OTR-OTA Relationships: Grow and Learn Together

pinky-swear cherylholt pixabayOTR-OTA Relationships:  Grow and Learn Together

by Marie Toole, MS, OTR/L

on the School Tools From Your Pediatric   Occupational Therapist Blog



One of the joys of working in the schools is the relationships you make with the teachers and other staff members.  One of the more important relationships to feather is that with the custodian as he or she will be your go-to person for a myriad of reasons.  Another person is the tech teacher for all things computer, keyboard, or technology related.   BUT…..the most important relationship there is in school-based occupational therapy is that between the Registered Occupational Therapist (OTR) and the Occupational Therapy Assistant (OTA).   I have been working with COTA’s (Certified OTR’s) for many years, first in the hospital setting and for the past 21 years in the schools.  I have learned a thing or two in that time about fostering that relationship and I wanted to share my perspective as an OTR who is supervising two COTA’s with more experience than me!

Although these suggestions can help all OTRs who are supervising COTA’s, they can be especially beneficial to those of you who are new graduates and will supervising COTA’s for the first time or someone who has transitioned into the school setting.   Here are a few of my suggestions:

Know your state guidelines for supervision.  As the OTR, it is your responsibility to know and understand your state guidelines for supervising COTA’s.  The American Occupational Therapy Association shares an informative outline for state-by-state guidelines.  Your license is on the line each and every time a treatment session commences between your COTA and the students on your caseload.  You are responsible even if your COTA carries her own caseload.  You need to know what is happening with those students. office-upsplash pixabay Your state licensing act will be very specific about how much supervision time is required.  My COTA’s have almost 30 years of experience each.  We have been working together a long time.  We have a formal sit-down time of one hour per week but have lots of more informal time to catch up and discuss cases.  I spend half my week at each school so there is plenty of face time at each building.  Make sure you both are comfortable with the amount of formal and informal supervision time you spend together.  You should always err on the side of caution and use your best judgement when deciding how and when supervision should occur.  Does it need to be sit down time? Do you attend IEP/evaluation meetings together?   Do you meet each morning over coffee?  Whatever works for you and meets the letter of the law is good.  If it doesn’t work or you find yourself skipping it…you need a different system.  Try different methods, meeting times, and scheduling.  Make it work so you both feel comfortable and ethical.

Understand each other’s role.  It is very important to understand the scope of practice for the COTA and OTR.  See the Standards of Practice for OT at this link, as well as the AOTA Guidelines for OTA Supervision for specific details.  The OTR performs most of the evaluations but there is a role that the COTAs can play as well.  Although the COTAs cannot interpret results, sometimes they have more time with the students and have a better relationship with them.  In this light, they can perform portions of evaluations under the direction of the OTR or complete classroom observations to add anecdotal information.  That is valuable information that will assist in making meaningful and appropriate treatment sessions.

diversity-ambroochizafer pixabayHave Mutual Respect.  I think this is probably the most important aspect of the OTA/OTR relationship.  It needs to be a true partnership in every sense.  Trust needs to be there as does open lines of communication.  When I first left the hospital setting and was transitioning to the schools for work,  the COTA I was to supervise had been working in the schools for years.  She had vast experience and knowledge that I soaked up and used to better myself.  I was coming from a medical model background and it took time to make the transition to the education/related service delivery model instead.  She helped me navigate the intricacies of IEP’s and school-based OT evaluations.  She schooled me on the timelines and regulations that go along with all things school related.  She was and still is a wealth of knowledge to this day.  I could not have done this job without her.   Yes I was her supervisor, but I was never her superior, nor will I ever be.  We have a wonderful working relationship and enjoy each other’s company on the occasional social events outside of the school day.  We have presented several workshops together and we often finish each other’s sentences.  Years of working together with both of my COTAs has shown me what mutual respect can look like.    Knowing your limits and what each can bring to the table will greatly enhance your relationship.

