A Code of Ethics and Standards of Practice
for Fieldwork Educators, Supervisors, Professors & Administrators
Introduction
As noted in previous essays, there is a dearth of leadership guidance in the profession of occupational therapy, especially in terms of ethics and standards of practice. In my role as the founder of the occupational therapy department at Western State Hospital, I attempted to remediate this need by creating and mandating a Code of Ethics for fieldwork educators and for supervisors as well.
The Code of Ethics I have developed was inspired by aspects of the AOTA Code of Ethics, a superior document but one that unfortunately narrowly only applies to the professional relationship between therapy professionals and patients. I have developed and expanded this code to include professors, administrators and supervisors. In addition to a code of ethics, I have also created a simple and straightforward standard of practice for leadership as a general guide to create more precise and specific standards by individual organizations.
Standards of practices are subjective, but they provide a starting point to build upon, a set of ideals to aspire to, and a set of categories that can be defined and operationalized for the precision, measurability or other needs set forth by schools, hospitals, nonprofits and other organizations.
Ethical practice and standards for excellence are the foundations for intellectual rigor and quality practice in any profession. Accountability is required from students, supervisees, employees, teachers, fieldwork educators and administrators alike if our profession is to maintain this rigor and continue to build what must be its strongest foundation: experiential learning. Students must be held accountable to the highest standard, but they cannot be made to bear the entire weight of our professions’ growth and development. By creating a set of mutually reinforcing set of codes of ethical and standards of practice, all the pillars of occupational therapy become stronger, and our profession will flourish.
Fieldwork Educator & Student Code of Ethics Compact
1. Purpose and Scope
The purpose of establishing guidelines for standards of practice is to ensure trust, credibility, and fairness. The student who is about to embark on fieldwork is at one of the most pivotal junctions of their process of becoming a therapist. The future quality of our profession directly resides in the quality of guidance received by students both in the classroom, but especially during their experiential learning. We owe it to our profession and to students to demand excellence and rigor from fieldwork educators as well as from students. Fieldwork students as well as supervisees have professional obligations and responsibilities.
In the case of fieldwork students, these expectations for growth, learning, and professional conduct are clearly delineated by AOTA, and each student’s success is measured by them. The AOTA Code of Ethics outlines the obligations that therapists have to their clients and patients, but it does not provide guidance regarding conduct between teachers and students, supervisors and supervisees, or fieldwork educators and students. This document aims to protect students from harm or exploitation, to establish standards of practice applicable to fieldwork educators, and to outline the responsibilities that accompany the role of fieldwork educator. This code exists as an adjunct to and does not supersede local, state, or federal laws, AOTA Occupational Therapy Code of Ethics or other Policy. If this Code of Ethics and Standards of Practice are in conflict with any of the aforementioned governing bodies, defer to those policies.
2. Fieldwork Code of Ethics & Standards of Practice
A) Process for Accepting a Fieldwork Student—The supervising occupational therapist or therapy assistant will accept fieldwork students only after consulting with the Director of Occupational Therapy and The Occupational Therapy Department Fieldwork Coordinator. A collaborative decision will be made about accepting fieldwork students after considering the following factors: work load, fieldwork educator qualifications, prior history as a fieldwork educator, OT Department labor needs, therapist motivations for accepting a student, therapist current and past employee conduct.
Regardless of how qualified a therapist may be to take on the role of fieldwork educator, the needs of the patients are the highest priority, and they are to take precedence over all other considerations. While determining fitness of a therapist to accept a fieldwork student shall be a collaborative process, the Director of Occupational Therapy grants the final approval or denial in every situation.
B) Back-Up Educator—Before accepting a fieldwork student, the Occupational Therapy Fieldwork Coordinator and the potential fieldwork supervisor will create a plan for a back-up fieldwork supervisor to supervise the student in the event that the primary fieldwork supervisor is unable to complete the supervision process for the student for any reason. The back-up fieldwork supervisor will agree to accept this responsibility before the student is formally accepted to this program.
