Sexual assault is a threat to public health in refugee and conflict-affected settings. It places survivors at risk for unintended pregnancy, unsafe abortion, sexually transmitted infections, HIV, psychological trauma, and social stigma.
Training health care providers in compassionate and competent care for sexual assault survivors is a cornerstone of the IRC’s approach. We know that for women and children to heal and recover, health staff operating services in conflict and post-conflict settings should be trained in the clinical care of sexual assault—including how to adapt a medical exam and treatment for child survivors—and have the necessary equipment and supplies to provide treatment for both child and adult survivors. To support health care providers serving sexual assault survivors in low-resource settings, the IRC, in collaboration with the University of California Los Angeles, has designed the Clinical Care for Sexual Assault Survivors (CCSAS) guidelines and training tools.
The Clinical Care for Sexual Assault Survivors (CCSAS) guidelines and training tools are a multimedia educational program developed to improve clinical care for and general treatment of sexual assault survivors by providing medical instruction and encouraging competent, compassionate, confidential care. The training is not intended to teach basic medical information; it is a skill-based training designed to help medical professionals and clinic staff better communicate with and serve survivors of sexual assault.
The CCSAS multimedia tool has been used all over the world, by INGOs and government institutions and in conflict as well as post-conflict settings. Based on experiences, feedback from partners and new research, the facilitator guide was updated and revised and a CCSAS psychosocial tool kit was added in early 2014. We are currently at work on the Arabic version, which will be available by the end of 2014.
CCSAS multimedia training tool:
The program is intended for both clinical care providers and non-clinical health facility staff. It is designed to be delivered in a group setting with facilitators guiding participants through the material and directing discussions and group participation as appropriate. It is divided into five sections:
- What Every Clinic Worker Needs to Know
- Responsibilities of Non-Medical Staff
- Direct Patient Care
- Preparing Your Clinic
- Forensic Examination
The first two are intended for a general (non-clinician) audience. Section 3 and Section 5 are intended for clinical care providers and contain graphic images inappropriate for untrained personnel. Section 4: Preparing Your Clinic is intended to guide participants through the process of assessing the currentsituation and developing an action plan for the improvement of services for sexual assault survivors. The CCSAS DVDs are downloadable through the CCSAS website.
Facilitator’s guide (English)
Facilitator’s guide (Arabic)
Guide du Facilitateur (Francais)
CCSAS Psychosocial Toolkit:
The 2012 CCSAS multi country evaluation showed that further training on psychosocial care approaches was needed for health workers to provide quality support to survivors during their medical exams. This new toolkit aims to respond to these specific gaps in the CCSAS multi-media training tool. The specific training topics included in this new toolkit have been developed to accompany and complement the original CCSAS multimedia training tool. The sections are meant to:
- Help health care providers develop the skills to confidently and competently respond to the psychosocial needs of sexual assault survivors when they seek treatment in a healthcare facility, and
- Enable providers to establish a relationship of trust with survivors. The set up of the toolkit allows facilitators to pick and choose topics to enhance their training on psychosocial care according to the specific needs of the training participants.
Please note that this toolkit is not a training module on comprehensive case management or complete psychosocial care. Instead, it reinforces the theme of survivor-centered care, which shows compassion for survivors while giving health care providers practical tools to understand, engage, assess, and refer survivors to relevant follow up care. A new module has been created with greater detail on how clinicians can provide survivor centered-care. We recommend trainers review the material as it will help answer some of participants’ questions. It also includes a section on self-care for providers dealing with the stress of working with survivors. This updated facilitators’ guide will refer to this new module where relevant throughout the training. However, the module is not part of the DVD.
Psychosocial Toolkit (English)
Psychosocial Toolkit (Arabic)
Un Outil de Formation Psychosocial (Francais)
Evaluating effectiveness of the Clinical Care for Sexual Assault Survivors Multimedia training tool in Humanitarian Settings: A multi-country evaluation of the CCSAS tool was carried out in 2012. The study aimed to evaluate the effectiveness of the CCSAS tool in diverse humanitarian settings worldwide. The CCSAS multimedia training tool demonstrated effectiveness in promoting compassion and competence among HCPs and improving quality of clinical care for sexual assault survivors in diverse humanitarian settings worldwide. The evaluation revealed limitations in the capacity of HCPs and quality of care for sexual assault survivors in low-resource settings. Aspects of the training that were more effective included respecting survivors’ universal rights, obtaining informed consent, conducting a medical history, performing a physical exam, and preparing the health facility, while training components focusing on beliefs about sexual assault, treatment and disease prevention, care for child survivors, and care for male survivors need to be improved. Finally, on-going technical support, long-term behavior change interventions, supply chain management, monitoring and evaluation, and interventions to raise awareness and identify survivors of sexual assault are needed in addition to the training to ensure quality clinical care is delivered to sexual assault survivors.
Multi-Country Evaluation (English)