Grant Proposal Summary
Childhood sexual abuse (CSA) poses a significant public health concern, with Dorchester County, SC, experiencing alarming rates. Despite this, the county lacks dedicated long-term support services for survivors, especially in gynecological care. This project addresses this critical gap by implementing trauma-informed gynecological care for adult survivors of CSA in Dorchester County aged 18-65. Survivors receiving care at Tri-County SPEAKS, where I worked for three years as the Prevention and Education Coordinator, will be empowered to advocate for themselves through coaching, barrier reduction, and peer support. This program will also develop provider capacity in trauma-informed care (TIC), and foster collaboration among gynecological and advocates to improve services, identify gaps in care, and overcome barriers. The project activities will improve the relationship between survivors and providers, increase provider knowledge in TIC, and create safer treatment environments. In partnership with Tri-County SPEAKS, I will serve as principal investigator.
Trauma-informed Principles
This program will focus in particular on SAMHSA’s Trauma-informed Principles of (1) safety; (2) empowerment and choice; and (3) cultural, historical, and gender issues (SAMHSA, 2014). Embedded in these principles, the program will focus on avoiding interpersonal and organizational retraumatization. Specific program practices are discussed below.
Training of medical providers will include how to communicate confidentiality and why, for example, screening for trauma is relevant to the individual’s health, diagnosis, and treatment. Further, providers will become skilled in establishing boundaries and creating a sense of safety by letting patients know what to expect before and throughout the exam with an understanding that they can stop at any time.
Empowerment and self-advocacy focus on building independence in the patient to advocate for themselves and develop the required skills to navigate systems that are often more complex and difficult in the context of their survivorship. In the coaching component, survivors will focus on building survivor self-efficacy and behavioral capability to advocate for themself in medical settings, especially vulnerable ones such as gynecological visits (Onyejiaka, n.d.). In addition to training providers in respecting and supporting patient voice, medical settings will also be encouraged to build in practices such as providing intake paperwork that prompts self-advocacy by establishing tailored needs and how the patient prefers to communicate (i.e., not disrobing fully, how to say stop, etc.)
While empowerment does highlight the specific need to amplify the voice of individuals who have been historically or structurally dismissed, it’s important to acknowledge specifically how trauma intersects with identity and lived experience. Organizations and providers will be trained to incorporate policies and adaptive processes that consider not just the context of the trauma but also the context of the individual. For example, when conducting a pelvic exam on a transgender individual, providers will be trained to use inclusive language for body parts and to provide competent care regarding pregnancy prevention and other aspects of treatment (Office on Violence Against Women, 2013).
Level(s) of the Social Ecological Model
This program will focus primarily on individual and community-level interventions of the CDC social-ecological model (CDC, n.d.). Interventions at these two levels collaborate to reduce the financial burden of sexual violence on the healthcare system, improve positive health outcomes for survivors, and improve survivor experiences and the patient/provider relationship in healthcare settings.
Individual Level
Because a person’s belief in their ability to accomplish, or tolerate a cervical screening is a powerful motivator of their likelihood to attend, building self-advocacy in survivors through the coaching program should produce outcomes in line with our goal to increase attendance at screening appointments (Young et al., 2017). Additionally, the program will provide survivors with information about what to expect and guide them in making adaptable plans (Brymer et al., 2006).
Community Level
When organizations screen for trauma and providers are trained on how to communicate with survivors about how trauma impacts health, survivors’ perceived susceptibility and severity are increased (Simons-Morton et al., 2011). Providers trained in TIC can help manage patient triggers through TIC practices. Additionally, making provider offices safer and more trauma-informed can provide environments that are comforting instead of threatening.
Public Health Framework.
The program targets tertiary prevention of sexual violence (Simons-Morton et al., 2011). The target population already has experienced sexual violence, and the goal is to reduce the negative physical health outcomes that result and the complications they can lead to such as cervical cancer and avoidance of preventative reproductive health care. Additionally, the program will reduce adverse experiences navigating healthcare such as re-traumatization. While the focus is tertiary, by increasing attendance at gynecology appointments including cervical cancer screenings, adherence to treatment plans, and attendance at follow-up appointments (all by improving the patient experience and patient-provider relationship), this program inadvertently incorporates secondary prevention (Simons-Morton et al., 2011).
The specific aim of this program is to alleviate the burden on, often inaccessible, mental health care providers to address the emotional and mental needs of patients when these needs are often inextricably connected to behavioral capability, self-advocacy, resilience, and other skills required for physical health care management. This imbalance and siloing provide a strong rationale for a program that collaborates across physical healthcare and community services. In addition, it is strengthened by a multilevel approach backed by social and behavioral public health theories and practices that incorporate both trauma-informed and trauma-specific policies.
Conclusion
This project will build resilience, reduce retraumatization, and improve health outcomes for CSA survivors in Dorchester County, ultimately contributing to Tri-County SPEAKS’ mission to create a community free of the consequences of sexual violence.
References
Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., Watson, P., National Child Traumatic Stress Network, & National Center for PTSD. (2006). Psychological first aid. In Field Operations Guide (2nd Edition). National Child Traumatic Stress Network and National Center for PTSD. https://www.ptsd.va.gov/profes.../type/PFA/PFA_V2.pdf
Office on Violence Against Women. (2013). SAFE Protocol: Trans-specific annotation (p. 1). https://evawintl.org/wp-conten...lusive-handout-2.pdf
Onyejiaka, T. (2019, December 20). A guide to navigating your next pelvic exam after sexual assault. Healthline. https://www.healthline.com/hea...after-sexual-assault
SAMHSA’s Trauma and Justice Strategic Initiative, Huang, L. N., Flatow, R., Biggs, T., Afayee, S., Smith, K., Clark, T., & Blake, M. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Substance Abuse and Mental Health Services Administration. https://ncsacw.acf.hhs.gov/use...es/SAMHSA_Trauma.pdf
Simons-Morton, B., McLeroy, K., & Wendel, M. (2011). Behavior Theory in Health Promotion Practice and Research. Jones & Bartlett Publishers.
The Social-Ecological Model: a Framework for Prevention. (n.d.). Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...ecologicalmodel.html
Young, B., Bedford, L., Kendrick, D., Vedhara, K., Robertson, J. F. R., & Nair, R. D. (2017). Factors influencing the decision to attend screening for cancer in the UK: a meta-ethnography of qualitative research. Journal of Public Health, 40(2), 315–339. https://doi.org/10.1093/pubmed/fdx026
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