Ethics Assignment 3: London Childrens Psychoeducational Services Pat Veleno Monique Janssen March 17, 2009

2 Description London Childrens Psychoeducational Services (LCPS) is a community-based agency that provides assessment, intervention, and training and consultation services for children between the ages of 2-18 with developmental disabilities exhibiting behavioural challenges, living in the London area. Behavioral and academic assessments are completed prior to the introduction of an individualized treatment plan that addresses the unique strengths and needs of the child and family. Using a constructive, collaborative approach, which focuses on early intervention, evidence-based practice, and innovation, a multidisciplinary team of psychologists, psychological associates, occupational therapists, social workers and behaviour therapists help prepare children to function successfully in everyday life. Referrals are accepted from parents, schools, and community agencies and children are seen on a priority basis. Services are fully funded by the Ontario Ministry of Children and Youth Services. Hours: Monday to Friday, 8:30 a.m. to 4:30 p.m. while service hours may vary Mission Statement The mission of the London Childrens Psychoeducational Services team is to support, facilitate, and empower children and youth with developmental disabilities in overcoming academic and behavioural challenges by developing functional skills. We use a multidisciplinary, evidencebased approach to train and support mediators in the development and implementation of individualized treatment plans in order to foster optimal social, academic, and behavioral development. Vision Statement LCPS will be a recognized provincial leader in the development and delivery of psychoeducational and behavioural services, by building the capacity and skill of individuals, families, community agencies, and professionals in the London area to help individuals with developmental disabilities fully realize opportunities for successful community inclusion and improved quality of life. Plan to Maintain Ethical Behavior Good Practice All employees of London Childrens Psychoeducational Services will adhere to federal, provincial and local legislation governing ethical conduct and with their own disciplines rules and regulations (2.1). These regulations along with the ethical codes of the Canadian

3 Psychological Association (CPA) and the College of Psychologists of Ontario (CPO) have been taken into account during the development of the LCPS employee handbook, which provides guidance to our employees in completing their jobs in a professional and ethical manner. The CPA requires us, as psychologists and directors of LCPS, to assist our employees in developing a full understanding of their ethical responsibilities and we intend to do this through the issuing and reviewing of the employee handbook, providing ethical training for employees, heading multidisciplinary meetings where ethical issues are discussed, and maintaining an open door policy with respect to employees ethical concerns. Our employees have an ethical responsibility to ensure their workplace is abiding by ethical regulations and must bring concerns to the attention of the directors so that management and employees can work collaboratively and creatively to solve problems and improve service (3.1). Following acceptance of employment, all members of the multidisciplinary team are provided with a copy of the LCPS employee handbook and expected to be thoroughly familiar with its contents prior to initiating clinical duties. Employees are encouraged to consult with each other and/or the directors on site regarding any questions or concerns on an as-needed basis. This handbook will act as a resource for employees seeking guidance for various ethical concerns including professional conduct, confidentiality, screening and eligibility, informed consent, record keeping, and competent assessment and intervention. Professional Conduct It is of utmost importance that employees of LCPS behave in a professional manner both while at work and when in the community. In compliance with the CPA Code our employees will respect all individuals equally and will not engage in comments that are demeaning towards others by making jokes about culture, nationality, ethnicity, color, race, religion, sex, gender, or sexual orientation (I.2). Employees will not engage in any form of harassment of their colleagues, clients, or others including but not restricted to sexual, verbal, or physical (13.1, 13.2). Our employees may not influence clients to provide gifts or contributions, nor will they accept gifts valuing more than $20 (12.3, 12.6). All gifts received are the property of LCPS and their receipt must be disclosed to LCPS directors. When offered gifts employees must decline in a polite and respectful manner. Employees of LCPS will continually strive for awareness of their own personal biases and beliefs and how these impact various workplace activities (II.10, 12.2). Our professionals

