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October 25th 2019
Speech-Language Pathology Services in the Schools
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Alexandra CarlingDirector of Professional Practice and Quality Assurance
Sarah Chapman-JayAdvisor, Professional Practice & Quality Assurance
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E-Forums
Click on Events & e-Forums
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• Consent
• Delegating a person to obtain informed consent
• Continuity of care with preschool services
• Concurrent intervention with private practitioners
• CDA supervision in remote areas
• Internal audits by non health information custodians
• Cloud Storage of Records
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Consent
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Consent for Screening
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Olga is a school board SLPwho screens all senior kindergartenstudents for language and literacy issues
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• Letters describing the SLP screening program are sent home with the students.
• Olga’s contact information is included if the parents have any questions.
• The letter includes information about not participating in the screening and possible next steps.
• There is a check box for parents to consent to a SLP screen.
• The parents sign the bottom of the letter indicating "I have read and understand this form“ and send it back with their child.
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Polling Question:
Is sending the consent letter sufficient
for informed consent?
• No – Olga must contact the parents by phone to obtain consent
• Yes – All the required information is in the letter
• No - Olga should first ensure that the parents can read and understand the letter
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Polling Question:
Is sending the consent letter sufficient?
• No – Olga must contact the parents by phone to obtain consent
• Yes – All the required information is in the letter
• No - Olga should first ensure that the parents can read and understand the letter
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• Olga can ask the classroom teacher if they know of any parents with English literacy difficulties.
• If the parents can read English, send the consent letter home.
• If they can’t read English, ask the teacher to go over the consent letter with the parent, or Olga can call the parent or ask for an interpreter.
• Consider getting the form translated into frequently used languages.
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At the SLP staff meeting, Lin, an SLP in the same school board, expressed concerns about a teacher getting consent for SLP services.
Is it acceptable?
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Polling Question:
Can a classroom teacher obtain consent for SLP services?
• No – Only a regulated health professional can obtain consent
• Yes – As long as the SLP is confident that the teacher adequately explains and obtains consent
• No – Only a resource teacher has the knowledge and skills to obtain consent
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Polling Question:
Can a classroom teacher obtain consent for SLP services?
• No – Only a regulated health professional can obtain consent
• Yes – As long as the SLP is confident that the teacher adequately explains and obtains consent
• No – Only a resource teacher has the knowledge and skills to obtain consent
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SLPs are responsible for all aspects of care, including obtaining and documenting consent to screen, assess and treat.
If another professional is obtaining consent for SLP services, they must be educated about valid and informed consent.
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Valid consent means the consent is: • Voluntary
• Not obtained through misrepresentation or fraud
• Relates to the services being proposed
• Is informed
Health Care Consent Act, 1996
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Informed Consent
Explain to the patient (parent/student):
• The nature of the services
• The expected benefits of the services
• The material risks of the services
• The material side effects of the services
• Alternative courses of action
• The likely consequences of not having the services
• Responses to questions about these matters.
Health Care Consent Act, 1996
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Consent Tool - Link
www.caslpo.com
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Rashid, an SLP in the same board,
obtained and documented consent
to screen Nathan.
The results indicated that Nathan
needed a language assessment.
Rashid sent home an ‘assessment consent form’ with Nathan but didn’t receive a response from the parents.
The contact phone number for Nathan’s parents was out of service.
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Rashid asks his colleagues if he can proceed with the assessment as Nathan’s mom had consented to the screen.
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Polling Question:
Can Rashid proceed with the assessment?
• Yes – the consent letter was for screening and assessment is the logical next step
• Yes – Nathan’s screen results indicate that he needs an assessment and probably language therapy
• No – The parents only consented to the screening. Rashid needs to obtain informed consent for assessment
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Polling Question:
Can Rashid proceed with the assessment?
• Yes – the consent letter was for screening and assessment is the logical next step
• Yes – Nathan’s screen results indicate that he needs an assessment and probably language therapy
• No – The parents only consented to the screening. Rashid needs to obtain informed consent for assessment
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No treatment without consent
• 10 (1) A health practitioner who proposes a treatment for a person shall not administer the treatment, and shall take reasonable steps to ensure that it is not administered, unless,
(a) he or she is of the opinion that the person is capable with respect to the treatment, and the person has given consent; or
(b) he or she is of the opinion that the person is incapable with respect to the treatment, and the person’s substitute decision-maker has given consent on the person’s behalf in accordance with this Act.
HCCA 1996, c. 2, Sched. A, s. 10 (1).
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Consent to collect, use and disclose personal
health information (PHI)
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Medical information about a student
is sent to a school board by the parent
who consented to sharing the report.
This may result in the student
requiring SLP services.
Medical information could include:
• ENT report (voice or hearing)
• Audiogram
• Audiology CAP report
• Pediatrician report
• External SLP report
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Polling Question:
Can the school’s SLP review the medical information?
