Tennessee Occupational Therapy Ethics and Jurisprudence

Course Description: “Tennessee Occupational Therapy Ethics and Jurisprudence” was designed to help therapy professionals with the ethical dilemmas they face in the workplace. This course is designed to meet the 2 hour Tennessee OT Board requirement for ethics and jurisprudence and promote a better understanding of ethics, morals and legal behavior in the hopes of facilitating a better decision making process for professionals in ethical situations. The information also includes the AOTA Occupational Therapy Code of Ethics and Ethics Standards, the occupational therapy portions of the Tennessee Code Annotated Title 63- Chapter 13: The Occupational and Physical Therapy Practice Act, the rules of the Tennessee Boardof Occupational Therapy Chapter 1150-02: General Rules Governing the Practice of OccupationalTherapy.

Course Author Darrell Smith, MPT, RN

Methods of Instruction: Online course available via internet

Target Audience: Occupational Therapists and Occupational Therapist Assistants

Educational Level: Intermediate

Prerequisites: None

Course Goals and Objectives: At the completion of this course, participants should be able to:

1. Define Ethics2. Define Morality3. Identify the basic similarities and differences between ethics and morals4. Differentiate between common ethical theories5. Define determinants of moral and ethical behavior6. Understand the ethical decision-making process7. Interpret and apply the AOTA’s Occupational Therapy Code of Ethics and Ethics Standards8. Understand and apply the occupational therapy portions of the Tennessee Code Annotated

Title 63- Chapter 13: The Occupational and Physical Therapy Practice Act9. Understand and apply the rules of the Tennessee Board of Occupational Therapy Chapter

1150-02: General Rules Governing the Practice of Occupational Therapy

Criteria for Obtaining Continuing Education Credits: A score of 70% or greater on the written post-test

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DIRECTIONS FOR COMPLETING THE COURSE:

1. Review the goals and objectives for the course. 2. Review the course material. 3. We strongly suggest printing out a hard copy of the test. Mark your

answers as you go along and then transfer them to the actual test. A printable test can be found when clicking on “View/Take Test” in your “My Account”.

4. After reading the course material, when you are ready to take the test, go back to your “My Account” and click on “View/Take Test”.

5. A grade of 70% or higher on the test is considered passing. If you have not scored 70% or higher, this indicates that the material was not fully comprehended. To obtain your completion certificate, please re-read the material and take the test again.

6. After passing the test, you will be required to fill out a short survey. After the survey, your certificate of completion will immediately appear. We suggest that you save a copy of your certificate to your computer and print a hard copy for your records.

7. You have up to one year to complete this course from the date of purchase.

8. If you have a question about the material, please email it to: info@advantageceus.com and we will forward it on to the author. For all other questions, or if we can help in any way, please don’t hesitate to contact us at info@advantageceus.com or 405-974-0164.

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Tennessee Occupational Therapy Ethics and Jurisprudence

Occupational Therapy should be black and white…right? You go to school, learn how to be a great therapist, graduate with the degree and then rush out to help the world. And usually, it works out that way and both patients

and therapists win. But more and more these days, well intentioned occupational therapists are running into situations where the lines between

right and wrong blur….where situations aren’t always black and white….where ethics plays a vital role….

As occupational therapists become more autonomous in their role as

healthcare providers, ethical situations are more likely to arise. This course is designed to educate therapists about ethics, to help them make good

ethical decisions and feel confident about those decisions.

What “IS” Ethics??

To better understand the concepts of occupational therapy ethics, it is good first to have an overview of the discipline of ethics. The word “ethics” is coined from the Greek word ethos which means “character” and from the Latin word mores which means “customs”. Together, they combine and define how individuals make a choice of interacting with one another. In the field of physical therapy, the study of ethics is categorized into normative or philosophical ethics and social scientific or descriptive ethics. Philosophical ethics mainly deals with what people are supposed to do and how they should carry themselves as well as the rationality in making such decisions. Social scientific ethics on the other hand focuses on the study of human ethical behavior with empirical or social scientific tools aiming at exploring the bases of human objectives and the bases of “right” and “wrong” human deeds that enhance or hinder these goals.

The significance of ethics is evidential on several levels. First, when people work in an ethical manner, they feel better about their profession and themselves. Second, ethics builds public trust which increases credibility of professions. Third, ethics promotes business at the organizational level. Businesses that are run ethically perform better than those run in an unethical manner.

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Breaking down the basic definitions….

The Definition of Ethics A set of principles designed to determine right or wrong conduct. A theory or a system of moral values. The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy. The rules or standards governing the conduct of a person or the members of a profession. The Definition of Moral Being concerned with principles of right and wrong or conforming to standards of behavior and character based on those principles. There are several sub-types of morality. Types of Morality Personal: values and duties you adopt as relevant

In its first, descriptive usage, morality means a code of conduct which is held to be authoritative in matters of right and wrong. Morals are created and defined by society, philosophy, religion, or individual conscience. An example of the descriptive usage could be "common conceptions of morality have changed significantly over time."

Societal: common denominator of shared beliefs

In its second, normative and universal sense, morality refers to an ideal code of conduct, one which would be espoused in preference to alternatives by all rational people, under specified conditions. In this "prescriptive" sense of morality as opposed to the above described "descriptive" sort of sense, moral value judgments such as "murder is immoral" are made. To deny 'morality' in this sense is a position known as moral skepticism, in which the existence of objective moral "truths" is rejected.

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Group: shared by the group you belong to such as work, religious, social and professional groups

In its third usage, 'morality' is synonymous with ethics.

When confronted with an ethical distress or dilemma that needs a decision, there are really three levels in which an ethical decision needs to be made.

1. An ethical problem is one in which the practitioner is confronted by challenges or threats to his or her moral duties and values.

2. Ethical distress occurs when practitioners know the course of action they should take, but for whatever reason, they do not take it. They may be blocked from being the kind of person that they want to be and cannot do the things that they really want to do or they feel is right. There may be institutional or financial barriers.

3. An ethical dilemma is when there are two morally correct courses of action, but they cannot both be followed at the same time.

Ethics versus Morals

People often confuse the words “ethics” and “morals” sometimes using them interchangeably. Notably though, the two words are not identical. The term morals refer to practices whereas ethics usually refers to the rationale that support or oppose such practices. In short, morals are concerned with actions and ethics with reasoning behind such actions. Ethics is usually at a higher intellectual level, more universal, and more emotionally involved than morals.

From time immemorial, man has tried to come up with philosophical bases for determining what is wrong or right. With this several ethical theories have been proposed. Some of generally accepted ethical theories are utilitarianism, social contract theory, deontological theory, ethical intuitionism, ethical egoism, natural law theory and virtue ethics.

Utilitarianism is the idea that the moral worth of an action is determined only by what it can contribute to overall utility. Its worth is its contribution to happiness as summed among all people. It is a form of consequentialism, meaning that the moral worth of an action is determined by its outcome. Utilitarianism is sometimes described by the phrase "the greatest good for the greatest number of people". It is commonly known as "the greatest happiness principle".

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Social contract describes a group of theories that explains how people maintain social order. This theory states that some individuals give up their rights to authority in order for society to maintain a higher and more organized social order.

Deontological theory states that all acts are either inherently good or bad, no matter what the end result is. Most deontological theorists believe that we have a duty to do what is inherently good, even if the end result or consequence is bad.

Ethical Intuitionism is described as common sense or conscience. It states that an act or decision is ruled as right or wrong, depending upon the natural intuition of the individual.

Ethical Egoism operates under the idea that each individual must make decisions based on what is in their own best interests.

Natural law theory is a philosophical and legal belief that all humans are governed by basic innate laws, or laws of nature, which are separate and distinct from laws which are legislated. It infers that natural law is akin to common sense or intuition.

Virtue ethics may be identified as the one that emphasizes the virtues, or moral character, in contrast to the other theories that emphasizes duties or rules. This theory points to how the decision could be good, charitable or benevolent.

Determinants of Ethical/Moral Behavior

There are basically four components to moral behavior - moral sensitivity, moral judgment, moral motivation and moral character. For a good ethical decision to be made, all four of these components have to be in place. None is more important than the other. All four of them have to be in place to meet the requirement of an ethical decision. 1. Moral Sensitivity Moral sensitivity is the ability to interpret the situation and project the consequences of your actions. If you do not have moral sensitivity, then you do not act ethically because it does not occur that what you are doing is going to affect anybody else. 2. Moral Judgment Moral judgment is deciding which action is right or wrong because you are able to assess how the different lines of actions that you could take will

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affect other people. 3. Moral Motivation Moral motivation prioritizes moral values over motives such as self gratification, making money, revenge, protecting your reputation or protecting your organization. 4. Moral Character This is the ability to have the perseverance, the toughness, the conviction and the courage to take action to correct something that you know is wrong. This is taking on the duty to report even if you are not required to report. It is truly the essence of professional behavior. This is the standard that we need to achieve. We need to help people understand that it is their responsibility to stop actions that might be negative for the people that they treat and for the community that we serve. 5. Moral Failure Moral failure occurs when any of these components do not happen. In order to take moral action, you have to have all four of them. It is a complex interaction.

Now that we understand all of the terminology and basic theories, we come down to a more important question. There are so many theories and rules…HOW do I go about making the right ethical decision in my every day practice???

The Ethical Decision-Making Process:

When making ethical decisions, we need to remember the 6 Ethical principles, as they could and SHOULD direct our decisions.

(1) Autonomy: patients have the right to make some decisions as well as we do.

