DEPARTMENT OF HEALTH

(Occupational Therapy Practice Board)

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1) "Adapting environments for individuals with disabilities" includes assessing needs, identifying strategies, implementing and training in the use of strategies, and evaluating outcomes. Occupational therapy focuses on the interaction of an individual's skills and abilities, the features of the environment, and the demands and purposes of activities.

(2) "Board" means the ((board of)) occupational therapy practice board.

(3) "Clients" includes ((patients, students, and)) those to whom occupational therapy services are delivered.

(4) "Client-related tasks" are routine tasks during which ((the)) an occupational therapy aide may interact with the client but does not act as a primary service provider of occupational therapy services. The following factors must be present when an occupational therapist or occupational therapy assistant delegates a selected client-related task to the aide:

(a) The outcome anticipated for the delegated task is predictable;

(b) The ((situation)) status of the client and the environment is stable and will not require that the aide make judgments, interpretations, or adaptations ((be made by the aide));

(c) The client has demonstrated some previous performance ability in executing the task; and

(d) The task routine and process have been clearly established.

(5) "Commonly accepted standards for the profession" in RCW 18.59.040 (5)(b) and 18.59.070 shall mean having passed the National Board for Certification in Occupational Therapy or its successor/predecessor organization, not having engaged in unprofessional conduct or gross incompetency as established by the board in WAC 246-847-160 for conduct occurring prior to June 11, 1986, and as established in RCW 18.130.180 for conduct occurring on or after June 11, 1986.

(6) (("Consultation" means that practitioners are expected to function as consultants within the scope of practice appropriate to their level of competence.

(9))) "Department" means the department of health.

(7) "Evaluation" ((is)) means the process of obtaining and interpreting data necessary for treatment((,)) which includes, but is not limited to, planning for and documenting the evaluation process and results. The evaluation data may be gathered through record review, specific observation, interview, and the administration of data collection procedures((,)) which include, but are not limited to, the use of standardized tests, performance checklists, and activities and tasks designed to evaluate specific performance abilities.

(11))) (8) "Occupational therapy aide" means a person who is trained by an occupational therapist or occupational therapy assistant to perform client and nonclient related tasks. Occupational therapy aides are not primary service providers of occupational therapy in any practice setting. Occupational therapy aides do not provide skilled occupational therapy services.

(((12))) (9) "Professional supervision" of an occupational therapy aide as described in RCW 18.59.020(5) means in-person contact at the treatment site by an occupational therapist or occupational therapy assistant licensed in the state of Washington. When client-related tasks are provided by an occupational therapy aide more than once a week, professional supervision must occur at least weekly. When client-related tasks are provided by an occupational therapy aide once a week or less, professional supervision must occur at least once every two weeks.

(((13))) (10) "Regular consultation((" as described in RCW 18.59.020(4) means in-person contact)) with an occupational therapy assistant" means at least monthly ((by an)) contact with the supervising occupational therapist licensed in the state of Washington, with further supervision available as needed ((by other methods which include but are not limited to phone and email)).

(((14))) (11) "Scientifically based use of purposeful activity" ((is)) means the treatment of individuals using established methodology based upon the behavioral and biological sciences and includes the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of participation in roles and situations in home, school, workplace, community, and other settings. "Occupations" are activities having unique meaning and purpose in an individual's life.

(((15))) (12) "Teaching daily living skills" ((is)) means the instruction in daily living skills by an occupational therapist or occupational therapy assistant based upon the evaluation of all the components of the individual's disability and the adaptation or treatment based on the evaluation.

Graduates of a United States military occupational therapy assistant course that is determined to meet the substantial equivalency requirements may apply for licensure in this state when the following additional requirements have been submitted:

(1) Proof of completion of the military's residency program included in their education program in lieu of the field work required under WAC 246-847-150;

(2) Proof of successfully passing the national certification examination as specified in WAC 246-847-080;

(3) Proof of completion of the online jurisprudence examination for occupational therapy with a passing score of one hundred percent; and

(4) An attestation to the completion of seven hours of HIV/AIDS awareness training as specified in chapter 246-12 WAC, Part 8.

