Health Professions Council
Psychologists Scope of Pactice Preliminary Report


Irvine E. Epstein, Q.C., Chair
Arminée Kazanjian, Member
David MacAulay, Member

August 1999

This Preliminary Report should be read
in conjuction with the Post-Hearing Update for the profession.

FOREWORD

This report is the result of the Health Professions Council's review of the scope of practice of psychology pursuant to the Terms of Reference from the Minister of Health and Minister Responsible for Seniors. Under the Health Professions Act, the Health Professions Council is a six-person advisory body appointed by the Government of British Columbia to make recommendations to the Minister of Health and Minister Responsible for Seniors about the regulation of health professions.

In this report the Health Professions Council examines how the existing scope of practice of psychology should be legislatively defined in order to reflect fairly and accurately the current state of practice and the public interest in the practice of psychology

CONTENTS

EXECUTIVE SUMMARY

I. INTRODUCTION

A. THE NATURE OF THE REVIEW

B. THE PROCESS FOR THE REVIEW

C. THE REGULATION OF PSYCHOLOGY

II. THE POLICY BACKGROUND

III. DISCUSSION OF ISSUES

A. SCOPE OF PRACTICE

B. RESERVED ACTS

C. SUPERVISED ACTS

D. RESERVED TITLES

E. OTHER ISSUES

1. Current Exemptions from Title Protection and Registration under the Psychologists Act
a) The College of Psychologists of BC's Position on the Exemption Issue

F. IMPLICATIONS OF THE COUNCIL'S RECOMMENDATIONS

IV. RECOMMENDATIONS

APPENDIX A: Terms of Reference
APPENDIX B: RESERVED ACTS LIST
APPENDIX C:
 
BC PSYCHOLOGICAL ASSOCIATION
PROPOSED SCOPE OF PRACTICE
APPENDIX D: PSYCHOMETRIC TESTS (LEVELS A, B AND C)
APPENDIX E:
 
SECTION 28, TEACHING PROFESSION ACT, RSBC 1996, c. 449 SECTION 16, SCHOOL ACT, RSBC 1996, c. 412

EXECUTIVE SUMMARY

The Health Professions Council has conducted a review of the scope of practice of psychology.

The purpose of the review is to provide recommendations to the Minister of Health and Minister Responsible for Seniors regarding four matters: scope of practice statements, reserved acts, supervised acts, and reserved titles.

The Health Professions Council has conducted a detailed consultation process and its recommendations regarding the four elements of the scope review are as follows:

  1. The Health Professions Council recommends the following scope of practice be granted to members of the College of Psychologists:

    The practice of psychology is the diagnosis, treatment and prevention of mental and psychological disorders, dysfunctions and conditions, and the assessment, treatment and enhancement of behavioural, emotional and interpersonal functioning by the application and use of psychometric testing, psychological assessment, and the treatment and management of clinical and non-clinical conditions.

  2. The Health Professions Council recommends the following reserved act be granted to members of the College of Psychologists:

    Making a diagnosis, identifying a mental or psychological disorder, dysfunction or condition as the cause of signs or symptoms of the individual.

  3. The Health Professions Council recommends that a provision be enacted which deals with general principles regarding delegation of reserved acts. The provision would apply generally, not to individual cases. It should require the following:

    • The assigning health professional's governing body must provide assent to the proposed reserved act being performed by someone else;

    • The reserved act to be assigned as well as the level of supervision must be clearly defined and circumscribed by the assigning health professional's governing body;

    • Where the person to whom the act will be assigned is a member of a self-regulated health profession, his or her governing body must approve of the assignment;

    • The instruction to perform the act must be made in writing either by way of a general written protocol or through a case-specific instruction;

    • The assigning health professional must be satisfied that the individual who will be performing the act has the necessary skills and training to perform the act safely;

    • The assigning health professional must ensure that the person who will be performing the act accepts the assignment.

  4. The Health Professions Council recommends that the title "psychologist" be reserved for members of the College of Psychologists.

  5. The Health Professions Council recommends that there be no exemptions from the title protection provisions of Recommendation 4.




I.     INTRODUCTION

A.     THE NATURE OF THE REVIEW

This is the preliminary report of the review of the scope of practice of psychology by the Health Professions Council (Council).

The review was conducted pursuant to Terms of Reference issued by the Minister of Health and Minister Responsible for Seniors in accordance with section 25 of the Health Professions Act (HPA). The Terms of Reference direct the Council to review the scopes of practice of the recognized health professions, of which psychology is one.

The Terms of Reference, which are included as Appendix A to this report, indicate that there are four main elements to the scope of practice review:

  1. scope of practice statements which describe what the profession does, the methods it uses and the purpose for which it does it;

  2. reserved acts which are those acts that present such a significant risk of harm that they should be performed only by professionals who are qualified to perform them;

  3. supervised acts which are reserved acts, or aspects of reserved acts, which may be performed by persons supervised by health professionals; and

  4. reserved titles which are titles that describe a profession's services and which are reserved exclusively for the health profession.




B.     THE PROCESS FOR THE REVIEW

The general process for the review provides for an initial meeting with the profession(s), submission of briefs by the regulatory body and professional association for each profession, a consultation process involving all health professions and interested parties regarding each professions' submission, drafting of a preliminary report, public hearings and a final report.

The Council initially met with the College of Psychologists of BC (College) on April 3, 1995, and again on July 28, 1995, to discuss the scope review process. The College made a submission to the Council in July 1995. The Council also met with the BC Psychological Association (Association) on June 26, 1995. The Association handed its submission to the Council at that meeting. A public consultation process was conducted in 1996 based upon the submissions of the College and the Association. In February, 1998, the College and the Association made a joint submission responding to the submissions to the Council's consultation letter.

This report will be circulated to all health professions and other interested parties who participated in the Council's consultation process. A public hearing is scheduled on December 2, 1999, after which a final report will be issued. Persons or organizations who have made written responses to either the original consultation letter or to this preliminary report will be invited to speak at the hearing.




C.     THE REGULATION OF PSYCHOLOGY

The first provincial enactment was the Psychologists Act, SBC 1977, c.19. It defined the practice of psychology and the term "registered psychologist", and restricted the use of the titles "psychologist" and "registered psychologist" to registered persons. It prohibited an unregistered person from practising psychology and representing him/herself as a psychologist, unless he/she fell within a class of exemptions. The exemptions included persons authorized to practise their profession under another Act; a person teaching, lecturing or engaging in research as a psychologist in a university setting; and a person acting in the course of employment by government or government agency or by a board of school trustees, where qualifications in psychology are a condition of such employment.

Various amendments were enacted from time to time which extended exemption from the Act, permitted the use of the restricted title "psychologist", expanded the disciplinary powers, set out the duties of the College and provided for public membership on the board.

Finally, at the end of 1998, the College of Psychologists of BC requested designation under the HPA and the repeal of the Psychologists Act.




II.     THE POLICY BACKGROUND

The main impetus for a scope of practice review was the Report of the British Columbia Royal Commission on Health Care and Costs (Seaton Commission). The Seaton Commission stated that the existing legislation governing the health professions creates persistent jurisdictional disputes and a distinct lack of cooperation among the health professions, despite the fact that all health professional colleges have the same mandate - to protect the public from preventable harm.

The Seaton Commission stated that the primary reason for the jurisdictional disputes was the present regulatory system's reliance on exclusive scopes of practice. Under the exclusive scope of practice model, the various health professions have been granted an exclusive right to practice within a legislatively defined scope of practice. No one, other than a member in good standing of that profession, can perform acts within the profession's scope of practice unless they are granted an exemption.

The Commission concluded:

...exclusive scopes of practice should be narrowed to focus on preventing harm, as has been initiated recently in Ontario. We believe that more appropriate, cost-effective and timely health care could be provided to more patients if B.C. were to follow the Ontario initiative.

(Closer to Home, The Report of the Royal Commission on Health Care and Costs in British Columbia, Volume 2, 1991, p. D-33)

This recommendation is also consistent with legislative initiatives underway in Alberta. The Seaton Commission was not the first review body to suggest that the present legislative model of exclusive scopes of practice was inappropriate. Restricting professional monopolies (exclusive scopes of practice) was also recommended in an earlier study commissioned by the British Columbia Minister of Health. In discussing the conflicts which may arise between the professional college and the public interest, the issue of exclusive scopes of practice was raised:

It must be emphasized that any professional legislation which unduly restricts the scope of practice of skilled personnel may be contrary to the public interest in greater supply and accessibility of service through the development of team practice. Therefore, it is urged that: Professional legislation should not contain narrow restrictions or rigid definitions of scope of practice which are excessively exclusive; that measures should be taken (as indicated below) to reduce the area of interprofessional strain and conflict; and that no prosecutions for violations of scope of practice legislation should be undertaken without the prior consent of the appropriate public authority.

