New93 role standards, now public
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Role standards

Therapy and rehabilitation

Occupational therapy assistant

What a newly certified occupational therapy assistant must be able to do under an occupational therapist's supervision: carry out the intervention plan through meaningful daily activities, teach people and their carers safe ways to manage them, record what the therapist needs, and recognise what belongs to the therapist. Drawn from the NBCOT COTA 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 therapy assistant does on day one, dimension by dimension.

Clinical skills

  • Carries out the occupational therapist's plan through meaningful daily activities, grading and adapting them and training equipment and strategies, while keeping to every medical precaution.
  • Assists functional mobility within daily activities - bed, chair, toilet, tub and car transfers - with the right device, guarding and handling, within precautions.

Workflow and tools

  • Documents each session accurately - the activity, the assistance and cues given, the person's response and actual time - without recording interpretations or goal changes that belong to the therapist.
  • Collects information on how a person performs daily activities and, once the therapist has established service competency, administers assessments reliably, reporting the results for the therapist to interpret.

Patient communication

  • Confirms that a person or carer can explain and show the key steps of a technique or strategy, and re-teaches differently when they cannot.
  • Adapts communication for people with dementia, delirium or aphasia so they can take part in daily activities, and recognises a sudden change in cognition as a medical concern rather than behaviour.

Compliance and safety

  • Knows what makes a person likely to fall during daily activities and how supervision, equipment and the environment reduce it, and applies that in every session.
  • Escalates a safety concern or change in a person's condition to the supervising therapist or the right clinician so that it is acknowledged and acted on, and follows up until it is.

Role knowledge

  • Works within the occupational therapist's plan and the OTA's legal scope, recognises when a request or a person's need goes beyond it, and takes it to the therapist rather than acting.
  • Knows the roles of nursing, physical therapy, speech-language pathology and others, shares what they observe in daily activities with the right person, and acts on their input.

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.

  • Teaches or carries out a daily task in a way that breaks a stated medical precaution - for example letting a person bend past hip precautions to reach their feet, push up with their arms against sternal precautions, or bear weight against a weight-bearing order.

    A hip can dislocate, a healing breastbone can separate and a fixation can fail, and a technique taught wrongly is repeated every day at home.

  • Would leave a person the plan identifies as at high risk of falling unattended in the bathroom, on a toilet or commode or in the shower, or approves a towel rail or suction-mounted grab bar as support for transfers.

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

  • Would document minutes or treatment that were not delivered, backdate a note or write it as if it were made on time, or sign for someone else.

    The therapist plans on that record and the payer pays on it, so a false entry misleads care and is fraud.

  • Carries out or documents an evaluation or re-evaluation, interprets results to set or change goals, writes or changes the intervention plan, or discharges a person on their own.

    These are the occupational therapist's responsibilities, and a person whose plan or discharge rests on an OTA's judgement has lost the evaluation the law requires before those decisions.

04Outside the role#

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

  • Does not evaluate, interpret assessment results, set or change goals, write the intervention plan, or decide on discharge.Contributes observations and data, and takes the decision to the supervising occupational therapist.
  • Does not administer a standardised assessment until the occupational therapist has established service competency for it.Asks the therapist to establish competency or to administer it themselves.
  • Does not practise without the supervision their state law and the setting require, which varies by state.Knows their state's supervision rule and confirms the supervising therapist and the plan are in place before treating.
  • Does not use physical agent modalities without the training and competency their state requires.Checks the state practice act and gets the required competency first, or leaves the modality to the therapist.

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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