Medical AdvocacyMedical Advocacy

Why is medical care Why is medical care importantimportant

What do you think are some What do you think are some reasons that prompt medical reasons that prompt medical care can be important for sexual care can be important for sexual assault survivors?assault survivors?

Detection and treatment of any physical Detection and treatment of any physical injuries, both internal and external.injuries, both internal and external.

- Detection, treatment, and/or - Detection, treatment, and/or prevention of sexually transmitted prevention of sexually transmitted infections.infections.

- Detection and prevention of - Detection and prevention of pregnancy.pregnancy.

- Collection of medical evidence that can - Collection of medical evidence that can be used during prosecution.be used during prosecution.

- Identification of any non-medical - Identification of any non-medical concerns of the victim and referral to concerns of the victim and referral to other service providers.other service providers.

- Providing reassurance that the - Providing reassurance that the victim can be cared for physically.victim can be cared for physically.

- Ascertaining the need for follow-up - Ascertaining the need for follow-up examinations and tests.examinations and tests.

Acute and Non-acute Medical Acute and Non-acute Medical situationssituations

An acute medical situation is one in An acute medical situation is one in which a victim has recently been which a victim has recently been raped (particularly within 96 hours raped (particularly within 96 hours but can be up to seven days.) This but can be up to seven days.) This time frame is crucial if the victim time frame is crucial if the victim wishes to have forensic evidence wishes to have forensic evidence collected for prosecution now or collected for prosecution now or later. later.

Nurse will ask for clothes survivor Nurse will ask for clothes survivor was wearing. If the survivor isn’t was wearing. If the survivor isn’t wearing them and would like to bring wearing them and would like to bring them to the hospital they should them to the hospital they should used a paper bag instead of plastic used a paper bag instead of plastic

The client may want to shower, bathe, The client may want to shower, bathe, or douche before going to the hospital or douche before going to the hospital but they should be made aware that but they should be made aware that forensic evidence may still be on/in forensic evidence may still be on/in their body and that these “cleansing” their body and that these “cleansing” actions may wash away that evidence. actions may wash away that evidence.

Of course this depends on what kind Of course this depends on what kind of assault took place.of assault took place.

The survivor may be thirsty, hungry, The survivor may be thirsty, hungry, or want to smoke. Again, these or want to smoke. Again, these actions may impact forensic evidence actions may impact forensic evidence collection. Always ask the nurse first collection. Always ask the nurse first before getting the client food.before getting the client food.

If they need to use the restroom, ask If they need to use the restroom, ask the nurse if they want the survivor to the nurse if they want the survivor to collect a urine sample. collect a urine sample.

Non-acute medical Non-acute medical situationssituations

The survivor may still seek medical The survivor may still seek medical care in order to determine if they care in order to determine if they incurred internal and/or external incurred internal and/or external injuries, pregnancy (if the survivor is injuries, pregnancy (if the survivor is able to get pregnant,) receive able to get pregnant,) receive emergency contraception, and be emergency contraception, and be given information or tests regarding given information or tests regarding sexually transmitted infections. sexually transmitted infections.

Emergency ContraceptionEmergency Contraception

RCW 70.41.350 -If not medically RCW 70.41.350 -If not medically contraindicated, provide emergency contraindicated, provide emergency contraception immediately to each victim contraception immediately to each victim of sexual assault who requests it.of sexual assault who requests it.

Ethical and Religious Directives for Ethical and Religious Directives for Catholic Health Care Services (2001) – Catholic Health Care Services (2001) – Directive 36: A female (or anyone who can Directive 36: A female (or anyone who can get pregnant) who has be raped should be get pregnant) who has be raped should be able to defend herself against a potential able to defend herself against a potential conception from the sexual assault. conception from the sexual assault.

Regardless of the situation, the final Regardless of the situation, the final decision of whether to have forensic decision of whether to have forensic evidence collected and/or receive medical evidence collected and/or receive medical care is a decision the survivor must make care is a decision the survivor must make for themselves. It is never appropriate to for themselves. It is never appropriate to persuade a survivor to do something they persuade a survivor to do something they don’t want to do. don’t want to do.

Your role as a medical advocate is to provide Your role as a medical advocate is to provide them with all the information you have and them with all the information you have and support their choices. support their choices.

The medical advocate’s role at The medical advocate’s role at the hospitalthe hospital

An information resource - Answering An information resource - Answering questions and explaining medical questions and explaining medical procedures, follow-up testing, possible procedures, follow-up testing, possible future concerns, and crime reporting.future concerns, and crime reporting.

An active listener - Helping the victim sort An active listener - Helping the victim sort through and identify feelings and concerns through and identify feelings and concerns

A resource identifier - Assisting the victim A resource identifier - Assisting the victim in thinking about those people in her/his in thinking about those people in her/his life that could be a support.life that could be a support.

