CAOT N National Occupational Exam OT Therapy Certification ... · The National Occupational Therapy Certification Examination Blueprint (2008) is intended to represent current occupational

Resource Manual

National Occupational Therapy Certification Examination (NOTCE)

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NOTCE

All rights reserved Ottawa, 2006

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Canadian Association of Occupational Therapists.

Revised March, 2010, September, 2012, August 2013

Published byCAOT Publications ACE Ottawa, Ontario

Copies are available from:Canadian Association of Occupational TherapistsCTTC Building1125-3400 Colonel By DriveOttawa, ON K1S 5R1Tel: (613) 523-2268 or (800) 434-2268Fax: (613) 523-2552 E-mail: [email protected]

Des exemplaires sont également disponibles en français sous le titre: Manuel de ressources© Canadian Association of Occupational Therapists, 2006 ISBN: 1-895437-49-0

PRINTED IN CANADA

Title

National Occupational Therapy Certification Examination (NOTCE) Resource Manual 3

Table of Contents

The ExaminationPurpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

New Item Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How is current practice reflected in the design of the Certification Exam? . . . . . . . . . . . . . . . . . . . . . 5

The National Occupational Therapy Certification Examination Blueprint (2008)

The Blueprint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

The Enabling Occupation Matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Blueprint Component Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Sample Cases and QuestionsSample Cases and Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Answers and Clinical Reasoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Applying the Sample Questions to the Blueprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Scantron Answer sheet sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Reference List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

National Occupational Therapy Certification Examination (NOTCE)

PurposeThe purpose of the National Occupational Therapy Certification Examination (NOTCE) is to protect public interest by assessing the written application of academic knowledge and professional behaviour of individuals entering the occupational therapy profession in Canada. Successful completion of the National Occupational Therapy Certification Examination allows candidates to meet:

a) a criterion of the Canadian Association of Occupational Therapists membership and/or; (membership details: http://www.caot.ca/membership)

b) a registration requirement for regulatory organization(s).

Occupational therapists are regulated health professionals in all Canadian provinces. Each province has a provincial regulatory organization responsible for regulating the practice of occupational therapy. When you apply to become registered to work as an occupational therapist in a specific province, it is important to note that each provincial regulatory organization has its own set of regulatory requirements.Please contact the provincial regulatory organization for the province in which you wish to work to obtain its specific requirements.

There is no reciprocity amongst countries with regard to certification exams i.e. a successful outcome of the NOTCE will not allow you to practice in the US or elsewhere without meeting their requirements, including their certification exam.

ProcessThe NOTCE is developed and regularly monitored by the Certification Examination Committee (CEC) of the Canadian Association of Occupational Therapists (CAOT).

Committee members are selected on the basis of expertise. Members represent a diversity of occupational therapy practice including clinical, academic, managerial and consultative experience with clients of all ages in a variety of practice settings. In conjunction with CAOT, the CEC established an item generation process to ensure ongoing development of new examination case studies and questions that reflect national practice. This process draws on the expertise of occupational therapists who practice across the country in a variety of areas and who have been trained in case and item development.

FormatThe National Occupational Therapy Certification Examination (NOTCE) uses a multiple choice format. Current research indicates that use of well designed, in-context multiple choice questions provides a valid measure of a candidate’s clinical reasoning and thinking skills. The cases and multiple choice questions on the exam reflect a variety of clinical settings, clients, occupational therapy tasks/activities and roles, in realistic situations.

The NOTCE presents a number of cases. Each case is followed by approximately four to seven items (multiple choice questions). The candidate is required to carefully read each case and use the content to assist in answering the associated questions.



Each question is followed by four options, of which ONE is the best answer. The examination contains 200 questions (associated with approximately 30 cases) designed to measure entry level knowledge. Sample cases and questions are provided in this manual.

New Item GenerationCases and related questions are generated at Item Generation Workshops by participating occupational therapists who are CAOT members and have received training in question writing. Once developed cases and questions are forwarded to and reviewed by the Item Generation Coordinator, they are brought to the CEC for final review and revision before being accepted into the exam bank. All accepted cases and questions are translated into English or French as required. If the CEC does not agree that a case is ready for inclusion in the bank then it is sent back to an Item Generation Workshop for further development. Once material is accepted into the exam bank, it is reviewed for currency each time it is used on an exam, or every two years. All cases and questions are coded according to the Blueprint and referenced. When a question cannot be referenced, CEC must reach consensus about the item.

How is current practice reflected in the design of the Certification Exam?The National Occupational Therapy Certification Exam is designed around a Test Blueprint or Table of Specifications. The purpose of the Blueprint is to depict the major content areas of the exam, provide a structural map indicating the relative distribution of desired content and reflect the way in which exam questions are coded. In addition, the Blueprint provides direction to the item generation process, the construction or make-up of each exam and informs candidates and other stakeholders of the primary exam foci. The Blueprint assumes that exam content is at the entry-level of occupational therapy practice in Canada.

Since the inception of the Exam, the Blueprint has undergone several revisions. The current blueprint (Figure 1) was newly revised in 2008 through an extensive review process and the assistance of an external facilitator. The purpose of this review was to ensure that the structure, weighting and description of the Exam Blueprint reflected the content of recently published professional documents and current practice. As a result of the 2008 review, the Exam Blueprint was revised to reflect the Profile of Occupational Therapy Practice in Canada (CAOT, 2007), herein called the Profile. The current Blueprint components are built on role descriptors, similar to those outlined in the Profile, that relate to the various roles an occupational therapist enacts during provision of occupational therapy services. Each component of the Blueprint is defined and given a code number. This Blueprint code system is used to code all questions on the exam, and these codes guide selection of questions for any particular exam. Definitions of each Blueprint component are outlined in the following section.

Figure 1: Exam Blueprint and Percentage of Exam Questions


The percentage of test questions allocated to each component of the exam is depicted in the Blueprint (Figure 1 and Figure 2) along with the code number. It is important to note that these percentages are used as a guideline and it is possible that these percentages may not be attained for all cells of the blueprint on every administration of the examination.

