Issue 57 | Winter 2018
The CAP Monitor W
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Who’s Who Council
Supervision Consultants
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Alderson President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . Kerry Mothersill Past-President . . . . . . . . . . . . . . . . . . . . . . . . . . . Paul Jerry Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reagan Gale Members-at-Large . . . . . . . . . . . . . . . . . . . . . . . . Farrel Greenspan Kathleen Kelava Greg Schoepp Public Members . . . . . . . . . . . . . . . . . . . . . . . . . . Elaine Andrews Gene Marie Shematek Garrett Tomlinson
Supervision consultants are available to advise provisional psychologists and supervisors. They also assist in the resolution of conflicts between provisional psychologists and supervisors. Jon Amundson 403-289-2511 aapsych@telus.net Walter Goos 780-986-7592
Committee Chairs Credentials Evaluation Sub-Committee . . . . . . . . Ali AL-Asadi Oral Examinations Committee . . . . . . . . . . . . . . . Erik Wikman Practice Advisory Committee . . . . . . . . . . . . . . . . Christoph Wuerscher Registration Advisory Committee . . . . . . . . . . . . . Christina Rinaldi Registration Approvals Sub-Committee . . . . . . . . Jill Turner Substantial Equivalency Sub-Committee . . . . . . . Ali AL-Asadi
College Staff Registrar & CEO . . . . . . . . . . . . . . . . . . . . . . . . . . Richard Spelliscy Deputy Registrar and Complaints Director . . . . . . Troy Janzen Assistant Deputy Registrar and Director of Professional Guidance . . . . . . . . . Deena Martin Finance and Administration Coordinator . . . . . . . Wendy El-Issa Complaints Coordinator and Hearings Director . . Lindsey Bowers Administrative Assistant to the Registrar . . . . . . . Kathy Semchuk Registration Coordinator . . . . . . . . . . . . . . . . . . . Ingrid Thompson Registration Assistant and Oral Examinations Coordinator . . . . . . . . . . . . Sheri Price Credentials Evaluation Coordinator . . . . . . . . . . . Kymberly Wahoff
waltergoos@shaw.ca
Continuing Competence Consultants Consultants are available to provide advice and guidance to members who wish to participate voluntarily in the Continuing Competence Program. The consultants are also available in special circumstances, for example, when a member does not have access to other regulated members who are able to review their plan. Such circumstances would occur on a very limited basis, as psychologists are encouraged to develop a network of professional peers. Dennis Brown 780-441-9844 brown.dennis002@gmail.com Christoph Wuerscher 403-234-7970 wuerscher@shaw.ca
Communications Coordinator . . . . . . . . . . . . . . . . Melanie Barclay
Bonnie Rude-Weisman
Receptionist/Office Assistant . . . . . . . . . . . . . . . . Renetta Geisler
403-526-8116 brudeweisman@shaw.ca
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Issue 57 | Winter 2018
Contents
8 7
4 Registrar’s Letter 6
College Updates
7
Professional Conduct Report
8 When a Privacy Breach Occurs
13 Evidence-Based Practice of
Psychological Assessment and Treatment
15 Examination Results & Statistics 16 Not-For-Profit Psychology:
Fundraising through Client Stories
11 Jurisprudence (Oral) Examination: An Enhanced Version for 2019
12 Professional Guidance Calls
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Register Updates
20 Collaborative Practice in Schools
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Registrar’s Letter NEW LEGISLATION TO PROTECT PATIENTS* FROM SEXUAL MISCONDUCT AND ABUSE BY HEALTH CARE PROFESSIONALS On October 30, 2018 the Hon. Sarah Hoffman, Minister of Health and Deputy Premier, introduced Bill 21, “An Act to Protect Patients.” This was the product of an Alberta Health initiative and Discussion Document issued in June 2018. Bill 21 has recently passed Royal Assent. The intention of the Bill is to strengthen protections for patients by introducing definitions for sexual abuse and sexual misconduct, increasing transparency of disciplinary proceedings including greater participation of complainants in investigations, mandatory publication of hearing decisions/practice permit conditions on College websites related to sexual abuse or sexual misconduct towards a patient, additional mandatory reporting and disclosure requirements for regulated members and the College. A key aspect of the proposed Bill is mandatory penalties for sexual abuse and sexual misconduct, specifically: (1) cancellation of a practice permit if a hearing tribunal decides that a regulated member’s conduct constitutes sexual abuse of a patient; and (2) suspension of a practice permit if a hearing tribunal decides that a regulated member’s conduct constitutes sexual misconduct towards a patient. While Bill 21 will impact only a very small number of psychologists, this initiative is clearly in the interest of the public. Psychologists have long been aware of the power differential inherent in professional relationships particularly those with vulnerable clients. Psychologists are also keenly aware of the potential significant and lasting adverse effects of sexual abuse and misconduct. As such, we have a higher duty than others to adhere to our ethical principles and professional standards of practice. To meet our regulatory obligations under Bill 21 the College will soon be introducing new standards of practice related to sexual abuse and sexual misconduct. New practice guidelines for the prevention of sexual abuse and sexual misconduct will also be introduced. We will be launching several related educational requirements for both College staff and all regulated members. A formal patient relations program will be implemented. This program will offer navigational assistance and funding to support
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individuals who allege sexual abuse/sexual misconduct by regulated CAP members including accessing treatment and counselling. The College website will be updated to address the additional legislated obligations under Bill 21. This new legislation take full effect by April 1, 2019. Additional information can be found at: • Draft legislation: http://www.assembly.ab.ca/ISYS/LADDAR_filesdocs/bills/bill/ legislature_29/session_4/2018021.pdf • Official news release: https://www.alberta.ca/reease.cfm?xID=61916C4E1D2FD-0B3A-88FDA47F6F7C9B7C *the term “patient” is the term used in the legislation and refers to the College’s definition of “clients.”
Richard J. Spelliscy, PhD, RPsych Registrar & CEO
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College Updates PRACTICE PERMIT RENEWAL 2019-2020 For the 2019–2020 Practice Permit renewal period fees for a Registered Psychologist will be $775.00 and the fees for a Registered Provisional Psychologist will be $387.50. The regulatory requirements of the Health Professions Act (HPA) and the operating expenses of the College continue to increase. Council nevertheless remains committed to being responsive to the needs of the members while ensuring the College can meet all legislated obligations and demonstrate excellence in professional regulation. Council will continue to operate the College in a fiscally responsible manner through careful planning and fiscal prudence to ensure successful self-regulation.
