ACTION STEPS FOR CAMPUS HEALTH CARE PROFESSIONALS As a health care professional, your patients’ health is your priority. You might be one of the first people a victim chooses to talk to about an experience of sexual violence. While your focus often is on treating a victim in the aftermath of sexual violence, you also are a critical part of primary prevention (preventing violence before it occurs). WHAT IS SEXUAL VIOLENCE? Sexual violence occurs when someone is forced or coerced into unwanted sexual activity without agreeing or consenting. Reasons someone might not be able to consent include: • Fear • Being underage • Having an illness or disability • Incapacitation due to alcohol or other drugs Consent can initially be given and later be withdrawn. Sexual violence is a crime that comes in many forms, including forced intercourse, sexual contact or touching, sexual harassment, sexual exploitation, and exposure or voyeurism. Sexual violence is never the victim’s fault. It does not matter what the victim is wearing or doing, whether the victim has been drinking, or what type of relationship the victim has with the person who is sexually abusing them. TAKE ACTION EDUCATE • Talk with your patients about sex in a way that focuses on individual choices along the continuum of sexual activity. Use these conversations to identify and normalize healthy sexuality (National Sexual Violece Resource Center [NSVRC], 2012) that respects gender, sexual orientation, and gender identity.i (http://www.nsvrc.org/sites/default/files/SAAM_2012_An-overview-on-healthy-sexuality-and-sexual-violence.pdf) • Reinforce the meaning of consent for your patients when discussing sexual health. Consent is a voluntary, sober, enthusiastic, mutual, and honest verbal agreement. It can’t be coerced. The absence of a “no” doesn’t mean “yes.” Consent must be asked for during every step of the way. ii • Provide patients with information about sexual violence and local resources, such as SAAM 2015 fact sheet on healthy sexuality and sexual violence . • Share your knowledge with other providers by presenting an in-service or training on sexual violence prevention. [Pop-out box: Sexual Violence Impacts Health • One in five women will be a victim of completed or attempted sexual assault while in college. (Krebs, Lindquist, Warner, Fisher, & Martin, 2007) • One in 16 men will be a victim of sexual assault during college. (Krebs, Lindquist, Warner, Fisher, & Martin, 2007) • Survivors of rape are more likely to report frequent headaches, chronic pain, difficulty sleeping, activity limitations, poor physical health, and poor mental health compared with people who have never been raped. (Black et al., 2011) • In the year following a rape, the average level of health care service use increases 18 percent more than pre-rape levels; during the second year, post-rape service use increases 56 percent. (Koss, Koss, & Woodruff, 1991) • The chances that a woman will develop post-traumatic stress disorder (PTSD) after being raped are between 50 percent and 95 percent. (Heise, Ellsberg, & Gottemoeller, 1999)]. INTEGRATE • Build your practice’s capacity to provide trauma-informed (Substance Abuse & Mental Health Services Administration [SAMHSA], 2012), survivor-centered care. (http://media.samhsa.gov/traumajustice/traumadefinition/index.aspx) • Develop protocols (NSVRC, 2011) that ensure consistent, effective practices for providing care to patients who experience sexual violence. This should include screening patients for sexual violence at every opportunity. • Enhance your services for early identification of risk factors for victimization or perpetration. Risk factors that increase one’s risk of committing rape include using alcohol, lacking inhibitions to suppress associations between sex and aggression, holding attitudes and beliefs that are supportive of sexual violence, associating with sexually-aggressive peers, and having experienced abuse as a child. , iv Refer patients to local organizations and programs to address these risk factors. iii, iv MODEL • Patients trust healthcare providers. Actively model respectful, equitable behavior in your interactions with colleagues and patients. • Intervene (NSVRC, 2013) when you see inappropriate behavior. If patients or colleagues make sexist comments or joke about rape or dating violence, speak up and say that this is not tolerated on your campus. (http://nsvrc.org/sites/default/files/publications_nsvrc_bulletin_engaging-bystanders-prevent-sexual-violence_0.pdf) ENGAGE • Talk with the Title IX Coordinator, your campus women’s center, or another anti-violence organization to: o Find and attend a training on sexual violence prevention. o Become