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

Researched and Written by...

Candice L. Schachter, DPT, PhD Adjunct Professor, School of Physical Therapy University of Saskatchewan, Saskatoon, SK

Carol A. Stalker, PhD, RSW Professor, Faculty of Social Work Wilfrid Laurier University, Waterloo, ON

Eli Teram, PhD Professor, Faculty of Social Work Wilfrid Laurier University, Waterloo, ON

Gerri C. Lasiuk, RN, PhD Assistant Professor, Faculty of Nursing University of Alberta, Edmonton AB

Alanna Danilkewich, MD, FCFP Associate Professor, College of Medicine University of Saskatchewan, Saskatoon, SK

Table of Contents

• Acknowledgments
• The Handbook as a Tool for Clinical Practice
  • Audience and focus
  • An issue for all heath care practitioners
  • Organization
  • Suggested uses of this Handbook
  • Terminology
  • Limitations
• Background Information about Childhood Sexual Abuse
  • Definitions
  • Childhood sexual abuse survivors
  • Perpetrators of childhood sexual abuse
  • The dynamics of childhood sexual abuse
  • Childhood sexual abuse and health
• What Childhood Sexual Abuse Survivors Bring to Health Care Encounters
  • Gender socialization: Women's experiences
  • Gender socialization: Men's experiences
  • Societal myths about the cycle of violence
  • Transference and counter-transference
  • Specific behaviours and feelings arising during health care encounters
  • Questions about sexuality and sexual orientation
• Principles of Sensitive Practice
  • Overarching consideration: Fostering feelings of safety for the survivor
  • The nine principles of Sensitive Practice
  • Using the principles to avoid retraumatization
  • Questions for reflection
• Guidelines for Sensitive Practice: Context of Encounters
  • Administrative staff and assistants
  • Waiting and waiting areas
  • Privacy
  • Other issues related to physical environment
  • Patient preparation
  • Encouraging the presence of a support person or "chaperone"
  • Working with survivors from diverse cultural groups
  • Collaborative service delivery
  • Practitioners' self-care
  • Community resources for survivors and health care practitioners
• Guidelines for Sensitive Practice: Encounters with Patients
  • Introductions and negotiating roles
  • Clothing
  • Task-specific inquiry
  • General suggestions for examinations
  • Time
  • Informed consent
  • Touch
  • Pelvic, breast, genital, and rectal examinations and procedures
  • Body position and proximity
  • Pregnancy, labour and delivery, postpartum
  • Oral and facial health care
  • Care within the correctional system
  • After any physical examination
  • Questions for reflection
• Guidelines for Sensitive Practice: Problems in Encounters
  • Pain
  • Disconnection from the body
  • Non-adherence to treatment
  • Appointment cancellations
  • "Save the Situation": a general approach for responding to difficult interactions with patients
  • Triggers and dissociation
  • Anger or agitation
• Guidelines for Sensitive Practice: Disclosure
  • The challenge of disclosure for survivors
  • Possible indicators of past abuse
  • Inquiring about past abuse
  • Responding effectively to disclosure
  • Additional actions required at the time of disclosure or over time
  • Responses to avoid following a disclosure
  • Legal and record-keeping issues
  • Questions for reflection
• Summary and Concluding Comments
  • Clinicians' contributions to survivor's healing from childhood sexual abuse
  • Sensitive Practice and patient-centred care
• Appendix A : Empirical Basis of the Handbook
• Appendix B : Prevalence of Childhood Sexual Abuse
• Appendix C : Traumagenic Dynamics of Childhood Sexual Abuse
• Appendix D : Diagnostic Criteria for Stress Disorders
• Appendix E : Sample Introduction to a Facility
• Appendix F : Using Plain Language in Consent Forms
• Appendix G : Working with Aboriginal Individuals
• Appendix H : a Note about Dissociative Identity Disorder
• Appendix I : The Evidence Debate Pertaining to Inquiry about Interpersonal Violence
• Bibliography
  • Works Cited
  • Recommended Reading and Resources
• Sensitive Practice At-a-Glance