Yarrow Place Rape and Sexual Assault Service is the lead public health unit responding to rape and sexual assault in Adelaide, South Australia.
One of our main roles is to resource other agencies and workers to provide quality services to people who have been raped and sexually assaulted. We do this by offering accredited and non-accredited training, information and support when working with adults who have been raped and sexually assaulted and working with other services in the metro and rural areas of South Australia.
Side menu
Support in responding to disclosure of rape or sexual assault
Information
about medical and legal options
Information about preserving forensic evidence
Yarrow Place Training
Employment at Yarrow Place
Rape and sexual assault can happen to anyone regardless of age, cultural background, sex, economic situation and sexuality. Your response as a trusted doctor or health worker to a victim of rape or sexual assault is very important. You can help them to feel more in control of what is happening. Below you will find guidelines in responding to someone who has told you they have been raped or sexually assaulted.
Believe them. False reports of rape and sexual assault are very rare.
Listen and hear what the person is saying to you. Acknowledge the pain. Don't get caught up in your own responses such as disgust or anger at the story told to you.
Let them know they are not to blame. No matter what they are wearing, how intoxicated they are, what they were doing or who they were with, rape or sexual assault is never the victim's fault. Beware of unintentional comments or questions that may be interpreted as implying responsibility (eg why were you there?).
Fear, shame, guilt, anger, frustration, panic, despair and calmness are all normal reactions. Let them know their feelings and reactions are OK. Take care not to minimise or discount how they feel.
Ask what might help them to feel safe and allow the person to have control and choice over what is happening to them. (Whether to involve the police, whether to contact a sexual assault service etc.)
Treat the person with dignity and respect. Confidentiality is important.
Respect the person's space - don't crowd or touch without permission.
Recognise and affirm the person's strengths and courage to disclose that they had been assaulted.
Give information about the options for further action.
Promote the concept of future recovery.
Remember - offenders may give plausible denials and may be pillars of society.
Not all victims of rape and sexual assault wish to take legal or police action. Some just want medical assessment and health care. Adults (16 years and over) should be allowed to make the decision about legal action themselves. They can report the crime any time (even years) after the assault. However, if they wish to have a forensic examination to assist them in taking legal action, the collection of evidence is usefully done within 1 week and ideally as soon as possible after the assault.
No legal action or a police report with no further action taken:
This option is for people who have been sexually assaulted and do not want to go through the legal process. They should be offered medical care to address concerns they may have in relation to the assault. Some of these concerns may include: pregnancy, sexually transmitted infections and the physical effects of the assault.
This medical care may be provided by:
Legal Action
If the decision is to take legal action, the person will be advised to have a forensic medical examination. This examination involves both medical care and the collection of forensic evidence which is important in the investigation of the assault. The forensic examination is generally only done up to a week after the alleged assault and is most useful if done within seventy two hours after the assault. The forensic examination can be a detailed and lengthy physical examination involving the taking of swabs for saliva and semen as well as samples of hair, blood and other substances.
In South Australia forensic medical examinations are performed by Yarrow Place as we are the only sexual assault service in the state. In rural areas there are general practitioners who have been trained to perform forensic medical examinations. Forensic medical examination summary sheet.
Undecided
People may find it difficult to make the decision about legal action and should be given the option of having the forensic specimens collected and stored until the decision is made. This examination also includes medical care. The procedure at Yarrow Place stores the forensic evidence collected in locked fridge for three months. After this, it is stored at the Forensic Science Centre for a further three months, after this time the evidence will be destroyed. This gives the victim up to 6 months to make a decision about reporting to the police.
Sometimes people choose to delay the forensic medical examination because they have more pressing needs such as arranging childcare, changing accommodation or needing to have a sleep.
The following information is provided to let you know what you can do to maximise the successful collection of forensic evidence when the examination is done, if there is to be a delay. This is only necessary if the person is considering legal action.
This section outlines the information required to preserve forensic evidence. Often people will already have performed a number of activities following the rape that may impact on the successful collection of evidence. Activities such as showering, douching and washing clothing are normal responses to rape and it is important not to make the person feel guilty for reacting in a normal way to the trauma of rape.
Oral rape or injuries
Ideally no food or drink until assessment by a doctor and oral specimens have been collected. The police can take the oral swab. If the person is uncertain about police involvement, contact Yarrow Place for advice.
