Specialized Training: Investigating Sexual Abuse In .
Specialized Training: Investigating Sexual Abuse inCorrectional SettingsNotification of Curriculum UtilizationDecember 2013The enclosed Specialized Training: Investigating Sexual Abuse in CorrectionalSettings curriculum was developed by The Moss Group, Inc. (TMG) as part ofcontract deliverables for the National PREA Resource Center (PRC), a cooperativeagreement between the National Council on Crime and Delinquency (NCCD) and theBureau of Justice Assistance (BJA). The PREA standards served as the basis for thecurriculum’s content and development with the goal of the Specialized Training:Investigating Sexual Abuse in Correctional Settings curriculum to satisfy specificPREA standard requirements.It is recommended that the Specialized Training: Investigating Sexual Abuse inCorrectional Settings curriculum be reviewed in its entirety before choosing whichmodules to use. Any alterations to the original materials must be acknowledgedduring their presentation or requires removal of the PRC and TMG logos.BJA is currently undergoing a comprehensive review of the enclosed curriculum forofficial approval at which point the BJA logo may be added.Note: Utilization of the enclosed curriculum, either in part or whole, does notguarantee that an auditor will find a facility “meets standard”. Rather, an auditorwill take into consideration the curriculum used as part of their overalldetermination of compliance.Notice of Federal Funding and Federal Disclaimer – This project was supported by Grant No. 2010-RP-BXK001 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office ofJustice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office ofJuvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the Office of Sex OffenderSentencing, Monitoring, Apprehending, Registering, and Tracking. Points of view or opinions in this document arethose of the author and do not necessarily represent the official position or policies of the U.S. Department ofJustice nor those of the National Council on Crime and Delinquency (NCCD), which administers the National PREAResource Center through a cooperative agreement with the Bureau of Justice Assistance.
Module 5:Role of Medical And Mental HealthPractitioners in InvestigationsNotice of Federal Funding and Federal Disclaimer – This project was supported by Grant No. 2010-RP-BX-K001 awarded by the Bureau of Justice Assistance. The Bureau ofJustice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of JuvenileJustice and Delinquency Prevention, the Office for Victims of Crime, and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Points ofview or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice nor those of theNational Council on Crime and Delinquency (NCCD), which administers the National PREA Resource Center through a cooperative agreement with the Bureau of JusticeAssistance.
Module 5: Objectives
Evidence Protocol and Forensic Exams§115.(3)21 Evidence protocol and forensic medicalexaminations Follow a uniform evidence protocol that is developmentallyappropriate and based on DOJ’s National Protocol for SexualAssault Medical Forensic Exams, Adult/Adolescents*. Offer all survivors access to exams, at no cost, whenappropriate. Exams must be performed by qualified medical professionals,such as Sexual Assault Nurse Examiners. *A National Protocol for Sexual Assault Medical Forensic Examinations,Adults/Adolescents is available at: https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf
Evidence Protocol and Forensic Exams –Access to Advocates§115.(3)21(d) Evidence protocol and forensic medicalexaminations Attempt to make available a victim advocate from arape crisis center (RCC) to provide accompaniment. If RCC is not available, qualified staff from communityorganization or agency staff must accompany survivors. Document efforts to secure services from RCCs. Can use advocates from government agencies if theyare not affiliated with the criminal justice system andprovide a comparable level of confidentiality asnongovernmental agencies.
Exam Evidence Protocol and ForensicExams – Access to Advocates§115.(3)21(e-h) Evidence protocol and forensicmedical examinations Advocates accompany and support victims throughthe exam process and investigative interviews andprovide emotional support, crisis intervention,information, and referrals. A qualified agency staff member must be screenedfor appropriateness and receive education onsexual assault and forensic exams.
Specialized Training§115.(3)35(a) Specialized training: Medical andmental health careEnsure medical and mental health staff are trainedin: How to detect and assess for signs of sexual abuseand harassment How to preserve physical evidence of sexual abuse How to respond professionally to victims How and to whom to report allegations orsuspicions of sexual abuse or harassment
Specialized Training, Cont.§115.(3)35(b-d) Specialized training: Medicaland mental health care Medical staff who perform forensic examinationsmust receive appropriate training. Maintain documentation of medical and mentalhealth staff participation in required trainings. Ensure medical and mental health staff receiveappropriate staff, volunteer, or contractortraining, in addition to the specialized trainingdescribed above.
Access to Outside Confidential Services§115.(3)53(a-b) Inmate/resident access tooutside confidential support services Provide inmates/residents with phone and mailaccess to rape crisis and/or other victimadvocates. Enable reasonable communication in asconfidential a manner as possible. Inform inmates/residents of the extent to whichthis communication is monitored and reports willbe filed in accordance with mandatory reportinglaws.