(2) Beneficence: providing care in the best interest of the patient

(3) Confidentiality: respecting an individual’s right to privacy

(4) Non malfeasance: “do no harm”

(5) Justice: equity or fair treatment

(6) Veracity: truthfulness

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It is also important that an individual be able to answer the following questions.

(1) Test for Right versus Wrong- is it obvious?

(2) Legal test: Is it legal?

(3) “PU” test: Does it smell or feel wrong-a test of common sense/conscience

(4) Front page test: How would it look on the front page of the newspaper? Would that make you change your decision or how you feel about the situation?

(5) Mom/Dad Test: How would your parents feel if they knew what you were doing?

(6) The professional ethics test: What do the Code of Ethics, Code of Conduct say? Know your practice act and rules and regulations. Be active in your professional organization. Realize that at times, rules and regulations change! Make sure you stay up to date at all times.

Occupational Therapy Code of Ethics and Ethics Standards (2010)

PREAMBLE

The American Occupational Therapy Association (AOTA) Occupational Therapy Code of Ethics and Ethics Standards(2010) (“Code and Ethics Standards”) is a public statement of principles used to promote and maintain high standards of conduct within the profession. Members of AOTA are committed to promoting inclusion, diversity, independence, and safety for all recipients in various stages of life, health, and illness and to empower all beneficiaries of occupational therapy. This commitment extends beyond service recipients to include professional colleagues, students, educators, businesses, and the community. Fundamental to the mission of the occupational therapy profession is the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of participation in roles and situations in home, school, workplace, community, and other settings. “Occupational therapy addresses the physical, cognitive, psychosocial, sensory, and other aspects

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of performance in a variety of contexts to support engagement in everyday life activities that affect health, well being, and quality of life” AOTA, 2004). Occupational therapy personnel have an ethical responsibility primarily to recipients of service and secondarily to society. The Occupational Therapy Code of Ethics and Ethics Standards (2010) was tailored to address the most prevalent ethical concerns of the profession in education, research, and practice. The concerns of stakeholders including the public, consumers, students, colleagues, employers, research participants, researchers, educators, and practitioners were addressed in the creation of this document. A review of issues raised in ethics cases, member questions related to ethics, and content of other professional codes of ethics were utilized to ensure that the revised document is applicable to occupational therapists, occupational therapy assistants, and students in all roles. The historical foundation of this Code and Ethics Standards is based on ethical reasoning surrounding practice and professional issues, as well as on empathic reflection regarding these interactions with others (see e.g., AOTA, 2005, 2006). This reflection resulted in the establishment of principles that guide ethical action, which goes beyond rote following of rules or application of principles. Rather, ethical action is a manifestation of moral character and mindful reflection. It is a commitment to benefit others, to virtuous practice of artistry and science, to genuinely good behaviors, and to noble acts of courage. While much has changed over the course of the profession’s history, more has remained the same. The profession of occupational therapy remains grounded in seven core concepts, as identified in the Core Values and Attitudes of Occupational Therapy Practice (AOTA, 1993): altruism, equality, freedom, justice, dignity, truth, and prudence. Altruism is the individual’s ability to place the needs of others before their own. Equality refers to the desire to promote fairness in interactions with others. The concept of freedom and personal choice is paramount in a profession in which the desires of the client must guide our interventions. Occupational therapy practitioners, educators, and researchers relate in a fair and impartial manner to individuals with whom they interact and respect and adhere to the applicable laws and standards regarding their area of practice, be it direct care, education, or research (justice). Inherent in the practice of 1occupational therapy is the promotion and preservation of the individuality and dignity of the client, by assisting him or her to engage in occupations that are meaningful to him or her regardless of level of disability. In all situations, occupational therapists, occupational therapy assistants, and students must provide accurate information, both in oral and written form

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(truth). Occupational therapy personnel use their clinical and ethical reasoning skills, sound judgment, and reflection to make decisions to direct them in their area(s) of practice (prudence). These seven core values provide a foundation by which occupational therapy personnel guide their interactions with others, be they students, clients, colleagues, research participants, or communities. These values also define the ethical principles to which the profession is committed and which the public can expect. The Occupational Therapy Code of Ethics and Ethics Standards (2010) is a guide to professional conduct when ethical issues arise. Ethical decision making is a process that includes awareness of how the outcome will impact occupational therapy clients in all spheres. Applications of Code and Ethics Standards Principles are considered situation-specific, and where a conflict exists, occupational therapy personnel will pursue responsible efforts for resolution. These Principles apply to occupational therapy personnel engaged in any professional role, including elected and volunteer leadership positions. The specific purposes of the Occupational Therapy Code of Ethics and Ethics Standards (2010) are to: 1. Identify and describe the principles supported by the occupational therapy profession. 2. Educate the general public and members regarding established principles to which occupational therapy personnel are accountable. 3. Socialize occupational therapy personnel to expected standards of conduct. 4. Assist occupational therapy personnel in recognition and resolution of ethical dilemmas.

The Occupational Therapy Code of Ethics and Ethics Standards (2010) define the set of principles that apply to occupational therapy personnel at all levels:

DEFINITIONS

• Recipient of service: Individuals or groups receiving occupational therapy. • Student: A person who is enrolled in an accredited occupational therapy education program. • Research participant: A prospective participant or one who has agreed to participate in an approved research project.

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• Employee: A person who is hired by a business (facility or organization) to provide occupational therapy services. • Colleague: A person who provides services in the same or different business (facility or organization) to which a professional relationship exists or may exist. • Public: The community of people at large.

BENEFICENCE

Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence includes all forms of action intended to benefit other persons. The term beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2009). Forms of beneficence typically include altruism, love, and humanity. Beneficence requires taking action by helping others, in other words, by promoting good, by preventing harm, and by removing harm. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp & Childress, 2009).

Occupational therapy personnel shall

A. Respond to requests for occupational therapy services (e.g., a referral) in a timely manner as determined by law, regulation, or policy. B. Provide appropriate evaluation and a plan of intervention for all recipients of occupational therapy services specific to their needs. C. Reevaluate and reassess recipients of service in a timely manner to determine if goals are being achieved and whether intervention plans should be revised. D. Avoid the inappropriate use of outdated or obsolete tests/assessments or data obtained from such tests in making intervention decisions or recommendations. E. Provide occupational therapy services that are within each practitioner’s level of competence and scope of practice (e.g., qualifications, experience, the law).

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F. Use, to the extent possible, evaluation, planning, intervention techniques, and therapeutic equipment that are evidence-based and within the recognized scope of occupational therapy practice. G. Take responsible steps (e.g., continuing education, research, supervision, training) and use careful judgment to ensure their own competence and weigh potential for client harm when generally recognized standards do not exist in emerging technology or areas of practice. H. Terminate occupational therapy services in collaboration with the service recipient or responsible party when the needs and goals of the recipient have been met or when services no longer produce a measurable change or outcome. I. Refer to other health care specialists solely on the basis of the needs of the client. J. Provide occupational therapy education, continuing education, instruction, and training that are within the instructor’s subject area of expertise and level of competence. K. Provide students and employees with information about the Code and Ethics Standards, opportunities to discuss ethical conflicts, and procedures for reporting unresolved ethical conflicts. L. Ensure that occupational therapy research is conducted in accordance with currently accepted ethical guidelines and standards for the protection of research participants and the dissemination of results. M. Report to appropriate authorities any acts in practice, education, and research that appear unethical or illegal. N. Take responsibility for promoting and practicing occupational therapy on the basis of current knowledge and research and for further developing the profession’s body of knowledge.

NONMALEFICENCE

Principle 2. Occupational therapy personnel shall intentionally refrain from actions that cause harm.

Nonmaleficence imparts an obligation to refrain from harming others (Beauchamp & Childress, 2009). The principle of nonmaleficence is grounded in the practitioner’s responsibility to refrain from causing harm, inflicting

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injury, or wronging others. While beneficence requires action to incur benefit, nonmaleficence requires non-action to avoid harm (Beauchamp & Childress, 2009). Nonmaleficence also includes an obligation to not impose risks of harm even if the potential risk is without malicious or harmful intent. This principle often is examined under the context of due care. If the standard of due care outweighs the benefit of treatment, then refraining from treatment provision would be ethically indicated (Beauchamp & Childress, 2009).

Occupational therapy personnel shall

A. Avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees.

B. Make every effort to ensure continuity of services or options for transition to appropriate services to avoid abandoning the service recipient if the current provider is unavailable due to medical or other absence or loss of employment. C. Avoid relationships that exploit the recipient of services, students, research participants, or employees physically, emotionally, psychologically, financially, socially, or in any other manner that conflicts or interferes with professional judgment and objectivity. D. Avoid engaging in any sexual relationship or activity, whether consensual or nonconsensual, with any recipient of service, including family or significant other, student, research participant, or employee, while a relationship exists as an occupational therapy practitioner, educator, researcher, supervisor, or employer. E. Recognize and take appropriate action to remedy personal problems and limitations that might cause harm to recipients of service, colleagues, students, research participants, or others. F. Avoid any undue influences, such as alcohol or drugs, that may compromise the provision of occupational therapy services, education, or research. G. Avoid situations in which a practitioner, educator, researcher, or employer is unable to maintain clear professional boundaries or objectivity to ensure the safety and well-being of recipients of service, students, research participants, and employees.

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H. Maintain awareness of and adherence to the Code and Ethics Standards when participating in volunteer roles. I. Avoid compromising client rights or well-being based on arbitrary administrative directives by exercising professional judgment and critical analysis. J. Avoid exploiting any relationship established as an occupational therapist or occupational therapy assistant to further one’s own physical, emotional, financial, political, or business interests at the expense of the best interests of recipients of services, students, research participants, employees, or colleagues. K. Avoid participating in bartering for services because of the potential for exploitation and conflict of interest unless there are clearly no contraindications or bartering is a culturally appropriate custom. L. Determine the proportion of risk to benefit for participants in research prior to implementing a study.