Figure 2: Enabling Occupation Matrix Codes and Percentage of Exam Questions

The National Occupational Therapy Certification Examination Blueprint (2008)

The BlueprintThe central focus of the blueprint, like the Profile, is Enabling Occupation. In the blueprint, this core component is defined more explicitly by an embedded matrix (Figure 2) that includes elements of professional knowledge on one axis intersecting with those of a practice process framework on the other. Peripheral to, but closely related with the blueprint core, are the supporting components based on the supporting roles articulated in the Profile including: Practice Management, Communication, Collaboration, Change Agent, Professional Behaviour and Scholarly Practice.

The blueprint illustrates that all of these components, core and supporting, exist on a background of occupational therapy related theories, models and frames of reference, which are assimilated and applied in practice. The relationship between these elements is iterative, that is, theory is applied to inform practice, which in turn, may influence theory. This relationship is demonstrated in Figure 1 above.

The Enabling Occupation Matrix (Figure 2)

As noted above and depicted in Figure 2, the examination blueprint uses a matrix to describe the core Enabling Occupation component.

The matrix includes professional knowledge on one axis including knowledge of the client, the environment and occupation.

The client is broadly understood as the individual with an occupational performance issue, their family and/or significant others as well as community and society groups, agencies, organizations or populations that may be considered clients. Knowledge related to the client includes understanding the physical, cognitive and affective attributes that affect their occupational performance. Knowledge about community and larger societal groups includes understanding social, cultural, organizational and institutional elements that influence the function of the larger group.

Environmental elements include those that influence occupational performance/engagement. These elements include the physical (natural and built environments), social, cultural and institutional.

Occupation relates both to our understanding of the different types of occupation, including self-care, productivity, and leisure as well as underlying conceptual ideas such as occupational engagement, performance, justice and deprivation.

The second axis of the matrix incorporates the occupational therapy practice process. This process has been modified from that described in the Canadian Practice Process Framework in Enabling Occupation II (Townsend and Polatajko, 2007, p.251). The components of the practice process within the matrix include: Initiating the therapeutic relationship, which includes all those activities in which an occupational therapist engages prior to commencing an assessment with a client, as well as, Assessment, planning, implementation and evaluation. Each of these elements is further defined in the definitions section of this resource manual.


Blueprint Component Definitions The National Occupational Therapy Certification Examination Blueprint (2008) is intended to represent current occupational therapy entry level knowledge and practice as described in the Profile of Occupational Therapy Practice in Canada (2007) (CAOT, 2007), Enabling Occupation: An occupational therapy perspective (CAOT, 1997), and Enabling Occupation II (Townsend & Polatajko, 2007). Consequently, where possible, the definitions listed below are those presented in these documents or are versions which have been minimally modified.

General DefinitionsApplication: Transference of theoretical and conceptual knowledge and assimilating (i.e., adopting and using the knowledge as appropriate) that knowledge into professional practice.

Theory: Conceptual systems or frameworks used to organize knowledge. (Whiteford and Wright-St. Clair, 2005, p. 52)

CORE Component

Enabling Occupation: Enabling Occupation refers to the processes of facilitating, guiding, coaching, educating, prompting, listening, reflecting, encouraging, or otherwise collaborating with people (the client) so that they may choose, organize, and perform those occupations which they find useful and meaningful in their environment (CAOT, 1997, 2002).

Definitions of the two major components and related subcomponents of the Enabling Occupation matrix include:

Practice Process Axis: Practice process forms the y-axis of the Enabling Occupation matrix. This axis reflects and describes the steps or process in which an occupational therapist engages with the client (individual or groups) during the course of enabling occupation of the client. The subcomponents of the practice process are derived and modified from the Canadian Practice Process Framework, Townsend and Polatajko (2007, p. 251) and include the following:

Initiating the therapeutic relationship: This element includes the first two stages of the Canadian Practice Process—Enter/initiate and Set the stage, and includes activities such as:

• Calltoaction:createpositivefirstpointofcontactwithclientbasedonareferral,contractrequest,or the occupational therapist’s recognition of real or potential occupational challenges with individual, family, group, community, organization, or population clients;

• Consulttodecidewhethertocontinueornotwiththepracticeprocess;

• Educateandcollaboratetoestablishanddocumentconsent;

• Engageclienttoclarifyvalues,beliefs,assumptions,expectations,ordesires;

• Collaboratetomediate/negotiatecommongroundoragreenottocontinue;

• Adaptgroundrulestothesituation,buildrapport,fosterclientreadinesstoproceed;

• Explicatemutualexpectationsanddocumentthe‘stage’set’

• Collaboratetoidentifypriorityoccupationalissuesandpossibleoccupationalgoals

Assessment: This element includes activities to identify needs or issues of the client (individuals, families, groups, communities, organizations or populations). It includes such as:

• Assess/evaluateoccupationalstatus,aspirations,andpotentialforchange;

• Consultwiththeclientandothersasrequiredtodeterminestatus

• Usespecializedskillstoassess/evaluateandanalyzespirituality,person,andenvironmentalinfluences on occupations;

• Coordinateanalysisofdataandconsiderallperspectivestointerpretfindings;



• Formulateanddocumentpossiblerecommendationsbasedonbestexplanations”.

