1. 1 ADVOCATING WITH YOUR AUDIOLOGIST Self Regulation Advocacy for Public Protection Other opportunities

2. 2 Privilege Professions not government set the rules Responsibility: Protect public from harm Promote high quality care Enforce the rules WHAT IS SELF REGULATION?

3. 3 WHAT IS CASLPO? 21 Health Regulatory Colleges / 250,000 Health Professionals Regulated Health Professions Act Audiology and Speech-Language Pathology Act Council – Professional & Public Members 524 Audiologists 2558 SLPs 40% of total in Canada

4. 4 5820 SLPs 1130 Auds 6 Provinces Regulate 80% of SLPs & AUDs Mandatory Membership » Alberta » Manitoba » New Brunswick » Ontario » Quebec » Saskatchewan CASLPA & Provincial Associations - voluntary CANADIAN PICTURE

5. 5 WORKING IN ONTARIO WHAT IS REQUIRED TO WORK AS AN AUDIOLOGIST OR SLP IN ONTARIO? Only persons who are registered members of CASLPO can use the titles Audiologist and/or Speech-Language Pathologist or Speech Therapist in Ontario Only CASLPO members can practice in Ontario as Audiologists or Speech-Language Pathologists

6. 6 ROLE OF CASLPO & ASSOCIATIONS Role of the College: protect the public regulate in the public’s interest Role of the Associations: advocate for the member promote the profession

7. 7 WHO SETS STANDARDS CASLPO is the only body authorized by law to set standards for AUDs & SLPs in Ontario CASLPO regulations are approved by the Government of Ontario

8. 8 WHAT CASLPO DOES Regulate Support the profession Assist the public

9. 9 REGULATE Set standards Register members Self Assessment / Peer Assessment CEEs Complaints / Discipline Incapacity / Incompetence Title Protection Controlled Acts

10. 10 SUPPORT PROFESSION PPGs Advisory Services Seminars Bulletin Website Protect Members’ rights  Employers  Insurance  WSIB, NIHB, RCMP

11. 11 ASSIST & PROTECT THE PUBLIC Public Awareness Advice Find a member Complaints & Discipline ADR Protect public rights Access

12. 12 HOW AUDs & SLPs ARE REGULATED Acts Regulations By-laws Code of Ethics Preferred Practice Guidelines Position Statements Professional Practice Standards

13. 13 ACTS RHPA Audiology & Speech-Language Pathology Health Care Consent Act Child & Family Laws Act Education Act Health Act Personal Information Privacy Act Others

14. 14 REGULATIONS Registration Quality Assurance Professional Misconduct Advertising Conflict of Interest Records Sexual Abuse Prevention

15. 15 CODE OF ETHICS Practice for benefit of patients Respect patients as persons Legal requirements Practice requirements Service delivery Patient information Business practices

16. 16 PREFERRED PRACTICE GUIDELINES Statements of Preferred Clinical Practice to be used as guidelines Used as standard if complaint is received

17. 17 PREFERRED PRACTICE GUIDELINES Existing: Dysphagia (2000) Hearing Aid Prescription for Adults (2000) Cognitive Communication Disorders (2002) Hearing Aid Prescription for Children (2002) Earmold Impression (2004) Cerumen Management (2004) Stuttering (2004)

18. 18 PRACTICE STANDARDS & GUIDELINES Dysphagia (2007) Hearing Assessment of Adults (2008) Hearing Assessment of Children (2008) Assessment of Children by SLP (2008) Under Development: Dispensing

19. 19 POSITION STATEMENTS Statements of College policies Used as standard if complaint Received Compliance mandatory

20. 20 POSITION STATEMENTS 1. Acceptance of Delegation of a Controlled Act. (2000) 2. Alternative Approaches to Intervention (2002) 3. Changing Hearing Aid Prescriptions (2000) 4. Concurrent Interventions Provided by CASLPO Members (2001) 5. Delegation of the Controlled Act of Hearing Aid Prescription (2000) 6. Facilitated Communication (1996) 7. Guidelines for the Use of Supportive Personnel (1997)

21. 21 POSITION STATEMENTS 8. Inter-professional Disagreement (2002) 9. Professional Relationships and Boundaries (2001) 10.Service Delivery to Culturally and Linguistically Diverse Populations (2000) 11. Supervision of Students (2002) 12. Use of Surveillance Material in Assessment (2000) 13. Doctor Title (2003) 14. Telepractice (2003)

22. 22 PROFESSIONAL PRACTICE STANDARDS Standards reasonably expected of profession Complaints, Discipline, QA, Fitness to Practice Self Assessment / Peer Assessment

23. 23 REGULATORY PROCESS Investigations Complaints Discipline Mediation / Dispute Resolution Board of Inquiry / Fitness to Practice Appeals

24. 24 COMPLAINTS Patients / Clients Members Other Professionals ?

