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The Association of Chief Psychologists with Ontario School Boards |
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Who Provides Psychological Services?
The Regulated Health Professions Act
The Controlled Act of Diagnosis
Ministry of Education Categories of Exceptionalities:
Psychologists·
Psychological Associates
In Canada, legal requirements for access to the title "psychologist" vary from province to province. For a comparison of the requirements in each province, visit the Work Destinations website maintained by the Forum of Labour Market Ministers.
In Ontario, psychological services are provided by, or under the supervision of, members of the College of Psychologists of Ontario. By law, no one may use the words "psychology" or "psychological" to represent their services unless they are members of the College of Psychologists. This is intended to protect the public by ensuring that only appropriately qualified, regulated professionals are able to provide services under these terms.
There are two titles in Ontario:
The College of Psychologists of Ontario recognizes 8 practice areas. Members who declare competence in the area of School Psychology must demonstrate knowledge and skill in a wide variety of areas relevant to practice with school-aged children.
School boards often employ a variety of non-regulated service providers to administer and score psychological tests. These individuals are most often referred to as Psychometrists, and usually hold a Master's degree in education, psychology or a related field. Other titles include Psychoeducational Consultants,Clinical Consultants,Teacher Diagnosticians and Teacher Testers. If these individuals provide assessment services under the professional supervision of a member of the College of Psychologists of Ontario, the services may be legally referred to as Psychological Services. However, all written reports prepared by such individualsmust be counter-signed by a member of the College of Psychologists, and parents have the legal right to meet with the psychologist or psychological associate providing the supervision. To ensure that all psychological services are performed to the highest standards, all members must observe the Guidelines for Supervision of Non Registered Personnel published by the College of Psychologists.
Further information
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College of Psychologists of Ontario (COPO) |
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Ontario Psychological Association (OPA) |
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Ontario Association of Psychological Associates (OAPA) |
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Canadian Psychological Association (CPA) |
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American Psychological Association (APA) |
Psychology has been a self-regulated profession in Ontario since the original Psychologists Registration Act in 1960. With the proclamation of the Regulated Health Professions Act (RHPA) in 1993, psychology joined 20 (subsequently, 23) other health professions under the umbrella of one major piece of health legislation, whose primary objective was to protect the public. In addition, the Psychology Act (RSO,1991) replaced the former Psychologists Registration Act (RSO, 1980), replaced the former Board of Examiners with a new College of Psychologists (under the authority of the Ministry of Health and Long Term Care), created a new title "Psychological Associate" for members registered at the master's level (while reserving the title "Psychologist" for doctoral-level members), and defined the practice of psychology as:
"the assessment of behavioural and mental conditions, the diagnosis of neuropsychological disorders and dysfunctions and psychotic, neurotic and personality disorders and dysfunctions and the prevention and treatment of behavioural and mental disorders and dysfunctions and the maintenance and enhancement of physical, intellectual, emotional, social and interpersonal functioning."
Members of the College of Psychologists must comply with The Regulations, Standards of Professional Conduct and Guidelines of the College of Psychologists (December 1995), as well as other standards and principles adopted by the College. For members who practice in the area of school psychology, two documents are of particular importance:
Practice Guidelines for Providers of Psychological Services, Canadian Psychological Association, 1989.
Standards for Educational and Psychological Testing. American Psychological Association, 1999.
For electronic versions of both the Regulated Health Professions Act and thePsychology Act, go the Statutes and Regulations of Ontario.
For another excellent, searchable electronic source for Ontario legislation, visit theAccess to Justice Network.
As of August 15, 2000, individuals using the titles "Social Worker" and "Social Services Worker" must be members of the Ontario College of Social Workers and Social Service Workers. This College falls under the authority of the Ministry of Community, Family and Children's Services.
For information on other regulated health professions in Ontario, visit the website of the Federation of Health Regulatory Colleges of Ontario.
Section 171(1)6 of theEducation Act empowers boards to appoint one or more "psychiatrists or psychologists", defining "psychologists" as individuals who are "legally qualified medical practitioners or hold a certificate of registration under the Psychologists Registration Act." (171(1)6ii). The Act has not been updated to reflect the legislative changes under the Regulated Health Professions Act. In particular, it does not recognize "Psychological Associate" as a legally protected title.
