Ethics Final Study Guide

What is client abandonment?

Withdrawing from client treatment without reasonable notice or a competent replacement

What section of the Code of Ethics addresses client abandonment?

Section 2G

What are the therapist responsibilities in a client abandonment scenario?

1. Provide timely notification to client and employer

2. Complete all necessary documentation

3. Create a transition plan with client collaboration as applicable.

What must the therapist consider when discontinuing temporary OT services like fieldwork?

Client autonomy and feelings of abandonment

To minimize harm in client abandonment scenarios,

1. Use transparent collaboration and timely notification with clients.

2. Recommend any available resources and facilitate community referrals

3. Prioritize accurate and timely completion of documentation when ending a therapeutic relationship.

State licensure and AOTA Ethics commision can both take disciplinary action for,

failure to uphold licensure requirements

Licenses are:

1. Issued by state regulatory boards

2. Indicate the person has met requirements and has legal authority to practice this discipline in this state.

3. Must be licensed in the state you provide services (doesn't have to match state of residence)

Letting Licensure laps:

violates standards of complying with state laws, billing legally, and holding requisite credentials.

Licensure compact:

formal agreement between states allowing practitioners to provide services in any one of those states.

We must compact privileges:

if we want to utilize licensure compacts (not every state is included)

OTA's are liable if their supervising OT does not:

hold an active license in their state

Who is responsible for your own liscensure?

The practitioners! NOT the employers job to remind you

CEUs

must track them yourself and proactively identify your own knowledge gaps/register for courses

CEUs are who's responsiblility?

The practitioners, not the employers

What are come common issues in private practice?

1. changing session length/frequency to align with productivity goals and result in financial gain for practice

2. Selling therapy related items at a profit (conflict between beneficence and financial interest)

What is an important core value in private practice?

Nonmaleficence, ensure you have appropriate training for services provided.

Practitioners cannot:

Allow reimbursement alone to influence tx duration and frequency. Avoid referring clients to more appropriate providers solely due to fear of losing business

What are potential HIPAA and confidentiality violations in private practice?

social payment apps for services

To uphold justice:

organizations can offer pro bono (free) services or grant based services

Siloing is when:

practitioners try to preserve their own business income by avoiding collaborating with other clinics/businesses

Supervisors serve as a:

bridge between staff and higher management

Good supervisors:

1. Engage in collaborative and immediate discussion of issues with supervisee

2. Build relationships based on trust and integrity

3. And provide performance appraisals that: gather information about employee's performance, compare current performance to standards, and reflect on and synthesize information

To facilitate a positive supervisory relationship:

1. Learn about the supervisee

2. Be clear and consistent about job expectations

3. Develop and implement a supervisory plan

4. Document supervision that is provided

Stage 1 of progressive discipline

Verbal warning and reprimand

Stage 2 of progressive discipline

Written repimand

Stage 3 of progressive discipline

Disciplinary suspension

Stage 4 of progressive discipline

Termination

Administrative supervision:

oversight over administrative job performance such as attendance, task completion, etc.

Clinical supervision:

Supervision directed toward support, training, and evaluation of professional discipline skills.

AOTA publication that outlines roles and responsibilities of OTA and OT:

Guidelines for Supervision, Roles, and Responsibilities during the Delivery of Occupational Therapy Service

OTs provide clinical supervision to:

OTAs

The supervisory relationship between the OT and OTA cannot be formally reversed. True or False?

True

An experienced OTA may have clinical competence in areas that a new grad OTR may not. True or False?

True

Is a new grad OTR required/obligated to oversee treatment plans, goals, and service delivery?

Yes

OTs and OTAs can both provide administrative supervision to each other. True or False?

True

Can OTAs be a rehab director?

Yes, but it requires additional training

OTs must determine OTA service competency for complex/specialized intervention. True or False

True

OTR and OTAs can collaborate to establish:

competency

OT must also determine competency in supervision if supervising a COTA with specialized experience. True or False?

True

OTRs and OTAs must maintain:

confidential and secure documentation of supervision

What are some core aspects of effective OT/OTA relationahips?

1. Ego minimization

2. Mutual appreciation

3. Open communication

What must OT/OTAs incorporate into their relationships?

cultural sensitivity and humility

Incorporating cultural sensitivity and humility:

resolves conflicts respectfully and maintains effective communication

Level II Fieldwork Students

Supervising OTP must have one year experience

If FWE is making unethical requests:

IMMEDIATELY notify academic fieldwork coordinator and refuse

If FWE has concerns about student competence:

Grade as objectively as possible and fail student if needed

Academic fieldwork coordinators:

1. Need to share relevant information that supports students success on fieldwork

2. Are not allowed to disclose for accommodations without student consent

Disclosure of disability status is left up to student discretion. True or False?

True. Students do NOT have to disclose disability status if they do not require accommodations to provide safe and effective care. Students are responsible for initiating requests and providing documentation for accommodations if needed.

