CASLPO - Supplement Jan 2006...5 Message from the President DEPARTMENTS CASLPO TODAY AUGUST 2009 CASLPO Today August 2009 Page 3 c o n t e n t s ... phy of “inclusive education.”

OFFICIAL PUBLICATION OF THE COLLEGE OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS OF ONTARIO

VOLUME 7 ISSUE 3 AUGUST 2009

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Publications Agreement Number 40025049 • ISSN 1713-8922

The Age of theElectronic HealthRecord

UnforgettableMemorable Clients Who have Touched Member's Lives

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5 Message from the President

DEPARTMENTS

CASLPO TODAY A U G U S T 2 0 0 9

www.caslpo.com CASLPO Today August 2009 Page 3

con

ten

ts6 Council Highlights: June

2009

6 Practice Scenarios:Changing the Record

8 Complaints: DisciplineDecision

CASLPO NEWS

9 CASLPO 2009 Priorities

12 Labour Mobility

13 Ontario Takes Key FirstStep in Addressing Long Waitsfor ALC

14 The Age of the ElectronicHealth Record

18 Taking Leave from thePractice of Audiology orSpeech-Language Pathology

21 Health ProfessionsDatabase: Better Informationfor Better Health

21 Registration Renewal2009-2010

22 Advocating for Ontario’sSLP’s and Audiologists

FEATURE

24 UnforgettableBy Sherry Hinman


MESSAGE FROM THE PRESIDENTMESSAGE FROM THE PRESIDENT

I suspect all of us had that feeling at one point inour professional careers that it just might be

easier/better/more rewarding/less hassle, to “slugcoffee or flip burgers.” We have all had those“bad days” and “difficult clients” who have

prompted us to question our commitment to ourprofession. Fortunately, for many of us those days

have been “fleeting” and we have “carried on.”When we do take the opportunity to reflect on

not only the challenges but the rewards, it oftenre-confirms our commitment to our professions.

In this issue, on page 24, you will read some poignant accounts of howsome "Unforgettable" patients/clients have impacted the lives or made a

significant impression on those with whom they have worked. I know theseaccounts will trigger your own thoughts and memories and, as is often thecase, serve as a reminder as to why you entered the profession.

My own account of my “special moment” came to me last week as I partici-pated in a celebration marking the end of this school year. The choirconsisted of a number of students from one of the nearby elementaryschools and included two older students who had been working with them.Both of these students have limited verbal skills and participated throughsigning each and every song. Not only did these students proudly sign but,the entire choir signed as they sang as did many people in the audience. Itwas truly amazing.

This practice of “inclusive communication” began along with the philoso-phy of “inclusive education.” For me, it began when a parent of a studentwith whom I was working found me in a school and, with teary eyes andemotion in her voice said: “Thank you for giving me the gift of being able tocommunicate with my son for the first time in his life. He just signed what Ithink was ‘red dog’ to me. I know that is his favourite book and he wantedme to read it to him. That has never happened before.” That was 25 yearsago. We now have signing/singing choirs, class presentations using symbolsand voice output devices and students who truly belong. Please take time toreflect for yourself and celebrate, as you read the accounts of others, howtruly “life altering” your contributions have been.

When the last edition of CASLPO Today came out, one of my colleaguestold me: “I read it cover to cover because I didn’t want to miss anything.” Iwould encourage you to do the same. There is so much happening profes-sionally and you want to make sure you are “in the know.” This publicationis a wealth of information.

In closing, I am happy to report that I have the privilege of being yourPresident for the next year. You have my assurance that I will work to serveyou well.

Meg Petkoff,President CASLPO

CASLPO College of Audiologists and Speech-Language Pathologists of OntarioOrdre des audiologistes et des orthophonistes de l’Ontario

A: 3080 Yonge St., Suite 5060, Toronto, ON M4N 3N1T: 416-975-5347/1-800-993-9459F: 416-975-8394E: [email protected] | W: www.caslpo.com

R E G I S T R A R

David HodgsonExt: 215 | [email protected]

D E P U T Y R E G I S T R A R

Carol Bock, M.H.Sc., Reg. CASLPOext 227 | [email protected]

D E P U T Y R E G I S T R A R

Karen Luker, M.H.Sc., Reg. CASLPOExt: 226 | [email protected]

D I R E C T O R O F F I N A N C E

Gregory Katchin, MBA, CAExt: 217 | [email protected]

M A N A G E R O F R E G I S T R A T I O N S E R V I C E S

Colleen MyrieExt: 211 | [email protected]

M A N A G E R O F S U P P O R T S E R V I C E S

Carol LammersExt: 214 | [email protected]

A D M I N I S T R A T I V E A S S I S T A N T

Camille PrashadExt: 213 | [email protected]

A D M I N I S T R A T I V E A S S I S T A N T

Linda MeissenheimerExt: 210 | [email protected]

M A N A G I N G E D I T O R

Scott [email protected]

A R T D I R E C T O R / D E S I G N E R

Binda Traver905.627.0831 | [email protected]

S A L E S A N D C I R C U L A T I O N C O O R D I N A T O R

Brenda Robinson905.628.4309

[email protected]

A C C O U N T I N G

Susan McClungC L A S S I F I E D A D V E R T I S I N G :

Brenda Robinson905.628.4309

[email protected]

G R O U P P U B L I S H E R

John D. Birkby

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CASLPO Today is published quarterly by Andrew John Publishing Inc. withoffices located at 115 King Street West, Suite 220 Dundas, ON L9H 1V1. Wewelcome editorial submissions but cannot assume responsibility or commit-ment for unsolicited material. Any editorial materials, including photographs,that are accepted from an unsolicited contributor will become the property ofAndrew John Publishing Inc. The publisher shall not be liable for any of theviews expressed by the authors of articles or letters published in CASLPOToday, nor shall theses opinions necessarily reflect those of the publisher.

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Page 6 CASLPO Today August 2009 www.caslpo.com

COUNCIL HIGHLIGHTS

Council held its regular meeting on June 5, 2009.The following are the highlights.

• Council approved a guide for SLPs in school boardsin principle for consultation with stakeholders.

• Council discussed various issues relating to labourmobility and requested the Registrar to monitor thelegislation as it is considered by the OntarioLegislature and report to the September Councilmeeting.

• Council discussed matters related to the formationof the Inquiries, Complaints, and ReportsCommittee (ICRC). Council approved that thecomposition of the ICRC would be eight includingthe Vice Presidents of Audiology and Speech-Language Pathology. It was agreed that the ICRCwould investigate the establishment of guidelinesrelated to the various dispositions that are availableto the ICRC with respect to complaints and reports.A summary of past decisions of the complaints andexecutive committees will be reviewed.

• Council discussed the updating and consolidationof bylaws and governance policies. It reviewed thecomments from members. It was decided that afurther in-depth review of all bylaws and gover-nance policies would be made.

• The election of officers was held and the results areas follows:

• Meg Petkoff, SLP from Hamilton, was acclaimedas President.

• Nancy Blake, SLP from Fergus, was elected VicePresident of Speech-Language Pathology.

• Sasan Borhani, Audiologist from London, wasacclaimed as Vice President of Audiology

• Vicky Papaioannou, Audiologist fromMississauga was acclaimed as audiology execu-tive committee member

• Pauline Faubert and John Krawchenko wereelected as public members of Executive.

For more information on any of these topics pleasecontact David Hodgson, Registrar at 416 975 5347 ext215 or by email at [email protected].

June 2009 Council Highlights Changing the Record

By Carol Bock, Deputy Registrar and Karen Luker,Deputy Registrar

“To err is human, to forgive divine.” We have likelyheard this famous quote from Alexander Popemany times due to the simple fact that we all makemistakes – it’s a given. However, in our professionallives, forgiveness is not the only thing we seek.When our reports and records contain mistakes, weare required to correct the error and to do so in acertain manner. Further, clients are now able toreview their records and request changes that wemay or may not agree with. There are specific detailsin the PHIPA legislation as well as CASLPO’sRecords Regulation that clearly direct our actions inthis matter. Consider the following recent practicequestions:

Situation 1

My client has pointed out that I made an error inthe assessment report I provided. I inadvertentlyreversed the month and day of their child’s dateof birth. Do I need to have them make a requestin writing to amend this or can I just go aheadand make the changes and give them the modi-fied report?Patient/clients may request alterations in theirrecord. PHIPA states:

“If the individual makes an oral request that thehealth information custodian correct the record,nothing in this part prevents the custodian frommaking the requested correction.”

