COVID-19 FAQS

Originally published in HeadLines Volume 1 Issue 2

Regulated Health Professionals are subject to Directive #2 of the Chief Medical Officer of Health.  This directive states that: In the gradual restart of services, Health Care Providers must comply with the requirements as set out in “COVID-19 Operational Requirements: Health Sector Restart” (May 26, 2020 or as current), including, but not limited to, the hierarchy of hazard controls.

The hierarchy sets out the following measures, in order of priority:

1. Elimination and Substitution – examples include not having patients physically come into the office/clinic, use of telemedicine, etc;
2. Engineering and Systems Control Measures – examples include physical barriers like plexiglass partitions;
3. Administrative Control Measures – examples include active screening, passive screening (signage), and visitor policies;
4. Personal Protective Equipment – examples of PPE include gloves, gowns, facial protection (including surgical/procedure masks and N95 respirators), and/or eye protection (including safety glasses, face shields, goggles, or masks with visor attachments).

As noted previously, the Ministry recommendations must be general enough to apply to all health care providers.  As a result, some of the examples provided may not be applicable to psychological services.

The Ministry is clear that PPE controls, such as masks, are the last tier in the hierarchy of hazard controls. Accordingly, they should not be relied on as a stand-alone primary prevention program. The Operational Requirements clearly state: Given community spread of COVID-19 within Ontario and evidence that transmission may occur from those who have few or no symptoms, masking (surgical/procedure mask) for the full duration of shifts for HCPs and other staff working in direct patient care areas is recommended.

Some local areas have enacted by-laws requiring mask use in indoor public settings, with exceptions to this requirement for health care providers. It is likely that such exceptions have been made in order to enable some health care procedures which cannot be performed while a mask is being worn.

The College continues to recommend that services should be provided virtually when possible. When in-person services are required, members should wear masks and require clients to do so in enclosed spaces, unless this is clinically contraindicated.

Originally published in HeadLines Volume 1 Issue 2

This can be a difficult situation to navigate and we are advising members to make best efforts to negotiate resolution of such problems.

The Standards of Professional Conduct, 2017 require:

2.1 General Conduct

A member must conduct himself/herself so that his/her activities and/or those conducted under his/her direction comply with those statutes and regulations that apply to the provision of psychological services.

and,

3.1.2 Employment Settings

A member must assume responsibility for the planning, delivery, and supervision of all psychological services he/she provides to a client.  Members working as employees must make best efforts to ensure that their work setting adheres to the Standards of Professional Conduct, 2017 in the planning, delivery, supervision and billing practices of all psychological services provided.

The College is not authorized to regulate workplaces, only the conduct of individual members.  As stated above, members are required to make best efforts to ensure that the work setting adheres to the Standards. This may involve escalating the issue within their organization and seeking outside assistance where necessary. Hopefully, in most cases, collaborative communication will help to resolve any “standoffs”.

Members may wish to advise those with the authority to grant their requests that Directive #2 has been issued to all Regulated Health Providers under Section 77.7 of the Health Protection and Promotion Act, 1990 and requires Health Care Providers to consider which services should continue to be provided remotely and which services can safely resume in-person with appropriate hazard controls and sufficient PPE.

Originally published in HeadLines Volume 1 Issue 2

The COVID-19 Operational Requirements: Health Sector Restart indicates that health care professionals should perform active screening, although we understand this can be assigned to a staff person. Screening should be done with the client.  If it is believed that a client is unable to answer the screening questions reliably, it should be done in discussion with a person’s parent or caregiver.

The Operational Requirements state:  Patients should be screened over the phone for symptoms of COVID-19 before coming for their appointments. If possible, any visitor accompanying a patient to an appointment, should also be screened prior to the appointment. The latest COVID-19 Patient Screening Guidance Document on the MOH COVID-19 website should be used and may be adapted as needed and appropriate for screening purposes. If a patient screens positive over the phone, the appointment should be deferred if possible and the individual referred for testing.

Originally published in HeadLines Volume 1 Issue 2

The College’s expertise and role is limited to professional regulation. It is beyond the purview of the College to provide clinical guidance to members. The College trusts that members practicing the profession have the knowledge, skill and judgment required to make appropriate clinical decisions.

With the large number of tools, techniques and tests in use, members should obtain current guidance from the test publishers about the administration procedures and the applicability of norm-based scores. At those inevitable times when answers are not clear, members may find it helpful to discuss these issues with other clinicians who they believe have relevant expertise.