Insofar as may be possible with due regard for public safety, professional law should not place rigid restrictions on the scope of practice of allied health personnel, and greater flexibility should be encouraged in the allocation of roles between the health disciplines.

(Professor J.T. McLeod, Public Regulation of the Professions in Health Security for British Columbians, Special Report: Consumer Participation, Regulation of the Professions, and Decentralization (1974), the report of Richard G. Foulkes, B.A., M.D., F.A.P.H.A. to the Minister of Health, Province of British Columbia, Tome Three, p. 145)

Thus, the trend in regulatory policy for the health professions has been towards reducing exclusivity in order to enhance interdisciplinary practice, improve accessibility to health care services and increase consumer choice, while at the same time maintaining the fundamental objective of protecting the public.

These policy trends are clearly reflected in the Terms of Reference for the scope of practice review which provide the basis for a new regulatory framework for health professions in British Columbia. The core elements of the new framework are scope of practice statements and reserved acts.

Under the present system, scope of practice statements are exclusive. In the new system, scope statements will not be exclusive but professions may be granted reserved acts.

Reserved acts are those elements of a profession's scope of practice which present such a significant risk of harm that they should be reserved to a particular profession, or shared amongst particular professions. Thus, unlike the present system in which each profession is granted exclusivity within its entire defined scope of practice (subject to specified exceptions), only those acts which present a significant risk of harm will be reserved.

In short, the government has assigned the Council the task of creating a regulatory model based on broad, non-exclusive scope of practice statements and narrowly defined reserved acts.

The government has the responsibility to ensure that those services which are accessible are safe and that the regulatory framework for the practice of health professions protects the public from incompetent, impaired, or unethical practitioners. At the same time, the regulatory framework should not entrench a paternalistic function for professions or reserve exclusive areas of practice simply to enhance professional status and control.

The new system of overlapping scopes of practice and narrow reserved acts removes barriers to interdisciplinary practice and offers greater choice and accessibility to the public. In the Council's view, the public interest is served by professional legislation which promotes quality in the delivery of health care services within safe parameters. Indeed, the Council's primary policy objective in conducting its review is achieving the optimum balance between safe practice and consumer choice.

With this in mind, the Council proposes to consider the practice of psychology having regard to the four elements of the scope review.




III.     DISCUSSION OF ISSUES

The issues raised by this review are the four elements listed above: scope of practice, reserved acts, supervised acts and reserved titles.

The Council's Terms of Reference direct it to review these four elements with regard to psychology.




A.     SCOPE OF PRACTICE

The scope statement describes what the profession does, the methods it uses, and the purpose for which it does it. Unlike the present legislative scheme, the statement itself does not grant an exclusive scope of practice. Nonetheless, the statement is important because-- it defines the area of practice for which the governing body must establish registration requirements and standards of practice; it defines the parameters of the profession for members of the profession, employers, courts and educators; and it informs the public about the services practitioners are qualified to perform. It is expected that the Council's recommendations will increase overlapping scopes of practice.

The Council believes that it is not necessary or useful to itemize every facet of a profession's scope of practice. Rather, a scope of practice definition should be sufficiently descriptive so that other health professions and members of the public alike can understand what the particular health professional does.

Currently the Psychologists Act (PA) describes "the practice of psychology." However, it does not confer an exclusive scope of practice on members of the College.

1 In this Act:

the practice of psychology includes

(a) the provision to individuals, groups, organizations or the public of any service involving the application of principles, methods and procedures of understanding, predicting and influencing behaviour, including the principles of learning, perception, motivation, thinking, emotion and interpersonal relationships,

(b) the application of methods and procedures of interviewing, counselling, psychotherapy, behaviour therapy, behaviour modification, hypnosis, research, or

(c) the construction, administration and interpretation of tests of mental abilities, aptitudes, interests, opinions, attitudes, emotions, personality characteristics, motivations of psychophysiological characteristics and the assessment or diagnosis of behavioural, emotional and mental disorder

for a fee or reward, or otherwise.

Both the College and the Association agree that section 1 of the PA does not define a scope of practice and in their individual submissions , each proposes a new scope of practice.

The College proposed the following scope statement in its 1995 brief to the Council:

Registered Psychologists

(a) diagnose, treat, and prevent any mental disease or disorder, or emotional or family disturbance, from infancy through the entire life span. These activities are accomplished by providing psychological assessment, psychometric testing, treatment and management of clinical and non-clinical conditions with the goal of furthering both emotional and physical health.

(b) provide consultative advice to other health providers, to legal counsel, to courts, to government agencies, to corporations, and to other community agencies.

(c) develop and evaluate assessment and intervention methods for use with normal and clinically-dysfunctional persons and groups.

The Association, proposed a similar scope but expanded it to include lengthy descriptions of what registered psychologists, school psychologists, industrial/organizational psychologists, and counselling psychologists do. The descriptions, while informative, go far beyond the prescribed purpose of a scope of practice statement as previously set out in this report (the full description as submitted by the Association is set out in Appendix C).

Respondents to the consultation process generally supported the scope of practice statements proposed by the College and the Association, as long as the scope statement is not exclusive, recognizing many other professionals provide services which fall within the proposed scope statements. Scope of practice statements, under the Shared Scope of Practice Model Working Paper (Working Paper) which the Council has been directed to review, are not exclusive, but descriptive, and aspects may be shared with others, including both regulated and unregulated practitioners. Reserved acts represent the only portion of a scope of practice which is restricted, but reserved acts may also be shared by more than one profession.

Many respondents recommended limitations to the scope so that psychologists practice only within their specialty areas of expertise. The College is currently utilizing a competency model for describing the areas in which a registered psychologist is competent to practice . As was stated in the College's August 11, 1998 letter to the Council:

Whether or not an individual has a Masters or Doctorate, it does not automatically qualify them for all possible tasks a psychologist can perform. Rather like most professions there are a number of different general areas of practice and specialties. Thus the College is pursuing a competency model for describing what areas a psychologist is competent to practice in. . . Please note that there are a wide range of areas of competency, many of which do not overlap and require specific training in order to develop specific expertise.

The College's position is consistent with the mandate of all regulated health professional bodies which must protect the public by determining that all registrants are practicing within their particular professional competency. However, specialty certification is not an issue to be addressed in a scope of practice statement.

There were specific concerns by some respondents about both the College and the Association scope statements. In particular, the BC Medical Association (BCMA), the College of Physicians and Surgeons of BC (CPSBC), the UBC Department of Psychiatry and the Registered Psychiatric Nurses Association of BC (RPNABC) object to the use of the term "any mental disease or disorder" to describe the range of conditions which psychologists are qualified to diagnose, treat and prevent. The BCMA believes that this proposed change to the scope of practice is unacceptable and would imply to the public that purely psychological treatment of an illness with mental or emotional manifestations would be adequate treatment. The RPNABC states that mental illnesses often involve a complex interplay of physical and mental causes, and psychologists are usually not trained to detect underlying physical causes. In short, the RPNABC believes that psychologists at best are able to diagnose the "psychological aspects" of a mental disorder or disease. The MOH (Adult Clinical Service Branch) is concerned about the use of the term "mental disease" as it would include psychiatric conditions which a psychologist may not be able to treat.

The College of Massage Therapists of BC (CMTBC) states that the Association's proposal is too long and procedure-specific to become a meaningful definition. It further states that like all professions, the psychology scope of practice definition should be sufficiently descriptive and complete so that an average person can understand what someone practising that profession does. The CMTBC submits that the definition used in Ontario's legislation is the most focused and best articulated of the alternatives and suggests that it be adopted.

The Council agrees that the Association's proposed scope of practice statement, while it usefully lucidates the specialty areas of psychology, is too detailed to meet the Council's Terms of Reference. However, certain aspects of it and of the College's proposed scope are appropriate to include in a scope statement.

The Council considered the scope of practice descriptions for psychology which have been adopted in other jurisdictions across Canada and the United States. Several were submitted by the College and Association.

