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ARCHIVED - Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse

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Appendix A: Empirical Basis of the Handbook

This Handbook is informed by two multidisciplinary, multisite research studies that employed grounded theory67 and action research126 methods. The overall intent of the project has been to facilitate a process by which childhood sexual abuse survivors and health care practitioners collaborate to develop practice knowledge that influences health care.166 In the first study, we explored women survivors' experiences of physical therapy, consulted with survivors, physical therapists and physical therapy students to develop guidelines for Sensitive Practice, and summarized the results of the study in a handbook. In the second study, we addressed gaps and questions from the first project, by asking men and women survivors about their experiences with and ideas about Sensitive Practice for a wide range of health care practitioners (including but not limited to physicians, nurses, nurse practitioners, oral health practitioners, massage therapists, complementary therapy practitioners, and other health care practitioners without special training in mental health/psychiatry or psychotherapy). We then engaged health care practitioners and survivors in a dialogue about Sensitive Practice and the creation of this second edition of the Handbook .

The first research project was conducted in three phases. In the first phase, 27 adult female childhood sexual abuse survivors in Saskatchewan and Ontario were interviewed. The women were between 19 and 62 years of age and from a broad range of educational backgrounds, professions, and income levels; 26 identified themselves as Caucasian and one woman self-identified as Métis. All had been referred for physical therapy in either inpatient or outpatient clinics; four had declined to see physical therapists. Transcripts of the interviews were analyzed and the central themes identified.142,143,158,164

In the second phase of the project, working groups of four survivors and four physical therapists in each group met in Saskatoon, Saskatchewan, and Waterloo, Ontario, four to six times over six months to refine the themes into principles and guidelines for Sensitive Practice. In the final phase of the project, the information from the interviews and working groups was used to draft the first edition of the Handbook. Approximately 200 survivor participants, other survivors, physical therapists, physical therapy students, and counsellors across Canada commented on successive drafts in writing or during focus groups. This lengthy and broad consultative process was intended to ensure the clinical relevance of the first edition of the Handbook .

In our second study, we focused on survivors' experiences with all types of health care providers. We conducted individual interviews with 49 men survivors and talked with one group of nine men. Interviews were conducted in six provinces (British Columbia, Alberta, Saskatchewan, Ontario, Nova Scotia, and New Brunswick). We also conducted interviews with 19 women survivors in Saskatchewan and Ontario. Repeated efforts to recruit Aboriginal survivors and survivors of colour were not overwhelmingly successful. Eight men and one woman self-identified as Aboriginal (Métis or First Nations). Participants ranged in age from 24 to 62 years. Participants were from a broad range of educational backgrounds, professions, and income levels.157,159,167

As in the first study, themes from these interviews served as the starting point for two working groups in each of two cities. In Winnipeg, one working group was made up of four male survivors and three nurses and nurse practitioners and the other working group consisted of four male survivors and four physicians. In Saskatoon, one working group included four female survivors and three nurses and the other was made up of three female survivors and four physicians. The groups met three or four times over four months. Interview findings and recommendations from the working groups in both studies were incorporated into a draft of the second edition of the Handbook that was sent to all participants. Feedback was incorporated into draft 2 and was sent to 110 health care practitioners representing a wide range of health disciplines and perspectives (including those from academic training programs, professional associations, regulatory/licensing bodies and various practice settings). Feedback was received from 56 consultants, including aroma therapists, chiropractors, dentists, dental hygienists, dental assistants, individuals teaching and researching in the area of kinesiology and sport, massage therapists, mental health practitioners, midwives, naturopathic doctors, nurses, nurse practitioners, physicians, physical therapists, occupational therapists, and reiki practitioners. Draft 3 was developed from this consultation and was used for further consultations with six focus groups of health care practitioners and students. In total, approximately 200 survivors and health care practitioners from across Canada participated in this consultation process.