Prepared by the Client Relations Committee of the College of Psychologists and Behaviour Analysts of Ontario
January 30, 2024
Introduction
Interchangeability of terms
This guide is about how a health care provider can handle situations when someone reports possible sexual abuse by another health care provider. Reporting such incidents is crucial to protect people, but it’s also a sensitive topic for those who’ve experienced it.
When a person tells their health care provider about sexual abuse[1] by another health care provider, the provider receiving the information might have to report this information to a regulatory body.[2] The health care provider will need to explain this to the client and provide support.
The process to be followed will depend on what information is shared, and how much the client wants to be involved. For instance, if the client is uncomfortable sharing the name of the health care provider they say abused them, the health care provider receiving the information won’t make a report. They can still offer support and services without getting that information.
If the client does share the name of the name of the health care provider they say abused them, the health care provider making the report must check if the information meets specific rules for reporting. If it does, they’ll explain what happens next, such as sending a report to the alleged perpetrator’s licensing body. They’ll also ask if the client wants their name included in the report. The health care provider making the report should explain that the report will not include the client’s name, unless the client consents to that.
When a regulatory body gets a mandatory report, it will want to investigate the matter further. If the client is named in the report, the regulator will likely reach out to the client directly. The regulator will provide information about its investigations process. It will also provide information about its funding for therapy program.[3] If the client is not named, the regulator will send this information to the reporting provider, to share with the client.
It’s crucial for health care providers to handle these discussions with care, respecting the client’s decisions and providing ongoing support. The health care provider should document what’s shared and any decisions made together during this process.
This entire process aims to ensure everyone feels safe and supported. It’s okay to seek guidance or help when dealing with such sensitive matters.
What follows are further guidelines to assist health care providers to manage potential mandatory reporting situations. The overarching goal is to provide tools for providers to handle such cases responsibly, especially in contexts that demand heightened sensitivity and confidentiality.
- Step-by-Step Communication Points in Mandatory Reports:
If a client tells a health care provider that they’ve experienced sexual conduct by another health care provider, like a dentist making sexualized comments, the law might require reporting it. However, the reporting health care provider cannot make a report without knowing the name of the dentist who is alleged to have abused the client. If the dentist is named and the three conditions outlined in section two, below are met, a report must be made. The report will only include the client’s name if the client provides written consent.
In conversation with the client, the reporting health care provider will need to go over the following points:
- You (the Client) Decide: If you don’t want to share the dentist’s name, I won’t make a report. You can always decide to name the dentist later. The service I provide won’t change based on your choice.
- If You Share: If you tell me the dentist’s name, I must make a report within 30 days. If there’s risk of ongoing harm, the report might be urgent. This will mean I may not be able to wait 30 days before making a report.
- Keeping Your Privacy: If you give me your permission, I will include your name in the report. I can only rely on your permission if you give it to me in writing. If you don’t give me permission, the report will not mention your name.
- Next Steps: The regulatory body may want to investigate. If your name is in the report, you might be asked if you want to make a formal complaint. This is your decision. You can also decide to provide information to the regulatory body without being involved in the complaint process. If your name is not in the report, the regulatory body will likely give me materials about its processes, to give to you.
- Getting More Information: You can check the regulatory body’s website or talk to someone you trust before deciding.
- Extra Support Available: Some regulatory bodies (including the CPO) offer external help to those dealing with this situation. They can guide you through the process on an anonymous basis.
- Respecting Your Choice: If you don’t want to pursue this further, I will respect your decision. I will only raise the issue for discussion if I believe it would be in your best interest.
- Keeping Records: All details about the allegations, our discussion about them, and a possible report, is significant information which must be documented in your file.
- Conditions for Making a Mandatory Report when the Alleged Perpetrator is Named
A mandatory duty to report sexual abuse will only arise if a client’s allegations meet certain conditions. If a client tells a health care provider about sexual conduct they experienced by another, named, health care provider, the reporting provider needs to assess:
- Was the health care provider a regulated health professional in Ontario when the incident happened? For example, a massage therapist is, but a yoga instructor might not be. If the person isn’t regulated, there’s no requirement to report. A list of Ontario regulated health professions can be found at https://www.healthforceontario.ca/en/Home/Health_Providers.
- Was the client being treated by this health care provider at the time of the incident? If not, like if a massage therapist did something inappropriate to someone who wasn’t their client, reporting might not be required.
- Is it clear the client is talking about behavior or comments that were possibly inappropriate? Sometimes, in a medical setting, certain behavior or talk might be okay. For example, while certain touching by a massage therapist, for example, would be inappropriate, other touching might be appropriate to the clinical service.
If the answer is “Yes” to all the questions, as a health care provider, you may have to make a report to the appropriate regulatory body within 30 days. If you believe the other health care provider might harm this or other clients again, you may need to report right away.
