Sexual Abuse Prevention
Introduction
Statement of Philosophy
Definitions
Goals and Objectives
Guidelines for Professional Behaviour
The Professional Relationship
Professional Conduct
Professional Practice
Professional Education Program
Staff Education
Public Education
Funding of Therapy and Counselling of Victims
Rehabilitation of Members
Procedures for Handling Complaints
Mandatory Reports
Program Evaluation
Summary
Introduction
Under the terms of the Regulated Health Professions Act, 1991, each health regulatory college must have a Patient Relations Committee and a Patient Relations Program.
The Patient Relations Program must contain measures for dealing with sexual abuse of patients. More importantly, the program must contain measures for preventing the sexual abuse of patients by clinicians. The College of Audiologists and Speech-Language Pathologists of Ontario has been diligent in its efforts to comply with these requirements.
In keeping with the requirement to deal with members who abuse patients, a variety of measures have been implemented. Staff and council member training on the nature of sexual abuse have been provided. Intake procedures for complaints are well established and modifications to the procedures have been described for complaints of a sexual nature. A fund to provide counselling for victims of sexual abuse has been established and guidelines for the rehabilitation of members who abuse patients are in place.
The Sexual Abuse Prevention Plan is the cornerstone of our strategy for preventing sexual abuse. It is intended to acquaint members with CASLPO's philosophy of "zero tolerance" of sexual abuse and to provide information and direction to members concerning their protections and obligations under the Act.
The Sexual Abuse Prevention Plan is also intended to provide a policy foundation for the further development of information resources and procedures to support the goal of eliminating sexual abuse. The members of the CASLPO Patient Relations Committee developed the Sexual Abuse Prevention Plan.
It was reviewed and approved by the Council of the College of Audiologists and Speech-Language Pathologists of Ontario whose membership includes members of the profession and the public. It has also been reviewed externally by members of the profession, members of victim support groups, and by legal counsel for the College. As always, we welcome feedback from members as well. (TOP)
Statement of Philosophy
CASLPO maintains that sexual abuse within a therapeutic relationship is unacceptable and will not be tolerated. (TOP)
Definitions
Zero Tolerance
The term "zero tolerance" is used as shorthand for the philosophy that sexual abuse of patients by members of the College will not be tolerated.
Sexual Abuse
The Regulated Health Professions Act, 1991, defines Sexual Abuse as follows:
Sexual intercourse or other forms of physical relations between the member and the patient
Touching of a sexual nature of the patient by the member
Behaviour or remarks of a sexual nature by the member towards the patient ("Sexual nature" does not include touching, behaviour, or remarks of a clinical nature appropriate to the services being provided.)
Prevention
CASLPO is committed to the prevention of inappropriate behaviour and will demonstrate this commitment by educating its members and establishing a discipline process that reflects the seriousness of the violation and makes public the names of offenders.
Sensitivity
CASLPO acknowledges the potential vulnerability of patients and strives to provide a reporting process that is accessible and sensitive to their needs. (TOP)
Goals and Objectives
CASLPO's Sexual Abuse Prevention Plan has the following goals and objectives:
Providing a strategic focus for the development of programs, procedures, resources and activities aimed at preventing and eliminating sexual abuse
Describing measures in place or in planning for dealing with sexual abuse
Describing measures in place or in planning for preventing sexual abuse
Prescribing and/or recommending means for the dissemination and distribution of information (programs, procedures, resources and activities) related to sexual abuse and its prevention (TOP)
Guidelines for Professional Behaviour
The Regulated Health Professions Act, 1991, specifies that measures for preventing or dealing with sexual abuse of patients must include "guidelines for the conduct of members with their patients" (84.3 (b)). The following description outlines CASLPO's position with respect to the nature of the professional relationship and basic parameters in regard to professional conduct within the professional relationship. Professional Conduct Guidelines are available under separate cover. (TOP)
The Professional Relationship
The purpose of the relationship between an audiologist/speech-language pathologist and a patient is to provide assessment, treatment, and management of communication disorders as defined in the scope of practice and preferred practice guidelines.
It is the professional's responsibility to establish a relationship with the patient based on trust, support, and mutual respect. Sexually abusive behaviour is a fundamental betrayal of such a relationship. The health care professional is always responsible for the occurrence of abuse and thus for preventing it.
