Use these cases to test your understanding of the relevant practice standards. Discuss these with colleagues, reflect on your practice, and take action if necessary.


Professional Development Cases

Case of “Capacity to Consent”
Focus: Medical Assistance in Dying (MAiD)

Case of the “New Certification Requirement”
Focus: Montreal Cognitive Assessment (MoCA)

Conflict of Interest Cases

“Gracious Appreciation”
Focus: gifts from clients

Case of the “Convenient Vendor”
Focus: offering choices

Case of the “Moonlighting OT”
Focus: explaining the potential conflict of interest if follow-up services are provided privately

Case of Accessing “Inside Information”
Focus: establishing boundaries with family members who request favours

Case of the “Best Deal”
Focus: purchasing equipment for a client


Case of “Capacity to Consent”

The College’s advisory statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists was released on June 25th, 2020. The following scenario and question
were developed to encourage further reflection and application of the information contained in the advisory statement.

Scenario

A 47-year-old female is diagnosed with a glioblastoma multiforme brain tumour. Four
months ago she had a tumour resection, with subsequent chemotherapy and palliative
radiation. She has ongoing symptoms including headache, nausea, dysphagia and left sided
hemiplegia. Her prognosis is now less than six months. She is admitted to hospital for
symptom management and wishes to pursue medical assistance in dying (MAiD).

Question

The client’s spouse is a physiotherapist and has been caring for the client at home. She
approaches the occupational therapist and expresses concern, as she is worried the client is
cognitively impaired and not competent to make medical decisions. She is not supportive of
the client’s wish to have an assisted death. She asks the occupational therapist to assess the
client’s cognition because she does not feel her spouse has the capacity to consent to MAiD.

How should the occupational therapist best proceed? (Select 1)

  1. Agree to assess the client’s cognition using a standardized assessment tool and provide a
    clinical opinion about the client’s capacity to provide consent for MAiD.
  2. Inform the spouse that a physician or nurse practitioner conducts the assessment process
    to determine the client’s capacity to provide consent for MAiD.
  3. Direct the spouse to the client’s physician to request an occupational therapy referral for
    a cognitive assessment to determine the client’s capacity to consent to MAiD.
  4. Observe the client’s cognition informally during an assessment of activities of daily living
    and provide a clinical opinion about the client’s capacity to consent to MAiD.

Answer Rationale

The College’s preferred response is B.

In order to enable clients to make informed decisions, occupational therapists must be able to
provide accurate, objective information in a respectful and thoughtful manner on the legal
provision of MAiD.

Once a person requests MAiD, the current eligibility process in BC requires the opinion of two
independent medical assessors, one of whom must also be the prescriber and/or
administrator of the lethal substances. Only a physician or nurse practitioner may be a
medical assessor.

Both medical assessors must be satisfied that the person requesting MAiD is mentally capable
of making a free and informed decision at the time of the request and throughout the
process. If either medical assessor is unsure that the person has capacity to consent to MAiD,
they will request a capability assessment from a third assessor or specialist (College of
Physicians and Surgeons, 2020).

Answers A, C and D are incorrect in this scenario because under the current legislation,
occupational therapists are not permitted to determine client eligibility for MAiD, however, as
described on page 4 of the advisory statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists (COTBC, 2020), occupational therapists working as
part of an interprofessional team may be asked to assist in this regard, given their knowledge,
skill, and experience in assessing the functional abilities of clients as it pertains to capacity for
decision-making.

References and Resources

British Columbia Ministry of Health. (n.d.) Medical Assistance in Dying – Information for Health Care Providers. https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/medical-assistance-in-dying/information-for-providers

College of Occupational Therapists of British Columbia. (2020). Advisory Statement on Medical Assistance in Dying (MAiD): Considerations for Occupational Therapists. https://cotbc.org/wp-content/uploads/COTBC-Advisory-Statement-MAiD-FINAL-June-2020.pdf

College of Physicians and Surgeons of British Columbia. (2020). Practice Standard: Medical Assistance in Dying. https://www.cpsbc.ca/files/pdf/PSG-Medical-Assistance-in-Dying.pdf

Government of Canada. Statues of Canada. (2016) Chapter 3, Bill C-14.
https://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent


Case of the “New Certification Requirement”

The College is aware of the new mandatory online training and certification program required by the developers of the Montreal Cognitive Assessment (MoCA) with an upcoming deadline of September 1st, 2020 for completion. The following scenario and questions were developed for the Annual Continuing Competency Review (ACCR), but since that was deferred for the 2019/20 year, we thought it might be helpful to publish the question as a case study for your reflection.