CONTINUING COMPETENCE PROGRAM In February 2010, after membership consultation, the College forwarded the Psychologists Profession Regulation to Alberta Health and Wellness as per procedures outlined in the HPA. Included in this Regulation is the Continuing Competence Program. The Regulation is still waiting for approval by the Lieutenant Governor in Council before it becomes enforced under the HPA. The College Council decided to continue the Continuing Competence Program on a voluntary basis in 2019 until formal regulatory approval has occurred. Please watch for further program updates through The CAP Monitor and on the College website. If you have any questions regarding the 2019-2020 Practice Permit renewal please call the College at 1-800-659-0857 or via email at registrar@cap.ab.ca
UPCOMING INVITATION FOR MEMBER CONSULTATION ON PRACTICE GUIDELINE: PSYCHOLOGICAL ASSESSMENT OF PARENTING TIME AND RESPONSIBILITIES The College of Alberta Psychologists’ Practice Advisory Committee (PAC) is pleased to announce an upcoming updated practice guideline for member consultation. In developing the guideline, Dr. Janzen, CAP Complaints Director, worked closely with subject matter experts and the PAC committee to develop a thoughtful and relevant resource to the profession. Based on feedback from a focus group held in September 2018, the College is confident the guideline provides reasonable and helpful guidance. The guideline is now officially in the ‘review process’ which involves approval from PAC and Council. From there, the guideline review process will move to ‘member consult’ where all CAP members will have the opportunity to provide feedback. The process of inviting member consultation is integral to several of CAP’s strategic goals. Specifically, by inviting members to provide feedback on the practice guidelines, we are: (a) ensuring guidance that aligns with ethical principles and Standards of Practice, (b) engaging and connecting with our members, and (c) encouraging psychologists in continuous learning. We kindly ask that when you receive the invitation in March 2019, you take the time to read through the draft guideline and offer feedback to PAC. Member consultation is your opportunity to bring forward and inform any issues that you may see arising from the documents. We thank you in advance for supporting the member consultation process.
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Professional Conduct Report Under section 119(1)(f ), the registrar may publish information with respect to any orders made by a Hearing Tribunal. The purpose of such publication includes specific and general deterrence including educating the profession. Publication also serves to enhance public confidence in self-regulation by promoting transparency. The College does not routinely publish the names of members unless it is determined by the Hearing Tribunal that a specific public protection issue is perceived to exist. This practice will change with the full implementation of Bill 21. A hearing was held by way of an Agreed Statement of Facts and Joint Submission on Sanctions. Both the College and the regulated member were represented by legal counsel. The regulated member acknowledged that they failed to maintain appropriate professional boundaries with a client by engaging in inappropriate email and text message correspondence, spending personal time together and engaging in intimate physical contact, and acted in a manner that encouraged the continued development of the client’s romantic and/or sexual feelings. The conduct of the regulated member was reported by the client’s ex-spouse. The Hearing Tribunal accepted the Joint Submission on Sanctions which included the following: • • • • • •
The regulated member’s practice permit was cancelled; The regulated member will not reapply to the College for reinstatement of their registration now or in the future, and will not apply for registration with any other professional regulatory body that provides psychological or mental health services now or in the future; The regulated member will ensure continuity of care of their clients in accordance with the College’s Standards of Practice (2013); That prior to terminating services, the regulated member will provide written notice to clients that they are no longer a registered psychologist in Alberta; The College will provide notice of the resignation to all psychology regulatory bodies in Canada, the Canadian Counselling Psychotherapy Association, and to the Association of State and Provincial Psychology Boards in the U.S.A.; and Payment of a portion of the College’s costs of the investigation and hearing in the amount of $5,000.00.
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When a Privacy Breach Occurs, What Are Your Legal Obligations in Alberta? From the Office of the Information and Privacy Commissioner of Alberta No matter the profession, people are leveraging personal information to develop tools that automate decision making and assist with day-today tasks. As recently imagined by CAP President Paul Jerry in the Summer 2018 edition of CAP Monitor, psychologists in the not-so-distant future could be maximizing what data-driven tools have to offer, but he rightfully notes ethical and privacy implications. The sheer amount of personal or health information being collected, used and shared in the private, health and public sectors raises inherent privacy risks, as evidenced by daily headlines on privacy breaches. In light of these realities, and the sensitive personal details psychologists are entrusted with by their clients, the Office of the Information and Privacy Commissioner of Alberta (OIPC or Commissioner) highlights the need to establish a privacy management program¹, including a breach response plan. Effective privacy breach response plans must contemplate the legal requirements to report certain breaches to the Commissioner or others and to notify individuals affected by a breach. Psychologists are in a unique professional position, in that you often work in multidisciplinary, inter-professional or team practices, where one, two or all three of Alberta’s privacy laws may be applicable, depending on the various contexts in which you practice. Psychologists are also subject to additional obligations under the HPA, the CAP Standards of Practice and relevant professional guidelines as well as the Canadian Code of Ethics
for Psychologists (4th Ed.). As such, psychologists have a higher duty to privacy and confidentiality to the individuals who provide information to them.* Below is a brief outline of Alberta’s privacy laws and what obligations exist in the event of a privacy breach.
What is a Privacy Breach? A privacy breach is a loss, or unauthorized access to or disclosure of personal or individually identifying health information. The most common privacy breaches happen when personal or health information of clients or patients is stolen, lost, mistakenly disclosed or improperly accessed. Examples include when a laptop containing personal or health information is stolen, computers, servers or websites are hacked, personal information in a file is mistakenly emailed or faxed to the wrong person, or an employee looks at a patient’s file without authority (i.e. often referred to as “snooping”).
