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Nebraska Occupational Therapy — Requirements & Free Practice

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Occupational Therapist License

License to practice occupational therapy under the Nebraska Occupational Therapy Practice Act.

Licensing authority: Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit (Board of Occupational Therapy Practice) · Application information

Occupational Therapist license by licensure/certification in another state
OTR exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Board Standards
Meets the standards set by the board under Neb. Rev. Stat. § 38-126 for a license based on licensure in another jurisdiction (Neb. Rev. Stat. § 38-2523(1)).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Not Practicing
An applicant licensed elsewhere who is not currently practicing must show 50 hours of continuing education within the 3 years preceding application (Neb. Rev. Stat. § 38-2523(1); 172 NAC 114-003.01(D)).
Other State License
Holds an occupational therapy license or certification in another state; verification is obtained from that state (application basis 'By Licensure/Certification in another State'; Section D).
Universal Reciprocity
The additional reciprocity method of Neb. Rev. Stat. § 38-129.02 does not apply: its subsection (7) does not list the Occupational Therapy Practice Act.
Occupational Therapist license by examination (graduate of an accredited U.S. program)
OTR exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Education
Completion of the academic requirements of an occupational therapy educational program recognized by the Department and accredited by a nationally recognized accrediting body (Neb. Rev. Stat. § 38-2518(1)(a)), including supervised fieldwork of at least 6 months (172 NAC 114-002.02).
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Examination Timing
The application may be filed before the examination is taken; the license issues after passing results are received (application Section G option A: passed or will be taking the NBCOT exam).
Prior Examination
If the applicant passed the licensure examination more than 3 years before applying and is not practicing, or holds a license elsewhere and is not practicing, 50 hours of continuing education (30 clinical, 20 practice) completed within the preceding 3 years are required (Neb. Rev. Stat. § 38-2522, § 38-2523(1); 172 NAC 114-003.01(B), (D)).
Occupational Therapist license by examination (educated in a foreign country)
OTR exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Education
Documentation of completion of a foreign occupational therapy educational program substantially equivalent to an ACOTE-accredited program or one accredited by an equivalent body as determined by the board (Neb. Rev. Stat. § 38-2518(2)(a)).
English Proficiency
Proof of proficiency in the English language (Neb. Rev. Stat. § 38-2518(2)(b)); no specific language test is named.
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Non English Documents
Documents in another language must be accompanied by a notarized translation (172 NAC 10-008).
Occupational Therapist license reinstatement from expired or inactive status
No examination is required for this applicant pathway.
Citizenship Lawful Presence
Meets Neb. Rev. Stat. § 38-129 and §§ 4-108 through 4-111 (172 NAC 10-007.03).
Continuing Education
20 hours of continuing education within the previous 24 months (reinstatement application Section E; 172 NAC 10-007.03).
Practice Before Reinstatement
Practice after expiration is subject to an administrative penalty of $10 per day up to $1,000 (reinstatement application Section D).

Official no-examination sources

Effective from 2020-06-20.

Occupational Therapist license biennial renewal
No examination is required for this applicant pathway.
Continuing Education
20 hours of acceptable continuing education in the preceding 24 months (172 NAC 114-008).
Expiration
Licenses expire August 1 of each even-numbered year (172 NAC 114-007).
Waiver
Continuing competency may be waived under Neb. Rev. Stat. § 38-146 and § 38-2521 (military service, first credentialed in the period, non-resident non-practicing licensee, illness, postgraduate study).

Official no-examination sources

Effective from 2020-06-20.

Temporary Occupational Therapist License

Temporary license to practice in association with an occupational therapist while the licensure examination is pending, or temporary credential for a military spouse.

