The CAP Monitor by College of Alberta Psychologists

the

cap monitor serving the interests of the public and guiding the profession of psychology

7102 remmus - gnirps | 15 .on eussi Information Sharing Strategy // Supervision // Apps in Psychology // Code of Ethics, 4th Edition

Who's Who

Council 2016-2017 President................................................................

Lorraine Stewart

President-Elect......................................................

Paul Jerry

Past-President.......................................................

Roy Frenzel

Treasurer................................................................

Roger Gervais

Members-at-Large.................................................

Kevin Alderson Terry Creighton Hanita Dagan

Public Members......................................................

Kenneth Bainey

Supervision Consultants Supervision consultants are available to advise provisional psychologists and supervisors. They also assist in the resolution of conflicts between provisional psychologists and supervisors.

David J. Ellement

Michael D. McLaws

Jon Amundson

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................

Jacqueline Pei

Substantial Equivalency Sub-Committee..............

Ali AL-Asadi

403-289-2511 aapsych@telus.net

Walter Goos 780-986-7592 waltergoos@shaw.ca

Continuing Competence

College Staff

Consultants Registrar & CEO.............................................

Richard Spelliscy

Deputy Registrar and Complaints Director....

Troy Janzen

Consultants are available to provide advice and guidance to members who wish to participate voluntarily in the Continuing

Assistant Deputy Registrar and

Competence Program. The consultants are

Director of Professional Guidance...........

Aaron Block

Administration and Finance Coordinator.......

Wendy El-Issa

Complaints and Hearings Coordinator..........

Lindsey Bowers

Administrative Assistant to the Registrar.......

Kathy Semchuck

Registration Coordinator...............................

Ingrid Thompson

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.

Registration Assistant and

Dennis Brown 780-441-9844 brown.dennis002@gmail.com

Oral Examinations Coordinator...............

Danielle Salame

Credentials Evaluation Coordinator..............

Kymberly Wahoff

Christoph Wuerscher 403-234-7970

Communications Coordinator and

wuerscher@shaw.ca

Professional Guidance Assistant..............

Melanie Rutten

Bonnie Rude-Weisman

Receptionist..................................................

Renetta Geisler

403-526-8116 brudeweisman@shaw.ca

Contents

3 1 Registrar's Letter 2 President's Letter 3 Annual Meeting & Professional Development Day

5 College News

7 Professional Guidance Corner Incorporating a Private Practice, Charging GST and Obtaining Business Licenses

11 13 15 21

ProfessionalÂ Conduct Report Information Sharing Strategy Supervision Is There an App for That?

24 27 28 29

Code of Ethics, 4th Edition Register Updates Examination Results & Statistics Town Hall Meeting Schedule

Registrar's Letter A letter from Dr. Richard Spelliscy

A tentative province-wide joint CAP/PAA Town Hall meeting schedule has been developed. The next Town Hall meeting will be on September 7, 2017 in Fort MacMurray.

This is my first letter to you in my capacity as Registrar. I would like to begin by thanking College Council, fellow regulators and the many members who wrote to me expressing the confidence they have in my appointment. Two early initiatives that took hold early in my tenure as Registrar include a review of the College’s most valuable resource, staff. The second was the development of a five-year strategic plan. These two critical initiatives will be followed by an information management review.

In keeping with the Town Hall initiative, the number of The CAP Monitor issues will double to enhance the relevancy of the College and to stay connected with members. You will notice The CAP Monitor has a new look. In addition, it has returned to an article format to provide relevant, timely regulatory information to increase its value to members. Looking forward, the College is exploring practical and meaningful ways to recognize the volunteer service of Council, committee, panel and general members. We are also identifying ways to connect meaningfully with the public, our members and various stakeholders including allied health professions. We, as a College, will strive to raise the value of regulated psychology within a collaborative healthcare model to serve the best interests of all Albertans.

Having the right people and tools is essential to ensuring the College is adequately equipped for the future. Dr. Richard Spelliscy

The College has also continued to promote a collegial and mutually beneficial relationship with the Psychologists’ Association of Alberta (PAA).

1 issue 51 | 2017

President's Letter A letter from Dr. Lorraine Stewart

It is my honor to serve as President of the Council of the College of Alberta Psychologists (CAP) from September 2016 to September 2017. The Council is the governing body of CAP and is required to implement the Health Professions Act requirements; establish and revise policies; work closely with the Registrar; and appoint committees. Our Council has been busy fulfilling these roles and responsibilities. In the last year: • We bid a fond farewell to our former Registrar, Dr. Alexandra Kinkaide, and welcomed our current Registrar, Dr. Richard Spelliscy. • We developed an Organizational Strategic Plan, 2017-2022, to help guide the profession and protect the public. • We are supporting the Registrar as the College: -- implements a Communications Strategy -- appoints a Registration Review Recommendation Implementation Sub Committee to establish a process and schedule to implement recommendations in a timely manner -- establishes policies and procedures to ensure that our College remains one of the preferred places to work -- establishes policies and procedures to help the College reach its goal of "creating compassionate, caring, and competent psychologists"

We want to hear from you. Click here to offer feedback.

I have had the privilege of representing the Council and College at national meetings of the Association of Canadian Psychology Regulation Organization (ACPRO) and international meetings of the Association of State and Provincial Psychology Boards (ASPPB). These meetings provide an opportunity to: make connections, gain a firmer understanding in how the issues facing psychology are similar in most jurisdictions and discuss problem-solving strategies. At our local Alberta level, I hope that you will consider serving on one of our College committees to experience professional development in action! Serving on committees is the best way to make connections, gain a firmer understanding of issues, and be part of the problem-solving strategies to help guide our profession and protect the public.