(1) Any initial applicant ((who has not been actively engaged in the practice of occupational therapy within the past four years shall provide, in addition to)) must comply with the requirements for licensure as specified in ((RCW 18.59.050 and WAC 246-847-190)) chapters 18.59 RCW and 246-847 WAC.

(2) Initial applicants who graduated more than three years but less than five years from date of application and never practiced must comply with the requirements for licensure as specified in chapters 18.59 RCW and 246-847 WAC and submit proof of:

(a) ((Evidence of having successfully completed an approved occupational therapy or occupational therapy assistant program within the past four years and documentation)) Completion of thirty hours of continued competency as described in WAC 246-847-065 for the previous two-year period; ((or)) and

(b) ((Evidence of having passed the examination as defined in WAC 246-847-080 within the previous two-year period and documentation of thirty hours of continued competency as described in WAC 246-847-065 for the previous two year-period; or

(2))) Completion of a board-approved reentry program.

(4) The applicant may be required to appear before the board for oral interview.

Licensed occupational therapists and licensed occupational therapy assistants must complete thirty hours of continued competency every two years in the form of continuing education and professional development. Licensee must submit documentation upon request as required by chapter 246-12 WAC.

(1) ((A minimum of twenty hours must be directly related to the practice of occupational therapy as defined in RCW 18.59.020 and WAC 246-847-010.

(3))) Beginning January 1, 2014, as part of their continued competency, occupational therapists and occupational therapy assistants are required to obtain at least three hours of training every six years in suicide assessment as specified in WAC 246-847-066. Licensee must keep documentation for six years.

(a) Except as provided in (b) of this subsection, an occupational therapist or occupational therapy assistant must complete the first training required by this section during the first full continued competency reporting period after January 1, 2014, or the first full continued competency reporting period after initial licensure, whichever occurs later.

(b) An occupational therapist or occupational therapy assistant applying for initial licensure on or after January 1, 2014, may delay completion of the first training required by this section for six years after initial licensure if:

(i) He or she can demonstrate successful completion of a three-hour training program in suicide assessment that was completed no more than six years prior to the application for initial licensure; and

(ii) The training meets the qualifications listed in WAC 246-847-066.

(((4))) (2) The thirty ((continued competency)) hours of continuing education and professional development must be obtained through two or more of the activities listed in this subsection. A minimum of twenty hours must directly relate to the practice of occupational therapy as defined in RCW 18.59.020 and WAC 246-847-010. Any remaining hours may be in professional development activities that enhance the practice of the licensed occupational therapist or licensed occupational therapy assistant. Documentation for all activities must include licensee's name, date of activity, and number of hours. Additional specific documentation is defined below:

(a) Continuing education course work. The required documentation for this activity is a certificate or documentation of attendance.

(b) Employer sponsored in-service training or professional study groups. The required documentation for this activity is a certificate or documentation of attendance. A maximum of fifteen hours is allowed per reporting period for this category.

(c) Attendance at a professional conference or workshop presented by a professional organization. The required documentation for this activity is a certificate or documentation of attendance.

(d) Course work offered by an accredited college or university, provided that the course work is taken after the licensee has obtained a degree in occupational therapy, and the course work provides skills and knowledge beyond entry-level skills or knowledge. The required documentation for this activity is a transcript. One course credit is equal to five hours. A maximum of fifteen hours is allowed per reporting period for this category.

(e) Interactive online courses and webinars. The required documentation for this activity is a certificate or documentation of completion.

(f) Presentation((s)) to professionals, including poster presentations. One hour of preparation time may be counted per hour of presentation time. The required documentation for this activity is a copy of the presentation or program listing. Any particular presentation may be reported only once per reporting period. A maximum of ten hours is allowed per reporting period for this category.

(g) ((Interactive online courses. The required documentation for this activity is a certificate or documentation of completion.

(h))) Guest lecturing on an occupational therapy-related topic in an academic setting. The occupational therapist or occupational therapy assistant must not be primarily employed in academia to submit credit for this activity. The required documentation for this activity is a letter or other documentation from the course instructor. A maximum of ten hours is allowed per reporting period for this category. One hour of preparation time may be counted per hour of lecture time.

(i) Development of instructional materials incorporating alternative media such as: Video, audio and/or software programs to advance professional skills of others. The required documentation for this activity is a program description. The media/software materials must be available if requested during audit process. A maximum of ten hours is allowed per reporting period for this category.

