Jan 04, 2021
Tara Leach creates first NP-led clinic for sexual violence, trafficking victims
Tara Leach first recognized the need for a comprehensive and holistic approach to health care for victims of sexual violence and human trafficking while she worked as a nurse in U.S. emergency departments.
In inner-city hospitals in Philadelphia, New York, and Baltimore in the early 2000s, where she moved when nursing jobs were tough to get in Ontario, Leach encountered a diverse mix of patients who had been assaulted and exploited.
Often, she saw them on their worst day. Despite that, she was drawn to these survivors.
“I always found working with people who had experienced violence and trauma was something that I felt rewarding,” says Leach, now living in Ottawa. “What was difficult about working in the emergency room was you only ever saw them on that day.”
Although Leach found it satisfying to provide emergency and forensic care, such as administering sexual assault evidence kits, she wondered often about how her patients fared after they left her care.
“I got to witness people who had gone through something traumatic,” she says. “I got exposed to the resilience of people. But I never got to see the recovery.”
Today, Leach gets to see the recovery. Now a nurse practitioner, she’s the founder and clinical director of Canada’s first primary health care clinic for victims of sex and labour trafficking and sexual violence. Leach helps to ensure the survivors who walk through the clinic’s doors get better.
“I feel very lucky to have done the job that I’ve done,” she says.
Leach and two colleagues — one a sex trafficking survivor who founded the anti-trafficking project HopeFound — secured funding from the Ontario Ministry of Community and Social Services to start the clinic, called H.E.A.L.T.H. (which stands for health care, education, advocacy, linkage, and trauma-informed healing). They received a three-year grant from 2017 to 2020.
Leach has now formed her own non-profit organization to operate and expand services at H.E.A.L.T.H.
“I got to witness people who had gone through something traumatic. I got exposed to the resilience of people. But I never got to see the recovery.”
At the clinic, Leach provides trauma-informed primary care, including reproductive and perinatal services, to survivors 13 and older. As a nurse practitioner, she brings a holistic approach to care. She understands trauma’s long-term impacts on an individual’s health, such as increased risk of diabetes and cancer.
Leach also starts from the principle that socio-economic determinants of health are not only relevant, but apparent. She collaborates with other service providers in Ottawa to secure whatever help her patients need. Those needs range from finding safe housing, food, and harm reduction programs, to exiting sex trafficking, finding peer support, and accessing treatment for PTSD.
Whenever possible, Leach provides primary care treatment herself. She’s learned protocols for providing Suboxone to patients who want to recover from opioid addiction and worked with specialists to treat hepatitis C and other illnesses with which she had limited or no prior experience.
She is always on call for her patients, although her scheduled time at the clinic is 2.5 days a week. When she’s not at the clinic, or trying to get more funding, Leach is a primary health care provider at the Royal Ottawa Mental Health Centre, where she works in the substance use and concurrent disorders program.
At the Royal, she assesses and treats patients with mental health concerns who are also using alcohol and/or opioids, and she teaches families, patients, community workers, and other health-care providers about harm reduction, relapse prevention, and recovery.
The two positions allow Leach to balance her desire to work independently, which she does at the clinic, with the “supportive, welcoming” team at the Royal.
Fundamentally, Leach believes in patient-centred treatment. She listens to her patients and strives to provide what they tell her they need, whenever they are ready for it. She focuses on their strengths, not their deficits. She starts with believing and validating her patients’ experiences.
“It’s about embracing a person’s stage of change, embracing what genuine informed choice is, and informed consent,” she says. “Too often in medicine, we become prescriptive. You have to be willing to be patient and to actively listen.”
It took not only patience, but persistence, hard work, and continuing education to get to the point of running her own clinic. After returning to Ontario from the United States in 2004, Leach worked in Kingston, near her home town of Harrowsmith, at a sexual assault and domestic violence treatment centre.
“Too often in medicine, we become prescriptive. You have to be willing to be patient and to actively listen.”
She took additional training and became a certified sexual assault nurse examiner. After marrying and moving with her husband to Ottawa, she worked as an emergency department nurse at the Ottawa Hospital while returning to the University of Ottawa to get her bachelor of science degree in nursing.
In 2008, Leach earned another diploma from the University of Ottawa as a primary health care nurse practitioner. For the next nine years, she worked in a variety of positions, serving children and adolescents in mental health and detention settings, as well as with geriatric patients in long-term care. She took additional training in Indigenous cultural safety and became a Rainbow Health Ontario provider.
In 2018, Leach obtained her master of science in nursing degree from Laurentian University.
“Throughout my career, I’ve always been somewhere increasing my education,” she says.
In her spare time, Leach teaches victimology at Ottawa’s Algonquin College; she is an advisory member of the Ontario Network of Sexual Assault/Domestic Violence Treatment Centres; and she spends time with her husband Aaron at the basketball games and practices that consume her sons, Nathan and Grayson. The family enjoys walks with their dog, a bernedoodle named Stella, and time outdoors.
Leach has not experienced sexual violence or intimate partner violence herself, but believes she’s fortunate to be able to serve people whom other health-care providers often don’t want — or know how — to help. Often, her patients are stigmatized as “non-compliant.” They may miss appointments, often because of lack of transportation, lack of child care, or depression or anxiety.
At the clinic, she’s created a safe space where she works through those issues. Patients don’t need identification or a health card to get treated, for example, as they would at a hospital or might at a doctor-led clinic. For Leach, it’s about reducing barriers to care for people who have faced more barriers than many of us could ever understand.
That work pays off for her patients, including a young woman she has now seen for more than two years. When she first came to the clinic, the woman was homeless, experiencing sex trafficking, and had an opioid use disorder. She wanted to change. She needed access to Suboxone but was terrified of going to a hospital or addiction treatment centre. She’d also contracted hepatitis C.
After getting the opioid use disorder under control, Leach consulted with an infectious disease specialist and treated the woman’s hepatitis C. She helped her find housing and other supports.
Today, the woman is employed, has stable housing, is recovering from her opioid use, and her system is clear of hepatitis C. She is no longer being sexually exploited or trafficked.
For Leach, who remains in touch with her, this woman’s story exemplifies the reason clinics like H.E.A.L.T.H. need to exist.
“It validates the role and the power of what nurses can do.”