Brian O'Riordan,
Registrar

As we finally get some spring-like weather here in Ontario, welcome to our fourth on-line issue of ex.press.  Thank you to all those who have shared your views and opinions about this new format.  Please continue to send your feedback to [email protected]

CASLPO will be marking this year’s "May is Speech and Hearing Month" with a new public awareness initiative which you will be hearing about shortly.

In this issue of ex.press, you will find some very useful and practical advice concerning several important matters relating to your work as a speech-language pathologist or audiologist.  This includes an article about working with volunteers in your practice, featuring a helpful question and answer section and answers to FAQs.  Elsewhere, we explain how certain information relating to College decisions concerning Oral Cautions and Specified Continuing Education or Remediation Programs (SCERPS), will now appear on the public register.

There is new information on our popular CASLPO Forum regional visits for 2016 and updates on developments in “Transparency”, “Clinic Regulation”, Registration and Quality Assurance.

This issue's Feature Article focuses on how the College has been working with the Aphasia Institute to make sure that our public information resources are truly accessible for people living with a communication barrier.

Enjoy ex.press Volume 2 - Issue 1, and have a great "May is Speech and Hearing Month"!

Brian O’Riordan
Registrar

These highlights relate to the Council meetings of December 11, 2015 and March 3, 2016.

At the December meeting, Council learned that the College received 134 first-time registrant applicants, with 76 members retiring, for a net increase in membership of 58.  The Council approved the College’s audited financial statements for 2014-2015, following a detailed review by the Finance Committee.

The Registrar reported that Assistant Deputy Minister Denise Cole of the Ministry of Health and Long-Term Care, had recently commented to registrars that the government did not have plans to reduce the number of 26 existing regulatory health professional Colleges, but is considering that an oversight body similar to the Public Standards Authority in England may need to be created.

At its meeting on March 3, 2016, the Council observed a minute of silence in tribute to the passing of Margaret Stoicheff, a speech-language pathologist and professor, who was a founding member of both the Ontario Association of Speech-Language Pathologists and Audiologists and CASLPO.

The Registrar reported on recent discussions with the College of Dietitians of Ontario concerning Dysphagia management competencies respecting their members and speech-language pathologists.

The Council approved sending out for review by members of the College, the revised Position Statement on The Use of Support Personnel by Speech-Language Pathologists, as well as the new Practice Standard and Guideline on the Provision of Hearing Aid Services by Audiologists.

Council was apprised of the work of the Law Commission of Ontario with respect to matters involving legal capacity and consent to treatment.  The College has submitted a response to the Commission’s Interim Report in this regard.

Carol Bock, Deputy Registrar

Increasing public awareness is a primary goal for the next 3 years.

Click here to view CASLPOs New Strategic Plan

Increasing Patient Protection through Clinic Oversight

Brian O’Riordan
Registrar

The Clinic Regulation Working Group (WG) of 13 health regulatory colleges, including CASLPO, completed its work recently by endorsing a draft document which will form the basis of a submission to the Ministry of Health and Long-Term Care.  The draft document reflects much of the input received over the last several months of province-wide consultation.  In all, there were 8,000 visits to the consultation website; over a thousand individuals viewed related webinars; 1,400 people completed the on-line survey; the 6 townhalls in different regions of the province drew over 250 participants; and 20 professional advocacy associations submitted responses, including the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). The feedback received indicated that stakeholders generally agreed that the lack of formal regulatory clinic oversight presented a serious gap in public protection.  However, there was less consensus about how to achieve such oversight, with reservations being expressed about the framework model being proposed by the Working Group, as well as the potential direct and downstream costs of an additional type of regulation.

Taking the feedback into consideration, the WG decided to present a report to the Minister of Health and Long-Term Care, which summarizes the work and research of the WG, and suggesting that the group stands ready to assist the government if it wishes to engage in future discussions about the area of clinic regulation.  The WG remains convinced that improved oversight of the care provided in clinics is essential to improving access, supporting patients and protecting the health care system.  The members of the WG are now bringing the draft report to the Minister to their individual governing councils for approval over the next few months.
 

