When I was in Kansas City last week one of my sessions was geared toward emerging issues in forensic healthcare. I was asked to speak on the topic, and while I understand that the request was geared more towards a “specific populations and circumstances” kind of talk, I decided to take it in a slightly different direction. Instead we talked about some of the Big “C” Conversations I have been having with people in my travels. The kinds of conversation topics that are almost universally applicable no matter where people are practicing, whether it’s North America or Australia, rural or urban. That’s not to say that the conversations about specific populations and circumstances aren’t also universal–they absolutely are. But they aren’t emerging issues. They have been an important part of our clinical knowledge base from the very beginning. Some of the issues I’ve noted below have been, too–but we haven’t necessarily explored them as much as a collective of healthcare providers as I’d like to see.
We ended up running out of time during this session, but I promised I would post a resource page with some helpful information related to the topics we covered in that session (and it’s here I should confess I presented that talk as a 10 Things list). Below are what I would consider to be good places to start on each of these areas. And because the specific populations and circumstances conversations are also important, I’ve included a few of those resources in here, as well. This is by no means a comprehensive list, but it’s meant to be a place to begin the conversation, or continue your exploration of the topics that intrigue you most. I’m certain some of you have other resources you like, so feel free to add them, or send them over and I will put them into the page:
Changes in STI prevalence, resistance and treatment:
http://www.cdc.gov/std/treatment/2010/toc.htm
Changes in our understanding of the needs of specific populations and circumstances:
No Safe Place: Sexual Assault in the Lives of Homeless Women (VAWnet)
http://www.vawnet.org/applied-research-papers/print-document.php?doc_id=558
Lesbian, Gay, Bisexual, Transgender & Queer Community (WCSAP)
http://www.wcsap.org/lesbian-gay-bisexual-transgender-queer-community
Creating a Trans-Welcoming Environment: A tips sheet for sexual assault service providers (FORGE)
http://forge-forward.org/2011/06/trans-welcoming-environment-a-tips-sheet/
Crime Victimization in Adults With Severe Mental Illness (FULL TEXT)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1389236/
Disability Etiquette: Tips on Interacting with People with Disabilities (VAWnet)
http://www.vawnet.org/summary.php?doc_id=2018&find_type=web_desc_GC
Polaris Project Tools for Service Providers and Law Enforcement (trafficking)
http://www.polarisproject.org/resources/tools-for-service-providers-and-law-enforcement (see Healthcare Professionals)
Expanded Practice:
6-Step Decision Making Model to Determine Scope of Practice (TX Board of Nursing)
http://www.bon.texas.gov/practice/pdfs/dectree.pdf (Note: this may be published by Texas, but the decision tree alone makes this a fantastic tool for looking at expanded practice to ensure anything you add is done in a manner that is legal under your state Nurse Practice Act)
State Boards of Nursing and Specific Diagnosis Language
http://www.scribd.com/doc/142741926/Links-to-State-Boards-of-Nursing-Diagnosis-Language (Note: If you would like the doc with active hyperlinks just email me and I will send it)
Program Sustainability:
Sustainability 101: Long Range Thinking for Sexual Assault Nurse Examiner Program Managers
Sustainability 101: Creating A Business Plan For Sexual Assault Nurse Examiners
Sustainability 101: Fostering Collaboration Between SANE Program Coordinators and Medical Directors
Trauma-Informed Care:
National Center for Trauma-Informed Care
Trauma Informed Care: The Role of the Health Care Provider
http://nhcva.org/2012/12/11/trauma-informed-care-the-role-of-the-health-care-provider-webinar/ (Note: this is a recorded webinar—scroll down to launch the webcast)
Secondary Trauma and Compassion Fatigue:
Vicarious traumatization: Concept analysis (JFN)
http://www.ncbi.nlm.nih.gov/pubmed/22123041 (Note: this is a lit review on the subject; IAFN members have free full-text access. This link leads to the abstract only.)
The Trauma Stewardship Institute
Evidence-Based Practice:
Clinical Guide: Evaluating Research
https://www.forensichealth.com/2012/07/31/clinical-guide-evaluating-research/
Evidence-Based Practice Glossary (ASHA)
http://www.asha.org/members/ebp/glossary.htm
Simulation Training:
The SAFE CARE model: Maintaining competency in sexual assault examinations utilizing patient simulation methods (JFN)
http://www.ncbi.nlm.nih.gov/pubmed/19538656 (Note: this article is available free full-text for IAFN members)
Evidence-Based Testimony/Working for the Defense:
Clinical Guide: Court Testimony
https://www.forensichealth.com/2012/06/05/clinical-guide-court-testimony/
Access to Care:
I don’t have a resource for this, but rather a message: there is no reason registered nurses shouldn’t provide forensic care to patients (adults or children) assuming that training standards, protocols, policies and procedures, competency evaluations and ongoing QA/QI processes are in place. For my fellow advanced practice/midlevel providers and physician colleagues who have concerns about particular programs because they are run by RNs? Rather than write them off, figure out how to be a source of support: collaborate to improve education, competencies and quality of care provided; step up and take on the role of medical director, making that position a fully engaged one rather than the figurehead it often is in many programs around the country; identify how emerging technologies such as telemedicine can be used to assist with quality assurance and quality improvement efforts. Access to care means doing everything we can to take care of patients in their own communities. Be a force of good in this work and help make that happen. No one should have to drive hours to receive this care if it’s possible to make it happen locally.
Healthcare Impact of Sexual Violence:
Clinical Guide: Adverse Childhood Experiences
https://www.forensichealth.com/2011/06/14/clinical-guide-adverse-childhood-experiences/
Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health (VAWnet)
http://new.vawnet.org/Assoc_Files_VAWnet/AR_SVReproConsequences.pdf
Health and Sexual Violence Online Resource Collection (NSVRC)
2 replies on “Big “C” Conversations”
Jen, What would you recommend as resources on the issue of electronic medical records and privacy concerns of sexual assault survivors? As more and more healthcare providers are asking about trauma-related issues, survivors have legitimate worries about where there disclosures will go and who will have access to the information that they may share for a specific medical purpose. I would really appreciate some resource suggestions on this topic.
Thanks so much,
Jennifer
Jennifer,
As you already know, not much has been written on this. Probably the best resource I know of is the Center on Medical Record Rights and Privacy at Georgetown: http://hpi.georgetown.edu/privacy/index.html
Much of the focus of the data related to privacy and EMRs centers around minors, but not necessarily for sexual assault care. Guttmacher released a report last summer, for instance, on Confidentiality for Individuals Insured as Dependents, which looks state by state at whether those insured as dependents (so not *just* minors) are able to get any privacy protections. That’s available at http://www.guttmacher.org/pubs/confidentiality-review.pdf. NNEDV also has a section of their technology and confidentiality toolkit on general issues for DV survivors that also apply to SA: http://www.nnedv.org/tools/faq/faq-flc/flc-hippa
Please let me know if you come across any other useful resources…