This post on Reddit’s Relationship Advice forum from a young woman whose fiance wanted her to have her hymen checked before their wedding (by his dad!) has been making its way around my Twitter feed, so I thought it would be a good time to re-up a few resources here. (BTW, here’s her update for all of you wondering.) Of course, virginity testing isn’t an actual thing, but we know that sometimes patients are brought in for that very purpose, so you can consider this a mini clinical guide:
As always, I encourage you to follow the footnotes in these documents because there is a treasure trove of related readings that are relevant to practice.
I am in Hawaii this week and while I will try and get posts up with some regularity, it will be a long week and the hours here are not my own. So, we’ll see how it goes. In the meantime, I’d like to draw your attention to this excellent article by IAFN CEO, Jennifer Pierce-Weeks, Going Beyond the Breakthrough Means Going Beyond Rape Kits. It beautifully encapsulates why the sexual assault medical-forensic exam is so much more than just collecting samples for a kit. Trying to figure out how to articulate in court why it’s important that patients come in and see us, even if they don’t want evidence collected? Well, Jen just helped you out by putting it down on paper. And she did it in less than a thousand words. Do yourself a favor–read it and then share it with your team.
Jason Kander and his wife Diana published an excellent article over at Crooked Media today, Five Lies We Tell Ourselves About Trauma. It’s 100% relevant to the work we all do because it applies equally to the issue of secondary trauma, which is something we should be discussing far more in our field. It would be a great topic for an upcoming staff meeting–particularly as a way to check in with the team.
There’s a lot that resonates, but one thing in particular:
I made the mistake of trying to rank—and therefore disregard—my own trauma for many years, and that only made things worse. If something happened and you haven’t felt right since, then you should address it. To quote a friend, “Somewhere there’s a vet who was in the first wave at the D-Day invasion telling himself to get over it because he was all the way in the back of the landing craft.”
Thinking “other people have it worse” doesn’t actually diminish your own trauma, it just diminishes your power to heal, because your brain only knows what you experienced. Whether it’s combat, a serious accident, or an assault, there are many possible sources of trauma. Telling yourself to get over it, or thinking “I shouldn’t let this bother me,” will get you nowhere.
This one hour webinar will cover national clinical highlights of the 2019 National Sexual Health Conference originally presented in Chicago, IL, July 10-12, 2019.
(Sorry–not a whole lot of info to go on, I know.) Register here.
This webinar will highlight collaborative work undertaken by multi-disciplinary teams across the U.S. to support domestic and sexual violence and human trafficking (DV/SA/HT) survivors. Presenters will share how their partnerships or task forces were initiated; strategies to enhance client services and case coordination; and tools and training opportunities to build or expand collaborative responses for HT survivors across communities and states. The webinar will share lessons learned from a community-based DV/SA/HT advocacy program, a law enforcement-led program, and a statewide task force operated by the Attorney General’s Office. It will also feature technical assistance and training resources offered by Futures Without Violence. Time will be included for audience question/answer and discussion.
After the webinar, participants will be better able to:
Define the unique service needs HT victims that differ from domestic violence and sexual assault.
Identify community and state-wide strategies to develop new collaborations or expand existing networks to support survivors of HT.
Clarify multidisciplinary professional and organizational roles in coordinating services for trafficked survivors.
Utilize resources to help build or expand multi-disciplinary teams and task forces to support survivors of HT.
In doing some writing this week for one of my projects I realized I had a decent collection of resources for a much-needed clinical guide: Caring for Transgender, Gender Non-Conforming and Non-Binary Patients in the Forensic Setting. It’s long overdue, and while I know it is not exhaustive, it’s a good starting place for everyone who hasn’t given this enough (or any) attention in their programs. To be clear, most of the guidance is focused more on general care issues than forensic setting-specific issues, which means it would be ideal to take one (or a few) of the resources listed here and have a robust discussion with your team about how to apply the recommendations to your own policies, documentation, and general approaches to patient communication. It’s a great topic for your next staff meeting.
It’s time once again for Articles of Note, our regular romp through the peer-reviewed science. Check it: we have not one, but two scientific papers this month on physicians committing misconduct, so that’s fascinating. We also get a look at how a clinician’s personal history of domestic violence impacts clinical care. Needless to say, there’s some good reading to be done in this edition (as always). Most links go to PubMed abstracts except where otherwise indicated.
ISPCAN’s August Journal Club webinar will be Child Sexual Abuse, Disclosure, and PTSD: Safer Responses to Disclosure. The session will be held August 8th at 12pm ET. From the registration page:
This webinar will discuss the relationship between child sexual abuse, disclosure, and post-traumatic stress disorder. Given the importance of safe responses to disclosure of child sexual abuse, this webinar will also discuss VEGA (Violence, Evidence, Guidance, Action), a Canadian public health response to family violence. VEGA includes a handbook for recognizing and responding safely to family violence, as well as scripts and ‘how-to’ videos showing providers examples of how to safely respond to family violence, including child sexual abuse.
