Category: Sexual Assault

IAFN has a webinar coming up, The National TeleNursing Center: Transforming Care for Sexual Assault Patients, Providers, and Communities. The session will be held September 5th at 1pm ET. It’s free for IAFN members and includes 1.5 CEUs ($35 non-members).  From the site:

Join us to learn how the National TeleNursing Center (NTC) piloted the use of Video Conferencing Technology (VCT) to support SANE/SAFE and emergency department clinicians caring for sexual assault patients across 3 states with diverse communities (tribal, rural, Military). Presenters will discuss the NTC teleSANE practice model based on Duffy’s Quality Care Framework. In addition, presenters will discuss evaluation findings from this 5-year pilot project in relation to its impact on patients, clinicians, and the broader community. Presenters will share important lessons learned that can help other agencies looking to implement this innovative teleSANE practice model to increase access to SANE/SAFE expertise.

Register here.

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

The National Criminal Justice Training Center is hosting a webinar, Studying Homeless Young Adults and Their Experiences with Human Trafficking. The session will be held August 28th at 1pm CT. From the website:

Presenter – Dr. Dominique Roe-Sepowitz

Upon completion of this webinar, you will be able to:

• Leverage new knowledge about issues facing homeless young adults including mental health and medical needs, childhood maltreatment, and family relationships
• Discuss the substance abuse experiences of a sample of homeless young adults
• Review the sex and labor trafficking experiences of homeless young adults in Arizona

Register for the webinar here.

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

RTI’s Forensic Technology Center of Excellence is hosting a webinar, Providing Gender Inclusive Care To The LGBTQ Population After Sexual Assault. The session will be held August 30th at 1pm. From the website:

This webinar will discuss considerations to best serve sexual assault victims of the LGBTQ community, particularly transgender survivors, and present case studies to illustrate gender inclusive responses to sexual assault.

To ensure the care and safety of all sexual assault victims, it is imperative that sexual assault forensic examiners and investigators examine their practices to ensure all needs of the LGBTQ Community are met. This webinar will discuss and explore safe care of the sexual assault victims within the LGBTQ community and will focus on the transgender community to better understand the spectrum of gender. The presenter will discuss the difference between gender and sexuality and discuss ways to look at forensic practices to increase gender awareness and inclusion. The webinar will illustrate practical ways to incorporate education, awareness, and improve services provided currently to ensure victims from any culture may feel safer reporting sexual assault. Additionally, the presenter will discuss reasons why victims may not access care and look at the increased risk of sexual violence in the LGBTQ population. Further discussion will include the implications for investigators, forensic science examiners, and others working sexual assault cases involving gender minorities.

Detailed Learning Objectives:

1. Define the LGBTQ Community & explore the spectrum of gender

2. Explore the increased risk of sexual assault in the LGBTQ community

3. Discuss modifications to consider during a sexual assault examination, investigation, and processes

4. Deconstruct barriers to accessing care and reporting after a sexual assault

Register here.

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Re-upping this post because there’s been some discussion on the IAFN listserv about intoxication and it’s worth reminding people there’s no BAC at which a patient must be before they are able to ask for emergency medical care (which is generally what a sexual assault medical forensic exam is considered). The same standard required to sign papers for a mortgage, or buy a car, or have elective surgery, or drive a car, is not the standard by which someone should be assessed for being able to consent to a medical-forensic exam. Please do not take my word for it (I do not provide legal advice–this is not legal advice). Please consult your hospital attorneys, risk managers and other smart professionals who get paid big money to help you make these decisions. However, if you need some supplemental materials to help them with the task, may I suggest, after you review the SAFEta website, some of the following:

A guide to decision-making capacity (Jones & Holden, 2004)

Assessment of Patients’ Competence to Consent to Treatment (Appelbaum, 2007; FULL-TEXT)

Mental capacity, legal competence and consent to treatment (Buchanan, 2004; FULL-TEXT)

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations (Marco, et al., 2017)

Bonus for our readers in the UK, Consent to Treatment–adults who lack capacity (as part of BMA’s medical student ethics toolkit)

I hope people will consider moving away from strict quantitative determinations and employ a set of clinical assessment criteria that are more likely to be accurate across populations. I would also encourage you to consider what the existing standard is in your Emergency Department, including your Fast Track (or equivalent) and consider using those policies as a yardstick by which to measure the policy for your medical-forensic exam patients, depending on where those patients are also seen (so possibly different if outside your ED, maybe even more so if seen in a community-based clinic).

