Scenario Analysis: This scenario presents a common challenge in acute care settings where a Certified Occupational Therapy Assistant (COTA) must balance the immediate needs of a patient with the ethical and regulatory requirements of documentation and communication. The patient’s rapid decline and the family’s distress create a high-pressure environment, demanding prompt and effective intervention while adhering to professional standards. The COTA must exercise sound clinical judgment to ensure patient safety and well-being without compromising the integrity of the care plan or violating professional guidelines. Correct Approach Analysis: The best professional practice involves immediately addressing the patient’s acute change in status by providing necessary hands-on assistance and ensuring their safety. Simultaneously, the COTA must promptly and clearly communicate the observed changes and interventions to the supervising Occupational Therapist (OT). This approach aligns with the fundamental ethical principle of beneficence, prioritizing the patient’s immediate well-being. Furthermore, it adheres to regulatory frameworks that mandate timely reporting of patient status changes to the supervising clinician, enabling the OT to make informed decisions regarding the treatment plan and necessary documentation. This collaborative communication ensures continuity of care and accurate record-keeping, which are essential for legal and professional accountability. Incorrect Approaches Analysis: Delaying direct patient care to complete documentation before reporting the change in status is ethically problematic as it prioritizes administrative tasks over immediate patient needs, potentially compromising safety and well-being. This violates the principle of beneficence and could be seen as a failure to act in the patient’s best interest. Focusing solely on documenting the event without immediately informing the supervising OT fails to ensure timely clinical decision-making and intervention adjustments. This can lead to a gap in care and potentially adverse outcomes, contravening the collaborative nature of occupational therapy practice and the requirement for prompt communication of significant patient changes. Assuming the patient’s condition will stabilize without intervention and waiting for the OT’s next scheduled check-in is a significant lapse in professional judgment and a failure to recognize and respond to a critical change in patient status. This approach neglects the COTA’s responsibility to monitor and report changes, potentially leading to serious harm and violating the duty of care. Professional Reasoning: Professionals in this situation should employ a decision-making framework that prioritizes patient safety and immediate needs. This involves: 1) Rapid assessment of the patient’s condition and immediate risks. 2) Implementing necessary interventions to ensure safety and comfort. 3) Prompt and clear communication with the supervising OT, detailing observations and interventions. 4) Collaborating with the OT to update the treatment plan and complete necessary documentation. This systematic approach ensures that patient care is both responsive and compliant with professional and regulatory standards.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to navigate the complex interplay of cultural, social, and environmental factors that significantly influence a client’s development and participation in therapy. A failure to adequately consider these elements can lead to ineffective interventions, client dissatisfaction, and potentially exacerbate existing disparities. The COTA must demonstrate cultural humility and a nuanced understanding of how a client’s lived experiences shape their needs and goals. Correct Approach Analysis: The best professional practice involves a comprehensive evaluation that actively seeks to understand the client’s cultural background, social support systems, and environmental context. This approach prioritizes client-centered care by integrating the client’s perspectives and lived experiences into the assessment process. This aligns with the ethical principles of occupational therapy, which emphasize respecting the dignity and autonomy of clients and promoting their right to self-determination. Specifically, it reflects the core tenets of occupational therapy practice that mandate a holistic understanding of the individual within their environment, ensuring interventions are meaningful and culturally relevant. Incorrect Approaches Analysis: One incorrect approach involves relying solely on standardized developmental assessments without considering the client’s unique cultural and environmental context. This can lead to misinterpretations of developmental milestones and inappropriate goal setting, as standardized tools may not account for cultural variations in expression or environmental barriers to participation. This approach fails to uphold the ethical obligation to provide individualized care and can inadvertently perpetuate biases. Another unacceptable approach is to make assumptions about the client’s needs and preferences based on their cultural or socioeconomic background without direct engagement. This is a form of stereotyping that undermines the client’s individuality and autonomy. It violates the ethical