Transparency is a priority for health care regulators

Federation of Health Regulatory Colleges of Ontario (FHRCO)

When it comes to your wellness, the best results come from being open with your health care professional. The same idea is true for the bodies that regulate Ontario’s health professions – and that is why transparency is stated as such a priority.

In health care, transparency means ensuring that you have access to relevant information about practitioners, as well as a clear understanding of regulatory processes and decision-making. The goal is to help you make informed choices about such an important aspect of your life.

“The role of regulators is to protect the public,” says Marshal Moleschi, president of the Federation of Health Regulatory Colleges of Ontario. “That can’t happen without trust and confidence in the people who provide care and in the organizations governing them.”

FHRCO (www.regulatedhealthprofessions.on.ca) is made up of 26 colleges which oversee over 300,000 Ontario health care professionals. The colleges set requirements for entering the professions, administer programs to ensure professionals maintain their knowledge, and also hold them accountable for their conduct and practice.

Transparency is a major part of the regulators’ own accountability, Moleschi points out. One of the most visible examples is the public register. Each college has a directory of members accessible to anyone online, which includes all sorts of information about those professionals.

The colleges are now considering how to add more details to the public register about individual health care professionals, around things like discipline and cautions. That will give the public even more crucial information to help make decisions about their care and who provides it.

Adding to transparency, the meetings of the college councils plus most disciplinary hearings are open to the public. The colleges hold public consultations as well to seek feedback on regulations, by-laws and policies. To participate in these consultations, contact the college you are interested in (you’ll find links on FHRCO’s website). Increasingly, the colleges are also providing the public with greater context and fuller explanations around how they regulate.

According to FHRCO, these efforts will continue to grow. In late 2014, the Ontario government’s minister of Health and Long-Term Care asked all of the colleges to report on how they’ll continue to integrate transparency in their strategic plans, and also how they will increase transparency in their processes, decision-making and information disclosure.

“From governments to corporations, we’re seeing an important trend to be more transparent in the eyes of the public,” Moleschi explains. “Transparency is not just about making more information public. It is also about making that information clear, timely, relevant and accessible so everyone can understand and act on it.”

Responses by the colleges to the minister’s request are posted on their individual websites. In many cases, you can also find special sections about their overall transparency initiatives.

Alexandra Carling-Rowland Ph.D.

Director of Professional Practice and Quality Assurance

Practice Advice: Benefits of volunteers

Here at the College we receive a number of enquiries regarding volunteers; either working with volunteers or members wishing to volunteer themselves. People volunteer for a variety of reasons, from a sense of wanting to ‘give back’, to gaining valuable experience or to help a university application. Volunteers bring a variety of skills and benefits to the work place: professional expertise, previous life experiences and enthusiasm.

Principles of working with volunteers

When working with volunteers remember that you, as the College member, are responsible for all aspects of patient care. Also, a patient’s name when connected to audiology or speech language pathology is personal health information and must remain confidential.

Before you work with volunteers, ask yourself the following questions:

• What activities and tasks do I want help with?
• What activities and tasks is the volunteer capable of doing?
• Will I ask the volunteer to carry out clinical tasks?
• What clinical tasks, with what patients and under what circumstances?

The answer to these questions will direct the use and supervision of your volunteers.

Frequently Asked Questions

Question - I have a psychology student volunteering with me who wants to apply to graduate school for speech-language pathology. She has been observing sessions, doing some patient activities with me and she has very good interactive skills. Can she work with patients on her own if I supervise her?

Answer - Although the student is a volunteer, if you want her to provide any form of intervention with patients, you should consider her ‘support personnel’. Support personnel refers to individuals who are directly assigned clinical tasks by the member to assist in the provision of speech language pathology or audiology related intervention.

As a College member, you are responsible for all aspects of patient care that you assign to the volunteer. You are expected to exercise discretion and judgement in assigning clinical tasks; ask yourself, does the volunteer have the skills for this task with this patient? You must get informed consent from the patient or substitute decision maker (SDM) to receive services from a volunteer and supervise them both directly and indirectly. You must also ensure that the volunteer’s clinical activities are documented in the patient record.

