The U.S. Department of Justice recently awarded the state of Massachusetts $3.3 million to create a telenursing center to assist health care providers in treating victims of sexual assault. If successful, the Massachusetts Sexual Assault Nurse Examiner (SANE) Telenursing Center will become the model for a national center. Ted Cross, a professor in the School of Social Work at the University of Illinois and an expert on sexual abuse investigation and prosecution, is leading an assessment team associated with the project. Cross recently spoke with News Bureau editor Sharita Forrest.
What services will the telenursing center be providing?
The telemedicine resource center will offer medical providers 24/7 access to expert assistance and professional support as well as advocacy for sexual assault victims.
The program will be physically located at Newton-Wellesley Hospital in Massachusetts and will provide services at four remote pilot locations across the nation that are yet to be determined but will include a corrections facility, a Native American community, a rural community and a U.S. Navy site. All of these communities have unique challenges for reporting, identification, response and disclosure of sexual assault.
Practitioners at the pilot sites will be able to have telenursing consultations with the center's staff, who will assist them with evidence collection procedures, exam techniques, documentation and chain of custody issues as well as with making resources available to victims to help them deal with the trauma.
American Doctors Online/PhoneDOCTORxs, the group providing the telemedicine technology, has the ability to set up a system using any device that has Internet connectivity, such as computers and smartphones. The TeleNursing SANE staff will then be able to provide real-time assistance to clinicians at the pilot sites.
This is really a groundbreaking program. The center builds upon Massachusetts' SANE program, which has been providing expert forensic nursing throughout the state for 15 years. They conduct sexual assault training at hospitals, law enforcement agencies and universities and have provided care to more than 14,000 patients. The Massachusetts SANE staff is some of the most extensively trained in the country.
This is a three-year project. In the first year, they'll be setting up the physical space and infrastructure, hiring the center staff and identifying sites across the country for the pilot study. In the second and third years, the focus will be on providing telenursing care to the four target populations.
There's an outstanding group of population experts involved with the project, including U.S. Navy Cmdr. Nanette Brown; Cathleen McElligott, an expert on rural populations; Lucy Simpson and Gwen Packard from the national Indigenous Women's Resource Center; and Raymond Marchilli from the Massachusetts Department of Corrections.
What are the challenges or problems that this center aims to address?
Sexual assault is really a unique crime in that the victim's body is actually the crime scene.
All of the pilot site populations have unique challenges related to sexual assault. For example, Native Americans experience much higher incidence of sexual assault than other racial-ethnic groups. Sexual assault rates are believed to be high among the military but vastly underreported because of institutional structure and culture, such as power dynamics and pressures about loyalty. Likewise, rural populations have their own challenges, such as lack of anonymity and lack of access to transportation and health care.
Forensic medical expertise isn't uniformly available across the country either. Health care professionals may rarely see sexual assault victims, so they may be unsure what types of injuries to look for, how to conduct forensic exams and collect evidence or how to address victims' emotional trauma.
Health care professionals who work with sexual assault victims also have high professional burnout and turnover rates. Working with these victims routinely can be emotionally draining, and practitioners can develop secondary traumatization from the things they see in their work, so many of them leave after two years.
The TeleNursing Center will provide peer support and debriefing opportunities as well as a learning portal so that providers can complete online training.
What will your team be looking at during the assessment?
We'll be collecting comprehensive data about the entire process: statistics on sexual assault, the care provided and the training of the medical staff that provide it, and data related to reporting and prosecution, such as evidence collection and jurisdictional issues.
We'll be assessing the center's functioning, the helpfulness of the consultations, and site professionals' experiences, and we will be identifying additional services that could be provided through telemedicine.