It was a long hot summer across Ontario this year, and I hope our readers took full advantage of the tropical temperatures to get a lot of well-deserved rest and relaxation. As we head into autumn, take a moment from your busy schedule to take a look at CASLPO’s 7 minute CHCH-TV health and wellness segment developed for “We Mean Business”. In an interview style, hosted by veteran consumer and business journalist Hal Roberts, questions are answered about access to audiology and speech-language services and the importance of seeing a professional regulated by CASLPO. To view CASLPO’s CHCH-TV video, click here.
In this issue of ex.press, you will find some excellent advice relating to practice matters, particularly the use of advertisements. Additionally, you will find more information relating to College Transparency and Public Awareness initiatives. There is an important reminder about renewing your registration with the College by October 3, 2016. Don’t delay! Avoid any late payment penalties by registering now.
You know what happens if you don’t renew your registration on time, but what happens if you do not complete your annual self-assessment tool (SAT) on time? Find out in this issue of ex.press. Get an update on where the next CASLPO Forum will be. (Hint: It’s where I commute from every day.)
We hope you will enjoy our feature article Communication Disabilities Access Canada: Recipient of the Honourable David C. Onley Award for Leadership in Accessibility.
Finally, kudos to two members of our College Council and a member of staff.
Enjoy ex.press issue 5!
By Brian O’Riordan
These highlights relate to the Council meeting of June 10, 2016.
It was noted that Scott Whyte, a Public Member of the Council and the President, had tendered his resignation in May.
A new Executive Committee of Council was elected, as follows:
President: Deb Zelisko (AUD)
Vice President (AUD: V. Papaioannou
Vice President (SLP): J. Rowlands
Member at Large: B. Kroll (SLP)
Member at Large: M. Moussa-Elaraby (Public Member)
Member at Large: S. Wilson (Public Member)
Council learned that McMaster University in Hamilton is establishing a new graduate level program in speech-language pathology, with enrollment commencing in fall 2017.
Council discussed the annual review of the Registrar’s performance.
Work in support of the Ministry’s Transparency Working Group continues. Reviewing the Ministry correspondence to the College (posted on CASLPO’s website, Transparency page) will enable you to have a fulsome sense of what is driving activity in addition to, and in some ways, complementing CASLPO’s strategic plan. More
Increasing public awareness to the patient populations of the members we regulate is a primary strategic plan goal for the next 3 years. Read about our College’s unique perspective including a detailed status update on our public outreach plans and activities. More
The Ministry of Children and Youth Services (MCYS) recently circulated an Update on the New Ontario Autism Program. More
CASLPO has been part of a special project to explore how to better protect patients through stronger oversight of clinics in Ontario. You can read the submission here.
By: Federation of Health Regulatory Colleges of Ontario (FHRCO)
So much of health care is based on trust. According to a recent Ipsos Reid poll, 75 per cent of Canadians say our health care is among the best in the developed world, and 80 per cent expect more from the health care system than they do from other public sector services or the private sector. So what gives the public such confidence in the health care professionals they see? A big factor is the regulators who put public safety first. Ontario’s health regulatory colleges govern the practice of over 300,000 professionals. These are doctors and dentists, pharmacists and physiotherapists, nurses and naturopaths, and many other regulated health professions. “Health colleges protect the rights of patients,” says Marshall Moleschi, president of the Federation of Health Regulatory Colleges of Ontario (FHRCO). “That happens by ensuring the professionals who deliver care have the required knowledge, skills and judgment, and are held accountable.”
These bodies serve the public in four main ways:
1. Ensuring qualifications: Colleges confirm that only professionals who have met specific and strict requirements can practice in Ontario.
2. Setting rules: Colleges develop, monitor and update the standards for the profession, i.e., the rules that every member of that profession must follow.
3. Keeping professionals current: Through quality assurance and continuing education programs, Colleges help professionals to maintain and improve their knowledge and skills.
4. Addressing public concerns and complaints: Colleges can conduct investigations and hearings about a professional’s conduct or practice, and take action to safeguard and serve the public.
