Questions and answers for psychologists

The Community Mental Health Program is a structured approach to give people access to psychological assessment and evidence-informed, outcome-focused treatment. The WSIB and the Ontario Psychological Association (OPA) collaborated in developing the program.

The program is delivered by psychologists registered in the Community Mental Health Network. For the purposes of the program, the term “psychologist” is used to describe members of the College of Psychologists of Ontario, which includes psychological associates. The program includes an intake and pre-authorization phase, an initial assessment, treatment provided within pre-authorized treatment blocks, and associated fees. Assessments and progress are documented with the Community Mental Health Program Assessment Form (PDF) and the Community Mental Health Program Progress Form (PDF) respectively.

The intake and pre-authorization phase requires the psychologist to briefly review basic information and determine whether a person needs assessment and treatment. The psychologist must confirm that the person meets the admission criteria for the Community Mental Health Program. The psychologist should then inform the WSIB by phone that the person is seeking care and obtain pre-authorization to assess and treat the person. The WSIB Case Management Team will then decide whether to authorize an assessment alone or an assessment and treatment if the appropriate criteria are met and the claim has been registered.

Timely assessment, treatment, and communication (i.e., submission of assessment and progress forms) are key features of this program. The initial assessment should be completed efficiently, and the assessment form must be submitted within five business days of the last assessment visit.

No. The Personal Health Information Protection Act, 2004, Section 43(1)(h) permits a health information custodian to disclose health information without consent as permitted or required by law, including section 37 of the Workplace Safety and Insurance Act, 1997. Section 37 of the Workplace Safety and Insurance Act 1997 states: “Every health care practitioner who provides health care to a worker claiming benefits under the insurance plan or who is consulted with respect to his or her health care shall promptly give the Board such information relating to the worker as the Board may require”. Therefore, when obtaining informed consent for services, the psychologist should inform their patient that the psychologist is required to provide information “relating to the worker as the Board may require”.

No. Psychologists may prepare separate narrative psychological reports and progress notes, which they may share with the patient and her or his other treatment provider(s); however, these do not need to be submitted to the WSIB. Furthermore, narrative psychological reports will not be accepted as substitutions for the Community Mental Health Program assessment and progress forms.

A treatment block is six sessions or eight weeks, whichever comes first. A progress report is submitted at the end of each treatment block. Initial treatment approval includes up to three blocks of treatment. If less than three sessions are delivered in a treatment block, the block fee is reduced by 50%. 

The Community Mental Health Program uses a bundled model of care to allow flexibility for each injured or ill person. The length of each treatment session is not defined and up to the discretion of the treating health provider. For example, this means that a session could be 30 minutes for one injured or ill person or two hours for another. Each treatment session that the ill or injured person has attended on a specific day is considered one treatment session. 
 

While the program does not stipulate specific psychological interventions, interventions delivered to a patient must be evidence-informed and support identified treatment goals that are relevant to the overall recovery and return to occupational function goals. To ensure focus on functional recovery progressing toward occupational restoration, psychological interventions should incorporate SMART goals approach. See more information about the  Community Mental Health Program.

Goal attainment scaling is an approach to setting individualized goals in therapy and monitoring the extent to which psychological intervention is progressing in the direction of goal attainment and recovery. 

At the beginning of each treatment block, the clinician and patient will collaborate to set SMART – specific, measurable, achievable, relevant, and time-bound – goals. This aids focus on functional recovery that, over time, progresses toward occupational restoration. At the end of each treatment block, they will discuss and determine the extent that those goals are being met using a five-point scale, ranging from ‘worse than expected’, ‘as expected’ or ‘better than expected’. This provides a ‘common language’ for goals and goal attainment, and facilitates improved communication between the patient, the treating psychologist, and the WSIB. 

It’s also helpful to consider the trend of goal attainment across several treatment blocks when engaging in treatment planning or making recommendations for next steps to the patient or WSIB. For more guidance about timing and the nature of communication, see goal attainment scaling and recovery navigation. 

In instances where the patient self-discharges from treatment or does not return, the progress form should be completed as fully as possible, relying on information available from the most recent visit. The treating psychologist should indicate on the form that the patient self-discharged from the program and the date of the last visit.

The WSIB may authorize additional treatment block(s) if it is clinically justified and if further improvement is expected. The treating psychologist should contact the WSIB Case Management Team to discuss the case and request authorization to deliver care through additional treatment blocks. The Case Management Team will review the case with the treating psychologist and evaluate the need for a referral to a WSIB Specialty Program.

Psychologists who are registered in the Community Mental Health Network may deliver the Community Mental Health Program. Please refer to questions and answers in the WSIB Community Psychologist Network section for more information.

The Community Mental Health Network is open to all psychologists and psychological associates in good standing with their college. Psychologists must be authorized in autonomous or interim autonomous practice. They must review all program materials available on the WSIB website, review a brief webinar (available on the WSIB and OPA websites), and obtain an electronic billing number. Once these activities are complete, the psychologist must submit a completed Community Mental Health Network Psychologist Registration Form (PDF) to the WSIB.

No. Training materials are available to all psychologists on the WSIB website and the OPA website.

People who need psychological assessment or treatment for a work-related psychological injury will be able to access care within the program, which will facilitate timely and effective care with less potential for delay or disruption. Additional benefits for psychologists include better remuneration, easier reporting, faster and simpler billing and payment, and online listing in the network.

