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The AOTA Fieldwork Performance Evaluation (for the Occupational

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NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist for use with:
The AOTA Fieldwork Performance Evaluation (for the Occupational Therapy Student)
Site: ______________________________________________ Date: __________________________
Contact Person: ____________________________________ Phone #: _______________________
Email: ____________________________________________ Fax #: _________________________
I. FUNDAMENTALS OF PRACTICE
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:
Demonstrates concern for well-being & safety of recipients of services (beneficence)
Intentionally refrains from actions that cause harm (nonmaleficence)
Respects right of individual to self rule (autonomy, confidentiality)
Provides services in fair & equitable manner (social justice)
Complies with institutional rules, local, state, federal, international laws & AOTA documents
applicable to profession of occupational therapy (procedural justice)
Provides comprehensive, accurate, & objective information when representing profession (veracity)
Treats colleagues & other professionals with respect, fairness, discretion, & integrity (fidelity)
Other: __________________________________________________________________________
FWPE item #2: Adheres consistently to safety regulations. Anticipates potentially hazardous situations & takes
steps to prevent accidents for clients & staff members throughout fieldwork related activities including:
record review OSHA/BBP
medication side effects I.V./lines
post-surgical ER codes/protocols
infection control restraint reduction
fall prevention HIPAA
swallowing w/c locks/bedrails/call button
food allergies Vital signs (BP, O2)
ambulation status Trach/Ventilator monitoring
behavioral system/privilege level Fire/Evacuation/Lockdown
(e.g., locked area/unit, on grounds)
CPR certification
1:1 for personal safety/suicide precautions Communication re: change in status
sharps count Other: ______________________
environment set up (no clutter, spills, unsafe items, etc.)
FWPE item #3: Uses sound judgment in regard to safety of self & others during all fieldwork related activities:
adheres to facility policies & procedures
thorough chart reviews/checks MD orders/parent agreement for IEP
consistently analyzes space for potential hazards based on client risk factors
addresses anticipated safety concerns
provides safe supervision of client based on client status
accurately identifies ambulation needs/functional mobility status
uses safe transfer techniques/equipment according to protocols
determines wheelchair positioning needs (e.g., footrests, cushions, trays/supports, etc.)
correctly positions client (e.g., in chair/bed; at desk, for feeding, etc.)
provides supervision of client based on client status to ensure safety
demonstrates proper splinting techniques such as
correct selection of type
correct selection of materials
making adjustments as needed
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
2
FWPE item #3 (con’t): Uses sound judgment in regard to safety of self & others during all fieldwork related
activities:
operates equipment according to training protocols
attends to professional boundaries in therapeutic use of self-disclosure
effectively limit sets & redirects client(s)
establishes safe group climate (reinforce expectations/group rules or contract)
Other: _________________________________________________________________________
II. BASIC TENETS
FWPE items #4-6: Clearly, confidently, & accurately communicates values/beliefs of occupational therapy
profession, occupation as method/outcome, roles of OT/OTA as collaborative team appropriate to setting, using
examples & language consistent w/ OTPF:
verbally via written material (e.g., handout, article, sample job description, etc.)
Communicates about these 3 tenets with:
client families/significant others OTA PT PTA SLP Teacher
Aides MDs Nursing LISCW Psychologist CRTS CRC AT MT
3
rd
party payers regulatory bodies general public (e.g., promotional materials, in-services)
Others: __________________________________________________________________________
Communicates about these 3 tenets in:
client intervention/education in-services, brochures, bulletin boards,
meetings media announcements, etc.