As part of looking after the interests of patients, health care regulation in Ontario directly involves the public. Public representatives appointed by the government serve on each College’s governing council (like a board of directors), and on every committee and hearing. That gives the public a voice in every decision. Health professionals also serve on these councils and committees, not to advocate for the profession, but to bring their professional knowledge to the issues. “The Colleges work as a partnership with the public,” says Moleschi. “The goal is to have care that’s safe, competent and ethical. Ensuring this from regulated health care professionals is what preserves the public trust in health care.”
More information is available at www.regulatedhealthprofessions.on.ca
Alexandra Carling, Director of Professional Practice and Quality Assurance and Preeya Singh, Director of Professional Conduct
The College receives a number of inquiries regarding the proposed Advertising Regulation from different parties including members of the public, audiologists, speech-language pathologists and employers. The Advertising Regulation is still in the ‘proposed’ stage. However, the College regards the content as reflective of the practice standards that are to be followed by members of the College.
Advertising is a form of marketing communication used to promote or sell a business, product or service. Advertising Standards Canada requires businesses, in their advertising practices, to be accurate and truthful. This is especially important when it comes to advertising healthcare services, as the public must be protected from false, misleading or unverifiable information.
The College, in particular, receives questions about the use of advertising strategies such as testimonials and endorsements, referral programs and “free” giveaways.
Question: Why can’t we use testimonials?
Answer: The Ministry of Health and Long Term Care prohibits the use of patient testimonials by any regulated health professional in order to protect the public. Consequently, the proposed regulation is clear in its restriction against the use of testimonials.
Section 2 (1) states that “An advertisement with respect to a member’s practice must not contain:
(g) a testimonial by a patient or client or former patient or client or any of their friends or relatives”.
The Business Dictionary defines advertising testimonials as “a written (or recorded) recommendation from a satisfied customer affirming the performance, quality, and/or value of a product or service”.
However, testimonials, in whatever format, are considered unreliable and cannot be verified. There is also a lack of balance as negative comments are rarely included. Finally, no one person’s experience is the same, especially with the provision of healthcare.
Question: If I remove a patient’s name, does that mean it is no longer a testimonial?
Answer: If a patient or relative or friend of the patient is providing a review about your service it is a testimonial and cannot be used in advertising, regardless of whether the patient’s name has been included or not. The source of the review (e.g. patient, etc.) will identify that it is a testimonial.
Question: I understand that we cannot use testimonials on our website, but what about unsolicited reviews on social media sites? What should we do about those?
Answer: While the use of social media can be an effective way to advertise your services, should you or your company use such sites, for example, Facebook, LinkedIn, etc. to advertise, it is your responsibility to monitor the site regularly and to remove any unsolicited patient reviews or testimonials. If it comes to your attention that a patient testimonial has been posted on a site you do not subscribe to, you should make best efforts to get the content removed.
Question: A freelance Public Relations writer has been asked by an audiology clinic to write stories about patients with hearing loss to post on the clinic’s website. Is this allowed?
Answer: Yes, this is allowed as long as what is written is true, accurate, verifiable and understandable to the intended audience. The content must be professionally appropriate, meet the standards of practice and relate to the audiology scope of practice. It must not be misleading nor include the use of testimonials.
Question: Can I use written reviews from other people, i.e., not patients or patients’ relatives, in my advertising?
Answer: These reviews are known as ‘endorsements’ and the Proposed Advertising Regulation prohibits their use in advertising with the following two exceptions:
(f) . . . . unless the organization or individual proposing to endorse a member or a member’s services:
(i) has the expertise relevant to the subject matter of the endorsement; and
(ii) has appropriately assessed the member as providing quality care;
However, if an individual has the relevant expertise and assessed your services but was also a patient of yours, then the endorsement is a patient testimonial and cannot be used.
Question: I work with a lawyer on a regular basis in my company which provides service to patients with traumatic brain injury (TBI). Can I ask him to endorse my practice on my website?
Answer: If the lawyer has the expertise relevant to the provision of speech-language pathology services to patients with TBI, has assessed you as a regulated health professional who provides quality care, and is willing to do so, then he or she may endorse your practice.
