Implementing Screening and Treatment Guidelines for Sexual Assault at a Student Health Center

It is estimated that nearly half of all females in the United States will be victims of sexual assault sometime in their lifetime. College-aged individuals are at a particularly increased risk. Sexual assault can lead to a myriad of serious acute and chronic medical conditions that can largely be minimized through early identification and proper care. Unfortunately, most victims of sexual assault do not receive timely, comprehensive medical care, in part due to high rates of underreporting. Despite established recommendations to routinely screen for sexual assault, research reveals that providers rarely do so. Implementing a screening and treatment protocol will aid primary care providers at a university student health center in identifying and providing trauma-informed, comprehensive care to sexual assault patients. Local Problem: There were no screening or treatment protocols for sexual assault at the University of Utah Student Health Center. Providers did not feel confident in their ability to screen or treat for sexual assault appropriately and rarely did so. Methods: A quality improvement (QI) project was developed to improve the frequency of screening for sexual assault and its subsequent treatment. An intervention was developed that included an educational training session, surveys, a screening tool, a sexual assault treatment protocol, a workflow diagram, and provider and patient resources. Interventions: The protocol was presented, discussed, and adjusted during a regularly scheduled all-staff meeting. The surveys were administered pre- and post-intervention. The screening and treatment protocol was implemented over a six-week trial period. Minor adjustments were made to the protocol based on provider feedback during the implementation period. Results: It was found that providers screened for sexual assault during 11% of the recommended screening opportunities during the intervention period. Out of 285 screening opportunities, there were 32 completed screens, with four being positive (13%). This positive rate is consistent with the national rate of sexual assault among college students, demonstrating that the screening tool worked as intended. All positive cases were from STI encounters. Every patient who screened positive was offered appropriate resources and treatment. Between pre- and post-intervention surveys, there was a positive increase in the number of providers who sometimes screened for sexual assault (50% to 83%, n=6). All providers who fully participated in the intervention felt confident in their ability to screen for and treat sexual assault patients (n=5). All providers who responded to the post-survey felt the protocol was easy to use and highly useful. They all intended to continue its use. Conclusion: This QI project was partially successful in improving the screening frequency and treatment for sexual assault patients at this clinic. It also demonstrated the efficacy of the screening tool used. Further QI cycles are needed to address the ongoing barriers to screening for sexual assault at this site and other institutions.