(((i))) (j) Professional manuscript review. The required documentation for this activity is a letter from the publishing organization verifying review of manuscript. One hour of continuing education may be counted per hour of review time. A maximum of ten hours is allowed per reporting period for this category.

(k) ((Serving)) Service on a professional board, committee, disciplinary panel, or association. The required documentation for this activity is a letter or other documentation from the organization. A maximum of ten hours is allowed per reporting period for this category.

(l) Self-study of ((cassette, tape, video tape, or other multimedia device, or book)) peer reviewed, role-related professional journal articles, textbooks or chapters, or professionally developed multimedia and digital media educational materials. The required documentation for this activity is a ((two)) typed, one-page synopsis of each item ((written)) authored by the licensee or a certificate from OT practice continuing education article. A maximum of ten hours is allowed per reporting period for this category. Time spent writing synopsis is not reportable.

(m) ((Level II fieldwork)) Direct supervision of an occupational therapy student or occupational therapy assistant student ((by site designated supervisor(s))). The required documentation for this activity is a name of student(s), letter of verification from school, and dates of fieldwork. Forty hours of supervision per student is equal to one hour of continued competency. A maximum of ((ten)) twelve hours per supervisor is allowed per reporting period for this category.

(1) If the license has expired for three years or less, the practitioner must meet the requirements of chapter 246-12 WAC, Part 2.

(2) If the license has expired for over three years but no more than five years at the time of application, ((and)) the practitioner ((has been in)) may return to active ((practice in another United States jurisdiction, the practitioner must)) status by submitting proof of:

(a) ((Submit verification of active practice from any other United States jurisdiction;

(b) Meet)) Having met the requirements of chapter 246-12 WAC, Part 2; and

(ii) Passing the Washington occupational therapy jurisprudence examination as offered by the department.

(3) If the license has expired for over ((three)) five years at the time of application, ((and)) the practitioner ((has not been in)) may return to active ((practice in another United States jurisdiction, the practitioner must)) status by submitting proof of:

(a) ((Either provide evidence of having passed the examination as defined in WAC 246-847-080 within the previous two-year period or provide evidence of successfully completing a board-approved educational program specifically designed for occupational therapists or occupational therapy assistants preparing for reentry into the field of occupational therapy;

(b) Meet)) Having met the requirements ((of chapter 246-12 WAC, Part 2)) in subsection (2) of this section;

(5) Completion of additional requirements may be required by the board.

(1) A practitioner may obtain an inactive credential. Refer to the requirements of chapter 246-12 WAC, Part 4.

(1) ((Before licensure may be extended to any individual)) Any initial applicant currently licensed to practice as an occupational therapist or occupational therapy assistant in another state, the District of Columbia, or a territory of the United States as provided in RCW 18.59.070(2), ((the following conditions must be met:

(b) Verification of)) may be licensed by endorsement. Applicants must comply with the requirements for licensure as specified in chapters 18.59 RCW and 246-847 WAC and submit proof of:

(a) Current licensure from ((any state, the District of Columbia, or a territory of the)) another United States ((on forms provided by the secretary; and

(c) Verification of)) jurisdiction;

(b) Having passed the examinations as defined in WAC 246-847-080; and

(3) The applicant may be required to appear before the board for oral interview.)) (c) Completion of thirty hours of continued competency within the two-year period immediately preceding the application.

"Supervised fieldwork experience" in RCW 18.59.050 (1)(c)(i) shall mean a minimum six months (twenty-four weeks) of full-time equivalency of Level II fieldwork conducted in settings approved by the applicant's academic program. Level II fieldwork is to provide an in-depth experience in delivering occupational therapy services to clients and to provide opportunities for supervised practice of occupational therapist entry-level roles. The minimum six months (twenty-four weeks) of full-time equivalency supervised fieldwork experience required by RCW 18.59.050 (1)(c)(i) shall not include Level I fieldwork experience as defined by the ((American Occupational Therapy Association.

The supervised fieldwork experience shall consist of a minimum of six months sustained fieldwork on a full-time basis. "Full-time basis" is as required by the fieldwork setting)) accreditation council for occupational therapy education.

