- Amendment to the SCP Regulatory Bylaws
- Areas of Practice Competency Claim
- Areas of Practice Competency Definitions
- Authorized Practice Endorsement (APE)
- Continuing Education Credits (CEC)
- Group Payments for License Renewal
- Oral Examination Interview Process
- Professional Corporation and Limited Liability Partnership
- Professional Executor Advisory
- Responsibilities of the Supervisor
- Responsibilities of the Member and their Professional Executor
- Supervision for the Purpose of Licensure – Things Important to Know Beyond the Rules
- Supervision of Provisional Members FAQ’s
- Use of Title, Title Format and Abbreviation – Advisory Jan19
- Term of Membership
- Advertising Template Examples
- Assessment of Aboriginal Affairs & Northern Development Canada
- Child Abuse Protocol
- College Notes – 2018-01-18 – When Acts Collide
- Contingency Payment Arrangements
- Covid19 and Contact Tracing – Ethical and Legislative Responsibility
- Diagnostic Privilege and the Profession of Social Work
- Duty to Report Under the Traffic Safety Act
- Final Checklist for Consent – Advisory Apr13
- Health Providers’ Privacy Obligations for Patient Records
- in Loco Parentis
- Learning Disabilities-Assessment and Diagnosis
- Legislation Relevant to Privacy Issues
Medical Assistance in Dying and Psychologist Participation – Legal Opinion
- Model Standards for Telepsychology Service Delivery
- New Regulations Under HIPA
- Parenting Capacity Assessments and Custody and Access Assessments
- Psychologists Working in School & Privacy Legislation
- Privacy Issues
- Professional Practice Guidelines and Privacy Message – Ad Hoc Committee on Privacy
- Release of Psychology Records (under revision)
Release of Test Data and Test Protocols
- Relaying Medical Information on Behalf of Medical Practitioners
- Responsibilities under HIPA
– (HIPA) Amendements to the Health Information Act – HIPA Amendements Questions and Answers – HIPA PROCLAMATION 002 Factsheet
- Responsiblity for One’s Actions as a Member of the Profession
- Self-Regulation of Professions in Saskatchewan
- Supervision of the Communication of Diagnoses by Provisional/Interns/Residents
- Supervision of Provisional Members FAQ’s
- Telepsychology – Professional Considerations in Choosing an Online Conference Platform – Advisory Apr20
- Traffic Safety Act – Mandatory Reporting Requirements of Unsafe Drivers
- Use of Psychometrists
- Use of Title, Title Format and Abbreviation – Advisory Jan19
Use of Waiver to Mitigate Liability for COVID19 Transmission
- Utilizing Electronic Health Records
- Videotape Use and Retention – Advisory Apr19
- Vital Statistics Criteria
- Workplace Injury – Working with Individuals Who Experience Psychological Distress
APA Guidelines for the Practice of Telepsychology: https://www.apa.org/practice/guidelines/telepsychology
AGM 2018 Merrilee Rasmussen, Q.C. Presentation – Planning for the End: Professional Wills and the Responsibility of the Professor Executor
AGM 2009 Gary Dickson, Q.C. Presentation – Strategies for Compliance with the Health Information Protection Act (HIPA) 1-7:
- 1. Strategies for Compliance with the Health Information Protection Act (HIPA)
- 2. Glossary
- 3. Annotated HIPA Section Index
- 4. PPCC Section Index
- 5. February 2009 FOIP FOLIO
- 6. Predictable Problem Areas for Trustees
- 7. Privacy Breach Guidelines
Dr. Falender Presentation May 27-28/09 – Clinical Supervision 1-2:
- 1. Casebook for Clinical Supervision – Dr. Carol Falender & Edward P. Shafranske
- 2. Clinical Supervision Presentation
Release of Psychology Records – under revision
Use of Psychometrists
One of the many contributions Psychologists make to health and educational services is that of psychological assessment. Often assessment includes the use of psychometric instruments or tests. Psychometric instruments are used to assess cognitive, behavioural and emotional functioning. Competency to administer psychometric instruments is established through a combination of formal training, supervision, and experience, and this is most often found within graduate training programs in Psychology. In their training, Psychologists obtain the necessary theoretical and experiential underpinnings required to competently administer and interpret instruments/tests, and to integrate the information obtained through testing with information from other sources to form a complete and valid picture of their client’s situation and needs.
Conducting an assessment which includes testing is a complex activity which requires more than technical skill in the administration of standardized psychometric instruments. The impact that test results can have on the lives of clients can be significant. When psychometric instruments are improperly administered and/or interpreted there is liability for both the assessor and the employer, and most importantly a potentially negative outcome for the client. It is essential that psychometric instruments are administered only by individuals who are well qualified and competent by virtue of their training, supervision, and experience.
Many organizations utilize non-Psychologists or Psychometrists to administer psychometric instruments. The qualification and training of individuals functioning as Psychometrists can vary greatly. At times Psychometrists work under the direct oversight of registered Psychologists, and at other times these individuals are functioning independently. The Saskatchewan College of Psychologists (College) advises that it is in the best interests of clients that psychometric instruments are administered only by qualified individuals, and if they are not a registered Psychologist that their assessment work is conducted under the direct oversight of a registered Psychologist. The College also advises that there are a number of important considerations which should be taken into account in utilizing non-Psychologists or Psychometrists to conduct psychometric testing:
- Perhaps the key purpose of psychometric testing is to help inform diagnostic formulation, prognosis, and the development of an effective treatment plan. Diagnostic privilege is a controlled activity under the Psychologists Act 1997, and is only open to duly qualified medical professionals, and registered Full Practice Psychologists with the Authorized Practice Endorsement (APE) on their license. Non-psychologists or Psychometrists are not qualified or legally entitled to convey diagnoses.
- Informed consent is essential in conducting a psychometric testing including discussing with the client, the training and qualifications of the assessor. It is essential that clients understand that a Psychometrist is not a member of a regulated profession and is not a Psychologist.
- When a Psychometrist or non-Psychologist is working under the direct oversight of a registered Psychologist, it is essential that this relationship is clearly identified for the client, and that the client is provided with information as to how to access the Psychologist should they have any questions or concerns with regard to the psychometric assessment and the outcome of that assessment.
- When a registered Psychologist is supervising the work of a Psychometrist, they are ultimately responsible for the work conducted under them. Psychologists must not diagnose a client based solely on the results of a psychometric assessment and without being involved in the assessment process with the client directly.
- A psychometric instrument/test is not by itself diagnostic. The results of testing must be taken into account within the larger context of the client’s history, current presentation, and current life situation.
- Test developers have established competency and training requirements for the purchase and the use of psychometric instruments. There are some instruments which require specific training in Psychology at the graduate level before they can be purchased and used.
- Psychologists have the responsibility to ensure that the integrity of instruments/tests is maintained, that psychological instruments are accessed only by those qualified, and that psychological information is not misused. In a practical sense this requires Psychologists to ensure that they allow access to test materials only to those who meet the competency and training requirements, must ensure that test protocols and other test data is accessed only by qualified professionals, and that they do not allow their name and qualification to be used to purchase test materials for the use of others without ensuring those using them are qualified to do so.
- The confidentiality and security of test results and client information is paramount and must be ensured. Test data should in general not be maintained within common files and/or cumulative files.
- The Saskatchewan College of Psychologists Professional Practice Guidelines (SCP 2010)
- Guidelines for the Practice of Professional Psychology in Schools Within Saskatchewan (Ministry of Education 2008)
- The Canadian Code of Ethics for Psychologists 3 rd edition (CPA 2000)
- Professional Practice Guidelines for School Psychology in Canada (CPA 2007)
- Practice Guidelines for Providers of Psychological Services (CPA 2001)
- Report of the Taskforce on Test User Qualifications (APA 2000)
Oral Examination Interview Process
The Saskatchewan College of Psychologists (College) oral examination interview (examination) was established by the Oral Examination Committee (OEC) to evaluate the practice competence and professional knowledge of members of the profession in Saskatchewan. For Provisional Psychologists this is the final step that must be successfully met, prior to being awarded a Full Practice license (independent license). The examination uses as a framework for assessment the core practice competencies established by the Association of Canadian Psychology Regulators as necessary for the practice of Psychology in Canada, the candidate’s declared/intended area(s) of practice, ethics and jurisprudence, and if applicable diagnostic knowledge and competence. Full Practice members who did not at initial licensure apply for the Authorized Practice Endorsement (APE; diagnostic competence) may apply for an examination focussed specifically on diagnostic competence.
There are two components of the oral examination interview: the competency portion and diagnostic competence (only if one is eligible for the APE). Regardless of whether the examination is being conducted to determine readiness to practice independently or competence to convey diagnoses in practice, the framework for assessment is the same, that is the use of the core competencies, the candidate’s declared/intended area(s) of practice, ethics and jurisprudence, and diagnostic competence if applicable.
Candidates must submit work samples for the examination. The samples must be current (within 6 months of application for examination), must be co-signed by the supervisor, must be pertaining to actual clients, cannot be pertaining to only one client, and must demonstrate an example of the candidate’s best work. The work samples will be pre-screened on one occasion only by the OEC. The samples are not pre-screened for errors in terms of the accuracy of the content or the accuracy of the conclusions made, but rather to identify glaring errors in format and/or presentation, and/or typographical errors. Candidates are given one opportunity to resubmit samples identified as problematic – these are not screened prior to being sent to the examination panels. It must be stressed that the fact that one’s sample was pre-screened and approved or was resubmitted, is not a tacit endorsement by the OEC or the College of the quality of the sample or of the candidate’s readiness for independent practice.
Examinations are held twice a year at a date and location established by the OEC. 10 candidates are examined at each sitting. Each candidate has an examination panel established for them which is comprised of 3 eligible and approved Full Practice members of the College, who as a group cover the candidate’s declared/intended areas of practice. Candidates and potential panel members are asked to declare any conflict-of-interest which may exist, prior to the examination date. Candidates may refuse a panel, but must recognize that this may mean a delay in when they can take the examination until a suitable panel can be established.
If candidates believe that they require a specific accommodation for the examination due to a differing ability, a restriction which may negatively impact the examination, or a medical condition they must submit supporting documentation i.e. medical documentation or a professional assessment to the Registration Committee for consideration. Requests for an accommodation must be submitted at the time of application for the examination and not post-result. The Registration Committee must approve the accommodation and will notify the candidate of the decision prior to the examination. The submission of a request for an accommodation does not guarantee its approval. The documentation must indicate:
- The condition for which the accommodation being requested
- The specific accommodation required
- Be endorsed by the professional as necessary
To take the overall examination candidates must:
- Have successfully completed all other requirements of the Provisional licensure process as established by the College
- Have applied to the Registration Committee to take the examination, and been endorsed as eligible
- Have submitted all necessary applications, fees, and documentation
- If applying for the APE they must have submitted the necessary application materials, fee, and have been endorsed by the Registration Committee as eligible for the endorsement
- Have been notified by the College office that a place has been reserved for them at the oral examination
To take the APE–only examination candidates must:
- Have made application and been approved by the Registration Committee of the College as eligible to have the endorsement
- Have submitted the necessary application, fees, and documentation
- Have been notified by the College office that a place has been reserved for them at the oral examination
The length of examination is approximately 90 minutes (actual questioning) for the overall examination and approximately 60 minutes (actual questioning) if you are being examined only for the APE. Examination panel deliberations regarding the result are approximately 30 minutes. It must be noted, however, that the timeline for the examination and panel deliberations may be lengthened or shortened at the discretion of the Chair.
Examination results will be conveyed to the candidate verbally following the panel’s deliberations. The results are not official until endorsed by the Registration Committee and have been communicated to the candidate in writing by the College office. Thus the candidate must continue to practice under direct supervision, using the “Provisional” disclaimer until written notification of the result is received. The applicant’s supervisor will be notified by the College of all unsuccessful examination results. Written feedback from the examination panel and/or the Registration Committee review panel will be provided to the candidate and the supervisor when requested by the panels.
