RMTAO Blog
New CMTO Standards
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The new College of Massage Therapists of Ontario (CMTO) Standards of Practice came into effect January 1, 2022. Although there are changes and updates to the old Standards of Practice (2006), these new Standards don’t significantly impact how an RMT should practice. The primary difference is the way the requirements are described, and the way you can apply those requirements to practice.
We have outlined some of the primary changes in the new Standards so that RMTs have a better idea of the changes. However, it is recommended that RMTs review all the new Standards of Practice. The names of some Standards have changed, and some requirements have been regrouped into new Standards. Some information in the new Standards was also in previous CMTO guidelines and policies.
More details relating to the changes and additions to each of the new Standards of Practice are outlined below.
Acupuncture
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Acupuncture.pdf
The new Standard is more explicit about the specific requirements for obtaining the patient’s informed consent prior to conducting an assessment, providing treatment or modifying a treatment plan. This outline of the six elements of informed consent is present in many of the new Standards.
As this and other Standards state, consent must include a discussion with the client about the following six elements:
- The nature of the treatment;
- The expected benefits;
- Risks and side effects;
- Alternative courses of action;
- Likely consequences of not having treatment; and
- The patient’s right to ask questions about the information provided and that assessment or treatment will be stopped or modified at any time at their request.
The new Acupuncture Standard is also explicit about the Infection Prevention and Control (IPAC) guidelines that must be followed in order to provide acupuncture. It specifies that the RMT must follow Infection Prevention and Control and the Standard of Practice: Safety and Risk Management, including:
- Ensuring needles are sterile prior to use;
- Storing and disposing of used needles safely;
- Documenting and implementing needlestick injury protocols; and
- Vigilance in maintaining high standards of cleanliness, skin disinfection technique, needling technique and careful anatomical considerations.
The new Acupuncture Standard also highlights the necessity of referring the patient to another health professional or another RMT, where appropriate and with the patient’s agreement, if that other professional has expertise that can best address the patient’s needs. It also indicates that RMTs should follow all other elements of the CMTO’s Standards of Practice including the Standard of Practice: Draping and Physical Privacy.
Client-Centred Care
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Client-centred-Care.pdf
This was not previously the focus of a stand-alone Standard, although elements of this Standard existed in other previous Standards.
The focus of this Standard is on obtaining the patient’s informed consent prior to assessment and treatment, with elaboration of what that conversation should entail. This includes the requirements for obtaining consent for the treatment of sensitive areas and ways to encourage the patient’s involvement in their own healthcare.
This Standard also includes the requirements for obtaining health history and developing a treatment plan, as well as taking an evidence-informed approach to treatment. It also emphasizes staying within the massage therapy Scope of Practice. If you have a dual registration, you should ensure the patient is aware when they’re receiving treatment in your capacity as an RMT and you should ensure you are providing fair and equitable access to treatment to all patients.
Finally, this Standard touches on other Standards RMTs are required to follow to ensure all patients are treated with respect and dignity including preventing abuse, proper draping and proper discharge of a patient.
Collaboration and Professional Relationships
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Collaboration.pdf
This is a new Standard that focuses on ensuring RMTs can effectively collaborate with other practitioners in order to achieve the best possible outcomes for patients.
This includes referring to other professionals where necessary and appropriate, the requirements for documentation when working with other health professionals and the requirements around sharing access to health records. This Standard also includes a reminder of privacy and confidentiality requirements, and steps for conflict resolution when collaborating with others.
Communication
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Communication.pdf
This Standard ensures patients receive the information they need so they can make an informed decision about their care.
This Standard lays out the requirements for communication include the use of plain language and the importance of active listening, as well as the importance of adapting your communication to every patient and allowing the patient to bring in a third party to help with communication.
As this Standard indicates, all communication with patients should be respectful, ethical and professional, and privacy and confidentiality should always be maintained.
Conflict of Interest
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Conflict-of-Interest.pdf
This Standard was designed to ensure that patients receive care based only on their best interests and not based on the financial or personal interests of the practitioner.
Things that would be a conflict of interest include receiving a fee for a referral, recommending a product that the RMT has a financial interest in without disclosing that financial interest and advising the patient they can obtain an alternative product elsewhere, and renting a premises where the rent is determined by the number of patient referrals to the landlord.
It is also considered a conflict of interest to share revenue, fees or income with someone who is not a regulated health professional, unless there is a written agreement in place that states that the RMT is responsible for the professional aspects of their practice including record keeping and billing.
Consent
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Consent.pdf
There have been some changes in wording from the previous Standard on Consent, but the goal is still to ensure the patient has the information they need to make an informed decision about their care prior to treatment and have the opportunity to ask questions and share concerns.
The six elements of obtaining informed consent are the same as in the previous Standard and legislation, just worded differently. This Standard also outlines the requirements for consent for the treatment of sensitive areas (with some changes from the previous Standard). Some changes are that the six elements of consent have been clarified, consent for assessment/treatment of breast (patient request, treatment of nipple/areola where appropriate), and the expectation of monitoring and reverification of consent is included. The transitionary nature of consent is also described. There are more details given about what to do if the patient is not capable of giving consent, and what to do if the RMT does not have enough information about the risks and benefits of the treatment being offered. It also further highlights the importance of ensuring the patient continues to consent throughout the treatment.
