Ethical Considerations Related to International Fieldwork Purpose: Identify and document ethical issues, including those related to cross cultural and practice factors that must be considered when negotiating an international placement Stimulate discussion by providing questions to ponder when evaluating the benefit/harm ratio of each placement Encourage fieldwork educators and students to articulate the value of ethical clarity in benefit of AOTA members and the global connectedness of the Centennial Vision Introduction: The following is presented to generate discussion regarding ethical issues that may arise while planning international fieldwork placements In addition, this document may be presented as issues for students to discuss or consider Questions may trigger and promote dialogue about content and potential dilemmas This document is meant to raise awareness of ethical issues to consider when planning for an international fieldwork experience Accompanying guides and documents should also be reviewed for other essential elements to consider when planning an international fieldwork Questions to Ponder by Category: Certification considerations: Will the international experience prepare the student sufficiently for certification? Should the student’s home country fieldwork assignment be specifically chosen to offer solid certification preparation in order to complement the international experience and offset any gaps related to requirements for certification? Is the academic OT/OTA program aware that international experiences are often scheduled as optional placements beyond required fieldwork? Clarity: Is there advance verification in writing of the type(s) of population, location, duration, credentials of fieldwork educator, supervision, contact persons, housing, hours, days of work per week, days when facility is closed for the international fieldwork placement? Is it clear that there will be no guaranteed replacement of the student(s) at the end of the agreed upon period of service? Communication: Is there clarity about availability of means for communication in the geographical location of the assignment (telephone contact, e-mail, voice over Internet, etc.)? How will necessary off-site communication be handled between FWE /preceptor/ coordinator and student? Competence: Does the student have the professional competencies to serve the population under the supervision that will be available? What professional competencies are expected by the fieldwork site? Has the academic OT/OTA program provided the titles, descriptions, and outlines of the occupational therapy courses that the student has completed? Is cultural sensitivity a required part of the preparation for an international experience? Cultural aspects: Have the student and educational program reviewed cultural competencies significant to the population to be served? Will the student appropriately be able to engage with staff and clients at the international fieldwork site? If a student requests a placement in a culturally different environment than his or her culture of origin, does the student have the awareness, knowledge, and skills to work in the culturally different environment? If a key goal of international fieldwork is to expose students to varied cultures, should a request for fieldwork placement in the country of origin be pursued? Is the student a person who will respect the culture of the assigned site? Does the student demonstrate some advance research/awareness of the cultural norms of the country to be visited? Is the student willing to abide by the dress code of the fieldwork site? Will the student be comfortable among individuals dressed according to the norms of the country? To what degree are religious differences a concern? Environmental conditions: Will the student be able to function within the environmental conditions likely to be encountered? How much detail should be explored regarding insect infestation, drinking water, crime, etc., in preparation for the placement? What health services/alerts should the student investigate in advance? Are there current US State Department warnings in place? Financial Issues: Is it ethically responsible to pursue a potential agreement before assuring that funding will be available to implement it? Who (student, academic OT/OTA program) is responsible for exploring potential funding sources? What is the anticipated cost of travel at the time of the placement? Are Internet-based reduced-fair bookings or equivalent an acceptable alternative to an established travel agency? Has the student been referred to the college’s study abroad office or equivalent? Does the student need to meet specific requirements for the college? At what stage should the student be asked how much he or she can contribute to the expected expenses? Have food costs been included in the overall package so that the student will not have to choose between eating or paying for a commuter bus or needed materials? Housing: If the potential fieldwork educator offers to have the student stay in his or her home for a minimal fee, should the college/educational program consider the possibility? Are there special needs/special requirements? What are the merits of the various options when values and morality are considered? What is most appropriate in the host country? Does the student meet the criteria for on-site housing? How many students are assigned per room? Are there mixed genders? Is public transportation available between the housing site and the clinical service site? How long is the commute? Will there be issues regarding