How Do: Health care personnel investigate a rape or violent sexual encounter?

How Do:

Health care personnel investigate a rape or violent sexual encounter?


http://www.ahrq.gov/research/victsexual/victsex3.htm

When a sexual assault victim presents to a hospital or clinic, medical staff will typically assess and respond to serious or life-threatening injuries. However, the decision to do a formal evidentiary examination is dependent on the patient who must give written consent, and is affected both by State laws and the judgment of local law enforcement officials or prosecutors as to whether an examination will be useful and can be justified.


http://www.cceb.upenn.edu/news/?id=25&category=2

In order to provide health care workers with the information needed to determine if, when, and how a patient may have been a victim of sexual violence, the Florida Council Against Sexual Violence (FCASV), in 2002, developed a guide for health care professionals (originally authored by Lynne Stevens, CSW, BDC) that can be used to assess patients.

Edie Camel, Director of Public Education and Research for NJCASA offered, "There is now a movement in the sexual assault field to make health care professionals more aware of the issue of sexual violence in the lives of their patients; and we can give them the tools and the guidance to do just that." To date, professionals in 16 of New Jersey's 21 counties have received training from both NJCASA and their local rape crisis centers in order to make providers more comfortable in broaching the subject with patients and helping to make a difference in the lives of thousands of women.

Disclosure of sexual violence may take awhile since victims first need to develop trust in others. While the above summary is just that, much more can be done during an office visit to assist patients. A provider's attention to patients' disclosures and caring referrals to further help can make a profound difference in the well-being of each survivor.
States all around the country need to become more proactive in identifying victims of sexual assault. Already, many states are beginning to follow Florida's lead in order to bring the health care community onboard as a partner in working with people whose lives have been touched by sexual violence.

All local rape crisis centers around the country are equipped to provide information to anyone seeking assistance with sexual assault survivors, including the health care community. All members of that community can improve services to all patients by becoming part of the solution. Development and use of procedures and protocols will allow practitioners to feel comfortable asking the questions and allow patients to address their concerns, issues, and feelings with dignity. It should be noted that while the majority of the work in this field pertains to women as victims, sexual violence is also committed against men (Tjaden and Thoennes found that 78% of the victims of rape and sexual assault are women, 22% are men), and this warrants additional study as well as attention from clinicians.


The NJCASA screening protocol used to assess patients is simple. The acronym S-A-V-E is an easy way to remember the steps used. The information is summarized for purposes of this article.

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.