Registrar and CEO
In this newsletter, you will find valuable information on how to continue to keep up to date with useful and accurate resources as well as practice advice. As always, it is important to continue to stay engaged with the College. Please visit the registrant standards and resource section for practice advice and other website updates.
Also, this ex.press issue offers you important new information on a variety of topics to assist you to better serve your patients as a self-regulated health professional including:
Let me again extend my thank you to all registrants for your continued outstanding service to your patients.
As always, be sure to visit CASLPO’s website often, - it’s your main source of the latest information.
Director of Professional Conduct, General Counsel & Diversity, Equity and Inclusion (DEI) Officer
Beginning in September of this year, CASLPO launched a Diversity, Equity and Inclusion (DEI) E-Forum webinar series discussing how different forms of discrimination impact the provision of healthcare.
We know that social inclusion and freedom from discrimination and violence are important social determinants that can have a significant impact on a patient’s or registrant’s health. Through this series, we are focusing on different forms of discrimination, discussing how they impact the provision of care and exploring the options we have available to address these issues in practice.
The first session in the series, “Addressing antisemitism in healthcare”, took place on September 19, 2023. A recording of this session will be posted on CASLPO’s website, E-Forum/Webinar section.
Upcoming sessions will include discussing different forms of discrimination, bias and racism at they relate to healthcare, such as:
For any questions or suggestions for future topics, please contact Preeya Singh, DEI Officer at [email protected].
Learn more, visit: caslpo.com, Diversity, Equity and Inclusion
By Preeya Singh, Director of Professional Conduct, General Counsel & Diversity, Equity and Inclusion (DEI) Officer
Speech-language pathologists are in a unique position to help children with language difficulties understand gender-inclusive pronouns.
Ontario is home to the largest community of transgender and non-binary people in Canada1. Toronto also has the largest population of non-binary people alone2. This increases the likelihood that children and their circles of support (e.g., families, parents, caregivers) may choose to use inclusive pronouns.
People can use pronouns that do not align with their sex-at-birth assignment. This can be difficult for some children to understand when they are taught there are only two types of pronouns she/he and her/him, or his/her. This difficulty may be more challenging when gender-inclusive pronouns are introduced to children who have language difficulties. Despite these challenges, SLPs can be a valuable resource for children with language disabilities to develop inclusive language practices.
Discussing pronouns today is about being flexible and creative. Listen to what a child and their circle of support (e.g., parents, caregivers) need and want. For example, ask if there are people in the child’s life who use they as a pronoun. These kinds of discussions can provide SLPs with real life examples to support intervention goals. Registrants may also use toys or photographs that are important to the child to support language development.
SLPs understand that language and grammar develop in stages. Pronouns, gendered and gender-neutral, should be worked on at a developmentally appropriate time. Discussing gender-neutral pronouns may not be best suited for every child. Often the child’s stage of language development could be the determining factor in any discussion. Goals in this area should be chosen on a case-by-case basis. Use your professional judgement on how and when to work on pronouns and how to balance this with the other goals you have for a child to address a language difficulty.
It is okay to be uncomfortable when discussing gender-inclusive pronouns for the first time. Leaning into the discomfort can help support everyone’s journey to develop our cultural humility (see Principle 2 of the Guide for Equitable and Inclusive Services) and can contribute to more inclusive forms of practice. For additional scenario discussions, watch for the FAQs that will be published following the E-Forum on the Guide.
1Data retrieved from Statistics Canada. (https://www150.statcan.gc.ca/n1/daily-quotidien/220427/mc-b001-eng.htm)"
Our online public register helps to protect the public by making important information about Ontario’s regulated audiologists and speech-language pathologists easily available. The handout conveys the benefits of seeing a regulated health professional. It also enables audiologists and speech-language pathologists to show patients that they are in good standing, building public trust.
The public register awareness campaign increases the public’s understanding about our online public register of audiologists and speech-language pathologists.
Digital Ad Examples
Web Page Preview
Integrated campaign components convey that our register is a helpful, trusted resource for ﬁnding a registered professional or learning more about a current provider.
