Private practice therapists in Canada should be aware that PIPEDA applies to free consults.
Q: Do private practice therapists need consent to offer free consults?
Private practice therapists in Canada must be vigilant about getting consent to offer free consults because of PIPEDA, the Personal Information Protection and Electronic Documents Act. This is a Canadian law that shares some of the principles contained in the US law known as HIPAA, the Health Insurance Portability and Acountability Act. The emphasis is on accountability. PIPEDA states that a private business must not collect names, addresses and background reports if the company does not have consent to have that information. Furthermore, a private business must make reasonable efforts to ensure that the individual is advised of the purposes for which his or her information will be used or disclosed, and state the purposes in a manner that the individual can reasonably understand.
Get Written Consent
Reduce your risk by getting written consent early in your interactions with the public. Create online referral and consent forms for your website. I teach private practice therapists how to do this in the AttractWell platform. People fill these in before they book any appointments. When an agency wants to set up a contract, ask the agency to direct the family to the URL with the consent form.
Therapists need consent before providing services.
Q: What does informed consent entail?
Informed consent entails informing the client about what will be collected and details about the type and number of services that will be provided. For SLP’s, it is a good idea to use the words assessment and therapy since this is how funders define SLP services.
Q: Should my clients give consent for telepractice service delivery?
Yes, your clients need to know what to expect. Your referral process, your consent forms and your contracts should provide all the necessary details in writing.
Q: What does consent for the release of information entail?
This consent is for collecting information and for disseminating information. The client should indicate which people or agencies are permitted to receive information from you. This applies to verbal, written and electronic communication.
Likewise, if you want to obtain information about a client from another professional or agency you need to provide a Consent for Release of Information form when you request the information. Even if the client wants a copy of their own data, they must request it formally and provide signed consent.
Q: When is a consent for services needed by clients accessing services from a public organization?
Consent for basic services offered by a public organization is assumed. For example, if a member of the public arrives at a hospital or if a child is enrolled in a school, it is assumed that the person wants the basic services offered by that organization. It should be noted, however, that non-residents may not be eligible for publicly funded services. They may need to pay privately in order to access those services.
Because the data collected belongs to the organization, the employees within that organization can collaborate and make decisions. For example, hearing screening is conducted in newborn nurseries and follow up is determined. Reading readiness screening takes place in schools and students are given learning assistance. Often screening programs have internal follow-up but no reports. The client or family may not even be aware that an assessment has taken place and treatment decisions have been made.
Essentially, the process of narrowing enquiries down to qualified prospects occurs seamlessly inside many public organizations. They might not call it by this name.
It is important for public organizations to define the services that go beyond basic services. Simply put, these are services that members of the public are not expecting. These are services that are only offered to people who need them, qualify for them and give consent for them. The client or family members should be made aware of the risks and benefits, and they should be involved in the decision. This is referred to as informed consent for services.
A hospital might require consent to do surgery. A school might require consent to do a psycho-educational assessment.
Does this mean that public agencies should ask for consent to offer telepractice services? Yes, if the client is expecting face to face services and the service provider is recommending telepractice services, this change requires consent. In addition, the client should be informed of the benefits, the risks and the safeguards in place to protect the confidentiality of the data.
Q: Can a teacher ask me questions about a student who is not on my caseload? Can I provide advice about a client if I have not asked for consent?
Professional communication within a workplace is normal; however, you are not permitted to reveal personal information about a client to anyone outside of your public organization or private business without consent. Be very careful about all your interactions. Privacy laws apply no matter what form of communication you use.
I was a service provider for a number of distance learning schools. The schools had contracts with my company. I was not their employee. Some of my students had large treatment teams which included teachers, assistants and other private service providers.
All phone calls that came to my office automatically went to voicemail. I asked team members to use my online scheduler to book phone calls. This helped me avoid phone tag and gave me a chance to ask the family for consent before I spoke to the person.
Telepractice is an Emerging Solution
During 2020 - 2021, the pandemic forced therapists to transition to telepractice service delivery. It didn't take long for the global community to realize that telepractice was an emerging solution for people who are looking for services and for professionals wanting to build a viable practice.
