Revictimization and recovery from sexual assault: implications for health professionals

Measuring Healing and Recovery After Gender-Based Violence: A Scoping Review

Healing after gender-based violence (GBV) is multidimensional, with varying instruments used in the scientific literature to capture this phenomenon quantitively in survivor populations. The purpose of this scoping review was to (a) describe quantitative measures used to evaluate recovery after GBV, (b) compare these findings with domains uncovered in a qualitative metasynthesis about survivors' perspectives about healing after GBV, and (c) summarize recovery relationships found. We searched Pubmed, PsycInfo, and Violence/Criminology/Family Studies Abstracts. Studies were included for review if they (a) used quantitative methods, (b) evaluated healing or recovery in survivors of GBV, (c) were available in English, and (d) were empirical articles in peer-reviewed journals. Two thousand nine hundred thirty-five articles were reviewed by title and abstract, and 92 articles were reviewed by full text. Twenty-six articles were included in this review. Eight studies used an alleviation of adverse symptomology as a proxy for recovery, eight used growth-related outcomes, and ten used a combination of both types of measures. While the quantitative instruments synthesized in this review seemed to map onto some of the recovery domains identified through qualitative metasynthesis, no study synthesized measured all domains simultaneously. Studies synthesized identified that recovery-related outcomes may be influenced by social support, symptom burden, disclosure, and various therapeutic intervention programs tested in the literature to date. Synthesizing research on recovery after GBV is an essential step to understand gaps in measurement and understanding. Streamlining and using holistic recovery outcome measurement can aid in the development of evidence-based interventions to promote healing in survivor populations.

Supporting victim-survivors during investigations of health practitioner misconduct: early learnings from a trauma-informed service

OBJECTIVE

In 2021, the Australian Health Practitioner Regulation Agency established a support service to provide additional assistance to victim-survivors involved in complaints related to sexual boundary violations. This study evaluates the first stages of service delivery to understand participants' experiences with the service, gauge the service's reception, and improve support provided in future.

DESIGN

Programme data was analysed descriptively to understand uptake and participant engagement since inception. Semistructured interviews with a purposive convenience sample of participants who had recently completed service engagement were conducted over 6 months and analysed using reflexive thematic analysis. Findings were triangulated to judge the effectiveness of the support provided by the service and highlight learning and development opportunities.

RESULTS

During the study period, 275 participants were referred to the programme and 175 (64%) of those referred had engaged with the service. At the time of analysis, less than a quarter (21%) had refused support or disengaged following referral. Participants reported appreciation of and satisfaction with the support they received from the service and strongly reiterated the need for support in this context. Flexibility and quality communication as part of the service model was associated with participants feeling supported through three main themes: safety and connection, guidance and process navigation and representation and advocacy.

CONCLUSION

Good uptake of the service and positive feedback from participants suggests that the programme has been a valuable and well-received initiative. Exploration of engagement trends as well as a more nuanced analysis of the benefits of support provided would augment these findings.

A Feasibility and Acceptability Assessment of Photo-experiencing and Reflective Listening (PEARL): An Intervention to Promote Recovery Engagement After Gender-Based Harm

Photo-experiencing and Reflective Listening (PEARL) is a trauma-informed intervention developed to promote recovery engagement in survivors of gender-based violence (GBV). This study aimed to understand the feasibility and acceptability of PEARL and identify potential healing elements. GBV survivors were recruited in Philadelphia through an online survey (n = 20). Participants completed the PEARL intervention, a postintervention survey, and a follow-up interview. Results revealed PEARL to be both feasible and acceptable, with thematic analysis revealing its ability to facilitate purposeful reflection, connection to the present, and progress toward healing goals. PEARL shows promise as an engaging strategy to promote healing for survivors of GBV.