Gloves
Gloves must be worn at all times to prevent contamination of evidence. Please explain to the person why this is necessary.
Toilet
The woman may urinate if necessary but should press her underpants to the vulva and anus before removing them to go to the toilet and should not wipe afterwards.
The person should be encouraged to avoid defecation if possible, if an anal rape has taken place. If this is not possible, request that the person press his/her underpants to the anus before removing them to go to the toilet.
Clothing
Leave clothes on if possible. If clothing needs to be removed:
Wounds
Record injuries carefully, being accurate with description of injury as this affects the interpretation of injury causation. Only clean those areas necessary for providing medical treatment. For example, clean wound edges prior to suturing. Record treatment given and procedures performed.
Lubricants
Use of lubricants should be minimised where possible if vaginal or rectal examination is done prior to performing a forensic medical examination.
Washing/showering
The person should be asked not to shower prior to the examination because some evidence may be lost. If this is not possible, ask the person not to wash those areas involved in the assault, for example for a vaginal assault, not to wash the genital area.
Contact Yarrow Place for advice if you are uncertain about preserving forensic evidence.
Medical care following an assault
All services and treatments provided at yarrow Place are free. This includes testing, ECP, prophylaxis provided on site.
Summary
Assessment of injuries
It is vital that any injuries are assessed and treated prior to the collection of forensic evidence. It is important in these circumstances that attending medical staff are aware of the need to preserve forensic evidence.
Many people are worried that they have been "damaged" as a result of a sexual assault. The reassurance of a thorough physical examination and information about the expected healing time of minor injuries can greatly allay these fears.
Provide information about options
As mentioned above give the person an explanation of their options in relation to medical care, legal action and counselling. If the person requests a Yarrow Place referral it is vital Yarrow Place be contacted to set up an appointment time.
Address concerns about pregnancy
For women who are not using reliable contraception, the emergency contraceptive pill (ECP) should be offered. There is now a marketed form of ECP available in Australia, Postinor-2. This is to be taken as a single stat dose of the two tablets. It is effective up to 5 days after unprotected sexual intercourse but is more effective when given as soon as possible after unprotected sexual intercourse. Postinor-2 is available without a prescription from chemists. However, it can cost around $25 and some chemists will not supply. Please check with local chemists and emergency departments for supply and cost.
A cheaper alternative for people on a concession card is to take 50 tablets of Microlut or Microval as a stat dose. This requires a prescription from a doctor.
Forensic paternity testing can be done on pregnancies diagnosed soon after a rape. Contact Yarrow Place for more information.
All women at risk of pregnancy should be encouraged to have a pregnancy test about 3 weeks after the sexual assault.
Address concerns about sexually transmitted infections (STI)
The probability of contracting an STI in South Australia is low, however it is important to encourage the person to return at appropriate intervals for STI testing. Also advise the person of safer sex practices until the results of testing taken at the appropriate intervals after the assault are available.
STI tests should only be taken after appropriate pre-test counselling and arrangements for results and post-test counselling are made.
STI Prophylaxis
The incidence of many STIs in South Australia is low. It is not considered necessary to give prophylactic medication for STI prevention as a matter of course, but people should be given information about prophylaxis and be allowed to make their own decision in relation to this. Prophylactic medication may be of more value in certain situations, for example, if:
Treatment options for STI prophylaxis
If prophylactic antibiotics are to be used the following regime may be considered:
This will cover chlamydia and to some extent gonorrhoea. It may also be appropriate to consider the use of an anti-fungal agent if the woman has a history of candida infections.
It there is a risk of contracting gonorrhoea, the following regime should be considered.
These options will cover pharyngeal, rectal and genital infections.
Post exposure hepatitis B prophylaxis
If the assailant is known to be a hepatitis B carrier, the following is recommended:
Consider checking the immune status of the victim.
If the status of the perpetrator is not known and not able to be tested, the risk of developing a hepatitis B infection should be discussed.