If the answer is “No” to any of these questions, reporting might not be required. If the client is still worried about what happened, you can talk with the client about other ways to handle the situation. For example, the client can go to the police, or make a complaint to the College. You should document the details of this discussion, including client reactions to any recommendations.
If you are still uncertain, you may wish to ask the client for more information. In doing so, you can tell the client that this might be a situation where you may be required to make a report but don’t have all the information you need. If you are asking for more information, be careful not to let it seem like you are assessing the client’s credibility. The test for whether to make a report is whether you have answered “Yes” to the questions above. You don’t need to prove the truth of what the client reports. Figuring out if a health care professional did something wrong is up to the regulatory body, not the reporter.
- Follow up with the Client after Making a Report
If you think it’s in the client’s best interest, you can tell them about the response from the college receiving the report. If possible and if the client wants, you can talk about what happens next in the college’s investigation. Sometimes, it may be appropriate to suggest the client talk to a health expert or lawyer who knows about this kind of situation. If the client doesn’t want to talk more about it, you don’t have to unless you believe it’s in the client’s best interest to do so. Any follow up or decisions about follow up should be documented in the client’s record.
- If the client is a regulated health professional who may have abused their own patient
A health care provider might have a client who is a regulated health professional, who might have engaged in misconduct of a sexual nature. The same obligation to report is there, whether the client is a possible perpetrator or a victim.
For example, a psychologist is counseling a radiation technologist (RT) who admits to sexual conduct while working with a patient. The psychologist must report this to the College of Medical Radiation and Imaging Technologists of Ontario (CMRITO). If the psychologist doesn’t believe, on reasonable grounds, that the RT will harm other patients, they can wait up to 30 days before reporting.
The psychologist doesn’t need to know the patient’s name or get permission from the client RT to report the incident to CMRITO. The psychologist must, in this case, identify the RT to CMRITO.
If the psychologist is providing psychotherapy to the client RT, the report must also include their opinion about the risk of the client RT repeating such behavior in the future.[4]
If, after making this report, psychotherapy is discontinued, the psychologist must file an additional report telling the CMRITO about this right away.[5]
Handling this reporting situation might bring up complex issues. Here are some things to consider:
- The psychologist must report the alleged abuse but also act in the best interest of their client, the RT, by staying understanding and supportive.
- The psychologist will need to decide what the report includes, when it’s sent, and what support they can offer.
- While transparency is generally desirable, if the psychologist thinks telling the RT might harm their patient or the investigation, they can choose not to tell the RT about the report.
- Health care providers may choose to seek consultation with colleagues or a legal professional before making such a disclosure to the RT.
Conclusion
In closing, these guidelines for mandatory reporting are based on principles of a trauma-informed approach to help people feel safe, trusted, and empowered during tough situations. Thoughtful management of these situations can keep a positive relationship between the client and the health care provider even when reporting sexual misconduct.
The reporting health care provider will need to use their clinical skills and understanding of the client’s situation to handle each case well. When things get tricky, health care providers are encouraged to talk to trusted colleagues, the CPBAO Practice Advice service, or a lawyer for guidance.
References:
Butler, L.D., Critelli, F.M., & Rinfrette, E.S. (2011). Trauma-informed care and mental health. Directions in Psychiatry, 31(3), 197-212. https://www.academia.edu/24689140/Trauma_Informed_Care_and_Mental_Hea
Goldenson, J., Brodsky, S., & Perlin, M. L. (2022). Trauma informed forensic mental health assessment: Practical implications, ethical tensions, and alignment with therapeutic jurisprudence principles. Psychology, Public Policy, and Law, 28(2), 226–239. https://doi.org/10.1037/law0000339
Harris, M. & Fallot, R. (2001). Using trauma theory to design service delivery systems. Jossey- Bass/Wiley.
[1] Section 1(3) of the Health Professions Procedural Code (Code), being Schedule 2 to the Regulated Health Professions Act, 1991, defines sexual abuse of a patient as (a) sexual intercourse or other forms of physical sexual relations, (b) touching of a sexual nature and (c) behaviour or remarks of a sexual nature. Specific acts of sexual abuse that will result in the mandatory revocation of a member’s certificate of registration are listed under section 51(5)(3) of the Code. Section 51(5.1) of the Code clarifies that “sexual nature does not include touching or conduct of a clinical nature appropriate to the service provided.”
[2] According to s.85.1 of the Code, members have a mandatory duty to report information if they have “reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or different College has sexually abused a patient.”
[3] Regulatory health colleges are required to have programs to provide funding for therapy to those who allege sexual abuse by their members. See s.85.7 of the Code.
[4] This is a requirement under section 85.3(5) of the Code.
[5] This is required by s.85.4 of the Code.