Categories
Sexual Assault

National STD Curriculum

An FHO reader asked if I had any recommendations for refresher training for members of her team who either hadn’t had education on STDs in quite some time or who didn’t feel had had sufficient training on STDs in their original SANE course. The concern was raised following a challenging cross-examination experience in which the testifying SANE was asked about whether some exam findings could be consistent with certain infections, particularly when those infections were not ruled out in the course of caring for the patient (as with many programs, this particular forensic nursing program does not test for STDs, but prophylaxes according to CDC guidelines). The nurse wasn’t certain she handled the cross as well as she could have, and in hindsight, wasn’t certain she was as prepared as she could have been.

I do, in fact, have a recommendation for comprehensive refresher training. It’s probably more than what people believe they necessarily need, but it will certainly provide clinicians with a solid knowledge base on STDs: the National STD Curriculum and its self-study modules. They can be completed at your own pace, for CMEs/CEUs, have been recently updated, and are free. I’ve done several since the hours are good for my NP recertification, too, and one of the things I think they are particularly useful for is the issue mentioned above–the differential diagnosis. Answering the critical question, what else could it be? So if you’re not confident in how you would answer that question on the stand, it might be worth spending some time with these modules. Help make your practice that much more defensible.

 

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Categories
Sexual Assault

Post-Sexual Exposure (nPEP) HIV Prevention Toolkit: UPDATED

I saw this was posted over at SAFEta, as well, but I wanted to amplify it a bit, because this is an area where we can always be collectively stronger (since we’re still not able to universally offer patients the option at this time, at least here in the US): the AETC National Coordinating Resource Center published a Post-Sexual Exposure HIV Prevention Toolkit earlier this month. It includes:

You’ll also find a relevant blog post by Diane Daiber of IAFN that’s definitely worth a read. I was pleased to see that IAFN is actually a collaborator on this toolkit, so you can expect it to be specifically relevant to our practice. A great focus for an upcoming staff meeting perhaps…

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Uncategorized

Since Last We Spoke: Memorial Day Edition

I am actually hanging out in the mountains of West Virginia with wife and pup for the remainder of this holiday weekend, but I wanted to leave you with something that I found profoundly thought-provoking. Perhaps you’ve seen it–Abby Wambach’s commencement address at Barnard College last week. You can read the full text here, but if you have the opportunity, I recommend watching it, because I found it to be pretty aspirational:

 

 

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Categories
Elder Abuse/Neglect

Tribal Elder Protection Team Toolkit

The National Indigenous Elder Justice Initiative has a Tribal Elder Protection Team Toolkit now available. “The Toolkit is designed to help you identify and implement a tribal elder protection team. The toolkit is made up of several sections. Each section contains information that concentrates on different aspects of developing a tribal elder protection team.” Obviously, since I’m posting it here, medical services are included in the team outline. You’ll find the following five sections:

You’ll also find some online education modules on their site, and while none of them are healthcare specific, I noted that healthcare is listed as one of the future topics, so continue to check back. Regardless, for those of you working with tribal communities, there is some solid, basic education available that is worth sharing with your team, particularly if they haven’t had much in the way of elder abuse education.

 

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Categories
Uncategorized

Two Years

You are missed–personally and professionally–every day.

1/23/69-5/23/16

Categories
Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault

Insights from the NCVS Data for the Victim Assistance Field: Who Might We Be Missing?

The Center for Victim Research is hosting a webinar, Insights from the NCVS Data for the Victim Assistance Field: Who Might We Be Missing? The session will be held May 30th at 2pm. From the announcement:

A major goal of the Center for Victim Research is to develop a community of victim service providers and researchers to improve practice through the effective use of research and data.  This webinar will focus on how data from the National Crime Victimization Survey (NCVS) can help inform the victim service community about victimization patterns and service needs among different groups in the population.  The NCVS is the nation’s primary source of information on criminal victimization, representing the self-reported victimization experiences of survivors 12 and older across the United States.  Though the NCVS data is publicly available, it is difficult for those without training to do their own analysis, including in pursuit of information not easily answered through annual NCVS reports (e.g., looking at victims and related needs intersectionally, considering multiple characteristics at once).

Presenters will share findings from the NCVS about who is at greatest risk for violence and the use of victim services.  Special emphasis will be placed on issues of race, ethnicity, gender, age, poverty, access to services, and the impact of victimization, especially at a time when historic funding levels and increased flexibility make data-driven strategies for return on investment in victim assistance as critical as ever.

Webinar participants will have the opportunity to ask questions about the data and how they might be used to inform their research and practice.

Register here.

 

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Uncategorized

10 Things: Ethiopia

Last week, Sasha and I were fortunate enough to have been invited to teach for several days on responses to gender-based violence for the US embassy in Ethiopia (Russ Strand was the 3rd member of our party, and taught on our day off). I spend a great deal of time traveling, both domestically and internationally, but this was my first time in Africa, and I went without any preconceived ideas about what we would experience. Although the trip was relatively brief (we spent only 4 days on the ground), I felt like I was able to see quite a bit of Addis Ababa. If you have any interest whatsoever, please keep reading. Otherwise, come back tomorrow for regular FHO programming.

