Categories
DV/IPV Testimony

Radiologic Findings in Intimate Partner Violence (and also, a few words about research)

Folks, I am happy to share a new study recently published in the journal, Radiology. But before I go there, let me remind readers of a couple things–the research I share is to help inform clinical practice and the opinions that we may or may not give on the stand. To give us a better understanding of what is knowable in our field, and what is still yet to be figured out. It is going to be a very rare occurrence indeed when any one article I post can be taken wholesale and generalized to a broad audience. In our discipline, we just don’t see a lot of studies like that. You’ll know this (apart from reading the Limitations section of the article, which will probably say so in black and white) because of the small sample size of the study, for instance, or the fact that all of the subjects in the sample represent a relatively homogenous population.

What I mean is that if you have an article that states that in a study of 100 people in my community, 50% of them hate dogs (what?!), you can’t take that study and say that means that half of all people hate dogs. No, half of the weird people in that particular study from that particular community hate dogs. But that’s all you can say. Especially if there are no other studies that have reproduced those results with other populations. Or larger populations. Or if there are studies that have found contrary results. Etc. Forgive me, because this is an oversimplification of a more complex issue, but it gets to the point, which is–read studies for what they are, but also for *what they are not*.

Why am I telling you this? Because this inappropriate generalizing of data happens a lot in our profession. Because I get emails and texts and frantic phone calls about it. Because FHO aims to help make people the best clinicians and the best expert witnesses they can be (regardless of which side they’re working for) and I would be remiss if I didn’t mention what seems to be an obvious problem with the way testimony may be going down in certain circumstances. This is not a nurse-specific phenomenon, BTW–many healthcare and healthcare-adjacent disciplines are taking the data in this area and using it in ways it shouldn’t be used at trial. Drawing conclusions you cannot draw. Anyway, you get the picture. [Rant complete.]

So with that, I bring you this very intriguing study by our colleagues out of Boston, Radiologic Findings in Intimate Partner Violence. Read it for what it tells us, and for what it doesn’t. It’s available free full text, at least right now, so before the nice people at Radiology change their mind, go ahead and download it and add it to your read pile. It’s worth your time.

(Add: based on a phone call I received, not 4 hours after posting this, let me also say, the whole generalizability conversation includes thinking long and hard about whether you can apply results in specific circumstances and apply them equally in similar, but not the same, circumstances. The answer is probably, no. Just because something is found to be likely in an intimate partner violence case, for instance, doesn’t mean it will also be likely in a human trafficking case or a child abuse case. One article, one study isn’t going to give you that.)

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Note: February 2019 Edition

It’s time once again for Articles of Note, our monthly waltz through the newly published peer-reviewed literature. I have to tell you, it’s a pretty glorious selection this month. Links lead to PubMed abstracts except where indicated.

Thinking about having a journal club for your team (or just looking for the next article to assign)? Here are some suggestions based on this month’s review:

For adult/adolescent SANE programs: Ectopic pregnancy following oral levonorgestrel emergency contraception use. or Vulnerabilities Relevant for Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking: A Systematic Review of Risk Factors.

For CAC/peds programs: Barriers and facilitators affecting self-disclosure among male survivors of child sexual abuse: The service providers’ perspective. or Estimating the probability of abusive head trauma after abuse evaluation.

For expanded programs: Acquired Brain Injury in the Context of Family Violence: A Systematic Scoping Review of Incidence, Prevalence, and Contributing Factors. or Childhood maltreatment and intimate partner violence victimization: A meta-analysis.

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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.

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Notes: January 2019 Edition

(Have you entered our giveaway yet for IAFN conference registration?)

It’s time once again for Articles of Note, our monthly romp through the newly published peer-reviewed literature. I hope you’ve made room on your nightstands and your e-readers, my friends, because there’s plenty to keep your brain occupied for a good long while. Links take you to PubMed abstracts except where indicated. Be a dear and cite back to FHO if you use our compilation 🙂

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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.

Categories
Testimony

Resolution: Read More

(Have you entered our giveaway yet for IAFN conference registration?)

