What should I do when a client discloses domestic abuse?

BACKGROUND

Joleen is an occupational therapist in a professional practice leadership role for a home and community agency. Since the staff have resumed more in-person sessions, Joleen has noticed an increase in calls from occupational therapists (OTs) seeking support in managing situations where client are reporting domestic abuse in the home. Joleen would like to provide some guidance and support to the team members when they are managing these concerning situations.

Occupational therapists are asking if there is a duty to report situations where a client has been the recipient of domestic abuse. Joleen turns to the College website to understand the expectations and obligations for occupational therapists who encounter these types of situations.
  

CONSIDERATIONS 

Joleen reviews the College website for relevant Standards and practice resources. As there is no specific position on domestic abuse, she decides to contact the practice consultant to discuss the OT’s obligations when a client discloses domestic abuse.

OUTCOME

Joleen learns that unlike the duty to report a child in need of protection, or sexual abuse of a client by a professional, there is no legal duty to report domestic abuse. When presented with concerns regarding domestic abuse, the OT must first determine if the client is capable of making decisions. If the client is capable, the OT must respect their right to make decisions about their own lives. The OT can provide support and information for community resources and crisis lines. An OT cannot take further action if the client does not consent.

There may however be situations where the client or others are at immediate risk of harm.  It is expected that the OT would take appropriate action (for instance, if the OT arrives at the client’s residence and observes the abuse in progress), the OT should contact emergency personnel at 911 for assistance. In these rare situations, client consent is not required as the immediate risk of harm takes priority.

After speaking with the College practice consultant, Joleen decides it will be helpful to develop protocols to assist OTs when responding to these situations.

Joleen plans to include the following strategies: 

  • Take time to listen to the client’s concerns – OTs may be the only person the client trusts in disclosing this domestic abuse information. OTs may ask probing questions to understand the situation better to assess the level of risk/danger for the client and others.
  • Notify a direct manager as per organization requirements. 
  • Understand when personal health information can be disclosed without consent.
  • Discuss emergency and safety planning and possible next steps.
  • Be knowledgeable about community resources such as crisis lines, safe houses (shelters), and legal advisors that clients may access when dealing with domestic abuse situations. 
  • If children are present and are in need of protection, you must carry out your duty to report as outlined in the College's Child, Youth and Family Services Act document.
  • Consider appropriate referrals to other practitioners (for example, social worker) who provide services to individuals who experience assault.
  • Document the relevant information and any actions taken in the clinical record. The OT must be mindful that they are documenting sensitive information as others may have access. OTs should consult with their employer about where in the record it is most appropriate to document this information.
  • Occupational therapists are encouraged to monitor their own thoughts, feelings and reactions after a client has disclosed distressing information.  If any of these events are emotionally triggering, occupational therapists should seek the support they need for their own well-being. 

CONCLUSION

As occupational therapists, you may encounter situations where clients are disclosing harm and distressing information. The College encourages communication and collaboration with the client to obtain a better understanding of the situation. OTs must use their clinical judgement to determine what action is appropriate given the context. Discussions with your employer or other colleagues can help you to manage these types of client situations. The goal is to support the client while remaining objective, professional, and responsive. 

 

CONTACT

If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org.

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