The professional must be sensitive to the possibility that the clinical relationship may create a vulnerability or dependency on the part of the patient. The patient, in turn, must be confident that the services provided will be free of sexual abuse. (TOP)
Professional Conduct
Dating during the therapeutic relationship is not acceptable under any circumstances; however, restrictions may extend beyond the treatment period. For example, a sexual or romantic relationship is inappropriate in cases where the therapeutic relationship has created a vulnerability or dependency on the part of the patient that affects the patient's ability to act freely, such as when extensive supportive counselling has been provided. Sexual relationships are not acceptable between an audiologist or speech-language pathologist and a patient's significant other(s), defined as anyone of emotional significance to the patient including, but not limited to, the patient's spouse, parent, sibling or caregiver. (TOP)
Professional Practice
Professional Conduct Guidelines have been produced to accompany the publication and distribution of this document. The intent of the guidelines is to assist members to:
Identify risks and increase awareness of situations in which sexual involvement might occur
Prevent inappropriate patient interaction
Establish and maintain professional-patient boundaries
Establish processes for initiating, maintaining and terminating personal relationships with patients
Develop awareness of multicultural issues and issues related to age or disability (TOP)
Professional Education Program
CASLPO is committed to providing ongoing education, direction and support to its members on the topic of sexual abuse of patients. The objectives of CASLPO's professional education program include:
Increasing awareness of professional development opportunities for members on the topic of sexual abuse and its impact on patients
Developing and collecting resource materials related to the topic of sexual abuse
Collaborating with business, professional, and educational partners to enhance the development and delivery of educational offerings for members
Alerting members to high risk situations and the consequences of engaging in sexual abuse
Providing assistance, direction and resource support to members in matters related to the reporting or disclosure of information concerning sexual abuse by a patient in respect of a member of this or another regulated health profession
Educating members about mandatory reporting requirements
Educating members about the complaints process and special procedures available for the reporting of complaints related to sexual abuse
These objectives will be met by:
Developing and distributing Professional Conduct Guidelines
Developing and compiling resource and educational materials related to sexual abuse and its prevention
Making professional conduct guidelines available to professional training programs
Collecting data on reports and complaints of sexual abuse
Publishing the findings of disciplinary hearings related to sexual abuse
Developing educational materials that generalize the circumstances arising from complaints and discipline matters and providing clear guidance on how such situations can be prevented
Complying with all terms of the evaluation of CASLPO's Patient Relations Program by the Health Professions Regulatory Advisory Council as discussed within the Regulated Health Professions Act.
Collaborating with other colleges, either individually or through the Federation of Health Regulatory Colleges of Ontario in the development and or delivery of educational materials or opportunities
Providing information to members on mechanisms for the reporting of sexual abuse including the complaints process, mandatory reporting requirements, and obligations for reporting not addressed under the RHPA
Recognizing the different needs of diverse populations, (e.g., children, non-communicative adults, people of different cultural backgrounds) in the design and delivery of programs and services relating to sexual abuse. (TOP)
Staff Education
CASLPO recognizes that it may be difficult for members of the public or the profession to report an occurrence of sexual abuse. This difficulty may arise from the fear that the process could be painful and result in further victimization or that additional unpleasant consequences might arise from the reporting process.
CASLPO is committed to ensuring that staff members are properly trained and that proper procedures exist for the intake of complaints or reports of sexual misconduct. Such procedures will be implemented in a competent, caring, and sensitive manner that does not lend itself to the re-victimization of a complainant. Staff responsible for the intake of complaints will receive special training for this purpose and will be aware of special modifications to the standard complaints procedure designed to facilitate the reporting of complaints having to do with misconduct of a sexual nature. (TOP)
Public Education
CASLPO is committed to its role of protecting the public by providing education about the role of the profession, standards of care and the College's regulatory responsibilities. Issues related to sexual abuse and reporting mechanisms are to be an integral part of this process. To this end CASLPO has articulated a philosophy of "zero tolerance" of sexual abuse. CASLPO will strive towards further protecting the public by informing the public of the role of the College and providing supportive and accessible facilities to its members and members of the public. Elements of a public education strategy to increase awareness of the College and its role in the prevention and elimination of sexual abuse by its members will include:
Dissemination of information on the definition of sexual abuse
Dissemination of information on reporting and complaints procedures in general, and on reporting and complaints procedures specific to sexual abuse
Provision of information and resources to members and members of the public on access to support groups for survivors of sexual abuse
Collaboration with the Federation of Health Regulatory Colleges of Ontario and with individual colleges and others in activities designed to increase knowledge of the Regulated Health Professions Act, 1991, and its various provisions for preventing and dealing with sexual abuse. (TOP)
Funding of Therapy and Counselling of Victims
Under the terms of the Regulated Health Professions Act, CASLPO is required to establish a fund to provide financing for the delivery of counselling services for members of the public who have been subjected to sexual abuse by members of the College. The fund has been established and monies accrue annually to the fund to a limit of $50,000. A minimum balance of approximately $10,000 must be maintained in the fund at all times. Monies that are recovered through action by the College against a guilty member will be returned to the contingency fund. L. Bohnen suggests that "Unless alternate requirements are prescribed in College regulations, a person is eligible for funding on the sole basis of there being a finding by the Discipline Committee that he or she was sexually abused by a member while a patient." (Bohnen 1996)
CASLPO's policy position on the matter of eligibility for funding for therapy is that a complainant is eligible if:
the Discipline Committee finds a member guilty of sexual abuse, and/or,
there is a legally documented admission of guilt through an alternative dispute resolution (ADR)
The funding that is provided to a person shall be reduced by the amount that the Ontario Health Insurance Plan, a private insurer, or the Criminal Injuries Compensation Fund is required to pay for therapy or counselling for the person during the period of time during the legislated time period.