Ontario: The practice of psychology is the assessment of behavioural and mental conditions, the diagnosis of neuropsychological disorders and dysfunctions and psychotic, neurotic and personality disorders and dysfunctions and the prevention and treatment of behavioural and mental disorders and dysfunctions and the maintenance and enhancement of physical, intellectual, emotional, social and interpersonal functioning.

Alberta: "practice of psychology" means the application of professional psychological knowledge for compensation for the purpose of the diagnosing, preventing, remedying or ameliorating human mental, emotional, behavioural or relationship difficulties, in order to evaluate or enhance human performance and to enhance mental or physical health;

Ohio: "The practice of psychology" means rendering or offering to render to individuals, groups, organisations, or the public any service involving the application of psychological procedures to assessment, diagnosis, prevention, treatment, or amelioration of psychological problems or emotional or mental disorders of individuals or groups; or to the assessment or improvement of psychological adjustment or functioning of individuals or groups; whether or not there is a diagnosable pre-existing psychological problem. Practice of psychology includes the practice of school psychology. For purposes of this chapter, teaching or research shall not be regarded as the practice of psychology, even when dealing with psychological subject matter, provided it does not otherwise involve the professional practice of psychology in which patient or client welfare is directly affected.

California: The practice of psychology is defined as rendering or offering to render for a fee to individuals, groups, organisations or the public any psychological service involving the application of psychological principles, methods and procedures of understanding, predicting, and influencing behaviour, such as the principles pertaining to learning, perception, motivation, emotions, and interpersonal relationships; and the methods and procedures of interviewing, counselling, psychotherapy, behaviour modification, and hypnosis; and of constructing, administering, and interpreting tests of mental abilities, aptitudes, interests, attitudes, personality characteristics, emotions, and motivations.

The application of such principles includes, but is not restricted to: diagnosis, prevention, treatment, and amelioration of psychological problems and emotional and mental disorders of individuals and groups.

Psychotherapy within the meaning of this chapter means the use of psychological methods in a professional relationship to assist a person or persons to acquire greater human effectiveness or to modify feelings, emotions, conditions, attitudes, and behaviour which are emotionally, intellectually, or socially ineffective or maladaptive.

After consideration of the respondents' comments and the College's and Association's proposed scope statements, the Council concludes that the following scope of practice definition most closely meets the requirements of the Terms of Reference.

Recommendation 1:

The Council recommends the following scope of practice be granted to members of the College of Psychologists:

The practice of psychology is the diagnosis, treatment and prevention of mental and psychological disorders, dysfunctions and conditions, and the assessment, treatment and enhancement of behavioural, emotional and interpersonal functioning by the application and use of psychometric testing, psychological assessment, and the treatment and management of clinical and non-clinical conditions.




B.     RESERVED ACTS

The rationale underlying the granting of reserved acts is to protect the public by limiting provision of those particularly dangerous acts to members of specific professions who are qualified to perform them. Only those acts which present a significant risk of harm will be reserved. The Council developed a list of reserved acts, and included it in a report it recently issued, the Working Paper.

The College and the Association have proposed reserved acts which differ slightly but overlap significantly. For ease of reference to respondents' positions with regard to those acts, these will be set out separately, first dealing with the College's proposed reserved acts. The Association's proposed reserved acts will be highlighted should they differ in a manner which would significantly affect the recommendation.

The College has proposed that the following act be reserved exclusively to psychologists:

  • Interpretation of Psychometric Tests designed and intended for the exclusive use of psychologists.

The description of psychometric tests which was contained in the 1996 consultation letter is included as Appendix D.

The College has proposed the following act be reserved and shared by psychologists and physicians:

  • Diagnosis of mental and emotional conditions as defined by the Diagnosis and Statistical Manual: Fourth Edition (A.P.A., 1994), and the International Classification of Diseases and Related Health Problems: Tenth Edition, or their future editions.

In support of its request for reserved acts the College provides the following rationale and documentation of risk of harm at pages 2 to 8 of its July 1995 submission. The 1995 submission states:

Psychologists offer services to normal individuals, individuals with mental disorders, with stress-related and chronic physical disorders (e.g., chronic headache, benign back pain, irritable bowel syndrome), and those requiring educational or vocational assessment and advice. These services involve assessment, diagnosis, counselling, and more technically complicated treatments including different psychotherapies.

. . .

Psychological assessments ... involve ... interviews concerning (a) current mental status, (b) social, medical, educational, vocational, and psychological histories, and (c) referral-question relevant issues. Psychologists administer and interpret standardised psychometric instruments (e.g., measures of personality, psychopathology, intelligence, academic aptitude or achievement, neuropsychological functioning) as part of their assessments. Psychologists review other records (e.g., health, school, criminal records etc.) and gather collateral information from family members and acquaintances to aid in their assessment. Psychologists also use published epidemiological and local base rate data for making diagnoses or other decisions.

. . .

The proposed scope will restrict the interpretation of those psychometric instruments designed and intended for the exclusive use of trained psychologists (i.e., level B & C tests).

In Louisiana, ... a specific judgment has been made in regards to who may administer and interpret tests ... [which] restricts them from administering or interpreting other tests considered to be "within the exclusive domain of psychologists and physicians."

. . .

The law further provides that a test must be considered "psychological" if it is used "for the purpose of treatment planning and diagnosis, classification or description of mental and emotional disorders and disabilities, disorders of personality, psychological aspects of physical illness, accident, injury or disability, and neuropsychological impairment. ..."

Restricting psychological testing will serve the public interest by best ensuring that consumers will receive safe services. Thus, it will be less likely for example, that individuals would be misdiagnosed as Mentally Retarded or Schizophrenic and suffer the stigma and restrictions that accompany those labels. Similarly, such restrictions will improve the reliability of psychological assessments. This is especially important given the remarkable growth in the use of psychological tests and psychological expertise in family, civil, and criminal litigation, and the serious consequences of assessments in these venues.

The proposed reserved act of diagnosis within the scope of practice of psychology will have beneficial consequences for the general public. This will reduce the likelihood of misdiagnosis by untrained professionals and reduce the likelihood of misguided therapy.

. . .

The current act does not protect the public from the mis-use of psychometric instruments (e.g., psychometric measures of psychopathology, personality, neuropsychological functioning, or intelligence), mis-diagnosis of mental health conditions, and incompetent counselling or therapy by untrained individuals. This results in harm to a large number of individual residents of British Columbia.

The Council has previously recognized the significant risk of harm inherent in the diagnostic process in its Working Paper. Diagnosis is a reserved act.

The College and the Association provided a number of cases where misdiagnosis resulted in harm to individuals. The examples involved persons who were exempted from regulation under the PA, however, they made diagnoses which were used to support treatment plans, court decisions regarding custody or institutionalization or long-term educational planning:

Case 1: ... [A] government employee (not a registered psychologist) diagnosing an individual as Mentally Retarded solely on the basis of a test score obtained in non-standardised conditions, and without reference to other data in conflict with that test score...

Case 2: A counsellor, trained in neither applied human processes nor sychopathology diagnoses her patient's panic attacks as a consequence of repressed memories of childhood sexual abuse.

Case 3: A physician, untrained in the interpretation of psychological tests ... routinely uses the M.M.P.I. for his assessments of motor vehicle accident litigants. He routinely mis-scores the test ... in a manner inconsistent with instructions in the manual ... the Court receives erroneous data for making its decision.

Case 4: A child was evaluated using questionable testing practices by a non-psychologist during a custody assessment. The report was instrumental in the decision to remove the child from the mother's custody. When challenged, the non-psychologist revised his report, stating that he had made numerous unsubstantiated conclusions.

Case 5: A girl was tested by a school psychologist who was not competent to evaluate her overall neuropsychological, cognitive, personality and behavioral development. The diagnosis was congruent with the test scores, but too few and the wrong tests were used. The girl was placed in a special class for mentally handicapped students and deprived of an appropriate education.

The Association originally proposed in 1995 that all psychometric testing should be either reserved to psychologists (Levels B and C) or supervised by psychologists (Level A). Within the context of a reserved acts system, only those acts or activities which carry a significant risk of harm and thus designated as reserved acts would qualify to be "supervised acts." Therefore, the Association's original submission was actually requesting that all three levels of testing should be reserved to Psychologists. This position appears to have been substantially altered by a joint submission of the College and the Association made on February 18, 1998 . This submission was made after both had reviewed the consultation process responses. The 1998 joint submission provides clarification and uniformity to the College and Association's request for reserved acts:

Determining the cause and naming a disease, disorder or condition is the feature which sets the act of diagnosis apart from testing or assessment. Only psychologists are qualified to accurately diagnose psychological conditions which are present, and characteristics or conditions which might also be present. ... The identification of a disease, disorder or condition as the cause of signs or symptoms of the individual, which may be termed diagnosis, is recommended by the BC Psychological Association to be a reserved act. The province of Ontario has reserved the act of diagnosis to Psychology. " In the course of engaging in the practice of psychology, a member is authorized to communicate a diagnosis identifying, as the cause of a person's symptoms, a neuropsychological disorder or a psychologically based psychotic, neurotic or personality disorder."