Enacting an "Empowerment Approach" After Sexual Assault: The Views and Beliefs of Forensic Nurse Examiners and Crisis Support Workers

BACKGROUND

Sexual violence is a profoundly disempowering experience. It is essential that survivors are offered access to comprehensive medical care, psychological support, and follow-up in a way that offers them a high level of choice and control.

AIMS

There has been little research into how practitioners working in the context of immediate postassault understand empowerment and reflect this in their care delivery. This study sought to explore how crisis support workers and forensic nurse examiners conceive how they enact an "empowerment approach" in a sexual assault referral center (SARC) in the United Kingdom.

METHODS

A phenomenological approach was taken, and data were gathered through focus groups and interviews.

FINDINGS

Themes were identified under the headings of "indicators of empowerment," "empowerment as a process," and "the empowerment approach."

CONCLUSION

As part of providing person-centered care that enacts an empowering approach within the SARC setting, professionals need the skills and resources to be able to respond flexibly to their clients. They have a role in addressing victim blaming of those subjected to sexual violence and in promoting the accessibility of SARC services.

Views on Interprofessional Collaboration in a Dutch Sexual Assault Center: A Qualitative Study Among Workers

Purpose

As the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.

Methods

In this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.

Results

Participants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline's competences.

Conclusion

Building collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.

The Legacy of Shame following Childhood Sexual Abuse Disclosures

Shame has been recognized as a barrier to child sexual abuse (CSA) disclosures, but there has been less focus on the impact of shame on post-disclosure. This study explores how shame is experienced by CSA survivors following disclosure. Semi-structured interviews were conducted with eleven CSA survivors aged 14-25 years on their CSA disclosure experiences. Thematic analysis of the transcripts produced four themes that highlight the various impacts of shame post-disclosure: 1) struggles with identifying as a sexual abuse survivor; 2) manifestations of shame; 3) shaming responses to disclosures; and 4) strategies to overcome shame. Clinical implications are presented using a social ecological perspective.

Healing After Gender-Based Violence: A Qualitative Metasynthesis Using Meta-Ethnography

Gender-based violence (GBV) is a significant violation of human rights, requiring specific understanding of how individuals heal and recover after these experiences. This article reports on findings of a qualitative metasynthesis that examined the nature of healing after GBV through the perspectives of female-identifying survivors. Empirical studies were identified by a search of peer-reviewed articles via electronic databases. Studies were included for review if they were available in the English language, reported on qualitative studies that directly engaged female-identifying survivors of GBV, and were aiming to understand the GBV healing journey, process, or goals. After our initial search, 1,107 articles were reviewed by title and abstract and 47 articles were reviewed for full text. Twenty-six peer-reviewed articles were included for the review and were analyzed using meta-ethnography. Key findings included the recovery journey as a nonlinear, iterative experience that requires active engagement and patience. Healing was composed of (1) trauma processing and reexamination, (2) managing negative states, (3) rebuilding the self, (4) connecting with others, and (5) regaining hope and power. "Shifts" or "turning points" are also mentioned which catalyzed healing prioritization. This article aggregates and examines the scientific literature to date on GBV healing and provides articulation of the limitations, gaps in evidence, and areas for intervention. The article considers implications for future research, policy, and practice and, in particular, focuses our attention on the need to expand our knowledge of alternative recovery pathways and mechanisms for healing.

Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape

INTRODUCTION

The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design.

METHODS

In a sample of 639 rape-exposed women who were assessed within 20 days of rape and over 6 months, baseline data were used to predict PTSD symptom severity scores up to 6 months post-rape.

RESULTS

The incidence of PTSD at 3 months was 48.5% and the cumulative incidence at 6 months post-rape was 54.8%. Baseline experience of rape stigma (guilt, shame, self-blame, social devaluation and discredit) and depression were significant predictors of PTSD symptom scores over time, in mixed linear regression models. Higher levels of depression and rape stigma were associated with higher PTSD scores. Assault-related factors were not associated with PTSD scores.