As in all cases, interpretation of test results includes consideration of the context in which an assessment is conducted.  The Standards of Professional Conduct, 2017 which guide members in making such judgments include:

10.1 Familiarity with Tests and Techniques
Members must be familiar with the standardization, norms, reliability, and validity of any tests and techniques used and with the proper use and application of these tests and techniques.

Practical Application: At times, a member may provide services in what would be considered an emerging area of practice. In such situations, a member should inform clients that the services being offered may not, yet, have been subjected to extensive research and validation. As with any informed consent process regarding the provision of services, clients would be informed of the risks, benefits and alternatives available.

10.2 Familiarity with Interventions
Members must be familiar with the evidence for the relevance and utility of the interventions used and with the proper use and application of these interventions.

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

10.4 Identification of Limits of Certainty
A member must identify limits to the certainty with which diagnoses, opinions, or predictions can be made about individuals or groups.

We have become aware from members that test publishers are providing guidance about how measures which rely on standardized administration procedures may be utilized. It is a member’s responsibility to ensure that they are using the tools properly, based on empirical evidence and good clinical judgment.

Originally published in HeadLines Volume 1 Issue 2

If someone has tested positive, the local Public Health agencies are expected to follow appropriate protocols with respect to notifying those who must be notified.

There does not appear to be a requirement for a member of the College to make a mandatory report of someone who has identified themselves as, or is suspected of being, COVID-19 positive. There are, however, provisions in the Health Protection and Promotion Act, 1990 that authorize the Chief Medical Officer of Health to make an Order requiring the release of confidential information, as specified in that Order. If ordered to provide information, the College would not expect a member to put themself in contempt of the Order. To date, we have not heard about any members receiving such Orders.  If one is unsure of the nature of such an Order or the information it may require by released, one should seek legal advice.

If concerned about individuals who may have crossed paths with an infected person, it would be permissible and reasonable for a member to provide general de-identified information to other clients and suggest they may wish to be tested. One should, however, take care not to provide any information that could identify the other person.

Confidentiality provisions under the Personal Health Information Protection Act, 2004 (PHIPA) prohibit the disclosure of personal health information without authorization by the client, other than in specified circumstances. Exceptions to the duty of confidentiality are set out in sections 39 (regarding certain health programs) and 40 (regarding risk of serious bodily harm). It is important to remain aware that these exceptions permit one to make disclosure but do not require this. When one uses the discretion to make a disclosure without a client’s permission, only that information which is necessary for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or group of persons should be disclosed. Additionally, such information should only be disclosed to a person who is in the position to eliminate or reduce the risk.

If unsure about whether a disclosure is permissible, it may be useful to obtain the opinion of a qualified legal professional. Many professional liability insurance policies entitle the policy holder to pro-bono legal advice.

Originally published in Volume 2 Issue 1 of HeadLines.

Throughout the pandemic, members have been permitted to use their professional judgment to decide when it was necessary to see clients in-person. The College wishes to advise members that Ontario’s Chief Medical Officer of Health recently rescinded Directive #2 for Health Care Providers (Regulated Health Professionals or Persons who operate a Group Practice of Regulated Health Professionals).This Directive had been amended and re-issued in mid-April due to the increasing COVID-19 case counts, hospitalizations, and ICU admissions.  Rescinding of Directive #2 means that non-urgent and non-emergent procedures may be gradually resumed by health care providers and health care entities who were subject to that Directive. This includes in-person services that are non-essential or non-emergent.

In making this decision, the Chief Medical Officer of Health advised that all health care providers should continue to follow the guidance issued by the Ministry of Health in the COVID-19 Operational Requirements: Health Sector Restart.  College members are advised to review this document to ensure an understanding of relevant requirements to return to in-person service provision appropriately and gradually.

In returning to the provision of in-person services, the College urges members to take a conservative approach to minimize the risk of community spread as much as reasonably possible, particularly with the emergence of new variants of the virus and localized outbreaks.

Proof of Vaccination:

Some members have asked whether they may require clients wishing to receive in-person services to demonstrate that they have been vaccinated. The Ontario Human Rights Commission has published a document entitled COVID-19 and Ontario’s Human Rights Code – Questions and Answers to provide some guidance to individuals, practitioners and employers.  The following section from this document may be of assistance.  Please note that this is the published position of the Ontario Human Rights Commission and the College is not qualified or authorized to offer interpretation of the Ontario Human Rights Code.  Members seeking specific guidance or further clarity on how to interpret their own responsibilities under the Code are encouraged to seek independent legal advice.

