This issue of ex.press offers you important new information on the following to assist you to better serve your patients as a self-regulated health professional, including:
In addition, under “Changes Affecting Registrants”, you will find news about:
As always, be sure to visit CASLPO’s website often, including ‘What’s New’ and the Resource section - it’s your main source of the latest information.
Learn more about other key topics in this issue.
We listened to your feedback and continue to work hard to improve your experience.
Thanks to those of you that responded to the CASLPO ex.press eNewsletter survey.
An overwhelming 88% felt that the information in ex.press was important to them. For example, we've captured some great suggestions for upcoming articles.
We’ll continue to develop informative, relevant articles that inform your practice. Articles will address the many settings in which audiologists and speech-language pathologists work. Where more information is available, including legislative information and changes, the articles will include links to that detail. The result will enable you to access the information you need, faster and when you need it.
We’ll continue with two issues annually and using the same format; i.e. an email pointing to articles.
We'll continue to post ex.press issues in the CASLPO website, resource section, for your convenience, after we distribute it to all registrants via group email. At this time, the page is within the ‘Public Awareness’ section. Further, watch for practice advice FAQs to be posted on the website in the ‘Resource Section’.
Registrants will be surveyed again in the future to enable another opportunity for valuable input.
Learn more and enjoy CASLPO’s e-Newsletter, ex.press
Who better to ask, than patients, when considering advertising audiology and speech-language pathology services? Fortunately, the College has regular access to the Citizen’s Advisory Group, which is a group of patients and caregivers from across Ontario who lend their voice to help support health regulators work in protecting the public interest. In November this year, CASLPO, together with the Colleges of Physicians and Surgeons, Naturopaths and Optometrists, posed a series of important questions to the group about health care advertising. Their answers were revealing and instructive.
Here’s what patients told us:
All told, it seems most colleges that regulate health care professionals are currently providing reasonable limits to advertising that the public agrees with.
To find out more about what patients think about advertising by health care professionals, have a look at the Citizens Advisory Group Report (November 2, 2019).
Brian O’Riordan, Registrar
Council welcomed new public members John Leitch and Arthur Lust to three-year terms on CASLPO Council.
John Leitch, of Pembroke, Ontario is a retired teacher, department head, consultant and principal. He has had over 39 years in education, at all levels from elementary to high school. As such, he has worked with Speech-Language Pathologists and children with special needs his whole career. As Principal, he has facilitated numerous case management conferences involving children with special needs including many with speech and auditory disorders. He is an advocate of a multi-disciplined approach for planning and delivery of services to children in need.
Mr. Leitch has volunteered with the John Howard Society, Development and Peace, the Canadian Cancer Society and various other justice organizations. He has contributed as a writer on several textbooks including the acclaimed 'Exploring Leadership and Ethical Practice Through Professional Inquiry'. Mr. Leitch holds a Bachelor’s and Master’s Degree in Education and additional Qualifications in Leadership with the Ontario College of Teachers. John Leitch was first appointed November 2019.
Arthur Lust, of Ottawa, formerly a geologist, is a lawyer with 30 years of experience primarily in administrative law. He has appeared before various Courts and Tribunals. He holds a Bachelor of Science (Geology) from Carleton University (1980), and a Juris Doctor from University of Ottawa (1987). He also acted as Investigation Counsel to the Law Society of Upper Canada, and, served as a Panel Member of the Workplace, Safety & Insurance Appeals Tribunal (2008-2013), and a Panel Member (Legal) of the Canada Pension Plan Review Tribunal (2009-2014). He is a published author of two novels. Arthur Lust was first appointed December 2019.
Council welcomed elected professional member Elissa Flagg, SLP, to a three-year term on CASLPO Council from District 6 – all Ontario.
Elissa Flagg earned her Master of Health Science degree in Speech Language Pathology from the University of Toronto in 2012. Since then, she has worked at The Speech & Stuttering Institute in Toronto, serving as both a clinician in the children’s speech program and as a research scientist/program evaluator. Prior to entering the field of speech-language pathology, Elissa earned her PhD in Linguistics from the Massachusetts Institute of Technology in 2002, with a focus on syntax and neurolinguistics, followed by a post-doctoral fellowship in the Department of Medical Imaging, UHN/U of T, focusing on the neural processing of speech. Elissa also taught undergraduate linguistics courses and supervised graduate students in applied linguistics before becoming an SLP. Elissa is a clinically certified member of Speech-Language & Audiology Canada (SAC) and holds an Adjunct Lecturer appointment with the Department of Speech Language Pathology at the University of Toronto. Elissa Flagg was elected in May 2019.
