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Medical Examination and Treatment for Victims of Sexual Assault

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Appendix B (continued)

Training Program/Policy Statement/Practice Protocol: 747474742626
Prevention of Violence and Abuse Resolution
Source: American Medical Association
Address: 515 North State Street, Chicago, IL 60610
Phone: (312) 464-5000
Web site: www.ama-assn.org
Description: The AMA House of Delegates approved in 2000 a resolution (#419) dealing with violence. The resolution called upon the AMA to establish a committee of representatives from the National Advisory Council on Family Violence and its Committee on Medical Education to:

  1. Identify knowledge and skills needed by physicians to identify, respond to and prevent violence and abuse.
  2. Identify appropriate places within the medical education system for the training and development of those skills.
  3. Explore ways to include the necessary training within the current medical education system.
  4. Establish a mechanism to respond to proposals from the IOM "Committee on Training Needs of Health Care Professionals to Responding to Family Violence."

The resolution also called upon the AMA to advocate for hospital and community support of violence survivor programs and to advocate for equitable coverage and appropriate reimbursement for all health care (including mental health) related to family and intimate partner violence.

Audience: AMA members and other physicians and health care providers concerned with domestic violence. Policy makers concerned with health policy and legislation.

Training Program/Policy Statement/Practice Protocol: 747474742727
Strategies for the Treatment and Prevention of Sexual Assault
Organization: American Medical Association
Address: 515 North State Street, Chicago, IL 60610
Phone: (312) 464-5000
Fax: (312) 464-4184
Web site: www.ama-assn.org
Description: This is one of a series of guideline booklets put out by the AMA to aid physicians in the examination and treatment of victims of violence. The guide was developed by staff and consultants with the oversight of an expert advisory group. Members of the expert advisory group represented a number of medical specialties including ob/gyn, pediatrics, family medicine, and emergency medicine as well as non-medical groups and AMA members. The guideline reflects the state of knowledge as of October 1995. The guide provides advice on how the physician should examine a victim of sexual assault, both in an acute care setting (Emergency Department) and in a primary care setting. The guide describes in detail the evidence exam and the use of the rape kit. The guide also discusses STD prophylactics and pregnancy counseling in acute care settings. The booklet also includes a discussion of treating special populations (males and adolescents), a discussion of symptoms reported by sexually assaulted patients and references and recommended readings and resources.
Target Audience: Physicians in practice who may encounter patients who are victims of sexual assault, either in an acute care or primary care setting.
Training Medium: Written guide; 46 pages including appendices and references.

Training Program/Policy Statement/Practice Protocol: 747474742828
Position Papers on Sexual Assault and Other Types of Violence
Source: American Osteopathic Association
Address: 142 East Ontario Street, Chicago, IL 60611
Phone: (800) 621-1773
Contact: Sharon L. McGill, M.P.H., Director Division of Minority and Women's Health, (312) 202-8150
Web site: www.aoa-net.org
Description: The American Osteopathic Association has published several position papers about sexual assault, domestic violence and child abuse. These include:

  • Violence-Development of Progress to Reduce: Urges that Federal and local governments develop educational and preventive programs to reduce abuse of all kinds, especially sexual and domestic (revised 1996).
  • Abused Persons: Public health agencies should provide training in advocacy for abused persons, assessment and intervention techniques to aid those in abuse situations, legal procedures, and attention to the special needs of the young and elderly (reaffirmed 1997).
  • Child Abuse: AOA urges its members to participate in national education programs relative to child abuse, to cooperate with state and local authorities in reporting suspected child abuse, and to be vigilant in recognizing child maltreatment wherever they encounter it (revised 1995).
  • Domestic Violence: The AOA supports the efforts of the United States Department of Health and Human Services to develop and foster programs that prevent domestic violence (revised 1999).

In addition to the position papers, there have also been several editorials in the Journal of the American Osteopathic Association, including "Increasing Awareness of Sexual Abuse" (May, 1989), "Join the Battle Against Domestic Violence" (April 1989); and "Breaking The Cycle of Family Violence" (July, 1994).

Target Audience: Osteopathic physicians and health policy makers.
Dissemination/Usage: In the Journal of the American Osteopathic Association.

Training Program/Policy Statement/Practice Protocol: 747474742929
Forensic Interview Training Clinic
Source: American Professional Society on the Abuse of Children (APSAC)
Address: Post Office Box 26901 CHO3B-3406, Oklahoma City, Oklahoma 73190
Phone: (405) 271-8202
Web site: www.apsac.org
Description: Training clinics are 40-hours in length and include both didactic and practicum sessions. In the interview practicum students have an opportunity to conduct interviews with actual children in a supportive environment where feedback can help develop confidence and skills. The topics covered in the clinic include: forensic interviewing techniques and types of interviews; legal issues affecting interviews; child development and issues of linguistics; cultural competency; the investigative versus the therapeutic interview; problems and pitfalls in interviewing; and effective performance as a witness in legal proceedings.
Target Audience: Professionals from the fields of mental health, child protective services, law enforcement, social services, medicine, and law.
Dissemination/Usage: The clinics are put on by APSAC and have been held for a number of years.
Other Comments: Currently the clinic planning committee is reviewing the curriculum and there is a temporary postponement of scheduled clinics.