Personal Information Protection Act (PIPA) PIPA applies to private sector “organizations”, including businesses or any individual acting in a commercial capacity. A psychologist may work for or own a business. Psychologists may also contract service providers to manage online applications or use cloud-based records management software that, as a business owner, you are ultimately responsible for if personal information in those systems is breached. PIPA requires organizations to report a privacy breach to the Commissioner, without unreasonable delay, when a reasonable person would consider that there exists a real risk of significant harm to
¹ Office of the Information and Privacy Commissioner of Alberta, Office of the Privacy Commissioner of Canada and Office of the Information and Privacy Commissioner for British Columbia. (April 2012). Getting Accountability Right with a Privacy Management Program. Retrieved from https://www.oipc.ab.ca/resources/subjects/privacy-management.aspx. Blue Text: Addition from the College of Alberta Psychologists
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an individual as a result of the privacy breach. The Commissioner can require organizations to notify affected individuals.²,³ PIPA prescribes the information that must be included in a report to the Commissioner and what a notice to an affected individual must include.⁴
Health Information Act (HIA) HIA applies to more than 54,900 health “custodians”, including Alberta Health Services (AHS), Covenant Health, nursing homes and Alberta Health.⁵ HIA also applies to “affiliates” who perform a service for custodians, such as employees, contractors or students. Custodians are responsible for the information collected, used or disclosed by their affiliates. As of August 31, 2018, it is mandatory for custodians to notify individuals affected by a privacy breach when the custodian determines there is a risk of harm to the individual, as a result of the breach. The custodian must also report the breach to the Commissioner and Minister of Health. Affiliates must notify the custodian (e.g. their employer) of any privacy breach of individually identifying health information for the custodian to determine if it is a reportable breach under HIA.⁶ Psychologists are not custodians under HIA, but may be employed by or under contract to custodians, such as AHS. In these cases, in the event of a privacy breach, a psychologist (as an affiliate) must notify the custodian of a privacy breach. The HIA Regulation prescribes what an affiliate’s notice of a privacy breach to a custodian must include. If a custodian has established breach
reporting requirements (e.g. a breach response plan, policy or protocol), then the affiliate must respect the process established by the custodian. If a custodian has not established requirements respecting the notice, then certain elements must be included in the affiliate’s notice to the custodian.⁷
Freedom of Information and Protection of Privacy Act (FOIP Act) The FOIP Act applies to “public bodies”, including provincial government departments, post-secondary institutions, school boards, municipalities and police services, among others. Psychologists may be contracted or employed by public bodies. There are no requirements to notify individuals who are affected by a privacy breach or to report certain breaches to the Commissioner under the FOIP Act. However, contractual agreements between a psychologist providing services to a public body may require notification of a privacy breach to the public body, if one were to occur. Or internal policies of a public body may require notification of privacy breaches by employees to their employer (i.e. the public body). Furthermore, public bodies may voluntarily report breaches to the Commissioner to seek general advice or guidance in responding to the breach.
Additional Professional Considerations For psychologists, there may be factors to consider against notifying an individual affected by a privacy breach when, using your professional judgment, you believe notifying your client about the breach could cause harm to their mental or physical health.
²,³ Section 34.1 of PIPA outlines the requirement to notify the Commissioner of a privacy breach. Section 37.1 outlines the Commissioner’s power to require an organization to notify individuals affected by a privacy breach. For analyses of risk and significant harm, the OIPC publishes breach notification decision where a real risk of significant harm was identified and notification to affected individuals was required. The decisions are available at https://www.oipc.ab.ca/decisions/ breach-notification-decisions.aspx. ⁴ Section 19 of the PIPA Regulation outlines what is required in the notification to the Commissioner. Section 19.1 outlines what is required in the notification to affected individuals. ⁵ Regulated members of 11 professional colleges and associations are also custodians. See complete list in section 2(2) of the Health Information Regulation. ⁶ Section 60.1 of HIA outlines the duty to notify. ⁷ Section 8.2(1)(b) of the HIA Regulation prescribes what information an affiliate must include in a notice of a privacy breach to a custodian, if the custodian has not established requirements respecting the notice.
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Under PIPA, no provision states that an organization may consider not notifying an individual affected by a breach if notification could reasonably be expected to cause harm to their mental or physical health. However, in a previous breach notification decision, the Commissioner directed a psychologist “to make [the decision to notify] on a case by case basis, bearing in mind each individual’s particular circumstances and exercising professional judgment, and considering various forms of direct notification that may help to offset potential harm, such as meeting with individuals in person or providing verbal notification (rather than sending a letter, for example) so that assistance and support can be immediately provided, and in order to answer any questions that may arise.”⁸ Notwithstanding such a decision, the organization must still notify the Commissioner. Under HIA, if a custodian believes giving notice to an individual subject to a breach could reasonably be expected to result in a risk of harm to the individual’s mental or physical health, the custodian must report to the Commissioner the decision not to give notice to the individual, and the reasons for the decision. In these cases, a psychologist (as an affiliate) may provide a written recommendation to the custodian not to notify a client, which may factor into the custodian’s notice to the Commissioner. The OIPC’s Privacy Breach Report Form for Use by Organizations, Custodians and Public Bodies, Key Steps in Responding to Breaches and other guidance on breach response and reporting are available at www.oipc.ab.ca.⁹
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⁸ Office of the Information and Privacy Commissioner. (August 2, 2017). Personal Information Protection Act: Breach Notification Decision, P2017-ND-06. Retrieved from https://www.oipc.ab.ca/ media/907618/P2017_ND_106_006154.pdf. ⁹ Breach reporting resources are available at https://www.oipc. ab.ca/resources/subjects/breaches.aspx. Information on How to Report a Privacy Breach is available at https://www.oipc. ab.ca/action-items/how-to-report-a-privacy-breach.aspx.
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via email.
Please click here for the Monitor feedback survey to let us know what you think of this issue!
Jurisprudence (Oral) Examination for Alberta Psychologists: An Enhanced Version for 2019 By Deena Martin, PhD (Special Ed), RPsych Director of Professional Guidance, CAP In efforts to excel as a regulator (CAP 2017-2022 Strategic Objective #5), the College of Alberta Psychologists undertook an administrative review of the Jurisprudence (Oral) Examination in 2018. The goal of the review was to identify and implement changes that would further promote the College’s regulatory values of transparency, fairness, and objectivity. It was also conducted with the view of modernising the College’s approach to assessing jurisprudence knowledge. As most psychologists know, the Jurisprudence Examination is designed to ensure applicants demonstrate a minimum standard of knowledge and judgment in matters of jurisprudence and ethics. This is to ensure the public interest is protected when professional, legislative, and legal matters intersect with client services. Applicants for registration as a psychologist must successfully pass the Jurisprudence Examination which is currently delivered in front of a panel of three psychologists. The administrative review involved: • • •
analysing the examination results of successful/unsuccessful candidates (2016 – 2018); reviewing the clarity of the question/answer content; and soliciting feedback from examiners (face-to-face and email) and examinees about their experiences (via online survey).