LIMITATIONS

We could not measure PTSD symptom trajectories in all rape survivors, some of who may be at greater risk for PTSD e.g. non-disclosing rape survivors, those who declined participation and those who were extremely distressed at the time of recruitment.

CONCLUSION

Addressing internalised and externalised stigma and resultant mental health effects on women who present to rape clinics may reduce the long-term adverse effects of rape on mental health outcomes, such as PTSD. Rape survivors who present with high levels of depression soon after a rape should be carefully monitored and appropriately treated in order to reduce PTSD severity.

Campus Sexual Violence Victims with Disabilities: Disclosure and Help Seeking

Undergraduate students with disabilities represent an important population on college campuses. Yet the incidence of sexual violence and disclosing/reporting of sexual violence among this population is understudied. This exploratory and largely descriptive study uses an intersectional framework to understand the sexual victimization of undergraduate students with disabilities at a large Mid-Atlantic academic institution. The sample consisted of students who completed a sexual violence module (N = 2,929) as part of a larger campus climate survey. Students with disabilities comprised a smaller sample within this group (n = 177) and descriptive and chi-square results from both groups of students are reported. Students with disabilities had a statistically significant higher likelihood of sexual violence victimization before coming to campus and while at the university, with much higher rates for precollege victimization than students with no disabilities. Disclosure rates were not different for students across the two groups, though students with disabilities were more likely to utilize formal sources of support, such as campus Title IX offices and mental health services. This study shows support for a strengths-based approach that recognizes that students with disabilities may be more likely to reach out to campus resources. The findings of the study also underscore the need for culturally relevant victim services for students with disabilities. An evaluation of the culture of a university and its environment of openness, sharing, community, and protection (or lack thereof) can be a key point for future approaches to sexual violence on campus.

A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

Psychometric Evaluation of the Healing After Gender-Based Violence Scale: An Instrument for Cross-Sectional and Longitudinal Assessment of Recovery Progress for Women-Identifying Survivors

PURPOSE

The Healing after Gender-based Violence Scale (GBV-Heal) was developed to measure the holistic recovery processes of woman-identifying survivors of gender-based violence (GBV). The GBV-Heal asks survivors to evaluate a series of statements based on perceptions of one's lowest point and how they currently feel. These scale response options create lowest point, current feelings, and difference scores to evaluate the healing outcome cross-sectionally. This manuscript aims to evaluate the psychometric properties of the GBV-Heal to understand its usefulness for research and practice.

METHOD

Instrument evaluation consisted of two phases analyzing online survey data from two GBV survivor samples recruited from online health research portals in the United States. In Phase One (N = 236), we conducted factor analyses and evaluated convergent/discriminant validity using depression, anxiety, posttraumatic stress, posttraumatic growth, and wellbeing measures. In Phase Two (N = 47), we evaluated GBV-Heal response consistency via test-retest within two weeks.

RESULTS

Results showed that the scale's final model included 4 components with 18 items, explaining 61.2% and 65% of the overall scale variances for "at my lowest point" and "my current feelings," respectively. The GBV-Heal difference score showed a weak positive correlation with wellbeing and posttraumatic growth scores and a weak negative correlation with depression, anxiety, and PTSD scores. Test-retest revealed Pearson r correlations of 0.82, 0.82, and 0.69 for the lowest point, current feelings, and difference scores respectively.

CONCLUSION

These findings substantiate the reliability and validity of our instrument as an outcome measure that can be used both cross-sectionally and longitudinally with survivors of GBV.

Health Professionals' Experiences of Providing Trauma-Informed Care in Acute Psychiatric Inpatient Settings: A Scoping Review

BACKGROUND

Trauma-informed care is increasingly recognized as the ideal model of care for acute psychiatric inpatient units; however, it continues to be a challenge to implement. The aims of this review are (1) to synthesize the research exploring health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient settings and (2) to examine these experiences through a gender lens, particularly relating to gender-based violence. This research will provide additional insights to facilitate implementation of trauma-informed care in acute psychiatric inpatient care.

