Since Last We Spoke (and a Giveaway Winner!)

Greetings to you all, and a good Monday morning–my hometown baseball team is up in the World Series 3-2 and we are a mere 9 days from this election being over, one way or another. Here’s hoping you had a lovely weekend, wherever you spent it. A continued trial means I am unexpectedly at home this week with nothing scheduled (but plenty to do), so I’m looking forward to that. Also, congratulations to Christianna Peterson, the winner of the latest giveaway.

Here’s what I’ve been reading since last we spoke:

It’s like we’ve just discovered contraceptives have side effects that can be unpleasant

Somewhat related

Life skills no one taught you

Be a leader people want to follow

I have seriously mixed feelings on this

News from Baylor just keeps getting worse and worse

In other football news…

We’ll end this list on a positive note:


Evaluating the Treating Clinician’s Testimony: A Defense Expert Perspective

Don’t forget we have a giveaway going on this week. See all the details here.

I taught a new session at IAFN this year, Evaluating the Treating Clinician’s Testimony: A Defense Expert Perspective. It was one of ten that was recorded, and it’s now available for purchase on the IAFN site. For $25 ($40 for non-IAFN members) you can check out the talk– 1.5 CEs are included in the fee. Find this, and all of the other recorded sessions here.


Child Abuse DV/IPV Sexual Assault

Childhood Trauma: Changing Minds

Don’t forget we have a giveaway going on this week. See all the details here.

Have you seen the new multimedia presentation on childhood trauma from Futures Without Violence? If not I encourage you to take a look–some terrific information about how trauma impacts kids’ brains and what we can do to help.


Sexual Assault

The Intersection Between Prostitution, Human Trafficking, and Victimization Among Justice Involved Women

Don’t forget we have a giveaway going on this week. See all the details here.

The National Resource Center on Justice Involved Women has a webinar coming up next week: The Intersection Between Prostitution, Human Trafficking, and Victimization Among Justice Involved Women. The session will be held November 1st from 2-3:30pm ET.

From the site:

It is estimated that 90% percent of justice involved women have experienced some form of victimization in their lifetime. As a result of this trauma, women may engage in behaviors that are criminalized, such as drug use or prostitution, and may be less commonly seen as “victims” by the justice system. What’s more, their vulnerability may expose them to further victimization, trauma, and exploitation — such as human trafficking.

The NRCJIW, in partnership with the Center for Court Innovation, will conduct a webinar on November 1 to explore the nexus between prostitution, human trafficking, and victimization among justice involved women. The webinar will discuss strategies that justice system stakeholders can take to identify women who may be victims of exploitation and human trafficking, address their needs, and improve their response to these women.

Register now for this informative webinar to take place on Tuesday, November 1 from 2:00 – 3:30 pm Eastern.


Welcome to the New FHO!

Welcome to the new, improved Forensic Healthcare Online! As we approach FHO’s 8th birthday, I thought it was time to spruce things up a bit. Here’s what you’ll find on the redesigned site:

  • More focused content: FHO readers have their favorite areas and now it’s easier than ever to find what you’re looking for, whether it’s DV/IPV, sexual assault, child abuse, elder abuse or court testimony.
  • More organization: the popular stuff leads, but nothing should be tough to find with clear categories and a pleasing lay out. All regular blog posts can now be found under Articles.
  • More consistent clinical guides: on the old site, clinical guides were all over the map, design-wise, making it harder to find what you needed. Now all clinical guides have one format, for a streamlined look that’s easier to read.
  • More responsiveness: check out how FHO looks on phones and tablets. Nice, right? Now you won’t miss out on content or functionality when you visit FHO on a mobile device.
  • More content: coming soon to FHO—an online store with resources that take your practice to the next level, whether in the exam room or the courtroom. Peer-reviewed, available for download to computers or mobile devices, and regularly updated. All of the things you’ve come to expect from FHO, just more of it.