25. 25 COMPLAINTS COMMITTEE Members of the Profession Public Members

26. 26 COMPLAINT DECISIONS Dismiss Discipline QA Caution or Reminders

27. 27 COMPLAINTS Rude and unprofessional conduct Breach of contract / overbilling Incompetence Disclosure of information False advertising Changing prescriptions

28. 28 CONSENT 1.Consent to Release Information 2.Consent to Collect Information (PIPEDA/HIPPA) 3.Consent to Treatment

29. 29 ADVOCATING FOR PUBLIC PROTECTION

30. 30 IMPORTANCE OF HEARING Communication Language & Literacy Infants – spoken language Children & Youth – education, social behaviour Working-age adults – jobs, family life Seniors – independence, safety

31. 31

32. 32 CRITICAL COMPONENTS Audiological Assessment Audiometry Electrophysiology (ABR, ASSR, ECochG, etc.) Central auditory tests Immitance testing Vestibular assessments Tinnitus assessments and management Cerumen Management Aural Rehabilitation Non-tech interventions Tech interventions Hearing aids Cochlear implants Middle ear implants, BAHA

33. 33 RISK OF HARM Testing, Prescribing, Dispensing Physical to the ear from testing fittings, ear impressions Physical because of missed medical risks – tumors Physical because of wrong test, prescription, dispensing – alarms, traffic

34. 34 RISK OF HARM (cont…) Emotional – depression, isolation Delays in speech & language development Development of inappropriate attitudes and behaviours - 60% of Young Offenders Loss of independence for seniors Disruption of family relationships Lost jobs and productivity Economic and social costs Monetary investment

35. 35 CRITICAL COMPONENTS OF HEARING AID PROVISION AUDIOLOGICAL ASSESSMENT (testing) DISPENSING PRESCRIBING Step #1 Step #2 Step #3

36. 36 WHAT ASPECTS OF HEARING TESTING, PRESCIBING AND DISPENSING SHOULD BE CONTROLLED? Some specific tests Some specific testing procedures – presenting sound or air pressure The provision of advice and recommendations for treatment, based on hearing tests, that may result in harm

37. 37 ADVOCACY FOR PUBLIC PROTECTION ISSUE: Audiological Assessments, Prescribing and Dispensing are not regulated in most provinces Competencies

38. 38 OBTAINING A HEARING AID Generic Specific None at all

39. 39 GENERIC PRESCRIPTION Mrs. Jones needs a hearing aid.

40. 40 SPECIFIC PRESCRIPTION The prescription for the prescribed hearing aid(s) should include, but not be limited to: a)Ear(s) to be fitted b)The style of hearing aid(s) or device(s) c)The manufacturer’s name/model number d)Frequency/gain characteristics obtained from an evidence based fitting rationale, including real-ear measurement characteristics e)Type of signal processing f)Special potentiometers, where appropriate, including but not limited to gain control, output control, tone controls, compression ratios and knee point adjustments

41. 41 SPECIFIC PRESCRIPTION (cont.) h)The initial volume control setting, where appropriate i)Features, including but not limited to directional microphone, telecoil, direct audio input j)The earmold style, material and specifications for modifications including venting and tubing, where applicable k)Any special applications for ear hooks including but not limited to pediatric ear hooks l)Special applications, including but not limited to a bone conduction hearing aid, CROS/BICROS systems, where applicable.

42. 42 DO CURRENT CONTROLLED ACTS ALLOW “GENERIC” PRESCRIPTIONS? Mrs. Jones needs a cancer drug – NO Mrs. Jones needs eyeglasses – NO Mrs. Jones needs a hearing aid – YES None at all

43. 43 ADVOCACY FOR PUBLIC PROTECTION Just like drugs and eyeglasses, there are many choices to meet the needs of the patient that must be made by the prescriber Prescribing and Dispensing hearing aids should be regulated Only persons who have the competencies, like Audiologists, should be allowed to prescribe and dispense

44. 44 Advertising Conflict of Interest REGULATIONS

45. 45 CASLPO can only regulate audiologists & speech-language pathologists CASLPO cannot regulate employers CASLPO cannot regulate hearing aid dispensers or dispensaries or retailers REGULATORY FACTS

