The CAP Monitor Issue 53 by College of Alberta Psychologists

The CAP

Monitor Issue 53 | Winter 2017

Informed Consent for Psychological Services in Schools

Legislative Updates // EPPP // Habits of Ethical Psychologists // Register Updates

Whoâ&#x20AC;&#x2122;s Who Council

Supervision Consultants

President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paul Jerry President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Alderson Past-President . . . . . . . . . . . . . . . . . . . . . . . . . . . Lorraine Stewart Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Roger Gervais Members-at-Large . . . . . . . . . . . . . . . . . . . . . . . . Hanita Dagan Reagan Gale Kerry Mothersill Public Members . . . . . . . . . . . . . . . . . . . . . . . . . . Elaine Andrews Vacancy Vacancy

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

waltergoos@shaw.ca

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 Greg Schoepp 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 . . . . . . . . . . . . Danielle Salame Credentials Evaluation Coordinator . . . . . . . . . . . Kymberly Wahoff

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 Rutten

Bonnie Rude-Weisman

Receptionist/Office Assistant . . . . . . . . . . . . . . . . Renetta Geisler

403-526-8116 brudeweisman@shaw.ca

Issue 53 | Winter 2017

Contents

14 21 4 Registrarâ&#x20AC;&#x2122;s Letter

10 EPPP: What is the Evidence?

6 Call for CAP Volunteers

14 Informed Consent for

College Council in Brief

8 Legislative Updates

Psychological Services in Schools

21 Seven Habits of Highly Ethical Psychologists

23 Register Updates 24 Examination Results & Statistics

www.cap.ab.ca

Registrar’s Letter The College continues to make considerable progress in addressing Council’s 2017–2022 strategic priorities. Chief among these is engaging the profession. Over 250 members attended the September 16, 2017 Annual Meeting and Professional Development Day. This was a record-setting attendance. The Professional Development Day satisfaction survey information was largely very positive. Some members expressed a desire for a more evidence-informed keynote discussion. Overall, it was a highly successful event and I would like to recognize all Council, staff and members who contributed to making it a rewarding day. A joint conference of the College and the Psychologists’ Association of Alberta Annual (PAA) will be piloted in September 2018. It will be held in Calgary at a location yet to be determined. The theme will be evidence-based practice. Continuing with the themes of member engagement and enhancing our PAA relationship, joint town hall meetings were recently held in both Fort McMurray and Grande Prairie. The next town hall meeting is scheduled for January 10, 2018 in Edmonton. Town hall meetings are an excellent way to communicate with both CAP and PAA. CAP and PAA recently submitted independent presentations and participated in a fishbowl discussion with the Provincial Child and Family Services Intervention Panel. This Panel is responsible for reviewing the services provided to children in care. The chair of the panel is MLA Debbie Jabbour, registered provisional psychologist. Denise Woollard, registered psychologist, was present as a panel member. Ms. Woollard is the MLA for Edmonton – Mill Creek. Additional joint stakeholder meetings during this reporting period included meetings with the Assistant Deputy Minister responsible for Prescriptive Services and with Alberta Health Services Provincial Professional Practice leads. CAP has continued to meet with members of various special interest groups. This has included psychologists working in schools, hospitals and community mental health centres as well as those involved with custody and access. These events are consistent with the College’s preferred practice of proactive engagement, ensuring that members are practicing in a manner consistent with the college’s standards of practice and ethical principles. The Registrar met with external stakeholders, including a meeting with Alberta Health Services personnel, held at the request of AHS, to address the generic use of the title “mental health therapist.” AHS has expressed a renewed interest in ensuring psychologists

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can work under the appropriate professional title. Meetings were also held with the Rehabilitation External Stakeholder Committee as well as the Community Health Information Stewardship Committee. The latter is one of several government committees dedicated to the issue of electronic health records. The province has expressed a strong commitment to moving forward with both digitization and sharing of information for treatment/research purposes. The College recently presented its 2017–2022 Communications Plan to Council. All feedback received was incorporated before final approval. The Communication Plan arose from the strategic priority of member engagement. The Registration Review Recommendation Implementation (RRRI) SubCommittee has been hard at work. The first concrete work products include the draft Terms of Reference, the revised (draft) Supervision Manual and the review of literature regarding EPPP pass rates (see the article by Dr. Troy Janzen in this edition of The Cap Monitor). The RRRI Sub-Committee has also drafted a letter to begin an engagement process with academic institutions. The sub-committee believes institutions will be very much in favour of streamlining their programs to meet the College’s academic criteria. The possibility of entering into memorandums of agreement with Alberta institutions has been proposed. This will lead to greater clarity and assurances that prospective CAP applicants will meet the academic criteria for admission to the College. The RRRI Sub-Committee will also be addressing the proposed changes to the EPPP, with the anticipated 2020 introduction of a skills component. This will include the possibility of undertaking Part 1 of the EPPP earlier in an applicant’s program. Additional information on Part 2 of the EPPP can be obtained from the Association of State and Provincial Psychology Board (ASPPB) website. The College has made excellent progress on the recommendations of the August 1, 2017 Audit Findings Report. Several financial policies have been updated or developed. A cyber-security review will be conducted in the upcoming weeks to ensure member and organizational information will be protected in the event of a hack or attack. All of the 2017 Audit recommendations have now been addressed and/or are in the process of implementation. Overall, the College continues to make significant strides toward becoming a more sophisticated, transparent and open organization. Council has also continued to demonstrate a strong commitment to organizational enhancements, with the end goal of being a model regulator both to our members and the public. This is evident in their desire for real and sustainable modernization of all College processes and activities.