Candidates have three opportunities in total to successfully pass the examination. Please see the relevant advisories on examinations – Oral Examination Incomplete Passes/Failures and APE Examination. Unsuccessful results are provided an automatic review by the Registration Committee. Candidates must wait a minimum of 6 months from the date of the Registration Committee’s review decision before they are eligible to retake the examination. In the case of the overall examination, it must be re-taken within 12 months of the date of the review decision. Unsuccessful examination results are not delegated decisions and as such are not open to appeal to Executive Council. Only decisions pertaining to the denial of licensure are open to appeal.
Videotape Use and Retention in Practice
The use of technology in the delivery of psychological services is increasingly more common. In integrating technologies into practice Psychologists are advised to keep in mind important issues such as, but not limited to, informed consent, privacy, the appropriateness of the technology to the client need, and record retention. Psychologists are required to practice in accordance with the Canadian Code of Ethics for Psychologists 3 rd Edition (Code), the Saskatchewan College of Psychologists (College) Professional Practice Guidelines (PPG), and all relevant legislation.
In particular the use of video recorded observation in the process of providing a psychological service such as assessment or treatment merits specific mention. Psychologists are reminded that in using video recordings, as they are part of the clinical service being provided, they should be maintained as part of the formal clinical record. As such the expectation is that standards for informed consent, record content and retention, confidentiality and privacy as covered in legislation, the Code and the PPG apply. This is similar to the expectation for the retention of psychometric test protocols. This record may be important in speaking to any concerns regarding the service provided or in legal proceedings where the opinion of the Psychologist is in question. The video recording is an accurate representation of what occurred. The College advises that it is in the best interests of the public and the members of the profession that informed consent be obtained from those whose image is captured on the record, and that the recording be maintained as part of the formal health record.
The Ad Hoc Committee on Privacy highly recommends all members sign up to receive the newsletter from the Saskatchewan Privacy Commissioner’s office, “FOIP FOLIO” (FOIP is the abbreviation for the Freedom of Information and Protection of Privacy Act). To be placed on the distribution list for this newsletter contact the Office of the Saskatchewan Information and Privacy Commissioner at firstname.lastname@example.org.
The newsletter routinely covers issues of interest to psychologists.
For example, were you aware you must keep all referrals sent to your practice, even if you do not end up accepting them?
The February 2012 issues contains a reference to the U.S. department of Commerce National Institute of Standards and Technology’s “Guideline on security and privacy in Cloud Computing”, available at www.nist.gov. This is a good primer on the security and privacy features of cloud computing.
The Saskatchewan Privacy Commissioner’s website also contains links to reports summarizing investigations undertaken by the office. Some of these have direct bearing on psychologists. There is the April 18, 2011 advisory issued to Saskatchewan health care providers for destruction of patient files; the Mobile Device Security – Best Practice document from March 2011; and the Report H-2008-002 regarding access to independent medical examination report and other personal health information, i.e., the referral letter (a report based on investigation of a complaint to the Privacy Officer about a psychologist).
Medical Assistance in Dying and Psychologist Participation – Legal Opinion
In June of 2016, the Canadian Federal Government passed Bill C-14 which is an Act amending the Criminal Code of Canada to allow for Medical Assistance in Dying (MAID). In the legislative preamble the objectives of the legislation are identified as:
- recognizing the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering to seek medical assistance in dying;
- recognizing that robust safeguards, which reflect the irrevocable nature of ending a life, are essential to prevent error and abuse in the provision of medical assistance in dying;
- affirming the inherent and equal value of every person’s life and avoiding encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled;
- protecting vulnerable persons from being induced, in moments of weakness, to end their lives;
- recognizing that suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities;
- recognizing that permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons in need of protection and those of society, on the other;
- recognizing that a consistent approach to medical assistance in dying across Canada is desirable, while recognizing the provinces’ jurisdiction over various matters related to medical assistance in dying, including the delivery of health care services and the regulation of health care professionals, as well as insurance contracts, coroners and medical examiners;
- recognizing that those who wish to access medical assistance in dying should be able to do so without adverse legal consequences on their families;
- recognizing that everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms and that nothing in the Bill affects those freedoms (as amended by the House of Commons Standing Committee on Justice and Human Rights);
- recognizing the Government of Canada’s commitment to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients (as amended by the House of Commons Standing Committee on Justice and Human Rights).
Government of Canada: Legislative Background: Medical Assistance in Dying
(Bill C-14, as Assented to on June 17, 2016); June 2016
The legislation seeks to strike a balance between allowing self-determination for those who are facing intolerable suffering due to an irremediable medical condition, and protection for those who are considered to be vulnerable (e.g. minors, the disabled). The Supreme Court of Canada in the Carter v. Canada ruling which led to the legislative amendment to the Criminal Code, made a clear statement that an irremediable medical condition “does not require the patient to undertake treatments that are not acceptable to the individual.” 1Suffering as a result of mental illness or a mental health condition is not at this time covered under the MAID legislation.
The term MAID is used to describe both “voluntary euthanasia” and “assisted suicide”. The former action refers to a qualified medical practitioner or nurse practitioner administering medication to a patient who is eligible for, and freely consents to MAID, and that action brings about their death. The latter action refers to the provision of medication by a qualified medical practitioner or nurse practitioner to a patient who is eligible for, and freely consents to MAID, and that the patient uses to end his own life. It is important to stress that only those circumstances outlined within the MAID legislation are exempted from criminal prosecution under the Criminal Code. Thus “a person’s consent to die is not a defense for someone who inflicts death on them”. 2The exception to the Criminal Code prohibition is when a medical practitioner or nurse practitioner exempted under the legislation to provide MAID services, provides that service, AND the patient is eligible for, and has freely consented to receive MAID.
Under the Criminal Code, it remains a crime to assist someone to commit suicide or to counsel them to commit suicide (paragraph 241(b) of the Criminal Code). The MAID legislation contains an exemption in regard to assisted suicide which exempts from prosecution designated medical practitioners or nurse practitioners, and people who would assist them in providing or dispensing medication to eligible patients to allow them to end their lives.
Only physicians and nurse practitioners are specifically identified within the legislation as legally allowed to administer MAID services to eligible patients. In the legislation physicians are referred to as “medical practitioners”. Indemnification from prosecution is extended to those in allied professions who may be engaged by eligible physicians or nurse practitioners to assist them in the provision of MAID e.g. Psychologists, Social Workers, and Pharmacists. The important issue to remember is that as a Psychologist one must be engaged by a qualified medical practitioner or nurse practitioner to participate in MAID and cannot initiate involvement independently.
It is important to be clear that legal counsel’s opinion is that a Psychologist should not, and legally cannot initiate a discussion with a patient in regard to whether MAID may be a reasonable alternative for them, or encourage and/or persuade a patient to seek MAID. These actions could potentially be viewed as a breach of the Criminal Code section 241 which pertains to counselling one to commit suicide. Psychologists however, may be asked to assist in the determination of patient capacity to make the decision to end their life and their freedom from duress in making the decision. Psychologists are cautioned to be careful to not go beyond these bounds as they may be subject to a complaint to the College or criminal prosecution. This is not to suggest that one cannot or should not address client suicidality should this issue come up in the process of providing a therapeutic service.
Psychologists are advised MAID is a complex issue that requires not only consideration of one’s competency in dealing with issues relating to end of life, and competency in the assessment of capacity to make such decisions, but also one’s personal beliefs about the right of patients to make such a decision. Psychologists are reminded that it is important to be clear with themselves and others about the legal limits of their participation in MAID, as well as any personal limits and the limits of their professional competency, which may apply.
It is important to state that involvement in MAID provides indemnification from criminal prosecution for those professionals who fall under the exemption. However, the exemption under the Criminal Code does not provide indemnification from civil action or complaint to the College by others such as family members who may not have agreed with their loved one’s decision. It is important to stress that the College legally is compelled to accept and consider all complaints it receives in regard to the practice or conduct of its members.
- 1 Carter v. Canada February 6, 2015
- 2 Government of Canada – Legislative Background: Medical Assistance in Dying June 2016
- Merrilee Rasmussen, Q.C. Legal Counsel
Model Standards for Telepsychology Service Delivery
Member organizations of the Association of Canadian Psychology Regulatory Organizations (ACPRO) are committed to ensuring the delivery of competent and ethical psychological services by licensed practitioners. Serving and protecting the public interest is the foundational responsibility of all member organizations. This is achieved in part through the establishment of standards with regard to the provision of psychological services, regardless of the medium of service delivery employed.
Model Standards adopted by ACPRO are intended to reflect consensus on important regulatory issues of mutual concern and to assist member jurisdictions. It is understood that Model Standards have no force outside of official adoption by a member jurisdiction.
Over the last decade there has been an evolution in terms of the modalities used to deliver health services, where services are no longer necessarily delivered in-person. This evolution has been spurred in part by innovations in communication technologies, the increased sophistication of health consumers in terms of their expectations for service and accessibility to services, and increased demands for service.
Telepsychology can be defined as “the use of information and communications technology to deliver psychological services and information over large and small distances” (adapted from Picot, 1998). Practice within psychology using this modality would include all client-centered services, consultation, supervision of students/professionals/colleagues, and education of the public and/or other professionals.
Regardless of the modality used for service delivery, psychologists are expected to practice according to the Canadian Code of Ethics for Psychologists (3 rd Ed.) or the code de déontologie (Québec), standards for practice within their home jurisdiction, and according to local laws and
regulations. While there are many practice issues of commonality between telepsychology and in-person service delivery, there are practice issues unique to providing services via tele-technologies. Psychologists are reminded of the following practice issues that should be considered in providing any psychological service:
- Respect for the Dignity of Persons
- Responsible Caring
- Integrity in Relationships
- Responsibility to Society
- Responsibility to do no harm.
- Practice within one’s area(s) of competence, including medium of service delivery.
- Responsibility to remain current with regard to the research/literature in the field.
- Appropriate choice of treatment, including treatment modality and medium of delivery, based on a thorough assessment of client situation and need. Decisions about choice of treatment, modality, and medium reflect the highest appropriate standard of care.
- Informed consent including but not limited to:
- Discussion of the assessment and intervention approaches and modalities to be used, and the pros and cons of such approaches, delivered via such modalities.
- Discussion regarding the maintenance of records, including electronic records, e.g. security, access, retention policy
- Discussion regarding confidentiality and duty to report
- Confirmation of the client’s informed consent, either through use of a written and signed consent form, or via electronic alternatives.
- Honesty and integrity in relationships
- Privacy and confidentiality
- Record maintenance and storage
- Planning for services in the event of an emergency, including how to contact the psychologist, and alternative services locally available to the client
- Security of Tests
- Liability Insurance
- Conflict of Interest
- Psychologists must be sensitive to cultural/regional/local issues which may impact service delivery, and this is especially critical when the psychologist is not familiar with the clientele or area being served.
- Protection for Vulnerable Persons
- Establishment of policies and procedures regarding the following:
- General Service Provision
- Emergency Services/Coverage
- Records (maintenance, access, retention, security)
- Transfer of Services (retirement, death, close of practice, services no longer wanted
- Client Verification
- Technology Maintenance Plan
- Outcome Evaluation Plan
In addition to the general responsibilities for providing psychological services as noted above, the following must be observed in the provision of services via telepsychology:
- The psychologist will be licensed in “good standing” within the jurisdiction in which the psychologist resides. If holding provisional/candidate licensure, the psychologist will be supervised in all telepsychology practice by a psychologist licensed in “good standing” within the jurisdiction. As such the expectation is that the psychologist conforms to any and all rules, regulations, and standards established within the home jurisdiction.
- Psychologists delivering telepsychology services outside of their home jurisdiction will ensure they are legally entitled to do so.
