Notes on Framework for Professional Practice

1. First (I) BOT. 105 Introduction to Occupational Therapy and Therapeutic Activities. Section A:
Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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Course Syllabus: Kerala University of Health Sciences (KUHS) BOT Programme 2020
Course Code: 022
Year: First (I) BOT
Subject: 105: Introduction to Occupational Therapy and Therapeutic Activities
Section A: Introduction to Occupational Therapy
Lecture: Module IX: Framework for Professional Practice
Contents
1. Core Values and Attitudes of Occupational Therapy Practice
2. Occupational Therapy Code of Ethics (AOTA and AIOTA)
3. The Therapeutic Relationship
References
1. Willard and Spackman's Occupational Therapy by Elizabeth Blesedell Crepeau, Ellen S.
Cohn and Barbara A Boyt Schell. 11th
Edition 2009 and 13th
Edition 2019. [Unit VIII: Core
Concepts and Skills]
2. Occupational Therapy Practice Framework (OTPF): Domain & Process. 4th
Edition.
American Occupational Therapy Association’s Official Guideline Document. The American
Journal of Occupational Therapy. August 2020, Volume 74 (Supplement 2). 7412410010p1
to 7412410010p87
3. American Occupational Therapists’ Association Code of Ethics 2020. Available at:
https://research.aota.org/ajot/article/74/Supplement_3/7413410005p1/6691/AOTA-2020-
Occupational-Therapy-Code-of-Ethics (Accessed on August 15, 2022)
4. All India Occupational Therapists’ Association Code of Ethics 2013 in Constitution.
Available at: https://aiota.org/temp/managepdf/THE_CONSTITUTION.pdf (Accessed on
August 15, 2022)
1. Core Values and Attitudes of Occupational Therapy Practice
Core Values: are the values that provide purpose and guide a professional and/or
organization’s decisions and future direction.
The occupational therapy profession is grounded in seven longstanding core values: Altruism,
Equality, Freedom, Justice, Dignity, Truth, and Prudence. The seven core values provide a
foundation to guide occupational therapy personnel in their interactions with others. These

2. First (I) BOT. 105 Introduction to Occupational Therapy and Therapeutic Activities. Section A:
Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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core values should be considered when determining the most ethical course of action.
(Adapted from Core Values and Attitudes of Occupational Therapy Practice; AOTA, 1993)
The most commonly used ethical approaches in healthcare are 1. principle-based approaches,
2. virtue- and character-based ethics, 3. utilitarianism and 4. deontology.
1. Principle-based approaches
Principles are duties, rights, or other moral guidelines that provide a logical approach to
analysing ethical issues for a given situation. In case analysis, principles are identified,
applied, and compared to weigh one principle against another in deciding a course of action.
The following principles are commonly used in health care: beneficence, nonmaleficence,
autonomy, justice, veracity and fidelity.
2. Virtue- and character-based ethics
Virtues are dispositions of character and conduct that motivate and enable practitioners to
provide good care.
3. Utilitarianism
Utilitarianism is concerned with actions that maximize good consequences and minimize bad
consequences. From this perspective, morally right acts produce the best overall results; that
is, the ends justify the means. The ethical action is one whose outcome brings about the most
good or the least harm overall. Utilitarianism is often used in public policy development.
4. Deontology
Deontology is a duty-based moral theory in which moral rules are universal and never to be
broken; consequently, doing one’s duty is considered primary, regardless of the
consequences. A practitioner would never keep the truth from a client even if the truth would
harm the client in some way. Respect for people is a moral imperative; therefore, withholding
the truth disrespects the client’s right to know.

