1. North carolina board of occupational therapy
Catharine Lees, MHA, MS, CBIS, OTR/L, Chair
Tommianne Haithcock, BS, COTA/L, Vice Chair
Lauren Holahan, MS, OT/L
Brenda Kennell, BS, MA, OTR/L
Melanee Mills, MS
David Richard, Secretary / Treasurer
Benjamin Wall, MD
Charles P. Wilkins, Legal Counsel
Barbara Williams, Board Administrator

3. Presentation Objectives
Increase knowledge of NCBOT purpose and operation
Increase awareness and compliance with NCBOT Rules
Increase knowledge of continuing competence

4. Purpose of NCBOT
Regulate persons offering occupational therapy services
Safeguard public health, safety and welfare
Protect public from being harmed by unqualified persons
Assure highest degree of professional services and conduct
Establish licensure requirements
Ensure availability of occupational therapy services to persons who need them

5. NCBOT 2008-2009 Operations 3854 total licensed practitioners
358 new
3779 renewals
1162 OTA
2692 OT
renewals resulted in:
2 consent orders
4 letters of reprimand
11 letters of admonishment
Bimonthly Board meetings at NCBOT office in Raleigh (Jan., Mar., May, July, Sept., Nov.)
223 continuing competence audits
18 disciplinary actions, 13 pending, 2 hearings
Jurisprudence exam
Make audience aware that the disciplinary actions are sent to the NBCOT and the National Practitioner Data Bank.
Active cases are posted on the NCBOT website.
Audits – Do we need to state exactly how many were done? We could share that the audit process for 2009 – 2010 is complete.
Ethics courses that were not approved include –
counseling families with high risk babies
documentation issues taught by an attorney
"Clinical Gems in Pediatric Rehab"
Annual employer core modules
HIPPA Courses
Business Ethics courses
"Nat'l Government Services Skilled Nursing Facility Clinical Overview"
"Mindfulness Approach to Stress Management"
"Developing an Emotionally Available Mind: The Challenge of Nurturing NICU Staff and Families“
Explain the purpose of the jurisprudence exam and the projected timeline.

6. 2009 Rule Changes Approved: Proposed: Re-entry
Grounds for disciplinary action or license denial
Proposed:
Ethics
Documentation
RE_ENTRY - 21 NCAC APPLICATION PROCESS
(b) An applicant previously licensed in any state re-entering the field of occupational therapy after not practicing occupational therapy for more than 24 months shall complete 90 days of general, supervised, re-entry fieldwork and shall provide to the Board;
(1) a written plan for 90 days of general, supervised, re-entry fieldwork within 10 days of securing employment; and
(2) monthly documentation confirming that the general, supervised, re-entry fieldwork is being provided.
.0304 GROUNDS FOR LICENSE DENIAL OR DISCIPLINE
(12) recording or communicating false or misleading data, measurements or notes regarding a patient;
(13) delegating responsibilities to a person when the licensee delegating knows or has reason to know that the competency of that person is impaired by physical or psychological ailments, or by alcohol or other pharmacological agents, prescribed or not;
(14) practicing or offering to practice beyond the scope permitted by law;
(15) accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform;
(16) performing, without supervision, professional services which the licensee is authorized to perform only under the supervision of a licensed professional;
(17) harassing, abusing, or intimidating a patient either physically or verbally;
(18) failure to exercise supervision over persons who are authorized to practice only under the supervision of the licensed professional;
(19) promoting an unnecessary device, treatment intervention or service for the financial gain of the practitioner or of a third party;
(20) delegating professional responsibilities to a person when the licensee delegating the responsibilities knows or has reason to know that the person is not qualified by training, by experience, or by licensure to perform the responsibilities;
(21) billing or charging for services or treatments not performed; or
(22) making treatment recommendations based on the extent of third party benefits instead of the patient’s condition.
(c) When a person licensed to practice occupational therapy is also licensed in another jurisdiction and that other jurisdiction takes disciplinary action against the licensee, the North Carolina Board of Occupational Therapy may summarily impose the same or lesser disciplinary action upon receipt of the other jurisdiction’s actions. The licensee may request a hearing. At the hearing the issues shall be limited to:
(1) whether the person against whom action was taken by the other jurisdiction and the North Carolina licensee are the same person;
(2) whether the conduct found by the other jurisdiction also violates the North Carolina Occupational Therapy Practice Act; and
(3) whether the sanction imposed by the other jurisdiction is lawful under North Carolina law.