documentation/correspondence Other: ___________________________________
Communicates re: occupation using:
examples of occupation-based assessment tools
citations of literature/evidence base for use of occupation relative to person/context
terms & examples specific to person, organization, population (facility mission/level of care/service
delivery)
OTPF language (revised) verbally & in written work
current AOTA official documents/fact sheets
Other: __________________________________________________________________________
Communicates re: OT/OTA roles using:
current AOTA official documents
federal & state laws/practice acts governing evaluation/intervention
state laws/practice acts re: role of OT/OTA
Other __________________________________________________________________________
FWPE item # 7: Effectively collaborates with clients, family/significant others throughout occupational therapy
process (evaluation, intervention, outcome):
seeks & responds to client feedback incorporates client/family priorities & interests
maintains client focus in sessions tailors client/family education to individual needs
respectfully engages in discussion when conflict arises to address concerns
provides written documentation of collaborative plan (e.g., home program)
Other: __________________________________________________________________________
III. EVALUATION AND SCREENING
FWPE item #8: Articulates clear & logical rationale for evaluation process:
describes reasoning based on client, condition, context, FOR/EBP
explains choice of occupation-based &/or client factors
discusses psychometric properties (validity & reliability) of assessment tool
Other: __________________________________________________________________________
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
3
FWPE item #9: Selects relevant screening/assessment* methods (*see assessment chart):
Selects assessment according to:
client condition client priorities current context future context
evidence psychometric properties/validity/reliability
___Selects assessment based on Theories/Frames of reference pertinent to setting 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 Coping
Other: Other:
Other: Other:
FWPE item #10: Determines occupational profile & performance through appropriate assessment methods
(see assessment chart for specific tools/competency expectations)
FWPE item # 11: Assesses client factors & contexts that support or hinder occupational performance (see
assessment chart for specific tools/competency expectations)
FWPE item #12: Obtains sufficient/necessary information from relevant resources such as client, families,
significant others, service providers, & records prior to & during evaluation process via:
thorough record/chart review
client interview
observation of client performance in areas of occupation (ADL/IADL, Education, Work, Play,
Leisure, Social Participation, Rest/Sleep)
assessment instruments addressing occupational performance (see assessment chart)
observation of client performance skills (motor & praxis, emotional regulation, cognitive,
communication/social, sensory-perceptual)
assessment instruments addressing client performance skills
observation of client performance patterns (roles, routines, rituals, habits)
assessment instruments addressing client performance patterns (see assessment chart)
assessment of client factors (see assessment chart)
observation in current context(s) (personal, physical/environment, social, cultural, temporal, virtual)
gathering information re: anticipated future context(s)
gathering input from family/significant others/service providers (PCA, nursing, teachers, team members,
referral source)
discussion of psychosocial factors that effect performance/disposition (e.g., motivation, adjustment,
anxiety, self-concept, QoL/participation, etc.,)
assessment instruments that address psychosocial factors that effect performance/disposition
(see assessment chart)
Occupational Profile addresses
Who is client? Client problems Client values/interests/needs
Why seeking services? Occupational history Client successes/strengths
Priorities Influence of environment/context
Other(s): ___________________________________________________________________________
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
4
FWPE item #13: Administers assessments in uniform manner to ensure valid/reliable results:
adheres to assessment tool protocols/procedures (format, script, item use, scoring, etc.)
FWPE item #14: Adjusts/modifies assessment procedures based on client needs, behaviors, cultural variables
such as:
fatigue O2 sat/respiration rate BP/heart rate frustration tolerance
anxiety acuity concerns re: safety (please specify): ________________________
cultural beliefs, values, customs, expectations cognitive status pain
language attention inability to perform task refusal
Other: ___________________________________________________________________________
FWPE item #15: Interprets evaluation results to determine client’s occupational performance strengths &
challenges by integrating quantitative & qualitative information such as:
standardized assessment results observations of client’s performance
information re: client condition/dx client’s stated values, beliefs/motivations
subjective/objective impressions identified problems/needs
verbal reports of others (team, family/caretakers, etc.)