Quantitative and anecdotal information collected was then used to identify and apply enhancement strategies to the examination questions. Examples of enhancements include: • • •
revising questions for clarity; reworking answers for completeness; and changing the ordering/presentation of questions.
In January 2019, the College of Alberta Psychologists will be switching to the refreshed Jurisprudence (Oral) Examination. Both supervisors and registered provisional psychologists are encouraged to review the revised questions and answers prior to the first round of examination in 2019. Questions about the examination may be directed to Sheri Price, the Oral Examination Coordinator at the College. The College would like to extend our appreciation to our Dr. Derek Truscott, Chair of the Registration Review Recommendation Implementation Group along with the Oral Examinations Committee Chair Dr. Erik Wikman for contributing their leadership. As well, we thank the Oral Examination Committee members and examinees who contributed their insight and time to the review.
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Professional Guidance Calls By Deena Martin, PhD (Special Ed), RPsych Director of Professional Guidance, CAP The Director of Professional Guidance engages daily with members providing regulatory information and guidance. At times, calls are also answered by the Registrar or Complaints Director. The number of professional guidance inquiries continues to rise - with 374 inquiries addressed between April 01 through September 30, 2018. Last year, the same timeframe received 190 calls, indicating an 197% increase in call volume. The three most frequently queried professional guidance topics have remained consistent across previous reporting periods. The most frequent area of inquiry is about maintenance and retention of psychological records (e.g., release of records, electronic records, retention of records). The second most frequent area of inquiry is classified as general inquiries given the questions are often specific to the psychologist/context (e.g., business questions, employer/employee issues, practice related questions). In previous years, the third highest area of inquiry was consent (e.g., consent of minors, informed consent). However, this year, inquiries related to supervision slightly outpaced consent. Additional inquiry areas that are less frequent include questions related to insurance, provision of supportable services, and continuity of care. To promote member engagement related to the Professional Guidance program, the quality of the professional guidance program, feedback was solicited using survey monkey. Information collected was analyzed monthly to ensure we are on the right path to excellence as a regulator. Between April 01st and September 30th, 2018, 74 surveys were completed (20% response rate). Sixty-six percent of inquiries received a same day response, with 96% of all inquiries being returned with 48 hours of being submitted. Slightly over half of the respondents (53%) indicated their initial contact with professional guidance was by phone with 92% percent of all inquiries being responded to by phone. Respondent comments indicated that the use of the phone as a delivery format was efficient and effective with one person writing “it was nice to hear a human voice.”
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Regarding quality of experience, 95% of respondents indicated the quality of the professional guidance experience was “very positive.” Themes emerging from the comments provided indicate that respondents viewed their interactions with professional guidance as respectful, informative, practical, and solution oriented. Respondents noted that they valued the comprehensive perspective they received, as well as the clarity regarding possible courses of action. Feedback in terms of areas to improve upon is notably limited in that 52% of respondents ‘skipped’ the question while 81% of those that answered the question indicated there was ‘nothing’ they did not like about the service. In closing, it continues to be a pleasure to support the College and guide its members with regulatory information. Every inquiry brings new insight and perspective to the highly nuanced, complex, and challenging situations psychologists encounter each day in practice.
Annual Meeting and Professional Development Day 2019
The Annual Meeting and Professional Development Day for 2019 will be held jointly with PAA in Edmonton at the Shaw. Keep an eye on your inbox for information later in the new year.
Evidence-Based Practice of Psychological Assessment and Treatment:
Solutions for Overcoming Barriers to Effective Implementation By David Dozois, PhD, RPsych University of Western Ontario In this article, I present some ideas on the uptake and utilization of evidence-based practice (EBP). After addressing the difficult fact that empirical research is often not utilized by practitioners, I highlight the Canadian Psychological Association’s (CPA) task force report on evidence-based practice (see Dozois et al., 2014) because it addresses the issue of “What is evidence-based practice?” and “How should evidence be used?” both of which have been cited as barriers to promoting greater reliance on the scientific literature among practitioners. I then focus on strategies for implementing EBP. By thinking more about EBP we can move away from our own cognitive biases, and from attempting to justify our own beliefs and assumptions about treatment change, to focus on what will maximize outcomes for the clients we serve.
sets up safeguards against confirmation and other heuristic biases. For example, clinicians’ judgements about patient outcome tend to be overly positive and rarely suggest that a patient has worsened (Newnham & Page, 2010)
Extensive evidence suggests that psychotherapy is efficacious for a number of mental health and health conditions (Dobson, McEpplan, & Dobson, in press; Hunsley, Elliott, & Therrien, 2013). In addition, a strong economic case can also be made for the cost recovery of psychological interventions (e.g., Chisholm et al., 2016). Although there is compelling efficacy and effectiveness data, few practitioners utilize treatments that have the strongest scientific support (Dozois, 2013).
1. Better Strategies for Searching for Evidence. Clinicians are very busy and it is next to impossible to keep up with the research literature. To do so, requires reading approximately 249 journal articles a day (Badenoch & Tomlin, 2015). One solution is to utilize databases that summarize information – systematic reviews and meta-analyses – to find the best available evidence (evidence that is highest in the hierarchy; Dozois et al., 2014). Unfortunately, beyond a few databases, many clinicians are not aware of the wealth of information that is out there that provides evidence at the highest level of the hierarchy (Berke et al., 2011). Aside from PsycINFO and MEDLINE, there are a number of other excellent resources available to practitioners (e.g., National Institute for Clinical Excellence, Database of Abstracts of Reviews of Effects, Cochrane Database), resources that provide data that are filtered and synthesized.
Numerous obstacles to using scientific research have been identified in literature (e.g., negative attitudes about EBP; that EBP requires a “cookiecutter” approach to treatment; see Dozois, 2013; Lilienfeld et al., 2013). These criticisms notwithstanding, we need rigorous controlled research to evaluate the impact of our interventions. Randomized controlled trials obviously do not answer all of our questions, and the findings need to be generalized to real world practice, but we do need controlled research. For one, science
A CPA Presidential Task Force proposed a new definition of EBP, suggested that EBP should rely, “first and foremost, on research findings published in the peer-reviewed scientific literature” (Dozois et al., 2014, p. 155), and provided a hierarchy of evidence to help determine the extent to which an intervention is evidence-based. Below, I outline some recommendations that I believe will help psychologists to best make use of the hierarchy and deliver interventions with a high level of evidence.