Training Program/Policy Statement/Practice Protocol: 747474743030
Guidelines for Practice
Source: The American Professional Society on the Abuse of Children
Address: PO Box 26901 CHO3B-3406, Oklahoma City, OK 73190
Phone: (405) 271-8202
Web site: www.apsac.org
Description: The APSAC National Interdisciplinary Guidelines task forces have produced five data based guidelines on key areas of practice in the field of child maltreatment. These guidelines, after being developed by task forces, are reviewed by subject matter experts not on the task force, the members of APSAC, legal counsel, and the board of directors. The five guidelines which have been published are as follows:

  1. Psychological evaluation of suspected sexual abuse in children. The guideline is produced by the task force on psycho-social evaluation of suspected child abuse in children. The topics covered include characteristics of the evaluator, components of the evaluation, interviewing procedure, the interview and the report.
  2. Descriptive terminology in child sexual abuse in medical evaluations. The guideline was prepared by the terminology subcommittee of the APSAC task force on medical evaluation of suspected child abuse. The guideline covers description of anatomical structures, including the hymen and peri-anal anatomy, as well as other structures and findings.
  3. Use of anatomical dolls in child sexual abuse assessments. Guideline was prepared by the APSAC task force in the use of anatomical dolls in child sexual abuse assessments. The guideline provides a summary of current research findings and describes how to interpret behavior with dolls, the efficacy of anatomical dolls and inappropriate use of the dolls.
  4. Photographic documentation of child abuse. These Guidelines were produced by the photodocumentation subcommittee of the APSAC task force on medical evaluation of suspected child abuse. The topics include the necessary equipment and lighting, legal considerations and documentation.
  5. Psychological evaluation of suspected psychological maltreatment of children and adolescents. Guideline was produced by the psychological maltreatment consortium and the APSAC task force on psychological maltreatment. The guidelines discuss the prevalence of psychological maltreatment and its short and long-term effects. The guidelines also discuss important considerations in assessing a child and reporting the findings.

Target Audience: Psychologists, social workers, attorneys, physicians, nurses, researches, law enforcement officials and protective services administrators involved with the evaluation and treatment of victims of child abuse.
Dissemination/Usage: The guidelines are available for purchase from APSAC. Details are available on their Web site.

Training Program/Policy Statement/Practice Protocol: 747474743131
Handbook on Child Maltreatment
Source: American Professional Society on the Abuse of Children
Address: P.O. Box 26901 CH03B-3406, Oklahoma City, Oklahoma 73190
Phone: (405) 271-8202
Web site: www.apsac.org
Description: The Handbook on Child Maltreatment is published by Sage Publications in cooperation with the American Professional Society on the Abuse of Children. The handbook covers physical and sexual abuse, all forms of neglect, and psychological maltreatment. The major topic areas include:

  • Overview: aspects of child maltreatment.
  • Psychological treatment.
  • Medical aspects of child maltreatment.
  • Legal aspects.
  • Reporting and prevention.
  • Organization and delivery of services.

Target Audience: All professionals working with maltreated children.
Dissemination/Usage: The handbook is for sale from APSAC.

Training Program/Policy Statement/Practice Protocol: 747474743232
Standard Guide for Sexual Assault Investigation, Examination, and Evidence Printed Guide
Source: American Society for Testing and Materials (ASTM)
Address: 100 Barr Harbor Drive, West Conshohocken, PA 19428
Phone: (610) 832-9500
Contact: Gloria Collins, Staff Manager, (610) 832-9715
Web site: www.astm.org
Description: The Guide was prepared by the sub-committee on Criminalistics under the jurisdiction of the ASTM Committee (E-30) on Forensic Sciences. The ASTM (organized in 1898) is the largest voluntary standards development organization in the world, with more than 32,000 members. The current Guide was approved on November 10, 1996.

The Guide covers the basic requirements for the development of a sexual assault investigation protocol. The Guide calls for using trained forensic examiners in the setting of a multidisciplinary team and indicates that this is the current standard of care.

The Guide indicates that every facility dealing with victims of sexual assault should have written procedures that provide information on the treatment plan, the evidentiary and medical examinations, the documentation and evidence collection, the transmittal of evidence and the chain of custody, and post examination procedures. The Guide states that agencies undertaking child sexual assault investigations should develop special protocols. The Guideline also calls for the development of protocols for the recognition, treatment and prevention of the transmission of sexually transmitted diseases arising from sexual assault investigations.

The Guide has an appendix that lists evidence kit specifications.

Target Audience: Organizations involved in investigating sexual assaults. Besides non-health organizations, the Guide is addressed to every treatment facility that deals with victims of sexual assault (as well as suspects.)
Dissemination/Usage: The Guide is voluntary. It is legally binding only when adopted by a government body or incorporated into a contract.
Other Comments: According to ASTM policies, the Guide must be revised and re-approved at least every five years.

Advanced Training in Domestic Violence for Healthcare Providers Training course with extensive participant manual.

