Emergency Preparedness

Information on COVID-19 & Practice

See this page for questions and answers on navigating practice pertaining to pandemic restrictions.

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Assessing Necessity of In-Person Practice and Risk of Transmission in Your Setting

 

Registrants who operate a solo private practice and registrants who own or run a joint practice or a practice with employees or contractors are responsible for engaging in operational risk assessment and return to work planning. For those who have not yet resumed in-person services, CRPO expects that this assessment and planning will occur before in-person services are resumed. For those who have already resumed (or continued to provide) in-person services, it is expected that you will have already implemented appropriate infection prevention and control (IPAC) measures.

 

 

Assess Whether In-Person Services Are Necessary

 

The first step in your return to in-person practice is to assess whether it is necessary or appropriate to provide in-person services based on your client’s care needs.

 

CRPO continues to advise that registrants are in the best position to determine when and if it is appropriate to resume in-person services. Please note that while resuming in-person services is permitted, it is not required.

 

Registrants must continue to evaluate their clients’ individual care needs on an ongoing basis, recognizing those clients who continue to benefit from e-therapy and those circumstances in which in-person contact with a client may be indicated. Unless it is not possible to do so, new clients should be assessed remotely to determine whether ongoing care via e-therapy is appropriate or whether in-person services are indicated. Registrants are encouraged to review current directives provided by the Chief Medical Officer of Health (CMOH) regarding essential health care services and consider current restrictions and public health measures. When determining which clients should be offered the option of in-person care, registrants should consider the principles set out in Directive #2: Proportionality; Minimizing Harm to Patients; Equity; and Reciprocity.

 

Relevant CRPO resources and guidance can also be found in the Electronic Practice Guideline (see in particular the section entitled Appropriateness); these resources offer useful information to support decision-making regarding provision of in-person services.

 

Evaluate Risk of Transmission in Your Practice

 

The next step in your return to in-person practice planning is to assess the risk of infection transmission in your practice by considering:

 

  • The intensity of your contacts with clients (e.g. how much time do you spend with people and how close are you); and
  • Your overall number of contacts (e.g. people in the setting at any given point in time)

 

You must either continue to provide e-therapy or implement IPAC measures in the setting (or a combination of both) if your contact with clients or others in the setting will result in:

 

  • Prolonged contact with another person in an enclosed space where the ability to physically distance is limited
  • Any contact that is closer than the recommended physical distancing measure

 

The extent to which IPAC measures can be implemented in the setting, and the effectiveness of those measures, must be carefully considered as part of an overall organizational risk assessment. The diagram below illustrates the domains that are within the control of individuals, employers and organizations. It sets out a range of IPAC measures that could be implemented, which are listed based on the order of the effectiveness of those interventions. Controls that appear in the top band are considered most effective, while those appearing in the lowest band are considered least effective.

 

The hierarchy of controls is a common model applied in occupational health and safety. The diagram used in this document was adapted from resources developed by the Government of British Columbia.

 

 

Hierarchy of Controls

 

 

Corresponding Examples

 

  • Eliminating in-person therapy & substituting with e-therapy wherever possible.
  • Providing services outdoors while distancing (e.g. walking therapy).
  • Adding physical barriers such as translucent screening.
  • Spacing office furniture to meet recommended guidelines.
  • Increasing ventilation and cleaning schedules. Establish and communicate effective policies, providing education & training to staff, clients and visitors.
  • Screening all staff, clients and visitors, including passive (e.g. signage) and active (e.g. pre-session by phone and onsite)
  • Reducing number of persons in the setting at any given point in time to only essential staff, clients and essential visitors.
  • Limiting gatherings in the settings (e.g. meetings, lunches).
  • Posting educational signage regarding cough/sneezing etiquette and use of PPE.
  • Making hand sanitizer, tissues and a wastebasket readily available.
  • Using PPE appropriately.

 

Adapted from: Key Steps to Safely Operating your Business or Organization and Reducing COVID-19 Transmission, Government of British Columbia, April 2020.