A formal presentation was made by President, Shari Wilson, on behalf of Council and staff, to Ruth Ann Penny at the December 6, 2019 Council meeting.
Ruth Ann was presented with a certificate of recognition for her many contributions in furthering the mission of the College and fulfilling its mandate and objects relating to the regulation of the professions of audiology and speech-language pathology in Ontario.
Ruth Ann, of Toronto, is a veteran educator, having been a teacher, principal, consultant, recruiter and leadership trainer. She has worked in both public and private settings, latterly focusing in the areas of marketing, admission, communication and continuous improvement. Ms. Penny sat on the Governing Council of the Ontario College of Teachers (OCT) from 2006 to 2012 and was Vice-Chair from 2009 to 2012. She served in the areas of Quality Assurance, Standards of Practice and Discipline and chaired the Accreditation Committee at OCT. Ruth Ann served as a Public Member of CASLPO Council from 2013 to 2019. She served on several Committees, including Executive. She chaired both the Discipline and Finance Committees.
Please join the College in congratulating Ruth Ann Penny on these significant accomplishments!
Click here for upcoming dates, instructions for attendance and past meeting information.
To review all Council member biographies, click here.
Director of Professional Practice and Quality Assurance
The Provisions of the Missing Persons Act (2018) are now in effect.
Preamble (S.O. 2018, CHAPTER 3 SCHEDULE 7)
“The Government of Ontario recognizes the seriousness of the issue of missing persons in Ontario and its negative impact on the family and loved ones of missing persons. The families and loved ones of missing persons have requested that the Government of Ontario enhance the tools available to police when attempting to locate missing persons.
The Government of Ontario recognizes that the circumstances surrounding each missing person’s absence are unique, but that sexism, racism, transphobia, homophobia, other forms of marginalization and the legacy of colonization are factors that may increase the risk of a person becoming a missing person.
The Government of Ontario acknowledges the importance of timely and effective measures being available to police to assist with locating missing persons. These measures must also take into account people’s privacy interests and agency.”
Advisor, Professional Practice and Quality Assurance
Director of Professional Practice and Quality Assurance
The “Speech Language Pathology Services in Schools” e-Forum presentation slides and recording have been posted on the CASLPO website -> Events -> Eforums -> 2019 E-Forums or click here.
These FAQs supplement the E-forum and address additional questions when providing SLP services in schools.
The questions have been divided into six sections:
Under the Personal Health Information Protection Act 2004, registrants must obtain knowledgeable consent from the patient or SDM for the collection, use, disclosure and retention of personal health information Consent and Capacity Standards.
Speech language pathologists need to obtain and document consent to collect, use, retain and disclose personal health information, as required. Self-Assessment Tool, Professional Standard 3.2.
When you consider “as required” you must think about who is responsible for obtaining this type of consent and whether you are responsible for documenting it, or not. Depending on your context, you may or may not be responsible for obtaining consent for the collection, use, retention and disclosure of personal health information (PHI). For example, when an agency sends you PHI, it is their responsibility to ensure they have obtained and documented consent and therefore, it is not your responsibility to obtain nor document consent. On the other hand, if you, or someone you supervise obtains this consent, then it is your responsibility to document it, or ensure it is obtained and documented appropriately.
Answer 1: Yes, if it is clear that the preschool SLP has obtained and documented the required consent to disclose information and discuss the student’s communication status, then the school board SLP can proceed with discussions. If there is any doubt, verify with the preschool SLP. Consent to collect, use, retain and disclose PHI is directed by the Personal Health Information Protection Act (PHIPA) and must:
Consent is knowledgeable if it is reasonable in the circumstances to believe the individual knows:
Transition between preschool and school SLP services takes place frequently. Ideally, your agencies will establish a method of how consent is obtained and documented related to collecting, using, retaining and disclosing personal health information to allow a smooth, seamless transition.
Answer 2: Assumed implied consent describes “Circle of Care”. If there has been an established protocol between partnering agencies for preschool and school board SLPs, and you are confident that consent to collect, use and disclose PHI was obtained and documented by the preschool SLP in their patient record, you are not required to document consent in your patient record as the receiving SLP of the PHI.
Refer to the six criteria of Circle of Care for additional information: https://www.ipc.on.ca/wp-content/uploads/Resources/circle-of-care.pdf .