Richard J. Spelliscy, PhD, RPsych Registrar & CEO www.cap.ab.ca

Call for CAP Volunteers Credentials Evaluation Sub-Committee (CESC) This is an excellent professional development opportunity and more: you will gain familiarity with College processes and staff, contribute to the profession, meet other psychologists, and will therefore embrace the profession in a more encompassing manner. Also, volunteer work will be an accepted Continuing Competence Program activity when the program becomes mandatory. Please contact Kymberly Wahoff, Credentials Evaluation Coordinator, by email here or by phone at (780) 424-5070, ext. 307, if you are interested in serving on the committee. All CESC applications must be received by January 26, 2018. About the Credentials Evaluation Sub-Committee (CESC) As established in legislation and regulation, the CESC reviews applications for the evaluation of academic credentials from accredited institutions.

The CESC determines whether the applicant meets core and substantive content areas and possesses the required number of credits as established in legislation and regulation. Foreign applicants are required to provide an assessment of their academic credentials from International Qualifications Assessment Services (IQAS) to assist the CESC in its evaluation. The CESC also reviews and approves doctoral credentials. The CESC meets once per year as a full committee, and in smaller panels generally six times per year. Committee members are asked to attend the full committee meeting and three out of six panel meetings per year. Meetings are generally scheduled to last four hours. However, their length may vary depending on the number of files reviewed. As required by the HPA, the CESC provides its decision results in writing.

Oral Examinations Committee The College is also looking for examiners to be part of the Oral Examinations Committee. To volunteer or for more information please email Danielle Salame, Oral Examinations Coordinator here or call her at (780) 424-5070, ext. 312. About the Oral Examinations Committee The Oral Examinations Committee is responsible for conducting oral examinations of applicants for registration as psychologists, to assess whether the applicant demonstrates a minimum

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standard of knowledge and judgment in matters of jurisprudence and ethics. Oral examinations are scheduled to last approximately 90 minutes. Panels of three examiners conduct the exams, using standardized interview questions. The examinations are held four times per year, over the course of two to three weeks, generally in January, April, June and October. As required by the HPA, the Oral Examinations Committee provides its decision results in writing. All Oral Exam Committee applications must be received by January 22, 2018.

College Council in Brief INDIGENOUS TASK FORCE PRACTICE PERMIT RENEWALS Online Practice Permit renewals begin on February 1, 2018. All fee payments must be received by the College by 4:00 PM on March 30, 2018. There is a late fee of $100.00 (if received after the deadline). All notices with respect to fees are communicated electronically. Regulated members are encouraged to ensure that their email address with the College is current. Maintaining a current email address is a regulatory requirement.

Practice Permit fees for 20182019 will increase by $25.00 for Registered Psychologists and $12.50 for Registered Provisional Psychologists. This is an increase of approximately 3.5%. This is the first increase in 3 years. College fees are comparable to other jurisdictions across Canada. There are many reasons for the fee increase. Chief among these is that the College must remain financially viable to maintain selfregulation status. College Council has also recently engaged an ambitious fiveyear strategic plan and a communication and engagement plan. The former includes implementation of the Registration Review Recommendations. This will lead to the first major enhancements to the registration process in over two decades. Both plans will also require additional investment in technology to further the College’s goal of becoming a paperless environment.

CAP President Paul Jerry’s suggestion that a task force be established to examine opportunities to honour the Truth and Reconciliation Commission of Canada recommendations received unanimous support at the November 25, 2017 Council meeting. As a first step the College is seeking participation from regulated members who identify themselves as indigenous to begin this journey. This committee will also examine efforts being undertaken by the Canadian Psychological Association which are currently underway. Interested indigenous regulated members are encouraged to submit their names to the College by January 15, 2018.

PARENTAL LEAVE POLICY CAP Council at the Registrar’s request recently approved a policy that addresses practice permit fees for those regulated members who are on parental leave. This policy recognizes the financial hardship parental leave may place on some members. Notwithstanding, it is a regulatory requirement that any member on an active register must maintain professional liability insurance. Please contact the College if you have questions.

CHILD CARE EXPENSES College Council recently approved the Costs and Expenses -Remuneration Policy at their September 15, 2017 meeting. This policy provides for cost reimbursement for those members who incur child care costs while performing their duties as members of Council. The College is committed to promoting diversity and inclusion at all levels. Member feedback in achieving this objective is welcome. www.cap.ab.ca

Legislative Updates By Deena M. Martin, PhD (Special Ed), RPsych Director of Professional Guidance From the recent passing of Bill 24 and the School Act (Passed November 15th, 2017) to the New Employment Standards Codes (rolling out January 1, 2018), Alberta law-makers have been busy. The College of Alberta Psychologists has made efforts to ensure psychologists have resources to help them navigate the changing landscape of federal and provincial legislation.

While College resources are updated regularly, at times the College may not have had the opportunity to integrate new legislation into existing documents. This does not absolve psychologists of engaging in competent, skillful and thoughtful practice. In novel and/or complex situations, as self-regulated professionals, psychologists are expected to further their knowledge by consulting supervisors, colleagues, the College, practice advisors through the Psychological Association of Alberta and/or legal support (through their employer and/or insurer). To be explicit, context, consultation and judgment are essential to successfully navigating the decision-making model of the Canadian Code of Ethics for Psychologists and our professional obligations.

