Closing the gap in gender-based violence care

St. Joseph’s Health Care London (St. Joseph’s) is breaking new ground in Canada with the creation of a specialized primary care clinic for survivors of domestic violence, sexual assault and other forms of trauma.

The Trauma and Violence Specialized Primary Care Clinic, with a key focus on care for women and children affected by sexual assault, abuse, sex trafficking and intimate partner violence, will fill a significant gap in the community, particularly for racialized individuals, those with disabilities, immigrants and refugees, and 2SLGBTQIA+ people.

“The need for a specialized trauma and violence-informed clinic is urgent,” says Dr. Susan McNair, a family doctor and Medical Director of the Regional Sexual Assault and Domestic Violence Treatment (SADVT) Program at St. Joseph’s. “Trauma often extends beyond a specific event or experience, profoundly disrupting a person’s sense of safety, connection and ability to function. Early-life trauma, such as sexual abuse and exposure to domestic violence, significantly increases the risk of chronic health conditions, substance use, and cycles of abuse that persist across generations.”

Yet many survivors do not have access to primary care, she adds. More than half of individuals seeking care at St. Joseph’s SADVT Program lack a primary care provider. 

Similarly, among the most frequent users of St. Joseph’s Urgent Care Centre – often a pathway to the SADVT Program – more than 25 percent don’t have a family doctor.

Primary care serves as the first access point and safety net for people seeking help for many conditions that may be rooted in or exacerbated by experiences in trauma. To meet this need, the Trauma and Violence Specialized Primary Care Clinic will provide care for people of all ages, promote early-intervention and foster safety and well-being to prevent recurrence of trauma. Part of this work will be helping patients understand the role of trauma in their life, and the importance of reducing self-blame and shame. Education to empower survivors to make choices that promote wellness, healthy attitudes and relationship skills is vital.

“Without culturally safe, trauma-informed care, these individuals remain at high risk of avoidable emergency use, chronic illness, and worsening health problems,” says Cassandra Fisher, Clinical Manager of St. Joseph’s SADVT Program.

The new clinic, adds Fisher, will integrate physical, mental and social health supports to meet complex needs.

“It will focus on building trust with each individual to transform primary care into a healing, equitable space for those most impacted by trauma and violence. Knowing that people experiencing trauma and violence often delay seeking initial and follow-up care, building this trust is critical.”

Setting the clinic apart nationally is the integration of clinical care, teaching and research - all grounded in trauma-and-violence-informed care. This will include on-site teaching of health care students rotating through the clinic, interdisciplinary research, and robust evaluation of health outcomes, patient and provider experiences, and the potential to replicate this unique model of care.

“By investing in this model, we are not only supporting the immediate, vital service of providing primary care for unattached individuals, but also seeding a region-wide shift in how we think about and deliver primary care for vulnerable individuals: one that is safer, more inclusive, and rooted in equity and healing,” says McNair.

The initial phase of the clinic, expected to open in the coming months, will serve patients referred from St. Joseph’s programs who fit the criteria.

Funding for the Trauma and Violence Specialized Primary Care Clinic has been established through a $3.82M investment from the Ministry of Children, Community and Social Services.

St. Joseph’s has a long history of providing expert care for people of any age, gender or sexual identity experiencing sexual assault and/or domestic violence living in Oxford, Elgin, Huron-Perth and Middlesex counties. The SADVT Program, with a team of highly specialized nurses, doctors and socials workers, has been a leader in this work since the program was established in 1992. With the launch of the Trauma and Violence Specialized Primary Care Clinic, St. Joseph’s is building upon that strong foundation of expertise and compassion.

Sobering stats

Since 2021, Canada has seen a troubling rise in sexual and domestic violence. The following is a snapshot of this growing crisis:

• 123,319 victims of intimate partner violence, aged 12 and older, were reported to police in 2023 in Canada.
• Reported cases in Ontario in 2023 were 41,991 – a 4.7 per cent increase from 2022 reported numbers. Of these victims, 78 per cent were women and girls.
• In Canada, 30 per cent of all women aged 15 and older have reported experiencing sexual assault at least once in their lifetime.  
• 29 per cent of women belonging to an ethno-cultural group designated as a visible minority reported experiencing some form of psychological, physical, or sexual violence committed by an intimate partner since the age of 15.
• 43 per cent of indigenous women age 15 and older have reported experiencing sexual assault at least once in their lifetime.
• 67 per cent of 2SLGBTQIA+ women age 15 and older have reported experiencing at least one type of intimate partner violence.
• Young women ages 15-24 are five times more likely to experience a sexual assault.
• Child sexual exploitation in Canada increased by 59 per cent from 2022 to 2023.
• Child pornography cases accounted for 87 per cent of all online child sexual exploitation incidents in 2023.