Research + Testimony: How Medical Professionals Respond to/Service Sexual Violence Survivors

While a research associate for the Chicago Taskforce on Violence Against Girls & Young Women, I conducted research with over 20 health care professionals at Stroger Hospital on how to improve health services for girls and young women who are survivors of sexual violence. Based on the results, I put together a brief report and policy recommendations (below is a condensed version), which I presented at Chicago’s Cook County Hearings, where I also provided testimony on my own experiences servicing survivors as a hospital crisis intervention counselor.

The Chicago Taskforce serves as a vehicle for addressing the following two questions:

1. How will we galvanize attention to the devastating violence plaguing the lives of girls and young women?

1. How will we marshal the public/political will to end the violence?

In its work, the Chicago Taskforce researches currently enforced public policies that affect and/or influence how health care professionals at Cook County’s Bureau of Health Services respond to girls and young women that report sexual violence. In addition to identifying public policies that address the issue of violence against women at-large, the Chicago Taskforce began interviewing health care professionals at John H. Stroger, Jr., Hospital of Cook County (hereinafter Stroger Hospital) in May and will continue to conduct these interviews.

As the public policy research assistant for the Chicago Taskforce and as a former Hospital Crisis Intervention Counselor (HCIP) at Stroger Hospital, I have employed other methods of evaluation, such as direct observation based on my experience working primarily in the Emergency and Trauma Departments, in addition to the use of existing data collection from other research.

The goal of the research is to identify what are the lacunae in current public policies, in addition to recognizing barriers in intervention practices and possible solutions.

Interview questions were organized according to the following categories:

• Structural
• Attitudinal
• Physical Context: Practices and Challenges
• Behavioral

I have selected the over-arching questions asked during the interviews and am including some of the responses:

Structural

Did you receive any training on how to respond to or assist (girls/young women) who report sexual violence? If yes, are there different levels of training? Any follow-up to previous training(s)?

Most providers responded that they have received trainings that address abuse in general either during orientation their 1^st year, through lectures or through computer programs. Half reported to have received trainings on a regular basis (once a year), while the remainder stated that they have had only one training and nothing since. Further, most answered that they have not received training on how to respond specifically to young girls and women survivors of violence. For those that responded that they have attended training specifically on young girls and women survivors of violence used the words “women” and “violence” as general categories, as opposed to ‘girls’ and ‘sexual violence.’

Attitudinal

Do you think there is a need for a training that addresses how providers respond to girls or young women who report sexual violence?

All providers responded yes.

“Yes, I think it’s important. Because a lot of times people come out for a reason other than the one that they tell you. [It’s a] way to seek help.”

“Yes. [In order to] know the basics about identification and reporting. Then, to make appropriate referrals to people specialized in [the] area, so not to miss an opportunity.”

“[We need] heightened awareness for screening. Something more specific for sexual violence.”

“I think so; we don’t do the best job at screening for [sexual violence]. [There are] different levels of comfort or acting on it if someone is in fact a survivor of violence. [There is] always room for more.”

Physical Context: Practices and Challenges

What challenges do you think would arise, both attitudinal and structural, in implementing such a training?

All providers responded that time is an issue and as a result highly value the support and collaborative effort amongst organizations stationed at the hospital, specifically Rape Victim Advocates and the Hospital Crisis Intervention Project. These organizations step in and follow-up with the young girls and women that require further assistance and services. While both organizations are an invaluable asset to the Cook County Bureau of Health Services, Rape Victim Advocates (RVA) has expert medical advocates on-site. Services are available 24 hours a day, 7 days a week, at the Emergency Rooms of all twelve (12) . The expert medical advocates provide emotional support, medical and legal information, referrals and initial follow-up services to survivors and their significant others. If the survivor requests additional follow-up services, a staff advocate can provide more long-term medical and legal advocacy.

“Time [is] always an issue. [One] has to approach different levels of staff, different types of staff; pretty big number of people.”

“Change is difficult because tradition [is so] embedded. [There is] more [time] available with online training. [It is] more accessible.”

“[The] biggest barrier is TIME.”

Does your department have a policy and/or protocol to screening girls or young women for abuse? Specifically around sexual violence?

Most providers responded that their department included a policy or protocol on violence as a general category and the remainder were not certain how specific are the policies, and a few were unsure whether there are existing policies or not.

Behavioral

Given its prevalence, what makes attending to a young girl or woman who reports sexual violence different than attending to other health issues?

Most providers responded that there is a level of attention and commitment required that they are not always able to provide due to time restrictions. Again, RVA and HCIP are identified as resources that providers consistently seek.

[Sexual violence is] very different. [It’s] a much more sensitive topic. [It] involves [not just] the patient herself, [but also her] children, family members, abuser, etc. [Addressing this issue requires] expertise [and] time. It’s a very different scenario.

“I think medical issues are a lot more straightforward; [you] throw a pill, [do an] operation, etc. With these kinds of injuries [sexual violence], [we] don’t know [the] extent of injuries. [We are] better at [the] medical [aspect of injuries],”

“Definitely [different although these are] medical issues that need to be investigated; [there are] emotional [and] psychological issues that need to be addressed.

According to the results, the Chicago Taskforce has identified six (6) priorities for the Cook County Department of Public Health and the Cook County Bureau of Health Services in the state of Illinois.

1. Young Girls and Women’s Civil Rights: To undertake an aggressive effort to create a public education campaign that raises awareness of and education on the causes and effects of sexual violence against girls and young women for health care professionals and staff employed by and at the Cook County Department of Public Health and the Cook County Bureau of Health Services. In order to create an effective public education campaign and to provide a space that empowers young girls and women, we need them to lead these discussions and the public education campaign.

2. Quality Assurance: To develop and implement a realistic set of policies and/or protocols that ensure and enable the Cook County Department of Public Health and the Cook County Bureau of Health Services to respond and meet the needs of young girls and women who are survivors of sexual violence.

3. Health: To create an initiative of the Cook County Department of Public Health and the Cook County Bureau of Health Services that acknowledges that violence against young girls and women is a health issue, thereby promoting and increasing the number of services and resources available to young girls and women and the potential for increased funding for and collaboration with existing organizations servicing young women and girls.

4. Education I: To create strategies that increase the number and consistency of educational trainings available to health care professionals working with the Cook County Department of Public Health and the Cook County Bureau of Health Services that address how to respond and service young girls and women survivors of sexual violence.

5. Education II: To promote and encourage the participation of external private Health Care institutions that collaborate with the Cook County Department of Public Health and the Cook County Bureau of Health Services to address the issue of sexual violence against young girls and women and services/resources available.

6. Community: To strengthen relationships amongst Cook County Bureau of Health Services health care professionals and non-profits working to eliminate violence against girls and young women, such as the Chicago Taskforce and Rape Victim Advocates, we welcome and encourage providers to participate in the dialogue. Providers are willing to collaborate in helping to find solutions to these issues either through research or effective trainings.