Healthcare professionals - supporting adults who present having experienced rape or sexual assault: clinical pathway

10. Follow Up Care and Ongoing Trauma-Informed Support

Key points

• Services should ensure access to a broad range of relevant services and expertise where required
• It is not appropriate to expect people to coordinate multiple appointments themselves
• Follow up appointments should be organised by the nurse coordinator, including with other agencies such as housing, social work and third sector organisations
• All healthcare staff have a responsibility to act to make sure that all children and young people are protected from harm. This responsibility includes acting on concerns about a child or young person even if the child or young person is not your patient

If the person has previously been engaging with social work then, with the person’s permission, a referral is made through their allocated social worker to help facilitate continuity of care

10.1 Referrals and Follow-up Care

Services need to have systems in place to enable people to have access to a broad range of multi-agency services e.g. sexual health, gynaecology, mental health social work, housing and third sector support and advocacy services (such as Rape Crisis Scotland).

Follow up appointments should be organised by the nurse coordinator and support should be available to facilitate attendance at follow up appointments. It is not appropriate to expect people to coordinate multiple appointments themselves.

Local arrangements will need to be developed, depending on the service model described above.

People with particular needs, e.g. homelessness or adults requiring support and protection, should be referred, with their consent, to the appropriate social work department. If the person has previously been engaging with social work then, with their consent, a referral is made through their allocated social worker to facilitate continuity of care.

If concerns exist regarding domestic abuse/stalking/human trafficking/ongoing sexual violence/interpersonal violence it is vital that they are provided with a place of safety if required and information on their local support services including social work services, police and sexual violence services.

After assessment and relevant examination an immediate treatment plan which includes timescales should be made jointly with the individual for their return to a safe environment, ideally accompanied by a family member, guardian, friend or support person – this is a multi-agency responsibility. Consent to contact the person to remind them of future appointments etc. should be confirmed and the preferred method documented prior to discharge.

Healthcare should meet both immediate and ongoing health needs including:

• Treating physical injuries that have resulted from the assault
• Safety assessment
• Emergency contraception where appropriate
• Testing and arranging treatment for sexually transmitted infections and post exposure prophylaxis against BBV and bacterial STIs
• Psychosocial assessment and support
• Ongoing trauma support – see the International Trauma questionnaire^[97] for a tool to assess needs
• Contact details so that people can seek future support, even if they decline immediate follow up arrangements

Rape Crisis Advocacy Project

The National Advocacy Project provides support and advocacy to anyone engaging or considering engaging with the justice system after a sexual offence. Advocacy workers are based in rape crisis services across Scotland, and can provide support, information and assistance around reporting to the police and the resulting justice processes. Workers can accompany survivors to meetings, as well as be a supporter in court. Referrals can be made directly to local rape crisis centres, or through the national rape crisis helpline on 08088 01 03 02.

This project has 3 main aims:

• To improve the support available to survivors of rape and serious sexual crime
• To improve the experience of the criminal justice process for survivors of rape and serious sexual crime
• To improve the development of a better understanding of survivors’ motivations to proceed or not to proceed with the criminal justice process and the difference advocacy support makes to this decision
• More information: National Advocacy Project | Rape Crisis Scotland

10.2 Domestic Abuse Services

If it becomes apparent that domestic abuse has occurred, referral should be made to the relevant local services.

10.3 Feedback

Feedback routes are very important for performance monitoring and continuous improvement. Where appropriate, feedback should be sought regularly both from those using services but also those agencies engaged in each stage of the pathway. For further information on feedback routes, refer to the Health Board service specification^[98].

Useful Resources

Scottish Women’s Aid^[99]

Hemat Gryffe^[100]

Rape Crisis Scotland^[101]

International Trauma Questionnaire^[102]