• Yes – the information was sent to the school board and the SLP is employed by the board
• Yes – the parents gave consent for the information to be disclosed to the board
• No – The student needs to be referred to the SLP first
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Polling Question:
Can the school’s SLP review the medical information?
• Yes – the information was sent to the school board and the SLP is employed by the board
• Yes – the parents gave consent for the information to be disclosed to the board
• No – The student needs to be referred to the SLP first
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Circle of Care:
assumed, implied consent
Circle of Care: Sharing Personal
Health Information for
Health-Care Purposes
• There are six criteria to help you determine if you are in the Circle of Care.
• All six must be met
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Circle of Care: criteria
1. The HIC is entitled to rely on assumed, implied consent• You are a health care practitioner (SLP or audiologist), and therefore a HIC
who is entitled to rely on assumed, implied consent
2. The PHI must have been received from the individual, SDM or another HIC• If the PHI was collected, used or disclosed by a third party (employer,
insurance company, educational institution), consent cannot be assumed or implied
3. The PHI was collected, used and disclosed for the purposes of providing health care to the individual• This does NOT include PHI collected, used and disclosed for research, fund
raising or marketing
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Circle of Care: criteria
4. The HIC must use the PHI for the purposes of providing health care to the individual
• You cannot rely on assumed, implied consent to collect, use and disclose PHI for research, fundraising, or marketing
5. Disclosure of PHI from one HIC must be to another HIC
• You need express consent to collect, use and disclose PHI to a person or organization who is not a HIC, regardless of the purpose of the disclosure
6. The receiving HIC must not be aware that the individual has expressly withheld or withdrawn consent
• Individuals have the right to withhold or withdraw consent to collect, use and disclose their PHI. However, this must be expressed by the individual or SDM to the HIC.
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Continuity of Care and Concurrent Intervention
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SLPs at the River Preschool Centre discuss with parents the need for on-going SLP services when their children start school.
The preschool SLPs obtain the parents’ consent to:
• Refer the child to the school board for SLP services
• Disclose personal health information (PHI) to the school board, typically through a report
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What does this consent mean to the school board SLPs?
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Polling Question:
Can the school SLP review the report and contact the preschool SLP to discuss the report?
• Yes – the parents consented to the use and disclosure of their child’s information
• No – the school SLP needs to get consent from the parents
• Partial – the school SLP can review the report, but not contact the preschool SLP
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Polling Question:
Can the school SLP review the report and contact the preschool SLP to discuss the report?
• Yes – the parents consented to the use and disclosure of their child’s information
• No – the school SLP needs to get consent from the parents
• Partial – the school SLP can review the report, but not contact the preschool SLP
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Principles:
• The purposes of this Act (PHIPA) are,(a) to establish rules for the collection, use and disclosure of
personal health information about individuals that protect the confidentiality of that information and the privacy of individuals with respect to that information, while facilitating the effective provision of health care; (PHIPA 1. a))
• Circle of Care
• Inter-agency communications regarding continuity of care
• When in doubt, get consent
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Concurrent Intervention
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Dan has autism and his parents receivefunding for private SLP services in the home through the Ontario Autism Program.
Dan attends Cherrywood school and his IEP includes SLP services.
Dan’s parents have consented to disclose PHI for collaboration of SLP services.
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Polling Question:
Is the school SLP required to follow the private SLP’s plan of care for Dan which involves intensive 1:1 intervention?
• No – the school SLP follows the board’s model of SLP service while collaborating with the private SLP.
• Yes – it’s in the child’s best interests to have both SLPs carrying out the same program.
• Yes – The parents have asked for the school SLP to follow the plan of care.
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Polling Question:
Is the school SLP required to follow the private SLP’s plan of care for Dan which involves intensive 1:1 intervention?
• No – the school SLP follows the Board’s model of SLP service while collaborating with the private SLP.
• Yes – it’s in the child’s best interests to have both SLPs carrying out the same program.
• Yes – The parents have asked for the school SLP to follow the plan of care.
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Concurrent intervention can work if it is in the student’s best interests.
Review the Position Statement on Concurrent Intervention
Principles:
5. SLPs must make reasonable efforts to contact the other SLP providing care to the patient.
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Position Statement: Competencies
1. Collaborating with others
a. Work with others to provide a complementary approach to patient services
b. Provide clinical expertise in a collaborative manner
c. Interact according to differing roles and responsibilities of team members
d. Respect personal and professional differences among clinicians
e. Manage misunderstandings, limitations and conflicts to enhance collaboration
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Position Statement: Competencies
2. Planning concurrent intervention
a. Consider the types of intervention each SLP is providing and their compatibility
b. Identify amount and form of communication between SLPs
If there is disagreement between SLPs over each other’s respective roles consult the Position Statement on Resolving Disagreements between Service Providers
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Supervision of Support Personnel
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We employ CDAs in our board, but I can’t directly supervise as much as I would like due to distance and time constraints.
