ATRA Membership Q&A April 20, 2016 Edition Potential Regulation with the Alberta College of Occupational Therapy (ACOT)
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1 ATRA Membership Q&A April 20, 2016 Edition Potential Regulation with the Alberta College of Occupational Therapy (ACOT) As we continue to explore how a combined regulatory college with ACOT would work, we expect you to have many questions, and rightfully so. This will be a learning process and we want to educate all of our members. Please read on to learn what this new opportunity could possibly involve, and how we will answer additional questions you might have. The following Questions and Answers have been clustered into sections for your ease of reference. Page Regulation. 1 Why partner with the Alberta College of Occupational Therapy? 2 Does a health profession need both a college and an association? 4 How will ATRA become regulated? 6 What changes shall I expect in my job and professional fees? 7 Membership Criteria. 7 Continuing Competence / CEU Program. 8 Maintaining Active Registration Requirements. 9 Scope of practice / standards of practice /restricted activity. 10 What happens next? 11 References 13 Regulation 1. Let s start at the beginning: what is regulation? Regulation is a set of requirements or consistent rules that define how health professions provide ethical and competent service to the public. Legislation is passed by a vote of members of the Alberta Legislative Assembly, and is called the Health Professions Act (HPA). All regulatory bodies under the HPA are called colleges. Each self-governing health profession must apply to Alberta s Health Minister to become regulated. If the application is approved, the minister takes a motion to members of the Alberta Legislative Assembly to include the profession under the Health Professions Act within a college. Regulations must be approved by the Lieutenant Governor in Council (Provincial Cabinet). *NEW* The Alberta Federation of Regulated Health Professions (2008) provides an excellent point of reference as it states, Self-regulation is a privilege, not a right, granted by government on behalf of the public. Self-regulation is commonly used in technically specialized and complex areas, like healthcare, because the professions, not the government, has the specific knowledge and expertise needed to set education, competence, license, and practice requirements/standards. 2. Why is regulation so important? Regulation ensures that Albertans are receiving competent and ethical services through: Protection of the public through mandatory registration with the college Mandatory continuing competence requirements Enforcement of standards of practice and codes of ethics Fair and consistent regulatory processes for registration and disciplinary procedures for all professions 1
2 Practice statements and protected titles identifying uniqueness for each profession. 3. Why should Recreation Therapists pursue regulation? Our therapeutic recreation profession should be accountable for its practice, the same way our colleagues are. Albertans should know that they are receiving competent and ethical health services from Recreation Therapists through mandatory registration that ensures standards of practice, entry to practice, continuing competence criteria and code of ethics are met. 4. What is ATRA s history in applying for regulation? Our professional association has been working on regulation of recreation therapy in Alberta for over a decade and has had membership support throughout the process. In 2010, ATRA submitted a formal and complete application for consideration to the Honorable Gene Zwozdesky, Minister of Health and Wellness. Since that time our association has been in direct contact with the offices of incumbents Honourable Fred Horne, Minister of Health, Honorable Stephen Mandel, Minister of Health and Honorable Sarah Hoffman, Minister of Health and Seniors. Our 2020 Vision Strategic Plan accepted by membership in 2014 is by in large a response to the feedback and direction provided by Alberta Health. ATRA membership endorsed through a motion at ATRA AGM in 2014 to continue active application for regulation. ATRA s current Regulation Professional Advancement Committee continue to work diligently towards regulation of therapeutic recreation in Alberta. 5. Where can I get more information on Alberta s Health Profession Act? As our association gets closer to our objective of regulating the profession, it is important for each of us to become familiar with the concept of regulation, which means learning the rules of the act and learning the language. The Alberta Government has made readily available a number of documents on line for ease of reference - HPA (2002) A new law for regulated health professionals published by Alberta Health is a great place to start. Their second publication of interest is the HPA (2004) Employers Handbook. Alberta Health Services has produced Overview of the Health Professions Act of Alberta implications for clinical practice. An AHS employee sign in with password is required to access this internal document. And be sure to be familiar with ATRA s (2013) Risk to the Public for Recreation Therapists in Alberta. This document is located in the Members section of the ATRA website in the ATRA Guiding Documents section of the Documents & Forms page. Why partner with the Alberta College of Occupational Therapy? 6. Why partner with ACOT when we can pursue our own regulatory college? The Alberta government is promoting organizations to work with existing regulated colleges because it s more fiscally responsible and sustainable. ACOT has had years to develop infrastructure, a strong record and expertise that can guide and benefit us. And 2
