Brian O'Riordan

Registrar

This issue of ex.press offers you important new information on a variety of topics to assist you to better serve your patients as a self-regulated health professional.  

This is our second newsletter since the onset of the COVID-19 pandemic. Since our last issue, provincewide shutdown measures went into effect and the government declared its second provincial emergency on January 12, 2021. A stay-at-home order was issued to reduce mobility and address hospital capacity concerns.  In this newsletter, you will find more valuable information on how to keep on top of useful and accurate resources concerning practice advice relating to the pandemic.  It continues to be vitally important to stay engaged with the College. Continue to access our website’s COVID-19 Information and ‘Providing Patient Care in a Pandemic’ pages.

Be sure to read the article on the updated Ministry of Health Guidance for Vaccine Prioritization COVID-19 Guidance for Prioritizing Health Care Workers for COVID-19 Vaccination (Version 2.0, February 9, 2021).

Among others, see the article on new insights that help us to support Mentees – the article includes mentorship data that tells us where mentees need the most support.

Learn more about how some of your colleagues are participating in new patient outreach approaches in the article ‘Registrants Affecting Changes: An Innovative Approach to Reaching Our Patients’.

CASLPO has progressed with diversity equity and inclusion as it relates to healthcare, practice and policies. Have you seen the answers to your FAQs?

In addition, you will find in this issue of ex.press a valuable article on Professional Conduct Challenges for CASLPO Registrants  and an update on what is happening with regard to a Virtual Peer Assessment trial and Virtual Registrant Outreach Through E-Forums.  Did You Know CASLPO’s Registration Practices are Regularly Assessed? Like you, CASLPO also undergoes evaluations that demonstrate our adherence to standards. Also included is a registration renewal update regarding suspensions and revocations.

Finally, let me express our thank you to all registrants for your amazing service to your patients during this continuing very difficult pandemic period.  

As always, be sure to visit CASLPO’s website often, - it’s your main source of the latest information.  

Please keep safe and stay healthy!  And keep engaged with the College.  

Thank you.

Diversity, Equity & Inclusion FAQs

Margaret Drent

Director of Professional Conduct and General Counsel & Diversity, Equity and Inclusion (DEI) Officer (Acting)

On June 9, 2020, CASLPO was one of the first Ontario regulators to issue a statement on anti-racism and the provision of ethical care, reminding registrants that “diversity, inclusivity, tolerance and equality must be embraced by all of us”. The statement also noted that these shared values were reflected in the College’s Guide for Service Delivery Across Diverse Cultures (Guide).

On July 23, 2020, CASLPO organized an eForum titled “Addressing Diversity and Inclusion in Healthcare: Practices and Policies”.  Registrants who missed the forum can view the slides.  The recently-released Diversity, Equity and Inclusion Frequently Asked Questions follow up on the discussion at the forum and include answers to questions raised.

Some of the questions addressed include:

• How does CASLPO support registrants to enable them to act appropriately to address socio-cultural factors that need to be taken into consideration when providing health care services?
• Who would an audiologist or speech-language pathologist ask when clarification is needed about the social and cultural norms of a patient?
• I have a young adult patient that has a head injury, who is making discriminatory remarks. What should I do?

As noted in the June 9, 2020 statement, the CASLPO Code of Ethics (By-Law 7) (Code) contains several provisions setting out obligations of registrants regarding Diversity, Equity and Inclusion (DEI).  These include:

• In the pursuit of patient/client benefit, audiologists and speech-language pathologists have an ethical obligation to respect patients/clients as persons (article 3, paragraph 3.2).
• Audiologists and speech-language pathologists shall not discriminate in their relationships with either their patients/clients or their colleagues on the basis of any of the prohibited grounds listed in the Human Rights Code (article 4, paragraph 4.1.7).

The Code, together with the Guide, are currently under review. Watch for more information about this review and how registrants and others can participate over the course of the coming year.

