Screening

• A screening involves “obtaining and reviewing data relevant to a potential client to determine the need for further evaluation and intervention”.¹ 
• Why screen?
  • Since the Affordable Care Act, there has been an increased demand for healthcare services.² 
  • While a referral may have been made properly, e.g., by a physician, it may not necessarily be ‘appropriate’ or necessary for the client.
  • The occupational therapist conducts a screening to determine if (1) further services are needed and to continue with an evaluation, or (2) to discontinue occupational therapy services.
  • There may be instances where there are more clients hoping to be seen than there are occupational therapy practitioners or time allowed for them all to be seen.
  • “In many acute care settings, a percentage of patients referred to therapists either may not require skilled therapy services at all or should have these services deferred to a later date. Allowing these referrals to be added to therapists’ caseloads results in the inefficient use of resources, a potential liability risk for patients who are not seen, and staff dissatisfaction that may result in burnout.”³ 
  • Medicare does not reimburse for nonskilled therapy: “Services that can be safely and effectively furnished by nonskilled personnel or by PTAs [physical therapist assistants] or COTAs [certified occupational therapy assistants] without the supervision of therapists are not rehabilitative therapy services.”⁴ 
  • A screen is less time-consuming than conducting a complete evaluation and its documentation.
  • Occupational therapists are still required to conduct a chart review of the client’s medical history, consult with the interprofessional team, and administer standardized screening tools,⁵  interview with the client and their caregivers, and perform a brief observation of the client to determine:⁶ 
    • Occupations the client can and cannot perform,
    • Premorbid functioning level in the performance of occupations,
    • Needs and plans of the client for the future.
• Screening can take place for groups.
  • The occupational therapist identifies the need for services based on available data and may then conduct a screening for each individual in the group.
• A ‘screen’ of the population is called an environmental scan, trend analysis, or preplanning.⁷ 
  • The occupational therapist similarly collects data,
  • Identifies health trends in the population, and
  • Potential positive and negative impacts on occupational performance of the population.

The Role of the COTA

The COTA contributes to the screening process for the occupational therapist and will require supervision for:⁶ 

1. Screening in accordance with laws and regulations,
2. Selecting screening methods appropriate for the client, and
3. Communicating screening results and recommendations to the appropriate person, group, or organization.

1. American Occupational Therapy Association. (1998). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 52(10), 866–869.[↩]
2. Killian, C., Fisher, G., & Muir, S. (2015). Primary
   care: A new context for the scholarship of practice model. Occupational Therapy in Health Care, 29, 383–396. http://dx.doi.org/10.3109/07380577
   .2015.1050713[↩]
3. Hobbs, J. A., Boysen, J. F., McGarry, K. A., Thompson, J. M., & Nordrum, J. T. (2010). Development of a unique triage system for acute care physical therapy and occupational therapy services: an administrative case report. Physical therapy, 90(10), 1519-1529.[↩]
4. Centers for Medicare and Medicaid Services. CMS Medicare Benefit Policy Manual. Available at: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf. Accessed December 30, 2008[↩]
5. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process
   (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001[↩]
6. Moyers, P. A. (1999). The guide to occupational therapy practice. American Journal of Occupational Therapy, 53(3), 247-322.[↩][↩]
7. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001[↩]