Fillable Form 1: BPCC OTA Program Level II Fieldwork (Bossier Parish Community College)

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Form 1: BPCC OTA Program Level II Fieldwork (Bossier Parish Community College)

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BPCC OTA Program Level II Fieldwork Site Specific Objectives Checklist for use
with: AOTA Fieldwork Performance Evaluation for the Occupational Therapy Assistant
Student
Site: Date:
1
Contact Person:
Email:
Phone #:
FUNDAMENTALS OF PRACTICE
Ethics (FWPE item #1 Adheres consistently to AOTA
Code of
Ethics
& Ethics Standards (AOTA
2010, draft) & site’s policies & procedures; including, when relevant, those related to human
subject research
) as stated below:
1. Demonstrates concern for well-being & safety of recipients of services (beneficence)
2. Intentionally refrains from actions that cause harm (nonmaleficence)
3. Respects right of individual to self rule (autonomy, confidentiality)
4. Provides services in fair & equitable manner (social justice)
5. Complies with institutional rules, local, state, federal, international laws & AOTA documents
applicable to profession of occupational therapy (procedural justice)
6. Provides comprehensive, accurate, & objective information when representing profession (veracity)
7. Treats colleagues & other professionals with respect, fairness, discretion, & integrity (fidelity)
___Other:________________________________________________________________
Safety (FWPE item #2 Adheres consistently to safety regulations. Anticipates potentially
hazardous situations & takes steps to prevent accidents
) for all clients & staff members
throughout all fieldwork related activities aeb:
___record review
___medication side effects
___post-surgical
___
infection control
___fall prevention
___
swallowing
___
food allergies
___
ambulation status
___behavioral system/privilege level
(e.g., locked area/unit, on grounds)
___OSHA/BBP
___I.V./lines
___ER codes/protocols
___
restraint reduction
___HIPAA
___w/c locks/bedrails/call button
___
Vital signs
(BP, O2)
___
Trach/Ventilator monitoring
___
Fire/Evacuation/Lockdown
___
CPR certification
___1:1 for personal safety/suicide precautions ___Communication re: change in st
atus
___sharps count
___other: _________________
__
_environment set up (no clutter, spills, unsafe items, etc.,)
___Other:______________________________________________________________________
Judgment in Safety (FWPE item #3 Uses sound judgment in regards to safety of self &
others during all fieldwork-related activities
) aeb:
___proper body mechanics for lifting
___effective use of self-disclosure (boundaries)
___ability to limit set
___follows a
mbulation/functional mobility protocols
___gait belt ___contact guard
___proper transfer techniques
___proper wheelchair positioning (e.
g., footrests, cushions, trays/poseys, etc.)
___effective group leadership (planning, protocols, time use)
___
monitors correct Splinting use by client
__Static __Dynamic
___proper positioning in chair/bed
___checks MD orders
___confirms parent agreement has been obtained for services per IDEA
___Other:______________________________________________________________________
BASIC TENETS
Occupational Therapy Philosophy
(FWPE item #4 Clearly communicates values & beliefs of
occupational therapy, highlighting use of occupation
) aeb:
Confidently explains profession’s values & beliefs, using examples appropriate to setting to:
___client
___families/significant others ___OT ___PT ___SLP ___Teacher ___Aides ___MDs
___Nursing ___LISCW ___Psychologist ___RT ___CRC ___AT ___MT ___3
rd
party payers
___regulatory bodies ___general public (e.g., via promotional materials/activities such as
brochures, flyers/press releases, in-services)
___Other ______________________________________________________________________ :
OT/OTA Roles
(FWPE item #5 Communicates role of OT/OTA) as collaborative team according
to state laws/practice acts ___verbally &/or ___via written material provided to:
___client ___families/significant others ___OT ___PT ___SLP ___Teacher ___Aides ___MDs
___Nursing ___LiSCW ___Psychologist ___RT ___CRC ___AT ___MT ___3
rd
party payers
___regulatory bodies ___general public (e.g., via promotional materials/activities such as
brochures, flyers/press releases, in-services)
___Other:______________________________________________________________________
Evidence-based practice (FWPE #6
Makes informed practice decisions using published research
& relevant informational resources
) using evidence from sources such as:
___summarized evidence from Critically Appraised Topics/Papers (CATs/CAPs)
___articles from peer reviewed journals (e.g., AJOT, OTJR, etc.,)
___discussion/sharing of material learned via other sources (textbooks, OT Practice, coursework,
conference workshops, website searches, conferences, etc.,) in supervision
___materials found using EBP approach (e.g., PICO question: Person, Intervention, Condition,
Outcome) to search for relevant evidence
___Other:______________________________________________________________________
EVALUATION & SCREENING
Gathers data (FWPE item #7 Under supervision of & in cooperation with OT/OTA, gathers
