Today’s post was written by Dana Katz, director of Rose Cottage, a special needs preschool in Cape Town, and she holds the Ethics portfolio on SAISI’s board.  Thank you Dana!

All I Really Need To Know I Learned In Kindergarten

by Robert Fulghum

“Share everything.
Play fair.
Don’t hit people.
Put things back where you found them.
Clean up your own mess.
Don’t take things that aren’t yours.
Say you’re sorry when you hurt somebody.
Wash your hands before you eat.
Warm cookies and cold milk are good for you.
Live a balanced life –
Learn some and think some
And draw and paint and sing and dance
And play and work everyday some.
Take a nap every afternoon.
When you go out into the world,
Watch out for traffic,
Hold hands and stick together.
Be aware of wonder”

The following blog post is written as a reminder to us all of our responsibilities as occupational therapists (OT’s), as well as SAISI’s position on the assessment and treatment of children. It is not enough for us to just be good OT’s – we need to be good colleagues, good advocates for our profession and good to ourselves. We need to remind ourselves of who we are as professionals, why we do what we do and of what is expected of us as paediatric OT’s, specifically.

We all graduated from pre-school with many new lessons in our toolbox. We had taken our first steps into independence, started to develop self-confidence, learned how to be a good friend, to respect others and to follow the rules. As we grew older, these lessons grew more complicated and complex. We grew from preschoolers into adults without much choice in the process.

But, we consciously made the choice, however, to grow from adults into OTs; into professionals in our chosen field of practice.

Our professional qualification is empowering in many ways, but we need to remember that with power comes responsibility.  In this case, responsibility to our clients, to our colleagues, to our profession and to ourselves.

At times in our growth, we can grow so big, that we may forget our purpose, forget our responsibilities and forget the lessons we learned in preschool: to share, play fair, not to hurt people, not to take things that aren’t yours, to say you’re sorry when you hurt somebody (even if unintentionally), to live a balanced life, to learn some and think some, to play and work everyday, to hold hands and stick together.

When we forget these lessons, our professional practice runs the risk of becoming unethical.

The HPCSA’s Ethical Guidelines for Good Practice remind us of the Main responsibilities of health practitioners:

“A practitioner shall at all times:

(a) act in the best interests of his or her patients;

(b) respect patient confidentiality, privacy, choices and dignity;

(c) maintain the highest standards of personal conduct and integrity;

(d) provide adequate information about the patient’s diagnosis, treatment options and alternatives, costs associated with each such alternative and any other pertinent information to enable the patient to exercise a choice in terms of treatment and informed decision-making pertaining to his or her health and that of others;

(e) keep his or her professional knowledge and skills up to date;

(f) maintain proper and effective communication with his or her patients andother professionals;

(g) except in an emergency, obtain informed consent from a patient or, in the event that the patient is unable to provide consent for treatment himself or herself, from his or her next of kin; and

(h) keep accurate patient records.”

A client’s BEST INTERESTS OR WELL-BEING must always be our highest priority. Health-care practitioners should:

  • “Always regard concern for the best interests or well-being of their patients as their primary professional duty.
  • Honour the trust of their patients.
  • Be mindful that they are in a position of power over their patients and avoid abusing their position”.

Informed consent is one of the ways that we can show respect towards our clients. “A practitioner shall refrain from withholding from their patients any information, investigation, treatment or procedure the health-care practitioner knows would be in the patient’s best interests.” In our case, we need to decide what support and which treatment modality would be best for a client, as well as what should be prioritized according to what the client ultimately wants and we MUST refer accordingly. It is important to remember that a client has the right to choose the practitioner with whom they would like to work.

We need to ensure that we are sufficiently experienced in the treatment modality that we are offering or else we need to refer on to someone who is. “We may not impede a patient, or in the case of a minor, the parent or guardian of a minor, from obtaining the opinion of another practitioner or from being treated by another practitioner”.

When WORKING WITH COLLEAGUES we should: “Work with and respect other health-care professionals in pursuit of the best health-care possible for all patients. Not discriminate against colleagues, including health-care practitioners applying for posts, because of their views of their race, culture, ethnicity, social status, lifestyle, perceived economic worth, age, gender, disability, communicable disease status, sexual orientation, religious or spiritual beliefs, or any condition of vulnerability. Refrain from speaking ill of colleagues or other health-care practitioners and passing judgement on the professional reputation of colleagues.”

HPCSA Rule 12:“A practitioner shall not cast reflections on the probity, professional reputation or skill of another person registered under the Act or any other Health Act.

Do not make a patient doubt the knowledge or skills of colleagues by making comments about them that cannot be fully justified. Support colleagues who uphold the core values and standards embodied in these guidelines. Advise colleagues who are impaired to seek professional assistance.”

With respect to assessment and treatment in ASI®, the following is noted:

SAISI prescribes the use of reliable, scientific assessment instruments in order to obtain client information. Standardized assessment tools are to be used alongside collateral information and researched clinical observations to determine the strengths and therapeutic needs of the child. Treatment goals need to be appropriate and individualized to effectively support the therapeutic intervention process. This intervention process should address the development of functional occupational performance-based skills and adaptive behaviour.

SAISI currently promotes the use of the Sensory Integration and Praxis Tests (SIPT). Internationally, this test is recognised as the gold standard of assessment in the field of ASI®.

SAISI encourages the use of the Data-Driven Decision-Making process (DDDM by Schaaf & Mailloux, 2015). This process supports a standardized and objective, outcomes-based approach to the assessment and treatment of children.

ASI® assessment and treatment must be carried out by an occupational therapist qualified in Ayres Sensory Integration®.

Parents should be provided with information to enhance their understanding of the underlying sensory systems and processes involved in the holistic development of the child.

Therapists need to have face-to-face contact with parents and feedback on the child’s therapeutic programme and progress needs to be provided on an ongoing basis. Parents must, at all times, be recognised and included as part of the goal-setting and therapeutic process of the child.

Therapists may not assess, provide information on or work with a child without parental consent – this is specifically noted for practices within school settings.

SAISI does not prescribe the use of generalised, non-standardised checklists and screening tools as methods of obtaining clinical information regarding the developmental, functional and behavioural status of a child. 

In closing, I challenge you all to remember the lessons learnt in pre-school and apply these in your daily practice. Let these simple rules guide your complex daily interactions: let us work together, share, play fair and support each other in our endeavours to support our clients and always remember that “A client’s BEST INTERESTS OR WELL-BEING must always be our highest priority!”

The information quoted above is taken directly from the HPCSA’s Ethical Guidelines for Good Practice.