Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario

www.collegeofpsychotherapists.on.ca

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Regulation of Psychotherapists & Mental Health Therapists

Transitional Council College of Registered Psychotherapists

and Registered Mental Health Therapists of Ontario

Joyce Rowlands, RegistrarMay 31, 2011

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Governing Council (“board”) Appointed by Ont. Gov’t in 2009 Develops Regulations for Psychotherapy Act

• Registration Regulation• Professional Misconduct Regulation• Quality Assurance Regulation

Mandate a public protection

What is the Transitional Council?

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2009 – 2012 Likely longer due to pre-registration For now, under wing of government 3 committees:

• Executive Cttee• Registration Cttee• Professional Practice Cttee

Transitional Period

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Restricted titles• Registered Psychotherapist• Registered Mental Health Therapist

Scope of practice Controlled Act of Psychotherapy ‘Holding out’ clause

Psychotherapy Act 2007

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Physicians Nurses Social workers Psychologists Occupational therapists

… along with their professional designation or the name of their regulatory College

Other Regulated Professions may usetitle “Psychotherapist” (but not Reg. Psychotherapist)

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Prohibits anyone who is not a member of the College (or one of the other authorized Colleges) from holding himself or herself out as a person who is qualified to practice psychotherapy or mental health therapy in Ontario.

‘Holding Out’ Clause

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The practice of psychotherapy is the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication.

Psychotherapy - Scope of Practice

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Under the RHPA, unregulated individuals may not perform restricted activities, known as controlled acts

Members of regulated health professions may perform only those controlled acts authorized for their profession

Controlled Acts

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“…to treat, by means of psychotherapy technique …an individual’s serious disorder that may seriously impair his or her judgment, insight, behaviour, communication or social functioning.”

[Subset of Scope of Practice]

Controlled Act of Psychotherapy

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Exemption in Regulated Health Professions Act (RHPA) for counselling

Defined as “…communication made in the course of counselling about emotional, social, educational and spiritual matters.”

Exemption for Counselling

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“The practice of psychotherapy is distinct from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religion or faith-based beliefs.”

HPRAC ‘Definition’ (Difference between Counselling & Psychotherapy)

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…to the exemption for counselling in the RHPA, the following is exempt:

“Counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling”

If we apply HPRAC’s Definition

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If your work falls into the scope of practice, you should become a member

If your work involves the controlled act of psychotherapy, you must become a member

But…determining whether you’re performing the controlled act may not be straightforward

What does all this mean?

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must take care not to work with clients who have serious disorders…

cannot use any protected title, variation or abbreviation

cannot ‘hold themselves out’ as qualified to practice psychotherapy or mental health therapy in Ontario

Unregulated Practitioners …

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Registered Psychotherapists Those engaged primarily in one-to-one or group

psychotherapy, on a contractual basis, often for an extended period

Registered Mental Health Therapists Practice psychotherapy as part of what they do;

also provide other services

Applicants will choose category

Differences between the Two Titles

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Intention: to include those who do not see themselves primarily as “psychotherapists”

Gives flexibility to regulate broad spectrum of practitioners

Strengthens public protection

2nd Title: Registered Mental Health Therapist

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Questions and Comments?

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As approved for consultation purposes

Consultation meetings March-April

Excellent feedback (new issues raised)

Regulations to be revised Further consultation planned

Registration Requirements

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Summary of Proposed Registration RequirementsDRAFT for Discussion Purposes ONLY (Subject to Change)

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Revised May 16, 2011

[1] Registration examination not expected to be available until 2013-14[2] See over for definition of clinical supervision[3] See over for Scope of Practice

MembershipCategory

Written Examination[1] Education Clinical Experience Self-awareness Comments

Student N/A Must be enrolled in:I)a program of education and training acceptable to the College, orII)a supervised program of clinical experience, orIII)enrolled to take the Registration Exam.

N/A Student members will be permitted to use the titles, “Student Psychotherapist” or “Student Mental Health Therapist,” as appropriate (no abbreviations or acronyms).May practise only with appropriate supervision.

Registered Psychotherapist

Professional Practice and Jurisprudence ExaminationRequired to write Registration Examination when it becomes available.

