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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
Partnering
with Practitioners: Rape Care and Health Care
http://www.cceb.med.upenn.edu/news/?id=25&category=2
"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)
SANE-
Sexual Assault Nurse Examiner
http://www.sane-sart.com/
"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.
Domestic
Violence Toolkit
http://www.transformcommunities.org/tctatsite/tools/bcdvtoolkit.html
"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."
Intimate
Partner Violence and Sexual Assault: A Guide to Training Materials and
Programs for Health Care Providers
http://www.transformcommunities.org/tctatsite/tools/intimatepartnerviolence.html
"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."
Best
Practices: Innovative Domestic Violence Prograns in Health Care Settings
http://www.transformcommunities.org/tctatsite/tools/tinnovative_dv_prog_in_hc.html
"....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."
Meeting
at the Crossroads: Cross Training Between Mental Health & Sexual Assault/Domestic
Violence Service Providers
http://www.transformcommunities.org/tctatsite/tools/meetingatcrossroads.html
"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."
Preventing
Pregnancy from Sexual Assault: Four Action Strategies to Improve Hospital
Policies on Provision of EC
"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"
E.C.
in the E.R.: A Manual for Improving Services for Women Who Have Been Sewxually
Assaulted
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"
Campbell, Rebecca;
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),
313-329, 17p.
Database: Academic Search Premier
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. 10.1037/0278-6133.23.1.67
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.
Training manuals
General
training manuals
PubMed
article citations on rape crisis
Related issues:
Secondary
victimization|Self
blame|The
effects of rape / psychology|Panic
attacks|Date
rape drugs|Vocabulary
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