Ethical Tensions in Transitioning to Tiered Models of School-Based Occupational Therapy

Background. School-based occupational therapy (SBOT) is shifting from pull-out interventions for students with special needs to tiered models focused on inclusion and participation. There are several noted benefits of tiered models. However, research has suggested that challenges exist in the transition to tiered models that are consistent with ethical tensions. It is unclear how occupational therapists are navigating the transition to tiered models, including addressing ethical tensions. Purpose. The purpose was to advance knowledge and understanding regarding ethical tensions experienced by school-based occupational therapists in transitioning to tiered models of SBOT. The research question was: What are the perceived ethical tensions experienced by occupational therapists in transitioning to tiered models of service delivery in SBOT? Method. Interpretive description was employed. Interviews were conducted with 11 self-nominated occupational therapists. Data analysis consisted of preparation, organization, and interpretation followed by a member checking focus group. Findings. Occupational therapists experienced ethical tensions around five inter-related ethical principles—fidelity, veracity, autonomy, confidentiality, and distributive justice. Conclusion. The transition to tiered SBOT exacerbated or created ethical tensions. Engaging established implementation guidelines can provide a structured framework to inform large-scale service delivery changes, lessening ethical tensions while eliciting desired outcomes.