Strengthening Hospital Responses to Family Violence and Sexual Assault

 
Strengthening
Hospital Responses to Family Violence
 
 
Responding to
Sexual Assault
 
 
1800 737 732
 
 
 
 
LGBTIQ
 
1800 755 988
 
1800 015 188
 
1800 105 303
 
1800 542 847
 
1800 806 292
 
1300 766 491
Specialist Family Violence Services
 
2
 
Definition of sexual assault
 
Consent
 
Prevalence and facts about sexual
assault
 
Responding to disclosures of sexual
violence – rights, options and control
 
Healing and recovery
 
Support and referral options
 
Any unwanted sexual behaviour that makes
people feel 
uncomfortable
, 
frightened
 or
threatened 
(CASA)
 
Any sexual activity that is not freely 
agreed
 to
 
Family violence often incorporates sexual assault
 
The 
LEGAL definition of sexual assault 
in
Victoria includes rape, incest, child abuse, and
unwanted sexual behaviour, for example,
unwanted kissing and touching.
 
It also includes behaviour that does not involve
actual touching. For example, forcing someone to
watch pornography or masturbation is also
sexual assault (Victorian Legal Aid website).
 
 
 
 
 
 
Consent, it’s simple as tea
Legal age of
consent for
children and
young people
 
 
The law sets restrictions around having sex,
sexual touching or performing sexual acts in
front of children and young people, even if the
child or young person agrees.
 
 
Under 12 years old: No-one can engage in
sexual behaviours with a child
 
 
12 to 15 years old: Must be within 2
calendar years in age
 
 
16 to 17 years old: Must not be caring for
or supervising the young person, e.g. a
teacher, youth worker or foster carer
 
Impacts of sexual assault
 
Emotional and psychological: PTSD, nightmares, depression, self
harm
Social, intimate and family relationships: lack of trust, parenting
issues
Physical health: genital injuries, gynaecological disorders, pregnancy
Legal: criminal activity, mistrust of police
Housing: homelessness, concerns about safety
Financial: lack of financial control, inability to manage finances
Education and employment: inability to sustain work or study
Barriers to
disclosure
Events that
may trigger
reminders
or
disclosures
of past
sexual
assault
 
Health issues, medical appointments
 
Pregnancy/childbirth / breastfeeding
 
Traumatic events (e.g. car accidents)
 
Natural disasters (e.g. bushfires)
 
Media reports relating to sexual assault
 
Relationship dynamics that are a reminder
of having no control
Case Study
Selma is a 23 year old woman, 32 weeks pregnant with
her first child
Attending ante natal clinic appointment at her local
maternity hospital.
Missed several appointments and tests including her 20
week scan and the Glucose Tolerance Test (GTT).
In her appointment with the midwife the need for an
ultrasound is discussed and Selma immediately
becomes distressed and starts crying
Selma is not making direct eye contact and saying that
she is over reacting  ‘just tired’ but mentions that she is
having nightmares and feels like she isn’t in control of
her body
Selma also discussed feeling scared about the pain of
childbirth
Sensitive
inquiry and
e
ffective
support
 
 
Respecting decisions and choices
 
Universal sensitive practice
 
Listening
 
Believing
 
Taking disclosures seriously
 
Initiating a conversation
 
 
 
 
 
Inquire
sensitively
 
 
 
 
 
 
 
Asking
about
safety
Ask yourself …
 
What deters you from
having a conversation
about sexual assault?
 