principle of respecting client dignity and can lead to interventions that are not only ineffective but also potentially offensive or harmful. A further flawed approach is to focus exclusively on the client’s immediate physical environment while neglecting the broader social and cultural influences that shape their daily routines and opportunities for engagement. This narrow focus misses crucial determinants of occupational performance and well-being, failing to address systemic barriers or cultural norms that may impact the client’s ability to participate in meaningful occupations. Professional Reasoning: Professionals should employ a decision-making process that begins with active listening and open-ended inquiry to understand the client’s unique story. This involves asking about their cultural beliefs, family dynamics, community resources, and environmental challenges. The next step is to integrate this qualitative information with objective assessment data, critically analyzing how these factors might influence developmental trajectories and functional abilities. Finally, interventions should be collaboratively developed with the client, ensuring they are culturally sensitive, socially supportive, and environmentally adaptable, thereby promoting meaningful participation and achieving client-centered goals.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to navigate the ethical and regulatory landscape of client assessment, specifically concerning sensory processing. The COTA must balance the need for comprehensive data with the client’s right to privacy and informed consent, while also ensuring the assessment methods are appropriate and contribute to meaningful intervention planning. The pressure to demonstrate efficiency can sometimes conflict with the thoroughness required for best practice. Correct Approach Analysis: The best professional practice involves the COTA collaborating with the supervising Occupational Therapist (OT) to select and administer sensory processing assessments that are evidence-based, age-appropriate, and directly relevant to the client’s stated goals and observed functional limitations. This approach ensures that the assessment is conducted within the scope of practice for a COTA, under the OT’s direction, and that the data gathered will be interpreted by the OT to inform a client-centered intervention plan. This aligns with ethical principles of beneficence and non-maleficence, ensuring the client receives appropriate care, and adheres to professional standards that mandate supervision and collaboration between OTs and COTAs. It also respects the client’s autonomy by ensuring assessments are purposeful and contribute to their therapeutic journey. Incorrect Approaches Analysis: One incorrect approach involves the COTA independently selecting and administering a battery of sensory processing assessments based on a general understanding of sensory integration theory without specific direction from the supervising OT or a clear link to the client’s current functional deficits. This fails to adhere to the regulatory framework that defines the COTA’s role as implementing interventions and collecting data under OT supervision. It bypasses the OT’s expertise in assessment selection and interpretation, potentially leading to the collection of irrelevant data or misinterpretation of findings, which is ethically unsound and could compromise client care. Another incorrect approach is for the COTA to focus solely on administering the most widely recognized or “gold standard” sensory processing assessments, regardless of their suitability for the client’s age, cognitive abilities, or specific presentation. This approach prioritizes familiarity over appropriateness and may not yield valid or reliable data for the individual client. It neglects the ethical obligation to provide individualized care and the professional responsibility to use assessment tools that are appropriate for the specific client population and their unique needs. A further incorrect approach involves the COTA administering sensory processing assessments without clearly explaining the purpose and procedures to the client or their caregiver, or obtaining their assent/consent. This violates the client’s right to autonomy and informed participation in their care. Ethically, it is imperative that clients understand what is being assessed and why, and that they agree to participate. Failure to do so undermines the therapeutic relationship and can lead to distrust and non-compliance. Professional Reasoning: Professionals should employ a decision-making process that prioritizes client-centered care, ethical practice, and adherence to regulatory guidelines. This involves: 1) Understanding the client’s needs and goals in collaboration with the supervising OT. 2) Identifying assessment tools that are evidence-based, appropriate for the client’s age and condition, and directly relevant to the identified goals. 3) Ensuring all assessments are conducted under the appropriate level of supervision and within the scope of practice for the COTA. 4) Prioritizing client autonomy through clear communication, informed consent, and assent. 5) Continuously evaluating the effectiveness and relevance of assessment data in collaboration with the OT to inform intervention planning.