Access & print a colour copy on 8 ½ x 11” paper
The handout has a similar look and feel as digital ads that drive recipients that click directly to our public register. CASLPO’s ‘About The Public Register’ web page appears similarly, and conveys the benefits in more detail.
Together, we will increase public awareness about the importance of regulated audiologist and speech-language pathologist services.
In June 2023, the CASLPO Board of Directors participated in a training session exploring mental health in the regulated health professions from a variety of perspectives. Yvonne Wyndham, Speech-Language Pathologist and CASLPO Board member, moderated a panel involving three speakers.
Gwen Merrick, Speech-Language Pathologist and Psychotherapist, described her own experiences during her presentation. Gwen worked in an acute care setting as a Speech-Language Pathologist during the COVID-19 pandemic. She reviewed the available literature regarding the prevalence of mental health issues in the audiology and speech-language pathology professions.
From time to time, registrants will find that their patients are experiencing mental health challenges. When providing audiology and speech-language pathology services, registrants should consider the distinction between psychotherapy and counselling, and keep in mind the CASLPO guidance (There is a Difference Between Psychotherapy and Counselling, published in December, 2019). Gwen urged all clinicians to ensure that they practice self-care, given the overall high cost that is associated with burnout - both for the patients involved, and for health care professionals. When health care professionals decide to leave their workplaces because of stress and burnout, this may create new challenges for remaining colleagues, thereby contributing to the issue rather than alleviating it.
Gurjit Singh, Ph.D., is a researcher employed by Sonova. During his presentation, Gurjit explored the link between hearing and well-being. Hearing loss can have a negative impact on quality of life as well as clinical and non-clinical mental well-being outcomes. The literature on burnout in communication sciences in Canada is limited. However, the greater the contact between the clinician and the patient, the higher the risk of burnout. Audiologists and Speech-Language Pathologists are in frequent contact with their patients. Stigma has been described as “a mark of disgrace associated with a particular circumstance, quality or person”. In this regard, Gurjit described a current study regarding the role of stigma in discouraging patients from obtaining hearing aids. Another current area of study is whether hearing aids can delay the onset of dementia.
Anita Ashton, Deputy Registrar and Chief Operating Officer at College of Physiotherapists of Ontario (CPO) described the mental health resources that have been developed to support CPO registrants. CPO has recognized the relationship between registrant mental health and public protection, given that a lack of mental well-being makes it more challenging to deliver high-quality health care. Anita, generously shared CPO’s resources which may also be useful to CASLPO registrants who wish to offer suggestions to their patients experiencing mental health challenges to enable patients to seek supportive services. See, for example, “Strategies to Support Patients at Risk – Suicide, Abuse and Mental Health Challenges”.
By Margaret Drent, Deputy Registrar
On August 31, 2023, the CASLPO emergency class regulation came into force. This new registration class will only be available if an emergency is declared in Ontario. In order to implement a fee for emergency class registrants, CASLPO has launched a sixty-day consultation. All of the feedback received will be considered by the CASLPO Board of Directors.
To learn more, please visit the CASLPO consultations page.
By Margaret Drent, Deputy Registrar
On July 1, 2024, Ontario’s regulated health professionals and others who wish to hold themselves out as a “Behaviour Analyst” or are qualified to practice “applied behaviour analysis” will need to register with the College of Psychologists of Ontario. The College name ‘College of Psychologists of Ontario’ will change to College of Psychologists and Applied Behaviour Analysts of Ontario.
Once the Psychology and Applied Behaviour Analysis Act, 2021, comes into force, applied behaviour analysts will be required to meet certain entry to practice standards and participate in quality assurance activities. They will also be subject to the new College’s complaints and discipline processes.
CASLPO registrants that wish to incorporate techniques of Applied Behaviour Analysis practices
CASLPO registrants who wish to incorporate techniques of applied behaviour analysis in their practices will not be required to register with the new College, since many of the activities that are included in the scope of applied behaviour analysis are in the public domain.
CASLPO registrants who wish to use the protected title “Behaviour Analyst” or to advertise Applied Behaviour Analysis qualifications
If a CASLPO registrant wishes to use the protected title listed above or to advertise that they are qualified to practice applied behaviour analysis, they will need to register.
