Health and Sexual Violence Online Resource Collection

This collection provides information on the short- and long-term impacts on health, information for healthcare professionals in various fields, and information on training professionals in the prevention and intervention of sexual violence with their patients.

Introduction
Advocating to support health
Prevention of sexual violence for improved health
Impact of sexual violence on health
Sexual assault across the lifespan
The body’s response to sexual trauma
Reproductive health
Mental health
Physical health
Seeking medical attention after an assault
Information for health care providers
General information
Working with Children
Sexual Assault Forensic Examiners (SAFE/SANE)
Reproductive healthcare providers
Dental healthcare providers
Mental healthcare providers
Relevant healthcare policies
Training materials
General information
Training on Prevention
Training on Intervention
Working with specific populations
Additional resources 
 
 Introduction
Sexual violence can affect the whole person in body, mind, or spirit. The responses of the body to a traumatic experience, like a sexual assault, can have lasting impact on health for any person at any age. We provide these resources in the hope that people who’ve experienced sexual violence can have better health outcomes, and that preventing sexual violence will lead to healthier people overall. Additionally, for those individuals who have already experienced sexual violence, knowing the impacts on health may help them in deciding what approach to take in pursuing or receiving medical care.  Additional information on sexual violence is available on the NSVRC website, publications pages, or in the eLearning portal.
 
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Advocating to support health: Advocates working to prevent and respond to sexual violence may find the following resources useful in their work raising awareness and competencies in prevention among health care providers.
A Message for Health Care Providers Concerning Survivors of Sexual Abuse/Assault (3 p.) by Prince Edward Island Rape and Sexual Assault Center. Composed by a local sexual assault center, this resource provides an overview of universal practices and procedures that health care providers can use to more effectively work with individuals who may have experienced sexual violence.
A National Protocol for Sexual Assault Medical Forensic Exams: Adults/Adolescents (141 p.) by the U.S. Department of Justice Office on Violence Against Women (OVW). In response to the 1994 Violence Against Women Act, this protocol was developed to guide criminal justice and health care practitioners in responding to sexual assault victims.
A Prosecutor’s Reference: Medical Evidence and the Role of Sexual Assault Nurse Examiners in Cases Involving Adult Victims (40 p.) by Jenifer Markowitz (2010). A monograph for prosecutors explains the role the Sexual Assault Nurse Examiner (SANE) and benefits of a medical and care focused SANE experience on later use of evidence and testimony.
A Recovery Bill of Rights for Trauma Survivors (2 p.) by Thomas V. Maguire (1997). To express the rights and power of any person who experiences a trauma, like sexual violence, this resource discusses authority, boundaries, communication, and safety issues. It may help in counseling and supporting individuals impacted by sexual trauma as they make personal decisions for health and healing.
Forensics for Survivors (web portal) by the Boston Area Rape Crisis Center. To inform people of their medical options for care after a sexual assault, this portal provides links to information on Time-sensitive information collection, going to the hospital, reporting the assault, thinking about next steps, rights as a survivor, and support services available. This page provides information specific to Massachusetts, but could be helpful in explaining options.
Guidelines for the Medico-Legal Care of Victims of Sexual Assault (154 p.) by the World Health Organization (2003). Based on studies showing that abused women seek more medical attention than those who have not experienced abuse, WHO provides these guidelines in an effort to educate health care workers on providing care to victims of sexual assault. It offers standards for the provision and medical and forensic exams and guidance in developing services for women exposed to sexual assault.
Helping Sexual Assault Survivors with Multiple Victimizations and Needs: A guide for agencies serving sexual assault survivors (65 p.) by Jill Davies (2007). Designed for rape crisis centers and victim advocates, this resource addresses the needs of people who have experienced multiple victimizations. It includes practical strategies for meeting these unique needs.
Limitations of the National Protocol for Sexual Assault Medical Forensic Examinations (4 p.) by Annie Lewis-O’Connor, Holly Franz, and Lucia Zuniga (2005). This article discusses emergency contraception and sexually transmitted infections, suggesting that the National Protocol lacks clarity on these issues and fails to incorporate best practices for care.
Preventing Pregnancy from Sexual Assault (124 p.) by the National Sexual Violence Resource Center, the Education Fund of Family Planning Advocates of NYS, & Clara Bell Duvall Reproductive Freedom Project of the ACLU of PA (2003). A toolkit compiled through joint collaboration, this resource discusses four action strategies for improving hospital policies on the provision of emergency contraception. Through legislation, administrative action, litigation/liability, and voluntary change hospital policies can change to reflect the needs and rights of people who experience sexual assault.
Rape: How women, the community, and the health sector respond (4 p.) by World Health Organization (2007). This research summary explores the research on responses to rape in the immediate and long term. Women who experienced sexual violence reported poorer health and higher rates of substance abuse and self harming behaviors.
Sexual Abuse in Childhood and Dental Fear (4 p.) by Jack Bynes and Carla Santos. This resource provides questions and responses from an interview with Carla Santos, a leading expert on dental fear as a response to childhood sexual abuse. It explains reasons for fear, potentially traumatic practices for the patient, and tips on how to cope with dental fear.
