Occupational therapists working in schools may be delivering service under different models of care depending on factors such as employer, location, and funding source.
The College often receives questions from occupational therapists working under various delivery models. We have answered some frequently asked questions for occupational therapists working in schools.
Consent obtained by a third-party
Question: Can I go into a school to do an occupational therapy assessment with a student if the case manager at the Home and Community Care Support Services (HCCSS) has obtained informed consent on my behalf? Do I need to call the parent/guardian myself to obtain informed consent?
Answer: The College expects that occupational therapists will obtain informed consent for all services, including assessment, treatment, and consultation.
If an occupational therapist believes a third party obtained consent for their services using an informed consent process, the occupational therapist can rely on that consent; however, the third party must be a regulated health professional. Section 13 of the Health Care Consent Act, 1996 (HCCA) states that one health practitioner can obtain informed consent for treatment on behalf of another health practitioner involved in the plan of treatment.
A case manager at the HCCSS could obtain informed consent for an occupational therapy assessment if they are a regulated health professional and apply an informed consent process as outlined in the HCCA.
An occupational therapist must ensure that consent for occupational therapy service obtained by a third party was acquired using an informed consent process as outlined in the College's Standard for Consent, 2023 (coto.org). If the occupational therapist is uncertain, they should call the parent/guardian themselves and obtain informed consent prior to conducting an occupational therapy assessment with the student.
Consent in a tiered service delivery model
Some occupational therapists work in schools that have adopted a tiered service model. An example of a tiered service model is Partnering for Change (P4C) where an occupational therapist may provide service at 3 different tier levels:
- In tier 1, services are provided universally to support the educator and all children in a classroom.
- In tier 2, targeted services are provided for children who require more support to address short term, targeted needs, and can help determine if there is a need for more individualized service.
- In tier 3, interventions are provided for children requiring more individualized, intensive, and/or longer-term intervention due to the complexity of their needs.
Question: Do I need to obtain consent for each student if I am providing consultation to the teacher in the tier 1 universal service?
Answer: Although the teacher is the direct recipient of the occupational therapy service in this situation, the students in the classroom are also impacted by your presence as the occupational therapist. Therefore, it is important to be clear and transparent with the parents/guardians about the role of the occupational therapist in the classroom. There can be different ways to achieve this. One method some occupational therapists utilize is a written letter that is sent home with the student. The aim is to be clear as possible about your service so that parents/guardians are not surprised by your presence in the classroom, and that they understand some of the areas you will focus on with all the students to promote their success.
In your communication with parents/guardians, consider including information such as:
- introducing yourself as an occupational therapist
- ·occupational therapists are regulated health professionals in Ontario
- the role of the occupational therapist
- the types of activities and interventions that you will be providing to support all children in the classroom
- any risks and benefits to the proposed service
- parents/guardians will be contacted by the occupational therapist or the educator if there are specific concerns regarding their child
- the name and information for the contact person if the parent/guardian has questions or concerns about the occupational therapy role or their child.
Occupational therapists are encouraged to work with their teams at the school or seek legal consultation to establish processes to support the parents/guardians’ understanding of what to expect and how to best address questions or concerns.
Question: If consent was already obtained to provide occupational therapy service at tier 1, is additional consent required from a parent/guardian to provide targeted service at tier 2?
Answer: Yes, consent is an ongoing process that should be re-evaluated throughout the course of service delivery, and this includes moving from one tier of service to another. The occupational therapist must use their clinical judgement to determine what their role is in each tier and what is the level of risk involved with the proposed service in each tier.
There may be risks (for example, physical and psychoemotional risks such as stigma, labelling, emotional impact), to consider when proposing services. In tier 2, targeted intervention typically occurs when the occupational therapist provides screening, assessment, or interventions that go beyond providing general universal strategies to the educator or for the entire classroom in tier 1. As such, the occupational therapist should follow up with the parent/guardian to obtain the appropriate consent.
Consent to share information
Question: I attend multidisciplinary school team meetings where children whom I have not obtained consent from are being discussed. Do I need parent/guardian consent to participate in this discussion?
Answer: This depends on the role of the occupational therapist at the meeting. An occupational therapist who will be contributing to a discussion about a child they are working with will be required to have obtained consent from the parent/guardian to collect, use and disclose information about the child.
An occupational therapist who is only participating in generic discussions that are not related to consultation about a specific child, is not required to obtain consent. However, if team members start to share specific information about a child whom they feel might benefit from occupational therapy service, the occupational therapist will need to obtain consent from the parent/guardian to collaborate with educators regarding the child’s needs. The occupational therapist will need to use their judgement to determine when the discussion moves from generic to specific.
Regardless of the nature of the discussion, maintaining confidentiality is a competency for all occupational therapists. It may be helpful to clarify your role as the occupational therapist in team meetings and reiterate your professional obligation to keep all information you hear private.
Summary
When making decisions about occupational therapy service, it may be helpful to take on the perspective of the parent/guardian and consider what they would want to know about their child at school. A parent/guardian would likely want to be aware about any discussions of their child involving an occupational therapist and not be surprised about any occupational therapy activities their child is engaging in.
Clear and transparent communication at the start and throughout service delivery can help parents/guardians know what to expect. The College relies on the occupational therapist’s clinical judgment to ensure that the principles of culture, equity and justice are considered when obtaining the necessary consents. Occupational therapists must be able to provide a reasonable rationale when a Standard is not met, including when contextual factors require a deviation from the expectations.