Providing Trans-Affirming Care for Sexual Assault Survivors

Trans populations experience disproportionately
high rates of sexual victimization, have historically faced discrimination by healthcare providers,
and may have unique and diverse needs post-victimization. In Ontario, a quarter of trans people seeking
care at a hospital emergency department have been ridiculed and one in 5 trans persons
avoided emergency departments, because of previous discrimination or fear of experiencing
discrimination (Bauer & Scheim, 2015). A 2017 survey across Ontario’s 35 hospital-based
Violence Treatment Centres, which provide comprehensive healthcare, psychosocial, medical
and forensic examination services for sexual assault survivors, found that 96% of specially
trained forensic nurses strongly agreed that there was a need for training in the care
of trans survivors of sexual assault (Du Mont et al., 2019).
To address this gap, Women’s College Research Institute and the Ontario Network of Sexual
Assault and Domestic Violence Treatment Centres, in collaboration with Rainbow Health Ontario,
a province-wide program aimed at improving the health of LGBT persons in Ontario, have
been developing a novel curriculum for Sexual Assault Nurse Examiners in the care of trans
persons who have been sexually assaulted. With funding from the Women’s Xchange 15k
Challenge, a specialized curriculum, entitled “Providing Trans-Affirming Care for Sexual
Assault Survivors Curriculum” was developed. The curriculum drew on skills-based competencies
that were adapted from recommendations in the U.S. Department of Justice, National Protocol
for Sexual Assault Medical Forensic Examinations and endorsed by FORGE, a transgender anti-violence
advocacy group (FORGE, 2014). The curriculum’s 31 competencies were finalized by an advisory
group of trans community members and their allies who subsequently aided in the development
of the curriculum. The curriculum includes a Training Manual,
Training Module and Facilitators Guide that include case studies and interactive discussion
components to facilitate learning. The curriculum was successfully piloted and
evaluated on November 21, 2018 with 47 nurses during the biannual Sexual Assault Nurse Examiner
training for frontline nursing staff. Quantitative data collected from pre- and
post-test questionnaires showed that although almost ¼ of participants indicated that they
had provided direct clinical care to a trans client in the past, over 70% of participants
indicated that they had not undergone any prior training on providing care for trans
clients (Du Mont et al., in draft). After the training, participants reported
on average a significant increase in their overall perceived level of expertise in trans-affirming
post-sexual assault care. Participant scores on competence improved significantly across
all domains of the curriculum: initial assessment, medical care, forensic examination, and discharge
and referral (Du Mont et al., in draft). Qualitative feedback revealed that participants
recognized the significance of this training. One participant indicated: “This training
is incredibly relevant and important! This should be available and mandatory for health
care providers EVERYWHERE” (Du Mont et al., in draft).