3. The psychologist will inform the client who the client may complain to if there is a problem, providing the contact information for the responsible regulatory body.
4. Psychologists must be familiar with the local jurisprudence and standards for practice in the jurisdiction in which the service is being delivered. Where there is a conflict between such laws/regulations/standards and those of the psychologist’s home jurisdiction, the psychologists must act according to the higher standard.
5. To minimize the possibility of someone impersonating the client and gaining access to confidential health information, or influencing the psychologist’s assessment or opinion of the client, psychologists must use some form of coded identification of the client in cases where live visual verification is not possible.
6. The psychologist will make plans with the client regarding what will happen in the event of technological failure.
- Psychologists delivering telepsychology services outside of their home jurisdiction will ensure they carry appropriate liability insurance with respect to such service.
- Psychologists will be competent in the technology of the service delivery medium.
1 Picot, J. (1998) Sector Competitiveness Frameworks Series: Telehealth Industry Part 1 – Overview and Prospects. Industry Canada: Industry Sector Health Industries (as cited in National Initiative for Telehealth Guidelines – Environmental Scan of Organizational, Technology, Clinical and Human Resource Issues, April 2003, Canadian Society of Telehealth)
2 For the purposes of this document the term “psychologist” includes all practitioners of psychology who are licensed / registered by a Canadian psychology regulatory body (e.g., psychological associate, provisional psychologist, psychological candidate)
Relaying Medical Information on Behalf of Medical Practitioners
At times Psychologists may be asked by their employers to perform tasks which may be considered to be outside of the scope of practice and licensed authority afforded to the profession. An example of this would be relaying information to clients regarding medication issues on behalf of medical practitioners. Members are reminded that the legislation and bylaws governing the practice of Psychology requires that members practice in accordance with the ethical and practice standards adopted by the Saskatchewan College of Psychologists (SCP). Principles 2 and 3 of the Canadian Code of Ethics for Psychologists 3 rd Edition (Code) direct members to practice only within their scope of competence, and to be accurate and honest in presenting their qualifications and limitations. Section 2 of the SCP Practice Guidelines (PPG) speaks to a member’s responsibility to practice in accordance with the Code and the PPG, and the obligation of the member to comply with these directives. Section 3 of the PPG speaks to competence and practicing only within the scope of that competence and the fact that regardless of the reason why one acts, they are accountable for the actions they undertake in their role as a Psychologist. While on the surface conveying to a client a directive from a physician regarding medication, whether provided verbally or in writing may appear to be a relatively harmless action, it has the potential to present a liability to the client, the individual Psychologist, and the employer. Ultimately, a Psychologist is not a medical practitioner, and does not have prescriptive authority. To provide clients with direction regarding medication usage may be viewed as going outside of one’s competence and legal scope of practice, and may result in harm to the client, and complaint to the regulatory body. Members are advised to be clear with their employers with regard to their scope of competence and the scope of practice for the profession, and to restrict their activities to those which they have the legislated authority to perform.
Traffic Safety Act – Mandatory Reporting Requirements of Unsafe Drivers
The Traffic Safety Act identifies the duty of medical practitioners to report to SGI any driver who they have reason to believe by virtue of a health condition may be unsafe to operate a motor vehicle. Psychologists are defined within the regulations as a medical practitioner and as such have a duty to report. Specifically Section 283 of the Act and Section 3 of the Regulations state:
Requirements of medical reports
283(1) Any duly qualified medical practitioner shall report to the administrator
the name, address and clinical condition of every person who:
- is 15 years of age or over attending on the medical practitioner for medical
- in the opinion of the medical practitioner, is suffering from a condition
that will make it dangerous for that person to operate a vehicle.
(3) For the purposes of section 283 of the Act, a “duly qualified medical practitioner” or “medical practitioner” means:
- a person who is registered pursuant to The Medical Profession Act, 1981, other than a person registered pursuant to section 42.1 of that Act, and whose registration is not under suspension;
- a person who is a member in good standing of the Saskatchewan College of Psychologists pursuant to The Psychologists Act, 1997
- a registered nurse who is entitled, pursuant to The Registered Nurses Act, 1988, to practise in the nurse practitioner category; or
- a person who is a member in good standing of the Saskatchewan Society
- of Occupational Therapists pursuant to The Occupational Therapists Act,1997.
SGI has implemented a form entitled “Cognitive Assessment Report” on which information regarding concerns is to be submitted (see link below). Questions regarding this requirement should be directed to the Medical Review Unit of SGI.
Learning Disabilities-Assessment and Diagnosis
The Learning Disability Association of Canada (LDAC) defines learning disabilities as follows:
Learning Disabilities refer to a number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning. As such, learning disabilities are distinct from global intellectual deficiency.
The differential diagnosis of a learning disability requires consideration other conditions including but not limited to whether or not an intellectual deficit is present which may better explain the learning problems being experienced. The assessment of learning disabilities should include the gathering of information from multiple sources and the integration of that information to provide a picture unique to each client. Assessment of intellectual deficit should be conducted by a professional with specific training in intellectual assessment who is recognized by the developers of the intellectual assessment tool to be qualified to provide that assessment. In practice this generally means individuals who have a minimum of Masters level training in psychometric assessment which is most often obtained in graduate-level Psychology programs. Diagnosis of learning disabilities often involves a multidisciplinary team approach and may include assessment by Physicians, Speech Pathologists, Audiologists, Ophthalmologists/Optometrists, Teachers, and Psychologists, in addition to demographic, medical and developmental information obtained from parents/guardians. The information from these various sources will assist in ruling in or out the presence of a learning disability.
In Saskatchewan the formal establishment of a diagnosis of a learning disability must be carried out by a duly qualified medical professional or a Registered Psychologist with the Authorized Practice Endorsement (APE) on their license. Section 23 of the Psychologists Act 1997 limits the right to convey psychological/psychiatric diagnoses to these two groups only. In Saskatchewan the scope of practice for the profession of Optometry does not include the primary assessment and diagnosis of learning disabilities.
Members of the Saskatchewan Association of Optometrists (SAO) may play an important contributory role in the assessment of a learning disability and ultimately in assisting in ameliorating the impact that a learning disability has in a client`s life. Members are encouraged to work collaboratively with other professions in assisting these clients and are advised to be cognizant of the limitations of scope in this jurisdiction in terms of assessment, diagnosis and treatment of learning disabilities.
Professional Executor Advisory
Sections 14.4 and 14.5 of the Saskatchewan College of Psychologists (SCP) Professional Practice Guidelines require members to “in advance” establish a contingency plan for clients and their records to ensure that clients and their health information are protected in the event of a member’s death, incapacity, or withdrawal from their position or practice. In April 2011 the Ad Hoc Committee on Privacy made a recommendation to Executive Council regarding establishing a requirement for members to identify a Professional Executor, and recommending to the membership the establishment of a professional will.
Requiring a formal articulation of a Professional Executor is consistent with the regulatory responsibilities/obligations of the SCP, the ethical responsibilities/obligations of the profession, legislative obligations regarding client health records, public expectation, and quality assurance efforts.
Members of the SCP who are practicing** or who have previously practiced and have in their possession client information and /or client health records are required to identify for the SCP a Professional Executor for their practice who will be responsible to do the following in the event that the member is no longer able:
- Ensure the security of their client health records and information.
- Respond to requests for access to client health record information.
- Assure or facilitate continuing client care.
** defined as any practice with and/or relating to clients from which one could reasonably expect that there would be a written/electronic record of that practice
On a yearly basis at annual renewal, members are required to update the contact information of their professional executor. This information will allow the SCP to respond to inquiries with regard to access to health record information. At this time, members are not required to establish a Professional Will but are strongly encouraged to do so.
- Members must annually at license renewal identify a Professional Executor for their client health records, who will take responsibility for those records in the event the member is no longer able to do so.
- A professional Executor must be a member of the profession unless the member is practicing within an institution or organization, in which case the professional executor may be an employer or an employer designate. Family members cannot serve as the Professional Executor.
- Individuals who were previously members of the profession, with no history of formal discipline or sanction (including Alternative Dispute Resolution; ADR) may serve in the capacity of professional executor with approval by the College Registrar or their designate.
- Members must make their own arrangements with their Professional Executor to ensure compliance with the relevant legislation, Canadian Code of Ethics for Psychologists 3rd Edition, the SCP Professional Practice Guidelines, and governing privacy legislation.
- Members are responsible to ensure that they inform the SCP in writing of any changes to who will serve as their Professional Executor if these occur prior to the license renewal period.
- Members, who do not comply with the requirement to identify a Professional Executor, will be sent a letter from the SCP outlining the policy and again requesting compliance. Subsequent refusal to comply may be referred to the PCC for follow-up.
- Executors are strongly encouraged to ensure a working understanding of relevant legislation (e.g. HIPA, the Psychologists Act 1997), the Canadian Code of Ethics for Psychologists, and the SCP Professional Practice Guidelines.
in Loco Parentis1
The Canadian Code of Ethics 3 rd Edition directs psychologists to obtain informed consent in the provision of psychological services, and in the case of a minor, or one not competent to provide consent this must be obtained from their legal guardian2. Compliance with the Code is required under the legislation and bylaws of the SCP. Failure to comply with the Code may be viewed as professional misconduct and may result in formal discipline.
Psychologists working in certain institutional settings, such as schools, custody facilities or hospitals, may be tempted to rely on the legal doctrine of in loco parentis to avoid obtaining consent, but should do so with great caution.
Literally, in loco parentis means “in place of the parent”. Application of the doctrine occurs when a “person or legal entity undertakes the care or control of a person lacking legal capacity in the absence of supervision by the person’s natural parent or in the absence of formal legal approval (e.g., adoption, guardianship).”3
The intent of the legal doctrine is not to appropriate the right to consent from a fit parent or guardian or legal caregiver, nor is it to be applied as a matter of course to expedite activities/actions, nor does it automatically apply simply because a child is temporarily placed in the care of other persons.
The doctrine has commonly been applied in school systems to justify discipline of students, but is appropriately used in that context ONLY when it is applied for the purpose of educating the child4. Nor is the doctrine applicable to all persons employed within the institution. For example, the Courts have held that school counsellors in their role as counsellors do not perform services directly related to education, and are not school teachers5. Thus, the doctrine does NOT automatically extend to the provision of psychological services, even if they are provided within the school. It is also important to stress that being in loco parentis does not allow teachers to “consent” on behalf of parents or guardians in order to provide psychological services to a minor child.
As a result, psychologists working in schools or other systems where the in loco parentis doctrine may be invoked are required by the Code of Ethics to obtain informed consent from the legal parent/guardian/caregiver of the child, except in cases of emergency.
Similarly, a related concept, the “mature minor” is not applied as a matter of course, and the psychologist must be able to justify its use in each case and to demonstrate that the specific minor is capable of providing informed consent.
1 This Practice Advisory has been prepared with the assistance of legal counsel to the College, Rasmussen Rasmussen & Charowsky LPC
2 Canadian Code of Ethics for Psychologists Third Editions, Canadian Psychological Association, 2000
3 Black’s Law Dictionary 787 (6 th ed. 1990)
4 Blackstone, Commentaries on the Laws of England, Book I, chap. 16, p. 441(1769)
5 R. v. Ogg-Moss,  2 S.C.R. 173.
College of Psychologists of BC Policy
There is a recent policy of the Registration Committee of the College of Psychologists of British Columbia (CPBC) regarding reciprocal applications. For those applicants fully licensed as registrants of a Canadian psychology regulatory body and whose main residence appears to be in B.C., please contact CPBC for more information.
As you may be aware the Practice Directorate for the national advocacy body for the profession, the Canadian Psychological Association (CPA), in conjunction with the provincial advocacy bodies across Canada are polling their memberships for their opinion regarding establishing the Doctoral degree as the national standard for entry into the profession as a Psychologist. The Psychological Association of Saskatchewan (PAS – advocacy body) indicated at its briefing on the issue (May 3, 2012 in Regina) that it is not advocating for licensure for only Doctoral individuals. It is important to note that some Canadian jurisdictions have or are looking to discontinue licensure at the Master’s level all together. The Saskatchewan College of Psychologists (College) feels that it is important to provide members with additional information regarding the issue under consideration and which may be of assistance in making a decision.
