Standards of Practice for Quebec Naturopaths

(Introduced in 2022)

[ View in French ]

A reminder that in regulated provinces, naturopaths must complete 4 years of full-time university (120 credits) before their first day of official naturopathic training, which is to continue for additional years.

INDEX

• Introduction
• Standard for Maintaining Professional Boundaries and preventing Sexual Abuse
•   Maintaining Professional Boundaries
•     Interpersonal Behaviours and Non-Verbal Communication
•     Gifts . giving or receiving
•     Preventing Sexual Abuse and post-termination relationaship
• Standards
•     Standard 1: Prepare the consultation area
•     Standard 2: Inform client of pricing
•     Standard 3: Cleanliness of all work surfaces
•     Standard 4: Initial visit: interview and intake form
•     Standard 5: Blood testing panels
• Special Considerations
•     Determine the Client's Condition
•     Issuing an insurance receipt to the client

---

Introduction

Scope of Practice

The practice of Naturopathyplaces a strong emphasis on prevention and education. Knowledge of lifestyle factors and the general degree of health so as toaugment physical function, improve and strengthen the immune system, and offer consultations that aims to empower clients with information and choices.

What are Standards of Practice?

The .Association québécoise des thérapeutesnaturels. (AQTN) in collaboration with other-like minded associations, publishes Standards of Practice for Quebec Naturopaths as a source of reference for therapists, schools the public and regulatory bodies so as to establish reasonable expectations from a naturopathy session.

Standards help guide a practice and also increase public protection. It is the obligation of the Quebec naturopath to ensure they are complying with the Standards, to maintain a legal practice in all dimensions of their therapeutical work. Standards of Practice will evolve as changes in practice occur, notably as new evidence regarding what constitutes a healthy lifestyle and factors that can positively influence it.

There is no specific legislation in Quebec for naturopathy, as the province is not provincially regulated. As such, the standards limit the Quebec naturopath to:

• 1) Completing or receiving a completed intake form ;
• 2) Genetic testing that is in compliance with existing laws ;
• 3) Explaining blood tests listed in the schedule ;
• 4) In addition: a Quebec Naturopath can practice any of the modalities that fall under the definition of .naturotherapist. (defined individually by each collaborating association) . however, a naturotherapist cannot identify themselves as a Quebec Naturopath, and cannot adequately perform the non-regulated acts above.

Definitions

Therapeutic Relationship:

A client-therapist relationship is designed to promote,support and advance the health and best interest of the client. It must be grounded in trust, respect and the appropriate use of knowledge and skill, with the awareness of limitations.

Boundaries:

We each have boundaries that define our personal space. Physicalboundaries determine responses to close physical presence and to touch. Individuals also have boundaries defining their psychological and emotional space. We each interpret questions or remarks as appropriate / inappropriate, unobtrusive / intrusive or comforting / discomforting. Personal boundaries can vary widely among individuals according to such things as life experience, gender, age, culture and personal preference.

Professional Boundaries:

Are defined by the professional role and the limits of the professional role. A boundaryviolation is a serious boundary crossing and abuse of power which places the client at risk ofpsychological, financial, physical and/or sexual harm.

Power:

The naturopath and client do not have equal power in the relationship. The client seeksthe assistance of the Quebec Naturopathwho is considered to have knowledge and skill that the client does not have. The Quebec Naturopathmay have confidential client information that he/she must use in the client.s best interest.

Abuse:

Abuse is a violation of the power in the client-therapist relationship. It violates thebasic requirements of a therapeutic relationship: trust and respect. The Quebec Naturopath must use the appropriate knowledge and level of power to prevent abuse. Abuse serves the Quebec Naturopath.s interest or personal needs, often at the expense of the needs of the client. The Quebec Naturopath who abuses a client acts outside of professional boundaries. Abuse may take the form of verbal, emotional,physical, financial and/or sexual..

Verbal Abuse:

language that demeans, humiliates or insults the client. Verbal abuse cancause emotional abuse since the language may harm the client emotionally, culturally or spiritually. Given that therapists work with clients of many cultures and beliefs, it is important to recognize that personal remarks about client.s appearance, behaviour, language, beliefs, religious practices, etc., may be distressing. Behaviours such as sarcasm, teasing, swearing, or threatening are examples of behaviours that may be considered verbal or emotional abuse.

Physical Abuse:

an act which may cause pain, or harm to another. Use of force during a treatment are examples of behaviours which can be viewed as physical abuse.