3 importantly ACOT is willing to partner with us. A combined college creates sustainability for membership numbers and enables funds to support the college and protect the membership. Examples of combined regulatory colleges in Alberta include: The Alberta College of Medical Diagnostic and Therapeutic Technologists have combined five. Both the College of Physicians and Surgeons of Alberta and the Alberta College of Speech-Language Pathologists and Audiologists regulate more than one profession. 7. What are the similarities between ACOT and ATRA? Although ACOT and ATRA represent different professions, there are many similarities: Alberta College of Occupational Therapists Alberta Therapeutic Recreational (ACOT) Association (ATRA) Protects and serves the public by providing Addresses the professional needs of its competent and ethical Occupational Therapy membership services through clearly defined membership Provides professional development, criteria, standards of practice, code of ethics research & education opportunities and continued competence criteria Advocates for Therapeutic Recreation in ACOT is a regulatory body governed by Alberta a Council that includes Occupational Promotes consistent practice for Therapists elected by their peers, and Therapeutic Recreation across the members of the public appointed by the province through clearly defined Alberta government membership criteria, standards of practice, code of ethics and continued competence criteria ATRA is not a regulatory body and is governed by a board 8. Will we lose our identity if we partner with ACOT? No. There would be two distinct professions under one regulated college. 9. *NEW* How does ACOT benefit from this partnership? It is clear to me how recreation therapists can benefit, but I am unsure what value it adds to ACOT? Maggie Fulford, ACOT Registrar responds Council recognizes that their mandate is to serve & protect all Albertans so partnering with the therapeutic recreation profession in a combined college helps serve that mandate. Personally, my viewpoint is that if my family member utilizes a Recreation Therapist at any point in their life, I would want to know that he/she is held accountable and is regulated. 3
4 Does a health profession need both a college and an association? 10. Will ATRA still exist if we become a regulated college? Yes. ATRA will continue to be an association with a definite role, providing membership services and promoting our profession to Albertans. We will continue as a voluntary, non-regulatory body that offers networking and educational opportunities for its members, as well as advocacy for therapeutic recreation service to the government and the public. 11. How does the role of a regulatory college differ from the role of a professional association, at provincial and national levels? A college is a regulatory body (defined by provincial law) that protects and serves the public interest by ensuring all practitioners are registered and that they provide competent and ethical services to Albertans. To do this, the college will investigate concerns or complaints about registered members. ATRA is technically a voluntary, non-regulatory body that offers networking and educational opportunities for its members, as well as advocacy for therapeutic recreation service to the government and the public. We are a professional association. The national association provides services, products, events and networking opportunities to assist Recreation Therapists in achieving excellence in their professional practice. CTRA offers leadership to actively develop and promote the multi-faceted profession of therapeutic recreation in Canada and internationally. The table below helps define the roles between the college and associations. The following table provides a quick overview of the similar and different roles of a college and provincial and national associations. 4
