The certified occupational therapy assistant in a 64 bed inpatient psychiatry setting contributes to a high level of patient care and departmental efficiency. The certified occupational therapy assistant's responsibilities include direct patient care, student education, and clinical management and are described in this article. The methods and philosophy for supervision of the certified occupational therapy assistant are explored. In conclusion, two adult psychiatry programs which utilize the Certified Occupational Therapy Assistant's knowledge and education are described.