C) Nonmaleficence—the fieldwork supervisor will not engage in any behavior towards the student that is exploitative, coercive, abusive, or contrary to or in violation of the Employee Code of Conduct, the AOTA Code of Ethics, and any applicable local, state, and federal laws. Examples of these unacceptable and illegal behaviors and their definitions may be found in the documents previously noted. The fieldwork educator will treat the student with courtesy, civility, respect and act as a role model whose exemplary behaviors goes above and beyond the minimum standards for professional workplace behavior.
The fieldwork educator will maintain professional boundaries with the student. They will refrain from socializing with the student outside of the workplace setting. The fieldwork educator may not exchange social media contact information with the student until the conclusion of the student’s fieldwork, and only after the student’s performance has been graded and sent to their school, and only by mutual consent of the student. Any exceptions to this policy must be pre-approved by the Director of Occupational Therapy.
D) Fidelity—the fieldwork educator will clearly communicate both the strengths and the areas requiring further development of the student relative to their professional growth as a therapist. Student performance expectations will be clearly communicated at the beginning of the fieldwork, consistently adhered to, and periodically reviewed throughout the duration of the fieldwork. Performance expectations will not change throughout the course of the student’s fieldwork experience. Student performance will be evaluated fairly and objectively. The fieldwork educator will identify and set aside any bias(es) they may have. If these biases interfere with the fieldwork educator’s ability to remain objective and fair in their evaluation of the student’s performance, they will make arrangements to transfer the student to the back-up educator.
E) Beneficence—the fieldwork educator will freely and openly share their skills, knowledge, information, and understanding of best practices in occupational therapy with their student. The fieldwork educator will seek opportunities both pre-planned and spontaneous “teachable moments” to contribute to the professional development of their student. In general, they will make a good faith effort to support the student’s professional development. They will regularly set aside time to answer students’ questions, and do so in a patient and respectful manner. They will acknowledge that there is more than one correct way to fulfill many of the responsibilities of being a therapist.
The fieldwork educator will allow and encourage the student to develop their own style of performing therapy tasks where it is feasible and permissible to do so. The fieldwork educator will give the student opportunities to think critically, exercise clinical reasoning, and problem solve, but the fieldwork educator will also therapeutically intervene where the potential harm to student or patient wellbeing outweighs the benefit of the learning experience.
The fieldwork educator will demonstrate and model therapeutic use of self at all times and towards all people the educator encounters professionally (including but not limited to patients, students, superiors, colleagues, family members of patients, supervisees): i.e. validating others’ concerns, exercising active listening and other skills that demonstrate empathy, demonstrating authentic concern for others’ needs and well-being, adhering to accepted standards of professionalism, and maintaining a positive attitude.
F) Competence—The fieldwork educator will be a registered occupational therapist (OTR) or Certified Occupational Therapy Assistant (COTA) depending on the type of fieldwork student. They will demonstrate the following qualifications in order to be eligible for the role of fieldwork educator: demonstrated clinical skill, judgement, knowledge of assessment, treatment planning, documentation, excellent communication skills, excellent rapport-building skills with patients, therapeutic use of self, time management, self-discipline, professional behaviors, team-oriented and service-oriented attitude, and the ability and willingness to teach a student.
Excellence is often subjective and can be a difficult quality to assess. However, the fieldwork educator should be someone whose skills and communication abilities are highly regarded by colleagues, patients, and supervisors. Experience plays a minor role in the determination of excellence; the traits noted above can be manifest or absent at any stage of a clinician’s career. While clinical skill and technical ability is an important consideration, attitude, communication ability, social skills, and therapeutic use of self are even more important considerations.
G) Dismissal and Appeal Process--When student performance falls below minimum standards for any reason, the student will be immediately notified. The fieldwork educator will determine (in discussion with the student) whether or not it is possible for the student to meet minimum performance expectations before the conclusion of their term, and whether it is feasible and warranted to extend the length of the student’s fieldwork experience. Ideally, potential problems are identified early and when they are minor, so that the student has ample time to correct any deficiencies. Sometimes, this is not possible.
