record Document Revision Framework Cadre de travail sur la révision des documents Hierarchy of Substitute Decision-Makers

VOLUME 13 ISSUE 1 record Document Revision Framework Cadre de travail sur la révision des documents Hierarchy of Substitute Decision-Makers New Standard for Use of Title Psychotherapist College of of Occupational Therapists of Ontario o n t h e r e c o r d VOLUME 13 ISSUE 1 WINTER 2013 WINTER 2013 ON THE

W I N T E R 2 0 1 3 O N T H E VOLUME 13 ISSUE 1 record Publications Account: 1479830 On the Record is printed on recycled paper using vegetable-based inks. ON THE RECORD IS PUBLISHED THREE TIMES PER YEAR BY THE COLLEGE OF OCCUPATIONAL THERAPISTS OF ONTARIO Contents Promoting Competent Practice Applying principles of competent practice Document Revision Framework...3 Cadre de travail sur la révision des documents...5 2013 PREP Module: Conflict of Interest...7 Hierarchy of Substitue Decision-Makers...8 Q&A...9 Discipline Decision...10 ACOTRO Update...12 Just The Facts: Statistics and OT Practice New Standard for Use of Title Psychotherapist... 13 Quality Assurance Update...14 College News Council Highlights... 15 Welcome Registration Manager... 15 Occupational therapists engage in collaborative decision making with clients, their family and/or the substitute decision-maker. Letters to the Editor To express your views on editorial content or any College matter, please contact the Editor by mail, phone or email: Jeff Payette Communications Coordinator College of Occupational Therapists of Ontario 20 Bay Street, Suite 900 P.O. Box 78 Toronto, Ontario M5J 2N8 Phone: 416-214-1177 ext 222 Toll Free: 1-800-890-6570 Fax: 416-214-1173 Email: jpayette@coto.org Council Officers and Chairs Lesya Dyk, President Jane Cox, Vice President Upali Obeyesekere, Member at Large, Finance Sharon Kular, Member at Large, Education Maria Lee, Chair, Registration Committee Karen Taipale, Chair, Inquiries, Complaints Committee Frank Cardile, Chair, Discipline Committee Shannon Gouchie, Chair, Quality Assurance Committee Nicole Thomson, Chair, Fitness to Practise Committee Angie Mandich, Chair, Patient Relations Committee College Staff Karen Giallelis, Quality Programs Associate Extension 239, kgiallelis@coto.org Anita Jacobson, Practice Resource Liaison Extension 240, practice@coto.org Wendy A. Joseph, Executive Assistant, Deputy Registrar Extension 228, wjoseph@coto.org Lisa Anne LaBillois, Finance and Operations Associate Extension 221, llabillois@coto.org Gillian Slaughter, Manager, Investigations & Resolutions Extension 223, gslaughter@coto.org Elinor Larney, Deputy Registrar Extension 233, elarney@coto.org Beth Laughlin, Investigations & Resolutions Associate Extension 234, blaughlin@coto.org Marnie Lofsky, Manager, Quality Programs Extension 227, mlofsky@coto.org Tim Mbugua, Policy Analyst Extension 246, tmbugua@coto.org Brandi Park, Manager, Registration Extension 229, bpark@coto.org Jeff Payette Communications Coordinator Extension 222, jpayette@coto.org Sue Price Registrant Services Associate Extension 224, sprice@coto.org Alison Reynolds Registrant Services Associate Extension 254, areynolds@coto.org Cathy Sannuto Executive Assistant, Executive Office Extension 232, csannuto@coto.org Serena Shastri-Estrada Practice Resource Liaison Extension 248, sshastri-estrada@coto.org Jewelle Smith-Johnson Director of Operations & Communications Extension 226, jsmith-johnson@coto.org Barbara Worth Registrar Extension 225, bworth@coto.org 2