To learn more, visit the College of Psychologists of Ontario website. The website includes a self-screening tool that registrants can use to determine whether they should register with the College of Psychologists.
For further information, contact Margaret Drent, [email protected] .
Advisor, Audiology Practice & Quality Assurance
The College has been following developments related to over-the-counter hearing aids (OTCs) in the United States for several years. A consistent question is, ‘how will the availability of OTCs south of our border impact audiology practice in Ontario?’ Given CASLPO’s regulatory mandate, a follow-up question is: ‘are there standards of practice to be applied in audiology practice to ensure public protection?’
In 2017, the U.S. Congress passed legislation that required the Food and Drug Administration to create and federally regulate an OTC hearing aid category. Fast forward to October of 2022, when regulated OTC hearing aids became available to the public in the United States.
As a health professions regulator, CASLPO’s role is to ensure that standards of practice for audiologists reflect current trends and address patient risk of harm. What remains uncertain is whether OTC hearing aids will be regulated in Canada at a federal level as they are in the United States. Federal regulation of OTCs would provide clarity for developing standards and guidance for audiologists in Ontario who may be integrating this option for patients into their clinical practice.
CASLPO has reached out to Health Canada to clarify this issue. Click here to read CASLPO’s Letter to Health Canada regarding Over-the-Counter Hearing Aids.
Although OTC hearing aids are not regulated in Canada, the public may choose to purchase them online or while visiting the U.S. CASLPO Practice Advisors are aware that the public are bringing OTCs acquired elsewhere to Ontario audiologists for advice or support.
The following CASLPO resources are available for audiologists and the public:
Ontario’s registered Audiologists, as regulated health professionals, can be a trusted source of information for the public about OTC hearing aids and their related considerations. CASLPO will continue to collaborate with system partners on this important issue.
If you have any questions, please contact Samidha Joglekar, at [email protected]
Director of Professional
Practice & Quality Assurance
Record keeping continues to be a hot topic for audiologists and speech-language pathologists. Here are just a few of the frequently asked clinical record keeping questions that are included in the Record Keeping FAQs and Tips published on CASLPO’s website.
Path: caslpo.com | Registrants | Standards and Resources | Practice Advice and FAQs:
Question: If a patient repeatedly comes to the clinic several times within a short period of time, can one note capture all the intervention?
Answer: No, the Records Regulation 2015 requires documentation of each professional contact. A patient health record needs to include:
The date and purpose of each professional contact with the patient and whether the contact was made in person, by telephone or electronically.
Question: What is considered "timely" for reports and case notes in our records?
Documenting within a short time of the patient interaction promotes accuracy and completeness. The longer the delay between the patient interaction and documentation in the patient record, the less reliable the record.
Question: Do we need to enter the audiologist’s name on a receipt for battery purchase?
Answer: Yes, if it is a clinical financial transaction, the audiologist's name should be indicated on the receipt, as this would count as a financial record.
If you have any questions or comments, contact CASLPO’s Practice Advice Team.
By Dana Prutschi, Director of Professional Practice and Quality Assurance
The phrase “Circle of Care” is something we hear about as healthcare professionals, but this isn’t a term found in the Personal Health Information Protection Act (PHIPA). The Information and Privacy Commissioner of Ontario created this phrase to refer to assumed, implied consent from a patient to collect, use or disclose personal health information (PHI). Health Information Custodians (HICs) who are in the patient’s circle of care can share PHI with others in their circle of care without getting consent from the patient to do so. The “circle of care” refers to those in the patient’s healthcare team who can share personal health information among themselves without obtaining consent from the patient to do so on the basis that the consent of the patient is implied.
However, there are six criteria to be in a patient's circle of care and all must be met:
For more information about Circle of Care, consult the following resources:
By Dana Prutschi, Director of Professional Practice and Quality Assurance
Audiologists and speech-language pathologists have recently asked the College if using AI is okay. Registrants are looking for quick ways to draft content for generic reports, create templates and write phrases without compromising length, format, style, level of detail and language used.