Sexual Assault Nurse Examiners and Victim Sensitive Evidence Collection (48 slides) by National Center for Victims of Crime (2010). These slides from a webinar provide information for Sexual Assault Nurse Examiners (SANEs) and others invested and involved in sexual assault forensic exam programs on collecting evidence in a sensitive and informed way. The presentation places emphasis on responding to the needs of individuals who experienced sexual assault as they go through the process of a forensic exam.
Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health (10 p.) by Sandra L. Martin and Rebecca J. Macy, with contributions from Janice A. Mirabassi (2009). In an effort to accessibly summarize research findings, this report provides an overview of the effects of sexual violence on women and resulting high-risk health behaviors. The document explains that certain social and economic factors, like poverty or discrimination, may influence experiences and health outcomes.
What Advocates Need to know about therapy: Working with children, adolescents, and families (40 p.) by the Washington Coalition of Sexual Assault Programs (2010). Advocacy for children, adolescents, and their families involves making connections to valuable community resources to promote healing. This guide provides information on how to establish good connections to therapists in the community and on establishing roles in the healing process.
 
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Prevention of sexual violence for improved health: Preventing sexual violence from occurring may lead to improved health outcomes. The following resources provide information on primary prevention from a health perspective and on adjusting policies to reflect a universal and informed approach to sexual violence in the healthcare setting.
Assessment for Lifetime Exposure to Violence as a Pathway to Prevention (12 p.) by Linda Chamberlain with contributions from Peggy Brown (2006). By providing a summary of research related to long-term health consequences and the health care response to a patient’s exposure to violence, this document discusses the increased risk of health problems, revictimization, and a continued cycle of violence between generations. 
In Brief: The Foundations of Lifelong Health (webcast) by National Scientific Council on the Developing Child & National Forum on Early Childhood Policy and Programs (2010). This report offers discussion and frameworks on improving lifelong health promotion and disease prevention by reducing traumatic or stressful childhood experiences.
Quick Reference Guide (4 p.) by American Academy of Pediatrics. This pocket reference guide provides basic questions for screening for and preventing sexual violence in all preschool, school age, and adolescent youth and their caretakers. 
Shifting the Paradigm: Primary Prevention of Sexual Violence (24 p.) by American College Health Association (ACHA) (2008). This resource guide provides information directed at preventing sexual violence on college and university campuses through changing cultural norms. It provides information on engaging campus health stakeholders and incorporating “Screening for Sexual Violence” tools in evaluations and health education and promotion.
Sexual Violence and the Spectrum of Prevention (20 p.) by Rachel Davis, Lisa Fugie Parks, and Larry Cohen (2006). The resource describes a primary prevention approach to addressing sexual violence. It discusses the elements included in preventing sexual violence before it occurs, which involves efforts ranging from behavior change with individuals to creating safe communities to affecting policy and large scale social change.
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence by CDC National Center for Injury Prevention and Control.   Fisher D, Lang KS, Wheaton J. (2010).  A planning guide for engaging and training professionals on preventing sexual and intimate partner violence, this publication includes fact sheets, worksheets, planning and training resources for professionals.
The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead (8 p.) by Vincent J. Felitti, MD (2002). This resource provides a general overview of the Adverse Childhood Experiences (ACE) Study. Study findings suggest that experiences of violence, abuse, or trauma in childhood have a significant impact on health in adulthood.
World Report on Violence and Health: Chapter 6: Sexual Violence (36 p.) by World Health Organization (WHO) (2002). This chapter explains the various forms of sexual violence and provides information on perpetration and responses in the healthcare setting. It provides a breakdown of risk factors for both victimization and perpetration and discusses multilevel strategies for the primary prevention of sexual violence.
What Advocates Need to know about therapy: Working with children, adolescents, and families (40 p.) by the Washington Coalition of Sexual Assault Programs (2010). Advocacy for children, adolescents, and their families involves making connections to valuable community resources to promote healing. This guide provides information on how to establish good connections to therapists in the community and on establishing roles in the healing process.
 
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Impact of sexual violence on health: Sexual  violence can have a lasting impact on a person’s health. Some of the resources listed here address short term health concerns, like seeking medical attention after a sexual trauma. Others discuss some possible long term consequences, like the health impacts on adult survivors of child sexual abuse. 
Health impacts across the lifespan
Sexual Violence Facts at a Glance (1 p.) by CDC National Center for Injury Prevention and Control (2008). This fact sheet provides information and statistics on the health outcomes for different populations who reported on their individual experiences of sexual violence.
 Assessment for Lifetime Exposure to Violence as a Pathway to Prevention (12 p.) by Linda Chamberlain with contributions from Peggy Brown (2006). By providing a summary of research related to long-term health consequences and the health care response to a patient’s exposure to violence, this document discusses the increased risk of health problems, revictimization, and a continued cycle of violence between generations. 
Facts for Prevention: The Health Impact on Children & Youth (2 p.) by National Coalition to Prevent Child Sexual Abuse and Exploitation. This fact sheet discusses the prevalence and impact of child sexual abuse on health.
 The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead (8 p.) by Vincent J. Felitti, MD (2002). This resource provides a general overview of the Adverse Childhood Experiences (ACE) Study. Study findings suggest that experiences of violence, abuse, or trauma in childhood have a significant impact on health in adulthood.