5 Roles College ATRA CTRA Protection of the public, investigate concerns raised about registrants practice Information to the public about such topics as qualifications for entry to practice, etc. Standards of Practice (Provincial) establish programs and guidelines to promote competent and ethical TR practice (e.g. continuing competency program). License Recreation Therapists, set standards for entry to practice. Maintain a practice advisor Assure public of Recreation Therapist s ability to perform the due diligence of a health professional. Keep Recreation Therapists informed of relevant federal and provincial legislation (e.g. privacy, persons in care, etc.). Advocate / marketing for Recreation Therapy to consumer and consumer groups. Represent Recreation Therapists on national committees, Facilitate malpractice insurance Maintain a website of interest to consumers Sponsor and facilitate education for professional development. Local / provincial advocacy for Therapeutic Recreation Represent Recreation Therapists at provincial interdisciplinary committees / boards Facilitate therapeutic recreation networking Facilitate therapeutic recreation communities of practice Disseminate pertinent practice and practical information through communication networks Recognize Recreation Therapists among their peers for outstanding practice and contribution to the society. 5
6 How will ATRA become regulated? 12. If we choose to pursue regulation with ACOT, are we officially regulated? No, this does not mean we are regulated. Choosing to work with ACOT demonstrates to the government that pursuing this initiative is a viable, supported application. The Alberta government ultimately decides whether or not to move forward with our application for regulation. At this time initial discussions are occurring however the government has the ability to stop, delay, or accelerate the process at any time. 13. If we decide not to pursue a combined college with ACOT is our application for regulation under the HPA still valid? Yes, but we will have to pursue it independently. However, the government values partnerships and sustainability. This has been the best opportunity presented to ATRA since pursuing the regulation process. In addition, with having such small professional membership numbers as compared to other professions, our sustainability may be questionable. 14. Why does this seem so sudden? Our Alberta Health liaison recently approached ATRA with an intriguing option an opportunity to pursue regulation under the Health Professions Act with the Alberta College of Occupation Therapy (ACOT). This would form a new combined college that represents the two distinct professions of recreation therapy and occupational therapy equally. The Alberta Health Liaison has provided a timeline, and a window of opportunity to possibly take a supported partnership application to the Alberta Government at the end of the parliamentary spring session to move our application for regulation forward. 15. *NEW* Will I have a say in whether we pursue regulation through a partnership with ACOT? Membership will cast their vote on the question of pursuing regulation through a partnership with Occupational Therapy in a combined college between April 21 28,
7 What changes shall I expect in my job and professional fees? 16. Will this affect my position or wages? ATRA does not anticipate that becoming regulated or partnering with ACOT will have an effect on recreation therapy positions and wages. Employers, the marketplace and the union determine these. 17. What would the annual college registration fee be if we became regulated? Fees will likely follow ACOT s membership fee schedule. The application fee is $150. Annual registration permit fee is $550 (fees are prorated for new registrants depending when they will begin practice). 18. *NEW* When will I need to start paying fees to the College? ATRA members will not be required to pay College application or registration fees until Recreation Therapy is regulated and a partnership college is established. An adjustment that reduces ATRA membership fees is anticipated after regulation. Membership Criteria 19. Would membership criteria change if we become regulated? Requirements for registration will be set out in new regulations. If any changes are made to registration requirements, recreation therapists will be grandfathered into the college with existing credentials. 20. *NEW* Will members be required to have a CTRS designation if we become regulated? No, the CTRS designation will not be required for college registration. 21. *NEW* Will ATRA members be Grandfathered as registered College members? Yes, Alberta Health seeks to sustain an intact workforce of practitioners when regulation takes effect for a health profession. Professional members of ATRA who remain Professional ATRA members at the time of the transition to the College will be eligible to be grandfathered in as registered Professional. 22. *NEW* Will the proposed college require mandatory registration of all those working as a recreation therapist? Yes. The HPA Employer Handbook (2004, p. 23) states Employing or contracting with practitioners who should be but are not properly registered (or do not have current practice permits) is unlawful under the HPA, and may present significant liability concerns for both the employer and the practitioner. 7
