The OT's Referral Handover Checklist

This series has been rotating around a single theme, the gap between an OT's understanding of a participant and the support provided. All the briefs, grading, observation frames and adoption plans in the preceding articles make the assumption that a foundation document is in existence, the thing you hand over to the support workers when you get to know a participant, and in most practice, that foundation document doesn't exist.

What exists is the funding paper and, sometimes, a report written for a very different reader. This is the foundational document: a one-page OT handover, functional version (where the nursing version is clinical, and the social work version is relational), designed to make a support worker useful and safe from the first shift.

The checklist

The person, functionally. Two or three sentences describing who this is through an occupational perspective: what they enjoy doing, what a good day looks like for them, what matters to them about how they're supported. This is where the "doing with" culture of the arrangement gets set, one paragraph in.

Function, one task at a time. What the person does, what support they require and what kind, how to set it up, prompt, stand by, physically support, and which direction points towards independence, for each significant task of the day. This is the grading discipline of the previous post in the series, but shrunk to fit in a table that any worker can carry.

Techniques and equipment. The specific methods that matter, in doing-language: transfer technique, energy conservation approach, the sensory or cognitive strategies that are in play, and each item of AT, when it is used and how it is set up, including the never-do items and one-line reasons. If a joint demonstration session has taken place, or should take place, say so.

The environment. What has changed, why, what has not changed, and what risks you as the worker have identified, so the worker comes to work with your risk assessment rather than being put in the position of having to learn it by the accidents that happen to them.

The reporting frame. The three or four observations you'll want to send back, based on the observation discipline from the previous installment in this series: function changes, strategy friction, unprompted activity, AT drift. Plus the line to you: name, channel, and what warrants contact between reviews.

Boundaries and review date. The therapy-versus-reinforcement line from the previous episode, stated plainly as what the worker is not being asked to do, and the date this document will be re-read against reality.

Writing it without doubling your admin

Honestly, the objection is time, and honestly, it's not extra writing, it's redirected writing. A lot of the content is already in your assessment and report, but it's in the wrong genre. The discipline is writing the handover as the last step of any assessment of a supported participant, the last thirty minutes of the assessment, and making it the living document to which the briefs, frames and adoption plans of the series hook. One page, updated at reviews, travelling to each new worker the participant has ever met, even the fill-in workers who arrive empty handed: the ratio of effort to protection is as good as clinical documentation can get.

How this plays out in practice

Imagine a person with Parkinson's who has had the same worker for a long time, and that worker quits at a week's notice. The typical version is the new worker gets an address and a list of tasks, and the first month erodes the OT's work: the wrong transfer technique, the walker set up nowhere, the help coming too soon for the independence targets to live. In the handover version, the new worker reads one page in the car; who this man is, the task-by-task function table, the transfer method in doing-language, the walker's morning position, the struggle bounds, the four things worth reporting. The first shift is safe and on-model, and week three's report, more freezing episodes in the mornings, appears weeks ahead of review. The continuity of worker was lost. The continuity of practice was not.

Next steps

Draft the template from the six sections and then write the first real one for the supported participant you know best. If a colleague's worker can get a safe, on-model shift from your page, then the template is good. And then use it as the last step in every assessment.