7. Continuing Competence
AOTA description
NCBOT Rule description
Ethics
Pre-approval
AOTA description – Continuing competence is a process involving
the examination of current competence
development of capacity for the future
-component of ongoing professional development and lifelong learning
-dynamic, multidimensional process
develop and maintain:
knowledge
performance skills
interpersonal abilities
critical reasoning
ethical reasoning skills
-necessary to perform current and future roles and responsibilities within the profession
NCBOT Rule description –
process in which an occupational therapist or an occupational therapy assistant develops and maintains the knowledge, performance skills, interpersonal abilities, critical reasoning skills, and ethical reasoning skills necessary to perform his or her professional responsibilities.
Ethics – not required for
Pre-approval – for CE providers, not participants; Board reviews application; all NCOTA, NBCOT and AOTA courses are acceptable; anything AOTA approves, NCBOT approves
Short discussion of MENTORSHIPS. They must be between 2 OT professionals.

8. Approaches to Learning
DUTIFUL & COMPULSORY “I have to get a minimum of 15 continuing competence points to renew my license.”
ANIMATED & ENTERPRISING “I want no less than 15 continuing competence points to grow as a practitioner and improve practice in North Carolina!!”

9. Documenting Continuing Competence
Continuing Education – certificate of completion
Name, date, & location of course
Author/instructor name
Sponsoring agency
Number of hours attended
Academic Coursework – official transcript
Small group study - Small Group Study Form
Title, author, & publisher of reviewed media
Date and amount of time spent ME
CE - Documentation shall include a certificate of completion or similar documentation
Academic coursework - original official transcript indicating successful completion of the course, date, and a description of the course
from the school catalogue or course syllabus.
Small group study - Includes review and discussion of journal articles, clinical videotapes or audiotapes by at least two licensed practitioners
Licensee must complete the Small Group Study Form provided by the NCBOT and include a statement that describes how the activity relates to a licensee's current or anticipated roles and responsibilities

10. Documenting Continuing Competence
Mentorship Agreement – signed mentorship contract
Name of mentor & mentee
Dates & hours spent
Focus of activities
Outcomes of agreement
Fieldwork Supervision– verification from OT school or signature page from student evaluation form
Name of student & sending school
Dates of fieldwork ME
Mentorship - Participation in a formalized mentorship agreement as defined by a signed contract between the mentor and mentee that outlines specific goals and objectives and designates the plan of activities that are to be met by the mentee. These activities must be related to the development of new occupational therapy skills outside current required job performance
FW - Participation as the primary clinical fieldwork educator for Level I or Level II OT or OTA fieldwork students

11. Documenting Continuing Competence
Professional writing – full publication reference
Presentation & Instruction – copy of official program, schedule, or syllabus
Title, date, & hours of presentation
Type of audience or signed verification of such
Professional Meetings – participation record validated by organization representative
Name of committee or board & its agency
Purpose of service & description of licensee's role
Hours of participation ME
Professional Writing - peer-reviewed book, chapter, article or contracted review of occupational therapy resource material
Documentation shall consist of full reference for publication including:
Title
Author
Editor - date of publication
or copy of acceptance letter, if not yet published
Credit for submitted items shall be given for one licensure period only
Presentation - Presentation of an academic course or peer-reviewed or non peer-reviewed workshop, seminar, in-service, electronic or Web-based course for the first time or for which more than 50% of the material has been revised;
A licensee may earn two points for each one hour of credit that is awarded for an activity
Professional meetings - participation in board or committee work with agencies or organizations to promote and enhance the practice of occupational therapy
Documentation must include name of committee or board, name of agency
or organization, purpose of service, and description of licensee's role.
Participation and hours must be validated by an officer or representative of
the organization or committee.