Recommendations for Practitioners
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2. Make Use of Clinical Practice Guidelines (CPGs). CPGs are another way to keep informed about the latest literature (unfortunately, there are problems with this in terms of having valid and reliable information; cf. Stamoulos et al., 2014). I am currently working with a team that is trying to compile a database of high quality clinical practice guidelines for Canadian psychologists…so stay tuned for that. For now, I would encourage you to scrutinize the CPGs you are reviewing. 3. Be Aware of Biases – Be a Scientist with your Patients. Continuing to check the research literature, fostering critical thinking in our practices, and ongoing assessment, are just a few ways that we can use science to protect ourselves (and our clients) against the many cognitive biases that can affect our work with clients.
https://www.div12.org/assessment-repository). Beidas et al. (2015) provided a listing of almost 50 psychometrically sound mental health measures for youth and adults that are freely available.
Conclusion We need to be cognizant of the fact that human judgment and memory are fallible. We need more science in practice. For the good of our profession and for the health and well-being of the clients we serve, we must to work together to study, practice, foster, develop, disseminate, and implement evidence-based practice. Doing so will make our work more rewarding and our outcomes more successful.
4. Engage in Evidence-Based Assessment. A key aspect of psychological interventions involves the link between assessment and treatment which is, unfortunately, underappreciated (Hunsley & Allen, in press). For instance, few clinicians routinely use reliable (structured or semi-structured) diagnostic interviews, relying instead on informal diagnostic questioning. In addition, considerable evidence suggests that routine monitoring can significantly improve treatment successes and minimize treatment failures, yet few clinicians routinely assess treatment progress (Hunsley & Allen, in press). 5. Measure Treatment Progress Systematically. By routinely administering reliable and valid indices of patient functioning, practitioners may better determine whether a particular intervention is effective and make informed treatment decisions that are less clouded with confirmation biases and other heuristics. In addition to determining efficacy, there are other important advantages to monitoring change over time (see Dozois, Wilde, & Dobson, in press; Tasca et al., 2018). There are a number of instruments available that are relatively short and free to use (see https://psychologytools.com/download-scalesand-measures.html and
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David Dozois, PhD, is a Full Professor of Psychology and Director of the Clinical Psychology Graduate Program at the University of Western Ontario. Dozois’ research focuses on cognitive vulnerability to depression and cognitivebehavioral theory/therapy. Dozois was twice President of the CPA (2011–12; 2016–17) and currently serves on its Board of Directors. He is also on the Board of Directors for Mental Health Research Canada (formerly the Ontario Mental Health Foundation) and the International Association of Applied Psychology. In addition, he maintains a small private practice.
Examination Results & Statistics
Updates for June 1 - September 30, 2018
Examination for Professional Practice in Psychology (EPPP) A total of 147 candidates undertook the EPPP in this reporting period. Results were:
Pass: 78 (53%)
Fail
11%
Pass
89%
Pass
Fail
53%
47%
Fail: 69 (47%)
Oral Examinations A total of 80 candidates undertook the oral exam in this reporting period. Results were:
Pass: 71 (89%)
Fail: 9 (11%)
Professional Guidance Statistics During this reporting period the College received 258 requests for professional guidance. The most frequently asked questions included those dealing with maintenance and retention of records, consent as well as supervision. Regulated members are welcome to contact the College for professional guidance or regulatory issues here.
Discipline Statistics The College received 11 new complaints. The most common reasons for allegations were issues of: bias, competence, and providing an opinion without direct and substantial contact.
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Not-For-Profit Psychology: Fundraising through Client Stories By Ashley Lim, RPsych In the world of not-for-profit agencies, fundraising events are often the highlight of the year. Without the funds generated by these events, many agencies would not be able to provide crucial services to those who need it most. Despite recent federal and provincial contribution to funding mental health programs, many people still do not have access to accessible and affordable support. As a result, many agencies, including my own, are left trying to find ways to generate enough funds to be able to provide critically needed counselling services. Some days, it feels like we are on a never-ending race track with no end in sight. The competition for every available grant or donation frequently comes down to who can tell a better story of their impact. Or better yet, who has the best client story to share? Psychologists in not-for-profit agencies have the unique experience of straddling the line between ethical practice and supporting fundraising initiatives where our mandate to do no harm is placed in direct opposition to the need to tell a good story. With this article, I hope to encourage our profession to take a deep reflective lens when considering the impact fundraising has on clients. For those who are not psychologists, or even other mental health professionals, the question about conveying impact may not raise any red flags. The initial thought, although made with the best of intentions, often involves wanting to share an impactful client story or even put a client center stage in front of an audience, a sea of nameless faces. They see these individuals as having something invaluable to share, a lesson that could not be taught otherwise. If you have ever attended a fundraising event where a client, past or present, shared their story, you will likely have seen one of two things happen. One, the client is an adept storyteller and is able to demonstrate their journey from struggle to success. These individuals are often past clients who have spent many years perfecting the retelling of their story. Or, more commonly, the individual is a current client who clearly, at least to those who come from
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trauma-informed backgrounds, should never have been asked to share their story. In these cases, you have become a live witness to the reliving of their trauma and the development of a new traumatic storyline. Within the general population, especially those who have never sat in a therapist’s chair, there exists a palpable draw to know more about what happens when a client enters a psychologist’s office - to see first hand the magic that occurs. As psychologists we know it has absolutely nothing to do with “magic” but instead long gruelling hours of being in the trenches with our clients, being side by side with them and holding space while they work through their struggles, uncovering hidden skeletons and unmasking present-day demons. We act as road maps that help clients get to their desired destinations. The stories that are shared and re-framed within the safety of our offices serve as a reminder of why many of us chose to become psychologists in the first place. The sharing of stories enables us to connect with one another on a deeper, more human, level. Something that is often missing within the current age of social isolation in the face of technological advances the misbegotten belief that the further away you are from someone the closer you can remain. The reality of our work as psychologists involves spending many hours sequestered behind closed doors, hearing stories never before told and safeguarding secrets for the hundreds if not thousands of people we work with. The relationships we create through the course of therapy with our clients offer us a sense of connection rarely felt in other avenues of life. For some of us, our clients and the stories they share have the ability to stay with us long after the therapy session is over. We can all look back on our careers and readily pull to mind a client or two whose stories affected us deeply and continue to resonate with us to this day. Aside from consultations with other mental health professionals or engaging in our own therapy, many