AUTONOMY AND CONFIDENTIALITY

Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination.

The principle of autonomy and confidentiality expresses the concept that practitioners have a duty to treat the client according to the client’s desires, within the bounds of accepted standards of care and to protect the client’s confidential information. Often autonomy is referred to as the self-determination principle. However, respect for autonomy goes beyond acknowledging an individual as a mere agent and also acknowledges a “person’s right to hold views, to make choices, and to take actions based on personal values and beliefs” (Beauchamp & Childress, 2009, p. 103). Autonomy has become a prominent principle in health care ethics; the right to make a determination regarding care decisions that directly impact the life of the service recipient should reside with that individual. The principle of autonomy and confidentiality also applies to students in an educational program, to participants in research studies, and to the public who seek information about occupational therapy services.

Occupational therapy personnel shall

A. Establish a collaborative relationship with recipients of service including families, significant others, and caregivers in setting goals and priorities

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throughout the intervention process. This includes full disclosure of the benefits, risks, and potential outcomes of any intervention; the personnel who will be providing the intervention(s); and/or any reasonable alternatives to the proposed intervention. B. Obtain consent before administering any occupational therapy service, including evaluation, and ensure that recipients of service (or their legal representatives) are kept informed of the progress in meeting goals specified in the plan of intervention/care. If the service recipient cannot give consent, the practitioner must be sure that consent has been obtained from the person who is legally responsible for that recipient. C. Respect the recipient of service’s right to refuse occupational therapy services temporarily or permanently without negative consequences. D. Provide students with access to accurate information regarding educational requirements and academic policies and procedures relative to the occupational therapy program/educational institution. E. Obtain informed consent from participants involved in research activities, and ensure that they understand the benefits, risks, and potential outcomes as a result of their participation as research subjects. F. Respect research participant’s right to withdraw from a research study without consequences. G. Ensure that confidentiality and the right to privacy are respected and maintained regarding all information obtained about recipients of service, students, research participants, colleagues, or employees. The only exceptions are when a practitioner or staff member believes that an individual is in serious foreseeable or imminent harm. Laws and regulations may require disclosure to appropriate authorities without consent. H. Maintain the confidentiality of all verbal, written, electronic, augmentative, and nonverbal communications, including compliance with HIPAA regulations. I. Take appropriate steps to facilitate meaningful communication and comprehension in cases in which the recipient of service, student, or research participant has limited ability to communicate (e.g., aphasia or differences in language, literacy, culture).

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J. Make every effort to facilitate open and collaborative dialogue with clients and/or responsible parties to facilitate comprehension of services and their potential risks/benefits.

SOCIAL JUSTICE

Principle 4. Occupational therapy personnel shall provide services in a fair and equitable manner.

Social justice, also called distributive justice, refers to the fair, equitable, and appropriate distribution of resources. The principle of social justice refers broadly to the distribution of all rights and responsibilities in society (Beauchamp & Childress, 2009). In general, the principle of social justice supports the concept of achieving justice in every aspect of society rather than merely the administration of law. The general idea is that individuals and groups should receive fair treatment and an impartial share of the benefits of society. Occupational therapy personnel have a vested interest in addressing unjust inequities that limit opportunities for participation in society (Braveman & Bass-Haugen, 2009). While opinions differ regarding the most ethical approach to addressing distribution of health care resources and reduction of health disparities, the issue of social justice continues to focus on limiting the impact of social inequality on health outcomes. Occupational therapy personnel shall A. Uphold the profession’s altruistic responsibilities to help ensure the common good. B. Take responsibility for educating the public and society about the value of occupational therapy services in promoting health and wellness and reducing the impact of disease and disability. C. Make every effort to promote activities that benefit the health status of the community. D. Advocate for just and fair treatment for all patients, clients, employees, and colleagues, and encourage employers and colleagues to abide by the highest standards of social justice and the ethical standards set forth by the occupational therapy profession. E. Make efforts to advocate for recipients of occupational therapy services to obtain needed services through available means.

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F. Provide services that reflect an understanding of how occupational therapy service delivery can be affected by factors such as economic status, age, ethnicity, race, geography, disability, marital status, sexual orientation, gender, gender identity, religion, culture, and political affiliation. G. Consider offering pro bono (“for the good”) or reduced-fee occupational therapy services for selected individuals when consistent with guidelines of the employer, third-party payer, and/or government agency.

PROCEDURAL JUSTICE

Principle 5. Occupational therapy personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy.

Procedural justice is concerned with making and implementing decisions according to fair processes that ensure “fair treatment” (Maiese, 2004). Rules must be impartially followed and consistently applied to generate an unbiased decision. The principle of procedural justice is based on the concept that procedures and processes are organized in a fair manner and that policies, regulations, and laws are followed. While the law and ethics are not synonymous terms, occupational therapy personnel have an ethical responsibility to uphold current reimbursement regulations and state/territorial laws governing the profession. In addition, occupational therapy personnel are ethically bound to be aware of organizational policies and practice guidelines set forth by regulatory agencies established to protect recipients of service, research participants, and the public.

Occupational therapy personnel shall

A. Be familiar with and apply the Code and Ethics Standards to the work setting, and share them with employers, other employees, colleagues, students, and researchers. B. Be familiar with and seek to understand and abide by institutional rules, and when those rules conflict with ethical practice, take steps to resolve the conflict. C. Be familiar with revisions in those laws and AOTA policies that apply to the profession of occupational therapy and inform employers, employees, colleagues, students, and researchers of those changes.

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D. Be familiar with established policies and procedures for handling concerns about the Code and Ethics Standards, including familiarity with national, state, local, district, and territorial procedures for handling ethics complaints as well as policies and procedures created by AOTA and certification, licensing, and regulatory agencies. E. Hold appropriate national, state, or other requisite credentials for the occupational therapy services they provide. F. Take responsibility for maintaining high standards and continuing competence in practice, education, and research by participating in professional development and educational activities to improve and update knowledge and skills. G. Ensure that all duties assumed by or assigned to other occupational therapy personnel match credentials, qualifications, experience, and scope of practice. H. Provide appropriate supervision to individuals for whom they have supervisory responsibility in accordance with AOTA official documents and local, state, and federal or national laws, rules, regulations, policies, procedures, standards, and guidelines. I. Obtain all necessary approvals prior to initiating research activities. J. Report all gifts and remuneration from individuals, agencies, or companies in accordance with employer policies as well as state and federal guidelines. K. Use funds for intended purposes, and avoid misappropriation of funds. L. Take reasonable steps to ensure that employers are aware of occupational therapy’s ethical obligations as set forth in this Code and Ethics Standards and of the implications of those obligations for occupational therapy practice, education, and research. M. Actively work with employers to prevent discrimination and unfair labor practices, and advocate for employees with disabilities to ensure the provision of reasonable accommodations. N. Actively participate with employers in the formulation of policies and procedures to ensure legal, regulatory, and ethical compliance.

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O. Collect fees legally. Fees shall be fair, reasonable, and commensurate with services delivered. Fee schedules must be available and equitable regardless of actual payer reimbursements/contracts. P. Maintain the ethical principles and standards of the profession when participating in a business arrangement as owner, stockholder, partner, or employee, and refrain from working for or doing business with organizations that engage in illegal or unethical business practices (e.g., fraudulent billing, providing occupational therapy services beyond the scope of occupational therapy practice).

VERACITY

Principle 6. Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession.

Veracity is based on the virtues of truthfulness, candor, and honesty. The principle of veracity in health care refers to comprehensive, accurate, and objective transmission of information and includes fostering the client’s understanding of such information (Beauchamp & Childress, 2009). Veracity is based on respect owed to others. In communicating with others, occupational therapy personnel implicitly promise to speak truthfully and not deceive the listener. By entering into a relationship in care or research, the recipient of service or research participant enters into a contract that includes a right to truthful information (Beauchamp & Childress, 2009). In addition, transmission of information is incomplete without also ensuring that the recipient or participant understands the information provided. Concepts of veracity must be carefully balanced with other potentially competing ethical principles, cultural beliefs, and organizational policies. Veracity ultimately is valued as a means to establish trust and strengthen professional relationships. Therefore, adherence to the Principle also requires thoughtful analysis of how full disclosure of information may impact outcomes.

Occupational therapy personnel shall

A. Represent the credentials, qualifications, education, experience, training, roles, duties, competence, views, contributions, and findings accurately in all forms of communication about recipients of service, students, employees, research participants, and colleagues.

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B. Refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, misleading, or unfair statements or claims. C. Record and report in an accurate and timely manner, and in accordance with applicable regulations, all information related to professional activities. D. Ensure that documentation for reimbursement purposes is done in accordance with applicable laws, guidelines, and regulations. E. Accept responsibility for any action that reduces the public’s trust in occupational therapy. F. Ensure that all marketing and advertising are truthful, accurate, and carefully presented to avoid misleading recipients of service, students, research participants, or the public. G. Describe the type and duration of occupational therapy services accurately in professional contracts, including the duties and responsibilities of all involved parties. H. Be honest, fair, accurate, respectful, and timely in gathering and reporting fact-based information regarding employee job performance and student performance. I. Give credit and recognition when using the work of others in written, oral, or electronic media. J. Not plagiarize the work of others.

FIDELITY

Principle 7. Occupational therapy personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity.