The authority to make changes to licensure standards is vested with the regulatory bodies across Canada, “at the pleasure” of the various provincial and territorial legislatures. The mandate of the regulatory body is to protect the public through the regulation of the profession. The mandate of advocacy bodies is to promote the interests of the profession. At times the two mandates converge and at other times the two diverge and this is important to remember.
The College does not currently have any plans to change the practice of licensing both at the Masters and Doctoral levels. Any changes to the current practice would have to be agreed to by Government as being in the best interests of the public. It is in the best interests of the public to have competent and ethical practitioners of Psychology under the umbrella of regulation.
Professional Corporation and Limited Liability Partnership
At the June 23, 2007 meeting of the Saskatchewan College of Psychologists the Executive Council approved the application forms for member psychologists to proceed with registration for Professional Incorporation, and Limited Liability Partnerships. Forms and procedural instructions are now available on this web-site. Completed forms can be forwarded to the College office where a Register is maintained. The Registrar will enter the name of the Professional Corporation or Limited Liability Partnership into the register then assign a registration number (Professional Corporation Number or Limited Liability Partnership Number) to the Professional Corporation or Partnership. A certificate bearing this number will be forwarded to the Corporation or Partnership from the Registrar. Members are strongly encouraged to seek legal and financial counsel regarding the costs and benefits before proceeding with this process. Additional questions about the process of registration as a Professional Corporation or Limited Liability Partnership can be directed to the Saskatchewan College of Psychologists office.
Alternative Dispute Resolution and Mediation – PCC
Amendment to the SCP Regulatory Bylaws
On June 30, 2016 amendments to the College’s Regulatory Bylaws were enacted. The amendments were made to update the bylaws to make them consistent with changes in regulation and practice. The bylaws will be presented to the membership of the College for ratification at the 2017 Annual General Meeting. In addition to some substantive changes, changes were made to address redundancy and update language. Amendments of particular note are as follows:
Section 5 pertaining to the Professional Conduct Committee, have two new subsections which are important to note; subsections 4 & 5. These subsections read:
4) Where the Professional Conduct Committee resolves a complaint by consent, the committee shall ensure that a copy of the agreement reached with the member, or a summary of it, in which no personal information is disclosed concerning any person other than the member with respect to whom the decision is made, is posted on the college’s website.
(5) Where the Professional Conduct Committee dismisses a complaint, the committee shall ensure that a summary of the complaint and the reasons for its dismissal, in which no personal information is disclosed concerning any person, including the member with respect to whom the decision is made, is posted on the college’s website.
The complaint and discipline processes have multiple purposes none of which are the intent to punish; the purposes are public protection, correction, and education. Subsection 5(4) pertains to alternative dispute mechanisms that the member and the College may enter into. An alternative resolution is employed when a member accepts responsibility for their actions, and is open to making changes. This is a desirable outcome for all concerned as opposed to proceeding to a full Discipline Committee hearing which is stressful and resource draining. Subsection 5(5) ensures transparency and accountability on the part of the College, and allows for education to occur.
Full Practice licensure is awarded when the Provisional member meets the requirements outlined in Section 10(1):
Section 10(1)(c) at the first available opportunity, successfully complete and oral interview conducted by the Registration Committee at which the applicant provides evidence, as required by the council, of:
- training and experience in the areas of psychological practice in which he or she intends to practice; and
- an understanding of contemporary ethical standards and professional regulation and jurisprudence in Saskatchewan;
In a practical sense the bylaw compels Provisional members to access the oral examination process as soon as it is available to them. This amendment was made as it is felt that it is not in the best interests of the Public, the Provisional member, or the supervisor to prolong the Provisional licensure period. Prolonging the Provisional licensure period encumbers already limited supervisory resources, prolongs risk exposure for the supervisor, limits the Provisional member’s practice and opportunity, and anecdotally it appears results in less direct oversight of practice.
Another significant change to the Regulatory Bylaws pertains to Section 11(2). This subsection alters the time limit that one can hold a Provisional license. That section reads:
(2) A provisional practicing membership expires at the earliest of the following times:
- subject to subsection (3), after the expiration of three years;
- if and when the member fails for a third time to complete the Examination for Professional Practice in Psychology (EPPP) with a score of 70% or higher;
- if and when the member fails for a third time to successfully complete the oral interview.
The decision was made to extend the Provisional licensure period to three years from two, and to remove the provision for the granting of one extension of up to 12 months upon request to the Registration Committee. The decision to extend the time limit and remove the possibility of an extension was made as a majority of Provisional members appeared to require three years to meet the requirements of the supervised practice hours and the EPPP. The three year time limit does not include time spend waiting to take the oral examination as scheduling of the examination is dependent on the schedule of the College. This does not apply to maternity/paternity or medical leaves with documentation that will still be granted and will in effect stop the Provisional limit time clock for the period of the approved leave.
Section 13(1) relating to the Authorized Practice Endorsement (APE) permits the communication of diagnoses by Provisional members or pre or post-Doctoral Psychology Interns / Residents who are under the direct supervision of Full Practice members of the College who have the APE. In a practical sense this removes the requirement for the supervisor to be physically present when a diagnosis is communicated initially to the client or if they cannot be physically present when the diagnosis is given, the requirement to communicate the diagnosis to the client in writing prior to the Provisional member or Intern/Resident communicating it. This would also apply to Full Practice members without the APE who are being supervised in order to apply for and obtain the endorsement.
A new bylaw pertaining to temporary practice was enacted. Section 15 Temporary License states:
“a person who meets the requirements of subsection 20(2) of the Act as a registrant of a Canadian jurisdiction may obtain a temporary license to practice in Saskatchewan for the period of time specified on the license.”
The temporary license will allow one who holds an independent practice license with full scope of practice in another Canadian jurisdiction to come into the province to provide a specified time-limited service. The license must be applied for, and is awarded at the discretion of the College. The license will allow those who qualify to practice without full licensure in this jurisdiction for a maximum of 14 days in a calendar year. This license is intended to allow for time limited practice (e.g. Court appearance) and is not intended to be used to allow for ongoing practice. Time Limited licenses will be subject to the approval of the Registration Committee or their delegate. The supporting policy and procedures that would allow for the provision of a Time Limited license are currently under development.
Section 16 prescribes for members the proper and expected use of Title. This section was added as it came to the attention of the College that there was confusion for some members in regard to what is required.
Members are encouraged to familiarize themselves with the amended Regulatory Bylaws and to contact the College with any questions they may have in regard to these.
Areas of Practice Competency Claim
Practice competency for Full Practice members of the College is self-declared. That is in most cases there are no additional examinations that one must take in order to add to their declared areas of practice competency, with the exception of diagnostic competency (Authorized Practice Endorsement). Members are reminded that in adding areas of competency they are accountable for making that declaration and that in the unfortunate event of a concern being raised about their practice, they will need to be able to explain and support the declarations made.
It is important to note that competency declaration is a self-report of practice limitation in general practice, not a specialty. Full Practice members may request the addition of a new competency by submitting a written request to the College. In the request members must indicate the rationale for the addition, and should provide supporting documentation e.g. transcripts from additional training, documentation of formal supervision etc. The request will be reviewed by the Registrar, and in general the member’s file will be amended. Requests which are atypical or where there are questions, will be referred to the Registration Committee for consideration and decision. Competency is generally established through knowledge, training and experience. Members are strongly encouraged to establish new competencies through an organized plan which is supported by education, supervision, and practice experience.
Members are reminded that responsibility for the claimed areas of competency rests with the Full Practice member, and that listing of the claim with the College does not constitute an endorsement of that claim by the College, its committees, or its employees.
Title Format and Abbreviation
Advertising Template Examples
The SCP Professional Practice Guidelines identify the proper representation of one’s licensure status, academic credential and areas of practice.
9.2 Representation of credentials: A member must accurately represent and must not misrepresent their area(s) of competence, education, training, experience and professional affiliations to the College, to the general public and to their colleagues.
Jane Doe, Ph.D, R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
Areas of Practice:
- eating disorders
- anxiety disorders
9.3 No specialty designation: A member must not hold themselves out: (a) as having any specialty designation granted by the College, or (b) as having any specialty qualification based upon any areas of practice declared by the member for the purpose of registration, renewal of registration or otherwise with the College.
NOT ACCEPTABLE: – cannot list one’s self as being a specialist or implying the College has recognized a specialty
Jane Doe, Ph.D, R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
- Specialist in XYZ Therapy
- Neuropsychology Specialist
9.4 Misrepresentation of affiliation: A member must not misrepresent their affiliations with institutions or organizations or the consequences of such affiliations e.g., a member must not offer registration or fellowship in the Canadian Psychological Association, the Psychological Society of Saskatchewan, the Saskatchewan Educational Psychology Association, or other associations as evidence of professional qualification.
NOT ACCEPTABLE: – listing of fraternal associations is misleading
Jane Doe, Ph.D, R. D. Psych. (APE)
PAS, CPA, CRHSPP
ABC Psychological Services, Prof. Corp.
- Specialist in XYZ Therapy
- Neuropsychology Specialist
9.6 Representation of others as members: A member must not represent or imply that an individual is a member if that individual is not registered with the College.
NOT ACCEPTABLE: – John Doe is not licensed – the listing implies he is
Jane Doe, Ph.D, R. D. Psych. (APE) / John Doe, MSc. (Counseling Psychology), CCA
ABC Psychological Services, Prof. Corp
9.7 Requirements for credential presentation: In the presentation of their qualifications, when representing themselves as a member, when describing their practice, or when being named in a group or multidisciplinary practice: (a) a member shall show their registration certificate and APE certificate if applicable, to a client upon request; (b) a member shall represent himself/herself to the public as a member of the College by the use of the title Registered Psychologist or Registered Doctoral Psychologist. This may be abbreviated to R. Psych. or R.D. Psych., as the case may be, including, if so required by the College, designating whether they are on the Provisional Register of the College, or a member may indicate that he/she is a “Member of the Saskatchewan College of Psychologists”; (c) the highest academic degree upon which registration is based shall immediately precede the professional title; (d) a member may specify other degrees or professional titles, such as MBA, P. Eng., when the area of study is relevant to the member’s psychological practice. The area of study must also be specified unless readily apparent from the degree or title; (e) a member who has obtained Diplomate status with the American Board of Professional Psychology (ABPP) may indicate their status, in the manner required by ABPP, immediately after reference to their title as member; and (f) applicants for registration or members awaiting the awarding of a degree must not describe themselves as “candidate for degree” or “candidate for registration”.
Jane Doe, Ph.D, R. D. Psych. (APE)
ABPP Diplomate, MBA
ABC Psychological Services, Prof. Corp.
Areas of Practice:
- Industrial / Organizational Psychology
- Sports Psychology
NOT ACCEPTABLE: – listing more degrees than allowed, cannot use a.b.d.
Janet Doe, B.A., M.A., Ph.D. a.b.d,
R. Psych. (APE)
ABC Psychological Services, Prof. Corp.
Areas of Practice:
- Industrial / Organizational Psychology
- Sports Psychology
NOT ACCEPTABLE : – missing the degree that she is licensed under
Janet Doe, R. Psych. (APE)
ABC Psychological Services, Prof. Corp.
Areas of Practice:
- Industrial / Organizational Psychology
- Sports Psychology
NOT ACCEPTABLE: – missing the Psychologists licensure title and instead lists Psychology
Jane Doe, Ph.D. (Psychology) #000
John Doe, M.Sc. (Marriage and Family Therapy)
ABC Counseling Services
10.1 Misleading information Members must not include false or misleading information in public statements concerning psychological services they offer.
