This article describes the Engage, Motivate, Protect, Organize, self-Worth, Educate, Respect (EMPOWER) Clinic for Survivors of Sex Trafficking and Sexual Violence located at Gouverneur Health in New York, New York, as a model for integrated gynecologic and psychiatric care of survivors of sexual and gender-based violence. Although patients with a history of sexual trauma often have critical health needs that persist long after the traumatic event, most existing services for survivors of sexual violence focus solely on the provision of acute care immediately after the violence has occurred. There are very few clinics in the United States dedicated to managing the significant long-term medical consequences and sequelae of sexual violence in a trauma-informed setting. We report on best practices for the provision of trauma-sensitive medical care to this patient population based on those employed at the EMPOWER Clinic. In particular, we outline some of the unique considerations for treating survivors relating to taking a patient history, conducting the physical and gynecologic examinations, ensuring confidentiality, and managing legal issues. Finally, we reflect on the challenges faced in sustaining the EMPOWER Clinic and the importance of the existence of a clinic dedicated to this specific population.
Introduction
Despite global improvements in maternal health, disparities in maternal mortality rates in the United States have worsened in recent years. Community health workers (CHWs) as maternal health educators have previously been studied in low‐ and middle‐income countries, however their use in the United States has been limited.
Methodology
To address the ongoing disparities in maternal mortality, we conducted a mixed methods pilot study consisting of discussion groups and a written survey with CHWs in two boroughs in NYC. The study's goal was to identify and explore CHW professional training, their daily tasks, and roles as well as their insights and perspectives regarding the needs of their pregnant clients.
Results
Eighteen CHWs participated in the discussion groups and 11 participated in the survey. Participants were predominantly Black and/or Latina. Key themes were very consistent across group discussion and survey data. Major themes were a lack of standardized training for CHWs on basic maternal health topics, the existence of racism and bias in the provision of care for Black and other minority individuals, along with pregnant peoples’ needs for support to better advocate to overcome systemic barriers.
Conclusion
This study suggests that targeted maternal health training of CHWs is needed to better enable them to identify pregnancy risks and advance health literacy and promote self‐advocacy among their pregnant clients. This will ultimately yield a more effective CHW workforce and better health outcomes for pregnant people.
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