DRIVING AND COMMUNITY MOBILITY SPECIALTY …/media/Corporate/Files/... · Web viewServing as an expert witness in a civil or criminal legal case court or in arbitration. ... ☐Publication

DRIVING AND COMMUNITY MOBILITY SPECIALTY CERTIFICATIONOccupational Therapist

Table of Contents: ACTIVITY EVIDENCE FORMS

Guidelines: Applicant must address 5 of the 12 criteria, in addition to #13 – Ethical Practice, by choosing one

(1) available option for each. Please note that the term “ensures” can refer to direct service delivery or the supervision or

teaching of others. Reflections should demonstrate advancement in professional development from initial

certification.

Instructions: Please complete 1 form for each criterion. Combine completed forms in a single document (e.g., Word or .PDF) and submit with the completed

Part 1 application to [email protected]. Please do not include unused forms.

Criterion 1: Knowledge: Diagnostic Considerations Expert Witness Formal Learning (Min. 10 contact hours needed) Independent Learning (Min. 10 contact hours needed) Mentee (does not include supervisory relationship) Publication – Reviewed by Expert(s)

Criterion 2: Knowledge: Evaluation Expert Witness Formal Learning (Min. 10 contact hours needed) Independent Learning (Min. 10 contact hours needed) Mentee (does not include supervisory relationship) Publication – Reviewed by Expert(s)

Criterion 3: Knowledge: Intervention Expert Witness Formal Learning (Min. 10 contact hours needed) Independent Learning (Min. 10 contact hours needed) Mentee (does not include supervisory relationship) Publication – Reviewed by Expert(s)

Criterion 4: Knowledge: Regulation & Payers Expert Witness Formal Learning (Min. 10 contact hours needed) Independent Learning (Min. 10 contact hours needed) Mentee (does not include supervisory relationship) Publication – Reviewed by Expert(s)

Criterion 5: Evaluation: Performance Skills Analysis of Recording or Observation Case Study Mentee (does not include supervisory relationship)

Criterion 6: Evaluation: Critical Reasoning Critical Reasoning Scenarios (2)

o List of Assessments for CR Scenarios Formal Specialized Consultation for Evaluation Program Development

© 2017 The American Occupational Therapy Association, Inc. All rights reserved.

mailto:[email protected]

Research

Criterion 7: Intervention: Performance Skills

Analysis of Recording or Observation Case Study, Client-Based Case Study, Instructional Formal Specialized Consultation for Intervention Program Development Research

Criterion 8: Intervention: Critical Reasoning Analysis of Recording or Observation Case Study, Client-Based Case Study, Instructional Formal Specialized Consultation for Intervention Program Development Research

Criterion 9: Psychosocial Critical Reasoning Analysis of Recording or Observation Case Study, Client-Based Case Study, Instructional Formal Specialized Consultation for Psychosocial Program Development Research

Criterion 10: Establishes Networks Formal Specialized Consultation Marketing Activities Presentation Volunteer Leadership

Criterion 11: Advocating for Change Advocacy Efforts Case Study, Advocacy Volunteer Leadership

Criterion 12: Service to BASC

Documentation of Service

Criterion 13: Ethical PracticeThe 3 ethical practice scenarios are found within the application itself.


EXPERT WITNESSBack to Criteria

Criterion 1–Knowledge: Diagnostic ConsiderationsDemonstrates knowledge of primary and secondary conditions that impact occupational engagement related to driving & community mobility.

Guidelines Serving as an expert witness in a civil or criminal legal case court or in arbitration. Providing expert testimony in official hearings at the local, state, or national level.

1. Describe the expertise which you were able to share relevant to driving & community mobility. (average word guideline–200)

2. Describe how the knowledge acquired from this activity “demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to driving & community mobility.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)

3. Submit verification of activity as a separate attachment. May include any 1 of the following: Transcript of the testimony. Notice of deposition. Letter from the attorney.