In this situation the change in information is undis-puted so there is no need to have the family put therequest in writing. Certainly you can and shouldmake the appropriate change and provide the fami-ly with the modified copy. Further, you must makethe change in the patient/client’s record in a mannerthat does not obliterate the original information. Inthis situation, it would be simple enough to crossout the date stated and write the correct date. Aneffort should also be made to provide a note of cor-rection to any other recipient of the report.

PRACTICE SCENARIOS

tation of their child’s language abilities as outlined inmy assessment report. They have asked that I changemy report in a fashion that would communicatesomething I do not agree with. I have discussed myfindings and the rationale behind my conclusions butthey are still insistent that I change the report. Am Iduty bound to amend the report to meet theirrequest?

Not necessarily. PHIPA states that you are not requiredto change a record upon request if, “… it consists of aprofessional opinion or observation that a custodianhas made in good faith about the individual.” So if youfeel that the change would be contrary to your profes-sional opinion, then you may follow the procedure for“refusal.” You must respond in writing within 30 daysand the notice of refusal must give the reasons for therefusal and inform the individual that the individual isentitled to,

(a) prepare a concise statement of disagreement thatsets out the correction that the health information cus-todian has refused to make;

(b) require that the health information custodianattach the statement of disagreement as part of therecords that it holds of the individual’s personal healthinformation and disclose the statement of disagree-ment whenever the custodian discloses information towhich the statement relates;

(c) require that the health information custodian makeall reasonable efforts to disclose the statement of dis-agreement to any person who would have been notifiedunder clause (10) (c) if the custodian had granted therequested correction; and

(d) make a complaint about the refusal to theCommissioner under Part VI. 2004, c. 3, Sched. A, s. 55(11).

Situation 4At the school board where I work we have long waittimes for psycho-educational assessments and theSLPs are being asked to modify their assessment rec-ommendations to help reduce the demand for thesetypes of assessments. Specifically, it has been sug-gested that we consider recommending aconsultation with the resource teacher, who special-izes in learning disabilities, prior to considering areferral to the psychologist.

As mentioned above, if changes to current reports arebeing considered, then the same principles apply.However, this appears to be a request for wording that


Situation 2I am a supervising clinician in a private practice and Iworked with a staff speech-language pathologist,hired as an independent contractor, who has sincemoved to another job. Upon reviewing a report hehad written and meeting with the family involved, Irealized that his assessment was conducted throughtranslation but this was not mentioned in the report.I feel this is a significant omission. What should I doto correct the information?

Because an independent contractor compiled andinterpreted the information, it may be beyond yourauthority to correct. PHIPA states:

“…a health information custodian is not required tocorrect a record of personal health information if,

(a) it consists of a record that was not originally createdby the custodian and the custodian does not have suffi-cient knowledge, expertise and authority to correct therecord; or

(b) it consists of a professional opinion or observationthat a custodian has made in good faith about the indi-vidual.”

However, you could suggest to the family that they con-tact the speech-language pathologist directly andrequest a change. It would also be advisable to contactthe speech-language pathologist directly and discussyour concerns. It may be an oversight that he is pre-pared to correct. Regardless, if a correction is to bemade, it must be done using the following procedure:

1. record the correct information in the record and,

(a) striking out the incorrect information in a man-ner that does not obliterate the record, or

(b) if that is not possible, labelling the informationas incorrect, severing the incorrect informationfrom the record, storing it separately from therecord, and maintaining a link in the record thatenables a person to trace the incorrect informa-tion, or

2. if it is not possible to record the correct informationin the record, ensure that there is a practical systemin place to inform a person who accesses the recordthat the information in the record is incorrect andto direct the person to the correct information.

Situation 3I have a client that does not agree with my interpre-

may or may not reflect the originalintent of the SLP. Careful consider-ation of wording is importantbecause other regulations could beimplicated. For example, theProfessional MisconductRegulation indicates that the fol-lowing is an act of professionalmisconduct:

(10) Failing to refer a patient orclient to more appropriate servicewhen the member is unable to pro-vide adequate service or failing torefer a patient or client whorequires additional services in otherprofessional areas.

Also, the Code of Ethics states thatmembers:

1.3 will be honourable and truth-ful in all their professionalrelations;

1.5 will respect the patients’/clients’ right to participate intreatment decisions and to beinformed of potential risks andbenefits of treatment options;

2.7 will exercise independent pro-fessional judgment beforeimplementing professionalservice/prescription;

3.2 will protect the health and well-being of their patients/clientsand advocate for them whenappropriate;

3.3 will utilize all possibleresources to ensure that qualityservice is provided, acknowl-edging the need for referral inspecial cases;

3.5 will apprise patients/clients ofprograms and services fromwhich they may benefit;

You therefore have an obligation toprovide referrals as you deemappropriate, and cannot alter yourrecommendations to reduce thedemand for assessments. However,if you believe that the modified rec-ommendation responds to theneeds of the specific student thenthe suggested wording may be ade-quate.

Discipline Decision

Summary of the decisions and reasons in thediscipline hearing held on February 11, 2009

concerning Mr. Stefan Fridriksson, Audiologist

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This matter came before a panelof the Discipline Committee

at a hearing which was held onFebruary 11, 2009.

AllegationsThe Statement of Allegations enu-merated elements of anadvertisement published onbehalf of Mr. Fridriksson in June2007. It was alleged that Mr.Fridriksson had engaged in pro-fessional misconduct within themeaning of paragraph 34(improperly permitting advertis-ing with respect to the member’spractice) of section 1 of OntarioRegulation 749/93 under theAudiology and Speech-LanguagePathology Act, 1991.

Response to theAllegationsMr. Fridriksson admitted engag-ing in professional misconduct onthe basis of an Agreed Statementof Facts.

EvidenceAn Agreed Statement of Facts, asapproved by the member and theCollege, contained the followingagreed upon facts:

• In June 2007, an advertisingagency engaged by Mr.Fridriksson published adver-tisements in two newspapers inthe Niagara region.

PRACTICE SCENARIOS

Page 8 CASLPO Today August 2009

COMPLAINTS

• In the advertisements, the fol-lowing statements areattributed to Mr. Fridriksson:(a) “Anyone can sell hearingaids in Ontario,” (b) “The dis-pensing, fitting and selling ofhearing aids in Ontario is sim-ply unregulated,” (c) “Membersof the public require a pre-scription to consult with ahearing instrument specialistwhereas they do not require aprescription to consult with anaudiologist,” (d) “The primaryconcern of an audiologist ishearing health, not sales,”(e) “Too often, unfortunatelythe most important qualifica-tion for an HIS (HearingInstrument Specialist) is thatthey’re a good salesperson,whose main goal is to sell morehearing aids. In this environ-ment, quality of care andservice is often not a priority,”(f) “An audiologist has “passeda national competency exami-nation,” (g) “Unlike an HIS, anaudiologist can’t just ‘make up’their credentials,” (h) “In con-trast to audiologists who aremore concerned with apatient’s overall hearing health,the focus for an HIS. ‘can be onsales using high-pressure tech-niques,’” (i) “An audiologistwill diagnose the problem, notjust treat the symptoms,”(j) “it’s all about proper diag-nosis.”

During the proceedings, the panelwas made aware that Mr.

Fridriksson published an apologyand retraction in the respectivenewspapers in December, 2007.

FindingsThe panel was satisfied that theconduct described in the AgreedStatement of Facts constituted pro-fessional misconduct as defined byparagraph 34 (improperly permit-ting advertising with respect to themember’s practice) of section 1 ofOntario Regulation 749/93 underthe Audiology and Speech-Language Pathology Act, 1991.

PenaltyThe parties filed a Joint Submissionon Penalty and Costs which sug-gested that the following penaltywould be appropriate in the cir-cumstances of this case:

(a) Reprimand the member;

(b) Require the member to pay theCollege’s costs fixed in theamount of $2,000.00 withinthree months from the date ofthe order;

(c) Direct that the results of theproceeding be publicizedthrough CASLPO Today and thepublic portion of the register,and that publication willinclude the member’s name.