The principle of fidelity comes from the Latin root fidelis meaning loyal. Fidelity refers to being faithful, which includes obligations of loyalty and the keeping of promises and commitments (Veatch & Flack, 1997). In the health professions, fidelity refers to maintaining good-faith relationships between various service providers and recipients. While respecting fidelity requires occupational therapy personnel to meet the client’s reasonable expectations (Purtillo, 2005), Principle 7 specifically addresses fidelity as it relates to maintaining collegial and organizational relationships. Professional

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relationships are greatly influenced by the complexity of the environment in which occupational therapy personnel work. Practitioners, educators, and researchers alike must consistently balance their duties to service recipients, students, research participants, and other professionals as well as to organizations that may influence decision making and professional practice.

Occupational therapy personnel shall

A. Respect the traditions, practices, competencies, and responsibilities of their own and other professions, as well as those of the institutions and agencies that constitute the working environment. B. Preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated by national, state, or local laws or permission to disclose is given by the individual. C. Take adequate measures to discourage, prevent, expose, and correct any breaches of the Code and Ethics Standards and report any breaches of the former to the appropriate authorities. D. Attempt to resolve perceived institutional violations of the Code and Ethics Standards by utilizing internal resources first. E. Avoid conflicts of interest or conflicts of commitment in employment, volunteer roles, or research. F. Avoid using one’s position (employee or volunteer) or knowledge gained from that position in such a manner that gives rise to real or perceived conflict of interest among the person, the employer, other Association members, and/or other organizations. G. Use conflict resolution and/or alternative dispute resolution resources to resolve organizational and interpersonal conflicts. H. Be diligent stewards of human, financial, and material resources of their employers, and refrain from exploiting these resources for personal gain.

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Tennessee Occupational Therapy Jurisprudence Statutes

The Occupational and Physical Therapy Practice Act (Tennessee Code Annotated, Title 63, Chapter 13)

T.C.A, Title 63, Chapter 13, Part 1: General Provisions

Table of Contents 63-13-101. Short title. 63-13-102. Legislative intent. 63-13-103. Chapter definitions. 63-13-109. Unauthorized practice of medicine — Scope of practice.

T.C.A, Title 63, Chapter 13, Part 2: Certification of Occupational Therapists and Assistants

Table of Contents 63-13-201. Legislative purpose. 63-13-202. Applicants for licensure -- Qualifications -- Examinations. 63-13-203. Determining qualifications of applicants -- Granting licenses and permits. 63-13-204. Licenses -- Issuance -- Fees -- Revocation -- Reinstatement -- Renewal. 63-13-205. Limited permits -- Failure of initial examination. 63-13-206. Supervision of an occupational therapy assistant by an occupational therapist. 63-13-207. Delegation of tasks to unlicensed personnel. 63-13-208. Construction of part -- Activities not prohibited 63-13-209. Denial, suspension or revocation of license. 63-13-210. Administrative procedure. 63-13-211. Unlawful practices -- Penalty. 63-13-212. License requirement. 63-13-213. Reciprocity. 63-13-214. Internationally trained applicants. 63-13-215. Retirement -- Inactive status. 63-13-216. Board of occupational therapy.

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The information found in this course has been abridged. To read the rules in their entirety, go to: http://health.state.tn.us/boards/OT/legislative.htm

63-13-101. Short title. This chapter shall be known and may be cited as the "Occupational and Physical Therapy Practice Act."

63-13-102. Legislative intent. This chapter is enacted for the purposes of protecting the public health, safety, and welfare and providing for state administrative control, supervision, licensure and regulation of the practice of physical therapy and occupational therapy. It is the general assembly's intent that only individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of physical therapy and occupational therapy as authorized by this chapter. This chapter is intended to promote the public interest and to accomplish the purposes stated in this section.

63-13-201. Legislative purpose. (a) This part is enacted to: (1) Safeguard the public health, safety and welfare; (2) Protect the public from being misled by incompetent, unscrupulous and unauthorized persons; (3) Assure the highest degree of professional conduct on the part of occupational therapists and occupational therapy assistants; and (4) Assure that the available occupational therapy services are of high quality to persons in need of such services. (b) It is the purpose of this part to provide for the regulation of persons offering occupational therapy services to the public.

63-13-202. Applicants for licensure -- Qualifications -- Examinations. An applicant for licensure as an occupational therapist or as an occupational therapy assistant shall file an application showing, to the satisfaction of the board of occupational therapy, that the applicant:

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(1) Is of good moral character; (2) Has successfully completed the academic requirements of an educational program accredited by ACOTE or its predecessor organization. The accredited program shall be a program for occupational therapists or a program for occupational therapy assistants, depending upon the category of licensure for which the applicant is applying; (3) Has successfully completed the period of supervised fieldwork experience required by ACOTE; and (4) Has made an acceptable score on a written or computerized examination designed to test the applicant's knowledge of the basic and clinical services related to occupational therapy, occupational therapy techniques and methods and other subjects that may help to determine an applicant's fitness to practice. The board of occupational therapy shall approve an examination for occupational therapists and an examination for occupational therapy assistants and shall establish standards for acceptable performance on each examination. The board is authorized to use the entry level national examinations prepared and administered by NBCOT as the examinations used to test applicants for licensure as occupational therapists or occupational therapy assistants and is authorized to use the standards of NBCOT in determining an acceptable score on each examination.

63-13-203. Determining qualifications of applicants -- Granting licenses and permits. (a) In determining the qualifications of an applicant for licensure as an occupational therapist or as an occupational therapy assistant, only a majority vote of the board of occupational therapy shall be required. (b) Licenses and permits issued by the board shall be granted by the board as provided in § 63-13-204.

63-13-204. Licenses -- Issuance -- Fees -- Revocation -- Reinstatement -- Renewal. (a) (1) The board of occupational therapy shall issue a license to any person who meets the requirements of this part upon payment of the appropriate fees. (2) Each licensed occupational therapist or occupational therapy assistant shall pay a biennial renewal fee to the board as prescribed in this part, payable in advance, for the ensuing years. The secretary of the board shall

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notify each licensee. (3) When any licensee fails to register and pay the biennial registration fee within thirty (30) days after registration becomes due as provided in this section, the license of such person shall be administratively revoked at the expiration of the thirty (30) days after the registration was required, without further notice or hearing. Any person whose license is automatically revoked as provided in this section may make application in writing to the board for the reinstatement of such license; and, upon good cause being shown, the board in its discretion may reinstate such license upon payment of all past-due renewal fees. (b) For purposes of implementing § 63-13-108(b) [repealed], the board shall prescribe and publish nonrefundable fees. (c) (1) Notwithstanding any provision of this chapter to the contrary, the division, with the approval of the commissioner, shall establish a system of license renewals at alternative intervals that will allow for the distribution of the license workload as uniformly as is practicable throughout the calendar year. Licenses issued under the alternative method are valid for twenty-four (24) months and shall expire on the last day of the last month of the license period; however, during a transition period, or at any time thereafter when the board shall determine that the volume of work for any given interval is unduly burdensome or costly, either the licenses or renewals, or both of them, may be issued for terms of not less than six (6) months nor more than eighteen (18) months. The fee imposed for any license under the alternative interval method for a period of other than twenty-four (24) months shall be proportionate to the biennial fee and modified in no other manner, except that the proportional fee shall be rounded off to the nearest quarter of a dollar (25cent(s)). (2) No renewal application will be accepted after the last day of the month following the license expiration date under the alternative method authorized in this subsection (c). (d) The board is authorized to establish requirements for assessing continued competence of licensees.

63-13-205. Limited permits -- Failure of initial examination. (a) A limited permit may be issued by the board to an applicant who has applied for a license under § 63-13-202, has successfully completed the educational and field experience requirements of § 63-13-202(2) and (3) and is scheduled to take the examination required by § 63-13-202(4).

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(b) An applicant who has received a limited permit shall take the examination within ninety (90) days of the date the applicant received the limited permit. If the applicant does not take the examination within that ninety-day period, the limited permit expires at the end of the ninety-day period. (c) If an applicant fails the examination, the applicant's limited permit expires upon the board's receipt of notice that the applicant failed the examination. (d) If an applicant passes the examination, the applicant's limited permit remains effective until the board grants or denies a license to the applicant. (e) An applicant may obtain a limited permit only once. (f) A limited permit allows an applicant to engage in occupational therapy practice under the supervision of a licensed occupational therapist. (g) The board shall adopt rules governing the supervision of persons to whom a limited permit has been issued. The rules shall address, at a minimum, initial and periodic inspections, written evaluations, written treatment plans, patient notes and periodic evaluation of performance.

63-13-206. Supervision of an occupational therapy assistant by an occupational therapist. (a) A licensed occupational therapy assistant shall practice under the supervision of an occupational therapist who is licensed in Tennessee. (b) The supervising occupational therapist is responsible for all services provided by the occupational therapy assistant, including, but not limited to, the formulation and implementation of a plan of occupational therapy services for each client, and has a continuing responsibility to follow the progress of each client and to ensure the effective and appropriate supervision of the occupational therapy assistant according to the needs of the client. (c) The supervising occupational therapist shall assign to the occupational therapy assistant only those duties and responsibilities that the occupational therapy assistant is qualified to perform. (d) The board shall adopt rules governing the supervision of occupational therapy assistants by occupational therapists. Those rules may address the

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following: (1) The manner in which the supervising occupational therapist oversees the work of the occupational therapy assistant; (2) The ratio of occupational therapists to occupational therapy assistants required under different conditions and in different practice settings; and (3) The documentation of supervision contacts between the supervising occupational therapist and the occupational therapy assistant. (e) The rules adopted by the board shall recognize that the frequency, methods and content of supervision of occupational therapy assistants by occupational therapists may vary by practice setting and are dependent upon the following factors, among others: (1) Complexity of the client's needs; (2) Number and diversity of clients; (3) Skills of the occupational therapy assistant and the supervising occupational therapist; (4) Type of practice setting; and (5) Requirements of the practice setting.