 

Those who own or run a practice with employees where in-person services are provided are responsible for establishing a safe practice environment and must assure that those working in the setting receive adequate education and training. Every person in the setting has a role in preventing the spread of COVID-19, and so must understand policies and expected procedures. These individuals may also have additional obligations with respect to workplace health and safety reporting and reporting staff illness to public health units.

 

 

From the Ministry of Health and Long-Term Care

 

PPE can still be accessed, depending on available supply, on an emergency basis through the established escalation process which is as follows:

 

1. Once you have ascertained that, despite stewardship and conservation efforts, you have a critical supply shortage, we would ask that you do the following:

 

  • Work with your regular supplier to determine when you will get regular shipments of PPE and equipment.
  • Submit a request via the appropriate Personal Protective Equipment Intake Form to work with your region/regional table and with other local health care providers to determine if others in your local area have supplies they can provide to you.

 

2. If none of these actions are successful, your appropriate regional PPE lead* will escalate your request to the Ministry’s Emergency Operation Centre (MEOC).

 

 

Developing a Return to In-Person Practice

Setting & Those Who Interact There

Develop a return to work plan to help you identify and implement the combination of Infection Prevention and Control (IPAC) measures that will be required in your setting.

To what extent can the setting enable physical distancing?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • Continue to provide services remotely if appropriate infection prevention is not possible, using communications technologies.
  • *Move furniture based on physical distancing recommendations.
  • Put physical barriers in place, such as plexiglass in front of administrative areas, where appropriate.

To what extent does the use of communal space and flow of people need to be managed?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Maintain a confidential log of all persons coming into the setting, including staff, clients and visitors, to facilitate contact tracing should a case of COVID-19 be associated with your practice. Log should include names and arrival and departure times.
  • *Close waiting rooms, encourage clients to wait outside or in their car, notifying them by text or phone call when you are ready to see them.
  • *Reduce or eliminate face-to-face meetings
  • *Restrict staff and visitors to those who are essential only, while ensuring enough staffing to meet service needs
  • *Space out appointments, including to accommodate cleaning of high-touch surfaces between clients
  • Restrict use of office kitchen or other shared spaces; stagger breaks in those spaces
  • Stagger staff schedules

How can hygiene practices in the setting be improved?

  • Remove high touch objects, such as magazines, toys, decorations, and products for sale
  • Sanitize high touch surfaces between clients
  • Increase cleaning schedules
  • Increase ventilation

What behavioural cues can be used to promote hygiene in the setting?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Remind staff, clients and visitors to self-assess for symptoms before coming into the setting
  • *Relax cancellation policies
  • *Place sanitizer and tissues in a prominent area
  • *Post signage regarding cough/sneeze etiquette and hand washing
  • *Post signage regarding self-assessment of  COVID-19 symptoms
  • Encourage clients to use an appropriate non-medical mask or face covering during their session and consider having a supply of disposable masks available for clients

If you employ or contract others to work in the setting, including associates or supervisees, what other considerations apply?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Establish and provide training in organizational policies and protocols regarding: self-assessment, self-isolation & self-quarantine, hygiene practices, symptom screening, appropriate use of PPE (including correct techniques for putting on and taking off equipment)
  • *Apply occupational health and safety standards as applicable, including reporting to Workplace Safety and Insurance Board and public health units
  • *Understand reciprocal obligations of employer and employee to promote the safety and well-being of those working in the setting during a pandemic

If you use equipment, tools or devices while providing psychotherapy, what measures must you take to ensure these are used safely and effectively?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • Refrain from using equipment unless necessary
  • *Use appropriate PPE if the use of equipment will bring you into contact with or within 2 meters of the client
  • *Establish sterilizing or sanitizing procedures and document these as appropriate

Is there anything about the client population or the services you provide that requires consideration?

