Categories
Testimony

Applying the Strangulation Research to Expert Testimony: Table of Contents

I have to tell you, I am overwhelmed at the response to the new research compilation, Applying the Strangulation Research to Expert Testimony. The response has been–unexpected. But a very smart attorney to whom I am married casually mentioned it would be nice for people to see a preview of what they would be getting for their money, and it occurred to me the Table of Contents is the easiest way to provide that. So it is now part of the product description on the store page (I also added preview pages for the other two compilations), but I am providing it here for those of you who might be interested:

Thanks for all of the kind comments and messages. You are really the very best readers.

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Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Sexual Assault

Abortion Resources for Patients

I saw a great abortion resource come across my Twitter feed this morning from the Abortion Care Network that would be an excellent part of discharge resources in the US for patients who might want/need it:

I tried it to make sure it really worked, and not only did it provide immediate information, but it also followed up, with this:

Incredibly helpful for those folks who aren’t certain what is currently available in their area, who serve a large region, or who have a transient patient population (I’m thinking of places like Las Vegas or other vacation areas).

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Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Testimony

Applying the Strangulation Research To Expert Testimony

It’s here, folks: Applying the Strangulation Research to Expert Testimony is now available for purchase in the store. A couple of things I’d like to mention–first of all it’s more expensive than the previous ones ($9.99) because it’s almost three times the length. So for all of you who will want to know why the big jump in price from the other two, there you go. The other thing I’d like to mention is this–these compilations don’t make me rich. Yes, you technically can share these compilations amongst yourselves once one person purchases it, but I ask you to buy individual copies where possible. An unbelievable amount of time went into this, as is this case with everything I publish here.

In putting this together, my hope is to improve the quality of expert testimony in cases of adult non-fatal strangulation. Patients shouldn’t luck into competent trial testimony by their forensic clinician. I truly believe this, which is what drives every single one of these compilations.  I hear a lot of weakly informed opinions on the stand and a lot of strangulation testimony not grounded in much more than information people have picked up from a lecture they’ve heard or course they’ve taken. Often clinicians have never read the primary sources from which they are pulling supporting statistics or conclusions, making their statements vulnerable on cross. I am trying to make it simpler for people to identify and access the evidence base, so that testimony can be presented from a scientifically sound foundation where possible. And so that we can acknowledge the left and right limits of the research when asked, and develop a program of research to close the gaps.

Because we are at the point where we have the ability to do so, I am also now offering all three of the FHO research compilations (Consensual Sex Injury, Aging Bruises and Strangulation Injury) as a single downloadable zip file. That one is $16.99, so it basically saves you three bucks when you buy them as a set.

The Store page looks wonky for reasons beyond my technical abilities, so I am trying to get that worked out–but everything seems to be working. Contact me if you have any issues. As always I look forward to your feedback (and I am taking ideas for the next research compilation, although it’ll be a few months before I start it).

Categories
Testimony

Coming soon: Strangulation Research Compilation

One week from today I will release the 3rd FHO research compilation: Applying the Strangulation Research to Expert Testimony in Cases with Adult Victims. It’s the biggest one to date, but it’s also the most needed. So I am spending the week traveling (hello, MSU), editing, and enjoying the girl-child’s high school graduation (hello, CLE). I’m also taking the week off the site. I will see everyone back here next Tuesday for the launch of the new compilation. Until then, friends…

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
Uncategorized

Friday Extra: Sex Ed for Senators

Let’s keep this party going, shall we? Courtesy of Samantha Bee, it’s Sex Ed for Senators, and I think it caps the week off nicely. Obviously not suitable for many workplaces (sadly):

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
Sexual Assault

Accessing Emergency Contraception After Sexual Assault

Not surprisingly, I have heard from many of you in the last 24 hours about your worries and concerns–there is a lot of angst about how many of you either work in facilities where patients are denied access to emergency contraception because it’s a religiously affiliated hospital or you’re hearing stories from others. There’s a lot to unpack here, and I can’t tackle all of it in this post, but I want to start with worst case scenarios. It’s never the ideal to have patients paying for/getting their own EC after a medical-forensic exam (it actually infuriates me that it still happens), but knowing that’s a reality, I did a search online for current prices, and here’s what it looks like for patients who must pay out of pocket at the biggest national retailers:

(Online prices, so they may differ in store; all brands listed were available in stores at the time of this search.)

