Information from the Practice Advice Service

The Practice Advice Service of the College of Psychologists provides information to members of the College and members of the public regarding relevant Legislation, Regulations, Standards of Professional Conduct, and other Guidelines. Answers are provided in response to specific inquiries and may not be applicable or generalize to all circumstances. Information is provided to support College members in exercising their professional judgement and is not an appropriate substitute for advice from a qualified legal professional.

We continue to appreciate that the current situation is difficult for everyone and can present unique ethical challenges. In situations where government agencies have not provided specific guidelines, members are expected to make reasoned decisions based upon the ethical principles underlying the usual rules, the existing information about COVID-19 precautions, and the particular circumstances of their clients, practices and communities. It is also recommended that one consult with colleagues when these or other issues arise.

The pandemic is an increasingly active threat to community safety.  The College continues to recommend that members provide services virtually when this can be done effectively. When clients require in-person services, members should undertake all necessary and appropriate safeguards. In situations where there is ambiguity about the requirements, we urge members to take a conservative approach to minimize the risk of community spread as much as reasonably possible.

NON-PANDEMIC INQUIRIES

There were five areas of concern about which members and others sought advice from the College during this quarter.  In order of frequency, these were:

1. Provision of Services Across Jurisdictions, Unrelated to the Pandemic queries were equally divided between those from members of the College wishing to provide services in other jurisdictions and those registered in other jurisdictions seeking to provide services in Ontario;
2. Member Authorized Practice queries included those about authorized areas of practice and/or authorized client populations; and, competence to provide specific services within ones’ authorized areas of practice and client populations;
3. Supervision queries related to the supervision of the controlled act of psychotherapy; supervision of non-regulated individuals; and supervision of members of other regulated professions;
4. Record Keeping most queries related to issues of file retention and destruction; the nature of information which must be contained in the records; planning for leaving or closing a practice; and the designation of a successor health information custodian;
5. Release of Information and the Client’s Right of Access to Information queries related to issues of substitute consent; release of raw test data; and release of information in the context of legal matters.

While not making the “top 5” list, the following composite Q&A’s illustrate principles from recent and frequently asked queries that have wide application.

Professional opinions unrelated to services provided

Q: May I provide a professional opinion about a client, when the information is likely to be used for purposes unrelated to the focus of the service I have provided?

A: This question often arises when a member has been treating or assessing a client where the primary focus of clinical attention has not involved an assessment of the factors bearing upon the opinion being sought.  This may occur, for example, when a member has conducted a psychoeducational assessment, or treatment for an anxiety disorder, and the member is later asked to provide information to be used in a parental rights matter. Another example is when a member has provided psychotherapy to address a client’s emotional disorder and is then asked to provide a letter regarding the individual’s readiness to return to work after an injury.

In providing professional opinions, a member must consider the following requirement in section 10.3 of the Standards:

10.3 Rendering Opinions
A member must render only those professional opinions that are based on current, reliable, adequate, and appropriate information. 

In the first example above, a member should only provide information that they can reasonably expect to be used to determine custody or access arrangements if they have conducted an appropriate assessment for the purpose of determining child custody and/or access. Likewise, in the second example, a member should only opine on a person’s suitability to return to work after appropriate consideration of the person’s rehabilitation needs and the task requirements of the workplace.

Members must ensure that they work only within their authorized areas of practice and provide only those services in which they have the adequate knowledge, skill, and experience, within those authorized areas.

Even when a member is authorized and qualified to provide an opinion unrelated to the service they have been providing, and have conducted an adequate assessment, problems may arise if they assume a dual role. Usually, such requests for information are related to the rights and entitlements of the client. They also have an impact on others, such as family members, colleagues, or employers.  A clinician who has not conducted an appropriate, objective assessment of the matter at hand can face challenges with respect to whether they have exercised sufficient neutrality. There may also be a perceived  conflict of interest if it appears that a continued professional relationship could be endangered by offering an opinion that is seen to be unfavourable to the client’s interests.  

Fees and Billings and Supervised Services  

Q: When supervising non-members, or supervised practice members of the College, am I required to sign the client invoices and receipts?

A: Section 4.1.1 of the Standards of Professional Conduct, 2017  requires that:
8) the supervising member must ensure that billing and receipts for services are in the name of the supervising member, psychology professional corporation or employer and clearly identify the name of the supervising member and the name, relevant degrees and professional designations of the supervised psychological service provider

There is no explicit requirement under this Standard for there to be a signature, however, the following Standards are also applicable to these situations:

4.1.2 Supervision of Supervised Practice Members; and
4.1.3 Supervision of Non-Members
In addition to the responsibilities outlined in 4.1.1:
a) the supervising member must co-sign all psychological reports and formal correspondence related to psychological services provided by non-member supervisees;

Invoices (and receipts) would be considered by most to be “formal correspondence” and should be co-signed by supervisors. 

Within the past few years, the College has received an increasing number of complaints about the transparency of such documents and what some third-party payers have alleged to be misleading practices by members. Increasing vigilance by third-party payers has, unfortunately, led to denial of insurance benefits for some clients.  It has also led to an increased level of scrutiny of College members by claims adjusters. Supervisors should demonstrate that they carefully oversee the administration of their services by personally applying their own signatures to invoices issued in their names. 

Record Keeping

Q: What are the record keeping requirements with respect to a client I met under a consultation contract to an agency.

A: In determining the appropriate record keeping requirements it’s important to consider what is meant by “consultation”. Sometimes, those using the title “consultant” are actually providing direct services to individuals. For example, this would be the case if the service involved interviewing clients of an agency and providing an assessment of their treatment needs. The member would, in such a situation, be required to create a client record in accordance with section 9.2 of the Standards of Professional Conduct, 2017.  Even if, by virtue of the administrative arrangements, the client is also a client of the agency and agency is the Health Information Custodian, the definition of client in the Standards is applicable:

Client: an entity receiving psychological services, regardless of who has arranged or paid for those services. A client can be a person, couple, family or other group of individuals with respect to whom the services are provided. A person who is a “client” is synonymous with a “patient” with respect to the administration of the Regulated Health Professions Act (1991). 

If involvement in a case was limited only to discussing the client with the clinician providing the direct client care, it is more likely that the consultation met the definition provided in the Standards: Consultation: the provision of information, within a relationship of professionals of relatively equal status, generally based upon a limited amount of information that offers a point of view that is not binding with respect to the subsequent professional behaviour of the recipient of the information.

If acting as a consultant, as it is defined above, then the following requirements regarding contents of records apply:

9.3 Organizational Client Records

1. A member must keep a record related to the services provided to each organizational client.
2. The record must include the following:
   a) the name and contact information of the organizational client;
   b) the name(s) and title(s) of the person(s) who can release confidential information about the organizational client;
   c) the date and nature of each material service provided to the organizational client;
   d) a copy of all agreements and correspondence with the organizational client; and
   e) a copy of each report that is prepared for the organizational client.

Even though the phrase “nature of” each material service, is not defined above, most prudent members record enough information to indicate the nature of the problem discussed and the nature of advice given.

Standard 9.4 provides the record retention requirements with respect to organizational records:

2) The organizational client record must be retained for at least ten years following the organizational client’s last contact.  If the organizational client has been receiving service for more than ten years, information contained in the record that is more than ten years old may be destroyed if the information is not relevant to services currently being provided to the client.