Rev: October 2015 1

Self-Initiation

Package

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This Standard of Practice will apply to CDHO registrants who plan to self-initiate the controlled act

of “scaling teeth and root planing, including curetting surrounding tissue” under the Dental Hygiene Act,

1991 as amended by the Health System Improvements Act, 2007. This standard applies regardless of the

health care setting in which self-initiation occurs.

This Standard of Practice must be applied in the context of the Dental Hygiene Act as amended and

the CDHO’s “Contraindications Regulation” (Ontario Regulation 501/07).

The objective of the Standard of Practice for Authorization to Self-Initiate is to provide assurance to

Ontarians who choose to have a dental hygienist clean their teeth without an ‘order’ from a dentist,

that the dental hygienist is fully competent to do so as safely and effectively as if the procedure were

performed under an ‘order’.

This Standard of Practice for Authorization to Self-Initiate describes three streams or scenarios

designed to provide this assurance. This Standard of Practice also articulates the professional

expectation that dental hygienists will not self-initiate the controlled act of “scaling teeth

and root planing, including curetting surrounding tissue” unless they have been authorized

to do so by the CDHO through one of the three streams as explained herein.

CDHO registrants who plan to self-initiate are expected to apply, pay the required application fee

($75), and provide proof that they meet the requirements of the stream that they are applying under.

The College will issue a new wall certificate with a foil-stamped seal that signifies authorization to

self-initiate. A notation will also be placed beside the approved registrant’s name on the public

register. Registrants who have been granted authorization with conditions will have that notation

recorded on their certificate and on the register.

…/2

One Currently holds a general or specialty certificate of registration with the CDHO, is in good standing and who: a) has practised clinically

under a ‘standing order’ or ‘protocol’ in Ontario for at least the two (2) years (3200 hours) previous to application or

b) has practised clinically for at least two (2) years (3200 hours) and completed either a CDHO-approved clinical refresher course or the CDHA self-initiation course within the previous 24 months or

c) has practised in Alberta or British Columbia for at least two (2) years (3200 hours) previous to application

d) is currently authorized to self-initiate in Nova Scotia

e) Has held a certificate of conditional authorization for at least six (6) months and has successfully completed the mentorship and any other requirements of Stream Two or Three.

Application & Fee Good standing with

relevant regulatory body

proof of clinical

practice with, and evidence of, a ‘standing order’ or ‘protocol’ for at least the two (2) previous years or

proof of clinical practice for at least two (2) years and proof of successful course completion or

proof of clinical

practice in Alberta or BC1 in the previous two (2) years or

Proof of authorization to self-initiate in Nova Scotia2 or

Proof of completed mentorship and Proof of conditional authorization under Stream Two or Three.

Full No limitation

Stream Eligibility Requirements Authorization Term

Level

1 Dental hygienists in the Provinces of Alberta and British Columbia are authorized under provincial legislation to self-initiate upon

registration.

2 Nova Scotia dental hygienists must meet the following criteria to be authorized to self-initiate in that province. Regulation Section

8 (1) (h) for an applicant who intends to engage in self-directed clinical practice and for an applicant applying for a practising licence

two (2) years after being issued an initial licence under the Act, they must (i) have successfully completed the self-initiation module.

Standard for Authorization to Self-Initiate Profession-Specific Acts

Currently holds a general or specialty certificate with the CDHO, is in good standing, graduated from a dental hygiene program but does not meet the eligibility requirements of Stream One and who: a) has completed either a

CDHO-approved clinical refresher course or the CDHA self-initiation course within the previous 24 months and

b) is being mentored by a CDHO-approved mentor3

Application4 (fee waived)

Good standing

Certificate of successful

completion of the CDHO-approved refresher5 course or the CDHA self-initiation course

Mentorship contract

with a CDHO-approved mentor for a minimum 6-month term

Conditional6

Minimum six (6) months, expires in 12 months (renewable)

Stream Eligibility Requirements Authorization Term

Level

Two

3 To qualify as a CDHO-approved mentor, applicants must be registered with the College, have a minimum five (5) years’ clinical

experience including a minimum of two (2) years with authorization to self initiate and be in good standing. They must also

successfully complete the CDHO mentorship course (under development).