Yesterday a reader reminded me that for all of my discussion about reading research on FHO, I never really talk about the best way to make it *easier* to identify relevant research. “There’s so much” and “it’s so overwhelming” are frequent complaints I hear when I discuss the issue at testimony workshops. So what are the top 3 tools I suggest for staying on top of the mountain of research that’s published every month?

**Here (FHO) is a pretty good place to begin. Between the Articles of Note, the reviews in the store, and the other publications I highlight in posts throughout the year, one of the reasons I keep FHO going is to bring the science to the profession on the regular. Subscribing makes it even easier.

**Automate your searches through email alerts. To keep my inbox from becoming completely overloaded, I subscribe to alerts from two places: Google Scholar and PubMed. I have a significant number of research terms for which I have alerts set up, so I still get a ridiculous amount of email traffic, but you can decide for yourself what’s most important/relevant/urgent and make alterations as you see fit. Depending on your access, there are a variety of other databases (e.g. ProQuest, EBSCO) for which you can set up alerts. Ask your university or hospital librarians if you’re not sure what’s available.

**Subscribe to journal email alerts. Your favorite journals allow you to subscribe to things like alerts for newly published articles online, or full tables of contents. Go to individual journals or check out JournalTOCs to make the process more efficient.

As I’ve said on many occasions, reading is part of the job. But locating the research doesn’t need to be difficult or overwhelming. Hope this helps steer folks in a manageable direction.

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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.

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Note: December 2018 Edition

It’s time once again for Articles of Note, our monthly romp through the peer-reviewed science. There’s a lot to work through here, but that’s a good thing, right? I have a ridiculously long reading list myself. So in the spirit of the holidays, here’s to chewy stats, lit reviews that make your pulse race (no? just me?) and topics that hit that sweet spot between I just saw this in clinic last week and holy crap there’s a subpoena waiting for me on my desk. Cheers everyone!

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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.

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Note: October/November 2018 Edition

It’s time once again for Articles of Note, our mostly-monthly romp through the newly published peer-reviewed literature. This edition is a whopper. Almost six pages of science for you to peruse, and it’s worth going through the whole list because there’s so. much. good. stuff. there. Seriously. Links take you to PubMed abstracts except where noted otherwise. Happy reading!

 

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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.

Categories
Testimony

Be A Demanding and Conscientious Consumer of Education

At the IAFN conference last week you probably heard me say this several times: be a demanding and conscientious consumers of education. This might just be my mantra for 2019. If I’ve learned anything from listening to as much testimony as I have this year, it’s that people are going to courses and conferences and swallowing wholesale what they are learning there without doing the deep dive. They are accepting as gospel what people teach simply because they are given a national (or even regional) platform, and then turning around and regurgitating that information on the stand. The problem is, that strategy won’t get you much past the direct exam, and even then, it’s pretty tough. If you don’t have a firm understanding of the material to which you are testifying, you cannot answer questions that probe the second or third layer down. And those questions will come. I promise they will. Memorizing training material won’t get you there. It will introduce you to what you need to know. And then it’s up to you to do the work.

Good education (and good educators) will give you source material. If there are statistics or metrics or numbers of any sort cited in their presentations, they will tell you where they came from. Then it is up to you to go to those sources and read them for yourself. Determine whether they apply to all circumstances or only some. Follow the footnotes to other articles that may contradict or expand upon the ideas in the original article. If they’re older, do a quick PubMed search and see if there’s newer information that has been published that may be useful. And then consider whether you might bring that information into court. Because testimony requires some work up front, and not just pretrial prep with counsel. The onus falls on you to do that work.

If you receive materials or see slides from presenters and they don’t include citations? Ask for them. Be a demanding and conscientious consumer of education. It is completely acceptable to ask for sources*. We are people of science. Science is what informs our opinions (along with clinical experience). It matters not at all how famous the educator, the course, the conference, or the academic program is–no one is above providing sources for their assertions. And if the presenters won’t or can’t give you that information? This is not information that should be the basis for any testimony you plan to give.

Every opportunity for testimony is an opportunity to be better. No one starts out a flawless expert, and errors in testimony can happen to even the most seasoned expert. But it’s possible to make sure you are approaching testimony from a position of strength (whether testifying for prosecution or defense) by ensuring your science is current, relevant, and on point. Be a demanding and conscientious consumer of education.