Planning: Planning follows the assessment/evaluation and re-evaluation stages of client interaction(s), and is considered the thinking and development stage of the process. Planning occurs when the therapist, often in collaboration with the client, plans and determines the objectives and the focus/approach of the intervention or actions to follow. Planning includes agreeing on objectives and follows the planning process from the Canadian Practice Process Framework. It includes activities such as:

• Collaboratetoidentifypriorityoccupationalissuesforagreementinlightofassessment/evaluation;

• Design/buildplan,negotiateagreementonoccupationalgoal,objectives,andplanwithintime,space and resource boundaries, and within contexts, using requisite elements

Implementation: Implementation is the doing phase or the carrying out of the plan. In the implementation phase the occupational therapist will:

• Engagetheclientinthetherapeuticprocesstoenableoccupationalengagement;

• Useoccupationasameansoranendtoenableparticipationandclient’soccupationalengagement

• Useframesofreference,models,theoreticalapproachesasappropriatetoeffectorpreventchange

Evaluate Outcomes: Includes the elements of monitor and modify and evaluate outcome from the Canadian Practice Process Framework. Evaluation includes those activities that are conducted to determine whether occupational therapy involvement with a client (individual or group, etc) has been effective. These elements include:

• Consult,collaborate,advocate,educate,andengageclientandotherstoenablesuccess;

• Monitorandmodifyclientprogress;involvesreassessment,adaptationandre-designofplan

• Useofformativeevaluation

• Re-assess/evaluateoccupationalchallengesandcomparewithinitialfindings;

• Documentanddisseminatefindingsandrecommendationsfornextsteps

Professional Knowledge Axis: Professional knowledge forms the x-axis of the Enabling Occupational matrix. Professional knowledge is information derived from theories, models of practice, research and clinical experience that form the foundation of occupational therapy practice. In particular this includes knowledge related to the client, whether this is an individual person where knowledge encompasses an understanding of the physical, cognitive and affective attributes that affect occupational performance; or a family, community or larger societal group where knowledge includes an understanding of social, cultural, organizational and institutional elements that influence the function of the larger group. Professional knowledge includes understanding of environment, its impact on occupation, occupational performance and occupational engagement and knowledge of occupation itself. Definitions of these three main components are outlined below.

Client:The‘client’includesindividuals,families,groups,communities,organizations,orpopulationswho participate in occupational therapy services by direct referral or contract or by other service and funding arrangements with a team, group, or agency that includes occupational therapy. Professional knowledge of the individual (person) includes any component of the person, such as physical, cognitive, affective components, and cultural or social experiences. Note that cultural experience includes beliefs, attitudes and values. Social experiences include organized interactions with family, friends and community.

Knowledge of family, community or larger societal group includes an understanding of group process and functioning as well as of social, cultural, organizational and institutional elements that influence the function of the larger group.

Environment: The environment refers to the contexts and situations that occur outside of an individual and elicit responses from them (Law, 1991). It is the context within which occupational performance


takes place and includes the dimensions of physical, social, cultural and institutional environments (CAOT, 2002). Definitions of environment subcomponents include:

• Physicalenvironmentreferstothatpartoftheenvironmentthatcanbeperceiveddirectlythroughthe senses. The physical environment includes observable space, objects and their arrangement, light, noise and other ambient characteristics that can be objectively determined (Christiansen & Baum, 1997. p. 601). It includes both natural and built environments.

• Socialenvironmentrefersto“thosesocialsystemsornetworkswithinwhichagivenpersonoperates,the collective human relationships of an individual, whether familial, community or organizational in nature”(Christiansen&Baum,1997,p.604).

• Culturalenvironmentreferstoa“sharedsystemofmeaningsthatinvolveideas,conceptsandknowledge and include the beliefs, values and norms that shape standards and rules of behaviour as peoplegoabouttheireverydaylives”(Townsend&Polatajko,2007).

• Institutionalenvironmentreferstoeconomic,legalandpoliticalinfluencesonthepersonandtheiroccupation (CAOT, 2002), e.g., government legislation and policies for the accessibility of buildings.

Occupations:“aregroupsofactivitiesandtasksofeverydaylife,named,organizedandgivenvalueand meaning by individuals and a culture; occupation is everything people do to occupy themselves, including looking after themselves (self care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic mediumofoccupationaltherapy”(CAOT,1997),(CAOT,2002,p.181).

SUPPORTING ROLE Components

Change Agent: Overall being a change agent encompasses responsible use of occupational therapy expertise and influence to advance occupation, occupational performance, and occupational engagement. Being a change agent may involve the following activities: (refer to CAOT, 2007, pages 6, 30)

• Occupationaltherapistsadvocateonbehalfof,andwithclients,workingtowardpositivechangetoimprove programs, services, and society, within health and other systems.

• Practitionersworkforpopulationandcommunitychangeinthefunding,management,policy,andother systems that impact occupations in daily life.

• Occupationaltherapistscollaboratewiththoseinsideandoutsidethesystem,anddrawonstrategies to enable the empowerment of populations.

• Oneexamplemightbeadvocatingforandrealizingtheimplementationofacommunitylivingskillsprogram for clients with mental health issues.

Collaboration: Collaboration includes working effectively with clients, teams and the broader community to enable participation in occupations by using and promoting shared decision-making approaches. The client is considered to be an equal member of the team.

Occupational therapists collaborate, both in an interprofessional and intraprofessional environment, sometimes leading, and sometimes sharing with team members including professionals and other members of the community. Teams work closely together at one site or are extended groups working across multiple settings and in the broader community. Collaboration includes understanding the role that various team members contribute to the team. Collaboration may include conflict management, prevention and resolution. (CAOT, 2007)

Communication: Communication includes oral, written, non-verbal, and electronic interaction or exchanges with the client (individual or group) and other relevant stakeholders or team members (CAOT, 2007). Occupational therapists communicate about occupations, occupational performance, and daily life, as well as about occupational therapy services. Communication approaches vary widely and require a high level of expertise that is adapted and changed in each different practice setting. Examples of communication may include:

• Buildingrapport,trust,andethicsintheoccupationaltherapy–clientrelationship


• Appropriatedisplayofempathy,compassion,trustworthiness,integrity

• Inclusionoftheclientvoiceinplanning,decision-making,andevaluation

• Supportingdiversityincommunication

• Ensuringmechanismsforinformedconsentanddecision-making(thisisabouttheprocessofcommunicating rather than the practice standard or ethical expectation of consent),

• Effectivelistening

• Useofverbalandnon-verbalcommunication

• Adaptcommunicationapproachtoensurethatbarrierstocommunication(e.g.,language,hearingloss, vision loss, inability to communicate verbally, cognitive loss) do not impact the client’s ability to direct their own care process

