Determining 24-Hour Supervision: A Scoping Review Through a Canadian Legal Database

Background: A highly contentious and controversial aspect of assessments in a medico-legal private practice is the determination of whether or not a client or patient requires 24-hour supervision. Purpose: The intent of this article is to review legal cases involving Occupational Therapist’s (OTs) and the determination of 24-hour supervision in Canada. Methods: A search and scoping review of the Canadian Legal Information Institute (CANLII) was completed using the terms “OT” and “24-hour supervision”. A review of the literature and determination of critical observations were completed. Findings: Based on 46 legal proceedings since 1986, the following critical observations emerged: Lack of pattern in the areas assessed in determining 24-hour supervision, inconsistent quality of OT testimony related to determining 24-hour supervision, increased demand on OTs to determine if a client requires 24-hour supervision, and lack of guidelines for assessing 24-hour supervision. Implications: Without clear guidelines, OT testimony may bear less weight in court. Recommendations: The authors propose that an evidence-based framework upon which to formulate a determination of 24-hour supervision needs to be considered. Further research into current OT practice in determining 24-hour supervision and exploration of existing assessment tools for determining 24-hour supervision are recommended.