*I am also of the opinion that if all the source material simply consists of the presenters’ own work, that should also be consumed with a grain of salt.

 

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

 

Categories
Testimony

Experts

Something to consider when it comes to evaluating experts:

One can be an expert in treating the injuries caused by a mechanism of injury…

…and not necessarily be an expert in the mechanism of injury itself.

We probably don’t talk about that nearly enough.

 

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.

Categories
Testimony

Looking for Volunteers to Help Facilitate at My Workshop

If you are planning on attending the IAFN conference this year in Reno AND you are not committed to teaching or meetings on that Wednesday the 24th, please consider the following request–I am looking for volunteer facilitators for a new day-long testimony workshop we are doing that day. It will begin immediately after the keynote speaker that morning and go until 5pm. I need about 4 additional people (I have already compiled a great crew of facilitators, thus far, but it’s a large session, so I need a few more) with the following qualifications:

  • Minimum 5 years working in forensic nursing
  • Must have testified or provided expert consultation at trial 10 or more times
  • Must be able to easily discuss the evidence base that supports forensic nursing practice and ethical testimony

I have nothing but my eternal gratitude to offer for your participation (plus a cocktail or two in Reno)–you will not receive any discounts or compensation of any sort for assisting. I would love to be able to do that, but this site does not generate that kind of scratch. Sorry. But you will get to participate in a terrific day or learning, mentoring new(er) forensic nurses and teaching alongside other experienced colleagues. If this sounds remotely interesting, please contact me and include a copy of your CV with your email. I will get back with folks shortly after the Labor Day holiday. Facilitators will receive details for the workshop by the end of September.

Thanks for considering it!

 

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.

Categories
Testimony

Research Article Review Template

Oh hey–I made you a thing! Actually, I built you a thing out of some solid, already crafted parts and few original ideas, so let’s not get carried away here. An FHO reader asked if I had a concrete way for people to sit down with a research article and analyze it for its relevance for practice and testimony, so here you go. It’s a mash-up of some of the best of what I have found online from a variety of sources (that I have used) for journal clubs (part I, Research Outline), plus some of my personal perspective regarding analysis (part II, Reader Synthesis). Good for a step-by-step through a research article solo, or as part of a collective discussion. Hope it’s helpful.

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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.

Categories
Testimony

Concede What Is Possible

I had a question from an FHO reader this week: if there was only one piece of advice I could give a newly minted forensic nurse about cross-examination, what would it be? That’s easy.

Concede what is possible.

It’s funny because we were working on a testimony project last week and this issue actually played itself out in front of us in a very real way, so the timing of the question is perfect, really.

I’ve watched more clinicians get themselves into trouble on cross by failing to simply concede things that could be possible are, in fact, possible. Often times it comes from a place of wanting to be helpful to “their” side (pro tip: it’s not helpful). Other times it is because people confuse possible with probable (possible is any chance at all that a thing could be; probable is more than 50% likely. Even when I don’t believe something is probable, there’s a good chance I would have to admit it’s still possible.)

If a clinician digs their heels in on the question of whether something is possible, the resulting questions can leave them looking biased or argumentative. Ultimately, it can undermine the most well-intended testimony.

Concede what is possible. We don’t take the stand to make an attorney’s case. We take the stand to educate judges and juries about what we know, what we saw, what we did, and sometimes, what we believe, based on science and our clinical experience. Simple as that.

 

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.

Categories
Testimony

Aging Bruises Based On Color: A Brief Review

I’m so pleased to announce the newest review article is now available for sale in the FHO store: Aging Bruises Based on Color. Like its predecessor, Injury Following Consensual Sex, it is a digital download, available for $4.99. When you purchase it you will be taken immediately to the download screen (it will be the same screen as your invoice), so please watch for that. You won’t be able to go back once you leave that screen.

A brief description:

This review paper will examine a specific issue related to bruising: aging or dating bruises based on color, as seen in routine clinical assessment. It is meant to assist clinicians and allied professionals with understanding the breadth of the science, but it is not a substitute for reading the articles themselves. The paper will include an overview of the physiology of bruising, review the specific challenges in assigning timeframes to bruising colors, and provide considerations for clinicians when testifying about bruising in court.

