Need to Know
I encourage you to review all of the articles in this issue. September’s ex.press contains several ‘Need to Know’ items for you, including:
- Your New Executive and Council – Resulting from the recent professional member election, and appointments, learn about CASLPO’s new Executive and Council members (See College Updates)
- "Self Reporting” and what you need to know in terms of changes made to provide the public with information that would assist them in making informed decisions about their care providers (See Government – New Act Announcements)
- Resources in place to assist you with annual registration renewal before the October 1st deadline and more (See Registration)
- Communicating Clinical information or a diagnosis: Do you know the Difference? For an article and answers to your frequently asked questions (See Practice Advice)
- Seeking Peer Feedback. Find out why seeking feedback from others is so important (See Quality Assurance)
- CASLPO Forums – Your opportunity to learn about new date(s), information and how to access forums you may have missed (See CASLPO Forum)
To find out more about these and other topics, click all sections and articles.
National Entry-to-Practice Exams Coming in 2020
The Canadian Alliance of Audiology and Speech-Language Pathology Regulators (CAASPR) recently announced an agreement with Speech-Language & Audiology Canada (SAC) to develop and administer entry-to-practice examinations for the registered professions of audiology (AUD) and speech-language pathology (SLP).
The professions will now join the ranks of other regulated health care professions in Canada that require successful completion of an national entry-to-practice examination as a necessary, non-exemptible condition of licensure. The examinations, with an anticipated first administration in the fall of 2020, will be based on essential competency profiles recently adopted by the CAASPR Board of Directors (Click here)
CAASPR Chair, Josée Levasseur, said: “The introduction of national regulator-sponsored exams is a great achievement for public safety. Partnering with SAC, who have thirty years of experience in the delivery of high-quality certification exams for our professions, made them the logical and responsible choice to administer our regulatory exams.”
Recognizing that the introduction of entry-to-practice examinations represents a paradigm shift in provincial assessment and admission processes, CAASPR and its member regulators will be providing regular updates to both current and prospective registrants on how the new “Canadian Entry to Practice (CETP) Examination”, may impact current and future registration. Implementation details are being determined by a joint CAASPR/SAC Exam Implementation Advisory Group, which is co-chaired by CASLPO, Registrar, Brian O’Riordan, and SAC Past-Chair, Jennifer O’Donnell. The ongoing work by CAASPR and its member regulators will be guided by the following principles:
- All SLPS and AUDS who are registered in regulated jurisdictions will not be required to pass the CEPT Examination to maintain licensure;
- SLPs and AUDs who are not registered with a provincial regulator and who wish to work in a regulated province will be required to write the CETP Examination to qualify for licensure;
- Due to provincial legislation in Quebec, new graduates from accredited Canadian speech-language pathology or audiology programs who are applying for licensure in Quebec may be exempt from writing the CEPT Examination, and
- Until transition to the new CAASPR CETP Examination is complete, those applying for registration in British Columbia and Newfoundland and Labrador, will still be required to meet the existing condition of passing SAC’s Clinical Certification Examination.
CASLPO and CAASPR will be providing information over the next two years to University students, Faculty and employers.
External funding facilitating this milestone in regulation of the professions of audiology and speech-language pathology has been made possible through a Contribution Agreement with the Government of Canada as part of their Foreign Credential Recognition Program.
CAASPR is the national alliance of regulators that have been established and mandated by provincial governments to regulate the professions of audiology and speech-language pathology and govern registrants in their respective jurisdictions.
CAASPR’s mandate is to address common regulatory issues on a national level to advance the practice and regulation of audiology and speech-language pathology in Canada. CAASPR facilitates the sharing of information and building of consensus on regulatory issues to assist member regulators in fulfilling their mandate to protect the public.
LtoR: Joanne Charlebois, CEO, SAC; Jennifer O’Donnell, Chair, SAC Board; Colleen Braun-Janzen, 1st Vice-Chair, SAC Board; Linda Walsh. Board Member, CAASPR; Lori McKietiuk, Past-Chair, CAASPR, Brian O’Riordan, Board Member, CAASPR.
CASLPO Annual Report 2017
Review the indicators of progress and accomplishments that your College has made. View Annual Report PDF
Changes Affecting Registrants
New CASLPO Executive Committee
The College has a new set of Officers and a new Executive Committee. In accordance with the By-Laws of the College, the Council holds elections for Officers and the other members of the Executive Committee at its June meeting each year. Any member of Council, whether an elected professional, an academic or a public member, may run for the Executive Committee. All terms are for one year and members may be re-elected.
As a result of the election held by Council on June 8, 2018, Bob Kroll was re-elected as President. Mr. Kroll, a Speech-Language Pathologist, represents District 6 (All Ontario).
Elected Vice-President (Audiology) is Jennifer Anderson. She represents District 5 (North-East Region).
Elected Vice-President (Speech-Language Pathology) is Tina D'Agnillo. Ms. D'Agnillo represents District 3 (South-West Region).
These three officers of the College are joined on the Executive Committee by Véronique Vaillancourt (AUD) representing District 1 (Eastern), Ruth Ann Penny (Public Member) and Melanie Moussa-Elaraby (Public Member).
The College also has a new academic member joining Council.