of these stories must remain locked away - hidden out of sight but never forgotten. We can’t talk about them openly or the impact they have on us without the fear of disclosing identifying information, or worse breaking our oath of confidentiality. Yet these stories remain, and could have the ability to move people to great heights to create lasting societal change. As a psychologist in a not-for-profit I can attest to the amount of time that is spent inhabiting the role of advocate or teacher educating others, especially potential funders, about the organization I serve and what we do to help end violence against women and children. In my experience there has never been a one-size-fits-all approach that has worked to convey this message in a meaningful way. In the world of not-for-profit agencies a meaningful message is synonymous with increased fundraising dollars. For some savvy business minded people, they are best convinced to support worthy causes by statistics and hard facts. Others respond best to the portrayal of human suffering through the vividness of personal stories and the sense of interpersonal closeness this creates. According to Thomas Schelling (1968), an American economist credited with developing the theory called the Identifiable Victim Effect, the more we know, the more motivated we are to care and by extension willing do so something to alleviate that person’s suffering. We are also less likely to help many faceless victims compared to a single, identifiable one. This theory supports why many charities attempt to use client sharing their stories in order to tap into potential donors’ emotions and to create that sense of closeness. It is important to recognize that some donors are motivated to support specific causes, not because of its social impact but because of the social status it carries, the warm glow it creates or the sense of familiarity it invokes. In a study conducted by Small, Loewenstein, and Slovic (2007) they found that potential donors were more likely to give based on feelings rather than logic, and that focusing on the struggle of one or just a few individuals had a greater emotional impact. In other words, donors are more likely to connect with your cause when presented with a single emotional story. The most
effective way to inspire them then is to introduce donors to people with whom they can connect directly - clients. Therefore it’s not surprising to see how charities are often at odds with one another, each fighting to tell a better story in order to bring in more fundraising revenue. As a Director and a psychologist I am constantly being asked to provide a ‘client or two’ who would be willing to share their story, be photographed or interviewed for the media, at the request of an external funder as a prerequisite for receiving their donation or even through our own fundraising initiatives. Some clients would love to have a way to help the agency that has helped them. Not all can volunteer time or give back money. But many people who have received services are eager to share their personal stories to help prevent others from suffering the way they did, or to help the agency that has been so helpful to them. However, some would strongly argue that just because a client offers to help does not mean that they should. They could experience real harm and experience a set back in their healing journey. Over the years, I have become increasingly concerned about the potential for exploitation of clients and their stories for fundraising purposes. This is true not just within our profession but across the sector as a whole. Our Ethics Code specifically states that psychologists should avoid relationships that could reasonably impair our professional judgment or create a conflict of interest. In addition to honouring client confidentiality, therapists have an ethical aspiration to do no harm or to exploit our clients. In a New York Times article, Greenberg (2016) argued that to publish or even to use a composite description of clients is to irrevocably damage the therapeutic relationship. He further notes that due to the inherent power dynamic that exists within the therapist-client relationship, even with informed consent the therapist should never write about their clients. I believe this same stance can and should be applied to using clients and their stories for fundraising purposes. Greenberg shared a statement that has continued to resonate with me and one that I use when I consider thirdparty requests for client’s stories: “the reason that people are willing to pay for the refuge we
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therapists offer: an hour of freedom from being treated as the means to someone else’s end”. Stories are powerful tools to convey meaning, importance and to create connection. For many charities and not-for-profits stories are an essential way to generate revenue for services that individuals may not otherwise be able to access. Telling a client that you are unable to serve them due to the length of your waiting list for subsidized trauma-focused counselling, knowing full well that they have few other options is a tough conversation to have - one that I have had too many times to count. Fundraising events are critical to ensure that at-risk clients can get much needed access to quality mental health care. So how do you balance the need to fund raise while preserving the sanctity of the therapeutic space where these stories come into shared existence for the first time, without treating them as a means to someone else’s end? As a profession we are charged with upholding public confidence in the services we provide and how we conduct ourselves. The reality of fundraising in the not-for-profit sector is one that will not be going away any time soon. Consequently we are left to manage a very delicate balance and be the champion for clients to ensure that no harm, unintentional or not, comes to them. Unfortunately, there are no clear guidelines on how to best manage this balance. Over the years I have come to develop a set of questions that I use to guide my practice in this area. Is the request being made of a current client and are they still struggling with the issue? Further to this, will the request interfere with the therapeutic process? This is often the harder question to answer. It is vitally important to be mindful of the inherent power dynamic that exists so as to ensure that the client is making the decision to participate of their own free-will and not because they are worried about letting you or the agency down. When I am unable to come to a conclusion that I am satisfied with, I will always seek consultation from various colleagues in order to get a range of feedback. These colleagues may not all be
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psychologists. I find this helpful at times as a way of expanding and challenging my own reflective practice. Finally, I will encourage everyone who finds themselves in the position of acting as a gatekeeper between clients and fundraising to stop and ask themselves is this to benefit the client or us? If “US” is your immediate answer then a deeper discussion needs to be had at the agency level about the appropriateness of using a client to tell their story. These discussions are often difficult but are made easier in the presence of a deep mutual respect and trust. You want to move from being a gatekeeper to more of a team –driven initiative centered around best practice in client care.
Ashley Lim is YWCA Edmonton’s Director of Counselling Services & Youth Leadership Programming, and a Registered Psychologist. Under her leadership the YWCA has grown significantly and become a sought after teaching facility specializing in family violence. Ashley’s re-visioning of YWCA Youth Programs created effective violence prevention curriculum for young teens in Edmonton. Ashley has a talent for making connections and sharing best practices. She has built partnerships across the country to support family violence prevention and recovery initiatives. As a psychologist, Ashley specializes in youth, complex trauma, and domestic violence. Her expertise and dedication to creating change has helped many Albertans move from crisis to resilience.