World Report on Violence and Health: Chapter 6: Sexual Violence (36 p.) by World Health Organization (WHO) (2002). This chapter explains the various forms of sexual violence and provides information on perpetration and responses in the healthcare setting. It provides a breakdown of risk factors for both victimization and perpetration and discusses multilevel strategies for the primary prevention of sexual violence.
 
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The body’s response to trauma
Common Responses to Trauma—and Coping Mechanisms (2 p.) by Dr. Patti Levin (2011). This fact sheet provides information on some of the common responses to a traumatic experience, like an experience of sexual assault. It includes information on both physical and emotional responses, and provides some basic coping mechanisms that many people find helpful in dealing this these stressors.
The neurobiology of trauma (3 p.) by David Lisak, 2002. This article describes the neurobiological process of fear and recollection of traumatic experiences. Based on the biological coding of fear-induced responses, it explains reasons for recovered memories that people may experience after a sexual trauma.
Current Trends in Psychological Assessment and Treatment Approaches for Survivors of Sexual Trauma (10 p.) by Nicole P. Yuan, Mary P. Koss, and Mirto Stone (2006). This resource provides a research summary on mental health treatment and services rendered to and recommended for women who have experienced sexual trauma. Authors use the term sexual trauma to describe distress experienced due to sexual violations, including rape, abuse, assault, and experiences labeled as something other than sexual assault during clinical observations.
 
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Reproductive health
Addressing Violence Against Women and Girls in Sexual and Reproductive Health Services: A review of knowledge assets (102 p.) by Bonnie L. Shepard (2010). This resource provides a review of literature, information, and skills helpful in integrating gender-based violence in the sexual and reproductive health services of women and girls. It also discusses policy and planning for this integration.
Facts on Adolescent Pregnancy, Reproductive Risk and Exposure to Dating and Family Violence (3 p.) by Futures Without Violence (2010). Sexual, dating and interpersonal violence pose challenges to reproductive health for young women especially. This fact sheet provides information on the ways that violence impact reproductive health and sexual behavior.
Gender & Reproductive Health (PowerPoint) by True Child, Inc. (2011). This PowerPoint presentation used in online training addresses integrating a gender transformative approach into programs and policies. Intersection of individual risk and societal vulnerability to HIV due to gender norms is discussed.
Human rights and women’s reproductive health (2 p.) by The People’s Movement for Human Rights Learning. This webpage discusses access to reproductive health as a human rights issue based on treaties and agreements from all over the world. 
Reproductive Justice and Violence Against Women (Special Collection) by the National Sexual Violence Resource Center, the National Resource Center on Domestic Violence, and the Women of Color Network (2010). This special collection features resources and articles on reproductive health and well-being. It explores the relation between reproductive justice and violence against women as basic issues of human rights.
Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health (10 p.) by Sandra L. Martin and Rebecca J. Macy, with contributions from Janice A. Mirabassi (2009). In an effort to accessibly summarize research findings, this report provides an overview of the effects of sexual violence on women and resulting high-risk health behaviors. The document explains that certain social and economic factors, like poverty or discrimination, may influence experiences and health outcomes.
 
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Mental Health
Child Sexual Abuse and Subsequent Psychopathology: Results from the National Comorbidity Survey (8 p.) by Beth E. Molnar, Stephen L. Buka, and Ronald Kessler (2001). This article offers research which suggests a high correlation between experiencing child sexual abuse and later having a diagnosis of various forms of psychopathology. It also explores various forms of child sexual abuse and the relation to psychopathology.
Common Responses to Trauma—and Coping Mechanisms (2 p.) by Dr. Patti Levin (2011). This fact sheet provides information on some of the common responses to a traumatic experience, like an experience of sexual assault. It includes information on both physical and emotional responses, and provides some basic coping mechanisms that many people find helpful in dealing this these stressors.
Current Trends in Psychological Assessment and Treatment Approaches for Survivors of Sexual Trauma (10 p.) by Nicole P. Yuan, Mary P. Koss, and Mirto Stone (2006). This resource provides a research summary on mental health treatment and services rendered to and recommended for women who have experienced sexual trauma. Authors use the term sexual trauma to describe distress experienced due to sexual violations, including rape, abuse, assault, and experiences labeled as something other than sexual assault during clinical observations.
Mental Health Consequences of Sexual Violence in Detention (2 p.) by Just Detention International (2009). A two page fact sheet talking about the devastating consequences of sexual violence in detention and addressing the extreme challenges that survivors must face.
Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health (8 p.) by Pamela A. Ratner et al (2002). This research reports relations between the experience of child sexual abuse, nonconsensual sexual activity, juvenile prostitution, and the inherent impacts on mental health. The authors recommend that mental health professionals develop cultural competency on men’s sexual trauma and deconstruct personal beliefs about same-sex sexual violence.
The Psychological Consequences of Sexual Trauma (11 p.) by Nicole P. Yuan, Mary P. Koss, and Mirto Stone (2006). This resource reports on and summarizes current research on the psychological outcomes and mental health of women who experienced sexual trauma in childhood, adulthood, or both. Gaps and controversies within research findings, as well as the wide variation in psychological responses to trauma are discussed.