Dr. Lorraine Stewart

www.cap.ab.ca

College of Alberta Psychologists

ANNUAL MEETING &

PROFESSIONAL DEVELOPMENT DAY

2017

SHAW CONFERENCE CENTER Edmonton, AB 8:00 AM - 4:30 PM Wine and Cheese Reception 4:30 PM - 6:00 PM

SEPTEMBER 16

KEYNOTE SPEAKER: DR. GABOR MATÉ on Compassion Fatigue Dr. Gabor Maté

Session Topics:

How can Psychologists Meet the Opioid Crisis Challenge? When the Body Says No! The Psychologist as an Expert Witness and more!

Dr. Gabor Maté and more

The next meeting will be on Saturday, September 16, 2017 at the Shaw Conference Centre in Edmonton. The College of Alberta Psychologists is pleased to have Dr. Gabor Maté as the keynote speaker at this year's Annual Meeting and Professional Development Day. Dr. Maté will present on "Compassion Fatigue" and two breakout sessions. A renowned speaker, and bestselling author, Dr. Gabor Maté is highly sought after for his expertise on a range of topics, from addiction to mind-body wellness. Rather than offering quick-fix solutions to these complex issues, Dr. Maté weaves together scientific research, case histories and his own insights and experience to present a broad perspective that enlightens and empowers people to promote their own healing and that of those around them. Dr. Maté has written several bestselling books including the award-winning "In the Realm of Hungry Ghosts: Close Encounters with Addiction." His works have been published internationally in 20 languages. Dr. Maté is the co-founder of Compassion for Addiction, a new non-profit that focuses on addiction. He is also an advisor to Drugs over Dinner. In the fall of 2017, Dr. Maté will be launching a new website offering online courses.

The first course will be a training program for health professionals working with people with addiction. To learn more, join his e-news list at www.drgabormate.com. Dr. Maté will also be speaking on psychologists' role in the opioid crisis that is currently an issue in Alberta and Canada, as well as a session titled "When the Body says No!," which will focus on stress and the mind/body unity. We look forward to hearing from Dr. Maté and other speakers on various topics including: Psychologists Meeting the Needs of the Refugee Community Collaborative Practice Essentials: Knowledge Café Advanced Topics in Supervision

Watch your email inboxes for a conference brochure that will be distributed to members soon. We look forward to seeing you all in September!

www.cap.ab.ca

College News Council Elections

The nominations are in. Council elections will take place for two Member-at-Large positions on the 2017–18 Council of the College of Alberta Psychologists. Voting ballots will be mailed to all regulated members shortly. Watch your mailbox for a copy of the ballot. Voting ballots must be received at the College office no later than Friday, August 11, 2017, at 4:00 p.m. All registered psychologists are encouraged to vote. Staff Changes

The College is pleased to welcome Troy Janzen, PhD, RPsych, as the newly appointed Deputy Registrar and Complaints Director. Troy Janzen has worked extensively in assessment and intervention with pediatric populations and families in hospitals, schools, private practice, First Nations communities and children’s services settings since 1993. For the past eight years he has served as the Clinical Supervisor and Practicum Coordinator for the recently CPA-accredited School and Clinical Child Psychology Program at the University of Alberta (UofA). He continues to serve as an Adjunct Assistant Professor with the Department of Educational Psychology at the UofA. Prior to being at the UofA, Dr. Janzen was Chair of the Psychology Department at Taylor University College (now closed). During that time he helped establish an undergraduate program in psychology. Most recently, Dr. Janzen has been asked on several occasions to assist the College of Alberta Psychologists with Ethics and Practice Reviews and to assist with supervision of members. 5 issue 51 | 2017

CAP 2016-2017 in Numbers

312

Applications for Provisional Status 2015 - 16: 252

180

88.8%

New Registered Psychologists

Candidates Passed the Oral exam

2015 - 16: 164

77.3%

Total Registered

3,399 members 31

Annual Meeting & Professional dev't 2016: 182 Attended

22.7% Average Age

Country of Education Others

3.6%

USA

25.6%

Canada

70.8% 6

www.cap.ab.ca

Professional Guidance Corner Aaron Block, MEd, RPsych Director of Professional Guidance

7 issue 51 | 2017

Incorporating a Private Practice Charging GST and Obtaining Business Licenses

Incorporation

A PC does not insulate the professional from personal liability for acts or omissions in the practice of the profession. Furthermore, the professional must own all voting shares in the PC and only non-voting shares can be issued to a spouse or children of the professional.

A Professional Corporation (PC) is a specialized type of corporation governed by both the Business Corporations Act and the applicable professional statute. For health professions, it is Part 5 of the HPA. In the 1980s, provincial governments began to amend regulatory statutes to allow certain self-regulated professionals to use Professional Corporations in professional practice.

Many of the tax advantages originally available to professionals who could have used a PC have been removed or reduced by subsequent legislation over the past three decades. As well, PCs have different corporate and tax filing obligations than individual practices have.

Can psychologists utilize a Professional Corporation in practice? The short answer is no. Section 109 of the Health Professions Act (HPA) allows only physicians, dentists, chiropractors and optometrists to utilize a Professional Corporation.

The primary benefit was a tax deferral mechanism. The professional could leave professional income inside the PC and it would be taxed at a lower corporate rate than if the income had been earned directly by the professional as an individual. The benefit is maximized when the individual professional is earning an income that would be taxed at the highest taxation rate. The income is left inside the PC until the professional has reached a point where his or her income has declined so that a lower tax bracket applies. Then the professional can draw out money from the PC as dividends and be taxed at a lower rate than would have applied in the past.

