Sexual assault of adolescent girls: Examining acute care service use

According to the Canadian Centre for Justice Statistics 2008 survey data, female adolescents experience rates of sexual assault that are more than double that of female young adults (1). In the most recent clinical paediatric guidelines on adolescent sexual assault, it was emphasized that adolescent victims have specific treatment and management needs (2). However, little is known about their use of services in the acute post-sexual assault period. The purpose of the present study was to examine adolescents' use of specialized acute care violence services, and to determine whether, compared with young adults, there are important differences in the types of sexual assaults experienced and their service utilization. Ontario has 35 hospital-based sexual assault/domestic violence treatment centres (SA/DVTCs) staffed by nurses with specialized training in sexual assault that includes paediatric and adolescent care. These centres provide emergency services 24 h/day, seven days per week to women, children and men who present within approximately seven days (72 h at the time of study) of a sexual assault or physical assault by an intimate partner. SA/DVTC nurses are trained to offer all relevant services to all clients, with clients free to accept or decline (eg, crisis counselling, referral for on-site medical follow-up care and services in the community). The goal of addressing the immediate emotional, medical, forensic and social needs of victims of sexual assault, through on-site care and referral to appropriate services in the community, is to reduce the occurrence of longer-term physical and psychological morbidity and re-victimization. As part of a larger project, information was collected prospectively from victims who presented at one of 30 SA/DVTCs between April 1, 2009 and June 30, 2011, and consented (or their guardians) to participate in a province-wide study investigating service use and satisfaction (3). Ethics board approval was obtained at all participating centres, with five programs not able to participate because of organizational restructuring, difficulty ensuring round-the-clock nursing coverage and/or significant modifications to the study design requested by their research ethics boards. In the present analysis, female adolescent (12 to 18 years of age) were compared with female young adult (19 to 24 years of age) sexual assault victims on sociodemographic-, assault- and care-related variables using χ2 and, where appropriate, Fisher's exact tests. Analyses for the assault-related variables included a ‘doesn't know/doesn't remember’ category. During the study period, 1082 female sexual assault victims were seen, of whom 665 (61.5%) were included in the sample: 347 (32.1%) were adolescents and 318 (29.4%) were young adults. Compared with young adult sexual assault victims, adolescent victims differed on ethnicity and race (P=0.004). Adolescents were more likely to identify as Aboriginal (16.3% versus 7.5%), Black (8.1% versus 6.1%) and biracial (2.0% versus 0.7%), and less likely to describe themselves as Caucasian (71.0% versus 82.6%) or Asian (2.6% versus 3.1%). They were also more likely than young adult victims to report sexual assaults that included cunnilingus (13.1% versus 8.2%; P<0.001), fellatio (20.8% versus 14.3%; P=0.032) and vaginal penetration with a penis (64.0% versus 51.4%; P=0.003). Despite this, adolescents were less likely than young adult victims to have used many of the acute care services available at SA/DVTCs: crisis counselling (59.1% versus 70.7%; P=0.002); medical care/treatment (68.0% versus 76.2%; P=0.024); vaginal examination with speculum (43.7% versus 55.1%; P=0.005); photo documentation of physical injuries (12.3% versus 19.4%; P=0.016); and assessment for risk of future victimization (33.8% versus 50.0%; P<0.001), as well as to have been referred to on-site medical follow-up care (73.8% versus 81.6%; P=0.020) and services in the community (24.6% versus 39.1%; P<0.001) (Table 1). Types of acute care services used by female adolescent and young adult victims of sexual assault Categories are not mutually exclusive Types of acute care services used by female adolescent and young adult victims of sexual assault Categories are not mutually exclusive Our comparison of adolescent and young adult victims of sexual assault revealed some important differences, principally, decreased use of various services among adolescents. Strikingly, adolescent girls were less likely to undergo a risk assessment and accept referral for on-site medical follow-up and services in the community. These girls may be at heightened risk for experiencing ongoing abuse, and developing longer-term and chronic post-sexual assault sequelae (eg, post-traumatic stress disorder), which may need to be addressed in later interactions with other health care providers. Adolescent girls may not be receiving the care they need because they may decline services more often due to the resistance that often characterizes adolescents' interactions with adult authority figures, such as nurses (4), and a tendency to minimize risk (5,6). It is important, therefore, that health care providers recognize these issues and work to develop trusting relationships with adolescent patients, while providing appropriate information on the health and revictimization risks for sexual assault, and facilitating referrals to additional supports. The authors thank participating SA/DVTC Program Coordinators/Managers and staff, and the survivors and guardians who made this study possible. They are also grateful to Tanya Smith for her helpful comments on an earlier draft of the manuscript and Linda Turner for her statistical support. Janice Du Mont is supported, in part, by the Atkinson Foundation.

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