PROJECTS
The "It's Still Not My Shame" (Holden, WHS 2002) report looked at the health care needs of adult survivors of CSA. This report recognised that the health care of many survivors takes place in the general practice setting and that not all general practitioners feel skilled in dealing with issues around CSA. A need for training for GPs in the care of adult survivors of CSA was identified and the report recommended that WHS focus on this area. Doctors at Dale St Women's Health Centre, who regularly work with adult survivors in both women's health and general practice settings, have similarly identified concerns about structural limitations for the care of adult survivors of CSA in general practice settings as well as the need for professional development and support needs for GPs in this area.
Bringing these concerns together, WHS and Dale St looked at how best to support general practitioners to work more effectively with adult survivors of CSA. As a result the Adult Survivors of Childhood Sexual Abuse in General Practice project was initiated in 2003. The project, a partnership jointly funded by WHS and Dale Street Women's Health Centre (Central Northern Adelaide Health Service), aims to:
- increase the capacity of general practitioners to respond appropriately to the health needs of adult survivors of child sexual assault;
- develop strategic partnerships to enhance the interface between general practitioners and specialised CSA services.
Within the first stage of the project, a review of national and international medical literature into the health effects of CSA and the care of survivors within general practice was undertaken. The review was funded by the University of Adelaide's Department of General Practice Primary Health Care Research Evaluation and Development program. It highlighted the extent of CSA (between 30 and 40% of women accessing General Practice have a history of CSA) and the range of its potential psychological and physical effects. A number of articles outlined the important fundamental elements necessary to ensure appropriate care for survivors: the importance of GPs who are skilled at listening, believing and being aware of the issues that some survivors may have with examinations and procedures. Missing from the literature was in-depth discussion of the complicated issues that may arise when women have been subjected to CSA. These include post-traumatic stress disorder, physical symptoms which may be affected or influenced by a history of CSA, ongoing feelings of wanting to suicide or self-harm, and difficulties in relationships between doctors and survivors. Also lacking was discussion about structural supports necessary to assist general practice to improve the quality of care for adult survivors of CSA.
Phase two of the project has seen the development of a pilot training package about working with adult survivors of CSA in the GP setting. It is being tailored for use within various general practice educational forums in South Australia. Yarrow Place Rape & Sexual Assault Service who have extensive expertise in both working with people subjected to sexual assault & training GPs has joined as a partner in the project.
To inform the development of the training package, the project consulted with women who are adult survivors of CSA. Respond SA has provided funding & support to conduct additional consultations with men whose experiences will be incorportaed into the package. Participants were asked about their experiences of care within the general practice setting: what has and hasn't worked, whether any difficulties have arisen in their relationships with their GPs and what they believe the important messages are for GPs to understand about supporting adult survivors of CSA.
Consultation with groups of GPs was also undertaken to explore their experience of providing general practice care for adult survivors of CSA. They were asked about what has worked, what difficulties have arisen and how some of these difficulties may be overcome or better managed within the general practice setting.
Information gathered from the literature review and the consultations have been used in the development of the training package which aims to assist GP educators to provide input about caring for adult survivors of CSA in the GP setting. Specifically it aims to:
- increase GP's understanding of the ways in which a history of CSA may affect some patients and their relationships with those patients
- develop GP skills in talking with patients about a history of CSA including opportunities to break the silence around sexual violence
- develop GP's skills in responding to a disclosure of a history of CSA
- develop GP's skills in responding to crises which may occur for patients with a history of CSA.
The training package contains resources, such as referral sources and articles, which can be distributed to GPs to further their skills and knowledge. Information about, and examples of, patient literature which can be placed in GP's waiting rooms will also included.