Incorporation of a business is a separate but related issue. Many psychologists incorporate their private practice. This is typically done for taxation purposes. The College does not provide business, accounting or legal advice. Psychologists are encouraged to seek appropriate guidance from regulated members of the accounting and legal profession to answer questions related to taxation and business. GST

Must psychologists charge GST to clients? The answer depends on whether the professional services provided are considered exempt under the GST legislation or considered a taxable supply of services. 8

www.cap.ab.ca

Incorporating a Private Practice Charging GST and Obtaining Business Licenses

Generally, the provision of professional services to a client is exempt whereas nonprofessional services such as fees for a speaking engagement or consulting work to an organization may not be considered an exempt supply. For a helpful article please click here. If in doubt, it is best to obtain professional accounting and/or legal advice on whether or not GST needs to be charged in a specific situation. Business Licenses

Can a psychologist be forced by a municipality to purchase a business license in order to open a professional practice? The answer is no, and this is because of Section 101 of the HPA. It states that no municipality has the power to require a regulated member to obtain a license from the municipality to practice a regulated profession. The City of Edmonton, for example, does not have any category of business license for health professions. The City of Edmonton does not require a business license for any health care professional opening or operating a professional practice. Staff in smaller municipalities may not be aware of Section 101 of the HPA, so it may be necessary for a psychologist to let them know about this stipulation if the municipality 9 issue 51 | 2017

insists they must have a business license to practice their profession. As with the GST question, psychologists should seek professional accounting and/or legal advice regarding this issue.

Resources The College website serves two purposes:

Communication with the public Communication with members

The website is updated regularly and is a good source of information.

Other useful websites: Health Professions Act Psychologists' Association of Alberta Canadian Psychological Association Association of State and Provincial Psychology Boards

Do we have your current information? Please notify the College promptly about any changes to your postal address, phone and fax numbers or email address. To update your contact information:

- Log in to the Member Portal - Go to the "I Want To" box on the left of the screen - Click "Update my Contact Information"

If you need assistance please contact the College at psych@cap.ab.ca.

Please note that information about your business address, phone and fax numbers and email address is available to the public. If you are providing a

residential address to

the College, clearly indicate this, so that this information can be kept confidential.

Email addresses are mandatory for all members of the College. It is crucial that we have your current email address as all information from the College is sent out via email.

It is the responsibility of each member to ensure the College has the correct and current

Click for

CAP Meetings and Exam Dates

email address.

www.cap.ab.ca

Professional Conduct Report

Hearing Tribunals routinely order that circumstances surrounding a finding of unprofessional conduct and the associated sanctions be published in The CAP Monitor. The purpose of such an order 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. Identifying information is typically altered/removed to respect the privacy of all involved. 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 student psychology intern by spending personal time together and expressing romantic feelings, resulting in an intimate relationship. The regulated member self-reported the conduct. The Hearing Tribunal did not accept the Joint Submission on Sanctions and imposed additional requirements on the regulated member. The regulated member subsequently appealed the Hearing Tribunal Decision to College Council. College Council heard the matter and determined that the standard of reasonableness applied.

11 issue 51 | 2017

College Council recognized the personal circumstances of the regulated member that were present at the time the conduct occurred. It was also recognized that the regulated member fully cooperated during all aspects of the investigation and hearing, self-reported and admitted to the inappropriate conduct, and acknowledged remorse. College Council determined that the Joint Submission on Sanctions was reasonable and should be upheld. A summary of the Joint Submission on Sanctions is as follows: • The regulated member will resign from the practice of psychology. • 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 that their clinical records are transferred safely and securely to another member of the College. • The College will provide notice of the resignation to all psychology regulatory bodies in Canada and to the Association of State and Provincial Psychology Boards in the U.S.A. • A non-identifying summary of the results leading to the regulated member’s resignation will be published in The CAP Monitor.

www.cap.ab.ca

Information Sharing Strategy (ISS) What is my authority to disclose? Aaron Block, MEd, RPsych

Albertans only want to tell their story once when receiving social-based client services, according to the Government of Alberta’s (GoAs) 'Information Sharing Strategy: Supporting Social-Based Service Delivery (2016)' document. The Government’s response was the development and implementation of the Information Sharing Strategy (ISS) to reduce the duplication of information gathered and to avoid the erection of artificial barriers between services. When personal and health information is shared among partners, Albertans are able to receive services in a more holistic manner. Decisions can be made based on a full consideration of the individual’s needs and available opportunities. This strategy applies both within the GoA and to external organizations, including psychologists’ organizations. The vision for ISS is to improve service delivery to Albertans through increased collaboration across the GoA and service delivery partners within an information sharing system. This optimized information sharing system creates a culture based on

13 issue 51 | 2017

principles of transparency, accountability, acknowledgement of risk, respect for privacy and confidentiality, efficient and effective information management and the sharing of information when necessary. The specific strategic actions are reported as the standardized collection, categorization, storage and distribution of information and data and the sharing of necessary information so that Albertans are engaged, staff are able to explain information-sharing and privacy legislation is aligned throughout the process. The product of the ISS is described as a common business model and governance approach. Staff are able to make more informed decisions, service delivery is clientcentered, clients are informed about information sharing during provision of service(s), the structures that support information sharing are explained and information sharing is encouraged and expected. In 2012, Cabinet approved the ISS . Alberta has a legislative framework, structured around four pieces of legislation, which provides a conduit for the flow of information:

The vision for ISS is to improve service delivery to Albertans through increased collaboration ...

For public bodies such as Alberta Human Services, Justice, and Education, the Freedom of Information and Protection of Privacy Act (FOIP Act) applies. For custodians of health information or within the health system (AHS), the Health Information Act (HIA) applies. For private practice (private organizations/not-for-profit organizations), the Personal Information Protection Act (PIPA) applies. For services benefitting children, the Children First Act (CFA) applies. Within the provincial and federal systems, additional legislation also provides parameters around the flow of information such as the Child, Youth, and Family Enhancement Act, the School Act, the Victims of Crime Act, the Youth Criminal Justice Act, and the federal Privacy Act. Which Standards Apply?