Licensing authority: Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit (Board of Occupational Therapy Practice) · Application information

Temporary Occupational Therapist credential for a military spouse
No examination is required for this applicant pathway.
Criminal Background Check
Fingerprints for the criminal background check under Neb. Rev. Stat. § 38-131.
Military Spouse
Spouse of an active duty member of the U.S. Armed Forces assigned to a duty station in Nebraska; submits the military dependent identification card and the spouse's orders (Neb. Rev. Stat. § 38-129.01(2)-(3)).
Other State Credential
Holds a valid credential in another jurisdiction with similar standards; submits a copy and its governing statutes and rules (Neb. Rev. Stat. § 38-129.01(2)(c), (3)).
Regular Application
Filed with the application for the regular license; valid until that application is approved or rejected, not over one year (Neb. Rev. Stat. § 38-129.01(4)).

Official no-examination sources

Effective from 2019-06-24.

Temporary Occupational Therapist license pending the licensure examination
OTR exam
Duration
Expires on the earliest of permanent licensure, denial, 180 days after issuance, or notice of examination failure; may be extended but never beyond one year (Neb. Rev. Stat. § 38-2517(2)-(3)).
Education Experience
Must have completed the education and supervised fieldwork requirements for licensure (Neb. Rev. Stat. § 38-2517(1)).
Examination Status
Must have applied to take the NBCOT licensure examination (not yet passed or failed) and request that the official score transfer be sent to Nebraska (Neb. Rev. Stat. § 38-2517(1); 172 NAC 114-003.02; temporary application Section F).
Permanent Application
An application for the permanent license must be submitted before taking the NBCOT examination (temporary application Section F).
Supervision
May practice only in association with a Nebraska-licensed occupational therapist named on the application (Neb. Rev. Stat. § 38-2517(1); Section C).

Occupational Therapy Assistant License

License to assist in the practice of occupational therapy under the supervision of an occupational therapist.

Licensing authority: Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit (Board of Occupational Therapy Practice) · Application information

Occupational Therapy Assistant license by licensure/certification in another state
COTA Certification Exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Board Standards
Meets the standards set by the board under Neb. Rev. Stat. § 38-126 for a license based on licensure in another jurisdiction (Neb. Rev. Stat. § 38-2523(1)).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Not Practicing
An applicant licensed elsewhere who is not currently practicing must show 50 hours of continuing education within the 3 years preceding application (Neb. Rev. Stat. § 38-2523(1); 172 NAC 114-003.01(D)).
Other State License
Holds an occupational therapy license or certification in another state; verification is obtained from that state (application basis 'By Licensure/Certification in another State'; Section D).
Universal Reciprocity
The additional reciprocity method of Neb. Rev. Stat. § 38-129.02 does not apply: its subsection (7) does not list the Occupational Therapy Practice Act.
Occupational Therapy Assistant license by examination (graduate of an accredited U.S. program)
COTA Certification Exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Education
Completion of an occupational therapy assistant educational program recognized by the Department and accredited by a nationally recognized association, and at least two months of supervised fieldwork (Neb. Rev. Stat. § 38-2519(1)(a)-(b)).
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Examination Timing
The application may be filed before the examination is taken; the license issues after passing results are received (application Section G option A: passed or will be taking the NBCOT exam).
Prior Examination
If the applicant passed the licensure examination more than 3 years before applying and is not practicing, or holds a license elsewhere and is not practicing, 50 hours of continuing education (30 clinical, 20 practice) completed within the preceding 3 years are required (Neb. Rev. Stat. § 38-2522, § 38-2523(1); 172 NAC 114-003.01(B), (D)).
Occupational Therapy Assistant license by examination (educated in a foreign country)
COTA Certification Exam
Age Character Presence
At least 19 years old, of good character, and a U.S. citizen or lawfully present per Neb. Rev. Stat. § 38-129 (172 NAC 10-003.01).
Criminal Background Check
Fingerprint-based criminal background check under Neb. Rev. Stat. § 38-131.
Education
Documentation of completion of a foreign occupational therapy assistant educational program substantially equivalent to an ACOTE-accredited program or one accredited by an equivalent body as determined by the board (Neb. Rev. Stat. § 38-2519(2)(a)).
English Proficiency
Proof of proficiency in the English language (Neb. Rev. Stat. § 38-2519(2)(b)); no specific language test is named.
Examination Score Report
The official NBCOT score report must be sent directly to the Department (172 NAC 114-003.01(B); application Step 1 item 6).
Non English Documents
Documents in another language must be accompanied by a notarized translation (172 NAC 10-008).
Occupational Therapy Assistant license reinstatement from expired or inactive status
No examination is required for this applicant pathway.
Citizenship Lawful Presence
Meets Neb. Rev. Stat. § 38-129 and §§ 4-108 through 4-111 (172 NAC 10-007.03).
Continuing Education
15 hours of continuing education within the previous 24 months (reinstatement application Section E; 172 NAC 10-007.03).
Practice Before Reinstatement
Practice after expiration is subject to an administrative penalty of $10 per day up to $1,000 (reinstatement application Section D).

