The Practice Advice Service provides information to College members and members of the public regarding relevant Legislation, Regulations, Standards of Professional Conduct, 2017, and other Guidelines. Answers are provided in response to specific inquiries and may not be applicable or generalize to all circumstances. Information is provided to support College members in exercising their professional judgement and is not an appropriate substitute for advice from a qualified legal professional.
FAQ’s – A New Resource for Members
The College’s Practice Advice Service has launched a Professional Practice FAQ page and this is can be found in the Members section of the College website. It is a place for members to quickly and easily search for answers to questions about a variety of practice issues commonly asked questions of the Practice Advice Service
NATURE OF INQUIRIES between June 1 and August 31, 2021:
Between June 1, 2021 and August 31, 2021, the College received and responded to 401 . During this period, a small number (16) of these queries were related to practicing during the COVID-19 pandemic.
Recent Q and A’s related to Vaccinations
Q: May I require that clients provide proof of vaccination before providing in-person services?
A: Ontario has recently mandated that individuals must be vaccinated before entering many specific settings. These settings are listed in O. Reg. 364/20: Rules for Areas at Step 3 and at the Roadmap Exit Step under the Reopening Ontario Act, 2020. It appears that this requirement does not apply with respect to entering a place for the purpose of health care.
The Ontario Human Rights Commission recently published a policy statement which provides guidance with respect to COVID-19 vaccine mandates and proof of vaccine certificates. It states, among other important things, that:
While receiving a COVID-19 vaccine remains voluntary, the OHRC takes the position that mandating and requiring proof of vaccination to protect people at work or when receiving services is generally permissible under the Human Rights Code (Code) as long as protections are put in place to make sure people who are unable to be vaccinated for Code-related reasons are reasonably accommodated. This applies to all organizations.
Members considering implementing such policies may find useful information about how to proceed in the Ministry of Health’s Proof of Vaccination Guidance for Businesses and Organizations under the Reopening Ontario Act, Version 2, September 27, 2021. If additional information is required, members may wish to seek independent legal advice.
Q: May I provide a client with a letter recommending an exemption to vaccination requirements?
A: It is our understanding that the criteria for an official “medical vaccination exemption” are very narrow and that these do not include psychological reasons. As well, only a physician, registered nurse or nurse practitioner may certify such an exemption for settings mandated to require proof of vaccination. It does not appear that members of the College of Psychologists are authorized to provide such certification. It is important that a client making a request of this type be aware of the limits of the member’s authority. Further information may be found in the Ministry of Health’s Questions and Answers, Version 2, September 28, 2021.
If the business or organization is not covered by the mandatory vaccination legislation, members could provide a professional opinion concerning a client’s need for accommodation. In doing so, as with any professional opinion given, they must be prepared to present a rationale for such an opinion.
Should a member proceed to provide a letter related to a vaccination exemption, members should clearly indicate that it is for psychological reasons and that, in keeping with Principle 10.3 of the Standards, “must render only those professional opinions that are based on current, reliable, adequate, and appropriate information.” As well, it is important that members recognize they could be held accountable should an employer or other party mistakenly accept their letter as a valid official “medical exemption”, and remember that making a record, or issuing or sign a certificate, report or similar document that they know or ought to know is false misleading or otherwise improper, is an act of professional misconduct.
There are answers to a variety of questions concerning practice during the pandemic available on the College website.
NON-PANDEMIC INQUIRIES
Between June 1 and August 31, 2021, member most frequently sought advice on the following five topics:
- Mobility of psychological services across jurisdictions;
- Records (most often about file contents, Health Information Custodians and retention and destruction of records);
- Supervision (most often about supervision of non-regulated individuals and individuals who are members of other regulated professions);
- Fees and billing (most often about issuing receipts, setting of fees and Harmonized Sales Tax); and
- Release of and access to personal health information (most often about authority to give substitute consent, particularly with respect to children of separated parents and release of raw test data).
Answers to most of the questions asked can be found on the College’s Professional Practice FAQ page.
The following questions and answers have recently been added and provide information with broad application that members may find helpful.
Compensation Models and Conflict of Interest:
Q: Can members who employ other practitioners offer financial or other incentives based upon clinical productivity and performance?
A: It is appropriate for private practitioners, including contractors, to be compensated based on time spent and the complexity of services provided. If providing additional incentives to treatment providers could be reasonably expected to lead to decisions about service planning that are motivated by factors beyond client needs this could be problematic. For example, this could be problematic if compensation rather than client needs lead to practicing the profession while in a conflict of interest and/or providing services which are not likely to benefit the client; both of which are considered acts of Professional Misconduct. Members are advised to support their staff and contractors in ensuring that client need is the primary consideration in service planning.
Supervisors Co-signing Documents
Q: I am aware of the requirement for supervisors to co-sign « all psychological reports and formal correspondence related to psychological services”. Does this mean they should co-sign all clinical notes, like progress notes in the client’s chart?
A: As required by Standard 4 of the Standards of Professional Conduct, 2017, members supervising anyone who is not a member of the College and any member with a Certificate of Registration Authorizing Supervised Practice must co-sign all psychological reports and formal correspondence related to psychological services prepared by their supervisee.
The term “formal” has not been officially defined so members must use their professional judgment based upon the particular circumstances of each situation.
In generally, formal documents would likely include printed or electronic communications which ordinarily require the person responsible for the information to provide their endorsement of the information in the form of a signature. This might include letters, reports, official memos, and emails about a client which would reasonably be expected to provide information about a client to anyone outside of the organization in which the supervision is occurring.
When in doubt about whether to co-sign a document, it may help to consider that a supervisor’s signature is meant to provide an assurance to readers of the information it has been endorsed by the professional responsible the service. Even if not strictly required to co-sign a document, supervising members may do so if they wish to inform readers that they endorse the contents.
Authorization to Provide Therapy Involving Family Members vs. Family Therapy
Q: Can a person authorized to work with individuals but not families involve family members in the individual’s therapy. In other words, where is the line between family therapy and involving family members to support interventions with an individual?
A: The answer to this question depends upon the reason for involving family members in the treatment of an individual.
Individual therapists appropriately may involve a client’s family member(s) for the purpose of facilitating support for intervention with the individual. For example, a person’s family member(s) might be asked to become involved in making changes in the client’s environment to facilitate change or to be trained to provide reinforcement for desirable behaviours as part of a behavioural intervention program. A family member could also be asked to attend sessions with a person who, for some reason, may not be able to successfully participate in individual therapy without support. In such a scenario, the family member(s) attending would not be the object of the intervention themselves but would instead be there to help the client obtain optimal benefit from the individual therapy.
If the purpose of involving family members is to facilitate any changes in the family dynamics or the way in which family members interact with one another, this would be viewed as an family intervention. For example, this would be the case when it is the therapist’s intention to address an individual’s symptoms or behaviours of concern by addressing the patterns of interaction between family members which precipitate or maintain the difficulties. In order to provide such intervention to families, one must have specialized knowledge and training and the specific authorization of the College.