The Essential Role of the Survivor Advocate

While reporting a few months ago on sexual assault forensic exams, it became abundantly clear the vital role of the survivor advocate during a survivor’s time in the emergency room. “Everyday superheroes,” the nurse I interviewed called them with appreciation, “a life raft on one of the hardest days of someone’s life.”

A survivor advocate is a trained volunteer who provides practical and emotional support, crisis counseling, and helps a survivor navigate medical, legal, and other systems they come into contact with during their time in the emergency room. These advocates work in on-call shifts, often living within a certain distance of their local hospital in order to be able to show up within 30 minutes and accompany the survivor throughout their entire time in the ER. Just as every survivor’s experience and response to trauma will look different, so too will every advocate’s interaction with a survivor based on what they choose to pursue while in the emergency room.

“It’s so important to have that support at any point in a survivor’s healing, but specifically when you’re in the emergency department after a traumatic event has occurred,” shares Gwenn Gideon, a licensed social worker and Program Coordinator of New York- Presbyterian Hospital’s Victim Intervention Program. “It’s overwhelming. Survivors are dealing with so many different factors and systems coming in and out, and so having one person [an advocate] be that constant for you and be able — in a trauma-informed, empathetic way — walk you through what your options are and meeting you where you’re at, it can have a lasting impact on your healing journey.”

When a survivor discloses in the emergency room that they’ve been assaulted, they’re offered the services of a survivor advocate to come and be with them during their time there. If they say yes to this, an advocate will arrive shortly after and will provide a multitude of services including:

• Answering questions about all the resources available to the survivor during their time in the emergency room. These resources include services such as receiving medication to prevent or treat any communicable diseases or infections, as well as prevent pregnancy, medically treating any injuries, collecting evidence for a forensic evidence kit, or reporting their assault to law enforcement.
• Bringing the survivor food, water, clothing, or blankets.
• Being present and providing comfort, in whatever form that the survivor asks for, during a survivor’s sexual assault forensic exam.
• Acting as a liaison between the medical staff, law enforcement, and the survivor. This can include things such as asking for breaks when the survivor becomes overwhelmed during an interview or asking for further explanation if the survivor seems confused by the next step of the forensic exam.
• Provide information on further resources the survivor can explore after leaving the emergency room.
• Talk with the survivor about whatever topics provide them comfort in that moment. For some survivors this might be talking about their assault and unpacking some of their initial emotions around it, and for some that might mean talking about the weather or reality television!
• Helping the survivor with paperwork and providing resources to get home safely.

Throughout all of these services, an advocate’s mission is to make a survivor’s time in the emergency room as navigable as possible, and to reaffirm in this first interaction that a survivor is heard, is believed, and is cared for. Every part of the advocate and survivor’s relationship is based on consent, validation, and trauma-informed care and communication because as studies have shown, the reaction and support a survivor receives the first time they disclose their assault can have a lasting impact on whether or not they continue to seek help.

As Francesca Guerriero, a therapist and Program Manager of the North Brooklyn Coalition, explains, “When a survivor has been admitted to the emergency room, we don’t know what their life looks like outside of the emergency department. We don’t know what their social supports are so an advocate might be the one person the survivor can talk to or has by their side when this happens. I think having someone who is trauma informed, who isn’t going to question the survivor, is incredibly healing, and really influences the survivor’s path to recovery.”

In accordance with New York State law, all New York City advocates must undergo a 40-hour training which walks advocates through how to support the practical and emotional needs of survivors during their time in the emergency department. In this role, an advocate’s relationship with the survivor begins and ends in the emergency room, and no personal information is shared in order to maintain the survivor’s confidentiality. In New York City, some advocate programs and trainings are run by the hospital themselves — like New York – Presbyterian, while others are contracted out to local rape crisis centers — like the North Brooklyn Coalition who work with Woodhull Hospital.

If you are interested in becoming an advocate, all programs require you to be at least 18 years of age, and within a certain distance of a hospital in order to respond to calls within 30 minutes. After choosing a program to apply to, applicants will submit an application and undergo an interview before finding out if they’ve been accepted into a program’s training course. These trainings take place once or a handful of times during the year depending on the organization’s structure and capacity. As the advocate continues to volunteer, they’re given support through group and individual check-ins, and further training sessions in order to support their needs as caregivers.

“It’s a very different type of volunteer experience. You’re meeting and working with people who have just experienced intense trauma, and are going through their healing processes. That is an overwhelming and powerful thing, and a lot of time people are drawn to this type of work from their own personal experiences — whether it’s happened to themselves or someone they know,” Gideon says. “What I always say when interviewing people who want to become advocates, ‘Be aware of where you’re at in your own healing process and make sure that this is a time that’s right for you. Make sure you’re within your own healing process and practicing self-care so that you can be fully present with a survivor.”