METHOD

A comprehensive scoping review methodology was adopted. English-language, peer-reviewed articles published between January 1998 and March 2018 were identified from seven databases. Inclusion criteria included a qualitative or mixed-method study design.

RESULTS

Eight full-text articles were found. This review highlights the importance for health professionals to have a reflective environment and a multilayered level of collaboration to adopt trauma-informed care. However, negative attitudes toward female consumers and inconsistent implementation strategies continue to hold back implementation of trauma-informed care in acute psychiatric inpatient units. Overall, limited consideration for gendered issues and gender-based violence in the implementation of trauma-informed care in acute psychiatric inpatient settings was found.

CONCLUSION AND IMPLICATIONS

There is a lack of research on health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient units, with even less research considerating gender-based violence. We argue that more research is needed to gain a better understanding of the experience of health professionals from acute psychiatric inpatient settings to inform future implementation of trauma-informed care.

Trauma-informed exercise for women survivors of sexual violence

Compared to their male counterparts, women experience alarmingly high rates of sexual violence (SV). Nearly 20% of women in the USA have been victims of SV, and prevalence of sexual assault among female service members is reported to be even higher, up to 50%. SV results in negative health outcomes like posttraumatic stress disorder, depression, obesity, poor body image, and pain-related disability. Exercise has been shown to positively impact both mental and physical health outcomes in populations experiencing posttraumatic symptoms, yet women survivors of SV are often excluded from exercise trials in trauma-affected populations. The purpose of this paper is to comment on the importance of incorporating women-specific trauma-informed principles in the content and delivery of exercise interventions in trauma-affected populations, particularly as it relates to SV. Researchers discuss the implications of female-specific and trauma-informed exercise considerations for SV survivors. This commentary highlights the need for trauma-informed implementation efforts and outcome measurements in exercise interventions involving women affected by SV. Researchers call for (a) increased qualitative work on trauma-specific implementation efforts across exercise intervention domains and (b) increased assessment of trauma-specific outcomes in exercise trials.

"I still feel so lost": experiences of women receiving SANE care during the year after sexual assault

OBJECTIVE

Emergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them.

METHODS

English-speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi-site observational study. We qualitatively analyzed responses to the open-ended question: "What do you think is most important for researchers to understand about your experience since the assault?" asked 1 week, 6 weeks, 6 months, and 1 year after enrollment.

RESULTS

Themes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors' daily lives.

CONCLUSIONS

Qualitative analyses of open-ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.

Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms

BACKGROUND

Sexual abuse is associated with severe health consequences, and the European Union has, through the Istanbul Convention, urged its member countries to provide specialist care for victims of sexual abuse.

AIM

This aim of this study was to investigate patient- and abuse-related characteristics among patients seeking help at a specialist clinic in Sweden, with focus on disclosure, mental health and appropriate healthcare access.

METHODS

This is a descriptive study where journal data from 100 consecutive patients January 2017 to February 2018 were analyzed. All adult individuals (women n = 80, men n = 8) who had taken part in the standardized semi-structured intake interview at the clinic were included (n = 88).

RESULTS

At admission, mean age was 40.3 (SD 11.9), mean number of psychiatric diagnoses 6.3 (2.6), and 93% of the patients scored above cut-off (≥34) on IES-R for PTSD. A majority of the patients (87%) had been exposed to childhood sexual abuse (CSA), and mean time to first disclosure was 15.9 (SD 15.3) years. In total, 82% of the patients had, despite disclosure, experienced difficulties accessing appropriate healthcare before coming to the specialist clinic.

CONCLUSION

Adult victims of sexual abuse have difficulties accessing appropriate healthcare. This constitutes a gender-based equality problem. A model of gatekeeping mechanisms with two dimensions (external and internal) and three categories (Competence related, Organizational and Emotional) is proposed to understand these difficulties.