12. Documenting Continuing Competence
Board or Specialty Certification – certificate of completion from certifying body
Research & Grants - verification from the primary investigator
Name of research project & major objectives
Dates of participation & licensee's role; or,
Name of grant proposal, source, purpose & objectives
Verification from grant author regarding licensee's role in development of grant, if not the author ME
Specialty Certification- completion of activities that result in board certification or specialty certification by AOTA during the current
licensure period
Research and Grants -Development of or participation in a research project or grant proposal
(b) A licensee may earn one point for each three hours spent working on a research project or grant proposal
(c) Documentation includes verification from the primary investigator
indicating the name of the research project, dates of participation, major
hypotheses or objectives of the project, and licensee's role in the project or
name of grant proposal, name of grant source, purpose and objectives of
the project, and verification from the grant author regarding licensee's role
in the development of the grant if not the author.

13. Continuing Competence Activities - I
ACTIVITY
POINT MAXIMUM
CONTINUING EDUCATION
NONE
ACADEMIC COURSEWORK
6 OR NONE
SMALL GROUP STUDY 3
MENTORSHIP AGREEMENT
5 (BOTH MENTEE AND MENTOR)
FIELDWORK SUPERVISION 6 ME
Continuing Education includes in-service educational programs and online courses
ACADEMIC COURSEWORK – 6 FOR RANDOM COURSE RELATED TO PRACTICE; NONE FOR PEOPLE ENROLLED IN GRADUATE OR POST-GRAUDATE OT CURRICULA
MENTORSHIP – 1 point for every 4 hours spent in mentorship activities
FW - .5 POINT PER 40 HOUR WORK WEEK

14. Continuing Competence Activities - II
ACTIVITY
POINT MAXIMUM
PRESENTATION & INSTRUCTION 6
PROFESSIONAL MEETINGS & ACTIVITES 2
BOARD OR SPECIALTY CERTIFICATION 15
RESEARCH & GRANTS 5
PROFESSIONAL WRITING
15 – BOOK; 10 – CHAPTER; 10 – EDITOR OF BOOK; 5 – PEER-REVIEWED ARTICLE; 5 – CONTRACTED REVIEW ME
ACADEMIC COURSEWORK – 6 FOR RANDOM COURSE RELATED TO PRACTICE; NONE FOR PEOPLE ENROLLED IN GRADUATE OR POST-GRAUDATE OT CURRICULA
Presentation & Instruction means that you DO the presentation NOT that you attend a presentation.
FW - .5 POINT PER 40 HOUR WORK WEEK
PRESENTATION 2 POINTS PER I HOUR OF CREDIT AWARDED TO PARTICIPANTS
PROFESSIONAL COMMITTEE – 1 POINT FOR 5 HOURS COMMITTEE WORK OR 2 POINTS FOR 10+ HOURS
GRANTS – 1 POINT PER 3 HOURS SPENT WORKING

