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New Ontario standards of practice for RMTs take effect

The new Standards for Maintaining Professional Boundaries and Preventing Sexual Abuse aims to update existing regulatory practice standards to be in compliance with Bill 87, The Protecting Patients Act. The document is designed to “articulate the minimum acceptable performance by the massage therapy profession in Ontario.”

Prior to finalizing the new standards, CMTO consulted with the public, stakeholders and registered massage therapists.

“After considering the input of nearly 2,500 participants on the draft, the finalized CMTO Standards are in effect (as of September 11, 2017),” the CMTO said in an e-mail to registrants.

The updated standards contain significant changes that may affect the RMT practice. CMTO outline these changes as follows:

Treatment of sensitive areas
The definition of what would lead to mandatory revocation of a registrant’s certificate of registration with the College has been expanded to include sexual touching of the following sensitive areas: breast, chest wall, gluteal, and upper inner thigh. If clinically indicated, registrants may treat these sensitive areas but need to ensure their client is aware of the assessment and treatment proposed, including any risks, benefits and other aspects of informed consent. Prior to treating sensitive areas, the treatment must be clinically indicated and written consent must be obtained.

One-year waiting period prior to commencing a romantic relationship
The Protecting Patients Act, 2017, requires that for a period of at least one-year, following termination/discharge of the professional relationship, a registrant cannot engage in a romantic or sexual relationship with a former client. Although this part of the Act has not yet come into effect, as the formal definition of a “client” is still being determined by the government, CMTO has implemented this restriction through the updated Standards.

Massage therapy treatments for friends and family
It is generally inadvisable, except in exceptional circumstances, to treat friends and family members (this excludes spouses and romantic partners to whom the practitioner must never provide massage therapy treatment). The reason being that despite a registrant’s well-meaning intentions to deliver the best possible care, clinical objectivity may be compromised. The Standards clearly explain exceptional circumstances, and outline guiding principles for treating family members and/or friends.

Mandatory reporting obligations
It continues to be mandatory for registrants to file a written report to the College if they have reasonable grounds, obtained in the course of their practice, to believe that a client has been sexually abused by any member of the College or by any member of another health regulatory college. The fines for failure to file a mandatory report by a regulated health-care professional have increased to $50,000, and constitute professional misconduct. The penalty for failing to file a mandatory report for organizations has increased to up to $200,000.

In addition to these four key changes, the updated Standards also clarify the appropriate maintenance of professional boundaries within a therapeutic relationship.

A boundary violation is an abuse of powe, which places the client at a risk of psychological, financial, physical and/or sexual harm. Healthy and appropriate boundaries ensure that registrants operate in the client’s best interest. Updated guidance contained in the new Standards includes:

Guidance on hugging and non-verbal gestures
Interpersonal behaviour and non-verbal communication are important ways that RMTs establish professional boundaries with their clients. RMTs must refrain from using physical gestures that increase the risk of boundary violation. One example of a boundary violation is hugging. RMTs must never initiate hugs with their clients. If a client initiates a hug, the RMT must decide whether or not to reciprocate after carefully considering the client’s intent (e.g., is it appreciative or sexual in nature?).

Use of video recording devices
Video or photographic recording equipment should only be used with informed client consent for assessment, treatment and educational purposes. Securing and storing any of the collected digital data must comply with CMTO’s Standards of Practice and legislative requirements for documentation and storage of client records. When using devices with recording functions for other activities (e.g., playing music using a smartphone during treatment) RMTs must ensure any recording capabilities are blocked or disabled to protect client’s privacy and ensure proper boundary maintenance in their practice.

Defining physical boundaries through draping
Another way that RMTs establish and maintain physical boundaries in the therapeutic relationship is through appropriate and secure draping measures. When appropriately applied and monitored throughout treatment, draping can increase the client’s sense of privacy and safety, and solidify the respect and trust inherent in the client-therapist relationship. The new Standard provides updated guidance on draping, and draping sensitive areas.

Gift giving
The updated Standards urge registrants to maintain professional boundaries by recognizing that receiving or giving gifts can become a boundary violation. Therefore, it’s recommended that all gifts of significant value (either monetarily or sentimentally) given by a client to a registrant should be documented in the client record.

There are a number of other provisions in the new Standards that describe professional boundaries and the client-therapist relationship. “It is important that all RMTs read and understand the new guidance to ensure that they are practising in compliance with CMTO’s Standards of Practice and the Protecting Patients Act, 2017. CMTO encourages registrants to familiarize themselves with the new Standards to meet their obligations as regulated healthcare professionals of Ontario,” the CMTO said.