63-13-209. Denial, suspension or revocation of license. (a) The board of occupational therapy has the power and it is its duty to deny, suspend or revoke the license of or to otherwise lawfully discipline a licensee whenever the licensee is guilty of violating any of the provisions of this part or is guilty of any of the following acts or offenses: (1) Unprofessional, dishonorable or unethical conduct; (2) Violation or attempted violation, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part or any lawful order of the board issued pursuant thereto or any criminal statute of the state of Tennessee; (3) Making false or misleading statements or representations, being guilty of fraud or deceit in obtaining admission to practice or being guilty of fraud or deceit in the licensee's practice;

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(4) Gross health care liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence in the course of professional practice; (5) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, controlled substance analogues or other drugs or stimulants in such a manner as to adversely affect the person's ability to practice; (6) Conviction of a felony, conviction of any offense under state or federal drug laws or conviction of any offense involving moral turpitude; (7) Making or signing in one's professional capacity any certificate that is known to be false at the time one makes or signs such certificate; (8) Engaging in practice when mentally or physically unable to safely do so; (9) Solicitation by agents or persons generally known as "cappers" or "steerers" of professional patronage or profiting by the acts of those representing themselves to be agents of the licensee; (10) Division of fees or agreeing to split or divide fees received for professional services with any person for bringing or referring a patient; (11) Conducting practice so as to permit, directly or indirectly, an unlicensed person to perform services or work that, under the provisions of this part, can be done legally only by persons licensed to practice; (12) Professional connection or association with any person, firm or corporation in any manner in an effort to avoid and circumvent the provisions of this part or lending one's name to another for illegal practice; (13) Payment or acceptance of commissions, in any form or manner, on fees for professional services, references, consultations, pathological reports, prescriptions or on other services or articles supplied to patients; (14) Giving of testimonials, directly or indirectly, concerning the supposed virtue of secret therapeutic agents or proprietary preparations, such as remedies, or other articles or materials that are offered to the public, claiming radical cure or prevention of diseases by their use; (15) Violating the code of ethics adopted by the board;

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(16) Any other unprofessional or unethical conduct that may be specified by the rules duly published and promulgated by the board or the violation of any provision of this part; (17) On behalf of the licensee, the licensee's partner, associate or any other person affiliated with the licensee or the licensee's facility, use or participate in the use of any form of public communication containing a false, fraudulent, misleading or deceptive statement or claim; or (18) Disciplinary action against a person licensed to practice occupational therapy by another state or territory of the United States for any acts or omissions that would constitute grounds for discipline of a person licensed in this state. A certified copy of the initial or final order or other equivalent document memorializing the disciplinary action from the disciplining state or territory shall constitute prima facie evidence of violation of this section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a person licensed in this state. (b) In enforcing this section, the board of occupational therapy shall, upon probable cause, have the authority to compel an applicant or licensee to submit to a mental or physical examination, or both, by a designated board of at least three (3) practicing physicians, including a psychiatrist, where a question of mental condition is involved. The applicant or licensee may have an independent physical or mental examination, which examination report shall be filed with the board for consideration. The physicians' board shall submit a report of its findings to the board for use in any hearing that may thereafter ensue. (c) The board, on its own motion, may cause to be investigated any report indicating that a licensee is or may be in violation of the provisions of this part. Any licensee, any occupational therapist or occupational therapy-related society or association or any other person who in good faith reports to the board any information that a licensee is or may be in violation of any provisions of this part shall not be subject to suit for civil damages as a result thereof.

63-13-211. Unlawful practices -- Penalty. (a) It is unlawful for any person to violate the provisions of this part. It is unlawful for any person who is not licensed under this part as an occupational therapist or an occupational therapy assistant or whose license has been suspended or revoked to use, in connection with the person's name or place of business, the words "occupational therapist," "occupational

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therapist registered," "licensed occupational therapist," "occupational therapy assistant," "certified occupational therapy assistant" or "licensed occupational therapy assistant," the letters "OT," "OTA," "OTR," "OT/L," "OTA/L" or "COTA" or any other words, letters, abbreviations or insignia indicating or implying that the person is an occupational therapist or an occupational therapy assistant or who in any way, orally, in writing, in print or by sign, directly or by implication, claims to be an occupational therapist or an occupational therapy assistant. (b) A violation of this part is a Class B misdemeanor.

3-13-212. License requirement. No person shall practice occupational therapy or act as an occupational therapy assistant, nor claim to be able to practice occupational therapy or act as an occupational therapy assistant, unless the person holds a license and otherwise complies with the provisions of this part and the rules adopted by the board.

63-13-213. Reciprocity. The board of occupational therapy may grant a license to an applicant who presents proof of current licensure or certification as an occupational therapist or occupational therapy assistant in another state, the District of Columbia or a territory of the United States and who possesses educational and experiential qualifications that meet or exceed the requirements for licensure in Tennessee, as determined by the board of occupational therapy.

63-13-216. Board of occupational therapy. (a) There is created a board of occupational therapy, which shall perform the same functions and have the same duties and responsibilities that were performed by the committee of occupational therapy prior to July 1, 2007. (b) The board shall consist of five (5) members appointed by the governor, each of whom shall be a resident of this state. Three (3) members of the board shall be licensed occupational therapists who have had at least five (5) years of experience in the actual practice or teaching of occupational therapy immediately preceding their appointment. One (1) member of the board shall be a licensed occupational therapy assistant who has had at least five (5) years of experience in the actual practice of occupational therapy or teaching of an occupational therapy assistant curriculum immediately preceding the appointment. One (1) member of the board shall be a person who is not engaged in the practice of occupational therapy and who is not

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professionally or commercially associated with the health care industry. (c) The Tennessee Occupational Therapy Association may submit to the governor a list of at least three (3) nominees for each appointment or vacancy to be filled pursuant to this section. The governor may make the appointment from the list. (d) The occupational therapists and the occupational therapy assistant who are serving on the committee of occupational therapy on July 1, 2007, shall continue to serve as members of the board until the expiration of their terms. (e) The board shall organize annually and select a chair and a secretary. Meetings shall be held as frequently as may be required. (f) A quorum of the board shall consist of at least three (3) members. (g) The division shall provide administrative, investigatory and clerical services to the board. (h) Each member of the board shall be reimbursed for actual expenses incurred in the performance of official duties on the board and shall be entitled to a per diem of one hundred dollars ($100) for each day of service in conducting the business of the board. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter. (i) All regular appointments to the board shall be for terms of three (3) years each. Each member shall serve until a successor is appointed. Vacancies shall be filled by appointment of the governor for the remainder of the unexpired term. (j) The governor may, at the request of the board, remove any member of the board for misconduct, incompetence or neglect of duty. (k) In making appointments to the board, the governor shall strive to ensure that at least one (1) member is sixty (60) years of age or older, that at least one (1) member is a racial minority and that the gender balance of the board reflects the gender balance of the state's population. (l) The board shall have the power and duty to: (1) Promulgate, in accordance with the Uniform Administrative Procedures

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Act, compiled in title 4, chapter 5, all rules reasonably necessary for the performance of its duties and the proper administration of this part; (2) Grant, in the board's name, all licenses approved by the board; and (3) Collect and receive all fees, fines and moneys owed pursuant to the provisions of this part and to pay the fees, fines and moneys into the general fund of the state. (m) After July 1, 2007, the board shall assume and fulfill all powers and duties previously assigned to the committee of occupational therapy, and the rules adopted by the committee of occupational therapy shall become the rules of the board without further action by the board.

RULES OF THE TENNESSEE BOARD OF OCCUPATIONAL THERAPY

CHAPTER 1150-02

GENERAL RULES GOVERNING THE PRACTICE OF OCCUPATIONAL THERAPY

1150-02-.02 SCOPE OF PRACTICE.

(1) The license to practice as an Occupational Therapist or an Occupational Therapy Assistant is prescribed and limited by the Tennessee Code Annotated (see especially T.C.A. §63-13-103). The license is conferred by the Board of Occupational Therapy for applicants who have been found to meet established standards.

(2) The Board adopts for licensed occupational therapists and occupational therapy assistants, as if fully set out herein, and as it may from time to time be amended, the current “Occupational Therapy Code of Ethics” issued by the American Occupational Therapy Association and the “Candidate / Certificant Code of Conduct” approved by the National Board for Certification in Occupational Therapy, except to the extent that it conflicts with the laws of the state of Tennessee or the rules of the Board. If either document conflicts with state law or rules, the state law or rules govern the matter. Information to acquire copies may be obtained by contacting the following:

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(a) The American Occupational Therapy Association, Inc.

4720 Montgomery Lane PO Box 31220 Bethesda, MD 20824-1220 Telephone: (301) 652-2682 Fax: (301) 652-7711 TDD: (800) 377-8555 Internet: www.aota.org

The National Board for Certification in Occupational Therapy, Inc.