Document Revision Framework Elinor Larney, Deputy Registrar The College maintains an extensive library of documents, posted on the website in the Resource Room, and usually mailed to OTs to put in their binders. These documents for the profession of OT consist of regulations, bylaws, the Code of Ethics (COTO, 2010), standards of practice, guides, guidelines, and position papers. This library has been increasing steadily since the inception of the College in 1993. Most recently, the College has determined that documents should undergo a regular review and either a revision or confirmation that the information continues to be accurate and up-to-date. While a review of each document will occur on a prescribed, timed basis, certain factors may initiate a policy change. A College committee will review the documents and consider the following key questions. Are there changes to the College environment that impact the content? Examples of this may be the development of other documents referred to in the document under review, internal policies or processes, or practice issues arising in College program areas. Are there changes to the external environment that will impact the STANDARDS FOR GUIDE TO USE OF TITLE PSYCHOTHERAPY 2010, College of Occupational Therapists of Ontario Store at Tab #4 of your Registrant Resource Binder content? Examples of this may be changes in legislation or regulations, terminology, government directives, practice changes, or feedback to the College about the content of the document. For example, the Guide to the Child and Family Services Act (COTO, 2012) was most recently revised to reflect an update to the legislation. The government has now added a section to the legislation Introduction Communicating a diagnosis is a controlled act not authorized to members of the College of Occupational The use of any title or designation is an effective method of quickly imparting Therapists considerable of Ontario. information However, about occupational therapists often play an important role in collecting and oneself to others. It immediately allows the audience to identify the common interpreting roles or activities data that and contributes characteristics to and in some cases confirms a diagnosis. associated with that title. A title serves as a means of representing yourself to others. Titles may be attributed to an individual through a variety of mechanisms; some earned through training Despite or education definitions (e.g. from professional Colleges authorized to perform this act, there has been considerable confusion credentials) and others as a result of a position held (e.g. a job title such as case regarding manager). how Some to differentiate titles such as communicating a diagnosis, from the process of communicating the results occupational therapist are also protected by legislation and their use is granted of through an occupational a process therapy of registration assessment. In addition, therapists have expressed concern regarding their need with an authorized body. While the process to secure a title may seem quite straightforward, to discuss and/or there educate are several the client about his/her diagnosis during the assessment and treatment process. elements to consider in relation to the use of title. This guide is intended to identify In order and to clarify provide the guidance issues related to its to members, the College of Occupational Therapists of Ontario developed title use for occupational therapists in Ontario with a General, Provisional, or Temporary the following Certificate position of statement. Registration. Protected Title Background Information One of the central elements of the Regulated Health Professions Act (RHPA), and The the controlled Occupational act of communicating Therapy Act a diagnosis in the Regulated Health Professions Act (1991) as amended (1991) is the protection of title. In Ontario, the title occupational therapist or is OT the or act any of variation communicating or abbreviation to the individual or his or her personal representative a diagnosis identifying of them, is reserved for individuals registered with the College of Occupational a disease Therapists or disorder of Ontario. as the Title cause of symptoms of the individual in circumstances in which it is reasonably protection as part of the regulation of a profession is one mechanism used to foreseeable help the public that readily the individual identify or his or her personal representative will rely on the diagnosis. those individuals who are registered with the College with a General, Provisional or Temporary Certificate. During the original development of this position statement, representatives of professions authorized to Section 43 of the College s Registration Regulation states, a member who uses perform an abbreviation this controlled indicating act*, that met and discussed the interpretation of this controlled act. It was determined the member is registered or is recognized as an occupational therapist shall use at that the abbreviation time that one OT would Reg. be (Ont.) considered to be communicating a diagnosis when a disease or disorder in English or Erg. Aut. (Ont.) in French. By virtue of using this title, Registrants has are been accountable identified for from the signs delivery or symptoms, based on investigation or analysis, which uses scientific of occupational therapy service that meets the established standards of the profession. knowledge, It skill, is in and fact judgement, a privilege and culminates in a statement or conclusion that will be relied upon by extended to those occupational therapists who have met the entry requirements the to individual practice and or his maintain or her representative. their accountability to a regulatory body for continued competence. After careful consideration of these guidelines, the College of Occupational Therapists of Ontario has The title, or designation OT Reg. (Ont.), is included in regulation for a variety derived of reasons. the following This title assumptions distinguishes regarding the parameters of communicating a diagnosis as they apply an OT who is registered with the College from those who are not. While it was to once the practice acceptable of occupational to include a (C) therapy in Ontario. after the OT, this no longer meets the requirement of regulation. There are also some individuals who hold a degree in occupational therapy but are not currently registered with the College. The addition of the modifier, OT Reg. (Ont.) clearly identifies those registered with the College as compared * to those who are not. This title These professions include: Medicine, Dentistry, Psychology, Chiropractic, Optometry and Podiatry designation also helps to remove some of the confusion that exists as a result of a variety of degrees issued by the University programs, all representing the same qualifications to practise occupational therapy in Ontario (e.g. BSc.OT, BHSc.OT, MCHSc.OT, MSc.OT) but potentially unclear in meaning to 2012, the public. College of While Occupational individuals Therapists of Ontario 1 who have received any of these conferred degrees may rightfully indicate such, if they are not also registered with the College, they may not use the additional designation OT Reg. (Ont.) or use the title Occupational Therapist. 2012, College of Occupational Therapists of Ontario 1 MAY 2012 POSITION STATEMENT: ON THE INTERPRETATION OF THE CONTROLLED ACT OF COMMUNICATING A DIAGNOSIS Store at Tab #3 of your Registrant Resource Binder MAY 2012 requiring the reporting of suspected abuse of children through their exploitation by pornography. When a document is updated, the College will inform Registrants that a new document is available. Registrants might notice familiar documents being re-distributed, or receive a notice that an updated document has been posted on the website in the Resource Room. OTs should consider information 3