Scenario

An 86-year-old female presents to the emergency department by ambulance following a fall in the house where she lives alone. Staff are concerned because in addition to her soft tissue injuries, she is demonstrating symptoms of cognitive impairment. She is admitted to the hospital and transferred to an acute care unit for a full medical workup.

Question One

The physician makes a referral to the occupational therapist with an order to administer the Montreal Cognitive Assessment (MoCA). What is the best first step for the occupational therapist to take in response to the physician’s referral? (Select 1)

  1. Accept the referral and complete the MoCA because the occupational therapist should follow the physician’s order.
  2. Discuss the purpose of the referral with the physician and determine how it relates to the client’s occupational performance.
  3. Decline the referral because it is within the physician’s scope of practice to administer the MoCA.
  4. Complete the MoCA and assess the client’s cognition in relation to her ability to complete activities of daily living (ADLs).

Answer Rationale

The College’s preferred response is B.

Per Essential Competency 4.1, occupational therapists must clarify “the role of occupation and enablement when initiating services” (ACOTRO, 2011, p. 17). By clarifying the purpose for the referral, the occupational therapist can better understand the nature of the request and determine if there are additional occupational therapy assessments or interventions that may be appropriate.

A is not the best response. Occupational therapists are autonomous health care professionals, and as such, are accountable for their professional judgement and decision-making. While occupational therapists collaborate with other health care professionals to provide safe, effective, ethical, and client-centred occupational therapy services, if an occupational therapist has questions or concerns about a referral, they should clarify these prior to proceeding if possible.

C is not the best response. As stated above, the occupational therapist should clarify the expectations of the physician regarding the referral and determine if occupational therapy services may be indicated.

D is not the best response. While the occupational therapist may determine that the MoCA and an assessment of the client’s abilities to complete ADLs are appropriate as part of a broader cognitive assessment process, the best first step is for the occupational therapist to determine the purpose of the referral and communicate with the physician.

Question Two

The occupational therapist is very experienced using the MoCA in her practice. However, she is aware that as of September 1, 2019, a new online training and certification program (with a cost of $125.00 US) was implemented by the developers of the MoCA.

The developers state that completion of the training and certification is mandatory by September 1, 2020, to ensure standardization of the testing procedures. The website states: “If you wish to continue using the MoCA Test without being officially trained and certified, you will be at increased risk for administration, scoring and interpretation errors which could lead to misdiagnosis and liability” (MoCA, 2019). The developers require clinicians to complete a disclaimer should they choose to use the MoCA without the training and certification.

The occupational therapist has not completed this training, but believes that she has the competence to continue to use the MoCA, given her familiarity with its appropriate application and many years of experience using it in clinical practice.

What is the best action for the occupational therapist to take in relation to administering the MoCA? (Select 1)

  1. Complete the training and certification program and continue to administer the MoCA when it is appropriate in relation to the client’s occupational performance.
  2. Recommend that the physician request that a resident or neuropsychologist administer the MoCA because they are exempt from the training.
  3. A change in practice is not required because the occupational therapist’s employer does not require the MoCA training and certification.
  4. Complete the disclaimer and administer the MoCA when clinically appropriate, given the occupational therapist’s individual competency.

Answer Rationale

The College’s preferred answer is A.

The occupational therapist demonstrates a commitment to continuing competence by completing the training and certification and continuing to use the MoCA in clinical practice. Doing so helps to foster the trust that clients have in knowing that the occupational therapist has the necessary training and competence to use the MoCA correctly.

It is also helpful to consider this scenario in the context of the following Essential Competencies:

6.2 – Demonstrates commitment to continuing competence.

  1. Maintains the knowledge, skills, and attitudes to provide a safe, efficient, and effective service in areas of practice.
  2. Integrates new knowledge, skills, and attitudes into practice.
  3. Implements a plan for continual professional improvement.
  4. Takes action to address deficiencies to enhance practice.