Our Standards of Practice (2013) specify, within our informed and ongoing consent process, that: 3.1 A psychologist shall obtain informed consent from the client and/or guardian before providing a professional service, including research, and before seeking formal consultation regarding a client.

3.2 A psychologist shall document the discussion held with a client, including whether consent was limited or refused. As part of: 3.5 The informed consent process shall address the following: 3.5.3 Confidentiality protections and limitations;And to build on the concept of an ongoing and informed consent process: 4.1 A psychologist shall obtain informed, written, signed and dated consent from a client for the release of confidential information. The consent shall stipulate the information to be released, the recipient and the period of time covered by the consent, as outlined in section 12.3. 12.1 A psychologist shall adhere to privacy legislation governing their practice. 12.3 Unless permitted or required by law or by these Standards of Practice, a psychologist shall disclose confidential information only with the informed, written, signed and dated consent of the client. The consent shall stipulate the information to be released, the recipient and the period of time covered by the consent, as outlined in section 4. Further: 12.5 A psychologist may disclose confidential information about a client without the informed written consent of the client when permitted or required by law. For more information about and training in ISS click here. 14

www.cap.ab.ca

Supervision Optimizing the Supervisory Relationship Dr. Greg Schoepp, RPsych

As the co-chair of the CAP Registration Subcommittee (RASC), I am grateful and appreciative of the roughly 300 supervisors across the province offering their time and expertise to about 600 provisional psychologists. The College relies on supervisors as gatekeepers to determine the competence level of provisional psychologists’ readiness for independent practice and requires that supervisors, when needed, assist the RASC in developing remediation plans for applicants requiring further supervised practice beyond the 1600 hours. Your role as supervisors is vital in strengthening our profession as you help provisional psychologists build professional knowledge, skills and attitudes. Given the challenges for supervisors, including lack of formal training, time constraints, limited technological resources, lack of institutional support, challenging clients, off-site supervision travelling distances, less skilled supervisees and difficulties maintaining professional boundaries, it is our responsibility to employ supervision practices that benefit both our supervisees and their clients.

15 issue 51 | 2017

My supervisory work is shaped from almost 17 years of supervising in a hospital setting with a pediatric population. I’ve supervised novice Master’s-level practicum students as well as psychiatry residents and skilled doctoral-level psychology students. As with many supervisors of my era, there was no formal supervision training. Workshops, peer supervision, professional readings and my work on the College’s RASC and Complaints Review Committee and Hearing Tribunal molded my knowledge and identity as a supervisor. For a working definition of supervision, Falendar and Shafranske’s (2004) description from competency-based clinical supervision is very useful. Supervision is a distinct professional activity in which education and training aimed at developing science-informed practice are facilitated through a collaborative interpersonal process. Supervision is conducted in a competent manner in which ethical standards, legal prescriptions and professional practices are used to promote and protect the client, the profession and society at large. Bernard & Goodyear (2014) add that supervision constitutes a relationship that is evaluative, extends over time and has the simultaneous purposes of enhancing

The success of supervision hinges on the effectiveness of the supervision relationship.

professional functioning of the more junior person, monitoring the quality of professional services offered to the client and serving as a gatekeeper of those who are to enter the particular profession. Supervision is a distinct professional activity that identifies specific knowledge, skills, attitudes and values that form foundational and advanced competencies in a measureable format. Ultimately, supervision provides valuable learning experiences in how to competently practice as a clinician while simultaneously facilitating the growth of professional attitudes for ethical practice throughout one’s career (Falendar & Shafranske, 2014).

supervisee anxiety and doubt and fosters better quality therapeutic skill development and professional identity, which in turn benefits the client(s). In contrast, when the supervisory relationship is plagued by mistrust and a weak connection, the relationship inauthenticity creates unclear or unrealistic expectations and mismatched or misguided supervision interventions. This increases supervisee anxiety and doubt and compromises skill and identity development. This, in turn, produces a negative impact on the client(s). Given the importance of the supervisory working alliance, defined as the mutual agreement on the goals and tasks of supervision and the bond between supervisor and supervisee, questionnaire research on the supervisory relationship identified common factors in effective supervision (Beinart, 2016). Some of these factors are listed, followed by suggestions about how to foster these elements in your own supervisory relationships.

The success of supervision hinges on the effectiveness of the supervision relationship. At an April 2017 supervision workshop in Edmonton hosted by the University of Alberta Counselling Psychology and the School and Child Clinical Programs, the guest speaker, C. Edward Watkins, outlined his “contextual supervision relationship model” (Watkins, 2016) to illustrate the central role of the Some qualities of an effective supervisory supervisory relationship in creating beneficial relationship are: 1) a safe base characterized outcomes for the supervisee and client. by feelings of respect and openness; 2) a structure that maintains practical boundaries In a supervisory relationship characterized by such as time; 3) supervisor professional trust, understanding and supervisor expertise, commitment to supervision as well as a process of learning occurs that reduces emotional investment in the relationship;

www.cap.ab.ca

4) supervisee investment and productivity; 5) facilitating learning through supervisee’s reflections; 6) formative feedback; and 7) external influences from the personal/professional lives of the supervisory dyad. Using the above factors, how do you build an effective supervisory relationship, the foundation of successful supervision? Falender and Shafranske (2014) highlighted three key aspects of a good working alliance: 1) agreement on goals; 2) agreement on the tasks to attain goals; and 3) a relational bond between partners. While the College requires the submission of a supervision plan, I suggest that supervisors go one step further and establish a supervision contract that is subject to regular review. The contract outlines in greater detail the specific learning goals, structure, duration and frequency of supervision, and means of formative and summative feedback. Beinart (2016) notes that a contract is an ongoing process that begins to establish the supervisory relationship, clarifies expectations, encourages collaboration, invites supervisees to actively create developmental and learning needs, facilitates discussion about managing feedback and evaluation and helps explore differences in assumptions from diversity aspects. Examples of supervision contracts can be found here. At the outset of creating a contract, establish the supervisee’s learning needs and preferred learning styles. 17 issue 51 | 2017