Official no-examination sources

Effective from 2020-06-20.

Occupational Therapy Assistant license biennial renewal
No examination is required for this applicant pathway.
Continuing Education
15 hours of acceptable continuing education in the preceding 24 months (172 NAC 114-008).
Expiration
Licenses expire August 1 of each even-numbered year (172 NAC 114-007).
Waiver
Continuing competency may be waived under Neb. Rev. Stat. § 38-146 and § 38-2521 (military service, first credentialed in the period, non-resident non-practicing licensee, illness, postgraduate study).

Official no-examination sources

Effective from 2020-06-20.

Temporary Occupational Therapy Assistant License

Temporary occupational therapy assistant license while the licensure examination is pending, or temporary credential for a military spouse.

Licensing authority: Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit (Board of Occupational Therapy Practice) · Application information

Temporary Occupational Therapy Assistant credential for a military spouse
No examination is required for this applicant pathway.
Criminal Background Check
Fingerprints for the criminal background check under Neb. Rev. Stat. § 38-131.
Military Spouse
Spouse of an active duty member of the U.S. Armed Forces assigned to a duty station in Nebraska; submits the military dependent identification card and the spouse's orders (Neb. Rev. Stat. § 38-129.01(2)-(3)).
Other State Credential
Holds a valid credential in another jurisdiction with similar standards; submits a copy and its governing statutes and rules (Neb. Rev. Stat. § 38-129.01(2)(c), (3)).
Regular Application
Filed with the application for the regular license; valid until that application is approved or rejected, not over one year (Neb. Rev. Stat. § 38-129.01(4)).

Official no-examination sources

Effective from 2019-06-24.

Temporary Occupational Therapy Assistant license pending the licensure examination
COTA Certification Exam
Duration
Expires on the earliest of permanent licensure, denial, 180 days after issuance, or notice of examination failure; may be extended but never beyond one year (Neb. Rev. Stat. § 38-2517(2)-(3)).
Education Experience
Must have completed the education and supervised fieldwork requirements for licensure (Neb. Rev. Stat. § 38-2517(1)).
Examination Status
Must have applied to take the NBCOT licensure examination (not yet passed or failed) and request that the official score transfer be sent to Nebraska (Neb. Rev. Stat. § 38-2517(1); 172 NAC 114-003.02; temporary application Section F).
Permanent Application
An application for the permanent license must be submitted before taking the NBCOT examination (temporary application Section F).
Supervision
May practice only in association with a Nebraska-licensed occupational therapist named on the application (Neb. Rev. Stat. § 38-2517(1); Section C).

