Addressing misinformation about CRPO’s Quality Assurance Program enhancement project

I’m writing to address inaccurate information that is being shared about the College’s efforts to overhaul the Quality Assurance Program (QAP). I want to ensure that RPs are fully and accurately informed about the goals of the work that is being done, the approach that is being used, and the implications of the changes that will be implemented.

CRPO’s QAP ensures that registrants continuously demonstrate that their knowledge and understanding of the Professional Practice Standards (the Standards) is adequate for safe, effective, and ethical practice. As a core principle, the program is intended to encourage RPs to reflect on their practice, consider where they may have knowledge gaps, and take proactive steps to address any deficits they identify.

The QAP has never been punitive in approach or outcome, and this continues to be the case. The changes that the Quality Assurance Committee is overseeing will result in a program that is more risk-focused; does not create unnecessary burden for clinicians who are already knowledgeable about the Standards; and assists registrants who demonstrate gaps in their knowledge of the Standards to avoid breaches that could lead to complaints about their conduct or care and – most importantly – harm to clients.

This approach ensures that CRPO and registrant resources are used in a way that is most likely to mitigate any risk of harm to the public without creating undue burden on the profession. As such, a case-based assessment (CBA) has been developed as a screening tool to help registrants determine if they are in need of support. Registrants will be required to complete the CBA as the first step of the peer and practice review process, approximately once every five years. Registrants will receive feedback on their CBA result to assist them in determining how to direct their professional development activities and take advantage of opportunities to improve their knowledge and understanding of the Standards.

As an early step in the launch of the CBA, the College invited registrants to volunteer for a pilot assessment. An evaluation of the pilot results and participant feedback will allow the College to make improvements to the cases and to the assessment process. We are grateful to the RPs who chose to contribute to the work of public protection by participating in the pilot.

The results of the pilot, which took place in November, were resoundingly reassuring. 

* Please see the response to the question “Is there a pass/fail mark for the case-based assessment?” for a detailed explanation of what each of these results mean. 

A feedback survey was provided to the 178 RPs who participated in the pilot; 151 chose to respond. The information received in the survey has been reviewed and resulted in recommendations (e.g., to allow RPs 4 hours versus 3 hours to complete the assessment) that will be incorporated into the first offering of the CBA in May. The College is committed to continuous review and improvement; further feedback will be sought throughout the early implementation of the program and used to make adjustments as needed.

I am aware that change often causes concern, so want to reassure registrants that the College's efforts to overhaul the QAP and introduce CBAs are a positive strategy for helping RPs identify gaps in their knowledge of the Professional Practice Standards. Ensuring RPs are practising safely, effectively, and ethically is the role of the CRPO and remains an ongoing priority for Council and staff.

As always, College staff and Council welcome respectful, informed feedback. In addition to taking the time to read the Q & A’s here, I would encourage RPs to review past and future communiqués from the College about the QAP changes; to consider watching livestreams of Council meetings where updates are provided and discussions about the project happen; and to participate in providing input throughout the rest of the development stages of the program’s launch. You may also find it useful to ask your professional associations to obtain and share accurate and factual information.

I hope that the following ‘question and answer’ format helps to clarify any inaccuracies or misinformation that has been circulating and will support meaningful engagement with between RPs and the College. 

Questions and Answers

Is CRPO introducing a mandatory examination?

No. The new addition to the QA Program is not an examination, but a case-based assessment (CBA).

The CBA will help RPs identify if they are at risk of not meeting Professional Practice Standards and consider how they might address any gaps in their knowledge or understanding.

The CBA is:

• open book with RPs encouraged to refer to any resources available to help them to complete the assessment
• available to complete online from wherever the RP chooses to complete it
• available for one-week periods, twice a year, on a 24/7 basis
• not monitored or proctored
• required once every 5 years

I already demonstrated that I have the required entry-to-practice competencies. Why is the College testing me again?

Every health regulator in Ontario is required to ensure the continued competence of all active registrants through its quality assurance processes. This includes an assessment of registrants’ competency, professionalism, ethical practice, and quality of care.

The new case-based assessment is not looking at an RP’s clinical- or modality-related competence. Rather, it is assessing risk by evaluating a registrant’s knowledge, understanding, and application of the Professional Practice Standards.

Is there a pass/fail mark for the case-based assessment?

The content of the Professional Practice Standards for any regulatory body represents essential foundational knowledge that members of the profession must be aware of and uphold. Consequently, any assessment focusing on such standards should reflect their importance by implementing a pass score that is in the interest of the public and the profession itself. Industry standards for assessing such content has frequently incorporated ‘mastery level’ expectations which require an 80% passing score.

CRPO has adopted this 80% mastery level as the cut score (a statistical parameter often used in assigning group membership) for registrants completing the case-based assessment (CBA). Accordingly, registrants achieving a score of 80% or higher on the assessment will be classified as “successful” with no further action required from them.

Registrants scoring within one standard deviation[1] of the cut score will be classified as “self-directed review,” meaning there were some areas of the assessment where they demonstrated relatively weaker understanding of a Standard or Standards and should, under their own initiative and supervision, address those areas as part of their usual 40 hours of professional development.

Registrants falling beyond one standard deviation from the cut score will be provided with support and a second opportunity to complete the CBA. If their second attempt is also more than one standard deviation below the cut score, they will be classified as requiring a “peer-assisted review”. A peer-assisted review includes supportive peer coaching to help the registrant gain insight into their practice and develop a plan for their next cycle of 40 hours of continuing education.