The Healing after Gender-Based Violence Scale (GBV-Heal): An Instrument to Measure Recovery Progress in Women-Identifying Survivors

Current literature has primarily equated gender-based violence recovery with an improvement of physical or mental health symptoms, causing a gap in our understanding of the impact of interventions beyond the amelioration of adverse symptomology. The purpose of this research was to create an instrument to holistically measure gender-based violence recovery based on survivor healing goals. Ethnographic interviews were conducted in women-identifying gender-based violence survivors (ages 18-76) to determine healing domains and develop items using survivor language (n = 56). Focus groups with academic and community experts (n = 12) and cognitive interviews with gender-based violence survivors (n = 12) were conducted to ensure content and face validity, as well as to evaluate acceptability. This yielded a 31-item instrument to measure healing progress on a 5-point Likert scale. The Healing after Gender-based Violence Scale has the potential to highlight survivor strength and growth while more accurately measuring their recovery process based on survivor goals and desires.

Shifting Sexual Assault Forensic Examiners Orientation From Prosecutorial to Patient-Centered: The Role of Training

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors' decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants' adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors' well-being can lead to positive outcomes; (c) earlier placement of patient-centered content to allow instructors to explain how patient-centered care can be applied to each component of the SAFE role including the medical forensic exam; and (d) continual emphasis on patient-centered care.

Exploring the potential moderating role of self-compassion on the relationships between event centrality and post-assault psychological outcomes

OBJECTIVE

The present study examined whether post-assault internal processes (i.e., present control, event centrality, and compassionate and uncompassionate self-responding) were associated with distress and resilience among women who have experienced adult sexual assault. The authors also tested whether compassionate and uncompassionate self-responses would moderate the relationships between event centrality and outcomes.

METHOD

A convenience sample of women who had experienced sexual assault during adulthood (N = 253) completed an anonymous online survey.

RESULTS

Regression analyses showed that lower present control, higher event centrality, and higher uncompassionate responses to the self were associated with posttraumatic stress disorder. Additionally, higher present control and higher compassionate responses to the self were associated with resilience. Moderation analyses were not significant.

CONCLUSIONS

Endorsing greater levels of uncompassionate responses was associated with greater distress while engaging in greater compassionate responses was associated with greater resilience, even when accounting for levels of present control and event centrality.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.

Helping survivors of sexual assault

Sexual assault is a widespread problem in US communities, affecting about one in every three women and one in every eight men. These assaults reverberate through the lives of survivors and their loved ones, often for decades or even a lifetime. Healthcare providers must be empowered and equipped to contribute to the medical and mental health of survivors. This article provides a framework for that knowledge and empowerment.

Health professionals' perceptions of how gender sensitive care is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence

BACKGROUND

Sexual violence is a global public health issue. It is a form of gender-based violence commonly experienced by women accessing mental health services. The biomedical model has been the dominant model of care in acute psychiatric units, however, there has been a global movement towards more gender-sensitive and trauma-informed models. To date, only a small amount of research has focused on evaluating these models of care and health professionals' experiences of providing this care. The aim of this study is to gain an in-depth understanding of healthcare professionals' perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence.

METHODS

This study used case study methodology and the Normalisation Process Theory (NPT) conceptual framework. NPT is a practical framework that can be used to evaluate the implementation of complex models of care in health settings. It included semi-structured interviews with 40 health professionals, document and policy reviews, and observations from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic and content analysis.

RESULTS

Themes were developed under the four NPT core constructs; 1) Understanding GSC in acute psychiatric units: "Without the corridors there's not a lot we can do", 2) Engagement and Commitment to GSC in acute psychiatric units: "There are a few of us who have that gender sensitive lens", 3) Organising, relating and involvement in GSC: "It's band aid stuff", 4) Monitoring and Evaluation of GSC in acute psychiatric units: "We are not perfect, we have to receive that feedback".