Subject to some minor restrictions under the Act itself, the complainant is free to choose a particular counselor or therapist, and funds are paid by the College directly to the therapist. The College is permitted to require that the therapist sign a document to ensure that minimal provisions have been met. The College will undertake to ensure that such procedures are developed and in place prior to the occurrence of a finding by the Discipline Committee or an admission of guilt through an ADR process should such proceedings against a member be initiated. (TOP)
Rehabilitation of Members
Sexual abuse is defined as:
Sexual intercourse or other forms of physical relations between the member and the patient
Touching of a sexual nature of the patient by the member
Behaviour or remarks of a sexual nature by the member towards the patient.
Of these, only behaviour or remarks of a sexual nature towards a patient may be referred to the Quality Assurance Committee. Should a member be referred to the Quality Assurance Committee for engaging in conduct of this kind, the committee may require the member to attend specific education programs and/or undergo therapy or counselling. Failure of the member to comply with the assessment or rehabilitation program can result in the imposition of terms, conditions, or limitations on the member's certificate of registration. Members who apply for reinstatement after having their registration revoked as a result of sexual impropriety will have their application reviewed by the Patient Relations Committee prior to returning to practice. The potential of rehabilitation of the member will be considered on an individual basis. Members may be required to obtain a psychological evaluation prior to applying for reinstatement. (TOP)
Procedures for Handling Complaints
CASLPO's procedures for handling complaints are specified within the Regulated Health Professions Act, 1991, and are identical to those of all other Colleges regulated under the Act. These procedures are described in a variety of resource materials including CASLPO's complaints brochure and a number of published texts. The flow-chart of the complaints process adapted from A Comprehensive Guide to the RHPA (Steinecke 1996) and previously published in the CASLPO Bulletin of March 1996 is reproduced on page 13. Enhanced procedures which are complainant-centered and designed to provide a safe supportive environment are applied to this process when complaints pertain to misconduct of a sexual nature. These procedures are intended to prevent process-related "re-victimization".
In the event of such a complaint, the College will ensure the immediate availability of a staff member to take the complaint. In most cases, the complaints will be directed to the Registrar. However, due to the sensitivity of sexual abuse complaints, the complainant will be advised that he or she may request to speak to a staff member of either gender. Complaints may be submitted in writing, on audio or videotape, or on any other recorded format.
Should the complainant wish to meet with a staff member, such a meeting will be arranged in accordance with the following criteria:
The meeting will take place in a setting which ensures the complainants' privacy.
The complainant's consent will be obtained for the presence of any additional College personnel.
Complainants will be advised prior to the meeting that they may bring other persons of their choosing to the meeting if desired (i.e., friends, counselors, interpreters, legal counsel)
College staff will offer to assist the complainants to draft any submissions required by the College's complaints or discipline processes. (TOP)
Mandatory Reports
Under section 85.1 of the RHPA, it is mandatory for audiologists and speech-language pathologists to file a report if they have "…reasonable and probable grounds, obtained in the course of practicing their profession to believe that a member of the same or a different college has sexually abused a patient." Operators of facilities where audiologists and speech-language pathologists practice are also required to report sexual abuse.
Reports must be made if the member has reasonable grounds to believe that another health care practitioner has sexually abused a patient. A report does not need to be made if the member does not know the name of the alleged abuser. The report must be made, in writing, to the Registrar of the College of the member who is the subject of the report within 30 days of learning of the abuse. The report must be submitted immediately if there is reason to believe that the abuse is on-going or abuse of other patients will occur. The client must be informed that it is mandatory to report the matter although the name of the patient does not need to be disclosed.
Failure to make a mandatory report is an offence punishable with a fine up to $25,000.00. The RHPA provides protection from civil lawsuits or other proceedings to anyone who files a report in good faith. Such reports, unlike complaints, need not be referred to the Complaints Committee, but may be referred directly to the Executive Committee for consideration of immediate action. (TOP)
Program Evaluation
Section 6. (2) of the Regulated Health Professions Act, 1991, indicates that "The Advisory Council shall report to the Minister within five years after this section comes into force, on the effectiveness of, each college's patient relations and quality assurance programs, and each college's complaints and discipline procedures with respect to professional misconduct of a sexual nature." CASLPO will comply with the evaluation procedure specified by HPRAC. In addition CASLPO will monitor on an on-going basis:
the number of reports that were resolved
the number of reports that went on to the Complaints Committee
the number of investigated complaints that did not go to disciplinary hearings
the number of investigated complaints that went to disciplinary hearings
the number and nature of disciplinary findings. (TOP)
Summary
This Sexual Abuse Prevention Plan was developed and introduced by the members of CASLPO's Patient Relations Committee. It is intended primarily for distribution to members of the College. The purpose of the guidelines is to familiarize members with CASLPO's philosophy regarding the sexual abuse of patients and its measures for preventing and dealing with sexual abuse. A policy platform is also outlined which is intended to inform and to provide direction to the College with respect to materials, activities and resource developments.
Please feel free to contact the College by mail, phone, fax or e-mail if you have questions regarding this or other college publications. (TOP)