For those folks purchasing Plan B One-Step, the manufacturer has an online coupon that can be redeemed for $10 off. Still costly, but if that’s the only brand your pharmacy carries, it’s not nothing.

Now, I am aware many of our patients don’t have even 10 extra dollars. I am aware some of our patients don’t have access to pharmacies in their area. I am aware that some states allow pharmacists to refuse to sell EC. I am aware some will refuse regardless of what the law allows. There are a lot of barriers out there. But there are some things we as clinicians can do:

  1. Know what’s available in your area and provide patients with regularly updated, accurate information. That should be part of the discharge plan.
  2. Instead of raising all your money for shiny new equipment, consider putting some of those dollars into store gift cards for patients who need to access EC but cannot get it from your agency. Ensure patients have a way to get there right after or have someone who can go get it for them. [Related: when people ask if they can donate items to your program, yes, gift cards.]
  3. Make sure you and your team are working with the most accurate science and know the current public policy issues related to EC. Guttmacher is my trusted resource for all thing policy. In regards to science, know what the research says about timeframes, potential weight impacts, and other considerations for the various types of EC. I am not providing you with a full research review on this (yet), but I have found articles like this one to be helpful in understanding the current evidence base.
  4. Ensure that all patients who can become pregnant are being offered EC. In this, the year 2019, it is frustrating that we must remind folks that people of all genders can become pregnant. Just because someone does not look like your idea of a pregnant person does not mean they cannot become pregnant. Just because someone is taking testosterone does not mean they cannot get pregnant. We need to ensure that our trans-/nonbinary/gender non-conforming patients are screened for pregnancy exposure, too.

This space will contain a lot on EC (and abortion) access in the coming months because what’s happening here in the US has a very real impact on our patients and our practices. We need to be having a national dialog on what this means moving forward, but all of you should be having these same conversations at the local level because that’s where much of the work will be done. I welcome suggestions for future topics of concern and question. And much as I love all of the private messages I get, it wouldn’t kill you to use the Comments section so others could benefit from your feedback 😉 [I know–after 10 years, I should be used to the fact that the Comments section is the least used section of this website. But a girl can hope.]

ADD: Transphobic garbage has me linking to an article in point #4, as if I should even have to do that. It’s but one example in the medical literature. I’m annoyed I have to even justify the statement, but I guess some folks are going to engage in nonsense, so here we are.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
Sexual Assault

Sexual Assault Patients and Access to Abortion

Well, the news isn’t great. Alabama has become the latest state to pass a near abortion ban, and it’s time we talk about what this means for our patients in the US, because it’s certainly not something we can ignore.

For now, at least, abortion is still legal in all 50 states, so let’s begin there. But as (predominantly male, non-physician or nurse) legislators chip away at abortion access, the question needs to be asked: how does this change the way we counsel patients about emergency contraception? Should we be ensuring we can offer copper IUDs for women who are concerned that their weight may make Ella or Plan B less effective? Do we need to have far more nuanced conversations with our patients who can become pregnant about EC and subsequent options if pregnancy occurs? Pregnancy tests are expensive, so will we offer follow up testing for pregnancy to ensure that the EC worked, just to make sure any EC failure is caught prior to the 6-week cut-offs (assuming they end up being the threshold)?

Abortion is incredibly personal, but access to abortion should not be. Regardless of the decisions we might make if faced with an unplanned pregnancy, every single patient who has the potential to become pregnant deserves a clinician who will provide full-throated advocacy for their right to not be if that’s what they want. And laws that would punish clinicians for terminating the pregnancies caused by rapists more harshly than the actual rapists is such absurdity it’s hard to even type that sentence. It’s time, as a profession, to have some very real conversations about what it looks like to provide patient-centered care in the face of laws that are anything but.

