaluation signed by their supervisor.

Fieldwork Grade AppealS

Any student who wishes to appeal a Level I Fieldwork grade must notify the Academic Fieldwork Coordinator within 14 days of notification of the failing grade. The student, Academic Fieldwork Coordinator, Primary Fieldwork Educator and OTA Program Director will meet to determine the outcome of the appeal process. If the student is unsatisfied with the appeal outcome, the student may then appeal the grade to LATI’s Assistant Director of Student Needs.

Dress Code

The OTA programs requires that students dress in a professional manner, however facility policy can override LATI dress policy at the Primary Fieldwork Educators or Clinical Supervisors discretion. If questions arise that cannot be readily answered, students are advised to follow LATI dress code policy.

Any student who disregards the dress code of the facility jeopardizes the future relationship between Lake Area Technical Institute’s Occupational Therapy Assistant Program and the facility. For this reason, dress code is taken very seriously and any violation of the facility’s dress code could result in suspension from the site if correction is not made after an appropriate verbal warning.

Guidelines are as follows:

1. Students will wear a nametag denoting OTA students daily.

2. Professional dress should include conservative and tasteful attire.

3. Clothes must be clean and in good condition (free of fading, tears, holes, wrinkles, etc).

4. Footwear should be practical and safe in conjunction with setting and situation.

5. Avoid sweat suits, workout clothes, denim jeans, ECT.

6 Special care should be taken to ensure good personal hygiene. Body perfumes and odors should be minimized, including the smell of smoke.

7. Hair must be neat and pinned back if excessively long. Beards and mustaches should be neatly trimmed.

8. Make-up and nail polish should be conservative and not distracting. Nails should be trimmed

STUDENT GRIEVANCE POLICY & PROCEDURE

Purpose To establish a method for expressing grievances during fieldwork experiences.

Policy: Students participating in Level I and Level II Fieldworks shall follow steps of specific criteria to address any grievances should they occur.

Procedure:

1. The student shall follow the grievance procedures outlined in the facility policy and procedures manual for specific grievances regarding personnel and/or facility issues.

2. The student shall express the grievance to the Occupational Therapy Assistant Program’s Fieldwork Coordinator and/or Program Director from Lake Area Technical Institute at the beginning of the next business day with written documentation to follow.

3. Grievances regarding fieldwork grades shall be handled in accordance with academic grievance procedures as outlined in the “Occupational Therapy Assistant Student Policies

11.

SUPERVISOR GRIEVANCE POLICY & PROCEDURE

Purpose: To establish a method for Primary Fieldwork Educators/Clinical Fieldwork Supervisors to express grievances against an OTA student.

Policy: Primary Fieldwork Educators/Clinical Fieldwork Supervisors of Level I and Level II Fieldwork experiences shall be given a procedure to address grievances against an OTA student.

Procedures:

1. Primary Fieldwork Educators/Clinical Fieldwork Supervisors are encouraged to follow their facility’s policies and procedures regarding grievances against a student if there is documentation pertaining to the specific grievance. Additionally, the following steps should be completed.

1. The Primary Fieldwork Educator/Clinical Fieldwork Supervisor should review the complaint with the OTA student,
2. The Primary Fieldwork Educator/Clinical Fieldwork Supervisor should contact the OTA Program Academic Fieldwork Coordinator the same day to inform LATI of the grievance.
3. A copy of the grievance should be mailed or faxed to the OTA Program Academic Fieldwork Coordinator by the end of the same day.

2. Primary Fieldwork Educators/Clinical Fieldwork Supervisors are encouraged to follow the steps listed below if their facility does not have a policy regarding grievance of an OTA student.

1. The Primary Fieldwork Educator/Clinical Fieldwork Supervisor should review the complaint with the OTA student.
2. Primary Fieldwork Educators/Clinical Fieldwork Supervisors are encouraged to complete the “Fieldwork Supervisor’s Grievance “ form.
3. The student’s Clinical Fieldwork Supervisor should contact the OTA Program Academic Fieldwork Coordinator the same day to inform LATI of the grievance.
4. A copy of the grievance should be mailed or faxed to the OTA Program Academic Fieldwork Coordinator by the end of the same day.