Decision on PenaltyThe panel concluded that the pro-posed penalty was reasonable andin the public interest having regardto the facts of this case.

The panel, therefore, accepted theJoint Submission on Penalty andCosts and issued an Order as set outabove.

The panel administered the repri-mand at the conclusion of thehearing.

On Friday, June 5, 2009 members of theCouncil of the College of Audiologists andSpeech-Language Pathologists of Ontario(CASLPO) participated in their annual prioritysetting session. The purpose of the sessionwas to examine issues and activities in orderto set priorities for 2009/2001. The identifiedpriorities will be used to develop a Workplanand Budget for Council consideration andapproval in September 2009.

To set the stage for the discussion, the Council was reminded of themandatory regulatory responsibilities, past year’s priorities and

recent environmental factors impacting the CASLPO direction andoperations. The Council also reviewed the core values; mandate, mis-sion, and objectives; core and discretionary activities; and currentallocation of time and financial resources.

It was also noted that in 2009/10 CASLPO will be going through a tran-sition, learning and adjustment phase. There will be a new Registrar andperhaps other new staff. There have also been major changes in legisla-tion that will impact on the ability of the college to complete tasks thatare not within its core regulatory mandate and activities.

1. Review the Self Assessment Tool and other QA program require-ments and processes to ensure compliance with the revised QARegulations and the Health Systems Improvement Act (Bill 171).

2. Undertake a major member education program regarding thenew/recent PSGs including the development of an online webinaron consent.

3. Develop an online Self Assessment Tool that has the capacity to pro-vide guidance as it’s completed, can collect aggregate data, assists ingoal setting, etc.

4. PSGs on;

• Central Auditory Processing Disorders

• Vestibular Function Testing

• SLP roles in provision of services to individuals with autism

• Assessment of adults by SLPs

Council will decide if and how to proceed in light of the commitment toother regulatory bodies and associations not to produce any new docu-


NEWS

CASLPO 2009 Priorities

ments until the pilot project of the interorganizationalgroup on infection control guidelines is completed inAugust 2009.

5. Pursue opportunities for interprofessional collabo-ration with other colleges and other professions.

6. Review and provide comments to Council on thecompetency profile being developed for audiolo-gists.

7. Move the Public Awareness project forward with aspecific request for funding for audiologists to pro-vide hearing testing for persons less than 21 yearsof age.

8. Review issues related to the Assistive DevicesProgram in terms of hearing aid corporationsbeing authorized to dispense.

9. Review CASLPO’s position statement on the use oftitle doctor in order to add clarity and addressissues which have come to light through practicecalls and the complaints process.

10. Develop a guide for members working in schoolboards distribute it to members and school boards.

11. Develop a strategy and advocate for a significantrole for SLPs in the provision of services to indi-viduals with autism.

12. Hold a conference in the fall of 2010 for memberson regulatory matters.

13. Develop a position statement and guide on elec-tronic documentation.

14. Complete the development of a Mentor TrainingProgram.

15. Develop a policy regarding language proficiencyrequirements for registration.

16. Complete Registration Practices Audit required byOffice of the Fairness Commissioner.

17. Ensure a smooth transition to the Inquiries,Complaints and Reports Committee (ICRC).

18. Develop guidelines related to various dispositionsthat are available to the ICRC with respect to com-plaints and reports.

19. Ensure that bylaws and regulations and governancepolicies are updated and amended as necessary.

20. Ensure Council is familiar with the revisedGovernance Policies and that Council adheres toits policies.

21. Ensure that a plan is in place to hire a newRegistrar in 2009.

22. Ensure that Council (existing and 4 new members)is provided with educational opportunities on reg-ulatory matters.

23. Develop a government relations strategy at Queen’sPark.

24. Take a leadership role on regulatory matters acrossCanada through the Canadian Alliance ofRegulators (CAR).

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NEWS



Amendments to the Agreementon Internal Trade (AIT)

endorsed by Canada’s premiers inJanuary 2009 commit all provincesand territories to improving labourmobility for certified workers inprofessions and trades.

If passed, the legislation wouldestablish a Labour Mobility Code togovern how Ontario regulators willsupport full mobility for out-of-province workers who are alreadycertified. Regulators include allhealth regulatory bodies such asCASLPO as well as other profes-sions like architects and engineers.The proposed legislation wouldensure that a worker certified topractice in one province or territo-ry will be entitled to be certified inthat occupation in Ontario withouthaving to complete additionalmaterial training, experience,examinations, or assessments.

The Act would recognize thatOntario regulators can set stan-dards that are considered necessaryto protect the public. At the sametime, it would encourage regulatorsto work with their colleagues acrossCanada to achieve common stan-dards, where possible.

Other key elements of the proposedlegislation include:

• Allowing workers to apply forcertification in Ontario withouthaving to be a resident ofOntario.

• Allowing the responsible minis-ter to review a regulator’spractices and take all necessarysteps to ensure those practices

comply with the LabourMobility Code that is set out inthe proposed Act.

• Enabling the Ontario govern-ment to impose fines onregulators who do not removemobility barriers such as addi-tional material testing andtraining, and to recover anyfines imposed on Ontario by anAIT panel because a regulatordid not work with the govern-ment to comply with the Code.

• Amending existing Ontario lawsto conform to the LabourMobility Code.

• Enabling the Ontario govern-ment to comply with the AIT’sdispute resolution process.

If passed, the following provisionswill take effect immediately uponthe Act coming into force:

• The Act would override provi-sions in any other Act,regulation or bylaw that conflictwith the Labour Mobility Code.

• The Act would apply to applica-tions made on or after the daythe Act comes into force or toany application where a finaldecision has not been made bythat date.

• To make it easy for workers toget information, the Act wouldrequire regulators to publish ontheir websites all certificationrequirements for workersalready certified in Canada.

Furthermore, if the Act is passed,regulators will need to amend any

inconsistent regulations and bylawswithin 12 months of the Act cominginto force.

Essentially this will mean thatCASLPO and the other regulatorybodies in Alberta, British Columbia,Manitoba, New Brunswick, Quebec,and Saskatchewan must acceptmembers in good standing fromother regulated provinces withoutexamination of their academicqualifications and without anyrequests for re-testing, retraining,or re-assessment. This is of someconcern to CASLPO because cur-rently in order to become a generalmember, who can practice inde-pendently, an applicant must haveeither practiced in Ontario as anInitial Practice Registrant and havesuccessfully completed a minimumsix-month mentorship program orhave practiced in another jurisdic-tion for a minimum of two years.This applies equally to all Canadianand foreign-trained applicants.

These requirements are in place toensure that new graduates or appli-cants who are practicing in otherprovinces or countries are compe-tent to practice before receiving ageneral certificate that would allowthem to practice independently. An“initial practice period” provides anopportunity for developing a firmfoundation for effective independ-ent practice. While the primarypurpose is public protection, it alsopromotes professional developmentand quality service provision bymembers.

There is no registration exam foraudiologists or speech-language

Labour Mobility

The Ontario Labour Mobility Act, 2009 was introduced in the OntarioLegislature on May 5, 2009 to implement full labour mobility forCanadian workers.

pathologists in Ontario or in any ofthe other provinces or territories.CASLPO’s mentorship programwhich includes an assessment of theinitial practice registrant’s perform-ance by a registered audiologist orspeech-language pathologist at theend of six months utilizing a stan-dard competency assessment tool isa fundamental component of ourmeasures to protect the public.CASLPO’s Initial PracticeRegistrant Program has been her-alded as an excellent competencyassessment process. CASLPObelieves these requirements shouldbe kept in place to meet the legiti-mate objectives of public safety andconsumer protection.

CASLPO submitted a request for anexemption to allow us to continueto do this but this was turned downby the Deputy Minister of Healthand Deputy Minister of CollegesTraining, and Universities. This will

probably mean that the require-ments in our registrationregulation approved by theGovernment of Ontario for twoyears of practice experience or sixmonths mentorship for all appli-cants for general registration willhave to be eliminated for applicantsfrom other regulated provinces.However, CASLPO plans to keepthese requirements in place for allother new graduates or applicantsfrom other unregulated provincesor countries to ensure that they arecompetent to practice independ-ently.

