Topic 1.6 Bias, Assumptions and Inclusive Decision-Making

Every person brings their own experiences, beliefs, values and perspectives into professional practice. These influence how we interpret information, interact with others and make decisions. While experience is an important source of professional knowledge, it can also lead to unconscious assumptions and cognitive shortcuts that affect judgement without us being aware of it. Ethical and inclusive practitioners recognise that bias is a normal part of human thinking. The goal is not to eliminate bias completely—which is impossible—but to recognise it, reflect upon it and minimise its influence on professional decision-making.

Within assistance animal organisations, decisions are made every day that significantly affect the lives of handlers, assistance animals and their families. Professionals determine whether individuals are suitable for an assistance animal, assess functional needs, recommend equipment, develop training plans, evaluate competency, monitor welfare and determine when a partnership should continue, be modified or come to an end. These decisions must be based upon objective evidence, professional standards and ethical reasoning rather than assumptions, stereotypes or personal preferences.

Inclusive decision-making requires practitioners to actively question their own thinking. Rather than asking, “What do I think?”, practitioners should ask, “What evidence supports this decision?” and “Could unconscious assumptions be influencing my judgement?”

Occupational therapists have an important responsibility to model reflective and evidence-informed decision-making. By recognising bias and adopting structured approaches to assessment, practitioners improve fairness, strengthen public confidence and ensure that both handlers and assistance animals receive equitable and ethical services.

Understanding Bias

Bias refers to a tendency to favour or interpret information in a particular way. Some biases are conscious and deliberate, while many operate automatically without conscious awareness.

Bias becomes problematic when it influences professional judgement in ways that disadvantage individuals, reduce fairness or compromise decision-making.

Bias is not the same as discrimination.

A person may hold unconscious biases without intending to discriminate, whereas discrimination involves actions or decisions that unfairly disadvantage individuals or groups.

Recognising unconscious bias is therefore an important component of professional self-awareness rather than an accusation of prejudice.

Explicit and Implicit Bias

Bias generally falls into two broad categories.

Explicit bias refers to attitudes or beliefs that an individual consciously holds. These beliefs are recognised by the individual and may influence behaviour intentionally.

Implicit bias, sometimes called unconscious bias, refers to automatic attitudes or assumptions that operate below conscious awareness. These biases develop through life experiences, culture, media, education and repeated exposure to stereotypes.

Research has demonstrated that even experienced healthcare professionals possess implicit biases despite strong commitments to fairness and inclusion.

Recognising this allows practitioners to approach decision-making with humility and ongoing reflection.

Common Biases in Professional Practice

Numerous cognitive biases may influence occupational therapy and assistance animal practice.

Confirmation Bias

Confirmation bias occurs when individuals seek or interpret information in ways that support their existing beliefs while overlooking information that contradicts them.

For example, if a practitioner initially believes that a handler is unlikely to manage an assistance animal successfully, they may unconsciously focus on behaviours confirming this belief while overlooking evidence of competence and resilience.

Inclusive practitioners actively search for evidence that challenges their initial impressions.

Halo Effect

The halo effect occurs when one positive characteristic influences overall judgement.

For example, a highly articulate applicant may be assumed to possess better organisational skills, animal handling ability or decision-making capacity despite limited objective evidence.

Conversely, one negative characteristic should not overshadow strengths demonstrated in other areas.

Each aspect of assessment should be evaluated independently.

Horn Effect

The horn effect is the opposite of the halo effect.

One perceived weakness influences overall judgement.

For example, a handler arriving late because of inaccessible public transport may be incorrectly viewed as unreliable in all aspects of their care.

Professional judgement should be based upon patterns of evidence rather than isolated incidents.

Anchoring Bias

Anchoring bias occurs when early information disproportionately influences later decision-making.

For example, a referral letter describing a handler as “challenging” may unconsciously shape the practitioner’s expectations before meeting the individual.

Inclusive practitioners approach every assessment with an open mind and remain willing to revise their impressions as new information becomes available.

Attribution Bias

Attribution bias involves making assumptions about why people behave in particular ways.

