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Overview

1. Use their title and name correctly
2. Ensure that those they supervise use an approved title
3. Avoid specialist titles, designations, and abbreviations
4. Accurately communicate additional credentials
5. Use the title “doctor” correctly
Related College documents
Appendix 1: Resignation from the Profession
Appendix 2: College Applicants

Introduction

The Standards of Practice establish the minimum expectations for all occupational therapists in Ontario. They describe how occupational therapists will provide safe, quality, ethical, accountable, and effective services. The Standards apply to all registrants of the College of Occupational Therapists of Ontario (“the College”), regardless of practice setting, job title, or role. The Standards, together with the Code of Ethics, Competencies, and Practice Guidance, establish the expectations for professional practice and the delivery of occupational therapy services.

Code of Ethics	The Code of Ethics defines the College’s expectations for ethical practice. It includes a set of values and principles, and is intended for use in all contexts and for all levels of decision-making. It forms the foundation for occupational therapists’ ethical obligations. Occupational therapists must know and adhere to these principles.
Competencies	The Competencies for Occupational Therapists in Canada, 2021,articulates the broad range of skills and abilities required of all occupational therapists. Occupational therapists are to remain familiar with the Competencies to inform practice and professional development.
Standards	Standards of Practice establish the minimum expectations for occupational therapists—expectations that contribute to public protection. Standards apply to all occupational therapists, regardless of their role, job description, or area of practice.
Practice Guidance	Practice Guidance provides information about specific practice situations or legislation. These are recommended practices.

How the Standards are developed and updated

The Standards are based on core occupational therapy principles outlined in the Competencies for Occupational Therapists in Canada (2021). The College monitors and revises Standards regularly through its committees, subcommittees, focus groups, and panels. The College consults with registrants and the public to ensure the Standards include core practice elements before seeking approval by the College’s Board of Directors. Registrant input is vital to ensuring the Standards reflect changing practice environments and expectations. Data from College committees and program areas such as Investigations and Resolutions, Quality Assurance, Registration, and the Practice Resource Service helps the College keep the Standards current.

How the Standards are used

Clients and the public

Occupational therapy clients and the public use the Standards to understand what they can expect from occupational therapists. These expectations include knowing that services are being provided in ways that are accessible, culturally sensitive, equitable, and inclusive.

The College

The College uses the Standards in all statutory programs to ensure that applicants and registrants have the competencies and skills to practise effectively, to address questions or concerns about a registrant’s practice, and to review and support the provision of quality services. Failure to comply with the Standards constitutes professional misconduct (Ontario Regulation 95/07, s. 1 [1]). The College’s Practice Resource Service is available as an additional resource to help registrants and the public if they have questions about the Standards and occupational therapy practice. The Practice Service is confidential and available at 416-214-1177 or [email protected].

Occupational therapists

Clinical and non-clinical occupational therapists are expected to use these Standards in their daily practice and, when requested by the College, be able to demonstrate how their practice meets the performance indicators. Occupational therapists must be able to provide a reasonable rationale when a Standard was not met, including when contextual factors required a deviation from the expectations. In applying the Standards, occupational therapists must use professional judgement in the following ways:

Determine how to best meet client needs in accordance with the Standards.
Understand that these Standards are the College’s interpretation of regulatory and practice expectations. When Standards and legislation conflict, the legislation prevails.
If workplace policies conflict with the Standards, collaborate with their employers to identify and work toward resolving the differences in clients' best interests.

Employers

Employers of occupational therapists use the Standards to know and follow the College’s expectations of occupational therapists working at their organization.

Educators and students

Educators and students use the Standards to inform curriculum and placement expectations.

Use of the terms “client,” “patient,” and “service”

The College uses the term “client” to align with the Competencies for Occupational Therapists in Canada. It states that clients are “people of any age, along with their families, caregivers, and substitute decision makers. Therapists may also work with collectives such as families, groups, communities, and the public at large” (2021, p. 19). The term “clients” applies to people and organizations that occupational therapists work with in both clinical and non-clinical settings.

The Regulated Health Professions Act, 1991 (RHPA) uses the term “patients” to refer to people receiving care from regulated health professionals. This definition is not as broad as the term “client” used in the Competencies. In these Standards, the College uses the broader term “client” with one exception: it remains consistent with the RHPA by using the term “patient” when referring to sexual abuse legislation.

The term “service” is used throughout these Standards to encompass all aspects of occupational therapy, including assessment, intervention, and consultation. “Service” also includes non-clinical roles or activities completed by occupational therapists in their practice setting (for example, leading education sessions, coordinating services, researching, or teaching).