For more information on working with support personnel please refer to the Position Statement on the Use of Support Personnel by Speech Language Pathologists.

Question - I work in a community communication program which uses trained volunteers. The volunteers document group attendance, but are experienced volunteers allowed to document anything else in the patient record?

Answer - Consider the knowledge, skills and judgement of the volunteer and the potential activities you wish them to document. If you have a supervisory relationship with the volunteer and you are assigning clinical tasks to carry out with the group members, the volunteers are considered to be support personnel and you must follow the College’s Position Statement.

Yes, volunteers, under these circumstances, can document activities and patient responses in the patient record. However, only College members can form a clinical opinion or interpretation. Remember your supervisory requirements, which include reviewing support personnel documentation. Position Statement on the Use of Support Personnel by Speech Language Pathologists. Finally, the Records Regulation requires the following to be documented:

32.2. 6. The identity of the person who provided any service to the patient, if that person was not the member.

Question - I am an audiologist and I own my own clinic. I have been approached by a high school student who wants to complete their volunteer hours at the clinic carrying out office duties. Can he file patient charts and answer the phone etc.?

Answer - If you would benefit from the services of a volunteer high school student, then yes. However, you should consider carefully the tasks you want to give the student and determine their skill level. Whatever task they do for you, they will come across people’s names, and because those names are linked to you as an audiologist, the names are personal health information. Your volunteer student must sign a confidentiality agreement and you must impress upon them the gravity of keeping personal health information confidential.

With regard to answering the phone, determine if the student has the competencies and communication skills to interact with your patients and potential patients. This task also involves collecting personal health information, and care must be taken. Presumably you will train him about the services you offer and the documentation requirements. If a patient cancels an appointment, for example, that must be documented in the patient record (Records Regulation).

Ultimately you are responsible for every aspect of patient care including ensuring personal health information is confidential and that patients are treated with respect and sensitivity.

Principles of working as a volunteer

As a general member, when volunteering your services as an audiologist or speech language pathologist, you must comply with all College standards as though you were in a paid position.

Question - I am a general member of CASLPO but lost my job six months ago. I thought it would be easy to get another job, but that isn’t the case. Can I volunteer at an Aphasia Centre program as an SLP? Will the hours count towards the currency requirement for registration (750 hours over a three year period)?

Answer - Yes you can volunteer your services as an SLP with a general member certificate. Remember, even if you are not being paid, as a general member of the College you have to follow all regulation requirements and practice standards, and participate in the Quality Assurance program. It is beneficial to ensure that the Aphasia Centre knows that they should have the same expectations of you as an SLP staff member.

Yes, you may document the volunteer hours towards the currency requirements outlined in the Registration Regulation. We have included the definitions of Direct Client Care and related work:

PATIENT CARE includes Direct Client Care or Supervision of Direct Client Care where:

DIRECT CLIENT CARE is defined as professional activities on behalf of a client including:

• Assessment of the hearing, communication or swallowing abilities and needs of the client.
• Recommending, developing or implementing a treatment and/or management program based on the clients abilities and needs.
• Counseling and consulting with the families/caregivers and/or other parties or individuals directly associated with the client.
• Other client management activities such as discharge, referrals, follow-up, report writing, case conferences.
• Conducting research in speech-language pathology or audiology that involves the assessment or management of patients with communication disorders.

SUPERVISION OF DIRECT CLIENT CARE is defined as:

• Overseeing and evaluating the clinical work of speech-language pathologists or audiologists (e.g. conducting performance evaluations or case reviews, assessing written reports, monitoring professional standards).
• Determining, on professional grounds whether an individual client should receive or be discharged from speech-language pathology or audiology services.
• Supervising research in speech-language pathology or audiology that involves the assessment or management of clients with communication disorders.

RELATED WORK includes:

• Making decisions on the organization and delivery of clinical services in speech-language pathology or audiology.
• Educating speech-language pathologist or audiologists concerning services or products that may be employed in the assessment or management of patients with communication disorders.
• The administration for professional organizations where the member sets or maintains professional standards of practice for speech-language pathologists or audiologists.