800 South Frederick Ave. Suite 200 Gaithersburg, MD 20877-4150 Telephone (301) 990-7979 Fax (301) 869-8492 Internet : www.nbcot.org

(b) Board of Occupational Therapy

665 Mainstream Drive Nashville, TN 37243 Telephone: (615) 532-3202 ext. 25135 Telephone: (800) 778-4123 ext. 25135 Fax: (615) 532-5164 Internet: www.tennessee.gov/health

(3) “Occupational therapy practice” means the therapeutic use of everyday life activities (occupations) for the purpose of enabling individuals or groups to participate in roles and situations in home, school, workplace, community and other settings. Occupational therapy addresses the physical, cognitive, psychosocial and sensory aspects of performance in a variety of contexts to support engagement in occupations that affect health, well-being and quality of life. Occupational therapy practice includes, but is not limited to:

(a) The screening, evaluation, assessment, planning, implementation and discharge planning of an occupational therapy program or services in consultation with the client, family members, caregivers and other appropriate persons;

(b) Selection and administration of standardized and non-standardized tests and measurements to evaluate factors affecting activities of daily living, instrumental activities of daily living, education, work, play, leisure and social participation, including:

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1. Body functions and body structures;

2. Habits, routines, roles and behavior patterns;

3. Cultural, physical, environmental, social and spiritual context and activity demands that affect performance; and GENERAL RULES GOVERNING THE

4. Performance skills, including motor, process and communication/interaction skills;

(c) Methods or strategies selected to direct the process of interventions, such as:

1. Modification or adaptation of an activity or the environment to enhance performance;

2. Establishment, remediation or restoration of a skill or ability that has not yet developed or is impaired;

3. Maintenance and enhancement of capabilities without which performance in occupations would decline;

4. Health promotion and wellness to enable or enhance performance and safety of occupations; and

5. Prevention of barriers to performance, including disability prevention;

(d) Interventions and procedures to promote or enhance safety and performance in activities of daily living, instrumental activities of daily living, education, work, play, leisure and social participation, including:

1. Therapeutic use of occupations, exercises and activities;

2. Training in self-care, self-management, home management and community/work reintegration;

3. Development, remediation or compensation of physical, cognitive, neuromuscular and sensory functions and behavioral skills;

4. Therapeutic use of self, including an individual’s personality, insights, perceptions and judgments as part of the therapeutic process;

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5. Education and training of individuals, family members, caregivers and others;

6. Care coordination, case management, discharge planning and transition services;

7. Consulting services to groups, programs, organizations or communities;

8. Assessment, recommendations and training in techniques and equipment to enhance functional mobility, including wheelchair management;

9. Driver rehabilitation and community mobility; and

10. Management of feeding and eating skills to enable feeding and eating performance;

(e) Management of occupational therapy services, including the planning, organizing, staffing, coordinating, directing or controlling of individuals and organizations;

(f) Providing instruction in occupational therapy to students in an accredited occupational therapy or occupational therapy assistant educational program by persons who are trained as occupational therapists or occupational therapy assistants; and

(g) Administration, interpretation and application of research to occupational therapy services.

(4) Occupational therapy services are provided for the purpose of promoting health and wellness to those clients who have, or are at risk of developing, illness, injury, disease, disorder, impairment, disability, activity limitation or participation restriction and may include:

(a) Training in the use of prosthetic devices;

(b) Assessment, design, development, fabrication, adaptation, application, fitting and training in the use of assistive technology and adaptive and selective orthotic devices;

(c) Application of physical agent modalities with proper training and certification;

(d) Assessment and application of ergonomic principles;

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(e) Adaptation or modification of environments (home, work, school or community) and use of a range of therapeutic procedures (such as wound care management, techniques to enhance sensory, perceptual and cognitive processing, and manual therapy techniques) to enhance performance skills, occupational performance or the promotion of health and wellness.

(5) Occupational therapy practice may occur in a variety of settings, including, but not limited to:

(a) Institutional inpatient settings, such as acute rehabilitation facilities, psychiatric hospitals, community and specialty hospitals, nursing facilities and prisons;

(b) Outpatient settings, such as clinics, medical offices and therapist offices;

(c) Home and community settings, such as homes, group homes, assisted living facilities, schools, early intervention centers, daycare centers, industrial and business facilities, hospices, sheltered workshops, wellness and fitness centers and community mental health facilities;

(d) Research facilities; and

(e) Educational institutions.

(6) Occupational therapy practice includes specialized services provided by occupational therapists or occupational therapy assistants who are certified or trained in areas of specialization, which include, but are not limited to, hand therapy, neurodevelopmental treatment, sensory integration, pediatrics, geriatrics and neurorehabilitation, through programs approved by AOTA or other nationally recognized organizations.

(7) Universal Precautions for the Prevention of HIV Transmission - The Board adopts, as if fully set out herein, rules 1200-14-03-.01 through 1200-14-03-.03 inclusive, of the Department of Health and as they may from time to time be amended, as its rule governing the process for implementing universal precautions for the prevention of HIV transmission for health care workers under its jurisdiction. 1150-02-.05 PROCEDURES FOR LICENSURE.

To become licensed as an occupational therapist or occupational therapy assistant in Tennessee, a person must comply with the following procedures and requirements.

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(1) Occupational Therapist and Occupational Therapy Assistant by Examination (a) An application packet shall be requested from the Board’s administrative office. (b) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and these rules to the Board’s administrative office. It is the intent of these rules that all steps necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously. (c) Applications will be accepted throughout the year and completed files will ordinarily be processed at the next Board meeting scheduled for the purpose of reviewing files. (d) An applicant shall pay the nonrefundable application fee and state regulatory fee as provided in rule 1150-02-.06 when submitting the application. (e) An applicant shall submit with his application a “passport” style photograph taken within the preceding 12 months. (f) It is the applicant’s responsibility to request that a graduate transcript from his degree granting institution, pursuant to T.C.A. §63-13-202, be submitted directly from the school to the Board’s administrative office. The institution granting the degree must be accredited by the AOTA at the time the degree was granted. The transcript must show that the degree has been conferred and carry the official seal of the institution and reference the name under which the applicant has applied for certification. (g) An applicant shall submit an original letter of recommendation attesting to the applicant’s good moral character. The letter cannot be from a relative. (h) Examination Verification 1. It is the responsibility of the applicant to request a copy of his certification examination results from the National Board for Certification in Occupational Therapy Examination be sent directly to the Board’s administrative office. 2. For examinations taken prior to January, 1985, the applicant shall request the

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National Board for Certification in Occupational Therapy send a verification of certification examination results to the Board of Occupational Therapy. For an examination taken in January, 1985, or later, the applicant shall request that Professional Exam Service send verification of certification examination results to the Board of Occupational Therapy. (i) Physical agent modality certification. If an applicant is seeking certification in the use of physical agent modalities, as provided in paragraph (4) of Rule 1150-02-.04, the applicant shall present to the Board’s administrative office proof of successful completion of didactic and clinical work that has been completed within the two (2) years prior to submission of the application for certification. (j) An applicant shall disclose the circumstances surrounding any of the following: 1. Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violations. 2. The denial of licensure application by any other state or the discipline of a license in any state. 3. Loss or restriction of licensure. 4. Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitations, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory, common or case law. (k) The applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check. (l) When necessary, all required documents shall be translated into English. Both translation and original document, certified as to authenticity by the issuing source must be submitted. (m) Personal resumes are not acceptable and will not be reviewed. (n) Application review and licensure decisions shall be governed by Rule 1150-02-07.

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(o) The burden is on the applicant to prove by a preponderance of the evidence that his course work and supervised field work experience are equivalent to the board’s requirements. (p) The initial licensure fee must be received in the Board’s administrative office on or before the thirtieth (30th) day from receipt of notification that the fee is due. Failure to comply will result in the application file being closed. (q) A license will be issued after all requirements, including payment of an initial licensure fee pursuant to Rule 1150-02-.06, have been met. (2) Occupational Therapist and Occupational Therapy Assistant by Reciprocity (a) An application packet shall be requested from the Board’s administrative office. (b) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and these rules to the Board’s administrative office. It is the intent of this rule that all steps necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously. (c) An applicant shall submit with his application a “passport” style photograph taken within the preceding twelve (12) months. (d) An applicant shall pay the non-refundable application fee, and state regulatory fee as provided in rule 1150-02-.06 when submitting the application. (e) Applications will be accepted throughout the year and completed files will ordinarily be processed at the next board meeting scheduled for the purpose of reviewing files. (f) It is the applicant’s responsibility to request that a graduate transcript from his degree granting institution, pursuant to T.C.A. §63-13-202, be submitted directly from the school to the board’s administrative office. The institution granting the degree must be accredited by the AOTA at the time the degree was granted. The transcript must show that the degree has been conferred and carry the official seal of the institution and reference the name under which the applicant has applied for licensure.

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(g) It is the applicant’s responsibility to request verification of licensure status be submitted directly to the Board’s administrative office from all states in which the applicant is or has ever been licensed. (h) Examination Verification 1. It is the responsibility of the applicant to request a copy of his certification examination results from the National Board for Certification in Occupational Therapy Examination be sent directly to the Board’s administrative office. 2. For examinations taken prior to January, 1985, the applicant shall request the National Board for Certification in Occupational Therapy send a verification of certification examination results to the Board of Occupational Therapy. 3. For examinations taken in January, 1985, or later, the applicant shall request that Professional Exam Service, send a verification of certification examination results to the Board of Occupational Therapy. (i) Physical agent modality certification If an applicant is seeking certification in the use of physical agent modalities, as provided in paragraph (3) of rule 1150-02-.04, the applicant shall cause to have proof of successful training completion be submitted directly from the training provider to the Board’s administrative office. (j) An applicant shall disclose the circumstances surrounding any of the following: 1. Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violations. 2. The denial of licensure application by any other state or the discipline of a license in any state. 3. Loss or restriction of licensure. 4. Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitations, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory, common or case law.