The College provides guidance and information on ethical and professional issues facing psychologists in their work. Professionally, our Standards of Practice, guidelines, policies and practices define our psychological practice. Legislation such as the Canadian Human Rights Act, the Health Professions Act, the Age of Majority Act, the Freedom of Privacy and Protection Act, etc., also governs what we do. To support psychologists in their practice, the College regularly updates the document Jurisprudence: Legislation Naming or Affecting Psychologists in Alberta. The latest revision was updated to the website in November 2017. Psychologists are encouraged to take the time to ensure the currency of their legislative knowledge and its influence on their professional practices.

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Furthermore, documentation and evaluation of carefully reasoned analyses are also considered critical steps that foster accountability and transparency in complex situations where someoneâ&#x20AC;&#x2122;s rights or well-being are at stake. Lastly, the context in which a psychologist provides services is important. In their day-to-day practice, psychologists may offer clinical support, engage in the professional activity of formal assessment, provide education and training, engage in research and/or contribute to policy development. Additionally, they may participate on boards, committees and/or multidisciplinary teams. It is essential that psychologists remain updated on the scientific research governing their clinical practice and apply current legislation across the multiple roles they may hold (e.g., supervisor, business owner, etc.) when carrying out their professional responsibilities.

Congratulations! The College would like to congratulate the following four psychologists on being chosen for Avenue magazine’s “Top 40 Under 40” for 2017 in Edmonton and Calgary:

Fiona Schulte

Melanie Noel

For changing and advancing international guidelines for long-term follow-up for pediatric cancer patients.

For changing the understanding and treatment of the psychological aspects of childhood pain.

Jill Green

Brea Malacad

For engaging young people to work against sexual violence on university campuses.

For establishing a program to address potentially violent incidents in academic settings.

www.cap.ab.ca

EPPP: What is the Evidence? By Troy Janzen, PhD, RPsych CAP Deputy Registrar and Complaints Director For this review I want to focus on three primary questions I think are relevant to College of Alberta Psychologists (CAP). 1. What does the Examination for the Professional Practice in Psychology (EPPP) validly measure? 2. What accounts for a worse pass/fail rate on the EPPP licensure exam in Alberta? 3. Does the EPPP play a role in the protection of the public?

What does the EPPP validly measure? In the case of test validity; criterion, construct, predictive, and face validity are all key concepts. The main concerns that have been expressed by some in the literature about the EPPP has been related to the test validity of this exam. The EPPP publishes considerable information about the exam construction and validation, which has primarily used a content validation approach. The Association of State and Provincial Psychology Boards (ASPPB) notes that this approach is considered appropriate based on the American Education Research Association’s (AERA’s) published standards for educational and psychological testing (AERA, 2014). Critics have expressed that some form of criterion or predictive validity would be important to establish for this measure (Sharpless & Barber, 2013). To date, little information is available as to whether the EPPP has any criterion or predictive validity and disagreement exists about the appropriateness of this form of validity for this measure. Generally, evidence exists that the EPPP does reflect content knowledge in psychology broadly speaking. See http://www.asppb.net/?page=ValidityStudies for more

What accounts for pass/fail rate on the EPPP licensure exam in Alberta? The EPPP pass rate in issue 52 of The CAP Monitor (Spring/Summer 2017) was published as 56%. In contrast, the pass rate published by ASPBB in one publication (Demers, 2009) was 73.7%. What

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accounts for the low pass rate in Alberta? The literature suggests that pass rates for accredited doctoral programs is typically quite high and usually above 90%. In fact, recently published rates (ASPPB, 2017) for all Canadianaccredited doctoral programs averaged 92.7%. In Alberta, graduates from the three doctoralaccredited programs had an 83.6% pass rate. Generally speaking, PhD>PsyD>EdD>Masters in terms of pass rates (Sharpless & Barber, 2013). However, the most recent technical report showed PhD>PsyD>Masters>EdD (ASPPB technical report, 2017). The pass rate data for repeat candidates who take the EPPP are quite low with 39.8% of PhD students and 36.2% of Masters students who had a previous attempt at the EPPP passing last year. Sharpless & Barber (2009, 2013) note that the best predictors for passing the EPPP include: • •

•

high GRE scores attending programs with low admission rates (i.e. highly sought after programs with few students admitted), and coming from a high ranking institution with a high research focus and having a high internship match rate.

One negative that correlates with EPPP pass rates includes percentage of minorities in a program. Schaffer et al (2012) note that study time and time elapsed from graduation are also important and significant predictors of EPPP pass rates. Interestingly, these same authors found that method of study added little to the prediction of pass rates. Demers (2009) notes that the EPPP was not intended to assess competence in psychology but to assess core knowledge and that this is just one

of a number of ways that regulatory bodies assess the minimum competence of psychologists prior to licensure. One statistic provided by Demers is that first-time test takers with a Master’s degree have a 56.9% pass rate while those with a PhD are 89.2%. He also notes that score rates improve when candidates report greater number of hours spent in studying or preparation. However, Schaffer et al (2012) note that studying more has limits. Based on their analysis, Schaffer et al (2012) suggest that 200 hours is optimal,and that studying more than 200 hours results in a diminishing return on pass rates. However, they also did not include Master’slevel students in their analysis. In conclusion, it appears that the EPPP tends to reflect content knowledge in psychology and is highly correlated with educational attainment and hours spent in preparation. In Alberta, with the ability to license at the Master’s level there may be a systematic bias towards lower pass rates, given the lower levels of educational attainment among our members compared to the levels of those represented in the published EPPP data.

Demers (2009). Our members who come from accredited doctoral programs in Alberta have consistently higher pass rates on the EPPP, which also correlates with Demers’ reported statistics. I was unable to access pass rate data or number of hours spent in preparation of non-accredited doctoral students.

