Various types and methods of supervision should be used. These may include direct, face-to-face contact and indirect contact. Examples of supervision involving direct, fact-to-face contact include: observation, modeling, co-intervention, discussions, teaching, and instruction. Examples of supervision involving indirect contact include: telephone conversations, written correspondence, and electronic exchanges.

1. (1) Primary responsibility for occupational therapy services rendered by supportive personnel rests with the supervising occupational therapist.

2. (2) Occupational therapists and occupational therapy assistants must exercise their professional judgment when determining the number of personnel they can safely and effectively supervise to ensure that safe and appropriate care is provided at all times.

   1. (a) Specific frequency, methods, and content of supervision should be determined based on the following factors:

      1. 1. Complexity of Clients' needs;
      2. 2. Number of Clients;
      3. 3. Diversity of Client conditions;
      4. 4. Service Competency of the occupational therapist and the occupational therapy assistant;
      5. 5. Type of practice setting and the administrative requirements of that setting; and
      6. 6. Other regulatory requirements.

   2. (b) Supervision may necessarily be more frequent than the minimum required by the practice setting or regulatory agencies depending upon:

      1. 1. The complexity or unpredictability of the Client's needs or the Occupational Therapy Service Delivery Process.
      2. 2. The number of Clients and the diversity of their conditions within a particular practice setting.
      3. 3. The professional judgment of the occupational therapist or occupational therapy assistant, that additional supervision is necessary to ensure the safe and effective delivery of occupational therapy services.

3. (3) Supervision of the Occupational Therapy Aide. Client-related activities may be delegated by the occupational therapist or the occupational therapy assistant only when the Occupational Therapy Aide has been trained and has demonstrated competency for the task, including equipment use, has been specifically instructed on how to carry out the task with the specific Client, and knows the precautions, signs and symptoms for the specific Client that indicate a need to seek assistance from the supervisor. The occupational therapist or occupational therapy assistant supervisor should consider the following additional factors before delegating selected Client-related tasks to the Occupational Therapy Aide:

   1. (a) The predictability of the task's outcome.
   2. (b) The situation of the Client and stability of the environment are such that the Occupational Therapy Aide will not be required to exercise judgment, interpretation or adaptation.
   3. (c) The Client has demonstrated some previous performance ability in executing the task.
   4. (d) The task routine and process have been clearly established.
4. (4) Supervision of supportive personnel must be documented with the date, method of supervision used, nature and extent of supervision, and name and designation of all persons participating in the supervisory process. Documentation of the supervision of the Occupational Therapy Aide must be done at least weekly and more often as needed.