NOT ACCEPTABLE: – claiming to be able to cure depression
Jane Doe, Ph.D., R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
More than 10 years of curing emotional pain related to abuse.
10.2 Misrepresentation of affiliations: In announcing or advertising the availability of psychological services or products, a member must not display any affiliations with an organization or individual in a manner that falsely implies the sponsorship or certification of that organization or individual.
NOT ACCEPTABLE: – claiming to cure and suggesting certification/endorsement by APA and CPA
Jane Doe, Ph.D., R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
More than 10 years of curing emotional pain related to abuse. Recognized by the American Psychological Association, and the Canadian Psychological Association
10.4 Use of name Members must not associate with any services or products or permit their name to be used in connection with any services or products in such a way as to misrepresent: (a) the services or product; (b) the degree of their responsibility for the services or products; or (c) the nature of their association with the services or products.
NOT ACCEPTABLE: – using status as a Psychologist to promote the product – implication of efficacy because as it is recommended by a professional
U Will B Skinny Weight Loss Supplement
Dr. Jane Doe, R.D. Psychologist in Saskatchewan
Practice in Clinical Psychology – “I recommend it to all my clients and overwhelmingly they experience success. You will too if you try them.”
10.6 Registration number: A member must include their registration number from the College Register on all advertisements of their practice.
Jane Doe, Ph.D., R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
10.8 No solicitation of testimonials: A member must not solicit testimonials from clients or former clients.
NOT ACCEPTABLE: – use of testimonial and the suggestion of ability to cure
Jane Doe, Ph.D., R. D. Psych. (APE)
ABC Psychological Services, Prof. Corp.
More than 10 years of curing emotional pain related to abuse.
“Dr. Doe cured me of my depression. She’s a life saver.” JD
Contingency Payment Arrangements
The Professional Practices and Ethics Committee provided advice to the Executive Council regarding the ethics of contingency fee arrangements. The Council, in its meeting on September 25, 2004, confirmed their position.
Two questions were presented to the Committee:
- Is a psychologist permitted to enter into a contingency fee arrangement for the provision of a psychological assessment including the administration and interpretation of psychological testing instruments?
- If a psychologist is retained to assess an individual and will only be paid for the assessment if the client is successful with a legal claim, does this violate either the bylaws or the Code of Ethics?
In regard to the first, more general, question, the opinion of the Professional Practices and Ethics Committee was that “there may be a situation in which a contingency option makes perfect sense and is permissible, primarily based upon whether or not the contingency and the outcome of the psychological service, or assessment provided, are tied together….If the service provided, and in particular, the outcome, of the service provided and the contingency are not connected, then the psychologist can make a business decision regarding if and when payment for services may occur. However, if the contingency and outcome of the service provided are tied together then a conflict of interest may exist, and the appropriateness of the arrangement is questionable.”
The Committee noted that a psychologist may choose to provide services to needy clients who have limited resources using a variety of payment methods. “However, the psychologist should explore methods of responding to that need without creating a contingency situation that may compromise the objectivity of the psychologist and the integrity of the profession.”
The second question outlined a situation that was clearly questionable under the guidelines outlined above. In the case described, payment could only occur if the assessment pointed in a direction that supported the client’s legal suit. The Committee stated that “The contingency arrangement regarding the payment for services for an assessment based upon a successful court process appear to conflict with (Principle III: of the Code of Ethics for Psychologists)
in both the areas of:
- Objectivity and bias
- Conflict of interest”
Maximization of objectivity and minimization of bias is the hallmark of psychological assessment. The expectation of a specific outcome implicit in the contingency fee arrangement clearly conflicts with this principle.
According to the Canadian Code of Ethics 3rd Edition “Conflict-of-interest situations are those that can lead to distorted judgment and can motivate psychologists to act in ways that meet their own personal, political, financial, or business interests at the expense of the best interests of members of the public.” In the view of the Professional Practices and Ethics Committee, “the contingency of assessment outcome, and hence court outcome, and the payment of services is clearly a conflict of interest.”
Diagnostic Privilege and the Profession of Social Work
Concerns have recently been raised by the professional association in regard to the 2013 decision of Government to extend diagnostic privilege to the profession of Social Work. There is significant history behind this issue that the College believes is important to know in understanding the decision of Government.
Prior to the establishment of the College in 2002, diagnostic privilege was not a controlled act in the same way that it is today. Those working in exempted settings (designated by government) were entitled to establish and communicate mental health diagnoses if this was deemed to be within the scope of their competency and their employment responsibilities. Thus until the implementation of the Psychologists Act 1997 (Act) in 2002, qualified psychiatric nurses, social workers, psychologists, and psychiatrists working within exempted settings were entitled to diagnose mental health issues/disorders. When the College was established in 2002 the Transitional Council was asked, by both Government and Saskatchewan Association of Social Workers (SASW) to participate in discussions in regard to SASW’s desire to re-establish the privilege for members of the profession it deemed qualified. SASW is the regulatory body for the profession of Social Work in Saskatchewan, and has a dual role also as the advocacy body for the profession. The College periodically participated in discussions with SASW and Government around the issue of social work and diagnostic practice/privilege between 2002 and until 2012. In 2012 the Government moved forward with the extension of the privilege to the profession of Social Work.
Over the years the various Executive Councils of the College acting on behalf of the membership as their elected representatives, and consistent with the College’s mandate, advocated for the protection of the public interest in moving forward with this issue. It is important to emphasize that the Government has the authority to change legislation, and that they in essence “own” the legislation. The Government did not ask for the College’s “permission” to extend the privilege. The Act did not require amendment to extend diagnostic privilege to Social Work. The Government indicated that in establishing Section 23 of the Act it had not intended that diagnostic privilege would be removed from Social Work entirely, rather just the right to diagnose complex psychiatric conditions.
Throughout the years of discussion, the College made efforts to keep its members apprised through various means including mail-outs, annual reports, and reports at AGMs. The College’s involvement in formal discussions regarding this issue ended in 2012. In 2012 the legislation was presented in the legislature for first reading. In May 2013 the amendment to the Social Workers Act allowing for diagnostic privilege was proclaimed by Government after receiving third reading in the Legislature. The College understands that press releases were sent out by the Ministry of Social Services and that articles pertaining to this legislative amendment appeared in the two major papers in the province. The publication of the proclamation of the legislation was carried out by the Ministry of Social Services and SASW as it is their governing legislation.
The College’s understanding is that this legislation is not open to retraction and that at this point in time the issues under consideration are the details of who will be granted the privilege and how will it be regulated. The College and other provincial health regulators were recently asked to comment on the SASW proposed bylaws and policies pertaining to diagnostic privilege. In that consultation, among other important issues, the College highlighted the importance of specialized coursework, training and supervised experience and examination in establishing diagnostic competence.
The College in its consultations with SASW and the Ministries of Health and Social Services, acknowledged the SASW’s right as both the regulatory body and advocacy body for the profession, to request that diagnostic privilege be extended to qualified SASW members. As the regulator for Psychology, the College does not have authority over the practice or regulation of another health profession, nor does it view this as its role. The College has always taken the position that diagnostic practice is a highly skilled practice that requires specific training and qualification. The College has consistently advocated for high standards in regard to the training for, and the establishment of diagnostic competence as the potential for harm to the public is significant. It is important to emphasize that the profession of Social Work, like the profession of Psychology practices under a code of ethics that requires its members to practice only within their established areas of competency.
Duty to Report Under the Traffic Safety Act
Members of the College working with those of legal age to operate a motor vehicle as outlined within the Traffic Safety Act are advised to familiarize themselves with the legislation. In particular Section 283 of the Traffic Safety Act states:
Requirements of medical reports
- Any duly qualified medical practitioner shall report to the administrator the name,
address and clinical condition of every person who:
- is 15 years of age or over attending on the medical practitioner for medical services; and
- in the opinion of the medical practitioner, is suffering from a condition that will make it dangerous for that person to operate a vehicle.
- Any optometrist shall report to the administrator the name, address and clinical condition of every person who:
- is 15 years of age or over attending on the optometrist for services usually rendered by an optometrist; and
- in the opinion of the optometrist, is suffering from a condition that will make it dangerous for that person to operate a vehicle.
- No action shall be brought against a medical practitioner or an optometrist who makes a report in good faith in accordance with subsection (1) or (2).
- A report made pursuant to this section:
- is privileged for the information of the administrator only;
- is not open to public inspection; and
- is not admissible in evidence in any trial, except to show that the report was
made in good faith in accordance with this section.
The applicable Regulations are The Driver’s Licensing and Suspension Regulations, 2006 and which state:
3) For the purposes of section 283 of the Act, a “duly qualified medical
practitioner ” or “medical practitioner” means:
- a person who is registered pursuant to The Medical Profession Act, 1981,
- other than a person registered pursuant to section 42.1 of that Act, and whose registration is not under suspension;
- a person who is a member in good standing of the Saskatchewan College of Psychologists pursuant to The Psychologists Act, 1997;
- a registered nurse who is entitled, pursuant to The Registered Nurses Act, 1988, to practice in the nurse practitioner category; or
- a person who is a member in good standing of the Saskatchewan Society of Occupational Therapists pursuant to The Occupational Therapists Act, 1997.
Psychologists are advised that there is a legal duty to report when in their professional opinion there is the potential for harm as an individual suffers from a condition which “will make it dangerous for that person to operate a vehicle”. The Medical Review Unit at Saskatchewan Government Insurance (SGI) make decisions regarding licensure and coverage based on the practitioner reporting. If a member of the public disagrees with a decision made by SGI they have the right of appeal to the Highway Traffic Board. Psychologists are reminded of their professional and ethical obligations in regard to the issues of informed consent, assessment and diagnostic practice in making such a report.
Assessment of Aboriginal Affairs and Northern Development Canada (AANDC)
Members of the Saskatchewan College of Psychologists (College) providing services to First Nations students in school environments periodically may be asked to assess them for eligibility for high cost funding. Such funding allows students with identified learning, behavioral or mental health needs to access to specialized supports and resources so as to maximize their learning outcomes.
The College has been made aware that at times due to limited psychological staff resources school divisions have utilized non-Psychologist professionals to administer psychometric tools for the purpose of identifying students with intensive needs. College members have at times been asked by their employers to “sign-off” on the test results from the assessment with little or no direct knowledge of the student. The results have then been submitted as an assessment to support a funding request. The outcome of the assessment process is to establish student need for specialized services, which in essence could be considered to constitute the establishment of a diagnosis (es). The College has concerns about such practices and respectfully reminds members who may be asked to provide assessments as noted above of the following:
- The Psychologist must obtain informed consent from parents/ guardians/those legally entitled to provide consent, prior to any formal assessment or screen being initiated. If non-Psychologists are to be utilized in the assessment process parent/guardians must be informed of that fact, the qualification of the other professional, and the supervisory relationship. “Blanket consent” provided by parents/guardians at the beginning of the school term for general services, does not constitute informed consent for the purpose of psychological services.
- The choice of assessment tool must be appropriate to the referral question and the student’s abilities/capacity.
- If a non-Psychologist is to be utilized in the assessment process as a Psychometrist, members are reminded that they must ensure that they meet the requirements established by the test company for use of the tool. Members are responsible for the oversight of the administration of the psychometric tool(s) if they are going to sign-off on the assessment. (Please see College advisory entitled “Use of Psychometrists”)
- Members are reminded that if they are ordering test materials on behalf of their employer they are responsible to ensure that those materials are being appropriately used, and used by only those qualified to do so.
- Assessments must not be based on a single source of information. Multiple sources of information and multiple informants should be utilized in an assessment.
- Members must have a working knowledge of, and experience with, the student before signing off on an assessment that identifies need or problem.
- Only Full Practice Psychologists with the Authorized Practice Endorsement (APE) on their license are entitled to communicate diagnoses.
