COVID-19 CLINIC UPDATE
The S. L. Hunter SpeechWorks team is excited to begin the gradual transition back to in-person service provision under the advisement of Ontario Public Health and our government leaders. At this time, we will continue to provide service via secure online sessions for those clients who are able to benefit from this service model. The clinic will be offering in-person sessions on a case-by-case basis only for those clients who are unable to be serviced virtually. The clinic will be adhering to the policies and procedures developed by Ontario Public Health and our regulatory college (CASLPO) for all in-person sessions. Please see below for important information regarding our screening process and physical distancing guidelines for in person sessions.
If you have any questions or concerns, please don't hesitate to reach out to us. You can contact your clinician directly or reach our to one our service coordinators by phone or email (below) if you would like discuss in-person or online session options:
We hope that you continue to stay safe and healthy. We thank you for your continued support and look forward to continuing to serve your speech therapy needs.
Your SpeechWorks team
Policy for Re-Opening the Clinic during COVID-19 Following Social Distancing & Health and Safety Requirements (June, 2020)
Notice to Clients
- Clients will be advised by signage at the door, email and potentially via social media:
- Of our screening process (by text, phone or in person) prior to appointment
- To wait in their car instead of in the waiting room, until their clinician invites them to come in. Family members should stay outside of the clinic unless the client requires their assistance. Any caregiver who needs to accompany the client into the clinic, will need to also be screened.
- Cones will also be placed along the sidewalk ensuring that those waiting outside are spaced the required 6 feet away from each other.
- To refrain from bringing bags, containers & food into the building.
- Inform of the sanitizing station at the inside front entrance:
- They must use hand sanitizer upon entry
- Individuals who refuse to apply hand sanitizer will be asked to accompany their clinician to the washroom where the following will occur:
- Clinician turns on taps for warm water
- Individual gets soap from automatic soap dispenser
- Clinician times hand washing for 30 seconds
- Clinician turns off water
- Clinician sanitizes the sink handles
- Everyone is to wear a mask in all common areas of the clinic. Clients are asked to bring their own mask but we will have masks available for those in need.
- We would appreciate if payments were made by e-transfer to minimize contact. If this is not possible, we can accept Visa, Mastercard, debit and cheque payments for in person visits. Please note that we do not accept cash payments at this time. The TAP feature has been enabled and can process up to $250. For those wishing to be billed monthly, a charge card number is required on file.
An instructional video is in creation documenting our process and will be:
- Attached to the above e-mail
- Shared on our website
- Shared on social media
- New referrals will be sent our Health Consent by email in advance of the session and asked to print, sign & scan/send pictures if possible. The Health Consent form has been modified to no longer require clients to hold off on initialing the main consent box until after the discussion with their clinician.
- Clinicians to ensure that informed consent is documented in their SOAP note.
- Clients to keep their hard copy, there is no need to provide it to SpeechWorks.
- Alternatively, if clients do not have access to a printer, verbal consent is sufficient and the clinician creates a case item in place of an uploaded consent.
- Hand sanitizer must be used by everyone entering the building (see above)
- Tissues to be made available in waiting area and offices
Use of Personal Protective Equipment
- Masks must be worn in all common areas. Clients should bring their own masks. Once client is in their treatment room and behind plexiglass screen, the mask is optional. Clinicians will use PPE as relevant to each clinical case.
- S.L. Hunter will provide contractors and staff with PPE including:
- Face shield
- Plexiglass for desktops
Please see the following link for assembly instructions for the face shields:
A touchless thermometer – is used by staff daily and available for anyone who is suspected of having an elevated temperature. It is not part of our regular per session client screening process.
The screening process will be conducted by the client at the door. They will text, “ready” when they have self-screened successfully. Clients will be asked the following questions (per CASLPO guidelines):
Q1: Did you travel outside Canada in the past 14 days?
Q3: Have you tested positive for COVID-19, or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
Q4: Did you have any of the following symptoms?
- New onset of cough
- Worsening chronic cough
- Shortness of breath
- Difficulty breathing
- Sore throat
- Difficulty swallowing
- Decrease or loss of sense of taste or smell
- Unexplained fatigue/malaise/muscle aches
- Nausea/vomiting, diarrhea, abdominal pain
- Pink eye (conjunctivitis)
- Runny nose/nasal congestion without other known cause
Q5: If you are 70 years of age or older, are you experiencing any of the following symptoms:
- unexplained or increased number of falls
- acute functional decline
- worsening of chronic conditions
Answering yes to any of the symptoms on the list is considered ‘positive’ and the in-person session is declined and encouraged to be conducted by videoconferencing as an alternative until the screening is passed. The client should be directed to contact telehealth at 1 866 797-0000. Screening results should be mentioned in the clinical note.