Lynn Ellwood (SLP) is an Associate Professor, Teaching Stream, and Coordinator of Clinical Education at the University of Toronto. Lynn brings clinical experience in a broad range of settings, from acute care to community-based, and in both public and private sectors. She has mentored volunteers, students and clinical peers and remains clinically active with a small private practice. She joined the Department of Speech-Language Pathology at the University of Toronto in 2003. She is an active member of the Canadian Academic Coordinators of Clinical Education Committee for the Canadian Council of University Programs, as well as the Ontario Council of University Programs in Rehabilitation. Lynn is a long-standing member of both the national and provincial professional associations. She has chaired the Awards Committee for Speech-Language and Audiology Canada, and currently advises the Exam Item Writing Sub-committee.
Jennifer Anderson (AUD) was re-elected to Council in May in District 5 (North-East Ontario) She provides diagnostic services to the ENT Associates and rehabilitation services at Helix Hearing Care in Barrie. She also serves as a Professor for the Communicative Disorders Assistant post-graduate course at Georgian College, Barrie.
Tara Barber (SLP) was elected in May to a first term on Council representing District 4 (Northwest Ontario). Tara works for the Keewatin Patricia District School Board, a board that covers a geographic area the size of France and two time zones! Tara has also been a part of various CASLPO committees as a non-council member for several years.
Pam Millett (AUD) was first elected to Council in May to represent District 2 (Central Ontario). She is an Associate Professor and Academic Coordinator in the Deaf and Hard of Hearing Education Program at York University. She was also an educational audiologist in school boards and schools for the deaf in Ontario. She served as a non-council member on CASLPO committees and as a member of the Board of Directors for the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA), and was awarded Honours of the Association for OSLA in 2015.
Yvonne Wyndham (SLP) was re-elected to Council in May representing District 2 (Central Ontario). Yvonne works currently with the Toronto District School Board as a field SLP. Yvonne is a member of her department’s Technology and Public Relations Committees and was also a long time member of her department’s Professional Practices Committee. Yvonne was also a BBC Canada voice-over artist for six years.
To review all Council member biographies, click here.
Government - Legislative Changes / Announcements
Director of Professional Conduct
Brian O’Riordan, Registrar
Preeya Singh, Director of Professional Conduct & General Counsel
SELF-REPORTING: WHAT YOU NEED TO KNOW
In the last issue of ex.press, we highlighted that, following the 2017 amendments to the Regulated Health Professions Act, 1991 (“RHPA”), all regulated health care professionals would be required to report details respecting registrations with other regulators as well as information about criminal charges and convictions. Some of that information will be made public on CASPLO’s register. These changes, which came into effect on May 1, 2018 and are now required of all CASLPO members, were made to provide the public with information that would assist them in making informed decisions about their care providers.
Findings of Guilt
Any audiologist (“AUD”) or speech language pathologist (“SLP”) practising his or her profession in Ontario who has been found guilty of an offence, must report information about such conviction to CASLPO. The reporting of offence information is not limited to those occurring within Ontario. Offences that occur within Canada or internationally must also be reported to CASLPO.
Charges & Bail Conditions
Being charged with an offence now triggers the reporting requirement. Further, any information respecting conditions of release, imposed or agreed to, must be reported to the College. As is the case with findings of guilt, information respecting charges and conditions are not restricted to those made within Ontario and any criminal charge must now be reported to CASLPO.
Professional Negligence & Malpractice
All RHPA-regulated health care professionals are required to report any findings of professional negligence or malpractice. As such, AUDs and SLPs must inform CASLPO of such findings of professional negligence or malpractice.
Professional Membership, Professional Misconduct, & Incompetence
As noted above, CASLPO must be informed if an AUD or a SLP is registered with another regulatory body. Members must report all their registrations and this reporting requirement is not restricted to health care regulators or registrations in Ontario. For example, if an AUD is registered to practice in England or as a lawyer in New York, she must inform CASLPO.
If there are findings against a member for professional misconduct or incompetence by other regulatory bodies, those findings must also be reported by the member to the College.
WHAT NEEDS TO BE REPORTED TO CASPLO?
Members who are obligated to make a report to CASLPO based upon the above categories must include:
- His/her name;
- The description of the offence or finding;
- Date in which the finding or charge was made;
- Name and location of the body who made the finding; and,
- Status of any appeal (if applicable).
Such reports should be made to the Registrar and should be made as soon as reasonably possible after the finding, charge, or registration has been made.
These reporting requirements are mandatory. AUDs and SLPs must remember that self-regulation means that members are held to a high standard that the public relies upon. Without regulation, and these requirements, the professions lose the respect and trust the public places in them.
Depending upon the details, information provided by a member may not fall into the categories identified above. All members are encouraged to contact the College for further information about any charges, findings, or registrations that occurred prior to May 1, 2018.
Please note that these obligations are in addition to the mandatory reporting requirements that regulated AUDs and SLPs are required to make in cases of sexual abuse, professional misconduct, incompetence, and/or incapacity. For further information on those requirements, please refer to the September 2017 issue of ex.press.
Director of Professional Practice and Quality Assurance
COMMUNICATING CLINICAL INFORMATION OR A DIAGNOSIS: DO YOU KNOW THE DIFFERENCE?
Alexandra Carling Ph.D.
Director of Professional Practice and Quality Assurance
The purpose of this article is to provide clarity about the clinical information that CASLPO members can communicate to patients and substitute decision makers (SDM) when providing health care services contrasted with information that is involved when communicating a diagnosis.
A diagnosis is the identification of an underlying disease or disorder that causes the speech, language, audiology and swallowing symptoms or disorders.
