A Qualitative Model for Integrative Trauma-Informed Care for Adult Survivors of Childhood Sexual Abuse in Marginalized South African Communities

Abstract

Background: Socioeconomic inequality, enforced through racial segregation during apartheid, continues to shape present-day disparities in South Africa. It limits equitable access to essential services and exacerbates health inequities, in particular, access to specialized trauma-focused mental health services in marginalized communities. Objectives: This study explores the intersections of systemic inequality and sexual violence by developing a qualitative framework for integrative trauma-informed care (ITIC) intended for resource-constrained settings. The study focuses on adult survivors of childhood sexual abuse (CSA) from the Cape Flats region of Cape Town. Methods: Framed within a critical, feminist community psychology perspective, ITIC sessions were facilitated for 13 adult survivors of CSA, with variation in the number of sessions and the duration of the intervention. Clinical histories were assessed. Applying ITIC, participant-specific narratives, and trauma recovery pathways were analyzed. Results: The findings highlight the complex physical and mental health needs of participants, given the long interval that had elapsed since their experiences of CSA. These findings informed the development of a multi-component care framework that addresses prolonged trauma suppression among adult survivors of CSA from marginalized communities, such as the Cape Flats. Despite the long time elapsed between CSA and the initiation of ITIC, this form of therapy supported more equitable trauma recovery. Conclusion: The study develops a qualitative research-informed care framework that integrates various factors associated with sexual trauma. Addressing the complexities in marginalized South African contexts, it highlights the importance of recognizing individual differences in trauma responses, comorbidities related to systemic violence, and pre- and post-trauma experiences, allowing for tailored interventions that may potentially enhance therapeutic outcomes