Adult and adolescent sexual assault (SA) patients/survivors have unique medical, emotional and forensic needs which require a trauma-informed approach to care. Such an approach assures survivors will be supported while making informed decisions regarding their post-assault medical care and involvement in the criminal justice system. Sexual Assault Nurse Examiner (SANE) Programs have been shown to improve the quality of health care for patients/survivors, increase the quality of forensic evidence collection, support police investigations, and increase the successful prosecution of such cases (Campbell, Bybee, Kelley, Dworkin, & Patterson, 2012; Campbell, Patterson, & Bybee, 2009; Crandall & Helitzer, 2003; Campbell, Patterson, & Lichty, 2005).
Access to SANE programs and other medical forensic expertise is not uniformly available across the country. Furthermore, clinicians who have been trained to provide medical forensic exams without SANE expertise often do not see the volume of patients necessary to maintain proficiency in examination and evidence collection procedures, nor do they receive the ongoing support required for this emotionally taxing work. As a result, attrition rates and professional burnout rates are very high when clinicians or SANEs provide trauma care without adequate supports (Townsend & Campbell, 2009). Indian Health Service (IHS) officials report most trained medical forensic examiners generally leave after two years of providing care to patients/survivors of sexual assault (GAO, 2011).
To address the lack of access to expert care and forensic evidence collection, the Massachusetts Department of Public Health (MDPH) has recently been awarded a grant by the Office for Victims of Crime (OVC), in collaboration with the National Institute of Justice (NIJ) and the Office on Violence Against Women (OVW). The purpose of the grant is to establish a National Sexual Assault TeleNursing Center that will use telemedicine technology to provide 24/7, 365 day remote expert consultation by 24 to 25 Massachusetts Sexual Assault Nurse Examiners (MA SANEs) to clinicians caring for adult and adolescent sexual assault patients in remote and/or underserved regions of the United States.
Four to five national sites will partner with the TeleNursing Center for this demonstration project. The National TeleNursing Center HUB is located at Newton Wellesley Hospital Newton, Massachusetts. Two US Navy pilot sites , one each in California and Florida will serve as the initial pilot sites for the military populations. Three additional pilot sites representing rural, tribal and corrections communities will be solicited for participation in 2014.
Telemedicine can improve the health status of patients by exchanging medical information from one site to another via electronic communications using voice (audio) and face-to-face (video) communication. When applied to SANE practice, telemedicine has the potential to create a community of support for SA clinicians, and increase their confidence, role satisfaction and retention.
Telemedicine equipment will be provided by project partner, American Doctors Online/PhoneDOCTORx (ADOL/PDR). Equipment will be installed at the TeleNursing Center hub and telemedicine carts will be provided to each pilot site. MA SANEs will use this equipment to provide 24/7, 365 day voice and face-to-face guidance and support whenever pilot site clinicians encounter sexual assault patients and initiate calls to the Center. It is anticipated that the use of telemedicine as a vehicle to access SANE expertise will provide a trauma-informed patient experience, promote healing and enhance the adjudication of cases.
To provide updates on TeleNursing Center activities, as well as a learning management system for continuing education, certification, peer support and debriefing, a web-based learning portal is currently in development.
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