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The following link directs you to the executive summary of the clinical work being done at the TRC, and the research data derived from it. The work being done at the TRC is simultaneously being documented and analyzed to provide the State of California Victim Compensation and Government Claims Board with the data necessary to substantiate our need for continued funding from the State of California to provide increased access for care to victims, as well as to provide it in a cost effective manner. This information was prepared in December 2004 and is available to the community to learn more about the TRC and our successes.
The Trauma Recovery/Rape Treatment Center (TRC/RTC) offers free, confidential medical and mental health services to adult who have experienced sexual assault, domestic violence and/or other forms of violent crimes who reside in San Francisco or residents from other counties who were sexually assaulted in San Francisco. When possible, clients who have been sexually assaulted should be encouraged to come to SFGH ED 24/7 for services provided by TRC/RTC medical provider specialists. They will be offered complete medical care including STD, pregnancy and HIV prophylaxis when appropriate (HIV prophylaxis may be available ONLY if seen within 72 hours of the assault), forensic evidence collection if desired, and follow-up medical and mental health services. If they are unsure of their desire for police involvement we can offer to collect and hold evidence until they are able to decide. The client should be seen as soon as possible post assault.
If, however, your client does not want services through SFGH and/or does not desire police involvement the following is offered as a guideline in the care of sexual assault clients.
Provide support repeatedly throughout your entire interaction with the sexual assault client.
Note: Client may at some point decide to make a police report and your record of the event may be the only documentation available to support legal action
1. Support: Continue to provide supportive statements
2. Provide STI, Pregnancy and HIV Counseling, Screening, and Prophylaxis:
Whenever possible directly assist client in making contact with one of the below agencies:
Know the reporting laws and complete appropriate mandated reporting forms.
Sometimes the TRC receives consultation calls from psychotherapists who are working with clients, who, during the course of treatment, experience a sexual assault or other type of trauma. At times we have heard from therapists who wonder if they should refer clients to us for adjunctive treatment or terminate with their clients in order to link them with trauma-focused services. In general, we recommend that if a client is comfortable and wants to continue his or her work with you, that you continue your work with them and broaden the focus to include the recent trauma, even though it was not the presenting issue.
Some factors for consideration in working with a client who has experienced an acute trauma are the same factors you would consider for any client experiencing a crisis: How is the person coping with the trauma? Does the client pose a danger to her or himself, or to anyone else, that must be dealt with immediately? Is there any remaining threat of danger posed by the perpetrator that should be addressed immediately? Is the client able to use coping strategies that don’t have harmful consequences (talking with a therapist, talking with safe friends or family, crying, resting, exercising, journaling, etc. etc.), or is (s)he coping in ways that could put her/him at further risk of harm (such as substance abuse)?
It is always helpful to normalize the distress that the person is suffering – most people have a difficult time after a trauma, and that is expressed differently by different people. It is important to help the person see that by coming to therapy, taking good care of themselves, and staying connected with safe people who care about them, it is possible to heal and to feel better.
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Adult Sexual Assault in San Francisco
Guidelines for Primary Care Providers and Emergency Departments
Guidelines for Primary Care Providers and Emergency Departments
The Trauma Recovery/Rape Treatment Center (TRC/RTC) offers free, confidential medical and mental health services to adult who have experienced sexual assault, domestic violence and/or other forms of violent crimes who reside in San Francisco or residents from other counties who were sexually assaulted in San Francisco. When possible, clients who have been sexually assaulted should be encouraged to come to SFGH ED 24/7 for services provided by TRC/RTC medical provider specialists. They will be offered complete medical care including STD, pregnancy and HIV prophylaxis when appropriate (HIV prophylaxis may be available ONLY if seen within 72 hours of the assault), forensic evidence collection if desired, and follow-up medical and mental health services. If they are unsure of their desire for police involvement we can offer to collect and hold evidence until they are able to decide. The client should be seen as soon as possible post assault.
If, however, your client does not want services through SFGH and/or does not desire police involvement the following is offered as a guideline in the care of sexual assault clients.
