Expectations of Care in Phase 3

On Monday, Premier Ford announced that, as of Friday, much of Ontario will be moving to stage 3 in the province’s coronavirus plan. The move to stage 3 does not affect anything regarding the provision of health care services, including psychotherapy . Rather, the change means that, in most regions of the province, nearly all businesses and public space will now be permitted to open, and the number of people allowed to attend indoor and outdoor gatherings will increase. The Toronto region, and several other public health units in southern Ontario, will remain in stage 2.
 
As such, CRPO advises that the safest way for RPs to provide psychotherapy services at this time is to remain in virtual practice . Before you can resume any in-person services, you must assure that you are able to implement measures that will help to prevent the spread of COVID-19 in accordance with the   COVID-19 Operational Requirements   provided by the Ministry of Health and   guidance provided by CRPO .

The Operational Requirements indicate that you should evaluate each client to determine whether e-therapy is (or continues to be) beneficial or whether in-person services are necessary. Communications with clients at this screening stage should take place remotely.

Registrants must rely on their professional judgment to determine if it is appropriate to provide in-person services to a client, taking into consideration the requirements detailed  in   the directive   from the Chief Medical Officer of Health and the guidance made available in the   Electronic Practice Guideline .

The guidance CRPO issued returning safely to in-person practice remains relevant, including supporting RPs with assessing the risk of transmission in your setting, and developing a plan for returning to in-person practice. 



Do RPs and Clients Have to Wear Masks During In-Person Appointments?

Yes, a face covering (a cloth or non-medical mask) must be worn in situations where physical distancing is not possible. This obligation comes from the  Operational Requirements for Health Sector Restart d ocument . Please see page 6:

“Signage should be posted at the entrance to the office/clinic and at reception areas requiring all patients and any visitors to wear a face covering/nonmedical mask (if available and tolerated), perform hand hygiene, and then report to reception to self-identify…”

This document is part of the Chief Medical Officer of Health’s  Directive #2 , which applies to all regulated health professionals (RHP), and so is mandatory. Even if a by-law in your community has included exemptions from the requirement that would otherwise apply to you or your practice setting, since the Operational Requirements state that all clients (patients) must wear a face covering (if available or tolerated), it is necessary to comply with the provincial requirement.

In all cases, RPs should be using their clinical judgement to assess and determine where in-person services are required and implementing the necessary infection and prevention control measures before providing those services.

Should you have a client who cannot tolerate wearing a face covering or non-medical mask, you will need to consider if in-person services are required and, if they are, whether you can provide care in a way that reduces the possibility of infection transmission.

Please continue to refer to CRPO’s  Guidance for Return to In-Person Practice   to assist you in this work.


When Employers Push for In-Person Practice

CRPO remains confident that the majority of settings in which RPs are employed are following the provincial directives that RPs themselves are required to adhere to. However, CRPO has heard from RPs working in community settings where employers have pushed for staff to return to in-person practice before some RPs are prepared to.
 
If your position is unionized, CRPO advises speaking with your union rep regarding options for finding accommodations or speaking with your employer. For RPs working in non-unionized roles, expressing your safety concerns to your immediate supervisor is a practical first step. You may consider putting your concerns in writing, and if necessary, going up the chain of responsibility within your organization. Employers need to be aware that if staff are unsafe, clients, other service users and families are unsafe as well.
 
Finally, under the Occupational Health and Safety Act, employers have to take precautions to keep workers safe. As a worker, you also have the right to refuse unsafe work. The provincial government has advice about strategies workers can use to keep themselves self as well as a worker’s right to refuse unsafe work



No Fee Increase

CRPO’s by-laws provide for a fee increase every two years to align with the percentage increase in the Consumer Price Index for goods and services over that time period. An increase was scheduled for June of this year. Considering the financial impact that the pandemic has had on many registrants as well as the ongoing economic uncertainties, CRPO’s Executive made the decision not to implement the increase. Given this, all CRPO fees will remain at their current rates until at least June 2021.