Women's mental health: What it means to you by U.S. Department of Health and Human Services, Office of Women’s Health (2009). This booklet provides information on the importance of mental health in the overall health of women. It discusses various stressors and experiences, including history of sexual abuse, as a major contributor to many mental health issues for women.
 
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Physical Health
Common Responses to Trauma—and Coping Mechanisms (2 p.) by Dr. Patti Levin (2011). This fact sheet provides information on some of the common responses to a traumatic experience, like an experience of sexual assault. It includes information on both physical and emotional responses, and provides some basic coping mechanisms that many people find helpful in dealing this these stressors.
Sexual Assault and the Body (16 p.) WCSAP Research & Advocacy Digest, v7:2 (2005). The February 2005 edition of WCSAP’s Research & Advocacy Digest provides overviews of several research articles related to the impact of sexual violence on the body. Topics include: Childbirth after Sexual Abuse, Body Image and Self-Concept, Women’s Decisions and Experiences of Cervical Screenings, Compulsive Weight Lifting and Anabolic Drub Abuse, Chronic Pain Patients after traumatic childhood events, and Assessing Dental Fear, among other topics.
The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead (8 p.) by Vincent J. Felitti, MD (2002). This resource provides a general overview of the Adverse Childhood Experiences (ACE) Study. Study findings suggest that experiences of violence, abuse, or trauma in childhood have a significant impact on health in adulthood.
 
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Seeking medical attention after an assault: Directly after an experience of sexual assault, a person has the option of seeking a Sexual Assault Forensic Exam (SAFE). The information shared below explains some of the basic information that may help a person to decide whether or not to pursue a forensic exam or another type of medical care after an assault. These exams are typically performed by a trained examiner. Undergoing a forensic exam does not mean that the person has to make a police report.
Forensics for Survivors (web portal) by the Boston Area Rape Crisis Center. To inform people of their medical options for care after a sexual assault, this portal provides links to information on Time-sensitive information collection, going to the hospital, reporting the assault, thinking about next steps, rights as a survivor, and support services available. This page provides information specific to Massachusetts, but could be helpful in explaining options. 
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Information for health care providers: Healthcare providers have many opportunities to employ universal practices that could help to provide important information and intervention to patients impacted by sexual violence. The following resources provide information on intervening, identifying, and treating their patients in a caring, informed way.
General information
A Message for Health Care Providers Concerning Survivors of Sexual Abuse/Assault (3 p.) by Prince Edward Island Rape and Sexual Assault Center. Composed by a local sexual assault center, this resource provides an overview of universal practices and procedures that health care providers can use to more effectively work with individuals who may have experienced sexual violence.
Caring for Trafficked Persons: Guidance for Health Providers (232 p.) by International Organization for Migration (2009). This handbook for healthcare providers offers information on the specific health concerns for trafficked persons, an overview of human trafficking, and specific information on various groups and types of persons who may experience trafficking. Sections provide special emphasis on safety, security, cultural competency, and individualized responses and care.
Clinical Management of Rape Survivors (76 p.) by World Health Organization (2004). This resource provides a response and outlines recommendations to meet the needs of rape survivors who are also refugees or internally displaced persons. It provides information on both the clinical care and follow-up efforts to fully meet the needs of individuals who seek medical attention after an experience of sexual violence.
Elder Abuse: An Introduction for the Clinician (PowerPoint, 52 slides) by Ronald Chez (2009). This PowerPoint presentation provides information on elder abuse, including sexual abuse, and how clinicians can respond to suspected abuse of elders in their medical practice.
Establishing a working office by Washington State Department of Health Injury and Violence Prevention Program (2010). This page provides steps that medical professionals can take to make their practices and environments safe for women who have experienced violence and prepare for prevention and intervention in violent situations.
Guidelines for the Acute Care of Adult and Post-Pubertal Adolescent Sexual Assault Patients by Virginia Domestic and Sexual Violence Action Alliance & Virginia Chapter of the International Association of Forensic Nurses (2009). In an effort to provide high quality healthcare and response for people who have experienced sexual violence, this collection of guidelines and fundamental criteria offers information on appropriate and caring responses in healthcare settings.
Guidelines for the Medico-Legal Care of Victims of Sexual Assault (154 p.) by the World Health Organization (2003). Based on studies showing that abused women seek more medical attention than those who have not experienced abuse, WHO provides these guidelines in an effort to educate health care workers on providing care to victims of sexual assault. It offers standards for the provision and medical and forensic exams and guidance in developing services for women exposed to sexual assault.
Healthcare Protocol Manual for Sexual Assault by Arkansas Commission on Child Abuse, Rape, and Domestic Violence (2005). Protocol manual for medical professionals including emergency medical services, primary care providers, mental health providers, and collaborating agencies and offices offers recommendations and guidelines for effectively responding to and caring for patients who have experienced sexual assault.
Intimate Partner Violence and Sexual Violence Victimization Assessment Tools for Use in Healthcare Settings  by Basile KC, Hertz MF, Back SE. Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: (2007). This collection of assessment tools provides tools and questionnaires currently in use in healthcare settings to screen for violence in patients’ lives. A majority of the tools are IPV focused, but it does provide a section devoted to sexual violence screening.