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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2. Occupational Therapy Code of Ethics
I. American Occupational Therapists’ Association (AOTA) Code of Ethics 2020
The code serves two purposes:
1. It provides aspirational core values that guide occupational therapy personnel toward
ethical courses of action in professional and volunteer roles.
2. It delineates ethical principles and enforceable standards of conduct that apply to AOTA
members.
AOTA Core Values
The occupational therapy profession is grounded in seven longstanding Core Values:
Altruism, Equality, Freedom, Justice, Dignity, Truth, and Prudence (AOTA, 1993).
1. Altruism (Selflessness) indicates demonstration of unselfish concern for the welfare of
others. Occupational therapy personnel reflect this concept in actions and attitudes of
commitment, caring, dedication, responsiveness, and understanding.
2. Equality indicates that all persons have fundamental human rights and the right to the
same opportunities. Occupational therapy personnel demonstrate this value by maintaining an
attitude of fairness and impartiality and treating all persons in a way that is free of bias.
Personnel should recognize their own biases and respect all persons, keeping in mind that
others may have values, beliefs, or lifestyles that differ from their own. Equality applies to
the professional arena as well as to recipients of occupational therapy services.
3. Freedom indicates valuing each person’s right to exercise autonomy and demonstrate
independence, initiative, and self-direction. A person’s occupations play a major role in their
development of self-direction, initiative, interdependence, and ability to adapt and relate to
the world. Occupational therapy personnel affirm the autonomy of each individual to pursue
goals that have personal and social meaning. Occupational therapy personnel value the
service recipient’s right and desire to guide interventions.
4. Justice indicates that occupational therapy personnel provide occupational therapy
services for all persons in need of these services and maintain a goal directed and objective

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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relationship with recipients of service. Justice places value on upholding moral and legal
principles and on having knowledge of and respect for the legal rights of recipients of service.
Occupational therapy personnel must understand and abide by local, state, and federal laws
governing professional practice. Justice is the pursuit of a state in which diverse communities
are inclusive and are organized and structured so that all members can function, flourish, and
live a satisfactory life regardless of age, gender identity, sexual orientation, race, religion,
origin, socioeconomic status, degree of ability, or any other status or attributes. Occupational
therapy personnel, by virtue of the specific nature of the practice of occupational therapy,
have a vested interest in social justice: addressing unjust inequities that limit opportunities for
participation in society. They also exhibit attitudes and actions consistent with occupational
justice: full inclusion in everyday meaningful occupations for persons, groups, or
populations.
5. Dignity (Self-Respect and Self-Esteem) indicates the importance of valuing, promoting,
and preserving the inherent worth and uniqueness of each person. This value includes
respecting the person’s social and cultural heritage and life experiences. Exhibiting attitudes
and actions of dignity requires occupational therapy personnel to act in ways consistent with
cultural sensitivity, humility, and agility.
6. Truth indicates that occupational therapy personnel in all situations should be faithful to
facts and reality. Truthfulness, or veracity, is demonstrated by being accountable, honest,
forthright, accurate, and authentic in attitudes and actions. Occupational therapy personnel
have an obligation to be truthful with themselves, recipients of service, colleagues, and
society. Truth includes maintaining and upgrading professional competence and being
truthful in oral, written, and electronic communications.
7. Prudence (Far-sightedness, Carefulness) indicates the ability to govern and discipline
oneself through the use of reason. To be prudent is to value judiciousness, discretion,
vigilance, moderation, care, and circumspection in the management of one’s own affairs and
to temper extremes, make judgments, and respond on the basis of intelligent reflection and
rational thought. Prudence must be exercised in clinical and ethical reasoning, interactions
with colleagues, and volunteer roles.

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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AOTA Ethical Principles
Principle 1. Beneficence (Generosity, Charity)
Beneficence: refers to actions done on or for the benefit of others.
Occupational therapy personnel shall demonstrate a concern for the well-being and safety of
persons. The Principle of Beneficence includes all forms of action intended to benefit other
persons. The term beneficence has historically indicated acts of mercy, kindness, and charity.
Beneficence requires taking action to benefit others—in other words, to promote good, to
prevent harm, and to remove 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, offering services that benefit persons with disabilities, and
acting to protect and remove persons from dangerous situations.
Principle 2. Nonmaleficence (“First, Do No Harm”)
Nonmaleficence: is the duty not to harm others
Occupational therapy personnel shall refrain from actions that cause harm. The Principle of
Nonmaleficence indicates that occupational therapy personnel must refrain from causing
harm, injury, or wrongdoing to recipients of service. Whereas Beneficence requires taking
action to incur benefit, Nonmaleficence requires avoiding actions that cause harm. The
Principle of Nonmaleficence also includes an obligation not to impose risks of harm even if
the potential risk is without malicious or harmful intent. This Principle is often examined in
the context of due care, which requires that the benefits of care outweigh and justify the risks
undertaken to achieve the goals of care. For example, an occupational therapy intervention
might require the service recipient to invest a great deal of time and perhaps even discomfort;
however, the time and discomfort are justified by potential long-term, evidence-based
benefits of the treatment.
Principle 3. Autonomy (Self-government, Self-rule, Independence)
Autonomy: is the ability to act freely and independently on one’s own decisions. It is often
called the principle of self-determination.
Occupational therapy personnel shall respect the right of the person to self-determination,
privacy, confidentiality, and consent. The Principle of Autonomy expresses the concept that
occupational therapy personnel have a duty to treat the client or service recipient according to
their desires, within the bounds of accepted standards of care, and to protect their confidential

