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

2 2 Regulation of Psychotherapists & Mental Health Therapists Transitional Council College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario Joyce Rowlands, Registrar April 15, 2011

3  Governing Council (“board”)  Appointed by Ont. Gov’t in 2009  Develops Regulations for Psychotherapy Act Registration Regulation Professional Misconduct Regulation Quality Assurance Regulation  Mandate  public protection What is the Transitional Council? 3

4  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 4

5  Restricted titles Registered Psychotherapist Registered Mental Health Therapist  Scope of practice  Controlled Act of Psychotherapy  ‘Holding out’ clause Psychotherapy Act

6  Physicians  Nurses  Social workers  Psychologists  Occupational therapists … along with their professional designation or the name of their regulatory College Other Regulated Professions may use title “Psychotherapist” (but not Reg. Psychotherapist) 6

7  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 7

8 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 8

9  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 9

10 “…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 10

11  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 11

12 “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) 12

13 …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 13

14  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? 14

15  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 … 15

16 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 16

17  Intention: to include those who do not see themselves primarily as “psychotherapists”  Gives flexibility to regulate broad spectrum of practitioners  Strengthens public protection 2 nd Title: Registered Mental Health Therapist 17

18 Questions and Comments?

19  As approved for consultation purposes  Consultation meetings March-April  Excellent feedback (new issues raised)  Regulations to be revised  Further consultation planned Registration Requirements 18

20 Summary of Proposed Registration Requirements DRAFT for Discussion Purposes ONLY (Subject to Change) 19 [1] Registration examination not expected to be available until [2] See over for definition of clinical supervision [3] See over for Scope of Practice Membership Category Written Examination [1] [1] EducationClinical ExperienceSelf-awarenessComments Student N/AMust be enrolled in: I)a program of education and training acceptable to the Council, or II)a supervised program of clinical experience, or III)enrolled to take the Registration Exam. N/AStudent 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 Examination Required 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) [2] 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 until completing 1000 client contact hours with appropriate clinical supervision. Registered Psychotherapist (Grandparented) Not a separate category Professional Practice and Jurisprudence Examination only Not 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. [3] Proposed: experience to include direct client contact hrs and clinical supervision Proposed: 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 aboveCurrency Requirement: 750 practice hrs in Ontario during 3 yrs prior to application. Grandparented members will be entitled to use the RP title and authorized to perform the controlled act of psychotherapy. May not practise independently until obtaining 1000 direct client contact hrs with appropriate clinical supervision. Revised April 14, 2011

21  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) 20

22  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) 21

23  Effective use of ‘self’ in the therapeutic process  Both categories of members  How will this be demonstrated?  One option: personal psychotherapy  Others? Self-Awareness 22

24  Draft Regulation states: program approved by the College  Framework  Criteria & 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 23

25  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) 24

26 2 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 25

27  Role may be supplanted by psychotherapists  Won’t be able to use “Chaplain”  May be required to be registered  Wish to join college but may not meet requirements  Training process is different  Supervision is different  Lay visitors & delegation of controlled act  Other? Concerns of Spiritual Counselors/ Therapists: 26

28 Questions and Comments?

29 2 Professional Misconduct Regulation …the don'ts of professional practice

30  2 nd 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 27

31 2 Abusing a Client Abusing a client or a client’s representative verbally, physically, psychologically or emotionally. NOTE: Sexual abuse is covered in the Procedural Code of the RHPA 28

32 2 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 29

33 2 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. 30

34 2 Supervision  Failing to appropriately supervise a person who the member is professionally obligated to supervise. 31

35 2 Conflict-of-Interest  Acting or being in a conflict-of-interest when in a professional capacity. 32

36 2 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. 33

37 2 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 34

38 2 Failing to Provide a Report …to a client or the client’s authorized representative, within a reasonable time period, when requested to do so. 35

39 2 Failing to Report Unsafe Practice  Failing to promptly report to the College reasonable grounds of an incident of unsafe practice by another member. 36

40 2 Record-keeping  Failing to keep records in accordance with the standards of the profession. 37

41 2 Misleading Advertising  Employing advertising that is false or misleading, or includes statements that are not factual and verifiable. 38

42 2 Practising while impaired  Practising 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. 39

43 2 Disgraceful… conduct  Engaging in conduct or performing an act, in the practice of the profession, that would be regarded by members as disgraceful, dishonourable or unprofessional. 40

44 2 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. 41

45 2 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 42

46 2 Failing to Co-operate  Failing to co-operate with a College investigation. 43

47 2 Purpose of Professional Regulation  Protect public from unqualified, unethical & unfit practitioners  Not about professional stature  Goal is to reduce risk of harm 44

48 Questions and Comments?

49  Revise draft Regulations:  Registration  Professional Misconduct  Quality Assurance  Formal Consultations (written submissions)  Competency Profiles  Framework for recognizing educ’n programs  Develop Exams  Prior Learning Assessment tools  Practice/other guidelines Next steps 45

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