The monitoring system demonstrates a potential ethical challenge for an Occupational Therapy Assistant (OTA) involving client confidentiality and professional boundaries. The scenario is professionally challenging because the OTA has received information about a client’s personal life from a family member, which could impact the therapeutic relationship and the client’s privacy. Careful judgment is required to navigate this situation ethically and in accordance with professional standards. The best professional practice involves directly addressing the situation with the client. This approach prioritizes client autonomy and confidentiality. By speaking directly with the client, the OTA can acknowledge the information received, clarify its relevance to their occupational therapy goals, and ensure that any discussions about their personal life are conducted with their explicit consent and within appropriate professional boundaries. This aligns with ethical principles of respect for persons, autonomy, and confidentiality, as typically outlined in occupational therapy codes of ethics and practice standards, which emphasize obtaining informed consent and maintaining privacy. An incorrect approach would be to ignore the information received from the family member and continue with the therapy session as if nothing was disclosed. This fails to address a potentially significant factor that could influence the client’s engagement or progress and neglects the opportunity to clarify boundaries and ensure the client feels respected and informed. It also misses a chance to reinforce professional boundaries. Another incorrect approach would be to immediately dismiss the family member and refuse to listen to any further information. While maintaining boundaries is important, a complete refusal to engage with a family member who may have relevant insights could be detrimental to the client’s care if the information is indeed pertinent and shared with the client’s implicit or explicit understanding. It can also create an adversarial relationship with the client’s support system. A further incorrect approach would be to discuss the information received from the family member with other members of the therapy team without first addressing it with the client. This constitutes a breach of confidentiality, as the information was shared by a third party and may not have been consented to by the client for wider team discussion. It also bypasses the client’s right to be informed and to control the disclosure of their personal information. Professionals should employ a decision-making framework that begins with identifying the ethical principles at play (autonomy, confidentiality, beneficence, non-maleficence). They should then gather information, considering the source and potential impact of the information received. The next step is to explore options, weighing the ethical implications of each. In this case, direct communication with the client is the most ethically sound option, as it respects their autonomy and upholds confidentiality. If direct communication is not immediately feasible, the OTA should document the information received and plan for a discussion with the client at the earliest appropriate opportunity, while avoiding further disclosure to others.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to balance the client’s expressed preferences with the established treatment plan and the supervising Occupational Therapist’s (OT) directives. The COTA must navigate potential communication breakdowns, ensure client safety and therapeutic efficacy, and maintain professional boundaries and responsibilities within the scope of practice. Careful judgment is required to determine the appropriate course of action that upholds ethical principles and regulatory compliance. Correct Approach Analysis: The best professional practice involves the COTA directly communicating with the supervising OT to discuss the client’s request and concerns. This approach is correct because it adheres to the fundamental principle of collaborative practice and the COTA’s responsibility to work under the direction and supervision of an OT. Regulatory frameworks for occupational therapy consistently emphasize that COTAs implement treatment plans developed by OTs and must consult with their supervising OT regarding any deviations or significant client feedback that might impact the plan. This ensures that changes are made with appropriate clinical reasoning and oversight, safeguarding the client’s well-being and the integrity of the therapeutic process. Ethical guidelines also mandate clear communication and consultation to ensure client-centered care while maintaining professional accountability. Incorrect Approaches Analysis: One incorrect approach is for the COTA to unilaterally decide to alter the activity without consulting the OT. This is professionally unacceptable because it bypasses the established supervisory relationship and the OT’s role in treatment planning and modification. It violates the principle of working within the scope of practice and could lead to a treatment plan that is no longer appropriate or safe for the client, potentially resulting in adverse outcomes and a breach of professional responsibility. Another incorrect approach is for the COTA to ignore the client’s request and proceed with the original activity without any discussion. This is professionally unacceptable as it fails to acknowledge the client’s autonomy and their right to express preferences and concerns about their treatment. While adhering to the plan is important, a complete disregard for client input can undermine the therapeutic relationship, reduce client engagement, and may miss crucial information about the client’s current state or needs, potentially leading to a less effective or even detrimental intervention. A third incorrect approach is for the COTA to simply tell the client that the activity cannot be changed because it is the plan. This is professionally unacceptable because it lacks empathy and fails to explore the underlying reasons for the client’s request. While the plan is important, a rigid and uncommunicative stance can alienate the client and prevent collaborative problem-solving. It misses an opportunity to understand the client’s perspective, which could inform future treatment adjustments or provide valuable insights to the supervising OT. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes client well-being, ethical conduct, and regulatory compliance. This involves: 1) Active listening and understanding the client’s perspective and concerns. 2) Recognizing the boundaries of their own role and the necessity of supervisory consultation. 3) Communicating effectively with the supervising OT, providing clear and concise information about the client’s request and their own observations. 4) Collaborating with the OT to determine the most appropriate course of action, which may involve modifying the plan, educating the client, or reinforcing the rationale for the current intervention. This systematic approach ensures that client needs are met while upholding professional standards and responsibilities.