4 The application fee for a conditional authorization under Streams Two and Three would be waived but would apply when the

registrant applies for full authorization under Stream One.

5 CDHO maintains a list of approved clinical refresher courses. The course outline matches that of the CDHA Self-initiation Course.

6 Authorization to self-initiate with conditions permits a registrant to decide, based on a comprehensive health assessment, to proceed

with the controlled act of scaling teeth, root planing and curettage of the surrounding tissue without the order requirement, while

under the mentorship of a CDHO-approved mentor. Removes the current requirement of a standing order.

www.cdho.org

Currently holds a general or specialty certificate with the CDHO, is in good standing, but does not meet the eligibility requirements of Stream One and graduated from an accredited7 dental hygiene program after January 1, 20138 who: a) is being mentored by a

CDHO-approved mentor9

Application (fee waived)

Good standing with relevant regulatory body

Mentorship contract

with a CDHO-approved mentor for a minimum 6-month term

Conditional10 Minimum six (6) months, expires in 12 months (renewable)

Stream Eligibility Requirements Authorization Term

Level

Three

7 Currently, all dental hygiene programs with graduates after this date are accredited. Should an institution lose its accreditation

status, the graduates would no longer be eligible to apply under Stream Three. They would be required to apply under Stream Two

which includes an additional requirement to successfully complete a CDHO-approved refresher course or the CDHA Self-initiation

Course.

8 Eligibility date for consideration as a graduate of the expanded dental hygiene curriculum.

9 Recognizes that the expanded dental hygiene curriculum provides more opportunity for students to be evaluated on their

knowledge of, and ability to, self-initiate their authorized acts.

10 Supports new graduates by giving them authorization to self-initiate with condition that the registrant is mentored by a CDHO-

approved mentor.

Revision: February 12, 2013

Effective: August 1, 2013

Rev: October 2015 2

Application for Authorization – Self-Initiation (effective August 1, 2013)

FOR OFFICE USE ONLY

Date application received: Date self-initiation approval was issued: ⃝ With condition

Please refer to the Standard for Authorization to Self-Initiate Profession-Specific Acts included in this package before completing this application.

Please print in block letters and/or check the appropriate box.

Name: ..................................................................................................... CDHO Registration No.: .......................................................

Self-Initiation Streams (Please select the Stream option that you are applying under.)

⃝ Stream One

Registrants who hold a General/Specialty certificate of registration with the CDHO and meet ONE of the following criteria options:

Supporting Documents: (to be submitted with application)

⃝ Option a) I have practised clinically under a “standing order/protocol” in Ontario for at

least two (2) years (minimum 3200 hours) immediately preceding this application; AND I can provide a copy of a “standing order/protocol” that authorizes me to perform the controlled act of “scaling teeth and root planning, including curetting surrounding tissue”.

Written statement not accepted in lieu of “standing order/protocol.”

⃝ Declaration of clinical practice for at least

two (2) years; AND

⃝ Copy of “standing order/protocol” for

previous two (2) years (3200-hour equivalent)

⃝ Option b) I have practised clinically for at least two (2) years (minimum 3200 hours); AND

I have completed a CDHO-approved clinical refresher course OR the CDHA Self-Initiation course during the 24 months immediately preceding this application.

