Level II fieldwork supervision is intended to begin direct then slowly progress to be less direct, promoting the student’s independence, following ACOTE® standard C.1.13 (ACOTE®, 2018). This varies, however, based on site, setting, and the complexity of the client. The progression of supervision is intended to prepare the student for entry-level competence (AOTA, n.d.).
In a study completed by Andonian (2017) occupational therapy (OT) students’ perceived self-efficacy was positively related to their experience of supervision. The specific positive characteristics included:
- Gradual building of expectations and responsibilities
- Communicating objectives and duties
- Providing opportunities to actively make decisions and choices
- Open and warm communication
- Supervision that was supportive and responsive to the students’ needs
Florida Administrative Regulations 64B11 – 2.011 Definition of Supervised Fieldwork Experience
Supervision, for purposes of this rule, shall mean that the occupational therapist student or occupational therapy assistant student has daily direct contact at the worksite with his or her supervisor. The term “supervised fieldwork experience,” as provided for in Section 468.209(1)(c), F.S., shall mean:
(1) For an occupational therapy student, experience at an occupational therapist level occurring in a clinical setting affiliated with an educational institution in occupational therapy for a minimum of 6 months, with the fieldwork experience supervised by a licensed occupational therapist.
(2) For an occupational therapy assistant student, experience at an occupational therapy assistant level occurring in a clinical setting affiliated with an educational institution in occupational therapy for a minimum of 2 months, with the fieldwork experience supervised by a licensed occupational therapist or by a licensed occupational therapy assistant under the supervision of a licensed occupational therapist.
As of October 2024, the 64B11-2.011 Definition of Supervised Fieldwork Experience regulation is currently under review for clarification. For OTs in Florida, please check the Florida Board of Occupational Therapy website for further updates.
Models of Supervision in OT Fieldwork Education
- One-to-One (1:1): one student is paired with one fieldwork educator. This is a more traditional model.
- Collaborative (1:2): two or more students work with a single fieldwork educator. This model provides more collaboration, cooperation, and peer-mentoring among students. The benefit of this model could be that students become less dependent on frequent direct supervision from the fieldwork educator
- Multiple Mentorship (2:1): one or more students work with a team of fieldwork educators who share responsibility for supervision, mentoring, and evaluating the students. This is beneficial for educators who do not work full-time or have smaller, unique caseloads. Students have access to more practitioners and a variety of clients.
- Faculty-Led Mentorship: one or more students is placed in a fieldwork setting where a faculty member from their program acts as their fieldwork educator. This engages students and faculty in the learning process and decreases the demand for a supervisor from the site.
- Fieldwork where no OT services exist: this is where there is no full-time or permanent OT. Student development in this setting focuses on direct practice skills and program development. In this case, the fieldwork educator must have at least 3 years of experience, provide 8 hours of direct supervision, and provide indirect supervision and support as needed. A staff member at the site must be available for day-to-day supervision.
(AOTA, n.d.)
The collaborative (1:2) model of supervision has been more widely used among fieldwork sites in recent years. The article Collaborative Fieldwork Supervision Model Supports Identified by Occupational Therapy Fieldwork Educators is a great resource for more information.
Rogers, O., Hanson, D. J., Graves, C., Turner, T., & Klug, M. G. (2023). Collaborative fieldwork supervision model supports identified by occupational therapy fieldwork educators. Journal of Occupational Therapy Education, 7(2). https://doi.org/10.26681/jote.2023.070215
The Discrimination Model
Developed in 1997 by Janine Bernard, the discrimination model involves the dual functions of assessing a student’s skills and choosing a supervisor role based on the student’s needs and goals. The student is assessed on three skill areas:
- Intervention – observable behaviors that the student demonstrates in the session
- Conceptualization – cognitive processes, such as the student’s ability to recognize the client’s patterns and their level of understanding during the session
- Personalization – self-awareness of personal issues and countertransference
Once you, the supervisor, have assessed the student’s three skill areas, you can utilize the discrimination model to identify the appropriate supervisor role:
- Teacher – when the student requires instruction or direct feedback
- Counselor – when the aim is to increase the student’s reflectivity, or to process the student’s experience of professional development
- Consultant – a more collaborative role when it is appropriate for the student to think and act more independently, or to encourage the student’s insight
(Crunk & Barden, 2017)
Needs of the Student
No two students are the same, so your method of slowly decreasing supervision may depend on many factors. Some of these factors may include:
- Competence and confidence of the student
- Complexity of the caseload
- Number and diversity of clients
- Practice setting
- Requirements of the practice setting
- Site regulatory requirements
(AOTA, 2010)
Student Supervision and Medicare Requirements
This resource provides information about the way Centers for Medicare and Medicaid Services (CMS) interprets how and whether the Medicare program should provide payment for services provided by students.
References
American Occupational Therapy Association. (n.d.). Commission on education (COE) guidelines for occupational therapy fieldwork education. Retrieved September 11, 2024, from https://www.aota.org/education/fieldwork/-/media/7f01a105e1eb4e7b80d379ab42e3b6f4.ashx
American Occupational Therapy Association. (2010). Practice advisory: Services provided by students in fieldwork level II settings. https://www.aota.org/-/media/corporate/files/educationcareers/educators/fieldwork/stusuprvsn/practice-advisory-services-provided-by-students-in-fw-level-ii-final.pdf
Andonian, L. (2017). Occupational therapy students’ self-efficacy, experience of supervision, and perception of meaningfulness of level II fieldwork. Open Journal of Occupational Therapy, 5(2). https://doi.org/10.15453/2168-6408.1220
Crunk, A. E. & Barden, S. M. (2017). The common factors discrimination model: An integrated approach to counselor supervision. The Professional Counselor, 7(1), 62-75. Doi: 10.15241/aec.7.1.62
State of Affairs Group. (2024). Statutes, regulations, and board guidance related to students. https://www.aota.org/-/media/corporate/files/secure/advocacy/state/students/statutes-and-regulations-on-students.pdf
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