FORMAL LEARNINGBack to Criteria


Guidelines Minimum of 10 contact hours required. Multiple activities may be used to meet the hour requirement for the criterion. Learning must have occurred in the past 5 years.

Please identify the type of activity in which you participated:☐ AOTA CE: Participation in CE course from AOTA. Does not include courses from AOTA Approved

Providers. Completion of course will be verified by AOTA. Submission of additional documentation beyond this form not required.

☐ Non-AOTA CE: Attending workshops, seminars, lectures, or professional conferences with formal established objectives.

☐ Participation in post-professional academic coursework. Attach unofficial transcript.

1. Activity information.

Activity Title

Provider/Instructor

Activity Date(s)

No. of Contact Hours

2. Activity Learning Objectives. List up to 5.

A)

B)

C)

D)

E)


3. Describe the relevance of the activity to your practice in driving & community mobility. (average word guideline–200)


5. Submit documentation that verifies completion of the activity, such as certificate of completion or unofficial transcript. Not required for AOTA courses.


INDEPENDENT LEARNINGBack to Criteria



Please identify the type of independent learning activity in which you participated:☐ Independent reading of recent peer-reviewed, professional articles, or chapters in textbook not

associated with a formal learning course. ☐ Independent review of professional electronic resources (e.g., NIH, CDC, CanChild).☐ AOTA Journal Club Toolkit (reading & discussion time). Must be AOTA member to access the kit.☐ AOTA Critically Appraised Paper (CAP, includes submission to the AOTA Evidence Exchange).

1. Why did you choose this activity?☐ Clinical reference for specific population, program, or individual ☐ Invited peer review of scholarly work or publication (print or online)☐ Preparation for poster or presentation ☐ Preparation for academic lecture☐ Literature review for research project☐ Preparation for serving as a mentor☐ Other, please specify:

2. Bibliography (APA Format) or list and objectives of select item(s) used for independent learning.

3. Date(s) of independent learning

4. Time spent engaged in independent learning. For reading, estimate 8–12 published pages/hour. For journal club, discussion time counts toward 10-hour requirement.


http://www.aota.org/en/Practice/Researchers/Evidence-Exchange.aspx

http://www.aota.org/en/Practice/Researchers/Journal-Club-Toolkit.aspx

5. Describe the relevance of the independent learning activity to your practice in driving & community mobility. (average word guideline–200)



MENTEEBack to Criteria


Guidelines Must represent a minimum of 10 hours over a minimum of 2 months. Does not include supervisory relationships. Relationship must have occurred in the past 5 years. May be with a non-occupational therapy professional if appropriate to goal(s) of relationship.

1. Dates of mentoring relationship

2. Approximately how many hours did this represent in total?

3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3.

A)

B)

C)

4.Mentor

Position/Role of Mentor

Workplace of MentorContact Information for Mentor (email or phone number)


5. State why the mentor was selected to help you meet the goals identified above relative to the criterion. (average word guideline–50)

6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of primary and secondary conditions that impact occupational engagement related to driving & community mobility.” (average word guideline–200)


PUBLICATION – REVIEWED BY EXPERT(S)Back to Criteria


Guidelines Examples of publication reviewed by experts include journals such as AJOT or OTJR. May include a chapter in an occupational therapy or related professional textbook, if chapter has

gone through peer review (a process in which subject matter experts, using a formal system and defined guidelines, provide content guidance to an author and recommend publication, revision, or rejection of a work).

1. Submit APA reference for the publication. For in-press publication, also include a verification letter or e-mail identifying applicant and anticipated date of publication.

2. If applicant is not identified as first or second author, please describe your contribution/involvement in the development of the publication. (average word guideline–200)

3. Provide a reflection indicating why this publication was chosen to represent “knowledge of primary and secondary conditions that impact occupational engagement related to driving & community mobility.” (average word guideline–200)



Criterion 2–Knowledge: EvaluationDemonstrates knowledge of relevant evidence specific to evaluation in driving & community mobility.



2. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to evaluation in driving & community mobility.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)







Providers.Completion of course will be verified by AOTA. Submission of additional documentation beyond this form not required.




Activity Title

Provider/Instructor

Activity Date(s)



A)

B)

C)

D)

E)



























A)

B)

C)

4.Mentor





6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of relevant evidence specific to evaluation in driving & community mobility.” (average word guideline–200)




Guidelines Examples of peer-reviewed publication include journals such as AJOT or OTJR. May include a chapter in an occupational therapy or related professional textbook, if chapter has




3. Provide a reflection indicating why this publication was chosen to represent “knowledge of relevant evidence specific to evaluation in driving & community mobility.” (average word guideline–200)



Criterion 3–Knowledge: InterventionDemonstrates knowledge of relevant evidence specific to intervention in driving & community mobility.



2. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to intervention in driving & community mobility.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)











Activity Title

Provider/Instructor

Activity Date(s)



A)

B)

C)

D)

E)



























A)

B)

C)

4.Mentor





6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of relevant evidence specific to intervention in driving & community mobility.” (average word guideline–200)








3. Provide a reflection indicating why this publication was chosen to represent “knowledge of relevant evidence specific to intervention in driving & community mobility.” (average word guideline–200)



Criterion 4–Knowledge: Regulation & PayersDemonstrates knowledge of laws and regulations relevant to driving & community mobility, including payer sources.



2. Describe how the knowledge acquired from this activity “demonstrates knowledge of laws and regulations relevant to driving & community mobility, including payer sources.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)











Activity Title

Provider/Instructor

Activity Date(s)



A)

B)

C)

D)

E)



























A)

B)

C)

4.Mentor





6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of laws and regulations relevant to driving & community mobility, including payer sources.” (average word guideline–200)








3. Provide a reflection indicating why this publication was chosen to represent “knowledge of laws and regulations relevant to driving & community mobility, including payer sources.” (average word guideline–200)


ANALYSIS OF RECORDING or OBSERVATIONBack to Criteria

Criterion 5—Evaluation: Performance SkillsEnsures that standardized assessments specific to driving & community mobility are administered correctly and include the integration of clinical observations throughout the evaluation process.

Guidelines Submission of actual recording is not required for application; however, appropriate permissions

should be obtained by applicant whenever engaging a client in a recorded session. Observation should be consultative or instructive in nature and a minimum of 1 hour. It may occur

over multiple sessions.

1.Age of Client

Client Diagnosis(es)

Setting for EvaluationDate of Recording or Observation

1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that standardized assessments specific to driving & community mobility are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–200)


2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to evaluation – performance skills. (average word guideline–400)


CASE STUDYBack to Criteria


Guidelines Client-based case study should not include any form of standard client documentation (e.g.,

evaluation summary, discharge plan) or identification of client name(s) or facility information.

1. Date(s) case study represents

2. Describe the client, client factors, and case contexts for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500)


3. Articulate how this case demonstrates how you “ensure that standardized assessments specific to driving & community mobility are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–500)








A)

B)

C)

4.Mentor





6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “ensure that standardized assessments specific to driving & community mobility are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–200)


CRITICAL REASONING SCENARIOSBack to Criteria

Criterion 6—Evaluation: Critical ReasoningEnsures that assessment data and clinical observations related to the client, context, and performance in driving & community mobility are synthesized and interpreted according to current evidence and best practice.

Guidelines Applicant chooses 2 assessments and completes this 2-part form relative to the application of each

assessment tool with a client. Selected tools can either have been used with the same client or different clients.

Assessment tools may be identified from the list, or applicants may submit an assessment that is not listed.

For each assessment, answer the following questions by reflecting upon a case from your practice. You may choose to use different cases for each assessment tool.

Part IASSESSMENT 1 (Part 1 of 2)1. Name of assessment.

2. Describe the client, client factors, and case contexts that contributed to your selection of the assessment for the identified case.

3. What considerations regarding reliability, validity, relevance, and currency did you consider when selecting this assessment?