4 will seek to participate in lifelong learning and education in order to provide optimal services with an emphasis on staying current with research in ethics, assessment, and intervention. Employees will also strive to understand and respect cultural differences of all individuals by acquiring knowledge about client religious beliefs or other relevant information before interpreting assessment results, as required (IV.15, IV.16). Additionally, our employees will remain current on the laws and regulations governing their work and will consult with colleagues or management if faced with conflicts between the law and personal ethical beliefs (IV.17, IV.18). When providing services LCPS professionals will communicate information clearly and objectively. The communication of all facts, opinions, theories, and other information will be expressed in a manner so as the client and/or their families can clearly differentiate between them. When communicating with clients, employees will not knowingly engage in the purposeful exclusion of information that does not agree with the professional recommendations or with therapists own personal beliefs or self-interests (III.11, III.12). Furthermore, LCPS employees recognize the limits of their own personal objectivity, and will take steps to transfer client files to appropriate colleagues if unable to rectify the situation appropriately (II.11). Under no circumstances do LCPS employees work under conditions in which their judgment may be impaired, including situations in which they have a physical or psychological impairment that prevents them from providing their best work, or have a preexisting familiarity with the client socially (11.1, 12.1). Following the termination of services, members of the clients multidisciplinary team will not enter into a sexual relationship with a guardian of the client for at least two years subsequent to the last professional contact (12.5). Confidentiality It is of the utmost importance that LCPS protects the confidentiality of its clients and their families. In order to protect client confidentiality, collected information is only shared with others (i.e. teachers, schools, or community agencies) with the permission of the childs guardian. Reasonable expectations of confidentiality and exceptions to this confidentiality will be discussed during the informed consent meeting (7.1). Signed consent specifying what information can be shared and with whom it may be disclosed will be obtained before information is shared (I.45, 8.1). When consulting with colleagues outside of LCPS, any and all information will be shared in hypothetical manner that ensures the persons involved cannot be

5 identified (I.45). Additionally, all information learned while fulfilling the duties of an LCPS employee or while on LCPS sites will be treated as confidential including that which relates to colleagues and their clients (I.43). The confidentiality of records will be ensured by collecting only information that is germane to the referral question and treatment plan. Information that is necessary for continuous and coordinated services will be shared with other members of the multidisciplinary team (I.37, I.39). Once collected, information will be stored and handled in a secure manner with hardcopies of the file to be maintained in locked filing cabinets and electronic copies stored on password protected, fire-walled hard drives or email servers. All computers must be password protected and measures must be taken to ensure that once the screensaver has been activated a password needs to be entered before accessing files. Additionally, computers used by clients for assessment and treatment purposes will have restricted access to sensitive materials. Whenever possible, all information shared electronically will occur without including identifying information about the client (I.41). For more information please see the record keeping section of this handbook. Screening and Eligibility A continuous, confidential voicemail box is maintained by LCPS where parents, school staff, or other community members can refer potential clients for services. It is the policy of LCPS that these inquiries must be responded to within 3 business days. Upon follow-up, LCPS staff will assesses the potential clients eligibility for services by ensuring the client is between the ages of 2-18, currently resides within the London, Ontario city limits, and has a diagnosed developmental disability (or is presenting with signs of a developmental delay) and behavioral challenges. LCPS is an equal opportunity treatment agency and no client will be denied on the basis of discrimination (I.9). If the referral source is someone other than the childs legal guardian, then informed consent from the legal guardian will be required in order to complete the referral process. During the screening process LCPS employees will be courteous, respectful, and knowledgeable about our services and other services offered in the area. If the client does not meet eligibility requirements than LCPS will seek to recommend alternate options (II.31). Additionally, all conversation pertaining to screening and eligibility will be treated as confidential and records will be made and stored in compliance with the record keeping policy.