To celebrate the launch of the new FHO site, let’s give something away, shall we? Leave a comment with feedback about the new look, and on Friday, 28 October one reader’s comment will be chosen at random to win either a copy of the Forensic Nursing Core Curriculum or a $50 Amazon gift card. THIS GIVEAWAY IS NOW CLOSED. THANKS ALL WHO ENTERED. I encourage you to take some time to really poke around the site—I’ll be fine-tuning as we identify issues in this next week, so by all means, let me know if you spot a problem. (I’ve spotted one of the 1st ones—the bulk of comments from the old site haven’t yet transferred to the new one).

Finally, I would be remiss if I didn’t take a moment to thank my spouse, Sasha Rutizer, JD, and my father, Alan Markowitz, MD, who have supported my work on this site since its inception. Both have been unwavering in their encouragement and provided terrific suggestions about next steps and ways to get there. And a special thank you to my merry crew (you know who you are) who have weighed in on logo choices and other design elements, cheered on the evolution of FHO and just generally make me a better clinician, educator and writer. I have had the great, good fortune to have wonderful collaborators, mentors and friends in my twenty plus years in this field.


Since Last We Spoke, 10-17-16

I’m really pretty well consumed with the election coverage, or at least my Twitter feed is (and my FB feed, and my Instagram feed). I fear until the election is over, this weekly feature will be a little sad. Sure, there are other things happening in the world, but I have no idea what. So here’s what little I’ve been reading since last we spoke:

 A familiar story

This hurt me on so many levels

A lovely tribute

As someone with chronic pain I feel all of this

The magnitude of stalking

One paper’s response to threats

A long, but fascinating, read

The sexism of the likability trap

Child Abuse

Consent for Kids

I’m just going to go ahead and leave this here (although feel free to share with some of our politicians…)

{By @BlueSeatStudios; h/t NSVRC}

Child Abuse

Trauma Informed Care of Immigrant and Refugee Children

The National Health Collaborative on Violence and Abuse has a webinar coming up next month: Trauma Informed Care of Immigrant and Refugee Children. The session will be held November 16th from 1-2:30 pm ET. CMEs will be available for physicians (sadly, with all of the nursing representation in this organization, they still aren’t offering CEUs for us, but a girl can hope). Click through for available details:

From the email (no session description available):

Learning Objectives:

  1. Examine the effects of trauma on immigrant children
  2. Discuss mental health screening of immigrant children
  3. Discuss strengths based approaches to build resilience and heal trauma
  4. Learn how to utilize the medical home/care coordination models to more effectively meet the unique needs of immigrant children and families.

Featured Speakers:

Andrea Green, MD, Director of the Pediatric New American Clinic at UVM Children’s Hospital

Cathleen Kelley, MSW, LCSW, Pediatric New American Clinic at UVM Children’s Hospital

Register here.

Elder Abuse/Neglect

Critical Issues Facing Seniors and Persons with Disabilities

The California Senior Medicare Patrol program is hosting a webinar, Critical Issues Facing Seniors and Persons with Disabilities. It will be held October 27th at 10am PT, but space is limited for this session so register soon. Click through for details:

From the site:

Please join us on October 27, 2016 at 10am PDT for an enlightening, three-part educational webinar on critical issues facing seniors and persons with disabilities: Medical Identity Theft and Healthcare Fraud; Marketing Violations involving Medicare Advantage Plans; and the Universal Epidemic of Elder Abuse.

Micki Nozaki, Facilitator: Micki Nozaki is the Director of the California Senior Medicare Patrol program a project of California Health Advocates.

Julie Schoen, Presenter: Julie Schoen is the Deputy Director with the National Center on Elder Abuse.

Julie Lowrie, Presenter: Julie Lowrie is an Investigator, with the Office of Enforcement at the California Department of Managed Health Care.

Articles of Note Child Abuse DV/IPV Sexual Assault Testimony

Articles of Note: October 2016

It’s time once again for Articles of Note, our (mostly) monthly look at what’s new and noteworthy in the peer-reviewed literature. Click through for the active-linked Word doc and the printer-friendly PDF. As always, please provide attribution if you distribute either or use the information for other than personal purposes.


