Violence Against Women

sexual violence

an umbrella term that refers to crimes such as SA, rape, and sexual abuse

sexual assault

any type of sexual contact or behavior that occurs w/o the explicit consent of the recipient

SA includes

complete or attempted forced penetration of a victim; unwanted sexual contact

Rape

the penetration of any bodily orifice by any part of the body or by any object performed against the victim’s will w/o consent and with the threat of actual use of force

statuatory rape

act done against 15 year or younger minor; age of consent is 16

consent

submission of victim by force, threat, or coercion

SV risks factors

younger age (adolescents & college-aged women at higher risk), hx of family violence during childhood/adolescence, pregnancy, hx of mental illness, sexual minority (LGBTQ, disabled), socioeconomic factors: poverty, low education level, unemployment and/or employment instability, homelessness/foster care system

neurobiology of trauma

• PTSD is a trauma (event) and stress (response) related disorder; occurs in the next two weeks 

• Freeze, flight, fight (and feelings of guilt)

• Fear response

fear response

fragmented memory; difficulty to remember order of events, but may remember specific smells, sounds, sights

cycles of abuse

tensions building→incidient→reconciliation→calm

screening for violence

validates violence as a health care issue, opens a dialogue and “plants a seed”, identifies those at risk, provide opportunity for education, safety/health assessment

education

participants should receive GPAC/FPAC information, opens to social media, targeted campaigns, survivor collab, focus on anonymity, trusted source

sexual trafficking/CSEC (commerical sexual exploitation of children)

involves the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act in which a commercial sex act is induced by force, fraud, or coercion, or in which the person forced to person such an act is younger than 18; 80% of those trafficked are women and young girls; enormous public health problem

sex trafficking/CSEC risks

youth experiencing homelessness, h/o sexual or physical abuse or neglect, h/x juvenile justice or CPS involvement, h/o mental health or learning disabilities, living in areas with high crime rates or high poverty rates, gang involvement, substance abuse, lack of social support and housing instability

sex trafficking/CSEC potential indications

relationships (grooming), behavioral, physical, emotional

sex trafficking/CSEC clinical practice

inconsistent health care, STIs, multiple pregnancies or terminations, poor dentition, substance abuse/addiction, partner who seems impatient about visit or insists on staying with the pt during the visit, pt stated illness that doesnt match with health account

suspecting abuse

emphasis on trust, safety, and agency; speak with pt alone; if underage, file a 51A; bring in social worker or advocate; give resources

Resources for abuse

MACA, CAC, SEEN, MyLifeMyChoice; Safety planning

SANE Program

to deliver coordinated, compassionate, comprehensive report forensic care to SA patients across the lifespan

Trauma Informed Care (and the 4 R’s!)

• Realizing the widespread of trauma + understanding potential paths for recovery 

• Recognizing the s/sx of trauma 

• Responding to fully integrating knowledge by fully integrating knowledge about trauma into policies, procedures, and practices 

• Resisting retraumatization

Purpose of evidence collection

to provide objective, scientific data about the event that is important to the successful prosecution of sexual assault cases, should the survivor choose to go forward; no injury is normal 

Pt’s what comes first

needs, safety; build rapport and trust, re-empowerment

SANE ROLE

• A complete head to the assessment and documentation

  • Hx of the assault 

  • Photographs 

  • May include internal and external pelvic exam 

• Collect evidence- swabs and smears 

  • Oral- within 24 hrs post assault; Anal-48 hrs; vaginal-120 hrs 

• Coordinate care with the ED staff/detectives/SW 

• Offer STI testing (urine/blood) 

• Recommend medication prophylaxis for pregnancy prevention and STI (trichomonas, Chlamydia, Gonorrhea, Syphilis, and HIV)

Meds offered during SANE exam

Zofran, Azithryomycin, Ceftriaxone, Metronidazole, Plan B or Ella, Vaccines-Hep B, Tetanus, HPV, HIV PEP

The MA-SAECK

• 6-step evidence collection kit; takes upwards of 4-5 hrs to complete; analysis completed by state crime lab

• If not reported, evidence will be stored for 15 years from collection…if pt under 16, all kits regardless and information will be analyzed and stored in CODIS database

The MA-SAECK steps

consent, buccal DNA sample, oral swabs/smears, hair combings, fingernail swabs, clothing collecting, bite marks, foreign material collection, additional swabs, pubic hair combings, external genital swabs, perianal swabs, vag swabs/smears, anorectal swabs/smears

most common sites of injury

mouth, throat (assess for strangulation), wrists, arms, breasts, posterior fourchette/hymen, anus (use black light to inspect body for fluids)

toxicology screen

offered if pt has periods of amnesia, confusion, unconsciousness, and/or lack of motor control…recreational drugs will show up

• within 96 hrs; urine/blood draw; drugs leave the body quickly

RN/NP role (if survivor presents to clinic within 5 days (120 days) of the assault)

• Encourage SANE exam at a SANE-affiliated hospital 

• It pt has changed clothes, encourage pt to bring clothes worn during the assault, in paper bay 

• Discourage showering or teeth brushing if the survivor has not yet done so 

• Make f/u appointment with them for 2-4 weeks 

RN/NP role (if survivor presents to clinic after those initial 5 days (120 days))

STI testing, pregnancy testing, HIV testing, HPV vaccine series, screening for depression and injuries, referral/resources (e.g. counseling)