Students follow same professional boundaries as practitioners while on fieldwork. True or False?

True. Especially for social media, gift acceptance, and HIPAA regulations and guidelines. (no pictures at site)

Fieldwork supervisors are required to honor __________ when assigning caseloads and productivity expectations.

Nonmaleficence

Students must communicate with their _____ if they don't feel competent in providing a specific intervention.

FWE

FWE (can or cannot) bill for services provided by student without student's name being attached to services

cannot. This prevents double billing

FWE and students are:

one entity regarding treatments

Moral distress:

knowing the right action to take but not being able to due to institutional constraints

Ethics rounds support _______

Prudence. This promotes good judgement and ethical mitigation of moral distress

Smoking case scenario:

Conflict between personal therapist values and client centered care/autonomy

Ethical rounds should include:

Interprofessional collaboration

Benefits of ethical rounding

◦Increase practitioner awareness of ethical challenges

◦Provide an opportunity for open/honest reflection and dialogue

◦Minimize moral distress

◦Share/receive support from colleagues

◦Develop skills to solve or prevent ethical issues

◦Promote a culture that prioritizes ethics in practice

Pediatric ICU Case study:

Primary issue was conflict between parental desire and medical team consensus

Typical 60 minute ethics round might include:

◦Case/topic presentation

◦Group discussion and reflection

◦Summary of key points and next steps

To implement ethics rounds in OT setting:

◦ Should be small and realistic

◦Frequency should match setting demands

◦Should occur during already planned meeting times or as optional continuing ed activity

Section 504

provides equal opportunity (but not guaranteed equal outcomes) for individuals with disabilities who are qualified to participate in educational programs or workplaces

Any institution/workplace employing ___ or more people are required to comply with section 504

15

Initiating the request for reasonable accommodations has to come from the ______________ in need of them

student or employee

To receive accommodations:

◦ Students go through administrative office like Office of Disability Services

◦Employees go through their personnel department (HR or supervisor-designated by employer)

FWE cannot informally offer accommodations:

This process is student initiated and has to go through appropriate institutional office

FERPA:

prohibits school personnel from sharing disability dx with FWE without student permission

You can share accommodations without sharing diagnosis. True or False?

True

Disability accommodations must honor:

◦ Nonmaleficence for client-job duties still have to be safely performed

◦ Justice for students-accommodations must be implemented objectively and fairly without favoring one student over another

Accommodations in academic setting may not carry over to:

fieldwork or workplace

Essential job functions do not have to be met for client safety. True or False?

False

Essential job duties cannot always be transferred to others, as this impacts client safety indirectly. True or False

True

Standardized assessments do not have to be current. True or False

False

Why do standardized assessments have to be current?

Normative data becomes outdated and doesn't reflect current population

Are assessment tools copyrighted?

Yes

Using photocopied tools violates standard:

1G engaging in behavior that undermines public trust. (Tools may still be current, but violates publication law)

Assessment tools must include a current and clearly identified:

conceptual model

Case Example: Student used DeGangi-Berk Test of Sensory Integration from 1983, using copies from FW

Not normed for corrected age and has outdated developmental norms overall

MOST important consideration for selecting assessment tool:

Current, Evidence based, Appropriate to client's needs

Ethical issues from outdated tests:

◦Cultural bias

◦Temporal bias

Incorrect norms impact the _______

validity (does this measure what it says it will measure)

Outdated test items also impact validity. Example:

A corded landline phone on a pediatric test may not represent "phone" to atoddler

If you cannot access or locate all parts to a test:

◦Do not just give parts you have!

◦Select a valid alternative or delay use of tool until you can find all components

Consultation:

sharing knowledge with an individual or organization

First step if OTP receives a consult request:

Gain awareness of consulting environment and needs of the client

Process of consultation:

◦Phase 1: discuss nature of the project and develop a proposal

◦Phase 2: dialogue with client and others involved in project

◦Phase 3: set goals for project and take action

Written consultation agreements must include:

◦Detailed description of engagement (scope)

◦Effort expected to achieve scope

◦Price to be charged

Deliverables:

product, services, or goods a consultant provides to a client

Unrealistic client goals or expectations:

MUST be formally addressed during consultation process

Coaching:

technique to help managers and supervisors make changes and move companies forward

Content issues

focus on the substance of organizational change

Contextual issues

focus on the conditions existing in and organizations external and internal environements

Process issues

address the actions undertaken during the enactment of an intended change

Criterion issues:

deal with outcomes of organizational change efforts

In order to consult:

the practitioner should reflect on their area of expertise

Its advised and permitted to charge a fee for

consulting work (it does not need to occur pro bono)

Flexibility:

being able to set aside your own agenda and accept different ideas

Organizational change management:

A structured approach that can be used to ensure that changes are successfully implemented