Psychologists seek changes to pilot project aimed at trimming backlog of ADHD, autism testing
A number of Nova Scotia psychologists and psychia‐ trists are sounding the alarm over a provincial pro‐ gram meant to help ad‐ dress the growing waitlist for autism and ADHD testing, saying the pilot could help drive badlyneeded public health pro‐ fessionals into the private sector.
In September, the provin‐ cial government announced it would pay some private practice psychologists to per‐ form autism spectrum disor‐ der and ADHD assessments for preschool and schoolaged children using health service codes as family doc‐ tors do - a first for mental health and addictions care in the province.
Glen Berry, a clinical psy‐ chologist who recently re‐ tired after 30 years working in the public sector in the An‐ napolis Valley, said while the public-private partnership has potential, he's concerned the program in its current form could have unintended consequences.
Berry said the pilot heightens the pay disparity between public and private psychologists and creates in‐ consistencies in the scope of assessments being offered to the roughly 1,600 people on the years-long waitlist for autism testing and the 400 people on the waitlist for AD‐ HD testing.
He and nine Nova Scotia
Health psychologists have penned a letter to the Office of Addictions and Mental Health outlining their con‐ cerns, while 11 rural child and adolescent psychiatrists from across the province have sent a separate letter echoing similar issues with the pilot.
"The way that this is being implemented is giving me and my former colleagues a lot of concern," Berry said in a recent interview. "I know of some psychologists who have left our system to go privately … in the last five years. One or two I know of is specifically related to this."
Berry noted there is a gap between what the province pays out for autism assess‐ ments conducted by a public psychologist, which is about $750, and what private psy‐ chologists are paid, which is up to $4,000.
He said he realizes those amounts could never be equal due to the various costs incurred in private practice, but "the amounts that we're talking about here are way far apart."
As well, there is a disparity between the scope of the as‐ sessments offered by public
and private psychologists, Berry said.
For example, he said those conducting testing in the public sector have been told they can't complete psy‐ choeducational assessments - which help identify an indi‐ vidual's learning style and needs - as part of ADHD as‐ sessments, as it falls outside Nova Scotia Health's man‐ date. But private psycholo‐ gists taking part in the pro‐ gram have professional dis‐ cretion to decide what com‐ ponents are needed for an assessment.
"This is a serious issue that needs to be addressed as it is unfair and unethical to provide a more comprehen‐ sive assessment to some clients when both are being paid for by the government," one of the letters read.
"When families become aware of this discrepancy in service, those who are as‐ signed to service-as-usual from [Nova Scotia Health] will likely have justifiable con‐ cerns about their children re‐ ceiving less comprehensive assessments."
Berry said this could be resolved by setting limits on what kind of assessment pri‐ vate psychologists can offer as part of the program, or by allowing public psychologists to use their professional dis‐ cretion to determine what as‐ sessments are needed.
He doesn't want clients placed with a public psychol‐ ogist to think they will not re‐ ceive a quality assessment. Clinicians are highly special‐ ized, are required to follow industry standards and all psychologists - public and private - are accountable to a regulatory body called the Nova Scotia Board of Examin‐ ers in Psychology.
Data provided by Nova Scotia Health shows the number of psychologists working for Nova Scotia Health has fluctuated over the past five years. There were 105 in 2019. Currently, the health authority has 96, with 31 vacancies.
Since the program was announced on Sept. 11, eight private psychologists have signed on and have per‐ formed 31 diagnostic autism assessments.
Brian Comer, the minister responsible for the Office of Addictions and Mental Health, said he takes the con‐ cerns of front-line health pro‐ fessionals seriously.
"It's really about increas‐ ing access and with any pilot, you certainly learn and evalu‐ ate as you go along," Comer said in a recent interview.
He wouldn't comment on the apparent pay disparity, noting public psychologists are unionized and compen‐ sation is negotiated as part of collective bargaining.
His office disputed the psychologists' claims that there is a disparity in the scope of the assessments.
"I want to be very clear that we place no restrictions on registered psychologists private or public sector when it comes to diagnostic assessment for autism," spokesperson Sarah Levy MacLeod said in an email statement.
"The length of an assess‐ ment and which tools are used as part of it are at the discretion of the clinician based on the needs of the child. Where clinically indi‐ cated, psychoeducational as‐ sessments can and will be provided whether the child and family are with a public sector psychologist in a hos‐ pital or a private sector psy‐ chologist at their offices as part of this pilot."
Waitlist continues to balloon
When asked what the province is doing to retain its public psychologists, Comer said where someone prac‐ tices is a personal choice.
"There's a lot of different reasons for that. In my previ‐ ous life, I worked with folks who have done both, worked in the public and the private. Some prefer one for a variety of reasons," said Comer, who is a registered nurse.
"There's a lot to unpack there, but we'll certainly do what we can on our end."
MacLeod said the province is making record in‐ vestments in the health-care system, including hiring more clinicians to support diagnos‐ tic autism assessments.
While the program was touted as a way to address the growing waitlist, the list for autism assessments has grown by 300 names in the last six months, according to figures provided by the province. The number of chil‐ dren on the list for ADHD as‐ sessment has remained un‐ changed.
Cynthia Carroll, executive director of Autism Nova Scotia, said her non-profit or‐ ganization commends the government's efforts to be more innovative in how it provides health care, but the pilot does little to address the years-long wait for an as‐ sessment.
"This is a very small pilot. I think we have to be realistic about that," said Carroll, not‐ ing that as the province's population booms, so too does the need for services.
"Are we happy about the partnership? Yes. Is it going to support new people com‐ ing into the system? Not real‐ ly, because we have 1,600 people still waiting for those assessments."
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