How the Standards are organized

As one document, the Standards are sorted alphabetically by title. Each Standard contains:

An introduction to the main topic explaining why the Standard is important
Performance indicators or specific behaviours that show how the Standard is to be met
A list of further references, including College, legislative, and regulatory documents

General References

Association of Canadian Occupational Therapy Regulatory Organizations, Association of Canadian Occupational Therapy University Programs, and Canadian Association of Occupational Therapists. (2021). Competencies for occupational therapists in Canada. https://acotro-acore.org/sites/default/files/uploads/ot_competency_document_en_hires.pdf

College of Occupational Therapists of Ontario. (2020). Code of Ethics. https://www.coto.org/resources/code-of-ethics

Occupational Therapy Act, 1991, Statutes of Ontario (1991, c. 33). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/statute/91o33

Ontario Regulation 95/07, Professional Misconduct. (2007). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/regulation/070095

Regulated Health Professions Act, 1991, Statutes of Ontario (1991, c. 18). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/statute/91r18

Standard for Use of Title

Occupational therapists use a protected title that tells the public they are qualified to provide services that meet the profession’s Standards. At times, it may be critical that clients have the assurance that a service provider is accountable to a regulator for ongoing competence and complaints.

Occupational therapists are expected to communicate their title clearly, so that the public can easily identify them as registrants of the College. They are also expected to ensure that those under their supervision communicate their own approved titles properly.

Occupational therapists are expected to:

1. Use their title and name correctly

1.1

Accurately present themselves using the protected title “occupational therapist” or “OT Reg. (Ont.).” The French title is “ergothérapeute” or “Erg. Aut. (Ont.).” Alternatively, use the acceptable psychotherapist title per the Standard for Psychotherapy

1.2

Place the protected title in a position of prominence in all communications.

1.3

Stop using any protected title or designation once they have resigned from the profession (see Appendix 1). Occupational therapists who misuse title can be found to be engaging in professional misconduct (Ontario Regulation 95/07, Professional Misconduct).

1.4

Use other titles or designations only when the occupational therapist is actively practising. For example, the occupational therapist cannot use “Assistive Devices Program Authorizer” when they are no longer a registered authorizer.

1.5

Practise using only their name as entered in the College’s public register (Find an Occupational Therapist). Occupational therapists who wish to use a different name must ensure that their preferred name is recorded with the College and that it appears on the public register.

1.6

When choosing to communicate any educational degrees to clients and the public, display the protected title “occupational therapist” or the designation “OT Reg. (Ont.)” in addition to their degrees. Even if holding a degree in occupational therapy, the individual must register with the College to use any version of the title “occupational therapist.”

1.7

When employment requires the qualification of “occupational therapist” but the designation is not part of the job title (for example, Case Manager or Practice Lead), ensure that proper use of title is maintained. One example is “First Name Last Name, OT Reg. (Ont.), Case Manager.”

2. Ensure that those they supervise use an approved title

2.1

Ensure that occupational therapy students use only the title “student occupational therapist” or “student OT.” The French equivalents are “étudiant(e) en ergothérapie” or “étudiant(e) en erg.”

2.2

Ensure that students who are from another profession and under the occupational therapist’s supervision present their student title clearly to clients, other professionals, partners, and interested parties.

2.3

Ensure that College applicants completing a refresher program under the occupational therapist’s supervision use the title “candidate occupational therapist” or “candidate OT.” For an explanation of the different types of applicants, including those not permitted to use these titles, see Appendix 2.

3. Avoid specialist titles, designations, and abbreviations

3.1

Never use a title or designation that indicates or implies that the occupational therapist is a specialist. The College does not have specialist designations. It is considered professional misconduct to use a term, title, or designation indicating or implying specialization in the profession.

3.2

When communicating an area of practice within the profession of occupational therapy to the public, use a term such as “practising in” or “with a focus in.” One example is “First Name Last Name, OT Reg. (Ont.), Practising in Driver Rehabilitation.”

4. Accurately communicate additional credentials

4.1

Include only credentials that represent a training program that is current, evidence-informed, and theoretically sound.

4.2

Before communicating the credential to the public, ensure that it:

Is valid and accurate
Applies to the scope of occupational therapy practice
Relates to the occupational therapist’s current area of practice
Depicts the level of credential earned
Is verifiable, with evidence to be provided by the occupational therapist upon request

4.3

When communicating with clients and the public, use the protected title “occupational therapist” or the designation “OT Reg. (Ont.)” and the full name of the additional credentials. One example is “First Name Last Name, MSc (OT), OT Reg. (Ont.), Certified Hand Therapist.”

4.4

When communicating with an audience who recognizes the credential, use an abbreviation, if desired. For example, an occupational therapist publishing research in a journal on hand therapy may use the abbreviation “CHT” to represent “Certified Hand Therapist.”

4.5

Maintain competence associated with additional credentials communicated to the public, and upon request, provide evidence of ongoing competence.