According to the Regulated Health Professions Act (RHPA), communicating a diagnosis is a controlled act that speech-language pathologists (SLPs) and audiologists are not allowed to perform. Communicating a diagnosis is described as:
“Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.” (RHPA 27 (2) 1.)
Impact On Members
1. Members are prohibited from Communicating to the individual or their personal representative a diagnosis
Members have the knowledge, skills and judgement to assess the patient and make an SLP/AUD diagnosis within their scope and area of practice. However, members, by law, cannot communicate the diagnosis (underlying cause) to the patient or their personal representative (SDM).
2. The diagnosis you are communicating "identifies a disease or disorder as the cause of symptoms"
Members cannot communicate the disease or disorder that causes the speech, language, audiology and swallowing symptoms or disorders. For example, members cannot tell patients that they have the following: stroke, autism, otosclerosis, cerebral palsy, ALS, Meniere's Disease, Parkinson's disease, genetic syndromes etc.
Members can communicate their clinical findings, including speech language pathology and audiology symptoms and dysfunctions if they are not the cause of symptoms.
3. "It is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis."
If another authorized health professional has communicated the diagnosis, members can refer to the provided diagnosis in discussions with the patient and/or SDM.
Patients often ask SLP and audiologists for more information about the disease or disorder. Providing this information, when the disease or disorder has already been communicated by the diagnosing professional, does not, in the College's opinion, fall within the controlled act of communicating a diagnosis, so this is permitted.
WHAT INFORMATION CAN BE SHARED WITH PATIENTS AND/OR SDMS?
Speech language pathologists and audiologists have a professional obligation to communicate their assessment results and clinical findings to their patients and/or SDMs (Code of Ethics Principle 1) However, in communicating assessment results and clinical findings, members must not communicate the underlying cause (diagnosis).
SLPs and audiologists must provide patients/SDMs with sufficient information to obtain informed consent for assessment and treatment. Informed consent for treatment requires an SLP or audiologist to communicate the nature of the proposed service, the risks and benefits of the proposed plan and alternatives before commencing treatment. (SAT Professional Standards, Consent Guide and Health Care Consent Act). The nature of the proposed service is based on the assessment results which are shared with the patient and/or SDM.
COMMUNICATING ASSESSMENT RESULTS
When communicating assessment results, members may use terms which describe symptoms and dysfunctions within their scope of practice. They may also use qualifiers such as mild, moderate, severe or profound.
Some of these terms may include the word “disorder”. Members must make sure the word disorder is being used to describe symptoms; for example, “swallowing disorder” or “vestibular disorder”. Here the word “disorder” describes symptoms but does not identify the cause of the symptoms.
Examples of terms that describe symptoms include, but are not limited to:
- Speech, motor speech, articulation delay and disorder
- Language delay and disorder
- Sensorineural, conductive or mixed hearing loss
- Fluid in the ear
- Aphasias, dysarthrias, apraxias, including childhood apraxia of speech
- Cognitive communication disorder
- Stuttering, hoarseness, hypo/hyper-nasality
- Tinnitus, vestibular disorders
- Auditory processing disorder
- Dysphagia or swallowing disorder
- Velopharyngeal insufficiency
- Auditory Neuropathy Spectrum Disorder
When using these terms, members should follow a patient-centred approach and discuss the symptoms and dysfunctions that contribute to the disorder. Members should explain that the disorder or dysfunction is not the underlying cause, that the cause could be multifactorial or unknown. When the patient or SDM want more information regarding the underlying cause (diagnosis), they should consult a physician or other professional who is authorized to communicate the diagnosis.
WHAT INFORMATION CANNOT BE SHARED WITH PATIENTS AND/OR SDMS?
When sharing clinical information and assessment results with patients and/or SDMs, members should avoid using the words “diagnose”, “diagnosing” or “diagnosis”. These words could lead the patient or SDM to rely on your information as the underlying cause, which is prohibited.
When members are the first health professional to identify a potential underlying cause (the diagnosis has NOT been communicated by an authorized health professional), members must not communicate terms that include an underlying cause or are outside the member’s scope of practice.
Examples include, but are not limited to:
- Vocal nodules/polyps etc.
- Gastro esophageal reflux disease
- Noise induced hearing loss
- Meniere’s disease
- Autism spectrum disorder
- Attention-deficit/hyperactivity disorder
- Acoustic neuroma
- Benign Paroxysmal Positional Vertigo (BPPV)
- Depression or Anxiety disorder
- Aspiration pneumonia
- Concussion or Traumatic Brain Injury (TBI)
- Zenker’s diverticulum
- Esophageal dysmotility
Members are encouraged to work collaboratively with other professionals to improve patient health outcomes through communication, enhanced decision making and mitigation of risk. You can discuss your clinical findings, including possible underlying causes with other professionals. This does not constitute communicating a diagnosis to a patient or SDM. The conversations you have with fellow professionals are different from the conversations you have with patients and SDMs. Use your professional judgement regarding patient risk of harm and urgency of referral.
SLPs and audiologists during their assessment, may be alerted to signs or symptoms which are indicative of a disease or disorder. Often SLPs and Audiologists are uniquely qualified to assess signs or symptoms and to provide data that is essential for a health professional with authority to communicate a diagnosis to arrive at a definitive diagnosis. In this case, it is the member’s responsibility to make the patient aware of the significance of the signs or symptoms and to suggest a referral to an appropriate diagnosing professional for a definitive diagnosis.
