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Handbook on Sensitive Practice for Health Care Practitioners

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Handbook on Sensitive Practice for Health Care Practitioners Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Child- hood Sexual Abuse was researched and written by Candice L. Schachter, Carol A. Stalker, Eli Teram, Gerri C. Lasiuk and Alanna Danilkewich Également en français sous le titre Manuel de pratique sensible à l’intention des professionnels de la santé – Leçons tirées des personnes qui ont été victimes de violence sexuelle durant l’enfance The opinions expressed in this report are those of the authors and do not necessarily refl ect the views of the Public Health Agency of Canada. Contents may not be reproduced for commercial purposes, but any other reproduction, with acknowledgements, is encouraged. Recommended citation: Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on sensitive practice for health care practitioner: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada. This publication may be provided in alternate formats upon request. For further information on family violence issues please contact: National Clearinghouse on Family Violence Family Violence Prevention Unit Public Health Agency of Canada 200 Eglantine Driveway Jeanne Mance Building, 1909D, Tunney’s Pasture Ottawa, Ontario K1A 0K9 Telephone: 1-800-267-1291 or (613) 957-2938 Fax: (613) 941-8930 TTY: 1-800-561-5643 or (613) 952-6396 Web site: www.phac-aspc.gc.ca/nc-cn E-mail: [email protected] © 2009 Candice L. Schachter, Carol A. Stalker, Eli Teram, Gerri C. Lasiuk, Alanna Danilkewich Cat.: HP20-11\2009E HP20-11\2009E-PDF ISBN 978-0-662-48577-3 978-0-662-48578-0 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 ................................................................................................................ vii Epigraph .............................................................................................................................. ix 1 The Handbook as a Tool for Clinical Practice ................................................................... 1 1.1 Audience and focus ........................................................................................... 1 1.2 An issue for all heath care practitioners ............................................................ 1 1.3 Organization ...................................................................................................... 2 1.4 Suggested uses of this Handbook ...................................................................... 2 1.5 Terminology ...................................................................................................... 3 1.6 Limitations ........................................................................................................ 4 2 Background Information about Childhood Sexual Abuse ................................................ 5 2.1 Defi nitions ......................................................................................................... 5 2.2 Childhood sexual abuse survivors...................................................................... 5 2.3 Perpetrators of childhood sexual abuse ............................................................ 6 2.4 The dynamics of childhood sexual abuse .......................................................... 6 2.5 Childhood sexual abuse and health .................................................................. 6 3 What Childhood Sexual Abuse Survivors Bring to Health Care Encounters ....................... 9 3.1 Gender socialization: Women’s experiences ...................................................... 9 3.2 Gender socialization: Men’s experiences ........................................................... 10 3.3 Societal myths about the cycle of violence ........................................................ 11 3.4 Transference and counter-transference ............................................................. 12 3.5 Specifi c behaviours and feelings arising during health care encounters ........... 12 3.6 Questions about sexuality and sexual orientation ............................................. 15 4 Principles of Sensitive Practice ......................................................................................... 17 4.1 Overarching consideration: Fostering feelings of safety for the survivor ........... 17 4.2 The nine principles of Sensitive Practice ........................................................... 17 4.3 Using the principles to avoid retraumatization ................................................. 23 4.4 Questions for refl ection ..................................................................................... 24 5 Guidelines for Sensitive Practice: Context of Encounters ................................................. 25 5.1 Administrative staff and assistants .................................................................... 25 5.2 Waiting and waiting areas ................................................................................. 25 5.3 Privacy ............................................................................................................... 26 5.4 Other issues related to physical environment.................................................... 26 5.5 Patient preparation ........................................................................................... 26 5.6 Encouraging the presence of a support person or “chaperone” ........................ 27 5.7 Working with survivors from diverse cultural groups ........................................ 28 5.8 Collaborative service delivery ............................................................................ 29 5.9 Practitioners’ self-care ....................................................................................... 30 5.10 Community resources for survivors and health care practitioners .................... 31 6 Guidelines for Sensitive Practice: Encounters with Patients ............................................. 32 6.1 Introductions and negotiating roles .................................................................. 32 6.2 Clothing ............................................................................................................. 32 6.3 Task-specifi c inquiry .......................................................................................... 33 6.4 General suggestions for examinations ............................................................... 36 6.5 Time .................................................................................................................. 37 6.6 Informed consent .............................................................................................. 38 6.7 Touch ................................................................................................................. 39 6.8 Pelvic, breast, genital, and rectal examinations and procedures ....................... 40 6.9 Body position and proximity ............................................................................. 41 6.10 Pregnancy, labour and delivery, postpartum..................................................... 42 6.11 Oral and facial health care ................................................................................ 43 6.12 Care within the correctional system .................................................................. 46 6.13 After any physical examination ......................................................................... 46 6.14 Questions for refl ection ..................................................................................... 46 7 Guidelines for Sensitive Practice: Problems in Encounters............................................... 48 7.1 Pain ................................................................................................................... 48 7.2 Disconnection from the body ............................................................................ 48 7.3 Non-adherence to treatment ............................................................................. 49 7.4 Appointment cancellations ................................................................................ 50 v Table of Contents 7.5 “SAVE the Situation”: A general approach for responding to diffi cult interactions with patients .................................................................................. 51 7.6 Triggers and dissociation ................................................................................... 52 7.7 Anger or agitation .............................................................................................. 56 8 Guidelines for Sensitive Practice: Disclosure .................................................................... 57 8.1 The challenge of disclosure for survivors .........................................................
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