You can read the article on which this webinar will focus here (FULL TEXT).
The Forensic Center of Excellence is hosting a webinar, A Campus-Wide Response to Sexual Misconduct: Best Practices. The session will be held August 7th at 1pm ET. I want to caveat this post by saying that I am *extremely* leary of almost anything claiming to be a best practice because it’s an almost meaningless phrase that people often declare of their own work without much evidence to support it (this isn’t specific to this webinar or this presenter, but much of what is presented in the forensic healthcare and -adjacent space). That being said, there are some interesting topics here, and it’s probably worth the 90 minutes. From the website:
This webinar highlights the dynamics of campus sexual assault that may be specific to, or heightened in the context of, a college or university setting. Additionally, the presenter discusses best practices in three areas of response to sexual misconduct on campus – encouraging reporting and use of supportive resources; resolution practices (including investigative/adjudicatory processes, adaptable resolution processes, and coordination with law enforcement); and interim and post-resolution measures. The webinar integrates information about the legal framework within which institutions must operate (e.g., Title IX, VAWA, Clery, case law, state laws, etc) with the nuances of supporting students and creating a safe and respectful campus climate.
The majority of children who have been sexually abused do not have residual findings of physical injury on the medical examination. Case based scenarios will be used to discuss how the anatomy of pre and post pubertal children and the dynamics of child sexual abuse (including disclosure dynamics) play into this fact. Key literature references will be provided and summarized for use in court preparation on “normal” cases.
It’s time once again for Articles of Note, our monthly romp through the peer-reviewed literature. This month there’s quite a bit that’s freely downloadable, so look for the FREE FULL TEXT notations for immediate gratification. Otherwise, links lead to PubMed abstracts and you can take it from there. Plenty here to keep you occupied…
This webinar will help participants unlock their ability to see and write; to document their patient’s physical state and behaviors in an accurate manner. You will learn how to “paint a picture” with your words and accurately describe outward appearance, visible behavior, speech and eye contact using instantly understandable language.
I wanted to point your attention to a recently published annotated bibliography by NSVRC on sexual violence and opioids (PDF). I’m such a huge fan of these types of compilations (obviously), and this is a topic that hasn’t been well covered. There’s some ACEs stuff in here, some IPV, and of course, adult sexual violence, so it spans age ranges. Worth adding to your library and distributing among your teams.
SAFEta has a webinar coming up featuring Dr. Lori Frasier, Pediatric Sexually Transmitted Infection Update. The session will be held July 25th at 2pm ET. It will be archived so no worries if you can’t attend live. From the announcement:
Dr. Lori Frasier, professor of pediatrics chief of the division of child abuse pediatrics at Penn State Hershey Children’s Hospital will discuss pediatric STI’s and HIV testing updates, when to test for STI’s, the implications of positive tests and transmission of these infections.
I hope everyone had a wonderful June. Our family had an amazing time in Japan, and now I am down in Charlottesville with the girlchild for college orientation for a few days. The vacation was a wonderful reset, and I am ready to get back to work. Let’s not waste any time, shall we?
Jumping right back into education with one of my very favorite presenters: Dr. Sharon Cooper is doing a session on pediatric case studies for the Tribal Forensic Healthcare project. The webinar will be held August 2nd at 11am (sorry Alaska and Hawaii, but take heart, all their sessions are archived, so listening live isn’t the only option). CEs are available for both nurses and physicians. From the announcement:
Forensic nurses provide specialized care for the pediatric patient who is presenting for health care related to known or suspected child maltreatment. A variety of case studies will be reviewed including parental opioid use, sexual assault, exploitation and children exposed to violence.
It’s often said they have “the best of both worlds,” but victimization rates tell a very different story. Bisexuals make up the largest part of the LGBTQ community, yet are the most invisible and have some of the highest rates of victimization. This webinar will go over the statistics, look at some of the reasons why this population is so invisible and at-risk, and explore the long-term health implications of these facts. We will also begin to explore how the victim service field and LGBTQ advocates can begin to better respond to this population’s unique needs.
Time once again for Articles of Note, our (almost) monthly romp through the peer-reviewed literature in search of all things new and/or useful to clinical practice, public policy, and testimony. As you may have noticed, I didn’t make one happen in May, so this month’s combined is pretty lengthy. There’s *a lot* here to work through, but I think it’s worth it. Some familiar faces in the bunch, too. Hope you enjoy.
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:
Don't be deterred by abortion restrictions: if you need help finding a clinic near you, you can text 'hello' to 202 883 4620. You will be prompted to enter your zip code and will receive a list of the three closest clinics near you as well as resources for funding an abortion. pic.twitter.com/qTSFugmJEU
— AbortionCareNetwork (@AbortionCare) May 28, 2019
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).
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:
Know what’s available in your area and provide patients with regularly updated, accurate information. That should be part of the discharge plan.
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.]
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.
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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