There are many programs in all areas of healthcare that include a diagnostic label. Because you are recommending to the patient or SDM that a referral be made to such a program, you are not communicating a diagnosis. This communication should occur in a manner that will not result in the patient or SDM relying upon the information as a diagnosis.
When members are communicating assessment information, they must ask themselves the following:
- Does the patient and/or SDM already know the causal diagnosis?
- Is the clinical information I want to communicate:
a. in my scope of practice?
b. describing symptoms and dysfunctions?
c. identifying the underlying cause of the symptoms (diagnosis)?
EXAMPLES OF LANGUAGE TO USE WITH PATIENTS AND SDMS
These examples refer to situations where diagnostic information has NOT been provided by an authorized health professional.
- The results of the aphasia assessment indicate that you have the symptoms of non-fluent aphasia, let me explain what this means . . .
- The audiogram and other tests show you have a moderate conductive hearing loss in both ears, the next steps are . . .
- The assessment results and my classroom observations suggest that your child has a language disorder. This means . . .
- I have assessed your son and observed him both in the classroom and during school recess with his friends. The results show that he presents with moderate to mild stuttering. We can explore treatment options which might include. . .
- As you know, your wife coughs when drinking liquids. The results of the video fluoroscopic swallowing study show that she has a swallowing disorder. The liquids entered her throat too quickly and the muscles that protect her airway are slow, so traces of liquid went into her airway and lungs. My recommendations are . . .
- From the background information you gave as well as my assessment, you have symptoms consistent with a balance disorder, also known as a vestibular disorder.
- Based on the assessment results, I am concerned about some of the atypical communication social and non-verbal behaviours and I would encourage you to have them investigated by a physician or a psychologist. They will be able to look at broader developmental skills that are beyond speech and language. There could be several reasons for these behaviours, so I recommend that you discuss this with your child’s physician.
- The results of the hearing assessment combined with your background information show a sensorineural hearing loss. There are many causes for this type of hearing loss. If you want to know more about the underlying cause, you need to consult a physician.
FREQUENTLY ASKED QUESTIONS
SLP SERVICES TO CHILDREN
1 Q: What if the team member that you communicate with documents your information in the patient record that includes a possible diagnosis?
1 A: Educate the team on who can and cannot communicate a diagnosis. There are other professionals who may not have access to the controlled act. Ensure your team members document your clinical findings without including a diagnosis.
2 Q: I am an SLP working in a school board. I have assessed a grade one student and the results indicate a severe language disorder. His language disorder is a barrier to him accessing the curriculum and I want to initiate a referral to Special Equipment funding, so he can use a dedicated iPad in the classroom. I have discussed my assessment results and recommendations with the student’s parents and told them they will receive a copy of the report. I am worried that the report is communicating a diagnosis because I have written “severe language disorder”, but if I don’t, he might not get the special equipment funding.
2 A: Because the term “severe language disorder” is a specific label for a description of symptoms, and does not suggest a cause, you can inform the parents of your assessment results, which indicate a severe language disorder. You can include the term in your recommendation of funding for an i-pad and software to help him in the classroom. However, if the parent asks you what caused the language disorder you can say the cause is often unknown. Nevertheless, if they wish to pursue this question, they should consult a pediatrician, child psychologist or developmental assessment team.
3 Q: I see many children who show clear signs of being on the autism spectrum, before the diagnosis has been made by a pediatrician or psychologist. I document my assessment findings in the patient record but am cautious about what I communicate to the parents. However, given the patient/SDM may request a copy of the record, should I document that my findings may suggest a potential diagnosis of autism?
3 A: It is prudent to avoid documenting diagnostic terms such as ‘autism’. Even though the patient record is not a typical vehicle of communication between a health professional and a patient, you are correct to consider that the patient has the right of access. At the same time the patient record must be accurate, complete, accessible and retained (Records Regulation). You should document the signs and symptoms you have observed, such as social skills, play behaviour, non-verbal communication etc. but avoid the diagnostic term, ‘autism’. You should also document your recommended referrals.
Speech-Language pathologists and audiologists are uniquely qualified to provide clinical information that contributes to a diagnosis outside of our scope of practice made by health professionals who can make and communicate the diagnosis.
4 Q: I am an SLP working in a preschool setting. When I assess a child who shows the typical signs of autism I make a referral to the local Autism Assessment Team. Also, the Hanen Program has an excellent program called ‘More than Words for Parents of Children for Autism’. How do I make a referral for either program without communicating a diagnosis to the parents?
4 A: After discussing the signs and symptoms you have observed, you can explain to the parents that although you recommend a referral to the Autism Team or Hanen Program, it does not necessarily mean that their child has autism. It does mean, however, that s/he will get a thorough developmental assessment or participate in the most suitable program. Explain that you are trained to examine one area of development, which is communication. The communication patterns you have observed are not typical and combined with other social and play behaviours warrant further investigation to ensure the best plan of care. The pediatrician/psychologist and team will examine all areas of development then the pediatrician/psychologist can make and communicate a diagnosis and discuss a plan of care.
5 Q: I recently assessed a young boy who shows ‘red flags for autism’. In the discussion following the assessment, the parents asked me if their child has autism. How do I respond?
5 A: You cannot make or communicate a diagnosis of autism as it is out of your scope of practice. However, you can discuss clinical information. In doing so, use your professional judgement in how you frame the information and the terms you may or may not use based on the perception of the parents.
