Health professionals, school nurses and counselors see the consequences of sexual violence and harassment regularly. Victims of physical and sexual violence are more likely to report sadness, hopelessness or suicidal ideation, engage in substance use, and eating disorders. They are more likely to become pregnant or become infected with an STI or HIV, and experience increased risk for school dropout lower grades and less connectedness to school. Because of this, health providers and centers are vital components of a response to sexual violence and harassment. New research finds that by discussing healthy and unhealthy relationships and offering brief interventions can reduce the risk of violence, cyber abuse and unplanned pregnancy.
Health providers can play also play an essential role in violence prevention and health promotion by discussing healthy, consensual and safe relationships with all patients. Health settings may be the sole place an adolescent experiencing abuse may be identified and connected to resources to stay safe.
Promote Privacy and Confidentiality:
Always set aside time to talk alone with student or patient before discussing abuse and disclose any limits of confidentiality (see below for more detail).
Talk to students and patients about healthy and unhealthy relationships:
Let students or patients know that you are talking to everyone about healthy and unhealthy relationships and harassment and sexual violence. Futures Without Violence has resources that provide information on healthy and respectful relationships, textual harassment, sexual and reproductive coercion and hot to get help or help a friend. Providers should review these materials with youth and encourage them to share them with their friends.
Promote Prevention and peer to peer support:
If the patient or student is not experiencing abuse or harassment:
Let them know you are glad that is not happening to them and let them know that if they ever need health you are there for them. Share extra resources and let the not that you give the resources to everyone in case they have a friend or family member who needs it
Support survivors: if someone disclose assault, abuse or harassment:
- Let patients know that you support and believe them:
“I’m sorry that happened. It happens way too often.”
“You don’t deserve this and it is not your fault.”
“I’m glad you told me.”
- Address the health issues (including offering emergency contraception, sexual assault exams and treatment for other health issues commonly associated with exposure to violence).
- Offer referrals to community based advocates who can help and/or hotlines such as: Love Is Respect and RAINN. For additional resources, click here. (link to resources/tools page)
What not to say to Survivors:
“You should definitely report immediately and go get a rape kit.”
“You are definitely in an abusive relationship.”
“That does not sound like rape to me…”
“Were you drunk? Were you using the buddy system?” or “What did you do to set them off?”
“So what happened after that, and what happened after that?”
Disclosing limits of confidentiality and Trauma informed Reporting
Navigating the balance between confidentiality and abuse reporting requirements is a fundamental challenge and as a provider it is critical to understand the state’s minor consent and confidentiality, physical and sexual abuse laws so that you can articulate them to your patients. This is critical to building trust with your patients.
Provider tips for discussing conditional confidentiality
- Be direct: Discuss confidentiality and the conditions under which it might be breached at the beginning of the visit.
- Keep it simple: Tailor your discussion to the youth’s age and context.
- Communicate care and concern: Frame your need to breach confidentiality in the context of “getting them the help that they might need,” rather than using the law, policy or phrase “I am a mandated child abuse reporter,” as a reason to breach confidentiality.
- Assure two-way communication: Let your patient know if you are going to share information that they told you in confidence.
- Know the law.
Sample Script for disclosing limits of confidentiality:
“Before we get started I want you to know that everything here is confidential, meaning I won’t talk to anyone else about what is happening unless ou tell me that you are (add state specific here: being hurt physically or sexually, planning on hurting yourself or planning on hurting someone else). Those things I would have to report ok?”
Watch this video between a healthcare professional and patient who discloses she may have been sexually assaulted at a party for tips on what to say and how to handle a disclosure of sexual violence if you are a mandatory reporter.
Resources for Healthcare Professionals on address teen relationship abuse.
Hanging Out & Hooking Up: Teen victims of relationship abuse are more likely to report unhealthy diet behaviors, engage in substance abuse, and report having suicidal thoughts. Given these sobering facts, adolescent relationship abuse is a major health concern facing teens today, and healthcare providers have a unique role to play in preventing it. Not only can they provide valuable prevention messages to help their patients build healthy relationships, but medical professionals are also uniquely positioned to help those exposed to abuse find the resources they need. And now, healthcare providers have a new tool that will make it easier than ever to integrate screening for relationship abuse and prevention into their practice.
- Guidelines: An Integrated Approach to Prevention and Intervention, focusing on the transformative role of the adolescent health care provider in preventing, identifying and addressing adolescent relationship abuse.
- Poster: Raise awareness and hang in your office or clinic.
- Teen Safety Card: Distribute to teens so they can self-assess if they are in a healthy or unhealthy relationship.