Training Program/Policy Statement/Practice Protocol: 747474743333
Source: California Medical Training Center, UC Davis
Address: 3300 Stockton Boulevard, Sacramento, CA 95820
Phone: (916) 734-4143
Fax: (916) 734-4150
E-mail: mtc@umdc.ucdavic.edu
Contact: Connie Mitchell, MD, (916) 734-3540
Web site: www.ucdmc.ucdavis.edu/medtrng
Description: An advanced level, one-day course with audio/visual material accompanied by an extensive participant manual. Attendees should have a basic knowledge of the dynamics of domestic violence, as well as basic skills regarding interviewing of victims who have been traumatized.

Course Goals:

  1. To understand current epidemiological data in the field of domestic violence.
  2. To recognize current theories and dynamics of domestic violence.
  3. To understand the behaviors which impede or promote the identification of victims of domestic violence.
  4. To understand the use of routine and in-depth inquiries to identify victims of domestic violence.
  5. To understand the basic injury assessment skills needed for evaluation of domestic violence victims.
  6. To know the components of a forensic evaluation for victims of domestic violence.
  7. To know the components of a comprehensive care plan for victims of domestic violence.
  8. To have an in-depth understanding of California law and the legal process as it relates to domestic violence.

Target Audience: Forensic examiners, members of hospital/clinic based response teams and emergency personnel.
Dissemination/Usage: Course has been conducted at various locations within California. There is no tuition for California residents. Out of state attendees are charged tuition and admitted if space is available.
Other Comments: One of a number of courses on sexual abuse, domestic violence, elder abuse and child molestation conducted by the California Medical Training Center.

Training Program/Policy Statement/Practice Protocol: 747474743434
Advanced Training in Elder Abuse (version 1.0)
Source: California Medical Training Center
Address: 3300 Stockdon Boulevard, Sacramento, CA 95820
Phone: (916) 734-4141
Web site: www.ucdmc.ucdavis.edu/medtring
Contact: Connie Mitchell, MD
Description: A one-day course designed to provide training for the conduct of a comprehensive evaluation and forensic examination of victims of elder abuse. The course is intended for the health care providers who have some experience in the normal aging process and geriatrics. It assumes a basic knowledge about elders and their health care issues. The goals of the course include:

  1. Developing appreciation that elder abuse is a prevalent health care problem.
  2. Learning how to recognize elder abuse in the office setting.
  3. Learning how to document suspected cases of elder abuse.
  4. Learning the role of adult protective services.
  5. Learning how to manage suspected cases of abuse in the nursing home setting.

Target Audience: Primarily physicians.
Dissemination/Usage: Course was taught by the California Medical Training Center as one of a series of courses on elder abuse, sexual abuse, domestic violence and child abuse. As with other programs put on by the California Medical Training Center, the course is intended primarily for health care workers in the state of California though others have been allowed to attend by paying tuition if space was available.
Other Comments: The course is currently being revised to add modules on dependent adults, financial abuse and sexual assault of the elderly.

Training Program/Policy Statement/Practice Protocol: 747474743535
Elder and Dependent Adult Abuse Training for Community Health Care Providers (Introductory Course)
Source: California Medical Training Center, UC Davis
Address: 3300 Stockton Boulevard, Sacramento, California 95820
Contact: Connie Mitchell, MD
Phone: (916) 734-4141
Web site: www.ucdmc.ucdavis.edu/medtrng
Description: A one to two hour overview course to familiarize clinicians with the epidemiology and variety of elder mistreatment. To familiarize the clinician with how to detect elder abuse and with the reporting requirements and procedures in California. The course is also intended to increase the ability of the clinician to assess and manage suspected abuse cases. The goals of the course are to:

  1. Provide information on the normal aging process.
  2. Provide appreciation that elder and dependent adult abuse is a prevalent medical problem.
  3. Provide the clinician with the ability to recognize elder and dependent adult patients during office visits.
  4. Provide information on the importance of the cognitive assessment.
  5. Provide information on how to appropriately document cases of elder and dependent adult abuse.
  6. Identify and manage suspected cases of elder abuse in nursing homes or other institutional settings.
  7. Gain an appreciation of the issue of self neglect as it pertains to elder and dependent adults.

Target Audience: Adult primary care providers, including physicians in general practice, family medicine and internal medicine, as well as advanced practice nurses and physicians assistants.
Dissemination/Usage: The course is taught in California as part of a series of courses on elder abuse, domestic violence, sexual assault, and childhood sexual and physical abuse presented by the California Medical Training Center at the University of California, Davis.

Training Program/Policy Statement/Practice Protocol: 747474743636
Forensic Examination for Victims of Domestic Violence
Organization: California Medical Training Center
Address: 3300 Stockton Boulevard, Sacramento, CA 95820
Contact: Connie Mitchell, MD
Phone: 916-734-4143
Web site: www.usdmc.ucdavis.edu/medtrng
Description: This is a module in the training course "Advanced Training in Domestic Violence for Healthcare Providers." The goal of the module is to teach the components of a forensic evaluation for victims of domestic violence. The comprehensive forensic evaluation includes: forensic history; mental status evaluation; forensic evidence collection; and injury assessment.
Target Audience: Physicians who may encounter domestic abuse patients in their practices
Dissemination/Usage: One of a series of courses prescribed by the California Medical Training Center.