15. Supervision OTA Occupational therapy students
Unlicensed personnel & delegated tasks ME
OTA
OTA supervision chart and unlicensed personnel chart is available online and on pages 41 and 42 of lavender Practice Act Booklet. (New Practice Act booklet will be coming out in the Fall after new Rules are reviewed by the Rules Review Committee.)
Documentation of supervision is the responsibility of both the occupational therapist and occupational therapy assistant. Documentation must include the frequency of supervisory contact, method(s) or type(s) of supervision, content areas addressed, and names and credentials
of the persons participating in the supervisory process
Supervision of occupational therapy students:
An occupational therapy practitioner shall comply with ACOTE requirements for experience when supervising Level II fieldwork occupational therapist and occupational therapy assistant students, which ACOTE requirements, including subsequent amendments and editions, are incorporated by reference.
(b) The occupational therapist may supervise Level I and Level II fieldwork occupational therapist and occupational therapy assistant students;
(c) The occupational therapy assistant may:
(i) Supervise Level I occupational therapist or occupational therapy assistant students;
(ii) Supervise Level II occupational therapy assistant students
(iii) Participate in the supervision of Level II occupational therapist students under the direction and guidance of the supervising occupational therapist
ACOTE Standards for experience of FWII Supervisor:
B Ensure that the student is supervised by a currently licensed or credentialed occupational therapist who has a minimum of 1 year of practice experience subsequent to initial certification, and is adequately prepared to serve as a fieldwork educator. The supervising therapist may be engaged by the fieldwork site or by the educational program.
B Ensure that supervision provided in a setting where no occupational therapy services exist includes a documented plan for provision of occupational therapy services and supervision by a currently licensed or credentialed occupational therapist with at least 3 years of professional experience. Supervision must include a minimum of 8 hours per week. Supervision must be initially direct and then may be decreased to less direct supervision as is appropriate for the setting, the client’s needs, and the ability of the student. An occupational therapy supervisor must be available, via a variety of contact measures, to the student during all working hours. An on-site supervisor designee of another profession must be assigned while the occupational therapy supervisor is off site.
Unlicensed Personnel
(a) Unlicensed personnel do not provide skilled occupational therapy services. Unlicensed Personnel are trained by an occupational therapist or occupational therapy assistant to perform specifically delegated tasks. The occupational therapist is responsible for the overall use and actions of the unlicensed personnel. Unlicensed personnel first must demonstrate competency to be able to perform the assigned, delegated client and non-client related tasks.
(b) The occupational therapist must oversee the development, documentation, and implementation of a plan to supervise and routinely assess the ability of the unlicensed personnel to carry out client and non-client related tasks. The occupational therapy assistant may contribute to the development and documentation of this plan.
(c) The occupational therapy assistant may supervise unlicensed personnel.
(d) Non-client related tasks include clerical and maintenance activities and preparation of the work area or equipment.
(e) Client-related tasks are routine tasks during which the unlicensed personnel may interact with the client but does not provide skilled 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 unlicensed personnel;
(1) The outcome anticipated for the delegated task is predictable;
(2) The situation of the client and environment is stable and will not require the judgment interpretation, or adaptations be made by the unlicensed personnel;
(3) The client has demonstrated some previous performance ability in executing the task; and
(4) The task routine and process have been established.
(f) When performing delegated client-related tasks the supervisor must ensure that the unlicensed personnel;
(1) is trained and able to demonstrate competency in carrying out the selected task and using equipment, if appropriate;
(2) has been instructed on how to specifically carry out the delegated task with the specific client, and
(3) knows the precautions, signs and symptoms for the particular client that would indicated the need to seek assistance for the occupational therapist or occupational therapy assistant.
(g) The supervision of the unlicensed personnel must be documented and include;
(1) information about frequency and methods of supervision used;
(2) the content of supervision; and
(3) the names and credentials of all persons participating in the supervisory process.
(h) Occupational therapy practitioners shall not allow employer or work place pressures to result in the prohibited use of unlicensed personnel.
(i) Services provided by unlicensed personnel may not be billed, charged, or identified as "occupational therapy”.

16. Submitted Questions – 1
If I am coordinating an in-service or my facility is offering a continuing education program, must we submit the program to NCBOT for approval? ANSWER:
That said, if the inservice is to be applied to a practitioner’s licensure renewal point total, it must fall within the scope of qualified activities:
.0804 SCOPE OF QUALIFIED ACTIVITIES FOR MAINTAINING CONTINUING COMPETENCE
(a) To be approved by the Board, activities must be related to roles and responsibilities in occupational therapy and must serve to protect the public by enhancing the licensee's continuing competence.
(b) Subject matter for approved activities include research; theoretical or practical content related to the practice of occupational therapy; or the development, administration, supervision, and teaching of clinical practice or service delivery programs by occupational therapists or occupational therapy assistants.
Be sure to include required information for documentation. Very often in-service documentation lacks the number of hours.