Does the EPPP play a role in the protection of the public? The “EPPP Myths versus Reality” section of the ASPPB website (found under the Training Directors tab, EPPP Exam) states, “The EPPP is designed only to protect the public from those who do not have sufficient basic knowledge about psychology to be licensed.” However, the ASPPB also notes that it is impossible to test predictions of future performance with the EPPP given that those who fail are not able to become licensed practitioners. Sharpless and Barber (2013, p.211) state “…there is no evidence to date that those who successfully pass (or score higher on) the EPPP are objectively better, more competent, or less dangerous to the public than those who do not.” (DeMers,2009, p. 351) responding to an earlier paper by these same authors, states, “Correlating EPPP performance with discipline records assumes that most cases of unprofessional or unethical conduct are the result of lack of knowledge rather than lapses of judgement, character problems, and human frailties that typically explain professional misconduct.” Overall, it remains unclear whether the EPPP plays a significant public protection role, as no evidence is available either way. I think the logical argument that having sufficient base knowledge is somewhat of a protective factor for a psychologist is sound enough but no data exists to support this argument.

Recommendations

Thus, our pass rates are consistent with the pass rates for Master’s-educated students as cited by

We advise provisional members with a Master’slevel training who have yet to write the EPPP to have a study plan that includes considerable study time to improve their likelihood of passing. Likely, a greater than average amount of study time is required of Master’s level test takers to improve their chance of passing.

www.cap.ab.ca

PASS THE EPPP Top 5 Tips for Passing in Alberta

TAKE THE TEST SOON AFTER GRAD STUDIES Researchers have shown that the longer you wait to take the EPPP after graduating, the lower your likelihood of passing.

TAKE PRACTICE TESTS Practice tests are available from many sources, including paid-for sites. Make use of these practice tests as often as possible. Take them in simulated, “exam-like” ways to help reduce anxiety. Some sites that provide practice exams include: AATBS, Academic Review, PsychPrep and The Taylor Study Method.

SET ASIDE ENOUGH TIME TO STUDY Research has shown that the more you study, the better your chances of passing… up to a point. Shaffer et al (2012) found that studying in excess of 200 hours results in diminishing returns on pass rate. If you have a Master’s level of education, be aware that you may require additional study time.

PRIORITIZE STUDY TIME The EPPP assesses knowledge across eight content areas. If you should happen to fail the EPPP, don’t despair! Those who do not pass are provided with a bar graph that provides information on how you did across each of the domains on the test. Use this information to prioritize your study for the next attempt.

5 12

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2 4

MANAGE YOUR TEST-TAKING ANXIETY Practice mindfulness and deep breathing, and use your already-known skills to reduce anxiety while taking practice exams.

Check In... CAP Meetings and Exam Dates

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.

Do we have your current information? Please notify the College of 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 any assistance please contact the College at psych@cap.ab.ca.

F E E D B A C K

We want to hear from you! Let us know what you thought of this issue in this short feedback survey: https://www.surveymonkey.com/r/MonitorIssue53

www.cap.ab.ca

Issue 53 | Winter 2017

Informed Consent for Psychological Services in Schools Some points of clarification By Troy Janzen, PhD, RPsych, CAP Deputy Registrar and Complaints Director

www.cap.ab.ca

Recently, Jeff Mah published an article in Psymposium (2017) titled, “Informed consent for minors: Not needed if you work in schools.” In this article, he outlines the tensions surrounding the issue of informed consent faced by psychologists working in schools. Specifically, the article notes the tensions created for psychologists employed by school districts in terms of provision of indirect services, such as being part of multidisciplinary school teams or gathering information for file reviews or resource team meetings, and whether those types of indirect services require informed consent from a parent. This tension is between the expectations placed on school psychologists for accessible services in schools and the obligations for informed consent for services mandated in our Canadian Code of Ethics (2003) and the College of Alberta Psychologists Standards of Practice (2013). It should be noted that the Psymposium article follows a 2015 practice guide published jointly by the Calgary Board of Education, the Calgary Catholic School District, the Golden Hills School Division and Rocky View Schools, entitled “Informed consent for minors: What does it mean for the work of school psychologists.” (Johnston et al, 2015). This latter article can be found online here. In both articles, the authors point to recent legislation such as the Children First Act (CFA, 2013) and the Freedom of Information and Privacy Protection Act (FOIPP, 2000) which apply to those working in public sector environments such as schools. These Acts state that a service provider may allow the collection and disclosure of personal information when “in the best interests of the child.” The CFA specifically states: •

•

• •

4(1) For the purposes of enabling or planning for the provision of services or benefits to a child, a service provider may collect and use either or both of the following: (a) personal information about the child or a parent or guardian of the child from another service provider; (b) health information about the child from a custodian. (2) For the purposes of enabling or planning for the provision of services or benefits to a

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•

child, (a) a service provider may disclose to another service provider personal information about the child or a parent or guardian of the child, and (b) a custodian may disclose to another custodian or to a service provider health information about the child if, in the opinion of the service provider or custodian making the disclosure, the disclosure is in the best interests of the child. (Bold mine)

This seeming permission to disclose confidential information to other service providers without informed consent stands in contrast to our Canadian Code of Ethics for Psychologists – Third Edition (2000) and particularly principle I.45 which states, I.45 Share confidential information with others only with the informed consent of those involved, or in a manner that the persons involved cannot be identified, except as required or justified by law, or in circumstances of actual or possible serious physical harm or death. (Also see Principles II.39, IV.17, and IV.18.) In the following article, I will seek to address and clarify several issues raised about disclosing confidential information. These questions include: 1. How do we define a “psychological service” that requires informed consent in schools? 2. Does recent legislation like CFA and FOIPP take precedent over the code of ethics or standards of practice for psychologists? 3. What exceptions already exist to providing psychological services without informed consent? 4. What standards of practice and codes of ethics are most applicable to the discussion?