• Elicitingandsynthesizinginformationforclientservice

• Conveyingeffectiveoralandwritteninformation/documentationforclientservice

• Flexibilityinapplicationofcommunicationandcriticalthinkingskills (CAOT, 2007, p. 6, 28)

Practice Management: Includes activities such as time management, prioritization and management of effective and efficient practice (CAOT, 2007. p. 6). Broader concepts include appropriate assigning of services and sharing of client information. Elements of practice management may include:

• Settingprioritiesinday-to-dayworkactivities,

• Managingcaseloads

• Runningeffectivemeetingsand/orparticipatingeffectivelyincommittees

• Participatinginqualityassuranceandimprovement (CAOT, 2007, p. 6, 29)

Professional Behaviour and Responsibility: This element encompasses ethical practice and high personal standards of behaviour. Professional behaviour includes concepts relating to the understanding of how the practice environment can impact on the scope of practice, and conversely, how scope of practice impacts the practice setting. It also includes concepts such as:

• Accountabilityforone’sownbehaviour

• Applicationofethicalprinciples

• Commitmenttoexcellenceinclinicalpractice

• Integrityandhonest

• Disclosureofconflictofinterest,

• Knowinglimitsofprofessionalexpertiseandclinicalcompetence

• Responsibilitytosocietyandpublicprotection

• Ensuringthepracticeofinformedconsentisinplaceandthatinformedconsentisattainedpriortoservice provision (CAOT, 2007, p. 6, 30-1)

Scholarly Practice: An occupational therapist engages in scholarly practice through the incorporation of critical thinking, reflection, and quality improvement in everyday practice and through a process of lifelong learning. The scholarly practitioner demonstrates a commitment to engaging in evidenced-informed practice. As educators occupational therapists facilitate learning with clients, team members, and other learners. The scholarly practitioner seeks out research that supports practice and in so doing is able to interpret, understand


and incorporate relevant research to inform practice. More specific scholarly activities might include:

• Reflectionbefore,during,andafterpractice

• Self-assessment

• Identifyinggapsinknowledge,skills,andattitudes

• Askingeffectivelearningquestions

• Accessinginformationtoimprovepracticeandservice

• Moralandprofessionalobligationtomaintaincompetenceandbeaccountable

• Criticalappraisalofevidence

• Translatingevidenceandknowledgeintopractice

• Enhancingpersonal,professionalcompetence

• Usingavarietyoflearningmethodologies

• Assessinglearnersandprovidingfeedback

• Teacher-studentethics,powerissues,confidentiality,boundaries

• Researchethics,disclosure,conflictsofinterest,humansubjects,andindustryrelations (CAOT, 2007, p. 6, 30)

Sample Cases and Questions

For each questions, you are to use the information within the case to select the correct response. The other responses will be plausible but not correct. As much as possible, questions are written using a client centered occupational performance model of practice. All cases will have associated questions drawn from the blueprint component areas.

The following sample cases are not meant to be a practice examination booklet. They are meant to illustrate the format only.

Case for questions 1 to 5

Client: Mrs. C is a 66 year old woman.Case:• Sheisrecentlydivorced.• Shelivesaloneinaseniors’apartment• Shehasdecreasedfunctioningasaresultofadegenerativeneurologicaldisorder• Shewasgettinghome-makingservicesinherapartment• Shewasgoingtoageriatricdayhospitaltoreceivetreatmentrelatedtophysicalproblems• Herphysicalproblemsincludeunstablegait,decreasedbalance,potentialrisksforfalls,decreasedvision

and general safety• Shehasbeenadmittedtoanin-patientgeriatricunitduetoincreasingdepression• Onadmissiontothein-patientgeriatricunit,sheiswithdrawn,irritable,expressedvaguesuicidal

ideation, and has stopped doing previous leisure activities • Herpreviousleisureactivitiesincludedmusicandsewing• Shehasfewclosefriendswhoareofthesameagenearby• Shehasonedaughterwholivesseveralhundredkilometersaway

Question 1:

What should the occupational therapist do FIRST to address Mrs. C’s depression?1. Arrange a visit from her friends.2. Challenge her with new activities.3. Engage her in short term, familiar activities.4. Suggest she attend the unit’s Friday evening social event.

Enabling Occupation Role: 7.4 - Client and Implementation

Question 2:

Mrs. C. tells the occupational therapist that she is upset that her decreased vision means that she is no longer able to sew. Using a client-centred perspective, what should the therapist do FIRST?


1. Suggest other leisure activities using the Interest Check List2. Explore low vision aids and techniques that could allow Mrs. C. to sew3. Encourage Mrs. C. to join activities at her local Senior’s Center4. Assist Mrs. C. to find a volunteer to help her do her leisure activities

Enabling Occupation Role: 9.4 - Occupation and Implementation

Question 3:

At discharge, the occupational therapist will recommend that Mrs. C. attend an activity at her local Seniors’ Centre. Which activity would be MOST appropriate for the therapist to suggest?1. Music enjoyment group.2. Recreational dancing.3. Playing cards.4. Recreational swimming.

Enabling Occupation Role: 9.3 - Occupation and Planning

Question 4:

Mrs. C. is often impulsive and is not following safety guidelines when walking with her walker. What should the occupational therapist do?1. Set up a behaviour modification program for Mrs. C.2. Continue teaching walker use, providing only 1 to 2 step instructions.3. Further assess Mrs. C’s comprehension and ability to remember information.4. Encourage Mrs. C. to regain internal locus of control and take responsibility for her safety.

Enabling Occupation Role: 7.3 - Client and Assessment

Question 5:

The multidisciplinary team is not confident that Mrs. C. has the functional ability needed to return to her apartment. Mrs. C. strongly states that she wishes to return to her apartment. What should the occupational therapist do?1. Have a discussion with Mrs. C. about safety and her ability to manage at home.2. Arrange for increased home care services.3. Investigate the potential for repeated hospitalizations.4. Provide legal documentation of Mrs. C.’s incompetence.