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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information. Often, respect for Autonomy is referred to as the self-determination principle.
Respecting the Autonomy of service recipients acknowledges their agency, including their
right to their own views and opinions and their right to make choices in regard to their own
care and based on their own values and beliefs (Beauchamp & Childress, 2019). For example,
persons have the right to make a determination regarding care decisions that directly affect
their lives. In the event that a person lacks decision-making capacity, their Autonomy should
be respected through the involvement of an authorized agent or surrogate decision maker.
Principle 4. Justice (Fairness, Righteousness, Impartiality)
Justice: refers to equal treatment. It deals with the proper distribution of benefits, burdens,
and resources. Procedural justice is often used to reflect impartial decision-making
procedures. Distributive justice refers to the equitable allocation of societal resources such as
health care.
Occupational therapy personnel shall promote equity, inclusion, and objectivity in the
provision of occupational therapy services. The Principle of Justice relates to the fair,
equitable, and appropriate treatment of persons (Beauchamp & Childress, 2019).
Occupational therapy personnel demonstrate attitudes and actions of respect, inclusion, and
impartiality toward persons, groups, and populations with whom they interact, regardless of
age, gender identity, sexual orientation, race, religion, origin, socioeconomic status, degree of
ability, or any other status or attributes. Occupational therapy personnel also respect the
applicable laws and standards related to their area of practice. Justice requires the impartial
consideration and consistent observance of policies to generate unbiased decisions. For
example, occupational therapy personnel work to create and uphold a society in which all
persons have equitable opportunity for full inclusion in meaningful occupational engagement
as an essential component of their lives.
Principle 5. Veracity (Authenticity, Truth, Accuracy, Reliability)
Veracity: refers to telling the truth.
Occupational therapy personnel shall provide comprehensive, accurate, and objective
information when representing the profession. The Principle of Veracity refers to
comprehensive, accurate, and objective transmission of information and includes fostering
understanding of such information. Veracity is based on the virtues of truthfulness, candor,
honesty, and respect owed to others. In communicating with others, occupational therapy

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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personnel implicitly promise to be truthful and not deceptive. For example, when entering
into a therapeutic or research relationship, the service recipient or research participant has a
right to accurate information. In addition, transmission of information must include means to
ensure that the recipient or participant understands the information provided.
Principle 6. Fidelity (Loyalty, Faithfulness, Trustworthiness)
Fidelity: means being faithful to one’s promises or commitments.
Occupational therapy personnel shall treat clients (persons, groups, or populations),
colleagues, and other professionals with respect, fairness, discretion, and integrity. The
Principle of Fidelity refers to the duty one has to keep a commitment once it is made. This
commitment refers to promises made between a provider and a client, as well as maintenance
of respectful collegial and organizational relationships. Professional relationships are greatly
influenced by the complexity of the environment in which occupational therapy personnel
work. For example, occupational therapy personnel should 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.
All India Occupational Therapists’ Association (AIOTA) Code of Ethics 2013
Bye-Law - XIV: Code of Ethics (Article X Section II)
Members of the AIOTA shall work on the basis of first contact/referral and shall observe
following code of ethics. AIOTA: The Constitution and Bye-Laws (2013)
i. Responsibility to the Patient
a. In accepting his / her charge of responsibility for the physical and mental well-being of the
patient, the occupational therapists should at all-time strive to give treatment of the highest
level of professional skill.
b. The occupational therapists must respect information of a confidential nature regarding the
patient and should discuss only pertaining facts with other professional persons involved in
the treatment program.