In diagnosis, tests are used to assist in naming a disease, condition or disorder, as part of decision-making regarding individuals' ability and education (intelligence testing), or treatment (personality testing) or punishment (forensic personality testing). Tests listed as Level C test and some Level B tests must be administered and interpreted in the correct context. In contrast, Level A and many Level B tests are used to evaluate preferences, vocational interests, reading ability, and other non-life threatening domains of behaviour. Their administration and interpretation requires a limited amount of training. Possible abuse of Level A and B tests is limited by the weight which others give to the test results when they make decisions regarding the patient, student or worker.

The February 18, 1998 joint submission appears to narrow the College's and the Association's request for reserved acts to diagnosis and to Level B and C testing.

Respondents to the consultation appeared to generally support the request for the reserved act of diagnosis, so long as it is worded to encompass the concerns already mentioned with regard to the scope of practice statement, i.e., to avoid the use of the term "any mental disease." Another concern of a number of respondents was that other professionals who are trained and competent to perform diagnosis not be prohibited from performing any type of diagnosis that may be granted to psychologists.

Reserved acts may be shared among regulated health professionals who are granted those acts. The reserved act of diagnosis, when occurring in a mental health or psychological context, can be shared among regulated health professionals, including medical practitioners, psychologists and others, if any, who demonstrate training and competency to perform this type of diagnosis.

The Ministry of Education, Skills and Training (MOEST) recommends that members of the College of Teachers be included in the following reserved acts proposed by the MOEST: diagnosis of mental and emotional disorders; mental retardation, learning disorders, motor skill disorder; developmental disorders and communication disorders. The MOEST further states that restricting diagnosis and treatment of conditions to registered psychologists would significantly infringe upon good educational practice, and would severely restrict the ability of educational professionals to perform the services for which they are trained. This submission fails to take into account that granting the reserved act to psychologists who are members of the College does not mean it is exclusive to them.

The issue of reserved acts for Level B and C testing caused a range of comments. The most controversy appears to surround level B testing, since many of these tests are used by counsellors, teachers, therapists of all kinds and others. In addition, it is not clear which level B tests carry sufficient risk of harm to require reservation. The College has acknowledged in its February 18, 1998 submission that:

Tests listed as Level C tests and some Level B tests must be administered and interpreted in the correct context. In contrast, Level A and many Level B tests are used to evaluate preferences, vocational interests, reading ability and other non-life threatening domains of behaviour.

In general, respondents who commented about Level C testing support reservation of Level C tests to those who have the requisite training and qualifications. The MOEST commented that Level C tests are commonly used by teachers. The BCMA finds the reservation of levels B and C testing to the exclusion of general medical practitioners and psychiatrists to be unacceptable. The BC Association of School Psychologists (BCASP) states that individuals certified by BCASP are as competent as registered psychologists to administer and interpret "psychological" and educational tests used in the school setting. The BC Society of Occupational Therapists indicates that there are a number of Level B and C tests which occupational therapists competently use at the present time. The Adlerian Psychology Association of BC objects to the exclusive reservation of levels A, B and C testing, to psychologists, noting that many educators, counsellors and other trained professionals have training and expertise in using these tests. The BC Teachers' Federation (BCTF) says there is no potential for harm in administration of Level A and B tests because of the "safeguards in the system." The BCASP states that supervision by its members or registered psychologists is desirable as incompetent administration of these tests can result in harm to individuals. The Canadian Association of Rehabilitation Professionals objects to the exclusive reservation of Level B and C testing and comments, as do many others, that these tests were not designed exclusively for psychologists but rather for specific uses. The American Association of Pastoral Counsellors objects because many of the tests are within the training of other counselling professionals. The BC Association of Clinical Counsellors notes that reservation of psychometrics is contrary to the position of the American Psychological Association which states that access to such tests should be based on knowledge and behaviours of test users rather than job titles or credentials.

The above comments are not an exhaustive list of responses to the issue of reservation of levels B and C testing. They however represent the range of concerns expressed. Although it appears that the majority of respondents see some degree of risk associated with Level C and some Level B tests, the principal objections seem to be based upon the exclusive nature of the reserved act requested. Respondents' comments were for the most part concerned that members of their particular profession or others might be prohibited from use of these tests. There appears to be general consensus that some degree of training and education must be possessed by persons who utilize some Level B and all Level C testing. There were concerns about both the administration and evaluation of these tests and in the interpretation of results by unqualified persons.

Most respondents did not directly address the risk of harm associated with the use of Level B and C testing. The College and the Association have provided examples of harm arising from misuse or misinterpretation of Level C and some Level B tests which can result in harm to individuals, even when utitlized by a qualified individual. The most significant risk of harm, in the Council's view, is in the misapplication, scoring, administration, or interpretation of test results which can lead to a mis-diagnosis or erroneous treatment plan. This is particularly important where, as is submitted by the Association:

in diagnosis, tests are used to assist in naming a disease, condition or disorder, as part of decision-making regarding individuals' ability and education (intelligence testing), or treatment (personality testing) or punishment (forensic personality testing). Tests listed as Level C tests and some Level B tests must be administered and interpreted in the correct context.

It is clear that only qualified individuals should administer and interpret Level C tests. Level C testing is one aspect of diagnosis. It is a critical component but the results and interpretation of Level C testing are not viewed in isolation when a health professional is arriving at a diagnosis or planning treatment interventions. For this reason, the Council's conclusion with regard to reserved acts is that members of the College be granted the reserved act of diagnosis as defined below. The use of the full range of psychological testing, including level B and C tests, may contribute to that diagnosis. However, it is the identification and naming of a psychological disorder, dysfunction or condition as the cause of signs and symptoms of the individual which carries a significant risk of harm and should be reserved to members of the College and others who are trained and qualified to perform it.

The College has expressed concern with physicians whose scope includes the diagnosis of mental disease, who use psychological testing in making their diagnosis even though unqualified to do so. The use of psychometric testing is no different than any other diagnostic tool and no one should use any diagnostic tool unless they have the requisite knowledge, skill and ability to use it competently.

Recommendation 2:

The Council recommends the following reserved act be granted to members of the College of Psychologists:

Making a diagnosis, identifying a mental or psychological disorder, dysfunction or condition as the cause of signs or symptoms of the individual.




C.     SUPERVISED ACTS

The Criteria and Guidelines attached to the Terms of Reference state that although reserved acts may only be performed by professions to whom they have been specifically granted, it may be appropriate for other persons to perform them or aspects of them, under the supervision of members of those professions. The Criteria and Guidelines also indicate that where Council is satisfied that a reserved act may be performed under supervision it may recommend training and qualification requirements, limitations regarding where the act may be performed and the degree of supervision required.

The College has proposed that its members supervise psychological diagnosis and testing, should the current exemptions from registration and title protection, be continued as they exist under section 28 of the PA.

The Association has proposed that persons in government and school settings performing psychological services but currently exempted from the PA should be supervised by a Registered Psychologist. This would apply to the reserved act, diagnosis.

Recommendation 3:

The Council recommends that a provision be enacted which deals with general principles regarding delegation of reserved acts. The provision would apply generally, not to individual cases. It should require the following:

  • The assigning health professional's governing body must provide assent to the proposed reserved act being performed by someone else;
  • The reserved act to be assigned as well as the level of supervision must be clearly defined and circumscribed by the assigning health professional's governing body;
  • Where the person to whom the act will be assigned is a member of a self-regulated health profession, his or her governing body must approve of the assignment;
  • The instruction to perform the act must be made in writing either by way of a general written protocol or through a case-specific instruction;
  • The assigning health professional must be satisfied that the individual who will be performing the act has the necessary skills and training to perform the act safely;
  • The assigning health professional must ensure that the person who will be performing the act accepts the assignment.