Supporting Role: 2 - Collaboration

END OF SERIES


Client: Mrs. H is a 39 year old femaleCase:• Married,livingwithherhusbandandthreechildren• Twoofherchildrenareteenagers• Heryoungestchildisfive• ThisisMrs.H.’sfirstcontactwithamentalhealthcentre.• Duringtheinitialoccupationaltherapyinterview,sheispleasant,cooperative,andabletotalkabout

herself.• Shestatessheisseekinghelpatthistimebecausesheisexperiencingincreasedfear.Shereportsthis

help will not be needed once her children leave home.



• Shedescribesaninabilitytoaskforattentionandsupportinadirectmanner,feelingattimesthatherhusband and children do not appreciate her.

• Herself-esteemislow.• Shecanneverfindtimetocompleteherhome-basedworkasaseamstress.• Allmajordecisionsinthefamilyaremadebyherhusband.• Shereportsalwaysfeelinglonely,likeanoutsider,andnowhasveryfewfriends.• Shedescribeshermarriageascomfortable,butaddsthatherhusbandis“boring”,andnotabletoaddress

her emotional needs.

Question 6:

One of Mrs. H’s goals is to improve time management. What time management principle will the occupational therapist stress as most important for Mrs. H.?1. Work on the easier tasks first to ensure success2. Rate tasks in order of priority3. Create a list of appointments4. Take responsibility for all tasks

Enabling Occupation: 9.4 – Occupation and Implementation

Question 7:

Mrs. H identifies a problem in her communication style. She tries to avoid conflict. What is the MOST appropriate intervention strategy for the occupational therapist use when assisting Mrs. H. to overcome this problem?1. Family therapy2. Assertiveness training3. Behaviour therapy4. Cognitive therapy

Enabling Occupation: 7.3 Client and Planning

Question 8:

What activity would be MOST appropriate to assist Mrs. H explore self-esteem and self-image issues?1. Role playing2. Refuting irrational beliefs3. Self-hypnosis4. Use of projective techniques

Enabling Occupation: 7.3 – Client and Planning

Question 9:

Mrs. H has agreed to a referral for a group for women who are considering returning to work. What is the MOST important benefit that Mrs. H would gain from attending this group?1. Support and encouragement from other woman2. Techniques for re-entering the work force3. New community contacts4. Assertiveness strategies

Enabling Occupation: 9.3 – Occupation and Planning

Question 10:

Mrs. H’s husband calls the occupational therapist and is very upset because his wife is late returning home. He asks about Mrs. H’s treatment program. What should the therapist do?


1. Tell the husband to attend the next session2. Refer him to his wife’s doctor3. Ask the husband the reason for his distress4. Encourage the husband to discuss his wife’s program with her

Supporting Role: 5 – Professional Behaviour and Responsibility

Question 11:

At discharge, the occupational therapist wants to know if therapy has been effective for Mrs. H. What approach should the occupational therapist use if applying a scientific and systematic method to determine client outcomes?1. Standardized, valid and reliable measurement approaches2. Feedback from the client and family about function3. Family reporting and client observation4. Both subjective and objective measures

Supporting Role: 6 – Scholarly Practice

END OF SERIES


Client: Justin is a 4 yr old male

Case:• Justinhasadiagnosisofautismspectrumdisorder.• Hehasanunevenscatterinhisdevelopmentalskills.• Hisdifficultiesinoccupationalperformanceinclude:

- Delayed language- Over-responds to environmental stimuli and changes in routine

• Heattendsanintegratedpreschoolprogramwithtypicallydevelopingchildren.• Thisprogramhasenoughstafftoprovideattentiontoallthechildren.• Occupationaltherapyisprovidedintheprogram.

Question 12:

Justin presents with hyperactivity, decreased attention span and limited eye contact. What occupational therapy intervention plan is MOST appropriate within a sensorimotor framework?1. improve overall social-emotional functioning2. reducedemandsmadeuponJustin,allowinghimsuccessexperiencesinhisplay3. decrease arousal through inhibitory methods4. decrease inappropriate behaviours through behavioural management

Enabling Occupation: 7.3 Client and Planning

Question 13:

Considering Justin’s diagnosis of autism spectrum disorder, which of the following specific characteristics is he most likely to display? 1. Deviations in rate of development, perceptual disturbances, echolalia, and inflexible behaviour.2. Sensory processing difficulties, tonal abnormalities, unusual facial features.3. Speech and language disorders, fine motor and perceptual skills at an age appropriate level.4. Emotional instability, increased sensitivity to postural adjustment, inability to relate to others.


Enabling Occupation: 7.2 Client and Assessment

Question 14:

Justin was seen to seek tactile stimulation quite aggressively. Which of the following would BEST illustrates this behaviour?1. Rubbing and twirling objects.2. Demonstrating peculiar hand movements.3. Forming attachments to odd objects.4. Cuddling with his peers.


Question 15:

Which activity would provide the MOST tactile stimulation for Justin in the pre-school setting?1. Water play at a standing table.2. Rolling in a furry blanket.3. Spinning in alternate directions on a swing.4. Playing video games with peers.


Question 16:

The pre-school staff has difficulty calming Justin after active group sessions. Using a Sensory Integration approach, what should the occupational therapist recommend?1. Justinrockinarockingchairduringthequieteractivities.2. HavingJustinjumponatrampoline.3. DoingafingerpaintingactivitywithJustin.4. HavingJustindosomersaultsonafloormat.

Enabling Occupation: 9.4 Occupation and Implementation

Question 17:

Justin’s father shows the occupational therapist an article on the use of music in the treatment of children with autism. What should the therapist do before the considering use of this intervention with Justin?1. Review the current literature and professional publications on the topic2. TellJustin’sfatherthatthisformoftreatmentisnotpartoftheserviceprotocol.3. Read the article and gradually implement some of the principles.4. Suggest to the father that he implement this treatment in the home environment first.

