Lauren Hapeman, BSDH, RDH, PHDHP
Patients often see a dental hygienist for routine care more frequently than they visit their primary care providers. This frequency lends itself to the building of an ongoing personal and professional relationship founded on trust, mutual respect, and confidentiality. With increased media attention on sexually violent behavior (e.g., the second wave of the #MeToo movement and the normalizing of speaking out against sexual violence), many victim-survivors have become comfortable disclosing their experiences to a trusted health-care provider. As dental hygienists, it is our responsibility to understand how to guide, support, report, and offer resources to patients who have experienced sexual trauma while maintaining trust and confidentiality. Shared experiences pertaining to any type of violence can also lead to vicarious trauma and understanding the importance of practicing self-care is paramount.
“Victim-survivor” is a term that acknowledges that those who have encountered sexual abuse may have a fluid identity that changes with time. Many individuals find the term “survivor” empowering, while others prefer to identify as a “victim” on their path to healing. There is no right or wrong identity along this spectrum, and these terms are used interchangeably throughout this article.
Sexual assault and domestic violence: Separate but linked
Sexual assault is a violent crime and a deeply traumatic experience that can occur regardless of age, race, gender identity, socioeconomic status, and geographic location: “Most sexual assaults are committed by men against women, but sexual assault also happens to men and people who identify as trans.”1 Similarly, abuse can involve siblings, spouses, and strangers, and can either be incidental (happening once) or ongoing in nature. In fact, according to the Rape, Abuse, and Incest National Network (RAINN), “eight out of ten rapes occur between the victim and somebody that they know.”2 For this reason, it is important to understand that sexual abuse cannot easily be predicted but can sometimes be categorized as a type of chronic violence that involves the victim-survivor and somebody that they know on a personal level.
It is also important to keep in mind that individuals who disclose abuse to a health-care provider may not be entirely prepared to exit a dangerous living situation, and may never choose to file a criminal report. Reasons for not reporting include feelings of confusion, guilt, and shame, disinterest in navigating a complicated legal system, fear of retaliation, and preferring to seek closure in other ways. Specifically, navigating a complicated legal system can prevent victim-survivors from reporting, as it often creates retraumatization and disempowerment when the survivor is faced with the prospect of retelling their story to multiple people. Regardless of an individual’s decision, hygienists should support them, connect them with resources, and make sure that the victim-survivor knows that the clinician believes them. Sexually violent crimes are alike in that they take power away from the victim-survivor, so it is imperative that clinicians become advocates for their patients.
Dental hygienists should possess a keen knowledge of their state requirements when it comes to reporting trauma experienced by a capable adult. At present, there is no one, uniform law that applies to dental hygienists, and this subject matter is not taught as a formal part of a dental hygiene curriculum. While some states (such as California) require primary care providers to report any treatment of an adult rape victim, other states require reporting on the condition that the patient has sustained obvious physical injuries related to an assault. A comprehensive list of states and specific regulations surrounding this topic for medical providers can be found at ncdsv.org If a dental hygienist has reason to suspect that a patient’s life is in immediate danger, they are both ethically and legally obligated to attempt to take steps to ensure the patient’s safety. This is a pertinent topic that deserves more attention in the years that follow.
When a patient has the bravery to disclose an assault, the dental hygienist should first ask whether that patient feels safe, discuss whether the individual has a safety plan, and document all information provided. Hygienists can then offer resources, acknowledge the limitations of their scope of practice, and (if they have not already done so) encourage the victim-survivor to follow up with primary care and mental health care providers. These professionals can further help to empower the patient and assist him or her in healing.
A safety plan contains a survivor’s ideas about how to realistically and safely cut off contact with an abuser. Whether or not a patient discloses fine detail about a sexually violent encounter, it is important to document any information related to the date of abuse, whether the patient feels safe, steps the patient has taken to heal, and the resources that were given to the victim-survivor. In terms of resources, it is important for hygienists to be able to provide information about domestic violence centers and hotlines, rape crisis or sexual assault centers, and information about sexually-transmitted disease (STD) testing (victim-survivors are placed at a higher risk for developing STDs). Additionally, many nonprofits offer rape crisis counseling and provide training (either for free or at a small cost) for laypersons who are interested in working with victim-survivors. Dental hygienists are in the perfect position to pursue continuing education related to this topic. PACT 5, a national network aimed at preventing assaults in colleges, recommends that supporters of victim-survivors “call the Rape, Abuse, and Incest National Network’s Sexual Assault Hotline at 1-800-656-HOPE” to find resources near them.3
Child abuse and mandated reporting
RAINN reported that “in FY16 alone, Child Protective Services agencies substantiated, or found strong evidence to indicate that, 57,329 children were victims of sexual abuse.”2 As of 2005, all states require dental hygienists to report suspected abuse of a minor, and all states encourage health professionals to file mandated reports. The strict laws that govern making a mandate report hold hygienists legally responsible for relaying any reasonable suspicion of the abuse of a child. The cutoff age for mandated reporting varies by state, and many states require continuing education for licensure renewal. The curriculum typically outlines a state’s specific steps for filing a report. When a patient discloses information about the abuse of a minor, it is important to make it clear that it is the obligation of the clinician to file a mandated report. The consequences of neglecting to file are serious, and for this reason, if you have reason to believe that a child is a victim of abuse, it is advisable to err on the side of safety and file a report.
Caring for ourselves as we care for others
It is difficult for clinicians to hear stories about sexual assault from patients. Listening to the details of a traumatic experience can cause us to absorb some of the thoughts and feelings of the victim-survivor and can create unforeseen physical or mental anguish. Practicing self-care regularly is an important component of dental hygiene practice, and it can be especially vital when providing support to a victim-survivor. It is critical to normalize the importance of maintaining a healthy mental state as we balance providing clinical care with our personal lives.
Seeing a therapist regularly for routine “emotional hygiene” can have a positive impact on our quality of life as clinicians. Additionally, exercise, meditation, journaling, self-guided mindfulness practices, and taking up new hobbies can help us to keep life outside of work separate and balanced. Self-care looks different for every clinician, so it is important to try several outlets for stress reduction in order to identify which techniques best suit an individual’s personality and lifestyle. By being prepared to serve as an active listener, resource, and advocate for patients, dental hygienists will increase trust, promote interprofessional collaboration, and be better prepared to act as part of an integrated care team amidst a changing health-care landscape.
References
1. Responding to a sexual assault disclosure: Practice tips for universities & colleges. Ending Violence Association of BC. http://endingviolence.org/publications/responding-sexual-assault-practice-tips-7/. Published May 31, 2016.
2. Children and teens: Statistics. RAINN website. https://www.rainn.org/statistics/children-and-teens.
3. How to report a sexual assault. PACT5 website. http://pactfive.nextmp.net/how-to-get-help/sexual-assault-reporting/.
Lauren Hapeman, BSDH, RDH, PHDHP, is a dental hygienist in Philadelphia, Pennsylvania, who has practiced clinically for five years. She is currently pursuing a master’s degree in dental hygiene through the University of Bridgeport. Her passions are equity and inclusion within the profession, periodontal therapy, and public health. Contact her at [email protected].