This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to balance the client’s expressed desires with the therapist’s professional judgment regarding functional goals and safety, all within the ethical and regulatory framework governing occupational therapy practice. The COTA must ensure that interventions are client-centered while also adhering to established standards of care and professional conduct. The best professional practice involves collaborating with the occupational therapist (OT) to develop a plan that integrates the client’s personal aspirations with achievable, functional goals. This approach prioritizes client autonomy and engagement by acknowledging their preferences, while simultaneously ensuring that the established goals are evidence-based, measurable, and aligned with the OT’s overall treatment plan and the client’s rehabilitation potential. This collaborative process, documented thoroughly, upholds the ethical principles of beneficence and respect for autonomy, and aligns with the COTA’s role in implementing interventions as directed by the OT. An incorrect approach would be to solely focus on the client’s expressed desire for a specific activity without considering its functional relevance or safety implications. This fails to uphold the COTA’s responsibility to promote meaningful participation and functional independence, potentially leading to interventions that are not beneficial or even detrimental to the client’s progress. It also bypasses the necessary collaboration with the supervising OT, undermining the team-based approach to care. Another incorrect approach would be to dismiss the client’s expressed desire entirely and unilaterally impose goals based solely on the COTA’s perception of what is “best.” This disregards the client’s right to self-determination and can lead to decreased motivation and adherence to the treatment plan. It also oversteps the COTA’s scope of practice by making independent clinical judgments about goal setting without adequate OT input. A third incorrect approach would be to implement interventions that are not clearly defined or measurable, or that do not align with the overall treatment plan established by the OT. This lack of specificity and direction can lead to ineffective therapy and a failure to demonstrate progress, potentially violating standards of documentation and professional accountability. Professionals should employ a decision-making framework that begins with understanding the client’s goals and values, followed by a collaborative discussion with the supervising OT to integrate these with functional and therapeutic objectives. This involves assessing the client’s current abilities, identifying potential barriers and facilitators, and developing SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals. Documentation should reflect this collaborative process and the rationale behind the chosen interventions.

This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to adapt assessment strategies to a client’s unique needs and limitations, while still adhering to professional standards and ensuring the validity and reliability of the information gathered. The COTA must balance the need for individualized care with the ethical and regulatory obligations to provide competent and appropriate services. Careful judgment is required to select techniques that are both effective for the client and ethically sound. The best approach involves the COTA utilizing their clinical reasoning skills to select and adapt non-standardized assessment techniques that are directly relevant to the client’s functional goals and environment. This includes observing the client’s performance in naturalistic settings, engaging in structured interviews about their daily routines and challenges, and using task analysis to break down complex activities into smaller, observable components. This approach is correct because it aligns with the principles of client-centered care, emphasizing the individual’s participation and the functional context of their lives. It also adheres to ethical guidelines that mandate the use of appropriate assessment methods and the collection of meaningful data to inform intervention planning. By focusing on functional performance in real-world situations, the COTA gathers ecologically valid information that is directly applicable to improving the client’s occupational performance. An incorrect approach would be to rely solely on informal observation without a structured plan or clear objectives. While observation is a component of non-standardized assessment, conducting it without a defined purpose or systematic method can lead to subjective interpretations and the collection of irrelevant data. This fails to meet the professional obligation to conduct assessments that are purposeful and contribute to evidence-based practice. Another incorrect approach would be to administer a standardized assessment tool in a manner that deviates significantly from its established protocol, such as providing excessive cues or altering the testing environment without justification. This compromises the validity and reliability of the assessment results, making it impossible to compare the client’s performance to normative data or to accurately track progress. Such a deviation would violate professional standards for assessment administration and could lead to inappropriate intervention planning. Finally, an incorrect approach would be to delegate the selection and adaptation of non-standardized assessment techniques to an unlicensed individual without direct supervision. This is a violation of professional boundaries and regulatory requirements, as the responsibility for assessment lies with qualified occupational therapy practitioners. It also risks the collection of inaccurate or incomplete information, potentially harming the client. Professionals should employ a decision-making framework that prioritizes client needs and functional goals. This involves first understanding the client’s presenting problems and desired outcomes. Then, the COTA should consider the most appropriate assessment methods, including non-standardized techniques, that can provide the necessary information to address these goals. This requires a thorough understanding of various non-standardized assessment strategies and their applicability to different client populations and contexts. The process should involve collaboration with the client and the supervising occupational therapist to ensure that the chosen techniques are both effective and ethically sound.