posted on the website to be the most current. All updated documents will not necessarily be recirculated. A decision will be made, based on the number and significance of changes to the document, whether it will be printed and distributed or just posted on the website. Alternatively, a summary of the changes may be distributed for lengthy documents. Each updated document will contain the original date of the document and any review or revision date. The list below outlines the purpose of each type of document and the reasons why some documents may change. Regulations Regulations hold the force of law and reflect the highest authority of the College, after the law itself the Regulated Health Professions Act (RHPA). Regulations must be approved by government. It is a long and involved process to change a regulation, therefore, these are not often revised. Most recently, the Registration Regulation has changed to reflect changes in government direction, namely, the Agreement on Internal Trade. The Registration Regulation was amended to comply with this agreement, promote inter-provincial mobility of occupational therapists, as well as update the references to other legislation. The Quality Assurance Regulation has recently been changed to reflect the direction of government for College Quality Assurance Programs articulated in the amended RHPA. The Advertising Regulation has some proposed changes currently out for debate. It is unclear at this time if this regulation will be revised. Standards Standards are written to reflect the existing and generally accepted expectation of practice, according to the consensus of informed OTs. Standards of practice may change over time, but not so quickly as to warrant constant updates and revisions. Standards are expected to be reviewed every five years. If a standard needs to be changed significantly, the College may reach out to OTs to provide feedback about the changes. For example, the College recently requested feedback about a new standard for the use of the title psychotherapist, which will be contained within the Standards for Psychotherapy (COTO, 2010). Guides Guides are written to assist OTs to comply with legislation or other weighty documents. As the base documents do not change frequently, guides will be reviewed every five years. Guidelines and Position Papers These documents are more fluid and will be reviewed every 3 4 years. Position papers reflect the College s approach to a current issue that may be longstanding or changing. Guidelines are not intended to be mandatory, but are communicated in order to enhance practice and support prudent practice. It is possible that practice may change over time and guidelines should be reviewed to reflect these changes. The bottom line for OTs is that when a notice of a revised document is received from the College, it is a good time to review it, reflect on its contents, and determine its current relevance to your practice. Standards are expected to be reviewed every five years. If a standard needs to be changed significantly, the College may reach out to OTs to provide feedback about the changes. 4