relevant information re: clients’ occupations of self care, productivity, leisure, & factors that
support/hinder occupational performance)
according to state law & to assessed level of
competency via:
___record review ___interview ___observation in context
___describing observed performance as per setting’s policies & procedures/scope of practice
___gathering data using site sanctioned methods within expected time frame of:___________
___completing expected number of screenings:
____per day
____per week ____per month
___completing expected number of evaluations:
____per day ____per week ____per month
___Other:______________________________________________________________________
____Theories/Frames of reference such as
PEO Sensory Integrative
Biomechanical NDT
Behavioral Functional Group Model
Acquistional MOHO
Psychodynamic Occupational adaptation
Cognitive Behavioral Ecology of Human Performance
DBT Rehabilitation
Sensory Processing Clinical Reasoning
Developmental Cognitive/Cognitive Disability
Motor Learning Other(s):
Other(s) : Other(s):
Administers Assessments (
FWPE item #8 Establishes service competency in assessment method
including but not limited to interviews, observation assessment tools, & chart reviews within
context of service delivery setting
)
Assessment method:
___Facility Specific Evaluation addressing:
___Occupational Performance in Areas of Occupation:
___ADL
___
IADL
___
Educatio
n
___
Work
___
Play/Leisure
___
Social
Participation
___
Rest/Sleep
___Client factors ____Performance Skills/Patterns ___Activity Demands
___Quality of Life ___Role Competence ___Adaptation
___Self Advocacy ___Health Wellness ___Occupational Justice issues
Informal methods:
___Classroom Observations ___Activity Analysis ___Informal interview
___Other(s):______________________________________________________________
Formal methods: (please indicate expectations for entry-level competency
on attached list)
Interprets (
FWPE item #9 Assists with interpreting assessment results in relation to client’s
occupational performance & goals in collaboration with occupational therapist
) by sharing
observations/information to assist occupational therapist re:
___standardized assessment results ___observations of client’s performance
___understa
nding of condition/dx
__
_client’s stated values, beliefs/mot
ivations
___inter/intrapersonal (subjective) impressions ___client identified problems/needs
___verbal reports of othe
rs (team, family/caretakers, etc.,)
___information re: client
contexts (personal, cultural, temporal, virtual, physical, social)
___Other:_________________________________________________________________
Reports (
FWPE item #10 Reports results accurately in a clear, concise manner that reflects
client’s status & goals
):
___completes standardized assessment data collection
___reports r
esults of interview/observations
___summarizes material contained in history of client/chart review
___accurate
ly reports standardized assessment data (raw scores/results) as applicable
___Other:_________________________________________________________________
Establishes Goals (
FWPE item #11 Develops client centered & occupation based goals in
collaboration with occupational therapist
):
___formulates specific, measurable, realistic, attainable, time-limited goals
___articulates suggestions for goals based on client problems/priorities, values/interests,
needs/strengths, setting scope of practice
___Other:_________________________________________________________________
INTERVENTION
Plans (
FWPE item # 12 In collaboration with OT, establishes methods, duration, & frequency of
interventions that are client centered & occupation based, Intervention plans reflect context of
setting
) relative to clients needs demonstrating clinical/pragmatic reasoning based on:
___client’s interests ___clients beliefs & values
___current context & resources ___future context & resources
___intervention plan goals ___client status
___scope of practice ___regulatory guidelines (Medicaid, Medicare, IDEA, etc.,)
___
length of stay ___resources (space/supplies/funding/time)
___
Other:_________________________________________________________________
Selects (
FWPE item #13 Selects & sequences relevant interventions that promote client’s ability to
engage in occupations
) based on:
___clients interests/roles ___clients beliefs & values
___current context & resources ___future context & resources
___intervention plan goals ___client status/current performance
___Other:_________________________________________________________________
Implements (FWPE item # 14: Implements occupation-based interventions effectively in
collaboration with clients, families, significant others, & service providers)
___maintains open attitude re: clients’ occupational performance needs/interests
___seeks & responds to feedback from clients, families, significant others, service providers
___respectfully engages in discussion with client/family/caregivers, occupational therapist, others
___provides written documentation of collaborative plan (e.g., home program)
___communication with others (documentation, at meetings, in letters or documents to other
providers) incorporates examples of occupation-based interventions used and clients response.
