Category: Sexual Assault

The folks over at SVJI‘s Rural Realities project have a new blog post on case file review that has a good chart differentiating review models that SARTs might find helpful. For those of you looking for more in-depth info, SVJI also has a series of archived webinars that will be useful:

• Case File Review with Your SART
• The Foundation and Preparation Steps for Case File Review
• Reviewing Case Files and Evaluating Your SART’s Findings

Looking for something more tangible? Download their Case File Review Guidebook (PDF).

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.

NSVRC and IAFN are co-hosting a webinar on the newly updated SART toolkit, to be released in August. The session will be held July 12th at 2pm ET. From the announcement:

The collaborative team approach to sexual assault is a recommendation contained in the US DOJ’s National SAFE Protocol. Forensic Nurses are often intimately involved in the creation of Sexual Assault Response Team’s (SARTs) and in sustaining them. Since the original Toolkit was created in 2009 there have been updates to the SAFE Protocol, the creation of a new Pediatric SAFE Protocol and other guiding documents for response teams to use. This webinar will introduce forensic nurses to the updated Sexual Assault Response Team (SART) Toolkit, hosted by the National Sexual Violence Resource Center. The new SART Toolkit is the result of collaborative efforts to provide evidence-based information on best practices to SARTs.

Register for the session 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.  And coming soon–the follow-up research brief on bruising, out at the end of the month!

Perhaps with all of the horror swirling about in the news, you missed this information: the National Center for Health Statistics at the CDC added new codes for patients experiencing sexual and labor trafficking to be used beginning October 1st, 2018. This will allow for more accurate data collection, differentiating human trafficking patients from other types of abuse patients.

T codes to report for cases of suspected and confirmed forced labor and sexual exploitation:

Under Adult and child abuse, neglect and other maltreatment, confirmed

T74.5 – Forced sexual exploitation, confirmed
T74.51 – Adult forced sexual exploitation, confirmed
T74.52 – Child sexual exploitation, confirmed
T74.6 – Forced labor exploitation, confirmed
T74.61 – Adult forced labor exploitation, confirmed
T74.62 – Child forced labor exploitation, confirmed

Under Adult and child abuse, neglect and other maltreatment, suspected

T76.5 – Forced sexual exploitation, suspected
T76.51 – Adult forced sexual exploitation, suspected
T76.52 – Child sexual exploitation, suspected
T76.6 – Forced labor exploitation, suspected
T76.61 – Adult forced labor exploitation, suspected
T76.62 – Child forced labor exploitation, suspected

Z codes for the examination and observation of human trafficking victimization:

Under Encounter for examination and observation for other reasons

Z04.81 – Encounter for examination and observation of victim following forced sexual exploitation
Z04.82 – Encounter for examination and observation of victim following forced labor exploitation

Under Problems related to upbringing: Personal history of abuse in childhood

Z62.813 – Personal history of forced labor or sexual exploitation in childhood

Under Personal risk factors, not elsewhere classified: Personal history of psychological trauma, not elsewhere classified

Z91.42 – Personal history of forced labor or sexual exploitation

You can find the full 2019 addenda to the ICD-10-CM List of Diseases and Injuries here (PDF)

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.  And coming soon–the follow-up research brief on bruising, out at the end of the month!

IAFN is hosting an upcoming webinar, Human Trafficking and Toxicology. The session will be held July 10th at 2pm ET. It is limited to 200 people, but will be archived (f0r IAFN members)–if you want to attend the live session I encourage you to register ASAP. 1.5 CEUs will be available. From the announcement:

This presentation will identify common dynamics in sex and labor trafficking and describe how drugs and alcohol are used to assert and maintain control over victims and perpetrate trafficking and trafficking-related crimes. The presenter will discuss the importance of and strategies for collaborating with medical professionals to identify drug-facilitated human trafficking, provide much-needed care, and educate other allied professionals about the effects of drug use in human trafficking.

Jane Anderson, Attorney Advisor from AEquitas will be the featured speaker.

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. 

If your sexual assault medical-forensic exam does not include offering the HPV vaccine to eligible patients, perhaps it’s worth considering. And if you’re looking for the evidence base to support its inclusion in your comprehensive exam, last month the nice folks over at Cochrane obliged us and contributed to said evidence base by publishing a review on the HPV vaccine to prevent cancerous and pre-cancerous changes to the cervix. According to the CDC, vaccine coverage data published in the National Immunization Survey (NIS) states that about 6 out of 10 adolescents received at least 1 dose of the HPV vaccine, which means there are a substantial number of young women who aren’t vaccinated at all or completely. The medical-forensic exam is a potential opportunity to start or continue the series, and some programs have been offering the HPV vaccine, particularly for patients who have limited access to routine healthcare services.