In addition, CASLPO has numerous Diversity, Equity and Inclusion initiatives that are currently in progress.  Among other initiatives, CASLPO is:

• planning another e-forum in the coming months on DEI issues in healthcare;
• ensuring that both Council and staff receive DEI training;
• identifying further initiatives, with the support of a staff Working Group on Diversity, Equity and Inclusion; and
• actively participating in the Health Profession Regulators of Ontario (HPRO) DEI group.

We encourage you to contact us with your ideas.

Carol Bock

Deputy Registrar

Registrants Affecting Changes: An Innovative Approach to Reaching Our Patients

You, the registrants, have been invaluable to our patient outreach initiative and we want to share our successes and our gratitude. Driven by our Strategic Goal #1, Directly engage patients and other stakeholders to inform our work, we have recently established two Patient Outreach Groups (POG). The POGs are a group of registrants, who are willing and able to reach out directly to their patients and gather invaluable input that informs our work. So far, this initiative has focused on directly engaging the following two  patient groups for two distinct projects:

1. Improving Access to our Public Register for Those With Communication Barriers:

Our first POG involved a group of registrants who joined our initiative to find out how user-friendly our Public Register is for people with communication barriers. These registrants surveyed their patients and families. Staff are now collating the data and working to make changes that will support those with communication barriers to access all the information more effectively. We thank the following registrants for their hard work to engage and ensure their patients have equitable access to our Public Register:

Jenny Law – Speech-Language Pathologist
Maria Ramos – Speech-Language Pathologist
Nancy Wilson – Speech-Language Pathologist
Joanne Winckel – Speech-Language Pathologist
Nadia Sandor – Audiologist
Sarah Chapman-Jay – Speech-Language Pathologist
Manon Ethier - Audiologist

2. Translating CASLPO’s Public Resources for Indigenous Communities:

We have engaged another group of registrants to establish an Indigenous Translation POG. Together we have developed a plan for engaging their patients and families to find out what language would be preferred based on the most predominant Indigenous languages used in Ontario and which CASLPO document would they prefer we translate first.

Through this POG, we hope to develop an Indigenous Community Patient Advisory Group, which will be a source of input for other projects in the future. We thank these registrants for their hard work so far on this project:

Bonnie Cooke - Audiologist
Nicole Hoover - Speech-Language Pathologist
Jocelyn Kennedy - Speech-Language Pathologist
Theresa Brassard – Audiologist

Thank you to these registrants who are providing an important voice for our patients and the public that CASLPO otherwise would not have reached.  We also thank all the patients and their families for their time and incredible input that has and will enhance the work we do!

Updated Ministry of Health Guidance for Vaccine Prioritization

CASLPO is relying on information from the Ministry of Health (MOH) regarding the COVID-19 vaccine roll-out and priority plan.  The College itself is not involved in vaccination delivery matters, nor the scheduling of when registrants will be receiving the vaccine.

Registrants of the College should pay close attention to information being posted by their employers, and the direct guidance from the Ministry, or their local regional public health authority, especially if they work in hospital or long-term care settings.

According to the Ministry of Health’s updated Guidance for Prioritizing Health Care Workers for COVID-19 Vaccination (Version 2.0 February 9, 2021),  audiologists working in community care, including clinics and other sites, fall within what is described as “High Priority”.  Speech-language pathologists fall under the same section, i.e. “High Priority” of the document (pages 11-12) under “Non-acute rehab therapy”.

The Guidance document describes the stepwise approach to prioritization of health care workers (“Highest”; “Very High”; “High”; and “Moderate”).  In the document, there are also case examples and FAQs.  The roles of the MOH, Public Health Units and local partners in determining the prioritization are also explained.   

Audiologists and speech-language pathologists are reminded to follow all directives, guidance and CASLPO's Pandemic Practice Advisories.  

As we work together to provide services in a pandemic, Practice Advice is here to help you.

