The Practice Advice Service provides information to College members and members of the public about relevant Legislation, Regulations, Standards of Professional Conduct, 2017, and other practical considerations. Answers are provided by College staff in response to specific inquiries and may not be applicable or generalized to all circumstances. Information is provided to support College members in exercising their professional judgment and is not an appropriate substitute for advice from a qualified legal professional.
During the third quarter of this year (December 1, 2022- February 28, 2023), the College’s Practice Advice Service addressed 411 queries. The five most common topics queried during this period, in descending order, were:
- Mobility and practice in other jurisdictions, mostly relating to member practice outside of Ontario;
- Release of and access to information, mostly relating to the client’s right of access and consent to access or disclose information;
- Supervision, primarily concerning the supervision of non-members;
- Fees and billing, the most common queries related to the setting of fees and prepayment of fees;
- Records, most focusing on file contents and file retention.
Answers to many of these queries can be found on the Professional Practice FAQ page of the College website which includes the following recent additions.
Sharing Raw Data with Non-Members
Q: I was taught many years ago that Raw Data from psychological tests should Only be shared with other Psychologists and Psychological Associates. More recently, I have heard this might not be true. Must such information only be shared with another member of the profession?
A: We’ve heard about this incorrect position from enough people to assume that, at some time in the past, it must have been promulgated widely. While the legislation permits one to refuse access to personal health information in some limited circumstances, including raw data from psychological tests, it does not prohibit one from allowing access to it. In many cases, it is expected that raw data will be provided, even to non-members.
A list of exceptions to the right of access to personal health information can be found in section 52 of the Personal Health Information Protection Act (PHIPA), 2004. Most of the exceptions relate to the expectation of serious risk associated with the disclosure.
Members who have insufficient cause to withhold raw data may have concerns about the risk of releasing the information to those who are not sufficiently trained to interpret it. In such cases, members are advised to attach a statement to the raw data indicating that raw data from standardized tests can lead to incorrect conclusions, and that this information should only be interpreted by those who are regulated psychological service providers with adequate training and experience in the interpretation of test results. Detailed further information about the release of raw data can be found on the College’s Professional Practice FAQ pages
Client Reluctance to Sharing Information within the Circle of Care
Q: I am working with a challenging patient who is reluctant to permit me to share information with other allied health care professionals who are involved in the patient’s care. They have not expressly prohibited me from sharing information but I worry that they might, if they knew they could. May I simply rely on the Implied Consent Provisions of PHIPA and just release relevant and appropriate information to colleagues that are also working with the patient?
A: It is a client’s right to decide who their personal health information may be shared with, subject to some exceptions set out in the Personal Health Information Protection Act (PHIPA), 2004. The Office of the Information and Privacy Commissioner of Ontario has published some helpful information about the Circle of Care, a colloquial term describing how one may rely on implied consent and the Lock Box, the colloquial language used to describe how a client may limit what can be shared where one could ordinarily have relied upon implied consent. All members who have not yet reviewed these documents, should familiarize themselves with these concepts and rules.
While there may be an argument that a member is not technically violating PHIPA if they provide information based upon implied consent, and in the absence of an explicit request not to share it, it isn’t really in the spirit of the legislation to do so, particularly if one believes a client who understood their rights, might capably choose to limit disclosure of their personal health information. In such cases, it would be most prudent to discuss this with the client and clarify what their wishes are.
If there is reason to believe that a client would not want their personal health information shared, even if they have not sought to have the information ‘placed in a lock box’, one should consider the impact of sharing the information on the therapeutic alliance or on the client’s trust of other health care professionals, if the client believes their privacy has not been respected.
Workplace Safety and Insurance Board (WSIB) and Privacy
Q: Can a custodian disclose personal health information to the Workplace Safety and Insurance Board (WSIB) about an injured worker without the individual’s consent?
A: This question has been answered by the Office of the Information and Privacy Commissioner of Ontario and can be found in the Frequently Asked Questions; Personal Health Information Protection Act September 2015, on page 31 of the document:
The answer reads as follows:
Yes. PHIPA permits the disclosure of personal health information without consent, if permitted or required by another law. For example, this means that PHIPA does not interfere with the Workplace Safety and Insurance Act (Act), where that Act requires a hospital or health facility, which provides health care
to a worker claiming benefits under the insurance plan, to give the WSIB such information relating to the worker as the WSIB may require. This requirement also applies to a health care practitioner who provides health care to a worker or is consulted with respect to a worker’s health care. When requested to do so by an injured worker or the employer, the Act requires a health care practitioner treating the worker to give the WSIB, the worker and the employer prescribed information concerning the worker’s functional abilities.
SERVICES DELIVERED VIA TECHNOLOGY
Q: I’ve been reading about ChatGPT, a newly popular artificial intelligence chatbot, and its applications to mental health services. Is it ethical to use AI in the provision of mental health services?
A: The Standards of Professional Conduct directly address the use of technology in the generation of assessments, reports and statements:
10.7 Use of Computer-Generated Reports
Information obtained from computer-generated assessments, reports or statements must not be substituted for a members professional opinion.
Members are free to responsibly use technological advances as an adjunct to their own assessments and interventions, however, it is the position of the College that these professional activities must always be actively mediated by members who are authorized to provide the services and that members must remain fully accountable for services provided in their names.
To date, there is insufficient scientific evidence to demonstrate the effectiveness and safety of using ChatGPT or other Artificial Intelligence (AI) to assess or treat mental health conditions and the risk to clients may outweigh any potential benefits. Anyone considering the use of AI to assist or augment their services should ensure, as part of the informed consent process that clients understand how technology is being used to assist them, what the risks are of technological error, and also what risks there are to their privacy when personal information is being used in an AI context.