Register Updates Updates for June 1 - September 30, 2018 Congratulations and welcome to the 88 new Registered Psychologists who were added to the register: Lisa Michelle Apperley Heather V. Baker Alshaba S. Billawala Kathryn A. Birnie Johnathan Lee Bown Erin Aisha Boyce Dawn N. Bremner Danielle L. Broad Austin D. Brown Sparks Cynthia A. Brummelhuis Nicole Marie Bullock Bonnie Leah Casella Amanda Cavaleri Kristin Janine Copeland Kelly Ann DeCoste Shari K. Derksen Naddley Desire Sherri L. Doblanko Iain B. Dolan Roxanne Rea Dowd Agnes M. Drysdale Ashlee Ellerbruch Young Rosemarie Alice Fabre Rebecca Lisa Fraccaro Cara Lee Freeman Illya (Ilya) Gladshteyn Evelyn Monica Gorecki Rina Goukon Olivia E. Griffioen Mirjam Cecilia Groen Leslie H. A. Hamilton Ryley Rachelle Hatchard Stephanie T. Hawryliw Katherine Hollowell Sheldon Whitney Marie Huckstep Dean J. Iatridis Natalie Jessica Imbach Paige Allison Irwin Nicholas Tyler Jackson Audrey Kabis Plante Lisa Alicja Kaldenbach Jackie M. Kamrowski Kimberley Leanne Kiefuik Chelsea S.H. King
Gina Ko Ramona C. Kotke Gapp John A. Laing Tamara Lane Caroline Marie-Eve LaPierre Lauraine F. Laudel Hilda Maria Leon Hernandez Tannia Shari Los William S. MacAllister Robert Lloyd Martens Karim McCallum Vanessa L. McConnell Shannon Leah McGuire Carly Anne McMorris Steve J.Mironuck Shari Moore Jacqueline F. Moss Adaeze Sarah Dea Obiajunwa Nicole E. O’Geil Olive O. Okraku Jayanthi Mary Parackel Lyndsey Marie Pearson Lisa Rowbottom Petrina Melanie Runke Julia Cathryn Russell Amanda T. Santarossa Natsumi Sawada Ashley Erin Shaw Nicole Elizabeth Singh Jennifer Ann Smith Amanda D. Smith-Demers Serena L. Smygwaty Melissa Anne Soares Michael Neil Sorsdahl Katharine Stabb Amanda M. Stillar Jamie D. Swan Lauren A. Terlecki Lisa M. Thomson Marsha Vasserman Laura Ann Walsh Bernadene M. Weskin Sandy Witdouck Igor Yakovenko
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Collaborative Practice in Schools By Rob McGarva, RPsych
Collaborative professional practice in schools continues to gain momentum (Segal, Fersterer, T., Sodeman, S. J., & Prescott, K. E. (2017). This approach has been accelerated in Alberta schools with the government’s funding and promotion of multiministry supports through Regional Collaborative Service Delivery (RCSD) networks. As Greidanus (2016) noted when discussing collaboration in health settings, few professionals receive training on how to work with other disciplines. However, this is a valuable opportunity to support clients and for a psychologist’s own professional growth (Vereen et al., 2018) While challenging, collaborative practice is a reality that is ethically encouraged as it respects the client by allowing a seamless integration of their supports, and serves society by efficiently integrating government funding. In general, the hurdles can be overcome through clear and constant communication. Section 15.1 of the Standards of Practice (2013) provide direction for psychologists in this situation. Time is often a challenge for ensuring adequate communication (Thielking, Skues, & Le, 2018). However, having time for discussion is essential when the factors of focus are often artificial constructs, that may be understood differently. For instance, I have found it very helpful to talk with speech-language pathologists and occupational therapists about how we conceptualize and have
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measured “language” functioning. This has helped my own professional understanding and supported client planning. It has also made our team able to clearly communicate with parents and teachers, and explain why one of us has assessed language as a deficit and the other has found typical levels of ability. Teachers generally operate independently in their classrooms, often dealing with exceedingly challenging demands. Recent studies have suggested the majority of teachers are usually working at a very high level of stress (Herman, Hickmon-Rosa, & Reinke, 2018). In addition, I have found the majority of teachers to deeply care about their students (Loreman, 2011). The traditional notion of “in loco parentis” has supported teachers in a role of decision-making for children. These incidents are an opportunity to educate school staff about psychologists and to develop a positive rapport. A strong relationship becomes essential in influencing teacher interactions with students when best practices and professional ethics suggest different methods. Psychologists (and other health professionals without a teaching certificate) are in an advisory capacity to teachers (ATA, 2016). Advising is much more effective if I have a relationship that allows me to explain why a restrictive behavioral strategy is inappropriate
or why another strategy may be more effective. It also increases the chance that other teachers will welcome me into their classrooms. Many school staff understand consent to mean a signed piece of paper. We have also struggled with creating a multi-disciplinary consent form for our region that allows a parent to agree to a range of services. I have agreed with this process, as the feedback I have received from parents is that this respects their wishes not to be confused and overwhelmed by being asked to sign multiple documents. However, I balance this process with trying to ensure that the parent understands and agrees with my specific services as they are explained during the initial case conference, or follow-up with a phone call if I have any doubts about their informed consent. Communication is also critical to understand variations in professional guidelines For example, although similar, the concept of a mature minor differs between educators and psychologists. Alberta Education directs schools to consider a student independent if they are at least sixteen and living independent of their parents (School Act). Psychologists have a higher duty to ensure maturity for consent based on their expertise in assessing cognitive and emotional factors (CAP, 2014). There may also be differences in best practices and treatment recommendations. For example, I have collaborated for years with an occupational therapist who is employed by another agency. This person has a history of suggesting an intervention which my reading and training leads me to believe is not supported by evidence. In this situation, I do not view the strategy as harmful, and occasionally have observed it to have a positive impact (although I think due to a placebo effect). If parents ask me about this approach, I attempt to be respectful of the other professional but demonstrate responsible caring. I tell them that I respect the other person, that they have many years of experience and that it has helped some children, but that my understanding is the research does not support it. This type of disagreement could become more challenging if the recommendation were part of
a joint multi-disciplinary report. I view myself as responsible for the entire written report completed by a team. However, I have tried to ensure that the language in the report communicates which parts are related to my findings and which are my specific recommendations. I have been fortunate in agreeing with all the other writers of joint reports. If there were a disagreement, I would suggest identifying who supports and who disagrees, and explaining the dissenting opinion. As with other areas of professional practice, clear and frequent communication helps to alleviate many problems. The CAP ethical guidelines have evolved because they provide a powerful framework for consideration of actions. Keeping the client’s well-being as the primary focus, but also respecting others and presenting psychological services in a positive fashion will ensure positive inter-disciplinary work.