46. 46 Free hearing tests? Free hearing tests if you purchase a hearing aid? Free batteries or alarm clocks with purchase of hearing aid? $1.99 hearing tests? Fees for services? ADVERTISING

47. 47 In public interest as it increases accessibility Raises public awareness May encourage public to act on a problem The non-regulated do. If members are restricted it creates an uneven playing field. Allows audiologists to compete with unregulated dispensers Can be done ethically and responsibly – CASLPO safeguards against provision of unnecessary services “YES” COMMENTS

48. 48 Better to get a free test from a regulated professional than from someone else. CASLPO needs to trust that their members are not forcing people to purchase hearing aids “YES” COMMENTS

49. 49 It is misleading It is unprofessional Devalues services provided May motivate members to provide unnecessary services and sell hearing aids where they are not needed to recoup the cost of free services Could lead to insurance industry pressuring clients to go for free services and to erosion of publicly funded health care Nothing is free “NO” COMMENTS

50. 50 Advertising by all hearing health care providers should be regulated. ADVOCACY FOR PUBLIC PROTECTION

51. 51 CONFLICT OF INTEREST A conflict of interest may be actual, potential or perceived.

52. 52 CONFLICT OF INTEREST Members may not in any circumstance accept or receive a benefit based on a quota system or specific number of services or products or hearing aids prescribed or dispensed.

53. 53 Volume discounts are allowed if they are utilized for the benefit of patients/clients. Volume discounts applicable to the dispensing of a product may be used to subsidize other clinical activities, or may be redirected to activities that benefit other patients/clients. CONFLICT OF INTEREST

54. 54 Trips and other rewards cannot be accepted if they are granted according to performance or a quota. Trips can be accepted if they are not tied to performance or a quota and have a meaningful educational component. CONFLICT OF INTEREST

55. 55 Should audiologists be restricted if others are not? CONFLICT OF INTEREST

56. 56 ADVOCACY FOR PUBLIC PROTECTION All hearing health care providers should be regulated for conflict of interest

57. 57 Access to Audiologists ADVOCACY FOR PUBLIC PROTECTION

58. 58 Rules for public services Rules for private services ACCESS

59. 59 THE PLAYERS Regulators - Boards - Colleges Providers - Health Professionals - Others Patients Clients Funders - Gov’t - Insurance - Others

60. 60 OVERVIEW Who’s in control? Who’s making the rules? Public Access Freedom of Choice Discrimination Public Interest Private Interests

61. 61 OHIP Diagnostic Hearing Tests Insured Benefit Performed by ENT or Audiologist Audiologists must be employed and supervised by ENT

62. 62 Direct to Audiologist GP or ENT referral Audiologist test & prescriptions Open public access OLD SYSTEM

63. 63 GP consult Referral to ENT ENT consult Test by Audiologist ENT interpretation / consult GP prescription for Hearing Aid Audiologist NEW SYSTEM

64. 64 REASONS FOR CHANGE Save $50 Million Pay Doctors Physician gatekeepers Restrict access

65. 65 PROBLEMS 200 ENTs 12 million Ontarians NO medical necessity for ENTs Hospital / private clinics closing Winners / losers Access / waiting lists Financial hardship

66. 66 ISSUES Infringement on Audiologists’ rights Infringement on Public’s rights Geographic discrimination & financial hardship Waste of time & money Two-tier health

67. 67 ISSUES Patient rights / responsibilities  to know condition  to know treatment options  to make informed decisions  to obtain quality treatment / service  to choose provider?  responsibilities?

68. 68 ISSUES Provider rights / responsibilities  to practice according to professional standards  to assist patients to make informed decisions  to not be fired for compliance  to work without interference / supervision?  to a fair and level playing field?

69. 69 ISSUES Funder rights & responsibilities  stay within budget  make a profit  stay in business  set eligibility criteria  provide cost effective services  set standards for quality & quantity  decide who is most in need?

70. 70 ISSUES Regulators rights & responsibilities  Regulate professions  Set professional practice standards  Protect the public  Protect rights of members  Ensure public access to professions / services??

71. 71 OPPORTUNITIES Smart use of resources Right professional for right task Co-operation

72. 72 OPPORTUNITIES Pubic & Audiologists to work together to ensure access to Audiologists

73. 73 ADVOCATING WITH YOUR AUDIOLOGIST Hearing health care is important All providers should be regulated The public should have the right to access regulated hearing health care providers directly