4. Describe the assessment results, including those gathered through clinical observation, and what these results told you about the client’s occupational performance.

Continued next page


5. Describe how and why you integrated these results into the client’s intervention plan.

Part II

ASSESSMENT 2 (Part 2 of 2)6. Name of assessment.

7. Describe the client, client factors, and case contexts that contributed to your selection of the assessment for the identified case.

8. What considerations regarding reliability, validity, relevance, and currency did you consider when selecting this assessment?

9. Describe the assessment results, including those gathered through clinical observation, and what these results told you about the client’s occupational performance.

10. Describe how and why you integrated these results into the client’s intervention plan.


CRITICAL REASONING SCENARIO ASSESSMENTS– Criterion 6Specialty Certification in Driving & Community Mobility

To complete the scenario activity, applicant may choose 2 assessments from the list below or complete the activity form with one (or two) assessments that are not listed. Examples provided may be with the same client or different clients.

Driving and Community Mobility Ancillary Screens

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1. Beck Depression Inventory (BDI)Source: www.cawt.com/Site/11/Documents/Members/Evaluation/ BeckDepressionInventory1.pdf

X

2. Behavioral Inattention Test (BIT)Source: www.pearsonassessments.com

X

3. Berg Balance ScaleSource: Internet search

X

4. Brain Injury Visual Assessment Battery for Adults (biVABA)Source: www.visabilities.com

X X X X X X

5. California Central Visual Field TestSource: www.mattinglylowvision.com

X

6. Catherine Bergego Scale (CBS)Source: strokengine.ca/assess/module_cbs_family-en.html

X

7. Colenbrander Driving and Community Mobility Test ChartSource: Internet search

X

8. Colenbrander Mixed Contrast Reading CardSource: Internet search

X X X

9. Collins Driving and Community Mobility Writing AssessmentContact Gale Watson

X

10. Developmental Test of Visual Perception–Adult (DTVP–A)

X



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Source: Internet search11. ETDRS Eye Chart

Source: Internet searchX

12. Geriatric Depression Rating Scale–Short Form (GDRS–SV)Source: www.chcr.brown.edu/GDS_SHORT_FORM.PDF

X

13. Home Environment Lighting Assessment (HELA)Source: ot.wustl.edu, click “Resources”

X

14. International Reading Speed Text (iReST)Source: precision-vision.com/index.cfm/feature/79_94

X

15. Landolt “C or Tumbling E”Source: Internet search

X

16. LeaNumbers Intermediate Acuity Test ChartSource: Internet search

X

17. LeaNumbers Near Vision and Crowding ChartSource: Internet search

X X

18. LeaNumbers & LeaSymbols Contrast Sensitivity TestSource: Internet search

X

19. Driving and Community Mobility Quality-of-Life QuestionnaireSource: www.ncbi.nlm.nih.gov/pubmed/11124300

X

20. Mars Contrast Sensitivity TestSource: www.marsperceptrix.com

X

21. MedMaIDE Medication Management AssessmentSource: medmanagement.umaryland.edu/self_med

X

22. Mini Mental State Exam (MMSE)Source: Internet search

X



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23. Minnesota Driving and Community Mobility Reading Test (MNRead)Source: Internet search

X X

24. Montreal Cognitive Assessment (MOCA)Source: www.mocatest.org

X

25. Morgan Driving and Community Mobility Reading Comprehension AssessmentSource: www.shoplowvision.com/morgan-low-vision-reading-comprehension-assessment.html

X

26. MOS Social Support SurveySource: www.rand.org/content/dam/rand/www/external/health/surveys_tools/mos/mos_socialsupport_survey.pdf

X

27. Motor-Free Visual Perception Test (MVPT)Source: Internet search

X

28. National Eye Institute Visual Function Questionnaire–25 (NEI–VFQ–25)Source: www.nei-govwww.healthmeasurement.org/pub_pdfs/_QUESTIONNAIRE_VFQ-25.pdf

