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Guiding AI into clinical practice

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Candice Alder has spent more than two decades helping children, youth and families in British Columbia navigate some of life’s hardest realities.

From her early work in public education as a child and youth counselor to her child protection work in government and experience in family court settings, and now in private practice, Alder’s work has consistently centred on supporting vulnerable children, youth and families navigating complex systems.

A clinical counselor and psychotherapist, Alder began her career with the Surrey School District before moving into child protection and child and youth mental health with British Columbia’s Ministry of Children and Family Development. Reflecting on that period, she highlights how the work was demanding but formative.

“It shaped my understanding of care, accountability and professional responsibility,” she said.
While child protection is often viewed as enforcement-driven, Alder described the work as inherently therapeutic when approached through a clinical lens.

“When you knock on a family’s door and tell them there’s been a child protection report, fear is already in the room,” she said. “Everything you do after that depends on your ability to engage people with care, honesty and skill.”

AI ethics through her clinical lens

Today, Alder brings that clinical lens and experience working with vulnerable populations to her work as an AI ethics and policy specialist focused on governance in high-risk, human-impact domains.

She is co-founder and principal consultant at Synthetica, where she advises organizations on responsible AI governance, risk management and ethical integration in professional and human-service environments. She also contributes to international AI governance and standards initiatives and serves as an IEEE CertifAIed authorized assessor of emerging AI systems.

When she first glanced over her partner’s shoulder at an early beta version of what would become ChatGPT, she saw a technological turning point with profound implications for the people she serves.

“It was obvious right away that this wasn’t just another tool,” she said. “This was something that could reshape systems very quickly, often without the people affected understanding how or why decisions were being made.”

While she was impressed by the efficiency of early generative AI tools, she quickly became concerned about their broader implications. What concerned her most was how easily AI tools could be adopted by professionals without adequate training, oversight or ethical guardrails. In mental health, that risk is intensified by power imbalances and client vulnerability.

“This is a technological revolution on par with the printing press,” she said. “But unlike previous revolutions, we are dealing with systems that may one day direct their own development. That’s something humanity has never faced before.”

She began examining how AI could affect children, youth and older adults, particularly in contexts involving consent, mental health and dependency. She points to harms already emerging, including documented cases of emotionally vulnerable youth forming harmful relationships with AI chatbots.

“When AI enters human-serving professions, the risks don’t stay with the technology,” she said. “They land on the people we serve.”

Guidance, governance and public protection

In Canada, the absence of comprehensive AI legislation has left regulators trying to fit fast-moving technologies into existing ethical and practice frameworks. From Alder’s perspective, many organizations are relying on broad, high-level principles while registrants are left without clear, practice-level guidance on how AI should be used responsibly. She sees this as a pivotal opportunity for regulatory bodies to shape how AI is integrated into professional practice, rather than simply responding to its use after the fact.

As president of the Board of Directors for the BC Association of Clinical Counsellors (BCACC), she is directly engaged in how the profession responds to the growing use of AI in clinical practice. Drawing on her AI ethics expertise and front-line clinical experience, she led the development of Canada’s first guidelines on the ethical integration of AI into clinical practice, released by BCACC in March 2025.

“With AI, you can’t expect clinicians to know what they don’t know,” she said. “The guidelines are meant to be a step-by-step roadmap so people can decide if AI is right for their practice, and if so, how to use it safely.”

Grounded in widely recognized ethical frameworks, including those developed by UNESCO and the OECD, the guidelines walk clinicians through issues such as informed consent, privacy, data storage and transparency. They aim to reflect both emerging international standards and the realities of clinical practice.

Alder noted that many clinicians are already using AI-based tools such as transcription services without understanding key details like privacy policies, where data centers are located, how data is handled or who can access it. She acknowledges that AI can ease the burden of clinical documentation but emphasizes that clients inherit the risks practitioners take.

“They deserve to know what’s happening with their information,” she said.
From Alder’s perspective, that expectation should not stop with clinicians. The same principles, she argues, need to apply to the regulators that are using AI in their own work and to set expectations for others.

She explains how that bar starts with regulators developing a minimum baseline understanding of how AI systems work, what data they rely on and where risks are. Even when external experts are involved, she said, boards and senior leaders still need enough literacy to ask informed questions and make defensible decisions.

She stresses that this is not just about future legislation or hypothetical systems. Many regulatory bodies are already experimenting with AI-powered tools to draft documents, summarize information or triage inquiries, sometimes using registrant or public data in the process.

“Every time you run information through an AI system, you’re making a decision about risk,”mAlder said. “You need to know what you’re using, nwhere the data goes and what your ethical obligations are.”

She expects that Canadian AI regulation, when it arrives, will likely adopt a risk-based approach similar to the European model, with heightened expectations for systems operating in high‑risk, human-serving domains. Regulators that begin building AI literacy now, she said, will be better prepared to adapt as formal rules evolve and to support registrants through that transition.

In her view, the questions boards and councils should be asking are straightforward, even if the answers are complex.

How are we already using AI with registrant and public data? What internal competencies do we need to understand and oversee those tools? What clear, practical expectations will best support practitioners who are beginning to use AI in their work?

“No one has all the answers yet, and that’s OK,” she said. “What matters is that we’re asking thoughtful questions an and keeping the public interest at the center.”

Public interest at the center

Keeping the public interest at the center reflects Alder’s longstanding dedication to supporting vulnerable children, youth and families across classrooms, courtrooms and years of clinical practice. She knows firsthand how the most vulnerable may never even know an AI system was involved in a decision that affects their lives and highlights how AI in regulated practice must be held to the same ethical standards as any other aspect of care.

“At the end of the day, children and families really are the fundamental units of society,” she said.

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