Adult CSA (child sexual assault) survivors face barriers accessing oral health care and performing oral self-care. This area was relatively unexplored in the UK but some research did exist which highlights cycles of shame, avoidance and retraumatisation when attending dental appointments as well as things that can facilitate access for survivors.

In 2018/19, Viv Gordon made a theatre show called ORAL exploring CSA and dentistry with wrap around conversations with survivor audiences. Many described a lightbulb moment having not previously connected their poor oral health, dental anxiety and abuse experiences.

In the year of this project, The Survivors Trust (national umbrella charity for CSA services) were launching a campaign around trauma informed healthcare environments including dentistry.

What did the project involve? 

The project held a series of conversations to explore approaches to listening and responding to CSA survivors experiences of oral health care with relevant academics at University of Bristol. As a first stage the team sought to establish priority areas for research, a research framework, multi-disciplinary collaborations (dentistry, medicine, social sciences), research questions, ethical considerations when working with survivor co-researchers/participants including approaches to safeguarding CSA survivors.

The ambition of this Ideas Exchange was to develop a research project with CSA survivors, dentists and trauma informed specialists to understand and embed trauma informed approaches to oral health care in dental training and clinical practice, utilising creative methods to carry out and disseminate research and locating survivors as co-researchers.

Within the projects conversation the following activities and issues were set and covered:

Activities:

• Conversations between Viv Gordon and Dr Angela Hague and other academics at Bristol Dental School.
• Reaching out to relevant academics in other university departments e.g., Medical School, Centre for Academic Primary Care, Social Sciences, Humanities Conversations with CSA organisations The Survivors Trust, SARSAS (Somerset and Avon Rape and Sexual Abuse Support), NAPAC (National Association for People Abused in Childhood).
• Pilot seminar with dental students.
• Pilot focus group with CSA survivors (if ethical considerations are satisfied).

Issues:

• Trauma informed approaches to dentistry.
• Supporting survivors as co-researchers.
• Presenting symptoms of CSA survivors in dental treatment eg non-verbal cues/signs of distress.
• Ways for CSA survivors to self-identify safely eg tick box on medical forms/health passports/”Ask Angela” type scheme.
• Effective tools for training e.g., CSA survivor narratives, creative approaches.

Who are the team and what do they bring?

• Viv Gordan (Viv Gordan Company) is a theatre maker, survivor activist and artistic director of Viv Gordon Company. Their work is a campaign to forge voice, visibility and community for and with the 11 million adult survivors of childhood sexual abuse in the UK.
• Angela Hague (Bristol Dental School, University of Bristol) is the Mental Health Champion for Bristol Dental School. She leads a vertical Theme of Lifelong Learning and Wellbeing Theme in the dental curriculum, and workshops within the Theme of Evidence Based Practice.

What were the results?

After this project’s initial conversation series, a bigger team was assembled and further Brigstow funded acquired for the larger project ‘Improving Access to Oral Health Services for Adult Survivors of Child Sex Abuse (CSA)’.