One way that we can continue to ensure that our work with survivors continues to build momentum throughout our lifespan is to offer information, resources and support that centers on all the ways survivorship can complicate tending to a survivor’s health or moving through the healthcare system. Annual exams, dentist appointments, abortions, STI testing and childbirth can be triggering and a supportive advocate can make a huge difference.
Advocates can work with survivors to create healthcare safety plans, normalize the survivors fear of, or desire to, avoid medical appointments, challenge stigma surrounding sexually transmitted infections and offer accurate information, attend births and abortions as well as develop a list of trauma-informed practitioners in their community.
Advocacy Approaches to Medical Advocacy
- Advocates play a huge role in validating and normalizing the experiences of sexual assault survivors to help fight isolation and lead to more self-knowledge and empowerment-based decision making. Let survivors know that it is common to avoid doctor’s appointments or feel a lot of fear / stress during exams, procedures, interacting with medical staff, or even just making an appointment.
- An advocate’s greatest resource is creating safety, including helping a survivor plan emotionally and physically, for any healthcare experience that is on the horizon. For this to be effective, we need to offer medical advocacy options to the survivors we support. It is not essential that advocates have extensive knowledge of medical practices and procedures to be helpful. However as advocates we can let survivors know that we offer appointments to help them create a personalized and emotional safety plan so that they have a structure in place to support them in any medical setting. This could include practicing how to explain to the doctor about their triggers or assisting a survivor in crafting an email to their dentist.
- As advocates we can also offer support by attending a medical exam with a survivor. Attending a medical appointment with a survivor can be as simple as accompanying the survivor in the appointment or in the waiting room. In the event that an in-person accompaniment is not required or available, many survivors find it helpful to bookend a triggering experience with a call to their local advocacy organization.
- We can help survivors look into their options for the individualized medical care they need. Sitting with a survivor and searching the internet for physician philosophy statements or consumer reviews is just one way advocates can be helpful.
Sometimes referred to as a "rape kit," a forensic exam is a means to collect evidence from a survivor's body and clothes following a sexual assault within a limited scope of time (generally 72 hours). The primary function is collection of forensic evidence but can also involve treatment for sustained injuries and STI prophylaxis. Survivors have a right to have an advocate or other support person present with them at this type of exam.
While there is no standard protocol for how these are conducted in Washington State, Harborview Medical Center provides best practice recommendations and guidelines for both adult and adolescent forensic exams (see resources). However, it is important to recognize that different counties and even different hospitals within counties may have difference procedures. It is also important to know that not every hospital or health facility has someone on staff that is specially trained to perform a sexual assault forensic exam and interact with recent survivors of sexual assault and, unfortunately, this means a survivor may be referred to a facility out of their area. The following are the professionals who provide these exams:
- Sexual Assault Nurse Examiners (SANE) are registered nurses who receive specialized education and fulfill clinical requirements to perform the exam. These are most common practitioners in Washington State.
- Sexual Assault Forensic Examiners (SAFE) and Sexual Assault Examiners (SAE) are other healthcare professionals who have been instructed and trained to complete the exam.
The term rape kit actually refers to the kit itself — a container that includes a checklist, materials, and instructions, along with envelopes and containers to package any specimens collected during the exam. All specimens should contain the patient's name, the date and time the evidence was gathered, the person collecting the specimen, and the type of evidence. A chain of custody must be maintained in order to protect the integrity of the evidence. This means that a record should be collected of all persons who handle the evidence, that is, the physician, nurse, and police officer (if a report was made). The evidence should not be left lying around where other people will have access to it and should never be handled by an advocate.
There are provisions in state and federal law ensuring sexual assault survivors have access to a medical forensic exam free of charge, without reporting to law enforcement. There is also billing guidance from the Crime Victim's Compensation Program. Both are found below in Guidelines that Ensure Survivors Have Free Access to SANE Exams.
- Guidelines that Ensure Survivors Have Free Access to SANE Exams
- Beyond the Forensic Exam: Support Survivors through Medical Advocacy
- Medical Advocacy Resources
- Getting Through Medical Examinations: A Resource for Women Survivors of Abuse and Their Health Care Providers - For Health Care Providers
- Getting Through Medical Examinations : A Resource for Women Survivors of Abuse and Their Health Care Providers - Survivors and the Health Care Encounter