If you have the means to donate some cash to support organizations doing the work of keeping abortion safe and legal for everyone in the US, consider:

https://yellowhammerfund.org/

https://sistersong.nationbuilder.com/donate

https://abortionfunds.org/

https://prochoice.org/about-naf/support-naf

(or add some of your favorites in the Comments)

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Categories
DV/IPV Elder Abuse/Neglect Sexual Assault

Is Your Agency Ready to Serve Transgender and Non-Binary Clients?

I just discovered that FORGE has recently published a self-assessment, Is Your Agency Ready to Serve Transgender and Non-Binary Clients, and before you are all, of course, we are, we already do, may I suggest you take a good long look at the tool. Then at your program. And then start making the fixes you need to make. Bonus: if you’re in program development mode like we are right now, it’s like a glorious (albeit extensive) checklist. Not everything will be applicable, but enough of it is that you should download this ASAP.

Excellent work, team FORGE. This is a great (and much needed) resource.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, 5-13-19

Greetings from cold and rainy DC. I was super privileged to spend a very satisfying day with the NY state IAFN chapter last Friday talking testimony. A lot of great conversation, many insightful questions, and just such good people. So much fun.

I’m back home this week because the work never stays put on the calendar, and now all my April and May work is August and September work, so it gives me plenty of time to wrap up some odds and ends, and maybe get something new going. I’m also prepping for the big graduation in a few weeks, and after that, a couple weeks in Japan. But for now, I’m staying put; here’s what caught my eye since last we spoke:

How women and minorities are claiming their right to rage

Generic HIV drugs will soon be within reach

I frequently play patriarchy chicken–most often in airports and on airplanes

NIWRC has a new special collection on Missing and Murdered Indigenous Women and Girls

Come on, Nike, do better

Let’s talk about how to end sexual violence

A poem to live by:

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
DV/IPV

No Visible Bruises

I am about a third of the way through the newly published book, No Visible Bruises: What We Don’t Know About Domestic Violence Can Kill Us. It is extremely well-written, and although this is my area of expertise, I still find the book compelling. I am not alone in this (reviews here and here). You’ll find a lot of familiar names, hear so much that is familiar from your own patients, and yet…

Tuesday, Terri Gross interviewed the author, Rachel Louise Snyder, and Suzanne Dubas, the CEO of one of the programs featured in her book. It’s worth your time.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Teen Sex Trafficking: Recognizing the Signs and Creating a Safe Space for Disclosure

Evidentia Publishing (publishers of the IAFN Pediatric Strangulation Case Review and Assessment) and MobileODT are co-hosting a webinar May 14th at 2pm ET, Teen Sex Trafficking: Recognizing the Signs and Creating a Safe Space for Disclosure. I haven’t attended any of their offerings before so I cannot tell you much except that it is an industry-sponsored event, for what that’s worth. I would expect some product promotion, but hopefully, there’s also some quality content contained in the session:

The average age of a victim’s entrance into sex trafficking is between 12 – 14 years old. At this developmental stage, teens are especially vulnerable to traffickers and may not even realize that they are victims of trafficking.

So how can healthcare professionals recognize the signs of sex trafficking and create a safe space for disclosure?

Our live webinar (co-hosted by MobileODT and Evidentia Publishing) featuring leading child abuse expert, Jordan Greenbaum, MD, Medical Director of the Global Health and Well-being Initiative with the International Centre for Missing and Exploited Children, is not to be missed. Be a part of the learning experience – get answers from experts and feedback from peers on this critical issue!

Gain knowledge in:

  • Definitions and signs of sex trafficking in teens – what in adolescent development makes them vulnerable
  • Using a trauma informed approach with adolescents in healthcare settings
  • How forensic exams and medical documentation may be different for this population

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Thank You!

Because of the volume of offers to review the latest research compilation, I cannot respond individually to everyone. I have reached out to those who I have asked to review at this point. So allow me to say thank you to everyone who sent me their CVs. I will hold on to them for future compilations. Your willingness to review was epic much appreciated!