Rob McGarva, M.A., is the Director of Student Services for Pembina Hills Public Schools. He currently serves as one of the leadership co-chairs for Aspen Collaborative Services. Rob is also a member of the CAP Practice Advisory Committee. He has worked in the school system and with multidisciplinary teams for thirty years. Rob has been a Registered Psychologist since 2001 and is a diplomate of the American College of School Neuropsychology. His current hobby is a Ph.D. program with a dissertation focused on teachers’ perception of help when trying to include students with an emotional/behavioural disorder in a regular classroom. www.cap.ab.ca
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References Page 13-14
Evidence-Based Practice of Psychological Assessment and Treatment By David Dozois, PhD, RPsych Badenoch D, Tomlin A. (2015) Keeping up to date with reliable mental health research: National Elf Service white paper. Minervation Ltd, Oxford. DOI: 10.13140/ RG.2.1.4404.2328 Beidas, R.S., Stewart, R. E., Walsh, L., Lucas, S., Downey, M. M., Jackson, K., Fernandez, T., & Mandell, D. S. (2015). Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cognitive & Behavioral Practice, 22, 5-19. Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. The Lancet Psychiatry, 3, 415-424. Dobson, K. S., McEpplan, A. M., & Dobson, D. J. G. (in press). Empirical validation and the CBTs. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioral therapies (4th ed.). New York: Guilford Press. Dozois, D. J. A. (2013). Presidential address – Psychological treatments: Putting evidence into practice and practice into evidence. Canadian Psychology, 54, 1-11. Dozois, D. J. A., Mikail, S., Alden, L. E., Bieling, P. J., Bourgon, G., Clark, D. A., Drapeau, M., Gallson, D., Greenberg, L., Hunsley, J., & Johnston, C. (2014). The CPA Presidential Task Force on Evidence-Based Practice of Psychological Treatments. Canadian Psychology, 55, 153-160. Dozois, D. J. A., Wilde, J., & Dobson, K. S. (in press). Depressive disorders. In M. M. Antony & D. H. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (3rd ed.). New York: Guilford Press. Hunsley, J. & Allen, T. (in press). Clinical assessment in cognitive-behavior therapies. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioral therapies (4th ed.). New York: Guilford Press. Hunsley, J., Elliott, K., & Therrien, Z. (2013). The efficacy and effectiveness of psychological treatments. Ottawa, ON: Canadian Psychological Association. Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33, 883-900. Newnham, E. A., & Page, A. C. (2010). Bridging the gap between best evidence and best practice in mental health. Clinical Psychology Review, 30, 127-142. Stamoulos, C., Reyes, A., Trepanier, L., & Drapeau, M. (2014). The methodological quality of clinical practice guidelines in psychology: A pilot study of the guidelines developed by the Ordre des Psychologues du Québec. Canadian Psychology, 55, 177–186. Tasca, G. A., Angus, L., Bonli, R., Drapeau, M. Fitzpatrick, M, & Hunsley, J. (2018). Outcomes and progress monitoring in psychotherapy. Ottawa, ON: Canadian Psychological Association
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Not-For-Profit Psychology: Fundraising through Client Stories By Ashley Lim, RPsych Greenberg, G. (2016, April 19). Should Therapists Write About Patients? Retrieved from http://opinionator.blogs.nytimes.com/2016/04/19/should-therapists-write-about patients/?smid=fb-share&_r=1 Schelling, T.C. (1968). “The Life You Save May be Your Own” in Samuel Chase (Ed.), Problems in Public Expenditure Analysis. Washington, DC: The Brookings Institute. Small, D.A., Loewenstein, G., & Slovic. P. (2007). Sympathy and callousness: The impact of deliberative thought on donations to identifiable and statistical victims. Organizational Behavior and Human Decision Processes, 102(2), 143-153. https:// doi.org/10.1016/j.obhdp.2006.01.005
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Collaborative Practice in Schools By Rob McGarva, RPsych Alberta Teachers’ Association. (2016). Teachers and educational assistants: Roles and responsibilities. Edmonton, AB: ATA. College of Alberta Psychologists. (2014). Practice alert: Mature minors. Retrieved from https://www.cap.ab.ca/Portals/0/pdfs/CAPPA-MatureMinors.pdf. Greidanus, R. (2016). Psychologists on health care teams. The CAP Monitor, 50, 9-12. Herman, K. C., Hickmon-Rosa, J. E., & Reinke, W. M. (2018). Empirically derived profiles of teacher stress, burnout, self-efficacy, and coping and associated student outcomes. Journal of Positive Behavior Interventions, 20(2), 90-100. Loreman, T. (2011). Love as pedagogy. Rotterdam, NL: Springer Science & Business Media. Segal, P., Fersterer, T., Sodeman, S. J., & Prescott, K. E. (2017). Promoting Success of School Psychology: Collaborating with Others. In Handbook of Australian School Psychology (pp. 125-143). Springer, Cham. Thielking, M., Skues, J., & Le, V. A. (2018). Collaborative Practices Among Australian School Psychologists, Guidance Officers and School Counsellors: Important Lessons for School Psychological Practice. The Educational and Developmental Psychologist, 35 (1), 1-18. Vereen, L. G., Yates, C., Hudock, D., Hill, N. R., Jemmett, M., O’Donnell, J., & Knudson, S. (2018). The Phenomena of Collaborative Practice: the Impact of Interprofessional Education. International Journal for the Advancement of Counselling. Advance online publication. doi: 10.1007/s10447-018-9335-1.
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Harvey Brink, James Canniff and Paul Jerry are members of the Publications Committee who monitor the content of The CAP Monitor to ensure the information being conveyed is consistent with the College’s mandate, governing documents and policy. The CAP Monitor is a regular publication of the College of Alberta Psychologists. To the best of our knowledge it is complete and accurate at the time of publication.