QUESTION - I am a bilingual member and have been approached by a Chilean family who are unable to pay for my services. Am I able to provide SLP services pro bono?

Answer - Yes you may waive a fee for service, but there are other issues you should consider. Ask yourself the extent of your service; will it include your travel expenses, travel time, reports for other agencies, phone calls to obtain other services etc.? Consider how many sessions you will provide pro bono and ensure that the family understands the extent and timeframe of your service. Treat this family in the same way as you would paying clients if you have attendance and discharge policies.

It is prudent in these situations to be aware of boundary issues. When we provide services pro bono, our patients and families may have unrealistic expectations some of which may cross boundaries. You are still required to keep a patient record, even if the service is free. Document your explanations to the family regarding the service you will provide, as well as the plan of care.

Question - I am a Non-Practicing member of CASLPO taking an extended parental leave. I have been asked to volunteer in my son’s pre-school one afternoon a week. They know that I am an audiologist and they want me to do some listening activities on a voluntary basis. Am I able to do this?

Answer - First you must make it clear to the preschool that you are currently ‘non-practicing’ which means that you are not eligible to engage in active professional practice in Ontario. Parents cannot be told that one of the volunteers in the preschool program is an audiologist. Nevertheless, as long as you, and the preschool, are not holding yourself out as a practicing audiologist, you can volunteer.

As a non-practicing member you cannot assess any child for hearing, speech, or language disorders. However, if, through your knowledge, skill and judgement, you observe a child who would benefit from a referral to an audiologist or speech language pathologist, you can make that recommendation to the preschool teacher.

Colleen Myrie

Director of Registration Services

2015 Fair Registration Practices Report

The College’s registration practices are reviewed annually and a Fair Registration Practices Report is submitted to the Office of the Fairness Commissioner.

Click here to read the 2015 Report now online.

Submission of the Self Assessment Tool: How did we do?

January is a busy month for CASLPO members, not only do you have to catch up from the holiday break, but you also have to complete and submit your Self-Assessment Tool (SAT).

Congratulations to the 97% of the membership who met the submission deadline of January 31st.

What was new this year?

• The French version of the Non-Clinical Self-Assessment Tool
• A Professional Standard Indicator was added:

  1.4 I have been delegated a controlled act (RHPA 27, 28, 29) and perform that controlled act according to the position of the college.

• The wording of three Professional Standard Indicators was revised.
• The SAT Guide was revised to reflect the changes.

How did the college support members?

We put many resources into reminding our members and providing education sessions to help you complete the SAT. We sent out 5 reminder e-mail blasts; 2 general e-mails to all members followed by 3 more e-mails to those who had not yet completed the SAT. We also provided, an ex.press article and 2 webinars which were recorded and posted on the website to assist you. All e-mail blasts provided links to the recorded webinars, the SAT Guide and a document outlining the consequences of missing the submission date.

Staff fielded many calls and e-mails regarding the submission process, right up to the midnight deadline!

How Did You Do?

Below is a table comparing the data over the three years that you have been required to submit your SAT online.

Member Aggregate Data

The Skilsure system provides us with aggregate data reports. Here are some of the reports that might interest you.

Summary

We are one of the most successful regulatory colleges regarding compliance with submitting the SAT. All but 4 members have now submitted their SAT. However, we learn from the process and your input every year. Our goal is to provide you with a clear and comprehensive system to help you reflect on professional practice standards, develop learning goals and collect Continuous Learning Activities Credits. Quality Assurance is one of the most effective methods to protect the public.

Acknowledgements

I wish to acknowledge the help and support from all of the staff, especially, Julie McFarland, Sarah Chapman Jay, Jodi Ostroff and David Beattie.

CASLPO Forum: Where are we going this Year?

The College finds interacting with you, the members, extremely valuable.  We can let you know about current projects and new documents that impact your practice, and you can bring up issues you want to discuss.

Once again we will open up CASLPO offices here in Toronto for the first CASLPO Forum on Thursday May 26th, 2016, 4:00-5:30pm (parking available).

We will then be visiting:

• Thunder Bay
• Oshawa
• Brantford

Keep your eyes open for the E-Forums that we will be holding throughout the year.  The first one will focus on Consent followed by Evaluating Capacity to Consent.