X

29. Patti Pics Logarithmic Visual Acuity ChartSource: Internet search

X

30. Pelli–Robson CSFSource: Internet search

X

31. Self-Report Assessment of Functional Visual Performance (SRAFVP)Source:ajot.aotapress.net/content/66/4/478.full.pdf

X

32. Semmes–Weinstein Monofilament Test X



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Source: Internet search33. Short Blessed Memory Orientation Concentration Test

Source: www.gcrweb.com/alzheimersDSS/assess/subpages/alzpdfs/bomc.pdf

X

34. SKReadSource: www.mattinglylowvision.com

X X

35. Tinetti Balance Assessment ToolSource: Internet search

X

36. Visual Skills for Reading Test (VSRT) (Pepper)Source: Internet search

X


FORMAL SPECIALIZED CONSULTATION FOR EVALUATIONBack to Criteria


Guidelines This should not be confused with consultation that is part of the ongoing services provided in your

routine job duties. It is a request to address a particular issue at a particular site, either external or internal.

Consultation may include (but is not limited to) developing or evaluating a program or service, developing a strategy for long-term planning, establishing outcomes measures, incorporating national guidelines into internal policies and procedures, assessing and addressing staff educational needs, assessing and addressing resource needs, and validating program/service delivery with current evidence.

Applicant must have had a minimum of 10 hours working with the site.

1.Entity for Which Consultation Was CompletedDate(s) of ConsultationNo. of Hours Completed During Consultation

2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3.

A)

B)

C)

3. Summarize the consultation results. (average word guideline–200)


4. Summarize how this professional development activity influenced your ability to “ensure that assessment data and clinical observations related to the client, context, and performance in driving & community mobility are synthesized and interpreted according to current evidence and best practice.” (average word guideline–400)


PROGRAM DEVELOPMENTBack to Criteria


Guidelines Program development refers to the creation of a new program or development of an evolving

program.

1. Dates of program development

2. Briefly describe the program purpose, services offered, and clients served. (average word guideline–250)

3. Describe how this program development activity, including description of resources used, demonstrates your ability to “ensure that assessment data and clinical observations related to the client, context, and performance in driving & community mobility are synthesized and interpreted according to current evidence and best practice.” (average word guideline–500)


RESEARCHBack to Criteria


What type of research was conducted? Please choose 1. ☐ Scientific inquiry–Qualitative, quantitative, or mixed-methods approach. ☐ Methodological research/instrument development–Scientific inquiry to establish psychometric

properties of (1) a new tool, (2) an existing tool with a new population, or (3) an existing tool translated to a new language.

☐ Systematic review of the literature–Comprehensive search, review, and analysis of the existing literature to answer a focused question.

1. Title of research conducted

2. Mechanism of dissemination:☐ Publication ☐ Evidence-Based Practice☐ Peer-reviewed presentation ☐ Project Web site ☐ Grant funding ☐ Dissertation/thesis☐ Critically Appraised Topic (CAT, e.g., AOTA)

Citation:

3. Role of applicant in the research. (average word guideline–25)


4. Purpose and rationale of the research. (average word guideline–250)

5. Describe how this research demonstrates your ability to “ensure that assessment data and clinical observations related to the client, context, and performance in driving & community mobility are synthesized and interpreted according to current evidence and best practice.” (average word guideline–400)


ANALYSIS OF RECORDING or OBSERVATIONBack to Criteria

Criterion 7—Intervention: Performance SkillsEnsures that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.




2.Age of Client



3. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–200)


4. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to intervention – performance skills. (average word guideline–400)


CASE STUDY, CLIENT-BASEDBack to Criteria







3. Articulate how this case demonstrates how you “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–500)


CASE STUDY, INSTRUCTIONALBack to Criteria


Guidelines Instructional case study refers to teaching that was provided to other practitioners that will be

delivering interventions in driving & community mobility. should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information.