involved in your campus’ broader sexual violence prevention and response efforts. The campus health system should have a robust presence at the table. o Get handouts and resources that you can give to patients. • Build a strong referral program for sexual assault advocacy and services by partnering with local rape crisis centers. LEARN MORE • American Academy of Pediatrics Preventing Sexual Violence: An Educational Toolkit for Health Care Professionals (http://www2.aap.org/pubserv/PSVpreview/pages/main.html) • American College Health Association Sexual Violence Resources • Academy on Violence and Abuse Competencies Needed by Health Professionals for Addressing Exposure to Violence and Abuse in Patient Care (http://www.acha.org/topics/violence.cfm) • Centers for Disease Control and Prevention (http://nsvrc.org/sites/default/files/CoreCompetenciesRevApril2011.pdf): o Sexual Violence Facts at a Glance (http://www.cdc.gov/violenceprevention/pdf/SV-DataSheet-a.pdf) o VetoViolence online learning platform (http://vetoviolence.cdc.gov/) • National Online Resource Center on Violence Against Women Screening for Sexual Violence: Gaps in Research and Recommendations for Change (http://www.vawnet.org/Assoc_Files_VAWnet/AR_ScreeningforSV.pdf) • National Sexual Violence Resource Center: o Assessing patients for sexual violence: A guide for health care providers (http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Guides_Assessing-patients-for-sexual-violence.pdf) o Sexual Violence and HealthResearch Brief (http://www.nsvrc.org/sites/default/files/publications_nsvrc_researchbrief_health-sexual-violence.pdf) o Assessing Patients for Sexual Violence (http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Guides_Assessing-patients-for-sexual-violence.pdf • Pennsylvania Coalition Against Rape: o Put down the chart, pick up the questions: A guide for working with survivors of sexual violence (http://www.pcar.org/sites/default/files/file/healthcare/put-down-the-chart.pdf) o Long-term health effects of sexual assault and rape (http://www.pcar.org/long-term-health-effects-sexual-assault-and-rape) References Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., … Stevens, M. R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Retrieved from http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf Heise, L., Ellsberg, M., & Gottemoeller, M. (1999). Ending violence against women. Population Reports, Series L(11). Retrieved from VAWnet: National Resource Center on Domestic Violence: http://www.vawnet.org/Assoc_Files_VAWnet/PopulationReports.pdf Koss, M. P., Koss, P. G., & Woodruff, W. J. Deleterious effects of criminal victimization on women's health and medical utilization. Archives of Internal Medicine, 151, 342-347. doi:10.1001/archinte.1991.00400020092019 Krebs, C. P., Lindquist, C. H., Warner, T. D., Fisher, B. S., & Martin, S. L. (2007). The Campus Sexual Assault (CSA) Study (NCJ 221153). Retrieved from the National Criminal Justice Reference Service: https://www.ncjrs.gov/pdffiles1/nij/grants/221153.pdf National Sexual Violence Resource Center. (2011). Assessing patients for sexual violence: A guide for health care providers. Retrieved from http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Guides_Assessing-patients-for-sexual-violence.pdf National Sexual Violence Resource Center. (2012). An overview on healthy sexuality and sexual violence prevention. Retrieved from http://www.nsvrc.org/sites/default/files/SAAM_2012_An-overview-on-healthy-sexuality-and-sexual-violence.pdf National Sexual Violence Resource Center. (2013). Engaging bystanders to prevent sexual violence: Bulletin. Retrieved from http://www.nsvrc.org/sites/default/files/publications_nsvrc_bulletin_engaging-bystanders-prevent-sexual-violence_0.pdf Substance Abuse & Mental Health Services Administration. (2012). Trauma definition. Retrieved from http://media.samhsa.gov/traumajustice/traumadefinition/index.aspx i American College Health Association. (2008). Shifting the Paradigm: Primary Prevention of Sexual Violence Toolkit. Retrieved from http://www.acha.org/SexualViolence/docs/ACHA_PSV_toolkit.pdf. ii Ibid. iii National Sexual Violence Resource Center. (2004). Global Perspectives on Sexual Violence: Findings from the World Report on Violence and Health. Retrieved from http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Booklets_Global-perspectives-on-sexual-violence.pdf. iv Tharp, A.T., DeGue, S., Valle, L.A., Brookmeyer, K.A., Massetti, G.M., & Matjasko, J.L. (2013). A systematic qualitative review of risk and protective factors for sexual violence perpetration. Trauma, Violence, & Abuse, 14(2), 133-167. Retrieved from http://tva.sagepub.com/content/14/2/133.full.pdf+html.