Victim Centered Care (cont)


Victims from various cultural groups


  • Understand that culture can influence beliefs about sexual assault, its victims, and offenders. It can affect health care beliefs and practices related to the assault and medical treatment outcomes. It can also influence beliefs and practices related to emotional healing from an assault. In addition, it can impact beliefs and practices regarding justice in the aftermath of a sexual assault, the response of the criminal justice system, and the willingness of victims to be involved in the system.1
  • Understand that some victims may be apprehensive about interacting with responders from ethnic and racial backgrounds different from their own. They may fear or distrust responders or assume they will be met with insensitive comments or unfair treatment. They may benefit from responders of the same background or at least who understand their culture. Conversely, in smaller ethnic and racial communities, victims may be more likely to know the responder and doubt the responder’s ability to maintain confidentiality.
  •  Be aware that cultural beliefs may preclude a member of the opposite sex from being present when victims disrobe. Also, it may be uncomfortable for victims from some cultures to speak about the assault with members of the opposite sex.
  • Understand that victims may not report or discuss the assault because the stigma associated with it is so overwhelmingly negative. In some cultures, for example, the loss of virginity prior to marriage is devastating and may render victims unacceptable for an honorable marriage. Even discussing an assault or sexual terms may be linked with intense embarrassment and shame in some cultures.
  • Be aware that beliefs about women, men, sexuality, sexual orientation, gender identity or expression, race, ethnicity, and religion may vary greatly among victims of different cultural backgrounds. Also, understand that what helps one victim deal with a traumatic situation like sexual assault may not be the same for another victim.
  • Help victims obtain culturally specific assistance and/or provide referrals where they exist.2

Victims with limited English proficiency3

  • Be patient and understanding tward victims’ language skills and barriers, which may worsen with the crisis of sexual assault.4
  • Develop policies and train responders to be able to identify a victim’s limited English proficiency and primary language spoken and written.
  • Make every attempt to provide same language service through the use of demonstrably bilingual examiners or by providing monolingual examiners with support from professional interpretation services and translated materials for victims who are not proficient in English,5 are LEP or who may prefer to communicate in a non-English language. Use qualified interpreters when possible and not families or friends.6s country of origin, acculturation level, and dialect into account when responding or arranging interpretation.7 Remember to speak directly to victims when s need for modesty and privacy when determining where interpreters should be located in the exam room.
  • Train interpreters about issues related to sexual assault and the exam process8 whenever they are needed to facilitate communication in these cases. Ensure that the examiners are trained in the proper utilization and ethical requirements of using an interpreter.
  • Make sure that interpreters understand that they may need to testify.9
  • Understand that immigrant victims may fear that assisting law enforcement may identify them to immigration authorities for deportation.
  • All sexual assault victims should be provided information regarding U-Visa relief, in the event that this information would be helpful. Even if this information is not helpful to them directly, the information is often passed on to others by word of mouth and can benefit others in the future.
  • Work with law enforcement partners to develop and publicize protocols precluding detention or other immigration enforcement against victims who come forward to report a sexual assault.
  • Work with law enforcement to develop and publicize U-Visa certification protocols.
  • While it is not appropriate to ask a victim’s immigration status, anticipate that an immigrant victim will not self-identify as undocumented for fear of deportation. Such information about their rights should be offered in a non-judgmental manner to all victims and in coordination with a referral to an immigration service provider expert in working with immigrant victim populations.
 Table of Contents Victim Centered Care (cont 2)

 

1 Bullet drawn from A. Blue, The Provision of Culturally Competent Health Care, from the Web site of the Medical University of South

Carolina College of Medicine (http://academicdepartments.musc.edu/fm_ruralclerkship/curriculum/culture.htm) .

2 For example, to raise their level of hope and comfort during the exam, some patients may benefit from talking about culturally specific

models of healing (where they exist) and their application to recovery from sexual assault. To facilitate such a discussion, they may wish

to speak with a religious or spiritual healer from their culture.

3 The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) New & Revised Standards & EPs for Patient-

Centered Communication, Accreditation Program: Hospital, HR.01.02.01, PC.02.01.21, RC.02.01.01, RI.01.01.01, RI.01.01.03, effective

January 1, 2011, http://medicine.osu.edu/orgs/ahec/Documents/Post_PatientCenteredCareStandardsEPs_20100609.pdf (PDF); Joint

Commission, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care, Appendix B, August

2010, http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf.

4 Carolyn Ham, Reducing Language Barriers to Combating Domestic Violence: The Requirements of Title VI, Battered Women’s

Justice Project, October 2004, http://new.vawnet.org/summary.php?doc_id=1621&find_type=web_desc_GC.

5 Health care providers generally are covered by language access requirements under Title VI which requires them to take reasonable

steps to provide language-appropriate health care, including the use of qualified bilingual staff, interpreters, and translators.

6  Use of such informal and biased interpreters may result in unreliable communication, violate the patient’s privacy, undermine the

patient’s claim of privilege, and jeopardize the use of the victim’s statements in court. In cases of intimate partner sexual assault, it is

particularly important not to use family members who are not likely to adopt a neutral stance or maintain the confidentiality necessary.

7  For example, a Cuban interpreter may encounter language and trust obstacles when trying to communicate with a victim from rural

Mexico. (L. Zarate, Suggestions for Upgrading the Cultural Competency Skills of SARTs, Arte Sana Web site, http://www.arte-sana.com,

2003.)

8  Professional interpreters are expected to be familiar with confidentiality requirements and cultural issues.

9  Interpreters would not be expected to act as witnesses as to what was said in the examination room if they are present solely to facilitate direct communication between the patient and examiner.