Medical Care Training Manuals
for Sexual Assault, Rape and Domestic Violence
See also: Communication with rape victims
"Examinations of rape victims are by their nature extremely stressful. The use of a video to explain the procedure before an examination has been shown significantly to reduce the stress involved" WHO
"S – SCREEN all your patients for sexual violence. Patients need to be asked before they will tell. Conduct the interview in a private setting, assuring confidentiality prior to asking questions.
A - ASK direct questions in a non-judgmental way. Practitioners need to remain calm, never blaming the patient or dismissing what she is sharing. Reminding the patient that many conditions can be a result of an assault, that many women are hurt in many ways due to an assault, and asking the patient to share anything in their past that they feel may be contributing to their condition or illness will put the woman at ease and develop trust.
V – VALIDATE the patient. If the patient discloses abuse, gently remind her that she is believed, that there is help available, that she was brave to discuss the issues, and the information will greatly improve the ability of the health care professional to provide the very best treatment. Offer empathy and understanding.
E – EVALUATE, educate, and refer. You need not hear the whole story to effectively treat the patient. But the provider needs to know how the patient is now feeling, and whether she is abusing drugs or alcohol or thinking of suicide. If the patient answers no to any of the initial questions, that does not always mean she is not a victim. Use it as an opportunity to provide information about sexual violence. Provide all patients with appropriate phone contacts, literature, and available support services." from (Kiesel, 2006)
"OVC’s Sexual Assault Advocate/Counselor Training is intended primarily for sexual assault advocates, counselors, volunteers, or staff at rape crisis centers. However, nurses, including sexual assault nurse examiners (SANEs), physicians, law enforcement officers, and mental health practitioners who assist sexual assault victims may also benefit from this training."
Articles on SANE:
Logan, T K, Cole, J., Capillo, A. (2007). Sexual Assault Nurse Examiner Program Characteristics, Barriers, and Lessons Learned. Journal of Forensic Nursing, 3, (1). pp. 24 - 34.
Quote: "This article describes the features of 231 SANE (Sexual Assault Nurse Examiner) programs across the country based on telephone interviews with SANE program coordinators conducted from February 15, 2005, through August 5, 2005. Although there was relative consistency among programs for the primary forensic documentation tools, 20 percent of the programs reported never using a colposcope, a tool that has been cited as important because it increases injury detection. The majority of programs reported that their outside time parameter for collecting DNA evidence was 72 hours; however, a small percentage of programs indicated they would still try to collect DNA evidence up to 120 hours or even longer under certain circumstances. Research suggests that the shorter the time between the assault and the forensic exam, the better will be the forensic evidence...The most frequently mentioned problems for SANE programs included staffing, funding, and conflicts or lack of cooperation with various agencies in the community. " Citation found in National Criminal Justice Reference Service Abstracts.
"This set of practical tools was designed to make it easier for doctors and other health care professionals to help domestic violence victims access services and support. Health care professionals are uniquely positioned to help battered women in outpatient clinic and office settings as well as in hospitals and emergency rooms."
"This guide offers detailed descriptions of 36 sets of training materials designed to educate health care providers about methods of screening and intervening in cases of domestic violence and sexual assault."
"....Unprecedented attention is being paid to the critical role that health care providers can play in intervening in the tragic spiral of domestic violence by screening, identifying, documenting and appropriately referring those patients who are being abused by their intimate partners."
"This video emphasizes the need for domestic violence advocates, substance abuse counselors and mental health service providers to share perspectives and expertise with one another in order to better address the needs of women who report substance abuse or mental health problems in addition to relationship abuse."
"This toolkit provides facts about emergency contraception for rape survivors, tools and strategies to assess the need for increased access, and four strategies to increase access. The four strategies discussed are legislation, administrative efforts, litigation and voluntary efforts. Samples, survivor stories and additional resources are also included"
Contents: "Building Alliances between pro-choice and sexual assault groups, Obtaining information on EC and sexual assault in your state, Potential obstacles to getting EC in the ER, Practical considerations for setting up this project, Obtaining approval from IRB"
Patterson, Debra; Lichty, Lauren F. (2005).
THE EFFECTIVENESS OF SEXUAL ASSAULT
NURSE EXAMINER (SANE) PROGRAMS: A Review of Psychological, Medical, Legal,
and Community Outcomes. Trauma, Violence & Abuse, 6 (4),
Quote: "In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day,first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains: (a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed."