- Members are responsible to debrief the results of the assessment and all recommendations with the parents/guardians or the student, and with parental/guardian permission, the teaching staff.
Members are encouraged to discuss these responsibilities with their employers, and are reminded of the general responsibilities of Psychologists as outlined in the Canadian Code of Ethics for Psychologists (3 rd Edition) and the Saskatchewan College of Psychologists Professional Practice Guidelines.
- this advisory was drafted in collaboration with AANDC
Child Abuse Protocol – Revision
On June 4, 2015 an email was received from the Ministry of Health regarding revisions to the Sask. Child Abuse Protocol. Excerpts from that email relevant to practice are as follows:
“…an updated Child Abuse Protocol was announced by the Ministry of Justice and the Ministry of Social Services in late October, 2014. This revised protocol supports the Saskatchewan Child and Family Agenda, and will enhance the province’s coordinated and integrated approach to child abuse investigations, while clarifying responsibilities for protecting children.
The protocol has been shortened and is more user-friendly, concisely explaining the role government ministries, police, communities, organizations and individuals play in responding to suspicions of child abuse.”
“You can view the new protocol and a Child Protection Services Fact Sheet online at the Ministry of Social Services website …:
- Child Abuse Protocol (English)
- Child Abuse Protocol (French)
- Child Protection Services Fact Sheet
- “The revised Child Abuse Protocol clearly states that it is the responsibility of all people in Saskatchewan to protect children from abuse.
- The revised Child Abuse Protocol is more user-friendly and clearly outlines roles and responsibilities. It replaces all earlier Child Abuse Protocol documents.
- Instances of child abuse negatively impact the health and well-being of children, their families and communities both directly and indirectly. Child abuse is a serious issue that requires a community response and the co-operation of service providers and the public. It is imperative for every individual to report suspicions of child abuse.
- If you observe or receive a disclosure of abuse from a child, or if you suspect child abuse or neglect, it is your personal and legal duty to report your observations and suspicions to the local Ministry of Social Services child protection office, First Nations Child and Family Services Agency or the police.
- The duty to report overrides other standards of confidentiality when you have a reason to believe that a child may be abused or neglected.
- There are no negative legal consequences for making a report as long as it is not made maliciously and is made in good faith. Failure to report suspicions of child abuse and neglect may result in professional disciplinary or legal action.
- It is the responsibility of each agency that provides direct services to children and families, including community-based or non-profit agencies, to ensure the Child Abuse Protocol is operationalized at the local level and appropriately identified in policies and procedures. The expectation is that agencies will now review any existing policies for compliance.
- Individuals and agencies must work together to share information regarding the child’s needs as required throughout the investigation, assessment and treatment of the child.”
Parenting Capacity Assessments/Custody and Access Assessments
Psychologists conducting Parenting Capacity Assessments or Custody and Access Assessments are reminded of the following expectations:
- Work in this area of practice is to be conducted in a manner that is consistent with the direction provided by the Canadian Code of Ethics for Psychologists and the Saskatchewan College of Psychologists Professional Practice Guidelines, and best practice/evidence-based research.
- A psychologist conducting assessments of the parenting capacity of Saskatchewan residents, and/or custody and access assessments of minors who are residents of the province must have Full Practice licensure with the Saskatchewan College of Psychologists (SCP) or be under the direct supervision of a Full Practice licensee of the SCP.
- The psychologist must have established competency in forensic assessment as well as other relevant areas such as developmental psychology, clinical psychology etc., and must have SCP acknowledgement of this area of practice competency;
- Competency to conduct the assessments includes, but is not limited to knowledge of relevant Saskatchewan legislation in particular that pertaining to capacity to parent, and/or custody and access e.g. the Child & Family Services Act (CFSA) and the Mental Health Services Act (MHSA), Health Information Protection Act (HIPA);
- A psychologist undertaking an assessment relating to legal considerations of parenting capacity and/or parental custody and access is expected to conduct the assessment with full and informed consideration of, and respect for the legal rights of the adult(s) and child(ren) who are the subjects of the assessment, as established by relevant legislation including but not limited to HIPA, the CFSA, and the MHSA .
- Notwithstanding establishment of practice competency in accordance with points 3 & 4, and full consideration of point 5, a psychologist conducting such an assessment shall ensure that:
- the subjects of such assessments are fully informed of the purpose and process of the assessment, the limits of confidentiality, the information to be included in the assessment report, how the information gathered will be used, who the assessment report will be given to, the potential that the psychologist may have to speak to their report in Court, and the right of subjects to refuse to participate in an assessment and the potential consequences should this be their choice (see 6, below);
- discussion occurs with the subject(s) of the assessment, regarding the professional impartiality to be exercised by the psychologist in reporting the results of the assessment findings and the recommendations given in response to the findings and the referral questions;
- written, dated, consent to proceed with the assessment is obtained from the adult subject(s) and/or legal guardians of minor subjects after obtaining full informed consent [outlined in (a)] and before the process of assessment is begun;
- the consent obtained as described in (a) is witnessed by a responsible independent adult whose printed name and signature appear in the same document;
- An assessment of capacity to parent, involving consideration of matters of custody and access shall be conducted, after consent as described in point 6 has been obtained. The assessment will be carried out by means of interviews, test administration and clinical observation and in keeping with relevant professional standards of practice (see 1,3,4, & 5, above);
- The psychologist shall produce a written, signed report of the assessment undertaken, which documents all participant(s), component assessment procedures, the dates on which those occurred, the results and any professional considerations including limitations to the assessment and recommendations arising from those procedures and results.
- Distribution of the assessment report will be the responsibility of the psychologist, in accordance with the processes (see point 6, above) communicated to the person(s) who is/are the subject(s) of the assessment.
- The psychologist has the responsibility to appear, as requested or subpoenaed by a court of law in any relevant legal hearing, to speak to her/his report as agreed to through the informed consent process.
Responsibilities under HIPA
The Health Information Protection Act (HIPA) outlines the responsibilities and obligations of “trustees” with respect to the handling (collection, storage, use and access) of personal health information in their possession. While there is differing opinion as to whether Psychologists working within the education system are subject to the jurisdiction of HIPA, legal opinion for the College is that the Education Act applies to the education of students and as such there may be a question as to whether it covers the provision of services not specifically educational in nature which are provided through the educational system.
The College’s position is that HIPA applies to all Psychologists.
Personal health information may be maintained in many forms including paper records, video recordings, and electronic records. There are a number of questions that members of the College are encouraged to consider in determining their responsibility and obligation under HIPA:
- Am I a trustee under HIPA? (Section 2)
- Do I have personal health information in my possession that is covered under HIPA? (Section 2)
- Is there another piece of legislation which I should also consider in determining how to proceed with the request?
- Have I obtained the full, informed consent from my client to use and/or disclosure of their health information?
- Is the information I am collecting germane to the service I am providing my client?
- Is the information I have collected on my client(s) and which will become part of their permanent health record, accurate and complete?
- If my client believes that some of the information contained within their personal health record is inaccurate have I amended the record appropriately according to the legislation? (Section 13)
- If I have disclosed my client’s health information without consent have I informed them of this fact and the reasons why? And if not is this justifiable?
- If my client’s information is maintained as part of a comprehensive health record which other trustees could access, have I obtained my client’s consent to their information being maintained in this manner?
- Does the person I am sharing my client’s personal health information with, have a right to know that information AND do they need to know that information?
- Do I have a directive from my client that allows another person to act on their behalf in regard to any issues surrounding their personal health information or is this a friend or family member who is simply concerned?
- Has my client revoked consent to share or use their personal health information? And if so does that directive apply in this particular situation?
- Does my question relate to the collection or disclosure of a Saskatchewan Health Number? If so am I acting in compliance with Section 11 of HIPA?
- Have I done due diligence in consulting regarding the questions I have about the use, access, and/or disclosure of my client’s health information?
- Do I, or the agency I work for have in place policies and procedures which address the collection, retention/destruction, use and disclosure of personal health information? Am I familiar with these policies and procedures?
- If I use a third party information management system/provider, do I know that their processes meet the requirements under HIPA for Information Management Service Providers? (Section 18)
- Have I met my responsibility to protect my deceased client’s personal health information?
- If I am not able to continue to function as a trustee have I made appropriate arrangements to ensure that my clients’ personal health information is appropriately maintained and managed?
- If I want to share client personal health information for the purpose of research, have I taken the necessary steps as outlined in HIPA to allow this to occur? (Section 29)
- Is there a defensible reason why my client should not be allowed access to their own personal health information if they request it?
Members of the College are strongly encouraged to become fluent with HIPA and the other relevant privacy legislation, and to do due diligence in consulting when faced with questions/issues pertaining to the collection, retention/destruction, disclosure and use of client personal health information.
- Health Information Protection Act
- HIPA Checklist for Compliance, Government of Saskatchewan
- Rasmussen, Rasmussen and Charowsky, L.P.C.
(HIPA) Amendments to the Health Information Protection Act
The Health Information Act (HIPA) has been amended to allow for the sharing of personal health information for the purposes of service provision through common or integrated programs and services such as the Community Mobilization Project in Prince Albert (the Hub). The amendments will come into force on June 1, 2016.
The amendments to HIPA outline the establishment of agreements for sharing client personal health information, and the rules for the sharing of that information between agencies/organizations providing interrelated services. In establishing the amendments, consultation was sought by the Ministry of Health with relevant stakeholders including the Information and Privacy Commissioner of Saskatchewan.
Affiliated legislation will also be amended to allow for this information flow between agencies providing integrated programs and services. The legislation that has also been amended are the Freedom of Information and Protection of Privacy Act, the Local Freedom of Information and Protection of Privacy Act, and the Youth Drug Detoxification and Stabilization Act. The amendments to these various pieces of legislation will also come into force on June 1, 2016.
Members are encouraged to familiarize themselves with these amendments. The amendments will necessarily impact the provision of services by Psychologists, in particular the informed consent and information sharing processes. Questions in regard to the amendments can be directed to the Chief Privacy Officer for the Ministry of Health at 306-787-2137, Email: Health.InfoPrivacy&AccessHelp@health.gov.sk.ca OR the Office of the Information and Privacy Commissioner of Saskatchewan at 306-787-8350 / 1-877-748-2298 (toll free), Email: email@example.com.
The amendments to HIPA are as follows (document provided by the Ministry of Health):
College Response to the Truth and Reconciliation Commission Report
In December of 2015 the Truth and Reconciliation Commission (TRC) of Canada released its final report. The report sought to identify and acknowledge the wrongs of the past that were imposed on Indigenous Peoples through the Indian Residential School System, and called on the Indigenous and Non-Indigenous Peoples of Canada to commit to establishing renewed and healthier relationships with one another through the process of reconciliation. Reconciliation as envisioned by the TRC involves establishing mutual recognition and respect, and calls for an end to the societal and systemic racism and paternalism that have been part of the Indigenous experience in Canada since colonization. The TRC hearings established that the negative events of the past cannot be changed, but they must be acknowledged, learned from and not repeated in order for society to move beyond these historic injustices and embark on partnerships forged in trust and mutual respect.
As a profession, we have a responsibility to contemplate the role that the profession has played in the events of the past, and the role that it should play in the process of reconciliation. Therefore, the Saskatchewan College of Psychologists in the spirit of reconciliation commits to the following actions:
- Promotion of cultural awareness and humility within the profession
- Establish practice guidelines sensitive to cultural diversity
- Support and promote culturally sensitive and ethically appropriate practices within the profession
- Support initiatives to increase awareness of psychology as a viable profession for Indigenous peoples
- Address practices within the profession that promote the maintenance of systems that may result in Indigenous citizens being disadvantaged or disenfranchised
The College encourages its members to consider the issues that were raised through the work of the TRC, and to work together to bring about change. Additionally, the College invites its membership to share their experiences of how the TRC’s Calls to Actions may have initiated discussions which lead to concrete steps aimed at addressing them.
