A “Who’s Who” of Occupational Therapy

Who's Who

We have had a lot of observers and students in our clinic recently. Keeping in mind that I was one of those observers many years ago, I have to admit- they can be a drag.

Adding one more person to an already crowded treatment space can be difficult. Plus, sometimes the kids are highly distracted by a new person disrupting their routines. And you know that saying that there are “no dumb questions”? That’s a lie. Or maybe I’m just bitter because one of them asked me if I thought autism would be cured if kids had more involved parents. Really?! Are you serious?! No OT career for you, my friend.

Regardless, it got me thinking. As a parent, you know your child’s therapist, sure. But there are quite a few players in the OT world, so I thought I would break it down for a bit of a “who’s who” of occupational therapy.

1. The Occupational Therapist

  • Signature is followed by OT, OTR, or OTR/L (None of these are any better than the other, it is just based on what their state requires them to sign).
  • The current qualifications require a Master’s degree in occupational therapy with completion of supervised fieldwork experience. (Older OT’s were only required to have a bachelor’s degree.)
  • Upon completion of academic requirements, OT’s must sit for an examination from the National Board for Certification in Occupational Therapy (NBCOT) as well as obtain licensure through the state in which they wish to practice.
  • OTs can perform any duties related to occupational therapy including administering evaluations, writing goals, implementing treatment, as well as supervising occupational therapy assistants and/or fieldwork students.

2. The Occupational Therapy Assistant

  • Signature is followed by COTA or COTA/L.
  • Qualifications require an Associates degree with completion of supervised fieldwork experience.
  • Upon completion of academic requirements, COTA’s are also required to sit for an examination through the National Board for Certification in Occupational Therapy (NBCOT) and obtain licensure through the state in which they wish to practice.
  • COTAs can perform treatment under the direct supervision of an OT who co-signs all documentation. (This is why if your child’s therapist is an assistant, you should see the signature of another therapist on all of their documents.) 
  • A COTA can assist with administering assessments if they have shown competency with them; however, they shouldn’t be completing an initial evaluation.
  • Can supervise fieldwork students. 

3. The Occupational Therapy Student

  • Signature followed by OTS.
  • Can perform treatment and administer assessments under the direct supervision of a licensed therapist.
  • Required to complete several level I (typically around 40 hours total) and level II (12 weeks) fieldwork rotations.
  • For a level II student, the OTS should demonstrate skills of an entry-level therapist by the completion of the rotation.

4. The Occupational Therapy Aide

  • No credentials required, except for a high school diploma.
  • OT Aides provide supportive care and assistance to OTRs or COTAs during treatment.

5. The Occupational Therapy Observer

  • Applicants to OTR or COTA programs must complete several observation hours in various settings. They mostly just observe and ask questions about OT.

I think it is important for parents to be informed about who their child is working with. Just like you know whether you see a physician, or a PA, or a nurse practitioner. But do I really think one of these is better than the other? Nope. There are amazing OTRs, COTAs, and students. There are also terrible OTRs, COTAs and students. The letters after someone’s name don’t necessarily change the quality of therapy they provide. Don’t underestimate the eager new graduate compared to a burnt out therapist with experience. I think a parent will know if their clinician is a good fit for their child from their personal interactions with them.

People that go barking around demanding the person with the most experience or the highest degrees aren’t always going to find what they are looking for. Usually, for me, that’s a big red flag of a parent who isn’t going to be satisfied with anyone they see.

My biggest concern would be to make sure that everything is on the up and up with the company you are receiving services from. COTAs should have signatures on their documents of OTRs that they have actually met with. Students need to have a direct supervisor available within eyesight. Sometimes, in order to save money, clinics will cut corners on these things so it is important to keep yourself informed.


About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Insider Information, Occupational Therapy, Therapy Process and tagged , , , . Bookmark the permalink.

3 Responses to A “Who’s Who” of Occupational Therapy

  1. Pingback: When Does a Therapist Have the “Right” Amount of Experience? | The Anonymous OT

  2. Pingback: The OTR/COTA Relationship | The Anonymous OT

  3. Heather Hall says:

    Thank you for writing this article. It was very informative as it can all be confusing. I am currently a COTA/L and a OTS. How would I write this after my name during my fieldwork rotation?


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