Again, not legal advice–simply food for thought based on my own clinical and professional experiences.

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

The folks over at SVJI‘s Rural Realities project have a new blog post on case file review that has a good chart differentiating review models that SARTs might find helpful. For those of you looking for more in-depth info, SVJI also has a series of archived webinars that will be useful:

• Case File Review with Your SART
• The Foundation and Preparation Steps for Case File Review
• Reviewing Case Files and Evaluating Your SART’s Findings

Looking for something more tangible? Download their Case File Review Guidebook (PDF).

Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

NSVRC and IAFN are co-hosting a webinar on the newly updated SART toolkit, to be released in August. The session will be held July 12th at 2pm ET. From the announcement:

The collaborative team approach to sexual assault is a recommendation contained in the US DOJ’s National SAFE Protocol. Forensic Nurses are often intimately involved in the creation of Sexual Assault Response Team’s (SARTs) and in sustaining them. Since the original Toolkit was created in 2009 there have been updates to the SAFE Protocol, the creation of a new Pediatric SAFE Protocol and other guiding documents for response teams to use. This webinar will introduce forensic nurses to the updated Sexual Assault Response Team (SART) Toolkit, hosted by the National Sexual Violence Resource Center. The new SART Toolkit is the result of collaborative efforts to provide evidence-based information on best practices to SARTs.

Register for the session here.

Our first offering in the FHO store, Injury Following Consensual Sex is now available. If you haven’t ordered a copy yet, you can find it here.  And coming soon–the follow-up research brief on bruising, out at the end of the month!

Perhaps with all of the horror swirling about in the news, you missed this information: the National Center for Health Statistics at the CDC added new codes for patients experiencing sexual and labor trafficking to be used beginning October 1st, 2018. This will allow for more accurate data collection, differentiating human trafficking patients from other types of abuse patients.

T codes to report for cases of suspected and confirmed forced labor and sexual exploitation:

Under Adult and child abuse, neglect and other maltreatment, confirmed

T74.5 – Forced sexual exploitation, confirmed
T74.51 – Adult forced sexual exploitation, confirmed
T74.52 – Child sexual exploitation, confirmed
T74.6 – Forced labor exploitation, confirmed
T74.61 – Adult forced labor exploitation, confirmed
T74.62 – Child forced labor exploitation, confirmed

Under Adult and child abuse, neglect and other maltreatment, suspected

T76.5 – Forced sexual exploitation, suspected
T76.51 – Adult forced sexual exploitation, suspected
T76.52 – Child sexual exploitation, suspected
T76.6 – Forced labor exploitation, suspected
T76.61 – Adult forced labor exploitation, suspected
T76.62 – Child forced labor exploitation, suspected

Z codes for the examination and observation of human trafficking victimization:

Under Encounter for examination and observation for other reasons

Z04.81 – Encounter for examination and observation of victim following forced sexual exploitation
Z04.82 – Encounter for examination and observation of victim following forced labor exploitation

Under Problems related to upbringing: Personal history of abuse in childhood

Z62.813 – Personal history of forced labor or sexual exploitation in childhood

Under Personal risk factors, not elsewhere classified: Personal history of psychological trauma, not elsewhere classified

Z91.42 – Personal history of forced labor or sexual exploitation

You can find the full 2019 addenda to the ICD-10-CM List of Diseases and Injuries here (PDF)

Our first offering in the FHO store, Injury Following Consensual Sex is now available. If you haven’t ordered a copy yet, you can find it here.  And coming soon–the follow-up research brief on bruising, out at the end of the month!