Tschudin S. (2005). Immediate care for women after sexual and physical assault. Ther Umsch, 62(4). 223-9 Link
Quote: "The management of recent sexual and physical assault in women has two aims: to provide medical and psychological care for the victim and to prevent possible health consequences of the trauma on one hand, and to facilitate the forensic assessment with regard to the perpetrator's prosecution on the other. The victim should always be encouraged to report an offence to the police and forensic medicine should be called in to assist in the victim's examination, whenever possible. In addition, emergency contraception and prophylactic measures against sexually transmitted infections (STI), especially HIV, must be offered. The profound emotional impact of sexual and physical assault requires knowledgeable and sensitive crisis intervention on the part of the counsellor and referral for ongoing counselling and support must be made available. A well trained and competent sexual assault care team with a sympathetic and non-judgemental attitude can contribute profoundly to the assaulted woman's regaining control over her life and being able to overcome the experienced trauma."
Osterman, J., Barbiaz, J., Johnson, P. (2001). Emergency interventions for rape victims. Psychiatric Services, 52(6). pp. 733-734,740. link
Quote: "Discusses emergency interventions for rape victims. The arrival of a rape victim in the emergency department initiates a system of medical, mental health, and forensic interventions with the overall goal of supporting the victim's adjustment to the trauma of rape. The urgency of the patient's medical requirements may preclude early mental health interventions; however, for most rape victims, the medical and forensic needs afford an opportunity to assess the patient's psychological status and provide early mental health interventions. The emergency mental health treatment of rape is complex because rape is not only an individual physical and psychological trauma but is also a crime. The required evidence collection and medical treatment may trigger symptoms of reexperiencing or shifts to survival-mode functioning, requiring ongoing psychological assessment and interventions to maintain psychological safety and effective coping skills. Psychoeducation about normal responses after rape and the need for ongoing community and family support will help to promote recovery."
Amey, A. L., & Bishai, D. (2002). Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey. Annals of Emergency Medicine, 39, 631-638.
Campbell, R., Sefl, T., & Ahrens, C. E. (2004). The impact of rape on women's sexual health risk behaviors. Health Psychology, 23(1), 67-74. 10.1037/0278-618.104.22.168
Martin, P. Y., & DiNitto, D. M. (1987). The rape exam: Beyond the hospital emergency room. Women & Health, 12, 5-28.
Resnick, H. S., Holmes, M. M., Kilpatrick, D. G., Clum, G., Acierno, R., Best, C. L., & Saunders, B. E. (2000). Predictors of postrape medical care in a national sample of women. American Journal of Preventive Medicine, 19 (4), 214-219. 10.1016/S0749-3797(00)00226-9 .
Anderson, S., McClain, N., Riviello, R. (2006). Genital Findings of Women After Consensual and Nonconsensual Intercourse. Source Forensic Nursing, 2 (2). pp. 59 - 65.
Quote: "This study compared the number, location, and type of genital injuries seen in 46 women after they had participated in consensual sexual intercourse, compared with the same data on genital injuries found in 56 women just after they had experienced nonconsensual sexual intercourse. Consistent with previous research, this study identified genital injuries following both consensual and nonconsensual intercourse. Ecchymosis was more commonly found following nonconsensual intercourse. This consists of the oozing of blood from a blood vessel into tissues as the result of contusions or disease. Ecchymosis may not be clearly visible if initial genital exams are performed immediately after the assault. In clinical practice, it may be necessary to conduct a re-examination of the genital area to allow for clearer evidence of ecchymosis. In the current study, the mean time to exam for the nonconsensual group was 12.9 hours; whereas, the examination of the consensual group was limited to the first 24 hours, with a mean time of 12.1 hours. Future studies should match these times in order to avoid missing genital findings due to delayed presentation or wound healing. Although the study found no statistical difference in the frequency of injuries to the posterior fourchette between the groups, there was a statistically significant group difference in the injuries to the labia minora; these injuries occurred only in the nonconsensual group. Also, there were significantly more women in the nonconsensual group with two or more injuries. Such findings indicate that there may be a possible pattern of injuries that can be identified following nonconsensual intercourse. Further research is needed. The study documented injuries with the colposcope in combination with dye enhancement and photography. The nonconsensual group consisted of women who came to the emergency department of a Virginia hospital following a reported sexual assault. Consensual women were recruited through advertisements." Found in National Criminal Justice Reference Service Abstracts.
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