If a client refuses to participate in the screening process, they will be declined service and encouraged to contact us when they are willing to participate. It will be clearly explained that this process has been put in place for the safety of our community and is in alignment with all Ministry, Government and College guidelines.
Physical Changes to Clinic
The clinic will be physically adapted by:
- Removal of coffee station; replaced with sanitizing station.
- Closing the water cooler
- Clearing pens, magazines & books
- All toys to be put away, clinicians are responsible for their own office materials
- Purchasing plexiglass screens for individual clinician desktops and one for the reception window that faces the front entrance.
- Replacing chairs made of non-washable fabric with the vinyl chairs from the mezzanine
- Closing all doors that are not in use
- Use of plexiglass on every treatment table
- Markings (e.g. Velcro) on floor to measure chairs 6 feet apart
Cleaning & Sanitizing
CASLPO states that clinical office settings haves two components for the purposes of cleaning:
- Public component – this is the public areas of the clinic that are not involved in client care and includes: waiting rooms, offices, corridors and service areas. These areas are cleaned with detergent. A more natural but effective cleaning product will also be available for cleaning to reduce the chemicals in the air.
- Clinical component - this is the area involved in patient care and includes: clinical offices examination/treatment rooms, procedure rooms, bathrooms and diagnostic areas. These areas are cleaned first with detergent and then disinfected with a hospital grade disinfectant. High touch areas may require more frequent cleaning.
CASLPO and Public Health Ontario (PHO) have advised to ONLY us disinfectants with DIN numbers.As such, we will be using a natural product from Melaleuca called ‘Sol-U-Guard Botanical’ that has the DIN #02301318.To order, please speak with Shanda.The website link is:
The cleaning detergent that we have on site is currently Lysol with Hydrogen Peroxide and Spray 9 Disinfectant.
Use of Kitchen Area
A sign will be posted on the Kitchen door indicating:
- That no more than one person should be in this room at a time
- That all areas touched, should be wiped down with a disinfecting cloth
- That use of the Brita water filtration jug should be discontinued and replaced by individual Brita’s at staff members’ desks if required
Staff will be required to clean their treatment space & any resources between sessions – see Public Health Ontario (PHO) attachment
- Staff will need to allow for 10-15 minutes between sessions for cleaning
- Consider having clients bring what they need for sessions so that they can take it with them, if at all possible.
- Each staff member will be supplied with a cleaning kit containing:
- Detergent Spray
- Melaleuca Spray
- Gloves should be worn when seeing clients IF you are required to touch them (e.g., oral motor exam, laryngeal massage)
- Diligent and regular hand washing routines are essential
- Staff will complete 2 walk throughs each day to disinfect frequently touched surfaces like door knobs, tables, light switches etc.
Toys & Equipment:
- Teletherapy is an option for all those that request it or are determined to be an appropriate candidate for it. Refer to the Directive #2 Principles when deciding on mode of treatment –
Directive # 2 Principles:
1. Proportionality. Decision to restart services should be proportionate to the real or
anticipated capacities to provide those services.
2. Minimizing Harm to Patients. Decisions should strive to limit harm to patients wherever possible. This requires considering the differential benefits and burdens to patients as well as available alternatives. May-20 16 COVID-19 Town Hall Directive # 2 Principles:
3. Equity. Equity requires that all persons with the same clinical needs should be treated in the same way unless relevant differences exist (e.g. different levels of clinical urgency). Special attention is paid to actions that might further disadvantage the disadvantaged or vulnerable.
4. Reciprocity. Certain patients and patient populations will be particularly burdened as a result of our health system’s limited capacity to restart services. Those who continue to be burdened should have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.