What is a psychological service that requires informed consent in a school setting? This key question must be answered to address the issue of informed consent. Psychological practice is defined under the Health Professions Act (HPA) (RSA, 2000) as: • •

3 In their practice, psychologists do one or more of the following: (a) assess, diagnose, treat, guide and support

•

(b) (c)

persons or groups of persons in order to enhance development, effective living and quality of life or to prevent, remedy or ameliorate mental, emotional, cognitive, behavioural and interpersonal difficulties; teach, supervise or consult in the practice of psychology; (b.1) manage and conduct research in the science, techniques and practice of psychology; provide restricted activities authorized by the regulations.

Further the HPA also defines our profession as self-regulated, which permits us to determine our code of ethics and standards of practice. It is important to note that neither the CFA, FOIPP, nor the HPA can be interpreted in isolation. Within our Code of Ethics (2000) it clearly outlines that the responsibility of the psychologist is “To adhere to the Association’s Code in all current activities as a psychologist.” Secondly, the HPA indicates that regulated health professions must establish the standards of practice that govern the profession. As such, psychologists have added obligations to that in legislation which is a defining characteristic of any self-regulated profession who has the client’s and public interest at heart.

Information Gathering Both Mah’s article and the 2015 practice guide argue that “information gathering”, when done as a school employee falls under FOIPP and CFA, and that a psychologist would be allowed to collect and share information about a named student when such actions are necessary for the psychologist to perform their duties. The article states, “School psychologists gather information on individual, named students during their roles on multi-disciplinary teams and in their service to schools. This service of information gathering on individual student as a member of a school/student learning team, referral, placement, file reviews, medical/psychological/ and other professional documentation review are not in themselves a psychological service, are permitted under FOIP and CFA and do not require informed consent.” (pp. 6-7). The College is of the view that information gathering may still be considered an important aspect of a professional psychological service. First, our Code does have

a specific statement about collecting and seeking information and it assumes that consent has been obtained as per the Code. Principle I.37 states, I.37 Seek and collect only information that is germane to the purpose(s) for which consent has been obtained. (bold mine) Arguably, information gathering as part of a multidisciplinary team still represents a psychological service or least is an “activity of a psychologist” and thus remains under obligation to adhere to the Code of Ethics and standards of practice. This means that school psychologists may still require informed consent in the activities they describe above. Another indicator is in our own College of Alberta Psychologists Standards of Practice (2013). Specifically, the standards that speak to this issue are 12.16 and 15.1 through 15.5. These standards state, •

12.16 When rendering a professional service as part of a team or when interacting with other professionals concerning the welfare of a client, the psychologist shall inform the client that personal information about the client may be shared, and obtain the client’s consent before sharing information.

•

12.1 Collaborative practice refers to practice in which healthcare professionals work cooperatively to provide client-centered care, often in multidisciplinary, interprofessional or team practice. When a psychologist works in collaboration with other healthcare providers in caring for a client or a group of clients, a psychologist shall: 15.1.1 explain the psychologist’s scope of practice, role and responsibilities to the client and the other healthcare providers; 15.1.2 understand the scope of practice and roles of the other healthcare providers; 15.1.3 clarify issues related to responsibility and accountability; 15.1.4 communicate positively and effectively with the other

www.cap.ab.ca

healthcare providers; 15.1.5 treat all healthcare providers with courtesy and respect; 15.1.6 provide services focused on the values and needs of the client; and 15.1.7 ensure that the psychologist’s contribution to the client’s care when working in a team setting is documented. While these standards are more targeted toward psychologists in health settings, psychologists are regulated healthcare professionals regardless of the setting in which they work. Thus, the above standards apply to psychologists in school settings and clearly indicate that consent should still be obtained for information sharing among a team for planning/providing services for a client. The argument by Mah (2017) that information gathering for placement decisions is not psychological services is problematic in that the public would not be able to make such a distinction. Concerns and complaints do come to the College from parents who indicate that a psychologist influenced a key decision about placement, even though they were part of a team. This has occurred even when the psychologist had little or no direct student contact. The question may arise, why would we not seek consent? Often the issue brought forward to the College is not that the psychologist was involved, but rather why were the parents not informed. Furthermore, the likelihood of advice being effective is arguably reduced when parents or guardians do not see themselves as full partners in decision making.

May disclose….in the best Interests of a child Even if CFA legislation is viewed as taking precedence over the Code and standards, it is important to consider two key phrases in section 4, namely “may disclose” and “in the best interests of the child.” First, the word “may” is not mandatory as in you shall or must. Rather, the word “may” indicates one has an option to consider sharing information, but only when it meets the burden of deciding that it is

Issue 53 | Winter 2017

in the “best interests of the child.” The important questions here are, “Who decides the child’s best interests?” and “What is required to determine a child’s best interests?” Professional judgement is a key aspect of such a decision. A good discussion paper on this topic can be found here. While a clear and commonly accepted definition of what is meant by “the best interests of a child” is not available, it is clear that a child’s best interests must be at the centre of decisions made about a child and should be determined outside of the interests of other adults, organizations (including schools), government, and even (arguably) the child’s parents. It is also clear that, while best interests may be determined outside of the interests of other adults and parents, the views of key adults should still be solicited and considered in making a decision. These points are illustrated in a recent Supreme Court of Canada decision (Eaton decision) and is outlined by Rasmussen in an online article found here.