Cadre de travail sur la révision des documents Elinor Larney, Régistraire adjointe L Ordre maintient une vaste «bibliothèque» de documents variés qui sont affichés sur son site Web dans la salle des ressources et qui sont habituellement envoyés aux membres par la poste pour que ceux-ci les placent dans leurs classeurs. Ces documents sur la profession d ergothérapeute comprennent des règlements juridiques, un code de déontologie (COTO, 2010), des règlements administratifs, des normes d exercice, des guides, des lignes directrices et des énoncés de principe. Cette bibliothèque ne cesse de s agrandir depuis l établissement de l Ordre en 1993. Récemment, l Ordre a déterminé que les documents devraient faire l objet d un examen périodique pour réviser ou confirmer que l information dans ces documents est exacte et à jour. L examen des documents sera réalisé sur une base régulière prescrite mais il est possible que certains facteurs entraînent un changement dans une politique. Le souscomité sur les questions relatives à l exercice examinera les documents et se posera les questions clés suivantes : Y a-t-il des changements dans l environnement de l Ordre qui influent sur le contenu du document examiné? Ces changements pourraient comprendre le NORMES DE PSYCHOTHÉRAPIE Ordre des ergothérapeutes de l Ontario, 2010 développement de nouveaux documents pouvant être mentionnés dans le document mis à jour, des changements apportés à des politiques ou processus internes, ou des questions relatives à l exercice qui sont soulevées dans certains des programmes de l Ordre. Y a-t-il des changements dans le milieu externe qui influeront sur le contenu du document examiné? Ces changements pourraient comprendre ÉNONCÉ DE PRINCIPE : GUIDE SUR L UTILISATION DU SUR TITRE L INTERPRÉTATION DE L ACTE AUTORISÉ DE LA COMMUNICATION Placez dans l onglet no 4 de votre classeur des ressources des membres D UN DIAGNOSTIC Introduction L utilisation d un titre ou d une désignation constitue une façon efficace et rapide de Placez fournir dans d importants l onglet no 3 de votre classeur des ressources des membres renseignements sur le porteur du titre. Il permet à l interlocuteur de connaître immédiatement les activités/ rôles et caractéristiques associés à ce titre. Le titre constitue donc un moyen de se représenter. Les titres peuvent être attribués par le biais de divers mécanismes, certains étant acquis par La la formation communication (par exemple, d un diagnostic est un acte autorisé interdit aux membres de l Ordre des les titres professionnels) alors que d autres sont associés au poste occupé (par exemple, ergothérapeutes un gestionnaire de l Ontario. de cas). Toutefois, les ergothérapeutes jouent souvent un rôle important dans la Certains titres, comme celui d ergothérapeute, sont protégés par la loi et leur utilisation collecte est et attribuée l interprétation par des données qui contribuent à un diagnostic ou qui le confirment. inscription auprès d un organisme d agrément autorisé. Bien que l obtention d un titre puisse sembler fort simple, plusieurs éléments doivent être pris en compte dans son utilisation. Le présent Malgré guide les définitions vise à identifier provenant des ordres autorisés à exécuter cet acte, il y a eu beaucoup de confusion et à clarifier les problèmes liés à l utilisation du titre d ergothérapeute en Ontario pour quant les à la personnes façon de détenant différencier la «communication d un diagnostic» du processus de communication un certificat d inscription général, provisoire ou temporaire. des résultats d une évaluation ergothérapeutique. De plus, les thérapeutes ont exprimé leurs inquiétudes concernant le besoin de discuter du diagnostic avec le client ou de l éduquer sur celui-ci au cours du Titre protégé processus d évaluation et de traitement. Afin d offrir à ses membres des conseils, l Ordre des La protection des titres est un des éléments centraux de la Loi de 1991 sur les professions ergothérapeutes de la santé de réglementées l Ontario a rédigé le présent énoncé de principe. et de la Loi de 1991 sur les ergothérapeutes. En Ontario, le titre d ergothérapeute et toute variation ou abréviation de celui-ci sont réservés aux personnes inscrites à l Ordre des ergothérapeutes de Renseignements l Ontario. La protection généraux des titres dans le cadre de la réglementation d une profession est un mécanisme utilisé L acte pour autorisé permettre de la au communication public d un diagnostic est défini dans la Loi de 1991 sur les professions de la d identifier rapidement les personnes qui sont inscrites à l Ordre et qui détiennent santé un certificat réglementées d inscription comme «la communication à un particulier, ou à son représentant, d un diagnostic général, provisoire ou temporaire. attribuant ses symptômes à tels maladies ou troubles, lorsque les circonstances laissent raisonnablement prévoir que le particulier ou son représentant se fiera à ce diagnostic». L article 43 du règlement sur l inscription de l Ordre stipule ce qui suit : «Le membre qui utilise une abréviation indiquant qu il est inscrit à l Ordre ou qu il est reconnu comme ergothérapeute utilise Au cours l abréviation de l élaboration «Erg. Aut. originale de ce document, des représentants des professions autorisées à exécuter (Ont.)» en français et «OT Reg. (Ont.)» en anglais». En utilisant ce titre, les membres cet acte inscrits autorisé* deviennent se sont rencontrés pour discuter de son interprétation. Il a été déterminé qu une personne est responsables de la prestation des services ergothérapeutiques qui respectent les normes jugée établies avoir communiqué de la profession. un diagnostic lorsqu une maladie ou un trouble a été identifié d après des signes Il s agit d un privilège accordé aux ergothérapeutes qui ont satisfait les exigences d exercice ou des symptômes, de leur profession basés sur et des recherches ou des analyses faisant usage de connaissances, d aptitudes ou qui continuent de rendre compte à un organisme de réglementation concernant leur de jugements compétence scientifiques permanente. et menant à une conclusion ou un énoncé sur lequel se fiera le particulier ou son représentant. Le titre, ou la désignation «Erg. Aut. (Ont.)», a été inclus dans le règlement pour plusieurs raisons. Ce titre distingue les ergothérapeutes qui sont inscrits auprès de l Ordre de ceux qui ne le Après sont pas. un L insertion examen attentif d un de (C) ces lignes directrices, l Ordre des ergothérapeutes de l Ontario a tiré les après erg. n est plus acceptée par le règlement. Il y a également le cas des personnes conclusions qui détiennent suivantes un diplôme en ce qui concerne les paramètres de la «communication d un diagnostic», tel en ergothérapie mais qui ne sont pas présentement membre de l Ordre. L ajout de qu ils la désignation s appliquent permettra à l exercice de l ergothérapie en Ontario. d identifier clairement ceux qui sont inscrits à l Ordre. L utilisation de cette désignation permet également de dissiper quelque peu la confusion créée dans le public par l attribution de divers diplômes universitaires, tous représentant les mêmes qualifications pour l exercice de l ergothérapie en Ontario (B.Sc.erg., B.Sc.M.erg., M.Sc. S.erg., M.Sc.erg.). Bien que les détenteurs de ces diplômes soient justifiés de l indiquer, 2012, s ils Ordre ne des sont ergothérapeutes pas inscrits de l Ontario 1 à l Ordre, ils ne peuvent ajouter la désignation Erg. Aut. (Ont.) ou le titre d ergothérapeute. 2012, Ordre des ergothérapeutes de l Ontario MAI 2012 1 MAI 2012 des modifications des lois, des règlements, de la terminologie ou des orientations gouvernementales, des commentaires soumis à l Ordre concernant le contenu du document ou des changements dans l exercice de la profession. Par exemple, le Guide à l intention des ergothérapeutes concernant la Loi sur les services à l enfance et à la famille (COTO, 2012) a été révisé récemment pour refléter une mise à jour dans la Loi. Le gouvernement a 5