School Psychologists: Parental/Guardian Consent to Psychological Services and Disclosure of Student Records
Over the last few years the College has had discussions with the Saskatchewan School Boards Association (SSBA) in regard to the work of Psychologists who provide services in Saskatchewan schools, and in particular in regard to the issues of Psychologist created records, and parent/guardian consent for assessment and treatment. The SSBA holds the position that the practice of Psychologists working within Saskatchewan schools is the jurisdiction of the employer and falls under the Education Act. In a practical sense what this has meant is that some Psychologists have been asked by their employers to provide services to students who are minors, without parental/guardian consent, at times without parental/guardian knowledge, and without allowing for parent /guardian to control access and dissemination of their health information.
After consideration of these issues and the relevant legislation, the Canadian Code of Ethics for Psychologists (Code), the SCP Professional Practice Guidelines (PPGs), and legal consultation, the Executive Council of the College adopted the formal position that HIPA applies to all members of the profession and to the work that they conduct as members of the profession (January 2014). The position recognizes that Psychologists are trustees as defined under HIPA. HIPA requires trustees to protect the confidentiality of client/student health information and to control access to that information. The position adopted by the College in regard to HIPA and Psychologists is not work site specific. It is important to understand that when there is a conflict between the requirements of HIPA and another piece of legislation, HIPA takes precedence. It is also important to note that legal opinion is that the Education Act does not supersede the Psychologists Act 1997.
The College recognizes that the difference in perspective between the SSBA and the College may have the unintentional consequence of putting members in a bind between their professional and ethical responsibilities and their employer’s expectations. Psychologists practicing within the school system are encouraged to work collaboratively with their employers to assist them in understanding the profession, its responsibilities, and its obligations, and to seek collaborative solutions which allow for both needs to be met.
Members are reminded that informed consent is key to the ethical provision of psychological services. Informed consent must include a discussion of the following: one’s qualifications, any supervisory relationships, the service to be provided and why, other alternatives for intervention, how the client’s health information will be stored and who will have access to that information, how the health information will be used. The Code and the PPGs direct that informed consent should be sought by the Psychologist directly, and must not be obtained under duress.
Consistent with HIPA, the confidentiality of client health information must be protected and access to that information controlled. Psychologists are reminded to exercise caution in terms of the information recorded, and in allowing access to the information gathered in the course of providing a service. In general, client consent should be sought prior to the release of their health information. There may be exceptions to this in extenuating circumstances such as an emergency. Documentation of consent is strongly advised. Psychologists also need to be cognizant of the duty to protect the integrity of test materials.
The College will continue to work with SSBA to seek a compromise which allows members of the profession to meet their employer’s expectations and those of the profession. At a meeting in April of this year with SSBA, it was agreed that there was some common ground, in particular that having Psychologists obtain informed consent in general is best practice and necessary, and that there is an obligation that Psychologists have to 1) protect the privacy and confidentiality of client information 2) protect the integrity of test information and 3) ensure to the best of their ability that psychological information is not open to misinterpretation, misuse or abuse. Work is ongoing between the two organizations on the development of a guiding document regarding the provision of Psychological services within Saskatchewan schools.
Legal Counsel for the College, Ms. Merrilee Rasmussen Q.C. has prepared a legal brief which provides more detail on the issues and the position of the College, which can be accessed at:
Self-Regulation of Professions in Saskatchewan
This advisory is based on excerpts from a presentation provided by Ms. Merrilee Rasmussen Q.C. (legal counsel) at the 2015 AGM of the College.
The regulation of professions in Canada is a provincial jurisdiction. Thus, it is no surprise that there is substantial variability in licensure standards for the profession of Psychology across the country. The history of the regulation of professions in the province goes back to the turn of the last century. One of the first pieces of legislation in the province pertaining to a health profession was enacted in 1917 in regard to the profession of Nursing. The legislative proposal was submitted as a private bill as opposed to a government measure. The fact that it was a private bill highlights that the practice of the profession was not viewed at the time as a practice that the public should be or was concerned with. “However, very quickly The Registered Nurses Act came to be regarded as public legislation and amendments to it and all other professional legislation are now handled as government measures that are part of the government’s legislative program.”
The first piece of governing legislation in the province for the profession of Psychology was enacted in 1962 and was called the Registered Psychologist Act. The legislation provided the profession with the authority to establish bylaws regarding important issues such as who can register as a Psychologist, regulation, discipline, and the investigation of complaints from the public. At that time registration as a Psychologist required “ a Doctoral degree and an exam, or a Doctoral degree and three years’ experience, or a Master’s degree and five years’ experience. A refusal of a membership application could be appealed to the Court of Queen’s Bench. Bylaws were confirmed by the membership but did not require Ministerial approval. The discipline provisions of that first Act comprised only one section, but if a member was suspended or expelled that decision had to be reported to the Minister who could request council to reconsider, send the matter to an arbitration hearing, or appeal to the Court. That Act remained pretty much unchanged until 1997”.
Template legislation was developed for the professions by the provincial government in the mid-1980s after an attempt at establishing umbrella legislation (an overarching piece of legislation that would cover all professions) was unsuccessful. Thus, while there is no umbrella legislation for professions in Saskatchewan, the template has been applied to the majority of legislative requests since that time thus creating “an umbrella of a strange sort.” The template has morphed over time, and changes to the template are applied going forward. Thus, existing legislation is not amended when there is a change to the template, resulting in issues of inconsistency between the professions in terms of authorities granted under the legislation, and difficulties in interpretation of the differences in the authorities. In considering the issue of the inconsistency in the template legislation in the province Ms. Rasmussen stated:
“… it is a general rule of statutory interpretation that if the Legislature means to say the same thing it uses the same words and, of course, if it means to say something different it uses different words. So, if the same provisions are worded differently in different template profession Acts, should they be understood as intending different results? Or if there are different provisions in template profession Acts should they be understood so as to make a difference in how or what the different professions are supposed to do or not do? These are questions that can only be answered in the context of specific situations as circumstances arise. One of the most interesting of these differences is the adoption of a “duty and objects” section in the professions legislation enacted since 2006, which states:
Duty and objects of college [or association]
4 (1) It is the duty of the college at all times:
- to serve and protect the public; and
- to exercise its powers and discharge its responsibilities in the public interest and not in the interests of the members.
(2) The objects of the college are:
- to regulate the practice of the profession and to govern the members in accordance with this Act and the bylaws; and
- to assure the public of the knowledge, skill, proficiency and competency of members in the practice of [the profession].
The “duty and objects” section of the 2006 template legislation identifies clearly that a regulatory College is not an advocacy body for the profession it regulates, and that the needs of the members of the profession are secondary to that of the public interest. “In effect, this provision codifies the 19th century ideal: professionals are persons who apply their skill and knowledge for the benefit of humanity. In my opinion, it would be very difficult to argue that this not the objective of those professions who do not have this explicit provision in their Acts.”
The distinction between regulation and advocacy is an important one. In 2008 in England the legal profession was stripped of its right to self-regulate due to the perceived inability of the profession to separate its regulatory responsibility from its own self-interest. The 2006 amendment to the provincial template legislation is clear in outlining the responsibilities of the professions in regard to regulating in the public interest. The duty we have as members of the profession is to provide ethical and competent services to our clients, and to act in their best interests. The duty of the College as the regulatory body is to serve and protect the public through the establishment of standards of competence and conduct, and the handling of complaints in regard to concerns of professional misconduct and/or professional misconduct. The 2006 amendment to the template legislation has implications for the College as well as its members. Ms. Rasmussen noted:
“Members should not look to their profession to advocate for them, but for guidance concerning what are the acceptable standards of conduct and competence to be met.
Supervision of the Communication of Diagnoses by Provisional Members or Psychology Interns/Residents
Section 23 of the Psychologists Act 1997 identifies the protected act of diagnosing mental health conditions by Psychologists. Section 13 of the Regulatory Bylaws identifies the requirements for one to be granted diagnostic privilege as well as the terms and conditions of the practice. The focus of this advisory is the supervision of Provisional members and Psychology Interns / Residents in the provision of diagnostic services in light of amendments (June 2016) to the Regulatory Bylaws of the College.
Consultation with legal counsel, and reference to the College Regulatory Bylaws, the Canadian Code of Ethics for Psychologists 3rd Edition (Code) [CPA, 2000] and the Saskatchewan College of Psychologists (College) Professional Practice Guidelines (PPGs) occurred in the revision of this advisory.
Section 23 of the Psychologists Act 1997 reads:
23(1) An authorized practice is the communication of a diagnosis identifying, as the cause of a person’s symptoms, a neuropsychological disorder or a psychologically-based psychotic, neurotic or personality disorder.
(2) No person shall perform an authorized practice described in subsection (1) in the course of providing services to an individual unless the person is a practising member authorized by council pursuant to his or her licence or the bylaws to perform that authorized practice.
(3) Prior to authorizing a member to perform an authorized practice, the council may require that member to successfully complete any examinations as may be prescribed in the bylaws.
(4) This section does not apply to a duly qualified medical practitioner.
Section 23 of the legislation directs that only those who have the APE on their license which by definition is a Full Practice Registered Psychologist or a duly qualified medical practitioner may communicate psychological/psychiatric diagnoses. Section 13 of the Regulatory Bylaws outlines the knowledge, skills, and training that one must have to be eligible to apply for the APE. All applicants for the APE seeking independent diagnostic privilege must successfully examine for the endorsement, and must have a Full Practice license in order for it to be awarded. When the legislation was drafted, the Government did not contemplate diagnoses being provided by students or Provisional members of the College who are under the direct supervision of a Full Practice member with the APE. It is the College’s view that practicum students should not be establishing or communicating diagnoses.
The June 2016 amendment to the Regulatory Bylaw addresses the issue of the communication of diagnoses by Provisional Psychologists and Doctoral Psychology Interns/Residents who are under the supervision of Full Practice members of the College with the APE on their licenses. The College views practice and experience in diagnostics as key in the training of the professional psychologist, and in the establishment of one’s qualification to diagnose in the case of Provisional Psychologists. Full Practice Psychologists providing supervision in diagnostics have the ultimate responsibility for the diagnosis (es) being established and communicated. The Code and PPGs would direct that one must not provide a diagnosis (es) without direct involvement and knowledge of the client.
Full Practice members with the APE providing supervision in diagnostics are advised that in light of the bylaw amendments, supervisees (i.e. only Provisional members and Doctoral Psychology Residents/Interns) may communicate diagnoses without your physical presence at the time the diagnoses are being presented to the client or your prior communication to the client in regard to the diagnoses established, under the following conditions:
- The supervisory relationship and all that it entails must be clearly identified and discussed with clients in the informed consent process.
- The supervisor must have been directly involved in the assessment process (i.e. have reviewed the assessments, consulted with the Provisional Member / Resident/Intern as to the signs and symptoms, have directly interviewed or observed an interview of the client etc.)
- The supervising Psychologist accepts responsibility for the diagnoses established and communicated.
Continuing Education Credits (CEC)
The College recently received notice form Saskatchewan Justice that the Limitations Act will be proclaimed in force on May 10, 2005. The Act applies to all professional groups in the province of Saskatchewan. The Act establishes limits of time during which an individual can take action/make a claim against a professional when they believe that they have been wronged. The Act defines an action or claim as “a claim to remedy an injury, loss or damage that occurred as a result of an act or omission.” The existing legislation identifies exceptions with regard to limitations of actions in cases relating to sexual abuse/assault, persons with a disability and certain other assaults, and these will continue to apply. The Limitations Act will make the time limits for action the same across professions, and will according to Saskatchewan Justice “clarify and modernize the law relating to limitation periods in Saskatchewan.”