This of course raises issues relatedto fairness in that a graduate from auniversity in Canada can becomeregistered in another province andthen come to Ontario after one dayof experience, whereas if they applydirectly to CASLPO they will haveto go through the mentorshipprocess. This would apply to inter-

national applicants as well.

One way to address this issue is forregulatory bodies to adopt com-mon registration standards throughan mutual recognition agreementthat deals with new members post-August 2009. However, there mustbe some mechanism to ensure thatregulatory bodies respect the MRAsand no changes are made withoutmutual agreement. Of course theproblem with this solution is that itonly takes one province to not agreeand again, as we understand theAIT rules, we will be forced toaccept the lowest standard in thecountry. CASLPO is working withother regulatory bodies acrossCanada through CAR to developcommon standards based on thecompetency profiles.

We will keep the membershipinformed as the Labour MobilityAct is implemented.

www.caslpo.com

NEWS


For all of us involved in the provi-sion of health care, moving

patients efficiently and effectivelythrough our health care system canbe a significant challenge. The diffi-culty we regularly face intransferring patients from one caresetting to another has been a long-standing issue and results in anumber of serious consequences,including compromising the avail-ability of acute and post-acute carebeds, increasing emergency room(ER) wait times and elective surgi-cal cancellations, and limitinghospital surge capacity.

Understanding the factors that cre-ate these difficulties is critical todeveloping effective solutions. Anew initiative is underway inOntario to capture timely and reli-able data on where patients arewaiting in our healthcare system,why they are waiting and whattypes of services they are waitingfor.

The term alternate level of care(ALC) is a clinical designationmade by a physician and/or a dele-gate in collaboration with theinterprofessional team, whichwould include audiologists and

speech-language pathologists. Thegoal is to identify patients who nolonger require the intensity ofresources or services provided intheir current setting and are waitingfor an alternate level of care. ALCpatients often wait weeks, months,and sometimes years in acute andpost-acute hospitals for transfer toan alternate level of care. This inturn prevents ALC patients fromaccessing services, such as rehaband community supports whilealso preventing other patients fromaccessing these beds and receivingcare in a timely manner.

Ontario Takes Key First Step in Addressing theLong Waits for Alternate Levels of Care

By Stephen McAteer, MBA, MHSc, SLP(C), Reg. CASLPO

Clinical Liaison, Wait Time Information Program


According to the Canadian Institutefor Health Information (CIHI), in2007 – 2008 ALC patients account-ed for 5% of hospitalizations and14% of hospital days in acute facili-ties across Canada, which equatesto 5,200 beds in acute care hospitalsbeing occupied by ALC patients onany given day. (CIHI; “Analysis inBrief - Alternate Level of Care inCanada”; January 14, 2009; pg. 3.)

The Ministry of Health and Long-Term Care (MOHLTC) isimplementing a number of initia-tives to reduce ER/ALC wait times;however, it has become evident thatto make significant progress in thisarea, timely and reliable data onALC patients in all acute and post-acute hospitals in Ontario isneeded. To do this, the Wait TimeInformation System (WTIS), whichcurrently captures wait times forsurgery and diagnostic imaging inOntario, will be expanded to cap-ture ALC wait times. A key first stepin the capture of high quality andnear-real time ALC data is to ensureall clinicians are designatingpatients as ALC consistently in allacute and post-acute hospitals.

On behalf of the Ontario Ministryof Health and Long-Term Care andeHealth Ontario, the Wait TimeInformation Program (WTIP) atCancer Care Ontario, worked inconsultation with health care stake-holders from across the province todevelop a standardized ProvincialALC Definition. The definition thatwas developed is applicable for allpatient populations across the con-tinuum of care, in both acute andpost-acute hospitals, and isdesigned to be easily applied by cli-nicians. On July 1, 2009, all

hospitals in Ontario began usingthe standardized definition whendesignating patients as ALC.

Currently, the WTIP continues tosupport health care providers asthey work to ensure the definitionis applied consistently within theirorganizations. Also, the WTIP is inthe process of planning activities tosupport the capture of ALC data.These activities will occur in anumber of phases, with initial databeing reported by the end of thecalendar year. Soon, timely andaccurate ALC data that is compara-ble at a provincial level will beavailable to support Ontario’s con-tinued efforts to improve patientflow, reduce emergency room waittimes, and inform decisions regard-ing the allocation of resources tohospitals and communities.

As clinicians, we need to continueto support initiatives of this nature,as they will allow us to identify gapsin the health care system. In partic-ular, audiologists and speech-language pathologists have anopportunity to shine a light on theneed for access to hearing, commu-nication, speech and swallowingservices for all Ontarians along thecontinuum of care. By collectingthis data, we will be in a muchstronger position to advocate forthe resources necessary to supportour patients’ communication andswallowing needs.

For a copy of Ontario’s ProvincialALC Definition, please visitwww.cancercare.on.ca/ocs/alc, or ifyou have any questions regardingthis initiative, please emailALCdefinition@cancercare. on.ca.

The Age of theElectronicHealth Record

By Karen Luker, Deputy Registrar

Where do we go from here

Now that all of the fileshave been thrown out?

And how do we spend ourtime

If there’s no one to lend usa hand?

Adapted from “Games People Play”

The Alan Parsons Project

The age of the electronic docu-ment has arrived. CASLPO has

been flooded with calls and e-mailsfrom members requesting advice onhow to deal with the transfer ofpatient/client records to electronicmedia. The challenge this presents istwo-fold: what to do with archivedfiles that have been developed usingtraditional paper-and-pencil meth-ods that are being converted todigital media, and what to do aboutnew files that must be created usingelectronic means only. Audiologistsand speech-language pathologistshave also been engaged to partici-pate in the development of softwareapplications that will meet theiremployer’s needs while complyingwith the requirements of regulationsas set out by the College.

There are many uses associated withpatient/client health records. Notonly does the record document

patient care, but it also providesfinancial and legal information. Itcan be used for research and qualityimprovement purposes. Becausemuch of this information must beshared among professionals withinthe healthcare team, and there con-tinue to be problems with the paperhealth record, it is becoming moreapparent that developing an auto-mated health record is veryimportant.

The electronic health record (EHR)provides the opportunity for healthcare organizations to improve qual-ity of care and patient safety. Itallows the health care system toprovide comprehensive, reliable,relevant, accessible, and timelypatient information to each mem-ber of the health care team. An EHRalso represents a huge potential forcost savings and decreasing work-place inefficiencies. Increasedstorage capabilities alone accountfor much of its appeal. Some of theother advantages associated withthe EHR include:

• The EHR may be set up to beaccessible from remote sites tomany people at the same time,and retrieval of the informationis almost immediate. The recordis continuously updated and isavailable concurrently for useeverywhere;

• The EHR can instantly connectthe clinician to protocols, careplans, critical paths, and data-bases of health care knowledge;

• It allows for customized viewsand reporting of informationrelevant to the needs of variousspecialties;

• It can provide information toimprove risk management andassessment outcomes;

• It can decrease charting timeand charting errors, thereforeincreasing the productivity of

health care workers anddecreasing medical errors due toillegible notes;

• Chart chasing is eliminated, asis duplicate data entry of thesame information on multipleforms. The patient is happier,because information is availableso the patient does not have tocontinue to provide the sameinformation over and overagain.

Even though the technology isavailable, there are several barriersand obstacles that must be over-come before any EHR endeavourcan be successful including organi-zational and human issues. Some ofthe disadvantages include start-upcosts, which can be excessive. Thereis also a substantial learning curveand it is helpful if the users havesome type of technical knowledge.Today, clinicians are the primaryusers of EHRs; systems must there-fore be user friendly, otherwise theywill not be easily accepted, nor willthey be used to their fullest capaci-ty.

One of the biggest challenges facingclinicians is the fact that they mustadhere to their respective Colleges’legislative requirements, while deal-ing with EHR systems that do notnecessarily make provisions forthese. When clinicians are consult-ed in the development of EHRsoftware, they are often over-whelmed by the number ofconsiderations, questions, and fac-tors which must be taken intoaccount in order to ensure compli-ance and practical use.