maintenant ajouté une section dans la Loi qui stipule le devoir de faire rapport concernant tout enfant qui est ou que l on soupçonne d être exploité sexuellement, à des fins de pornographie juvénile. l Ordre informera les membres lorsqu un nouveau document est mis à jour. Les membres remarqueront peut-être que des documents familiers sont redistribués ou pourront être avisés qu un document mis à jour a été affiché dans la section les dossiers du site Web de l Ordre. Les ergothérapeutes devraient considérer l information sur le site Web comme l information la plus à jour. Tous les documents qui sont mis à jour ne seront pas nécessairement redistribués. Une décision concernant la réimpression du document ou seulement son affichage sur le site Web sera prise selon le nombre de changements importants qui ont été apportés au document. Il est aussi possible qu un résumé des changements apportés soit distribué aux membres pour les documents plus longs. Chaque document mis à jour indiquera la date de publication originale du document ainsi que toute date de révision ou d examen. La liste ci-dessous explique la raison d être de chaque type de document et pourquoi ils pourraient être modifiés. Règlements Les règlements ont force de loi et reflètent le plus haut pouvoir de l Ordre, après la loi même Loi de 1991 sur les professions de la santé réglementées (LPSR). Les règlements doivent être approuvés par le gouvernement. La modification d un règlement est un processus long et compliqué et ceci ne se produit donc pas souvent. Récemment, notre règlement sur l inscription a été modifié pour refléter des changements dans l orientation du gouvernement, dont l Accord sur le commerce intérieur. Ce règlement a été modifié pour se conformer à l Accord, promouvoir la mobilité interprovinciale des ergothérapeutes et mettre à jour les références à d autres lois. Le règlement sur l assurance de la qualité a récemment été modifié pour refléter l orientation du gouvernement concernant le programme d assurance de la qualité de l Ordre qui a été articulée dans la LPSR. Des changements sont présentement proposés pour le règlement sur la publicité. Il n est pas certain pour l instant si ce règlement sera modifié. Normes Les normes sont rédigées pour refléter les attentes actuelles et généralement reconnues dans l exercice de la profession, conformément à un consensus auquel sont parvenus des ergothérapeutes bien informés. Les normes d exercice peuvent changer mais probablement pas très rapidement. On s attend à ce que les normes soient revues tous les cinq ans. Si une norme a besoin de changements importants, l Ordre peut consulter les ergothérapeutes pour obtenir leurs opinions sur ces changements. Par exemple, l Ordre a récemment sollicité des commentaires sur une nouvelle norme concernant l utilisation du titre de «psychothérapeute», qui fera partie des Normes de psychothérapie (COTO, 2010). Guides Les guides sont rédigés pour aider les ergothérapeutes à se conformer à des lois ou à d autres documents importants. Étant donné que les documents de base ne changent pas souvent, les guides seront revus seulement tous les cinq ans. Lignes directrices et énoncés de principe Ces documents sont plus susceptibles de changer et feront donc l objet d un examen tous les 3 à 4 ans. Les énoncés de principe reflètent comment l Ordre traite une question actuelle qui peut dater de longtemps ou être en plein changement. Les lignes directrices ne sont pas supposées être obligatoires; elles sont plutôt communiquées afin d améliorer l exercice de la profession et de recommander des pratiques prudentes. Il est possible que des pratiques changent avec le temps et les lignes directrices devraient être revues pour refléter ces changements. En fin de compte, lorsqu un avis de mise à jour d un document est envoyé par l Ordre, il s agit d un moment opportun pour le revoir, réfléchir à son contenu et déterminer sa pertinence actuelle dans la pratique d un ergothérapeute. 6

2013 PREP Module: Conflict of Interest Elinor Larney, Deputy Registrar If your client was an accountant, would you consider using their accounting services? If they were a mechanic, would you use their auto repair shop? Could you have them perform an oil change to your car as part of their therapy? Each of the scenarios above has the potential to be, or is, a conflict of interest. The College is pleased to present the new PREP module about conflict of interest. While the Standards for Conflict of Interest (COTO, 2012) were released in spring of 2012, the College is aware, mostly through the discussions that occur with the Practice Resource Service and through the Quality Assurance Program, that many OTs have a limited understanding of conflict of interest. It can be a difficult topic to grasp, especially when one is personally involved with such a situation. Most calls to the practice line are from OTs who feel uneasy about a situation but may not label the issue a conflict of interest. It is appropriate professional behaviour to discuss situations that make OTs feel uneasy with an objective third party. In Quality Assurance, OTs are asked about how they manage any conflicts of interest that occur within their practice; most times, OTs cannot identify any such situations. Likely, many OTs deal with these unconsciously and manage these situations appropriately without even knowing. For example, most OTs would decline an offer from a vendor to fabricate personal orthotics free of charge. They would instinctively know that it would not be correct to accept such a personal benefit. They may not know exactly why, but upon discussion might be able to state that they should avoid using professional relationships for personal benefit if this relationship could be perceived to influence the care that was subsequently given to clients. In this situation, an obligation is now created to this particular vendor that may play out in preferential referrals, rather than decisions made in the best interest of the client. In promoting a consciously competent practice, it is of benefit for OTs to understand the concepts related to conflict of interest and apply these in a conscious manner to their practice. After completing the PREP module, OTs should reflect on their practice and determine if there is potential for conflict of interest. This risk management activity could be followed up by setting up some rules or policies that could guide decision making in the future. In promoting a consciously competent practice, it is of benefit for OTs to understand the concepts related to conflict of interest and apply these in a conscious manner to their practice. 7