Other: __________________________________________________________________________
FWPE item #16: Establishes accurate & appropriate plan based on evaluation results, integrating factors such as
client’s priorities, context(s), theories & evidence-based practice:
integrates information with client priorities to create plan relative to setting/scope of practice
incorporates client’s present and future context(s) (personal, cultural, temporal, virtual, physical,
social) in clinical reasoning/intervention planning
utilizes summarized evidence from Critically Appraised Topics/Papers (CATs/CAPs) to guide
decision-making/reasoning (http://www.otcats.com/index.html
)
uses EBP approach (e.g., PICO question: Person, Intervention, Comparison, Outcome) to search
for/find relevant evidence according to client priorities & frame of reference
critically appraises findings (e.g., CAT: http://www.otcats.com/template/index.html; or
CanChild (www.canchild.ca/en/canchildresources/educationalmaterials.asp#CriticalReview
)
uses structured method to review evidence (journals, case studies, consensus of experts)
creates realistic plan reflective of accurate understanding of client abilities and potential
sets goals consistent with client priorities, theory/frame of reference, evidence, & setting
Other: __________________________________________________________________________
FWPE item #17: Documents results of evaluation process in manner that demonstrates objective measurement of
client’s occupational performance:
records observed performance in areas of occupation (ADL/IADL, Education, Work, Play, Leisure,
Social Participation, Rest/Sleep) as per setting’s policies & procedures/scope of practice
accurately reports standardized assessment data (raw scores/results) as applicable
formulates goals that are specific, measurable, realistic, attainable, time-limited
utilizes outcome measurement methods when available or per setting policies
Other: __________________________________________________________________________
IV. INTERVENTION
FWPE item #18: Articulates a clear and logical rationale for intervention process:
verbally in supervision sessions verbally in client sessions
via written assignments (journal, case study) in pt education materials
via sharing EBP article reviews in written documentation
in rounds/team meetings via in-services
Other: ___________________________________________________________________________
Egg
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
5
FWPE item #19 (part 1): Utilizes evidence from published research & relevant resources to make informed
decisions, with supervisor/client/team/caregiver/agency (as appropriate) using information found in:
Critically Appraised Papers (CAPs)/Critically Appraised Topics (CATs)
(www.aota.org/Educate/Research.aspx
; http://www.otcats.com/index.html)
articles from peer reviewed journals (e.g., AJOT, OTJR, etc.,)
FWPE item #19 (part 2)): Utilizes evidence from published research & relevant resources to make informed
decisions with supervisor/client/team/caregiver/agency (as appropriate) using:
discussion/sharing of material learned via other sources (textbooks, OT Practice, coursework,
association website searches, conferences, etc.,) in supervision
Other: __________________________________________________________________________
FWPE items #20 & 21: Chooses relevant occupations that motivate & challenge clients to facilitate meeting
established goals based on clients’:
condition/status stated interests beliefs & values psychosocial needs
progress current context & resources future context & resources
Other: __________________________________________________________________________
FWPE items # 22 & 23: Implements client centered & occupation based intervention plans considering areas of
occupation/outcomes such as:
Role competence ADL Play Work IADL Sleep/rest
Social participation Education Leisure Adaptation Health/wellness
Quality of life Self advocacy Occupational (social) justice
Other: __________________________________________________________________________
FWPE item #24: Modifies task, approach, occupations, & environment to maximize client performance by:
adapting sequence of activity & objects used changing length/frequency/timing of sessions
 sensory input  cognitive demand
 visual/verbal cues  physical requirements
 amount of physical assistance provided
 social demand (1:1 vs. group, family vs. peer(s), rules/norms)
 amount of emotional/behavioral support provided
promoting safety (awareness, education/feedback, environmental modifications, removing
potential sources of injury, etc., )
creating adaptive device(s)
reviewing/revising expectations with client(s) relative to desired occupations, role(s) & context
Other: __________________________________________________________________________
FWPE item #25: Updates, modifies, or terminates intervention plan based upon careful monitoring of client’s
status:
accurately represents client progress verbally & in documentation
accurately reports change in client status (e.g., illness, affect) affecting performance
frequently re-evaluates effectiveness of intervention based on goal achievement and/or
outcome measurement
subjective data consistent with objective data reported verbally or in documentation
FWPE item # 26: Documents client’s response to services in a manner that demonstrates efficacy of
interventions via:
progress reports with quantitative data (goal attainment scaling, excel charts/graphing,
re-assessment, score comparison, outcome measurement results)
narrative summary with qualitative descriptors according to problems identified/goals achieved
Other: __________________________________________________________________________
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
6
V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES
FWPE item # 27: Demonstrates through practice or discussion ability to assign appropriate responsibilities to the
occupational therapy assistant & occupational therapy aide:
describes or assigns duties commensurate to educational level, assessed competency,
federal & state laws regulating use of supportive personnel
considers number of clients, complexity of needs, type of setting, safety
describes or provides type of supervision required (close, direct, line of sight)
provides reference for state statutes/regulations governing performance of services & definitions of
supervision (www.aota.org/Practitioners/Licensure/StateRegs/Supervision/36455.aspx
)
Other: __________________________________________________________________________
FWPE item # 28: Demonstrates through practice or discussion ability to actively collaborate with occupational
therapy assistant:
describes &/or engages in tasks with OTA relative to job description &/or scope of practice as
defined by state guidelines (e. g., soliciting contributions to evaluation process &/or delegating
implementing & adjusting intervention plan) in accordance with AOTA Official Guidelines for
Supervision, Roles, & Responsibilities (www.aota.org/Practitioners/Official.aspx)
completes alternate assignment to meet objective (please describe or attach):
FWPE item # 29: Demonstrates understanding the costs and funding related to occupational therapy services at
this site:
discusses political issues/policy decisions that affect funding
outlines how services are regulated and funds allocated pertaining to local and/or federal laws such as
IDEA, ADA, Medicare/Medicaid, etc.