Where Do We GoFrom Here?The following discussion addressessome of the issues which have beenbrought forward to CASLPO by cli-nicians who are considering or are

involved with the transition to elec-tronic health records.

Document Retention andDisposal: To Scan or Not toScan?Members who are involved intransferring records to an electronicformat frequently ask what needs tobe scanned and/or retained. Theanswer is the same as that for paperrecords. CASLPO’s ProposedRegulation for Records (1996) indi-cates that:

5. (1) Subject to Sections 6 and 7, amember shall keep a patient orclient record for each patient orclient whom the member treatsor assesses.

(2) The patient or client recordmust include the following:

a. The patient’s or client’s nameand address and phone num-ber;

b. The date of each of thepatient’s or client’s visits withthe member, unless thisinformation is available fromsome other readily accessiblesource;

c. The name of the referringsource;

d. Pertinent history of thepatient or client or referencewhere this information maybe found;

e. Reasonable information aboutassessments and treatmentsperformed by the memberand reasonable informationabout significant clinicalfindings, diagnosis and rec-ommendations made by themember;

f. Reasonable information aboutsignificant recommendationsmade by the member forexaminations, tests, consulta-tions, or treatments to be

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performed by any other per-son;

g. Every written report receivedby the member with respectto examinations, test, consul-tations, or treatmentsperformed by other profes-sionals or a reference towhere the reports are avail-able;

h. Reasonable informationabout advice given by themember and every pre-treat-ment or post-treatmentinstruction given by themember;

i. Reasonable information aboutevery controlled act withinthe meaning of subsection27(2) of the RegulatedHealth Professions Act, 1991,performed by the member;

j. Reasonable information aboutevery delegation of a con-trolled act within themeaning of Subsection 27(2)of the Regulated HealthProfessions Act 1991, by themember including the nameof the person to whom theact was delegated;

k. Reasonable informationabout every referral of thepatient or client by the mem-ber to another professional;

l. Any reasons a patient or clientmay give for cancelling anappointment;

m. Reasonable informationabout every relevant andmaterial service activity thatwas commenced but notcompleted, including reasonsfor the non-completion;

n. A copy of every written con-sent related to the member’sservice to the patient orclient.

It should be noted that at present,

CASLPO does not provide a defini-tion of “reasonable information.” Itis up to the individual clinicianand/or employer to determine whatinformation is considered reason-able.

Confidentiality and Security:Going into Hiding

Confidentiality and security issuesare concerns associated with boththe paper health record and theEHR. There has been much discus-sion about this topic and althoughthe patient record must be protect-ed, the patient must also rememberthat the record has to be accessibleto the professionals who use therecords to provide medical care.There are several security technolo-gies available that will help preventunauthorized access to protectedhealth information. Some of thesetechnologies include firewalls andpasswords. Furthermore, properlydesigned and monitored audittrails can enhance user accounta-bility by detecting and recordingunauthorized access to confidentialinformation. System designs mustconsider how individually identifi-able medical information will beprotected and also meet CASLPO’sregulatory requirements, whichinclude the following:

(3) Where a member makes orkeeps records required by thisregulation in an electronic com-puter system, the system shallhave the following characteris-tics:

f. The system includes a pass-word or otherwise providesreasonable protection againstunauthorized access.

g. the system backs up files andallows the recovery of backedup files or otherwise providesreasonable protection againstloss of, damage to, and inac-cessibility of, information.

Most systems will provide a meansto ensure that the author of everyentry is identifiable through sometype of unique identifier or pass-word protection.

Portability and Access toEquipment: Does theComputer fit into the Trunk ofMy Car? Placement of hardware is an issueand decisions regarding the porta-bility of equipment and remoteaccess to files must also be consid-ered. CASLPO suggests thatclinicians carry and access informa-tion only when necessary and thatonly necessary information be car-ried and accessed. All digitalinformation should be encryptedand protected. This would not pre-clude the clinician’s ability to accesspatient/client files remotely; howev-er, safeguards must be built into theprocess. Should a breach occur, theprovisions of the Personal HealthInformation Protection Act (2004)apply (see CASLPO’s “PHIPAGuide: Privacy Requirements andPolicies for Health Practitioners”,available on www.caslpo.com).

Organizing the Information:Storage SolutionsThere are probably as many meth-ods of storing records as there arerecords themselves. CASLPO mem-bers are reminded that anyelectronic record-keeping systemmust ensure their compliance withthe following sections of theProposed Regulation for Records(1996):

(3) Where a member makes orkeeps records required by thisregulation in an electronic com-puter system, the system shallhave the following characteris-tics:

a. the system provides a visualdisplay of the recorded infor-mation;

copying may be done by suchelectronic or optical means orcombination thereof.

(2) A member shall ensure thatthe electronic or optical meansreferred to in subsection (1) isso designed and operated thatthe notations, report, record,order, entry, signature or tran-scription is secure from loss,tampering, interference orunauthorized use or access.

Titles, Designations, andSignatures: Where Does It AllGo?

Members report that some elec-tronic charting systems provideonly a minimal amount of space –or a set number of characters – inwhich to enter their name and des-ignation(s). One solution is to enteran abbreviation which designatesthe professional (e.g., JulietteFisher, SLP), and to develop anaccompanying policy that indicatesthe full title to which the abbrevia-tion refers. Another is to have thespace extended by the programmerso that full names and designationsmay be entered.

Original signatures are not neces-sarily accessible in EHRs, so howare members to indicate that theyhave authored a report or note? Asmentioned above, most systemsaccount for this by tracking theauthor of every single entry, andonly certain portions of the recordmay be accessible to individualpractitioners. Ideally, the softwareshould clearly indicate the author ofthe entry during printing as well.

Where Do We GoFrom Here?The electronic health record pro-vides a new and innovativeinformation management toolwhich contributes to integrated

of electronic record-keeping is thatmost systems have built-in audittrails, which ensure that all entriesare tracked by author, date, andtime. This becomes a challenge inthe case where incorrect informa-tion has been entered, or where aclinician may wish to review andmodify the information entered bya student or support personnel. Aswith the issue of draft documents,the most efficient method of deal-ing with this situation is to beinvolved in the design of the systemfrom the outset. Should this not befeasible, clinicians must be mind-ful of the requirements of theProposed Regulation for Records(1996):

(3) Where a member makes orkeeps records required by thisregulation in an electronic com-puter system, the system shallhave the following characteristics:

e. the system maintains an audittrail that:

(i) indicates any changes inthe recorded information;

(ii) preserves the originalcontent of the recordedinformation when changed;

(iii) in respect to the patientor client record and financialrecord of each patient orclient;

A. records the date of eachentry of information foreach patient or client; and

B. is capable of being printedseparately from therecorded information foreach patient or client.

9. (1) Where in this regulation anotation, report, record, order,entry, signature or transcriptionis required to be entered, pre-pared, made, written, kept orcopied, the entering, preparing,making, writing, keeping or

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b. relative to the patient or clientrecord(s) and financialrecord(s), the system pro-vides a means of access to therecord of each patient orclient by the patient’s orclient’s name;

c. the system is capable of print-ing the recorded informationwithout unreasonable delay;

d. relative to the patient orclient record(s) and financialrecords(s), the system iscapable of visually displayingand printing the recordedinformation for each patientor client in chronologicalorder;

Preparation of Documents:Draft DodgersSpeech-language pathologists haveexpressed apprehension over thefact that draft progress notes andreports which are entered into elec-tronic charting systems auto-matically become part of the offi-cial record (and are thereforeaccessible to whoever else hasaccess to the record) as soon as the“Enter” button is depressed on thekeyboard. Furthermore, cliniciansindicate that using “cut and paste”functions available through wordprocessing software are disallowedin their employer’s electronicrecord-keeping system. One way toavoid this is to ensure that clini-cians are involved in the design ofthe system from the outset.Ensuring that software developersand consultants are aware of pro-fessionals’ needs is the best way tohave specific needs addressed andsystem limitations avoided.