The reserved act of diagnosis as defined in Recommendation 2 has been recommended for members of the College. Therefore, the above recommendation regarding delegation of this reserved act would apply in all settings where diagnosis occurs, whether or not the exemption to title protection and College membership continue to exist.




D.     RESERVED TITLES

Reserved titles are titles reserved exclusively to a health profession. Reserved titles afford a means for consumers to identify the different types of health care providers, to distinguish the qualified from the unqualified, and to differentiate those practitioners who are regulated from those who are not. Titles must adequately serve the public in describing the practitioner and the services being provided and must distinguish the practitioner from others performing services outside the jurisdiction of the college.

The current title protection is contained in section 26 of the PA:

Prohibition
26 (1) A person must not engage in or carry on the practice of psychology and represent himself or herself as a psychologist, unless the person is registered under this Act.

(2) A person must not use, assume, or employ, or advertise or hold himself or herself out under the title of a "registered psychologist" or "psychologist" or any affix, prefix or abbreviation of the title as an occupational designation relating to the practice of psychology, unless the person is registered under this Act.

(3) A person must not obtain or attempt to obtain registration under this Act by fraud or misrepresentation.

(4) A person who contravenes subsection (1), (2) or (3) commits an offence.

(5) A person represents himself or herself as a psychologist if the person, for a fee or reward, monetary or otherwise, acts, represents, holds himself or herself out or advertises as a psychologist, and uses a title or description or words incorporating the word "psychology", "psychological" or "psychologist", or other terms implying training, experience or expertise as a psychologist.

The title protection is subject to the following exemptions:

Exemptions
28 (1) Nothing in this Act prevents a person

(a) who is authorized to practise a profession under an Act from practising that profession,

(a.1) from practising a profession in the course of the person's employment with a board or council under the Health Authorities Act or with a community health services society, designated by the minister for the purposes of this paragraph, incorporated under the Society Act,

(b) from teaching, lecturing or engaging in research as a psychologist, if those activities are carried out by reason of, and in the course of, duties under an academic appointment or program in a university as defined by the University Act, or

(c) from acting in the course of employment by a Provincial, federal or municipal government or government agency, by a francophone education authority as defined in the School Act or by a board of school trustees constituted under the School Act, if qualifications in psychology are a condition of such employment.

(2) Nothing in this Act prevents

(a) a person to whom subsection (1) (b) or (c) applies from using the title "psychologist" or an affix, prefix or abbreviation of the title, or

(b) a society whose members are persons to whom subsection (1) (b) or (c) applies from using a title or designation incorporating the word "psychology", "psychological" or "psychologist".

The College has requested the following reserved titles for its members:

  • psychologist
  • psychology
  • psychological, and its derivatives

The College's rationale for reserving these terms and title is that:

Currently, most members of the public do not understand the difference between a Psychologist and a Psychiatrist, a Psychologist and a Counsellor, a Psychologist and a Therapist, etc.

The Association has requested the titles:

  • psychologist
  • psychological associate
  • psychotherapist, to be used only by a psychologist or psychological associate

The Association's rationale is as follows:

"Psychologist" should be reserved for those who are Registered Psychologists. A second title "Psychological Associate" should be reserved for...persons acting in the course of employment by government or school boards...Currently, practitioners exempted from registration are not required to be trained to the standards required for registration, and they are not governed by the ethical guidelines of the profession of psychology. This has created a two-tiered system of service delivery, where Registered Psychologists in private practice often provide higher quality psychological services than do practitioners who are exempted.

The Association has also proposed that psychological associates be subject to general supervision by a psychologist.

Most respondents to the consultation process support the title "psychologist"; however, they do not see the usefulness of the term "psychological associate" when applied to persons trained at a masters degree level. The term "psychotherapist" was controversial as many respondents considered that it did not distinguish members of the College from those performing services outside the jurisdiction of the College.

Recommendation 4:

The Council recommends that the title "psychologist" be reserved for members of the College of Psychologists.




E.     OTHER ISSUES

1. Current Exemptions from Title Protection and Registration under the Psychologists Act

The first provincial enactment to regulate the practice of psychology was the Psychologists Act, SBC 1977, c.19. It defined the practice of psychology and the term "registered psychologist" and restricted the use of the titles "psychologist" and "registered psychologist" to registered persons. It prohibited an unregistered person from practising psychology and representing him/herself as a psychologist, unless he/she fell within a class of exemptions.

The Health Statutes Amendment Act, SBC 1987, c.55, expanded persons exempt from the Psychologists Act to include employees of a board of school trustees constituted under the School Act. It also provided that university psychology teachers and lecturers, and government employees in positions where psychology was a condition of employment may use the title psychologist.

In 1997, RSBC 1996, c. 381 was amended to include section 28(1)(a.1) and to add the phrase "by a francophone education authority as defined in the School Act" in section 28(1)(c).

a) The College of Psychologists of BC's Position on the Exemption Issue

The College, in its scope of practice submission in July 1995, states that the exemptions in the PA render it without jurisdiction over the exempted persons. It feels that the exemptions place the public at greater risk as there is no professional regulatory body to which these exempted professionals currently report and noone ascertains their competence or adjudicates complaints about either their competence or ethical conduct. The majority of individuals providing psychological services in the public school system are currently not regulated.

The College also states that there are multiple risks to the public through incompetent practice in school psychology. These include the misuse of specific psychological tests and miscommunication of psychological tests results, thereby resulting in erroneous conclusions and misdirection of the education and rehabilitation of students.

Further, the College states that there is a large number of psychologists employed by the Ministry of Health (MOH) and the College receives frequent complaints against these psychologists. To date, all psychologists found guilty of serious sexual impropriety in BC have been MOH employees and committed the sexual improprieties with MOH patients. Because there is no oversight by a professional body in place, the College believes that those who can afford private sector psychologists receive care from a generally more qualified psychologist than a person who can only afford government subsidized health care. Finally, the College states that non-psychologist supervisors often subscribe to a different set of ethical values.

The College suggests introducing categories of psychologists depending on qualifications. School psychologists in BC could create their own regulatory body or be regulated under a sub-section of another college. The College states that other jurisdictions have gradually withdrawn the exemption clause, by "grandparenting" currently exempted psychologists.

In 1998, the College wrote a number of letters to the Minister of Health regarding the recent amendments to the PA. The most significant factor for the Council's review of the scope of practice of psychology is the College's concern that public protection is compromised by the exemptions and that the College is unable to discipline exempted psychologists.

The College states that it receives complaints from the public regarding government-exempted psychologists. The College asks whether government's intention is to have two standards of practice; one for the government and one for the private sector.

The College further states that the amendments leave only private practitioners within the jurisdiction of the PA. It asks how it can protect the public from incompetence and harm when it will have no jurisdiction to discipline a large number in its profession.

Because there are three distinct categories of persons exempted from the PA under section 28, the Council will deal with each in turn.

Section 28(1)(a.1):

Persons authorized to practise a profession in the course of employment with a board or council under the Health Authorities Act or with a community health services society, designated by the minister for the purposes of this paragraph, incorporated under the Society Act

The Council has received submissions on the exemption issue as it applies to persons employed in government service under the Health Authorities Act, with community health services societies, or with various levels of government specifically mentioned in section 28(1)(c). In the Council's view, the issues of exempted persons employed by any of the above are similar.

The College and the Association have made their position clear on these issues and their reasons have been quoted earlier in this report.

In its response to the consultation, the MOH (Mental Health Division) commented with regard to risk of harm inherent in psychological services:

Important decisions are made on the basis of test results for a school-aged child that will affect his/her entire school program; test findings are used for court decisions; treatment activities are so personal that there is a greater risk of abuse by individuals who are not regulated by a profession.

With regard to the exemption, the MOH (Mental Health Division) further stated:

This exemption should be eliminated...Maintaining this exemption puts the public at a significant risk of harm. There are a number of cases in point, such as a former government employee who was convicted for fraudulently holding himself out as a registered psychologist. The importance of controlling the title and function of psychologists lies basically in the maintenance of standards and ethics in practice. If government employees are not subject to the same standards as the private sector, the result will be a two-tiered system with lower standards for those who avail themselves of government services.

MOH, Adult Clinical Services Branch, supports elimination of the exemption if the person currently in such positions in government are given the opportunity to be evaluated for "grandparenting" for registration as a psychologist.

Section 28(1)(b):

Persons teaching, lecturing or engaging in research as a psychologist, if those activities are carried out by reason of, and in the course of, duties under an academic appointment or program in a university as defined by the University Act.

