Healthcare Support Strategies and Practices
Medical care and forensic exams can be distressing for survivors because:
- They involve touching, examining, or inserting an object into parts of their body that have been traumatized.
- Of the power differential between the survivor and healthcare provider.
- The process may trigger memories and feelings from the assault (Sherman et al., 2019).
It can be helpful for the survivor to bring a support person such as a friend, family, or partner when accessing healthcare.
Many communities may have victim services, outreach, or sexual assault response workers who can accompany survivors to the hospital or healthcare facility.
Below are some tips that can help prepare the survivor for medical care and a forensic exam:
- If survivors are interested in a forensic exam and the collection of forensic samples, it is best if they do not bathe, shower, or use the washroom (Adefuye et al., 2024). It is important to support survivors with doing what they need for their comfort and wellbeing, even if it impacts the forensic exam.
- Many sexual assault services that offer the forensic exam may have clothing and underwear for survivors. Please check with your local healthcare resource on what they have available. You may need to bring an extra set of clothing if the survivor decides to submit their clothing as forensic samples.
- Encourage the survivor to bring something that makes them feel grounded or safe.
- Identify potential triggers (i.e., noise), self-settling strategies, accessibility needs, and options that could make the survivor more comfortable, e.g., healthcare provider gender preference where available, ear plugs, music, book(s), neck pillow.
- Pack food, water, warm clothing, 2 pieces of personal identification (ID) (1 with photograph) if possible, health insurance ID card(s) if available, and cell phone and charger if available (Jorsvik, n.d.; Health Information Management, n.d.).
- Avoid bringing anything valuable, i.e., tablet, jewellery.
- Check hospital wait times where applicable.
Trauma-Informed and Survivor-Centred Medical Care and Forensic Exam Practices
Healthcare providers may not have the capacity to deliver trauma-informed care. If you are present with the survivor, you can advocate for practices that support a trauma-informed and survivor-centred approach.
Encourage healthcare staff to:
- Avoid offering reassurance through touch (e.g., a pat on the back or knee).
- Explain the process in detail using plain language, including what and why they are asking/doing.
- Ask for the survivor’s ongoing consent including permission to touch them and conduct each part of the exam.
- Offer options (e.g., healthcare provider gender preference where possible, choice to partially disrobe) and explain what to expect with each option.
- Allow more time so the process is not rushed.
- Speak in a calm, matter-of-fact voice and avoid sudden movements.
- Check-in regularly about how the survivor is feeling and provide reassurance.
- Ask the survivor about:
- How they can support them.
- What parts of the procedure are difficult or triggering.
- How they want to let the healthcare provider know that they need a break or want them to stop (Manning and Mana, 2022; Sherman et al., 2019).
- Use gender inclusive language. Please refer to this resource that describes inclusive terms clinicians can use when providing care to gender diverse people.
Ask if there are ways for the survivor to be more comfortable e.g., water, extra gown, breaks, lighting change.
Clarify whether the survivor wants their healthcare provider to be notified about the sexual assault.
Prepare the survivor for the components of medical care and forensic exam.
Ask for a medical note to support time off for the survivor from work or school.
Pay attention to the survivor’s body language. Survivors may have been conditioned to be passive and defer to the healthcare provider; they also may not disclose that a procedure is upsetting or triggering (Subramanian and Green, 2015).
Debrief with the survivor.