Activity analysis: (FWPE item #15 Grades activities to motivate/challenge client & facilitate
progress) by:
___adapting sequence of activity & objects used
___changing length/frequency/timing of sessions
___ increase and/or decrease sensory input
___ increase and/or decrease cognitive demand
___ increase and/or decrease visual/verbal cues
___ increase and/or decrease physical requirements
___ increase and/or decrease amount of physical assistance provided
___ increase and/or decrease social demand (1:1 vs. group, family vs.
peer(s), rules/norms)
___ increase and/or decrease amount of emotional/behavioral support provided
___promoting increased safety (awareness, environmental modifications for fall prevention, removing
potential sources of self injury, etc., )
___reviewing/revising expectations with client(s) relative to desired occupations, role(s) & context
___Other:______________________________________________________________________
Therapeutic Use of Self: (FWPE item #16: Effectively interacts w/clients to facilitate
accomplishment of established goals)
___communicates to address concerns in 1
st
person manner (e.g., “I statements”)
___provides clear and concise instructions
___provides timely and specific feedback
___remains calm when conveying point of view
___compromises as needed to facilitate therapeutic alliance
___demonstrates ongoing awareness of impact of own behavior on others
___displays positive regard for others; genuine in client interaction
___utilizes own strengths and personality to establish rapport & motivate clients
___provides encouraging and empathetic responses to maximize client’s participation &
occupational performance
___sets limits to allow for positive performance in therapeutic process
___Other:_________________________________________________________________
Monitors client status to modify intervention plan as needed in collaboration with occupational
therapist based on (FWPE item #17):
___fatigue ___O2 sat/respiration rate ____BP/heart rate ___frustration tolerance
___anxiety ___acuity ___concerns re: safety (please spec
ify):
____________________
___
cultural sensitivity ___cognitive status ___pain ___client distress/discom
fort
___inability to perform task ___refusal to engage
___Other:_________________________________________________________________
COMMUNICATION
Verbal & Nonverbal (
FWPE item #18 Clearly & effectively communicates verbally & nonverbally
with clients, families, significant others, colleagues, service providers, & the public
)
___uses language appropriate to the level of understanding of person with whom communicating
___utilizes examples to illustrate meaning/intent
___
uses active listening strategies (restates/paraphrases) to ensure that both parties have
shared understanding of information/plan
___uses multiple modes of communication (verbal, written, nonverbal)
___makes eye contact when appropriate
___attends t
o physical boundaries/body space
___demonstrates professional presentation/demeanor in facial expression, posture, grooming
affect, & attire
___utilizes setting’s services for translators or translation of written materials when
indicated/available
___Other:_________________________________________________________________
Written
(FWPE item #19 Produces clear & accurate documentation according to site
requirements. All written communication is legible, using proper spelling, punctuation, & grammar)
___completes computerized &/or hand-written documentation per setting protocols/formats
___uses approved institutional terminology/abbreviations
___completes all do
cumentation within expected time periods
___writes in a manner conducive to being read by recipients of services & other disciplines, free of
jargon while retaining language consistent with OTPF-Revised
___uses technology when available to check work (grammar, spelling)
___uses strategies such as proof reading, reading aloud, checking against template, asking
colleague/peer to proof if feasible
___Other:_________________________________________________________________
PROFESSIONAL BEHAVIORS
Self-Responsibility (
FWPE item #20 Takes responsibility for attaining professional competence
by seeking out learning opportunities & interactions with supervisor(s) & others)
___shares information about learning style with supervisor
___asks for help incorporating learning style in ways consistent with setting if needed
___comes to supervisio
n with list of questions/concerns & possible options for how to address
___takes in
itiative to meet with other members of team to understand their role/perspective
