Psychological Services Across Jurisdictions

Originally published in Volume: 1 Issue: 2 of HeadLines

Members may provide services to an individual located in another jurisdiction, but only if they have been authorized by the College or Board in that jurisdiction to do so. If the psychology regulator in the other jurisdiction permits this practice, it would also be important to confirm that one’s professional liability insurance coverage extends to one’s work with an individual in the other jurisdiction.

In Canada, the practice of psychology is regulated at the provincial/territorial level.  That is, each province/territory is responsible for the regulation of psychological services delivered within its borders.  Within the United States, psychology is similarly regulated.

At this time, most jurisdictions regulating psychology in Canada and the US, including the College of Psychologists of Ontario, view services to be delivered in the province/territory/state in which the client is located whether such service is provided in person or through telepsychology.  That is, the service is deemed to be provided where the client is, regardless of where the psychologist or psychological associate may be located.  Given this, many regulatory bodies expect the practitioner to be registered/licensed in the jurisdiction in which the service is being provided.

At this time, there is some variability in the expectations of the various Canadian jurisdictions with regard to what is required of a practitioner providing services by telepsychology into their province/territory.  Some may have temporary or courtesy registers which permit a member to practise within their jurisdiction for a limited period of time without formal registration with them.  For members considering providing service by telepsychology into another jurisdiction, it is recommended that they contact the regulatory body of the jurisdiction into which they may be considering practising to determine what may be required of them in terms of registration/licensing or formal notification of the regulatory body for psychology. The College of Psychologists of Ontario has adopted, as advice to members, the Model Standards for Telepsychology developed by the Association of Canadian Psychology Regulatory Organizations (ACPRO).  In addition, a joint task force of the Association of State and Provincial Psychology Boards (ASPPB), the American Psychological Association (APA) and the American Psychological Association Insurance Trust (APAIT) has recently developed Guidelines for the Practice of Telepsychology.  The Canadian Psychological Association has also published Draft Ethical Guidelines for Psychologists Providing Psychological Services Via Electronic Media.

Members considering providing telepsychological services will find these documents very useful as they provide guidance on a variety of issues related to this type of service.  This includes ensuring one is legally entitled to practise in another province, territory, or state and one is familiar with the relevant laws and regulations applicable within that jurisdiction.

The provision of psychological services is regulated locally within most North American provinces, states and territories, for the purpose of protecting those located within the province, state, or territory.

In most jurisdictions, including Ontario, services are deemed to be delivered in the location of the client. Each jurisdiction has its own statutes and regulations and has the authority to take action with respect to unauthorized practice. For this reason, permission must be sought from the College or Board in the same province, state or territory as the person who will be receiving services is physically located.

Members may provide services to an individual located in another jurisdiction, but only if they have been authorized by the College or Board in that jurisdiction to do so. From time to time, requirements of other jurisdictions can change and members are encouraged to check with the jurisdiction in which the client is located. If the psychology regulator in the other jurisdiction permits one to practice in their jurisdiction, it would also be important to confirm that one’s professional liability insurance coverage extends to one’s work with an individual in the other jurisdiction.

Members may be interested to know that there is a Memorandum of Understanding with Nunavut. At this point in time, there are no such agreements with other provincial regulators.

Ontario statute requires that one must be a member of the College of Psychologists of Ontario, or supervised by a member of the College, to provide psychological services to a person located in Ontario.

The Psychology Act, 1991 states:

Restricted titles

8 (1) No person other than a member shall use the title “psychologist” or “psychological associate”, a variation or abbreviation or an equivalent in another language. 

Representations of qualification, etc.

(2) No person other than a member shall hold himself or herself out as a person who is qualified to practise in Ontario as a psychologist or psychological associate or in a specialty of psychology. 

Idem

(3) A person who is not a member contravenes subsection (2) if he or she uses the word “psychology” or “psychological”, an abbreviation or an equivalent in another language in any title or designation or in any description of services offered or provided. 

Exception for university faculty

(4) Subsections (1) and (3) do not apply to a person in the course of his or her employment by a university. 

Temporary, limited membership is available to individuals licensed to provide psychological services in other jurisdictions allowing them to provide services for a period of up to 12 months. To learn more and to apply for this form of membership please click here.