Coordinate your Professional Development.  One area that we work on is continuing education and professional development.  We almost never go to the same workshops.  Going to different workshops or conferences brings more knowledge into the working relationship.  We share what we learned and try out new ideas or treatment methods and have an honest and true discussion about merits and pitfalls.  You have to be able to give and take and at times agree to ditch something that is not working for something better.  Bettering yourself professionally only enhances that relationship.

businessman-ravadosa pixabayHave a Way to Communicate quickly.  Sometimes I am in one building and something happens at the other building that needs immediate or quick attention.  Sharing schedules and telephone contact information only enhances your communication.  We use text messaging as well as phone messages and email as ways of communicating quickly.  The school secretary can always find me if it is a true emergency.  Sometimes, if there are snow days or holidays, I may not get to one of the buildings for several days.  Things come up.  So have a way of communicating that works for both of you.

Communicate, Communicate, Communicate!   Speaking of communicating…do it often!  Open lines of communication are a MUST in this job.  Do not let things fester or boil over.  We need to work as a team to get the best from our students.  The best and easiest way to do that is to talk, and talk, and talk some more.  We often bounce ideas off each other or ask questions and even think out loud.  Often I am typing evals or writing IEP’s if I am not working directly with students.  My favorite thing is when my COTAs say “When you have a minute, I need advice/have a question/want to try something, etc.”  It lets me know they need something but gives me a chance to finish up what I am working on to shift gears and give them the full attention the request deserves.  Do not be checking email or your phone while doing this.  Listen attentively and actively; and if you need time to digest or think about their request, let them know.  Sometimes I don’t have all the answers…actually more often than not I don’t.  It is okay to say that and to gather the information and report back.  It is not okay to guess and make a mistake because you thought you had to have an answer right then and there.  “Let me get back to you on that” is a great phrase to use.  Sticky notes are my absolute favorite things ever (why didn’t I think of that invention?).  My COTAs leave me sticky notes so they won’t forget to ask me something the next time they see me.  Have a spot where they can leave you notes/messages/forms that need signing, etc., and that they do not want to forget.  I have a mailbox and share a desk at each building.  It is the first place I check when I arrive at each building.    My COTAs know it is the place to leave all important things that need my attention.  Make sure you have a place that is safe and secure so that wandering eyes do not necessarily see information that is private or sensitive.

Know each other’s strengths and weaknesses.  This goes back to communication.  You must share and acknowledge the areas that are challenging for each of you.  One of my COTAs is “technologically challenged” and she readily admits it.  I help her with all things team geralt pixabaycomputer and she balances my impulsiveness.  When the ebb and flow of the school year gets crazy and there are all kinds of evals to complete, this is when you need to be able to say “Can you shift something to help me with this?”  When you understand each other’s strengths and challenges ,you can play off each other and complement services to fit both people’s needs.   It is a give and take and with time this should be a comfortable arrangement.  When you both share the same drive and passion for working with children, this is easy.  When you are out of sync it takes work.

Understand that life happens.  I think this is the best piece of advice I can give you.  Personal issues come up, there are weddings and  graduations to attend, babies and grandchildren are born,  kids or parents get sick, loved ones die….all these things need to be put into perspective.  As I tell my COTA’s (and anyone who will listen), “They are not going to name the school after you!”  Giving each other the needed time off to attend to family needs is a must.  Family comes first and when a crisis hits, you want to know that your school family will be there to support you.  Being flexible and understanding goes a long way in building trust and respect.  Allowing each other the room tolive life to the fullest  will guarantee a mutually respected, complementary, trusting OTR-OTA relationship that others will be envious of.


**This blog is dedicated to the two amazing COTA’s I work with.  Penny and Judy …I thank you from the bottom of my heart for the helping me to grow as a supervising OTR and for the trusting, caring, mutually respectful relationship we have.  You Rock!  I will miss you as I start my new adventures in life!



Marie TooleMarie L. Toole, MS, OTR/ L, is a pediatric occupational therapist with 28 years experience in NICU, Early Intervention, and private practice with the last 20 years spent working in public schools. She is NBCOT and SIPT certified as well as a member of AOTA and NHOTA.  She lives in southern New Hampshire and can be reached at marietoole320@gmail.com.  Follow her on Twitter @MarieTooleOTNH, on Pinterest marietooleNHOT, and on School Tools for Pediatric Occupational Therapists  where she tweets, pins, and posts about OT, education, autism, and sensory integration, as well as other school related topics.


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OTR-OTA Relationships: Grow and Learn Together