Question: I understand the requirements regarding the use of testimonials and endorsements, but I work for a company whose owners and managers are not regulated health professionals. They tell me that they are trying to run a business in a competitive market and need to use these strategies in advertising. What should I do?
Answer: While members may understand advertising restrictions, some are employed by companies who are not governed by the College’s regulations, as the College only regulates members of the professions. When faced with a situation where an employer has advertised contrary to the regulations, members are expected to notify their employer of the problem as soon as possible. Members should explain to their employer that advertisements cannot include testimonials nor endorsements as a result of specific direction from the Ministry of Health and Long-Term Care. This restriction applies to all regulated health care professionals in Ontario and is an indication that regulated health care professionals are held to a higher standard to protect the public interest. Show the employer the regulation, you can find it on the College website under ‘Resources’. If these strategies are unproductive, call us and we can discuss your situation further.
Question: Can I give a coffee gift card to a patient if they refer a friend to my place of work who has a hearing loss?
Answer: No, this scenario is normally described as a “referral program” and referral programs can be perceived as encouraging the public to receive potentially unnecessary intervention and may appear as though the member is encouraging services for a financial benefit. Consequently, advertisements that offer a benefit program to generate referrals constitute a conflict of interest as defined in the proposed Conflict of Interest Regulation. Specifically, section 10 states that:
... it is a conflict of interest for a member, where the member or a related person to the member or a related corporation to the member, accepts or receives any benefit, directly or indirectly from, or confers any benefit, directly or indirectly on, any person for the purpose of making or accepting a referral of a patient or client.
Question: The company I work for wants to offer a $20 donation to the charity of the patient’s choice for referring a friend. Is this okay?
Answer: No, this is not acceptable because the initiative still confers an indirect benefit to the patient for referring a friend, i.e. a donation to a charity of their choice. There may also be income tax implications with charitable donations. Principles which frame the proposed Conflict of Interest Regulation generally aim to prevent members from being influenced by considerations other than what is in the patient’s best interest and to ensure that patients are making informed choices based solely upon their health care needs.
Question: I have seen companies offer free hearing tests – is this allowed?
Answer: Many companies have chosen to offer “free” products or services to clients, should they make a purchase or book an appointment. While members can certainly engage in these programs, the advertisements should not be misleading in their offer of “free” products. For example, if a company advertises a “buy one get one free” deal on hearing aids, the cost of the free hearing aid should not be hidden in the cost of the hearing aid purchased. As well, the cost of the hearing test should not be hidden in any subsequent purchases made by the patient. Not only is this misleading to the public, and contrary to section 2(1)(a) of the proposed Advertising Regulation, such an advertisement would also conflict with the College’s Code of Ethics, which requires all audiologists and speech-language pathologists to “be honourable and truthful in all their professional relationships” (article 4.1.3).
Question: Can I advertise a therapy product or app on my website that I have developed? I will receive money from the sale.
Answer: Yes, as long as you declare to the patient or family who is receiving your services any conflict of interest such as benefits, including financial, you may receive as a result of the sale.
Question: Can I advertise that my practice is restricted to a certain area of practice?
Answer: Yes, you can advertise that your practice is restricted to a certain area of practice, as long as you do not hold yourself out to be a ‘specialist’ or ‘expert’ in an area. You can advertise that you practice in certain areas, such as childhood apraxia of speech, voice, tinnitus, stuttering, if it is factual and true.
Question: I have recently joined a website to promote my private practice. In order to post my business on this site, I have to offer a promotion. Am I able to offer $20 off the first therapy visit?
Answer: Yes, you are allowed to offer a promotion as long as you do not try and recoup the money by inflating the price of your services elsewhere. As with the offer of free products you are required to practice according the Code of Ethics and be honourable and truthful in your professional relationships” (article 4.1.3).
Advertising can be a challenging prospect. What you intend, and what the public understands from the advertisements can be two different things. Members must remember that regulated professionals are held to a higher standard and meeting those standards upholds the trust and faith the public has in the profession overall. Also, be aware that patients seeking out health care are frequently in a vulnerable situation and need to rely on the advertised message.