In order to provide psychological services to an individual located in Ontario, or hold out as qualified to do so, the Psychology Act, 1991 requires that one must be a member of the College of Psychologists of Ontario, or be working under the supervision of a member of the College. There may be circumstances in which there is a need to include, by way of videoconferencing or teleconferencing, an individual located in Ontario in a session conducted with your clients in your own home jurisdiction. So long as the involvement of the person in Ontario is limited to their role as a resource in treating or assessing the clients in your own local jurisdiction, and not for the purpose of treating or assessing the individuals located in Ontario, they may be included. In such a case, they may be considered a collateral resource for the benefit of the clients receiving your service in your own jurisdiction.

The Psychology Act, 1991 limits the provision of psychological services in Ontario to members of the College of Psychologists of Ontario.  In the absence of legislative amendments, the College is not able to authorize anyone other than members of the College to provide telepsychology services to clients located in Ontario.

Under normal circumstances, the College views such activities by non-members as "unauthorized practice" and considers whether there is a need for appropriate action. The College has carefully considered the extreme circumstances in which we find ourselves.  We recognize this must be taken into account with regard to duly registered/licensed practitioners from other jurisdictions who must provide telepsychology services into Ontario for their existing clients during the current emergency situation.

Therefore, in response to the urgent COVID-19 situation, the College will not initiate an "unauthorized practice" action against an out of province practitioner provided the practitioner is:

• registered/licensed in good standing in another jurisdiction at the time the services are provided;
• practices only within their areas of competence and in accordance with any terms, limits and conditions on their license/certificate of registration; and
• only provides the services to:

– existing clients temporarily in Ontario due to the COVID-19 situation when it is clinically ill-advised to temporarily stop services and/or to transfer the service to a member of the College of Psychologists of Ontario;

–  clients who are temporarily located in Ontario due to the COVID-19 situation and are entitled to receive those services as a benefit of their registration with a University or College or other benefit program outside of Ontario, where the services will be provided by an out of province practitioner on behalf of the University or College counselling service or other benefit program; or

– clients who are temporarily located in Ontario due to the COVID-19 situation, when it is reasonably expected that the clients will require continuing services with the same practitioner upon the client’s return to the jurisdiction in which the clinician is registered.

Out of province practitioners are asked to confirm their understanding and acceptance of the requirements listed above by notifying the College of their intention to provide telepsychology service to existing clients in Ontario. Practitioners should email the College (cpo@cpo.on.ca) providing their name, the jurisdiction in which they are registered/licensed, and their registration/license number.  While the College will endeavour to acknowledge receipt of this information, practitioners need not wait for confirmation before initiating service.

A member of the College of Psychologists of Ontario may provide services to clients located in Ontario, whether or not the College member is in Ontario at the time. In other words, a member of the College of Psychologists of Ontario who is travelling outside of the province may provide services via technology to clients located in Ontario while they are away. Specific information about the provision of services via technology may be found in in Standard 15 of the Standards of Professional Conduct, 2017.

The College of Psychologists of Ontario does not have the authority to grant permission to provide psychological services anywhere other than in Ontario. College members may provide services in other jurisdictions wherever they are permitted to by the psychology regulatory body in that jurisdiction, so long as they do so in accordance with the Standards of Professional Conduct, 2017.

Section 125 of the Child, Youth and Family Services Act, 2017 (CYFSA) sets out the duty to report a child in need of protection. It states:

125 (1) Despite the provisions of any other Act, if a person, including a person who performs professional or official duties with respect to children, has reasonable grounds to suspect one of the following, the person shall immediately report the suspicion and the information on which it is based to a society. Society is defined in the legislation as an agency designated as a children’s aid society under subsection 34 (1);

In considering this section of the legislation, there are two components to contemplate.  First, there is nothing in the legislation which suggests that the suspected abuse or neglect must have occurred in Ontario to be reportable.  Therefore, one is obligated to make a report regardless of where the suspected concerning behaviour occurred.

Second, the duty to report is to a “society” which the Act states is an agency designated by the Minister of Children and Youth Services as a children’s aid society.  Since the Minister only has the authority to designate an agency as a “society” within Ontario, the obligation to report “to a society” must be to an appropriate agency within Ontario.

This analysis suggests that if a member has an obligation to report a suspicion of abuse or neglect which occurred outside of Ontario, they would have a duty to report to an Ontario CAS.  It would then be up that agency to determine the best course of action to take but the member would have fulfilled their legislative obligation.

Section  125 also sets out the nature of emotional harm that a child must be experiencing, or which it is reasonably expected would experience, to necessitate a report, if the harm results from, or would be expected to result from the actions, failure to act or pattern of neglect on the part of the child’s parent or the person having charge of the child.