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(k) The applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check. (l) When necessary, all required documents shall be translated into English. Both translation and the original document, certified as to authenticity by the issuing source, must be submitted. (m) Personal resumes are not acceptable and will not be reviewed. (n) Application review and licensure decisions shall be governed by Rule 1150-02-.07. (o) The burden is on the applicant to prove by a preponderance of the evidence that his course work, and experiential qualifications are equivalent to the board’s requirements. (p) The initial licensure fee must be received in the Board’s administrative office on or before the thirtieth (30th) day from receipt of notification that the fee is due. Failure to comply will result in the application file being closed. (q) A license will be issued after all requirements, including payment of an initial licensure fee pursuant to Rule 1150-02-.06, have been met. 1150-02-.10 SUPERVISION.

The Board adopts, as if fully set out herein, and as it may from time to time be amended, the current “Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services” issued by the American Occupational Therapy Association but only to the extent that it agrees with the laws of the state of Tennessee or the rules of the Board. If there are conflicts with state law or rules, the state law or rules govern the matter. Information to acquire a copy may be obtained by contacting either of the following:

American Occupational Therapy Association

4720 Montgomery Lane Bethesda, MD 20824-1220 Telephone: (301) 652-2682 T.D.D.: (800) 377-8555 Fax: (301) 652-7711 Fax On Request: (800) 701-7735 (for a specific document)

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Internet: www.aota.org

Board of Occupational Therapy

665 Mainstream Drive Nashville, TN 37243 Telephone: (615) 532-3202 ext. 25135 Telephone: (888) 310-4650 ext. 25135 Fax: (615) 532-5164 Internet: www.state.tn.us/health

(1) Supervision of an Occupational Therapist on a limited permit must include initial and routine inspection of written evaluations, written treatment plans, patient/client notes and routine evaluation of performance. The supervision must be conducted in person, by a licensed occupational therapist and must be as follows:

(a) Routine supervision with direct contact every 2 weeks at the site of treatment, with interim supervision occurring by other methods such as the telephone, conferences, written communication, and E-mail.

(b) Supervision must include observation of the individual treatment under a limited permit in order to assure service competency in carrying out evaluation, treatment planning and treatment implementation.

(c) The frequency of the face to face collaboration between the person treating under a limited permit and the supervising therapist should exceed direct contact every 2 weeks if the condition of the patient/client, complexity of treatment, evaluation procedures, and proficiencies of the person practicing under the limited permit warrants it.

(d) Therapists must maintain documentation of each supervisory visit, and must identify a plan for continued supervision. Records must include, at a minimum, the following information:

1. Location of visit; a method of identifying clients discussed

2. Current plan for supervision (daily, weekly, bi-monthly)

3. Identification of type(s) of interventions observed. These include but are not limited to:

(i) Interventions

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(ii) Training

(iii) Consultations

4. Other supervisory actions. These include but are not limited to:

(i) Discussion/recommendation for interventions and/or goals

(ii) Discussion/training in documentation

(iii) Demonstration/training in intervention techniques

(iv) Assessment/re-assessment/discharge

(v) Additional Comments

5. An agreement statement signed and dated by both parties, that the supervisory visit did occur and met the needs of the supervisor and supervisee.

6. It is the responsibility of the supervising occupational therapist to provide and the limited permit holder to seek a quality and frequency of supervision that ensures safe and effective occupational therapy service delivery. Both parties (supervisor and supervisee) must keep copies of the supervisory records. Visit records must be maintained for three (3) years, and must be provided to the Board and/or its representative, upon request.

(e) A co-signature by supervising Occupational Therapist is required on evaluations, treatment plans, and discharge summaries.

(2) Supervision of an Occupational Therapy Assistant on a limited permit means initial direction and routine inspection of the service delivery and provision of relevant in-service training. The supervising occupational therapist must provide additional supervision, if the patient’s required level of care is beyond the level of skill of an entry level Occupational Therapy Assistant on a limited permit. This decision is based on client’s level of care, OTA caseload, experience and demonstrated performance competency. Supervision of an Occupational Therapy Assistant on a limited permit must include initial and routine inspection of patient notes and routine evaluation of performance. The supervision must be conducted in person by a licensed occupational therapist and must be as follows:

(a) The Occupational Therapist shall be responsible for the evaluation of the patient and development of the patient/client treatment plan. The

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Occupational Therapy Assistant on a limited permit may contribute information from observations and standardized test procedures to the evaluation and the treatment plans.

(b) The Occupational Therapy Assistant can implement and coordinate intervention plan under supervision of a licensed Occupational Therapist.

(c) The Occupational Therapy Assistant can provide direct services that follow a documented routine and accepted procedure under the supervision of the licensed Occupational Therapist.

(d) The Occupational Therapy Assistant can adapt activities, media, environment according to needs of patient/client under supervision of the licensed Occupational Therapist.

(e) Documentation provided by the Occupational Therapy Assistant while on a limited permit must be co-signed by a licensed Occupational Therapist.

(f) Therapists must maintain documentation of each supervisory visit, and must identify a plan for continued supervision. Records must include, at a minimum, the following information:

1. Location of visit; a method of identifying clients discussed

2. Current plan for supervision (daily, weekly, bi-monthly)

3. Identification of type(s) of interventions observed. These include but are not limited to:

(i) Interventions

(ii) Training

(iii) Consultations

4. Other supervisory actions. These include but are not limited to:

(i) Discussion/recommendation for interventions and/or goals

(ii) Discussion/training in documentation

(iii) Demonstration/training in intervention techniques

(iv) Assessment/re-assessment/discharge

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(v) Additional Comments

5. An agreement statement signed and dated by both parties, that the supervisory visit did occur and met the needs of the supervisor and supervisee.

6. It is the responsibility of the supervising occupational therapist to provide and the limited permit holder to seek a quality and frequency of supervision that ensures safe and effective occupational therapy service delivery. Both parties (supervisor and supervisee) must keep copies of the supervisory records. Visit records must be maintained for three (3) years, and must be provided to the Board and/or its representative, upon request.

(3) Supervision of an Occupational Therapy Assistant with permanent licensure means initial direction and inspection of the service delivery and provision of relevant in-service training, according to the level of supervision the occupational therapy assistant requires. It is the responsibility of the occupational therapist and the occupational therapy assistant to seek the appropriate quality and frequency of supervision that ensures safe and effective occupational therapy service delivery. This decision is based on client’s level of care, OTA caseload, experience and demonstrated performance competency.

(a) The frequency of the face to face collaboration between the Occupational Therapy Assistant and the supervising Occupational Therapist should exceed direct contact of once a month if the condition of the patient/client, complexity of treatment, evaluation procedures, and proficiencies of the person practicing warrants it.

(b) The Occupational Therapist shall be responsible for the evaluation of the patient and the development of the patient/client treatment plan. The Occupational Therapy Assistant may contribute information from observations and standardized test procedures to the evaluation and the treatment plans.

(c) The Occupational Therapy Assistant can implement and coordinate intervention plan under the supervision of the licensed Occupational Therapist.

(d) The Occupational Therapy Assistant can provide direct services that follow a documented routine and accepted procedure under the supervision of the Occupational Therapist.

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(e) The Occupational Therapy Assistant can adapt activities, media, environment according to the needs to the patient/client, under the supervision of the licensed Occupational Therapist.

(f) Therapists must maintain documentation of each supervisory visit, and must identify a plan for continued supervision. Records must include, at a minimum, the following information:

1. Location of visit; a method of identifying clients discussed

2. Current plan for supervision (daily, weekly, bi-monthly, monthly, other)

3. Type of supervision provided. These include but are not limited to

(i) in person

(ii) phone contact

(iii) electronic contact

4. Identification of type(s) of interventions observed. These include but are not limited to:

(i) Interventions

(ii) Training

(iii) Consultations

5. Other supervisory actions. These include but are not limited to:

(i) Discussion/recommendation for interventions and/or goals

(ii) Discussion/training in documentation

(iii) Demonstration/training in intervention techniques

(iv) Assessment/re-assessment/discharge

(v) Additional Comments

6. An agreement statement signed and dated by both parties, that the supervisory visit did occur and met the needs of the supervisor and supervisee.

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7. It is the responsibility of the supervising occupational therapist to provide and the occupational therapy assistant to seek a quality and frequency of supervision that ensures safe and effective occupational therapy service delivery. Both parties (supervisor and supervisee) must keep copies of the supervisory records. Visit records must be maintained for three (3) years, and must be provided to the Board and/or its representative, upon request.

(4) Supervision of occupational therapy students and occupational therapy assistant students.

(a) Supervision of occupational therapy students and occupational therapy assistant students shall be consistent with the standards of the Accreditation Council for Occupational Therapy Education (ACOTE) for such supervision.

(5) Supervision of an unlicensed person shall be as follows:

(a) There shall be close supervision with daily, direct contact at site of treatment, which demands the physical presence of a licensed physician, Occupational Therapist or Occupational Therapy Assistant, whenever the unlicensed person assists in the practice of Occupational Therapy.

(b) There shall be personal instruction, observation and evaluation by the licensed physician, Occupational Therapist or Occupational Therapy Assistant.

(c) There shall be specific delineation of tasks and responsibilities by the licensed physician, Occupational Therapist or Occupational Therapy Assistant who is responsible for reviewing and interpreting the results of care. The licensed physician, Occupational Therapist or Occupational Therapy Assistant must ensure that the unlicensed person does not perform duties for which he is not trained.

