Read Standard 4: Supporting and responding to initial disclosure: adults

Healthcare and forensic medical services standards
Healthcare Improvement Scotland

Standard statement

Healthcare professionals respond to initial disclosure in a trauma-informed way and in line with national clinical pathways.

Rationale

A person may disclose rape, sexual assault or historical child sexual abuse at any time following an incident. This standard is intended to support healthcare staff when responding to an initial disclosure where there has been no report to Police Scotland. This standard applies wherever the person discloses including in non-SARCS settings.

Healthcare professionals should respond to an initial disclosure in a trauma-informed, person-centred way. This is a key step to recovery. Healthcare professionals should reassure the person and support them to make a decision about the care that is right for them and at a time, and pace that is right for them.

People should be supported to make sense of the psychological impact of the event they have experienced. Staff should help them to understand the activities that will promote or hinder natural recovery and what may improve later outcomes.

The disclosure of rape and sexual assault: guidance for health care professionals sets out the pathways of care available to the person depending on when the assault happened. It provides information for staff about time-dependent treatment. This includes the need to treat any immediate concerns or medical conditions requiring attention or to make necessary arrangements for urgent treatment (such as the provision of emergency contraception). Healthcare professionals responding to an initial disclosure should also assess if the person is at risk and follow relevant guidance. Any safety concerns, associated with domestic abuse or non-fatal strangulation should be discussed with the person, using compassionate and sensitive language, and appropriate action taken.

Staff should refer people to specialist services (including SARCS) for follow-up care, information and support as appropriate. For example, signposting to support organisations.

Where a child or young person under 16 years (or under 18 with additional vulnerabilities) discloses rape, sexual assault or child sexual abuse, staff should follow the appropriate child protection procedures for all identified concerns, including sexual violence.29 See Standard 7 for further information.

Criteria

4.1

NHS boards have local protocols or systems in place to support healthcare staff responding to an initial disclosure, which includes:

  • access to pathways of care and the guidance for healthcare professionals
  • awareness raising of local services including SARCS
  • location and contact details for SARCS within their NHS board

how to access Turn to SARCS information.

4.2
NHS boards ensure staff have the relevant training, in line with their roles and responsibilities, to respond to an initial disclosure of rape or sexual assault.
4.3

When responding to an initial disclosure, healthcare staff should, in line with the disclosure of rape or sexual assault guidance:

  • respond in a trauma-informed and person-centred way
  • treat any immediate concerns or medical conditions or arrange treatment elsewhere
  • ensure the person feels supported and give them time and information to make informed decisions that are right for them
  • provide information, advice, support and available options based on the person’s needs and circumstances
  • explain the SARCS and appropriate pathways into these services
  • contact the local SARCS nurse coordinator (or equivalent) for advice, if required
  • signpost the person to local support services and third sector organisations.
4.4

Staff follow local referral pathways for any adult support and protection or child protection concerns raised during initial disclosure.

What does this standard mean for...

What does the standard mean for people receiving care and support? 

  • You will be supported by staff who will listen to you with kindness and compassion.
  • Staff will explain what care and options are available to you.
  • You will be supported to make choices about the care you want to receive.
  • Any immediate medical conditions or concerns needing attention will be arranged for you.

What does the standard mean for staff?

Staff, in line with their roles, responsibilities and workplace setting:

  • understand their role in relation to responding to initial disclosure
  • can identify and act on any adult or child protection concerns
  • provide empathetic, respectful and compassionate support
  • address any immediate medical conditions or concerns needing attention or make arrangements for this
  • support the person to access services they may need.

What does the standard mean for the NHS board?

NHS boards:

  • provide awareness raising and relevant training for staff on responding to initial disclosure of rape, sexual assault or child sexual abuse
  • ensure adult or child protection concerns are responded to
  • provide support for staff responding to disclosure
  • provide information to support staff to make appropriate referrals based on the person’s needs and circumstances.

Examples of what meeting this standard might look like

  • Provision of information to healthcare professionals on responding to initial disclosure.
  • Referral pathways for adult or child protection concerns.
  • Uptake of trauma-informed training at an appropriate level for staff roles and area of practice.
  • Provision of information to support a person’s decision making.
  • Local referral protocols detailing options available to the person based on their needs and circumstances.