Training Program/Policy Statement/Practice Protocol: 747474743737
Pediatric Sexual Abuse Evidentiary Exam Training Course with extensive participant manual.
Classroom training with extensive use of audio/visuals and class handouts.
Source: California Medical Training Center, UC Davis
Address: 3300 Stockton Boulevard, Sacramento, CA 95820
Phone: (916) 734-4143
Fax: (916) 734-4150
Email: mtc@umdc.ucdavic.edu
Contact: John McCann, MD, (916) 734-3691
Web site: www.ucdmc.edu/medtrng
Description: Training to conduct evidentiary examinations on children and adolescents suspected of being victims of sexual abuse or assault. Special emphasis is placed on training examiners to follow the guidelines for conducting evidential examinations as outlined in the California Medical Protocol for Examination of Sexual Assault and Child Sexual Abuse Victims. Four-day course with a wide range of faculty representing all organizations involved in child sexual assault cases.

The goal of the training is to provide participants with:

  1. Understanding of California law on the medical/legal aspects of child/adolescent sexual abuse.
  2. Understanding of how to conduct a forensically defensible medical interview.
  3. Opportunity to recognize differences between normal and abnormal genital findings.
  4. In-depth understanding of how to effectively conduct an evidentiary examinations.
  5. Understanding of current methods of performing and interpreting anal/genital examination.
  6. Understanding of emotional and behavioral responses.
  7. Understanding of how to evaluate, identify, prophylax and interpret STD's.
  8. Understanding of the California judicial system including the types of hearings, the roles of personnel within the judiciary, how to respond to subpoenas and how to testify.
  9. Understanding of the importance of identifying and developing self-care strategies.
  10. Opportunity to develop clinical assessment skills.

Target Audience: Physicians, registered nurses, nurse practitioners, and physician assistants.
Dissemination/Usage: Courses are conducted throughout California at a minimal or no cost to residents; out of state participants are charged tuition and accepted if space is available.
Other Comments: Part of an extensive curriculum of training programs in sexual abuse, child molestation, elder abuse and domestic violence conducted by California Medical Training Center.

Sexual Assault Evidentiary Exam Training for Health Care Providers.
Source: California Medical Training Center

Training Program/Policy Statement/Practice Protocol: 747474743838
Address: UC Davis, 3300 Stockton Boulevard, Sacramento, California 95820
Phone: (916) 734-4141
Contact: William Green, MD
Web site: www.ucdm.edu/medtrng
Description: This is a three-day course focusing on fundamental forensic examination techniques for adult and adolescent victims of sexual assault. The course is designed for the inexperienced examiner and teaches basic knowledge, skills, and attitudes. The course is built around the Office of Criminal Justice Planning (OCJP) form 923 Medical Protocol for Examination and Treatment of Sexual Assault Victims.

The goals of the course are to teach:

  1. An appreciation of the advantages of using a Sexual Assault Response Team.
  2. An understanding of legal issues involved in sexual assault crimes.
  3. How to obtain a sexual assault history with precise and complete documentation.
  4. A basic understanding and skills in crisis intervention.
  5. An understanding of the essential elements of rape trauma syndrome, and the role of a rape crisis advocate.
  6. Ability to perform a sexual assault forensic examination with adequate and appropriate documentations.
  7. Ability to recognize and properly manage the collection of evidence in the forensic examination.
  8. Recommended strategies for the treatment, referral, and followup of the sexual assault victim.
  9. Advanced exam techniques involving colposcopy, forensic photography, and videography.

Target Audience: Nurses, physicians, nurse practitioners, physician assistants, and law enforcement personnel involved with the interface with health care providers.
Dissemination/Usage: This is one of a series of courses taught by the California Medical Training Center. The courses are intended for California health professionals who will serve as medical, i.e., sexual assault forensic examiners. Others, including out of State personnel are accepted upon payment of tuition if there is space available.

Training Program/Policy Statement/Practice Protocol: 747474743939
Clinical Forensic Medicine in the ED: A Training Video
Source: Jayne J. Batts, M.D.
Address: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC 28232
Contact: Jayne J. Batts, M.D.
(704) 643-7709
E-mail: JayneBatts@aol.com
Description: A brief 7-minute training video for emergency physicians and others involved with forensic medicine in the emergency department. The brief film depicts a gunshot victim arriving by ambulance in the emergency department and then traces the steps through the emergency department until the patient is being discharged to an inpatient bed. The 7-minute film depicts 17 forensic errors, e.g., the failure to keep the chain of evidence, failure to keep the potentially valuable evidentiary material, failure to conduct the evidentiary exam until after the victim has been contaminated, etc.
Target Audience: Emergency department physicians and others involved with treating of forensic evidence in the emergency department.
Additional Comments: The film was prepared by Dr. Batts for the training of emergency department residents and forensic nurses in issues surrounding emergency forensic medicine.

