6A person treating patients for post-concussion symptoms should be a regulated health care professional, licensed by a regulatory body under the Regulated Health Professions Act, 1991; and the Social Work and Social Service Work Act, 1998, who:
- has had training involving direct patient care/contact and knowledge of traumatic brain injury and its biopsychosocial effects;
- has experience in concussion management with a high volume of patients with concussion annually; practices according to the most up-to-date, evidence-based guidelines;
- practices within their defined scope of practice and recognizes when to refer to other interdisciplinary providers as patient symptoms require.
It is necessary that patients get the right care from the right provider to ensure that persistent symptoms are managed effectively. Direct and regular experience with patients with concussion is required, in addition to appropriate qualifications to ensure that providers are appropriately able to manage the persistent post-concussion symptoms relevant to their scope of practice.
An understanding of the scope of practice for each healthcare profession typically involved in post-concussion care provides guidance to healthcare providers and also to patients seeking the suitable provider. Better understanding of what individual professions do and are regulated to provide, facilitates an improved collective competence in post-concussion care.
What this standard means:
No one person or discipline is a concussion expert, as it often takes the expertise of interdisciplinary healthcare professionals to manage and treat the persistent symptoms of concussion.
Healthcare professionals are encouraged to speak to their scope of practice, training, knowledge and experience, and what these contribute to their services, rather than to speak of themselves as experts. Persons can refer to themselves as concussion experts but should adhere to the specific criteria that exist for the use of this term.20
There needs to be an increase in the application of evidence-based clinical practice guidelines, and avoiding treatments that may be ineffective, potentially harmful and costly.
The core group of practitioners within a concussion clinic should be regulated healthcare professionals. There is value, for patients, in working with regulated health professionals as there is a complaints process available to them and quality assurance measures in place. Non-regulated professionals may be knowledgeable, capable and competent, and work in a clinic or interdisciplinary team, however, there are no regulatory bodies overseeing their practices.
Regulated healthcare professionals whose scopes of practice include assessing and treating concussion can benefit from additional education and training regarding concussion and post-concussion management to further their competencies. For providers who are not trained or qualified to provide care within their specific scope of practice, a stand-alone course is not sufficient to be able to provide safe, quality, or comprehensive care in the domains of function affected by concussion.
In Ontario, regulatory bodies for healthcare professions provide general direction in the form of standards of practice. It is important to refer to the defined scopes of practice for each regulated healthcare profession and the controlled acts they are able to perform. Currently, many regulatory bodies are considering whether they should be developing more specific scopes of practice for post-concussion care.