Sexual violence against women: the need for a multidisciplinary integrated care model.
According to Ades and co-workers [1], clinical practice with women who experienced sexual violence requires multidisciplinary trauma-informed care addressing patients’ medical and psychological needs, either short- or long-term [1]. In line with these key points, at the Sexual and Domestic Violence Service of the Ospedale Maggiore Policlinico, Milan, Italy, we adopt an integrated multidisciplinary approach to assist victims, with a team including gynaecologists, psychologists, social workers, forensics, sexologists, lawyers, and, when needed, paediatricians [2].
The correct analysis, documentation and interpretation of genital and extragenital lesions and the appropriate reporting to the judicial authority, constitute additional important aspects of the care of a sexual violence victim. Attention to health issues (including psychological aspects related to trauma as post-traumatic stress disorder), as well as an empathetic and non-judgmental approach, are crucial factors that may impact on long-term outcomes. Moreover, besides medical and psychological assistance, meticulous examination, interpretation and documentation of genital and extragenital lesions, as well as correct evidence collection—e.g., DNA swabs, sperm slides, blood and urine samples to test for drug-facilitated rape—are fundamental, as they may affect possible legal proceedings. These practices entail high levels of specialization and an efficient collaboration between all the professionals involved. At the same time, physical examination and evidence collection should be conducted in full respect of women’s dignity, which is an important component of victims’ perception of justice [3]. Lack of thoughtfulness during these procedures may intensify psychological trauma by re-exposing women to objectification, in the sense of feeling treated like a body of evidence rather than a person of worth.
Based on our experience, collecting data for the judicial system is as important as clinical assistance, as we have observed that an appropriate and qualified management of forensic evidence, and at times even the condemnation of the perpetrator, may significantly improve the victim’s psychological outcome and quality of life. Such a model requires appropriate training and continuity between different services (i.e., medical, social, and legal), as well as facilities to guarantee women free access to the anti-violence service at any time. Indeed, clinical forensic activity is not only for “prosecution” but is a fundamental tool as the first step towards protecting the victim and society.
Securing justice for victims of sexual violence is a complex process that should not be considered as exclusively aimed at convicting the perpetrators. Providing patient-centred care, characterised by sensitivity, empathy and attention, is a fundamental component of restoring justice.
REFERENCES:
1) Ades V, Goddard SB, Ayala P, Greene JA. Caring for long term health needs in women with a history of sexual trauma. BMJ 2019;367:l5825 doi: 10.1136/bmj.l5825 (Published 22 October 2019).
2) Barbara G, Collini F, Cattaneo C, Facchin F, Vercellini P, Chiappa L and Kustermann A. Sexual violence against adolescent girls: labelling it to avoid normalization. J Womens Health 2017;26:1146-1149. doi: 10.1089/jwh.2016.6161.
3) McGlynn C, Westmarland N. Kaleidoscopic justice: sexual violence and victim-survivors’ perceptions of justice. Soc Leg Stud 2019;28:179-201. doi: 10.1177/0964663918761200.
Competing interests:
No competing interests
07 November 2019
Giussy Barbara
M.D., Obstetrics and Gynecology Unit and Service for Sexual and Domestic Violence
Federica Facchin, Paolo Vercellini, Cristina Cattaneo, Alessandra Kustermann
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, Milan, Italy
Rapid Response:
Sexual violence against women: the need for a multidisciplinary integrated care model.
According to Ades and co-workers [1], clinical practice with women who experienced sexual violence requires multidisciplinary trauma-informed care addressing patients’ medical and psychological needs, either short- or long-term [1]. In line with these key points, at the Sexual and Domestic Violence Service of the Ospedale Maggiore Policlinico, Milan, Italy, we adopt an integrated multidisciplinary approach to assist victims, with a team including gynaecologists, psychologists, social workers, forensics, sexologists, lawyers, and, when needed, paediatricians [2].
The correct analysis, documentation and interpretation of genital and extragenital lesions and the appropriate reporting to the judicial authority, constitute additional important aspects of the care of a sexual violence victim. Attention to health issues (including psychological aspects related to trauma as post-traumatic stress disorder), as well as an empathetic and non-judgmental approach, are crucial factors that may impact on long-term outcomes. Moreover, besides medical and psychological assistance, meticulous examination, interpretation and documentation of genital and extragenital lesions, as well as correct evidence collection—e.g., DNA swabs, sperm slides, blood and urine samples to test for drug-facilitated rape—are fundamental, as they may affect possible legal proceedings. These practices entail high levels of specialization and an efficient collaboration between all the professionals involved. At the same time, physical examination and evidence collection should be conducted in full respect of women’s dignity, which is an important component of victims’ perception of justice [3]. Lack of thoughtfulness during these procedures may intensify psychological trauma by re-exposing women to objectification, in the sense of feeling treated like a body of evidence rather than a person of worth.
Based on our experience, collecting data for the judicial system is as important as clinical assistance, as we have observed that an appropriate and qualified management of forensic evidence, and at times even the condemnation of the perpetrator, may significantly improve the victim’s psychological outcome and quality of life. Such a model requires appropriate training and continuity between different services (i.e., medical, social, and legal), as well as facilities to guarantee women free access to the anti-violence service at any time. Indeed, clinical forensic activity is not only for “prosecution” but is a fundamental tool as the first step towards protecting the victim and society.
Securing justice for victims of sexual violence is a complex process that should not be considered as exclusively aimed at convicting the perpetrators. Providing patient-centred care, characterised by sensitivity, empathy and attention, is a fundamental component of restoring justice.
REFERENCES:
1) Ades V, Goddard SB, Ayala P, Greene JA. Caring for long term health needs in women with a history of sexual trauma. BMJ 2019;367:l5825 doi: 10.1136/bmj.l5825 (Published 22 October 2019).
2) Barbara G, Collini F, Cattaneo C, Facchin F, Vercellini P, Chiappa L and Kustermann A. Sexual violence against adolescent girls: labelling it to avoid normalization. J Womens Health 2017;26:1146-1149. doi: 10.1089/jwh.2016.6161.
3) McGlynn C, Westmarland N. Kaleidoscopic justice: sexual violence and victim-survivors’ perceptions of justice. Soc Leg Stud 2019;28:179-201. doi: 10.1177/0964663918761200.
Competing interests: No competing interests