  • When working with children, those with disabilities and other vulnerable persons
  • When providing services in home-based settings
  • When providing therapy that involves animals
  • Refrain from bodywork or any technique that requires contact with or proximity to the client, unless PPE is used as described in the Occupational Health and Safety section of the COVID-19 Operational Requirements
Developing a Return to In-Person Practice

Working with Clients

In what circumstances will you provide in-person services, and in what circumstances will you not?

  • Develop a protocol based on appropriate resources
  • Recognize that clients with certain pre-existing conditions may suffer the most severe symptoms if they become infected

How will you communicate implemented screening measures?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Encourage clients and visitors to self-screen in communications with them and in posted signage.
  • *Conduct phone screening before appointments and in-person upon client arrival -various screening tools available here.
  • Defer in-person appointments for clients who fail screening
  • *Develop a policy for managing clients who show a positive screening result. The policy should identify that, unless it is essential the client receives in-person services, a client who has a positive screening cannot attend their scheduled session in-person and alternate arrangements will be made. If a client with a positive screening requires face-to-face services, the plan must identify what PPE protocols will be employed.
  • *If a client shows a positive screening result onsite, require they wear a surgical/procedure mask, isolate them from others in the setting, consider whether it is possible to make alternate arrangements for their scheduled session, and engage in a deep cleaning of the room. In all cases, clients who show a positive screening result should be encouraged to seek COVID-19 testing at the assessment centre nearest to them.

Will there be any new limitations or requirements that clients should be aware of?

  • Limit or prohibit early arrival and use of common spaces
  • Limit the circumstances in which another person can accompany a client to a session, and the number of individuals who may accompany a client
  • Employing hygiene practices in the setting or use of PPE (such as non-medical face masks)
  • Manage care of clients who have pre-existing conditions that place them at higher risk of serious complications or death (e.g., age, underlying chronic illness, compromised immune systems)
  • Manage care of clients who fail the screening test
  • Adjust payment procedures to reduce contact

What behavioural cues can be used to promote hygiene in the setting?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Remind staff, clients and visitors to self-assess for symptoms before coming into the setting
  • *Relax cancellation policies
  • *Place sanitizer and tissues in a prominent area
  • *Post signage regarding cough/sneeze etiquette and hand washing
  • *Post signage regarding self-assessment of  COVID-19 symptoms
  • Encourage clients to use an appropriate non-medical mask or face covering during their session and consider having a supply of disposable masks available for clients

How will you communicate effectively with clients about changes or new protocols implemented in your setting?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • Recognize the impact of the content, timing and the communication method employed
  • Manage client questions and concerns
  • Update practice websites
  • *Make pre-screening and point-of-care of clients a standard of care and use it as an opportunity to reinforce understanding of infection and prevention control measures

What measures must you personally employ to prevent spread of infection as you work with clients?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • *Assess self for symptoms daily
  • *Refrain from going into the work setting if symptoms are present, and report as necessary to employers or public health units
  • *Refrain from physical contact, including handshakes
  • *Disinfect high touch surfaces after each client
  • Refrain from sharing office equipment
  • *Engage in frequent hand washing
  • *Use PPE appropriately, for example, by donning a surgical/procedure mask when providing services to a client, as described in the Occupational Health and Safety section of the COVID-19 Operational Requirements
Developing a Return to In-Person Practice

Managing Resources

Will you be able to obtain the supplies needed to carry out your return to work plan?

  • *Maintain a list of supplies and determine their general availability, including the use of surgical, procedural masks that will be distributed to clients and visitors who do not come with their own non-medical mask
  • Identify credible, reliable suppliers of workplace PPE
  • Communicate with suppliers to anticipate and manage shortages

What will you do if there is a disruption in your access to supplies that are necessary for safe delivery of care?

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

 

  • Maintain an updated list of available supplies
  • Identify appropriate substitutions
  • Change session format, rebooking or canceling sessions

What actions will you take to manage disruptions to client care in the event you or another person working in the setting become infected with COVID-19?

  • Manage communications with clients and others working in the setting
  • Develop a contingency plan for your practice

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