describes agency billing/payment system (grant funding, types of insurance, private pay, cost- share,
state/federal funding)
describes eligibility criteria for reimbursement and discharge
identifies possible resources available (grants, community partnerships, sources for donations,
fundraising ideas, etc.,)
demonstrates awareness of risk management and liability as part of costs and quality care
demonstrates awareness of budgetary implications when procuring/using supplies
Other: __________________________________________________________________________
FWPE item #30: Accomplishes organizational goals by establishing priorities, developing strategies, and
meeting deadlines:
articulates setting’s mission & values
schedules meetings/sessions according to facility expectations
begins & ends sessions on time
attends meetings on time
reports in meetings in concise manner
meets paper work deadlines per policy & procedures
prioritizes workload according to policies & caseload demands
uses time management strategies (checklists, templates, to-do list)
Other: __________________________________________________________________________
FWPE item #31: Produces the volume of work required in the expected time frame:
is self directed in managing schedule to meet workload/caseload
gathers necessary evaluation data within allotted amount of time - specify:
completes evaluation write-up with documentation co-signed & in chart/record within:
8 hours 24 hrs 1 week other: ____________________________
conducts (specify number) of evaluations: per day per week per month
serves caseload commensurate with entry-level therapist (please specify # of clients/groups):
_____/____ per day ____/____ per week ____/____ per month
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
7
FWPE item #31 (con’t): Produces the volume of work required in the expected time frame:
completes progress note documentation within expected time period of: ______________________
completes (specify number) of progress notes: per day per week per month
Other: __________________________________________________________________________
VI. COMMUNICATION
FWPE item #32: Clearly & effectively communicates verbally and nonverbally with clients, families, significant
others, colleagues, service providers, and the public:
uses language appropriate to the recipient of information, including but not limited to funding
agencies & regulatory agencies
gauges use of terminology to level of understanding of person with whom communicating
utilizes examples to illustrate meaning/intent
uses active listening strategies (restates/paraphrases) to ensure both parties have shared
understanding of information/plan
uses multiple modes of communication (verbal, written, nonverbal)
makes eye contact when appropriate
attends to 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: __________________________________________________________________________
FWPE item # 33-34: Produces clear and accurate documentation according to site requirements. All written
communication is legible, using proper spelling, punctuation, and grammar:
completes computerized &/or hand-written documentation per setting protocols/formats
uses approved institutional terminology/abbreviations
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: __________________________________________________________________________
FWPE item #35: Uses language appropriate to the recipient of the information, including but not limited to
funding agencies & regulatory agencies:
writes in a manner conducive to being read by recipients of services & other disciplines, free of
jargon, retaining language consistent with OTPF-Revised (client profile, analysis of occupational
performance (areas, skills/patterns, influence of context(s), client factors)
gauges use of terminology to level of understanding of person with whom communicating
utilizes examples to illustrate meaning/intent (verbal/demonstration)
takes into account cultural differences, providing handouts in client’s first language, when
available, providing illustrations with written content
adjusts content (verbal/nonverbal) in response to clients/family/caregivers colleagues’ response
provides clear & concise instructions
Other: __________________________________________________________________________
VII. PROFESSIONAL BEHAVIORS
FWPE item #36: Collaborates with supervisor(s) to maximize the learning experience:
asks supervisor for specific feedback
consistently checks in to clarify expectations
shares information about learning style with supervisor and asks for help as needed to adjust
utilizes structures in setting to support learning (e.g., student manual, reviews expectations,
tracks own caseload/workload)
asserts need to schedule supervision meetings
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
8
FWPE item #36 (con’t): Collaborates with supervisor(s) to maximize the learning experience:
discusses concerns & identify possible avenues for changes or improvements
discusses &/or negotiates need for adjustments to supervisory relationship, performance