Support:
Provide support repeatedly throughout your entire interaction with the sexual assault client.
- Assure client that this was not her/his fault
- Create a safe environment for client in clinic or emergency department
History and assessment:
- Ask client to describe the event (what occurred, where, when, any identifying information about perpetrator, sexual assault acts involved, weapons involved)
- Ask client specifically about anal, vaginal, and oral involvement
- Ask about any physical injury
- Assess support systems
- Ask about current safety
- Assess client’s interest in pursuing police report
Physical Examination:
- Do a full physical exam, allow client to have accompanying support person if requested
- Consider possible injury based on acts described by client
Documentation:
Note: Client may at some point decide to make a police report and your record of the event may be the only documentation available to support legal action
- Carefully document incident and acts as described by client
- Use client’s own words and direct quotes whenever possible and appropriate
- Document information about anal, vaginal, and/or oral involvement
- Carefully document any findings on physical exam with both words and drawings
- Document pain/tenderness as well as objective findings
- Obtain client permission and take photographs when appropriate
Intervention:
1. Support: Continue to provide supportive statements
2. Provide STI, Pregnancy and HIV Counseling, Screening, and Prophylaxis:
- If less than 3 weeks post assault offer STI prophylaxis
- If greater than 3 week offer STI screening
- Offer pregnancy prophylaxis if appropriate
- Offer HIV prophylaxis ONLY if sexual assault occurred within past 72 hours
STI Prophylaxis for:
- Chlamydia
- Gonorrhea
- BV/Trichomonas
Pregnancy Prophylaxis:
- offer progestin only or progestin-estrogen combination per protocol
HIV Prophylaxis:
- make risk assessment based on sexual assault event
- if 72 or more hours post assault do not offer HIV prophylaxis
- for questions about the use of HIV prophylaxis call SFGH ED and ask to speak with the
TRC/RTC medical provider on call:
- recommend HIV screening at time of visit, if positive stop HIV prophylaxis and refer
- recommend repeat HIV screening at 3 and 6 months post assault
Syphilis:
- recommend baseline RPR with repeat screening at 3 months when appropriate
Whenever possible directly assist client in making contact with one of the below agencies:
- Trauma Recovery/ Rape Treatment Center 415- 437-3000. Psychotherapy and clinical case management for women and men.
- San Francisco Women Against Rape (SFWAR) 415-647-7273. 24-hour crisis line for men and women and peer-based counseling for women.
- Victim Services SF District Attorney’s Office 415-553-9044. Advocacy with police and judicial system and assistance applying for victims of crime funds for clients who file a police report.
- San Francisco Police Department Sex Crimes 415-553-1361. For clients who may want to report at some time or have questions.
Know the reporting laws and complete appropriate mandated reporting forms.
Sometimes the TRC receives consultation calls from psychotherapists who are working with clients, who, during the course of treatment, experience a sexual assault or other type of trauma. At times we have heard from therapists who wonder if they should refer clients to us for adjunctive treatment or terminate with their clients in order to link them with trauma-focused services. In general, we recommend that if a client is comfortable and wants to continue his or her work with you, that you continue your work with them and broaden the focus to include the recent trauma, even though it was not the presenting issue.
Some factors for consideration in working with a client who has experienced an acute trauma are the same factors you would consider for any client experiencing a crisis: How is the person coping with the trauma? Does the client pose a danger to her or himself, or to anyone else, that must be dealt with immediately? Is there any remaining threat of danger posed by the perpetrator that should be addressed immediately? Is the client able to use coping strategies that don’t have harmful consequences (talking with a therapist, talking with safe friends or family, crying, resting, exercising, journaling, etc. etc.), or is (s)he coping in ways that could put her/him at further risk of harm (such as substance abuse)?
It is always helpful to normalize the distress that the person is suffering – most people have a difficult time after a trauma, and that is expressed differently by different people. It is important to help the person see that by coming to therapy, taking good care of themselves, and staying connected with safe people who care about them, it is possible to heal and to feel better.
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