  1. Addis Ababa is more than 7700′ in elevation, making the weather in May relatively cool, dry and honestly, not what I expected. It was lovely, and Sasha and I spent each evening sitting outside having drinks or dinner at our hotel, which was a welcome respite from the general chaos of the city. Addis is crowded and sprawling–traffic is impressive and that’s coming from someone who lives in the city with some of the worst traffic in the US. The streets weren’t just crowded with cars, but with people, and without a clear sense of traffic laws or signals. By the time we got back each evening, the idea of venturing back out wasn’t particularly appealing, so adventures were saved for the couple of unscheduled days we had in the city, where both time and the ability to safely negotiate the regulated yellow cabs (as opposed to the unregulated blue cabs and vans, from which we were warned away) was simpler. Addis doesn’t have the kind of violent crime that many countries are known for, but muggings and pickpocket-type crimes are prevalent, and because of what we do for a living, we are probably more vigilant than most. So safety was always on our minds, and we moved around the city accordingly. Most ex-pats we met had stories of having their wallets lifted in some fashion or another, but thankfully we did not run into any issues.
  2. The focus of the conference was on eradicating GBV in Ethiopia, but until we showed up on Day One, it wasn’t clear who our audience would be, or even what the true goal of the conference was, as it was the first time any embassy had hosted something like this. We went with the impression that our predominant audience would be embassy personnel (healthcare providers, security staff, etc.) with some local professionals also invited. In truth, there were very few embassy personnel and the audience was overwhelmingly local professionals. This made for incredibly rich discussion but required us to shift our plan for teaching on the fly. We had local law enforcement, prosecutors, physicians, victim advocates, UN personnel, and a variety of other individuals. Our sessions were simultaneously translated into Amharic, the local language, although the majority of participants also spoke English. We covered a pretty broad range of topics during the two days that Sasha and I taught, including female genital mutilation/cutting; identifying and addressing IPV in the healthcare setting; injury in sexual assault cases; strangulation assessment; and corroboration in sexual assault. I honestly don’t know how effective the lectures were, but the conversations they spurred felt incredibly valuable.
  3. As is the case in the US, if you want to know the breadth of what is happening, ask the victim advocates. No one has a better sense of the realities for victims, and we saw this dynamic repeatedly during our time in Ethiopia. At one point I was having a discussion with the group about strangulation assessment and the physicians were politely listening, but they let me know that this wasn’t something they saw frequently in Ethiopia. The UN personnel mentioned that acid attacks were perhaps something that should garner greater attention than strangulation. But the victim advocates stepped in and made it clear that they heard about strangulation over and over again from victims, which surprised many in the room. That multidisciplinary conversation was impactful, and shared perspective made for some great dialogue during our time with the group. And the advocates, as we so often see in the US, seemed to have the fullest picture.
  4. We met many, many remarkable professionals in our short time there, but none more so than Maria Munir, who started the first shelter for rape and domestic violence victims in Ethiopia. The things she has accomplished are impressive, and we were so privileged to see her work in action on our last day when we were invited to visit the shelter. We met (and danced) with many of the teens and preteens, were treated to a traditional coffee and sweet made by some of the residents and staff and received a tour of the facilities. If I had done nothing else, the trip would have been worth it for that visit alone. Their shelter educates the children who live there, provides skills training for the women before they leave to live independently (we received beautiful scarves made by them), provides a huge range of healthcare, including deliveries, for the residents, and has on-site counseling services, child care services and pretty much anything else you could imagine being offered by a small village of dedicated women. You can read more about Maria and her amazing work here.
  5. To prepare for the trip we followed all recommended CDC guidelines for travel in Ethiopia (with the exception of malaria, because we were only in the city and it was still the dry season). That meant all the immunizations, water and food precautions, and traveling pharmacy for emergencies. Knock wood, we seem to have managed without major issues, so good guidance all the way around.
  6. Many of you asked how public Sasha and I planned to be about our marital status. The answer is simple. Not public at all. We shared a hotel room, but we reverted back to our days living under Don’t Ask, Don’t Tell, and while it felt lousy to proceed in that fashion, compromising our safety or freedom would most definitely have felt worse. The embassy organizer was aware of our marital status, we took our advice from him, it ended up being fine. Not ideal, but our reality for the week was tolerable. And I was reminded of just how lucky I am that I get to live freely most days of my life, with a family that looks like mine, and not get hassled a whole lot for it. So yeah, it was what needed to be done. It was fine. My heart aches for the hundreds of thousands of people in this world who are not free to love like I get to.
  7. Sasha was a huge hit. Seriously, what did you expect?
  8. We identified more commonalities, and many issues felt more familiar than I think we expected. For instance, Ethiopia has several existing or planned “one-stops”, hospitals that essentially mirror the family justice center model with multiple services under one roof. One of the lectures during the conference was from a physician from Gandhi Hospital, the site of a one-stop (Facebook page), and their services mirrored many of the ones we also offer (no DNA testing, though–only two private labs in the country have the capacity to analyze, and they are prohibitively expensive). As Sasha was talking with the group about prosecuting these cases, many of the frustrations in the room about challenges in taking cases successfully to trial were similar to challenges we face in the US every day–consent, coercion, culture. Familiar.
  9. Shutting up and listening was the most effective thing I could do while I was there. And so I tried to do that as much as humanly possible. Our jobs were ultimately less about teaching and more about facilitating conversation and to that end, I hope we succeeded.

