Patient-centered care without judgement

It takes courage for a survivor of sexual assault or abuse to tell someone what happened. If a survivor discloses an occurrence to you, give them space and your attention to share their experience and emotions.

Ask how you can help or if they have access to resources. While our primary concern is for their well-being, keep in mind an adult can't be forced to receive medical care or report to law enforcement; for adolescents, follow state guidelines in Indiana or Ohio.

However, you can empower the victim/survivor by letting them decide what to do next.

Medical attention:
April is Sexual Assault Awareness Month (#SAAM), a time dedicated to ending the stigma surrounding sexual assault and prevention education.

The Reid Health Sexual Assault Nurse Examiner (SANE) Team provides trauma informed care for victims and survivors of sexual assault and abuse. The team works to address the issues of sexual assault and to serve as a resource.

"Sexual assault has a history of victim blaming and that needs to change," said Shana Evans, Coordinator for the SANE Team.

If a victim/survivor chooses to receive medical care, the hospital will offer a forensic medical exam to collect and preserve physical evidence of the assault, either with the patient's identification or anonymously.

"Reid supports victims. Our top priority is providing care without judgement," Shana Evans, SANE Team Coordinator

Sexual assault and abuse can have long term concerns such as:

• Mental health
• Depression
• Anxiety
• Post-traumatic stress disorder (PTSD)
• Suicidal ideation
• Substance abuse
• Gynecological concerns
• Sleep disorders
• Eating disorders

Reid's SANE team has five nurses highly trained in trauma informed care to assess a patients' safety, collect specimens for use as evidence in court, photograph injuries, and provide resources and information for follow-up care for victims of violent crimes.

Caring for survivors is a personal calling for Sabrina Retherford, an RN for Reid Outpatient Surgery and Endoscopy and SANE team member. The program has increased consistency for patient survivors during emergency room exams, she said.

The program is a source for community education and resources, with nurses serving as advocates for survivors and their families, Retherford added.

"I had a dear friend disappear when we were 17 years old and seniors in high school, she was never found," Retherford said. "There are a lot of speculations as to what happened to her, and caring for these patients and being their advocate helps fulfill this void for me."

The SANE Program focuses on patient-centered care that's respectful of and responsive to individual patient preferences, needs, and ensuring that patient values guide all clinical decisions. The program is dedicated to:

• giving the patient back some control of their life and providing them with choices in their care.
• meeting them where they are and seeing them as a unique person.
• finding out what their worries/priority of needs are.

Sexual Assault Patient Rights:
Support the survivor by encouraging them to know and/or understand their patient rights. The SANE Program provides judgement-free care. Reid is committed to providing patient care with privacy, dignity, and respect.

"We want the public to feel as comfortable as possible to come here for care," Evans said.

Your rights as a sexual assault patient are:

• to receive treatment with dignity and respect.
• to be seen and receive treatment for a sexual assault regardless of whether you choose to have a sexual assault kit collected or not.
• to decide to have a sexual assault kit collected or not. It's entirely your choice, and nobody can overrule that choice.
• to have an anonymous sexual assault kit collected. Reid's care team understands that after a traumatic event it might be difficult to report it to the police at that time due to safety concerns, embarrassment, or many other reasons, and we want you to know that we can collect a kit anonymously. There's no judgement here at Reid. Your health and safety are our top concerns.
• to keep your visit confidential. You decide if you want to report it to law enforcement or not. Your visit will not be shared with law enforcement without your written consent (18 years and older).
• adolescents aged 17 and under require mandatory reporting to law enforcement and the Department of Children's Services (DCS). However, adolescents have the right to choose to participate with law enforcement. Adolescents have the right to choose if they want a sexual assault kit collected or not, regardless of parental consent.
• to have any treatment, collections, and tests fully explained to you in language you can understand.

Timeframes and treatment options:
A survivor should be aware timing could be key if they choose to have a sexual assault kit collected or for preventive medications.

Preventive medications, such as Levonorgestrel or Post-Exposure Prophylaxis, must be started within 72 hours of the occurrence to be effective. Levonorgestrel (Plan B) will prevent pregnancy but will not terminate a pregnancy. Post-Exposure Prophylaxis is a 28-day HIV risk prevention medication that must be fully completed to be effective.

Timeframes for sexual assault kit collections follow specified guidelines from 24-120 hours, depending on the type of assault. During a forensic medical exam, possible DNA samples will be collected from the body, clothing, or personal belongings. It's recommended for the patient survivor not to change clothes or shower prior to receiving medical care.

Optional anonymous kit collections are assigned a number by the hospital and given to law enforcement without any patient identification. The kit is secured by law enforcement for one year. Anonymous kits aren't sent to a crime lab for processing unless the survivor makes a report.

Make a report:
Adult victims or survivors who choose to report the sexual assault or abuse can inform medical staff or contact the local police department. Most police departments have specially trained officers to respond and interact with survivors. You can provide support for survivors of sexual assault or abuse by staying with them as they file the report, if they choose, or check back with them in the days and months ahead.

Reporting the assault or abuse to law enforcement isn't a requirement to receive a forensic exam. The exam is free under state and federal laws, according to the Indiana Coalition Against Sexual Assault.

If a survivor chooses to file a report, they'll need to include an anonymous kit was collected and the date of the visit, or at least an approximate date. With the survivor's consent, law enforcement will contact the hospital to provide the assigned kit number for the patient.

Resources:
During #SAAM learn how you can help raise awareness through education and prevention efforts.

Resources are available through the national Court Appointed Special Advocates (CASA), the Rape, Abuse & Incest National Network (RAINN and En Español), or the Indiana Coalition Against Sexual Assault and Human Trafficking (ICESAHT).

The Indiana Criminal Justice Institute and Ohio Attorney General's Office provides information on the rights of victims and resources.

The Reid Health Sexual Assault Nurse Examiner (SANE) Team is available at the Richmond and Connersville emergency departments. For locations, visit reidhealth.org.