8 Continuing Competence / CEU Program 23. *NEW* Does legislation dictate the continuing competency requirement? The Health Professions Act sets out what the continuing competence program will look like. Colleges determine their own definition of competence and the required knowledge base. The role of the College is to enforce compliance with continued competence. What will the continuing competence program look like if we become regulated? ATRA will adopt ACOT s continuing competence program, made up of four components: self-assessment, practice challenge log, action plan and reflection. This must be completed and submitted prior to renewal each registration year. 24. *NEW* Please provide clarification of the four components of the Competency Program that ATRA will adopt. It sounds like a lot! Self-Assessment: The self-assessment questionnaire prompts each member to reflect on their Standards of Practice and ensure they are meeting the standards and ethics as established by Council and the areas where continuing competence activities are to be undertaken by the regulated member for the next registration year. Practice Challenge Log: The practice challenge log allows you to reflect on those challenges that you identified in your self-assessment in order to create goals in the upcoming year as well as the future. Action Plan: The action plan allows you to set goals and record professional activities that support the maintenance of competence or the enhancement of the regulated member s practice. With respect to setting goals, this is not a legislative requirement; however, the College recommends you identify one to three practice challenges you wish to address and that you update your progress records with the professional activities you engage in to maintain or enhance your practice. Reflection: In order to assist you in maintaining and enhancing your practice the College recommends that you be engaged in reflective thinking about your practice, and as required by legislation, reflect on your practice challenge, our Standards of Practice and that you record all professional activities that maintain or enhance your practice. All regulated members are required to keep a continuing competence portfolio containing documentation that supports their learning activities and illustrates the quality of the regulated member s practice. It may include documents such as testimonials, results of client satisfaction, questionnaires, notes, and samples of work. You are not required to submit these documents unless requested to do so, however, you must retain documents from your portfolio for five years. When passed, legislation allocates a period of time for associations to transition operations to meet college requirements. When the time is right, ATRA Members will have prior and ongoing access to a training program to learn about the new Continuing Competence Program. 25. How and when will Continuing Competence requirements change? No changes to continuing competence requirements will be in effect until Recreation Therapy is regulated and a partnership college is established. 8
9 Once the proposed College is in place, ACOT s continuing competence program will be adopted and that will replace ATRA s current CEU program. Maintaining Active Registration Requirements 26. *NEW* Are active (currency) practice hours a requirement from the Health Profession Act? Yes, active registration is dictated in the legislation. That is how practitioners ensure competence in practice. Each college has a different number of required hours or a different definition of practice requirements if not hour based. 27. How many hours must I work as a recreation therapist to maintain active registration within the proposed college? To maintain registration with a college, practitioners must work either a minimum of 400 hours in the past year, 800 hours in the past 2 years, 1200 in the past 3 years or 1550 hours in a five-year period to ensure competent practice or successful completion of educational upgrading requirements as deemed necessary by the Registrar. *NEW* Practitioners must meet at least one of the currency hour criteria, not all of them. They can work 1550 hours in one year and not work for four years. When the college processes annual registration and checks for currency of practice, the first check is to see if the practitioner has worked 400 hours in the past year, if they have, then they meet the currency requirement. If they have not then they move on to see if they have worked 800 hours in the past two years etc. This requirement applies to all Recreation Therapists regardless of Full Time Equivalent (FTE) or employment status (casual, part-time, full-time). For those working casual, in a small FTE, or for those taking extended periods of time off i.e. raising their family, traveling, etc., the currency hour requirement would apply. At maximum, the criteria of 1550 work hours within 5 years would need to be met. If the therapist does not meet the currency hour requirement, and wishes to work as a Recreation Therapist, he/she would need to re-apply to become a registered Recreation Therapist. Members are able to count volunteer hours, however all standards of practice and code of ethics must be adhered to. If they spend time researching for a specific treatment plan, this can also be used for hours. It is also important to note that the College does not require proof of time worked 28. *NEW* What if I meet the education and practicum hours to be a recreation therapist but I am employed as a recreation therapy assistant. Will I be able to be registered with the college? Yes, as long as you are an ATRA Professional member at the time we transition, you are eligible to register with the College. However, you would need to meet the currency hours working as a Recreation Therapist once you are registered. This would require 9