Training Program/Policy Statement/Practice Protocol: 747474744040
Sexual Assault and STDs: Sexually Transmitted Diseases Treatment Guidelines, 2002.
Source: Centers for Disease Control and Prevention (CDC)
Description: The guideline includes recommendations on the identification, prophylaxis, and treatment of sexually transmitted infections and conditions commonly identified in the management of such infections. Examination of survivors of sexual assault should be conducted so as to minimize further trauma to the survivor and should be performed by an experienced clinician. The decision to obtain genital or other specimens for STD diagnosis should be made on an individual basis. Mechanisms to ensure continuity of care (including timely review of the results of any tests obtained) and to monitor compliance with and adverse reactions to any therapeutic or prophylactic regimens should be in place in any setting where survivors of sexual assault are examined. Laws in all 50 states strictly limit the evidentiary use of a survivor's prior sexual history, including evidence of previously acquired STDs, as part of an effort to undermine the credibility of the survivor's testimony. Evidentiary privilege against revealing any aspect o the examination or treatment is enforced in most states. In unanticipated, exceptional situations, STD diagnoses may later be accessed, and the survivor and clinician may opt to defer testing for this reason. However, collection of specimens at initial examination for laboratory STD diagnosis gives the survivor and clinician the option to defer empiric prophylactic antimicrobial treatment. Among sexually active adults, the identification of sexually transmitted infection after an assault is usually more important for the psychological and medical management of the patient than for legal purposes, because the infection could have been acquired before the assault. Furthermore, a post-assault examination is an opportunity to identify or prevent sexually transmitted infections, regardless of whether they were acquired during an assault.
Audience: Clinicians who examine or treat victims of sexual assault.
Dissemination/Usage: Published in the May, 2002 issue of MMWR, 10;51 (RR-6):69-74.

Training Program/Policy Statement/Practice Protocol: 747474744141
Sexual Assault Protocol, Departments of Social Service and Emergency Medicine
Source: Children's Hospital Medical Center
Address: 3333 Burnet Avenue, Cincinnati, Ohio 45229
Phone: (513) 636-4200
Web site: www.cincinnatichildrens.org
Description: The protocol is for children who are victims of alleged sexual assault. The protocol indicates that the child and family should be provided with the following services:

  • Emotional support.
  • Medical assessment and treatment of injuries.
  • Documentation of the alleged assault by collection of evidence.
  • Referral to appropriate counseling services.
  • Expert medical testimony in subsequent litigation.
The protocol points out two aspects of child sexual assault which present difficulty in recognition and management:
  1. Since the child is usually assaulted by a relative or acquaintance there is likely to be denial or blame of the child.
  2. There is frequently little physical evidence to corroborate the child's story.

The remainder of the protocol describes the functions of the individuals involved in the treatment of the victim of child sexual abuse. These include the triage nurse, the social worker, the nurse in attendance, the physician, the protective service worker, and the police officer.
The protocol contains a number of appendices including the following:

  • The vaginal exam in pre pubertal girls.
  • Culturing for sexually transmitted diseases.
  • Interpretation of the genital examination.
  • Post coital contraception.
  • Venereal disease prophylaxis.
  • Treating the uncooperative patient.
  • The social and medical clinic.

Target Audience: Physicians and other health workers who may need to examine and treat victims of childhood sexual assault.
Additional Comments: The protocol is available from the Children's Hospital Medical Center of Cincinnati or on the Web site listed above.

Training Program/Policy Statement/Practice Protocol: 747474744242
Police Response to Crimes of Sexual Assault: A Training Curriculum
Source: Produced by Connecticut Sexual Assault Crisis Services, Inc. Funded by Police Office Standards and Training Council under a STOP grant. Available from: Violence Against Women Online Resources, U.S. Department of Justice, Office of Justice Programs
Web site: www.vaw.umn.edu
Description: A training curriculum for law enforcement professionals involved in sexual assault issues. The curriculum includes the following six modules:

  • An overview of sexual assault.
  • Definitions of sexual assault and related statutes.
  • Procedures for police investigations including collection of evidence.
  • Services available to victims of sexual assault.
  • Information for sex offenders.
  • Legal issues.

While intended for police professionals, the material provides a good general overview of issues surrounding the crime of sexual assault, and provides insight into the issues which are critical in police investigations.

Target Audience: Police professionals dealing with sexual assault issues.
Dissemination/Usage: Material can be downloaded from Violence Against Women Online Resources available at the Department of Justice, Office of Justice Programs Web site. While the material is specifically designed for Connecticut police, it could be modified for other police jurisdictions.

Training Program/Policy Statement/Practice Protocol: 747474744343
Care of Sexual Assault Victims: Position Statement
Source: Emergency Nurse Association
Address: 915 Lee Street, Des Plaines, IL 60016-6569
Phone: (847) 460-4000
Web site: www.ena.org/about/position/caresexualassault.asp
Description: This position statement reflects the ENA's belief that a need exists for improving treatment and care of sexual assault victims. It further states that improved and comprehensive care requires extensive preplanning, education, and the collective expertise of emergency care and other team members. The position statement establishes objectives for emergency nurses which, when achieved, will further the goal of comprehensive competent care.