Hierarchy of Substitute Decision-Makers Heli Telmet, Student OT, McMaster University During my placement with the College, it has been a great interest of mine to learn more about what I can expect from the Quality Assurance (QA) program as a future Registrant. One thing that stood out in my discussion with the manager of QA Programs, was that many Registrants were unaware of the hierarchy of substitute decisionmakers (SDMs), as outlined in the Health Care Consent Act (HCCA, 1996) and provided as Appendix 1 in the Standards for Consent (COTO, 2008). Registrants mistakenly use the following strategies to receive informed consent from a client that lacks the capacity to provide consent for treatment: Asking the client or looking in the chart to see if a Power of Attorney exists; Assuming that the substitute decision-maker (SDM) would be the individual accompanying the client; Contacting the parent, spouse, sibling or a child to provide consent. The end result may very well be that one of the individuals discussed above is in fact the appropriate SDM. What is missing from these responses is a demonstrated understanding of the process that, by law, must be followed. Nine potential SDMs are defined in the hierarchy and the ranking is intentional. In general, OTs are required to obtain consent from the highest available and willing potential substitute. Think you are a SDM guru? Test your knowledge of the hierarchy of SDMs by answering the following true or false statements: 1. The first SDM in the hierarchy is the incapable person s attorney for personal care. 2. The incapable person s child is higher up on the hierarchy than a brother or sister. 3. If two or more equally ranked substitutes cannot agree, the next substitute in the hierarchy is considered. 4. A lower substitute that is present can act as the SDM as long as the higher level substitute would not object to the decision. If you were stumped by any of these statements, now is the time to review the hierarchy of SDMs provided in the two resources listed above. Answer key: 1. False, correct answer is the incapable person s guardian; 2. True; 3. False, if they cannot agree the Public Guardian and Trustee becomes the SDM; 4. True. For more information on SDMs and consent, consult the College s Standards for Consent (COTO, 2008). 8

Q& A Q U E S T I O N S A N D A N S W E R S Q. I provide occupational therapy services to children in schools as part of my private practice. I have a contract to provide occupational therapy services to a community care access centre. Would I be considered the Health Information Custodian? As I am leaving this area of practice, what are my responsibilities? A. Under the Personal Health Information Protection Act (PHIPA, 2004), you are considered the health information custodian for the files that you have regarding the children on your school caseload. You therefore have all the responsibilities of managing these files as per the College s Standards for Record Keeping (COTO, 2008), including obtaining consent to collect, use and disclose the information contained. You are also responsible for protecting these files from unauthorized use, disclosure, copying, modification or destruction, or theft. When leaving a position, you maintain these responsibilities until the records are either transferred to another Health Information Custodian, or the time period of keeping records has passed. For children, that is 10 years past their 18 th birthday. You have a professional responsibility to facilitate the transfer of a client s records to another Health Information Custodian when you are leaving a position. There is a helpful document, Frequently Asked Questions: PHIPA (February, 2005) on the Privacy Commissioner s website www.ipc.on.ca. The exceptions to the rules regarding the disclosure of personal health information are listed on page 24. There is one exception that may apply to your situation; health information custodians may disclose information without an individual s consent when transferring records to a custodian s successor who is also a regulated health professional. If this applies to your situation, and there is another OT who has been given a contract for services, PHIPA allows you to transfer these files without consent. Other considerations include informing the client or parent of your plans, and documenting a transfer or discharge note indicating the status of the client goals and recommendations. Other resources which will give additional information are the College s Standards for Record Keeping (COTO, 2008) and Essential Competencies of Practice for OTs in Canada (COTO, 2011). This information will help clarify the expectations for OTs acting as health information custodians, and assist Registrants with planning for the ongoing care of clients. 9

Discipline Decision Gillian Slaughter, Manager, Investigations & Resolutions On December 3, 2012, a panel of the Discipline Committee of the College of Occupational Therapists of Ontario held a hearing to determine if Ms. Alice Tam had committed several acts of professional misconduct. Before the hearing, Ms. Tam s lawyer and legal counsel for the College had reached an agreement on the facts (an Agreed Statement of Facts) and an agreement on the penalty (a Joint Submission on Penalty). Ms. Tam also admitted the allegations against her. Both the Agreed Statement on Facts and the Joint Submission on Penalty were accepted by the Discipline Panel. Having been found guilty of professional misconduct by the Discipline Committee in 2007, Ms. Tam was subject to a term, condition and limitation on her certificate of registration which required her to practise occupational therapy under supervision for three years. In December 2012, Ms. Tam was found by the Discipline Panel to have breached that term, condition or limitation of her certificate of registration; she practised occupational therapy outside of business hours without supervision, including on evenings and weekends. In addition, the Discipline Panel also determined that Ms. Tam failed to disclose to another employer that she had conditions on her certificate of registration, in violation of that employer s code of conduct. She also solicited her employer s clients following the termination of her employment contract with her employer, in breach of that contract, and used her personal email account for her work. Ms. Tam also failed to meet the standards of practice in that she did not communicate effectively with clients and staff. She issued false statements to her supervisor by stating that she was at a facility when in fact she was on vacation. She submitted invoices and accounts to her employer for assessments and visits conducted on dates that were different from the dates and times of the actual assessments and visits. She failed to substantiate in her records the need for occupational therapy for her clients. Lastly, she failed to return to her employer at least one client file within two weeks after the clients were discharged as required by the employer. The Discipline Panel found that each of these acts constituted In December 2012, Ms. Tam was found by the Discipline Panel to have breached that term, condition or limitation of her certificate of registration: she practised occupational therapy outside of business hours without supervision, including on evenings and weekends. professional misconduct and was in violation of the following sections of the professional misconduct regulation, Ontario Regulation 95/07 under the Occupational Therapy Act (1991), S.O. 1991, c. 33: Paragraph 1: Contravening, by act or omission, a standard of practice of the profession or failing to maintain the standard of practice of the profession. Paragraph 18: Practising the profession while the member is in a conflict of interest. 10