Education/training program acceptable to the College. Proposed: program with min. 2 yrs/10 courses in psychotherapy, having an undergrad degree as an admission require-ment (or equivalent program). Also see: Registration Require-ments, Information for Applicants (Sample)

Completion of min. 450 client contact hrs & 150 hrs clinical supervision[2] (individual, dyadic, or group)

Personal psycho-therapy or other means of demonstrating self-awareness and effective/ safe use of self in the psycho- therapeutic relationship (DetailsTBD)

Currency Requirement: must have completed education program, clinical experience requirement (i.e. 450 client contact hrs + supervision) or registration exam within 12 months prior to application, or have completed 750 practice hrs within previous 3 yrs.May not practise independently without supervision until completing 1000 client contact hours with appropriate clinical supervision.

Registered Psychotherapist(Grandparented)Not a separate category

Professional Practice and Jurisprudence Examination onlyNot required to write Registration Examination

Must provide portfolio evidence of appropriate level of relevant education, training & experience related to the scope of practice of psychotherapy[3] with a focus on psychotherapy.Proposed: experience to include direct client contact hrs and clinical supervisionProposed: portfolio information to be evaluated using a point system & weighted scale; the applicant would need to achieve a certain benchmark through combined scores for education/training, experience, teaching, supervision, etc. (Details TBD)

As above Currency Requirement: 750 practice hrs in Ontario during 3 yrs prior to application (may include a range of professional activities).Grandparented members will be entitled to use the RP title and authorized to perform the controlled act of psychotherapy.May not practise independently without supervision until completing 1000 direct client contact hrs with appropriate clinical supervision.

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Summary Registration RequirementsDRAFT for Discussion Purposes ONLY (Subject to Change)

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Revised May 16, 2011

[1] Case supervision: To be defined, e.g. workplace case conferences, etc.

Membership Category Written Examination Education Clinical Experience Self-awareness Comments

Registered Mental Health Therapist

Professional Practice and Jurisprudence Examination Required to write Registration Examination when it becomes available.

Education/training program acceptable to the College. Proposed: min. 2 yrs post-secondary education in a field related to the scope of practice, including 5 courses in psychotherapy.Note: Many such programs are likely within the community college system.

Completion of a structured, compre-hensive, supervised & evaluated program of clinical experience (min. 900 hrs), e.g. practicum/ co-op placement/work term), etc.(Details TBD)

Personal psycho-therapy or other means of demonstrating self-awareness and effective/ safe use of self in the psycho- therapeutic relation-ship. (Details TBD)

Currency Requirement: same as for RPs (see over) with practicum, instead of client contact hrs + supervisionRegistration exam will differ from that for Reg. Psychotherapists; however, there will likely be common elements, and other components that are different.May not practise independently without supervision until completing additional courses, 1000 direct contact hrs and 150 hrs of clinical supervision.

Registered Mental Health Therapist(Grandparented)Not a separate category

Professional Practice and Jurisprudence Examination onlyNot required to write Registration Examination

Must provide portfolio evidence of an appropriate level of education/ training & experience related to the scope of practice of psychotherapy.Proposed: portfolio information to be evaluated using point system & weighted scale; the applicant would need to achieve a certain benchmark through combined scores for education/training, experience, teaching, supervision, etc. (Details TBD)Proposed: experience to include direct client contact hours and case supervision.[1]

As above Currency Requirement: 750 practice hrs in Ontario during 3 yrs prior to application (may include a range of professional activities).Grandparented members will be entitled to use the title RMHT and authorized to perform the controlled act of psychotherapy.May not practise independently without supervision until completing additional courses (details TBD), 1000 direct contact hrs & 150 hrs of clinical supervision

Temporary Must have an offer of employment to practise or teach in Ontario for no longer than 9 months.Must hold a valid certificate of registration as a RP or RMHT (or equivalent title) in another jurisdiction.A member of the College must agree to be responsible for ensuring continuing care to clients after the applicant leaves the province, or his/her temporary certificate expires.May use title:: Registered Mental Health Therapist (Temporary) or Registered Psychotherapist (Temporary), as appropriate

Inactive Must have previously held a certificate of registration with the College as an RMHT or RP.May not practise, supervise, make a claim regarding competence, or earn income from the profession.