Under the present legislation, the Limitations of Actions Act (amended 2001), action can be taken against a psychologist within six years after the cause of action arose. Section 3(1)(j)of the Limitations of Actions Act states:
“Periods of Limitation
3(1) The following actions shall be commenced within and not after the times respectively hereinafter mentioned:
(j) any other action not in this Act or any other Act specifically provided for, within six years after the cause of action arose.”
The Limitations Act will decrease the time limit for initiation of action from six years to two years “from discovery of the cause of action,” with an outside limit of 15 years in some situations. Thus an individual has two years from the day that they knew or ought to have known that damage/injury had occurred. Exceptions to this are outlined in the Act.
Of particular importance to all psychologists and especially those working with minors, the mentally ill, or with those deemed “not competent to manage his or her affairs or estate and are (is) not represented by a guardian” pursuant to the Public Guardian and Trustee Act or the Adult Guardianship and Co-decision-making Act is that limitation periods do not apply for the time during which the claimant is either a minor or is incapacitated by mental disability. Theoretically, therefore, in the case of a minor the outer limits of the limitation period could be 15 years from the time they legally become an adult. Again theoretically, in the case of the mentally disabled the outside limit for taking action could be indefinite.
The Limitations Act has implications for all psychologists. Liability coverage and record keeping are central (especially for those individuals who are in private practice). An action theoretically could be initiated against a retired member for events which occurred during a period of practice, therefore, the College strongly recommends that members ensure that they have adequate insurance coverage for liability, and maintain their records for a suitable period of time.
Members are urged to give serious consideration to purchasing their own liability insurance in addition to any potential employer coverage. An employer may receive legal advice to claim that a member was not acting in a manner consistent with the employer’s standards in order to limit employer liability. Further, the College advises that members download a copy of the Limitations Act from the Queen’s Printer website at www.qp.gov.sk.ca (until proclaimed – Bill 51), and consult with legal counsel if necessary.
Authorized Practice Endorsement (APE)
Recent failures of the APE portion of the oral examination have highlighted for Council concerns regarding the APE evaluation process in general. The need to clarify for the membership the meaning and acquisition of APE designation has evolved. The goal of this service advisory is to provide some clarity about these issues.
Under the Psychologists Act 1997, Section 23 the communication (understood by SCP Council as referring primary to written communication) of a diagnosis is a protected practice. Full Practice members wishing to convey diagnoses in their practice must apply to the Saskatchewan College of Psychologists (SCP) for APE, and be declared as competent to diagnose in order to be awarded the APE designation. The only other professional body in the province that is allowed to convey a diagnosis is the medical profession. Delegation of the privilege to diagnose is non-permissible under the Act.
As psychologists we understand that diagnoses can, and usually do, have major consequences and implications for the individual being given diagnoses. The implications can be far reaching and life long, and may impact the individual’s sense of self, his/her family, his/her interpersonal relationships, and his/her employment, education and opportunities. As a regulatory body whose primary responsibility is the protection of the public, the College takes very seriously the issue of competence of diagnostics and its impact on the lives of individuals and families. As a profession we are bound by our Code of Ethics (CPA) to practice only in those areas in which we are competent, and we are compelled to Respect the Dignity of Persons (Principle 1) above all else. The College takes these responsibilities very seriously, and thus has been rigorous in its requirements for members wishing to diagnose in their practices.
In June 2001 the Canadian regulatory bodies in psychology across the country signed the Mutual Recognition Agreement (MRA). Through this agreement Canadian Psychology regulators seek to ensure a national standard of training, licensure and practice in psychology, and to allow for the increased mobility of psychologists between jurisdictions. The requirements for APE in Saskatchewan are consistent with, and are assumed under the MRA.
The ability to competently diagnose is viewed by the SCP as a broad function that is not limited to a specific classification system (e.g. DSM IV-TR, ICD 10), a specific set of disorders, or a specific client population. Psychologists agree that diagnostics involve more than simply a “cookbook” approach to classification. An individual competent in diagnostics not only has a
thorough understanding of particular classification systems, but also psychopathology, psychological assessment, personality and individual differences, and psycho diagnostics. Therefore, individuals who are granted the APE by the College are viewed as competent to diagnose in general, using various diagnostic systems and with various disorders and populations. Further, these individuals are judged to have competency and understanding in the areas of diagnostics and psychopathology. While there are no limitations placed on the scope of mental disorders diagnoses that an individual with the APE can give, the expectation of the College is that qualified members will use the Canadian Code of Ethics for Psychologists (CPA) in guiding their practice and thus will avoid practicing in areas where they are not completely competent.
With few exceptions (MRA compliant applicants from other jurisdictions and “grandparented” members of Saskatchewan College of Psychologists) all members of SCP are now required to sit an oral examination in order to be awarded the APE designation (see Saskatchewan College of Psychologists Policy – APE). Application forms for the APE are available here. In applying for APE, applicants must be recommended by a Full Practice member of the College who has the APE designation and the declared areas of practice competence that are consistent with those of the applicant. The endorsing psychologist is responsible for the diagnostic competence of the member being endorsed. Inadequate diagnostic performance by the applicant may create liability for the endorsing member. The required application forms/documentation for APE differs slightly, depending on whether the applicant is a Full Practice member, a Full Practice member from another jurisdiction, or a Provisional Practice member. The composition of the oral examination panel will also differ slightly depending on the member’s status.
Applicants are required to pay a $100.00 application fee and to submit this with all required documentation before an oral examination will be considered. In preparation for the oral examination the applicant must submit two work samples (identifying information removed) and a CV. An oral examination can be up to 90 minutes in duration. The College reserves the right to impose additional requirements for education, and/or supervision, and/or an oral examination in cases where there are concerns or unclear qualifications. This may include both MRA compliant candidates from other jurisdictions or “grandparented” members of the College.
Characteristics of Oral Examinations for APE
Questions asked during an oral examination may relate to general questions relating to topics such as multi-axial diagnoses, diagnostic process, differential diagnosis, and psychological assessment or to specific diagnostic criteria from the DSM IV or ICD 10.. Candidates are directed to the SCP Policy on APE as well as the Psychologists Act 1997, Bylaw 43 for more detail on the required knowledge, skills and abilities for APE designation. The focus of the designation and the consequent examination is not narrow, rather it is broad. Assessment for APE relates to the assessment of “broad capacity.” Concerns have been raised as to the fairness of assessing broad capacity. However, as the College cannot predetermine the extent of one’s ability to diagnose, nor can it restrict a candidate’s job mobility, the College has to ensure that a psychologist with this designation is competent to diagnose beyond the population served, the type of diagnostic problem, or the job description at the time of examination.
Failure of an APE Examination
In the event that an applicant is unsuccessful in obtaining the APE designation he/she will be given two additional chances to re-take the examination. The first can occur no sooner than 6 months following the original examination, and if the second is necessary it must be requested within two years of the original examination. In between re-examinations, the candidate is required to document for the Registration Committee and Oral Examination Committee the sources and type of additional knowledge and training that they have acquired since the last examination. In all re-examinations, an assessor/supervisor will have to recommend the candidate for re-examination, and attest to the candidate’s sufficient knowledge and capacity.
Prior to successfully achieving the APE designation, the candidate will continue to require a qualified co-signer for any diagnoses, and in the case of a Provisional Practice member will also continue to require direct supervision of their practice as outlined by the College. If a candidate fails both re-examinations they will have to wait an additional three years before they reapply for APE. At that time they will be viewed by the College as a new applicant. Failure of the APE portion of the examination, but passing the remainder of the examination may still entitle a candidate to receive a Full Practice License, without the APE endorsement. If a candidate is already a Full Practice member of the SCP, their status will not be affected by a failure of the APE.
Term of Membership in the Saskatchewan College of Psychologists
The Council of Saskatchewan College of Psychologists (SCP) recently adopted a policy regarding the length of the term that one is considered a member of the College. Perhaps more simply put “when does one cease to be a member?” The need for a policy arose out of issues facing the Professional Conduct Committee (PCC) in carrying out their investigatory duties for the College. As the SCP has jurisdiction only over members of the College, the question arose as to whether a member can resign from the College to avoid an investigation into their conduct, and/or disciplinary action.
Membership vs. Annual License
In developing its policy Council differentiated between membership and an annual license to practice. The College is a regulatory body and not a fraternal organization. As such, membership is essentially mandatory for those who wish to call themselves a psychologist and to practice psychology in the Province of Saskatchewan. Membership in the College therefore is ongoing. Once one is registered they become a member and remain a member until such time that Council receives and accepts their resignation, or until such time that they are discharged from the College as part of a disciplinary action. Whether or not there are sufficient grounds to undertake disciplinary action, Council continues to have jurisdiction over the member.
An annual license is granted once the yearly fee is paid to the College. The license entitles a member to use the title of “psychologist” and to diagnose (and transmit diagnoses) if the member has the APE designation. Non-payment of annual fees results in removal from the Register, but not removal from the membership list. When this occurs the member is considered “no longer in good standing”, and cannot use the title of “psychologist” or diagnose if they have APE. Once the annual fee and consequent late fees are paid in full, a member will revert back to being in “good standing” provided that there are no outstanding disciplinary issues. The Saskatchewan College of Psychologists continues to have jurisdiction over members who are not in good standing.
Membership and the MRA
Council also endorses the position of the Canadian Regulators that under the Mutual Recognition Agreement (MRA) a member must remain a Full Practice member of Saskatchewan College of Psychologists in good standing until such time as they successfully complete all registration requirements and become Full Practice in the new jurisdiction to which they are moving.
Resignation from the Saskatchewan College of Psychologists
Resignation from the SCP requires the member to make a written request to the Registrar who will present the request to Council for a decision. Council will vote on whether to accept or reject the request for withdrawal from the College. The member will be informed by the Registrar in writing as to Council’s decision. Accepted resignations will result in the member’s name being removed from the Register, as well as the membership list of the College. The Saskatchewan College of Psychologists file on that member will be kept by the College, and that information can be accessed by other jurisdictions under the MRA if the individual applies for registration elsewhere. If the individual wishes to resume their membership in the future they will have to reapply for registration and their application will be treated by SCP as a new application.
Responsibilities of a Supervisor
Supervision of Provisional Members FAQs
Mutual Recognition Agreement (MRA) – June 2001
The Mutual Recognition Agreement (MRA) is a national agreement which was developed to address jurisdictional obligations under the federal Agreement on Internal Trade (AIT). The MRA was developed by the national regulators of Psychology in Canada. The Saskatchewan College of Psychologists (SCP) is signatory to the agreement. The SCP formally began to admit applicants under the MRA in November 2003, once the necessary infrastructure had been established. The MRA facilitates the mobility of Full Practice registered Psychologists between jurisdictions, and outlines the standards of competence and training that are felt to be necessary for the independent practice of Psychology in Canada.
The MRA outlines 5 areas of core competence skills that independent practitioners of Psychology must possess: Interpersonal Relationships, Assessment and Evaluation, Intervention and Consultation, Research, and Ethics and Standards. In addition, an amendment in 2004 to the MRA established the core body of academic training that Psychologists must possess to be deemed MRA compliant. This is referred to in the agreement as the Foundational Knowledge (FK) requirement. The FK requirement consists of one graduate course or a one year equivalent undergraduate course at the 300-400 level in each of the following areas: Biological Bases of Behaviour, Cognitive Bases of Behaviour, Social Bases of Behaviour, and the Psychology of the Individual.
Members who were admitted to the Register prior to July 1, 2003 can be grandparented into MRA compliance once they have been listed on the Register for 5 years as a Full Practice member in good standing with no history of complaints or disciplinary action against them. Full Practice members who do not qualify for grandparenting under the MRA can be assessed for MRA compliance by the SCP; this will involve writing the EPPP, submission of documentation and references, and may involve an MRA oral examination.
To qualify for transfer to another jurisdiction under the MRA, members must be registered and practicing as a Full Practice Psychologist in their home jurisdiction at the time of application to the receiving jurisdiction. Additional information on the MRA can be obtained at www.cpa.ca/documents/MRA.pdf.