6.3 – Enhances personal competence through integration of on-going learning into practice.

  1. Keeps abreast of changes in practice setting that affect scope of practice.
  2. Adapts to changes in practice using evidence, practice standards, and best practices.
  3. Enhances knowledge, skills, and attitudes in needed areas of personal competence.

The MoCA is one of many cognitive screening tools. The occupational therapist may decide to administer an alternative cognitive screening tool based on the intended population and psychometric properties of such tools, the occupational therapist’s clinical reasoning and the client’s presenting occupational performance issues.

D is the next best response. The occupational therapist can choose to complete the disclaimer, acknowledging the developer’s stated risks. Using the MoCA without the training and certification ultimately involves the occupational therapist’s accountability. If choosing this option, the occupational therapist should carefully consider the context within which the MoCA is being used and what the potential impacts and risks are of not completing the training and certification. As stated in COTBC’s Code of Ethics, occupational therapists “are fully responsible for their practice and are obligated to account for their actions” (2006, p. 5). If choosing not to do the training, the occupational therapist needs to consider the risks to their own competence, as well as the possible implications related to fostering trusting relationships with their clients and others (e.g., fee payers, colleagues, acceptance as an expert witness in occupational therapy, etc.).

Occupational therapists should also consider any employer or health authority policies regarding the use of the MoCA. The MoCA is a copyrighted screening tool; therefore, the occupational therapist is required to follow applicable copyright laws.

B is not the best response. As stated above, occupational therapists are fully responsible for their practice and are obligated to account for their actions. While residents and neuropsychologists are exempt from the training and certification, the occupational therapist’s focus should be on determining the need for occupational therapy services. As such, the occupational therapist should clarify the expectations of the referral and determine what occupational therapy services may be indicated.

C is not the best response. As noted above, the MoCA is a copyrighted screening tool. Per COTBC’s Code of Ethics, occupational therapists must “practise within the scope of the profession, with knowledge of, and adherence to, national and provincial legislation, regulations, standards of practice and policies relevant to the practice of occupational therapy” (2006, p. 4). The occupational therapist should complete the disclaimer and not rely solely on the employer’s policy, even if that policy does not require the MoCA training and certification.

Resources

Association of Canadian Occupational Therapy Regulatory Organizations. (2011). Essential Competencies of practice for occupational therapists in Canada (3rd ed.).
https://cotbc.org/wp-content/uploads/EssentialCompetenies3rdEd_WebVersion.pdf

College of Occupational Therapists of British Columbia. (2006). Code of Ethics.
https://cotbc.org/wp-content/uploads/Code_of_Ethics.pdf

Montreal Cognitive Assessment. (2019). https://www.mocatest.org


“Gracious Appreciation”

wrapped gift
© Can Stock Photo : trancedrumer

Your appointment with Ms. Jones wraps up. She reaches into her handbag and pulls out a box of chocolates. They are your favourite – salted caramels! Smiling, she passes them to you and says, “Thanks for all the you have done for me! I would be lost without your ongoing support”.

Who doesn’t love a box of chocolates?! You can almost taste them but something is making you feel a bit “twitchy”. Should you accept them?

Tough question and sadly one where there isn’t always an easy “black and white” answer. Our colleagues at the College of Physical Therapists of BC (CPTBC) highlight that, “It’s important to be aware that whenever a gift is accepted, it comes with a degree of risk… The therapeutic relationship with the [client] exists for one purpose only – to provide services for the benefit of the [client]… Accepting gifts can lead to the perception that there is a personal or reciprocal relationship, as opposed to a professional relationship between the [client] and therapist.”

This situation is often more common during the holiday season. During this time or anytime, refresh yourself on the Conflict of Interest Practice Standards which include a risk assessment and management framework. You can also ask yourself the following questions:

  • Will your professional judgment be influenced by accepting the chocolates?
  • Will your client misunderstand the nature or boundaries of your relationship, if you accept?
  • Would you be happy to disclose to your boss or colleagues that you accepted them?