For example:

A handler missing appointments may be assumed to be unmotivated when the actual cause is inaccessible transport, chronic illness, fatigue or financial hardship.

Rather than assuming intent, practitioners should explore the circumstances contributing to behaviour.

Availability Bias

Availability bias occurs when recent or memorable experiences influence future decisions.

For example, after working with one unsuccessful assistance animal partnership involving a particular breed, a practitioner may unintentionally overestimate the likelihood of similar outcomes in future cases.

Professional decisions should be based upon objective evidence rather than memorable anecdotes.

Stereotypes and Assumptions

Stereotypes are simplified beliefs about groups of people.

While often unconscious, stereotypes can influence expectations regarding disability, age, culture, socioeconomic status, gender, family structure or education.

Examples might include assuming that:

• older adults cannot successfully handle an assistance dog;
• autistic individuals cannot advocate for themselves;
• people living in rental accommodation are unsuitable handlers;
• individuals with mental illness cannot maintain animal welfare;
• families with children cannot successfully manage an assistance animal.

These assumptions may unintentionally create barriers to equitable service delivery.

Each person should be assessed individually based on their own circumstances rather than assumptions associated with group membership.

Diagnostic Overshadowing

Diagnostic overshadowing occurs when professionals incorrectly attribute new concerns solely to an existing diagnosis.

For example, behavioural changes in an autistic handler may be assumed to result from autism rather than pain, anxiety, grief or environmental stress.

Similarly, fatigue may be attributed solely to disability when it may indicate an unrelated medical condition.

Occupational therapists should avoid allowing existing diagnoses to overshadow comprehensive assessment.

Every concern deserves careful consideration on its own merits.

Bias Towards Assistance Animals

Bias may also affect perceptions of assistance animals themselves.

Examples include assumptions that:

• certain breeds are always suitable;
• rescue dogs are less capable than purpose-bred dogs;
• older dogs cannot learn new tasks;
• particular disabilities require specific breeds;
• larger dogs are always more capable.

While evidence should inform selection, practitioners should avoid relying on generalisations.

Every dog should be assessed individually according to temperament, health, welfare and task suitability.

Inclusive Decision-Making

Inclusive decision-making is a deliberate process that reduces the influence of bias by using objective, transparent and evidence-informed methods.

Strategies include:

• using standardised assessment tools where appropriate;
• applying consistent eligibility criteria;
• documenting clinical reasoning;
• seeking multidisciplinary perspectives;
• encouraging reflective practice;
• considering alternative explanations;
• involving the handler in shared decision-making;
• reviewing decisions regularly.

Structured decision-making improves consistency while reducing the influence of personal assumptions.

Reflective Questions

Before making important decisions, occupational therapists should ask themselves:

• What evidence supports this decision?
• Have I considered alternative explanations?
• Could unconscious assumptions be influencing my judgement?
• Would I make the same decision if this person belonged to a different group?
• Have I actively considered the individual’s strengths?
• Have I sought the person’s own perspective?
• Would another practitioner reviewing this case reach a similar conclusion?

These questions encourage deliberate reflection and strengthen professional reasoning.

Organisational Strategies to Reduce Bias

Inclusive organisations recognise that bias affects systems as well as individuals.

Strategies may include:

• structured assessment processes;
• clear eligibility criteria;
• multidisciplinary decision-making;
• regular calibration between assessors;
• reflective supervision;
• cultural safety training;
• diversity education;
• auditing organisational decisions;
• reviewing complaints and appeals;
• encouraging feedback from service users.

Reducing bias should be viewed as an ongoing quality improvement process rather than a one-off training activity.

Key Message

Bias is a natural part of human thinking, but ethical practice requires professionals to recognise its potential influence on decision-making. Occupational therapists should continually reflect upon their assumptions, seek objective evidence and adopt structured decision-making processes that promote fairness, transparency and inclusion.

By remaining curious, reflective and evidence-informed, practitioners strengthen the quality of their assessments, protect assistance animal welfare and ensure that every handler is considered as an individual rather than through the lens of stereotypes or assumptions. Inclusive decision-making ultimately benefits individuals, organisations and the broader assistance animal sector by creating services that are equitable, accountable and grounded in professional integrity.