The Ministry of EducationPolicy/Program Memorandum No. 59 (October 11, 1982) specifies a set of principles with which school boards must comply when providing psychological services. In particular, it stipulates "that psychologists perform their professional duties within the rules of conduct which govern their profession at large."
For more information on the Education Act, and its provisions for special education, visit the Ministry of Education's Special Education webpage.
Teachers often refer students who are exhibiting difficulties at school for a psychological assessment.
The most common reasons for referring students for a psychological assessment are that they are having difficulty acquiring age-appropriate academic skills, or controlling their behaviour.
In addition to the standards set by the College of Psychologists, The Ministry of Education has set out requirements for conducting psychological assessments within school boards in its Policy/Program Memorandum No. 59.
Prior to beginning a psychological assessment (or to offering any psychological service), the psychologist/psychological associate must have obtained informed consent from the parent, or from the adult student. In this regard, the Toronto District School Board has developed a Record of Informed Consent Process for documenting the information necessary to support informed consent, as well as a more general discussion of the informed consent process. (NOTE:These two links are to files in pdf format, which will require you to have the Adobe Acrobat reader installed on your computer in order to access them. Also, they are a little slow to open at a slow connection speed.)
The purpose of a psychological assessment is to determine the strengths and needs of the student. With this understanding, Psychological Services staff can make recommendations to the school staff and parents about ways to help the child. Recommendations often include teaching and learning strategies, curriculum areas to reinforce, language and learning skills to teach, and behaviours to target for change.
Sources of information for a psychological assessment include:
a review of the student's educational history from the Ontario School Record (OSR);
a review of the student's developmental history, provided by the parent or guardian;
the teacher's description of the student's difficulty;
the parents' or guardians' understanding of the student's difficulty;
tests of intellectual or cognitive ability
tests of specific processes, such as visual-perceptual skills, auditory skills, and memory;
tests of academic achievement;
tests of social and emotional functioning;
measures of personality and self-esteem
discussion with the student on his or her perspective on the problem.
behavioural rating forms completed by the child's teacher and parent(s) to examine for behavioural, attentional or emotional difficulties
Outcomes of psychological assessments are shared with parents and school staff in a variety of ways. Psychological Services staff share assessment outcomes orally with parents at scheduled interviews. They also write psychological reports which summarize the information gathered from the above sources, for the benefit of parents and school staff. These reports contain scores reported in a number of different forms, usually percentiles. A Conversion Chart has been prepared to assist in comparing the various kinds of scores.
Legal access to psychological reports is controlled through the Education Act, the Municipal Freedom of Information and Protection of Privacy Act, and the standards of the College of Psychologists of Ontario. Reports may only be released to individuals outside of the school board with the written consent of the parent or the student (if 18 years of age or older). School boards and other institutions in Ontario vary in the forms which they use for this purpose. A number of these forms are available as downloads at the website of the George Hull Centre for Children and Families.
Psychology staff who conduct assessments of children in schools should be familiar with the Risk Management Advisory for Specialists and First Aid Providers of the Ontario School Boards Insurance Exchange (OSBIE) . This site requires that you apply for a password to access this information.
Useful
Resources:
Dumont-Willis
on the Web
The
Uses and Misuses of Processing Tests
Under the Regulated Health Professions Act (RSO,1991), in the interests of public protection only certain professions were given legal access to the controlled act of diagnosis. The controlled act of diagnosis is defined 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."
For members of the College of Psychologists, the Psychology Act states:
"In the course of engaging in the practice of psychology, a member 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 the overall interest of public protection (which is the fundamental basis of the RHPA), the only persons legally entitled to communicate such a diagnosis in Ontario are members of a Regulated Health Profession with access to the controlled act. There are substantial penalties under RHPA for individuals who perform the controlled act of diagnosis without authorization, as well as penalties 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.
The College of Psychologists has set out the Knowledge, Skills and Training required to formulate and communicate a diagnosis. Unless there is a limitation on their certificate of registration, all psychologists and psychological associates have legal access to the controlled act of diagnosis.
