Standard for the Prevention and Management of Conflicts of Interest
Occupational therapists are required to be proactive in preventing, recognizing, and managing conflicts of interest in their practice. They must not exploit the client-therapist relationship for any form of direct or indirect benefit. They must ensure that clients’ interests and well-being are always prioritized. Practising occupational therapy while in a conflict of interest is an act of professional misconduct (paragraphs 1.1 and 1.18 of the Professional Misconduct regulation).
Occupational therapists are expected to:
1. Understand what conflicts of interest are
1.1
Understand the types of conflicts of interest, their relevance to the occupational therapist’s practice, and the situations that may lead to them. Conflicts of interest can be:
- Perceived (for example, referring clients internally for other services)
- Potential (for example, a close family member interviewing for a position at an organization to which the occupational therapist refers clients)
- Actual (for example, receiving or making payment for referrals)
1.2
Recognize that client consent is not an acceptable reason to practise while in a conflict of interest.
1.3
If uncertain whether a conflict of interest exists, seek advice from knowledgeable individuals such as managers, peers, the College, or legal counsel.
2. Monitor and manage conflicts of interest
2.1
Provide fair and equitable services (for example, avoid preferential scheduling for referral sources that pay more).
2.2
Never take advantage of their position as an occupational therapist, and always maintain relationships of trust and confidence with clients.
2.3
Remain aware of and address any conflicts of interests that arise during the client-therapist relationship.
2.4
Understand when conflicts of interest are based on strongly held values, beliefs, or biases, or on cultural, human rights, or social grounds, and address these sensitively and carefully.
2.5
Avoid dual or multiple relationships with clients, such as additional financial, personal, or professional roles with clients while also providing occupational therapy services.
2.6
Take appropriate steps to resolve conflicts of interest in the client’s best interests. This could include ending the therapeutic relationship.
2.7
If avoiding a conflict of interest is not possible, manage it by taking these steps:
- Discuss the conflict of interest with the client, other professionals, partners, and interested parties before providing services.
- Advise the client of their right to decline services at any time and, if possible, suggest alternatives.
- Document in the client record the steps taken to address the conflict.
3. Avoid giving or receiving gifts or benefits
3.1
Know that the inappropriate exchange of gifts, money, services, or hospitality can exploit client relationships and is considered a boundary violation.
3.2
Exchange gifts with clients only if these have little to no monetary value, the offer is not recurring, and refusal could harm the client-therapist relationship.
3.3
Recommend only products or services that are appropriately indicated, and that do not involve any personal gain, relationship, or financial interest for the occupational therapist or someone close to them. This applies unless the occupational therapist can manage the conflict of interest by taking these steps:
- Disclose the nature of the benefit or relationship to clients in advance
- Discuss other options for products or services, and allow clients to choose
- Assure clients that services will not be adversely affected should they select an alternative supplier or product
- Document the discussion in the client record
3.4
Never give or receive any incentive or benefit in return for client referrals.
3.5
Avoid self-referrals or soliciting clients (for example, referring clients from an employer’s practice to the occupational therapist’s private practice). This applies unless alternative options are not available or are not in clients’ best interests (for example, clients are at risk of not receiving the services). In these cases, take these steps:
- Disclose the self-referral to the occupational therapist’s employer, clients, and others involved in the referral or services
- Give clients the option of seeking alternative services
- Document the full disclosure in the client record
4. Manage relationships with interested parties
4.1
Ensure that professional interactions with other professionals, partners, and interested parties (for example, vendors or lawyers) are in clients’ best interests. Recognize that the occupational therapist’s primary obligation is to their clients. Relationships with other professionals, partners, and interested parties must never affect the integrity of, trust in, and confidence in the client-therapist relationship.
4.2
Provide clients with options when recommending other services, professionals, and equipment.
5. Follow protocols for client participation in research or quality projects
It is important for occupational therapists to help build their profession’s body of knowledge and to contribute to research and initiatives that will innovate practice. This may involve formal or informal research studies, client and non-client participants, or quality activities in the workplace. Occupational therapists must recognize any conflicts of interest that may arise from these initiatives and manage them appropriately.
5.1
Before involving clients in research activities, get approval from a Research and Ethics Board (following the Tri-Council Policy) to ensure that the proposed study is ethically defensible, socially responsible, and scientifically valid. This must include disclosing any conflicts of interest if the occupational therapist is acting as a researcher while also providing clients with services.
5.2
Obtain informed consent from clients before and throughout participation.
5.3
Ensure that clients are not pressured, unduly influenced, or coerced to participate, and that there is no adverse impact on them should they decline.
5.4
Disclose to clients any financial or other benefit that they or the occupational therapist will receive for participating.
5.5
Ensure that clients are fully informed about the purpose, methods, and risks, including intended use of any results.
5.6
Communicate the results to clients where possible, or provide them with information about where the results can be found.