Key points for your discussion:
- Discuss observed communication issues within your scope of practice
- Make it very clear that you are NOT making a diagnosis of autism
- Refer the child to an authorized health professional who can make and communicate an autism diagnosis
- Document the conversation in detail in the patient record
Some of the atypical communication, social and play behaviours I am seeing, such as XXX, are behaviours that may be associated with developmental issues such as autism. However, as an SLP, I am only looking at one area of your child’s development.
It is not within my scope of practice to make an autism diagnosis. I strongly recommend that you see your family doctor to get a full developmental assessment that will look at all areas of your child’s development. For example, a developmental pediatrician, psychiatrist, or a psychologist are the professionals that can look at all areas of development and can make and communicate a diagnosis.
Don’t say “I think your child has autism”.
6 Q: The College has said that we can communicate apraxia as long as we don’t provide information on the cause of the apraxia. Can we use the term Childhood Apraxia of Speech (CAS) when talking to parents?
6 A: Yes, you can. You must make sure that the child’s parents understand the motor speech symptoms and proposed plan of care. Ensure they are not under the assumption that you are providing a diagnosis identifying a disease or disorder as the cause of the symptoms.
SLP SERVICES TO ADULTS
7 Q: I work in an adult outpatient rehab clinic. The other day I saw a patient for an initial assessment and my observations and clinical findings suggest signs and symptoms of Parkinson’s disease. I know I cannot communicate Parkinson’s disease to the patient, but can I discuss my concerns about a potential progressive neurological disease with her family physician?
7 A: Yes, you can. Consistent with a patient centred approach, discuss your concerns with the patient first regarding her speech, voice or swallowing without using diagnostic terms such as Parkinson’s disease. Recommend that you would like to communicate directly with her physician regarding your findings, and if required, obtain consent to do so. You can call or write to the physician outlining your assessment results, the signs and symptoms you have observed and recommend a neurological consultation. Finally, recommend that the patient make an appointment to see their physician for further investigations and discussions.
8 Q: Can we quote objective findings from the patient chart in our reports that outline a diagnosis; e.g.; CT results which describe an infarct or chest X-ray that shows pneumonia?
8 A: Yes you can when the findings have been documented by a physician and shared with the patient. When writing reports, you are always using your clinical judgement to determine relevance of what needs to be included.
9 Q: When an outpatient presents with symptoms of esophageal dysphagia and gastroesophageal reflux, how can we communicate this to the individual and give them lifestyle or diet strategies that may help to alleviate their symptoms while they wait for an appointment to see their physician?
9 A: You can discuss their symptoms, your clinical findings and offer suggestions for lifestyle modifications and diet suggestions to see if these make a difference, until they see their physician. If the patient asks about the cause and diagnosis, encourage them to discuss it with their physician. The physician can confirm an underlying cause of the symptoms they are experiencing.
10 Q: I often ask my patients: “Do you know what has happened to you?” as part of the interview. If they reply with: “Yes, I have had a stroke”, would this be sufficient evidence of the diagnosis already being known?
10 A: Yes, you can assume this is sufficient evidence, and refer to the stroke when explaining the communication issues the patient is experiencing.
11 Q: What can I say when reporting on imaging of the esophagus during a VFSS? If the radiologist is not available immediately to comment on the esophageal phase or a structural abnormality, can I document what I’ve seen, with the intent of seeking consultation after the VFSS?
11 A: Yes, you can document what you are observing such as a protrusion, reduced esophageal clearing, or prominence specifying the area. You cannot use terms that indicate a diagnosis such as esophageal motility, achalasia, web, or any additional anatomical structural abnormalities or esophageal abnormalities. The authorized physician can make and communicate these diagnoses (cricopharyngeal bar, cervical osteophytes, Zenker's diverticulum, Barrett's esophagus, etc.).
12 Q: I am an SLP who works in a hospital outpatient voice clinic. The format of the team is interprofessional and the ENT physician has delegated the controlled act of communicating to patients and SDMs the voice diagnosis of vocal nodules. We do not communicate any other voice disease or disorder which provides information about the underlying cause. Is this okay with the College?
12 A: Yes, as long as you have the competencies necessary to distinguish between vocal nodules and other voice pathologies and follow the requirements in the Position Statement on the Acceptance of Delegation of a Controlled Act.
13 Q: During the hearing assessment of a child with reported speech delay, I conducted tympanometry and the results were suggestive of middle ear fluid. During inspection of the ear (otoscopy) I saw that the ear drum was inflamed, and audiometry indicated an air-bone gap. What can I communicate to the child’s parents?
13 A: You can report your findings, that the hearing test results indicate a conductive hearing loss and that otoscopy and tympanometry suggest fluid in the middle ear. You cannot tell the parents that the child has an ear infection (i.e., otitis media) because this would be identifying the disease or disorder that causes the audiology symptoms, the conductive hearing loss and middle ear fluid being the symptoms. You would share your recommendations for follow-up, for example, encouraging the parents to consult with a family physician or an ENT for the diagnosis and treatment. Finally, you would document the assessment findings and information you provided to the parents, being cautious about the language you use so that the information in your report is not interpreted as a diagnosis.
14 Q: I am confused! I am an audiologist working at a children’s hospital. Can we communicate Auditory Processing Disorder (APD)? Research shows that APD is not a diagnostic term rather it is a disorder with either an unknown cause or it is linked to various other causes, for example autism, ADHD, or traumatic brain injury. APD is a term that describes symptoms or dysfunctions, so can I tell the parents that their child has APD?
