Frequently Asked Questions

Fieldwork – ACOTE Section C Standards

The 2018 ACOTE Standard C.1.10 requires that:

-OTA students complete their Level II fieldwork for a minimum of 16 weeks full-time…reflective of more than one practice area, or in a maximum of three different settings.

-OTM or OTD students complete their Level II fieldwork for a minimum of 24 weeks full-time…reflective of more than one practice area, or in a maximum of four different settings.

Settings reflect a system of service delivery with a defined scope and organizational structure. The Standards allow for fieldwork experiences in traditional, nontraditional, and emerging settings that are consistent with a program’s curriculum design. Settings may include those encompassing the medical/healthcare model, social care setting, educational setting, academic setting, home/community-based setting, etc. Additionally, a setting may have multiple practice areas that are distinct from each other. The distinct nature of practice areas may include:

-Type of population (e.g., diagnostic groups, age groups, etc.)

-Type of service provided (e.g., inpatient, outpatient, direct, consultative)

As practice areas vary regionally, ACOTE encourages programs to reflect on practice areas addressed in their curriculum (A.5.1.). Each program can determine whether the fieldwork experiences serving the same population by age group (e.g., children, older adults) or by diagnostic group (e.g., chronic diseases, mental health diagnoses) are sufficiently different in their area of practice focus.

The decision to use remote supervision when otherwise unregulated is a collaborative decision between the academic program, fieldwork educator, and clinical site. How frequent fieldwork educator supervision occurs, remote or on site, is dependent upon if the site is a traditional placement (a setting where OT services currently exist) or a role-emerging placement (a setting where no OT services currently exist). The 2018 ACOTE Standards do not include requirements specifically related to remote supervision. However, 2018 ACOTE Standard C.1.13 requires that supervision be direct and transition to less direct as the student establishes competency with consideration to skills and client safety/protection.

The 2018 ACOTE Standards require a minimum of 8 hours of direct supervision each week of the fieldwork experience for a site where no OT services exist. ACOTE does not require a particular format of how this supervision is delivered. However, an on-site supervisor must be assigned to the student when the fieldwork educator is not on site. As with all Level II fieldwork, the initial supervision must be direct and then decrease to less direct within the fieldwork experience.

The 2018 ACOTE Standard C.1.10 requires that:

-OTA students complete their Level II fieldwork for a minimum of 16 weeks full-time…reflective of more than one practice area, or in a maximum of three different settings.

-OTM or OTD students complete their Level II fieldwork for a minimum of 24 weeks full-time…reflective of more than one practice area, or in a maximum of four different settings.

Furthermore, C.1.10 allows for Level II fieldwork to be completed on a part-time basis if it is at least 50% of an FTE (full-time equivalent) at that site. The FTE depends on the fieldwork placement’s usual and customary personnel policies. The setting and the academic program determine the total hours required to comprise a full-time equivalent.

The 2018 ACOTE Standards relevant to fieldwork (C.1.0-C.1.16) provide broad flexibility to programs in order to meet their mission during the COVID-19 public health emergency. ACOTE acknowledges the pandemic has led to the suspension and/or cancellation of fieldwork placements, many of which were in traditional practice settings. In the COVID-19 Update of 4-14-20 (https://acoteonline.org/covid19-update-4-14-20/), ACOTE provided information about alternative fieldwork experiences when traditional delivery models or settings are not available. These include:

-Telehealth modes of delivery in traditional and nontraditional settings

-Role-emerging fieldwork in settings where OT services are a benefit, but not yet established

-Nontraditional fieldwork where OT professional reasoning, ethical practice, and professionalism can be fostered in alternative ways to apply the occupational therapy process with non-traditional clients (at the individual, group, community, or population level)

ACOTE does not indicate how many students a fieldwork educator can supervise. 2018 ACOTE Standard C.1.4 states that sites must ensure that the ratio of fieldwork educators to students enables proper supervision, and provides protection of consumers, opportunities for appropriate role modeling of occupational therapy practice, and the ability to provide frequent assessment of student progress in achieving stated fieldwork objectives. The fieldwork sites must determine the ratio based on the requirements of the Standard, organizational policy and procedures, state practice act guidelines, and the competency, skill set, and expertise of the supervisor.

The 2018 ACOTE Standards do not specify caseloads. The academic program and fieldwork educators should collaborate regarding other occupational therapy activities to support the achievement of fieldwork objectives. The goal of Level II fieldwork is to develop competent, entry-level, generalist occupational therapists. Level II fieldwork must be integral to the program’s curriculum design and must include an in-depth experience in delivering occupational therapy services to clients, focusing on the application of purposeful and meaningful occupation and research, administration, and management of occupational therapy services.

2018 ACOTE Standard C.1.6 states that the program must have evidence of valid memoranda of understanding (MOUs) in effect and signed by both parties from the onset to conclusion of the Level I fieldwork and the Level II fieldwork if it involves an entity outside of the academic program. The MOU is to provide clarity and outline responsibilities of both parties.

The student must be supervised by a currently licensed or otherwise regulated occupational therapist with at least 3-years full-time or its equivalent of professional experience prior to the Level II fieldwork placement. Supervision must include a minimum of 8 hours of direct supervision each week of the fieldwork experience. An occupational therapy supervisor must be available to the student during all working hours. The availability of the occupational therapy supervisor can be through a variety of contact measures. An on-site supervisor designee of another profession must be assigned while the occupational therapy supervisor is off-site. The occupational therapy service provision and supervision plan must be documented and verified prior to the fieldwork placement.

The program must demonstrate that a documented formal evaluation of student performance on the Level II fieldwork was completed. The evaluation should note the number of weeks completed for the placement.

The 2018 ACOTE Standards do not address the employment status of the student related to the fieldwork site. Therefore, site-specific policies and procedures and/or the presence of a collective bargaining agreement, state practice acts, state labor laws, and institutional policies would dictate if fieldwork can be completed at a site where the student is employed.