Statutory Regulation and Statutory Regulation and Practice Competencies for Practice Competencies for

Spiritual Care ProfessionalsSpiritual Care Professionals

Dr David Cane

Catalysis Consultingwww.catalysisconsulting.net

Vancouver BCNov 5 2008

Presentation to:Canadian Association for Pastoral Practice and EducationBritish Columbia

TopicsTopics

Statutory regulation in CanadaCanadian approach, mandates, mechanismsDevelopments in regulation for counselling and

mental health professionsBest Practices - Competencies and Credentials

CAPPE competencies for spiritual care professionalsNational validation survey

Statutory RegulationStatutory Regulation

Canadian approach, mandate, mechanisms

Regulation in CanadaRegulation in Canada

Regulating professional practice is a provincial government responsibilityDifferent legislative approaches existUmbrella actsOccupation-specific acts

Extent of delegation by government variesGov’t dept / “College” / Professional Assn“Self-regulation” concept

Regulatory MandateRegulatory Mandate

The only reason governments regulate is to protect the publicThe regulator's mandate is to ensure safe, effective and ethical practiceControl of entry to practiceControl of practice standardsControl of conditions for ongoing registrationHandling of public complaints

So is it in the profession’s interest So is it in the profession’s interest to achieve statutory regulation?to achieve statutory regulation?

Possible Pros Increased recognition and “credibility”Enhanced public awareness Increased public protectionAllows professional association to focus on member

services and back away from “regulation”Access to third party billing

Possible Cons Increased costs to individualsLoss of control over standards

Mechanisms of RegulationMechanisms of Regulation

Title protectionRestricted / protected / controlled title(s)No restriction on activities

Restricted / controlled activitiesSpecific reserved activities establishedOften granted to several professions

Restricted scope of practiceBroad-based protection of the profession’s work

Ontario: Regulation of Ontario: Regulation of Psychotherapists and Registered Psychotherapists and Registered

Mental Health TherapistsMental Health Therapists

Practice of Psychotherapy defined: the assessment and treatment of cognitive, emotional or

behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication

Authorized Act of Psychotherapy defined: to treat, by means of psychotherapy technique delivered through

a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning

TerminologyTerminology

Confusing!Regulation

statutory… voluntary…statutory… voluntary…Licensure

license to practice… goes with restricted activity?license to practice… goes with restricted activity?Registration

with whom?with whom?Certification

by whom?… for what purpose?by whom?… for what purpose?Accreditation

of educational programs… of health care facilitiesof educational programs… of health care facilities

Coordinating Regulation Nationally:Coordinating Regulation Nationally: The Agreement on Internal TradeThe Agreement on Internal Trade::

Federal-provincial agreement, 1994Broad scope (trade, investment, employment)Labour Mobility Chapter seeks to facilitate

cross-jurisdictional mobility of workers

Current AIT RequirementsCurrent AIT Requirements

Regulators must collaborate when establishing or changing standards, and in general work together to enhance Labour Mobility

Regulators must compare standards and identify “competency gaps” between jurisdictions

Regulators must accommodate differences by enabling transferring workers to address competency gaps

Major AIT changes are coming as Major AIT changes are coming as of April 1 2009!of April 1 2009!

As of Apr 2009 Full Labour Mobility (FLM) will exist in all professions across all jurisdictions unless government has approved an exception“Declared full mobility” replaces

“accommodation of differences”Exceptions will be limited, and based upon

major scope of practice differences

Current Status of Regulation Current Status of Regulation for Counselling & Mental for Counselling & Mental

Health ProfessionalsHealth Professionals

Quebec has statutory regulation in effect Career counsellor; psychoeducator Competencies are in place

Ontario has initiated regulation Psychotherapist; registered mental health therapist Designations yet to be defined; “authorized act” established

BC’s Task Group for Counsellor Regulation active since mid 1990s Group is advocating a broad generalist designation (“Counselling

Therapist”) with specialties (tiered approach) Competencies developed for Counselling Therapist Gov’t has recently indicated that regulation is not on their “immediate

agenda”

Regulation may take place this year in Nova Scotia NSACT is advocating a model based upon the Counselling Therapist

with a minimum Masters degree requirement

Numerous processes of voluntary self-regulation exist BCACC, CCA, CAPPE

Counselling TherapistEntry-to-Practice level

Generic Counselling Skills

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Generalist Entry-Level Designation:Broad, inclusive scope of practice with generic skill setMaximizes public protection

Specialty Designations:Reflect more complex skill setsRecognize specialist credentials

BC’s Proposed Multi-Tier ModelBC’s Proposed Multi-Tier Model

Best Practices in Best Practices in RegulationRegulation

Occupational Competencies and Credentials

Professional Regulation Involves Professional Regulation Involves AccountabilityAccountability