14 A: Yes, you can use the term Auditory Processing Disorder, and discuss the symptoms and dysfunctions with the parents and how it affects their child and the child’s learning. If the parents have been informed by a professional with access to the Controlled Act, you can discuss the underlying cause, for example, a traumatic brain injury.
15 Q: In my audiology practice, I often see patients who present with a case history and hearing assessment results typical of noise induced hearing loss (NIHL). Is it acceptable for me to say to the patient, or to write in the patient file, that the type of hearing loss is “consistent with NIHL”? Also, am I providing a diagnosis if I refer the patient to the WSIB NIHL program of care and provide them with the funding application?
15 A: Audiologists can make the diagnosis of NIHL. However, they can’t communicate NIHL because it is a diagnosis identifying the disease or disorder that causes symptoms such as sensorineural hearing loss or difficulty hearing in noise. Therefore, you must be cautious about using NIHL in your direct communication with the patient and in your documentation. You can use terminology such as “consistent with”, “may be consistent with” or “may suggest” NIHL, if it is clear to the patient, and in your documentation, that you are not communicating a diagnosis.
A referral to the WSIB’s program for NIHL, does not mean that you are communicating a diagnosis. However, if you suspect that your patient is interpreting your referral to the NIHL program as a diagnosis, you should take steps to clarify the information with the patient and document appropriately.
16 Q: I had a patient with all the typical signs for acoustic neuroma. I went through his hearing test results and told him that he should be referred to an ENT for further investigation (I did not mention my diagnostic findings). He agreed to the referral and to me writing a report to his family physician outlining my findings. The patient came back into the office today very distressed, he had looked up his symptoms on the internet. He wanted to know if he had an acoustic neuroma. What can I say?
16 A: You can acknowledge that the symptoms may appear consistent with what was found on the internet related to acoustic neuroma, but that the symptoms may have another cause. Underscore the peril of relying on the internet and the value of consulting a physician. It would not be appropriate to confirm the diagnosis of acoustic neuroma. Advise your patient to discuss his symptoms with the ENT, who will be able to identify many other factors that go into an accurate diagnosis. If his appointment is not immediate, encourage him to visit his family physician.
17 Q: I am an audiologist who does testing for the Infant Hearing Program (IHP). We are trained to follow specific protocols to determine if an infant has Auditory Neuropathy Spectrum Disorder (ANSD). If assessment results indicate ANSD I feel compelled to communicate this information immediately to the parents/family. If I do not communicate my findings right away it could delay important intervention needed by the infant and the family. In addition, if I do not specifically indicate “ANSD” in my report I fear that the other healthcare providers, including physicians, involved with follow-up care may not act upon my findings. How can I ensure that I meet my professional obligations while also being compliant with the legislation on communicating a diagnosis?
17 A: It is understandable that in some circumstances it may be crucial for timely intervention that the patient and family immediately receive information about assessment results.
ANSD is a term used to describe a “component” of, or type of, hearing loss, much like the terms sensorineural or conductive. The term ANSD does not refer to an underlying disease or disorder that causes symptoms but rather refers to specific assessment findings associated with a cluster of symptoms that lead to serious auditory challenges. Therefore, use of the term ASND in your communication with patients or in a patient report would not be outside the legislation.
However, it is important to carefully consider how the parent/family will rely on the information you provide. If you tell the parents that your results indicate possible ANSD, you must ensure that the parents are not relying on this information as a diagnosis. If the parents ask you what caused the ANSD, or if ANSD is a diagnosis, then you must tell them that identifying the cause of ANSD is outside your scope of practice and encourage them to consult with the ENT physician. In your documentation and reporting you should use the term ANSD judiciously and be clear that your use of this term is not a diagnosis.
If you have questions about what you can and cannot communicate to patients and families, contact our Practice Advice team:
Alexandra Carling, Director of Professional Practice and Quality Assurance
416-975-5347 ext. 226
Sarah Chapman-Jay, Advisor, Professional Practice (speech language pathology) and Quality Assurance
416-975-5347 ext. 228
Samidha Joglekar, Audiology Advisor and Manager of Mentorship; English/French Language
416-975-5347 ext. 220
David Beattie, Speech Language Pathology Practice Advisor, French-language
Director of Registration Services
Each CASLPO member must renew their registration online to continue practising as an audiologist or a speech-language pathologist in Ontario. To renew, you must complete CASLPO’s online renewal and submit a payment of the annual fee.
Monday, October 1, 2018 at 11:59 PM EDT
The College experiences the highest volume of renewal submissions the week before the October 1 deadline. To avoid any last-minute complications, please renew early.
If you choose NOT to renew your certificate of registration, you must formally resign from the College. To resign, log into CASLPO's Member Portal and click on the link to Renew. Then select the link to change your membership status and select resigned. Follow the instruction to complete your resignation request. The College will contact you by email when your request has been processed.
Academic - $750
General - $750
Initial - $750
Non-Practising - $375
Life - $70
Reporting Professional Registrations
You are now required to report all professional licenses and registrations in any jurisdiction.
Reporting Charges and Bail Conditions
You are also now required to report:
- if you have been charged with any offence in any jurisdiction; and
- if you are subject to any bail or other conditions by a court or similar authority.