Financial Abuse:

Financial abuse exploits the power differential between the therapist andclient and is often a monetary or equivalent gain for the therapist. Examples of financial abuse can include accepting gifts, borrowing money, becoming a trustee of a client.s account, accessing a client bank account, seeking financial benefits or other services.

Sexual Abuse:

Sexual abuse is a boundary violation and an abuse of power. Sexual abuse is regulated by the Quebec criminal code. Sexual abuse is defined very broadly as any undesired touching perceived as a sexual nature.

Standard for Maintaining Professional Boundaries and preventing Sexual Abuse

Quebec Naturopaths work with clients for health, preventionor therapeutic purposes. As unregulated health professionals, AQTN requires that therapists maintain professional boundaries at all times, as outlined in the code of ethics. Understanding the importance of boundaries and respecting boundaries is critical to the prevention of abuse and sexual abuse in particular.

The Quebec Naturopath Standardsare divided into fourparts:

• 1) .Maintaining Professional Boundaries. ;
• 2) .Preventing Sexual Abuse. ;
• 3) .Limited scope of practice in prevention. ;
• 4) .Quebec Naturopath continuing education requirements..

Maintaining Professional Boundaries

In these steps, the Quebec Naturopath is to maintain a strictly therapeutic relationship, and attentive to professional boundaries. The Quebec naturopath works with the client to meet realistic client needs and goals, referring as necessary.

Establishing a Practice Setting that Maintains Professional Boundaries

When working in a public or mobile space, the naturopath must take reasonable steps to ensure professionalism in the practice setting.

Elements that are deemed important (and which can be audited)::

• Cleanliness is observed at all times.
• Adequate lighting to ensure client safety.
• Free from potential hazards for injury.
• Respects individual needs related to allergies and sensitivities.
• Provides for client privacy and confidentiality.
• Ensures that any visual media or messaging accessible to clients or members of the public is appropriate and is not of a sensitive, discriminatory or offensive nature.

Interpersonal Behaviours and Non-Verbal Communication

Interpersonal behaviour and non-verbal communication are significant to setting professional boundaries. The Quebec naturopath must maintain professional behaviour toward clients at all times. The Quebec naturopath must also refrain from behaviours, remarks or physical gestures that increase the risk of boundary violations.

Quebec Naturopaths must ensure professional behaviour, body language and gestures by:

• Wearing attire appropriate to the therapeutic approach in the context of the work environment.
• Engaging in appropriate personal hygiene practices.
• Providing adequate physical boundary space between the therapist and client at all stages of the client appointment.
• Being mindful to identify and recognize any client .non-verbal. communication cues and address respectfully.

Standard: Verbal Communication to Maintain Professional Boundaries

The predominant part of the relationship is communication. Communication must be respectful, professional, and appropriate to a health care environment.

In communicating to maintain professional boundaries, QUEBEC NATUROPATHs must:

• Use language that is respectful, courteous, and non-sexual in nature.
• Respect client culture and diversity.
• Restrict inquiry on blood tests to the schedule, and as relevant to the assessment and focus personal disclosure of information on that which furthers the therapeutic relationship. Set and maintain appropriate boundaries in conversation at all times.

Gifts . giving or receiving

The QUEBEC NATUROPATH maintains boundaries by recognizing that receiving or giving gifts can violate boundaries. Gifts from clients may be offered, even unintentionally, as a means to secure .special. or preferred treatment.

• All gifts of a significant value (either monetarily or sentimentally) given / received should be documented in the client records. The Quebec naturopath must use their professional judgement to determine if the gift is of significant value to the client.
• The QUEBEC NATUROPATH must not allow gift giving / receiving to influence their professional decision-making nor allow it to impact the frequency, duration, cost, or modality used for/with the client.

Preventing Sexual Abuse and post-termination relationaship

Sexual abuse of clients by non-regulated health professionals is prohibited under Quebec criminal law.

Sexual abuse is often preceded by growing boundary crossings and violations. This slippery slope can be avoided by a clear understanding of boundaries and the limits of the professional relationship.

Defining Sexual Abuse a client by a QUEBEC NATUROPATH means:

1. Any form of physical sexual relations between the therapist and the client ;
2. Touching, of a sexual nature, of the client by the therapist, ;
3. Behaviour or remarks of a sexual nature by the therapist towards the client.