As soon as reasonably possible after a student has been notified that their performance is below minimum expectations AND they are in danger of failing the fieldwork, the student will meet with their fieldwork educator, the Director of Occupational Therapy, the Fieldwork Coordinator, and if possible, the fieldwork coordinator at the student’s university. The purpose of the meeting will be to determine whether or not the student should be immediately dismissed or allowed to continue their fieldwork. The student should be allowed to continue only if it is possible for them to remediate their performance and meet minimum standards by the end of the agreed upon term.
If a student who is not meeting minimum performance expectations is allowed to continue their fieldwork, they must, in collaboration with the fieldwork educator, the fieldwork coordinators, and the Director of Occupational Therapy develop, sign, and agree to adhere to an action plan that clearly outlines each step required to correct each performance deficiency, and a timeline set forth that each deficiency must be corrected by. Thereafter, the student and the fieldwork educator must meet to discuss the student’s progress or lack thereof in correcting their performance deficiencies, at least twice per work week.
If the fieldwork educator believes insufficient progress is being made, and/or new performance concerns arise, the student, the Director of Occupational Therapy, the Fieldwork Coordinator, and the university fieldwork coordinator will be notified in writing of the educator’s intent to dismiss the student. If the student wishes to appeal the decision, they may request a hearing with the fieldwork team to discuss the situation. If the dismissal results from safety or ethics violations, harm or potential harm towards patients, or illegal activity on the part of the student, the student may be informed after the fact of their dismissal.
Occupational Therapy Supervisor, Professor, Administrator Code of Ethics and Standards of Practice
1. Purpose and Scope—Without accountability and standards, there is no incentive to excel, maintain high standards of academic rigor, or consequences for breaches of conduct other than those that are personal and internal. Tenure, unions and other organizations decrease accountability even further by ensuring that supervisory power and status is augmented by layers of protection that greatly diminish the threat of consequences of any wrongdoing that may occur in the classroom. Decreased accountability damages credibility, which in turn corrodes the profession.
Therefore, a code of ethics is required in order to protect not only students but the profession itself from the damage wrought by lack of accountability. By the same token, standards of practice for teaching, supervisory and leadership skills require delineation so that standards of excellence can be aspired to and attained. These Standards are not intended to precisely delineate the leadership skills to meet the needs of every institution they apply to, but rather to provide a means to guide the process of creating and choosing skillsets that are broadly applicable across numerous domains.
2. Therapy Supervisor, Professor Code of Ethics and Standards of Practice
A) Process for Promotion to a Teacher or Supervisory Role—This process should be based on a set of clear and objective standards. If regulatory standards or union contracts stipulate that seniority plays a role in promotion, seniority should be given as little weight as possible, except as it pertains to the demonstration of skills required for the position. If possible, interview panels should consist of more than one person. Interview questions should include leadership case scenarios and equal emphasis should be placed on both the relevance of prior experience as well as the value and efficacy of current, demonstrable leadership ability.
Interview questions and scenarios should be carefully crafted and curated in order to elicit current abilities rather than focus on past achievements. Nepotism, conflicts of interests, and friendships should be guarded against by including members on the interview panel who have never met the interview candidate. In additions to the competence required for the position, the interview candidate should also express an earnest enthusiasm for teaching or leading others. In addition to several interviews, the process for promotion should include a length probationary period in order to observe their performance so that their contract can be amended as needed based on necessity.
B) Back-Up Candidates—In addition to hiring a candidate, the organization should maintain a list of qualified candidates as well as a list of internal candidates, students and current employees who demonstrate maturity and leadership potential.
C) Nonmaleficence—the professor, supervisor or administrator will not engage in any behavior towards the student or student/supervisee that is exploitative, coercive, abusive, or contrary to or in violation of the Employee Code of Conduct, the AOTA Code of Ethics, and any applicable local, state, and federal laws. Examples of these unacceptable and illegal behaviors and their definitions may be found in the documents previously noted. The professor, supervisor or administrator will treat the student/supervisee with courtesy, civility, respect and act as a role model whose exemplary behaviors goes above and beyond the minimum standards for professional workplace behavior.