Supporting Role: 6 – Scholarly Practice

Question 18:

What would be the MOST appropriate way for the occupational therapist to demonstrate the efficacy of the occupational therapy service provided to Justin? 1. ReviewthedocumentedchangesinJustin’sbehaviourinhishomeenvironment.2. ReassessJustin’sbehavioursandcomparewithbaselinebehavioursintheclassroom.3. Measure his behaviour at home as a result of having a new teacher. 4. Implement a satisfaction survey with the staff and parents.

Enabling Occupation: 9.5 – Occupation and Evaluation

END OF SERIES


Case for Questions 19-24.

Client: Mr. S. is a 45 year old male

Case:• Mr.S.hasadiagnosisofaleftcerebrovascularaccident(CVA)• Helivesinthecitywithhiswife• AtthetimeofhisCVA,heworkedasatravelagent• HehasbeenreferredtoanoutpatientOccupationalTherapyserviceandwillbeseentwotimesaweek

for 30 minute sessions• Duringinitialassessmenthisoutstandingphysicalproblemwasimpairedrighthandfunction• Heisrighthanddominant• Heisbeginningtodevelopfingerandthumbprehensionbutisstillnotabletovoluntarilyextendhis

fingers

Question 19:

The occupational therapist notes that although the tone in Mr. S’s right upper extremity varies from session to session, he frequently exhibits high tone in this arm during visits. Which one of the following factors is MOST likely to contribute to this increased tone?1. Anxiety about attending intervention sessions.2. Calm environment in the occupational therapy department.3. Outdoor temperature of 230 C. 4. Positioning of arm in a sling.


Question 20:

Mr. S would like to return to work part time in the near future. Which task would be the MOST difficult for him to manage?1. Filing folders2. Filling out forms3. Using the telephone4. Using the calculator

Enabling Occupation: 9.2 – Occupation and Assessment

Question 21:

In discussing Mr. S’s occupational goals which of the following should the occupational therapist address FIRST?1. Driving2. Writing with the right hand3. Walking with a normal gait pattern4. Reading travel brochures


Question 22:

As Mr.S. has had a left hemisphere lesion, it is MOST important that the occupational therapist assess for the presence of which of the following impairments?1. Neglect of the affected side2. Spatial orientation difficulties3. Body scheme disturbances


4. Varyingdegreesofaphasia

Enabling Occupation: 7.3 – Client and Planning

Question 23:

Mr. S’s employer phones the occupational therapist to request details regarding Mr. S’s ability to return to work. The employer has not discussed this with Mr. S. Which is the MOST appropriate action for the therapist?1. Inform the employer that he does not need to know this information2. Obtain Mr. S’s permission to discussion this information with the employer3. Discuss return to work with Mr S. and obtain permission before discussions with the employer4. Invite the employer to meet with the therapist and Mr. S

Supporting Role: 5- Professional Responsibility and Behaviour

Question 24:

Which would be the MOST difficult self-care activity for Mr. S?:1. Washing his hair2. Washing the dishes 3. Shaving with a disposable razor4. Putting on a sweater

Enabling Occupation: 9.2 – Occupation and Assessment

END OF SERIES

Answers and Clinical ReasoningClinical ReasoningAnswers to questions:

Item Answer Item Answer Item Answer1 3 10 4 21 22 2 11 1 22 43 1 12 3 23 34 3 13 1 24 35 1 14 1 6 2 17 1 7 2 18 2 8 4 19 1 9 1 20 2

Questions 1-5:

Question 1 – The answer is option 3: engaging Mrs. C. in short-term familiar activities is likely to provide successfulandpositiveexperiences.TheOTwouldnotselectactivitieswhich‘providenewchallenges’,becausenew challenges will increase the probability of stress, failure and anxiety, and will overemphasize Mrs. C’s declining physical ability. It is not the role of the therapist to arrange for Mrs. C.’s friends to visit her at the unit. Mrs. C. may not feel confident enough in herself yet to join a large group of patients at a social evening.

Question 2 – The answer is 2, because it allows Mrs. C to resume activities meaningful to her, and builds on her strengths and interests.


Although the other options are possible approaches, only answer 2 specifically addresses possible solutions to regain independence in the identified meaningful activity.

Question 3 –Theansweris1,becausetheactivitydrawsonpastexperience.

The other options are not ideal. Playing cards is not a good option, because of low vision. Swimming is not a social activity. Recreational dancing is inappropriate because of her balance issue.

Question 4–Theansweris3,becausethecorrectprocedureistoassessbeforeprovidingintervention.Theotherchoices provided are all interventions. Mrs. C’s impulsivity and non-compliance may be a result of cognitive decline.Therearetwopossibleindicatorsofpotentialcognitivedecline–adegenerativeneurologicalconditionand possible symptoms of early dementia. Early dementia and depression have similar presentations; therefore it is important to differentiate what is happening. The intervention for each would be different.

Question 5 –Theansweris1,becauseoccupationaltherapistsprovideclientcenteredpractice.Forthistohappen, Mrs. C’s perspective needs to be considered as it pertains to the issues and possible solutions. Answer 1 also allows Mrs. C to make an informed decision.

Option 2 and 4 require further assessment before determining these as appropriate actions. Option 3 does not reflect the role of the OT and regardless of the findings would not impact whether or not Mrs. C can be permitted to return home at this time. Mrs. C has not been deemed incompetent, and therefore Option 4 is not a valid response.

Questions 6 to 11:

Question 6 –Theansweris2,becausetodevelopgoodtimemanagementskillsoneneedstoprioritize.Prioritizing facilitates planning and decision making, which is necessary for Mrs. H to determine how she will spend her time effectively.

The other options do not stand alone as an effective plan. Option 1 is not correct because the goal is not success in activities but management of time. Option 3 is a possible option because making a list is a beginning, but prioritizing that list (Option 2) is more correct because it is the prioritizing that permits better time management. Option 3 indicates Mrs. H is only having difficulty managing her appointments. There is nothing in the case study to suggest this. Option 4 will not lead to better time management, because taking responsibility for all tasks does not mean you can manage getting things done in a timely fashion.