Mandatory reporting
 
Social work department
 
Centre Against Sexual Assault (CASA)
24/7 crisis care response
Free and confidential support and advice to adult victim/survivors of past and
recent sexual assault
Telephone support and advice to friends and family
Advice, secondary consultation and debriefing to other professionals
 
For children and young people
Police
Child protection
CASA
Gatehouse at the Children’s
Victorian Forensic Paediatric Medical Service (VFPMS)
 
 
Professional
Manager or supervisor
Family violence workplace contact via the Workplace Support
Program
Clinical champions
Employee Assistance Program
Centre Against Sexual Assault - 24/7 counselling for professionals
1800 RESPECT - 24/7 counselling for professionals
 
Self-care
Any activity that we do deliberately in order to take care of our
mental, emotional and physical health and can include;
Talking with someone you trust
Taking regular breaks and annual leave
Healthy eating and exercise
Debriefing (formal and informal)
Work-life balance and keeping work and your personal life
separate
Prioritise activities you find enjoyable outside of work
 
 
Family violence often incorporates
sexual assault
Many people have experienced sexual
abuse, sexual assault and violence in
their lives
This could be a factor in their hospital
presentation
If you notice the signs, respond
sensitively
Remember people are experts in their
wellbeing and safety
Remember people have choices – their
body and their health
You don’t have to fix the problem –
always consult if you are unsure
CASA is an excellent resource for staff
and patients
 
Australian Institute of Health and Welfare 2018. Family, domestic and sexual violence in Australia 2018. Cat. no. FDV 2. Canberra: AIHW.
 
Family Violence Protection Act 2008 (Vic), 
Sourced from http://www.austlii.edu.au/au/legis/vic/consol_act/fvpa2008283/
 
Our Watch. & Australia’s national Research Organisations for Women’s Safety. (2014). Violence against Women: Key Statistics. Sourced from
https://d2c0ikyv46o3b1.cloudfront.net/anrows.org.au/s3fs-public/Key%20statistics%20%20all.pdf
 
Royal Commission into Family Violence (RCFV), 2016, “Royal Commission into Family Violence: Summary and recommendations” Paper No 132, p.
2014-2016.
 
Victorian Legal Aid:  Sourced from https://www.legalaid.vic.gov.au/find-legal-answers/sex-and-law/sexual-assault
 
Australian Institute of Family Studies: 
https://aifs.gov.au/publications/sexual-violence-and-gay-lesbian-bisexual-trans-intersex-and-queer-
community
 
The Royal Australian College of General Practitioners Sourced from:  
http://www.racgp.org.au/your-practice/guidelines/whitebook/chapter-9-
sexual-assault/#3
 
World Health Organisation Sourced from: 
http://apps.who.int/iris/bitstream/10665/136101/1/WHO_RHR_14.26_eng.pdf WHO p.16
 
 
 
Slide Note

***This slide is repeated from the Sensitive Practice Module and tailored to this supplementary module***

Instructions for facilitators:

This training has been tailored specifically for the clinical operating environment within the health sector and covers the MARAM practice expectations for staff groups assigned sensitive practice responsibilities as set out in the Workforce Mapping for MARAM Alignment Guide.

CASA House has designed this module to address the specific needs of patients who have experienced sexual assault.

It is assumed that people attending this session will have completed Sensitive Practice module and have a good understanding of family violence and how to apply sensitive practice

Welcome participants

Introductions

Suggested facilitator dialogue:

Welcome to the Strengthening Hospital Responses to Family Violence Supplementary Module- Responding to sexual assault

We wish to acknowledge the traditional owners of our land, the people of Kulin Nation and pay our respect to elders past, present and emerging.

We also wish to acknowledge victim survivors of family violence, particularly women and children that have been killed in the context of family violence. We hope what is presented in this training is respectful to their individual experiences.

Family violence is a complex and sensitive topic, we want to ensure that our interactions are supportive and provide everyone with the opportunity to participate.

To support a safe learning environment we ask you to commit to the following group agreement:

- You are welcome to take a break at any time during the training without asking permission

- One person at a time to speak

- De-identify examples from practice to protect confidentiality

- Acknowledge that there will be people in their room with their own experience of family violence

This presentation will inform you of how to access support if you feel emotionally impacted by anything covered in training

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This content covers crucial information on sexual assault, consent, prevalence, and legal aspects in Victoria, Australia. It highlights definitions, learning objectives, and ways to respond to disclosures of sexual violence, along with the importance of consent and understanding the law's restrictions on sexual behaviors involving children and young people.