Obviously, this review doesn’t speak to all of our patients, but we’ll take it to start.

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.

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:

•  Post-Sexual Exposure Clinical Guide (poster)
•  Post-Sexual Exposure Clinical Pocket Guide (you can also order hard copies for yourself and your team)
•  nPEP Infographic Slides
•  nPEP Poster

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…

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. 

IAFN is offering a free webinar next month, Drug Facilitated Sexual Assault. the session will be held April 25th at 2pm ET. From the website:

This webinar will define DFSA. It will review the drugs used, their signs and symptoms and prevalence. It will present details about specimen collection and will present the latest (2017) SOFT guidelines for laboratory analysis in DFSA cases.

Presented by: Teri Stockham, Ph.D.

Dr. Teri Stockham is a respected consultant, author and lecturer in the field of forensic toxicology. Over the past three decades, she has gained extensive education, training and experience both in the laboratory and the courtroom. The three degrees Dr. Stockham earned have all been focused in the specialty of forensic toxicology. She holds a Ph.D. from the Medical College of Virginia, and a Master’s degree from The George Washington University. She graduated Magna Cum Laude from Indiana State University. Her laboratory training, including the role as Chief Toxicologist for Broward County, Florida, complements her education and expertise. Dr. Stockham is experienced on the witness stand and has testified hundreds of times.

Dr. Stockham serves as a consultant to a number of law firms, providing her expertise for various court cases involving personal injury, insurance defense, probation/parole, court martial, DUI, workers compensation, child custody and drug-facilitated sexual assault. Her forensic toxicology services have encompassed a large number of clients who represent insurance companies, individuals, government agencies and healthcare providers.

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. 

The Tribal Forensic Healthcare project has a webinar coming up, Developing a SART in Indian Country. It’ll be held April 18th at 3pm ET. All of their webinars are archived; CEUs/CMEs are available. From the site:

American Indian and Alaska Native women are raped at rates higher than any other race. Despite the alarming rates, sexual assault is still the most underreported crime. In response to this crisis occurring in Indian Country, tribal nations have been developing culturally appropriate programs and adapting existing response models to create appropriate responses to sexual assault.  One such model is the Sexual Assault Response Team (SART). SART establishes a multidisciplinary team that collaborates to create a coordinated response to sexual assault. Presenters will share their experiences, challenges, successes and the importance of developing practices and protocols that are responsive to the immediate needs of adult victims of sexual assault victims and overall benefits to the criminal justice response.

Register for the session 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. 

(Apologies for the delayed notice on this one, but it just came across my desk)

Battered Women’s Justice Project has an upcoming webinar, Promising Strategies and Practices in Medical Forensic Compliance. The session will be held March 29th at 2pm CT. They archive their webinars, so if you can’t make it for the live session you should be able to find it online afterward. From the website:

This webinar will outline the key components of medical forensic compliance and what a compassionate and competent response to victims/survivors can look like. Challenges that many communities face with medical forensic compliance will be explored such as medical forensic exam access and quality, kit storage and testing, and statewide coordination issues. We will share what we have learned through our Statewide Medical Forensic Policy Program and some promising strategies and practices in medical forensic compliance.

PRESENTERS:
Caroline Palmer, Public and Legal Affairs Manager, Minnesota Coalition Against Sexual Assault and Jude Foster, Statewide Medical Forensic Policy Program Coordinator, Minnesota Coalition Against Sexual Assault.

Register here.

IAFN’s SAFEta project has a webinar coming up next month, Post Exposure Prophylaxis to HIV: Make it Simple. The session will be held April 30th at 2pm ET. From the announcement:

Non-occupational post-exposure prophylaxis (nPEP) should be started rapidly after sexual assault. The CDC treatment guidelines have recommended guidelines in place for occupational exposure since 1996 and non-occupational exposure since 2005. Although the guidelines have been updated and streamlined in subsequent years, healthcare providers still struggle with providing CDC recommended nPEP. The AIDS Education & Training Center (AETC) Program Rural Health Committee, the Georgia Department of Public Health, the IAFN and the National Center for Medical-Legal Partnership has developed a Post-Sexual Exposure nPEP Toolkit. This webinar will provide an overview of the resources and materials that are provided in the toolkit and the circumstances when it should be used.

Objectives:

1. Identify when HIV nPEP should be considered post sexual assault.
2. Recognize recommended regimens of antiretroviral medications are for nPEP.
3. List ways to obtain the materials provided in the toolkit for EDs and clinics serving patients who may experience sexual exposure to HIV.

Register here.

Every now and again I feel like it’s important to remind folks about the parameters for using initials after one’s name. It’s a regular issue, and those of you who conduct SANE training and/or manage teams are encouraged to review this with participants and staff.  You can find the whole post here.

[Related: certificate vs certification]

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.