3. The Academic Fieldwork Coordinator and the OTA Program Director from LATI will discuss the specific grievance with the Primary Fieldwork Educator/Clinical Fieldwork Supervisor and/or student.

1. Action taken against the student will depend on:

a. Any existing policies the facility may have regarding the grievance.

b. Any existing policies LATI may have regarding the grievance.

c. The severity of the grievance.

d. The recommendations of the Primary Fieldwork Educator/Clinical Fieldwork Supervisor and the staff of the OTA program at LATI.

2. Every effort will be made to come to a mutual agreement for resolution between LATI and the facility.
3. LATI shall assume responsibility for discussing the action against the student with the student.

12.

Guide to LATI Forms

Foreword: The following descriptions give a synopsis of the various forms that LATI utilizes to address fieldwork issues. Copies of these forms are to be made when the need arises. If replacements are ever required please contact the Academic Fieldwork Coordinator

Supervisor Evaluation of Supervisor

This form must be completed by the Fieldwork Educator/Supervisor/Clinical Supervisor or Facility Fieldwork Coordinator and sent to LATI each time a student has completed a Level I Fieldwork Experience at the facility. The student has been provided with this form and should present it to the facility personnel upon arrival to the Fieldwork setting. However, this form may be reproduced if necessary.

Student Evaluation of the Fieldwork Experience

Each student who is assigned to your facility will be required to complete this form and review it with the Fieldwork Educator or Facility Fieldwork Coordinator. This will need to be signed by a facility representative and returned to LATI by the student. Each student will be issued this form and take it with them to the site.

Supervisor Grievance Form

This form is to be filled out by the Fieldwork Educator or Facility Fieldwork Coordinator in the event of a grievance against a LATI OTA student. This form may be reproduced if needed. Please send completed form to The LATI OTA Fieldwork Coordinator.

LATI Accommodations Request Form

This form is utilized for students that request special accommodations for a documented disability.

LATI Placement Request Form

This form is sent out to fieldwork site to address possible placements for a specific calendar year. It lists various OT areas in which a facility may be able to accommodate a student placement.

LATI Student Information/Profile Packet

This packet is sent out to the site prior to the student attending a fieldwork experience. It gives the fieldwork site pertinent student information. It includes forms that address or provide proof of immunization, insurance, confidentiality, CPR and ECT

Appendix A

Forms

SUPERVISOR EVALUATION OF STUDENT

STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE

LATI OTA Program

Level I Fieldwork

Supervisor Evaluation of Level I Student

Supervisor Name: _______________________________________Student Name: _________________________________

Facility Name ___________________________________________________________________Date: ________________

**To the Supervisor: Please rate the student’s skills as you observed from 1.0-4.0 using the scale below. Please circle your response for each category. If more space is needed for comments, the back of this page can be utilized. A student’s overall grade will be determined by averaging the scores. A total of 32 is required to pass.

Listening Skills
1.0 No listening skill present	1.5		2.0	2.5	3.0	3.5	4.0 Excellent listening skills
Verbalization Skills
1.0 Limited verbal skills	1.5		2.0	2.5	3.0	3.5	4.0 Excellent verbal skills
Initiative
1.0 No initiative	1.5		2.0	2.5	3.0	3.5	4.0 Excellent initiative
Behavior
1.0 Immature Behavior	1.5		2.0	2.5	3.0	3.5	4.0 Professional Behavior
Dependability
1.0 Unreliable	1.5		2.0	2.5	3.0	3.5	4.0 Excellent dependability
Professional Dress
1.0 Inappropriate dress	1.5		2.0	2.5	3.0	3.5	4.0 Appropriate dress
Time Management
1.0 Limited time management skills	1.5		2.0	2.5	3.0	3.5	4.0 Utilized time effectively
Assignments/Learning Experiences
1.0 Didn’t participate	1.5		2.0	2.5	3.0	3.5	4.0
Supervisory relations
1.0 Limited ability to interact with supervisor		1.5	2.0	2.5	3.0	3.5	4.0 Excellent Supervisory skills
Professional awareness
1.0 No professional awareness		1.5	2.0	2.5	3.0	3.5	4.0 Excellent professional awareness