Categories
Sexual Assault

Demystifying Care of Patients with Mental Illness Following a Sexual Assault

SAFEta has a webinar coming up next month, Demystifying Care of Patients with Mental Illness Following a Sexual Assault. The session will be held June 10th at 2pm ET. As with all of their offerings, it will be archived in case you can’t attend live. From the website:

Recent research suggests that up to 40% of patients who present for care following a sexual assault have some history of mental illness. But there has been limited academic work that examines unique considerations that may arise when caring for this patient population. How do we best provide medical care and forensic services for patients with mental illness in the acute setting following a reported sexual assault? How do we determine when it is, and is not, appropriate to offer a sexual assault medical forensic exam (SAMFE)? In this webinar, an interdisciplinary panel of SANEs and psychiatrists will highlight some of the challenges faced and questions that may arise, including:

What does the research suggest about prevalence of various mental illness among victims of sexual assault? What is the relationship between experiencing trauma and developing symptoms of mental illness? What are the practice implications?

What are some circumstances in which a patient’s mental illness may limit their capacity to consent an SAMFE? How should we perform capacity assessments in these patients?

What signs and symptoms of mental illness may not preclude capacity, but otherwise interfere with the SAMFE? How can we conceptualize other factors of a patient’s presentation when assessing whether the SAMFE is appropriate?

What are some approaches that can be used when providing a SAMFE to a patient with mental illness, to facilitate delivery of compassionate and safe care?

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Uncategorized

Since Last We Spoke, National Nurses Week 2019 Edition

A happy National Nurses Week this week! Here’s hoping you are feeling the love wherever you are working this week–I will have the good fortunate of spending part of it with my friends and colleagues in New York where I will be collaborating on a testimony workshop with members of the NY State IAFN chapter. Seriously looking forward to that trip.

Also, Ramadan Mubarak to all observing this holy month. Peace and blessings to you.

I worked most of the weekend, but I managed to get a fair bit of reading done. Here’s what caught my eye since last we spoke:

Frustrating news from the Pentagon

And the military story I want to hear

Coworkers keep mixing up people of color

Whew, this discrimination suit at Mount Sinai is no joke. Wishing peace and power to all those women.

Confronting institutionalized racism in nursing

The myth of testosterone

This story about women having to do men’s emotional labor was a ride

Wonder if this really will buy you more time

If you could win a Pulitzer for a headline…(also, seriously)

The best thing I saw this weekend:

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
DV/IPV Sexual Assault Testimony

Peer Reviewers Needed

Looking for a few folks who are interested in being peer reviewers for the next research compilation on strangulation. This compilation is much lengthier (it’s clocking in at about 25 pages, so it’s monograph-length), so you have been warned.

If you would like to be considered, and you have the time to do a thorough review in the next two weeks, please email me (jenifer.markowitz@gmail.com since you cannot attach a CV to the Contact email on the site) along with a copy of your CV. This is meant to assist clinicians with being better prepared to go to court, so I need folks who have some experience in—well, preparing to go to court. I’m less concerned about formal educational credentials, but you do need to be comfortable reading research. You do not have to be a nurse. I am equally interested in the opinions of physicians, attorneys, and other professionals who read this site who have served as expert witnesses in the past. In fact, I always have one non-nurse reviewer.

All reviewers will receive a copy of the final research compilation once it’s published, along with the other two research compilations in the store (if you don’t have them, or you want to give them to someone else, your choice).

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Categories
Sexual Assault

Updated Clinical Guide: Use of ALS to Identify Fluids on the Body

We can’t update Part II and not update Part I, so here’s the updated clinical guide, Use of ALS to Identify Fluids on the Body. There’s much less new here, but it’s nice to be complete. Let me know if I’m missing something, but I think all the peer-reviewed literature is there. Please don’t read one clinical guide without the other–much of what is contained in the ALS for Bruising guide is applicable, particularly as it concerns understanding the underlying science of how ALS works and its limitations.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.