Access to OutsideConfidential Services - Agreements§115.(3)53(c) Inmate/resident access to outsideconfidential support services Enter into written agreements (MOUs) withoutside victim advocates who are able to provideinmates/victims with confidential emotionalsupport. Document attempts to enter into suchagreements.
Coordinated Response§115.(3)65 Coordinated response Develop a written institutional plan to coordinateactions taken among first-responders, medicaland mental health staff, investigators, andadministrators.
Access to Emergency Medical andMental Health Care§115.(3)82(a-b) Access to emergency medical andmental health services Provide timely, unimpeded access to emergencymedical treatment and crisis interventionservices. If no practitioners are available, first respondersprotect victims and notify appropriate staff.
Access to Emergency Medical andMental Health Care§115.(3)82(c-d) Access to emergency medicaland mental health services Offer victims information about and timelyaccess to emergency contraception and sexuallytransmitted infections prophylaxis. Treatment must be provided at no cost to thevictim, regardless of whether or not the victimcooperates with the investigation or names theabuser(s).
Access to Ongoing Medical and MentalHealth Care§115.83(a-b) Ongoing medical and mentalhealth care for sexual abuse victims and abusersOffer evaluation and treatment toinmates/residents who have been sexuallyabused, including: Follow-up services Treatment plans Referrals for continued care
Access to Ongoing Medical and MentalHealth Care, Cont.§115.(3)83(c-d) Ongoing medical and mentalhealth care for sexual abuse victims andabusers Provide medical and mental health servicesconsistent with the community level of care,including:– Pregnancy tests for victims of sexuallyabusive vaginal penetration– Timely and comprehensive information andmedical care for victims who becomepregnant as a result of abuse– Tests for sexually transmitted infections
Access to Ongoing Medical and MentalHealth Care, Cont.§115.(3)83(c-d) Ongoing medical and mentalhealth care for sexual abuse victims and abusers Provide treatment at no cost and regardless ofwhether the inmate names the abuse orcooperates in the investigation. Within 60 days of learning of an inmate/residentpreviously perpetrated sexual abuse, prisonmental health staff:– Conduct a mental health evaluation– Offer treatment, when appropriate
Interpreting the Medical and Mental HealthStandardsCorrections must offer victims of sexual abuse: Hospital accompaniment by an advocate Emergency and ongoing medical and mentalhealth care Forensic evidence collection, as appropriate Preventive measures such as pregnancy andHIV/AIDS tests and prophylaxis
Interpreting the Victim ServicesStandardsCorrections must: Provide care in a trauma-informed manner Develop an institutional coordinated responseplan Enter formal agreements with victimadvocates and other service providers Use a uniform evidence protocol to collect themost usable physical evidence
The Forensic MedicalExamination
Sexual Assault Nurse ExaminerA Sexual Assault Nurse Examiner is aRegistered Nurse who has been speciallytrained to provide comprehensive care tosexual abuse patients; who demonstratescompetency in conducting a medicalforensic examination; and has the abilityto be an expert witness.
Forensic Medical ExaminationA sexual assault medical forensicexamination is performed by specially trainedmedical professionals for the purpose of: Evaluation and treatment of trauma Collection of evidence following a reportof sexual abuse by a victim Treatment of possible exposure tosexually transmitted infections Referral to counseling and follow-upmedical care
Medical Examination forSexual Abuse VictimIf reported within 120 hours: A forensic medical examination kitcan be completed for the victim ofthe sexual abuse for use in theinvestigation or prosecution of theoffense may be requested Medicine and other preventativemeasures can extend beyond 120hours
Dual Purpose of the Forensic ExamProvide victim-centered careAddress the needs of inmate(s)/residents who report sexualabuseInvestigationsGather evidence to assistthe criminal justiceprocessThe medical well-being of the patient is theprimary objective of the SANE at all timesduring the examination.
Restraints should not restrict!Recommended guidelines for retrievalof evidence on incarcerated survivorsare NO different from the nationalprotocol for sexual abuse victims.
Victim Adaptations Age Gender/gender identity Disabilities Culture, ethnicity, religion Sexual orientation Victimization history Abuse by an authority figure Coping – support available Consent/assent for exam
What does a sexual assault forensicmedical examination entail? Collect medical forensic history fromthe patient Head-to-toe examination to look forsigns of trauma Detailed Ano-Genital Exam to assessfor trauma Collection of forensic evidence
First StepsStep 1:Giving ConsentPatient InformationStep 2a:History of AssaultStep 2b:Medical History
Step 3: Clothing Collection
Step 4: Debris Collection
Step 5: Oral Swabs & Smears
Step 6A: Vaginal Swabs & SmearsStep 6B: Penile Swabs & Smears
Step 7: Rectal Swab & Smear
Step 8: Head Hair Combings
Step 9: Pulled Head Hairs
Step 10: Pubic Hair CombingsStep 11: Pulled Pubic Hair
Step 12: Saliva Sample
Final Steps Police evidence seals are affixed whereindicated, dated & initialed by examiner. ALL requested information if filled out. Offer prophylaxis for sexually transmittedinfections and pregnancy, if necessary Provide discharge instructions andreferrals
Documentation
Remember!It is important to alwaysremember that the absence ofinjuries does not mean that sexwas consensual or that thesexual abuse did not occur.