Ontario Human Rights Commission

21.    Can my employer or any service or housing provider require proof that I’ve received a COVID-19 vaccine?

• Receiving a COVID-19 vaccine is voluntary.
• At the same time, the government of Ontario has said they plan to issue proof-of-vaccination cards to people who receive a COVID-19 vaccine who may be required to take part in some activities.
• Requiring proof of vaccination to ensure fitness to safely perform work, or protect people receiving services or living in congregate housing, may be permissible under the Code if the requirement is made in good faith and is reasonably necessary for reasons related to safety.
• The Code grounds of disability and / or creed may be engaged when employers, housing or other service providers impose medical testing or treatment requirements, including proof of vaccination.
• Under the Code, organizations have a duty to accommodate people who may be unable to receive a COVID-19 vaccine, for reasons related to disability or creed, unless it would amount to undue hardship based on cost or health and safety.
• The right to be free from discrimination can be limited under the Code, where, for example, broader health and safety risks are serious, like in a pandemic, and would amount to undue hardship. The OHRC and relevant human rights laws like the Code recognize the importance of balancing people’s right to non-discrimination and civil liberties with public health and safety, including the need to address evidence-based risks and treatment associated with COVID-19.
• Everyone involved should be flexible in exploring whether accommodation is possible, including alternative ways a person might continue to safely work, receive a service or live in congregate housing without being vaccinated.
• Organizations should make clear the reasons why proof of vaccination is needed in the circumstances, and ensure prior, informed consent.
• Organizations should only request and share medical information, including proof of vaccination, in a way that intrudes as little as possible on a person’s privacy, and does not go beyond what is necessary to ensure fitness to safely perform work, or protect people receiving services or living in congregate housing, and accommodate any individual needs.
• No one should experience harassment or other discriminatory treatment based on a Code ground because they are unable to receive a vaccine. 
• In addition, workers have rights and employers have obligations for workers’ health and safety under the Occupational Health and Safety Act. Visit the Ontario Ministry of Labour, Training and Skills Development website for more information, including how to contact the Ministry.

The College will continue to provide updates to members as further information becomes available.

Please be advised that provisions made for service provided during the pandemic are no longer available as of May 15, 2023. If you have a question about providing psychological services to an existing client who is temporarily in Ontario, please review the College’s information regarding temporary and time limited registration found here

Ontario has recently mandated that individuals must be vaccinated before entering specified high-risk settings. These settings are listed in O. Reg. 364/20: Rules for Areas at Step 3 and at the Roadmap Exit Step under the Reopening Ontario Act, 2020. It appears that this requirement does not apply with respect to entering a place for the purpose of health care.

The Ontario Human Rights Commission recently published a policy statement which provides guidance with respect to COVID-19 vaccine mandates and proof of vaccine certificates. It states, among other important things, that:

While receiving a COVID-19 vaccine remains voluntary, the OHRC takes the position that mandating and requiring proof of vaccination to protect people at work or when receiving services is generally permissible under the Human Rights Code (Code) as long as protections are put in place to make sure people who are unable to be vaccinated for Code-related reasons are reasonably accommodated. This applies to all organizations.

Members considering implementing such policies may find useful information about how to proceed in the Ministry of Health’s Proof of Vaccination Guidance for Businesses and Organizations under the Reopening Ontario Act, Version 2, September 27, 2021. If additional information is required, members may wish to seek independent legal advice.

It is our understanding that the criteria for an official “medical vaccination exemption” are very narrow and that these do not include psychological reasons. As well, only a physician, registered nurse or nurse practitioner may certify such an exemption for settings mandated to require proof of vaccination. It does not appear that members of the College of Psychologists are authorized to provide such certification. It is important that a client making a request of this type be aware of the limits of the member’s authority.   Further information may be found in the Ministry of Health’s  Questions and Answers, Version 2, September 28, 2021.

If the business or organization is not covered by the mandatory vaccination legislation, members could provide a professional opinion concerning a client’s need for accommodation.  In doing so, as with any professional opinion given, they must be prepared to present a rationale for such an opinion.

Should a member proceed to provide a letter related to a vaccination exemption, members should clearly indicate that it is for psychological reasons  and that, in keeping with  Principle 10.3 of the Standards, “ must render only those professional opinions that are based on current, reliable, adequate, and appropriate information.”   As well, it is important that members recognize they could be held accountable should an employer or other party mistakenly accept their letter as a valid official “medical exemption”, and remember that making a record, or issuing or sign a certificate, report or similar document that they know or ought to know is false misleading or otherwise improper, is an act of professional misconduct.