Modifications and Corrections:Oops!Clinicians are concerned with theirability to modify information ormake corrections once an entry hasbeen made. One of the advantages


Taking leave can be the result ofcareful planning and prepara-

tion, such as with a pregnancy, aneducational pursuit, or a well-deserved sabbatical. It can also bethe unfortunate outcome of diffi-cult circumstances such as illness.

Preparing for LeaveEvery year, many members face thedaunting task of getting everythingready prior to taking leave. Thisinvolves ensuring that reports arecomplete and that client charts arein order. It may also include train-ing a replacement or distributingoutstanding and ongoing responsi-bilities to colleagues. Membersmust also consider their status withthe College for the duration of theirabsence.

CASLPO is aware of the challengesfacing our members during shortor extended periods of leave.Depending on the length of the

leave and the desire of the memberto practice during that period ourmembers have four options:

1. Retain “General” membership.This option would be useful formembers who plan to take aleave from full time practice butstill wish to practice part timewhile on their leave or wish totake a leave of less than oneyear.

2. Become a “Non-practicing”member. The “Non-Practicing”class of membership is availableto members who will not bepracticing at all during theirleave, but intend to return towork and general membershipat the end of their leave. Theannual fees for “Non-PracticingMembers” are $250.00 per year.

3. Become a “Life Member.” Thisclass of membership is for thosemembers who do not anticipatecoming back to work in the

future but wish to maintaintheir ties with the profession.The annual fees are $50.00 peryear.

4. Resign their membership. Thiswould be for those memberswho decide that they will nolonger practise as an audiologistor speech-language pathologistin Ontario.

Each of these options is describedbelow.

Maintaining GeneralMember StatusGeneral members have the abilityto leave their practice for an extend-ed period (e.g., for a maternityleave), as long as they complete 250hours of patient care or relatedwork annually, or 500 over twoyears. This requirement appliesregardless of the type and durationof leave. Assuming a member takes

care, evidence-based practice, com-puter-based decision support, careplanning, and analysis of outcomes.Although the benefits are clear,there are still barriers; therefore theconcept is still not widely accepted.There are many factors which mustbe considered before an organiza-tion implements electronic healthrecords, and the involvement of

end-users from the early stages ofdevelopment will help to ensure itssuccess.

CASLPO will be developing docu-mentation related to the issue ofelectronic documentation in thenext several months. Members areencouraged to submit their ques-tions and challenges to Karen Lukerat [email protected] for consider-

ation during the development

phase.

Taking Leave from the Practice of Audiology orSpeech-Language Pathology

By Colleen Myrie, Manager of Registration and Karen Luker, Deputy Registrar

The act of departing one’s work setting for a short or extended leavecarries with it a number of responsibilities and questions.

four weeks vacation in one calendaryear, 250 hours represents approxi-mately 5.2 hours per week. Keepingin mind that the hours may becomprised of both patient care andrelated work, this could easily cor-respond to just a few clients.However, if a member who holds aGeneral certificate of registrationfails to provide 500 hours of patientcare or related work within the lasttwo years of professional practice,the member must be reviewed bythe College’s Registration Com-mittee.

Members do not need to advise theCollege of their absence from prac-tice if they anticipate meeting thehourly requirements. In makingfinal preparations, however, mem-bers should ensure that theirSelf-Assessment Tool is up-to-dateand accessible.

To maintain General membershipstatus, certain requirements contin-ue to apply despite a member’sabsence from practice:

Annual Renewal: Members mustcontinue to submit their annualrenewal form (or complete thisonline). Membership fees of$500.00 must be paid in full.

Continuous Learning ActivityCredits (CLACs): Members mayaccumulate CLACs during leave.This is not mandatory during theperiod of leave but the minimumnumber of 45 credits must still beobtained over the three-year cycle.

Self-Assessment: Members areexpected to continue to completetheir Self-Assessment Tool (SAT).As the selection of members whomust submit their SAT is generatedby an off-site computer in order toensure they are truly randomized,any General member can be select-ed while on leave.

Peer Assessment: From the pool ofSATs submitted, 30 members are

randomly selected to participate inthe peer assessment process.Members who are selected while onleave may contact the College torequest a temporary deferral of theprocess.

Becoming a Non-Practicing MemberThe “Non-Practicing” class ofmembership is available to mem-bers who will not be practicing atall during their leave, but whointend to return to work and re-establish their General membershipat the end of their leave. The annu-al fee for Non-Practicing Membersis $250.00 per year.

This class of membership wasspecifically created to enable mem-bers to take a leave withoutworrying about whether or notthey will be allowed to return topractice without additionalrequirements. It also removes theneed to submit self-assessmenttools or to be peer assessed for theduration of the leave.

To become Non-Practising, themember must submit a renewalform with the change of classrequest section completed. Thisshould be done prior to theOctober 1st deadline for registra-tion renewals. There is noapplication fee for members whoapply to become non-practising atrenewal and a General member'sfees will be reduced from $500.00to $250.00 as a non-practisingmember effective October 1st. Ifhowever, a member applies tobecome non-practising at any othertime during the membership yearwhich runs from October 1 toSeptember 30, there will be anapplication fee and no reduction infees until the following October 1st.

Members who are non-practicingmust apply to the College annually

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to maintain their non-practicingstatus. They may fulfill any continu-ing education requirementsexpected of holders of a general cer-tificate of registration duringabsence from practice, but must doso before applying for reinstate-ment as a General member. Thereare no additional requirements tobe met if leave is shorter than threeyears, however, re-entry to practicedoes involve contacting the Collegefirst to apply for a General certifi-cate of registration.

Generally speaking, if a memberhas been away from practice formore than three years, his or herapplication will be referred to theRegistration Committee for consid-eration. The committee may elect toimpose re-entry requirements suchas asking the member to undergo asupervised practice period in orderto give the member an opportunityto “refresh” his or her knowledgeand skills.

If a member holding a Non-Practicing certificate of registrationfor a period of five years or moreapplies for a General certificate ofregistration, the applicant must bereviewed by the RegistrationCommittee and may be required tosuccessfully complete a period ofmentorship and an examinationspecified by the committee.

Applying for LifeMembershipThe College offers a Life certificateof registration to individuals whohave retired from the practice ofspeech-language pathology or audi-ology due to age, disability or otherpersonal reasons, but who wish toretain their membership with theCollege.

Life (retired) members are restrict-ed to the use of the following titles:

Speech-Language Pathologist –


Retired;

Speech Therapist – Retired; or

Audiologist – Retired.

Life (retired) membership is formembers wishing to retire perma-nently. Should circumstanceschange, life (retired) memberswishing to return to practice mustmake a full application for generalmembership. This will include sub-mitting a new application to theCollege along with official tran-scripts, a summary of universitysupervised clinical practicumhours, and applicable fees. In orderto become reinstated as a generalmember, the life (retired) membermust meet the current registrationrequirements and may be subject toany terms, conditions and limita-tions which the RegistrationCommittee considers appropriate.

Resigning fromPracticeIf a member decides that they willno longer practise as an audiologistor speech-language pathologist inOntario, the member may chooseto resign from the College. In orderto resign, the member must send aresignation letter to the College ornotify the College of his or her res-ignation on the annual registrationrenewal application form. Whenthe resignation becomes effective,the member’s Certificate ofRegistration expires and they mustcease practising in Ontario.

If a former member of CASLPOapplies for a General certificate ofregistration and it has been morethan three years since the applicantheld a General certificate of regis-tration, the applicant will besubject to the regulations and pro-cedures in force at that time. Theapplicant must submit a new appli-cation, along with verification ofthe applicant’s registration, licen-

sure or certification in anotherprovince, state or country, a refer-ence from the applicant’s mostrecent employer in another juris-diction, proof of professionalliability insurance coverage andpayment of all applicable fees.

If a former member of CASLPOwho has been absent from profes-sional practice for a period of morethan three years, applies for aGeneral certificate of registration,the applicant must be reviewed bythe Registration Committee andmay be required to successfullycomplete a period of mentorshipspecified by the Committee and/orsuccessfully complete an examina-tion specified by the Committee.

How Do CASLPORequirementsCompare to OtherColleges?On occasion, members have com-

mented on the reasonableness ofthe College's requirements, withrespect to patients hours, especiallyas they apply to individuals whochoose to work “very part-time” orwho wish to take an extended leave.