17. Submitted Questions – 2
If I am considering attending an in-service or continuing education program that is not pre- approved by NCBOT, how do I determine whether it meets the requirements of relevance to occupational therapy? ANSWER: How is it relevant to your practice? How will course objectives enhance your competence? Can you envision applying the skills and knowledge you get from the course in your current work as an OT practitioner? ME
Would it make sense for your employer to pay for the course (e.g. is a good investment for them?)
.0804 SCOPE OF QUALIFIED ACTIVITIES FOR MAINTAINING CONTINUING COMPETENCE
(a) To be approved by the Board, activities must be related to roles and responsibilities in occupational therapy and must serve to protect the public by enhancing the licensee's continuing competence.
(b) Subject matter for approved activities include research; theoretical or practical content related to the practice of occupational therapy; or the development, administration, supervision, and teaching of clinical practice or service delivery programs by occupational therapists or occupational therapy assistants.

18. Submitted Questions – 3
What questions or guidelines does NCBOT use to determine whether a program is relevant to occupational therapy? What about occupational therapy services in new or non-traditional settings--how does the board decide what is relevant to OT? ANSWER: There is no description in the Rule; decisions are made on a case-by-case basis. The Board uses a review rubric for all CC activities submitted for prior approval by CC providers.
Note should describe the rubric.

19. Submitted Questions – 4
If I’m working on a research project or serving on a professional board, do I keep track of all hours or just the hours up to the maximum that can be counted? ANSWER: Once the maximum is reached, the Board does not require ongoing documentation. ME
Documentation must include:
name of committee or board, agency or organization
purpose of service
description of licensee’s role
validated participation and hours by organization representative
1 point for 5 hours of service or Up to 2 points (for 10+ hours of service) can be earned in this category. The Board or committee work must be with agencies or organizations to promote and enhance the practice of OT.
For Research or grants you may earn 1 point for each 3 hours spent working on a research project or grant proposal, up to a maximum of 5 points. See the required documentation in .0805(10)(c)

20. Submitted Questions – 5
What kind of record do I need to track hours for being a mentor or mentee?
ANSWER:
Documentation must include:
name of mentor or mentee
copy of signed mentorship contract
focus of mentorship activities
dates and hours spent participating in mentorship relationship
outcome of mentorship
Mentorships MUST be between 2 OT professionals and do NOT include new employee orienation.

21. Submitted Questions – 6
What counts as peer-reviewed professional writing? Is that journals only? What about writing for publications that are practice-oriented, but don’t do a formal “peer” review like OT Practice or the AOTA SIS Quarterlies or OT Today? ANSWER: "Peer reviewed" means any written work that is reviewed by more than one person in the same field in order to maintain or enhance the quality of the work or performance in that field. ME
.0801(7) "Peer reviewed" means any written work that is blind reviewed by more than one person. Having said that, there were possibly 3 CCA submissions this year in that category and I accepted them all because they included a copy of the article. Next year I will refer them to the Board for their approval.
Does the term “peer-reviewed” in the Rule apply mainly to journal articles, as in (b) but not (a) of this section?
What is the intent of (b)(iv) in this section?
Peer-reviewed = Peer review is the evaluation of creative work or performance by other people in the same field in order to maintain or enhance the quality of the work or performance in that field; The word peer is often defined as a person of equal standing. However, in the context of peer review it is generally used in a broader sense to refer to people in the same profession who are of the same or higher ranking.
Peer review (also known as refereeing) is the process of subjecting an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field. Peer review requires a community of experts in a given (and often narrowly defined) field, who are qualified and able to perform impartial review.
Pragmatically, peer review refers to the work done during the screening of submitted manuscripts and funding applications. This process encourages authors to meet the accepted standards of their discipline and prevents the dissemination of irrelevant findings, unwarranted claims, unacceptable interpretations, and personal views.

22. Submitted Questions – 7
What do I need as documentation when I present an in-service or another kind of presentation that doesn’t have a formal program or brochure?
ANSWER:
Documentation must include:
copy of in-service syllabus or outline
title, date, and length of in-service
hours of preparation
Type of audience or verification of participants
Signature of in-service sponsor

23. Submitted Questions – 8
AHEC has started a new system so I can track my continuing education activities on the website (MyAHEC), but is all online and the records are electronic. Another system lets me scan and store certificates. If I am audited, can I submit files (word or PDF)? Do I need to keep originals or are PDFs or copies okay to submit? ANSWER: Electronic files and copies are acceptable to the Board, but licensees should maintain originals. ME