10 you to work at least 1550 hours as a Recreation Therapist by the end of five years. Within that time frame, it would allow you the opportunity to acquire a Recreation Therapist job if you chose to do so. 29. *NEW* What will be the Return to Practice criteria if a recreation therapist has not maintained Active Registration status? A re-entry applicant is a Recreation Therapist applying to re-enter the profession after a period of absence, and does not have sufficient practice hours. ATRA will adopt ACOT s process for re-entry or return to practice. An eight-week (320 hr.) period of supervised practice under a registered recreation therapist is mandatory. Once the supervisor s competency assessment of the Recreation Therapist is complete and approved by the Registrar, and the applicant has completed any coursework or training requirements that may have been identified during the competency assessment, the Recreation Therapist will have Registered Professional status. Scope of practice / standards of practice /restricted activity 30. *NEW* The scope of practice between OT and Rec T overlaps. Will that pose any difficulties? Scope of practice is written into regulation. The current HPA mandates overlapping scopes of practice to provide more flexibility in health service provision. HPA does not use a list of tasks to define scope of practice, the focus is on competency, which is defined as the knowledge, skills, attitudes and judgment to safely provide care, guide decision making and perform restricted activities granted by the HPA schedule for a particular college. This is where Professional Association s are really important as they can give a strong voice to each profession to discuss scope. Under the Health Professions Act, there may be shared elements of scope of practice between professions. Unless the activity is defined as a restricted activity, anyone can perform it. Restricted activities are granted by regulation and can be granted to multiple professions as appropriate. Both Rec T and OT have leisure as part of their service delivery model. Using leisure as a modality is not a restricted activity much the same as an activity such as dressing, which is also a part of the OT serviced delivery model and shared with other professions. For example, OT; SW; and nurses can do psychosocial interventions. Some acts specify you need specialized training to do certain things, whereas others don t. Legislation grants all OT s permission to utilize psychosocial activities; whereas Social Work requires their members to have extra training in that area. 31. *NEW* ATRA uses a Competency Profile to guide practice. Do we need Standards of Practice? Under the Health Professions Act, Standards of Practice are a requirement of regulated Colleges rather than a competency model and as such Recreation Therapists will have a Standards of Practice. The ATRA Competency Profile will continue to be a reference 10
11 document that will guide continuing competence of Recreation Therapists in ATRA following regulation. Standards of practice for each health profession are shared for review by all colleges (29 college in Alberta) for comment. After this step, the Standards of Practice document goes back to the College Council for ratification, and then the document goes to government for finalizing. The government does take the comments into consideration, but at the end makes the final determination. 32. *NEW* Do Recreation Therapist perform restricted activities? ATRA addresses restricted activities in our Competency Profile (2012) document. Recreation therapists practicing in specialized services such as acute inpatient psychiatry may be trained and supervised by regulated health professionals to perform [the restricted activity] of psychosocial intervention. As an unregulated profession, supervision by regulated health providers must meet the supervisors' college regulations. ATRA acknowledges that specified activities which pose a significant risk to a patient's physical and/or psychosocial well-being such as [restricted activity of] psychosocial intervention require a high level of professional competence to be performed safely. 33. *NEW* Will psychosocial intervention as a restricted activity be considered for inclusion within the recreation therapist s scope of practice? Yes, ATRA considers psycho social intervention to be an appropriate restricted activity for recreation therapy s scope of practice. 34. *NEW* Can two professions share one restricted activity? Yes. Professions do not own or have exclusive rights to perform restricted activities. Practitioners must be authorized by statute or regulation. Different professions can provide the same restricted activity such as psychosocial intervention. There are 25 restricted activities under the Alberta Health Professions Act. To learn more about them please read the government organization act that lists restricted activities. What happens next? 35. Open access to regulation documents Our Regulation Q&A will be updated on a regular basis and will remain posted on the ATRA Website for member reference. If after reading the Q & A you have further questions please send them to vicepresident@alberta-tr.org. 11
