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Notice: The Competencies for Occupational Therapists in Canada (2021) are now in effect.

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Feb 22, 2021

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The goal of the Quality Assurance program is to promote safe, competent, and ethical practice through the three mandatory tools of Self-Assessment, Professional Development Plan, the Prescribed Regulatory Education Program (PREP) and, for selected registrants, the Peer and Practice Assessment.

Occupational therapists who complete a Peer Assessment report the experience is positive, and the outcome is typically a change to their practice that helps them improve the quality of their services.  This is the foundational goal of the QA program, and why the College wants OTs to know the most common areas identified for coaching so they can proactively work to make practice changes even before they are required participate in an assessment.

What are the most common areas identified for coaching through Peer and Practice Assessments? 


1. Consent

While most occupational therapists have a process for obtaining consent, and this may or may not include a consent form, many are missing the aspect of consent that involves explaining to the client the risks and benefits of the services being proposed.

The Standards for Consent, item 2.1 states “an OT will ensure the client has been given all the information a reasonable person in the same circumstances would require in order to make a decision about the services including…(c.) expected benefits and relevant risks of proceeding with the services.”  

2. Substitute Decision Maker Hierarchy

Most occupational therapists know of the hierarchy, and where to find it, but Peer Assessments tend to highlight that many would not know this well enough to implement it at bedside or quickly if needed.  

The Substitute Decision Maker Hierarchy is part of the Health Care Consent Act (1996) and in the Standards for Consent, indicator 1.4 states “an OT will…(b) take reasonable measures to confirm the SDM and inform the client that the SDM will make the final decision related to the occupational therapy services.” Further, 1.5 states “an OT will use the hierarchy of substitute decision-makers to determine the most appropriate decision-maker (Appendix 1) if a SDM has not been identified.”

3. Understanding the Power Imbalance that Exists in the Client-Therapeutic Relationship

The very nature of any therapeutic relationship allows for strong and supportive interactions between therapist and client. However, what some occupational therapists fail to realize is that the relationship is not equal as the OT is in a position of authority over the client’s situation. For example, the OT has access to information about the client that the client does not in turn have about the OT. Also, the OT is in a position to make decisions that can have an impact on the client’s life and can facilitate, or prevent, their access to goods and services.  These situations tip the scales of power towards the OT.

In the Standards for Professional Boundaries, performance indicator 1.1 states “an OT will recognize the position of power the therapist has over the client within the therapeutic relationship.” It is important to reflect on this in practice and to understand how this power imbalance impacts the therapeutic relationship and be mindful of this when services by maintaining professional boundaries and client-centered practice.