Sexual assault is one of the most violating traumas an individual can experience. In the U.S., a woman or man is sexually assaulted every 68 seconds, adding up to nearly a half-million victims a year, according to the Rape, Abuse & Incest National Network (RAINN). RAINN defines sexual assault as “sexual contact or behavior that occurs without the explicit consent of the victim,” including rape and attempted rape, fondling or unwanted sexual touching, and forcing a victim to perform sexual acts.

Victims are left with profound and long-lasting physical, emotional, mental, and social repercussions. The study “PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies,” published in the journal Trauma, Violence, & Abuse, reported that 75 percent of victims of sexual assault met the diagnostic criteria for post-traumatic stress disorder (PTSD) after one month, while about 42 percent still met PTSD criteria after a year.

Following a sexual assault, a survivor seeking emergency care can anticipate consultations with medical and social service providers, interviews with law enforcement and criminal justice officials, and the physically invasive and emotionally distressing collection of forensic evidence. Unfortunately, and unavoidably, the result of this care and support for the sexual assault survivor is inherently complex, time consuming, and often re-traumatizing.

Emergency facilities are typically equipped with professionals trained to deliver a medical and forensic response to trauma victims, including sexual assault survivors. In many of these settings, “trauma-informed care” (TIC) occurs in areas designated to accommodate physical and psychological traumas. These spaces integrate principles of TIC into the design of the built environment (defined as “trauma-informed design” or TID), serving all trauma survivors equally.

However, healthcare systems are increasingly concluding that this is not sufficient. A growing number are adding separate sexual assault response facilities (SARF), either adjacent to or embedded within the emergency department (ED), to address the unique physical, emotional, clinical, and judicial considerations of emergency sexual assault treatment, both for the survivor and caregiver.

In collaboration with healthcare providers expert in the field of sexual assault, and building on the existing work of TID experts, Taylor Design developed several best practices for designing emergency facilities for sexual assault survivors.

Emphasize safety
In a well-conceived SARF plan, the sexual assault survivor is triaged in the ED and escorted to a decidedly nonclinical and natural-light-filled lounge. From the lounge, the survivor moves to a consult room and then on to a forensic exam room. Immediately following the forensic exam, the survivor has access to a generous bathroom and private shower. Because of the personally invasive nature of forensic evidence collection, the survivor’s path never again intersects with the forensic exam room.

To ensure that the survivor feels and experiences safety, the SARF is a single-function space, serving no other purpose within the hospital. Whether the SARF is within or adjacent to the ED, designers should ensure that it maintains discretion in signage or other identifying features. For example, signage should conform with facility standards and be more akin to a facility support space as opposed to the public-facing signage of a stand-alone clinic.

Access to the SARF is highly controlled with a single, locked access point and entry granted only by the specifically trained care team. The location of this access point in relation to staff workstations, consult space, forensic exam room access, and clothing wardrobe should be planned for optimal privacy and safety of the survivor.

When possible, designers should provide access to natural daylight and views to help the survivor feel comfortable and connected to the flow of the world outside. If there’s potential for any immediate views of public space, exterior screening fences, sufficiently dense planting, and generous space between the SARF windows and the public realm can be used to ensure that the SARF remains private. If the space is otherwise windowless, leverage products that provide a time-based lighting profile, such as LEDs that transition to mimic blue skies and sunsets.

Subtle design choices such as artwork and color palettes can create a calm space without increasing the risk of triggering re-traumatization. Art within the space should feature abstract images with no immediately recognizable forms, motifs, or themes that have the potential to lead a survivor to relive the experience of their assault. Throughout the facility, color selection, such as earth tones and muted neutral colors, can help create a sense of warmth.

Give control and agency
Sexual assault, at its core, is about an individual’s loss of control and agency over their body. A dedicated facility must provide the survivor with as much control and agency as possible. Following the forensic examination, the survivor is encouraged to take as long a shower as they need in the private bathroom. An integrated wardrobe provides space for selecting fresh, comfortable clothes with sufficient options to fit all unique bodies.

In the bathroom and wardrobe area, incorporating high-quality and otherwise nonclinical selections of materials, finishes, and furniture, such as an oversized shower or an expansive vanity, helps deliver a private, intuitive, and generous experience.

Following this private time, the survivor is given the option to return to the lounge or consultation room (pending availability), which are adjacent to one another. To give survivors a sense of control in both areas, designers can incorporate individual lighting and audio control, access to a well-stocked food and drink amenity alcove, and generous placement of electrical outlets to charge devices. Creating places for solitude, while keeping a survivor safe and stable, improves the likelihood of success for ongoing support and treatment.

Duty of design
Sexual assault is a profound and unique trauma requiring a facility created specifically with the survivor in mind. The care delivery process can be a long, stressful, and re-traumatizing experience, but designers can leverage best practices to attune the treatment space to allow survivors to feel safe, calm, and in control.

Teresa Endres is a project director and lead medical planner at Taylor Design (Sacramento, Calif.). She can be reached at Matt Johnson is Northern California regional director at Taylor Design (San Francisco). He can be reached at Aaron McKenzie is a senior strategist at Taylor Design (San Francisco). He can be reached at