Question 7 –Theansweris2,becauseinordertomanageconflictoneneedstolearntobeassertive.Assertiveness training is about feeling comfortable expressing opinion and managing conflict, as opposed to avoiding conflict.

The other three options do not necessarily address the client’s ability to deal with conflict as well as assertiveness training.

Question 8–Theansweris4,becauseitisasafetechniqueusedwithinasafeenvironment.Projectivetechniques are about exploring beliefs, values, and emotions in a safe way.

The option of role playing is not ideal, because role playing involves exploring behaviour in a particular situation rather than generally exploring feelings around self-esteem/image. Self-hypnosis is not an OT role. Refuting irrational beliefs is an intervention not a method of exploring.

Question 9–Theansweris1becausethisgroupallowshertohavesupportandencouragementfromothersto promote her self-esteem, without having to ask for it. It facilitates her developing a support system outside of her family system so that she is not as dependent on them for all of her psycho-social needs.

Options 2, 3, and 4 are potential secondary benefits from attending the group.

Question 10 –Theansweris4becauseofconfidentialityandprivacyrules.The other three options do not support client centered practice. Mrs. H is the OT’s client; the husband is not.

Question 11–Theansweris1,becauseyouneedareliable,valid,andstandardizedtoolinordertoapplyscientific and systematic methods.

The other options are good outcomes too, but they are not scientific or systematic in their approach.


Questions 12 to 18:

Question 12 –Theansweris3,becausedecreasingarousallevelthroughtheuseofinhibitorymethodscanfacilitate attention to tasks, reduce activity level, and allow participation. In addition, this intervention utilizes the sensorimotor framework.

The other answer options are not interventions associated with the sensorimotor framework.

Question 13–Theansweris1,becausesomeoftheprimarycharacteristicsofautismarelistedinanswer1.Children with autism generally have difficulties with communication, social interaction, including play, and tend to demonstrate rigid behaviours and repetitive movements. They may also have ADL difficulties rooted in poor sensory processing.

Options 2 and 3 include features that are not consistent with autism. While you may see the behaviours noted in option 4, they are not the primary characteristics.

Question 14 –Theansweris1,becausereceptorsarebeingcontinuouslystimulated.Thisisthebestanswer.

Option 2 is more related to visual stimulation. Option 3 is not correct because it can demonstrate a rigidity of behaviour rather than a need for tactile stimulation. Answer 4 is not correct, because children with autism have difficulties with social attachment.

Question 15 –Theansweris2,becauseafurryblanketwouldprovidefullbodytactileinput.Option 1 involves tactile input to the hands only. Option 3 provides vestibular rather than tactile stimulation. Option 4 is a visually stimulating activity and does not encourage tactile stimulation.

Question 16 - The answer is 1, because linear rocking facilitates calming. It is in keeping with the Sensory Integration principle of the child being an active participant. It is also a socially appropriate activity for circle time, reading, etc.

Options 2 and 4 are alerting rather than calming activities. Option 3 is more likely to be alerting than calming.

Question 17–Theansweris1,becauseitisimportantforOT’stobeknowledgeableaboutdifferentapproachesthrough critical evaluation of information from reputable sources. OT’s need to use evidence-based practice to direct treatment planning. OT’s also need to be open to ideas from parents, and respond to them in an appropriate way.

The other options do not provide the best approach. Option 2 dismisses the father’s idea for treatment without knowing whether or not it might be a valid approach. Options 3 and 4 imply that the OT would implement this intervention, or encourage the father to implement, without investigating more broadly the evidence of its effectiveness.

Question 18–Theansweris2,becauseitmeasuresefficacyinthesettingwheretheservicewasprovidedandintendedtohavethemosteffect,i.e.onJustin’sbehaviourandabilitytomanageintheclassroom.

Option 1 is not correct, because the OT service is not provided at home. Option 3 is not relevant because it does not relate to OT intervention. Option 4 evaluates how service was provided, but does not necessarily look at client outcome.

Questions 19 to 24:

Question 19–Theansweris1.Anxietyismorelikelytoincreasetonethananyoftheotheroptionslisted.Warmtemperature and calm environments are more likely to reduce tone as they have a calming effect and use of a sling is not likely to increase his tone.

Question 20–Theansweris2,duetothedegreeoffinemotorcontrolrequired,whichisaffectedbythestroke.

The other options require less fine motor skills, can be achieved using gross motor movements, or can be done more easily with the left non-dominant hand.

Question 21–Theansweris2,becauseheisbeginningtogetreturnoffunctionoftherighthandwithsomeapprehension. It is too early to set driving as a goal. There is no indication in the case study that he has difficulty with walking. The issue of walking with a normal gait pattern is often a physiotherapy role. There is no indication that he has any difficulty reading.

Question 22 –Theansweris4.Fromaneuroanatomicalknowledgebase,itisknownthatthelanguagecenteris generally located in the left hemisphere of the brain. Therefore damage to this area is likely to result in varying degrees of aphasia.


TheotherproblemslistedaremorecommonwitharightCVA.

Question 23–Theansweris3.Becauseofprivacyissues,permissionmustbeobtainedfromtheclienttodiscuss any matters with other parties.

Option 3 is the superior choice to option 2, because the OT must discuss return to work issues with the client first, as part of the client-centered approach to facilitate a successful outcome. Option 1 does not facilitate good relations with the employer. Option 4 should not be considered without first talking to the client to gain permission.

Questions 24–Theansweris3,becauseofthefinemotorandmotorplanningcontrolrequiredforshavingwitha disposable razor. This activity will be difficult whether attempted using his right hand, given limited level of hand function, or alternatively using his left hand. Change of dominance to the left hand requires a lot of work, and may not result in acceptable standards of self care with the client. Safety will also be an issue when the activity involves use of a razor.