6 Following the screening phone call a determination will be made regarding eligibility criteria, and if appropriate, the records from the initial contact will be forwarded to the wait list manager. Clients will be seen on a priority basis and this will be determined by the wait list manager, in consultation with colleagues, if necessary. In keeping with the CPA code standard I.11, fair distribution of services will be ensured so that the most vulnerable clients are not unfairly excluded or disadvantaged. Informed Consent Informed consent is obtained by arranging a meeting with the guardians of the child and reviewing the services to be delivered; qualifications of the involved members of the multidisciplinary team; expectations of privacy; record keeping policies; access to records, including who has access to what information; qualifications of any multiple relationships; responsibilities of all parties; likely benefits and risks of services offered, including non-action; and, the option to refuse or withdraw from treatment at any time and how to do this (I.24, I.26, I.45, 3.2, 4.2). At the conclusion of this meeting LCPS will seek to obtain signed informed consent; however, it must be recognized that true informed consent is an ongoing and collaborative process. It is the mutual responsibility of both the client and treatment team to provide new and relevant information in a timely manner (I.17, I.21, I.25). Given that LCPS provide services for children between the ages of 2-18, a guardian must always approve treatment before the initiation of services. Extenuating circumstances for considering treatment under mature-minor status must be brought to the directors for approval. However, in order to respect the rights of the child being treated the professional will strive to obtain the informed assent of the child before providing services in all cases (I.19, I.35). Record Keeping Clear, concise, and efficient record keeping is critical to the success of the multidisciplinary team in assessing and treating the client. A file that belongs to the agency will be made for each client and stored in our locked filing cabinets (9.2, 9.8.2). Members of the treatment team and the directors will have access to these files. These records are not to be taken off the LCPS premises. When recording information in files employees will use clear, concise language that respects the dignity of the persons involved, avoids conjecture, and labels opinion. Discretion must be used when recording information (I.3, II.30).

7 LCPS will seek to maintain the highest standards as it pertains to record keeping. As per the College of Psychologists of Ontario (2005), the clients record shall include the following (9.2.2): a) the client's name(s), address(es) and (if available) telephone number(s), as well as any other identifying information needed to distinguish the client from other clients; b) the clients date of birth; c) the date of every relevant and material contact between the member and the client; d) the date of every material consultation, either given or received by the member, regarding service to the client; e) a description of any presenting problem and of any history relevant to the problem; f) relevant information about every material service activity related to the client that is carried out by the member or under the responsibility of the member, including, but not limited to: assessment procedures; resulting assessment findings; diagnoses; goals or plans of service developed; reviews of progress on the goals and/or of the continued relevance of the plan of service; activities related to crises or critical incidents; and interventions carried out or advice given; g) relevant information about every material service activity that was commenced but not completed, including reasons for the non-completion; h) relevant information about every controlled act, within the meaning of Section 4 of the Psychology Act, 1991 and subsection 27(2) of the Regulated Health Professions Act, 1991, and the regulations under both statutes, performed by the member; i) all reports or correspondence about the client, received by the member, which are relevant and material to the member's service to the client; j) all reports and communications prepared by the member regarding the client; k) a copy of every written consent and/or documentation of the process of obtaining verbal consent related to the member's service to the client; and l) relevant information about every referral of the client, by the member, to another professional. Following closure of the clients file the records will be archived, in accordance with CPO standards, for 10 years following the clients 18th birthday and then shredded by a LCPS employee (9.4). An LCPS employee accompanies transportation of records to the archiving