Professionals are accountable for the quality of their services (their job skills)The regulator is accountable (to government and to the public) to set and enforce standards for these servicesStandards must be defensible based upon the

mandate of public protection

Accountability is an ongoing expectation

Best regulatory practice means…Best regulatory practice means…

…regulating on-the-job activity (not prior education)

Registrants are accountable for their job skillson a daily basis, in real-timethey are not accountable for their credentials;

credentials are historical

Defining and measuring job skills is Defining and measuring job skills is the keythe key

Measurable job skills are called Occupational Competencies

An Occupational Competency is a statement describing a job task that a person can perform to a specified level of proficiency

Competencies can serve different Competencies can serve different purposespurposes

Occupational Competencies Describe job tasks

Used by employers and by regulators to define job requirementsUsed by employers and by regulators to define job requirements

Assessment Competencies Break job tasks into components for assessment purposes

Used by regulators to blueprint a registration examUsed by regulators to blueprint a registration examUsed by employers to assess worker performanceUsed by employers to assess worker performance

Educational Competencies Break components into smaller steps to facilitate student

learningUsed by educators to develop curriculum and assess student Used by educators to develop curriculum and assess student learninglearning

Hierarchy of Competencies

CAPPE Practice CAPPE Practice Competencies for Spiritual Competencies for Spiritual

Care ProfessionalsCare Professionals

National Validation Survey

Why did CAPPE undertake a Why did CAPPE undertake a validation process?validation process?

Involved with national initiatives to establish regulation for counselling and mental health professionals Substantial common ground exists across the counselling /

mental health field

Developed Practice Competencies to guide its Certification ProgramsOpportunity to integrate and validate competencies Competencies can distinguish common ground from specialties Help prepare for an effective regulatory process

Integrated Competency Model for Integrated Competency Model for Spiritual CareSpiritual Care

Generic Competencies(applicable to a broad range

of counsellors and therapists)

Spiritual Care“Specialist Competencies”

SpiritualCareProfessional

The validation processThe validation process

On-line survey made available to CAPPE membership nationally (March-April 2008)Listings of competencies (generic & specialist)For each competency, respondents to rate:How important you consider this competency to be for

safe and effective practiceHow frequently you use this competency in your own

practiceDemographic questions included to help analyze data

Summary of demographicsSummary of demographics

198 respondents nationally (~20% of membership)59% of respondents from ON14% of respondents from BC

74% of respondents in Clinical Pastoral Education stream16% of respondents in Pastoral Counselling Education stream

NLPENSNBQCONMBSKABBC

In which province or territory do you work?

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In which province or territory do you work?

Membership Type N %

Associate Member 89 45.9% Provisional Teaching Supervisor Member 5 2.6%

Associate Teaching Supervisor Member 5 2.6%

Certified Specialist Member 70 36.1%

Certified Teaching Supervisor Member 29 14.9%

Student Member 10 5.2% Retired Member 8 4.1%

Where do you work? N %

Parish / Congregation Ministry 21 11.6% Hospital 148 81.8% Residential Care Facility 26 14.4% Prison 2 1.1% University 9 5.0% Private Practice 20 11.0%

What is your occupation title? N %

Staff Chaplain 102 61.4% Denomination Chaplain 8 4.8% Pastoral Care Worker 8 4.8% Pastoral Care Associate 4 2.4% Pastoral Counsellor 20 12.0% Department Manager 19 11.4% Director 13 7.8% Coordinator 27 16.3% Pastor 9 5.4% Congregation Minister 2 1.2%

Competency rankings – what Competency rankings – what constitutes “validation”?constitutes “validation”?

Importance scale: Critically important Important Somewhat important Not important Cannot rate

Frequency scale: Very frequently Frequently Occasionally Seldom Not used

Margins of ErrorMargins of Error

Margin of error on 150 responses (for respondents nationally)+- 6% on a cumulative % value ( 90% conf)

ON respondents (N = 70)+- 9%

BC respondents (N = 25)+-16%

Retired members (N = 5) too high to estimate

Are the competencies “Validated”?Are the competencies “Validated”?

Broadly speaking yes, very strongly for both generic and spiritual careExamples of exceptions: 5.3.a and H.3

Are there significant differences between the BC survey results and Canada-wide?NoBear in mind the larger margin of error on the

BC data

What next?What next?

Will the competency validation data impact CAPPE’s certification program?Will the counselling-related professions be able to move ahead on a consistent basis nationally?There are different approaches emerging x-CanadaWill the new AIT help promote a common approach?

Can CAPPE find a way to have Spiritual Care practice recognized within the broader context of regulation in counselling and mental health?

Thank You!Thank You!