The objectives include:

  1. All personnel involved with sexual assault victims should have an empathetic and non judgmental attitude.
  2. Emergency nurses should conduct a brief mental assessment of needs and support necessary. to prevent further trauma.
  3. Provide internal crisis intervention and assist in further intervention as needed.
  4. Provide treatment for physical injury and conduct evidence collection in a private setting with only a limited number of people in attendance.
  5. Provide access to rapid assessment, testing and disease prophylaxis.
  6. Conduct or assist with the conduct of the physical examination.
  7. Perform or assist with the performance of evidence collection and documentation.
  8. Facilitate followup care.
  9. Provide appropriate referrals to community resources.
  10. Understand the special diagnostic and treatment needs of sexually assaulted or abused children.

Target Audience: Emergency room nurses.

Training Program/Policy Statement/Practice Protocol: 747474744444
Domestic Violence & Child Maltreatment: Position Statement
Source: Emergency Nurse Association
Address: 915 Lee Street, Des Plaines, IL 60016-6569
Phone: (847) 460-4000
Web site: www.ena.org/about/position/domesticviolence.asp
Description: This position paper states ENA's belief that the emergency nurse is an advocate for the survivor of domestic violence. Additionally, ENA believes that the survivor has a right to be treated in a physical and social environment conducive to compassionate and unbiased care; and to that end recommends the development and use of routine protocols/procedures for assessment, identification and referral for survivors of domestic violence. As part of the position paper, the ENA supports extending use of protocols for routinely identifying, treating and referring victims of sexual assault in hospital emergency departments. In an addenda to the position paper entitled "Child Maltreatment," ENA states its support for increased public education for prevention, detection, treatment, reporting and followup of child maltreatment/abuse. It also calls for the development of a national format for reporting child maltreatment.

Training Program/Policy Statement/Practice Protocol: 747474744545
Forensic Evidence Collection, Position Statement
Source: Emergency Nurse Association
Address: 915 Lee Street, Des Plaines, IL 60016-6569
Phone: (847) 460-4000
Web site: www.ena.org/about/position/forensicevidence.asp
Description: This position paper states:

ENA's belief that it is within the nurse's role not only to provide physical and emotional care to patients, but also to help preserve the "chain" of evidence collected in the Emergency Department. ENA encourages nurses to become familiar with the concepts and skills of evidence collection and documentation, and that nurses should have basic skills or access to resources to obtain photo documentation in the emergency care setting. ENA also believes that nurses should work collaboratively with the emergency physicians, social services and law enforcement personnel to develop guidelines for forensic evidence collection and documentation in the emergency care setting.

The position statement includes a rationale and a bibliography of key journal articles.

Training Program/Policy Statement/Practice Protocol: 747474744646
Catalog of Training and Education Materials on Domestic Violence
Source: Family Violence Prevention Fund
Address: 383 Rhode Island Street, Suite 304
San Francisco, CA 94103-5133
Phone: (415) 252-8900
Web site: www.fvpf.org
Description: Catalogue of education and training materials developed by the Family Violence Prevention Fund as part of a National Health Initiative on Domestic Violence, to provide health care professionals and institutions with training and information required to effectively meet the needs of battered women. The materials have been widely used in hospitals, clinics and doctors' offices. In addition to information on best practices and training manuals, the catalogue features practical tools such as laminated reference cards for busy practitioners, patient brochures, and items that can be utilized for raising public awareness such as t-shirts and mugs.

Training Program/Policy Statement/Practice Protocol: 747474744747
Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health
Source: Family Violence Prevention Fund
Address: 333 Rhode Island Street, Suite 304, San Francisco, CA 94103-5133
Phone: (415) 252-8900
Web site: www.endabuse.org
Description: These guidelines were developed by the Family Violence Prevention Fund, in partnership with: the American Academy of Family Physicians (AAFP); the American Academy of Pediatrics (AAP); the American College of Obstetricians and Gynecologists (ACOG); the Child Witness to Violence Project at Boston Medical Center; and the National Association of Pediatric Nurse Practitioners (NAPNAP). The development of the guidelines was funded by the U.S. DOJ Office for Victims of Crime, with support from the HHS Administration for Children and Families and the Conrad N Hilton Foundation. The guidelines offer specific recommendations for screening and responding to domestic violence in child health settings which provide a unique and important opportunity to screen for domestic violence and to educate parents about the impact of such violence on children. The guidelines also speak to the need for child health providers to engage in, model, and take leadership in delivering effective primary prevention of domestic violence and other types of family and community violence, by highlighting violence prevention during well child and other routine visits as a component of routine anticipatory guidance.

The report includes appendices with position statements on domestic violence by medical and health professional associations; abstracts of studies on provider and patient attitudes toward screening; indicators of abuse; reporting requirements and State code information; resources for providers and patients; and safety plans and instructions.