The analysis reveals a scenario where a Certified Occupational Therapy Assistant (COTA) must navigate a client’s evolving needs and goals, which may diverge from the initial treatment plan. This situation is professionally challenging because it requires the COTA to balance adherence to the established plan of care, which is guided by the occupational therapist’s (OT) evaluation and the physician’s orders, with the client’s right to self-determination and the dynamic nature of recovery. Careful judgment is required to ensure that interventions remain client-centered, effective, and ethically sound, while also respecting the scope of practice for both the COTA and the OT. The best approach involves the COTA actively listening to the client’s expressed desires and concerns, documenting these observations thoroughly, and communicating them promptly and clearly to the supervising OT. This collaborative communication is crucial because the OT is responsible for reassessing the client’s needs, modifying the plan of care as appropriate, and ensuring that any changes align with the client’s overall rehabilitation goals and are medically justified. This approach upholds ethical principles of client autonomy and beneficence, ensuring that the treatment plan remains relevant and beneficial. It also adheres to professional standards that mandate communication and collaboration between COTAs and OTs for effective client care. An incorrect approach would be for the COTA to unilaterally alter the treatment plan based on the client’s expressed wishes without consulting the supervising OT. This fails to respect the established hierarchy of care and the OT’s ultimate responsibility for treatment planning. It also risks providing interventions that are not evidence-based, not aligned with the client’s broader medical condition, or outside the COTA’s scope of practice. Another incorrect approach would be to dismiss the client’s expressed needs and goals, insisting on strictly following the original plan despite the client’s discomfort or lack of engagement. This disregards the principle of client-centered care and can lead to decreased motivation, poor adherence, and ultimately, less effective outcomes. It also fails to acknowledge that client needs and goals can and often do change throughout the course of therapy. A third incorrect approach would be to document the client’s expressed desires but fail to communicate them to the supervising OT, continuing with the original plan. This creates a gap in communication and prevents the OT from making informed decisions about the client’s care. It also means the client’s evolving needs are not being adequately addressed, potentially leading to suboptimal therapeutic outcomes and a breakdown in the therapeutic relationship. Professional reasoning in such situations involves a systematic process: first, actively listen and empathetically acknowledge the client’s perspective. Second, document observations and client statements accurately. Third, identify the discrepancy between the client’s current desires and the existing plan. Fourth, consult with the supervising OT, presenting the client’s input and seeking guidance on how to proceed. Fifth, collaboratively revise the plan of care as necessary, ensuring it remains client-centered, evidence-based, and within the scope of practice for both the COTA and the OT.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to navigate a complex interpersonal dynamic while maintaining professional boundaries and ensuring the client’s well-being. The client’s expressed desire for a more personal connection, coupled with the COTA’s awareness of the potential for boundary blurring, necessitates careful judgment to uphold ethical standards and regulatory requirements. The COTA must balance empathy with professional objectivity. Correct Approach Analysis: The best professional practice involves acknowledging the client’s feelings and gently redirecting the conversation back to therapeutic goals while reinforcing the professional nature of the relationship. This approach demonstrates empathy by validating the client’s expressed sentiment without reciprocating the personal overture. It upholds ethical standards by maintaining appropriate professional boundaries, which are crucial for effective therapy and client safety. Specifically, this aligns with the ethical principles of maintaining professional competence and integrity, as well as avoiding exploitation or undue influence, as often outlined in professional codes of conduct for occupational therapy practitioners. The focus remains on the client’s occupational performance and therapeutic outcomes. Incorrect Approaches Analysis: One incorrect approach is to reciprocate the client’s expressed desire for a more personal connection by sharing personal information or agreeing to engage in non-therapeutic activities outside of the session. This action directly violates professional boundaries, potentially leading to exploitation, undue influence, and a compromised therapeutic relationship. It undermines the client’s trust in the professional capacity of the COTA and can hinder progress towards therapeutic goals by shifting the focus away from the client’s needs. Such a breach could also have regulatory implications, potentially leading to disciplinary action by licensing boards. Another