As a registered provider with the Community Mental Health Network, a psychologist must provide services under the Community Mental Health Program and bill using the associated fees for services provided to people who are eligible for the program. Network psychologists may not bill using the general WSIB Psychology Fee Schedule for people who are eligible for the Community Mental Health Program.

Yes. To ensure they are meeting program standards, psychologists who deliver the Community Mental Health Program will be monitored and evaluated for adherence to program delivery guidelines and quality of services. The WSIB will contact providers to discuss feedback about program delivery, quality of services and form completion, and/or billing.

Yes. Psychologists who are not registered under the Community Mental Health Network can still treat people with a WSIB claim. However, they will not be able to provide treatment under the Community Mental Health Program and will not be eligible to bill Community Mental Health Program fees. Psychologists not registered under the Community Mental Health Network must bill using the WSIB Psychology Fee Schedule (PDF).

To update your information on the Community Mental Health Program Directory, please call the Health Care Provider Registration Line at 416-344-4526 or 1-800-569-7919 from 7:30 a.m. to 5 p.m. 

Please see the Community Mental Health Program Fee Schedule (PDF) and billing instructions for details. Assessment and progress forms are paid upon receipt; no separate online billing is required. Treatment blocks are billed electronically by the provider. The assessment and treatment blocks are only payable when the corresponding forms have been received.

Psychologists must submit Community Mental Health Program assessment and progress forms within five business days of the completing the assessment or treatment block. If the assessment or progress form is submitted after five business days, the associated fees will be reduced. Failure to submit the forms may impact payment for services. In addition, the block treatment payments will be withheld until the WSIB has received the progress form.

The health professional can call the WSIB at 1-800-387-0750 or 416-344-1000 and ask for the Health Care Payment Inquiry Line.

The Community Mental Health Program is designed for all people with a WSIB registered claim who require psychological assessment or treatment. This includes people who experience a psychological reaction secondary to a work-related physical injury, as well as people who experience a significant work-related psychological response to a workplace incident or cumulative incidents, such as chronic mental stress, traumatic mental stress, first responder PTSD.

No. A referral from a physician is not required to enter the program; however, the psychologist must always obtain pre-authorization from the Case Management Team to proceed with assessment and treatment.

The WSIB Case Management Team may pre-authorize assessment and/or treatment. Psychologists should call the WSIB general line at 1-800-387-0750 or 416-344-1000 to speak with the Case Management Team.

The psychologist must screen the person to determine whether she or he meets the program intake criteria, which includes having a registered WSIB claim. In cases where the person does not have a registered claim, the psychologist should refer to the Psychologist Intake Guide document (PDF) for recommendations on how to proceed. The psychologist may also direct the person to the

which they can submit at wsib.ca/upload. 

The psychologist ensure timely submission of the assessment and treatment progress forms that identify return-to-work details. The psychologist can request a telephone discussion(s) with the WSIB case management team by documenting it in the forms as necessary. In addition, the psychologist ensures their availability to communicate with the WSIB case management team (e.g., this can be part of a treatment session with the Return-to-Work Specialist).

In addition to the above, completing the Return-to-Work Recommendations form (PDF) and submitting it to the WSIB with a copy to the injured or ill person is another communication tool that facilitates return-to-work planning and information sharing with employers. The injured or ill person is required to provide their employer with a copy to plan for return to work. Additional Return-to-Work Recommendation forms may be submitted if the person’s condition changes. 

The Return-to-Work Recommendation form is a communication tool that facilitates the sharing of information with employers. Once it has been determined that the injured or ill person is ready to return to work, the treating psychologist can complete and submit the form to the WSIB with a copy to the injured or ill person to facilitate return-to-work planning and information sharing with their employer. The injured or ill person must provide their employer with a copy to plan for return to work. Psychologists may submit additional Return-to-Work Recommendation forms if the person’s condition changes. The Return-to-Work Recommendations form (PDF) enables information sharing with all workplace parties to help them understand the person’s functional abilities and what accommodations they need for a safe and sustainable return to work.

The employer cannot request the Return-to-Work Recommendations form (PDF), unlike the Functional Abilities Form.

The completed form includes details about the injured or ill person’s functional limitations, restrictions and accommodations with respect to occupational activities and specifies their duration.

The case management team uses this information for return-to-work planning and goal setting, and to engage people such as the Return-to-Work Specialist. If the injured or ill person is not ready to return to work, the information included can inform plans for their eventual return. The case management team also uses the information to explore return-to-work options with the employer. The form includes a signature line for the injured or ill person to indicate their consent to the disclosure of this information.

Not necessarily. It depends on where the person is on their path to recovery. The form is a signal that discussions can start to explore work within the stated limitations, restrictions and abilities.

The injured or ill person provides the form directly to their employer. The WSIB case management team can also share the form and information directly with the employer, since the person has indicated their consent by signing the form.

The Return-to-Work Recommendation form is not requested directly by the employer. We encourage employers to contact the WSIB case management team to get up-to-date functional ability information they need for return-to-work planning. If the form is not on file, the WSIB case management team may contact the psychologist to get clarification or to review assessment/progress forms to assess injured or ill person’s readiness for return to work.
 

Yes. Additional information, tips and resources, including the Community Mental Health Program Reference Guide, are available on the Community Mental Health Program web page and the Ontario Psychology Association (OPA) website.