Kate is 18 years old and has a history of running away from home. For the last three weeks she has been sleeping rough or in shelters when she gets a place. She was living with her mother and her mother’s boyfriend, who is the reason she gives for running away.
She has bruising and swelling to her face and scratches to her knees and elbows. She tells you someone bashed her last night but she will not talk about it. She only wants help to get a regular place in a homeless shelter and money to buy the ‘morning after pill’. She appears to be very agitated and tearful. She is extremely nervous and frightened.
It is important to recognise that Kate is in this situation because she likely feels it is her only choice. You understand that the situation at home is intolerable for her. Young women often run away because of abuse (physical, emotional or sexual), and it is likely to have been going on for some time for her to have considered this course of action. She may have been on the streets for several months or years, but you understand that she may not wish to talk about this right now, and do not press it.
Because Kate asks about emergency contraception, you realise that a sexual act has taken place. You are concerned whether this may have been consensual or not. She may have been selling sex to get money (for food, shelter, alcohol or drugs), or she may be in an ongoing sexual relationship. This will need to be explored carefully, as she will be fearful of criminal charges relating to prostitution or substance use. You assure her that whatever her situation, it does not give someone the right to beat her or sexually assault her in any way. Many abuse survivors and homeless women, whether working in the sex industry or not, use alcohol or other substances to make their situation more tolerable, or to numb their painful experiences. Kate may or may not wish to report any sexual assault to the police – this should be explored with compassionate understanding. Kate should be given any information she might need to make a decision about reporting and be supported in her decision. As you are unsure about the legal processes, you obtain assistance from 1800RESPECT or from the sexual assault phone line in your state or territory.
Kate’s priorities are her personal safety and stopping a pregnancy, and you acknowledge these practical concerns, but tell her you are also concerned she may have other injuries that need to be looked after. She may have internal damage or others injuries that cannot be seen by you.
The physical assault may be unrelated, but you also understand that you cannot make any assumptions about whether she may want to report it to the police and that this is separate to her decision to report any sexual assault. You talk to her about this.
In some states and territories, there are other options for people who do not wish to formally report to the police. You check with the sexual assault counselling service in your state or territory for information about whether there is a Sexual Assault Reporting Option questionnaire or Investigation Kit available, which may make it easier for Kate to provide information to the police, and help them identify the offender, should she wish to take action later.
If Kate thinks she may wish to report the assault at a later date, it would be beneficial for her to have had a forensic medical examination. You explain to her that this is a special medical examination that can only be conducted by specifically-trained doctors and nurses. Its purpose is to collect any physical evidence and specimens that may be used as evidence if criminal charges are laid. This is done best within 72 hours of the sexual assault, but can be done up to a week after, depending upon the assault. The results of the forensic examination can be kept for up to three months.