Rasmussen states: In Eaton, the parents of a child with cerebral palsy were upset with the school’s decision to place their child in a special education class, rather than in a regular class. They argued that the school’s decision was discriminatory under s. 15 of the Charter. The Court held that this decision was not discriminatory and, in so doing, rejected the argument that there is a presumption in favour of placing a child in an integrated classroom that can be displaced by parental consent. The Court said that what is in the best interests of the child is determined on the basis of the individual facts and circumstances of each case; there are no presumptions. So, just as the best interests of the child are not necessarily determined by parental consent, nor are the best interests of the child determined by what the school board may think is appropriate. There is no presumption either way. All of the facts and circumstances of each case must be taken into account in order to decide what is in the best interests of this child. For more insight on the best Interests of the child can be found within the Family Law Act (FLA, 2003), the FLA has an entire section that outlines a considerable burden of criteria that the courts require in order to establish the best interests of a child in a family law context. What is clear in looking at these criteria is that a substantial amount of contact and information gathering would be required in order to meet the criteria within the Act. The Act requires the courts to consider protective factors, needs of the child, their history, external factors such as culture, language and religion,

the child’s perspective, the parent’s/guardian’s perspective, and other contextual factors. A psychologist, who argues that they correctly shared confidential client (child) information with another service provider in the school without consent because they felt it was in the child’s best interests would have to show how they made such a determination. This determination can’t simply be “it is my opinion” but must point to objective criteria and weight of considerable information. Such a decision should also be made only after considering why consent was not obtained and/ or what efforts were made to secure consent. All of these decisions should be recorded in the student’s clinical file.

What exceptions already exist to providing psychological services without informed consent? It is also important to consider the fact that our Code and standards have already specified the circumstances under which a psychologist may disclose private information about a client to a third party. Namely, the College of Alberta Psychologists Standards of Practice (2013) state Disclosing Without Informed Written Consent 12.4 A psychologist may disclose confidential information about a client without the informed written consent of the client when the psychologist has reasonable and probable grounds to believe that disclosure is necessary to prevent immediate and grave harm to: 12.4.1 the client; 12.4.2 another person’s mental or physical health or safety; 12.4.3 public safety. 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.

12.6

A psychologist disclosing confidential information pursuant to section 12.4 and 12.5 shall limit disclosure to persons who reasonably need to know and to the extent necessary in the circumstances.

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These standards allow for possible disclosure of confidential client information when a psychologist expects grave and immediate harm to the student or others. Here we see similar language as is used in the CFA where a psychologist “may” disclose rather than “must” disclose, in situations where they suspect grave and immediate harm to their client or others. When a psychologist does make an ethical decision to break confidence to prevent harm, there must still be a burden of proof and documentation that they followed a carefully considered, ethical decision-making process in making the reasoned decision to break confidence. It could be that the same is required when determining the best interests of a child as a reason to disclose to other professionals. Possible counterarguments and protests to the above Argument: “You will tie my hands in situations where I am just doing general consultation.” Response: No, we agree with Mah (2015) and Johnston et al (2015) that consultation about an unnamed child or children (i.e., a general consultation) does not necessarily require informed consent if it involves broad psychological principles or generic information that is nonspecific to a particular individual. The previously mentioned 2015 guide is generally useful in this regard. Argument: “My employer demands that indirect services be provided without consent and points to FOIPP and CFA for justification. If I go against my employer’s demand and insist on informed consent, do I make myself useless to the school and jeopardize my employment?’ Response: This is the tension of the dilemma facing psychologists who work in employment settings where it may or may not be understood that all self-regulated professionals are bound by an ethical code and standards of practice. It is a responsibility of all psychologists to help employers to become aware of the importance and rationale behind our professional responsibilities. This is particularly true where being helpful in the immediate situation may have more profound legal, professional and interpersonal complications.

Issue 53 | Winter 2017

Generally, employers wish to respect the rights and obligations of all involved. The FOIPP article produced by the Government of Alberta could also be helpful here to educate school personnel that exceptions exist for regulated health professionals in school and the provision of services. Argument: “What if the student is a teen? Can’t they provide their own consent for my services?” Response: The answer to this question is provided by the CAP’s Practice Alert: Informed Consent for Minors. Argument: “I provide specific group-based workshops and other learning sessions on topics like exam stress, anxiety, and the like in my school. Do I need informed consent from parents for kids to attend these activities?” Response: Extracurricular activities that are purely informational may need to be distinguished from group activities that may include aspects of intervention. That is, if a workshop includes children who are required to do experiential/ therapeutic exercises, consent of parents would be required. The proposed GSA Bill 24 in Alberta may pose significant restrictions on informing parents of their child’s participation in some groups. Overall, psychologists are required to remain current in all legislation relevant to their practice. Psychologists may go to the College website for jurisprudence information.

Seven Habits of Highly Ethical Psychologists By Derek Truscott, PhD, RPsych, University of Alberta Having spent the past 30-plus years of my life studying ethics, I have come to appreciate a few truths. The most important is that ethical knowledge has little impact on our ethical behaviour. My favorite example, because it hits so close to home, is how ethics professors are no more ethical than other professors. We are no more likely return overdue library books, give to charity or be nice to our mothers by staying in contact ( just ask mine). However, ethical knowledge does have an important impact on the behaviour of professionals as a group. Over time, professional standards and expectations are refined, improved and raised such that the average psychologist today is more ethical than in the past. But as individuals, our greatest ethical imperative is not learning more rules or divining the intricacies of legal decisions. It is abiding by what we already know about ethics and law. Our tendency to do the wrong thing is rarely the result of ignorance of the right thing to do. It is typically the result of either:

(a) not thinking about right or wrong in situations where we should be thinking about them, (b) a lack of fortitude to do what we know is the right thing, or (c) wanting very much to do the wrong thing despite knowing that we should not.