Paragraph 19: Submitting an account or charge for services that that the member knows is false or misleading. Paragraph 27: Failing to keep records in accordance with the standard of the profession. Paragraph 36: Contravening, by act or omission, a term, condition or limitation on the member s certificate of registration. Paragraph 48: Engaging in conduct or performing an act relevant to the practice of the profession that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. Paragraph 49: Engaging in conduct that would reasonably be regarded by members as conduct unbecoming an occupational therapist. The Discipline Panel accepted the Joint Submission on Penalty and determined that the proposed order on penalty was reasonable. The Discipline Panel directed the Registrar to revoke Ms. Tam s certificate of registration effective December 3, 2012 and ordered Ms. Tam to pay towards the College s legal costs and costs of the hearing in the amount of $3,500.00. The Discipline Panel considered Ms. Tam s conduct to be of a very serious nature, and stated that the penalty in this case needed to reflect the seriousness of that conduct. The Discipline Panel took into consideration that this was Ms. Tam s second offence and that it occurred while terms, limitations and conditions on her certificate of registration were still in effect as a consequence of the first finding of professional misconduct by the Discipline Committee. Since Ms. Tam s conduct in this offence was similar to her first offence, the Panel considered Ms. Tam to be ungovernable. Although there were mitigating factors in the case including the fact that Ms. Tam had cooperated with the College, accepted responsibility for her actions, and, by agreeing to the facts and a proposed penalty, avoided unnecessary expense to the College, she had nevertheless engaged in acts of serious professional misconduct which established that she was ungovernable. The Panel concluded that the proposed penalty was reasonable and in the public interest. A summary of the facts in evidence and the penalty imposed as a result of this hearing can be found on the College s website at www.coto.org, and will appear in the 2012/2013 annual report. The summary will be a permanent record on Ms. Tam s registry page. Additional information can be obtained by contacting the Manager, Investigations & Resolutions. 11

ACOTRO Update: New Website Launched! Barb Worth, Registrar The Association of Occupational Therapy Regulatory Organizations (ACOTRO) is a not-for-profit corporation with a board comprised of a member from each province s regulatory organization responsible for registering/ licensing occupational therapists. As previously reported, ACOTRO has secured over $2 million of funding to 2015 from the Government of Canada s Foreign Credential Recognition program. This generous funding allows ACOTRO to complete the final phase of a Pan-Canadian Harmonization Project aimed at implementing a common assessment approach for qualification and competence based assessment of Internationally Educated Occupational Therapists (IEOTs). One of the components of the Harmonization Project was to develop a website that would provide a one stop resource for IEOTs to access information on registration requirements in all provinces. There are also links to important sites such as on language fluency tests, academic credential assessment and the Canadian Association of Occupational Therapists (CAOT) certification examination. ACOTRO published documents will also be posted on the website. The official launch of the site took place in Ottawa in late September 2012. It was attended by the Human Resource and Skills Development Canada, CAOT President and Executive Director, ACOTRO Board members and members of the public. Stay tuned for updates on other components of the Harmonization Project as ACOTRO continues its collaborative efforts. One of the components of the Harmonization Project was to develop a website that would provide a one stop resource for IEOTs to access information on registration requirements in all provinces. 12