1. A licensed physician, Occupational Therapist or Occupational Therapy Assistant may delegate to unlicensed persons specific routine tasks associated with nontreatment aspects of occupational therapy services which are neither evaluative, assessive, task selective, or recommending in nature, nor which require decision-making or making occupational therapy entries in official patient records, if the following conditions are met:

(i) The licensed physician, Occupational Therapist or Occupational Therapy Assistant accepts professional responsibility for the performance of that duty by the personnel to whom it is delegated. In the case of duties delegated by a OTA, the licensed physician, Occupational Therapist or Occupational Therapy Assistant who supervises the technician will be

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responsible; and (ii) The unlicensed personnel do not perform any duties which require licensure under this act; and (iii) The licensed physician, Occupational Therapist or Occupational Therapy Assistant ensures that the unlicensed personnel have been appropriately trained for the performance of the tasks.

2. Tasks which may be delegated may include:

(i) Transporting of patients;

(ii) Preparing or setting up a work area or equipment;

(iii) Routine department maintenance or housekeeping activities;

(iv) Taking care of patients’ personal needs during treatments; and

(v) Clerical, secretarial or administrative duties.

(d) Appropriate records must be maintained to document compliance.

(e) The intensity of the supervision is determined by the nature of the task to be performed, the needs of the consumer, and the capability of the unlicensed person.

(6) Supervision parameters

(a) Supervision is a collaborative process that requires both the licensed occupational therapist and the licensed occupational therapy assistant to share responsibility. Appropriate supervision will include consideration given to factors such as level of skill, the establishment of service competency (the ability to use the identified intervention in a safe and effective manner), experience and work setting demands, as well as the complexity and stability of the client population to be treated. (b) Supervision is an interactive process that requires both the licensed occupational therapist and the licensed occupational therapy assistant or other supervisee to share responsibility for communication between the supervisor and the supervisee. The licensed occupational therapist should provide the supervision and the supervisee should seek it. An outcome of appropriate supervision is to enhance and promote quality services and the professional development of the individuals involved.

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(c) Supervision of occupational therapy services provided by a licensed occupational therapy assistant is recommended as follows: 1. Entry level occupational therapy assistants are persons working on initial skill development (less than 1 year of work experience) or who are entering new practice environments or developing new skills (one or more years. of experience) and should require close supervision. 2. Intermediate level occupational therapy assistants are persons working on increased skill development, mastery of basic role functions (minimum one - three years of experience or dependent on practice environment or previous experience) and should require routine supervision. 3. Advanced level occupational therapy assistants are persons refining specialized skills (more than 3 years work experience, or the ability to understand complex issues affecting role functions) and should require general supervision. 4. Licensed occupational therapy assistants, regardless of their years of experience, may require closer supervision by the licensed occupational therapist for interventions that are more complex or evaluative in nature and for areas in which service competencies have not been established. 5. Certain occupational therapy assistants may only require minimal supervision when performing non-clinical administrative responsibilities. 1150-02-.12 CONTINUED COMPETENCE. On January 1, 2006 the Board shall begin to notify applicants for licensure renewal of the continued competence requirements as provided in T.C.A. § 63-13-204 (d). The Board shall require each licensed occupational therapist and occupational therapist assistant to participate in a minimum number of activities to promote continued competence for the two (2) calendar years (January 1-December 31) that precede the licensure renewal year (a.k.a. biennium). Beginning January 1, 2008 all applicants for licensure, renewal of licensure, reactivation of licensure, or reinstatement of licensure must attest to having completed continued competence requirements for the two (2) calendar years (January 1-December 31) that precede the licensure renewal, reactivation or reinstatement year. (1) The requirements for continued competence activities are defined as planned learning experiences that occur for occupational therapists and

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occupational therapist assistants. Content of the experiences must relate to a licensee’s current or anticipated roles and responsibilities in occupational therapy. Qualified learning experiences may include theoretical or practical content related to the practice of occupational therapy; research; management; or the development, administration, supervision, and teaching of clinical practice or service delivery programs in occupational therapy. The purpose of this requirement is to assist in assuring safe and effective practices in the provision of occupational therapy services to the citizens of Tennessee. (2) For applicants approved for initial licensure by examination, successfully completing the requirements of Rules 1150-02-.04, .05, and .08, as applicable, shall be considered proof of sufficient competence to constitute compliance with this rule for the initial period of licensure. The use of physical agent modalities by any licensee requires additional certification pursuant to Rule 1150-02-.04. (3) Occupational Therapists and Occupational Therapy Assistants are required to complete twenty-four (24) continued competence credits for the two (2) calendar years (January 1 - December 31) that precede the licensure renewal year. (a) A maximum of four (4) continued competence credits achieved during the two (2) calendar year period that are in excess of the twenty-four (24) credit requirement may be used to partially complete the requirement for the subsequent two (2) calendar year period. (b) The subjects of any continued competence credits used to partially complete the requirement for the subsequent two (2) calendar year period shall not pertain to: 1. the AOTA Code of Ethics; or 2. the occupational therapy portions of T.C.A. §§ 63-13-101, et seq., the Tennessee Occupational and Physical Therapy Practice Act; or 3. Chapter 1150-02, General Rules Governing the Practice of Occupational Therapy. (4) Twelve (12) of the required twenty-four (24) continued competence credits must be directly related to the delivery of occupational therapy services.

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(5) One (1) hour of the required twenty-four (24) continued competence credits shall pertain to the AOTA Code of Ethics or other ethics related continued competence activities which have implications for the practice of occupational therapy. (6) One (1) hour of the required twenty-four (24) continued competence credits shall pertain to the occupational therapy portions of T.C.A. §§ 63-13-101, et seq., the Tennessee Occupational and Physical Therapy Practice Act, and shall pertain to Chapter 1150-02, General Rules Governing the Practice of Occupational Therapy. (7) Ten (10) hours of the required twenty-four (24) continued competence credits may pertain to the licensee’s current or anticipated professional role or may be directly related to the delivery of occupational therapy services. (8) Continued competence credits are awarded pursuant to the Activity Table in paragraph (11). (9) Approved Continued Competence Activity Providers (a) American Medical Association (AMA) (b) American Nurses Association (ANA) (c) American Occupational Therapy Association (AOTA) and AOTA approved providers (d) American Physical Therapy Association (APTA) (e) American Speech-Language-Hearing Association (ASHA) (f) International Association of Continuing Education (IACET) (g) Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) (h) Tennessee Occupational Therapy Association (TOTA) (i) State occupational therapy associations (j) State occupational therapy regulatory agencies (k) Accredited colleges and universities

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(10) The Board does not pre-approve continued competence activities. It is the responsibility of the licensed occupational therapist and occupational therapist assistant to use his/her professional judgment in determining whether or not the activities are applicable and appropriate to his/her professional development and meet the standards specified in these rules. 1150-02-.20 CONSUMER RIGHT-TO-KNOW REQUIREMENTS. (1) Malpractice reporting requirements. The threshold amount below which medical malpractice judgments, awards or settlements in which payments are awarded to complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-Know Act of 1998” shall be ten thousand dollars ($10,000). (2) Criminal conviction reporting requirements. For purposes of the “Health Care Consumer Right-To-Know Act of 1998”, the following criminal convictions must be reported: (a) Conviction of any felony. (b) Conviction or adjudication of guilt of any misdemeanor, regardless of its classification, in which any element of the misdemeanor involves any one or more of the following: 1. Sex. 2. Alcohol or drugs. 3. Physical injury or threat of injury to any person. 4. Abuse or neglect of any minor, spouse or the elderly. 5. Fraud or theft. (c) If any misdemeanor conviction reported under this rule is ordered expunged, a copy of the order of expungement signed by the judge must be submitted to the Department before the conviction will be expunged from any profile.

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Conclusion

In today's healthcare settings it is imperative that we as clinicians, provide the highest level of care, both ethically and professionally. Not because we have to, but because we should and our patients both deserve and expect it from us. Continually furthering our knowledge base, not only clinically, but ethically and through a better understanding of our state laws and rules, is paramount in achieving the highest level of care for our patients. Stating that you are an occupational therapist is only part of the equation. Understanding and applying all facets of the profession is the true key to success.

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References

Barnitt, R. (1998). Ethical dilemmas in Occupational Therapy and Physical Therapy: A Survey of Practitioners in the UK National Health Service. Journal of Medical Ethics. 3(24): 193

Boylan, M. (2000). Basic Ethics. Englewood Cliffs, NJ: Prentice-Hall Delany CM. (2008). Making a difference: incorporating theories of autonomy

into models of informed consent. Journal of Medical Ethics 34(9):3 Driver J. (2007). Ethics, the fundamentals. Oxford, UK: Blackwell Publishing

Ltd Duncan P. (2010). Values, Ethics & Health Care. London: SAGE Publications

Ltd Gabard, Donald L. (2003). Physical Therapy Ethics. University, Orange

County: F.A. Davis Company. Kirsch, N., Iglarsh, A. (2006). Ethical Decision Making to Avoid Disciplinary

Action. Federation Forum Magazine. 22:1

Marietta C. McGuire AL. (2009) Currents in contemporary ethics. Journal of Law, Medicine & Ethics. 37(2):369-74

Purtilo, R. B. (2005) New respect for respect in ethics education: In Educating for Moral Action. A Sourcebook in Health and Rehabilitation Ethics. F.A. Davis Company. Venglar, M., Theall, M. (2007). Case-Based Ethics Education in Physical Therapy. The Journal of Scholarship of Teaching and Learning. 7:1 Thiroux, J.P. (1995). Ethics: Theory and Practice. 5th ed. Englewood http://www.aota.org//media/Corporate/Files/Practice/Ethics/Docs/Standards/Code%20and%20Ethics%20Standards%202010.ashx http://health.state.tn.us/boards/PT/legislative.htm

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