As cautioned by CPTBC, “No gift is risk free, and often the ‘strings attached’ are not visible until later.” By pre-emptively assessing risk factors such as: your client’s vulnerability and culture, your familiarity with your employer’s policies, and existing workplace social norms, you might feel better prepared to take action in your client’s best interests. Sometimes, you might choose to accept a small token gift given a cultural risk of declining and then mitigate the risk by sharing the gift with your team. Other times, you might decide to graciously acknowledge the gift, politely decline, and reinforce the message that “your thanks is thanks enough”.

Reference

College of Physical Therapists of British Columbia. (2018). Ask your practice advisor. Retrieved from https://cptbc.org/physical-therapists/practice-advice/


Case of the “Convenient Vendor”

© Can Stock Photo / cteconsulting
© Can Stock Photo / cteconsulting

An occupational therapist (OT) works in a BC health authority residential setting. He has recently completed a seating assessment and the findings indicate that a resident requires a customized tilt-in-space wheelchair and specialty cushion.  The residential setting is in an urban area where there are several local medical equipment vendors that sell these types of seating systems.

The OT is relatively new to this practice area and has limited experience working with wheelchair vendors. Recently he had an excellent experience working with one particular vendor representative and would prefer to work with representative again. The process was smooth and efficient for the OT, the vendor was knowledgeable, and the client was very satisfied. How should the occupational therapist proceed? (Select 2)

  1. Ask for consent to work with this preferred vendor because it is in the resident’s best interest to use a knowledgeable vendor who provides good service.
  2. Provide the resident with the alternatives available in the area and then encourage the resident to choose a vendor representative.
  3. Seek out organization policies and procedures related to working with medical equipment vendors and/or fair business practices.
  4. Encourage the resident to choose the vendor after outlining the alternatives and describing previous professional experiences.
  5. Provide the resident with information regarding vendors recommended by colleagues with more experience in the area.

College Preferred Answer

2 and 3 are correct
Conflict of Interest Practice Standard #2: Preventing Conflict of Interest states that occupational therapists “avoid preferential or discriminatory treatment towards particular … organizations” and will “apply any conflict of interest-related policies and procedures of the occupational therapist’s employer or organization” (pp. 16-17). While the occupational therapist may have had a positive experience with one particular vendor, it remains the occupational therapist’s responsibility to provide the client with information about the range of alternatives available, so that the client themselves can make an informed choice. For example, this may include, but is not limited to, the occupational therapist objectively presenting information regarding differences in vendor costs and types of equipment sold, as well as customer service considerations such as return policies, warranties, availability of trials, and timeliness of equipment repairs and servicing. The occupational therapist must be careful not to inadvertently influence a decision when communicating information about vendors. What’s easiest for the occupational therapist is not necessarily in the client’s best interests.
Checking with your organization’s purchasing or procurement department will help prevent unnecessary violations of policies. If not available, consider developing policies and procedures to ensure you are consistent and fair when dealing with suppliers.

1 is incorrect
This approach does not give the client an opportunity to understand the alternatives available and personally make an informed choice among them.

4 is incorrect
While the occupational therapist has provided the client with an understanding of the alternatives available, by ‘encouraging’ the client to choose the occupational therapist’s preferred vendor, the occupational therapist is introducing his own bias and influencing the informed consent process.

5 is incorrect
While talking with colleagues is one approach the occupational therapist may use to develop his professional knowledge about various vendors, as with previous answers, limiting the alternatives presented impacts the client’s ability to make an informed choice among the options and introduces bias.

Reference

College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standard #2: Preventing Conflict of Interest, pp. 16-17.

Additional questions for reflection, on your own or with others…

  1. What would you do in a similar situation?
  2. What other factors might have made it easier or more difficult for the occupational therapist to explain the conflict of interest?
  3. What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?

Case of the “Moonlighting OT”

© Can Stock Photo Inc. / Bialasiewicz
© Can Stock Photo Inc. / Bialasiewicz

An occupational therapist in a publicly funded, community-based facility is working with a 4-year-old boy diagnosed with autism. The child is getting ready to start kindergarten soon and has some issues with independent toileting, managing transitions, and certain fine-motor activities. The occupational therapist has established a strong therapeutic relationship with the child and his parents, and they have been making positive gains working together. The parents approach the occupational therapist at the next visit and ask that she also work privately with their son as they have access to some extra funding that must be used within the next few months. In this community there are occupational therapists in private practice who already provide this service.