OTR exam

Format
Three- and four-option single-response multiple-choice items and six-option multi-select scenario sets
Exam questions
180 items
Examination outline
  • Domain 1 — Evaluation and Assessment: Acquire information regarding factors that influence occupational performance on an ongoing basis throughout the occupational therapy process. (23%)
    • Task 1: Identify the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Assess a client’s functional skills, roles, prioritized needs and wants, and performance context to evaluate their occupational performance.
    • Task 2 knowledge 1: Resources and considerations for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans; theoretical approach and frame of reference.
    • Task 2 knowledge 2: Administration, purpose, indications, advantages, and limitations of standardized and nonstandardized screening and assessment tools. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
  • Domain 2 — Analysis, Interpretation, and Planning: Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process. (23%)
    • Task 1: Synthesize assessment results to determine eligibility for services and establish a client-centered intervention plan.
    • Task 1 knowledge 1: Interpretation and analysis of quantitative assessments. Examples include statistical terminology; scoring; limitations of scores; client reactions to testing.
    • Task 1 knowledge 2: Interpretation of qualitative findings. Examples include occupational profile; outcomes of needs assessment; results from interviews or observations.
    • Task 1 knowledge 3: Integration and application of quantitative assessment results and qualitative findings to guide critical decision-making and prioritize needs.
    • Task 2: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to manage occupational therapy services.
    • Task 2 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 2 knowledge 2: Processes for managing interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 2 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 2 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 2 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 3: Monitor and modify the intervention plan, approach, context, and goals on an ongoing basis using clinical reasoning.
    • Task 3 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 3 knowledge 2: Strategies for monitoring the effectiveness of individual and group interventions. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 3 knowledge 3: Clinical decision-making for assessing and adapting the intervention plan and prioritizing goals based on client response to intervention. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 3 knowledge 4: Precautions or contraindications associated with a client’s condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 3 — Select and Manage Interventions: Select and implement interventions for managing a client-centered plan throughout the occupational therapy process. (38%)
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wound management and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Select and implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Select assistive technology options, adaptive devices, mobility aids, and other durable medical equipment to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Recommend environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 4 — Competency and Practice Management: Manage professional activities of self and relevant others as guided by evidence, regulatory compliance, and standards of practice to promote quality care. (16%)
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, interpreting, and critically appraising scholarly research to guide practice-relevant decision-making. Examples include defining a clinical question; determining the clinical bottom line.
    • Task 1 knowledge 2: Methods for applying continuous quality improvement processes and procedures to occupational therapy service delivery. Examples include program evaluation; outcome measures.
    • Task 1 knowledge 3: Evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing; supervisory role under state practice acts.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.
Examination sources

COTA Certification Exam

Format
Three- and four-option single-response multiple-choice items and six-option multi-select items
Exam questions
190 items
Examination outline
  • Domain 1 — Collaborate and Gather Information: Under the supervision of the OTR, acquire information on an ongoing basis regarding factors that influence occupational performance. (27%)
    • Task 1: Recognize the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Acquire information about a client’s functional skills, roles, prioritized needs and wants, and performance context to inform the development of and updates to an occupational profile.
    • Task 2 knowledge 1: Resources for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans.
    • Task 2 knowledge 2: Purpose, advantages, limitations, and service competency needs related to the administration of standardized and nonstandardized assessments and screening methods. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
    • Task 4: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to provide quality occupational therapy services.
    • Task 4 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 4 knowledge 2: Processes for supporting interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 4 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 4 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 4 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 5: Monitor the intervention plan, approach, context, and goals on an ongoing basis, in collaboration with the OTR, using clinical reasoning.
    • Task 5 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 5 knowledge 2: Strategies for monitoring the effectiveness of individual and group intervention. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 5 knowledge 3: Clinical decision-making for prioritizing goals and implementing modifications to the intervention plan based on client responses, under the supervision of the OTR. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 5 knowledge 4: Precautions or contraindications associated with a client condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 2 — Select and Implement Interventions: Implement interventions, under the supervision of the OTR, in accordance with the intervention plan and level of service competence to support client participation in areas of occupation throughout the occupational therapy process. (55%)
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety; theoretical approach and frame of reference.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wounds and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices in order to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Integrate assistive technology options, adaptive devices, mobility aids, and other durable medical equipment into the intervention to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Implement environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 3 — Uphold Professional Standards and Responsibilities: Uphold professional standards and responsibilities by achieving service competence and applying evidence-based interventions to promote quality in practice. (18%)
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, and interpreting scholarly research to guide practice-relevant decision-making. Examples include applying the Patient, Intervention, Comparison, Outcome (PICO) model; identifying best evidence.
    • Task 1 knowledge 2: Methods for contributing to continuous quality improvement processes and procedures related to occupational therapy service delivery. Examples include program evaluation; acquiring information to measure outcomes.
    • Task 1 knowledge 3: Types of evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.
Examination sources