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  1. Strengthening Hospital Responses to Family Violence Responding to Sexual Assault

  2. Specialist Family Violence Services 1800 806 292 1800 737 732 1800 015 188 1800 105 303 1800 755 988 2 LGBTIQ 1800 542 847 1300 766 491

  3. LEARNING OBJECTIVES Definition of sexual assault Consent Prevalence and facts about sexual assault Responding to disclosures of sexual violence rights, options and control Healing and recovery Support and referral options

  4. Any unwanted sexual behaviour that makes people feel uncomfortable, frightened or threatened (CASA) Any sexual activity that is not freely agreed to Family violence often incorporates sexual assault What is Sexual Assault? The LEGAL definition of sexual assault in Victoria includes rape, incest, child abuse, and unwanted sexual behaviour, for example, unwanted kissing and touching. It also includes behaviour that does not involve actual touching. For example, forcing someone to watch pornography or masturbation is also sexual assault (Victorian Legal Aid website).

  5. Consent, its simple as tea

  6. Submit because of force or the fear of force or harm of any type A person cannot consent when they Submit because they are unlawfully detained Are asleep, unconscious, or significantly affected by alcohol or other drugs Don t understand the sexual nature of the act Are mistaken about the sexual nature of the act or the identity of the person Mistakenly believe that the act is for medical or hygienic purposes

  7. The law sets restrictions around having sex, sexual touching or performing sexual acts in front of children and young people, even if the child or young person agrees. Legal age of consent for children and young people Under 12 years old: No-one can engage in sexual behaviours with a child 12 to 15 years old: Must be within 2 calendar years in age 16 to 17 years old: Must not be caring for or supervising the young person, e.g. a teacher, youth worker or foster carer

  8. Prevalence of sexual assault

  9. Impacts of sexual assault Emotional and psychological: PTSD, nightmares, depression, self harm Social, intimate and family relationships: lack of trust, parenting issues Physical health: genital injuries, gynaecological disorders, pregnancy Legal: criminal activity, mistrust of police Housing: homelessness, concerns about safety Financial: lack of financial control, inability to manage finances Education and employment: inability to sustain work or study

  10. Sexual assault is often undisclosed and under reported due to: society s attitudes to sexual assault: blame victims and excuse perpetrators Barriers to disclosure shame and internalised beliefs: nobody will believe me , I must be crazy , it s my fault offender behaviour: threats, bribes or promises

  11. Events that may trigger reminders or disclosures of past sexual assault Health issues, medical appointments Pregnancy/childbirth / breastfeeding Traumatic events (e.g. car accidents) Natural disasters (e.g. bushfires) Media reports relating to sexual assault Relationship dynamics that are a reminder of having no control

  12. Selma is a 23 year old woman, 32 weeks pregnant with her first child Attending ante natal clinic appointment at her local maternity hospital. Case Study Missed several appointments and tests including her 20 week scan and the Glucose Tolerance Test (GTT). In her appointment with the midwife the need for an ultrasound is discussed and Selma immediately becomes distressed and starts crying Selma is not making direct eye contact and saying that she is over reacting just tired but mentions that she is having nightmares and feels like she isn t in control of her body Selma also discussed feeling scared about the pain of childbirth

  13. Rights Options Control Respecting decisions and choices Sensitive inquiry and effective support Universal sensitive practice Listening Believing Taking disclosures seriously Initiating a conversation

  14. A key element of the experience of sexual assault is loss of control and feelings of powerlessness Sensitive practice: Aims to make people feel safe, respected and in control Sensitive Practice ensure health needs are met, inclusive of safety respects a person s dignity and intrinsic sense of empowerment supports autonomy and active decision making acknowledges unique experiences and support needs can be a catalyst for action

  15. Inquire sensitively Ask about safety and effects of abuse, not details of abuse You don t need to tell me details of what happened I d like to talk about how it s affecting you and what might help you now in the pregnancy and labour/in addressing your health issues now. Are you comfortable with that?

