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Response And Prevention: An Emerging Weapon In The Battle Against Sexual Assault

Webcams allow clinicians who work with sexual abuse victims to extend the reach of their services.
Photograph by temniy/Getty Images, Illustration by Emily Judem/WGBH News.

For those of us working in the field of sexual assault response and prevention, 2018 will be long remembered as the year that gave us Brett Kavanaugh. The destructive impact of his October testimony before the Senate Judiciary Committee on survivors of sexual assault was so extensive that it prompted a physician to document it in the pages of the New England Journal of Medicine.

“Stories of struggle and abuse, of trauma inflicted by people with power, have permeated my sessions with patients over the past couple of weeks,” wrote Dr. Eve Rittenberg, who practices primary care medicine at Brigham and Women’s Hospital. “Many of my patients named the Kavanaugh hearings as a source of dread, which has been slightly tempered by admiration for Dr. Blasey Ford. The news in which they are immersed has resonated deeply and brought back memories of their own experiences.”

But we’re also going to remember something else from 2018 that received far less public attention. In a hard-to-believe coincidence, the day before Kavanaugh’s testimony—which “brought back memories” for so many survivors of sexual assault—independent evaluators of a six-year pilot program to improve treatment and care of sexual assault survivors presented their findings before the US Justice Department’s Office for Victims of Crime.

I was in Washington D.C. for the presentation, though I cannot pretend to have been a disinterested observer. When the pilot launched in 2012, I was appointed to the pilot’s project management team, a position I still hold.

The pilot was designed to improve the treatment that sexual assault survivors receive in the immediate aftermath of an assault. Proper care must include the following three components: treating physical injuries; prescribing medications that reduce the risk of pregnancy and sexually transmitted infections; and collecting forensic evidence, which may includeswabbing the body for DNA and documenting injuries. The entire process can take anywhere from three to eight hours and the exam is difficult for sexual trauma victims and health care providers alike.

The person best qualified to conduct these exams is a sexual assault nurse examiner (SANE), sometimes called a forensic nurse. There are no nationally standardized qualifications for SANE practitioners. However, in Massachusetts these clinicians must be registered nurses with at least three years of specialized training, education, and experience in providing quality forensic medical-legal examinations. Since these exams can be intrusive, SANE clinicians must also be trained in providing trauma-informed care, which reduces the likelihood that the survivor will be re-traumatized by the exam itself.

It’s impossible to put a price on the critical expertise SANE clinicians bring to the exam room. Research shows that post-assault exams performed by SANE practitioners are much more complete in “collection of specimens, documentation of evidence, properly sealing and labeling evidence, and maintaining chain of custody.” Jurisdictions that implement SANE nursing programs are also more likely to see arrests of suspected offenders by police and more charges brought by prosecutors. Perhaps more important for survivors is the fact that their long-term health outcomes are inextricably tied to the first interactions they have with others when initially disclosing their abuse or assault.

Unfortunately, there is a nationwide shortage of these clinicians. In response, the Department of Justice funded an experiment to expand the reach of existing SANE practitioners through telemedicine. Nurses from the Massachusetts Department of Public Health were invited to create the National Telenursing Center, which provides 24-7 access to SANE clinicians who guide post-assault exams by talking to the patient and supporting the hospital clinician via secure webcam.

I knew the results of the pilot would be good. But they exceeded even my high and hopeful expectations. In one question after another, outside evaluators gave unequivocally positive responses about the efficacy of the program.

Did the technology consistently work over a period of hours? Yes.

Did the nurses on the ground experience increased confidence in caring for rape survivors? Yes.

Were survivors open to exams led via webcam? Yes. To date, 270 survivors have taken advantage of SANE services delivered to the program’s six participating hospitals via webcam. Many said they were relieved that they would not have to wait hours for a SANE nurse to come to the hospital. Some also expressed gratitude that their needs were taken so seriously that medical staff consulted a sexual assault expert before treating them.

Kavanaugh-esque setbacks are painful to absorb. But we now know that the six-year experiment in telemedicine works. The lessons learned from this project will fuel advancements in treatment and care of sexual assault survivors for years to come. In the end, the impact will be much longer lasting and positive than the damage wrought by the Kavanaugh hearings.

Gina Scaramella is the executive director of the Boston Area Rape Crisis Center.

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