Screening for Sexual Violence: Gaps in Research Recommendations for Change (19 p.) by Lynne Stevens with contributions from Barbara Sheaffer (2007). This applied research document discusses universally screening patients for a history of sexual violence in primary health care settings. According to research discussed by the author, healthcare settings provide a gateway to other services for women and girls who experience sexual assault.
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Working with children
Addressing Sexual Abuse in the Primary Care Setting (6 P.) by Mary Ranee Leder, MD; S. Jean Emans, MD; Janet Palmer Hafler, EdD; and Leonard Alan Rappaport, MD (1999). This research article discusses the outcomes of a focus group on the factors that lead clinicians to suspect child sexual abuse.
The Evaluation of Sexual Abuse in Children (7 p.) by Nancy Kellogg (2005). This article discusses the physician’s role in identifying signs and symptoms of abuse and providing resources and follow-up for a child who has been abused. It reviews aspects of physical, sexual, and emotional well-being that abuse impacts in the course of child development and when to make reports of abuse.
Quick Reference Guide (4 p.) by American Academy of Pediatrics. This pocket reference guide provides basic questions for screening for and preventing sexual violence in all preschool, school age, and adolescent youth and their caretakers. 
Child Sexual Abuse: Are health care providers looking the other way? (7 p.) By Shelia Savell, IAFN (2005). This article provides information on the role of health care providers in recognizing sexual abuse in children. It includes recommendations to improve identification and intervention.
What Advocates Need to know about therapy: Working with children, adolescents, and families (40 p.) by the Washington Coalition of Sexual Assault Programs (2010). Advocacy for children, adolescents, and their families involves making connections to valuable community resources to promote healing. This guide provides information on how to establish good connections to therapists in the community and on establishing roles in the healing process.
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Sexual Assault Forensic Exams (SANE/SAFE)
A National Protocol for Sexual Assault Medical Forensic Exams: Adults/Adolescents (141 p.) by the U.S. Department of Justice Office on Violence Against Women (OVW). In response to the 1994 Violence Against Women Act, this protocol was developed to guide criminal justice and health care practitioners in responding to sexual assault victims.
A Prosecutor’s Reference: Medical Evidence and the Role of Sexual Assault Nurse Examiners in Cases Involving Adult Victims (40 p.) by Jenifer Markowitz (2010). A monograph for prosecutors explains the role the Sexual Assault Nurse Examiner (SANE) and benefits of a medical and care focused SANE experience on later use of evidence and testimony.
Guidelines for the Medico-Legal Care of Victims of Sexual Assault (154 p.) by the World Health Organization (2003). Based on studies showing that abused women seek more medical attention than those who have not experienced abuse, WHO provides these guidelines in an effort to educate health care workers on providing care to victims of sexual assault. It offers standards for the provision and medical and forensic exams and guidance in developing services for women exposed to sexual assault.
Healthcare Protocol Manual for Sexual Assault by Arkansas Commission on Child Abuse, Rape, and Domestic Violence (2005). Protocol manual for medical professionals including emergency medical services, primary care providers, mental health providers, and collaborating agencies and offices offers recommendations and guidelines for effectively responding to and caring for patients who have experienced sexual assault.
Limitations of the National Protocol for Sexual Assault Medical Forensic Examinations (4 p.) by Annie Lewis-O’Connor, Holly Franz, and Lucia Zuniga (2005). This article discusses emergency contraception and sexually transmitted infections, suggesting that the National Protocol lacks clarity on these issues and fails to incorporate best practices for care.
National Training Standards for Sexual Assault Medical Forensic Examiners (33 p.) by the U.S. Department of Justice Office on Violence Against Women (2006). This guide provides a standard for education of health care providers interested in becoming Sexual Assault Forensic Examiners (SAFEs). The standards seek to meet the needs for healthcare, forensic evidence collection and information that an adult or adolescent may seek after experiencing a sexual assault.
Sexual Assault Nurse Examiners and Victim Sensitive Evidence Collection (48 slides) by National Center for Victims of Crime (2010). These slides from a webinar provide information for Sexual Assault Nurse Examiners (SANEs) and others invested and involved in sexual assault forensic exam programs on collecting evidence in a sensitive and informed way. The presentation places emphasis on responding to the needs of individuals who experienced sexual assault as they go through the process of a forensic exam.
The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs (10 p.) by Rebecca Campbell with contributions from Renae Diegel (2004). An applied research document produced for VAWnet, this report summarizes research on SANE programs, personal experiences reported in research, and provides suggestions on future directions for programs with the intention of making research accessible to practitioners.
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Reproductive Healthcare Providers
Addressing Violence Against Women and Girls in Sexual and Reproductive Health Services: A review of knowledge assets (102 p.) by Bonnie L. Shepard (2010). This resource provides a review of literature, information, and skills helpful in integrating gender-based violence in the sexual and reproductive health services of women and girls. It also discusses policy and planning for this integration.
Reproductive Health of Urban American Indian and Alaska Native Women (64 p.) by Urban Indian Health Institute (2010). This report examines survey results specific to American Indian and Alaska Native women in urban settings. Of particular interest is the section on non-voluntary sexual intercourse. Outcomes suggested a higher rate of sexual violence experienced by AI/AN women than white women who responded to the survey.
Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health (10 p.) by Sandra L. Martin and Rebecca J. Macy, with contributions from Janice A. Mirabassi (2009). In an effort to accessibly summarize research findings, this report provides an overview of the effects of sexual violence on women and resulting high-risk health behaviors. The document explains that certain social and economic factors, like poverty or discrimination, may influence experiences and health outcomes.
Back to top
 
Dental care providers
Dental Fear in Abuse Survivors (9 p.) by “a survivor of childhood sexual abuse,” found on dentalfearcentral.org. This article provides insight on working with individuals who exhibit dental fear, encouraging dentists to keep in mind the possibility of childhood abuse as a possible cause. It discusses potentially traumatic events in a standard visit and ways to help a patient have a safe experience.
Dentist’s Action After Identifying Child Sexual Assault (9 p.) by C. Stavrianos, A. Kokkas, H Katsikogiani, and G. Tretiatov (2010). This publication from the Research Journal of Medical Sciences addresses the identification of child sexual abuse by a dental practitioner. The article discusses some common indicators and stressors exhibited by patients and discusses when it is appropriate to make a report.
Sexual Abuse in Childhood and Dental Fear (4 p.) by Jack Bynes and Carla Santos. This resource provides questions and responses from an interview with Carla Santos, a leading expert on dental fear as a response to childhood sexual abuse. It explains reasons for fear, potentially traumatic practices for the patient, and tips on how to cope with dental fear.
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Mental Healthcare Providers
A Sexual Abuse and Assault Therapy Resource Guide: Working with Children, Adolescents, and Families (60 p.) by the Washington Coalition of Sexual Assault Programs (2010). Resources for both therapists and their child, adolescent, and nonoffending family member clients are provided in this guide. These resources were collected from therapists in an effort to increase access to more knowledge on working with youth who experienced sexual violence and their families.
Action Steps for Improving Women’s Mental Health (64 p.) by US Department of Health and Human Services (200-?). This resource provides action steps that professionals can take to improve women’s mental health, provides a glossary of common terms, and lists tools available for providers seeking to improve services to women.
Healthcare Protocol Manual for Sexual Assault by Arkansas Commission on Child Abuse, Rape, and Domestic Violence (2005). Protocol manual for medical professionals including emergency medical services, primary care providers, mental health providers, and collaborating agencies and offices offers recommendations and guidelines for effectively responding to and caring for patients who have experienced sexual assault.
The Psychological Consequences of Sexual Trauma (11 p.) by Nicole P. Yuan, Mary P. Koss, and Mirto Stone (2006). This resource reports on and summarizes current research on the psychological outcomes and mental health of women who experienced sexual trauma in childhood, adulthood, or both. Gaps and controversies within research findings, as well as the wide variation in psychological responses to trauma are discussed.
What Advocates Need to know about therapy: Working with children, adolescents, and families (40 p.) by the Washington Coalition of Sexual Assault Programs (2010). Advocacy for children, adolescents, and their families involves making connections to valuable community resources to promote healing. This guide provides information on how to establish good connections to therapists in the community and on establishing roles in the healing process.
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Relevant healthcare policies: Resources on developing policies within a healthcare setting are important for providers and for advocates. Establishing trauma-informed policies and protocols for working with people who have experienced sexual violence can impact healing in a positive way. Articles, protocols and reports shown below will help providers to take action steps toward effectively meeting the needs of sexual assault survivors.
A National Protocol for Sexual Assault Medical Forensic Exams: Adults/Adolescents (141 p.) by the U.S. Department of Justice Office on Violence Against Women (OVW). In response to the 1994 Violence Against Women Act, this protocol was developed to guide criminal justice and health care practitioners in responding to sexual assault victims.
Action Steps for Improving Women’s Mental Health (64 p.) by US Department of Health and Human Services (200-?). This resource provides action steps that professionals can take to improve women’s mental health, provides a glossary of common terms, and lists tools available for providers seeking to improve services to women.
Addressing Violence Against Women and Girls in Sexual and Reproductive Health Services: A review of knowledge assets (102 p.) by Bonnie L. Shepard (2010). This resource provides a review of literature, information, and skills helpful in integrating gender-based violence in the sexual and reproductive health services of women and girls. It also discusses policy and planning for this integration.
Advancing the Nation’s Health: A Guide to Public Health Research Needs, 2006 - 2015 by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (2006). This document provides an overview of public health research priorities issues by the CDC for this time period. Areas of interest include trauma systems, risks and protective factors for interpersonal violence and suicidal behavior, among other topics.
Caring for Trafficked Persons: Guidance for Health Providers (232 p.) by International Organization for Migration (2009). This handbook for healthcare providers offers information on the specific health concerns for trafficked persons, an overview of human trafficking, and specific information on various groups and types of persons who may experience trafficking. Sections provide special emphasis on safety, security, cultural competency, and individualized responses and care.
Establishing a working office by Washington State Department of Health Injury and Violence Prevention Program (2010). This page provides steps that medical professionals can take to make their practices and environments safe for women who have experienced violence and prepare for prevention and intervention in violent situations.
Guidelines for the Acute Care of Adult and Post-Pubertal Adolescent Sexual Assault Patients by Virginia Domestic and Sexual Violence Action Alliance & Virginia Chapter of the International Association of Forensic Nurses (2009). In an effort to provide high quality healthcare and response for people who have experienced sexual violence, this collection of guidelines and fundamental criteria offers information on appropriate and caring responses in healthcare settings.