Post exposure HIV prophylaxis
HIV post exposure prophylaxis has proven to be effective in the occupational setting and it is reasonable to think that it would be effective for sexual exposure. The incidence of HIV/AIDS in South Australia is low and post sexual exposure prophylaxis is not indicated for the majority of sexual assault victims. However, it should be discussed and if the risk is increased, for example if the alleged perpetrator is known to be HIV positive or comes from a community where the incidence of HIV/AIDS is high, HIV post exposure prophylaxis should be offered.
Post exposure prophylaxis is available through the Emergency Department at the Royal Adelaide Hospital in South Australia (phone: 08 8222-4000). The medical officer should contact either the Infectious Diseases registrar on call or the Emergency Department to organise the referral. There may be a cost for this.
It is important to be aware that some medications and their side effects can interfere with the action of the Emergency Contraceptive Pill. This needs to be considered when prescribing prophylactic medications and when possible, the medication should eitherbe delayed until ECP has been taken or a medication which does not interfere with the action of the ECP be prescribed.
Address concerns about the physical and psychological effects of the assault.
People who have been sexually assaulted may experience a variety of physical symptoms.
It is important to:
Drugs, alcohol and sexual assault
Some people present with concerns that they have been drugged and sexually assaulted. A typical history is that a person has been out to a nightclub or party and feels intoxicated out of proportion to the amount of alcohol consumed. He/she may have no memory of events but wakes in a strange place and in circumstances that make him/her believe that he/she has been sexually assaulted.
In this situation people may request a medical examination and testing to determine whether or not they have been sexually assaulted. An examination should be offered but may not provide answers unless genital injuries are present. Testing for drugs and forensic testing for sperm and semen may be of value (but is not always conclusive) and should be offered. Note it is important to look test for drugs as soon as possible after an assault. Contact Yarrow Place for more information.
Offer follow up medical care/counselling
Not all people who have been sexually assaulted will want follow up medical care, but it should be offered for pregnancy testing, STI testing, review of injuries and an opportunity, if not already in place, to organise counselling services.
If the person develops what is thought to be a seroconversion illness for HIV, diagnostic PCR testing can be done at that time. This testing is not to be done for screening purposes.
Mandatory notification
In South Australia, under the Children's Protection Act 1993, notification must be made to the Child Abuse Report Line (ph: 131478) for people who have been sexually assaulted under the age of 18 years. A report must also be made where there is a suspicion on reasonable grounds that the child has been abused.
The law does not require proof of harm, but a notification must be accompanied by a statement of the observations, information and opinions upon which the suspicion is based.
Mandated notifiers are assured of confidentiality and are immune from civil liability and from allegations of any breach of professional ethics for reporting their suspicions in good faith.
Replace with information in “have you been raped” section?
Yarrow Place offers a number of accredited and non-accredited training programs for health workers. Forensic training courses are held several times a year.
These include:
Yarrow Place Training Programs aim to provide individuals with the necessary skills, knowledge and attitudes to undertake work in the area of rape and sexual assault. It is expected that appropriately trained workers will contribute to improving access, equity and quality of service provision to victim/survivors, and as a result reduce the negative health impacts of rape and sexual assault.
Yarrow Place training programs focus on a ‘victim’s rights’ perspective and are therefore aimed at empowering people who have experienced rape and sexual assault through practices that promote client self-determination. Yarrow Place acknowledges that in many instances, workers already possess the interpersonal skills needed, therefore facilitation is based on applying these skills in a rape and sexual assault context. Participants will be involved in exercises and activities that relate to their own work practices and experiences.
You can enrol online here.
Prerequisites : None
This course will enable participants with the knowledge, skills and attitudes necessary to provide appropriate responses to adults who have been raped or sexually assaulted. This involves an understanding of the context in which rape and sexual assault occurs; the ability to assess client needs and match them to services available; and supporting the rights of clients through the implementation of practices which promote client self-determination.
This course is available to both paid and unpaid workers in community services and health sectors. It is also available via distance learning should participants prefer this option.
DATES & LOCATION
COST
Face to face (assessment) $275
Face to face (no Assessment) $198
Distance (assessment) $264.00
Distance (no Assessment) $ 66
20% discount given to organisations where 2 or more people enrol.
50% discount
given for concession card holders
Recognition of Current Competency (RCC)
Participants who believe that they are already competent in any of the courses mentioned above, either through previous learning and/or current experience can apply for RCC.
Enrol in this course now.
