1. Statutory Regulation and Practice Competencies for Spiritual Care Professionals Dr David Cane Catalysis Consulting www.catalysisconsulting.net Vancouver BC Nov 5 2008 Presentation to: Canadian Association for Pastoral Practice and Education British Columbia

2. Topics Statutory regulation in Canada  Canadian approach, mandates, mechanisms  Developments in regulation for counselling and mental health professions  Best Practices - Competencies and Credentials CAPPE competencies for spiritual care professionals  National validation survey

3. Statutory Regulation Canadian approach, mandate, mechanisms

4. Regulation in Canada Regulating professional practice is a provincial government responsibility Different legislative approaches exist  Umbrella acts  Occupation-specific acts Extent of delegation by government varies  Gov’t dept / “College” / Professional Assn  “Self-regulation” concept

5. Regulatory Mandate The only reason governments regulate is to protect the public The regulator's mandate is to ensure safe, effective and ethical practice  Control of entry to practice  Control of practice standards  Control of conditions for ongoing registration  Handling of public complaints

6. So is it in the profession’s interest to achieve statutory regulation? Possible Pros  Increased recognition and “credibility”  Enhanced public awareness  Increased public protection  Allows professional association to focus on member services and back away from “regulation”  Access to third party billing Possible Cons  Increased costs to individuals  Loss of control over standards

7. Mechanisms of Regulation Title protection  Restricted / protected / controlled title(s)  No restriction on activities Restricted / controlled activities  Specific reserved activities established  Often granted to several professions Restricted scope of practice  Broad-based protection of the profession’s work

8. Ontario: Regulation of Psychotherapists and Registered Mental Health Therapists Practice of Psychotherapy defined:  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 Authorized Act of Psychotherapy defined:  to treat, by means of psychotherapy technique delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning

9. Terminology Confusing!  Regulation statutory… voluntary…  Licensure license to practice… goes with restricted activity?  Registration with whom?  Certification by whom?… for what purpose?  Accreditation of educational programs… of health care facilities

10. Coordinating Regulation Nationally: The Agreement on Internal Trade: Federal-provincial agreement, 1994  Broad scope (trade, investment, employment)  Labour Mobility Chapter seeks to facilitate cross-jurisdictional mobility of workers

11. Current AIT Requirements Regulators must collaborate when establishing or changing standards, and in general work together to enhance Labour Mobility Regulators must compare standards and identify “competency gaps” between jurisdictions Regulators must accommodate differences by enabling transferring workers to address competency gaps

12. Major AIT changes are coming as of April 1 2009! As of Apr 2009 Full Labour Mobility (FLM) will exist in all professions across all jurisdictions unless government has approved an exception  “Declared full mobility” replaces “accommodation of differences”  Exceptions will be limited, and based upon major scope of practice differences

13. Current Status of Regulation for Counselling & Mental Health Professionals

14. Quebec has statutory regulation in effect  Career counsellor; psychoeducator  Competencies are in place Ontario has initiated regulation  Psychotherapist; registered mental health therapist  Designations yet to be defined; “authorized act” established BC’s Task Group for Counsellor Regulation active since mid 1990s  Group is advocating a broad generalist designation (“Counselling Therapist”) with specialties (tiered approach)  Competencies developed for Counselling Therapist  Gov’t has recently indicated that regulation is not on their “immediate agenda” Regulation may take place this year in Nova Scotia  NSACT is advocating a model based upon the Counselling Therapist with a minimum Masters degree requirement Numerous processes of voluntary self-regulation exist  BCACC, CCA, CAPPE

15. Counselling Therapist Entry-to-Practice level Generic Counselling Skills Tier 1 Tier 2 PastoralCounsellorCareerCounsellorMusicTherapistSpecialty Designation 5 Marriage & Family Therapist Family Therapist Generalist Entry-Level Designation: Broad, inclusive scope of practice with generic skill set Maximizes public protection Specialty Designations: Reflect more complex skill sets Recognize specialist credentials BC’s Proposed Multi-Tier Model

16. Best Practices in Regulation Occupational Competencies and Credentials

17. Professional Regulation Involves Accountability Professionals are accountable for the quality of their services (their job skills) The regulator is accountable (to government and to the public) to set and enforce standards for these services  Standards must be defensible based upon the mandate of public protection Accountability is an ongoing expectation

18. Best regulatory practice means… …regulating on-the-job activity (not prior education) Registrants are accountable for their job skills  on a daily basis, in real-time  they are not accountable for their credentials; credentials are historical

19. Defining and measuring job skills is the key Measurable job skills are called Occupational Competencies An Occupational Competency is a statement describing a job task that a person can perform to a specified level of proficiency

20. Competencies can serve different purposes Occupational Competencies  Describe job tasks Used by employers and by regulators to define job requirements Assessment Competencies  Break job tasks into components for assessment purposes Used by regulators to blueprint a registration exam Used by employers to assess worker performance Educational Competencies  Break components into smaller steps to facilitate student learning Used by educators to develop curriculum and assess student learning Hierarchy of Competencies

21. CAPPE Practice Competencies for Spiritual Care Professionals National Validation Survey

22. Why did CAPPE undertake a validation process? Involved with national initiatives to establish regulation for counselling and mental health professionals  Substantial common ground exists across the counselling / mental health field Developed Practice Competencies to guide its Certification Programs Opportunity to integrate and validate competencies  Competencies can distinguish common ground from specialties  Help prepare for an effective regulatory process

23. Integrated Competency Model for Spiritual Care Generic Competencies (applicable to a broad range of counsellors and therapists) Spiritual Care “Specialist Competencies” Spiritual Care Professional

24. The validation process On-line survey made available to CAPPE membership nationally (March-April 2008) Listings of competencies (generic & specialist) For each competency, respondents to rate:  How important you consider this competency to be for safe and effective practice  How frequently you use this competency in your own practice Demographic questions included to help analyze data

25. Summary of demographics 198 respondents nationally (~20% of membership)  59% of respondents from ON  14% of respondents from BC 74% of respondents in Clinical Pastoral Education stream 16% of respondents in Pastoral Counselling Education stream

30. Competency rankings – what constitutes “validation”? Importance scale:  Critically important  Important  Somewhat important  Not important  Cannot rate Frequency scale:  Very frequently  Frequently  Occasionally  Seldom  Not used

31. Margins of Error Margin of error on 150 responses (for respondents nationally)  +- 6% on a cumulative % value ( 90% conf) ON respondents (N = 70)  +- 9% BC respondents (N = 25)  +-16% Retired members (N = 5)  too high to estimate

32. Are the competencies “Validated”? Broadly speaking yes, very strongly for both generic and spiritual care  Examples of exceptions: 5.3.a and H.3 Are there significant differences between the BC survey results and Canada-wide?  No  Bear in mind the larger margin of error on the BC data

33. What next? Will the competency validation data impact CAPPE’s certification program? Will the counselling-related professions be able to move ahead on a consistent basis nationally?  There are different approaches emerging x-Canada  Will the new AIT help promote a common approach? Can CAPPE find a way to have Spiritual Care practice recognized within the broader context of regulation in counselling and mental health?

34. Thank You!