2. Describe the audience and context for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500)


3. Articulate how this case demonstrates how you “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–350)

4. How was learning of the audience to whom you were instructing measured? (average word guideline–150)


FORMAL SPECIALIZED CONSULTATION FOR INTERVENTIONBack to Criteria








A)

B)

C)



4. Summarize how this professional development activity influenced your ability to “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–400)





program.



3. Describe how this program development activity, including description of resources used, demonstrates your ability to “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–500)









Citation:




5. Describe how this research demonstrates your ability to “ensure that driving & community mobility interventions are performed competently and include the integration of varying client factors and contexts.” (average word guideline–400)


ANALYSIS OF RECORDINGBack to Criteria

Criterion 8—Intervention: Critical ReasoningEnsures that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.




5.Age of Client



1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–200)


2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to intervention – critical reasoning. (average word guideline–400)









3. Articulate how this case demonstrates how you “ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–500)





delivering interventions in driving & community mobility. should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information.




3. Articulate how this case demonstrates how you “Ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–350)



FORMAL SPECIALIZED CONSULTATION FOR INTERVENTIONBack to Criteria








A)

B)

C)



4. Summarize how this professional development activity influenced your ability to “ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–400)





program.



3. Describe how this program development activity, including description of resources used, demonstrates your ability to “Ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–500)









Citation:




5. Describe how this research demonstrates your ability to “ensure that the selection, planning, and modification of interventions in driving & community mobility are based on evidence and evaluation data.” (average word guideline–400)


ANALYSIS OF RECORDINGBack to Criteria

Criterion 9—Psychosocial Critical ReasoningRecognizes immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensures that therapeutic approach and occupational therapy service delivery are modified accordingly.




6.Age of Client



1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–200)


2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to psychosocial critical reasoning. (average word guideline–400)









3. Articulate how this case demonstrates how you “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–500)





delivering interventions in driving & community mobility. It should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information.




3. Articulate how this case demonstrates how you “Recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–350)



FORMAL SPECIALIZED CONSULTATION FOR PSYCHOSOCIALBack to Criteria



routine job duties but is a request to address a particular issue at a particular site, either external or internal.




2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3.A)

B)

C)



4. Summarize how this professional development activity influenced your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–400)





program.



3. Describe how this program development activity, including description of resources used, demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–500)









Citation:




5. Describe how this research demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients with driving & community mobility issues and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–400)


FORMAL SPECIALIZED CONSULTATIONBack to Criteria

Criterion 10—Establishes NetworksEstablishes and collaborates with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of driving & community mobility.


routine job duties but is a request to address a particular issue at a particular site, either external or internal.




2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3.A)

B)

C)



4. Summarize how this professional development activity influenced your ability to “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of driving & community mobility.” (average word guideline–400)


MARKETING ACTIVITIESBack to Criteria


Type of media used for marketing: (check all that apply)☐ Presentation to potential referral source audience☐ Presentation to potential clients☐ Participation in community event such as health fairs☐ Speaking to community groups☐ Development and dissemination of marketing materials (e.g., brochures, Web sites,

podcasts)☐ Participation in media interview (e.g., television news, newspaper)☐ Other

1.Target Audience of Marketing

Date(s) of Marketing EffortsApproximate Total Hours Engaged in Marketing Activity

2. Provide a brief summary of the marketing activity. (average word guideline–50)

3. Applicant’s objectives for the marketing. List no more than 3.

A)

B)

C)


4. Describe how this marketing activity demonstrates how you “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of driving & community mobility.” (average word guideline–200)


PRESENTATIONBack to Criteria


Type of presentation:☐ In-service to professionals☐ Academic program lecture☐ Professional level workshop (e.g., state conference) ☐ Community

1. Presentation information.

Title

Target Audience

Date and Time of Presentation

2. Brief description of the presentation, including content focus. (average word guideline–50)

3. Applicant’s objectives for networking. Objectives must have been met by time of application. Please list no more than 3.A)

B)

C)


4. Describe how networks were established or strengthened through this presentation and any changes which have occurred as a result of your presentation. (average word guideline–200)


VOLUNTEER LEADERSHIPBack to Criteria


Guidelines Service with a local, state, national, or international agency or organization that has relevance to

the certification area. Minimum of 25 hours for at least 1 year.