The College and Association have not provided specific examples of harm that has been documented as a result of the exemption for university teaching, lecturing or engaging in research under section 28(1)(b), however the Council is not aware of any other regulated health professionals who are exempt from membership in their regulatory body by virtue of university employment. The College has indicated that persons exempted from registration under s.28(1)(b) are frequently involved in unregulated private practice or consultation, outside the course of employment.

Section 28(1)(c):

Persons acting in the course of employment by a Provincial, federal or municipal government or government agency, by a francophone education authority as defined in the School Act or by a board of school trustees constituted under the School Act, if qualifications in psychology are a condition of such employment.

The College's position on the issue of persons employed by government agencies, other than in the school system, has been canvassed under section 28(1)(a.1).

The MOEST has made a lengthy submission to the Council. The MOEST acknowledges the need to protect the public by regulating all professionals practicing psychology. The education system employs professionals to provide services which may be regarded as having a psychology component using either a narrow or a broader definition of the scope of psychology. These include school psychologists, counsellors, specialist teachers and other professional support personnel, faculty in colleges, universities and institutes and researchers. The Council intends to review the practice of psychology in the context of the school system as it applies to those practising school psychology, not counselling, thereby taking the narrow approach to the definition of the scope of psychology.

There is no formal regulatory body for school psychologists, although the BC Association of School Psychologists (BCASP) is their voluntary professional association. Entry to practice as a school psychologist is determined by the local school Board or Authority.

MOEST Guidelines recommend that school psychologists be teachers with a masters degree in one of three areas: special education, school psychology or educational psychology. UBC offers masters degrees in all of these areas, however, the three programs vary in their content of psychometric testing. Masters level programs in school psychology throughout North America have training in levels A, B and C tests. Only those with an MA in School Psychology are guaranteed to have received formal training in psychometric testing.

Information provided during the consultation process indicates that there have been difficulties attracting qualified persons for positions as school psychologists in some areas of BC including major metropolitan areas. Some persons employed and utilizing this exemption may have no formal training at all. The MOEST Guidelines for credentials of school psychologists are not mandatory, therefore persons who are not otherwise qualified may fill a position when there are no qualified persons. By virtue of some local union agreements, after filling a position for a number of months, that person is deemed "qualified".

While membership is not required, a number of school boards expect that persons hired for the position of school psychologist be eligible for membership in the BCASP. BCASP submitted that most of its approximately 200 members are certified teachers, however 15 are not. It has also come to the attention of the Council that approximately 50 per cent of psychometricians who perform diagnostic psychological testing and are employed at one of the larger Vancouver area school boards are not certified teachers. Non-teaching psychometricians are reportedly employed by a Victoria-area school board.

The BC College of Teachers (BCCT) and the MOEST have submitted that school psychologists, as qualified teachers, are currently regulated by "safeguards in the system." The MOEST makes reference to the School Act (SA), RSBC 1996, c.412, and the Teaching Profession Act (TPA), RSBC 1996, c.449, among others, in its submission with regard to the authority vested in the education system and to establish accountability mechanisms and states that the TPA and the SA address issues of accountability and professional standards. The MOEST further states:

There are no recorded cases in this province where the provision of psychological services by professionals in the education system in BC has resulted in harm to a member of the public.

The MOEST indicates it would support the removal of exemptions provided the PA included appropriately qualified employees of school boards, universities and accredited colleges and universities in reserved acts and did not limit the ability of professionals working in the education system from continuing to carry out their work based on standards accepted in the education system.

The Council examined the accountability mechanisms referred to in the MOEST submission. The MOEST states all professionals certified to teach in the school system are subject to the authority of the BCCT and are accountable to locally elected boards. The legal authority referred to by the MOEST and the BCCT is set out in Appendix E and includes section 28 of the TPA and section 16 of the SA.

The combined operation of section 28 of the TPA and section 16 of the SA provide that the only means by which a complaint can reach the BCCT discipline committee is via the local school board or authority, from 5 BCCT members, or from the Registrar of the BCCT. The TPA does not appear to provide any mechanism for receipt or adjudication by the registrar or the discipline committee of complaints from a member of the public (a student or parent) about a member of the BCCT. The SA does not provide for receipt or adjudication of complaints from a member of the public (a student or parent) about the conduct of an employee of a school Board. Section 11 of the SA provides for an appeal to the Board of a "decision" made by an employee of the Board. Other conduct or unethical practices do not appear to be covered in the SA.

The BCASP has submitted and the Council accepts that because there is no mandatory minimum education and training required of persons employed by a board of school trustees where qualifications in psychology are a condition of employment, there is the possibility that the public will be at risk from unqualified persons making diagnoses of educational and learning disabilities within the school system. Additionally, there are persons providing psychological services within the schools who are not certified teachers, therefore are not subject to any regulatory body. These persons may be supervised by non-psychologists. Even persons who possess qualifications in school psychology may be supervised by non-psychologists.

The risk of harm inherent in the practice of psychology has not been disputed by any of the respondents. The MOEST acknowledges the need to protect the public by regulating all professionals practicing psychology. The Ministry of Health (MOH), Mental Health Division comments as follows:

Important decisions are made on the basis of test results for a school-aged child that will affect his/her entire school program; test findings are used for court decisions; treatment activities are so personal that there is a greater risk of abuse by individuals who are not regulated by a profession.

The MOH, Mental Health Division, notes that the issue of school psychologists requires special attention and suggests that they may need to be regulated separately.

Others who commented on the exemption issue and are in support of eliminating the exemption are: the BCASP; the B.C. Medical Association; the BC Association of Clinical Counsellors; the Canadian Psychiatric Association; BC Psychiatric Association; the BC Colleges and Institutes Counsellors' Association; Riverview Hospital (with qualification that elimination of the exemption be prospective only); P. Anne Carney, Vocational Evaluator with WCB; and UBC Department of Counselling Psychology, Faculty of Education, UBC Department of Psychiatry and Facutly of Medicine.

Those who oppose elimination of the exemption are: BC Teachers' Federation; the BCCT; UBC Faculty of Education; the Canadian Association for Vocational Evaluation and Work Adjustment; Michael and Associates Vocational Testing and Evaluation; the BC Art Therapy Association; Janice A. Booth, MA., Ed.D. Educational Consultant; North Shore Counselling Centre; SRS Vocational Services; and Youngs Ferris International Vocational Testing Service; LTD.

Others gave qualified support to the exemption. The University of Victoria, Department of Psychological Foundations, recommends retaining the exemption and comments that as long as individuals providing services "are qualified in their sub-specialization as defined in the exemption provision of the PA, the exemption presents no risk of harm to the public." The Council points out that, outside the jurisdiction of the College, there is no effective minimum qualification for exempted persons. Although the various professions may have voluntary membership in a professional association and while membership, or eligibility for membership may be recommended, the Council has received information that such membership is not mandatory or uniformly recommended by all employers who hire exempted persons.

UBC Department of Counselling Psychology, Faculty of Education, recommends that masters trained personnel should be included within the College and comments that the exemptions (contingent upon the inclusion of masters prepared personnel in the College) likely increase the risk of harm to the public as the competence of psychological practitioners in government ministries may not be at the accepted level.

The BCASP believes that while the exemption encourages the possibility of inadequate service, it also feels that the provision of psychological services should be undertaken within a "pluralistic model" which recognizes the variety of expertise that are often essential to the diagnosis and treatment of individual difficulties.

The submissions indicate that the practice of psychology is clearly a health care service. There is a risk of harm in the practice of psychology, whether in the school setting, in the health care system, or in private practice. The Council has recommended that the title "psychologist" be reserved to members of the College. The Council has recommended that psychologists be granted a reserved act, diagnosis. That reserved act can only be performed by a qualified member of the College; however it may be shared with other qualified professions, including psychologists currently exempted from registration under the PA, should they become regulated by this or some other means. Under the HPA, delegation of the reserved act diagnosis may only occur, if at all, in accordance with the principles outlined in Recommendation 3, whether or not the current exemptions are retained in some form.

In the Council's view, those who submit that the public interest is protected by the safeguards within the system must show how that system effectively protects the public interest. That burden has not been met by the submissions of the MOEST or the BCCT which the Council has received to date.

The employment relationship which exists for employees of school boards, regional health boards and other government or private agencies, who are functioning as school psychologists where qualifications in psychology are a condition of employment, has not been shown to provide any mandatory minimum educational requirements, nor has it demonstrated that in all cases, such persons are supervised by persons who are qualified psychologists. There is no clear mechanism for a member of the public to make an effective complaint about the conduct, practice or ethics of a person providing psychological services in the schools or in government or private agency employment.