8 destination to ensure confidentiality is maintained and the director of the archiving facility has signed a confidentiality contract (9.6). Competent Assessment and Intervention All members of the multidisciplinary team are professionals with unique knowledge and skills to contribute to the diagnosis and treatment of the client. Given this, each professional will conduct his/her responsibilities in conjunction with his/her area of expertise in a coordinated manner to prevent the duplication of services (II.18). All ethical standards will be respected, as will the confidentiality of copyrighted test materials (14.9). Before using a standardized test the professional will be familiar with standardization, norms, reliability, and validity of the test and must ensure that the test is administered properly (14.1). All data collected, including any problems encountered while collecting data, will be properly documented in the clients record (14.7). Computer reports may be generated as part of data entry or analysis but will not be substituted for the professionals own report (14.8). When communicating results of the assessment with clients professional opinion will be based on current research, will not be biased, and will be clearly delineated as opinion (14.3, 14.5). Test scores will be included in the report but clients may not see the test protocol (14.9). Only the professional qualified to make the diagnosis will share the diagnosis with the client (4.3.1, 14.4). Following assessment clients will be presented with intervention options and these interventions will be grounded in empirical findings and will always be based on the individual characteristics of the child (II.21, 14.2). The treatment team will respect the dignity and autonomy of the child and family and will make concerted efforts to provide clinical treatment options that are most appropriate and acceptable (I.8). LCPS professionals will utilize a Best Practice approach to assessment and intervention. Additionally, if appropriate, mediator training will be offered to significant care providers involved in the clients life (i.e. extended family, teachers, etc.). Interventions will be discontinued at the request of the guardians, when identified treatment goals have been met, treatment is no longer effective, or when it is clear that the benefits of treatment are not proportionately greater than the risk (II.17, II.37). Promotion of Continuing High Standards All regulated professionals employed at LCPS must be familiar with and adhere to their respective standards of practice germane to their discipline (IV.1, IV.3). Unregulated professionals employed at LCPS (i.e., behaviour therapists), will be expected to be familiar with

9 and adhere to the standards of practice of their respective organizations (i.e., Standards of Practice for Behaviour Analysts in Ontario, as outlined in The Ontario Association for Behaviour Analysis). Adherence to appropriate standards of practice is essential in the promotion of ethical practice and high quality service delivery to clients. This encourages the promotion of client rights, autonomy, dignity and independence, while protecting professional practitioners and their respective fields. Furthermore, the adherence to high standards of practice will help ensure integrity; professionalism; and promote high standards of governance, accountability, and performance. LCPS is committed to the promotion of high employee standards of performance and lifelong learning. To that end, employees of LCPS will be required to engage in regular activities that serve to meet and exceed expected standards of performance. encourage success in this regard by engaging in the following: a. Fostering an attuned, responsive workplace environment, where accountability, integrity and professionalism are paramount (IV.7, IV.9, IV.13). b. Encouraging regular employee self-assessment and/or peer assisted review, as per the CPA guidelines (IV.6). c. Requiring an annual formal employee performance review with one or both directors (IV.8). d. Providing each employee with a job description for his or her file (accessible as required). e. Requiring minimum educational and professional requirements for employment f. Providing all employees with an annual academic stipend, to be utilized at the employees choosing, for the purposes of professional growth (IV.3, IV.4) g. Accessing the services of respected educators and professionals for the purposes of staff training opportunities/workshops as it pertains to relevant clinical, cultural and ethical issues and/or professional development (IV.1, IV.2, IV.3, IV.4, IV.15, IV.16) h. Procuring appropriate resources, including books, videos, computer software, training tapes, etc. to build and enhance the current resource library on-site (IV.3) i. Encouraging regular clinical team meetings within small group settings to address ethical dilemmas, clinical questions, or other work-related issues (IV.4, IV.5, IV.7 LCPS will