If you need assistance, please refer to the following available resources on our website:
Still need assistance?
1. Email email@example.com. This is the recommended method during this busy time.
2. Call 416-975-5347 or Toll-free (Ontario) 1-800-993-9459, Monday through Friday between 9 AM to 5 PM (EDT) to speak to a member of our Renewal team or to leave a message:
- Colleen Myrie, Director of Registration Services ext. 211
- Jessica Laforet, Program Assistant Registration Services, ext. 213
- Baron French, Director of Information Technology, ext. 216
Including your name, registration number and a brief summary of your problem (via email or voice message) will enable us to find a solution.
Please note that due to a higher volume of emails and calls during this time, it may take longer than usual to reply. We appreciate your patience.
If you experience issues in the Member Portal, please clear your browser cache and log into the member portal again before you call the College for assistance. For instructions to help you clear your browser cache, click here.
RENEWAL SUMMARY AND PAYMENT RECEIPT
After you have completed your renewal, a summary of your renewal, including your payment information, is displayed for you to print. Your summary remains available via the Top Items section on the portal welcome page.
OFFICIAL TAX RECEIPT
Your official tax receipt for 2018 may be downloaded from our website on March 1, 2019.
If you fail to complete your renewal before the October 1st deadline, a 20% late fee in addition to the annual fee must be paid to complete your online renewal.
NOTICE OF INTENTION TO SUSPEND
If you do not complete your online renewal before the October 1st deadline has passed, the Registrar may send you a notice of intention to suspend your certificate of registration. If you have not completed the online renewal within 30 days of the notice being sent, the Registrar will proceed with suspension of your certificate of registration.
After your certificate of registration has been suspended, the Registrar will notify your employer of the suspension.
A permanent notation of the suspension will appear in your record on the College’s public register. Your name may also be included on a list of the suspended members appearing in CASLPO’s newsletter ex.press.
UPDATES AFTER YOUR RENEWAL:
You must update the following information in the member portal within 30 days of a change:
- your registered name;
- your citizenship or immigration status;
- the address and telephone number of your primary residence;
- your business addresses or business telephone numbers;
- your preferred email address.
If one of your colleagues passes away during the registration year, please notify the College. The College will need to know the name of the deceased member and the date upon which the member died. Once the College has received and confirmed the information, we will update the public register and stop all further correspondence to the deceased member.
Why is seeking feedback from others so Important?
There are two major reasons. First, having regular communications with peers helps audiologists and speech-language pathologists to reduce the risk to patients of ‘regulatory drift’. Secondly, one of the most effective forms of learning is through peer-feedback; we are not always the best judges of our own behaviours.
Every January you complete the Self-Assessment Tool (SAT) and reflect if you are meeting the professional practice standards.
The Clinical Practice standard requires audiologists and speech language pathologists (SLPs) to:
possess, continually acquire and use the knowledge and skills necessary to provide quality clinical services within their scope of practice.
There are seven behavioural indicators to help you to determine if you meet the Clinical Practice standard, the last one being:
“I seek feedback from others in my profession regarding my clinical practice”
1) REGULATORY DRIFT: REDUCING PATIENT AND MEMBER RISK
Members who work on their own may be at increased risk of ‘drifting away’ from maintaining the College’s practice standards.
How do we know this?
In addition to an emerging body of research regarding risk factors for healthcare practitioners, CASLPO’s own data supports this. All the members who have participated in a Specified Continuous Education or Remediation Program (SCERP) as an outcome of a peer assessment have been sole practitioners or with little contact with other members of the College.
When we seek feedback from our peers about difficult cases, ethical dilemmas, new approaches and current standards we protect the public by reducing the risk of drifting away from regulation.
2) THE VALUE OF OBJECTIVE FEEDBACK AND LEARNING
By its very nature, self-assessment is subjective. Although the SAT provides members with behavioural indicators to reflect on and determine if they meet the standards, not all of us are good judges of our own behaviours and needs. Some members are hard on themselves deciding that they need work to meet the standards when they don’t. Others, after reflection, decide that they meet the standards, when they could benefit from reviewing standards to keep current. For example, perhaps details have been forgotten about record keeping, consent, supervising support personnel or being responsive to a patient’s cultural background. Also, may be the most current assessment and treatment protocols have not been considered.
By communicating with colleagues and seeking their feedback, we can learn and better determine if we meet the College’s Practice Standards, which includes remaining current, and providing evidenced based, safe, quality service.
SUGGESTIONS FOR SEEKING PEER FEEDBACK
Research into the area of continuing education tells us that one of the most effective forms of learning is peer-feedback. This can take a variety of forms:
- Face to face, e-mail, or telephone exchanges regarding complex case discussions
- Reviewing a chart or report with a colleague
- Having a colleague observe your therapy for additional input
- Clinical special interest groups
- Interactive clinical special interest blogs
Any form of documentation that reflects these activities (e.g. email, note in calendar) is evidence that you are meeting the standard.
Also, you can contact one of the College’s Practice Advisors by phone or email. Remember, you don’t have to give us your name.