It can be helpful to discuss previous positive and negative supervision experiences. It is critical to approach the issue of feedback and evaluation early on, including past hindrances and helpful experiences. Flag early any potential issues that may impact supervision, such as supervisor time away from work. Clearly lay out roles and responsibilities within the supervisory relationship, for example, note taking and report writing, professional issues or confidentiality, particularly if ethical or skill competence issues arise. The supervisor’s ability to approach potentially challenging issues through discussion from the outset is key to building an effective supervisory relationship. The effectiveness of feedback and review will depend on the strength of the supervisory relationship and the environment created by the supervisor to promote honest disclosure. Strains and ruptures in supervision often occur around evaluation or its omission, so procedures for evaluation must be established at the outset of the supervisory relationship. These components would include performance monitoring, feedback and formal written evaluation and time frames (Falender & Shafranske, 2014). Beinart (2016) stresses the importance of directly observing supervisee practice and giving specific feedback on observed practice, be it audio or video recordings or live observation. Supervisee verbal reports to the supervisor are less effective because of the reliance on the supervisee being able to openly disclose all aspects of their work, including difficulties and clinical mistakes.

Feedback will have the most beneficial impact when it is provided in a manner that is: frequent, a regular part of supervision, and based on work samples tied to specific learning goals and addresses knowledge, skills and values that need attention identifying strengths as well as next steps in developing competence balanced between support/reinforcement and challenges/constructive feedback inviting reflection and articulation of the specific skill targeted for development owned by the supervisor as a professional opinion, not proclaimed as a universal truth a two-way street where supervisors seek regular feedback about their supervision approach (Bernard & Goodyear, 2014; Falender & Shafranske, 2014)

Monitoring supervisee’s skill development, risk management and client welfare can be accomplished with a supervision record form. After each session, I complete a onepage record form based on Bernard and Goodyear’s template (2014) that contains the topics below. This information is used to track and guide supervisee skill development and improve the supervision process, as well as for formal evaluation. Supervision Notes Date and time of supervision session Follow-up on previous supervisory input Major topics that emerged Risk management review, if needed (client, concern, intervention at this time) Supervision interventions and rationale Area(s) for growth attended to in session Strengths demonstrated in session Goals for next supervision session

www.cap.ab.ca

A challenging role for supervisors is providing feedback about supervisee professional behaviour or personality, which again hinges on the strength of the supervisory relationship and whether feedback is given, received, integrated and used. Supervisor reasons for avoiding this feedback may relate to avoiding confrontations or believing the supervisee will later discover the issue themselves. Beinart (2016) noted that experienced supervisors were able to approach rather than avoid conflict and were prepared and expected to give difficult feedback. For providing challenging feedback, she encourages supervisors to: consult with a colleague, if needed acknowledge the challenges in facing difficult issues name the issue and clarify your views own your opinions and invite supervisee self-reflection explore the differences and possible explanations attend to the process in emotionally charged issues allow time for continuing reflection and follow-up Finally, addressing supervisory alliance strains is to be expected as conflict commonly occurs in all relationships, including professional ones. How these conflicts are resolved affects the supervisory relationship’s growth or stagnation. Conflict arises from a variety of sources, including supervisor incompetence, unrealistic or lack of clear expectations, or inadequate feedback. Other contributing factors may include supervisee anxiety or overconfidence, unreceptiveness to feedback, feeling 19 issue 51 | 2017

overwhelmed, inadequate competency development or ethical violations. Strain indicators include withdrawal, lack of disclosure, overt expression of criticism or hostility, non-compliance or passive responding and acting in or out. Bernard and Goodyear (2014) described two types of alliance ruptures, a more serious strain that requires skillful intervention. A confrontational rupture leads to the supervisee directly expressing dissatisfaction or even anger, while a withdrawal rupture leads to supervisee disengagement. Supervisors’ attempts to resolve the rupture may perpetuate the negative cycle with supervisor defensiveness/anger to confrontation or controlling behaviour to withdrawal. Falender and Shafrankse (2008) suggest metacommunication that involves the supervisor leading the way in stepping back from the rupture, in a process of examining or metacommunicating about what is currently unfolding in the supervisory dyad. The supervisor uses their emotions and behaviours as a jumping-off point for collaborative exploration. While many ruptures can be resolved, admittedly there are situations when it is not possible to reestablish an effective working relationship. However, competent handling of conflict allows for a more amiable end to the supervision relationship, and hopefully equips the supervisee with more proficient skills as they work with another supervisor. In summary, the supervisory relationship is highly complex and places many demands

upon both the supervisor and supervisee. No matter how skilled a supervisee is and how collegial the relationship becomes, there always remains a power differential due to the evaluative function of supervision. Effective supervisors recognize the tremendous impact of the supervisory alliance and take effective steps to lay the foundation for a successful supervision experience. Again, on behalf of the College I extend a thank you and appreciation to the supervisors across the province who are committed to providing high quality supervision that ensures our profession grows in competence and professionalism.

Jon Amundson 403-289-2511 aapsych@telus.net

Walter Goos 780-986-7592 waltergoos@shaw.ca

References Beinart, H. (2016). Building and sustaining the supervisory relationship. In Watkins, C. E. Jr., & Milne, D. L. (Eds.). The Wiley International Handbook of Clinical Supervision (pp. 257-281). West Sussex, UK: John Wiley & Sons Ltd.

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston: Pearson Education.

Falender, C. A. (2008). Casebook for clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.

Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.

Falender, C. A., & Shafranske, E. P. (2014). Competent clinical supervision: Emerging effective practices. Counselling Psychology Quarterly, 274, 393-408.

