Prevention of abuse (including sexual, physical, verbal, emotional and financial) has been a priority since the CRTO’s inception. There are several documents to support and inform CRTO Members, including the Professional Practice Guideline (PPG) on Abuse Awareness and Prevention which describes the prevalence of abuse among the general population and information on how to practice with sensitivity. The Abuse Awareness and Prevention PPG provides direction on how to practice in a way that is respectful of survivors’ needs.
Therapeutic and professional relationships are addressed in the standards and guidelines, and clarifies that whenever a power imbalance exists (as a result of RTs’ authority, knowledge, access to information and influence), that inequality can increase the potential for abuse which cannot be managed by obtaining consent. Furthermore, the responsibilities lie with Respiratory Therapists to ensure that relationships fall within the professional expectations of the CRTO.
The guidelines also includes information on Members’ responsibilities and reporting requirements under the Child and Family Services Act, Regulated Health Professions Act and CRTO Standards of Practice. Penalties for not reporting suspected abuse or for abusing patients are clearly articulated.
The PPG on Abuse Awareness and Prevention forms part of the CRTO Standards of Practice and is reviewed on a pre-set schedule or sooner, if required. Contravention of the standards is considered professional misconduct in accordance with the Professional Misconduct regulation (O.Reg 753/93) under the Respiratory Therapy Act.
Zero Tolerance for Sexual Abuse
In November 1994 one of the very first orders of business by the CRTO Council was the approval and publication of a position statement on zero tolerance for the sexual abuse of patients by Members. Since then, the CRTO has reaffirmed this position on a number of occasions, most recently in July 2014 to coincide with the release of the updated Professional Practice Guideline on Abuse Awareness and Prevention. The updated statement was distributed to Members via email in the summer of 2014.
Statistics and Other Information
- On average the CRTO received one (1) complaint/report per year alleging sexual abuse or boundary violation(s) of a sexual nature between 2004 and present.
- The average length of time between complaint/report submission and resolution for all complaints received is 6.9 months. The average length of time between submission and resolution for complaints/reports of sexual abuse or boundary violations is 7.4 months.
- During the period of reporting (2004-present) there were eight (8) complaints/reports, of which one (1) was withdrawn. The withdrawal therefore represents 12.5% of complaints/reports received alleging sexual abuse.
- The CRTO has a policy on reporting allegations of criminal behaviour, including sexual abuse, to the police.
- As the CRTO receives few complaints of sexual abuse/boundary violations of a sexual nature, the results have never been broken out in Annual Reports for fear that complainants or members may be identifiable. Typical reporting for the Inquiries, Complaints and Reports Committee includes year-over-year comparisons of decisions by category (e.g., referral to discipline, remediation, caution, take no action or other).
Funding for Therapy
As stipulated under Section 85.7 of the Regulated Health Professions Act, the CRTO has a program to provide funding for therapy and/or counselling of patients who are sexually abused by Members. A Fact Sheet describing the details of the funding program administered by the Patient Relations Committee is accessible to all stakeholders. Each year the Patient Relations Committee reviews the Ontario Health Insurance Plan (OHIP) rates for psychiatric assessment and treatment to ensure that sufficient funds have been budgeted to provide this care for up to 100-hours over a maximum of five years.
Education and Training for RTs, Committee Members and Staff
In addition to the guidance offered to Members when consultations and publications are circulated regarding CRTO standards, guidelines and positions, the Professional Standards Assessment (or PSA) tests Respiratory Therapists on all manner of professional responsibilities, including sexual abuse prevention and awareness. The PSA is an online, open-book, multiple-choice test that members who are randomly selected as part of the Quality Assurance Program are required to complete. The questions are based on the standards, guidelines and legislation of the profession and a blueprint developed by the Quality Assurance Committee sets out the specific areas of focus, including:
- Definitions of abuse,
- Reporting responsibilities of members,
- Conduct that may be considered professional misconduct,
- Maintaining professional boundaries,
- Therapeutic and professional relationships,
- Ethical practice, and
- Funding for therapy of abused patients/clients.
As mentioned above, there are many other publications that are provided to the public, Members and other stakeholders on the CRTO website such as position statements, fact sheets, standards of practice and guidelines. For those Members and public appointees who sit on the Patient Relations Committee, additional training has been offered. For example, the CRTO brought in guest speaker from the Domestic Abuse & Sexual Assault Program for York Region in April 2013. Staff who are responsible for supporting the Patient Relations Program and the Inquiries, Complaints and Reports processes also attended this session. This training assisted the Committee in drafting amendments to the Abuse Awareness and Prevention Practice Guideline, and assisted staff in preparing to deal with patients/complainants more sensitively and compassionately. The training was repeated in April 2015 with a professor from the University of Toronto.
Legislation to Support Programs & Processes
In April 2014, the CRTO submitted proposed amendments for Ontario Regulation 596/94 Part IV (Professional Misconduct) to the Ministry of Health and Long-Term Care. The proposed Professional Misconduct Regulation revisions include expanding the definition of abuse to mirror that of the Professional Practice Guideline on the Prevention of Abuse. The main reason for this is the increase in instances that are brought to the attention of the CRTO alleging poor conduct by Members. Although the conduct being reported rarely involves any sexual undertones, the Regulation amendments are intended to explicitly outline the conduct that will not be tolerated and reinforces the expectations of professionalism.