Answer 3: Yes, if it is clear that the parents have consented to the PHI being disclosed to school board personnel, including the SLP. If there is any doubt, verify consent has been given.
Even though the consent to disclose the health information has taken place, a separate consent for services needs to be obtained before the school board SLP initiates any SLP intervention.
Answer 4: School boards often have within their processes a method of obtaining and documenting in the OSR consent to disclose PHI. As long as you are confident that this has occurred, then you can be assured that the parent has consented. However, if no such methods or documentation occurs as a regular process, then seek confirmation from an appropriate source, and document.
Answer 5: No, not if the SLP is satisfied that the consent (PHI) was collected and documented by another professional (see above answer to questions 1-4).
Answer 6: It depends. If the consent obtained by the pre-school SLP includes disclosing PHI to the school board SLP, teachers and school board staff, then yes, the report can be discussed with those school staff. If the consent obtained is specifically for the schoolboard SLP, then no, parent consent is required to disclose PHI with school board staff who are non-health information custodians. Non-health information custodians in the school board include teachers, special education resource teachers and educational assistants. Health information custodians who can be part of the assumed implied consent (circle of care) include school psychologists, audiologists, occupational therapists, physiotherapists, and school nurses.
Answer 7: The Ministry of Education have created the Ontario Student Record Guideline which includes information about accessing a student’s OSR. If SLP services have not been initiated, consent from the parents would be required for the SLP to access the OSR. If school board staff have obtained consent for the SLP, then they can access the OSR.
Answer 8: If you are recommending additional services provided by another agency and the parents agree to the referral, then the two SLPs (school board and agency) are in the Circle of Care and can share the student’s PHI. Frequently, case managers from the external agencies will also obtain consent to collect, use and disclose PHI, and share information with parents about where the records will be retained.
Speech language pathology services in the school board 2019 e-forum slides: pages 25-31,52-57
https://www.ipc.on.ca/wp-content/uploads/2015/11/phipa-faQuestion.pdf Frequently Asked Questions about PHIPA
https://www.ipc.on.ca/wp-content/uploads/Resources/up-PosterFacility.pdf Health Information Privacy in our Facility
https://www.ipc.on.ca/wp-content/uploads/Resources/fact-11-e.pdf Health Information Custodians working for Non-Health Information Custodians
https://www.ipc.on.ca/wp-content/uploads/2019/01/fs-edu-privacy_access-guide-for-educators.pdf Privacy and Access to Information for Educators
According to the Health Care Consent Act (1996), registrants must obtain valid and informed consent for all interventions (Consent and Capacity Standards).
Speech language pathologists must obtain and document consent for all intervention plans or courses of action and any significant changes thereafter (Professional Standard 3.1 in the Self Assessment Tool).
Remember, “intervention” encompasses all SLP services from screening to consultation, and everything in between. (Guide to Obtaining Consent for Services).
Answer 9: Careful consideration is needed on how to obtain informed consent for services through written consent forms versus verbal means. You need to ensure you are adequately communicating information on the following:
Material risks and side effects are:
You are also considering any additional accommodations to patients/SDMs as needed, for example, English as a second language, translate form into commonly known used languages, offer telephone contact, literacy supports, use of plain language, etc. You can check with the classroom teacher that parents have the language and literacy skills to understand the consent forms (e-Forum slides 12 and 16).
Informed consent under the Health Care Consent Act (HCCA) means that before agreeing to the service (for example: screening, assessment), the patient or substitute decision maker (SDM) has received information that a reasonable person in the same circumstances would require. In addition, the person must have received responses to his or her requests for further information. Therefore, there is a limit to what is reasonable to include in written consent forms. For example, if you are obtaining consent for an assessment, then it is probably not reasonable to include enough information about the “treatment” that you may propose after the assessment.
Answer 10: Yes, if the form provides the necessary information about both the screening and assessment purpose and process.
Answer 11: Yes, screening is considered an SLP service and would require informed consent from the parents (SDM). For more information regarding screening, please refer to the Guide for Obtaining Consent for Services. The definition of “screening” is in the Glossary.
Answer 12: No, if you are satisfied that the parents have provided a valid and informed consent, you can proceed with your SLP services (refer to answer 9). If for any reason you are not satisfied, then you must follow up with the parents. Keeping parents informed regarding any significant changes to assessment/treatment plans of care is expected, once consent has been obtained (refer to answer 13).
Answer 13: No, because consents do not have any identified, legal timeframe. You may presume that consent to service remains valid as long as:
If there is a significant change to the plan of care, then a new consent needs to be obtained. You are always expected to use your professional judgement.