There are no guarantees that such a person who resigns from one school board or government or private agency could not be rehired by another, as there is no mandatory reporting of such action to a regulatory body.

Further, the College and the Association have submitted the following with regard to the operation of the exemption at all levels:

many government, school, and university practitioners also provide private services to the public without regulation. Although they are not members of the College of Psychologists and may not use the title Psychologist, they provide psychological services in their private practices on a fee for service basis. They are currently exempt from regulation, and thus an increased risk of harm to the public.

Here the College and the Association are addressing their concern that although these exempt government, school and university employees are currently able to use the title "psychologist" by virtue of their exempt employment, such employees are frequently asked to provide private consultation and psychological services, such as testing or psychotherapy outside of their employment. Because they are able to use the title "psychologist" in the employment context, a member of the public would not be able to ascertain that the person was not subject to any professional regulation. Although the private provision of psychological services, outside of the exemption, would be considered practice in violation of the PA, even as it is currently worded, the public has no way of knowing that a person able to use the title "psychologist" in his or her employment situation may not meet the standards of education or ethics that a member of the College must adhere to. Nor would such a person be subject to the disciplinary processes provided by the regulatory body. Whether in private practice, or in the school setting or government employee setting, use of the title "psychologist" by persons who are not members of the College and subject to its regulation is misleading to the public and may place it at risk.

Recommendation 5:

The Council recommends that there be no exemptions from the title protection provisions of Recommendation 4.

The Council has received various suggestions with regard to the issue of exemptions from membership in the College for persons mentioned in section 28(1)(a), (b) and (c) of the PA. The Council has recently received information which indicates that the College is considering a variety of mechanisms which would open its membership to exempted persons, including those with masters level preparation.

The Council currently has insufficient information about the details of such proposals There has been no formal presentation to the Council on this option, nor was it subject to the consultation process. Because there are a variety of routes open to exempted persons, including forming a separate college, the Council believes it is premature to make a recommendation directly on this issue. However, the Council has concerns that all persons practising psychology and using the title "psychologist" should be subject to effective regulation or supervised by a member of the College if performing the reserved act of diagnosis.

Clearly there is a public interest in preserving the uninterrupted provision of psychological services within schools, government or private agencies. However, there must be effective regulation of those professionals who call themselves "psychologists" when delivering psychological services especially when performing a reserved act. For the most part, it is only within the school system that children receive psycho-educational support services, since most children are identified as having needs for these services by the schools. For children whose parents cannot afford private psychological services, the school system is the only place where these services can be delivered. Persons receiving psychological services through governmental or private agencies, likewise deserve services and assurances of competency on a par with those of private psychologists' patients.

The College has indicated a willingness to include school psychologists within its membership. The College has suggested regulation of school psychologists either as associate members of the College of Psychologists or through supervision of school psychologists should the exemption be continued. The BCASP has indicated that it is considering applying for designation under the HPA as a self-regulating profession, but is awaiting the outcome of the review of the psychologists scope of practice.

The BCCT and the MOEST submit that school psychologists should be regulated by the BCCT, not the College. They argue that regulation of school psychologists by a regulatory body other than the BCCT would cause fragmentation of the education system. They assert that there would be different ethical constraints and standards of practice among the various professions who provide services through the education system. The Council does not see how the regulation of professions by different regulatory bodies would be detrimental to the education system. The MOH has authority to administer the health care system through a number of statutes including the HPA. Other professionals who practise in both the health care and the education systems are regulated or have applied to be regulated under the HPA, i.e., speech/language pathologists and audiologists. Numerous professions are currently regulated in the public interest by separate regulatory bodies under the HPA or separate statutes. They function in a multidisciplinary team approach within the health care system. The regulation of professional standards of ethics, competency and practice should only enhance the performance of individual members of that profession in an interdisciplinary team approach, whether in the health care or the education system.




F.     IMPLICATIONS OF THE COUNCIL'S RECOMMENDATIONS

Many regulated professionals and unregulated persons provide services which fall within the scope of practice of psychology as defined by the scope of practice statement. A scope of practice statement is descriptive, not exclusive. Persons who provide such services, except for reserved acts, within the school system, governmental and private agencies, or in a university or college setting, would be able to continue to do so without registering with the College. However, they would not be able to use the title "psychologist".

Reserved acts are restricted to members of the College or other regulated health professionals who have been granted those acts or activities. In this case diagnosis, as described in Recommendation 2, has been granted to members of the College. The Council recognizes that many qualified professionals who may currently be exempt from the registration provisions of the PA are performing diagnosis in the schools and in governmental or private agencies. Clearly, there is a public interest in the uninterrupted provision of these services.

A number of comments and suggestions were made during the consultation process to address this issue. Membership in the College was suggested by some and could be achieved by either "grandparenting" or by the College establishing masters level entrance requirements. An alternative to College membership is establishment of a separate college(s) to regulate those professionals who perform diagnostic services outside the jurisdiction of either the College of Psychologists or the College of Physicians and Surgeons. Another alternative, although not supported by many respondents, is supervision of diagnosis by a member of the College who is qualified to practise in that particular area.

The Council encourages submissions in response to this preliminary report that would address this issue as it is in the public interest to continue the provision of psychological services within the province without interruption.




IV.     RECOMMENDATIONS

1. The Health Professions Council recommends the following scope of practice be granted to members of the College of Psychologists:

The practice of psychology is the diagnosis, treatment and prevention of mental and psychological disorders, dysfunctions and conditions, and the assessment, treatment and enhancement of behavioural, emotional and interpersonal functioning by the application and use of psychometric testing, psychological assessment, and the treatment and management of clinical and non-clinical conditions.

2. The Health Professions Council recommends the following reserved act be granted to members of the College of Psychologists:

Making a diagnosis, identifying a mental or psychological disorder, dysfunction or condition as the cause of signs or symptoms of the individual.

3 The Health Professions Council recommends that a provision be enacted which deals with general principles regarding delegation of reserved acts. The provision would apply generally, not to individual cases. It should require the following:

  • The assigning health professional's governing body must provide assent to the proposed reserved act being performed by someone else;

  • The reserved act to be assigned as well as the level of supervision must be clearly defined and circumscribed by the assigning health professional's governing body;

  • Where the person to whom the act will be assigned is a member of a self-regulated health profession, his or her governing body must approve of the assignment;

  • The instruction to perform the act must be made in writing either by way of a general written protocol or through a case-specific instruction;

  • The assigning health professional must be satisfied that the individual who will be performing the act has the necessary skills and training to perform the act safely;

  • The assigning health professional must ensure that the person who will be performing the act accepts the assignment.

4. The Health Professions Council recommends that the title "psychologist" be reserved for members of the College of Psychologists.

5. The Health Professions Council recommends that there be no exemptions from the title protection provisions of Recommendation 4.




APPENDIX C

THE BC PSYCHOLOGICAL ASSOCIATION
PROPOSED SCOPE OF PRACTICE

The Association suggests the following scope of practice:

Registered psychologists are qualified to:

(a) diagnose, prevent or treat any mental disease or disorder, or emotional or family disturbance, from infancy through the entire life span, and to examine or advise on the behavioral, mental, neuropsychological, or emotional conditional of a person;

(b) consult with other professionals to assist in the diagnosis of a behavioral, mental, neuropsychological, or emotional condition;

(c) provide or advise on a course of treatment for a person, a family or a group or organization to improve their behavioral, mental, neuropsychological or emotional condition;

(d) provide clinical, counselling, organizational/industrial or school psychological services as described below.

School Psychology

In schools, psychologists provide:

A. Psychological and psycho-educational evaluations and assessments of the functioning of children. Procedures include screening, the use of psychological educational tests (particularly individual psychological tests of intellectual functioning, cognitive development, affective tests of intellectual functioning, cognitive development, affective behaviour, and neuropsychological status), interviews, observations, and behavioral evaluations.

B. Interventions to facilitate the functioning of individuals or groups. Such interventions may include, but are not limited to, counselling, affective education programs and training programs to improve coping skills; recommending, planning and evaluating special education services, and carrying out psycho-educational therapy.

C. Interventions to facilitate the educational services and child care functions of school personnel, parents and community agencies. Such interventions may include, but are not limited to, in-service school-personnel education programs, parent education programs, and parent counselling.