In other words, when does a Speech-Language Pathologist or Audiologistforget how to be a Speech- LanguagePathologist or Audiologist?

The College’s mandate is to regulatethe professions in the public inter-est. The College must deviseprograms which assure consumersthey are receiving quality servicesfrom competent professionals. Therequirements have been set as ameans of providing this assurance,and of offering members support asthey re-enter the workforce.

A brief survey of other RegulatedHealth Professions in Ontarioreveals that CASLPO’s annualhourly requirements are consistentwith:

Profession 1 Year* 2 Years 3 Years 5 Years

SLP and Audiology 250 500

Physiotherapy (240) 1,200

Occupational Therapy (250) 750 1,550

Nursing (225) 1,125

Pharmacy (200) 600**

*Numbers in brackets are extrapolated from the 3 and 5-yearrequirements

**Must be direct patient care

CASLPO s reviewing its requirements regarding leave. Should you haveany questions, comments, or suggestions regarding leave, please do nothesitate to contact Colleen Myrie, Manager of Registration, at 1-800-993-9459, ext. 211 or Karen Luker, Deputy Registrar, ext. 226.

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Health ProfessionsDatabase – BetterInformation for BetterHealthThe College of Audiologists and Speech-Language

Pathologists of Ontario, the Ontario governmentand 18 other health professional regulatory Collegesare working on a project to learn more about you. Theexpected result – improved health care for Ontarians.

The Ontario Ministry of Health and Long-Term Careis working with Colleges such as CASLPO to create theHealth Professions Database. The ministry and collegesare collecting demographic, education, and employ-ment information from health professionals across theprovince.

“We’re building improved evidence so we can allmake better decisions to promote the right supplyand mix of health professionals,” says Jeff Goodyeardirector of the Health Human Resources PolicyBranch for the Ministry of Health and Long-TermCare. “We’re looking forward to learning more abouthealth professionals and working with them so we allcan help provide better patient care and access tocare.”

Regulatory Colleges, professional associations, gov-ernment, researchers, post-secondary institutions andLocal Health Integration Networks will all use theinformation from this database. They’ll use it to shaperesearch, policy and programs that will help buildstronger health care teams. All of this will help towardoffering you the best work environment possible soyou can continue to serve the people you care for.

The Health Professions Database will be used toexplore questions such as: Where do health profes-sionals work? How many may retire over the next fewyears? How many work full-time and how many workpart-time? What type of care do they provide?

The information for the Health Professions Databasewill come from professionals like you through licenserenewal forms. So there will be more questions on thenext form than previously.

“Some of the questions may seem simple, but they’reimportant,” says Goodyear.

“We know you’re providing the absolute best care pos-sible for the people you serve. Now we all need to workon making the best health care system possible. Andwe need your help.”

Registration Renewal2009/10Once again this year, you will be able to complete your reg-

istration renewal online. Last year, 76% of CASLPO’smembers completed their annual registration renewal online.

The deadline for renewal this year is Thursday, October 1,2009. Your renewal forms and fees must be received at theCollege office by mail or completed online on or beforeOctober 1. Renewals received after October 1 will incur a 20%late penalty.

You can start to renew for 2009–2010 online atwww.caslpo.com on August 1, 2009. You can also renewusing a paper renewal form if you download CASLPO’s2009–2010 renewal package from our website. If you wouldlike the College to send you a renewal package, you mustmake a request by telephone, email or fax before September18. After this date, a renewal package may not get to you intime by regular mail for you to meet the October 1 deadline.

You will notice that this year’s form is longer than in the past.The Ministry of Health and Long-Term Care and CASLPOare working together to learn more about our profession bycollecting demographic, geographic, educational, andemployment information. This data collection is part ofHealthForceOntario, the province’s health human resourcesstrategy. Your answers to these questions will help the min-istry develop policies and programs that address supply anddistribution, education, recruitment and retention for yourprofession.

All of Ontario’s 80,000 regulated allied health professionalsare providing this information as part of their annual regis-tration and renewal process. To protect your privacy, the datawe submit to the ministry will be made anonymous. You arerequired to provide this information under the RegulatedHealth Professions Act, 1991.

The reliability of the information we receive and the qualityof the decision-making that follows depends on you. By com-pleting your renewal form accurately and thoroughly, youwill help ensure that Ontarians have access to the services ofyour profession, when and where they need them.

Additional information regarding HealthForceOntario andthe required information may be obtained at: www.health-force ontario.ca/WhatIsHFO/evidence_hhr/hpdb.aspx .

NOT RENEWINGMembers who decide not to renew their certificate of regis-tration for 2009–2010 must notify the College in writing orcomplete the Resignation Section of the paper renewal appli-cation form and return it to the College on or before October1, 2009. If you fail to renew your membership with theCollege and do not resign, your membership will be suspend-ed for non-payment of fees.


The Ontario Association ofSpeech-Language Pathologists

and Audiologists is well-positionedto represent the professions at theprovincial table where issues ofinterest are decided. As an associa-tion, we are invited to meet withthe Ministries of Health and Long-Term Care, Education, Child andYouth Services, Finance, andCommunity and Social Services.We work hard to build positiverelationships with ministry staff sothat our services are respected andvalued and so that we continue tobe included in meetings wherefunding and service delivery issuesare decided.

2009 – 2010 will be an exciting andchallenging time for OSLA and itsmembers. Here are some highlightsof our upcoming activities repre-senting SLPs and Audiologists inOntario:

• Participation in the joint min-istry review of the CCAC SchoolHealth Support ServicesProgramme which will deter-mine how these services shouldbe funded and coordinated;

• Lobbying for improved fundingand standards for service deliv-ery for audiology services forchildren age 18;

• Consultations with theFinancial Services Commissionof Ontario (FSCO) will result inour suggestions included in theofficial recommendations of

their five-year review of autoinsurance;

• Rollout to all Ontario SchoolBoards of the Oral LanguageFoundations for AcademicSuccess, a major education doc-ument researched and writtenby OSLA members;

• Chairing and leading the initia-tive for CASLPA’s Wait ListTimes for Non-ProgressiveNeurological Disorders;

• Participation on theCollaborative RehabilitationGroup of OntarioCollege/University Programs forRehabilitation Sciences(OCUPRS);

• Allied Health ProfessionalDevelopment Fund (AHPDF)allowing OSLA members thepossibility of accessing up to$1,500 for professional develop-ment per annum;

• Providing a voice for membersat the Workplace Safety andInsurance Board (WSIB) onissues relating to the Noise-Induced Hearing Loss and MildTraumatic Brian InjuryPrograms of Care as well as theRevised Fee Schedule review;

• Fall 2010 – A Joint Conferencewith CASLPO!

OSLA continues to be concernedabout ongoing issues of insufficientfunding or poor service deliverymodels for our professions as well

as new issues as they arise – forexample, the impact on the provin-cial blended sales tax (HST) andhow it will affect the delivery ofservices by audiologists. We needOSLA at the table!! And enjoy peaceof mind knowing that you are amember of the organization thatspeaks for you on matters that affectyour practice and your profession.We hope you are excited as we areabout the events and challengesimpacting our vibrant professions.

In addition to our many advocacyefforts, OSLA continues to be aresource for our members. We pro-vide support and seek memberinput through our committees,regional chapters and interestgroups. Our members also have on-line access to resources such asdiscussion forums, the memberdirectory, pertinent documents,surveys, and data and informationrelevant to your practice in Ontariowritten specifically by and forspeech-language pathologists andaudiologists including OSLA’sSuggested Fee Schedules.

We know that OSLA members are adedicated group of professionalswho value the strength of aresource-rich association; you rec-ognize that a strong voice inOntario is necessary for you as aspeech-language pathologist oraudiologist practicing in thisprovince. OSLA is here to supportyou; you have a team of peers andsupport staff available to you. OSLAis here to help!

Advocating for Ontario’s Speech-LanguagePathologists and Audiologists

By Mary Cook, Executive Director, OSLA

We worked together, initially onher dysarthria, but the focus

of therapy soon shifted to compen-sating for the cognitive problemsthat developed as she began to havestroke after stroke. In a matter ofmonths, this delightful woman lostall connection with those aroundher.