All other activities can be performed relatively easily using one-handed techniques with the non-dominant arm or hand, or allow the dominant hand to assist in the activity without significant performance issues.

END OF SERIES

Applying the Sample Questions to the BlueprintIn terms of the CAOT certification examination blueprint, the 24 sample questions would appear in the test blueprint as shown below. For example, Item 1 appears in the Client and Implementation cell of the Enabling Occupation Matrix.Note: Questions are not coded for frames of reference or occupational performance.

Figure 2: Enabling Occupation Matrix Codes and Percentage of Exam Questions


Sample of Answer Sheet



Reference List

Documentary sources considered for the NOTCE content include: Enabling Occupation: An Occupational Therapy Perspective (CAOT, 2002), Enabling Occupation II: Advancing an occupational therapy vision for health, well-being and justice through occupation (Townsend & Polatajko, 2007), the Profile of Occupational Therapy Practice in Canada (CAOT, 2007) and relevant academic texts

Reference List for the NOTCEIn preparation for the NOTCE, the candidate is expected to use the textbooks which were assigned throughout his/her course of study. In the event that supplements to the study program are desired, the following is a list of the most frequently cited references in a selection of topic areas. The list is a resource and should not be construed as the definitive source for all the questions on the NOTCE.

This bibliography has been prepared from the reading lists of accredited occupational therapy programs in Canada and notes the most frequently cited references. It is reviewed and updated on a regular basis (every two years) but due to publishing lags and updating of exam questions, the latest edition and texts may not always appear on the current reference list.

For candidates who may not be close to a university offering an occupational therapy program, a number of texts are listed in some areas in case a particular book is unavailable.

•Atchison, B. & Dirette, D. (eds.)(2012). Conditions in occupational therapy: Effect on occupational performance (3rd ed.). Baltimore: Lippincott

•Bee, H., & Boyd, D. (2012). Les âges de la vie : Psychologie du développement humain (F. Gosselin, Trad.). Saint Laurent, Québec : ERPI

•Berger, K., & Bureau, S. (2011). Psychologie du développement (2e édition. ed.). Montréal: Modulo.

•Bonder, B. & Wagner, M. (Eds.). (2009). Functional Performance in Older Adults. (3rd ed.). Philadelphia, PA: F. A. Davis Co..

•Boyt Schell, B., Gillen, G. & Scaffa, M.E. (Eds.)(2014). Willard and Spackman’s Occupational Therapy (12th ed). Baltimore, MD: Wolters Kluwer, Lippincott, Williams & Wilkins.

•Braveman, B. & Page, J.J. (2012). Work: Promoting Participation and Productivity Through Occupational Therapy. Philadelphia PA: FA Davis.

•Crouch, R. & Alers, V. (2014) Occupational Therapy in Psychiatry and Mental Health (5th ed). Oxford, UK: John Wiley & Sons, Ltd.

National Occupational Therapy Certi ication Examination (NOTCE) Resource Manual

26

•Case-Smith, J. and O’Brien, J. (Eds.). (2015). Occupational Therapy for Children. (7th ed.). St. Louis: C.V. Mosby.

•DePoy, E. & Gitlin, L. (2011). Introduction to Research: Understanding and applying multiple strategies (4th ed). Toronto: Elsevier Mosby.

•Fortin, M.F. (2010). Fondements et étapes du processus de recherche, 2e édition : Méthodes quantitatives et qualitatives. Chenelière Éducation.

•Hétu, J.-L. (2007). La relation d’aide: éléments de base et guide de perfectionnement, 4e édition.

•Law, M. Baum, C. & Dunn, W. (Eds.) (2005) Measuring Occupational Performance: A guide to best practice (2nd ed.). Thorofare, NJ: Slack Incorporated.

•Letts, L. & Stewart, D. Rigby, P. (Eds.). (2003). Using Environments to Enable Occupational Performance. Thorofare, NJ: Slack Incorporated.

•McHughPendleton, H. & Schultz-Krohn, W. (Eds.). (201). Pedretti’s Occupational Therapy – Practice Skills for Physical Dysfunction. (7th ed.). St Louis, MO: Mosby, Elsevier.

•Radomski, M.V, & Trombly, C.A. (2013). Occupational therapy for physical dysfunction (7th ed.), New York, NY: Lippincott, Wilkins & Williams.

•Scaffa, M.E. & Reitz, S.M. (2014). Occupational Therapy in Community-Based Practice Settings. (2nd ed.). Philadelphia PA: FA Davis.

•St-Arnaud, Y. (2003). L'interaction professionnelle : efficacité et coopération, 2e edition. Montreal PQ: Les presses de l'Université de Montréal.

•Stewart, D. (Ed.) (2013). Transitions to adulthood for youth with disabilities through an occupational lens. Thorofare, NJ: Slack Incorporated.

•Townsend, E.A. & Polatajko, H. J. (2013). Enabling Occupation II (2nd edition): Advancing an occupational therapy vision for health, wellbeing and justice through occupation. Ottawa, ON: CAOT Publication ACE.

•Townsend, E.A. & Polatajko, H. J. (2013). Habiliter à l’occupation II (2e édition) : Faire avancer la perspective ergothérapique de la santé, du bien-être et de la justice par l’occupation. Ottawa, ON: CAOT Publication ACE.

•Association canadienne des ergothérapeutes. (2006). Code d’éthique. Ottawa, ON: CAOT Publications ACE. Téléchargé de : http://www.caot.ca/default.asp?pageid=2090&francais=1

•Canadian Association of Occupational Therapists. (2006). Canadian framework for ethical occupational therapy practice. Ottawa, ON: CAOT Publications ACE. Retrieved from: http://www.caot.ca/default.asp?pageid=2090

•Canadian Association of Occupational Therapists (2007). Guidelines for the Supervision of Assigned Occupational Therapy Service Components. http://www.caot.ca/default.asp?pageID=579

Documents

CAOT N National Occupational Exam OT Therapy Certification ... · The National Occupational Therapy Certification Examination Blueprint (2008) is intended to represent current occupational