Use your professional and clinical judgement when using any tool in your practice, especially a new one such as AI. For example, your digital platform for virtual care or electronic records needs to comply with confidentiality and security obligations. The standards of practice do not currently prevent registrants from using conversational AI chatbots to generate ideas or provide writing assistance. However, it is important you review content generated by AI software to mitigate for potential bias, privacy and security concerns and to ensure that your ability to meet standards and provide quality care is not compromised.
There are potential disadvantages to consider with ChatGPT:
NOTE: CASLPO does not endorse any particular tools or software to support your practice. This article was not written using any AI.
By Dana Prutschi, Director of Professional Practice and Quality Assurance
Thank you to the dedicated audiologists and speech-language pathologists who participate in CASLPO’s Advisory Working Groups (AWGs). Your time and attention to detail on the revised Practice Standards for Dysphagia Intervention and the development of CASLPO’s new Advertising Standards for registrants contributed towards the development of these important documents.
The College greatly appreciates the continued contributions of registrants to ensure Standards of Practice are in the public interest and appropriate for various practice settings.
Find the Standards, E-Forums, FAQs, and resources developed for Patients on the CASLPO website.
Are you interested in being on a future CASLPO Advisory Working Group? Learn more about Working With the College
Director of Registration Services
As part of CASLPO’s ongoing commitment to review our existing policies and procedures to ensure that they meet standards for fairness, objectivity, impartiality, and transparency, we are pleased to announce two new College policies that have been recently implemented: Canadian Entry to Practice (CETP) Exam Attempts Policy and Non-Practising Returning to General Policy.
This new CASLPO policy aims to:
Provide applicants with a reasonable number of opportunities to demonstrate their competence, and also, prevents excessive retakes which could undermine the credibility and integrity of the CETP Exam.
The College recognizes the significance of the Canadian Entry to Practice (CETP) Exam as a crucial step in the licensure process.
To ensure fairness and consistency, the CETP Exam Attempts Policy has been introduced to allow all applicants a maximum of three attempts to successfully complete the CETP exam.
The Registration Committee considered all aspects of the CETP Exam and the decision to limit the number of attempts to pass the CETP Exam was made to protect the integrity of the CETP Exam, and to match the attempt limits imposed by Speech-Language and Audiology Canada and other Canadian regulators of audiology and speech-language pathology.
This policy also allows an applicant to request a fourth attempt if the applicant can demonstrate that they have experienced extenuating circumstances that impacted their successful completion of the exam or if the applicant upgrades their credentials and demonstrates that they sufficiently prepared for another attempt.
It is crucial for applicants and initial registrants to adequately prepare for the CETP exam. Speech and Audiology Canada (SAC) provides resources to assist with exam preparation. More information about preparing for the CETP Exam can be found on SAC’s website.
This new CASLPO policy is intended to:
Clarify the education, training and examinations that would be required of a non-practising registrant who does not meet the 750 hours requirement so that they will be able to prepare for their return to practice.
The College understands that career paths can evolve, and circumstances may change over time. The Non-Practising Returning to General Registration Policy addresses the transition of registrants from a non-practising status back to the general practice category.
If a non-practicing registrant applies for a general certificate and has not provided 750 hours of patient care or related work in their profession in the last three years and:
The decision of CASLPO’s Registration Committee Panel to require a registrant to successfully complete mentorship or the CETP Exam and mentorship is primarily influenced by the potential risk of harm to patients based on:
The CASLPO Registration Team is available to assist you with any questions, you may have regarding these policies, or any other matters related to your registration. Feel free to reach out to our Registration Services team at [email protected] .
By Dana Prutschi, Director of Professional Practice and Quality Assurance
In September 2022, the Quality Assurance Committee approved piloting registrant peer assessment Evidence Reviews as a way of enhancing public protection. Registrants in the pilot upload evidence for each indicator in the Professional Practice Standards to their Self-Assessment Tool (SAT). Trained peer assessors reviewed the evidence that had been uploaded for these for pre-selected standards.
The 2023 Peer Assessment Evidence Review pilot is well underway! Twenty registrants have completed their Evidence Review, with 6 having received support for remediation. By December, 48 Evidence Reviews will be completed; 94 registrants will have undergone “regular” peer assessments.