Training Program/Policy Statement/Practice Protocol: 747474744848
Improving Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers
Source: Family Violence Prevention Fund
Address: 383 Rhode Island St., Suite 304, San Francisco, CA 94103-5133
Phone: (415) 252-8900
Web site: www.fvpf.org
Description: A 250 page loose leaf resource manual for health professionals developing and implementing comprehensive domestic violence prevention and treatment programs in emergency departments, primary care and ob/gyn settings. The manual provides information on the dynamics of domestic violence; identification, screening, assessment and interventions with victims of domestic violence; and responding to batterers. The manual also provides resource material for both patients and providers including model protocols, screening and discharge material and additional clinical tools.
Target Audience: Physicians, medical social workers, nurses, health educators and domestic violence advocates.
Dissemination/Usage: Sold by the Family Violence Prevention Fund.

Training Program/Policy Statement/Practice Protocol: 747474744949
Improving the Health Care Response to Domestic Violence: A Training Manual for Health Care Providers
Source: Family Violence Prevention Fund
Address: 383 Rhode Island St., Suite 304, San Francisco, CA 94103-5133
Phone: (415) 252-8900
Web site: www.fvpf.org
Description: The training manual is a companion document to the resource manual and provides complete step by step instructions on how to teach each of the modules. Areas covered include the dynamics of domestic violence, developing clinical skills, understanding legal issues and identification of community resources. The training manual also includes a special section on developing cultural competency in providing help to diverse populations.
Target Audience: Physicians, nurses, medical social workers, health educators and violence advocates.
Dissemination/Usage: Sold as part of a package with the resource manual by the Family Violence Prevention Fund.

Training Program/Policy Statement/Practice Protocol: 747474745050
Preventing Domestic Violence: Clinical Guidelines on Routine Screening
Source: Family Violence Prevention Fund (FVPF)
Address: 383 Rhode Island Street, Suite 304, San Francisco, CA 94103-5133
Phone: (415) 252-8900
Web site: www.fvpf.org
Description: The guideline includes recommendations for how screening for domestic violence should occur within the health care system. Recommendations are based on an extensive literature review and a conference with expert health practitioners in the field of domestic violence screening, intervention and prevention and advocates in the domestic violence community.

The guideline recommends:

  • Routine screening for domestic violence victimization for all female patients over the age of fourteen in primary care, obstetric/gynecology and family planning, emergency department inpatient, pediatrics and mental health settings.
  • That all practitioners and health organizations within these settings implement culturally competent programs to ensure routine screening.
  • That screening be carried out in private settings and through the use of straight-forward, nonjudgmental questions in a culturally competent manner.
  • Confidential documentation of screening outcomes.

Audience: All health care institutions and practitioners
Dissemination/Usage: FVPF works with national health and medical associations and stat organizations to jointly encourage the widespread implementation of theses guidelines.

Training Program/Policy Statement/Practice Protocol: 747474745151
SART/SANE Institute
Source: Forensic Nursing Services
Address: P.O. Box 2512, Santa Cruz, CA 95063-2512
Phone: (831) 465-9826
Contact: Sandra Goldstein, R.N., M.S., (831) 465-9826
Web site: www.Forensicnursing.com
Description: A one-week multi-disciplinary training program on how to implement a Sexual Assault Response Team/Sexual Assault Nurse Examiner (SART/SANE) program with assistance from the staff of Forensic Nursing Services and materials designed by them. The training meets the educational guidelines of the International Association of Forensic Nurses (IAFN).

The Forensic Nursing Services provides, as part of the Institute package the following:

  • Participants manual, including an overview of the Institute.
  • Outlines of the presentations by various speakers.
  • Articles related to sexual assault.
  • Abstracts of sexual examination research.
  • Sample diagrams and terminology definitions.

The entire Institute curriculum includes the daily agenda, presentation content outlines, presentation objectives and evaluation forms. The program also includes a preceptorship instructor and a SART/SANE Preceptorship Guide for each person. Forensic Nursing Services also provides an introduction to the preceptorship, suggestions for selecting preceptors, sample preceptor recruitment letters and sample letters to preceptors, instructions for preceptor nurse examiners, the identification of goals for each preceptor area and evaluation forms for each preceptor.

Target Audience: Nurses, health care providers, advocates for assault victims, law enforcement personnel, and district attorney's interested in developing SART or SANE programs in a community.
Dissemination/Usage: The program has been operational since the early 1990's. The references and other materials are updated as techniques and technology change.
Other Comments: Information on the SART/SANE Institute can also be obtained from Sherry Arndt, R.N., M.P.H. at 40758 100th Street, Comfrey, MN 56018-4011. Telephone (507) 877-3663. Fax (507) 877-6011.

Training Program/Policy Statement/Practice Protocol: 747474745252
The SART/SANE Orientation Guide
Source: Forensic Nursing Services
Address: P.O. Box 2512, Santa Cruz, CA 95063
Phone: (831) 465-9826
Contact: Sandra Goldstein, R.N., M.S., (831) 465-9826
Web site: www.Forensicnursing.com
Description: The Sexual Assault Response Team/Sexual Assault Nurse Examiner (SART/SANE) Orientation Guide provides a step by step outline to aid a community in developing a Sexual Assault Response Team (SART). Chapters discuss developing a task force, identifying funding, development of the multi-disciplinary team and the preparation for a SART/SANE institute. The orientation guide contains community assessment worksheets to determine the readiness for developing a program, it includes discussions on how to introduce the concept of a SART/SANE program to community leaders and includes a slide presentation with accompanying text.

