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Serving Transgender Victims of Sexual Assault
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Transgender 101Sexual Assault in the Transgender CommunityTips For Those Who Serve Victims
June 2014
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Perpetrator Issues

Companions as Abusers

Many transgender people feel safer if they are accompanied by a loved one in health care or other settings. These companions can be helpful not only to the victim but to the professionals involved as well, and they often provide valuable information. At the same time, it is critical to remember that abusers sometimes escort their victims when they seek care to intimidate them and control what is revealed. As with other sexual assault survivors, the vast majority of perpetrators are known to their victims. According to FORGE's survey of survivors of sexual violence, perpetrators were usually a family member (40 percent), "someone else you knew," (35 percent), an intimate partner (29 percent), or "a date" (20 percent). Only 25 percent were assaulted by a stranger.32

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As stated above, many people are sexually assaulted by their partners, including by partners who are female and/or transgender. Transgender people may be less likely than non-transgender people to leave sexually abusive partners due to a fear—often perpetuated by others, including other transgender people—that it is extremely difficult for transgender people to find loving, respectful partners. Those who are assaulted by a transgender individual may hesitate to report for fear of the treatment the offender may receive from law enforcement, health care providers, mutual acquaintances, and/or family members.

If a victim is accompanied by someone to the emergency room or another facility after an assault, screen the victim privately to ensure that the companion is not the abuser.

Implications and Actions for ...

Health Care Providers

Abusive companions often try to control how much the victim says by accompanying their victims when they seek medical care. Ask patients privately about the perpetrator of their abuse to ensure that the people who have accompanied them to exams are not the ones who assaulted them. To screen patients privately, consider asking companions to complete administrative forms in a separate room.1

Many agencies and organizations already have screening policies in place regarding partner and family abuse. Some hospitals and other facilities have implemented screening of all patients, asking several brief questions about past or current abuse (family, partner, stranger, others). The types of questions you ask will depend on the patient's age, current physical and psychological state, ability to communicate effectively, and need for acute medical care that supersedes screening. The circumstances of the patient's arrival at the facility and the nature of the crime that occurred should also guide your questions. For example, it may be less necessary to screen a friend accompanying a patient to the emergency room if the patient and friend were both victims and there are other witnesses as noted by law enforcement officers, who also arrive at the emergency room.

Abuser's Use of Hormones

When a transgender person is the abuser, hormones may be used as an excuse for the abuse. For example, one survivor said of her perpetrator, "He was FTM [female-to-male]. He used him being on testosterone as one of the excuses for his 'needs'" (FORGE, 2005, Sexual Violence in the Transgender Community Survey, quotation from narrative response).


During the screening, ask direct, nonjudgmental questions. To normalize the process, inform the patient that everyone is asked these screening questions. Because many transgender people have encountered providers who correlate transgender identity with abuse history, make sure that your questions do not imply that being transgender and having a history of sexual assault or abuse are related.

Screening questions could be as simple and direct as "Do you feel safe at home?" or "Does anyone in your life hurt, hit, or threaten you?" or "Is there any reason you may feel uncomfortable or unable to openly answer questions while your companion is present?"

Keep in mind that some transgender relationships involve power and control tactics that do not apply in non-transgender relationships (e.g., claiming that rough sex is normal, threatening to out the person, controlling access to the person's hormones). Ask even more specific questions if you see signs of some of these tactics in the screening interview.

The screening process should be thorough, yet brief. Transgender victims of sexual assault often rely heavily on their companions for emotional support and safety and should be quickly reunited with them if no danger is present.

If you determine that the companion, partner, loved one, or family member is the perpetrator, privately talk with the patient about what options are available to ensure that the patient is and will remain safe. If the perpetrator is not currently with the patient but will be after treatment, safety planning is highly recommended. Partner with a victim advocate or a victim service provider to ensure that the patient is aware of available safety planning options. (More information on safety planning is in Implications and Actions for Advocates.)

States have varying mandatory reporting requirements about domestic violence and sexual abuse; it is vital that you remain up to date regarding the requirements of your profession and local laws.

1. Mayor’s Office to Combat Domestic Violence, 2004, Medical Providers’ Guide to Managing the Care of Domestic Violence Patients within a Cultural Context, 2d ed., New York, NY: New York City Mayor’s Office, accessed April 22, 2013.

Emergency Medical Personnel

You may be called to a scene or hospital directly following a sexual assault. In some cases, the patient’s intimate partner, spouse, or date may be the perpetrator and may be with the patient. In these cases, the perpetrator might be acting supportive and loving and it may be difficult to recognize that the intimate partner is actually the abuser. Learning screening methods to help identify perpetrators is essential for victim safety in both the short and long term. Each individual should be questioned (briefly) in isolation, to help determine if the perpetrator is present.