Evidence reviews are different from full peer assessments because they take place through the SAT, include only select SAT indicators and do not involve a conversation between the peer assessor and registrant. The goal of the pilot is to evaluate whether the evidence review is an effective way of verifying that registrants are meeting the required standards of practice, especially standards that pose a higher risk of harm. CASLPO is exploring whether this evidence review initiative will enable the College to expand the reach of peer assessments in a cost-effective and resource-efficient manner.
One registrant who has completed the Evidence Review process said:
“While it was an added stressor to an already busy workload, it is reassuring to know that my practice is up to standard. I was also pleasantly surprised at how quick the process of compiling evidence really was. It seemed like a daunting task at the start but when all was said and done, it really wasn't that bad. I was able to pull examples for each standard quite readily, reinforcing that I am practicing exactly as I should be as well as highlighting areas where I can continue to tighten up my practice. As a still somewhat new clinician (4 years), I also appreciated the positive feedback from a more seasoned colleague.”
The College looks forward to sharing the outcomes of the 2023 Evidence Review Pilot. A review of the Pilot in the coming months will determine how we continue this important innovation. In particular, we will be assessing how it strengthens protection for patients.
The following topics are planned for upcoming CASLPO E-Forums. Please watch for an email inviting you to register to attend.
To review past E-Forums visit the CASLPO E-Forums webpage.
Reviewing E-Forums and associated resources can be counted as time towards Continuous Learning Activity Credits (CLACs) for Ontario's registered audiologists and speech-language pathologists who have a related learning goal.
CASLPO’s E-Forums web page is an up to date archive of all published E-Forums available for viewing.
Visit the CASLPO E-Forums page today!
Hearings and Case Manager
By Preeya Singh, Director of Professional Conduct, General Counsel & Diversity, Equity and Inclusion (DEI) Officer and Grace Maharaj, Hearings and Case Manager
Billing concerns in private practice and obtaining consent in a school board setting are some common practice challenges for audiologists and speech-language pathologists that can affect patients and registrants negatively. The examples below were drawn from cases reviewed by the Inquiries, Complaints and Reports Committee (ICRC) in CASLPO’s 2020-2021 and 2021-2022 fiscal years.
Billing in Private Practice (11 instances)
Payment for services in a private practice setting is usually made privately by the patient or by a third-party payer. Patients or their families have identified billing fees as a concern due to the lack of communication or clear billing policies. When fee policies and explanations are vague, ICRC panels have issued reminders or advice to registrants to improve their practice. For false or misleading billing, the ICRC can direct registrants to complete remediation or refer the case to the Discipline Committee.
Registrants must ensure that the fee structures clearly identify in detail the fees patients can expect to pay for services, such as: assessments, progress reports, or cancelations. This information should be transparent and provided in a way that patients and families can understand.
When billing third-party providers, such as insurers, registrants must be careful that insurance companies are billed appropriately. Billing should be based on services required by the patient rather than targeted to the funds available by the provider. Invoices should also be transparent about the services provided, who provided them and the associated fees. If it is unclear whether a patient has coverage for a specific service, registrants should advise patients to verify funding coverage with their third-party payer.
For more information on billing practices and third-party billing, please refer to CASLPO’s website | Standards and Resources section: Advertising, Billing and Private Practice page.
Obtaining Informed Consent (7 instances)
In a school-board environment, the responsibility to obtain consent is often delegated to Special Education Resource Teachers (SERT) or other school staff. That staff will send consent forms to students’ parents or guardians to complete and return to the school. In such a hectic environment, completed consent forms may not be given to the registrant and so they may not know whether consent has been obtained.
ICRC panels have consistently taken the position that a busy practice environment is not an excuse for a registrant failing to obtain consent before proceeding with treatment. Registrants have a legal obligation to obtain informed and knowledgeable consent for all clinical interventions. To meet this requirement, registrants can take the following steps:
For more information on obtaining consent, please refer to CASLPO’s website | Standards and Resources section : Consent and Capacity Resource page.
While there may be challenges in specific practice environments, registrants can take steps to adjust their practices and policies to meet their professional obligations. Please contact the College’s Practice Advice team if you have any questions.