(1) It is the professional responsibility of occupational therapists and occupational therapy assistants to provide services for clients without regard to race, creed, national origin, gender, handicap or religious affiliation.

(2) Treatment objectives and the therapeutic process must be formulated to ensure professional accountability.

(3) Services shall be goal-directed in accordance with the overall educational, habilitation or rehabilitation plan and shall include a system to ensure professional accountability.

(4) Occupational therapists and occupational therapy assistants shall recommend termination of services when established goals have been met or when further skilled services ((would not produce improved client performance)) are no longer beneficial.

(5) Occupational therapists and occupational therapy assistants shall accurately represent their competence, education, training and experience.

(6) Occupational therapists and occupational therapy assistants shall only provide services and use techniques for which they are qualified by education, training, and experience.

(7) Occupational therapists and occupational therapy assistants shall accurately record information and report information as required by facility standards and state and federal laws.

(8) All data recorded in permanent files or records shall be supported by the occupational therapist or the occupational therapy assistant's observations or by objective measures of data collection.

(9) Client's records shall only be divulged as authorized by law or with the client's consent for release of information.

(10) Occupational therapists and occupational therapy assistants shall not delegate to other personnel those client-related services where the clinical skills and expertise of an occupational therapist or occupational therapy assistant are required.

(11) If, after evaluating the client, the case is a medical case, the occupational therapist shall refer the case to a physician for appropriate medical direction if such direction is lacking.

(a) Appropriate medical direction shall be sought on at least an annual basis.

(b) A case is not a medical case if the following is present:

(i) There is an absence of pathology; or

(ii) If a pathology exists, the pathology has stabilized; and

(iii) The occupational therapist is only treating the client's functional deficits.

(12) Occupational therapists shall establish, review, or revise the client's treatment objectives at sufficient intervals to meet the client's needs. The occupational therapy assistant shall collaborate with the occupational therapist in this review of the client's treatment objectives.

(1) "Telehealth" means providing occupational therapy via electronic communication where the occupational therapist or occupational therapy assistant and the patient are not at the same physical location.

(2) An occupational therapist or occupational therapy assistant using telehealth to provide therapy to patients in Washington must be licensed to provide occupational therapy in Washington.

(3) Licensed occupational therapists and occupational therapy assistants may provide occupational therapy via telehealth following all requirements for supervision and standard of care, including those defined in chapters 18.59 RCW and 246-847 WAC.

(4) The occupational therapist or occupational therapy assistant must identify in the clinical record that the occupational therapy occurred via telehealth.

(1) The occupational therapist and occupational therapy assistant shall never engage in sexual contact or sexual activity with current clients or a key party.

(2) "Key party" in this section means immediate family members and others who would be reasonably expected to play a significant role in the health care decisions of the patient or client and includes, but is not limited to, the spouse, domestic partner, sibling, parent, child, guardian and person authorized to make health care decisions of the patient or client.

(((2))) (3) Sexual contact or sexual activity is prohibited with a former client or key party for two years after cessation or termination of professional services.

(((3))) (4) The occupational therapist and occupational therapy assistant shall never engage in sexual contact or sexual activity with former clients or a key party if such contact or activity involves the abuse of the occupational therapy practitioner-client-key party relationship. Factors which the board may consider in evaluating if the occupational therapy practitioner-client-key party relationship has been abusive includes, but is not limited to:

(a) The amount of time that has passed since therapy terminated;

(b) The nature and duration of the therapy;

(c) The circumstances of cessation or termination;

(d) The former client's or key party's personal history;

(e) The former client's or key party's current mental status;

(f) The likelihood of adverse impact on the former client, key party and others; and

(g) Any statements or actions made by the occupational therapist or occupational therapy assistant during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the former client or key party.

(5) Sexual misconduct includes, but is not limited to, activities listed in WAC 246-16-100.

(((4))) (6) These rules do not prohibit:

(a) The provision of occupational therapy services on an urgent, unforeseen basis where circumstances will not allow an occupational therapist or occupational therapy assistant to obtain reassignment or make an appropriate referral;

(b) The provision of occupational therapy services to a spouse or any other person who is in a preexisting, established relationship with the occupational therapist or occupational therapy assistant where no evidence of abuse of the occupational therapy practitioner-client relationship exists.