Watkins, C. E. Jr. (2016). A unifying vision of psychotherapy supervision: Part I – Productive and unproductive supervision relationships. Journal of Unified Psychotherapy and Clinical Science, 4, 21-35.

www.cap.ab.ca

Is There an App for That?

Use of mobile applications in psychological care Marianne Hrabok, PhD, RPsych Aaron Block, MEd, RPsych

What are you holding right now? If you are like many Canadians, it may be a mobile phone(1). Use of mobile applications (apps) in psychological care has been the subject of increased attention due to their accessibility, mobility, ease of operation, and potential to increase client engagement and enhance care (2, 3). App use in client care relates to a number of regulatory tenets relevant to the profession of psychology. For example, it is important that psychologists select the most reasonably accessible service for clients, as guided by relevance to the client and the best available evidence (II.184). In the service of maximizing benefit and minimizing harm, psychologists are encouraged to keep up-to-date with the potential impact of information, including technologies, on clients involved in their care (II.94). Despite potential benefits associated with app use, there are also several challenges that must be considered, including: There are many mental health apps. According to one estimation, there are at least 10 000 mental health apps available for download(5). Systematic reviews have also indicated there are a plethora of apps. Even after applying screening criteria, systematic 21 issue 51 | 2017

reviews of suicide(6), CBT and behavioural activation(7), mindfulness(8), and bipolar disorder(9) typically yield in excess of 100 results. Despite the large number of apps, most have poor content quality that are not evidencebased or founded on best practice(5). A recent review of self-harm and/or suicide apps suggested most contained one suicide prevention feature, however, most failed to include multiple features (as recommended based on best practice guidelines)(6). Similarly, a review of CBT and behavioural activation apps for depression found that only 10% included evidence-based principles(7). A review of apps for bipolar disorder suggested few apps incorporated core psychoeducation principles or best practice guidelines(9). Content in some apps can be harmful because of omissions. For example, one review of bipolar disorder apps intended for symptom monitoring reported that most failed to include features to monitor medication (57% of apps) or sleep (51% of apps)(9). Inclusion of harmful content has also been identified. For example, a review of suicide apps yielded apps containing content such as listing lethal access to means or encouraging risky behaviour during a crisis(6). Notably, many of these harmful apps were reportedly presented as being helpful to the user despite their actual content.

Many apps do not address privacy. Although privacy is paramount(5,10), and psychologists should strive to manage information in a way that protects privacy (I.414), a privacy policy is frequently not included in mental health apps. For example, less than half of the apps in a review of suicide apps included a privacy policy(6), a privacy policy was rarely included in a systematic review of CBT and behavioural activation apps for depression(7), and was included in only 22% of apps for bipolar disorder(9). Quality of content is not consistently related to ease of use. At times, content is at odds with functionality(5). For example, reviews of CBT apps(7) and bipolar apps(9) found no significant relationship between evidence base and functionality according to statistical analyses. Due to the challenges identified above and the lack of regulatory oversight of apps, various models focused on app evaluation have been developed (e.g.,6,7,9–11). The American Psychiatric Association (APA) has a detailed model that is easily accessible online that users may wish to evaluate apps against (10). The following additional information is offered to psychologists who wish to incorporate apps into their services: When viewed in the context of theoretical orientations to psychotherapy, most apps are within the behavioural domain. For example, a large percentage of apps involve techniques such as: self-monitoring, breathing, relaxation, mindfulness and so on. Many are either designed as an adjunct to psychotherapy and counseling or can be used in that manner.

Prior to recommending use of an app to a client, it is advisable to download and use the app yourself to evaluate whether it fits the intended purpose. Although a minority of apps are available from purportedly third party credible sources, such as an academic, health or public institution, choosing apps from these organizations may confer a level of quality and security that is not available from other sources. For example, the Department of Defense(12) has a number of free apps that have been developed based on commonly accepted principles of psychological care. Their apps address a wide range of concerns, include a privacy policy, and many of the apps have been subject to peer-reviewed research. Broad categories that can be applied when evaluating an app include: Who is the author/developer? (consider: credibility, for example, a health care organization, educational institution or the like; minimization of financial bias; and attitude toward helping professionals). What is the content? (consider: whether the app has been subject to peer-reviewed research, is based on wellestablished principles of care, and excludes harmful content). Is there a privacy policy? Note that locating a privacy policy can at times be challenging (personal correspondence, APA, May 18, 2017), yet examination of privacy 22

www.cap.ab.ca

is key in most app evaluation models(10) and, as discussed, an important aspect of ethical frameworks for psychologists. Is there any significant, up-todate news on the app? Search the app name in Google News to see if there have been challenges of false claims or harmful consequences associated with app use.

References: 1. Two-thirds of Canadians own a smartphone, and almost half have a tablet, CRTC says. CBC News. http://www.cbc.ca/news/business/crtc-telecom-report1.3290603. Accessed May 24, 2017. 2. Firth J, Torous J. Smartphone Apps for Schizophrenia: A Systematic Review. JMIR MHealth UHealth. 2015;3(4):e102. doi:10.2196/mhealth.4930. 3. Menon V, Rajan T, Sarkar S. Psychotherapeutic applications of mobile phone-based technologies: A systematic review of current research and trends. Indian J Psychol Med. 2017;39(1):4. doi:10.4103/0253-7176.198956. 4. Canadian Psychological Association > Canadian Code of Ethics for Psychologists - www.cpa.ca.

