The Willows is the Ayrshire Sexual Assault Response Coordination Service (SARC). Anyone who has experienced rape or sexual assault should be able to choose where to access the appropriate medical and psychosocial interventions including the option to stay as close to home as possible.
The challenge
In March 2017, Scottish Ministers requested a taskforce be established to provide national leadership for the improvement of healthcare and forensic medical services for adults, children and young people who have experienced rape, sexual assault and child sexual abuse. The vision of the taskforce was to ensure consistent, person-centred, trauma-informed health care and forensic medical services and access to recovery was available for anyone who experienced rape or sexual assault in Scotland.
The 2017 standards for Healthcare and Forensic Medical Services for People who have experienced Rape, Sexual Assault or Child Sexual Abuse also highlight the importance of person-centred and trauma-informed care. Standard 2 states: “Each NHS board ensures that people who have experienced rape, sexual assault or child sexual abuse receive person-centred and trauma-informed care”.
Prior to the Willows opening, Ayrshire residents could access forensic medical services at Archway, Glasgow. Archway remain the Centre of Expertise and now are able to provide a peripatetic service for health boards in the West of Scotland. This provides more choice for those who have experienced rape or sexual assault to have their medical needs met locally in the Willows or another SARC in the West of Scotland.
Outline of activity
Person-centred care involves people and services working collaboratively and in genuine partnership. Care provision that focuses on personal goals, preferences and needs, result in more effective care with improved outcomes and experience for people who use services.
Research highlights that a victim-centred and trauma-informed response to sexual crime can reduce further trauma and have a positive effect on the long-term recovery of an individual, continued engagement in any criminal justice process, and better quality evidence to support any criminal proceedings.
NHS Ayrshire and Arran are committed to providing a trauma-informed, person-centred sexual assault response coordination service and as such convened a small group to establish the best way forward, linking into activities ongoing across the organisation and tailor specific learning and support resources for staff.
An action plan was developed and the following activities were undertaken or are underway:
- A video was produced to give people accessing the service the opportunity to view the facility if they were unsure of attending a medical examination. The aim of this is to provide comfort and decrease unknowns that could induce anxiety.
- A self-care booklet was developed in partnership with local Women’s Aid services. The booklet includes self-care advice for people accessing the service and the details of all third sector agencies in Ayrshire and Arran.
- A Seven Minute Brief (7MB) was produced on trauma-informed practice and was disseminated throughout the organisation. The aim of this brief was to raise awareness of trauma-informed practice across the organisation. A follow-up 7MB was then developed on trauma-informed care and sexual assault, which was also designed to raise awareness. A patient will encounter many different services and personnel during their journey, so every worker should be trauma informed. This also compliments the Scottish Government, COSLA and key partners’ wider ambition of trauma-informed services and workforces across Scotland.
- A letter to services was produced, which outlines the considerations for health professionals to think about within a seven day period after the incident. This guidance was developed from a national document. This guidance is for staff who might encounter someone who reports sexual assault and explains the most appropriate response, depending on whether the disclosure is pre- or post-seven days since the sexual assault. The letter was sent to a variety of services and organisations to help guide staff on how to approach this discussion with people they support. The letter also makes staff aware that the Willows has opened. This exercise will be repeated when self-referral becomes available.
- The project is also looking to develop HR guidance for staff, such as managers, who might have a member of staff who has experienced sexual assault.
- Ensuring staff have access to reflective practice, supervision and training.
- Promoting the National Trauma Training Programme throughout third sector and other partners.
Additional funding from the Scottish Government has been received to enhance patient pathways. This funding will contribute to:
- Printing the self-care booklets.
- Painting a mural within the comfort suites to make it more welcoming and less clinical. Work has been undertaken with colleagues in Forth Valley who have undertaken research with Rape Crisis into images that are less likely to cause re-traumatisation. The mural will have a theme of wellness, recovery and growth.
- Working on the garden area to make this a welcoming environment for people to use as a breathing space and to continue to create a trauma-informed environment for survivors.
Results
The Trauma-Informed Care group identified and addressed a number of actions to encourage trauma-informed practice throughout the organisation, as well as in the Willows, for both service users and staff who provide a service that can be challenging and traumatic.
The working group focused on applying the five principles of trauma-informed practice to the whole patient journey. This extended to the physical environment, including building safety and the impact of the artwork.
The working group also undertook a tabletop exercise which aimed to consider the whole patient journey – from the time of assault, to contacting services, and beyond. This involved any partners that could be in contact with victims/ survivors of sexual assault, including public and third sector organisations. There was also engagement with service user groups through the third sector to design the facility used for forensic medical examination. Resulting actions included ensuring staff were supported and had appropriate supervision. In addition, it was proposed that self-care bags should be offered to women coming through services to provide comfort and support.
Online meetings via Microsoft Teams provided an opportunity to bring many different partners and colleagues together during the pandemic. However, it would have been good to have been able to have onsite walk-through opportunities at the beginning of the service, but this was not possible due to restrictions.
Feedback from the Police, third sector and the peripatetic team has been very positive since the service opened. Feedback from people accessing the service has been difficult to gather as it can be challenging to determine when to ask for feedback in such a sensitive situation. However, partners have created a shared template for feedback across the partner organisations and this is due to be reviewed soon.
Learning
Despite the challenges brought by the pandemic, the voices of experts by experience were successfully included in developing this service. A variety of partners were also involved in this project, and this has highlighted the importance of collaboration. This was a great example of multi-agency and multi-disciplinary partnership working, particularly the tabletop exercise mapping a person’s journey, and taking a trauma-informed lens to their experience of services and systems.
Key advice for future work would include earlier networking with colleagues in other health boards. This is important as there is already a wealth of knowledge and experience out there to draw upon and learn from.
Ann McArthur, Adult Support and Protection Lead
NHS Ayrshire and Arran
Ann.McArthur@aapct.scot.nhs.uk