And if you’ll indulge me, a personal request: With the exception of these research briefs, which require an incredible amount of my time, everything provided at FHO over the last decade has been free. Please continue to support the work here by purchasing the brief rather than making a digital copy of someone else’s. Doing so helps defray the cost of keeping this site online and making sure FHO can continue to bring readers all over the world current science, education and news that allows for patient-centered, evidence-based forensic healthcare. Thanks for being a supporter.

Categories
Testimony

Trials and Social Media…

…Don’t mix. Resist the urge to post anything* about trials in which you are involved. Before, during or after. Particularly commenting on the results of trials. I love social media, and I use it all the time; there’s a lot about my life I discuss online, both personally and professionally. But not cases in which I am involved.

I mention this all the time, so many of you have heard me say this before, but periodically it needs to be repeated. One of these days I am going to write formally on this topic, but for now, please, take my word for it and just don’t comment on any aspect of a trial on your social media feeds. There is literally no upside and plenty of potential down-. And yes, I know other professions do it–I’m not talking to them. I’m talking to us, clinicians.

 

*I say anything because I cannot define what the bright line is between what is okay and what isn’t. I cannot tell you when something will be used in a way that will make you look unprofessional or biased. I cannot refer you to official guidance on this because there is none. All I can tell you is that there is no reason to mention this aspect of your professional life in a tweet, Facebook update or beautifully composed Instagram pic. Seriously. Let this part of your life be a bit of a mystery.

 

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

Categories
Articles of Note Child Abuse DV/IPV Sexual Assault Testimony

Articles of Note: May 2018 Edition

It’s time once again for Articles of Note, our (almost) monthly romp through the peer-reviewed literature. Somehow I missed April–sorry about that. Keep in mind this is not an exhaustive overview; simply a list of what is particularly interesting and relevant to my practice that I thought you might also find useful. There’s some really interesting stuff here–I hope you’ll spend time sorting through the abstracts and grabbing articles that speak to you. Active links lead to PubMed (no free full-text articles this month):

 

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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

Categories
Testimony

Testimony Is an Essential Part of Forensic Practice

The issue of whether forensic clinicians have to testify, and if so, who determines whether they testify as a fact witness or an expert witness is one that we discuss regularly in these circles. I’ve written about it before; nothing in that post has changed. What I want to emphasize is that there are many areas in which clinicians and program managers lack control when it comes to testimony. But there is plenty over which you do have control. I would submit that in anticipating future testimony, a program has the ability responsibility to:

  1. Ensure that baseline education of all staff meets the minimum standards of practice as agreed upon in the field (to the extent that there is consensus, and understanding that some areas of practice lack consensus);
  2. Ensure that policies and procedures are in place, regularly reviewed, and again, consistent with the standards of practice as agreed upon in the field (see caveat in #1);
  3. Ensure that practices within the program have both a clinical rationale and an evidence base to support their use, particularly where consensus or guidance is lacking;
  4. Ensure that there is a quality assurance process in place so that if any mistakes were made, or a clinician deviated from policy, that issue is identified up front and the program has the opportunity to learn and grown from that issue;
  5. Ensure that the program’s medical director and institution’s administration understand that testimony is a part of practice and staff need to be compensated for their time*;
  6. Ensure that testimony prep happens–the exact questions may be unknown, but one can certainly anticipate the foundational questions and practice answering them ahead of time;
  7. Ensure that testimony is peer-reviewed–program managers and senior staff members should go to court with less experienced staff and provide feedback on that testimony afterward (please–not while still at the courthouse).  But seriously–no one is so experienced that they can’t afford some peer-review on their testimony.
  8. Ensure that if there are opportunities to observe the testimony of someone more experienced, staff take advantage of it and go. Testimony is not something one learns during the mock trial portion of the SANE/SAFE/SAMFE course. That is the place one is oriented to testimony. Honing testimony skills happens over the course of years, and there’s no better way to improve than to watch and to do.