With safeguards in place for thoughtful, intentional and judicious use, apps as an adjunct to psychological care have the potential to engage clients and enhance psychological service.

http://www.cpa.ca/aboutcpa/committees/ethics/code ofethics/. Accessed June 15, 2017. 5. Torous J, Roberts LW. Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. JAMA Psychiatry. 2017. http://jamanetwork.com/journals/jamapsychiatry/fullarti cle/2616170. Accessed May 8, 2017. 6. Larsen ME, Nicholas J, Christensen H. A Systematic Assessment of Smartphone Tools for Suicide Prevention. Seedat S, ed. PLOS ONE. 2016;11(4):e0152285. doi:10.1371/journal.pone.0152285. 7. Huguet A, Rao S, McGrath PJ, et al. A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PloS One. 2016;11(5):e0154248. 8. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and Evaluation of Mindfulness-Based iPhone Apps. JMIR MHealth UHealth. 2015;3(3):e82. doi:10.2196/mhealth.4328. 9. Nicholas J, Larsen ME, Proudfoot J, Christensen H. Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. J Med Internet Res. 2015;17(8):e198. doi:10.2196/jmir.4581. 10. App Evaluation Model. https://www.psychiatry.org/psychiatrists/practice/menta l-health-apps/app-evaluation-model. Accessed May 24, 2017. 11. Boudreaux ED, Waring ME, Hayes RB, Sadasivam RS, Mullen S, Pagoto S. Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Transl Behav Med. 2014;4(4):363-371. doi:10.1007/s13142-014-0293-9. 12. Mobile Applications | t2health. http://t2health.dcoe.mil/products/mobile-apps. Accessed May 24, 2017.

23 issue 51 | 2017

Code of Ethics, 4th Edition Evolution of the Code Aaron Block, MEd, RPsych

The dawn of a new age is upon is. The fourth edition of the Canadian Code of Ethics has arrived after several rounds of stakeholder consultation, including review by regulatory bodies across Canada and by the public. Being a self-regulated profession, psychologists have a contract with society that each psychologist places the welfare of individuals and society above and before the welfare of the profession of psychology and each practicing psychologist. Formally approved on January 30, 2017 by the Canadian Psychological Association, the Code has been updated and enhanced with several new features grouped into five core areas. As indicated in the article by Chair of the CPA Committee on Ethics, Carole Sinclair, PhD, in Psynopsis Winter 2017, the Code addresses or expands on the issues of technology, collaborative/interdisciplinary practice, diversity and globalization, definitions of distinct types of clients, and phrasing related to “imminent serious bodily harm,” as opposed to the previous “serious physical harm” phrasing. A revised ethical decisionmaking model was also provided.

More specifically, this Code makes specific statements such as: 1. The 2000 Code made no reference to technology; this Code does. For example, with telepsychology evolving as a viable modality to deliver professional services, many risks are emerging. This Code emphasizes that “The ethical principles and values also are applicable regardless of the communication modality used (e.g., spoken, written, or printed; in person, or remotely through telephone, text, audio, video, online communication or other means).” Emergency policies and procedures were highlighted by Dr. Maheu at our 2016 Annual Meeting and Professional Development Day. In minimizing harm, the Code states: II.37 Establish suitable procedures for responding to emergencies, including procedures for situations in which they are unavailable due to illness, absence, death, or technology failure. 2. Psychologists often deliver services within a strength based team environment with our allied health partners to wrap around clients to maximize benefit. Reference to collaborative/interdisciplinary practice appeared three times in the 2000 Code. Now collaboration appears 36 times, including:

www.cap.ab.ca

II.18, Strive to provide and/or obtain the best reasonably accessible service for those seeking psychological services. This may include, but is not limited to, selecting assessment tools, methods, interventions and communication modalities that are: (a) relevant and tailored to the needs, characteristics and contexts of the primary client or contract examinee; and (b) based on the best available evidence in light of those needs, characteristics and contexts. It also may include, but is not limited to: consulting or collaborating with service-providing organizations in the community, members of other disciplines, individuals and groups relevant to the culture or belief systems of those receiving or being subject to services; or advocating on behalf of a primary client when appropriate and needed. 3. Diversity and globalization are addressed by the Code, which includes the integration of the Universal Declaration of Ethical Principles 25 issue 51 | 2017

for Psychologists. The Declaration was developed to provide an ethical framework for the evolution of codes worldwide and incorporated a working group collaboration of psychologists from different continents and cultures. This is embodied in the title of the first principle, “Respect for the Dignity of Persons and People.” Not withstanding III.28, and still requiring that Principle I be upheld and that the public is protected, issues of diversity and dual roles/conflict of interest have been expanded in this Code and include: The risk level of and acceptability of other conflicts of interest (e.g., dual or multiple relationships) might be partially dependent on cultural or geographical factors and the specific type of professional relationship (e.g., long-term psychotherapy vs. organizational consultation vs. community-oriented activities). In some situations, for instance, a dual or multiple relationship might be inevitable or culturally expected (e.g., in rural, indigenous or immigrant

CAP Council approved the Fourth Edition on June 17, 2017.

communities), or could enhance the benefit of an activity. 4. A "Definition of Terms for the Purpose of this Code" section was developed and consists of "Terms related to persons and peoples" and "Other terms". A few of the terms contained in the "Terms related to persons and peoples" are “primary client,” “contract examinee” and “retaining party.” “Best available evidence” and “interdisciplinary” are two terms within the "Other terms" section. Most notable is the definition of “Ethical attitudes” which: Refers to personal dispositions and ways of thinking and feeling about ethics and ethical issues. It includes such concepts as ethical sensitivity, moral perception, and moral intent and integrity, and is reflected in what an individual or group says or does. 5. Having an ethical attitude is essential. In this Code the process of making an ethical decision when principles conflict has been revised into one section called “Ethical Decision Making.” The ongoing development of ethical sensitivity, commitment, knowledge and decision-making skills is explicit, as well as the emphasis on maintenance of such. The 10-step model remains, with emphasis on personal and cultural considerations and it ends with:

Psychologists engaged in time-consuming deliberation are encouraged and expected to consult with individuals and groups affected by the ethical problem when appropriate. In addition, they are encouraged and expected to consult with colleagues or relevant others, including advisory bodies, when such individuals or groups can add knowledge or objectivity to the decision-making process. Although the decision for action remains with the individual psychologist, the seeking and consideration of such assistance reflects an ethical approach to ethical decision making. In short, the Code reflects the current thought on ethics. The Canadian Psychological Association is revising The Companion Manual to the Canadian Code of Ethics for Psychologists and the web-based course “Being an Ethical Psychologist” to align with the fourth edition of the Canadian Code of Ethics. The College of Alberta Psychologists’ Council approved the Fourth Edition of the Canadian Code of Ethics for Psychologists on June 17, 2017. References: http://www.cpa.ca/docs/File/Psynopsis/2017/Psynopsis Winter2017.pdf http://www.cpa.ca/aboutcpa/committees/ethics/codeo fethics https://www.ucc.ie/en/media/academic/appliedpsycho logy/ethicsforms/universal_declaration_of_ethics.pdf

www.cap.ab.ca

Congratulations and welcome to the 94 new Registered Psychologists who were added to the register between December 1, 2016 and May 31, 2017:

Ellie M. Arsenault

Aimee Nicole Griffiths-Petersen

Carissa Janel Muth

Kayla Ann Balsden

Kelsey Alida Haley-Humphries

Thomas Stuart Nakonechny

Shannon B. Batten

Brittany Jean Hansen

Caroline J. Nolan

Maria Cathrine Bianco

Ashley J. Hanson

Kathleen Anne O'Connor

Angela Robyn Bishop

Laura G. Heal

Natalia Ovechkina

Morgan Marie Bissegger

Lindsey L. Helmer

Kelli N. Palfy

Carly Dana Brown

Silvia Henning

Davinder Pandher

Krista L. Bruyer

Amber Hills

Leslie Allison Pearson

Dean David Buhr

Alyson D. Howatt

Jenny J. Peetoom

Alison Byrne

Mackenzie J. Jensen

Bonny Jui-Yao Peng

Sarah Cadogan

Amy D. Johnson

Ashley Victoria Pettigrew

Hollie L. Campbell

Andrea L. Jubinville

Tory (Arthur) Pino

Tobi Lynn Ceh

Altaf Kassam

Farah Premji

Hina Chatha

Shannon Margaret Kelly

Nicole Marie Racine

Jennifer Lee Cochrane

Sandy S. Y. Lai

Kirthana Ramani

Sarah Marie Connolly

Carmen A. Lang

Christopher J. Rozell

Marcy R. D'Agostini

Stephanie Lavallee Baker

Alyssa Rebecca Ryan

Janel A. Daugela

Irene Liu

Damian Sarnecki

Amy L. Davis

Jeremy Wing-Fone Luk

Lindsay Aleta Sewall

Correne A. DeCarlo

Elisa Michelle Lutz

Chelsey Fay Stang

Dana Nicole Delorme

Katherine A. MacDonald

Jill Storcer

Julia M. Denyer

Sheri Leigh Madigan

Jillian Anna Thompson

Brittany L. Doherty

Erica M. Makarenko

Aileen Michelle Thornton

Jennifer Lynn Douglas

Marnie Lenore Makela

Kirsten Suzanne Timpany

Susan S. Eapen

Corinne Ann Mandin

Laura Michelle Turnbull

Andrea Belle Feldstain

Amy Marco

Brian T. F. Welling

Claire Michelle Fox

Jillian P. Martin

Kalyn E. Wiebe

Jessica Laine Frison

Pina Martinovich

Valerie Dawn Willan

Marcella Galizia

Loretta M. McConnell

Jessica Yott

Kaylee Corrine Garside

Sherise Delee Miller

Marley N. Young

Andrea M. Gleason

Kelley A. Mitchell

Karen Nancy Gregory

Elizabeth A. Moxley-Paquette

27 issue 51 | 2017

Examination Results and Statisitcs

Examination for Professional Practice in Psychology (EPPP)

A total of 156 candidates undertook the EPPP between December 1, 2016 and May 31, 2017. Results were:

Fail 44%

Pass 56%

Pass: 87 (56%) Fail: 69 (44%)

Fail 7%

Oral Examinations

A total of 153 candidates undertook the oral examination between December 1, 2016 and May 31, 2017. Results were: Pass: 143 (93%) Fail: 10 (7%)

Pass 93%

Professional Guidance Statistics Professional Guidance Contact Aaron Block 780-424-5070 ext. 306 a.block@cap.ab.ca

Toll-Free in AB: 1-800-659-0857

Between December 1, 2016 and May 31, 2017 the College received 185 requests for professional guidance. Informed consent and release of information continue to pose ethical decision-making challenges. The most frequently asked questions include those dealing with consent for minors and the duty to report. Regulated members are welcome to contact the College for professional guidance or regulatory issues. Complaints Statistics

Between December 1, 2016 and May 31, 2017 the College received 37 new complaints. 28

www.cap.ab.ca

Town Hall Meeting Schedule Town hall meetings are an informal

2017

way for organizational representatives

September 7

Fort MacMurray

to engage their communities

November 7

Grande Prairie

and discuss issues and plans. The College of Alberta Psychologists

2018

(CAP) and the Psychologists’

January 10

Edmonton

February 7

Calgary

April

Lethbridge/Medicine Hat

November

Red Deer

Association of Alberta (PAA) will provide updates and ask questions of attendees, who will also have an opportunity to present ideas, voice their opinions and ask questions.

2019 January

Edmonton

February

Grande Prairie

April

Fort MacMurray

Format: A brief presentation from both CAP and PAA followed by an informal Question/Answer time with light refreshments.

For more information regarding Town Hall Meetings please contact PAA at brittany@paa-ab.ca

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. Please contact us at communications@cap.ab.ca about any errors or omissions.

29 issue 51 | 2017

2100 Sun Life Place 10123 - 99 Street NW Edmonton, Alberta T5J 3H1 www.cap.ab.ca