How should the occupational therapist proceed? (Select 2)

  1. Decline working with the family privately and provide the name of a past colleague/friend that now works privately.
  2. Decline working with the family privately and create a home program that she will modify on an as-needed basis.
  3. Decline working with the family privately and provide them with a list of occupational therapists in private practice.
  4. Decline working with the family privately but increase the frequency of visits to maintain their strong relationship.
  5. Agree to work with the family privately once she has appropriate insurance and storage for the client’s information.
  6. Discharge the child from her current caseload at the public facility so that she can work with the family privately.

College preferred answer:
2 and 3 are correct
Conflict of Interest Practice Standard #1: Recognizing Conflict of Interest (2016) states that occupational therapists will “recognize if a situation involves any direct or indirect benefit (i.e. personal, professional, political, academic, financial, or material) to the occupational therapist that could affect his or her judgement” (p. 13). It also states that occupational therapists “consider whether others could potential perceive a conflict of interest that could compromise the occupational therapists credibility or quality of client care” (p. 14). By declining the provision of private services and recommending suitable alternatives, the occupational therapist manages any perceived or actual conflict of interest associated with referring to her own private practice.

1 is incorrect
The occupational therapist does not have to gain directly for there to be a conflict of interest. Others may still perceive a conflict of interest if the occupational therapist refers only to a past colleague/friend, when there are other suitable alternatives available.

4 is incorrect
Conflict of Interest Practice Standard #2: Preventing Conflict of Interest states that occupational therapists “avoid preferential … treatment towards particular clients or organizations” (p. 16). Increasing the frequency of visits beyond service levels typically offered by the centre could be perceived as preferential treatment.

5 is incorrect
Despite completing some of the necessary preparations to work privately, the occupational therapist is not addressing the conflict of interest that arises given the benefits she stands to gain.

6 is incorrect
The occupational therapist is not acting in the client’s best interest to discharge him from her current caseload and personally benefit by offering her services privately.

References

College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standard #1: Recognizing Conflict of Interest, pp. 13-14.

College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standard #2: Preventing Conflict of Interest, pp. 16-17.

Additional questions for reflection, on your own or with others…

  1. What would you do in a similar situation?
  2. What other factors might have made it easier or more difficult for the occupational therapist to explain the conflict of interest?
  3. What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?

Case of Accessing “Inside Information”

© Can Stock Photo Inc / BernardaSv
© Can Stock Photo Inc / BernardaSv

An occupational therapist practising on an acute care psychiatric unit receives a phone message from her cousin who is a health care professional working in community mental health. The cousin had just visited his close friend who is a client on the unit and working with the occupational therapist. The cousin is seeking information about his friend’s care and would like to support him post discharge. The occupational therapist has just completed an assessment during which time the client expressed he had limited supports in the community. How should the occupational therapist respond? (Select 2)

  1. Inform the cousin that the information is accessible to him via the client’s e-record.
  2. Offer to send the cousin a copy of the client’s assessment, in confidence, provided he does not share it.
  3. Inform the cousin that this information is confidential and cannot be shared without the client’s permission.
  4. Do not respond to the call and avoid the cousin until the client has been discharged.
  5. Invite the cousin to attend the unit’s rounds to discuss discharge plans for the client.
  6. Suggest the cousin contact the client directly to offer his support post-discharge.

College preferred answers:
3 and 6 are correct
This case is related to both the Conflict of Interest (COI) and the Managing Client Information (MCI) practice standards and illustrates how a conflict of interest can be interconnected with other practice issues such as patient/client privacy.

COI Practice Standard #2: Preventing Conflict of Interest (2016) states that “occupational therapists must maintain a relationship of trust and confidence by not taking advantage of his or her position, including access to privileged information or knowledge received in dealings with clients or organizations” (p. 17). As an occupational therapist on the unit, the occupational therapist has access to privileged confidential information. The occupational therapist must not use this information for her benefit or for the benefit of her family, in this case, her cousin.