When considering whether your advertisement meets the proposed Advertising Regulation or conflicts with the proposed Conflict of Interest Regulation or the Code of Ethics, members are encouraged to speak with a practice advisor at the College about their concerns.
Director of Registration Services
Director, Registration Services
Congratulations to those members who have successfully completed their online renewal ahead of the October 3rd (midnight) deadline!
If you have not completed your online registration renewal, you must do so before midnight on Monday, October 3rd, 2016. Don’t wait until the last minute. Click here to renew now.
After midnight on October 3rd, a 20% late fee will be added to your payment.
We have the following support options:
Director of Professional Practice and Quality Assurance
In the last edition of ex.press we informed you of the successful 2016 submission of the Self-Assessment Tool (SAT). Ninety seven per cent of members submitted by the January 31st deadline. What happens to the 3% who fail to meet the deadline?
All the members are contacted by the College and are informed that they are required to submit their SAT as soon as possible and to submit a written explanation to the Quality Assurance Committee as to why they missed the deadline. The Quality Assurance Committee reviews the explanations, a letter is sent to the member and their information is retained by the College.
If a member continues to fail to submit their SAT, and/or fails to provide a written explanation or misses the submission deadline for a second year, the Quality Assurance Committee have the following options for action:
Imposition of a $50.00 fee for reminding a member to do something that they are required to do but have failed to do as per BY-LAW NO. 2011-3, 9.2
Staff review of their SAT for accuracy and completeness as per the Quality Assurance Regulation Reg. 373/12, s. 4 (5).
Participation in the Peer Assessment process as per the Quality Assurance Regulation 373/12, s.5 (2) (c)
A referral to the Inquiries, Complaints and Reports Committee (ICRC) with an allegation of professional misconduct, as per Schedule 2 of the Regulated Health Professions Act, 1991, Section 51(1)(b.0.1)
The Quality Assurance Program, including the submission of the SAT, is a process that encourages self-reflection and goal-centered learning to ensure that all members meet the College’s professional standards and thereby protect the public. We want to support you in this endeavour. Not only do we provide you with materials and webinars to help you complete and submit your SAT, but we are also available by telephone, e-mail or in person to help you in any way you need. Call us . . . . . don’t be late!
Alexandra Carling, Director of Professional Practice and Quality Assurance
We are halfway through our annual program of visiting audiology and speech language pathology members in their communities.
Our first Forum was held here at CASLPO’s office in Toronto at the end of May with most of staff and some council members attending. Twenty-four members attended in person, with 19 joining by webinar. The webinar was recorded and can be found in the Events section on our website.
In June, Carol Bock, Deputy Registrar and Alex Carling, Director of Professional Practice and Quality Assurance, went to Thunder Bay to St Joseph’s Hospital, who kindly hosted the CASLPO Forum. Thanks go to members Karen Halverson and Paola Humeniuk who helped arrange the event. Through Ontario Telemedicine Network (OTN) several members from Kenora were also able to join the Forum.
Here is the feedback provided by members who attended the Toronto and Thunder Bay Forums.
It was positive and informative to meet all of CASLPO's staff in person
Updates were informative
Sending in questions before the Forum is a good method of engaging the membership
CASLPO were open to answering questions and discussing issues
I personally felt comfortable to ask questions
I received answers to my questions
We will take on board the feedback received regarding the balance of providing information versus time for questions and discussion. Yes, we value tremendously the face to face contact with members, and will continue to travel across the Province for CASLPO Forums.
We are looking forward to visiting Brantford on Thursday, September 29th 2016. The Lansdowne Children’s Centre is hosting the Forum from 4.00pm to 5.30pm. We would like to thank Lisa Sylvester who is helping us with the arrangements.
Our final Forum will be in Oshawa on Thursday, October 27th 2016. The Durham District School Board are our hosts and Anila Punnoose is assisting us. Thank you!
In November and December we will be holding two 90 minute E-Forums via webinar. Our topics this year are:
Stay tuned for e-mails to register for these E-Forums.