Practice Advice in a Pandemic

As we mark the first-year anniversary of the World Health Organization’s declaration of a pandemic, the Practice Advice team is reflecting on the challenging time that COVID-19 has wrought on audiologists, speech-language pathologists (SLPs) and the patients and families they serve. Audiologists and SLPs have had to adapt their services as never before from wearing personal protective equipment (PPE), carrying out active COVID-19 screens, being redeployed, to learning about virtual care platforms and programs.

The Practice Advice program saw a significant rise in practice advice contacts from March to September 2020. The main areas registrants needed information about were: essential versus non-essential services, virtual care, redeployment, re-starting non-essential services and the reopening of Ontario’s schools.  College Practice Advisors were busy answering calls and emails, interpreting documents from three ministries, and developing supports for registrants.  But we were not alone; we reached out to practice advice programs at other health profession regulator Colleges including physiotherapists, occupational therapists, dietitians, kinesiologists, and social workers. We met virtually on a regular basis to share issues, resources, and solutions.  We also worked together to approach the government to clarify information and develop practice advice.  This closer intercollege collaboration has been an unforeseen benefit to the pandemic, and we look forward to continued communications, even maybe in person!

Here are some statistics we thought would interest you:

ANNUAL COMPARISION OF PRACTICE ADVICE CONTACTS OVER FIVE YEARS

Practice Advice reports over CASLPO’s fiscal calendar year (Oct – Sept) rather than the calendar year.

From March to the end of September we received:

• 1,352 queries regarding COVID-19
• 528 queries regarding virtual care

We want to introduce you to our Practice Advice Team:

Alex, Sarah, Sandra, and David are speech-language pathologists and Samidha is an audiologist.  Samidha and David are bilingual and provide practice advice in French.  Please reach out to any one of us to discuss regulatory issues and professional standards.  You can also refer to our Providing Patient Care in a Pandemic web page.  We keep the advisories up to date, so please refer to them on a regular basis.

Practice Advice Team

Alexandra Carling
Director of Professional 
Practice & Quality Assurance
[email protected]

(416) 975-5347, ext. 226

Sarah Chapman-Jay
Advisor, SLP and Quality Assurance
[email protected]

(416) 975-5347, ext. 228

Samidha Joglekar
Audiology Advisor (English and French)
[email protected]

(416) 975-5347, ext. 220

Sandra Corte
Speech Language Pathology Practice Advisor
[email protected]
 
(416) 975 5347, ext. 231

David Beattie
Conseiller sur l’exercise
de l’orthophonie
[email protected]
(Communiquez avec David pour des conseils sur la pratique en orthophonie)

Colleen Myrie

Director of Registration Services

Registrant Suspensions and Revocations

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. The reason for this is to ensure that the public knows that they should not be receiving services from these suspended registrants, nor should they be using the protected titles.

The following individuals are currently under suspension for failing to pay their annual fees for 2020/2021 in accordance with section 24 of the Code:

Audiology Certificate Suspended

Speech-Language Pathology Certificates Suspended

While under suspension:

1. The individual is not permitted to practice as an audiologist or as a speech-language pathologist in Ontario.
2. The individual is prohibited from using the titles “audiologist”, “speech-language pathologist” or “speech therapist” or a variation or abbreviation or an equivalent in another language in Ontario.
3. The individual is prohibited from holding himself or herself out as a person who is qualified to practice as an audiologist or a speech-language pathologist in Ontario.
4. The College will inform the individual’s last employer on record of the individual’s suspension.
5. A notation of the suspension appears indefinitely in the College’s public register.

