Focus: explaining the potential conflict of interest if follow-up services are provided privately
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)
- Decline working with the family privately and provide the name of a past colleague/friend that now works privately.
- Decline working with the family privately and create a home program that she will modify on an as-needed basis.
- Decline working with the family privately and provide them with a list of occupational therapists in private practice.
- Decline working with the family privately but increase the frequency of visits to maintain their strong relationship.
- Agree to work with the family privately once she has appropriate insurance and storage for the client’s information.
- 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.
Additional Questions for Reflection
Additional questions for reflection, on your own or with others…
- What would you do in a similar situation?
- What other factors might have made it easier or more difficult for the occupational therapist to explain the conflict of interest?
- What organizational policies are in place – or could be – to help prevent conflicts of interest in your practice?
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.