IAFN is hosting an upcoming webinar, Human Trafficking and Toxicology. The session will be held July 10th at 2pm ET. It is limited to 200 people, but will be archived (f0r IAFN members)–if you want to attend the live session I encourage you to register ASAP. 1.5 CEUs will be available. From the announcement:

This presentation will identify common dynamics in sex and labor trafficking and describe how drugs and alcohol are used to assert and maintain control over victims and perpetrate trafficking and trafficking-related crimes. The presenter will discuss the importance of and strategies for collaborating with medical professionals to identify drug-facilitated human trafficking, provide much-needed care, and educate other allied professionals about the effects of drug use in human trafficking.

Jane Anderson, Attorney Advisor from AEquitas will be the featured speaker.

Register here.

Our first offering in the FHO store, Injury Following Consensual Sex is now available. If you haven’t ordered a copy yet, you can find it here. 

If your sexual assault medical-forensic exam does not include offering the HPV vaccine to eligible patients, perhaps it’s worth considering. And if you’re looking for the evidence base to support its inclusion in your comprehensive exam, last month the nice folks over at Cochrane obliged us and contributed to said evidence base by publishing a review on the HPV vaccine to prevent cancerous and pre-cancerous changes to the cervix. According to the CDC, vaccine coverage data published in the National Immunization Survey (NIS) states that about 6 out of 10 adolescents received at least 1 dose of the HPV vaccine, which means there are a substantial number of young women who aren’t vaccinated at all or completely. The medical-forensic exam is a potential opportunity to start or continue the series, and some programs have been offering the HPV vaccine, particularly for patients who have limited access to routine healthcare services.

Obviously, this review doesn’t speak to all of our patients, but we’ll take it to start.

An FHO reader asked if I had any recommendations for refresher training for members of her team who either hadn’t had education on STDs in quite some time or who didn’t feel had had sufficient training on STDs in their original SANE course. The concern was raised following a challenging cross-examination experience in which the testifying SANE was asked about whether some exam findings could be consistent with certain infections, particularly when those infections were not ruled out in the course of caring for the patient (as with many programs, this particular forensic nursing program does not test for STDs, but prophylaxes according to CDC guidelines). The nurse wasn’t certain she handled the cross as well as she could have, and in hindsight, wasn’t certain she was as prepared as she could have been.

I do, in fact, have a recommendation for comprehensive refresher training. It’s probably more than what people believe they necessarily need, but it will certainly provide clinicians with a solid knowledge base on STDs: the National STD Curriculum and its self-study modules. They can be completed at your own pace, for CMEs/CEUs, have been recently updated, and are free. I’ve done several since the hours are good for my NP recertification, too, and one of the things I think they are particularly useful for is the issue mentioned above–the differential diagnosis. Answering the critical question, what else could it be? So if you’re not confident in how you would answer that question on the stand, it might be worth spending some time with these modules. Help make your practice that much more defensible.

I saw this was posted over at SAFEta, as well, but I wanted to amplify it a bit, because this is an area where we can always be collectively stronger (since we’re still not able to universally offer patients the option at this time, at least here in the US): the AETC National Coordinating Resource Center published a Post-Sexual Exposure HIV Prevention Toolkit earlier this month. It includes:

•  Post-Sexual Exposure Clinical Guide (poster)
•  Post-Sexual Exposure Clinical Pocket Guide (you can also order hard copies for yourself and your team)
•  nPEP Infographic Slides
•  nPEP Poster

You’ll also find a relevant blog post by Diane Daiber of IAFN that’s definitely worth a read. I was pleased to see that IAFN is actually a collaborator on this toolkit, so you can expect it to be specifically relevant to our practice. A great focus for an upcoming staff meeting perhaps…

Our first offering in the FHO store, Injury Following Consensual Sex is now available. If you haven’t ordered a copy yet, you can find it here.