8. First (I) BOT. 105 Introduction to Occupational Therapy and Therapeutic Activities. Section A:
Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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ii. Responsibility to Professional Colleague
The occupational therapist must show concern for loyalty to those practicing the same or
other professional skills, recognizing that only by achieving and fostering mutual respect and
understanding can the greatest service be rendered to the patient.
iii. Responsibility to the Employer
The occupational therapist should be responsible to his / her employing institution and should
assist in interpretation of its functions within the community. He / She must accept his/her
proper share of responsibility to the organization and administration to the department to
which he / she is appointed.
iv. Responsibility to the Profession of Occupational Therapy
c. The occupational therapist must recognize his / her responsibilities in contribution to the
growth and development of his / her profession through the exchange of information, raising
of treatment and educational standards and improving conditions or employment by
supporting his / her professional organizations at the local, national and international levels.
v. Responsibility to the Community
The occupational therapist should promote information and understanding, relative to the
function and procedures of occupational therapy. He / She should at all times recognize the
fact that, in the eyes of the public, the attitude and philosophy he / she presents, portrays the
profession.
3. The Therapeutic Relationship
What is Therapeutic Relationship? Why is Therapeutic Relationship Important in
Occupational Therapy?
Occupational therapy personnel develop therapeutic relationships to promote occupational
well-being in all persons, groups, organizations, and society, regardless of age, gender
identity, sexual orientation, race, religion, origin, socioeconomic status, degree of ability, or
any other status or attributes.

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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In occupational therapy, therapeutic relationships are not just a by-product of working with
human beings. Rather, the therapeutic relationship is the central aspect of the therapeutic
process of occupational therapy and one catalyst for change.
The relationship aspect of the therapy process has often been called “the art of practice.” The
process of establishing a relationship with another person is a creative and interdependent act
and requires that two people come to understand, trust, and respect one another and create
shared meanings about what the therapy process means for the person’s life and future.
The interactive qualities that enable two people to build a therapeutic relationship are not
instinctive or automatic but require mutual willingness, vigilance, attention, and
responsiveness. The interactive aspects of the therapeutic relationship require interpersonal
and communicative skills that an occupational therapist can learn and develop through
reflective practice.
Achieving outcomes that are both achievable and desirable can be a complex and difficult
process, so clients need therapists who are both professionally and empathically competent.
The degree to which therapists are willing and able to enter the life worlds of clients and
listen deeply to and experience their hopes and fears will determine the degree of
collaboration clients and therapists can undertake to develop meaningful interventions.
Standards of Conduct of Therapeutic Relationship
A. Respect and honour the expressed wishes of recipients of service.
(Principle: Autonomy; key words: relationships, clients, service recipients)
B. Do not inflict harm or injury to recipients of occupational therapy services, students,
research participants, or employees.
(Principle: Nonmaleficence; key words: relationships, clients, service recipients, students,
research, employer, employee)
C. Do not threaten, manipulate, coerce, or deceive clients to promote compliance with
occupational therapy recommendations.
(Principle: Autonomy; key words: relationships, clients, service recipients)
D. Do not engage in sexual activity with a recipient of service, including the client’s family
or significant other, while a professional relationship exists.
(Principle: Nonmaleficence; key words: relationships, clients, service recipients, sex)