Thoughts of Rose fell to the back ofmy mind after she was transferredto the long-term care unit, and Inever expected to see her again. Butone day, I passed her in the hall,slippered feet shuffling her wheel-chair forward with slow tiptoemovements, her eyes staringvacantly ahead.

Forgetting the devastation thestrokes had caused, I croucheddown to bring my face level withhers, and touched her arm. “Rose!Do you remember me? It’s Sherry!”No glimmer of recognition; noresponse. Hope spun away as I real-ized what the strokes had stolenfrom her.

And then I remembered somethingthat used to reach Rose in therapy,and I began to sing. “AmazingGrace…” As if in a reflexiveresponse, Rose’s jaw dropped and aloud, throaty voice joined mine.

“…how sweet the sound…” cameour two voices. “…that saved awretch like me….” As we sang, a

hand appeared on Rose’s shoulderand a third voice joined in. Ourmusic swelled as three of the nursesadded their voices. As I looked up, Isaw that all the nurses at the nurs-ing station had dropped theirpaperwork to watch, and severalhad begun to sing.

As the verse came to a close, Rose’sjaw, too, snapped closed and herface resumed its stare. As I straight-ened up, I saw the faces of thenurses around me, some wet withtears.

“Have you never heard her sing?” Iasked them.

“No,” one nurse answered. “Rosehas been here for a couple of years.And in all that time she’s never spo-ken before. I didn’t know shecould.”

“Sing to her,” I said. “Sing to herwhenever you can. It’s all that’s left

of her.”

As clinicians, we all meet peoplewho leave their mark on us inindelible ink and make us richer forthe experience. We spoke to a fewother speech-language pathologistsand audiologists and asked themfor their stories about those whohave affected them unforgettably intheir clinical lives.

Janice Krymuza is a speech-lan-guage pathologist who encounteredthree-year-old Cody and his familywhen she was working with chil-dren privately in her clinic,

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UnforgettableBy Sherry Hinman

The first day Rose* clunked her walker into my office at LakeridgeHealth, where I worked as a speech-language pathologist, I was taken bythe sweet, 92-year-old’s smile. Rose’s speech was a little slurred from herstroke, but she could fully express herself, and her Jamaican upbringing

wove its way through her island accent.


Janice Krymuza

Sherry Hinman

Working with Words, in Stittsville.Her assessment revealed that Codyhad a severe expressive and recep-tive language delay as well asdifficulties with social and playskills. “The family was grief-strick-en,” Janice recalls. “They just didn’tknow how to get him to talk.”

Janice had her work cut out for her.“Cody didn’t have pretend play,”she says. “So we modelled pretendplay. A few weeks later his momreported that he began driving histoy cars, sitting on a mat, whichbrought her to tears.”

Being able to work with the youngboy and his mother in their ownhome was key, Janice recalls. “Byhaving motivated parents on boardand right there participating meansthe amount of progress was a lotfaster and more evident.” Within afew months, Cody’s expressive lan-guage flourished, soon reachingwithin normal limits. Though hisreceptive language progressed sig-nificantly as well, it remained aconcern and he was eventuallydiagnosed with PDD/NOS (perva-sive developmental disorder/nototherwise specified).

Janice gained a great deal of satis-faction from working with Codyand his family. “It was not ‘cookiecutter’ therapy,” she says. “It was aquestion of putting the pieces of thepuzzle together. It was about treat-ing the family as a unit.” Janiceworked with Cody and trained hismother, helping her learn tech-niques. “Whatever I recommendedher to do, she did.”

When she reflects on what shelearned from her encounter withthis young boy and his family,Janice says, “I felt like all I hadlearned came together. Knowledgeof multiple techniques andapproaches as well as hands-onexperience are important, and thesematter more than textbooks.”

She adds that her great sense of sat-isfaction came from pulling all herexperiences together. “You need tohave the knowledge base, but withexperience you are able to knowwhat is needed for each child andfamily. This can result in wonderfulsuccess.” She adds, “Plus being aparent myself has affected myapproach with families.”

When Yvonne Oliveira describesthe “beautiful, bright little girl” whocame into her office at almost fouryears of age, you can sense the con-nection instantly. Yvonne is aspeech-language pathologist, audiol-ogist and auditory-verbal therapistwho runs her own clinic, HearSaySpeech & Hearing Centre, inMilton.

Mariana’s hearing loss was identi-fied late, but she had already beenwearing her hearing aids for 15months by the time she came to seeYvonne for aural rehabilitationtherapy. Mariana’s parents wereconcerned with the lack of progressin her speech and language devel-opment, and wanted to build herlistening skills through the use ofher hearing aids. Unfortunately she

had been denied candidacy for acochlear implant, though thatremained a hope for the future.

At the time Yvonne began to workwith Mariana, she had only a hand-ful of single words, and was notconsistently localizing to sound.One of her few words was /a-i/, theword she used to call her mom.

Without fail, Mariana’s familywould attend hour-long rehab ses-sions, but despite their dedication,it soon became evident thatMariana lacked access to the entirespeech spectrum, always strugglingto detect the /s/ and other high fre-quency sounds. Unfortunately,however, she was wearing the mostpowerful behind-the-ear hearingaids available.

But through diligent weekly ses-sions, Mariana made enoughprogress to be considered eligiblefor a cochlear implant. Yvonnerecalls the day both she and thefamily rejoiced at this news, muchas she will never forget the dayMariana’s implant was first activat-ed. “When her mother describedMariana’s excitement and positivereaction to the sounds she heardwhen the implant was turned on, Icouldn’t help but cry tears of joy forall of them. This began a new chap-ter in Mariana’s life!”

Yvonne says there was no end to thethanks and praise the familybestowed upon her, yet she feels itwas their positive attitude, lovingnature, and patience for their childthat made the biggest difference.“They became not just a client, buta friend, and an extension of myown family.”

Corina Murphy will never forgetspeaking to the parents of 14-year-old Katie, following her assessment.“I looked down at my folded hands,sighed deeply and looked up intotheir expectant faces. ‘Katie is dis-playing neurological symptoms,’ I


Yvonne Oliveira

told them.” The parents were in dis-belief.

When she asked Katie to yell as loudas she could, she barely whispered.How would she be able to yell andlaugh with her girlfriends or shout ata football game? Corina wondered.When she asked Katie to smile andpucker, she could perform neithermovement. How would she smile ather prom or kiss that boy she had amonster crush on? The list of symp-toms went on: poor breath support,hypernasal resonance, imprecisevelar consonants, absent soft palatemovement, inability to swallowmeats, and inability to use a straw tosip drinks. With each observation,the alarm bells in Corina’s headrang louder and the knot in herstomach grew tighter.

They tried to guess at the cause of

Katie’s problems, but nothing addedup: her new braces, Bell’s palsy, abrain injury or, worse – a braintumour? All Corina could thinkabout was that Katie might notmake it to her high school prom.

Katie was scheduled for an urgentMRI, and a week later, Katie’s fathercalled to say she had been diagnosedwith myasthenia gravis, exacerbatedby the anesthetic for her toothextractions. Corina sighed withrelief, knowing that myastheniagravis was treatable. For monthsafterward she received weeklyupdates from Katie’s parents; her ill-ness had not responded well todrugs, but surgery to remove herthymus gland had restored most ofher speech.

Corina recalls with fondness a visitfrom Katie a few months after her

surgery. Katie brought her a teddybear puppet to use in her privatepractice. “As they left, Katie smiled.At that moment, I could see theKatie of a few years in the future:the chubbiness of pubescence gonefrom her face, her teeth straight andclear of braces, all decked out in herprom dress.”

As for the bear – now tattered andone-eyed after dozens of encounterswith preschoolers and Corina’s dogand son – it sits in a place of honouron her shelf, a reminder of the effectshe had on one child, one family.

Sherry Hinman is a freelance writerand editor. She is also a professor in

the Communicative DisordersAssistant Program, Durham College;

worked clinically as an SLP for fourteen years; and served three

years on the CASLPO Council

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Names of patients/clients and a few personal details have been changed to preserve their privacy.