We look forward to many good discussions in 2016.

Specified Continuing Education or Remediation Programs (SCERPS) and Oral Cautions now publically disclosed

Courtney Campbell, Director of Professional Conduct; and
Preeya Singh, Director of Professional Conduct 

The CASLPO Public Register includes information about every registered speech-language pathologist and audiologist, as well as those previously registered with CASLPO to practise in Ontario. The Register is accessed by clicking the ‘Find an Audiologist or Speech-Language Pathologist’ button on our website. As a result of the request to enhance transparency from the Honourable Dr. Eric Hoskins, Minister of Health and Long Term Care, CASLPO developed a comprehensive plan to make more information about its members accessible to the public. This plan included information related to outcomes directed by the Inquiries, Complaints and Reports Committee (“ICRC”).

At its October, 2015 meeting, Council moved to amend By-law 2011-6, a By-Law relating to the Register.  The amendments reflected CASLPO’s comprehensive plan to make more information public in connection to its Transparency Initiative.  ICRC outcomes respecting investigations commenced on or after January 1, 2016 will be publically available on the College’s Register if:

• a panel of the ICRC requires a member to appear before a panel of the Committee to be cautioned. (A summary of the caution as well as the date of the panel’s decision will be published).
• a panel of the ICRC requires a member to complete a specified continuing education or remediation program (“SCERP”). (A summary of the SCERP as well as the date of the panel’s decision will be published).

In both instances, if a panel’s decision is subject to review or appeal and therefore is not yet final, a notation of that fact will appear on the College’s Register until the review is finally disposed of.

The requirement to “appear before a Panel of the Committee to be cautioned” is generally referred to as an “oral caution”. This is to be distinguished from “written cautions”, which fall under paragraph 4 of section 26(1) of the Health Professions Procedural Code (being schedule 2 of the Regulated Health Professions Act) (the “Code”):  “Take action it [the ICRC] considers appropriate that is not inconsistent with the health profession Act, this Code, the regulations or by-laws.”  The direction of an oral caution is educational in nature (not to be confused with a penalty but it is nevertheless a serious outcome for a professional member). Such a decision is an indication to the speech-language pathologist or audiologist that their conduct was serious enough that the ICRC panel chose to provide guidance on it in person.

SCERPs (which fall under section 26(3) of the Code) are applied in cases where the ICRC has identified concerns with a member’s practice that presents an ongoing risk to the public if it is not remediated. SCERPs are programs designed by the ICRC to address identified concerns and ultimately upgrade a member’s knowledge, skills or judgement. ICRC panels are creative in their approach to target the specific gaps that have been identified during the course of an investigation. Some examples of SCERPs that have been ordered by CASLPO’s ICRC include: a one-on-one session between the member and a more experienced member to discuss a particular clinical skill; directing the member to self-study on a certain topic; requiring the member to undergo a series of monitoring and mentoring sessions with a peer assessor; directing the member to complete an external course; and requiring the member to submit a self-reflection paper.

The amendments to By-law 2011-6 stipulate that information placed on the Register in connection to oral cautions or SCERPs can be removed if a member makes a written request to the Registrar for the removal because the information is no longer relevant to the member’s suitability to practise and the Registrar believes that the removal outweighs the desirability of public access to the information. However, requests to remove the information can only be brought to the Registrar two years after the decision of the ICRC was made.  

Making Regulation Accessible

Alexandra Carling-Rowland Ph.D.
Director of Professional Practice and Quality Assurance

Introduction

May is a time to celebrate the two professions and acknowledge the quality service you provide to help people communicate through hearing, understanding speaking, and to swallow safely.

May is Speech and Hearing Month is also an opportunity to inform the public about audiology and speech language pathology, and the services you provide which allow people to learn and participate more fully in their lives.

Here at the College, we are challenged with increasing public awareness of the professions in the context of self-regulation. We are mandated to serve and protect the public. To help fulfill our mandate, one of our strategic goals is to increase the public’s awareness of the College and its members. We want to outline the benefits of regulation, promote the use of regulated audiologists and speech language pathologists, simplify the complexities of regulation and ensure that the information is accessible and understandable to the public.

