CASLPO News

Recognizing and Responding to Child Abuse and Neglect: What Should Audiologists and SLPs Know?

Many audiologists (AUDs) and speech-language pathologists (SLPs) work closely with children and families in schools, clinics, hospitals, private practices, and community settings. Those providing clinical care may notice changes in a child’s behaviour or become aware of concerns affecting a child’s well-being. Clinicians should be aware of possible indicators of abuse, know how to respond, and be familiar with Ontario's duty to report when working with children.

Recognizing possible signs of abuse and neglect

Child abuse and neglect do not always present in obvious ways; professionals do not need to know that abuse has occurred before acting. The Ontario Association of Children's Aid Societies (OACAS) identifies physical, sexual, and emotional abuse, as well as neglect as forms of child abuse.

For example, OACAS identifies possible signs as:

• unexplained or concerning injuries;
• significant changes in behaviour, such as unusual aggression or withdrawal;
• recurrent nightmares or disturbed sleep;
• sudden changes in confidence or school performance;
• persistent hunger, inadequate clothing, poor hygiene, or inadequate supervision; and
• information shared by the child that raises concerns about their safety or well-being.

Neither single nor multiple signs of abuse mean that abuse is occurring. Children may experience behavioural, emotional, or physical changes for many reasons. The circumstances that lead to a child being “in need of protection” under Ontario's Child, Youth and Family Services Act, 2017 (CYFSA) are also broader than obvious signs of abuse. They can include circumstances involving inadequate care, supervision or protection, neglect, and failure to obtain necessary medical or other treatment.  Clinicians need to ask themselves whether there are reasonable grounds to suspect that a child is or may be in need of protection. You do not need to be certain. CASLPO describes “reasonable grounds” as information that an average person would rely on to conclude that a child is or may be in need of protection from harm or neglect.

What might this recognition look like in audiology or speech-language pathology practice?

AUDs and SLPs may see a child repeatedly or over an extended period. This allows for opportunities to notice changes from what is typical for that individual child.

A clinician might notice:

• a significant change in a child's behaviour between appointments.
• observe an injury or unmet care need that raises concern.
• become aware of concerning interactions between a child and caregiver.
• hear something directly from a child.

AUDs and SLPs are uniquely attuned to the communication needs and mode of the children they work with.  Because many AUDs and SLPs have knowledge and experience working with children who hear and communicate differently, these clinicians may provide important context when something changes for an individual child. The clinician’s role is not to investigate or determine whether abuse has occurred. It is Ontario Children’s Aid Societies’ exclusive mandate and responsibility to investigate allegations of child abuse and neglect and to provide child protection services.

The Role of AUDs and SLPs in addressing concerns about child welfare

AUDs and SLPs may find themselves in a situation where a child shares something concerning. How AUDs and SLPs respond in these situations is important. They should:  

• actively listen to the child.
• make no promises that information will remain confidential as there may be a legal obligation to report.
• avoid investigating the situation.
• avoid making attempts to prove or disprove the child’s account

Note that it is not necessary to have all details about the situation before making a report. If you have reasonable grounds to suspect that a child is or may be in need of protection, report the situation to the Children’s Aid Society. The Children’s Aid Society is responsible for assessing the information and determining whether further investigation is required.

Understanding Ontario's duty to report

Under section 125 of the CYFSA, a person who has reasonable grounds to suspect that a child is or may be in need of protection must immediately report the suspicion and the information on which it is based directly to a Children's Aid Society.

CASLPO's Mandatory Reporting guidance confirms that this legal obligation applies to audiologists and speech-language pathologists. Evidence or proof of harm is not required before making a report.

There are a few important things to remember:

• You must report directly. You cannot rely on a colleague, manager, teacher, or another professional to make the report on your behalf.
• The duty is ongoing. If new information creates additional reasonable grounds for concern, another report must be made, even if a previous report has already been made about the same child.
• Professional confidentiality does not prevent reporting. The duty to report overrides professional confidentiality and provincial legislation that would otherwise prohibit disclosure, including the Personal Health Information Protection Act, 2004.
• You are protected when reporting in good faith. The CYFSA provides protection from legal action for making a report unless the person acts maliciously or without reasonable grounds for the suspicion.
• Document appropriately. Disclosures of personal health information made under mandatory reporting legislation must be documented in the patient health record in accordance with CASLPO's record-keeping and privacy requirements.
• Making a report is not the same as determining that abuse occurred. After receiving a report, the Children's Aid Society assesses the risk and urgency of the situation and determines whether an investigation is required.
• If someone is in immediate danger, contact the police.

What happens to a child and family is not determined solely by the report made to the Children’s Aid Society. The Children’s Aid Society will determine whether an investigation is necessary. Where an investigation is required, Children’s Aid Societies work with children and families using a family-centred, strengths-based approach, providing services and supports where appropriate.

What if you are unsure?

If you are unsure whether a situation meets the threshold for reporting, you can contact a Children's Aid Society to discuss the circumstances and seek guidance. The Government of Ontario also recommends contacting a lawyer or Children's Aid Society if you have questions about a specific situation.

The important distinction is that uncertainty about whether abuse actually occurred should not prevent a report where reasonable grounds for suspicion exist. It is the responsibility of the Children's Aid Society—not the clinician—to investigate the concern.

What about youth who are 16 or 17?

The mandatory duty to report under section 125 applies to children under the age of 16. If there are concerns that a 16 or 17-year-old is or may be in need of protection in circumstances identified in the CYFSA, a person may make a report to a Children's Aid Society.

Professionals should also be aware that failing to make a required report can have legal consequences. Under the CYFSA, a professional who obtains information in the course of their professional or official duties and fails to make a required report may be guilty of an offence and, on conviction, liable to a fine of up to $5,000.

Key Takeaways

Child abuse and neglect may not always be immediately apparent. For audiologists and SLPs who work with children, awareness means being attentive to changes, patterns, disclosures, and other information that may raise concerns about a child's safety or well-being.

As the school year begins, consider refreshing your knowledge of:

• possible signs of child abuse and neglect;
• what “reasonable grounds to suspect” means;
• how to respond when a child shares concerning information;
• Ontario's legal duty to report;
• your documentation responsibilities; and
• how to locate and contact a Children's Aid Society when concerns arise.

You are not responsible for proving that abuse or neglect has occurred. When reasonable grounds for suspicion exist, your responsibility is to report the concern. Assessing the information, investigating where necessary, and determining what happens next are the responsibilities of child protection professionals.

Resources for Registrants

• CASLPO – Mandatory Reporting for Registrants: Mandatory Reporting (for Registrants) 
• CASLPO’s Mandatory Reporting FAQs 
• Government of Ontario – Report Child Abuse and Neglect
• Ontario Association of Children's Aid Societies – What is Child Abuse?
• Ontario Association of Children's Aid Societies – Locate a Children's Aid Society or Indigenous Child and Family Well-Being Agency
• Information and Privacy Commissioner of Ontario – Yes, You Can. Dispelling the Myths About Sharing Information with Children’s Aid Societies 
• Information and Privacy Commissioner of Ontario – Sharing Information in Situations Involving Risk of Serious Harm: A Quick Guide for Professionals