8.8 Guidelines for Counseling on Sexual Coercion and Abuse

Part II: Guidelines for Client Services and Clinic Management

  1. Client Education On Sexual Coercion:
  2. Client Clinic Services and Counseling:
  3. Referral Requirements:
  4. Referral Follow-up Requirements:

In the IDHS Family Planning Program, coercive sex is defined as:

A sexual relationship in which a partner possesses an unhealthy dominance that causes submissive behavior, not consensual behavior. Elements of coercion may be deception, bribery, manipulation, violence or threat of violence, which control when, where and how to have sex.

The IDHS Family Planning Program supports the belief that sexual relationships between individuals should be established and maintained in a mutually respectful and healthy context. IDHS recognizes that individuals who are uncomfortable with or feel that harm may result to themselves from a sexual relationship should have the opportunity to express these concerns during a visit to a family planning clinic and should receive appropriate counseling and referrals. This opportunity should be available to clients regardless of their age, gender, sexual orientation, marital status, or race/ethnicity. Adolescents, in particular, are a population that may need additional information about consensual sexual relationships and strategies for resisting coercive encounters.

The IDHS Family Planning Program requires the following of its family planning clinics to assure that clients receive information and counseling about coercive relationships:

  1. Include general questions about abuse and sexual practices that may be indicative of an abusive or coercive relationship on intake questionnaires that are administered to all clients. This information should be reviewed during the individual education and counseling session with the client and documented in the client's record. Documentation should also include any referrals and follow-up information.
  2. Offer adolescents, and other clients, as appropriate, information that presents strategies for avoiding and/or resisting coercive sexual situations. Documentation that adolescents have been given this information must appear in the medical record.
  3. In each family planning clinic there should be at least one staff person who has advanced training in screening, interviewing, documenting and reporting suspected minor victims of sexual coercion. Upon hire and then annually, all Title X staff must be oriented to the State of Illinois Department of Human Services Family Planning Program's Sexual Coercion Training Module.
  4. Clinic staff members are required to have thorough training opportunities to ensure that the staff is aware of the legal reporting requirements, as well as confidentiality concerns, and how these may affect counseling encounters with clients.
  5. Each family planning clinic must maintain a directory of local resources to which clients may be referred and assure that staff are trained on the appropriate use of this directory. All referrals should be followed-up to be certain that a client's needs are being appropriately addressed through the referral process.
  6. Adolescents should be counseled about the potential benefit of involving their parents, caregivers, and/or other appropriate adult family members in supporting their efforts to establish non-coercive sexual relationships.

Client Education On Sexual Coercion:

All clients who visit an IDHS family planning clinic for an initial or annual visit, regardless of age or gender, should be offered appropriate written education materials on sexual coercion. Family planning staff should briefly review the material with the client and explain the term "coercive sexual relationship." The discussion with the client should also provide techniques to prevent or resolve coercive sexual situations.

Client Clinic Services and Counseling:

At each initial and annual visit to a family planning clinic, a client, regardless of age or gender, should be evaluated for her/his risk of being in a coercive/abusive sexual relationship. The visit intake process must include a mechanism to reveal abusive or coercive relationships. One suggested way of eliciting this information is by asking, "Have you ever been forced to have sex?" If the answer is yes, the client should receive appropriate counseling and referral. If the answer is no, prevention information may be given. This discussion may also elicit a client's concern about safety in a current relationship. Refer to Appendix M for Is Your Relationship Healthy?. This checklist may be used with clients to assist them in determining sexually coercive relationships.

All information should be documented in the client's medical record. On the physical exam section of the visit form, include a check box or other flag for the examiner to assess for physical, verbal or behavioral indicators of coercion and abuse, and a place for documentation of findings and follow-up needed.

Referral Requirements:

In the event that a family planning clinic is unable to provide a service, such as professional counseling, medical services related to abuse or rape, or other victim service, to a client who has revealed information about a coercive relationship or incident, the client should be provided with a written referral. Wherever possible, clients should be offered a choice of referral service providers. Each clinic site must develop a referral resource guide, which will be maintained and updated annually.

Pertinent information must be forwarded in written form to the referral provider with the appropriate written client consent. This must be documented on the medical record along with copies of the written documents and the reason for the referral. Any written information received from the referral provider must be filed in the client's medical record. Any verbal communication should be recorded in the medical record as well.

Referral Follow-up Requirements:

Determination of the extent of the follow-up should be based on the nature of the problem referred. Family planning staff should consider telephone follow-up with clients who are extremely nervous, upset, depressed, victims of abuse and other cases where additional support in completing the referral may be useful. Family planning staff may arrange for the client to call in to report that the referral contact is complete or have the referral provider make the report. If a pre-arranged follow-up visit or contact is missed, staff may call the client within a reasonable time to ascertain if the client needs further assistance.

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