DISCUSSION

Many health professionals held a simplistic understanding of GSC and avoided the responsibility of implementing it. Additionally, the competing demands of the biomedical model and a lack of appraisal has resulted in an inconsistent enactment of GSC.

CONCLUSIONS

Health professionals in this study enacted GSC to varying levels. Our findings suggest the need to address each NPT construct comprehensively to adequately implement GSC.

Health professionals' experiences of providing care for women survivors of sexual violence in psychiatric inpatient units

Background

Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units.

Methods

This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis.

Results

Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing.

Discussion

Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences.

Conclusions

Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.

Evaluation and Management of Female Victims of Sexual Assault

Sexual assault is characterized by any sexual contact or behavior that occurs without explicit consent. Classifications vary based on the status of the perpetrator's relationship to the victim (eg, stranger, acquaintance) and characteristics of the victim herself (eg, child, elder adult, mentally disabled adult). Regardless of the classification, sexual assault is a significant individual as well as public health issue affecting women of all ages. While the majority of sexual assault cases are not initially reported to law enforcement, the best available data suggest the lifetime prevalence of sexual assault in the United States is approximately 20% among adult women. With such a significant proportion of women affected by sexual assault, women's health care providers in both ambulatory and emergency care settings play key roles in the evaluation, management, and advocacy of these victims. Establishing standard protocols based on state laws and on victim-centered practices to avoid revictimization of the patient is critical. The primary goals of care include the assessment and treatment of physical injuries, psychological assessment and support, pregnancy assessment and prevention, and therapy for prevention of sexually transmitted infections. In addition, evidentiary collection is a critical component of the sexual assault evaluation and subsequent legal proceedings. This report focuses specifically on the immediate evaluation and management of adult female victims of sexual assault. Best practices include the utility of the Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner programs, as well as standardized treatment protocols.

Cultures of gendered violence: An integrative review of measures of attitudinal support for violence against women

National and international research has repeatedly identified the specific gendered nature and context of women’s victimisation of violence, whereby women are disproportionately victims of sexual and partner violence and overwhelmingly at the hands of known male perpetrators. As such, violence against women warrants a targeted and substantial focus, within overall violence reduction and prevention efforts. In the Australian policy context, there is an emerging and influential focus on attitudes towards violence against women as key targets for primary prevention and as foci for monitoring progress in reducing this violence. The Australian National Community Attitudes Towards Violence Against Women Survey was established to estimate community-level understanding of and attitudes towards violence against women. It has arguably evolved into an important instrument both for monitoring shifts in Australians’ knowledge and attitudes, as well as for directing primary prevention efforts. The purpose of this article is to provide an integrative review in relation to one of the key dimensions of the national community attitudes survey: violence supportive attitudes (see Webster et al., 2014). Here, we seek to identify patterns in defining and measuring attitudes that support violence against women, as well as advance the field by offering recommendations for progressing the measurement of violence supportive attitudes in Australia in the future.

Interventions to support recovery after domestic and sexual violence in primary care

Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013-2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother-child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother-child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.

Posttraumatic Growth and Sexual Violence: A Literature Review

Posttraumatic growth (PTG) is the positive psychological growth that a person might experience after enduring a traumatic event. PTG is a relatively new area of research identified by researchers because it represents a shift in thinking. Rather than focusing on the negative consequences of trauma, it explores the potential for positive outcomes associated with trauma. Although PTG is well documented across different types of traumas, it is unclear how this kind of growth stems from sexual violence, specifically. This review provides an overview of the literature concerning PTG that is associated with sexual violence. Results across the literature indicate that sexual violence is consistently associated with PTG. However, given the inconsistency in research designs, assessment, and operational definitions used to study PTG, many researchers suggest that it might be difficult to determine how and when PTG occurs. This study provides a literature review of the research on PTG in the aftermath of sexual violence. Important implications for future directions and trauma-based therapy are discussed and include the identification of relevant predictors, the importance of context, and how service providers might benefit from a better understanding of PTG.