I’m certain I haven’t covered everything, so by all means, add your own feedback in the comments. I love these conversations.

*It is not the responsibility of the prosecutor’s office to pay you for your time on the stand (or prepping to take the stand) unless they are hiring you as an expert on a case where you are not the treating clinician. If you’ve worked out this agreement with them in your community, fine, but it’s still not their responsibility. It should absolutely be the responsibility of the clinical program, and if you are spending your money on shiny new camera systems or other equipment, and not paying staff for expected activities, like continuing education and testimony, that is a fail in my book. Yep, I said it.

 

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

Categories
Child Abuse DV/IPV Sexual Assault Testimony

Myths Surrounding Virginity: A Guide for Service Providers (and a few other resources)

I found this so fascinating: the International Rescue Committee has a new guide for service providers, Myths Surrounding Virginity. I just finished working my way through it; what a great resource for really sifting through the issues related to the subject. I can see using it for educating other disciplines on the realities of what we already know as forensic clinicians (and probably a few folks within healthcare, as well).  It’s brief, so I encourage you to download it (PDF) and check it out for yourself.

From the website:

Virginity is a sensitive subject. The concept itself has a complicated history and, while it describes sexual activity for all genders, there is greater value placed on female virginity. For women and girls, virginity is too often tied to moral character, purity, honor, and social, moral and religious values.

In following the endnotes in this document, I was reminded of a piece I had posted a while back. You may want to also revisit it, while you’re focused on the subject matter. See also this free full-text article (PDF) on virginity testing (as well as this one); this expert statement on the issue of testing (abstract only); and ethics statements here and 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

Categories
Child Abuse DV/IPV Sexual Assault Testimony

New Resource Library from Alliance for Hope (and Signing Off for 2017)

You know how I do love a good library. Alliance for Hope just announced their new online library has launched, and it’s worth bookmarking as a source for a multitude of professional materials, including strangulation resources. There is a section specific to medical; the library itself is multidisciplinary. As with many things online, be discerning in your review–not everything contained in the library is peer-reviewed or current, so caveat emptor.

And with that, I am signing off for the year. FHO will return on January 3rd with new content, including a brand new resource for the Store (it may or may not be on bruising–who can tell with these things 😉 ) and the 9th anniversary of our little nerdy site. I am going to take some time off to spend with my family, particularly my wife (whose birthday is today–happy birthday, honey), and kiddo. We’ll be traveling a bit, and throwing an end of year party to celebrate the garbage fire that was 2017 (well, it wasn’t all bad, but a good chunk of it was pretty awful). In addition to Sasha’s birthday, we have just started Hanukkah (Chag Sameach! to all my peeps); Christmas is right around the corner, our 5th wedding anniversary falls a few days after that, and then the New Year. What a whirlwind. Here’s hoping you have some fun and relaxation during the holiday season; that your days are filled with love, laughter and good food; and that for those of you struggling during what is sometimes a difficult time of year, you find peace and the inner fortitude to just keep moving forward. Thanks for spending time with us in 2017.  See you in 2018!

Categories
Child Abuse Testimony

Working with Your Prosecutor in Child Sexual Abuse Cases

Midwest Regional Children’s Advocacy Center has a webinar coming up, Working With Your Prosecutor in Child Sexual Abuse Cases. The session will be held December 14th at 2pm ET. I have zero information on the webinar, except what I’ve already told you here, so check back with the site to see if they post more details. And yes, they archive, so it’ll be available after the fact.

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

Categories
Testimony

Forensic Nurses Week: Strengthening Practice

Last year for Forensic Nurses Week I wrote a series of posts about how we can do better by our patients. Reading through them, they’re still relevant. Enjoy!

This Forensic Nurses Week, Ask Yourself: How Do We Do Better?

Strive for Better Documentation

Be Better: Implement a Quality Improvement Process

This Forensic Nurses Week, A Look Ahead

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

Categories
Sexual Assault Testimony

Trauma-Informed Care

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

I received a request from an FHO reader looking for research about sexual assault and trauma-informed care. Conveniently enough, the recent National Best Practices doc from NIJ has an Appendix with a grid that provides the citations on this topic (p 107; click on the image to download the PDF report):