In addition, the following certificates were revoked for failing to pay the annual fees for 2019/2020 in accordance with section 26 of Ontario Regulation 21/12:

Audiology Certificates Revoked

Speech-Language Pathology Certificates Revoked

After a certificate has been revoked:

1. A notation of the revocation appears indefinitely in the College’s public register.
2. The former registrant must satisfy the following requirements for reinstatement to the College:
   1. The former registrant must pay any applicable fees and penalties required by the by-laws.
   2. The former registrant must satisfy the Registrar that he or she has corrected the deficiency or deficiencies that provided the grounds for the revocation of his or her certificate.
   3. The former registrant must meet all of the requirements in force for the class of certificate of registration being reinstated on the day that the former registrant submitted their new application to the Registrar.

Did You Know CASLPO’s Registration Practices Are Regularly Assessed?

By Colleen Myrie, Director of Registration Practices

Each year, the Office of the Fairness Commissioner (OFC) requires regulated professions to submit reports about their registration practices and their compliance with the provisions for fair access to regulated professions.  These reports are posted on CASLPO’s website annually and reflect how transparent, objective, impartial and fair our registration practices are.

Review CASLPO’s Fair Registration Practice Reports from 2008 – 2019

The OFC will also assess each regulatory body’s registration practices, make recommendations for improving practices as needed, and monitor the implementation of these recommendations and action plans. CASLPO was last assessed in 2018.  The OFC found the College in compliance with the OFC’s fair registration practice standards and did not identify any recommendations for improvement in this assessment cycle.

Review CASLPO’s 2018 Assessment (Cycle 3)

The Office of the Fairness Commissioner (OFC) has the mandate of overseeing the registration practices of regulatory bodies in Ontario to ensure that regulators meet their duty to provide fair access to regulated professions.

All regulators are expected to provide:

1. Clear information about registration requirements, processes, timelines, and fees.
2. Registration decisions and written reasons for those decisions within a reasonable time.
3. Internal reviews by a panel of the College’s Registration Committee when a deficiency is identified in an application, including the opportunity for applicants to submit arguments and additional relevant evidence of their qualifications.
4. Information about an applicant’s right to request an appeal of the Registration Committee’s decision from the Health Professions Appeal and Review Board (HPARB).
5. Information about the documentation that must accompany an application to demonstrate qualifications.
6. Assessments that are conducted in a way that is transparent, objective, impartial, and fair.
7. Adequate training for all individuals who assess qualifications or make registration decisions.
8. Access to the records related to an application, upon written request and within certain legal limitations.

CASLPO is proud of our record to date regarding our fair registration practices because registering competent professionals is fundamental to our mandate to protect the public interest.

Samidha Joglekar

Audiology Advisor and Manager of Mentorship

New Insights Help Us Support Mentees

Our recently introduced Mentorship Self-Assessment Tool (MSAT) is providing invaluable data that gives preliminary insight into where Initial Registrants (Mentees) need support most and that the Mentorship process is providing the support!

During the 6-month mentorship period, mentors and mentees engage with the MSAT, which includes assessment on the practice standards and reports submitted from the mentor to the College on a mentee’s progress to meet the standards. Data from these reports is shedding light on areas where mentees require additional time and support to meet the standards.

The following data represent the 186 mentorship periods completed between June 2019 and November 2020.  The data reflects emerging trends that the College will continue to follow.

MSAT Data Source - June 3^rd, 2019 to November 10^th, 2020

Unmet Red Flag Standards at the Midterm Evaluation

The MSAT has 7 “red flag” standards that mentees are expected to have met by their midterm evaluation.  These 7 are deemed to be essential at the earliest stage of practice (e.g., obtaining informed consent). In order to support the mentee to meet these important standards, the MSAT focuses on these standards when they are unmet by the midterm as opposed to addressing them towards the end of the mentorship.

Out of 186 mentees, 21 mentees needed work to meet one or more red flag standards at the midterm of their mentorship period.

Unmet Red Flag Standards at Midterm: 21 of 186 mentees (11.2%)

The data suggests that mentees require additional support in the areas of record keeping and obtaining informed consent, in particular. Health and Safety standards have emerged as well, due to the COVID-19 Pandemic.  Fortunately, all 21 mentees met these red flag standards by the end of their mentorship, which confirms the importance of a 6-month mentorship period.

