HJAR Sep/Oct 2024

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2024 17 clicking through it, and so forth. Are those people engaged?Are they really taking it in? Is it really creating change in thoughts and behaviors and beliefs and attitudes? That's the side we're not asking enough. We're not looking at that part enough. We kind of just go through the motions in general. I think that any systemic approach toward addressing sexual relationship violence can always use improvements, and I think a big part of that improvement is making education more engaging, impactful, and meaningful to the audience. Editor You have the ear of the healthcare industry right now. With a quarter of the women that they're seeing being victims of sexual assault, rape, or attempted rape, what do they need to know about caring for such a huge part of the population, on such a sensitive topic, in a 15-minute appointment. How do you get to the root of some of the symptoms this person's having that she doesn't even realize are associated with a trauma? Wyandt-Hiebert I think appropriate screening techniques can help. So often, when I go to a medical provider's office, I have to fill in some kind of form. A lot of them are electronic these days, and they'll send them to you before you get there. I think having a couple of screening questions, "Have you ever experienced this or that ...” or however you want to state it, and when you see affirmations to those, then that's a flag that should generate dialogue as part of that visit. It may require extending that visit a lit- tle bit or a follow-up appointment to see what's going on. I think that those flags should not be ignored. It's a prime oppor- tunity because people trust their medical providers, and medical providers have a great opportunity through screening ques- tions to identify victimization. They have the opportunity to help that victim to process. Have they received help? Are they in need of help?Where are they in their healing pro- cess along their journey? I use the term “victim” for those indi- viduals who are still being victimized by their experience, when their experience is still having control over their life, their daily activities. I tend to reserve the term “survivor” for those who have truly got- ten to that point where they've integrated what happened to them into their life and they're living the “new normal.” It's not to say they won't ever have those moments when they think about it, but when they do, it's not consuming their entire afternoon, their entire day. They have their moment, and then they move on from it the rest of the day. If people want to use victim or sur- vivor interchangeably, that's fine too. I'm not going to tell somebody who comes into my office if they're using the term survivor, "No, you're not a survivor yet because you haven't done this." I mean, if that's where they're at, and that's a term that empowers them, by all means, use what terminology is comfortable for the individual. That's part of trauma-informed prac- tice — identifying where those individuals are and what terminology they’re comfort- able with. It’s also important to have a real conversation with yourself before starting to engage in all of this. Where are you with this? How comfortable are you with talking about sexual violence, and if you're not, then how can that be changed?What can you do as a provider to become more comfortable and more knowledgeable about sexual vio- lence so that you can have those conversa- tions? And if you're not there yet, who can you rely on when you see that flag go up? Is there another provider or support staff that can help? Medical providers are in a unique posi- tion to help identify past victimizations, whether they occurred last night, a week ago, a month ago, a year ago, 10 years ago. So many individuals are walking around for years, decades with trauma that they never really have been able to fully process and are still victimized by it to this day. Editor Are there certain signs with rape specifically that, say, a female might exhibit to a physician as trauma related, even if she doesn't check the box? Wyandt-Hiebert There may be things that an individual, in general, whether they're a female or not, [may exhibit]. If they're anxious when one goes to touch them ... I'm a firmbeliever, too, that the providers should always ask permission to touch before they do something — not just come in and do their thing. I think sometimes individuals get complacent in their professions; and that’s not just medical providers, that's everybody. Sometimes we get wrapped up with whatever it is that we do, and people tend to get complacent and forget. Again, that's not a very trauma-informed environment then. I think before you listen to somebody's heart, you shouldn't just tell them, "I'm going to listen to your heart." I mean, "Is it OK if I listen to your heart?" Giving them that autonomy, that sense of being able to say yes or no, is important. Part of consent culture is teaching consent as well. We need to practice what we preach. If you go to listen to somebody’s heart, for example, and they're flinching and pulling back from you, what's going on here?That’s unusual. When most people see the stetho- scope coming toward their chest, they know what's coming; but if somebody flinches back, what's going on here? Those types of things, anything that's an unusual reaction to what you would customarily expect to happen, would be a sign. Start thinking like that. There may be something more going on, and it may be an option to say, "Oh, I'm sorry, I didn't mean to startle you. Is there something you want to talk about?" Or, "I'm a safe space here if you want to talk about anything. It's OK to talk about any- thing here." And just kind of lead into those questions. Ultimately, they have the choice as to whether they want to talk about some- thing or not, but those are just some things to think about. Editor How common is revictimization? Wyandt-Hiebert In the sense that somebody