JUST THE FACTS: STATISTICS & OT PRACTICE New Standard for Use of Title Psychotherapist Tim Mbugua, Policy Analyst & Anita Jacobson, Practice Resource Liaison In fall of 2012, the College conducted a survey seeking feedback from Registrants and other stakeholders on an addition to the current Standards for Psychotherapy (COTO, 2010) that would guide Registrants on the use of the title psychotherapist. Nearly 700 Registrants responded, which is more than 13 percent of the total number of Registrants. This high response rate demonstrated the importance of the issue and the commitment of OTs to self-regulation. While the College is considering the many comments that Registrants took the time to log, some important issues were raised during this process that require further explanation or clarification. The support for the additional standard was over 90 per cent, however, a small percentage of respondents thought the options given in the survey were confusing and cumbersome. It is important to mention that the proposed standard contains the language of the amended Regulated Health Professions Act (RHPA, 1991). The amended RHPA gives Registrants a variety of ways they can identify themselves verbally and in written form namely by using: their restricted title or its abbreviation; the name of the health profession or; the name of the College or health profession. The College did not want to limit the respondents choice where the legislation has provided for it. For instance, some respondents argued that the name of the College in a title is redundant because it does not indicate a title or designation. Others felt it carries more weight than the OT title, especially if they are practising psychotherapy. Regardless, Registrants are not required to use all the options, but can choose which best works for them. The occupational therapy profession was among the five regulated professions that were authorized to use the title psychotherapist through an amendment of legislation, along with those who will be registered through the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario. Thus, this is a unique situation where the title use is granted through government legislation, rather than the College initiative. What sets College Registrants apart from others practising psychotherapy is that they are first and foremost occupational therapists practising psychotherapy. Therefore, it is imperative that they let the public know that they are occupational therapists, accountable to the College of Occupational Therapists of Ontario, with expertise and skills to practise psychotherapy. The legislation emphasizes that the OT s occupational therapy title or college should come first, particularly when identifying themselves in writing. The College proposes that any time the OT is identifying themselves, their occupational therapy designation should come first to avoid any ambiguity or confusion. The College wishes to thank those who took time to respond to this important survey. The valuable comments that were received will be carefully considered when the document is finalized and presented to Council for final approval. 13

JUST THE FACTS: STATISTICS & OT PRACTICE Quality Assurance Update Marnie Lofsky, Manager, Quality Programs Practice Development Portal and QA Tools: This year, all Quality Assurance tools are required to be completed in the Practice Development Portal. The College has made the final shift to a paperless portfolio. Many OTs have already been in the Portal completing the Self-Assessment Tool. More than half of the College s Registrants completed the 2012 PREP Module Reflection Page in the Portal. Starting in 2013, all Registrants will be required to complete their 2013-2014 Professional Development Plan in the Portal as well. When you create your 2013-2014 Professional Development goals, you are required to enter the goal(s) in the Portal; the College will no longer accept paper copies of tools from 2013 onwards. Remember that all tools are to be completed by May 31, 2013 including: 2012-2013 Professional Development Plan (enter evidence and select Complete); 2013 Self-Assessment Tool; 2013 PREP Module: Conflict of Interest. The recorded education session/ training video on how to use the Portal to complete the mandatory tools is still available on the College website home page, under What s New? Competency Review and Evaluation: In total, there were 391 clinical Registrants notified of their need to participate in the October 2012 review process. Of these, 350 Registrants were randomly selected and 41 Registrants were previously deferred and were required to participate. The participating Registrants should expect to receive their results in February 2013. The College will continue to select clinical Registrants to participate in April and October 2013, and should complete reviews for all eligible clinical Registrants by the end of 2013. The College is currently developing the mixed practice review process and will launch this process within the next year. The next non-clinical selection process is scheduled for October 2013. Please ensure you read the nature of practice descriptions on this year s Registration Renewal Form this spring and select the most appropriate classification of your role. If unsure of the nature of your practice, please complete the Am I Practising? Tool available in the Portal or contact the College. Council Election 2013 In October 2012, nomination forms for the College Council election for District 1 were distributed to Registrants working or residing in that district. February 4, 2013 Voting packages will be mailed to occupational therapists in District 1. March 7, 2013 Ballots must be received at the College office by 2:00 p.m. 14

PCOLLEGE R O M OT I NNEWS G CO M P E T E N T P R AC T I C E Council Highlights The following are highlights from the October 25, 2012 Council Meeting: Council approved the First Quarter, 2012 Financial Report and Balance Sheet; A presentation was made to Council on the different processes and requirements involved in registering Canadian and internationally educated OTs; A presentation was made to Council on reading financial statements and Balance Sheets; Council approved the draft terms of reference for the Election Committee; Council approved amended terms of reference for the Executive Committee. Upcoming Council meeting March 28, 2013 9:00 a.m. Please call Cathy Sannuto 416-214-1177 ext. 232 or email csannuto@coto.org if you wish to attend. Space is limited. The College would like to announce Brandi Park as its new Manager, Registration. Brandi has extensive experience with processes within a health regulatory environment and has a thorough understanding of the RHPA and related health care legislation. Brandi previously worked for the College of Opticians of Ontario; firstly, as an Assistant to the Director of Professional Programs and later in the role of Coordinator, Inquiries, Complaints, and Reports Committee. Most recently, she held the position of Manager of Professional Programs at the College of Opticians, where she provided support to the Inquiries, Complaints and Reports committee as well as the Registration Committee. Brandi has conducted research and created policy in accordance with that college s mandate, as well as with internal and external legal Counsel to ensure compliance with legislation. Brandi also previously worked as the Assistant Registrar, for the College of Opticians in British Columbia and has completed the Council on Licensure, Enforcement and Regulation (CLEAR) certification to be a National Certified Investigators/Inspector. Brandi can be reached at 416-214-1177 ext. 229 or at bpark@coto.org. 15