As of September 2000, psychometrists and other unregulated providers may not legally communicate diagnoses. The psychologist or psychological associate supervising them must personally communicate the diagnosis to the parent (or to an adult student).
Psychological diagnoses may follow from a psychological assessment, by identifying a disorder or dysfunction as the cause of the individual's symptoms or difficulty. The diagnosis usually falls within a recognized classification system of disorders and dysfunctions. Typically individuals or their personal representatives will rely on psychological diagnoses made from psychological assessments for developing treatment and intervention plans. The College of Psychologists of Ontario requires that the communication of a psychological diagnosis to an individual or his or her personal representative, may be made only by a Psychologist or Psychological Associate who has access to the controlled act.
Nondiagnostic feedback provides information on assessment results and outcomes gathered from this broad range of sources. It could include a description of the procedures used in the assessment, a description of the test performance and of the information gathered through interviews and observations. Parents and school staff receive nondiagnostic feedback orally and in written psychological reports.
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 diagnose would reduce confusion for students and parents alike and ensure appropriate allocation of needed resources."
Behavioural Intervention
School Psychologists provide a variety of direct and indirect services to students who present with inappropriate social behaviours. These students may be diagnosed with conduct disorder or oppositional defiant disorder or may display inappropriate behaviour as part of a complex of other disorders such as attention deficit/hyperactivity disorder, pervasive developmental disorder (autistic disorder), mental retardation, mood disorders, etc.
Direct student services include such things as conducting anger management and social skills groups, direct counselling and advocacy, and establishing behaviour management plans in conjunction with the student, family and school. Indirect services can take the form of collaboration in the development and implementation of safe schools programmes, provision of workshops in behavioural techniques, development of policies around the use of restraints, suspension, etc.
Behavioural programming focuses on the development of age appropriate academic social and life skills. Interventions begin with a functional assessment of the problem behaviors which includes the recognition that problem behaviour serves a purpose for the student, has a communicative intent, is context related, and may service multiple purposes. All interventions must respect the student's dignity, personal privacy and right to individual choice.
Consultation
Psychological Services staff (psychologists, psychological associates and psychoeducational consultants) provide consultation services to parents, students, teachers, school administrators and other Board of Education support staff on the social, emotional, intellectual, physical development of students, as well as the students' learning strengths and needs. Psychological consultation benefits students by assisting in the development of appropriate classroom programs and remedial strategies, and in providing appropriate social/emotional interventions within the school. Psychological consultation also may lead to recommendations for therapeutic interventions with community agencies, hospitals and professionals. Where this occurs, Psychological Services staff act as a liaison between the community agencies/professionals and the Board of Education staff who are directly involved with the student. Consultation services may be provided through the School Team to individual teachers, administrative staff and/or groups of school staff. Consultation services to parents and students is usually accessed through the school principal.
Psychological Services may have on file existing information on services previously provided to the student and family, either through a Board of Education or a community agency/hospital/professional (eg. psychological, speech and language, social work, medical and psychiatric services). This information would have been obtained with parental consent. A school principal or parent may request Psychological Services to review their files to consult on previous information that is available to assist the student. When previous information is not on file, Psychological Services can assist in obtaining information from a Board of Education or community agency/hospital/professional with the written consent of the parent or adult student.
Psychological Consultation with Parents Can Help......
to obtain relevant family background information to assist the student in school;
to help parents understand their children's learning, social/emotional and behavioural needs;
to help develop and implement strategies to be used at home;
to advise and recommend appropriate Board of Education and community resources/support services;
to provide student and family support in crisis situations.
Psychological Consultation with Educators Can Help......
to identify the students' strengths and needs;
to develop and implement strategies and program modifications which address the needs of students experiencing learning, social/emotional and behavioural difficulties;
to facilitate referrals for additional support;
to assist in dealing with traumatic experiences.
Counselling
School psychologists have training and expertise in the area of counselling. The counselling might be carried out with individuals or it can involve group counselling. Social skills training in groups is a common form of counselling offered by school psychologists.
