How to Supervise a COTA as a New Grad OTR

How to Supervise a COTA as a New Grad OTR

One of the most common questions I receive from new grad OTs is “How do I supervise a COTA?” For many new grads, it can be very daunting to supervise a COTA with a lot of experience.

How to Supervise a COTA as a New Grad OTR all comes down to knowing your state laws, setting expectations, and respecting and forming a relationship with the COTA.

In occupational therapy, the collaboration between the Occupational Therapist Registered (OTR) and Certified Occupational Therapy Assistant (COTA) is fundamental. Over the years I have supervised many COTAs. And I have learned something from each one of them.

First: Remember that not everyone can go to every Continuing Education class ever created! So you can learn something from every single therapist you work with.

Second: Respect is key. We are not superior because we can complete evaluations and because we have more schooling. So much of OT is learned on the job. The COTAs you work with are the same.

Third: They are not YOUR COTAs. Respect what they know. No, they can not work 100% independently (and Yes, I have seen that boundary pushed) but they know so so much.

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The Benefits of a Great OTR-COTA Partnership

A strong partnership between you, as an OTR, and the COTAs you work closely with, can transform the therapeutic environment, yielding remarkable benefits.

Valuing the expertise of COTAs and integrating their knowledge into the therapeutic process not only enriches patient care but also fortifies the supervisory relationship. It's a dynamic that benefits everyone involved: enhancing patient outcomes, enriching your professional experience, and creating a cohesive, collaborative team focused on delivering the best possible occupational therapy services.

This collaborative approach not only enhances clinical outcomes but also contributes to a more satisfying and productive work environment, where mutual respect and shared goals drive the success of the therapeutic interventions and the overall well-being of the clients.

The OTR-COTA partnership is symbiotic rather than hierarchical. It flourishes through the sharing of knowledge and expertise, and a collective dedication to delivering the highest standard of care. In this dynamic partnership, both you and the COTA will experience growth, and learning, and together, you'll have a profound impact on the lives of the patients you serve.

In my own experience, when I first started out as a therapist, my therapeutic abilities were significantly enriched through active collaboration with knowledgeable COTAs.

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Understanding the COTA’s Scope of Practice

As an OTR, it's imperative to grasp the COTA’s scope of practice. Understanding their roles, responsibilities, and the boundaries of their professional capacity. COTAs bring a rich blend of knowledge and practical skills, nurtured through comprehensive academic learning and hands-on training. They are well-equipped to support and carry out the therapeutic plans you, as an OTR, develop.

Yet, it’s important to note the clear distinction between your roles: While you are tasked with conducting comprehensive evaluations and creating detailed treatment plans, COTAs do not hold the license to perform these initial assessments. Their expertise is more centered on the execution and adaptation of these plans, ensuring they are applied effectively in the therapeutic setting.

Legal Considerations for COTA Supervision

Supervision in the context of occupational therapy is a structured process that involves directing and monitoring the activities of a COTA to ensure the safe and effective delivery of occupational therapy services. It encompasses guidance, evaluation, and enhancement of the professional skills and competencies of the supervisee.

Navigating the legal and ethical landscape of supervising a Certified Occupational Therapy Assistant (COTA) is a fundamental aspect of your responsibilities as an Occupational Therapist Registered (OTR). This supervision not only aligns with ensuring quality patient care but also adheres to stringent regulatory standards set by state licensure boards and professional bodies.

Legal responsibilities in supervising a COTA are underpinned by state-specific regulations that define the scope of practice. The frequency and type of supervision required, and the qualifications necessary to serve as a supervisor. You must familiarize yourself with these laws to effectively oversee the work of COTAs and ensure compliance.

Every state has significantly different requirements!

Understanding and adhering to state regulations and practice guidelines are paramount. These rules not only vary from state to state but also evolve over time.

two women sitting beside table and talking

Setting Clear Expectations and Goals

Setting clear objectives and expectations with COTAs is fundamental to fostering a successful supervisory dynamic. Initiating these guidelines early in the professional relationship helps prevent misunderstandings, sets a professional tone, and clarifies the roles, responsibilities, and goals of the collaboration.

Open discussions about the scope of practice, communication preferences, documentation standards, and treatment planning processes are essential, ensuring alignment and understanding between you and the COTAs.

Developing a structured plan that aligns with both your professional goals and those of the COTAs is crucial. This plan needs to be adaptable to cater to the evolving needs of the patients and to support the professional development of the COTAs.

Setting regularly scheduled check-ins and meetings is vital to reviewing and adjusting this plan, and maintaining its relevance and effectiveness. Such ongoing dialogue is key to achieving the best possible outcomes for the patients and solidifying the supervisory partnership, enhancing the impact and fulfillment of your collaborative efforts.

COTA Supervision Models

There are several ways to provide supervision for COTAs. Some of this will depend on your state's requirements.

Here is a quick overview:


Observing a COTA's treatment sessions and giving feedback and suggestions.

Caseload Collaboration

Engaging in caseload discussions with the COTA is one of the most productive ways to foster this partnership. These discussions serve as a forum for clinical reasoning, allowing you both to explore the nuances of each case, exchange insights, challenge existing assumptions, and collaboratively formulate treatment plans.

Treatment Technique Discussions

These are similar to caseload discussions but focused on general treatment techniques versus individual clients on a shared caseload.


Treating clients together is a great way to supervise and learn from each other. Make sure co-treatments are allowed for reimbursement.

Mentorship and Professional Development as a New Grad OTR

For new grad OTRs mentorship is invaluable during this phase, offering guidance that can significantly enhance your clinical reasoning and treatment planning skills. Having a mentor—a seasoned practitioner who can share wisdom, insights, and practical advice—is crucial for navigating the complexities of your new role effectively.

In my program, The Efficient Pediatric OT Roadmap, a new grad OTR once asked how to supervise a COTA, especially one with extensive experience. This question underscored the need for supportive mentorship to help new OTRs understand the dynamics of professional relationships and clinical practice. Through mentorship, you can learn how to form effective partnerships with COTAs, leveraging their experience to enhance patient care while also developing your supervisory skills.

As a new grad OTR, embracing mentorship accelerates your learning curve but also builds a strong foundation for your professional growth.

Having a mentor greatly increases your happiness and satisfaction as a therapist. It isn't just about improving outcomes for your clients. Think about it as doing something for YOURSELF.

If you do not have a mentor in your place of employment, explore how you can find one outside of work.

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Supervising a COTA as a new grad OTR presents both challenges and opportunities for professional growth and enhanced patient care. By understanding the COTA’s scope of practice, respecting their knowledge and experience, and fostering a strong, collaborative partnership, you can create a therapeutic environment that benefits everyone involved. Legal considerations and state-specific regulations form the backbone of this supervisory relationship, ensuring that patient care is safe, effective, and compliant with professional standards. Setting clear expectations and goals, and adopting various supervision models, can further enhance this dynamic, leading to successful outcomes for patients, COTAs, and yourself as an OTR.

Remember, the journey from being a new grad to an experienced OTR is a continuous learning process, enriched by the contributions and insights of those you work with, especially COTAs. Embrace mentorship, engage in open communication, and be willing to learn and grow together. This approach will not only improve your practice and patient care but also contribute to a fulfilling and rewarding career in occupational therapy.


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