Will I lose my license if I am not successful when I complete the assessment?

No. The case-based assessment (CBA) is a preliminary step in the peer and practice review component of the QA Program and will only be used to assess risk for RPs. Registrants whose assessment results suggest significant gaps in knowledge or understanding of the Professional Practice Standards will be provided with ongoing support to assist them in mastering the Standards. If an RP continues to demonstrate gaps in their understanding and application of the Standards after completing educational activities, the Quality Assurance Committee may require the registrant to complete a Specified Continuing Education or Remediation Program (SCERP). This type of remedial education is already directed by the Regulated Health Professions Act and is not a new component related to the introduction of the CBA.

Do the program changes remove an RPs right to manage their professional development?

No. RPs will continue to be able to choose which learning activities make up the required biennial 40 hours of learning activities.

RPs who demonstrate mastery of the Professional Practice Standards (the Standards) in the case-based assessment (CBA) will be provided with feedback that includes information for which, if any, Standards they answered incorrectly. They will not be required to do anything with this information, but they will be encouraged to consider reviewing the relevant Standards.

RPs whose assessment shows slightly less than mastery (see the above response to the question Is there a pass/fail mark for the case-based assessment?) will be provided with feedback showing which Standard or Standards they missed. They will be asked to address those areas as part of their usual 40 hours of professional development and to report on the activities they undertook during their regular 40-hour reporting cycle.

RPs whose assessment suggests that they have significant gaps (more than one standard deviation below the average result) in their knowledge and understanding of the Standards will be provided with assistance from College staff to ensure that they have the support they need to complete the CBA successfully. They will be asked to complete the assessment again at the next available opportunity (i.e., approximately 6 months later). If their assessment result continues to show significant gaps, they will be asked to participate in a peer-assisted review with a trained peer coach. This will involve a one-on-one review of their practice that will result in a learning plan, developed collaboratively between the RP and the peer coach, to address any gaps in knowledge of the Standards that are identified by the CBA and peer-assisted review. The RP will be asked to complete the learning plan and report on the activities they undertook during their regular 40-hour reporting cycle. The registrant will also be required to complete a third CBA once all of the activities are completed.

How will the assessment deal with the diversity of practice among Registered Psychotherapists?

It is important to note that the case-based assessment (CBA) is focused on the Professional Practice Standards; it is not an assessment of clinical or modality-specific competence.

The CBA is informed by the perspectives of a diverse group of professionals representing a variety of psychotherapy modalities, communities of practice, and lived experiences.

CRPO contracts members of the profession as case writers, case developers, and answer sequencers to develop the cases used in the CBA. Additionally, the process is overseen by the Quality Assurance Committee (QAC), which includes both members of the public, who are appointed to Council, and professional members, who are elected or appointed. The QAC reviews each stage of the QA Enhancement Project.

Feedback from the professionals involved to date and from 151 of the 178 registrants who completed the pilot assessment has been considered and will be reflected in the CBA when it is offered in May 2023. Feedback will be sought after each assessment offering and incorporated into subsequent versions of the assessment. Additionally, new cases will be added each year and more RPs will be recruited at each stage so that each new iteration of the assessment can be further enriched by the perspectives of more practitioners.



I have accommodation needs. Will I have to disclose my health or other personal information to the College in order to get an accommodation to support me in completing the assessment?

No. RPs will be able to request any reasonable accommodations they need to successfully complete the case-based assessment (CBA). The platform being used for the CBA allows for the use of assistive technology.

Since the CBA is online, open-book, and not proctored, there is considerable flexibility in how, when, and where RPs complete the assessment. For many RPs, this means that they will be able to incorporate whatever supports they need (e.g., having a reader, using assistive technology, taking breaks, etc.) without needing to make an accommodation request.

Any requests for accommodations that an RP wishes to make will be treated confidentially, in accordance with the College’s Accessible Customer Service Standard.

Is there an alternative to the case-based assessment (CBA)?

Yes. If a registrant completes the CBA and their results indicate the need to be re-assessed, they will have the option of participating in a peer-assisted review as an alternative.

Is the introduction of the case-based assessment an attempt by the College to collect more fees from registrants?

No. There is no cost to RPs participating in the case-based assessment or in peer-assisted reviews. These activities are a core part of CRPO’s work of public protection. Registrants who receive coaching from a trained peer coach will not be charged a fee. As well, since RPs will continue to be able to choose which educational activities they undertake as part of the existing required biennial 40 hours of professional development, it will be up to the individual registrant to decide whether they want to engage in activities that have an associated cost.

Is CRPO overreaching their authority?

No. All of the changes that are taking place in the QA Program are authorized by the Quality Assurance Program regulation (which is a regulation that every health college in Ontario is required by government to have in place and to abide by).

Moreover, the changes will align CRPO’s QA Program with standards that are established by the College Performance Measurement Framework. In particular, the enhanced QA Program identifies which registrants might be at risk of breaching the Standards; provides appropriate support to help registrants at risk to meet the required Standards; and re-assesses registrants to ensure that any remediation efforts have been effective.

[1] Standard deviation is a number used to tell how measurements for a group are spread out from the average. A low standard deviation means that most of the numbers are close to the average, while a high standard deviation means that the numbers are more spread out.

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