Who is our Public?

When thinking about communication strategies to inform the public of our role, it is helpful to consider who our public is. CASLPO’s public is individuals you work with; those who have speech, language, communication, voice, swallowing or hearing issues and the family and significant others who care for these individuals. You work with people literally from the cradle to the grave in a variety of settings, across the continuum of care. Our public also includes other professionals, government and people who are interested in the two professions.

However, people are not defined by whether or not they have a communication barrier. Patients, and others, come from a multitude of diverse communities and cultures with different levels of understanding regarding the two professions. All of these factors have to be taken into consideration when developing resources and information for the public.

Communication Barriers

CASLPO is keenly aware of the responsibility to overcome barriers when communicating with the public. Whether the barrier arises from aphasia, cognitive communication disorders, low literacy levels, English/French language learners, hearing impairments or a lack of information, we are reaching out to our public.

Communication Strategies

CASLPO has been working hard on the project of ‘Accessible Regulation’. We have identified the key messages and documents that must be made communicatively accessible. They are:

• What is an Audiologist?
• What is a Speech Language Pathologist?
• How to Make a Complaint
• The Public Register and Finding an Audiologist and Speech Language Pathologist
• The Benefits of Using a Regulated Professional

We have been working closely with the Aphasia Institute in Toronto who have developed images that help explain what the professions do and how to make a complaint. ‘The Public Register’ and ‘Benefits of Using a Regulated Professional’ will be rolled out over the next two years. We would like to thank the Aphasia Institute, especially Lisa Samson, for their help with this project.

Are they Accessible?

We wanted to make sure that these resources were truly accessible to people living with a communication barrier. We approached the Ontario Aphasia Centers Interest Group (OACIG) and trialed the documents with members living with aphasia and other communication barriers. The feedback lead us to move the accessibility symbol to a more prominent section of the website which also allowed us to enlarge it. Members of the aphasia groups were able to find specific information in the two documents showing that they understood and could communicate their response.

We would like to thank those individuals living with aphasia from the Niagara Aphasia Centre and the Halton Aphasia Centre and the CASLPO members who helped them, Lesley Bracken Coyne and Brittany Clark. Have a look at what CASLPO has put in place. Please click Accessibility or go to the CASLPO website to look at the accessible documents.

Communication Access Symbol

CASLPO has adopted the Communication Access Symbol created by Communication Disabilities Access Canada (CDAC). CDAC canvassed members of the public across Canada regarding a number of symbols.

TRANSLATIONS

We are very grateful to our members who have helped with translation for ‘What is an Audiologist’ and ‘What is a Speech Language Pathologist’.  We researched the languages most frequently spoken in Ontario, other than English and French, they are Italian, Spanish, Arabic, Chinese and Hindi.  We reached out to members who work with adults with acquired communication disorders and who have identified on the Public Register that they speak one of the target languages.

We would like to thank:

• Barbara Anne Molo-Kato – Italian
• Nabil Jabbour – Arabic
• Maria Piccini – Spanish
• Teresina Chan - Chinese

We would also like to thank Jaskaran Wadera, a Ryerson law student completing the Law Practice Program at CASLPO, who helped with the translation to Punjabi. Our goal is to translate this information in more languages, with Hindi and Tagalog as priorities.  If you are interested in helping us, please contact the College.

COMMUNICATION ACCESS AT CASLPO

Information on The College’s requirements arising from the Access for Ontarians with Disabilities Act 2005 (AODA) is on the website written in plain English, using short sentences and with key words highlighted to help understanding.

Staff members have received training in how to communicate effectively with people who live with a communication barrier. We have developed a set of communication aids to ensure that requests and messages are expressed and understood. We will also provide large print versions of any documents if asked.

CASLPO uses assistive devices in their everyday tasks. Our board meeting-room is set up with an FM system to help those who are hard of hearing. This system is portable and is regularly used at off-site meetings. Bell Relay is also used to help people who live with a hearing loss to communicate via the telephone.
 

Lisa Gibson

[email protected]

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 and Executive Office Manager for more information.