1. Name of organization

2. Dates of service

3. Approximate number of hours of service

4. Identification of the volunteer leadership role served (must be leadership in nature, e.g., officer, chair, committee member, board member)

5. Describe how this leadership activity helped you “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of driving & community mobility.” (average word guideline–200)


ADVOCACY EFFORTSBack to Criteria

Criterion 11— Advocating for ChangeInfluences services for clients (person, organization, population) in driving & community mobility through independent or collaborative education or advocacy activities.

Guidelines Active involvement in or facilitation of advocacy activities at the local, regional, state, or national

level for the purpose of influencing decision-makers about policy, procedures, services, reimbursement, or occupational justice issues.

Merely serving as a participant does not constitute advocacy efforts. Minimum of 10 hours over at least 2 months.

Type of advocacy activity: (check all that apply)☐ Development and dissemination of advocacy materials (e.g., letters, brochures, Web sites,

podcasts)☐ Lobbying to/education for policy-makers☐ Organizer of community event (e.g., fundraising, health fair)☐ Subject expert in media interview (e.g., radio, television news, newspaper)☐ Presentation to stakeholder☐ Other

1.Description of Activity Target Audience Date(s) No. of Hours

Involved

2. Applicant’s objectives for advocating for change. List no more than 3.A)

B)

C)


3. Discuss the results, outcomes, or progress toward change affected by this advocacy effort that demonstrates how you “influence services for clients (person, organization, population) in driving & community mobility through independent or collaborative education or advocacy activities.” (average word guideline–350)


CASE STUDY, ADVOCACYBack to Criteria


Guidelines Efforts toward change that influence access to services or promote the health and occupational

engagement of clients. This should not be confused with routine job duties associated with expected occupational therapy

service delivery. For example, submitting letters of necessity for equipment would not meet intent.

1. Describe the client (person, organization, population) or program and the context as it applies to an identified need for change. (average word guideline–100)

2. Summarize your efforts to influence change. (average word guideline–200)


3. Describe the change outcomes or progress toward change as a result of your efforts. (average word guideline–200)

4. Articulate how this case demonstrates your ability to “influence services for clients (person, organization, population) in driving & community mobility through independent or collaborative education or advocacy activities.” (average word guideline–500)


VOLUNTEER LEADERSHIPBack to Criteria


Guidelines Service with a local, state, national, or international agency or organization that has relevance to

the criterion. Minimum of 25 hours for at least 1 year.

1. Name of organization

2. Dates of service

3. Approximate number of hours of service

4. Identification of the volunteer leadership role served (must be leadership in nature, e.g., officer, chair, committee member, board member)

5. Describe how this leadership activity helped you “influence services for clients (person, organization, population) in driving & community mobility through independent or collaborative education or advocacy activities.” (average word guideline–400)

Documentation of Service© 2017 The American Occupational Therapy Association, Inc. All rights reserved.

Back to Criteria

Criterion/Activity Exchange 13 Service to BASCApplies specialized knowledge to encourage, support, and recognize continued competence and professional development of members in specialty areas of practice.

Guidelines Service to the BASC in one or more of the following capacities within the last 5 years can be used

in exchange for meeting one criterion:

☐ Served as a reviewer for at least five AOTA Certification applications (initial and/or renewal)☐ Served on the BASC☐ Participated as a Phase I or II Panel Member: _______________________ (indicate which)

1. Please verify relevant activity information:

Date(s) of application review:

Total number of applications reviewed:

Dates as a BASC Member:

Dates as a Phase I or II Panel Member:

2. Submit documentation that verifies completion of activity, such as thank you letters from AOTA. If you are unable to locate verification information, please contact [email protected] a minimum of 2 weeks in advance of the renewal deadline to obtain this information.