The medical advocate’s role at The medical advocate’s role at the hospital cont’dthe hospital cont’d

A reality tester - Letting the survivor know A reality tester - Letting the survivor know the survivors reactions are normal, what the survivors reactions are normal, what may happen in the near future, and may happen in the near future, and dispelling the myths and misconceptions dispelling the myths and misconceptions they may have.they may have.

A representative of the rape crisis center – A representative of the rape crisis center – A person that will be there whenever and A person that will be there whenever and for whatever the survivor needs.for whatever the survivor needs.

Can you think of anything else?Can you think of anything else?

At the hospital…At the hospital…

It is important that to become It is important that to become familiar with the steps that the familiar with the steps that the hospital goes through so that you hospital goes through so that you can prepare survivors who are can prepare survivors who are considering going to the hospital or considering going to the hospital or to support a survivor who has to support a survivor who has already arrived at the hospital. already arrived at the hospital.

You will need to know You will need to know

Check-in processCheck-in process Where to take/meet the survivorWhere to take/meet the survivor Who to talk toWho to talk to Evidence collection procedures Evidence collection procedures Crime reporting options Crime reporting options

Activity: Comfortable vs. Activity: Comfortable vs. UncomfortableUncomfortable

Most of us have experienced Most of us have experienced going to the doctor, emergency going to the doctor, emergency department, getting department, getting gynecological exams, having gynecological exams, having blood work drawn, surgery, etc.blood work drawn, surgery, etc.

Take a minute to think about an Take a minute to think about an uncomfortable medical experience uncomfortable medical experience and what made it uncomfortable. and what made it uncomfortable.

Comfortable and Comfortable and UncomfortableUncomfortable

Being told about proceduresBeing told about procedures Knocking on the doorKnocking on the door Being listened to and Being listened to and

respectedrespected Having someone give you a Having someone give you a

warm blanketwarm blanket Respecting the pain you are inRespecting the pain you are in Genuineness, warmth, Genuineness, warmth,

compassioncompassion Asking permission to be Asking permission to be

touchedtouched

Assuming gender identity or Assuming gender identity or sexual orientationsexual orientation

Wearing exposing gownsWearing exposing gowns Not being told what will Not being told what will

happenhappen Not being listened toNot being listened to Painful proceduresPainful procedures Feeling out of controlFeeling out of control Waiting for resultsWaiting for results Lots of people aroundLots of people around Not being asked permission Not being asked permission

before being touchedbefore being touched Being coldBeing cold Repeating information Repeating information

How are the uncomfortable aspects of a How are the uncomfortable aspects of a medical experience similar to the traumatic medical experience similar to the traumatic incident? incident?

Again, your role is to try and facilitate as much Again, your role is to try and facilitate as much comfort as possible. comfort as possible.

Advocates try to minimize distractions and Advocates try to minimize distractions and discomfort as much as possible and increase discomfort as much as possible and increase the decision making and power of the the decision making and power of the survivor.survivor.

Can you think of small ways to do this that we Can you think of small ways to do this that we haven’t already talked about?haven’t already talked about?

It is the middle of the night. You have just been at the It is the middle of the night. You have just been at the hospital for four hours supporting a victim through a hospital for four hours supporting a victim through a forensic exam. The victim is a young man with a small forensic exam. The victim is a young man with a small build. He decides to report the incident to the police. While build. He decides to report the incident to the police. While waiting for an officer to arrive, you and he wait in a cold waiting for an officer to arrive, you and he wait in a cold quiet room. You get a blanket to try and make him feel quiet room. You get a blanket to try and make him feel comfortable. When the officer arrives you see that he is comfortable. When the officer arrives you see that he is 6’3” and weighs about 225 lbs. He is in uniform and has his 6’3” and weighs about 225 lbs. He is in uniform and has his baton and gun attached to his belt. This particular police baton and gun attached to his belt. This particular police officer has a very good understanding of sexual assault and officer has a very good understanding of sexual assault and attempts to decrease the uneasiness and power disparity attempts to decrease the uneasiness and power disparity by getting down on his knee to talk with the victim. What by getting down on his knee to talk with the victim. What he did was incredibly sincere and made the victim feel he did was incredibly sincere and made the victim feel more at ease.more at ease.

What would you have done if What would you have done if the officer hadn’t responded to the officer hadn’t responded to

the survivor with such the survivor with such kindness?kindness?

Politely offer the police officer a chair Politely offer the police officer a chair to sit in. to sit in.

Do not be confrontational; step out of Do not be confrontational; step out of the room to voice your concern.the room to voice your concern.

Report unacceptable behavior to Report unacceptable behavior to your supervisor or file an OPD your supervisor or file an OPD compliant form.compliant form.