⃝ Declaration of clinical practice for at least

two (2) years; AND

⃝ Proof of successful completion of a CDHO-

approved clinical refresher course OR the CDHA Self-Initiation course

⃝ Option c) I have practised clinically in Alberta or British Columbia for at least two (2) years

(minimum 3200 hours) immediately preceding this application. ⃝ Declaration of clinical practice for at least

two (2) years; AND

⃝ Certificate of Professional Conduct

(Form B) OR Letter of Standing, to be sent directly from the CRDHA or the CDHBC

⃝ Option d) I have practised clinically in Nova Scotia and I was authorized by the CDHNS to

self-initiate during that time. ⃝ Proof of authorization to self-initiate in

Nova Scotia to be sent directly from the CDHNS; AND

⃝ Certificate of Professional Conduct

(Form B) OR Letter of Standing to be sent directly from the CDHNS

⃝ I have completed the requirements of ⃝ I have completed the requirements of

Stream Two Stream Three ⃝ Proof of successful completion of

Mentorship Program (Mentor’s Declaration)

1

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Rev: October 2015 3

Signature Date

Registrant’s Declaration

I certify that the statements made by me in this application are complete and correct to the best of my

knowledge and belief. I understand that making a false or misleading statement on this application is

considered professional misconduct and could be subject to disciplinary action. I have enclosed or

made arrangements to have supporting documentation sent directly to the CDHO.

⃝ Stream Two / Conditional Authorization

Registrants who hold a General/Specialty certificate of registration with the CDHO, who do not satisfy any of the criteria in Stream One, and meet ALL of the following criteria:

Supporting Documents: (to be submitted with application)

⃝ I graduated from an accredited or non-accredited Dental Hygiene program before

January 1, 2013, or non-accredited program after January 1, 2013; AND

⃝ I completed a CDHO-approved clinical refresher course OR the CDHA Self-Initiation course

within the 24 months preceding this application; AND

⃝ I have entered into a mentorship contract with a CDHO peer mentor.

Note: This conditional authorization is for a minimum of six (6) months to a maximum of twelve (12 months), and can be renewed. Once the mentorship period has been completed, the registrant can apply under Stream One.

⃝ Proof of successful completion

of a CDHO approved clinical refresher course OR the CDHA Self-Initiation course; AND

⃝ Copy of mentorship contract

⃝ Stream Three / Conditional Authorization

Registrants who hold a General/Specialty certificate of registration with the CDHO, who do not satisfy any of the criteria in Stream One or Two, and meet ALL of the following criteria:

Supporting Documents: (to be submitted with application)

⃝ I graduated from an accredited Dental Hygiene program after January 1, 2013; AND

⃝ I have entered into a mentorship contract with a CDHO peer mentor.

Note: This conditional authorization is for a minimum of six (6) months to a maximum of twelve (12) months, and can be renewed. Once the mentorship period has been completed, the registrant can apply under Stream One.

⃝ Copy of mentorship contract

⃝ I have reviewed the Standard for Authorization to Self-Initiate Profession-Specific Acts included in this package.

I am applying for authorization to self-initiate under the following:

⃝ Stream One — Please see payment instructions below

⃝ Stream Two / Conditional Authorization (fee waived) ⃝ Stream Three / Conditional Authorization (fee waived)

Payment Instructions: STREAM ONE (CDN $75.00—Processing Fee)

Offline Payment:

Amount: CAN $75.00 Payment Type: Certified Cheque ⃝ Money order ⃝

Online Payment:

An email with payment instructions will be sent to you once your application has been approved.

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Declaration of Clinical Practice –

To be completed if applying under Stream One

Please print in block letters.

Name: ..................................................................................................... CDHO Registration No.: .......................................................

Employment Profile (Please record your clinical practices over the last two (2) years, starting with the most current.)

Start Date

(mm/dd/yyyy)

End Date

(mm/dd/yyyy)

Business Name and Address

No. of Clinical Hours

Provide details regarding hours declared. (E.g. 10 hours a week, 50 weeks a year)

Total Number of Clinical Hours

Signature Date

Registrant’s Declaration

I declare that I have practised clinically for at least two (2) years (3200 hours) and the above information is correct. I understand that making a false or misleading statement on this declaration is considered professional misconduct and could be subject to disciplinary action. (Please consult the CDHO’s Professional Misconduct Regulations.)

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