Unmet “Non-Red Flag” Standards at the Final Evaluation

Out of 186 mentees, 15 SLP mentees were evaluated as needing work to meet one or more “non-red flag” standards by their final evaluation.  No audiologists fell into this category for this data set.  When “non-red flag” standards still need work, a mentee is permitted to complete their mentorship as long as their mentor’s report does not indicate a concern with the mentee’s competency to meet the standard in the future.  The College contacts mentees who still need work to meet standards at the end of their mentorship to ensure they carry goals related to those standards over to their Self-Assessment Tool as General registrants.

CASLPO was also able to look at the practice settings of the mentees with an unmet “non-red flag” standard at their final evaluation. As yet, we see no trend related to the practice setting.

The chart below lists the “non red-flag” standards that were rated as “needs work to meet the standard” in the mentor’s final report for the 15 SLP mentees identified.

The College continues to collect mentorship data of this nature in order to identify and confirm emerging trends that will inform resources and supports for mentors and mentees. We would like to extend our very sincere thanks to all of our Mentors who have given so generously of their time to guide and assist their mentees.

Alexandra Carling

Director of Professional Practice and Quality Assurance

---

Sarah Chapman-Jay

Advisor, Professional Practice and Quality Assurance

2021 Virtual Peer Assessment Trial

Why move to a virtual process?

The Quality Assurance Committee (QAC) has been generating solutions to three critical challenges in peer assessment:

1. How to achieve a reasonable percentage of registrants to be peer assessed when the membership has doubled since the beginning of the Peer Assessment Program?
2. How to use risk of harm as criteria to focus the peer assessments more efficiently?
3. How to complete 1. and 2. with current human and financial resources?

The QAC has decided to approach the first challenge by adopting a virtual format to allow a substantial increase in the number of peer assessments while keeping costs lower. The Committee has developed a trial virtual peer assessment process to see if it is as effective as the in-person peer assessments.  Fortunately, the feedback from the modified 2020 peer assessment process, which was carried out virtually due to the pandemic, was positive and provided confidence that it could be a format to adopt permanently.

The Committee wanted to trial the process in 2021 to thoroughly evaluate and answer the following questions:

• Can virtual assessments accurately identify which standards of the profession are met and which are not met?
• Can the virtual peer assessment cover all areas of practice sufficiently?
• Can the behaviours that reflect higher risk of harm be sufficiently identified?

What Will Change For The Trial Virtual Peer Asessment This Year?

• An increase from 60 to 80 peer assessments.
• The virtual peer assessment replaces the site visit and the records review.
• The registrant and peer assessor will discuss the most suitable platform for the virtual peer assessment.
• Instead of having 5 patient files ready for review, registrants will need to ensure their uploaded evidence comes from different patient files.
• Behaviour-based questions (BBQs) have been added for areas of practice that are   identified as posing a higher risk of harm. Examples of the behaviour-based questions can be found in the Virtual Peer Assessment Guide.
• Advertising Review - Peer assessors will review registrants’ and/or employer’s website and social media sites, if applicable.
• Registrants will record or photograph to demonstrate:

a. Secure storage of patient records

b. Effective infection prevention and control measures

c. Reasonably current standardized tests and equipment

d. Therapy materials are in good order

What Remains Unchanged For The Trial Virtual Peer Asessment in 2021?

• Discussion of the registrant’s practice setting.
• Review and discussion of uploaded SAT evidence.
• Discussion of CASLPO’s required document and how it related to the registrants’ practice. A second CASLPO document is chosen by the registrant.
• The clinical reasoning tool is administered on two patients with different clinical presentations.
• Discussion of Learning goals, CLACs, progression towards achieving goals and how has the learning impacted practice.
• Virtual remediation.

What is the Measurement of Effectiveness?