The professor, supervisor or administrator will maintain professional boundaries with the student/supervisee. They will refrain from socializing with the student/supervisee outside of the workplace setting. The professor, supervisor or administrator may not exchange social media contact information with the student/supervisee until the conclusion of the student’s term or termination of employment, and only after the student’s performance has been graded, and only by mutual consent of the student/supervisee. Any exceptions to this policy must be pre-approved by the Director of Occupational Therapy.
D) Fidelity—the professor, supervisor or administrator will clearly communicate both the strengths and the areas requiring further development of the student/supervisee relative to their professional growth as a therapist. Student/supervisee performance expectations will be clearly communicated, consistently adhered to, and periodically reviewed. Performance expectations, if and when they change, will be communicated verbally and in writing. Student/supervisee performance will be evaluated fairly and objectively. The professor, supervisor or administrator will identify and set aside any bias(es) they may have.
E) Beneficence—the professor, supervisor or administrator will freely and openly share their skills, knowledge, information, and understanding of best practices in occupational therapy with their student/supervisee. The professor, supervisor or administrator will seek opportunities both pre-planned and spontaneous “teachable moments” to contribute to the professional development of their student/supervisee. In general, they will make a good faith effort to support the student’s professional development.
They will regularly set aside time to answer students/supervisees’ questions, and do so in a patient and respectful manner. They will acknowledge that there is more than one correct way to fulfill many of the responsibilities of being a therapist. The professor, supervisor or administrator will allow and encourage the student/supervisee to develop their own style of performing therapy tasks where it is feasible and permissible to do so. The professor, supervisor or administrator will give the student/supervisee opportunities to think critically, exercise clinical reasoning, and problem solve, but the professor, supervisor or administrator will also therapeutically intervene where the potential harm to student or patient wellbeing outweighs the benefit of the learning experience.
The professor, supervisor or administrator will demonstrate and model therapeutic use of self at all times and towards all people the educator encounters professionally (including but not limited to patients, students, superiors, colleagues, family members of patients, supervisees): i.e. validating others’ concerns, exercising active listening and other skills that demonstrate empathy, demonstrating authentic concern for others’ needs and well-being, adhering to accepted standards of professionalism, and maintaining a positive attitude.
F) Competence—The professor, supervisor or administrator will be a registered occupational therapist (OTR) or Certified Occupational Therapy Assistant (COTA). They will demonstrate the following qualifications: demonstrated clinical skill, excellent judgement, knowledge of assessment, treatment planning, documentation, excellent communication skills, excellent rapport-building skills with patients, therapeutic use of self, time management, self-discipline, professional behaviors, team-oriented and service-oriented attitude, and the ability and willingness to teach, lead, supervise and mentor. Excellence is often subjective and can be a difficult quality to assess.
However, the professor, supervisor or administrator should be someone whose skills and communication abilities are highly regarded by colleagues, patients, and supervisors. Experience plays a minor role in the determination of excellence; the traits noted above can be manifest or absent at any stage of a clinician’s career. While clinical skill and technical ability is an important consideration, attitude, communication ability, social skills, and therapeutic use of self are even more important considerations.
G) Dismissal and Appeal Process—If a professor, supervisor or administrator falls below minimum standards, it should be determined whether this is due to misconduct or incompetence. Incompetence may be remediated during a probationary period and careful observation. Misconduct should be evaluated objectively and dealt with based on the severity of the breach of ethics or infraction. All punitive action should be taken based on evidence. Minor cases of misconduct should be met with written warnings. Moderate cases should require censure. Severe cases of misconduct should be met with immediate censure and/or legal action. Protection of students/supervisees and their right to be safe and free of abuse and harassment should be the first priority.
H) Leadership Development—Where possible, leadership development programs and opportunities for career development should be enacted. Lead staff position, placing employees with demonstrated sound judgement on interview panels, awards, continuing education, mentorship and clinical supervision should be offered to support students and supervisees in their professional’s development.