Post-Termination Relationships

Ending the client-therapist relationship does not eliminate the power imbalance that exists between therapist and client. This is because there may be continuing trust, knowledge, or influence derived from the previous professional relationship.

Standards

Standard 1: Prepare the consultation area

Conditions: In a treatment area, using disinfecting cleaning materials.

Task: Prepare the treatment area.

Quality / Technical :

• . Ensure that the room has been cleaned.

Safety:

• So that any obstacle or substance that could make the floor slippery is removed from the treatment room to prevent accidental falls.
• So that the transference of infectious diseases is limited.

Timing :

• Prior to the client entering the work area.
• After a client who leaves the work area.

Standard 2: Inform client of pricing

Ensure client has obtained and agreed to pricing

Conditions : A client seeking a consultation with a Quebec Naturopath.

Task: Ensure client has the information pertaining to fees and agrees.

Quality / Technical :

• Pricing should be posted and visible in waiting area or treatment room if the same.
• Ensuring that you explain the rates for a naturopathic appointment and any additional costs, such as:
  • Cost of a consultation with a medical doctor in the private sector ;
  • Administrative fees related to the process of blood panels.
• Ensuring that you explain your cancellation policy.
• Providing the client with an opportunity to ask questions about rates and policies.

Timing :

• When client arrives or makes contact to book initial treatment.

Standard 3: Cleanliness of all work surfaces

Conditions : Given that the consultation area and the client are ready for a manual treatment.

Task : Wash your hands and any skin surface that will/has come in contact with the client.

Quality / Technical:

• Ensure that soap and water or alcohol based hand sanitizer is used to clean skin surfaces by washing for a minimum of 30 seconds, including all surfaces.

Timing :

• Immediately before and immediately after each client treatment.

Standard 4: Initial visit: interview and intake form

Conditions : In a treatment area, given a client who comes to you for a naturopathy consultation.

Task : : Interview the client to obtain his/ her objectives (optionally documenting it in a SOAP note).

Quality / Technical:

SSo that your interview questions include :

• client's objective for the treatment
• identification of area(s) client would like to focus
• review of contributing lifestyle factors

Quality /Interpersonal:

• So that you give the client an opportunity to inform you of any specific area(s) to be treated and to relay any information the client chooses about his/her treatment goals.
• So that you give the client an opportunity to ask questions.

Timing :

• Before the consultation begins.

Establish recommendations

(may not apply to every session)

Conditions : Conditions: When completing / ending a consultation

Task : RComplete the lifestyle assessment review, keeping a copy and giving a copy to the client.

Quality / Technical: :

• Records must include
  • The completed LF assessment review
• So that records are confidential and are stored so as not to be accessible to unauthorized individuals.
• So that records are kept for a minimum of 1 year from the client's last visit
• If the client was under 18 years old at the time of his / her last visit, the records are kept for 1 year after the day he / she turned (or would have turned) 18.

Standard 5: Blood tests and schedule

Schedule of accepted blood tests for year 1: Annex I / Blood schedule.

Quebec Naturopaths cannot use blood tests to diagnose any condition. The results can only be used to make lifestyle recommendations to healthy individuals. The results must always be sent to a physician and ordered by a physician. The Quebec Naturopath does not choose or decide on any blood tests, nor does the naturopath order them.

Special Considerations

Determine the Client's Condition

Quality / Technical and Safety :

• So that you refer the client to health care professionals for conditions that you cannot assess or if the need for referral is indicated in the assessment or re-assessment, for example
  • severe pain with no history of injury
  • pain above 2/10

Issuing an insurance receipt to the client

Conditions : When the treatment is complete.

Task : Record the details on the insurance receipt provided to the client.

Quality / Technical:

• So that your records include:
  • date, initial/subsequent treatment, cost, client name, your name, your permit number, a contact phone number and your signature.

Timing :

• As soon as possible after a treatment, ideally within 24 hours.

Note : A Quebec naturopath can use natural therapy techniques and issue a naturopath receipt if and only if they have the training as a Quebec naturopath. The initial consultation must include an offer of both blood tests and genetic tests.

Not all naturopaths are permitted to review any of the blood tests in the schedule in exchange for fees for services rendered.

A naturopath who is capable of reviewing blood tests will not be required to do so, as this service is a choice each therapist will make based on their level of knowledge, best judgement and experience. The Quebec Naturopath can use any skill or competency towards any act that is not regulated and that is done safely and respecting all regulatory rules, if applicable.

Annexe schedule 1 - blood tests.