Draping and Physical Privacy
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Draping.pdf
The new Draping Standard has many similarities to the previous Standard, most notably that the goal is that the patient is appropriately covered for their comfort and safety and boundary crossings are prevented.
There are, however, differences in the focus of the Standard, with more of a focus on patient-centred care. For example, the new Standard emphasizes the need to always drape the patient unless they arrive to the treatment with appropriate clothing and prefer to remain clothed. It also has more of a focus on client-centred care by requiring that you consider the patient’s needs, preferences and concerns when you engage in a discussion with them about draping. There is also guidance on treating sensitive areas and areas that should never be touched. This standard also includes information about draping and physical privacy during childbirth and requirements regarding physical privacy while clothed and not draped (where appropriate).
Overall, this standard provides more detail and focuses more on discussion with the patient and the importance of informed consent.
Fees and Billing
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Fees-and-Billing.pdf
This is similar to the previous Standard relating to fees, however there are additional details included and a slightly different area of focus.
This new Standard includes the requirements for receipts including the specific requirements for receipts when a patient uses a gift certificate. This information is also contained within the CMTO Receipt Policy.
This Standard also includes things the RMT cannot do including selling debt to a third party (e.g. a collection agency), or charging for services that are false or misleading. RMTs should also only use the term “massage therapy treatment” for services that are within the scope of practice of massage therapy. RMTs are also not able to reduce the fee charged for prompt payment.
Infection Prevention and Control
https://www.cmto.com/assets/CMTO-Standards-of-Practice-IPAC.pdf
Although there was some information about the prevention of infectious diseases in previous Standards, this Standard has more information about cleaning and disinfecting requirements. It also goes more in depth on IPAC requirements and personal protective equipment (PPE) requirements. Essentially this requirement is to protect the patients from being exposed to an infectious disease. There is emphasis on following the Infection Prevention and Control (IPAC), government and CMTO requirements and guidance.
Prevention of Sexual Abuse
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Prevention-of-Sexual-Abuse.pdf
The content of this Standard is very similar to the previous Standard for Maintaining Professional Boundaries and Preventing Sexual Abuse. However, this Standard focuses solely on preventing sexual abuse. It contains more detail about the definition of sexual abuse and emphasizes that RMTs should not provide treatment to anyone they have a sexual relationship with, which would be considered sexual abuse. It may never be appropriate to have a sexual relationship with someone who was previously a patient regardless of passage of time.
Some other additional elements in this Standard include information on disabling of audio, video, photographic transmitting and recording functions, and additional information on requirements regarding mirror locations.
Privacy and Confidentiality
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Privacy-and-Confidentiality.pdf
There were other elements of privacy requirements in other previous Standards, but this Standard puts privacy requirements all in one place. This Standard primarily focuses on the importance of understanding the Personal Health Information Privacy Act (PHIPA). This includes understanding what PHIPA says about sharing personal health information, obtaining the patient’s consent before collecting or sharing personal health information, and how to appropriately store and protect personal health information.
Professional Boundaries
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Professional-Boundaries.pdf
Much of the content of this Standard was in the previous Standard for Maintaining Professional Boundaries and Preventing Sexual Abuse, which was essentially divided into different, more concise Standards.
This Standard also includes the six elements of obtaining informed consent as well as the special consent requirements for treatment sensitive areas. It highlights dual relationships, the importance of recognizing the power imbalance in the therapeutic relationship and defining various ways that boundaries might be crossed.
Safety and Risk Management
https://www.cmto.com/assets/CMTO-Standards-of-Practice-Safety-and-Risk-Management.pdf
This Standard was designed to ensure that patients receive care that is delivered as safely as possible. This information was primarily contained within several previous Standards.
It focuses on the requirements for maintaining safe practice settings including cleaning and sanitizing, equipment maintenance, appropriate lighting and requirements to ensure patient privacy. It also includes the requirement to follow government and CMTO directives, complete necessary education to ensure patient safety, and the importance of recognizing and preventing situations that might put themselves, their patients, or their colleagues at risk. It is also essential to respond appropriately to any safety situations that might occur to prevent further adverse events.
Conclusion
This is a high-level overview of the changes to the Standards of Practice, which came into effect January 1, 2022.
Please see CMTO’s Standard Spotlights for additional information on how to apply the new Standards of Practice. They can be accessed at https://www.cmto.com/cmtos-new-standards-of-practice/
The CMTO began the process of updating the Standards of Practice in 2019, reviewing the previous Standards, and similar Standards and policies across Canada. The CMTO then created a Standards of Practice Advisory Group (SPAG) made up of RMTs in Ontario who provided feedback on the new Standards. Finally, in 2020 the CMTO solicited feedback from all RMTs, massage therapy educators and patients, and the majority agreed that the new Standards were clear and applicable. The approach to the new Standards was intended to allow RMTs more flexibility to suit an RMT’s specific practice needs. If you have any questions the CMTO recommends you contact the CMTO Practice Specialist at practicespecialist@cmto.com or by phone at 416-489-2626/1-800-465-1933 extension 4124.