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SECTION 5.4: Clinical Staffing Requirements

A range of clinical staff may be involved in the supervision and delivery of evidence based behavioural services in the OAP. The following section outlines the roles and responsibilities of different clinical staff members, as well as two sets of qualifications:

While all qualifications requirements are effective January 15, 2018, compliance will be phased in over time to facilitate a smooth transition for families and service providers. Clinical Supervisors who do not have the required qualifications will need to confirm that they are working towards these qualifications within a specified timeframe on the OAP Clinical Supervisor Attestation form.

As the capacity of the OAP workforce evolves, additional clinical staffing requirements may be developed and implemented for staff at all levels to ensure effective, safe provision of evidence based behavioural services in the OAP. The ministry will continue to work with families, practitioners, and other partners to support long-term capacity building in the sector, including in remote and rural areas.

Clinical Supervisors

As an expert in assessment and behavioural interventions, the role of the Clinical Supervisor is to assess, develop and recommend appropriate evidence based behavioural services in a manner that is consistent with the OAP Clinical Framework.

Titles of individuals in a supervisory role vary in Ontario, and may include Clinical Supervisor, Clinician-in-Charge, Clinical Director, or similar.

Clinical Supervisors are accountable for overseeing all aspects of a child/youth's OAP Behaviour Plan, in close collaboration with families, therapists, and inter-professional partners.

Supervisors are expected to have direct contact with the child/youth and family in real-time, ideally in-person or, if this is not possible, through a secure remote connection. Tasks involving direct contact with the child/youth and family include but are not limited to:

Supervisors also carry out a number of tasks outside of their interactions with families, in collaboration with other clinicians. These tasks may include (but are not limited to):

Clinical Supervisors may delegate some of their duties to front-line therapists under their supervision and are responsible for confirming that these therapists are competent, and continue to be competent, to perform the tasks assigned to them, taking into account numerous factors, including skills, education, and experience.

Required Qualifications for Clinical Supervisors

Professionals supervising behavioural services in the OAP must have the following qualifications:

  • One of the following professional designations:
    • Board Certified Behavior Analyst® (BCBA®)
    • Board Certified Behavior Analyst – Doctoral™ (BCBA-D™)
    • Clinical Psychologist or Psychological Associate registered with the College of Psychologists of Ontario with documented expertise in ABA 7
  • At least 3,000 hours post-certification/registration experience (typically completed over two years) delivering Applied Behaviour Analysis (ABA) services to children and youth with ASD (including a minimum of 1,500 post-certification hours involving supervisory duties)
  • Vulnerable Sector Screening/Check
  • Professional liability insurance (purchased individually or through employer)
  • Adherence to a professional code of conduct (e.g., Behavior Analyst Certification Board® Professional and Ethical Compliance Code, College of Psychologists of Ontario Standards of Professional Conduct)

Front-Line Therapists

Front-Line Therapists are responsible for implementing the services outlined in the Behaviour Plan, and must receive an appropriate amount of training and clinical supervision from the Clinical Supervisor.8

Most front-line tasks involve direct contact with the child/youth and family, and include, but are not limited to, the following:

A child or youth may have one or more front-line staff involved, depending on the complexity of their needs, the behavioural services being delivered, staff competencies, and frequency of supervision delivered by the Clinical Supervisor.

Given the breadth of OAP services, each Front-Line Therapist's level of responsibility will vary, but will typically fall into one of two categories:


Qualifications for Front-Line Therapists

Required

All Front-Line Therapists delivering services in the OAP must have a Vulnerable Sector Screening/Check

Recommended

The following qualifications for Front-Line Therapists are strongly recommended for clinical teams delivering OAP services. It is the responsibility of Clinical Supervisors to confirm that the therapists they are clinically supervising have the appropriate skills, education, and experience to deliver behavioural services in the OAP.

Senior Therapist: (if applicable)

  • At least one of the following credentials:
    • Board Certified Behavior Analyst® (BCBA®)/Board Certified Assistant Behavior Analyst® (BCaBA®) (or in progress with appropriate supervision) with 3,000 hours of supervised experience delivering ABA services
    • 4,500 hours experience delivering ABA services under the supervision of a BCBA® and/or registered psychologist with expertise in ABA

ABA Therapist

  • At least one of the following credentials:
    • Registered Behaviour Technician™ (RBT®) (BACB®)
    • Completed, or on track to complete, related university degree (psychology, ABA, etc.)
    • 1 year experience delivering ABA/IBI services under the supervision of a Senior Therapist and/or Clinical Supervisor
    • Completed, or on track to complete, related college diploma (e.g., Autism and Behavioural Services, Behavioural Science and Technology, Early Childhood Education, Child and Youth Worker)

It is recommended that all Front-Line Therapists also obtain and/or demonstrate:

  • Professional liability insurance (purchased individually or through employer)
  • Adherence to a professional and ethical compliance code (e.g., Behavior Analyst Certification Board® Professional and Ethical Compliance Code, College of Psychologists of Ontario Standards of Professional Conduct, or other applicable compliance codes)

Partnerships with a Professional with Specialized Expertise

Clinical Supervisors may partner with a peer (i.e., a professional with specialized expertise who they are not clinically supervising) to deliver a specific component of a Behaviour Plan. This would typically occur when, in the Clinical Supervisor's opinion, the child or youth would benefit from an additional evidence based behavioural service that is outside of the Clinical Supervisor's scope of expertise.

Partnerships with professionals with specialized expertise are unique to each child/youth's individual needs. A Clinical Supervisor may consult with this professional, or the child/youth may work directly with the professional with specialized expertise.

Note that only services that meet the criteria of an evidence based behavioural service, as defined in these guidelines are eligible for OAP funding.

Clinical Supervisor Responsibilities

The Clinical Supervisor does not clinically supervise these partners, but is responsible for:

Independent Clinical Review Process

The Independent Clinical Review process (ICR) allows families to request a review of key components of their child's OAP Behaviour Plan. It is administered by a third party agency, the ICR Coordinator.

As a prerequisite to the ICR process, families who are dissatisfied with their child's OAP Behaviour Plan must first notify their Direct Service Option or Direct Funding Option OAP service provider. OAP service providers must work with the family through their internal review process to try to resolve any differences in perspective about a child's OAP Behaviour Plan. To support this internal process, the provider will consider applying a range of conflict resolution strategies such as seeking an internal second clinical opinion, having a senior management representative review the plan, or involving an internal facilitator. If the family remains dissatisfied with the outcome of the OAP provider's internal review, they can request an independent review of their child's OAP Behaviour Plan by completing a Family Request Form available from their OAP provider as well as from the ICR Coordinator's website. The family signs and submits the form to their OAP provider who submits it to the ICR Coordinator on their behalf.

Families requesting an independent clinical review of their OAP Behaviour Plan will receive a decision from the ICR no later than 45 business days from the date they submitted the ICR Family Request Form to their OAP service provider.

For more information about the ICR guidelines please refer to the ICR Guidelines.

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