10 j. Promoting a mentorship program, whereby junior employees have limited access to senior staff for the purposes of clinical supervision and performance improvement (IV.4, IV.5) k. Requiring the mandatory reporting of incompetent, unethical or otherwise unprofessional behaviour (IV.9, IV.10, IV.11, IV.13, IV.30, IV.31) l. Partnering with local agencies, schools and professional organizations to encourage mutually beneficial relationships aimed at promoting individual and agency-wide growth opportunities (IV.12) Policies for Addressing Grievances Grievances are addressed in a progressive capacity at LCPS. These steps are outlined as follows: 1. Direct communication between parties 2. Facilitated meeting between parties 3. Formal complaint Dispute Resolution Process 4. Formal Grievance Firstly, LCPS encourages direct communication between supervisors and employees to promptly resolve workplace concerns (IV.7, IV.9, IV.10, IV.11, IV.13, IV.14, IV.29, IV.30, IV.31). Although a formal grievance procedure is in place, employees are encouraged to use conflict resolution services to resolve differences amongst themselves as a first measure. The dispute resolution process helps resolve concerns at the earliest possible opportunity, increases the parties satisfaction with the solutions, develops positive and effective communication, and preserves the ongoing working relationship. Should the aforementioned process result in an unsatisfactory outcome, a facilitated meeting can be arranged with all parties involved, which includes a supervising staff person who will assist in the process of dispute resolution, to the satisfaction of all parties involved. Should this process yield unsatisfactory outcomes, the option exists to file a formal complaint. A formal complaint must be filed within ten business days from the date of the incident related to the dispute. The complaint must be filed with the Human Resources Office in writing and must identify the basis of the dispute, the facts, how attempts have been made to resolve the concerns, and the desired resolution. Employees are encouraged to contact Human Resources to schedule an appointment with an advisor prior to filing a complaint. The Human Resources

11 representative will listen to the concerns, discuss issues and interests, and try to brainstorm available options. After the meeting, the employee may feel empowered to handle the concern independently, not take any action, mediate, or move forward with the complaint process. The dispute resolution process is a participatory process and is required prior to filing a grievance. By working through a problem-solving process, this may yield greater satisfaction with the outcome of the complaint process, preserve an ongoing working relationship, and open opportunities for future workplace success. In the complaint process, a Human Resources representative will act as an impartial third party to work with the employee, supervisor, and management to help address concerns and resolve the complaint. The HR representative is not a decision-maker in the complaint process or an advocate for any party to the dispute. The HR representative will attempt to resolve employee complaints through individual consultation with the employee and his or her management to help the parties identify issues and interests, gather relevant information, and identify options for resolution. The process may also involve bringing in other levels of the employees supervision in order to fully address the concerns presented. The HR representative will include the employee filing the complaint in this process and will discuss the approach to resolving the dispute. Once the dispute resolution process is closed, should the employee not be satisfied with the outcome of the dispute resolution efforts, the employee may pursue the formal grievance procedure. The employee has ten business days from the date that the complaint was closed to file the formal grievance. The Human Resources department, in conjunction with appropriate union representatives, then handles this process. The grievance and all decisions or responses relating to it shall be a part of the employee's departmental personnel file. All external complaints will be handled in similar fashion, and where necessary, may include a required duty to report suspected professional violations to the appropriate professional governing body for further investigation (IV.9, IV.10, IV.11, IV.13, IV.29, IV.30, IV.31).

12 References Child and Parent Resource Institute. (2006). About us. Retrieved February 27, 2009 from http://www.cpri.thehealthline.ca/aboutus.asp College of Psychologists of Ontario. (2005). Standards of professional conduct. Retrieved March 10, 2009, from http://www.cpo.on.ca/ Vanier Childrens Services. (n.d.). About us. Retrieved February 27, 2009 from http://www.vanier.com/vanier.about.shtm National Mentoring Centre. (2003, October). Generic mentoring program policy and procedure manual: template version. Retrieved March 10, 2009, from http://nationalserviceresources.org/files/legacy/filemanager/download/mentoring/NMC_t emplate_whole.doc Sinclair, C., & Pettifor, J. (2001). Companion Manual to the Canadian Code of Ethics for Psychologists (3rd ed.). Ottawa: Canadian Psychological Association. St. Johns University. (2009). Grievance policy 2009. Retrieved March 14, 2009, from http://www.stjohns.edu/academics/graduate/liberalarts/departments/psychology/programs /psyd_sp/policy/grievance.stj Trillium Health Centre. (2009). Programs and services 2009. Retrieved March 10, 2009, from http:///www.trilliumhealthcentre.org/programs_services/womens_childrens_services/chil drensHealth/specialized_childrens_services/peelBehaviouralServices.html Truscott, D., & Crook, K.H. (2004). Ethics for the Practice of Psychology in Canada. Edmonton, Alberta: The University of Alberta Press.