LEGISLATION:
ministry of education categories of exceptionalities vs. clinical diagnosis
The Ministry of Education has developed definitions for 5 main categories of exceptionality:
- Behaviour,
- Communication,
- Intellectual,
- Physical and
- Multiple
These are described in the Ministry of Education's Categories and Definitions of Exceptionalities.
The College has stated that,
"Several exceptionality groupings describe conditions which fall within the meaning of the controlled act as in the defined in the Psychology Act...Such groups include, but are not limited to: Communication (Autism; Language impairment; Learning disability), Intellectual (Educable retardation; Trainable retardation) and Behaviour (Emotional disturbance and/or social maladjustment; Attention Deficit Hyperactivity Disorder."
(College of Psychologists of Ontario. Communication of a diagnosis: A controlled act in psychological practice. The Bulletin, 24(2), December 1997)
Consequently, a distinction must be made between these terms when used as a psychological diagnosis versus a formal identification made using the Ministry Categories through the Identification, Placement and Review Committee (IPRC) process.
1. Diagnosis
Under the Regulated Health Professions Act (RHPA), "communication of a diagnosis" is listed as one of several "controlled acts", the performance of which is legally restricted to members of certain professional colleges, including the College of Psychologists of Ontario.
Section 27(1) of the Regulated Health Professions Act defines the controlled act of "communicating a diagnosis" as:
"Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis"
(emphasis added)
All three elements highlighted must be present for the controlled act to be considered to have been performed.
A more specific statement regarding the communication of a psychological diagnosis is provided in Section 4 of the Psychology Act:
"In the course of engaging in the practice of psychology, a member (of the College) is authorized, subject to the terms, conditions and limitations imposed upon his or her certificate of registration, to communicate a diagnosis identifying, as the cause of a person's symptoms, a neuropsychological disorder or a psychologically-based psychotic, neurotic or personality disorder."
In Communication of a Diagnosis: A Controlled Act in Psychological Practice (Statutory Requirements and Policy of the College of Psychologists of Ontario, December 1997) it states:
"The formulation of a diagnosis is usually made in the course of a psychological assessment that takes the observations of an individual's strengths and weaknesses further to identify and integrate causes, antecedents and determinants in such a way as to provide a psychological interpretation consistent with an accepted nomenclature and associated body of knowledge and research."
(The Bulletin, Volume 24 No. 2, page 5)
Considering all of the above points, the use of a term such as "learning disability" or "autism" constitutes a diagnosis when it is used to provide an explanation for a learning problem through a classificiation, formulation or causal statement linking it to a neuropsychological disorder, when the person offering the explanation is a member of a Regulated Health Profession with access to the Controlled Act, and when it is communicated to the individual who has been assessed, or to his or her personal representatives under circumstances in which he/she or they could be expected to rely upon the diagnosis (i.e., generally in a face-to-face meeting or through a written report).
There are substantial penalities under RHPA for individuals who perform the controlled act of diagnosis without authorization, as well as penalities for their employers. Restrictions imposed on the performance of controlled acts are not uniquely the policy of the College of Psychologists of Ontario. They are legislated under the RHPA and apply to all regulated health professionals, unregulated service providers, and the public generally.
2. IPRC Identification
Formal identification through the I.P.R.C. process is governed under the Education Act, and occurs through reference to the Ministry of Education's definition of an Exceptional Pupil under the Education Act:
"A pupil whose behavioural, communicational, intellectual, physical or multiple exceptionalities are such that he is considered to need placement in a special education program."
(Emphasis added)
Identification involves consideration of a variety of information in order to determine whether a pupil meets the criteria for the Ministry of Education's definitions as an area of exceptionality. Information used to make an identification includes reports from teachers, parents, and regulated health professionals including by not limited to members of the College of Psychologists. Unlike diagnosis, which involves a professional opinion concerning the cause of an individual's symptoms, identification is accomplished through a school board committee and is carried out solely for the purpose of planning how best to meet the pupil's needs.
Furthermore, since the Controlled Act is only performed when information is communicated to a client or his/her personal representative, communicating such information to other individuals (e.g., to other professionals, in mulitidisciplinary teams, or at I.P.R.C. meetings where the client or his/her representative is not present) does not constitute performance of the Controlled Act. However, the policy of the College of Psychologists also stipulates:
"Normally, the outcomes of psychological assessments, including any psychological diagnoses, have been communicated to the pupil or his or her parents, guardians or personal representatives prior to the IPRC meeting because of the implications of potential harm and the right of the client to have direct access to the regulated professional who is accountable to the public. Unless a member of the IPRC team is authorized under the law to perform the controlled act, a diagnosis should not be conveyed to the client or his or her personal representative at, or following the meeting, unless this has already been done by a legally authorized health care professional."
(Communication of a Diagnosis: A Controlled Act in Psychological Practice (Statutory Requirements and Policy of the College of Psychologists of Ontario, December 1997, The Bulletin, Volume 24 No. 2, page 9)
3. Diagnosis Versus Identification
Several exceptionality groupings describe conditions which fall within the meaning of the controlled act as defined in the Psychology Act. The policy of the College of Psychologists of Ontario states:
"If a pupil is included in one of these categories due to a determination of the cause of the disorder, this would require a psychological diagnosis. This is in contrast with the use of similar terminology by the IPRC to refer to the nature of services provided by the educational system. Care must be taken in making this distinction clear to the client so as to avoid the unauthorized communication of a diagnosis."
(Communication of a Diagnosis: A Controlled Act in Psychological Practice: Statutory Requirements and Policy of the College of Psychologists of Ontario, December 1997, The Bulletin, Volume 24 No. 2, page 9)
In particular, while the College of Psychologists recognizes the distinction between the diagnosis and identification of learning disabilities, the College has stated to the Ministry of Education that communicating a diagnosis of a learning disability is a controlled act within the meaning of the Regulated Health Professions Act and should be carried out only by qualified health practitioners.
In April 1999, the Registrar of the College wrote to the Minister of Education and Training with the following proposal:
"The College would like to stress the importance of having learning disabilities formally diagnosed in school systems by qualified health professionals, in particular members of the College of Psychologists, prior to identifications being made through I.P.R. Committees. This will ensure that all relevant factors and other possible conditions are considered and minimise the likelihood of students being misdiagnosed or mislabelled as having a learning disability when they do not".
"Many parents are not sufficiently knowledgeable to appreciate the difference between a psychological diagnosis of a learning disability and the identification of a learning disability through the I.P.R.C. process. To ensure that all students who receive this identification have been previously diagnosed would eliminate this source of confusion and contribute to better programming, based upon carefully identified areas of strength and weakness. Accurate diagnosis would reduce confusion for students and parents alike and ensure appropriate allocation of needed resources."