SARP ProtocolSARP Protocol

Handouts and questionsHandouts and questions

What to doWhat to do

Follow your organization’s protocols for Follow your organization’s protocols for responding to a hospital call. (insert SARP responding to a hospital call. (insert SARP Protocol and make copies available to volunteers)Protocol and make copies available to volunteers)

Be timely, the victim may have been waiting a Be timely, the victim may have been waiting a while or already have started the exam.while or already have started the exam.

Eat something before you leave the house; bring Eat something before you leave the house; bring a snack! You may be there for a while. a snack! You may be there for a while.

Introduce yourself to the victim and identify Introduce yourself to the victim and identify yourself as an advocate. Explain what your role yourself as an advocate. Explain what your role is. Obtain permission from the victim to stay and is. Obtain permission from the victim to stay and support them through the process. support them through the process.

If an interpreter is needed, be sure to advocate for If an interpreter is needed, be sure to advocate for one. Children and/or relatives are not appropriate one. Children and/or relatives are not appropriate interpreters for many reasons. Private information interpreters for many reasons. Private information needs to be protected and medical terminology needs to be protected and medical terminology needs to be accurately translated. needs to be accurately translated.

Act as an attentive and supportive listener if the Act as an attentive and supportive listener if the survivor wants to talk. Do not elicit information survivor wants to talk. Do not elicit information regarding the assault unless it is necessary to tell regarding the assault unless it is necessary to tell the survivor what to expect during the exam.the survivor what to expect during the exam.

Explain to the survivor why medical care can be Explain to the survivor why medical care can be important and what medical procedures to expect.important and what medical procedures to expect.

Remain with the survivor until the SANE arrives for Remain with the survivor until the SANE arrives for the medical examination. the medical examination.

The victim has the right to have a support The victim has the right to have a support person present. Ask the survivor if they person present. Ask the survivor if they wish for you to remain in the room during wish for you to remain in the room during the medical examination for support. the medical examination for support.

RCW 70.125.060- If the victim of a sexual RCW 70.125.060- If the victim of a sexual assault so desires, a personal assault so desires, a personal representative of the victim's choice may representative of the victim's choice may accompany the victim to the hospital or accompany the victim to the hospital or other health care facility, and to other health care facility, and to proceedings concerning the alleged proceedings concerning the alleged assault, including police and prosecution assault, including police and prosecution interviews and court proceedings. interviews and court proceedings.

If the survivor asks you to If the survivor asks you to leave during the exam…leave during the exam…

Ask if they would like you to wait Ask if they would like you to wait outside.outside.

If they want you to leave the hospital If they want you to leave the hospital offer other forms of assistance: offer other forms of assistance: check-in after medical examinations; check-in after medical examinations; give them a call in a few days, etc. give them a call in a few days, etc.

If you are asked to stay…If you are asked to stay…

The possibility of pregnancy may be something the survivor The possibility of pregnancy may be something the survivor may not have thought about. Be sure you are supportive may not have thought about. Be sure you are supportive and patient and clarify any information needed to make and patient and clarify any information needed to make decisions.decisions.

Be sensitive to cultural or religious concerns that the Be sensitive to cultural or religious concerns that the survivor may have when discussing pregnancy. Put your survivor may have when discussing pregnancy. Put your own biases aside.own biases aside.

Snacks are available after the exam. They often bring juice Snacks are available after the exam. They often bring juice and crackers with the antibiotics. They have coffee, snacks, and crackers with the antibiotics. They have coffee, snacks, juice, water and warmed blankets. Ask the ER staff to get juice, water and warmed blankets. Ask the ER staff to get what you need for the survivor.what you need for the survivor.

Most likely, the survivor’s clothes will be taken as evidence. Most likely, the survivor’s clothes will be taken as evidence. St. Pete’s has sweats for the victims after the exam. If the St. Pete’s has sweats for the victims after the exam. If the clothes are taken as evidence, it is unlikely they will ever clothes are taken as evidence, it is unlikely they will ever get them back again.get them back again.

Another important thing you will need to do Another important thing you will need to do is practice appropriate body language. is practice appropriate body language. Although you might not see a lot of blood Although you might not see a lot of blood and/or injuries, it is possible. You will and/or injuries, it is possible. You will certainly be hearing some really difficult certainly be hearing some really difficult information and stories. information and stories.

Your reaction is important. Should you Your reaction is important. Should you flinch, vomit, pass out, Know that you can flinch, vomit, pass out, Know that you can debrief once you leave on the HelpLine or debrief once you leave on the HelpLine or with supervisor if they are available.with supervisor if they are available.

Advise the survivor that additional services Advise the survivor that additional services are available from the organization. are available from the organization.

Offer a follow-up from the SAAS at SafePlace Offer a follow-up from the SAAS at SafePlace within the next few business days to check in within the next few business days to check in on the survivor. on the survivor.

Ask for a phone number. Ask for a phone number. Be sure and ask how the SAAS should identify Be sure and ask how the SAAS should identify

herself over the phone and/or messages. herself over the phone and/or messages.