The next therapist opened the chart. There was no transfer note.

An occupational therapist in an Ontario pediatric clinic described inheriting a child’s care after another OT left. The notes were disorganized, there was no transfer note, and the goals were unclear. The incoming therapist said they approached the first session much like an initial assessment. During that visit, the parent asked for oral-motor work to support speech, something the previous OT had tried at the parent’s request. The new therapist was left trying to establish its purpose and whether it belonged in their work. The account appeared on r/OccupationalTherapy.

That is one practitioner’s account, not evidence of how often transfers go wrong. But it exposes a specific gap: the next clinician could see that something had happened without knowing what had been agreed.

For a clinical lead, that distinction makes a handoff easier to review. The incoming therapist needs a current starting point: the goal, the evidence behind it, and the decisions still waiting for someone to make them. A record of activities alone cannot answer all three.

Make the current plan findable

Session notes explain individual visits. A transfer needs to bring the current direction of care into view. If a goal changed across several visits, the receiving therapist needs to find the version that now applies and understand why it changed.

Ontario’s occupational therapy regulator makes transfer information explicit. Section 3.7 of its record-keeping standard calls for relevant details when services transfer or end, including the client’s status and input, accountability, resources, and recommendations or referrals. This is an Ontario OT standard; it does not prescribe a universal form for every pediatric discipline. College of Occupational Therapists of Ontario, Standard for Record Keeping.

A clinic can turn that concern into a practical review. The following questions are a proposed way to check an internal handoff, adapted to the department’s documentation requirements.

These answers may already exist in a current plan and a recent progress summary. In that case, a short transfer entry can point to them and explain what is changing. Copying the whole history into another form creates another version to maintain. The useful test is whether the incoming therapist can locate and interpret the current information.

Keep a request separate from an agreed goal

The parent’s request in the opening account matters because it could be read in several ways: a family priority, an activity tried once, or an established treatment goal. Those are different starting points for the next clinician.

The post also clarifies that the child’s speech therapist worked outside the clinic. The reported internal handoff was from one OT to another. Coordination with speech would have required a further conversation, rather than a walk to another department. Nothing in the account establishes that the requested intervention was appropriate or that a shared plan had been agreed.

Consider this hypothetical documentation example, separate from the reported case. A transfer entry says only: “Parent requested work on speech; continue previous activities.” The receiving therapist cannot tell which activities, what they were intended to achieve, or who decided to continue them.

A more useful entry would preserve the uncertainty:

Parent has asked whether OT can support the child’s speech. The records reviewed do not establish an agreed OT goal for this request. The current OT plan is linked separately. The receiving OT will clarify the request with the parent and supervising clinician before adopting a new goal. If coordination with the speech therapist is needed, the receiving OT will arrange it through the appropriate consent and information-sharing process. Review is planned before changing the treatment plan.

This example does not settle a clinical scope question. It shows how to leave a decision open without losing it. The request has a source, its status is clear, and someone has responsibility for following it up. The actual chart would identify the relevant clinicians, record dates, and review date.

The family’s account remains valuable. It tells the new therapist what matters now and what the family understood from earlier conversations. Keeping that account distinguishable from the documented clinical plan gives the therapist a place to clarify differences with the family.

Give preparation and review a place in the transfer

For a planned departure or caseload change, the clinical lead can make preparation part of the reassignment. The outgoing therapist brings the current plan and outstanding questions up to date. The receiving therapist gets time to review them before the first appointment. The lead checks that the receiving clinician has the appropriate access and resolves missing information or ownership.

That review needs a response. The incoming therapist can record that they have reviewed the handoff and identify any questions that remain. If the goal is clear but the latest result is missing, the follow-up is specific: locate the supporting observation or establish what needs checking at the next visit. An unread document cannot reveal that gap.

In a multidisciplinary clinic, it also helps to distinguish a change of therapist within one department from adding another profession to the child’s care. The second clinician needs to understand relevant existing work while establishing their own role. A shared family priority can connect the plans; each discipline’s contribution and responsibility still need to be explicit.

Give the family a clear account of who is taking over, what the team understands will continue, and what needs discussion. The receiving therapist can then use the appointment to check current priorities with the family, with the earlier record already in view.

When the previous therapist has already left

An unexpected departure leaves the lead with a different task. A transfer process that depends entirely on the outgoing therapist is no longer enough.

Start with the available assessment, current plan, recent notes, and relevant correspondence. Assign an appropriate clinician to bring together what those records establish. Date that summary, identify its author and sources, and make missing information explicit. Keep a parent’s recollection or a colleague’s later explanation identifiable as information obtained during the review. Neither should silently become a statement attributed to the departed therapist.

The receiving clinician then decides what can be carried forward and what requires clarification, consultation, or reassessment. A good handoff cannot guarantee that reassessment is unnecessary: the child’s needs may have changed, or the available evidence may be insufficient. It can make the reason for that decision visible. If a gap affects preparation for the next appointment, the lead needs to arrange the required review and communicate any change with the family.

For the next transfer in your clinic, ask the receiving therapist to open the record before the session and identify the current goal, the latest supporting evidence, and the next unresolved decision. Wherever the answer stops, assign the follow-up. That is the work the handoff still has to do.