Domestic and Sexual Violence __________________________________________________________________
Ending Assessments and Safety Planning In some contexts of repeated trauma exposure, victims present- ing for treatment may remain vulnerable to ongoing threat and further trauma. With victims of domestic violence and victims of sexual assault perpetrated in their current job set- ting or by an intimate partner, treatment may be affected by returning to unsafe environments. In the presence of ongoing risk, interventions should initially focus on ensuring safety, stabilization, and symptom management, instead of initiating the trauma-focused components of treatment. Ensure, to the extent possible, the safety, security, and survival needs of the patient by helping secure food, hydration, clothing, hygiene, and shelter. This will include promoting patient stabilization and the importance of sleep and replacing medications that are destroyed or lost. Patients also benefit from education on the process they are experiencing. There are apps developed to help with safety planning, including myPlan (https://www. myplanapp.org) [155]. Patients should be counseled regarding limiting ongoing harm by reducing the use of alcohol, tobacco, caffeine, and illicit psychoactive substances, if needed. Family, friends, and com- munity resources should be identified. From the initial point of contact onward, it is vital to establish a working treatment alliance with the patient and maintain a supportive, non- blaming, non-judgmental stance [152; 156].
Finally, the third component involves a negotiation process between the patient and the professional [151]. The negotia- tion consists of a dialogue that involves a genuine respect of beliefs. It is important to remember that these beliefs may affect symptoms or appropriate interventions in the case of domestic violence. Culturally sensitive assessment involves a dynamic framework whereby the practitioner engages in a continual process of questioning. By incorporating cultural sensitivity into the assessment of individuals with a history of being victims or perpetrators of domestic violence, it may be possible to inter- vene and offer treatment more effectively. Sexual Assault Victims Given the societal context of sexual assault reporting, the practitioner should accept the person’s account of his or her traumatic experience without investigating the authenticity of the claims. Victims/survivors may anticipate disbelief and denial from the clinician due to past negative responses to their disclosures from friends, family, or the criminal justice system. Practitioner gender should also be considered when working with sexual assault survivors. Avoid assuming that a female or male patient will prefer a practitioner of either the same or the opposite gender. Instead, discuss this issue with the patient and, if possible, let him or her choose the provider gender [152]. The proper clinical assessment of a person who has been sexually assaulted requires a systematic, patient, and thorough approach. It is of necessity time-consuming and should be con- ducted with sensitivity and respect for the patient’s emotional state. Preferably, providers who have been specifically trained for this task should perform the initial clinical examination. More than 500 hospitals and other health facilities in the United States have now addressed this need by adopting the sexual assault nurse examiner (SANE) program. A SANE is a trained nurse specialist who works within an interdisciplinary team to carry out a general and forensic clinical examination of the sexual assault patient and to develop a strategy for support and after-care [153]. The evaluation and treatment of sexual assault victims should incorporate the following components [153; 154]: • General assessment and treatment of physical injuries, with special attention to the genitalia • Forensic evaluation, where indicated and with informed consent • Pregnancy risk assessment and prevention • Evaluation, treatment, and prevention of STDs • Psychological assessment, crisis intervention, and follow-up referral for counseling As discussed, when appropriate, a trauma-informed approach should be used for victims of sexual violence—during both physical and psychological assessments.
The World Health Organization asserts that women who disclose any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator should be offered immediate support.
(https://apps.who.int/iris/bitstream/handle/10665/ 85240/9789241548595_eng.pdf. Last accessed May 29, 2025.) Level of Evidence : Strong/Indirect Evidence
It is important to note that general safety planning does not take into account the specific needs of victims who fall into vulnerable populations or affected children [157]. Because these individuals are at higher risk of marginalization and oppression, they may feel powerless to execute a safety plan. It is important for practitioners to assess each victim and his/ her readiness to change, circumstances, resources, and needs in order to tailor a specific safety plan [158]. Victims often feel they would have to sacrifice too much in order to be safe or that choosing safety would result in new problems [159].
15
MDCT2026
Powered by FlippingBook