Director of Professional Conduct
Over the years, the College has received numerous complaints against members in relation to advertisements created by their employers and other third parties. The Regulated Health Professions Act (1991) established the Inquiries, Complaints and Reports Committee (ICRC) to investigate these and all other complaints against members. The ICRC is composed of professional and public members of Council as well as non-council professional members.
Members are responsible for their own advertisements regardless of who created the advertising materials. As such, members are not absolved from their advertising responsibilities by stating that their employers or other third parties created the offending advertisements. Moreover, the fact that the members’ employers or other third parties are not regulated by CASLPO has no bearing on the College’s authority to regulate its members respecting inappropriate advertisements.
The ICRC considers each case based upon the specific circumstances. It will consider how serious the advertising concerns are, any actions taken proactively by the members to address the infractions, as well as the members’ compliance with the College’s regulations once the investigation has begun.
In some cases, the ICRC has issued reminders or directed that written cautions be delivered to members who did not proactively bring these violations to the attention of their employers or undertake corrective actions. Also, when external parties (for instance, an advertising agency) are retained, the ICRC has determined that it is the member’s responsibility to appropriately supervise and inform those parties of the advertising obligations of regulated healthcare professionals. Failure to do so has resulted in a written caution being issued by the ICRC. In all circumstances, members must take proactive steps to ensure that third parties are aware of appropriate advertising content and are invited to contact the College with any questions. CASLPO staff are always happy to assist by providing information and clarity. Additionally, members should put into place checks and balances to ensure that advertisements are not finalized without the express approval of the members.
At times, members may feel powerless because they feel they do not have the authority to correct advertisements created by their employers. In other situations, members may not be aware of the exact statements advertised by third parties. While the ICRC appreciates the difficult positions in which members can find themselves, as regulated healthcare professionals, audiologists and speech-language pathologists are nevertheless expected to take reasonable steps to address concerns that appear to contradict the College’s regulations. The public relies on the knowledge, skill, and judgement of self-regulated members to act in the public interest in all areas of their practice.
Although the ICRC continues to investigate such complaints, the ICRC is not permitted to release most of its decisions to the public or to the rest of the membership. However, following calls for more transparency from the Honourable Dr. Eric Hoskins, Minister of Health and Long-Term Care, recent amendments to the College’s By-Laws will now permit the publication of some ICRC decisions. These include details respecting cautions delivered in person and Specified Continuing Education or Remediation Programs (SCERPs) directed by the ICRC. With that said, decisions to take no action, or issue a reminder or written caution will remain confidential. For more information about these changes, please see the April 2016 issue of ex.press.
“The greatest barrier to accessibility lies not in our infrastructure—our buildings, streets and transportation. It lies in our attitudes and our lack of awareness.” These are the words of the Honorable David Onley, Ontario’s 28th Lieutenant Governor, who served from 2007 to 2014, making him the province’s longest-serving Lieutenant Governor.
“The greatest barrier to accessibility lies not in our infrastructure—our buildings, streets and transportation. It lies in our attitudes and our lack of awareness.”
The theme of Mr. Onley’s mandate was accessibility, more specifically, employment opportunities for people with disabilities. His own personal experience of contracting polio at the age of three shaped his career and also his role in advocacy. He broke through social barriers and became a role model for others, and he says this never would have happened had he not lived those early experiences.
Prior to Mr. Onley’s service as Lieutenant Governor, he had a distinguished career as a broadcaster. One of his early roles was as a weatherman for Citytv. At the time, in 1984, reporters were shown from the ground up. But when the camera was on him, the shots were from the waist up or showed only his head and shoulders, hiding, or at least diverting attention away from, his scooter or cane. After three months, Moses Znaimer, co-founder and head of Citytv at that time, insisted that Mr. Onley be shown from the ground up, like any other reporter.
“I realized I was becoming a role model."
Mr. Onley says this was a turning point for him. “I was a bit uncomfortable being shown as a person with a disability on TV, as this was not the usual. People asked why I was using my cane. I did stories about disability. But as time went on, I was seen by many, and I realized I was becoming a role model.”