12 36. Are we meeting ATRA s Bylaws for Special Meetings by communication via webinars and (Q & A). Yes. ATRA s Bylaws (Article Special Meetings) provides direction to the Board of Directors to call a special meeting at any time. Our two webinars and the Regulation Question and Answer document are the format by which this special meeting on the topic of regulation is taking place. Bylaws require that notice of the meeting will be sent by mail ( ) to all members at least 21 days prior to the meeting date. On March 24, 2016 all ATRA membership received notice by eblast of the possibility to regulate ATRA through a combined college. As our regulation meeting format concludes with a vote effective April 21, 2016, bylaw criteria has been met. This format of holding a special meeting does not alter or amend ATRA s bylaws. Our ATRA bylaws do not stipulate how a vote is to be conducted. As technology makes available secure online, efficient and effective mechanisms, ATRA has with diligence selected to use an on-line method to conduct this very important vote to make it as inclusive as possible for all ATRA membership and retain anonymity of one's vote. 37. ATRA Membership Votes ATRA Membership will vote online on whether or not ATRA will pursue regulation with ACOT between April 21 28, Determination of a successful vote is 50% plus 1 of all members that voting. If YES vote, ACOT and ATRA will write a joint letter to the Minister of Health to provide rationale for Recreation Therapists to become regulated and our desire to be considered for regulation as part of ACOT. If regulation proceeds, this is still not a guarantee ultimately the Alberta government decides if it s in the best interest of the public for us to be regulated. 38. ATRA Endorsement The ATRA Board of Directors and the Executive Director endorse the opportunity to work with ACOT to form one college that represents both professions. We encourage membership to vote yes. Pursuing regulation through a combined college will elevate our profession, and help ATRA and its practitioners offer the best possible service to Albertans. 39. Letter to the Minister of Health and Seniors If ATRA membership votes yes to proceed, ACOT and ATRA will write a joint letter to the Minister of Health and Seniors to provide rationale for Recreation Therapists to become regulated and our desire to be considered for regulation as part of ACOT. If regulation proceeds, this is still not a guarantee ultimately the Alberta government decides if it s in the best interest of the public for us to be regulated. Sincerely, Your ATRA Board of Directors and Executive Director 12
13 References Alberta College of Occupational Therapy (n.d.) What you need to know about continuing competence. Retrieved April 18, 2016 from the Alberta College of Occupational Therapy website: - Applicants. ACOT (n.d.) Permit registration & renewals / Canadian applicants. Retrieved April 18, 2016 from the Alberta College of Occupational Therapy website: - Applicants. Alberta Federation of Regulated Health Professions (2008). Enhancing Public Protection Together. Retrieved April 20, 2016 from the AFRHP website Alberta Health Services, Inter-Professional Services and Regulatory Affairs. Health Professions Strategies and Practice (2012, November). Overview of the Health Professions Act of Alberta: Implications for Clinical Practice. Retrieved December 23, 2015 from Alberta Health and Wellness (2004, June). Health Professions Act Employers Handbook. Retrieved April 20, 2016 from Alberta Therapeutic Recreation Association (2012). Competency profile for recreation therapists in Alberta. Retrieved April 18, 2016 from Alberta Therapeutic Recreation Association, (2013) Risk to the Public for Recreation Therapists in Alberta). ATRA members can locate this document in the Members section of the ATRA web site in the ATRA Guiding Documents section of the Documents & Forms page. Government of Alberta (2014). Psychosocial Interventions: An Interpretive Guide to the Restricted Activity. April 20, 2016 from Province of Alberta (2015). Health Professions Act. Revised Statutes of Alberta 2000, Chapter H-7. Retrieved April 20, 2016 from This April 20, 2016 document takes precedent over previous editions. For questions or suggestions to this material, please contact: vicepresident@alberta-tr.org. 13
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