Sexual Assault

Legal Aspects of Human Trafficking for Health Providers: Case Studies and Legal Remedies

Good morning. I hope all of our Canadian readers had a lovely Thanksgiving. Tonight begins Yom Kippur, so I will be knocking off a bit early to get ready for services. Apologies for the lack of post yesterday. It was a federal holiday in the US, so I played hooky with my wife who had the day off. And let’s face it–the only thing I’ve read since last we spoke is about our unfortunate Republican candidate, and no one needs more to read about him. So let’s move on to things that lift us up, shall we? Namely quality education that improve our capacity as clinicians, this one from Futures Without Violence:

They are hosting a webinar, Legal Aspects of Human Trafficking for Health Providers: Case Studies and Legal Remedies. The session will be held October 20th from 3-4:40pm ET. From the site:

Description: This webinar will provide health care providers with insight into the legal remedies available to human trafficking victims. Each year, thousands of men, women, and children are held in forced labor, forced prostitution, and the commercial sexual exploitation of children. This webinar will explore the role health care providers can play in identifying trafficking victims, providing documentation, developing expert testimony, and providing affidavits for submission in legal cases. The program will cover both US citizen and foreign-born victims trafficked in the United States. Presenters will use case studies to discuss trafficking victims’ contact with the providers, including missed opportunities when victims might have been identified but were not. The speakers, both attorneys, have more than three decades of combined experience in the human trafficking field.

Learning Objectives

  1. Identify legal remedies – immigration, civil, and criminal – available to trafficking victims in the United States;
  2. Define the critical role that healthcare providers can play in identifying victims, providing documentation, developing expert testimony, and providing affidavits for submission in legal cases;
  3. Identify human trafficking red flags through case examples of victims seeking medical care.


Hanni Stoklosa, MD, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA and Executive Director, HEAL Trafficking.

Stephanie Richard, JD, Policy & Legal Services Director, Coalition to Abolish Slavery and Trafficking (CAST), Los Angeles, CA

Martina Vandenberg, JD, Founder and President, The Human Trafficking Pro Bono Legal Center (HT Pro Bono), Washington, DC.

Register here.

Sexual Assault Testimony

Applying the Best Available Research Evidence to Build Comprehensive Strategies for Sexual Violence Prevention

The National Center for Campus Public Safety has a webinar coming up,Applying the Best Available Research to Build Comprehensive Strategies for Sexual Violence Prevention. It will be held October 20th from 2-3pm ET. Anyone participating in campus-based SARTs or MDTs in communities with colleges and universities should consider attending. Click through for details:

From the site:

Eliminating sexual violence on college campuses and in communities requires a comprehensive approach to primary prevention based on the best available research evidence. The CDC, in partnership with federal and local partners, is committed to advancing the science of sexual violence prevention to inform the development of more effective strategies. In this webinar, Kathleen will provide an overview of the latest knowledge related to sexual violence, including risk and protective factors, evidence-based strategies, and the need for comprehensive, multi-level approaches that address the complexities of this problem. Participants are encouraged to think about ways to apply this knowledge to build a comprehensive prevention plan for their campus or community. There will be opportunities for questions and answers throughout the webinar.

SpeakerKathleen C. Basile, PhD, a subject matter expert for sexual violence definitions, research, evidence-based prevention strategies, and surveillance, for the next free webinar in our Campus Public Safety Online series.  Kathleen is the Lead Behavioral Scientist of the Sexual Violence and Child Maltreatment Team in the Research and Evaluation Branch of the Division of Violence Prevention (DVP) of the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control. She recently presented onApplying the Best Available Research Evidence to Build Comprehensive Strategies for Sexual Violence Prevention at our Trauma-Informed Sexual Assault Investigation and Adjudication annual conference.

Note: October 17th is the deadline for registering for this session.