If the companion is the perpetrator (or if the perpetrator is still in an active role in the patient’s life), it is important that safety planning discussions take place. Partner with a victim advocate or a victim service provider to ensure that the patient is aware of available safety planning options. (More information on safety planning is in Implications and Actions for Advocates.)

Law Enforcement

You may be called to a scene or hospital directly following a sexual assault. In some cases, the victim's intimate partner, spouse, or date may be the perpetrator and may be with the victim. In these cases, the perpetrator might be acting supportive and loving and it may be difficult to recognize that the intimate partner is actually the abuser. Learning screening methods to help identify perpetrators is essential for victim safety in both the short and long term. Each individual should be questioned (briefly) in isolation, to help determine if the perpetrator is present.

If the companion is the perpetrator (or if the perpetrator is still in an active role in the victim's life), it is important that safety planning discussions take place. Partner with a victim advocate or a victim service provider to ensure that the patient is aware of available safety planning options. (More information on safety planning is in Implications and Actions for Advocates.)

Advocates

If the person accompanying a victim for medical or other services is determined to be the perpetrator, safety planning is a must. Safety planning typically includes a predetermined course of action that victims can take if they need to escape from an unsafe environment or situation. Safety planning is always necessary in emergency situations but is also important to review with clients who have a history of abuse or assault. Augment the typical safety planning questions with reminders that they may also need to pack or secure alternate supplies of hormones and prostheses and copies of supporting documents or "carry letters" (documentation from a mental health therapist or a physician saying the patient is in the process of transitioning).

If you are uncomfortable or unaccustomed to assisting patients with safety planning, many agencies are available to help. Knowing local referrals to transgender-inclusive, anti-violence agencies is essential to better serve patients who have been or are being abused. If local referrals are unavailable, contact FORGE for direct technical support and referrals or contact the LGBT anti-violence program nearest you for a referral (see the National Coalition of Anti-Violence Program's Web site for a list of local programs).

Therapists

Abusive companions often try to control how much the victim says by accompanying their victims when they seek care. Ask clients privately about the perpetrator of their abuse to ensure that the people who have accompanied them are not the ones who assaulted them.

Many agencies and organizations already have screening policies in place regarding partner and family abuse. Some facilities have implemented screening of all clients, asking several brief questions about past or current abuse (family, partner, stranger, others). The types of questions you ask will depend on the client’s age, current physical and psychological state, ability to communicate effectively, and need for acute care that supersedes screening.

During the screening, ask direct, nonjudgmental questions. To normalize the process, inform the client that everyone is asked these screening questions. Because many transgender people have encountered providers who correlate transgender identity with abuse history, make sure that your questions do not imply that being transgender and having a history of sexual assault or abuse are related.

Screening questions could be as simple and direct as "Do you feel safe at home?" or "Does anyone in your life hurt, hit, or threaten you?" or "Is there any reason you may feel uncomfortable or unable to openly answer questions while your companion is present?"

Keep in mind that some transgender relationships involve power and control tactics that do not apply in non-transgender relationships (e.g., claiming that rough sex is normal, threatening to out the person, controlling access to the person’s hormones). Ask even more specific questions if you see signs of some of these tactics in the screening interview.

The screening process should be thorough, yet brief. Transgender victims of sexual assault often rely heavily on their companions for emotional support and safety and should be quickly reunited with them if no danger is present.

If you determine that the companion, partner, loved one, or family member is the perpetrator, privately talk with the client about what options are available to ensure that the client is and will remain safe. If the perpetrator is not currently with the client but will be after treatment, safety planning is highly recommended. Partner with a victim advocate or a victim service provider to ensure that the client is aware of available safety planning options. (More information on safety planning is in Implications and Actions for Advocates.)

States have varying mandatory reporting requirements about domestic violence and sexual abuse; it is vital that you remain up to date regarding the requirements of your profession and local laws.

Support Group Facilitators

Although rare, it is possible in any support group setting for an abusive partner to try to access the same support services as the victim. For this reason, consider screening all potential participants carefully. If a transgender survivor in your group was sexually assaulted by an intimate partner, it is critical that one-on-one safety planning discussions take place whether they are still in a relationship with the abusive partner or not.

Privately talk with the client about what options are available to ensure that the client is and will remain safe. In addition, partner with a victim advocate or a victim service provider to ensure that the client is aware of available safety planning options. (More information on safety planning is in Implications and Actions for Advocates.)