The orientation guide also includes sections on the following topics:

  • Developing goals and objectives for the task force.
  • Developing a budget.
  • Selection of staff.
  • Role development and description of team activities.
  • Setting up exam rooms, including information on location design, décor and equipment.

Target Audience: Nurses and other community leaders interested in establishing a SART/SANE program in their community.
Dissemination/Usage: Sold through Forensic Nursing Services Web site.
Other Comments: Information on the SART/SANE Orientation Guide and other services provided by the Forensic Nursing Services can also be obtained from Sherry Arndt, R.N., M.P.A. at 40758 100th Street, Comfrey, MN 56018-4011. Telephone (507) 877-3663. Fax (507) 877-6011.

Training Program/Policy Statement/Practice Protocol: 747474745353
Injuries and Evidence and Sexual Assault: Documenting the Trauma for Trial (A Video and Workbook)
Source: Health Education Alliance
Address: 2611 Garden Road, Monterey, CA 93940
Phone: (831) 333-0300
Description: In sexual assault cases, forensic evidence may be useful in two ways. It may establish facts or corroborate testimony by showing links between the victim, her attacker and the scene of the crime. These links consist of physical traces exchanged during violent acts. Today, exploitation of this kind of evidence is possible, but frequently not done. This unsatisfactory situation derives from a lack of forensic knowledge by some of the crucial actions involved in the investigation: physicians, investigators and magistrates. Also, taking into account the high level of recidivism in this kind of crime, systematic forensic investigation can point to links between cases having no obvious relation in terms of time or location. Physicians and other health care providers have to know how to handle the cases optimally in order to guarantee that all potentially useful information is available.

The program is divided into three main areas: Overview; Documentation of Injuries and Evidence; and Assessment Instrument.

The overview section is divided into two parts:

  1. Sexual Crimes: The Importance of Forensic Investigation.
  2. Bite Mark Evidence on Crimes Against Persons.

The Documentation of Injuries and Evidence section consists of the following:

  1. Investigation of Microtrauma after Sexual Assault.
  2. Genital Injury and Implied Consent to Alleged Rape.
  3. Cervical Findings in Rape Victims.
  4. Colposcopy to Establish Physical Findings in Rape Victims.
  5. Use of Toluidine Blue for Documentation of Traumatic Intercourse.
  6. Toluidine Blue in the Corroboration of Rape in Adult Victims.

The Assessment Instrument section presents a case study of a sexual assault with the relevant reporting forms.

Target Audience: Physicians and Nurse Examiners
Dissemination/Usage: For sale from the Health Education Alliance

Training Program/Policy Statement/Practice Protocol: 747474745454
Sexual Assault Response Teams: A training video
Source: Health Education Alliance
Address: 2611 Garden Road, Monterey, CA 93940
Phone: 800-404-3258
Description: A 30-minute video explaining basic facts about Sexual Assault Response Teams (SART), their development, organization and function. The major topics discussed include:

  • Who should examine rape victims?.
  • What are the benefits of a SART?.
  • What are the barriers to creating a SART in a community?.
  • What are the responsibilities of various team members?.
  • What is the District Attorney's role?.
  • What are the resources necessary for getting started?.
  • How to initiate a SART?.

Audience: Those individuals interested in organizing a Sexual Assault Response Team. Also suitable to show to community groups to explain the SART concept.
Dissemination/Usage: Available from Health Education Alliance

Training Program/Policy Statement/Practice Protocol: 747474745555
Save the Evidence, Save a Life! and Sexual Assault: The Medical-Legal Exam (A Video and Workbook)
Source: Health Education Alliance
Address: 2611 Garden Road, Monterey, CA 93940
Phone: (831) 333-0300
Description: Much of the information in the video and workbook was taken from the California Medical Protocol for Examination of Sexual Assault and Child Sexual Abuse Victims and the California Medical Protocol Informational Guide. The workbook and video are divided into three main sections and, in addition, the workbook has an extensive Appendix. The main sections are: Overview; Examination Procedures; and Multicultural Issues.

The Overview section addresses: the Rape Trauma Syndrome; The Behavior-Oriented Interview of Rape Victims; The Key to Profiling and Sexual Assault; and Guidelines for Clinicians.

The Examination Procedures section covers the following topics: Patient Consent for Examination, Treatment, and Evidence Collection; Special Considerations in the Collection & Preservation of Evidence; Adult Female Patients (Psychological Reactions, Evidential Examination, Possibility of Pregnancy); Adult Male Patients (Psychological Reactions, Evidential Examination); Pediatric Patients (Psychological Reactions & Behavioral Indicators, Evidential Examination); Treatment of Sexually Transmitted Diseases; and followup Patient Care.

The Multicultural Issues section covers the following: Cultural Considerations in the Treatment of Asian Sexual Assault Victims; Providing Support Services to Black Sexual Assault Survivors; and Medical Protocol for the Latina Survivor.

Target Audience: Physicians and Nurse Examiners
Dissemination/Usage: For sale from the Health Education Alliance.

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