416-975-5347 or 1-800-993-9459 (Ontario)
Alexandra Carling, Director of Professional Practice and Quality Assurance
firstname.lastname@example.org Extension 226
Sarah Chapman-Jay, Speech Language Pathology Practice Advisor; English-language
email@example.com Extension 228
Samidha Joglekar, Audiology Advisor and Manager of Mentorship; English/French Language
firstname.lastname@example.org Extension 220
David Beattie, Speech Language Pathology Practice Advisor, French-language
Director of Professional Practice and Quality Assurance
Audiologists and speech language pathologists are able to view newly developed and broadcasted eForums
So far this year e-Forum topics have included:
- External Influences on CASLPO
- Consent Issues for Audiologists
- Communicating Clinical Information
If you missed them, you can access the slides and recordings on the ‘Events’ page of CASLPO website http://www.caslpo.com/events/e-forums.
You will have an opportunity to attend three e-Forums scheduled for the fall:
- September 19th - Billing Insurance Companies for Service
- October (TBD) - Guide for the Provision of Second Opinions
- October (TBD) - Practice Standards for Cerumen Management
Timmins and Windsor are planned for October. We are looking forward to meeting with audiologists and speech language pathologists to update you with new information and to discuss issues important to you and your clinical practice.
If you would like a CASLPO staff member to visit your department or group and present on a topic of interest, contact me at email@example.com. We will come in person for large groups and join via webinar or teleconference for smaller groups.
Complaints and Hearings
Director of Professional Conduct & General Counsel
LEARNING FROM OUR DISCIPLINE HISTORY
An important part of self-regulation is the ability of a profession to effectively regulate its members when they engage in acts of professional misconduct. For audiologists (“AUD”) and speech-language pathologists (“SLP”) practising their respective professions in Ontario, CASLPO’s Professional Misconduct Regulation (“Regulation”) outlines 37 profession specific acts, that when engaged in, constitute professional misconduct. This is in addition to the acts of professional misconduct applicable to all regulated health care professionals outlined by section 51(1) of the Health Professions Procedural Code (being Schedule 2 of the Regulated Health Professions Act, 1991).
In recent years, decisions issued by panels of the College’s Discipline Committee highlight important obligations AUDs and SLPs bear in their professional lives.
USE OF THE DOCTOR TITLE
Section 33 of the Regulated Health Professions Act (“RHPA”) restricts the use of the doctor title, including any variations, abbreviations, or equivalents in another language, to seven categories of health care professionals. AUDs and SLPs are not among the seven categories identified by the RHPA.
In CASLPO v. Berge, a panel of the Discipline Committee found the member guilty of professional misconduct in that she used the doctor title while she practised the profession of Audiology (guilty of paragraphs 16, 31, 34, and 37 of the Regulation). The panel ordered a reprimand, a three-month suspension of her licence (one month to be remitted), six unannounced practice inspections, and the completion of a remediation course. The panel also ordered costs to the College in the amount of $97,595.00.
This decision has application to both AUDs and SLPs, and all health professions subject to the RHPA. While using the doctor title may not seem like a grievous violation, it is against the law. The restriction is meant to prevent confusion by vulnerable patients dealing with health concerns or illnesses. It should also be noted that this decision has withstood a considerable amount of judicial scrutiny, as Ontario’s Divisional Court upheld the Discipline decision and leave to appeal was denied by both Ontario’s Court of Appeal and the Supreme Court of Canada.
PROFESSIONAL RELATIONSHIPS & BOUNDARIES
Members must maintain strictly professional relationships with their patients. Previously, AUDs and SLPs could determine when enough time had passed following a professional relationship to engage in a personal or sexual relationship with a former patient.*
In CASLPO v. D’Onofrio, a panel of the Discipline Committee found the SLP member guilty of professional misconduct for entering into a sexual relationship with a former patient too soon after discharge from her care (guilty of paragraph 37 of the Regulation). The panel ordered a reprimand, a four-month suspension, three months of which was to be remitted if she completed a remediation course (although the course had to be successfully completed in any event), a two-year practice monitoring program and $5,000.00 in costs to the College.
All AUDs and SLPs must remember the inherent power imbalance that exists in the treatment relationship. Patients are vulnerable in this power imbalance, so it is always the responsibility of the AUD or SLP to behave in a professional manner.
THIRD PARTY BILLING
Health care providers are not only entrusted by the public to provide quality health care, but they are also entrusted by organizations to conduct themselves in an honorable manner. Organizations, like those that are publically funded, rely upon the professionalism of AUDs and SLPs to bill in an honest way.
In CASLPO v. Thomas, a Discipline Committee panel found the AUD member guilty of professional misconduct in that, among other things, he knew, or ought to have known, that using the billing number of a retired ENT doctor for OHIP funding was inappropriate (guilty of paragraph 2, 22, 23, and 37 of the Regulation). The panel ordered a reprimand, revocation of the member’s certificate of registration, and $10,000.00 in costs to the College.
Inappropriate third party billing is a very serious offence, as it impairs the ability of public and private programs to provide funding for patient care. AUDs and SLPs bear the responsibility to bill in an honest way, and, in so doing, are trusted to help these programs continue to be viable for the benefit of Ontarians.
These decisions highlight only a few areas of professional misconduct. While very few members will ever find themselves before a panel of the Discipline Committee, AUDs and SLPs are responsible for understanding all areas of professional misconduct contained within the RHPA and the College’s Professional Misconduct Regulation.
*As of May 1, 2018, amendments to the RHPA prohibit a health care professional from engaging in a sexual relationship with a patient within one year of the treatment relationship ending.
Do you or your colleagues have a positive patient impact story to share?
Consider sharing an experience about either your practice setting, technology usage or innovative programs implemented. Email Lisa Gibson, Communications Manager for more information.