incorrect approach is to abruptly dismiss or ignore the client’s expressed feelings without acknowledgment. While this might seem like a way to maintain boundaries, it can alienate the client, making them feel unheard or invalidated. This can damage the therapeutic alliance, which is built on trust and open communication. Ethically, practitioners are expected to respond to clients with respect and sensitivity, even when addressing boundary issues. Failing to acknowledge the client’s statement can be perceived as a lack of empathy and may lead the client to withdraw or become resistant to therapy. A third incorrect approach is to become overly defensive or rigid in response to the client’s statement. While maintaining boundaries is essential, an overly defensive posture can create an adversarial dynamic and shut down communication. This can be perceived as a lack of confidence or an inability to handle client interactions professionally. It fails to acknowledge the client’s perspective, even if that perspective is leading towards boundary issues, and can create an uncomfortable and unproductive therapeutic environment. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes client well-being and adherence to ethical and regulatory standards. This involves active listening to understand the client’s perspective, assessing the potential impact of their statements on the therapeutic relationship, and responding in a manner that is both empathetic and boundary-affirming. When faced with boundary-testing statements, professionals should reflect on their own professional role, the established therapeutic goals, and the relevant ethical codes. The goal is to de-escalate any potential boundary creep while preserving the therapeutic alliance and ensuring continued progress in therapy.

This scenario is professionally challenging because it requires the Certified Occupational Therapy Assistant (COTA) to navigate the delicate balance between client autonomy, the need for comprehensive assessment, and the legal and ethical obligations to ensure client safety and well-being. The COTA must recognize that a client’s refusal of a specific assessment component, while their right, could potentially mask underlying issues that impact their functional capacity and safety. Careful judgment is required to respect the client’s wishes while still fulfilling the COTA’s professional responsibilities. The best approach involves a collaborative discussion with the client to understand the reasons behind their refusal and to explore alternative assessment methods or modifications that address their concerns while still gathering necessary information. This approach respects client autonomy by acknowledging their right to refuse, but it also proactively seeks to understand the underlying issues and find solutions. This aligns with ethical principles of client-centered care and the regulatory framework that emphasizes informed consent and the provision of appropriate services. By engaging in dialogue, the COTA can identify potential barriers to participation, such as fear, misunderstanding, or discomfort, and work with the client to overcome them or adapt the assessment. This also supports the COTA’s role in gathering information to inform the occupational therapist’s plan of care. An approach that immediately proceeds with the assessment despite the client’s expressed discomfort or refusal is professionally unacceptable. This disregards the client’s right to self-determination and informed consent, potentially leading to a breakdown in the therapeutic relationship and an inaccurate assessment due to the client’s resistance or distress. It fails to uphold the ethical obligation to respect client autonomy. Another professionally unacceptable approach is to simply document the refusal and cease all assessment activities related to that functional area. This could leave critical gaps in the occupational therapist’s understanding of the client’s needs and risks, potentially compromising the development of an effective and safe intervention plan. It abdicates the COTA’s responsibility to contribute to a comprehensive evaluation and to advocate for the client’s best interests within the scope of their practice. A further professionally unacceptable approach is to attempt to persuade or coerce the client into participating in the assessment without fully understanding their reasons for refusal. This undermines the principles of informed consent and can create an adversarial relationship, making future therapeutic engagement difficult. It prioritizes the completion of the assessment over the client’s emotional and psychological well-being. Professionals should employ a decision-making framework that prioritizes client-centered care, ethical principles, and regulatory compliance. This involves active listening, open communication, and a commitment to understanding the client’s perspective. When faced with a client’s refusal of an assessment component, the professional should first seek to understand the underlying reasons, explore alternatives or modifications, and document the process and rationale thoroughly. If the refusal poses a significant risk to the client’s safety or well-being, the COTA should communicate these concerns to the supervising occupational therapist to collaboratively determine the next steps.