expectations, caseload, & learning environment to improve quality of experience (e.g., reviews
AOTA Fieldwork Experience Assessment Tool)
Other: __________________________________________________________________________
FWPE item # 37: Takes responsibility for attaining professional competence by seeking out learning
opportunities & interactions with supervisor(s) & others:
comes to supervision w/ list of questions/concerns & possible options for how to address them
takes initiative to meet w/ 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, etc.,
pilots new program ideas/improvements (e.g., assessment tools, outcome measures, groups, new
forms or procedures etc.,) when feasible/available
collaborates in research design or data collection with others (per IRB approval)
exercises good judgment when choosing to attend in-services or other continuing education
opportunities (e.g., based on workload management, caseload focus, scope of practice)
Other: __________________________________________________________________________
FWPE item #38: Responds constructively to feedback:
engages in mutual feedback exchange (e.g., listen, clarify, acknowledge feedback &/or redirection,
provide examples, ask "How can I improve?"; discuss ways to make active changes, identify what
would be helpful, discusses options)
demonstrates commitment to learning by identifying specific goals/actions to improve behavior/
performance in collaboration with supervisor
processes feedback & seeks support from supervisor appropriate to context of supervisory
relationship & learning opportunity
utilizes tools to reflect on own performance or variables affecting performance (e.g., self-assessment
on FWPE, journaling, FEAT)
takes initiative to contact academic program resource persons for support if needed
Other: __________________________________________________________________________
FWPE #39: Demonstrates consistent work behaviors including initiative, preparedness, dependability, and work
site maintenance:
takes initiative to address workload management
demonstrates consistent work behaviors in both task & interpersonal interactions
attends to site cleanliness, safety & maintenance of supplies as appropriate to role
comes prepared for meetings/sessions
takes responsibility to address areas of personal/professional growth
proactively plans for & requests appropriate supports or accommodations in manner consistent with
federal law & site resources (e.g., open in communication, provides appropriate documentation,
requests reasonable accommodation if indicated)
Other: __________________________________________________________________________
FWPE item #40: Demonstrates effective time management:
monitors, maintains & adapts own schedule in accordance w/ site’s priorities
organizes agenda or materials for meetings & sessions
conducts evaluation &/or intervention sessions w/in allotted time, inclusive of set-up/clean-up
arrives on time to work, meetings, client sessions
completes documentation/paperwork in timely manner
completes learning activities by due dates
NEOTEC Inc., Level II Fieldwork Site Specific Objectives Checklist
9
FWPE item #41: Demonstrates positive interpersonal skills including but not limited to cooperation, flexibility,
tact, and empathy in social interactions w/ clients/patients, peers & colleagues:
communicates concerns in 1
st
person manner (e.g., “I statements”)
remains calm when conveying point of view when conflict arises
compromises as needed when negotiating workload
demonstrates flexibility to support own learning or department mission (e.g., extra effort, stay late if
needed, etc.,)
demonstrates ongoing awareness of impact of own behavior on others
displays positive regard for others
demonstrates effective use of self disclosure (e.g., moderate)/therapeutic use of self to build rapport,
establish alliance(s) & motivate others (peers/colleagues/clients)
provides genuine encouragement to maximize client’s participation/performance
provides timely & specific feedback
sets limits to maintain safety & support positive behavior/performance improvement
FWPE #42: Demonstrates respect for diversity factors of others including but not limited to socio-cultural,
socioeconomic, spiritual, and lifestyle choices:
demonstrates awareness of own background and sensitivity to worldviews of others (clients, family,
colleagues)
refrains from imposing own beliefs & values on others
maintains clients’ dignity
gathers information about clients’ cultural values &/or spiritual beliefs
incorporates clients’ values & beliefs into therapeutic interactions & interventions
considers clients socioeconomic & community resources & lifestyle when designing intervention
plans & discharge planning
demonstrates tolerance for differences in others & willingness to work w/ all clients
Other expectations not noted above:
_________________________________
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The AOTA Fieldwork Performance Evaluation (for the Occupational

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Completed 5 May 2022

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