Supervisor Comments

Signatures indicate that both parties have read and discussed the information contained in the supervisor evaluation of student form

Clinical Supervisor Signature: ____________________________________ Date__________________

LATI OTA Student Signature: ______________________________________ Date________________

STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE

LEVEL IA AND IB

Student Name: ______________________________ Supervisor Name: ________________________

Facility Name: ______________________________ Placement Dates: ________________________

Type of Fieldwork (area): __________________________________________

Circle the numerical value that you feel is appropriate for the following fieldwork placement issues
Organization of the Fieldwork Educational Program
1.0	1.5	2.0	3.0	3.5	4.0
Unprepared, expectations were not discussed					Facility was prepared, expectations were clear
Assignments from the site
1.0	1.5	2.0	3.0	3.5	4.0
Were not explained, were overwhelming					Were explained, clear, appropriate amount and level difficulty
Observations of services or clients
1.0	1.5	2.0	3.0	3.5	4.0
Very little					All day every day
Supervision
1.0	1.5	2.0	3.0	3.5	4.0
Supervisor was rarely available for questions					Supervisor was available at all times
Clinical Supervisor
1.0	1.5	2.0	3.0	3.5	4.0
Friendly, helpful Appeared knowledgeable of services					Appeared knowledgeable of services, offered very little explanation
Professional relationships
1.0	1.5	2.0	3.0	3.5	4.0
Student felt like an outsider, uncomfortable in the setting					Student felt welcomed into the setting

STUDENT EVALUATION OF THE FIELDWORK EXPERIENCE LEVEL IA AND IB

Comments:

Identify the strengths of this placement.

Identify suggestions for improvements to this fieldwork experience.

Identify any suggestions to the OTA program for preparing a student for this Level I placement.

Student signature: _______________________________________________________ Date:_____________

Clinical Supervisor signature______________________________________________ Date: ______________

or

Primary Fieldwork Educator signature: ______________________________________Date: ______________

LAKE AREA TECHNICAL INSTITUTE

OCCUPATIONAL THERAPY ASSISTANT PROGRAM

STUDENT SUPERVISOR GRIEVANCE OF AN OTA STUDENT

(FOR LEVEL I AND LEVEL II FIELDWORK EXPERIENCES)

To be completed by the Student Supervisor of the fieldwork facility. Please utilize the back of this page if needed.

DATE ______________________________________________

NAME OF FACILITY: ________________________________________________________________________________

STUDENT SUPERVISOR: _____________________________________________________________________________

STUDENT: __________________________________________________________________________________________

NATURE OF GRIEVANCE: _______________________________________________________________________________________________________________________________

Facility policy (if any) regarding grievance and action to be taken against the OTA student:

If no facility policy exists; administration's or the student's supervisor recommended action to be taken against the OTA student:

SUPERIVISOR SIGNATURE ______________________________________________ DATE _______________

STUDENT SIGNATURE __________________________________________________ DATE _______________

Lake Area Technical Institute

Occupational Therapy Assistant Program

FIELDWORK SPECIAL ACCOMMODATION REQUEST FORM

According to the guidelines of the Americans with Disability Act, it is the student’s choice and responsibility to reveal any information regarding a disability that may require special accommodation and thereby impact their educational experience.

Accommodations requested?

Summary of the accommodation agreed upon by the facility, LATI Fieldwork Coordinator, and student:

Signatures:

___________________________________________________________ _______________________

Student Date

___________________________________________________________ _______________________

Primary Fieldwork Educator Date

___________________________________________________________ _______________________

LATI Fieldwork Coordinator Date

5/02