Guidelines for the Medico-Legal Care of Victims of Sexual Assault (154 p.) by the World Health Organization (2003). Based on studies showing that abused women seek more medical attention than those who have not experienced abuse, WHO provides these guidelines in an effort to educate health care workers on providing care to victims of sexual assault. It offers standards for the provision and medical and forensic exams and guidance in developing services for women exposed to sexual assault.
Healthcare Protocol Manual for Sexual Assault by Arkansas Commission on Child Abuse, Rape, and Domestic Violence (2005). Protocol manual for medical professionals including emergency medical services, primary care providers, mental health providers, and collaborating agencies and offices offers recommendations and guidelines for effectively responding to and caring for patients who have experienced sexual assault.
Income, Poverty, and Health Insurance Coverage in the United States: 2007 (84 p.) by Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica Smith (2008). This document includes demographic and state-specific breakdowns of income, poverty, and health insurance coverage in the United States during 2007.
Preventing Pregnancy from Sexual Assault (124 p.) by the National Sexual Violence Resource Center, the Education Fund of Family Planning Advocates of NYS, & Clara Bell Duvall Reproductive Freedom Project of the ACLU of PA (2003). A toolkit compiled through joint collaboration, this resource discusses four action strategies for improving hospital policies on the provision of emergency contraception. Through legislation, administrative action, litigation/liability, and voluntary change hospital policies can change to reflect the needs and rights of people who experience sexual assault.
Screening for Sexual Violence: Gaps in Research Recommendations for Change (19 p.) by Lynne Stevens with contributions from Barbara Sheaffer (2007). This applied research document discusses universally screening patients for a history of sexual violence in primary health care settings. According to research discussed by the author, healthcare settings provide a gateway to other services for women and girls who experience sexual assault.
Women's Health Research: Progress, Pitfalls, and Promise (438 p.) by the Committee on Women's Health Research, Institute of Medicine (2010). In this report, the IOM finds that women’s health research has contributed to significant progress over the past 20 years in lessening the burden of disease and reducing deaths from some conditions, while other conditions have seen only moderate change or even little or no change. Gaps remain, both in research areas and in the application of results to benefit women in general and across multiple population groups.
 
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Training materials: A major part of preparing the healthcare sector to prevent and respond to sexual violence is the training of professionals in the field. The following resources may help in collecting information and planning trainings on health and sexual violence.
General information
Impact of Sexual Violence (2 p.) by National Sexual Violence Resource Center (2010). This brief factsheet offers information on the impact and experiences that may affect a person after a sexual assault. It also discusses impacts on significant others and the community.
Gender & Reproductive Health (PowerPoint) by True Child, Inc. (2011). This PowerPoint presentation used in online training addresses integrating a gender transformative approach into programs and policies. Intersection of individual risk and societal vulnerability to HIV due to gender norms is discussed.
Guidelines for the Medico-Legal Care of Victims of Sexual Assault (154 p.) by the World Health Organization (2003). Based on studies showing that abused women seek more medical attention than those who have not experienced abuse, WHO provides these guidelines in an effort to educate health care workers on providing care to victims of sexual assault. It offers standards for the provision and medical and forensic exams and guidance in developing services for women exposed to sexual assault.
Sexual Violence Facts at a Glance (1 p.) by CDC National Center for Injury Prevention and Control (2008). This fact sheet provides information and statistics on the health outcomes for different populations who reported on their individual experiences of sexual violence.
What is Sexual Violence (2 p.) by National Sexual Violence Resource Center (2010). This fact sheet discusses examples of the various forms of sexual violence and defines the term and various elements associated with it.
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Training on Prevention
In Brief: The Foundations of Lifelong Health (webcast) by National Scientific Council on the Developing Child & National Forum on Early Childhood Policy and Programs (2010). This report offers discussion and frameworks on improving lifelong health promotion and disease prevention by reducing traumatic or stressful childhood experiences.
Preventing sexual violence: An educational toolkit for healthcare professionals (online learning tool) by American Academy of Pediatrics. This toolkit provides basic sexual violence information for pediatric and family medicine health care providers. Scenarios by age group help to guide best-practice decision making and additional resources are imbedded in this learning tool.
Primary Sexual Violence Prevention Project (2 p.) by the International Association of Forensic Nurses (IAFN). This brochure was produced by IAFN in an effort to guide forensic nurses through the action steps of incorporating primary prevention practices into their programs. 
Sexual Violence and the Spectrum of Prevention (20 p.) by Rachel Davis, Lisa Fugie Parks, and Larry Cohen (2006). The resource describes a primary prevention approach to addressing sexual violence. It discusses the elements included in preventing sexual violence before it occurs, which involves efforts ranging from behavior change with individuals to creating safe communities to affecting policy and large scale social change.
Sexual Violence Prevention Bibliography (2 p.) by the International Association of Forensic Nurses. This resource page provides a list of articles and resources that may be helpful to forensic nurses who are incorporating a sexual violence prevention plan.
