Endings: concluding therapy and discontinuing services

1On the exam (CRPO's words)

• Area 5 of CRPO's blueprint, Manage separation and ending, is at least 5 to 10% of the assessment (Resource Manual, Test Blueprint Specifications).
• CRPO does not publish how many points any one competency carries within the area.

2Concluding well (4.5t, 4.6, 4.7)

• Recognize when to discontinue or conclude therapy (4.5t), from reviewing progress with the client (4.5s).
• Prepare the client in a timely manner for the ending of a course of therapy (4.7a).
• Outline follow-up options, support systems and resources (4.7b).
• Refer, where indicated, in a reasonable time (4.6c).

3When is discontinuing appropriate?

1. Your reasons for discontinuing.
2. The client's condition.
3. The availability of alternate services.
4. The opportunity given to the client to arrange alternate services before the discontinuation.

4Misconduct both ways

• Discontinuing services unless members would reasonably regard it as appropriate, given the four points above (O. Reg. 317/12, s. 1, para. 6).
• Continuing to treat a client where the treatment is no longer indicated or has ceased to be effective (para. 7).

6Never a reason

• Any ground protected by the Ontario Human Rights Code, such as race, creed, sex, sexual orientation, gender identity, age, family status or disability (6.3.2); nor personal reasons such as the client's political views.
• A client's disability: accommodate unless it causes undue hardship.
• Disagreement over the treatment plan, personality incompatibility or general foul language: CRPO says these are not abusive behaviour.
• Saying you lack competence when the real reason lies elsewhere: the decision is made in good faith.

7Fees (6.1)

• Non-payment is not grounds for immediately discontinuing: first advise the client of alternative services accessible to them.
• Make sure, at the start, the client understands services will be discontinued if payment is not received.
• Block fees: no pressure to continue; refund services not yet provided within seven days.

8Say it and record it (6.3.3, 6.3.4)

• If the client wants further treatment, make reasonable efforts to provide referrals to other providers.
• Clearly communicate the reasons, and document them and the conversation with the client.
• The record holds the reasons, the client's condition, the discharge plan with any transition, and the conversations.
• Ending over a conflict of interest: note the conflict without any detail that could identify another client.

9Closing or leaving a practice (6.4)

• Notice of at least 30 days for a foreseeable closure or move; as much as possible in an emergency.
• Direct notice first; if some clients cannot be reached, at least two forms of indirect notice. Document every attempt.
• When leaving an organization, still make reasonable efforts to tell active clients.
• Keep a contingency plan, name a records successor, and keep records for 5.1's period even after closing.