D. Consultation and collaboration with school personnel and/or parents concerning school-related problems of students and the professional problems of staff. Such services may include planning educational programs from a psychological perspective, consultation with teachers and other school personnel to enhance their understanding of the needs of particular pupils; modification of the classroom instructional programs to facilitate children's learning; promotion of a positive climate for learning and teaching; assistance to parents to enable them to contribute to their children's development and school adjustment, and other staff development activities.

E. Program development services to schools, school systems, and community agencies in such areas as needs assessment and evaluation of programs, liaison with community, provincial and national agencies concerning the mental health and educational needs of children, coordination, administration and planning of specialized educational programs; generating, collecting, organizing and disseminating information from psychological research and theory to educate staff and parents.

F. Supervision of school psychological services.

Industrial/Organizational Psychology
Industrial/organizational psychological services involve the development and application of psychological theory and methodology to problems of organizations and problems of individuals and groups in organizational settings. The purpose of such applications to the assessment, development, or evaluation of individuals, groups, or organizations is to enhance their effectiveness. Examples are:

A. Selection and placement of employees. Services include development of selection programs, optimal placement of key personnel, and early identification of management potential.

B. Organizational development. Services include analysing organizational structure, formulating corporate personnel strategies, maximising the effectiveness and satisfaction of individuals and work groups, effecting organizational change, and counselling employees to improve employee relations, personal and career development, and superior-subordinate relations.

C. Training and development of employees. Services include identifying training and development needs; formulating and implementing programs for technical training, management training, and organizational development; and evaluating the effectiveness of training and development programs.

D. Personnel research. Services include continuing development of assessment tools for selection, placement, classification, and promotion of employees, validating test instruments, and measuring the effect of cultural factors on test performance.

E. Improving employee motivation. Services include enhancing the productive output of employees, identifying and improving factors associated with job satisfaction, and redesigning jobs to make them more meaningful.

F. Design and optimization of work environments. Services include designing work environments and optimizing person-machine effectiveness.

(American Psychological Association Committee on Standards for Providers of Psychological Services & the American Psychological Association Professional Affairs Committee of the Division of School Psychology, 1981).

Counselling Psychology
Counselling psychology services refers to services that apply principles, methods and procedures for facilitating effective functioning during the life-span developmental process. Counselling psychologists place significant emphasis on positive aspects of growth and adjustment, with a developmental orientation. Their services help persons acquire or alter personal-social skills, improve adaptability to changing life demands, enhance environmental coping skills, and develop a variety of problem-solving and decision-making capabilities. Counselling psychology services are used by individuals, couples, and families to cope with problems connected with education, career choice, work, sex, marriage, family, other social relations, health, aging, and handicaps or a social or physical nature. Counselling psychological services include the following:

A. Assessment, evaluation and diagnosis. Procedures may include, but are not limited to, behavioral observation, interviewing, and administering and interpreting instruments for the assessment of educational achievement, academic skills aptitudes, interests, cognitive abilities, attitudes, emotions, motivations, status, personality characteristics, or any other aspect of human experience and behaviour that may contribute to understanding and helping the user.

B. Interventions with individuals and groups. Procedures include individual and group psychological counselling (e.g. education, career, couples, and family counselling) and may use a therapeutic, group process, or social-learning approach. Interventions are used for purposes of prevention, remediation, and rehabilitation; they may incorporate a variety of psychological modalities, such as psychotherapy, behaviour therapy, marital and family therapy, biofeedback techniques, and environmental design.

C. Professional consultations relating to A and B above. For examples, in connection with developing in-service training for staff or assisting an educational institution or organization to design a plan to cope with persistent problems of students.

D. Program development services in the areas of A, B, and C above, such as assisting in a rehabilitation centre to design a career-counselling program.

E. Supervision of all counselling psychological services, such as the review of assessment and intervention activities of the staff.

F. Evaluation of all services noted in A to E above and research for the purpose to their improvement.

(American Psychological Association Committee on Standards for Providers of Psychological Services & the American Psychological Association Professional Affairs Committee of the Division of School Psychology, 1981).

APPENDIX D

PSYCHOMETRIC TESTS (LEVELS A, B AND C)

Level A tests are tests which can be adequately administered, scored, interpreted, and reported with the aid of a manual, a familiarity with the client population, an orientation to the kind of setting within which the testing is done, and a general knowledge of measurement principles and of the limitations of test interpretation. Their misuse results in bad advice and, in the case of employment proficiency tests, lost job opportunity or inappropriate job placement. These tests are generally 'transparent' in that it is easy for the client to ascertain how his or her responses to individual items will affect the overall results.

Level B tests are complex tests and require graduate level training for selection, administration, scoring, and interpretation. The outcome from these tests can also have influence on the course of one's life. Level B tests are generally 'opaque', that is they are designed so that clients are unable to determine how their responses affect the outcome. Because the results cannot be distorted, the interpretation to the client can be very confrontative. It must be done by a Psychologist trained in test interpretation to avoid any harm that may come from information the client was psychologically unprepared to receive.

Level C tests are more complex than Level A and B tests. They are developed using the most sophisticated test construction methods because the outcome from these tests often has a significant impact on the course of a person's life. Level C tests are tests which require graduate level training in such areas as abnormal psychology, personality, psychometrics, statistics, and psychometrics in order to be able to appropriately select, administer and provide interpretation in the specific professional field to which the tests apply. Level C tests include an aptitude or language or personality or clinical diagnostic test, group or individual.

(For actual listing of tests in each category, if necessary, please contact the Council's office.)

APPENDIX E

TEACHING PROFESSION ACT AND SCHOOL ACT

Section 28 of the Teaching Profession Act, RSBC 1996, c. 449, provides:

    Discipline committee and inquiry

    28 (1) The council must appoint 2 council members to act as the chair and vice chair of a discipline committee.

    (2) All members of the council are entitled to sit on the discipline committee.

    (3) The quorum of the discipline committee is 3 members.

    (4) If the college receives

    (a) in respect of a member, a report from the board under section 16 or 166.28 of the School Act,

    (b) in respect of a member or other person, a report from an authority under section 7 of the Independent School Act,

    (c) a complaint in writing signed by 5 members about the conduct of a member, or

    (d) a report from the registrar relating to the conduct of a member,

    the council or discipline committee may, after considering the report or complaint, make or cause to be made a preliminary investigation into the conduct or competence of the member in respect of whom the report or complaint is made.

    (4.1) If a grievance has been taken under the terms of a collective agreement respecting a dismissal, suspension or other disciplinary action reported under section 16 of the School Act, the council or disciplinary committee must not proceed under subsection (4) in response to the report until the grievance procedure has been concluded.

    (4.1) If a grievance has been taken under the terms of a collective agreement respecting a dismissal, suspension or other disciplinary action reported under section 166.28 of the School Act, the council or discipline committee must not proceed under subsection (4) in response to the report until the grievance procedure has been concluded.

    (5) The council or discipline committee may, whether or not it has conducted a preliminary investigation under subsection (4), inquire into the conduct or competence, or both, of any member in respect of whom a report or complaint referred to in subsection (4) is made.

    (6) If a member of the discipline committee ceases to be a council member, he or she may, with the consent of the committee chair, continue to be a member of the discipline committee for the purpose of completing any hearings in which he or she has been involved.

    (7) For the purposes of subsection (4), the registrar may make reports in accordance with the directions of the council.

Section 16 of the School Act, RSBC 1996, c. 412, provides:

Report of dismissal, suspension and discipline

16 (1) If a board dismisses, suspends or otherwise disciplines a member of the college or a person holding a letter of permission to teach issued under section 25(2) of the Teaching Profession Act, it must

(a) without delay, report the dismissal, suspension or other disciplinary action to the council of the college, giving reasons, and

(b) send a copy of the report to the member or the person, as the case may be.

(2) If a member of the college or a person holding a letter of permission to teach issued under section 25(2) of the Teaching Profession Act resigns, the board must

    (a) without delay, report the circumstances of the resignation to the council of the college if the board considers that it is in the public interest to do so, and

    (b) send a copy of the report to the member or the person, as the case may be.

(3) A board that has made a report to the college under this section in respect of a member of the college or a person holding a letter of permission to teach issued under section 25(2) of the Teaching Profession Act must, without delay after being requested to do so by the college,

(a) provide the college with all of the records available to the board that touch on the matter in respect of which the report was made, and

(b) send a copy of the records referred to in paragraph (a) to the member or the erson.