Health and Wellness Information:
Providing Survivor-Sensitive Treatment and Support

Working with people who have complex and often extreme histories of exploitation has given us some important insights about extending effective healthcare for people in the sex industries, and for survivors of trauma. Above all it is important to understand that the majority of people who suffer from drug abuse and addiction have a history of trauma, oppression, and poverty, and have often experienced the effects of racism as well.

Survivors may come from communities that are traditionally considered economically and politically powerless, and may lack the sense of entitlement to utilize community resources and push past the prejudice with which they have experienced. Survivors may come from families in which they were betrayed by those they trusted, including people in authority. These circumstances may have contributed to an unstable lifestyle, populated with unstable relationships, thus making it hard to establish a support system that could be trusted or relied upon.
We believe that our SAGE clients deserve a profound level of safety relative to mind, body, thoughts, emotions, and relationships. A confrontational approach is unlikely to be effective (particularly with women and youth), so SAGE takes an empowerment approach. We provide services which support a client's self-esteem, confidence and ability to take charge of their recovery. SAGE creates a supportive space to establish safety and experience remembering, reconnecting, and grieving.

Every aspect of treatment is voluntary, and we try to provide as much information as a client needs about the physical and mental conditions we treat, and about the "whole health" techniques we use.

We also want anyone who comes to us to know that we respect and understand the importance of triggers, sensitivities, and boundaries. A SAGE client never deserves to feel ashamed or awkward about communicating what’s hard for them, what they want, or what they would rather do or not do. At SAGE, it's vital to create an atmosphere in which it's okay to ask questions!

Suggestions for Providers Working With CSE Survivors

We offer the following suggestions to service providers wanting to work with survivors of trauma, addiction or exploitation:

• Practitioners providing resources to trauma survivors need to have very good, clear boundaries, and create ‘self-care plans’ to manage overwhelm and burnout.
  


• Creating a structure which gives clients support for self-advocacy or autonomy is important. Some means to do this include “Patient’s Rights” information, educational materials about treatment, clear posting of grievance policies and non-discrimination policies, clear information about confidentiality, and providing accessible materials across language and disability needs.
  


• Careful disclosure about even very minor health risks, discomfort, or side effects of treatment is crucial. Even if a treatment is completely well-intentioned and otherwise appropriate, failing to give a client options and information can result in a sense of betrayal or increased powerlessness.
  


• It can be very important to offer clients reassurance that it is completely okay to ask for information, to decline any kind of treatment, protect privacy, or to take time considering options. Asking questions like “Do you feel able to let me know if you need help with this?” can be a good way to identify whether more reassurance or invitation is wanted or needed.
  


• Keep in mind that survivors of homelessness, incarceration, or violence may have difficulty maintaining or establishing boundaries. Practitioners need to be prepared for and respectful of the emotions behind intense or sudden disclosure, wariness or expressions of anxiety or distrust. If practitioners become reactive or display shock or disbelief, this can increase feelings of fear, shame and alienation many survivors are already experiencing.
  


• Asking questions or requesting permission for any increased degree of touch, for introduction of new elements into the health process (such as music or aromatherapy), or for involvement of anyone besides the primary practitioners in healing interactions is very important. It’s never a good idea to take for granted what a client will be comfortable about or okay with.
  


• Being sensitive to body language, facial expressions, or subtle cues about discomfort or fear are important. It’s always important to keep in mind that not all clients will be empowered to express distress or discomfort, and may have varied means of communicating.
  


• Keep in mind that there is no possible way to avoid every possible trigger someone may have—particularly since trauma survivors have such varied experiences and coping skills. However it’s crucial to respect and work to understand that what for one person is normal and helpful, for another may be frightening or feel unsafe. Treatment needs to be organized around and in response to the client’s individual needs, communication skills, and boundaries.