By all means, do keep up-to-date on professional standards and ethics. This is an invitation to update the ways you go about being ethical. The term ethic actually comes from the Greek ethos, meaning habit. And this is an excellent place to focus our energies. In fact, we can think of our ethical practice as the sum total of our habits. Good habits orient us to the ethical aspects of our practice, free up cognitive resources that would otherwise be devoted to making repetitive decisions and save our cognitive resources for when we really need them.

We all know that establishing a habit is difficult (think abandoned New Year’s resolutions). We also know that maintaining an established habit is easy (think daily dental care). If we establish good ethical habits we are therefore more likely to do the right thing even if we are not paying particular attention or not particularly inclined to do so. Habits become established when precise behaviours are motivated by deeply held values and performed at regular times every day for two months to a year (depending on the complexity of the behaviour). So, find your “why” for starting a new habit, and make a plan to do it regularly until it becomes, well, habitual. Based on a review of situations where psychologists are more likely to do the wrong thing, I have identified seven aspects of our practice where good habits can help us do the right thing: Connection, Consent, Competence, Confidentiality, Care of Self, Community and Conscientiousness.

1. Take as much time as I need to connect with every client Most complaints arise at the outset of the relationship by clients who are hurt and angry. Professionals who have had multiple complaints tend to spend less time with clients, express less concern for their clients, show less interest in their clients’ opinions and be interpersonally dominant in the first session. It doesn’t take too much imagination to see how these are related and how we can avoid complaints by connecting with new clients more fully and genuinely.

2. Treat consent as an ongoing process of collaboration Most psychologists spend less time obtaining consent than they know they should. This error is compounded by the fact that people retain very little of information presented while they are emotionally aroused, which is pretty typical of the circumstances under which we provide services.

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Additionally, many complaint investigations find the psychologist’s consent process was insufficient. A more helpful approach to obtaining consent is to think of it as a process of collaboration—keeping in mind that we are expected to document our ongoing discussions with clients regarding their consent.

3. Keep trying to get just a little bit better No one likes to hear that experience is uncorrelated with competence. But it isn’t. This tendency is enabled because we are poor judges of our competence. The average psychologist thinks they are above average, 90% think they are in the top 25% and nobody seems to think they are below average. The truth is, over time some of us get better, most get ever so slightly worse and some get a lot worse. The only way to stay on the good side of this curve is by continually striving to enhance our competence.

4. Protect my clients’ confidences as if my life (or at least my career) depends on It Clients place trust above all other ethical values when seeking help from professionals—especially psychologists. Yet, whether and when to break confidentiality is the number one concern for psychologists worldwide. It seems that we forget or perhaps take for granted how important confidentiality is. We seem to focus instead on those rare instances where we are permitted by law and our code of ethics to break it. In fact, we are much, much more likely to get in trouble for breaking confidentiality than for failing to do so.

6. Keep the good people in my life close Psychologists who get in ethical trouble are more likely to be isolated than those who do not. In fact, the strongest influence on our ethical intuitions is the people with whom we associate. (Might it be that ethical intuitions wither in the absence of companionship?) Plus, if we make our values known to others, we are more likely to live by them. All of these factors point us toward the importance of establishing a close group of supportive, ethical colleagues in our life.

7. Strive to have my practice reflect my core values Willpower is like a muscle—the more ethical we are in one area of our life, the more we are able to be ethical in another. The biggest hurdle for most of us is that humans tend to slouch toward automaticity, thereby increasing our risk of doing the wrong thing in novel or complex situations, and when we are rushed, distracted or under pressure. Thus, if you want to do the right thing, you have to continuously work against automaticity by conscientiously trying to do the best thing. Doing so is aided and abetted by having a clear and vivid appreciation of our core values.

AGM 2018

5. Dedicate regular (ideally daily) time to taking care of myself Deciding to do, and doing, the right thing takes energy, which gets depleted but is renewable. When we feel overwhelmed or low on personal energy, we are more likely to take shortcuts in our professional activities, increasing our risk of doing the wrong thing. Thus, our practice is a product of our personal functioning. And if we are not at our best, neither will our practice be, increasing our risk of doing the wrong thing. Ergo, taking care of ourselves helps us to be ethical.

Issue 53 | Winter 2017

The Annual Meeting and Professional Development Day for 2018 will be held in Calgary jointly with PAA. Information will be sent out in the new year closer to the date.

Register Updates Updates for June 1, 2017 - November 15, 2017 Congratulations and welcome to the 85 new Registered Psychologists who were added to the register: Marina Agafonov Felicia Anderson Andrea C. Andrews Jillian M. Aucoin Shristi Shivani Bali Sara M. Bawol Jeannine Krysta Beck Zachary J. Berg Shadi Beshai June E. Birch Lindsay Miranda Booker Candace Brooke Brown Marcia Lynne Buhler Erin Elizabeth Buhr Brandy Lee Callahan Jenny Carstens Damien Cormier Jennifer Jewel Daines Helena Satu Neelam Dayal Alexandra Dewan Danielle Droucker Hanna A. Duffy Rachel Dawn Dundas Heather L. Dyck Michael R. Edwards Natasha A. Egeli Kara Anne Eissfeldt Julien Charles Elia Meaghan Farquharson Meghann Fior Nicola Evelyn Fortin Cindy Lou Gaetz Raymond James Gibbons Mary M. Giffen Valerie Grenier Janet Lynn Groom Laurie Kathleen Hamer Kathleen Elizabeth Harper Rupinder Kaur Hehar Pamela June Hillaby Neil Robert Hogan Simren Jhuty Rachel A. Jose