Crisis Intervention
School psychologists have training and expertise in the area of Crisis Intervention. They are usually a major player in school Board's Traumatic Events Response Team. They also can provide individual and group counselling to staff and/or students who have experienced a crisis or trauma.
Parent Education
School psychologists know that parent education is key to supporting and fostering healthy, happy and productive learners. School psychologists provide parent education by offering workshops in local schools and communities. Some of the topics addressed by school psychologists in parent education workshops include:
Children with learning disabilities
Behaviour problems at home - what to do about them
Child and adolescent achievement and motivation
Enhancing student self-esteem by positive discipline and effective communication
Stress management for parents and children
In these workshops, local resources available to parents are highlighted. School psychologists also run parent support groups in schools. They also provide parent education ot parents on an individual basis; this would be as part of feedback to parents when an individual psychoeducational assessment has been carried out.
Prevention Programs
School psychologists become involved in a number of prevention programs within their boards of education. The Early and On-going Identification program is a Ministry of Education and Training mandated program that requires school boards to identify young learners at risk. Psychological Services staff are often part of the school team who identify these "at-risk" children. In that role, they consult with parents and teachers, to help ensure that programs become modified to meet the child's unique needs.
Psychological Services staff are also often part of a school support team. This multi-disciplinary team of professionals (often including a social worker, a resource teacher and a speech/language pathologist, along with the school psychologist) supports the classroom teacher in trying to modify the regular program to meet an individual child's needs. Sometimes a child's learning problems can be identified and managed without further assessment/intervention through consultation with the school's support team.
Professional Development
Members of Psychological Services often are requested to provide professional development opportunities for others in the educational community. Their presentations, workshops and/or seminars can cover a range of topics, e.g., Attention Deficit Disorder, Violence Prevention, Social Skills Training, Behaviour Management, Crisis Intervention, etc. A variety of groups in the educational community have benefited from these professional development sessions. For example, superintendents, principals, teachers, educational assistants, parents and community groups have participated and found them to be informative and helpful.
Program Development
School psychologists sometimes develop specific programs which are within their area of expertise. For example, programs such as Social Skills or Anti-Bullying training have been developed by Psychological Services staff. Once the program has been developed, staff typically in-service teachers on the program. This allows the teachers to deliver the program to their classes.
Program Evaluation and Research
Psychological Services staff in Ontario Schools provide many programmes for students. Once completed, they evaluate the effectiveness of these programmes. Evaluation information is used to refine the programmes.
Services to individual students
Psychological Services staff do ongoing evaluation of their counselling and intervention services to individual students. The student's response to the counselling is considered in determining the content of the next counselling sessions. Outcomes for students, including changes in behaviours and emotions are indicators that the counselling services are being effective.
Services to groups of students
Psychological Services staff evaluate the outcomes of the group counselling, prevention and intervention services that they provide to students. Outcome goals are set at the onset of the group, and students are evaluated at the end of the group to determine which outcomes have been achieved. Evaluation data are used to determine the effectiveness of group programmes, and to plan adjustments in programmes to effect more positive outcomes for future groups of students. Evaluation measures may include questionnaires, discussion and measures of changes in behaviour and emotions. Parental permission for such evaluation is obtained when parents give their informed consent for their child to participate in the group.
Services to whole classes or whole schools
Psychological services staff work with school staff to plan an implement prevention and intervention programmes for whole classes and whole school populations. Programmes include evaluations, based on the goals of the programme. By evaluating the responses of large groups of students, psychology staff can make adjustments in the programme to better meet the needs of the student population.
Research
Psychological services staff may use group evaluation information, without identifers, to research outcomes of their services, and to develop more efficient and effective services to students. Journals that publish the research of school psychologists include:
Canadian Journal of School Psychology
National Association of School Psychologists Journal
Journal of Psychoeducational Assessment
Other Models of Psychological Services
The practice of school psychology in the U.S. differs in some interesting respects from Canadian models. Information on psychological services from an American perspective can be found in the Educational Resources Information Center (ERIC) Digest Psychological Services in the Schools, and an evolving American model is described in the ERIC Digest Creating a New Vision of School Psychology: Emerging Models of Psychological Practice in Schools.
www.acposb.on.ca