Prerequisites: None
CPD Points: 50 (if completing assessment)
This course will equip participants with the necessary skills and knowledge to provide appropriate health care to adults who have been raped or sexually assaulted. This involves having an understanding of the context in which rape and sexual assault occurs: the impact this has on the victim/survivor’s health needs; and the ability to provide medical intervention whilst upholding the rights and interests of the individual.
This accredited short course is open to individuals who provide health care as an integral part of their work role (ie general practitioners, nurses, community health workers and Indigenous health workers). This course is also offered via distance learning, should participants prefer this option.
DATES & LOCATION
COST
Face to face (assessment) $297.00
Face to face (no Assessment) $220.00
Distance (assessment) $286.00
Distance (no Assessment) $ 66
20% discount given to organisations where 2 or more people enrol.
50% discount
given for concession card holders
Recognition of Current Competency (RCC)
Participants who believe that they are already competent in any of the courses mentioned above, either through previous learning and/or current experience can apply for RCC.
Enrol in this course now.
Prerequisites : None
CPD Points : 50 (if completing assessment)
This course will equip participants with the necessary competencies to provide forensic services, in order for legal action to be taken. It outlines the skills, knowledge and attitudes required to collect and maintain evidence while upholding the rights and interests of adults who have been raped or sexually assaulted. It also allows participants the opportunity to give evidence in court.
This accredited short course is open to individuals who want to or already provide forensic services to adult survivors of rape or sexual assault. This course is also offered via distance learning should participants prefer this option.
DATES & LOCATION
COST
Face to face (assessment) $297.00
Face to face (no Assessment) $220.00
Distance (assessment) $286.00
Distance (no Assessment) $ 66
20% discount given to organisations where 2 or
more people enrol.
50% discount given for concession card holders
Recognition of Current Competency (RCC)
Participants who believe that they are already competent in any of the courses mentioned above, either through previous learning and/or current experience can apply for RCC.
Enrol in this course now.
After Hours Doctors Panel
Yarrow Place is currently looking for doctors to be part of the after hours crisis response service. The following information is provided for doctors considering this work.
After Hours Call Outs
Yarrow Place provides a dual response to a person who has been recently raped. The crisis counsellor takes the initial call and will liaise with the doctor to set up a crisis response at the Women's and Children's Hospital. The aim is to provide a service within 2 hours of the doctor being contacted. Clients are seen in the Day Surgery Unit at WCH. Parking is available at the WCH for doctors.
Very occasionally clients are seen at another hospital if the client has been admitted there or if their injuries are such that it is considered inadvisable to move them.
The counsellor is responsible for organising the response, providing information about legal, medical and counselling options to the client and supporting the client through the examination. The counsellor will also address practical needs such as accommodation.
The doctor is responsible for providing medical care and the forensic examination. Medical care includes assessment and care of injuries not requiring casualty attendance, risk assessment, pregnancy, STI prophylaxis and assessment of psychological risk and safety. The forensic examination entails the careful examination and documentation of all injuries and the taking of relevant forensic specimens for analysis. Generally the whole intervention takes between 2 and 3 hours. This includes the drying and packaging of forensic specimens and writing up the medical examination.
Court availability
A doctor is only likely to go to court in between 5-10% of cases. Doctors are encouraged to attend expert witness training (part of the forensic training course) to prepare for this and they can be supported by an experienced doctor the first few times they are called to give evidence.
Rosters and time commitment
Rosters are flexible and are created on a monthly basis. Doctors can choose to nominate a set day each month or they can choose shifts to fit in around their other commitments. Week night shifts run from 5.30pm to 8.30am the next morning. Weekends and public holidays are divided into 12 hour shifts between 8.30am to 8.30pm and then 8.30pm to 8.30am the next morning. Overall, doctors can expect to be called out one in every 3 rosters, however the weekends are when more call outs are likely to happen. Three (3) shifts a month is optimum to maintain competence in the forensic examination, however doctors can choose to do fewer than this.
Pay and Conditions
The pay and conditions are dependent on qualifications, experience and work outside Yarrow Place.
Further information
Workingon the after hours panel is rewarding, varied, interesting and surprisingly straightforward. If you would like to discuss this further, please contact the Medical Coordinator, at Yarrow Place on 08 8226-8777.