Additionally, MCI Practice Standard #4: Disclosing the Occupational Therapy Record (2014), states “the occupational therapist will transfer, share, or disclose personal information only with the express consent of the client unless otherwise permitted to do so by law” (p. 2).
By suggesting that the cousin talk with the client and offer his support, the client is directly informed of the support available and is able to control if and/or how he accepts it. If interested, the client may choose to invite his friend to become more actively involved in discharge planning.

1 is incorrect
The cousin is not seeking information from the occupational therapist in the capacity of a health care professional. By recommending the cousin access the e-record, the occupational therapist is encouraging a breach of the client’s privacy in an attempt to meet the interests of a family member.

2 is incorrect
The client has not provided consent to disclose this information, even ‘in confidence’.

4 is incorrect
Occupational therapists have the responsibility to manage professional boundaries and communicate honestly and transparently. By ignoring the cousin’s message, the occupational therapist is not meeting these expectations. Additionally, the COTBC Code of Ethics states that occupational therapists “assist their colleagues to recognize and address potential boundary violations” (p. 9). Given the cousin is also a health care professional, by ignoring this request the occupational therapist is not fulfilling this responsibility. An additional consideration is that if the occupational therapist ignores the message, the client may not be able to benefit from a potentially valuable support upon discharge. This is not acting in the client’s best interest.

5 is incorrect
Consistent with answers 1 and 2, the client has not provided consent to disclose his personal information. Additionally, the occupational therapist’s cousin is not the client’s health care professional.

References
College of Occupational Therapists of British Columbia. (2014). Code of ethics, pp. 8-9.
College of Occupational Therapists of British Columbia. (2014). Managing client information practice standard #4: Disclosing the occupational therapy record, p. 2.
College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standard #2: Preventing Conflict of Interest, p. 17.

Additional questions for reflection, on your own or with others…

  1. What would you do in a similar situation?
  2. What other factors might have made it easier or more difficult for the occupational therapist to maintain professional boundaries?
  3. What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?

Case of the “Best Deal”

© Can Stock Photo Inc. / McIninch

An occupational therapist works in two different settings: an acute care orthopedic unit and a community-based private clinic. A client from the unit has tried different dressing aids and finds that a few really help increase his independence and comfort. The client would like to purchase these for use at home but has a limited income. The private clinic where the occupational therapist works orders these dressing aids in bulk so can offer competitive pricing.

How should the occupational therapist proceed? (Select 1)

  1. Arrange for the client to buy the dressing aids from the clinic at their regular price.
  2. Arrange for the client to buy the dressing aids from the clinic at a discounted price.
  3. Provide the client with a list of various retailers who sell the dressing aids.
  4. Give the client dressing aids from the clinic with the recommendation to follow up there.

College preferred answer:
3 is correct
A conflict of interest occurs when the occupational therapist’s interests interfere with the client’s best interests or the occupational therapist’s own responsibilities. Practice Standard #2: Preventing Conflict of Interest states that occupational therapists must “provide clients with alternative options for receiving occupational therapy services in circumstances where a perceived or actual conflict of interest exists or a potential conflict of interest may arise” (p. 17). In this case, if the list includes the private clinic where the occupational therapist works, it will be important that she manage the conflict of interest in accordance with Practice Standard #3: Managing Conflict of Interest. This involves disclosing the conflict, providing information about options, informing the client of his right to decline the service, and documenting any steps taken.

1 and 2 are incorrect
Practice Standard #1: Recognizing Conflict of Interest indicates that occupational therapists must “recognize if a situation involves any direct or indirect benefit (i.e., personal, professional, political, academic, financial, or material) to the occupational therapist that could affect his or her professional judgement” (p. 13). If the occupational therapist specifically arranges for the client to buy the dressing aids from the private clinic, the occupational therapist may directly or indirectly benefit, creating a conflict of interest.

4 is incorrect
The occupational therapist stands to gain by soliciting the client to contract her privately as a way of obtaining the dressing aids for free. Additionally, it is unclear from the information provided in the scenario that the client actually requires follow up.

Reference
College of Occupational Therapists of British Columbia. (2016). Conflict of interest practice standards.

Additional questions for reflection, on your own or with others…

  1. What would you do in a similar situation?
  2. What other factors might have made it easier or more difficult for the occupational therapist to maintain professional boundaries?
  3. What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?