5. Use the title “doctor” correctly

5.1

Use the title “doctor” only as permitted by the Regulated Health Professions Act, 1991. The Act permits the use of this title by chiropractors, dentists, naturopaths, optometrists, physicians, and psychologists.

5.2

When holding a doctorate degree such as a PhD or a clinical doctorate of occupational therapy (OTD), use the title “doctor” for only non-clinical purposes. Never use the title “doctor” when providing or offering to provide healthcare services.

Appendix 1: Resignation from the Profession

The College does not have an “inactive” status that permits occupational therapists to maintain a certificate of registration when they are no longer actively registered with the College. Occupational therapists who have resigned from the College cannot use the protected title.

Former registrants may be called upon to share knowledge with service groups, the public, students, and other occupational therapists or professionals through formats such as presentations, articles, and book chapters. Former registrants should clearly communicate that they were educated as an occupational therapist or used to be an occupational therapist, but do not currently provide occupational therapy services.

Appendix 2: College Applicants

Individuals who have applied for registration with the College but are not yet registered are called “applicants.” Applicants are not legally entitled to work as occupational therapists in Ontario. Applicants awaiting confirmation of registration status from the College, for either a provisional, general, or temporary certificate of registration, are not permitted to use the protected title or designation.

Nor can applicants use the title “candidate occupational therapist.” The “candidate” title is reserved for individuals completing a College-approved clinical refresher placement under the supervision of a registered occupational therapist.

Applicants are also not permitted to start work, training, or orientation for a job as an occupational therapist. This may be considered presenting oneself as a registrant before being registered and licenced to practise.

Glossary of Terms

Co-create

Co-create is to “create (something) by working with one or more others” (Merriam-Webster, n.d.).

Context

Context strongly influences occupational possibilities and healthcare services. There are three layers of context:

Micro context refers to the client’s immediate environment: their own state of health and function, family and friends, and the physical environment they move through
Meso context refers to the policies and processes embedded in the health, education, justice, and social service systems that affect the client
Macro context refers to the larger socioeconomic and political context around the client: social and cultural values and beliefs, laws, and public policies

Culturally safer

Culturally safer is a refinement on the concept of cultural safety. Competent occupational therapists do everything they can to provide culturally safe care. But they remain aware that they are in a position of power in relation to clients. They are mindful that many marginalized people—Indigenous people, for example—have a history of serious mistreatment in healthcare settings. These clients may never feel fully safe. Occupational therapists allow those who receive the services to determine what they consider to be safe. They support them in drawing strength from their identity, culture, and community. Because cultural safety is unlikely to be fully achievable, occupational therapists work toward it.

Ecological considerations for care

Occupational therapists consider the wider impact of the tools used to practise in order to support the sustainability of environmental resources. As environmental stewards where possible, occupational therapists recognize the ecosystems on which human health depends and support sustainability as part of a global initiative.

Intersectionality

Intersectionality describes how a person’s multiple social identities (for example, ability, age, class, education, ethnicity, gender, geography, immigration status, income, indigeneity, race, religion, and sexual orientation) combine, overlap, or intersect to create different modes of discrimination and privilege. Intersectionality can help occupational therapists understand the myriad factors affecting a client’s health and the disparities in access to healthcare.

Power imbalance

Occupational therapists are in a position of trust and authority over their clients. As a result, the client-therapist relationship is inherently unequal, which results in a power imbalance in favour of the occupational therapist. The client relies on the occupational therapist’s clinical judgement and experience to address health-related issues, and the occupational therapist knows the client’s personal information and has the ability to influence the client’s access to other resources and services.
This power imbalance places the client in a vulnerable position in the therapeutic relationship. Occupational therapists are expected to be aware of this inherent imbalance, and ensure that professional boundaries are maintained to protect the client’s best interests and keep the client safe.

Vulnerable client

The vulnerability of a client is determined by many factors, including their health status, life stage, social context, ability to access supports and resources, and the overall complexity of their condition and needs. Some indications of client vulnerability in occupational therapy practice may include those people who are at risk of being highly dependent on the occupational therapist or the services they can help them access, and where services may be prolonged or are high risk and intensive.

Resources
Merriam-Webster. (n.d.). Cocreate. In Merriam-Webster.com dictionary. Retrieved November 27, 2022, from https://www.merriam-webster.com/dictionary/cocreate

References

Association of Canadian Occupational Therapy Regulatory Organizations. (2016). Backgrounder on use of title in retirement. http://www.acotro-acore.org/sites/default/files/uploads/otc_backgrounder_on_use_of_title_in_retirement.pdf

Association of Canadian Occupational Therapy Regulatory Organizations. (2017). Frequently asked questions (FAQ) on use of title in retirement. http://www.acotro-acore.org/sites/default/files/uploads/acotro_faq_on_use_of_title_in_retirement_with_logo.pdf