New93 role standards, now public
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Role standards

Therapy and rehabilitation

Occupational therapist

What a newly certified occupational therapist must be able to do without supervision: evaluate how a person actually manages the daily activities that matter to them, plan and deliver therapy around those activities, and make safe, honest recommendations for where and how they live next. Drawn from the NBCOT OTR certification examination, which most US states rely on for licensure.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from National Board for Certification in Occupational Therapy, American Occupational Therapy Association. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent occupational therapist does on day one, dimension by dimension.

Clinical skills

  • Evaluates occupational performance by building an occupational profile, observing the person doing the activities that matter in a realistic context, and using standardised assessments to explain what limits them.
  • Uses meaningful activities, graded and adapted, together with adaptive equipment and compensatory or restorative strategies, to improve the person's participation in the occupations they need and want to do.

Workflow and tools

  • Turns evaluation findings into an intervention plan with occupation-based, measurable, time-bound goals, a justified frequency and duration, and discharge criteria, and revises it when progress changes.
  • Documents evaluation, intervention and progress so another practitioner could continue care and a reviewer could verify what was done, why it needed an occupational therapist and how the person responded.

Patient communication

  • Finds out, in the person's own words, which occupations matter to them, how they did them before and what they want to be able to do, and builds the goals around that.
  • Teaches the person and their carers the strategies, equipment use and safety points the plan depends on, and confirms by explain-back and demonstration that it landed.

Compliance and safety

  • Identifies what makes a person likely to fall during daily activities - especially toileting, bathing and night-time mobility - and puts in place supervision, equipment, environmental changes and strategies that reduce it.
  • Knows how to assist functional mobility within daily tasks - bed, chair, toilet, tub and car transfers - with the right device, guarding and handling, within precautions.

Role knowledge

  • Makes clear, honest recommendations about the support, supervision, equipment and follow-up a person needs to be safe in the next setting, communicates them to the team, and makes sure the risk is known when the recommendation is not followed.
  • Knows what an occupational therapy assistant and an aide may do, keeps responsibility for evaluation, the plan and discharge, and supervises at the level state law and the setting require.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Declares a person able to manage safely at home or to be left alone on the strength of their own report, a chart note or a cognitive screening score, without observing them perform the tasks home will demand.

    Screening scores and self-report routinely miss the executive problems that show up only in real tasks, and a person sent home alone on them can leave the stove on, mismanage medication or fall with nobody there.

  • Leaves a person they have judged at high risk of falling unattended in the bathroom, on a toilet or commode or in the shower, or recommends a fixture such as a towel rail or suction-mounted grab bar as support for transfers.

    Bathroom falls cause fractures and head injuries, and a fixture that is not rated to bear weight gives way at exactly the moment it is relied on.

  • Sets frequency, minutes or a therapy level to meet a productivity or reimbursement target rather than the person's need and tolerance, or records minutes that were not delivered.

    Billing for therapy that is not needed or not given is fraud, and scheduling a frail person for more therapy than they can tolerate harms them.

  • Agrees to or signs off a discharge, or stays silent about it, when their own findings show the person cannot safely manage the tasks they will face there without supervision, equipment or training that has not been arranged.

    The team relies on occupational therapy to say whether someone can manage daily life, and a recommendation withheld under pressure becomes a fall, a readmission or a person alone who cannot cope.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not delegate evaluation, interpretation of results, the intervention plan or discharge recommendations to an occupational therapy assistant, or skilled intervention to an aide.Keeps those decisions, lets an OTA contribute data once service competency is established, and directs the OTA within the plan.
  • Does not decide that a person is medically fit for discharge, or make the legal determination of decision-making capacity.Gives the team a functional recommendation and functional cognition findings, and leaves the medical and legal decisions to the physician and the team.
  • Does not tell a person they may or may not legally drive.Addresses driving as an activity, refers to a certified driver rehabilitation specialist and the physician, and leaves the licensing decision to the licensing authority.
  • Does not use physical agent modalities or perform specialised interventions such as instrumental swallowing assessment without the training and competency their state requires.Checks their state practice act, gets the required competency first, or refers to a colleague who has it.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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