Answer 14: Yes, you will need to obtain both consents:
SLP services in the school board 2019 e-forum slides: 7-12, 13-24, 32-44.
The Records Regulation 2015 requires speech language pathologists to document:
“A record of every consent provided by the patient or by the patient’s authorized representative.”
Answer 15: If the student is not your patient, then you are not providing intervention, rather you are giving general information to another school staff person and therefore you do not need to obtain consent. If you are obtaining consent for any type of service or intervention then that student is your patient, you will develop a patient record and document the consent in the record.
Answer 16: The SLP can maintain one record for “group” screenings which needs to contain the following as per the Records Regulation, 2015:
(3) For every patient who is part of a screening process, a member shall maintain a patient health record that contains the following information:
2. If the patient is part of a group screening process, the patient’s name and a reference to the group with whom the patient is identified.
3. The date, nature and result of every screening process performed by the member on the patient.
4. Any action taken by the member as a result of the screening process.
5. A record of every consent provided by the patient or by the patient’s authorized representative.
Answer 17: CASLPO requires documentation of consent for services, but it is up to each SLP how they document. Options include checkboxes, forms or descriptions outlining consent for screening, assessment, treatment, consent for involving support personnel, withdrawal of consent for services, and locked box information. Always use your professional judgement. Additional documentation may, at times, be warranted.
https://members.caslpo.com/elearning/consent/ Consent tool with suggestions on discussion of consent for services and the collection, use, disclosure and retention of personal health information.
Answer 18: CASLPO requires registrants to ensure that PHI, including names of students on your caseload or patient records are stored securely and safely in electronic, cloud and/or paper formats. You are expected to make reasonable efforts to ensure that whatever cloud storage system is chosen meets these requirements.
Given the everchanging advancement in technology, the college does not recommend or endorse any single system, network, software or hardware. We suggest that you contact your school board IT department and ask them for recommendations regarding cyber security.
When determining what safeguards should be put in place, consider the nature of the records, including:
Speech Language Pathology Services in the School Board 2019 e-Forum slides: pages 58-62
https://www.ipc.on.ca/wp-content/uploads/2016/08/Thinking-About-Clouds-1.pdf Thinking about Clouds: Privacy, security and compliance considerations for Ontario public sector institutions
Answer 19: CASLPO requires security of PHI when using live platforms (e.g.: patient interactions or discussions identifying patients). Given the everchanging advancement in technology, the college does not recommend or endorse any single system, network, software or hardware. We suggest that you contact your school board IT department for recommendations.
Answer 20: The degree to which you use video recordings for assessment is directed by the College Code of Ethics, which states that SLPs:
4.2.5 shall ensure that the primary assessment/treatment/consultation will be a face-to-face encounter or other professionally appropriate encounter.
It is up to you to determine the most appropriate approach, depending on the child’s presentation, behaviours and other unique factors. Although the “primary assessment” must be a face-to-face encounter, which includes in-person (in the same room) or face-to-face using video and audio in real time (remote live secure platform), this is not intended to suggest that no facet of your assessment can involve video recordings that are not in real time. You may include, as part of your assessment, remote recordings which are not in real time in order to determine behaviours/abilities in real life situations.
Answer 21: No, CASLPO’s mandate is to protect the public by regulating registrants. It is the mandate of the associations (OSLA or SAC) to advocate for the profession regarding SLP services and service delivery. The associations are accountable to their members and engage in political advocacy impacting the professions and their patients including: effecting changes to service delivery, promoting changes to scopes of practice, increasing government and public awareness of the value of the professions, influencing government policy, and improving government funding for services. The College (CASLPO) is accountable to the public and the government (Ministry of Health) and does not engage in political advocacy activities.
(Click here for the “Did You Know the differences between a regulatory body and an association?").
For any additional questions or support regarding regulations, legislation and standards for speech-language pathology issues in the school board setting, please contact us at practice advice: https://caslpo.com/public/practice-advice
Director of Registration Services
The Health Professions Procedural Code of the Regulated Health Professions Act, 1991 requires information about suspended registrants to be made available to the public by each regulatory college.
This is one of the many ways in which the College protects the public.