As part of the theme of his mandate, Mr. Onley established the David C. Onley Award for Leadership in Accessibility. The leadership component of the award was especially important to him. “When change occurs, there is leadership. My hope is that, somewhere down the road, access will be part of our society,” he says. “One day, it will be just ‘leadership.’”
There are four categories for the award:
The Champion Award, in particular, “recognizes outstanding leadership in the integration of people with disabilities into its workforce; provides barrier-free working conditions for its employees with disabilities; and is compliant with the Accessibility for Ontarians with Disabilities Act (AODA).”
One of the eight recipients of the Champion Award this year is Communication Disabilities Access Canada (CDAC). CDAC (formerly known as Augmentative Communication Community Partnerships Canada) is a national, non-profit charitable organization that “promotes human rights, accessibility and inclusion for people who have speech and language disabilities that are not primarily caused by hearing loss.”
Barbara Collier, executive director of CDAC, speech-language pathologist, and fellow of the International Society for Augmentative and Alternative Communication (ISAAC), says, “The award is recognition for years of work we have been doing.” She says there is a problem with getting the public to see accessibility for people with communication disorders as a critical issue. “The award selection committee and government representatives are putting weight behind this for the first time.”
Pictured below are The Hon. Minister Helena Jaczek, The Hon. David Onley, Barbara Collier (Executive Director, CDAC) and The Hon. Lt. Gov. Elizabeth Dowdeswell.
CDAC’s achievements were well recognized by the committee. “Their research, education and outreach have highlighted the barriers these individuals experience when accessing goods, services, health care and justice supports. As a trailblazer in inclusive communication, CDAC published the world's first research project defining what accessibility means for those with speech and language disabilities. Today, their online training module is being used by businesses, hospitals, city services and justice personnel to help break down communication barriers throughout Ontario.”
Collier says that CDAC is unique in North America, with its focus on:
“Nothing about us without us”
CDAC takes a human rights perspective and engages a different set of participants for each project it undertakes, to ensure the right mix of perspectives. It employs people with disabilities—Collier believes strongly in a “Nothing about us without us” philosophy. For each project, she writes a proposal and hires a team specific to that project, including, for example, a person with a disability, a lawyer, an accountant, and so on.
“Every project focuses on new issues, and every project is leading edge,” she explains. They seek police, legal and justice accessibility. “There are enormous barriers,” she says. Every day, people with communication disabilities are having difficulty, for example, with the following:
What’s needed is better legislation to ensure what it takes to make services accessible—for example:
CDAC has been involved in a wide range of projects. Topics relate to the following:
The website also offers a self-study course in augmentative and alternative communication.
For example, one project provides information on the following, to people with communication disabilities, family members, social workers, speech-language pathologists, and disability advocates:
CDAC provides training and a national roster of communication intermediaries to enable effective communication within the legal and justice system. CDAC also provides a list of communication access rights on its website, to set out expectations for businesses and organizations.
“There are 165,000 people in Ontario who have no access to justice and don’t know their rights.”
Collier says CDAC must apply for a grant for each project, which is difficult and time-consuming. “There are 165,000 people in Ontario who have no access to justice and don’t know their rights,” she says. These people need:
While the award doesn’t come with a monetary prize, Collier hopes it will raise awareness and understanding of the important work CDAC is doing. “They gave us a platform and credibility,” she says.
Collier sees the issue of accessibility for people with communication disabilities as urgent. Speech pathologists play a significant role in:
“I’m always looking for collaborators.”
CDAC is a registered charity and accepts donations. Those interested in supporting CDAC’s work are encouraged to join the organization’s Facebook group, which is where regular updates are provided. Collier is often contacted by fellow speech pathologists for her opinion and says she would like to learn from them what they think the needs are. She seeks their help in identifying ideas for projects, funding, and so on. “I’m always looking for collaborators.”
To learn more about the David C. Onley Award for Leadership in Accessibility, click here: http://www.citizenship.gov.on.ca/english/citizenship/honours/onley.shtml.
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.