The College will look at the following sources of information:

• Survey feedback from the registrants upon completion of the peer assessment process
• Feedback from the peer assessors (survey and discussion for qualitative data)
• Data regarding the average length of the virtual peer assessments
• Comparison of data of registrants meeting/not meeting standards in 2021, with previous years.

The Quality Assurance Committee, with College staff, will review all the measurements effectiveness to formulate recommendations for the future of virtual peer assessments in the coming years.

If you are one of the 80 selected registrants for peer assessment this year, we will be very interested in your feedback.

Virtual Registrant outreach through e-forums

By Alexandra Carling, Director of Professional Practice and Quality Assurance

Early in the pandemic, the College made it a priority to reach out to registrants to provide information about patient services during these unprecedented times. In the summer, the movement to address discrimination grew, and CASLPO again wanted to reach out in person.

The e-Forums allowed us to connect with registrants virtually, in real time, answer questions and review issues. Through these interactions we developed the resources registrants needed.

For the six e-Forums that took place in 2020, we had 4,562 registrations; evidence of truly committed and engaged audiologist and speech-language pathologist professionals.

These e-Forum recordings are found on the Events Page -> e-Forums.  Here are links to the presentation slides.

• COVID-19 Town Hall
• Audiology Services in a Pandemic
• Speech-Language Pathology Services in a Pandemic
• Addressing Diversity and Inclusion in Healthcare
• School Services in a Pandemic
• Virtual Care Standards

Following the e-Forums, College staff reviewed questions and comments and developed several FAQs.  These FAQs can be found on our website:

• Providing Patient Care in a Pandemic
• Diversity Equity and Inclusion
• Practice Advice/FAQs

Professional Conduct Challenges for CASLPO Registrants

By Margaret Drent, Director of Professional Conduct and General Counsel & Diversity, Equity and Inclusion (DEI) Officer (Acting)

Here are some areas of focus to consider when developing your professional judgement skills regarding the use of support personnel, electronic signatures, and record-keeping.

Use of Support Personnel

CASLPO’s Position Statement on the Use of Support Personnel by Speech-Language Pathologists provides that Speech-Language Pathologists (SLPs) are responsible for all aspects of patient care assigned to support personnel. Support personnel must always be under supervision by an SLP when providing SLP services. The SLP will use different methods of supervision as deemed appropriate for safe and effective patient care.

Challenges can sometimes arise for new registrants if their employer expects them to operate in a manner that is inconsistent with the Position Statement. In its decisions, the Inquiries, Complaints and Reports Committee (ICRC) has emphasized that registrants are expected to demonstrate insight and independent professional judgement regarding the use of support personnel, even if they are relatively new to private practice and their employer is not a regulated health professional.

If it is unclear whether support personnel are providing services to their patients, registrants are responsible for proactively bringing issues forward for their employer’s attention. In summary, registrants are responsible for ensuring that they are fully informed about their obligations to adequately supervise support personnel.

Electronic Signatures

The ICRC has considered cases in which electronic record-keeping systems automatically attach an SLP’s signature to a record even if the SLP did not create the record.   The ICRC noted that registrants are responsible for controlling the use of their name and electronic signature.  The ICRC also noted the risk that the indiscriminate use of an electronic signature could lead to billing inaccuracies. As set out in the Records Regulation, billings must accurately represent the service provided.

Record-keeping

Record-keeping challenges are also a recurring issue in ICRC cases.  In one instance, a service provider invoiced all therapy provided by support personnel using the SLP’s name and credentials, although the SLP had not provided the service; nor had the SLP appropriately supervised the support personnel. The ICRC noted that only the services that an SLP provides directly can be invoiced in the SLP’s name. Registrants should review all receipts generated in their name(s) to ensure accuracy.  The Records Regulation also requires that patient records include the name of the person who provided the service, if the service was not provided by the registrant.

In order to reduce the risk of a complaint in one of these areas, you can review the resources on CASLPO’s website or contact the College’s Practice Advice team.