Program Overview
What is the Community Mental Health Program?
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.
What is the intake and pre-authorization phase?
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.
In what timeframe must the initial assessment be completed once there is authorization to proceed?
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.
Do psychologists have to collect their patient’s consent when submitting information to the WSIB?
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”.
The Community Mental Health Program has an “Assessment Form” and “Progress Form” that need to be completed and submitted to the WSIB. Does the WSIB still need separate narrative psychological reports under the program?
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.
How long is a treatment block?
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%.
Do treatment sessions need be a specific length of time?
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.
Are there specific interventions that must be delivered under the Community Mental Health Program?
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.
What is goal attainment scaling within the Community Mental Health Program psychological interventions, and how does it support recovery and return to work?
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.
How should the progress form be completed if the patient does not return or self-discharges from treatment?
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.
What steps should a psychologist take if the patient requires ongoing treatment after the third treatment block is complete?
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.
Who may deliver the Community Mental Health 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.
Community Mental Health Network
Who is eligible to register for the Community Mental Health Network and how?
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.
Does a psychologist have to be a member of the Ontario Psychological Association (OPA) to complete the training?
No. Training materials are available to all psychologists on the WSIB website and the OPA website.
What are the benefits of joining the Community Mental Health Network?
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.
Can psychologists who are part of the Community Mental Health Network still provide service and bill using the WSIB Psychology Fee Schedule?
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.
Will there be a quality assurance process for Community Mental Health Program providers?
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.
Can psychologists who are not part of the Community Mental Health Network still treat people with a WSIB claim?
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).
How can I make changes to my practice details on the Community Mental Health Program Directory?
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.
Billing
Where can I find information about billing under the Community Mental Health Program?
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.
What will happen if the psychologist does not submit the assessment form or the progress form on time?
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.
Why would a psychologist not receive payment for the initial assessment and assessment form OR for treatment blocks?
Payment for the assessment form is included in the fee for the initial assessment. The WSIB will only process payment for the initial assessment and assessment form will only be processed once it has received the assessment form.
The WSIB will pay treatment blocks once it has received the corresponding progress form.
Does the WSIB require health professionals to bill electronically?
Yes, health professionals must submit bills for treatment services electronically for efficient payment. Please bill electronically through the WSIB’s payment processor, TELUS Health Solutions. Please do not bill electronically for the initial assessment, the assessment form or the progress form. Forms are pre-populated with billing information, and the WSIB will process payment if the form is completed in full.
For further information on electronic billing, please call the TELUS Health Solutions Support Centre at 1-866-240-7492 or visit www.telushealth.com/wsib.
Who can a psychologist call with questions about payment?
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.
Eligibility and Admission Requirements
Who is the Community Mental Health Program for?
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.
Do people need a physician’s referral for entry into this program?
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.
Who should psychologists call to obtain pre-authorization for assessment and/or 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.
What should a psychologist do if a person wants an assessment and treatment but has not registered a claim with WSIB?
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.
Return-to-Work Recommendations form
How does a psychologist communicate return-to-work recommendations when an injured/ill person is ready to return to work?
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
form 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.What is the purpose of the Return-to-Work Recommendation form?
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
form 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
form, unlike the Functional Abilities Form.What information does the Return-to-Work Recommendation form include?
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.
How does the WSIB case management team use this information?
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.
Does a completed Return-to-Work Recommendation form imply that an injured or ill person can return to work immediately?
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.
How is the Return-to-Work Recommendation form shared with the employer?
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.
Resources
Are other resources and tips available?
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.