- Clinicians will continue to follow CASLPO’s position statement on use of tele-practice including consent, documentation & PHIPA compliant platforms
- S.L. Hunter SpeechWorks has purchased licenses for Zoom business accounts that meet privacy requirements
- All staff are encouraged to meet with one another via telephone or video so as to avoid contact when possible, until this policy is revised
- For the month of June (and to be evaluated at the end of the month) Working from home is acceptable and encouraged for indirect work (reports, notes, invoicing, phone calls, telehealth sessions, therapy prep, etc.,)
Providing Treatment in Community
- When contacting the patient to make an appointment, explain that you will be practicing physical distancing as much as possible
- Explain that you will be contacting the client shortly before their scheduled appointment time (same day) to complete the screening process outlined above
- Ask the client to be ready for the appointment time
- Ask for all other people in the home to be in a different room
- Remain two metres apart from each other for all, or as much of the assessment or treatment session as possible
- Adhere to the clinical policy about use of PPE, hand washing and sanitization
- When providing care to multiple clients within the same facility, (LTC, NRIO) it is necessary to screen each individual client
Documents to reference related to this policy:
- The Chief Medical Officer of Ontario, Dr. David Williams, released a revised version of Directive #2 on May 26, 2020, revoking the original Directive #2 issued on March 19, 2020. This revised Directive #2 supports the gradual restart of all deferred and non-essential and elective services carried out by Health Care Providers (HCP). All staff are to review this document, in detail, which outlines specific requirements, including adherence to the "COVID-19 Operational Requirements: Health Sector Restart". https://caslpo.com/sites/default/uploads/files/INFO_EN_COVID19_CMOH_Directive_2_May_26_2020.pdf
• Conduct initial consultations with your patients through virtual/telephone contact and determine if an in-person appointment is necessary
- The Operational Requirements document provides more detail regarding the steps which must be taken before reopening and resuming non-essential services, and includes the following:
• Limit the number of in-person visits for the safety of all
• Service resumption decisions must be guided by the four foundational principles outlined in Directive #2 (proportionality, minimizing harm to patients, equity and reciprocity)
• Conduct both organizational and point of care risk assessments
• Apply the recommended Hierarchy of Hazard Controls
• Follow the screening and testing recommendations
• Ensure you have the physical capacity and environment for physical distancing, waste management, hand hygiene, signage, etc.
• Source sufficient Personal Protective Equipment • Ensure safe and appropriate human resources are in place
• Put in place fulsome Infection Prevention and Control policies and procedures You must always use your individual clinical judgement, while complying with Directives from the Ministry of Health, information from Public Health Ontario and speak with your employers.
- See CASLPO’s "Pandemic Practice Advice Topics" (revised May 27, 2020) https://caslpo.com/public/covid-19-information/providing-patient-care-in-a-pandemic
- Public Health Ontario https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources
- CASLPO’s Position Statement on use of Tele practice
To understand and be understood is essential for living a full and meaningful life. People with a communication challenge may experience isolation from friends, family or colleagues. Communication challenges also present as barriers to achieving success in educational and employment settings and can affect all age groups, from infants to the elderly.
S.L. Hunter SpeechWorks is a private Speech-Language Pathology practice that is dedicated to helping you achieve your full communication potential and to overcome challenges with swallowing and/or feeding. Our Speech-Language Pathologists and Communicative Disorders Assistants are committed to offering innovative programs that are tailored to meet your individual needs by working closely with you, your family and other professionals. Our innovative programming can be delivered within our clinic, at your home, school, workplace or other community location.
We’re proud to serve clients living in Burlington, Oakville, Grimsby, Hamilton, Stoney Creek, Ancaster, Mississauga, Milton, the GTA, Kitchener-Waterloo, Niagara and surrounding areas.
SHANDA L. HUNTER TROTTIER
Shanda Hunter-Trottier, the director and founder of S.L. Hunter SpeechWorks, has many years of clinical experience as a Speech-Language Pathologist. Her private clinic has been in full operation since 1995.
Shanda received the provincial association’s (OSLA’s) “Honours of the Association” award after nomination by a colleague in the community. Her staff describe her as a warm, caring and compassionate woman who always puts the needs of her clients, her employees, and the practice before that of her own. She is a true mentor and leader whose inspiration and skill-set goes beyond that of an SLP, to educator, advocate, collaborator and innovator. She has created and nurtured a superior, full service clinic with a broad scope of services.
Shanda continues to contribute greatly to the overall profession of Speech-Language Pathology as demonstrated by her active involvement in advocating for our clients and the profession. She participated on the Board of Directors with the provincial association for Speech-Language Pathology (OSLA) for 7 years including 3 years as President.