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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E. Do not accept gifts that would unduly influence the therapeutic relationship or have the
potential to blur professional boundaries, and adhere to employer policies when offered gifts.
(Principle: Justice; key words: relationships, gifts, employer)
F. Establish a collaborative relationship with recipients of service and relevant stakeholders
to promote shared decision making.
(Principle: Autonomy; key words: relationships, clients, service recipients, collaboration)
G. Do not abandon the service recipient, and attempt to facilitate appropriate transitions when
unable to provide services for any reason.
(Principle: Nonmaleficence; key words: relationships, client, service recipients,
abandonment)
H. Adhere to organizational policies when requesting an exemption from service to an
individual or group because of self-identified conflict with personal, cultural, or religious
values.
(Principle: Fidelity; key words: relationships, client, service recipients, conflict, cultural,
religious, values)
I. Do not engage in dual relationships or situations in which an occupational therapy
professional or student is unable to maintain clear professional boundaries or objectivity.
(Principle: Nonmaleficence; key words: relationships, clients, service recipients, colleagues,
professional boundaries, objectivity, social media)
J. Proactively address workplace conflict that affects or can potentially affect professional
relationships and the provision of services.
(Principle: Fidelity; key words: relationships, conflict, clients, service recipients, colleagues)
K. Do not engage in any undue influences that may impair practice or compromise the ability
to safely and competently provide occupational therapy services, education, or research.
(Principle: Nonmaleficence; key words: relationships, colleagues, impair, safety, competence,
client, service recipients, education, research)
L. Recognize and take appropriate action to remedy occupational therapy personnel’s
personal problems and limitations that might cause harm to recipients of service.
(Principle: Nonmaleficence; key words: relationships, clients, service recipients, personal,
safety)
M. Do not engage in actions or inactions that jeopardize the safety or well-being of others or
team effectiveness.

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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(Principle: Fidelity; key words: relationships, clients, service recipients, colleagues, safety,
law, unethical, impaired, competence)
How the Phases of Therapeutic Relationship Development Intersects with the Stages of
Therapeutic Process
The therapeutic process is intertwined with and propelled by the therapeutic relationship.
S.
No.
Phases of Therapeutic
Relationship Development
Strategies Stages of Therapeutic
Process
Strategies
1. Developing rapport 1. Honour the
client’s dignity.
2. Demonstrate
willingness to
experience the
client’s grief,
despair, and hope.
3. Meet the client’s
desired level of
intimacy.
Being there and
understanding the client
1. Be with
socially.
2. Ask about
habits, roles,
interests,
priorities,
and resources.
3. Generate past
and present
narrative images
of the client.
4. Observe the
client’s responses,
abilities, and
adaptive style.
2. Establishing trust 1. Create trust by
spending time,
giving information,
and ensuring client
choice.
2. Convey best
practice options
within an
understanding of the
Engaging the client in
therapy process
1. Get the client
to self-appraise
through doing,
using a functional
measurement
scale, videotapes,
and other clients
to increase
awareness.

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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client’s priorities. 2. Offer
meaningful
options and
explore
possibilities.
3. Explain the
purpose of
therapy activities.
3. Developing a collaborative
partnership
1. In the role of
covenanter, share the
difficult path to
knowledge and
competence.
Working together 1. The therapist
and client take on
active and
equal roles and
effort.
2. The therapist
brings
professional
expertise; the
client brings
expertise about
his or her own
life.
3. Support the
client to set goals
and make
decisions
about therapy
activities.
4. Convey trust in
the client’s
abilities.
5. Uncover and
activate the

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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client’s resources
and problem
solving.
6. Have the client
perform to
explore
limitations
and solutions.
4. Sustaining a therapeutic
relationship/partnership
1. As trust and
confidence deepen,
therapeutic roles,
strategies, and
activities change.
2. The client
fluctuates between
need for affiliation
and need for
autonomy.
Enabling occupational
performance
1. Pool resources
and persevere in
creating
solutions.
2. Point out
disabilities and
accomplishments.
3. Adjust
therapeutic
strategies.
4. Teach problem
solving and
convey
confidence
through taking
risks; create
opportunities to
practice in real
situations.
5. Go with the
client’s time
rhythm.
6. Change roles
from director to

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Introduction to Occupational Therapy. Module IX: Framework for Professional Practice
Punita V. Solanki. August 2022
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follower.
5. Enduring relationship 1. The relationship
endures after therapy
ends.
2. The client is “held
in mind” & “they
would always be
there for you”
Outcomes 1. Clients reach
their goals.
2. Clients live
fulfilling lives
doing their
occupations.
3. Therapy results
are satisfying to
both client
and therapist.
4. The client has a
sense of control
and autonomy
over managing
his or her life.