Healthcare Provider Interventions for Patients Experiencing Sexual Harassment
Immediate Response and Safety Assessment
Healthcare providers must first assess the patient's immediate safety, provide a supportive nonjudgmental environment, and refer to specialized sexual assault services while addressing acute medical and psychological needs. 1
Initial Safety Evaluation
- Directly ask whether the patient has safety concerns related to the perpetrator, the perpetrator's friends, or others 1
- Assess whether the patient has been threatened, is afraid of anyone, or if the perpetrator has a history of violence or access to weapons 1
- Determine if the patient is safe to discharge from medical care 1
Immediate Referral to Specialized Services
- Refer to a forensic examination and treatment at an emergency department or sexual assault treatment center after addressing immediate health concerns 1
- Consult a sexual assault forensic or nurse examiner if available to provide optimal care and follow-up coordination 1
- Provide the Rape, Abuse & Incest National Network hotline (which maintains resources to locate sexual assault services and healthcare professionals) 1
Comprehensive Medical Care
Acute Medical Interventions
- Treat all physical injuries immediately 1
- Provide empirical treatment for sexually transmitted infections (Chlamydia, gonorrhea, and trichomoniasis) 1
- Offer emergency contraception within 120 hours of sexual assault 1
- Initiate or complete hepatitis B virus and HPV immunization series 1
HIV Post-Exposure Prophylaxis (nPEP)
- Offer HIV nPEP when the assault included contact associated with substantial risk for HIV transmission and the source has HIV or unknown HIV status 1
- Begin nPEP as quickly as possible, ideally within 72 hours 1
- Assess risk factors including multiple perpetrators, HIV-positive perpetrator(s), high HIV prevalence in the geographic area, or perpetrator with genital lesions 1
- Provide enough medication to last 3-7 days until the patient returns for tolerance assessment 1
Mental Health Assessment and Intervention
Immediate Psychiatric Screening
- Screen immediately for suicidal ideation, self-harm behaviors, and homicidal ideation, as sexual assault survivors have significantly elevated rates of depression, suicidal ideation/attempts, self-mutilation, and eating disorders 2, 3
- If any suicidal or homicidal ideation is present, refer urgently to a mental health professional experienced in trauma—this requires immediate attention and cannot be delayed 2, 3
Evidence-Based Psychological Treatment
- Initiate trauma-focused cognitive behavioral therapy (CBT) immediately, as CBT-based interventions delivered within days to weeks after trauma demonstrate efficacy in reducing PTSD symptoms, depression, anxiety, and substance use 2, 3
- Both in-person and video-based CBT modalities are equally effective 2
- Address trauma-specific reactions including violated trust, self-blame, negative self-concept, and anxiety through ongoing counseling 2
- Consider pharmacologic treatment for PTSD symptoms if indicated, as medication shows equivalent outcomes to psychological interventions 2
Common Pitfall to Avoid
Never delay psychiatric assessment if concerning symptoms are present—the most common error is requiring stabilization before addressing trauma 3
Follow-Up Care Coordination
Structured Follow-Up Schedule
- Schedule a visit within 1-2 weeks of initial presentation to assess injuries, medication adherence, mental health functioning, and need for additional psychological counseling 1
- Provide written instructions for later reference, as many patients will not recall everything said during the initial evaluation 1
- Reassess for STIs depending on which medications were given initially and whether the patient has had consensual sexual activity since the assault 1
Multidisciplinary Care Team
- Establish a coordinated care team including primary care, mental health (trauma specialist), and any specialty services needed 2
- Assess social support systems and connect to additional supportive services, including support groups for trauma survivors and community resources 2
- Secure the patient's consent before communicating with other providers, respecting confidentiality laws 1
Financial and Legal Considerations
Payment Resources
- Inform patients that in all states, sexually assaulted persons are eligible for reimbursement of medical expenses through the U.S. Department of Justice Victim's Compensation Program when the sexual assault is reported to police 1
- Certain states and localities have special programs providing reimbursement for medical therapy after sexual assault, including antiretroviral medication 1
Reporting Requirements
- Be aware of state-specific mandatory reporting requirements for sexual assault, which vary by jurisdiction 1
- Understand that some states mandate reporting of sexual intercourse between minors with certain age differences, even if consensual 1
Prevention Education and Screening
Routine Screening in Practice
- Screen adolescents and adults for sexual victimization during visits for psychological problems, sexuality issues, contraception, substance abuse, and health supervision 1
- Ask direct questions without parents present regarding past sexual experiences, age of first sexual experience, use of the Internet to find partners, and unwanted or forced sexual acts 1