Three Types of Telepractice
The American Speech Language Hearing Association (ASHA) is recommending the term telepractice over other terms such as telehealth, telemedicine, telespeech, and speech teletherapy to avoid the misperception that these services are used only in health care settings.
Common terms describing types of telepractice are as follows:
Synchronous (client interactive): Services are conducted with an interactive audio and video connection in real time to create an in-person experience similar to that achieved in a traditional encounter. Synchronous services may connect a client or group of clients with a clinician, or they may include consultation between a clinician and a specialist.
Asynchronous (store-and-forward): Images or data are captured and transmitted (i.e., stored and forwarded) for viewing or interpretation by a professional. Examples include transmission of voice clips, audiologic testing results, or outcomes of independent client practice.
Hybrid: Applications of telepractice that include combinations of synchronous, asynchronous, and/or in-person services.
Common Fears for Online Therapists
The barriers to telepractice in Canada were reduced during the pandemic because of the urgency of taking care of caseloads. Funders were forced to accept telepractice as a service delivery method. Clients downloaded apps and showed up for sessions.
All therapists had to take risks and learn new skills. Private practice therapists were faced with becoming online entrepreneurs. Here are some common fears expressed by therapists.
- First of all, how do you stay legal? What are your obligations regarding compliance with privacy protection laws and professional conduct? Currently, Canada has vastly different privacy protection laws from province to province. Within provinces, there are variations depending on the place of employment and even the source of the caseload data.
- Secondly, how do you convey competence when the technology keeps changing and the learning curve is so steep?
- Thirdly, how do you compete online to attract your ideal caseload?
- Fourthly, how do you keep your clients committed, paying you well and staying long enough to get clinical outcomes?
Telepractice Service Delivery Solves Problems
In Canada, we have a long history of inequitable access to therapy services for rehab and intervention. During the pandemic, we saw that telepractice service delivery solved some of our intractable problems.
Risk of Spreading Disease
Speech language therapy became a dangerous profession during the pandemic. SLPs could no longer sit close to clients and use the mouth to teach concepts. Some SLPs tried to work behind plexiglass. The acceptance of webcam sessions was rapid because it eliminated the spread of the virus.
Vacancies
Therapy positions in rural communities sometimes stay vacant for a long time while employers try to recruit someone. Experienced therapists tend to be well-established in their careers. They are not interested in moving or even taking short term assignments away from home. Long waiting lists create desperation for people living in those rural communities. They waste their precious funding on fads, unproven therapies and unqualified service providers.
In contrast, telepractice services can be used to address vacancies. Employers can either develop their own telepractice outreach programs or hire private contractors to provide online services.
Demands on Therapists
Even people living in urban centers struggle with finding a therapist who is available at the right time. Many families want a therapist who will come to their home evenings or weekends. Children are in daycare or school all week. Adults can't take time off work.
Private practice therapists can't sustain a caseload that involves giving up evenings and weekends and travelling to homes without being reimbursed.
In contrast, telepractice services allow private practice therapists to build a business that is efficient and profitable. It gives them work-life balance.
Telepractice Service Delivery Offers Benefits
Telepractice gives people access to expert help, so they can make progress on their rehab and intervention. There are benefits for the public, for individual therapists and for the professions.
- The time and expense of travel for clients and therapists is eliminated. Therapists can extend the reach of their practice.
- Telepractice can increase the frequency of contact.
- It is a future-proof way to provide assessment and intervention. The reliance on pen and paper and physical therapy materials is greatly reduced.
- Monitoring can be done asynchronously by viewing data on a server
- Telepractice can turn therapists into leaders in their professional field because therapists can develop a clinical niche.
- Clients with rare and difficult diagnoses can get access to highly effective treatments.
- It can provide new grads with mentoring from confident leaders.
- A more affordable tiered service model is possible because a highly specialized expert can create goals and direct a local team in following a robust therapy protocol.
- Software can be used as curriculum, greatly reducing the need to train paraprofessionals to fidelity.
- The risk of spreading diseases is eliminated.
- Telepractice increases the efficiency and profitability of a therapy practice.