Access to Victim Advocates Survivors need anddeserve access to rapecrisis services. PREA standards requireagencies to attempt tomake a victimadvocate available tosurvivors. Access to advocatesmay also be requiredby federal and statelaws.Members of JDI’s SurvivorCouncil in Washington, DC
The Rape Crisis Model Survivor-centered Goal is empowerment Focus on managing immediatetrauma symptoms and assistingthe survivor to regain control andto heal A problem-solving, non-directiveapproach
The Role of the Victim AdvocateA victim advocate can: Accompany survivorsthrough the responseprocess, including theforensic exam andinvestigation Provide survivors withcrisis intervention andongoing support Serve as a source ofinformation about theprocessAssociate Warden, Victim Advocate, andformer Investigative Lieutenant (Left toRight) at California Correctional Institution,Tehachapi.
Importance of Victim Advocates Sole focus is onsurvivors’ safetyand well-being Can maintainconfidentiality Available at anytime - typically24 hours/dayJDI Survivor Council member Frank Mendozatalking with an advocate.
Rape Crisis lsHospitalAccompanimentLegal AdvocacyGroupsPsychoEducationalApproachSafety PlanningOpportunitiesfor Activism
Role of the AdvocateDuring the Forensic Exam Accompany survivors during theexam process. Provide emotional support andinformation. Advocate a survivor’s comfortand privacy during the exam. Inform the survivor of his or herrights regarding the medicalforensic exam.
Role of the Advocate in InvestigativeInterviews Accompany survivors duringinterviews. Provide emotional support andinformation regarding the investigativeprocess. Will not participate in the interview orserve as a translator. Assist the survivor to address his orher needs during the interview, such astaking a break, when needed.
Role of the Advocate inProvidin
Module 5: Role of Medical And Mental Health Practitioners in Investigations Notice of Federal Funding and Federal Disclaimer –This project was supported by Grant No. 2010-RP-BX-K001 awarded by the Bureau of Justice Assistance.The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of .
3. Demonstrate ability to recognize potential cases of elder sexual abuse a. List four signs or symptoms of sexual abuse. b. Provide three situations under which cases of sexual abuse may come to the attention of APS workers. 4. Demonstrate ability to effectively screen for sexual abuse and interview clients regarding possible sexual abuse a.
Elder Abuse Important Facts about Elder Sexual Abuse 70% of reported sex abuse occurs in nursing homes. Only 30% of victims of elder sexual abuse report it to authorities The abuser is the primary caregiver 81% of the time Elderly women are six times more likely than men to be sexually abused Types of Sexual Abuse Elder Abuse
The UK report from an Australian Research Council funded project examining Image-Based Sexual Abuse . Extend English & Welsh and Northern Irish law to cover threats to share nude or sexual images . sexual abuse in the context of a previous or ongoing intimate . abuse. Shattering Lives and Myths: A Report on Image-Based Sexual Abuse .
symptoms of elder sexual abuse. This knowledge could help identify at-risk elders and provide early intervention. Behavioral signs of distress in elders who are physically and/or cognitively compromised may often be the first clue of sexual abuse. All suspected elders of sexual abuse need an immediate report to those in charge of their
Mean age at time of onset of sexual abuse is 9-10 years Unknown exactly how many cases actually occur each year Sexual Abuse Data US NC SC GA VA TN % of cases 8.3 2.0 5.2 3.4 1.1 2.4 Percent of the total number of child victims including physical abuse, neglect, etc In NC: 1595 sexual abuse cases out of 14856 children abused From NCANDS .
What is Abuse? Child abuse is when an adult hurts a child, and it is not an accident. Hitting, constant yelling, or unwanted touching can all be child abuse. Sexual Abuse is forced sexual contact, inappropriate sexual talk, showing private body parts, etc. Most of the people in your life are not abusers. Most adults
Where abuse/neglect were found: 60% neglect, 18% physical abuse, 10% sexual abuse, 7% emotional maltreatment, 15% "other" based on specific state laws and policies Where abuse/neglect were found: 66% neglect, 25% physical abuse, 9% sexual abuse Age/Gender Highest rate of victimization: Children ages 0-3—16.1 per
or threatened with physical or mental harm by the acts or lack of action by a person responsible for the child's care. Each state has its own laws concerning child abuse and neglect. There are several forms of abuse: physical abuse, emotional abuse, and sexual abuse. Child neglect is a form of abuse that occurs when a person responsible