The following individuals are currently under suspension for failing to pay their annual fees for 2019/2020 in accordance with section 24 of the Code:
Sameh Dawn Mikhail Abdelsayed
Nina Lisa Jason
While under suspension:
In addition, the following certificates were revoked for failing to pay the annual fees for 2018/2019 in accordance with section 26 of Ontario Regulation 21/12:
Samantha Evelyn Lewis
After a certificate has been revoked:
Audiology Advisor and Manager of Mentorship
Considerable changes have been made to CASLPO’s mentorship program in response to feedback gathered from you, our mentors and initial practice registrants (mentees). Past survey results (see below) showed that mentors and initial registrants felt that distance, the time required, and the mentor’s understanding of their role were the top three barriers to effective mentoring. More electronic resources, integration of the online Self-Assessment Tool (SAT) and further guidance from the College on the mentoring process were also desired.
In response to your input, the College has implemented the Mentorship Self-Assessment Tool (MSAT), which brings some basic mentorship processes online and makes distance mentoring easier and more efficient. We have also modified the mentorship program policies so that only one mentor is required, even if the mentee is employed in more than one setting. This eliminates the need for multiple mentorship contracts. We have created a role for “collaborators” who may be SLPs or audiologists who are involved in mentoring the mentee but are not the primary mentor. Finally, the College has put in place explicit criteria for being a mentor.
Our latest 2019 survey data revealed that the vast majority of mentors consider the mentorship program to be crucial in supporting new SLPs and audiologists and ensuring competency during the first six months of professional practice in Ontario. 89% of mentors indicated that they would participate in a College mentor training session and expressed a need for training in order to ensure reliability and consistency in the mentoring process.
In response, the College has started, and will continue, to offer training for mentors. The next mentor training webinar on the Clinical Reasoning Tool is anticipated to be in the late Spring of 2020 so stay tuned!
The College’s first mentor training webinar, “A Conversation about Consistency”, took place in September of 2019 and covered the basics of mentorship, including: ]
If you were unable to attend, the following resources are available on our website!
Read up-to-date information about the mentorship program policies and procedures.
Alex Carling, Director of Professional Practice and Quality Assurance
Every January registrants are randomly selected by the College for peer assessment. They are joined by registrants who do not meet registration currency requirements and therefore are also required to participate in peer assessment. It is a challenging time for all peer assessment participants, but tips from our peer assessors will make it a much easier task.
So, we reached out to peer assessors for advice to help with both peer assessment preparation and the site visit. This is what they advised:
Alex Carling, Director of Professional Practice and Quality Assurance
One of the most effective ways we can protect the public is by connecting with registrants in-person or via webinar regarding specific topics and areas of practice. This outreach helps to ensure that speech language pathologists and audiologists are informed and are following professional standards.
In addition to providing registrants with information about standards, this year we used in-person forums to help realize the strategic initiative of directly engaging with stakeholders to inform our work.
The College produced eight e-Forums in 2019. Topics focused on the publication of new standards and programs, analysis of data the College collects through Practice Advice, Quality Assurance and Professional Conduct, focusing on risk of harm, as well as reaching out to the membership for topics:
Missed an e-Forum? Slides and recordings can be found in the Events section of the website.
Each year the College selects one city in the south and one in the north of the province for an in-person forum. This is our opportunity to inform registrants of external changes arising from new or revised legislation and government policies as well as internal College information regarding practice standards, programs and projects.
St Catharines – District 3
Thank you to Lori Serafino Harper, Audiologist and Professional Practice Leader from Hotel Dieu Shaver Rehabilitation Centre, St. Catharines.
Kenora - District 5 with Ontario Telehealth Network (OTN)
Registrants from Kapuskasing, Sault Lookout and Red Lake joined via OTN.
Thank you to Tara Barber and Cameron Bay Children's Centre, Kenora.
This year we introduced a new initiative, ‘call us and we will come’ or ‘invited Forums’. We included an abbreviated CASLPO Forum and then focused on issues important to the site. Issues included advertising versus fundraising, preparing for peer assessment, the Ontario Autism Program and regulation, providing second opinions, scope of practice and interprofessional collaboration.
Six sites reached out to us:
We directly interacted with over 150 registrants in 2019 through CASLPO Forums and invited forums.
If you want us to visit you in 2020, and meet the criteria, call us and we will come.
When visiting the seven sites for the Forums, we used the opportunity to ask the registrants questions about patient risk of harm. Our goal was to help identify the behavioural and environmental risk factors that could cause an adverse event impacting patient care and to determine how we can mitigate risk factors. The resulting information is being collated and will be reviewed by the Professional Conduct and Quality Assurance departments in order to inform our work regarding risk-based regulation.
Have you seen the Complaints Process Infographic and the detail identified under each of the 6 steps?... more