Shifting the Paradigm: Primary Prevention of Sexual Violence (24 p.) by American College Health Association (ACHA) (2008). This resource guide provides information directed at preventing sexual violence on college and university campuses through changing cultural norms. It provides information on engaging campus health stakeholders and incorporating “Screening for Sexual Violence” tools in evaluations and health education and promotion.
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence by CDC National Center for Injury Prevention and Control.   Fisher D, Lang KS, Wheaton J. (2010).  A planning guide for engaging and training professionals on preventing sexual and intimate partner violence, this publication includes fact sheets, worksheets, planning and training resources for professionals.
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Training on Intervention
A Prosecutor’s Reference: Medical Evidence and the Role of Sexual Assault Nurse Examiners in Cases Involving Adult Victims (40 p.) by Jenifer Markowitz (2010). A monograph for prosecutors explains the role the Sexual Assault Nurse Examiner (SANE) and benefits of a medical and care focused SANE experience on later use of evidence and testimony.’
Addressing Violence Against Women and Girls in Sexual and Reproductive Health Services: A review of knowledge assets (102 p.) by Bonnie L. Shepard (2010). This resource provides a review of literature, information, and skills helpful in integrating gender-based violence in the sexual and reproductive health services of women and girls. It also discusses policy and planning for this integration.
Dentist’s Action After Identifying Child Sexual Assault (9 p.) by C. Stavrianos, A. Kokkas, H Katsikogiani, and G. Tretiatov (2010). This publication from the Research Journal of Medical Sciences addresses the identification of child sexual abuse by a dental practitioner. The article discusses some common indicators and stressors exhibited by patients and discusses when it is appropriate to make a report.
Guidelines for the Acute Care of Adult and Post-Pubertal Adolescent Sexual Assault Patients by Virginia Domestic and Sexual Violence Action Alliance & Virginia Chapter of the International Association of Forensic Nurses (2009). In an effort to provide high quality healthcare and response for people who have experienced sexual violence, this collection of guidelines and fundamental criteria offers information on appropriate and caring responses in healthcare settings.
National Training Standards for Sexual Assault Medical Forensic Examiners (33 p.) by the U.S. Department of Justice Office on Violence Against Women (2006). This guide provides a standard for education of health care providers interested in becoming Sexual Assault Forensic Examiners (SAFEs). The standards seek to meet the needs for healthcare, forensic evidence collection and information that an adult or adolescent may seek after experiencing a sexual assault.
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Working with specific populations
Beyond Women’s Health: Incorporating Sex and Gender Differences into Graduate Public Health Curricula (62 p.) by Health Resources and Services Administration (2006). This report explores the incorporation of women’s health focuses into masters’ level public health programs. Findings demonstrate a major focus on reproductive and sexual health in many programs, accompanied by an emphasis on integrating women’s health issues and perspectives into mainstream coursework.
Caring for Trafficked Persons: Guidance for Health Providers (232 p.) by International Organization for Migration (2009). This handbook for healthcare providers offers information on the specific health concerns for trafficked persons, an overview of human trafficking, and specific information on various groups and types of persons who may experience trafficking. Sections provide special emphasis on safety, security, cultural competency, and individualized responses and care.
Clinical Management of Rape Survivors (76 p.) by World Health Organization (2004). This resource provides a response and outlines recommendations to meet the needs of rape survivors who are also refugees or internally displaced persons. It provides information on both the clinical care and follow-up efforts to fully meet the needs of individuals who seek medical attention after an experience of sexual violence.
Preventing Sexual Violence in Disasters (online collection) by the National Sexual Violence Resource Center. This collection of online resources provides information on disaster planning, preparedness, and response. It focuses specifically on the needs of disaster survivors in a time when they are at increased risk for experiencing sexual violence.
The Availability and Utility of Interdisciplinary Data on elder abuse: A white paper for the National Center on Elder Abuse (67 p.) by Erica F. Wood (2006). This paper provides an overview of survey statistics from various organizations on the prevalence of and response to elder abuse. Large portions of the report focus on medical services data.
Sexual Violence in the Lives of African-American Women: Risk, Response, and Resilience (11 p.) by Carolyn M. West, with contributions from Jaqueline Johnson (2006). This resource provides a summary of and response to research conducted on the experience of sexual violence by African-American women. It discusses a culture of silence, risks factors, and long-term mental and physical health outcomes.
Mental Health Consequences of Sexual Violence in Detention (2 p.) by Just Detention International (2009). A two page fact sheet talking about the devastating consequences of sexual violence in detention and addressing the extreme challenges that survivors must face.
Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health (8 p.) by Pamela A. Ratner et al (2002). This research reports relations between the experience of child sexual abuse, nonconsensual sexual activity, juvenile prostitution, and the inherent impacts on mental health. The authors recommend that mental health professionals develop cultural competency on men’s sexual trauma and deconstruct personal beliefs about same-sex sexual violence.
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Additional resources
The National Sexual Violence Resource Center
National Center on Trauma-Informed Care
National Child Traumatic Stress Network
Academy on Violence and Abuse
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists
American College Health Association
Dental Fear.com
Survivors of Childhood Sexual Abuse: A Guide for Primary Care Providers
International Association of Forensic Nurses (IAFN)
David Baldwin’s Trauma Information Pages
Women’s Health.gov Resource Pages
SAFEta
Forensics for Survivors
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