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Currency requirement… Undergraduate degree (or equivalent) + 2yrs/10

courses education/training in psychotherapy Min. 450 direct client contact hrs (1000 hrs for

independent practice) Min. 150 hrs clinical supervision Written examination + Jurisprudence exam Self-awareness training

Registered Psychotherapist (RP)

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Currency requirement…

Min. 2 yrs post-secondary education/ training related to scope of practice

(e.g. community college diploma) Supervised practicum

Written examination + jurisprudence exam

Self-awareness training

Additional requirements for independent practice

Registered Mental Health Therapist (RMHT)

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Effective use of ‘self’ in the therapeutic process

Both categories of members

How will this be demonstrated?

One option: personal psychotherapy

Others?

Self-Awareness

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Educ’n/ training rogram approved by the College Framework aCriteria & process for recognizing programs To be developed by transitional Council Great diversity of programs… No established accreditation body Goal is flexibility Underlying concept: development of competencies

Framework for Recognizing Education & Training Programs

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Currency requirement: 750 practice hrs in previous 3 yrs

Alternate route for established Ontario practitioners Registration exam (no); Jurisprudence exam (yes) Portfolio evidence of education, experience, type of

practice, etc. (weighted point system)

PLA tool for grandparenting & for internationally trained professionals

May use appropriate title

Grandparenting (both categories)

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Access to Controlled Act All members have access, but … under the RHPA, practitioners may only

provide services for which they have the necessary competency (knowledge, skill and judgment)

If not, they must refer client to another professional

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Questions and Comments?

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Professional Misconduct Regulation …the don'ts of professional practice

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2nd major regulation needed for proclamation

Enforceable in law

Unlike the Code of Ethics, which is inspirational but not enforceable

Will discuss selected provisions

Professional Practice Regulation

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Abusing a ClientAbusing a client or a client’s representative verbally, physically, psychologically or emotionally.

NOTE: Sexual abuse is covered in the Procedural Code of the RHPA

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Discontinuing Services…without due consideration given to:

reasons for discontinuing services condition of the client availability of alternate services opportunity for client to arrange alternate

services

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Providing Unnecessary Treatment Recommending or providing unnecessary

treatment, or continuing to treat a client, where the treatment is no longer indicated or has ceased to be effective.

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Supervision

Failing to appropriately supervise a person who the member is professionally obligated to supervise.

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Conflict-of-Interest

Acting or being in a conflict-of-interest when in a professional capacity.

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Unsubstantiated Claims

Making a claim about a therapeutic approach, modality, remedy, treatment, device or procedure other than a claim that can be supported as reasonable professional opinion.

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Implying Specialization Using a term, title or designation

indicating or implying a specialization in an area or areas of practice, except in accordance with any formal specialist recognition program approved by the College

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Failing to Provide a Report…to a client or the client’s authorized representative, within a reasonable time period, when requested to do so.

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Failing to Report Unsafe PracticeFailing to promptly report to the College

reasonable grounds of an incident of unsafe practice by another member.

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Record-keeping

Failing to keep records in accordance with the standards of the profession.

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Misleading AdvertisingEmploying advertising that is false or

misleading, or includes statements that are not factual and verifiable.

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Practising while impairedPractising while one’s ability to do so is impaired by any condition, dysfunction or substance, which the member knows or ought to have known, impairs his or her ability to practice.

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Disgraceful… conductEngaging in conduct or performing an

act, in the practice of the profession, that would be regarded by members as disgraceful, dishonourable or unprofessional.

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Conduct unbecoming… Engaging in conduct [outside the practice

of the profession] that would reasonably be regarded by members as conduct unbecoming a practitioner of psychotherapy or mental health therapy.

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Business Practices Failing to itemize an account when requested Charging block fees for ongoing care Charging excessive fees Issuing a false or misleading invoice or receipt Selling or assigning a debt

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Failing to Co-operate

Failing to co-operate with a College investigation.

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Purpose of Professional Regulation

Protect public from unqualified, unethical & unfit practitioners

Not about professional stature

Goal is to reduce risk of harm

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Questions and Comments?

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Revise draft Regulations:RegistrationProfessional MisconductQuality Assurance

Formal Consultations (written submissions) Competency Profiles Framework for recognizing educ’n programs Develop Exams Prior Learning Assessment tools Practice/other guidelines

Next steps

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Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario

www.collegeofpsychotherapists.on.ca

UPDATE