hitching a ride, involving staff in transportation,, having to cover taxi costs? Is walking between housing and treatment site feasible and safe according to the standards of the host country? Impact on Population and Beyond: Will there be a possibility for replacement of the student when he or she leaves to carry on the services provided? Does it matter? What is the balance between doing good and harm if after being provided with occupational therapy the population has no ability to continue receiving service after the student leaves? Is there the possibility of even brief training of individuals in the community for carryover in order to maximize the value of a one-time intervention? Will the student’s sharing of information about conditions and salaries in the US contribute to therapists leaving that country? How can such a potentially negative impact be minimized? Has the student been referred to such works as F Kronenberg’s, Occupational Therapy Without Borders to enhance use of professional nomenclature and awareness of social justice issues, such as apartheid? Language: What are the language requirements of the site? Is the student prepared to engage in language training, if required, in advance of assignment to be sufficiently proficient by the starting date? Is there any reason not to proceed with the placement if the student is not proficient in the language of the country, but is proficient in the language of a large segment of the population served, and is, therefore acceptable to the site? Will the language in which supervision is documented be understood by both student and fieldwork educator? Does the student or academic OT/OTA program recognize the value (cognitive/connections) of being exposed to a new language? Legal Considerations: Is the student aware that legal standards of the home country may not apply in the country to which the student is to be assigned? Is the student likely to raise concerns about laws and rights that may only apply and/or need to be posted in the home country? Does the student know that penalties for such violations as drug use may be much more severe in the host country than in the home country? Is the student sufficiently astute/informed to realize that practice carried out in the host country may well be beyond the scope of practice and supervision requirements of the state to which the student will return? Liability: What are the liability and risk management considerations that must be delineated and agreed upon by institutional leadership, faculty, and fieldwork educators from both the sending school and student prior to placement? Is the country considered a litigious society? Does the student’s liability insurance cover an international experience? Will the student be registered as such in the home educational institution while completing a fieldwork placement outside of the country? Does the host agency provide liability coverage for students? Respect: Does the student already demonstrate respect for people from different ethnic backgrounds and for people of different ages and abilities? Is the student ready to respect the norms of the host country and the policies of the receiving agency? Are there safety issues within the country or fieldwork site that may compromise the student’s ability to complete fieldwork at that site? Does the student have the self sufficiency and emotional maturity needed to negotiate unexpected situations that might be encountered? Has the student been prepared to “expect the unexpected?” Is the fieldwork site aware that the student may be out of his or her comfort zone in the new setting? Is the student likely to engage in risky behaviors in the anticipated host environment? Is the fieldwork site located within a country of relative calm? What procedures are in place regarding crime, terrorism, disaster planning? Valuing differences: Is the student committed to make diversity an advantage? Is the student eager for the learning experience offered by a different environment, different people, different equipment, different treatment approaches, and more? Has the student read some of the OT-related articles regarding international experiences? Has the student read some of the OT-related articles regarding cultural sensitivity? Resources: American Journal of Occupational Therapy Tips for traveling abroad (including safety), by the U.S Government Prepared by: International Fieldwork Ad Hoc Committee for the Commission on Education (1/26/09) Patricia Crist, PhD, OTR/L, FAOTA (Chair)—Duquesne University, PA Naomi Greenberg, MPH, PhD, OTR—LaGuardia Community College, NY Susan K Meyers, EdD, OTR, Private Foundation, IN Susan Mullholland MSc (rehab), BScOT, OT©—University of Alberta Patty Stutz-Tanenbaum, MS, OTR—Colorado State University, CO Pamela Richardson, PhD, OTR/L, FAOTA—San Jose University, CA Debra Tupe, MS, OTR—Columbia University, NY Neil Harvison, PhD, OTR/L—AOTA Staff Emerging Leaders Development Program Participant Juleen Rodakowski, OTD, OTR/L ... host agency provide liability coverage for students? Respect: Does the student already demonstrate respect for people from different ethnic backgrounds and for people of different ages and abilities?... the culturally different environment? If a key goal of international fieldwork is to expose students to varied cultures, should a request for fieldwork placement in the country of origin be pursued?... preparation for the placement? What health services/alerts should the student investigate in advance? Are there current US State Department warnings in place? Financial Issues: Is it ethically