Amanda Marie Jubb Megan Maria Just-Mancini Hala Wassim Kaiss Jennifer Georgette Kees Kathleen Elizabeth Kelava Lindsay Jean Kennedy Melanie D. Khu Sharon D. Kroeker Jessica Lebovic Kristin J. LeCoure Ivana Lizdek Linda Mah John-David Henry Malta Alicia Carissa Marchini Nicole Kristen Martin Craig William Martynuck Patrick Turner McFarland Lindsay L. McLachlan Kathryn Ann McMaster Amanda M. Medland Brittany Mae Meredith Tanya Elaine Mudry Judith A. Naylor Melanie Elizabeth Noel Samuel Arthur Platts Vickie Jessica Plourde Victoria Else Richards Adriana C. Rodriguez Valencia Cheryl Lynne Roffe Renee Jody Schmidt Paloma Barros Scott Phillip Robert Sevigny Hillary A. Sharpe Nadia M. Sokoloski Michael J. Sornberger Andrea M. Stelnicki Anna E. Stenton Amy Van Deurzen Melanie Lynn Vassell Kimberly J. Walters Carly Jennifer Warren Kristyn N. Wright

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Examination Results & Statistics Examination for Professional Practice in Psychology (EPPP) A total of 133 candidates undertook the EPPP between June 1 and November 15, 2017. Results were:

Pass: 64 (48%)

Fail

Pass

52%

48%

Fail: 69 (52%)

Fail

Oral Examinations A total of 51 candidates undertook the oral exam between June 1 and November 15, 2017. Results were:

Pass 94%

Pass: 48 (94%)

Fail: 3 (6%)

Professional Guidance Statistics Between June 1 and November 15, 2017 the College received 234 requests for professional guidance. The most frequently asked questions included those dealing with consent and maintenance and retention of records. Regulated members are welcome to contact the College for professional guidance or regulatory issues here.

Discipline Statistics Between June 1 and November 15, 2017 the College received 12 new complaints. The most common allegations received were: competence, informed consent and bias related. Correction: It was reported in issue 51 that the number of new complaints for the period of December 1, 2016 and May 31, 2017 was 37. The correct number was 21.

Issue 53 | Winter 2017

References Page 10-11

EPPP: What is the Evidence? By Troy Janzen, CAP Deputy Registrar and Complaints Director DeMers, S. T. (2009). Understanding the purpose, strengths, and limitations of the EPPP: A response to Sharpless and Barber. Professional Psychology: Research and Practice, 40(4), 348-353. Schaffer, J. B., Rodolfa, E., Owen, J., Lipkins, R., Webb, C., & Horn, J. (2012). The Examination for Professional Practice in Psychology: New data–practical implications. Training and Education in Professional Psychology, 6(1), 1-7. http:// dx.doi.org/10.1037/a0026823 Sharpless, B. A., & Barber, J. P. (2009). The Examination for Professional Practice in Psychology (EPPP) in the era of evidence-based practice. Professional Psychology: Research and Practice, 40(4), 333-340. Sharpless, B.A. & Barber, J.P. (2013). Predictors of program performance on the Examination for Professional Practice in Psychology (EPPP). Professional Psychology: Research and Practice, Vol 44(4), Aug 2013, 208-217. ASPPB (2017) Downloads https://c.ymcdn.com/sites/ppb-temp.site-ym.com/resource/resmgr/eppp_/Annual_Exam_ Technical_Report.pdf 2014 AERA Standards on Educational and Psychological Testing www.aera.net/Publications/Books/Standards-for-Educational-Psychological-Testing-2014Edition

Page 14-20

Informed Consent for Psychological Services in Schools By Troy Janzen, PhD, RPsych, CAP Deputy Registrar and Complaints Director Canadian Code of Ethics for Psychologists – Third Edition (2000) Canadian Psychological Association. Children First Act (CFA, 2013) Alberta Queens Printer, Edmonton, Alberta. College of Alberta Psychologists Standards of Practice (2013) download http://cap.ab.ca/ Portals/0/pdfs/StandardsOfPractice.pdf Family Law Act (FLA, 2003) Alberta Queens Printer, Edmonton, Alberta. Freedom of Information and Privacy Protection Act (FOIPP, 2000) Alberta Queens Printer, Edmonton, Alberta. Johnston, H., Gordon, T., Mah, J., Nunziata, D., Pawluk, C., & Drefs, M. (2015). Informed consent for minors: What does it mean for the work of school psychologists? A Practice Guide jointly developed by the school psychology leadership of the Calgary Board of Education, Calgary Catholic School District, Golden Hills School Division, and Rocky View Schools. Downloaded from https://www. psychologistsassociation.ab.ca/ieadmin/files/Joint_Psychology_Informed_Consent_ for_Minors.pdf Mah, J. (2017.) Informed consent for minors: Not needed if you work in schools. Psymposium, Getting Schooled, August. Rasmussen, M. (undated) Legal Opinion: School Psychologists - Parental Consent to Psychological Assessment of Students and Disclosure of Student Records. Saskatchewan College of Psychologists. Downloaded from http://www.skcp.ca/ pdf%20files/school-psychologists-Merrilee%20Rasmussen-advisory-link.pdf www.cap.ab.ca

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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 Collegeâ&#x20AC;&#x2122;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. This issue was created by Melanie Rutten, Communications Coordinator, if you have any questions please email communications@cap.ab.ca.