  16. Respond respectfully Listen actively and believe Validate and normalise responses to sexual assault I believe you Thankyou for telling me Be aware of non-verbal cues It makes sense that you would feel like that That sounds understandable given what you have been though Place blame with perpetrator not person experiencing abuse Help people identify & express their needs & concerns and provide options It s not your fault, they/he should not have done that You should not have had to experience that You have a right to a respectful and safe relationship Is there anything that you need now or are concerned about? Would you like to speak with someone about what happened to you?

  17. Asking about safety Is anything like that still going on? Do you feel safe now? Will you be safe when you leave here? Is anyone treating you or other people around you like that now?

  18. What deters you from having a conversation about sexual assault? Ask yourself

  19. Mandatory reporting Health professionals have a legal responsibility to report disclosed or suspected child abuse. It is important to know your hospital s policies around duty of care and mandatory reporting

  20. Referral Social work department Centre Against Sexual Assault (CASA) 24/7 crisis care response Free and confidential support and advice to adult victim/survivors of past and 7 out of 10 recent sexual assault Telephone support and advice to friends and family Advice, secondary consultation and debriefing to other professionals 2 out of 10 SUFFER FROM MENTAL ILLNESS For children and young people Police Child protection CASA Gatehouse at the Children s Victorian Forensic Paediatric Medical Service (VFPMS) GET PROPER TREATMENT

  21. Professional Manager or supervisor Family violence workplace contact via the Workplace Support Program Clinical champions Employee Assistance Program Centre Against Sexual Assault - 24/7 counselling for professionals 1800 RESPECT - 24/7 counselling for professionals Staff resources: Support for you Self-care Any activity that we do deliberately in order to take care of our mental, emotional and physical health and can include; Talking with someone you trust Taking regular breaks and annual leave Healthy eating and exercise Debriefing (formal and informal) Work-life balance and keeping work and your personal life separate Prioritise activities you find enjoyable outside of work

  22. Family violence often incorporates sexual assault Many people have experienced sexual abuse, sexual assault and violence in their lives This could be a factor in their hospital presentation If you notice the signs, respond sensitively Remember people are experts in their wellbeing and safety Remember people have choices their body and their health You don t have to fix the problem always consult if you are unsure CASA is an excellent resource for staff and patients Key messages

  23. Reflections 1. What stood out to you from this session today? 2. What could you do in your work to support people to feel safer, comfortable and in control? 3. Who might you access for support, or to talk with, after this session?

  24. References Australian Institute of Health and Welfare 2018. Family, domestic and sexual violence in Australia 2018. Cat. no. FDV 2. Canberra: AIHW. Family Violence Protection Act 2008 (Vic), Sourced from http://www.austlii.edu.au/au/legis/vic/consol_act/fvpa2008283/ Our Watch. & Australia s national Research Organisations for Women s Safety. (2014). Violence against Women: Key Statistics. Sourced from https://d2c0ikyv46o3b1.cloudfront.net/anrows.org.au/s3fs-public/Key%20statistics%20%20all.pdf Royal Commission into Family Violence (RCFV), 2016, Royal Commission into Family Violence: Summary and recommendations Paper No 132, p. 2014-2016. Victorian Legal Aid: Sourced from https://www.legalaid.vic.gov.au/find-legal-answers/sex-and-law/sexual-assault Australian Institute of Family Studies: https://aifs.gov.au/publications/sexual-violence-and-gay-lesbian-bisexual-trans-intersex-and-queer- community The Royal Australian College of General Practitioners Sourced from: http://www.racgp.org.au/your-practice/guidelines/whitebook/chapter-9- sexual-assault/#3 World Health Organisation Sourced from: http://apps.who.int/iris/bitstream/10665/136101/1/WHO_RHR_14.26_eng.pdf WHO p.16

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