Sexual Assault

Unique Perspective for Women with Traumatic Brain Injury: Gender Differences and Coping Strategies

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury have a webinar coming up this month, Unique Perspectives for Women with Traumatic Brain Injury: Gender Differences and Coping Strategies. It will be held October 13th from 1-2:30 pm ET. While I imagine it will address mild TBI specifically from combat-related activities, these issues also apply for many of our interpersonal violence patients, such as domestic violence victims. The gender-specific nature of this session makes it particularly interesting to me. Click through for details:

From the site:

The data regarding active-duty servicewomen who have sustained traumatic brain injury (TBI) suggest their experiences, aftereffects and outcomes differ from servicemen. This presentation will integrate current research and clinical expertise to advance health care provider awareness of TBI among women serving in the military. The speakers will present current evidence comparing female athletes and active-duty service members with a TBI history as well as data about servicewomen with and without symptoms from co-occurring conditions such as posttraumatic stress disorder, anxiety and chronic pain. The presenters will also address the gaps in the present knowledge base concerning gender differences and TBI.

At the conclusion of this webinar, participants will be able to:

  1. Describe three ways in which brain injuries in women (including concussion or mild TBI) are unique.
  2. Articulate factors that may account for gender differences in TBI incidence, severity and recovery.
  3. Apply best practices in the education of women who have sustained a TBI to facilitate recovery.

Injury Terminology and Testimony

I wanted to address an issue that I heard repeatedly at the conference; one that has also been brought directly to me from FHO readers–injury documentation. There was a session in Denver where it was the focus, and before I go into the heart of things I want to start with this–this post is solely intended to add to the discourse, since that’s what helps move the profession forward.

Now, I was not in the session, but I heard from so many people who were there, I feel confident that I am accurately reflecting at least a bit of what has people talking: the notion that we shouldn’t document blood, but rather red fluid (or something to that effect), and we should not document bruise, but simply discoloration, and an appropriate descriptor. The reasons appear to stem from a cross-examination experience at a trial, where a nurse couldn’t speak to how she definitively knew blood was blood, and presumably, the same was true of the bruise (if I have any of this wrong, please correct me). Were I in this session, it’s possible I would have agreed with everything else the presenter said, but on these two points let me offer this:

1. We are clinicians, and as such, we assess patients. But we have to be able to describe the knowledge base that informs our capacity to do so. I feel fairly confident in my ability to identify blood–from its feel, its source (such as a wound out of which it is flowing); the way it appears after it has dried; the accompanying clinical signs, symptoms or history that support its positive identification, such as wounds, or pain, or a report of a traumatic event. You get where I’m going with this. I would question a clinician’s ability to definitively identify bleeding in the vaginal vault as menstrual blood, perhaps, but I wouldn’t challenge the blood part of it. Just the nature of that blood. The same is true for bruises: in general, I have been assessing them my whole career and I know what one looks like, that it is generally tender with palpation, often accompanied by a history of trauma, etc. The exception to that is when it’s the cervix–then I will call it discoloration, because many things can give the appearance of a bruise, but until I have the ability to assess the cervix on follow up, one of the things I can’t rule out is the possibility that that discoloration is normal for that woman.

2. I generally try and remain consistent in how I assess and document patients. Which means if I would use the terminology with other patient populations (read: primary care), I wouldn’t change it for the forensic one. I implement the same nursing process no matter the patient population, only the chief complaint and some of the tools and forms I use differ. The approach is generally consistent. I use blood and bruise for other types of patients; I’m probably going to use it for this patient population, too.

3. Perhaps one of the most important points: a tough cross-examination is not enough of a reason to change practice, but instead an opportunity to identify problems with your response. A nurse who can’t articulate why she knows something is blood shouldn’t just stop identifying blood, but get better at describing the information that supports its identification as such. This is true for much of what we do–there will be times when some aspect of our practice subjects us to pain on the stand, but most of the time, the 1st step should be to do the post-game analysis and see where we need to get better at our explanations rather than simply changing practice based on that single experience.

I’m certainly interested in people’s thoughts on this. There’s no single answer, so we can respectfully disagree. But if you do disagree, please help me understand where our opinions diverge so that all of us can engage in more thoughtful and constructive debate.

DV/IPV Sexual Assault

Since Last We Spoke, 10-3-16

Shanah Tovah to all who are celebrating today; I came home a little early from Denver to be with my wife for the Jewish New Year (and cook for a full table). I have a light schedule today and will be attending services, so I’ll keep today’s post brief. Come back for tomorrow for some comments on the IAFN conference. For now, here’s what caught my eye while waiting for my flight since last we spoke: