Ethics of Occupational Therapy Alyssa Finn Pacific Institute for Ethics and Social Policy Spring 2009

Overview Occupational Therapy Practice Development of Ethical Standards AOTA Code of Ethics Case Study Presentation Discussion

OT Practice Human Occupation Activities of Daily Living “Directed use of energy, time, attention, & interest” Broad Scope of Practice Holistic Approach Psychological Physical Social Quality of Life via Inclusion Education Prevention Screening Independence

Development of Ethical Standards World Federation of Occupational Therapy (WFOT) American Occupational Therapy Association (AOTA) Licensure Legal & Ethical Standards Occupational Therapy Association of Oregon (OTAO) AOTA Code of Ethics Public Statement of values and principles

AOTA Code of Ethics 7 Principles Beneficence Nonmaleficence Autonomy/ confidentiality Duty Procedural Justice Veracity Fidelity

Current Ethical Issues Colleague Interactions Quality/Standards of Care Professional vs Personal Relationships Deception Scope of Practice Insurance Coverage Service Continuation Autonomy vs Beneficence

Case Presentation 3rd year OT student Local School District Low in funding/resources – High Case Loads Single FT OT 6 year old girl with High Functioning Autism Currently in special education programs for OT, Speech Pathology, and Adapted Physical Education Regular classroom setting with teaching aide

Case Presentation Satisfactory Academic Progress District suggests removal of student from special programs OT student recently had discussion with teaching aide Socially, she should stay in special programs

Case Presentation IEP Meeting and Assessments Qualifies for services Because of case loads and academic performance, APE and Speech Pathologist changed scores Suggest that district OT do same Student reveals conversation with aide Discounted by other members of IEP Team OT changes score Family consents based on info presented

Ethical Questions Should the student address the family of the false documentation? Is the student’s education jeopardized from the actions taken? Were the APE, Speech Pathologist, and OT justified in their decision? What institutional changes can be made to prevent this situation?

Legal Process Individuals with Disabilities Educational Act (2004) Special education and related services provided to students with designated disabilities “Free Appropriate Education” Designed specifically to child’s need Future employment, education, independence

Should the student address the family of the false documentation? Veracity False documentation Autonomy Family not able to make fully informed decision Fidelity Respecting professional opinion of colleagues

Benefits of School Based OT Fine Motor Skills Linked to academic, social, emotional capability Need for fine motor assistance only Not included within IDEA Academic Performance Sensory Integration Independent function

High Functioning Autism Children with HFA Generally on level academic performance Lacking in social capabilities Autistic behaviors Isolation Repetitive behavior

Is the student’s education jeopardized from the actions taken? Yes Education more than academic performance Evaluation Standards Sensory Integration and Academic Performance

Were the APE, Speech Pathologist, and OT justified in their decision? Beneficnce Individual student vs Collective case load Underlying lack in funding OT Advocacy True ‘Occupational Justice’ Increase in FT OT Decreased case load Improved direct services

What institutional changes can be made to prevent this situation? Brown (2003) Multi-skilled & Cross Trained Practitioners Practitioner trained in 2 or more disciplines Single professional trained with skills of another Positives Decreased Costs Decrease in health care providers with single patient Negatives Lacked Specialization Regulation/ Liability

References Barbara, A. & Curtin, M. (2008). Gatekeepers or advocates? Occupational therapists and equipment funding schemes. Australian Occupational Therapy Journal, 55, p Brown, G.T. (2003). Integrated health human resource options: The impact on occupational therapy professional practice. Scandinavian Journal of Occupational Therapy, 10, Ericksen, J.B. (2010). Critical reflections on school-based occupational therapy. Scandinavian Journal of Occupational Therapy, 17, Gal, E., et al. (2009). Enhancing social communication of children with high- functioning autism through a co-located interface. Al & Soc, 24, Jackman, M., & Stagnitti, K. (2007). Fine motor difficulties: The need for advocating for the role of occupational therapy in schools. Australian Occupational Therapy Journal, 54, Schaaf, R.C. & Miller, Lucy, J. (2005). Occupational therapy using a sensory integrative approach for children with developmental disabilities. Mental Retardation & Developmental Disabilities Research Reviews, 11(2), p AOTA Code of Ethics