Can we use technology to supervise at a distance?
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Polling Question:
Can we use technology to supervise at a distance?
• No – supervision of CDAs must be at the same time and in the same place.
• Yes – but it must be in real time via a secure live platform. It cannot be a recorded session with a student.
• Yes – via a secure live platform or video recordings as close to the therapy session as possible.
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Polling Question:
Can we use technology to supervise at a distance?
• No – supervision of CDAs must be at the same time and in the same place.
• Yes – but it must be in real time via a secure live platform. It cannot be a recorded session with a student.
• Yes – via a secure live platform or video recordings as close to the therapy session as possible
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Position Statement
5) SUPERVISION
• The SLP is responsible for the patient and all aspects of patient care.
• Support personnel must always be under supervision by an SLP when providing SLP services.
• The SLP will use different methods of supervision as deemed appropriate for safe and effective patient care.
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Position Statement
5) SUPERVISION
a) All support personnel must be directly observed providing patient intervention on a regular basis; however, not necessarily with every patient.
b) Direct observation can be in person, via secure live video or video recordings as close to the therapy session as possible.
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• Position Statement on the use of Support Personnel by SLPs
• 2017 E-Forum Slides And Recordings
Use of Support Personnel by SLPs
Access Slides
Access Webinar Recording
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of Personal Health Informationby non-Health Information Custodians
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Our manager is not a regulated health professional, she is a member of the College of Teachers.
When she is doing a ‘chart audit’ as part of my performance appraisal, do I have to get parent consent
for her to review my records?
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Polling Question:
Do I have to get consent for my manager to audit my charts?
• No – Your manager is regulated by the College of Teachers, so you don’t require consent.
• No – PHIPA allows for internal audits without requiring consent.
• Yes – You are a health professional and your record is personal health information, therefore you need consent.
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Polling Question:
Do I have to get consent for my manager to audit my charts?
• No – Your manager is regulated by the College of Teachers, so you don’t require consent.
• No – PHIPA allows for internal audits without requiring consent.
• Yes – You are a health professional and your record is personal health information, therefore you need consent.
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Personal Health Information Protection Act (2004)
Auditing and Accreditation
• A HIC (SLP) may disclose PHI about an individual without that individual’s consent to a person conducting an audit or reviewing an application for accreditation or reviewing an accreditation.
• However, the audit or review must relate to services provided by the custodian (SLP),
• and the person does not remove any records of PHI from the custodian’s premises. (PHIPA, part IV, 39, (1) (b))
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Practice Advice Article:
Disclosing Information without Consent: When and How.
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Cloud Storage of Personal Health Information
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What should school board SLPs consider?
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Cloud Storage of Records considerations:
• Ensure privacy and confidentiality
• School board policy on protecting PHI
• Engage privacy and IT staff
• Remote access across schools & privacy
• The record is accessible upon patient/SDM request
• Consult legal and other relevant expertise when undertaking significant cloud-related initiatives
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Extent of information
(2) A health information custodian shall not collect, use or disclose more personal health information than is reasonably necessary to meet the purpose of the collection, use or disclosure, as the case may be. PHIPA 2004, c. 3, Sched. A, s. 30 (2).
Have an incident management plan
- Interrupted access to cloud computing
- Privacy breaches
- Corrections
- Mitigate risks
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Additional Information:
Information and Privacy Commissioner of Ontario
IPC: Thinking about Clouds
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Practice Advice Team
Alexandra CarlingDirector of Professional Practice & Quality Assurance
Samidha JoglekarAudiology Advisor
French and [email protected]
Sarah Chapman-JayAdvisor, SLP and QASLP English
David BeattieConseiller sur l’exercisede l’orthophonieSLP French
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Thank You!
Additional contact information and resources:[email protected] | 416 975-5347, ext. 226
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facebook.caslpo.com youtube.com/user/caslpo
www.caslpo.com
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www.caslpo.com/members/resources
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Position Statement on the use of Support Personnel by SLPs
FAQ 5: I am employed by a school board where early childhood educators (ECEs) work with children who have speech and language difficulties. I have assessed the children and I am expected to provide the ECEs with programs to help develop speech and language skills. However, I do not directly supervise them. Are they still my support personnel?
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Position Statement on the use of Support Personnel by SLPs
Answer 5:
• If you do not have the authority to supervise the ECEs, which entails setting specific goals, directly observing the ECE with the child, modifying tasks, and training, then you should not be assigning clinical tasks to the ECEs.
• This does not prevent you from working with them however as part of an interprofessional team.
• You may give the ECEs tasks to maintain
and reinforce established speech/language/
communication skills but not tasks that help
establish new skills.
