While there are many well-recognised benefits of sport, evidence and testimony demonstrate that there are also negative influences on athlete health, well-being and integrity caused by harassment and abuse.
Doctors, Physiotherapists, Counsellors and other Health Professionals in an athlete’s entourage can play an important role in the prevention of harassment and abuse in sport.
The IOC has developed this factsheet to highlight some key roles and responsibilities of this entourage group in championing a Safe Sporting environment: One that is fair, equitable and free from all forms of non-accidental violence.
Recognise the signs and indicators of non-accidental violence.
Effectively and appropriately respond to disclosures of non-accidental violence.
Ensure you have access to a multi-disciplinary professional support team prior to initiating any treatment plan for athletes who are survivors of non-accidental violence.
Know where and how to refer disclosures or suspicions.
Recognise the signs and indicators of non-accidental violence
Just as in society, harassment and abuse are likely widely underreported in sport. Not perceiving behaviour as harassment or abuse, the “normalisation” of abuse, fear of repercussions and/or fear of not being believed are all reasons why some athletes may be afraid to speak up.
For other athletes, sport may be their only safe place. You, as a health care professional in the athlete’s entourage, may be in the best position to recognise early signs and indicators of abuse. Therefore, it is important that you know what these are.
Signs and indicators of abuse, include:
- Unexplained bruising, lacerations, handprints, etc. which the athlete is uncomfortable for you to see
- No explanation for injuries or inconsistencies in the account of how they happened
- Withdrawal or change in the psychological state of the athlete
- Disruptive team behaviour
- A change in appetite, weight loss/gain or signs of malnutrition
- Obvious discomfort or subdued behaviours around a specific person
- Sexual related infections / unwanted pregnancies
- Suspicions of doping
- Mental health signs/symptoms such as drug/alcohol addiction, depression, anxiety, disordered eating/eating disorders, PTSD, etc.
Effectively and appropriately respond to disclosures of non-accidental violence
Whether you recognise signs or indicators of abuse or if an athlete discloses an incident to you, it is important to ensure that you respond effectively and appropriately. Your immediate response may have a have a significant impact.
Here are some things to remember:
- Take the time – treat all reports seriously
- Do not pre-judge the situation or make assumptions
- Acknowledge the athlete’s bravery/strength for reporting/disclosing
- Do not denigrate the perpetrator
- Treat the immediate symptoms and sequelae of abuse if you are trained to do so, or make certain they have access to the appropriate treatment
- Ensure they are safe and not in any immediate danger
- Document what you are being told and any observations using the athlete’s exact words as they are spoken to you – do not paraphrase
- Do not make promises you cannot keep; assure them you will do all you can
- Follow up swiftly and appropriately as per your organisation’s protocols
- Keep a secure record – incidents which may seem innocuous or of low severity at the time could lead to more serious forms of abuse or form part of a larger case file in the future.
… findings confirm the negative health outcomes (eating disorders/disordered eating behaviors, and suicidal thoughts) associated with all forms of harm (psychological, physical, sexual, neglect), in spite of the common misconception that sexual harm is the most deleterious for athletes’ health and well-being. These findings also highlight the notion that negative health outcomes are experienced long after the National Team athletic career has ended.”
(Kerr et al., 2019)
Ensure that you have access to a multi-disciplinary professional support team prior to initiating any treatment plan for athletes who are survivors of non-accidental violence
It is important to remember that survivors of non-accidental violence may have complex needs and circumstances which require access to a multi-disciplinary support team.
This team may include:
- Medical providers such as physicians, nurses, sexual assault response specialists, etc.
- Mental Health Professionals
- Law enforcement – in the case that the incident may be criminal or involves a minor
- Victim advocates or crisis counsellors
- A child advocacy centre or similar if the case involves a minor
- Legal professionals
Know where and how to refer disclosures or suspicions
It is important that you follow your organisation’s protocol when referring disclosures or suspicions of harassment and/or abuse. These protocols should detail:
- How to report
- What you must report (including mandatory reporting requirements)
- To whom you must report
- The time frames in which you must report
Not all cases of harassment and abuse are criminal. Those which are criminal, involve a minor, or where there is an imminent risk of harm will require a different process to be followed than incidents which may not be criminal but are against the values of sport and are detrimental to athlete health and well-being. In all cases of suspected harassment and abuse in sport it is important to treat the report seriously, to know what referral processes are in place, and to keep a detailed and secure record of what has been reported.
Remember: By ignoring abuse, not reporting it or neglecting to stop it you are indirectly encouraging it to continue, and giving the impression that the treatment is ok, increasing the negative impacts on the victim. This is called The Bystander Effect.
Athletes enjoy the same fundamental rights as all patients in their relationships with physicians and health care providers, in particular, respect for: a. their human dignity; b. their physical and psychological well-being; c. the protection of their health and safety; d. their self-determination; and e. their rights to privacy and confidentiality.“
Olympic Movement Medical Code
(version dated 2016)
Another important role that you as a health professional can play is to advocate for the implementation of prevention strategies and provide expert input towards their development.
Prevention strategies include:
- Athlete protection or safeguarding policies
These are “statements of intent that demonstrates a commitment to create a safe and mutually respectful environment” (IOC, 2007)
- Athlete protection or safeguarding procedures
Which indicate the series of specific steps or actions which should be followed in response to a safeguarding report or concern
- Safe Sport awareness raising and educational initiatives
For athletes and all persons linked to the organisation
- Codes of Conduct for athletes and entourage members
Which “specify standards of what is acceptable and unacceptable in terms of both physical contact with athletes/children and issues of dependency and control” (Cense and Brackenridge, 2001)
Codes of conduct for team physicians and any other adults in an athlete’s environment, should include clear guidelines for the physicians’ specific roles, responsibilities, relationship boundaries and appropriate professional boundaries”
(Extract from Marks et al., 2011)
Familiarise yourself with what constitutes harassment and abuse in sport and with your role and responsibility in fostering a safe sporting environment.
Help to develop and promote education and raise awareness of what constitutes harassment and abuse for athletes and entourage members.
Check to see if your organisation has an athlete safeguarding policy in place and familiarise yourself with it. If there isn’t one, raise this to your organisations board.
Check to see who your organisations Safeguarding Officer is and discuss the procedures to follow in the event of a disclosure or suspicions of abuse.
International Olympic Committee. Consensus Statement on “Sexual Harassment & Abuse in Sport.”, 2007. Cense M, Brackenridge CH. (2001) Temporal and developmental risk factors for sexual harassment and abuse in sport. European Physical Education Review;7:61–79. Marks, S. Mountjoy, M. Marcu, M. (2011) Sexual harassment and abuse in sport: the role of the team doctor British Journal of Sports Medicine 46:905–908 Kerr, G. Willson, E, Kin, B. Stirling, A. (2019) Prevalence of Maltreatment Among Current and Former National Team Athletes, [pdf] Available at: https://athletescan.com/sites/default/files/images/prevalence_of_maltreatment_reporteng.pdf (Accessed 19 September 2020)