___reviews testing materials/manuals on own prior to observing or administering
___
seeks out, reviews & shares reading materials/articles on frames of reference/EBP, client
conditions, public law/policy
___judges when choosing to attend in-services or other continuing education opportunities based
on workload management & caseload focus
___asks for specific feedback
___consistently checks ins to clarify expectations
___
utilizes structured methods in setting to support learning (e.g., student manual, readings, in-
services, self-assessment, tracking own caseload/workload
___assertive regarding need to meet for supervision
___openly discusses concerns & identifies possible avenues for changes or improvements
__
_able to discuss &/or negotiate needs for adjustments to supervisory relationship,
expectations, caseload, environment to improve quality of experience
___Other:_________________________________________________________________
Feedback (
FWPE item #21 Responds constructively to feedback):
___engages in mutual feedback exchange (e.g., listens, clarifies, acknowledges the feedback &/or
redirection, provides examples, asks "How can I improve?";
discusses ways make active
changes, identifies what would be helpful, discusses options)
___demonstrates commitment to learning by identifying specific goals/actions to improve
behavior/performance based on feedback in
collaboration with supervisor
___processes feedback & seeks support from supervisor within context of supervisory
______________________________
relationship & learning opportunity
___utilizes tools to reflect on own performance or variables affecting performance (e.g., self
assessment on FWPE, journaling, Fieldwork Experience Assessment Tool)
___Other:_________________________________________________________________
Work Behaviors
(FWPE item #22 Demonstrates consistent work behaviors including initiative,
preparedness, dependability, & work site maintenance)
___takes initiative to address workload management
___demonstrates consistent work behaviors in task & interpersonal interactions
___attends to site cleanliness, safety & maintenance of supplies as appropriate to role
___has ideas/plans prepared for meetings/sessions
___takes responsibility to address areas of personal/professional growth
___
asks for appropriate supports or accommodations in responsible manner consistent with
federal law & site resources (e.g., open in communication, provides appropriate documentation,
requests reasonable accommodation if indicated)
___Other:_________________________________________________________________
Time Management
(FWPE item #23 Demonstrates effective time management)
___maintains own schedule
___has agenda or materials organized for meetings, sessions
___arrives on time to work, meetings, client sessions
___completes documentation/paperwork in timely manner
___Other:_________________________________________________________________
Interpersonal Skills
(FWPE item #24 Demonstrates positive interpersonal skills including but
not limited to cooperation, flexibility, tact, & empathy)
___interacts professionally with peers & colleagues
___
addresses concerns in 1
person manner (e.g., “I statements”) at appropriate times
st
___compromises as needed when negotiating workload
___
puts in necessary amount of effort to support own learning or department mission (e.g., willing to
stay late if needed, etc.,)___collaborates with others to maximize the learning experience
__
_respectfully engages in discussion when conflict arises
___Other:_________________________________________________________________
Cultural Co
mpetence
(FWPE item #25 Demonstrates respect for diversity factors of others
including but not limited to socio-cultural, socioeconomic, spiritual, & lifestyle choices)
___demonstrates awareness of own background & sensitivity to worldviews of others (clients,
family, colleagues)
___refrains from imposing one’s own beliefs & values on others
___treats everyone with dignity & respect
___gathers information about clients’ cultural values &/or spiritual beliefs
___incorporates clients’ values & beliefs into therapeutic interactions & interventions when feasible
___
considers clients socioeconomic & community resources & lifestyle when designing
intervention plans & discharge planning
___demonstrates tolerance for differences in others & willingness to work with all clients
Other expectations not noted above:
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Form 1: BPCC OTA Program Level II Fieldwork (Bossier Parish Community College)

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Completed 3 February 2021

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