10. My intention is to stay connected to the remarkable people that I met there–to Maria and her great good works; the physicians who are seeing enormous patient loads because there are too few providers for the population; to the various other professionals who have already reached out for protocols or slides or additional resources. The trip wasn’t an easy one, but it was extraordinary, and I have never met, collectively, a more welcoming, generous, hospitable people than those I met in Ethiopia. We came home with some great stories, an obscene amount of coffee, and burning desire to figure out how we can keep supporting the work happening there. So very lucky to have been able to go.

 

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Categories
DV/IPV Sexual Assault

National Intimate Partner and Sexual Violence Survey: 2015 Data Brief

Before I head out of the country for the week, I leave you with newly published data from the CDC’s National Intimate Partner and Sexual Violence Survey: 2015 Data Brief. There’s a lot of information to sort through, but a few highlights:

  • In the U.S., over 1 in 3 (36.4% or 43.6 million) women experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime.
  • In the U.S., about 1 in 3 (33.3% or 37.2 million) men experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime.
  • Both women and men experience these forms of violence, but a greater number of women experienced several types of violence examined. For instance, during their lifetime, 1 in 5 women experienced completed or attempted rape; 1 in 6 women were stalked; and 1 in 4 experienced contact sexual violence, physical violence, and/or stalking by an intimate partner and reported some form of intimate partner violence-related impact.

Read the full data brief here.

 

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Categories
Child Abuse

Differential Diagnosis in Pediatric Sexual Assault: Looking for the Zebra

SAFEta and KIDSta have a webinar coming up next month, Differential Diagnosis in Pediatric Sexual Assault: Looking for the Zebra. The session will be held June 19th at 2pm ET. The session will be archived if you cannot attend live. From the registration:

Due to the well-documented acute and long-term negative health consequences associated with child sexual abuse, the medical forensic examination is an integral component of the coordinated community response to child sexual abuse. This webinar presentation will illustrate the differential diagnosis tree the clinician must consider when performing a prepubescent medical forensic exam or consulting when ano-genital injury has been identified. A review of normal pediatric anogenital anatomy, followed by case studies that include normal variants that can be mistaken for abuse, STI’s that may mimic trauma, straddle injury review, and traumatic injuries from sexual abuse.

Register here.

 

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Categories
Articles of Note Child Abuse DV/IPV Sexual Assault Testimony

Articles of Note: May 2018 Edition

It’s time once again for Articles of Note, our (almost) monthly romp through the peer-reviewed literature. Somehow I missed April–sorry about that. Keep in mind this is not an exhaustive overview; simply a list of what is particularly interesting and relevant to my practice that I thought you might also find useful. There’s some really interesting stuff here–I hope you’ll spend time sorting through the abstracts and grabbing articles that speak to you. Active links lead to PubMed (no free full-text articles this month):

 

 

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Categories
Uncategorized

Since Last We Spoke, 5-7-18

Friends, I am getting ready to embark on a really amazing professional adventure on Saturday, so it’ll be business as usual at FHO this week, and then it’ll be quiet here next week. I can’t share too many details until my return, but I will devote some real estate to the trip when I am back in the office. In the meantime, I have a new Articles of Note coming this week, and maybe another goodie or two. And of course, I was perusing the interwebs during quiet moments over the weekend; here’s what caught my eye since last we spoke:

Every Thing This Man Writes

A modicum of justice

How to complain so a partner will listen

Democrats aren’t the only women who care about #MeToo

Interesting op-ed about the loss of genetic privacy

In case you were hoping air travel could get worse

Consent is only one part of the conversation. Pleasure is another. 

And finally, this week is National Nurses Week –a very happy one to all my friends and colleagues!

 

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Categories
Child Abuse

Normal Variants in Pediatric Exams

More peds webinars coming up: the Tribal Forensic Healthcare Project is presenting Normal Variants in Pediatric Exams. The session will be held June 27th at 2pm ET. Diane Daiber and Kim Nash, both IAFN staff, will present the content. As with all webinars from this project, CEUs/CMEs are available. It will be archived if you cannot attend live. From the website:

This webinar presentation will illustrate the differential diagnosis tree the clinician must consider when performing a prepubescent medical forensic exam or consulting when ano-genital injury has been identified.  A review of normal pediatric anogenital anatomy, followed by case studies that include normal variants that can be mistaken for abuse, STI’s that may mimic trauma, straddle injury review, and traumatic injuries from sexual abuse.

Register here.

 

Our first offering in the FHO store, Injury Following Consensual Sex is now available. If you haven’t ordered a copy yet, you can find it here