Homer nurse Colleen James had been working in her field for about five years when she was confronted with something she’d never dealt with before — a child patient who was sexually assaulted.
“No one knew how to take care of that child and it ended up being a pretty hideous experience for everyone involved, especially the child,” said James, who was working in Homer at the time.
When she encountered another case only a week later, James knew there had to be a better way. She went on to start Alaska’s first, and longest running, Sexual Assault Response Team program in Homer.
“I just felt very passionate that there had to be a better way to take care of victims of crime, of sexual assault, so I started researching and I found out there were a couple programs in the United States using nurses to do the exams … and we had the first training there in Homer in 1993,” said James, now a SART trainer herself.
James came to Juneau with another trainer, Anchorage nurse Angelia Trujillo, who earned a Ph.D. in forensic nursing and specializes in launching SART programs, to conduct Sexual Assault Response Team and Sexual Assault Nurse Examiner training at Bartlett Regional Hospital. Eleven nurses stepped forward to become certified nurse examiners from many departments, from ER to OB, the mental health ward and critical care.
Bartlett nurse Cece Brenner spearheaded the formation of the SART program in Juneau about a year ago, seeking help from the Bartlett Regional Hospital Foundation, now headed by Maria Uchytil.
The Juneau community recognized the importance of having a SART program and certified nurse examiners, donating $45,000 last year for the program and nurse training at an event held at Mount Roberts Tramway. The money has gone a long way, Brenner said, funding a 40-hour SART class last month, as well as the SANE training that took place last week.
“It’s important because it’s the best patient care that we can deliver to these victims and it helps them in the process of prosecution,” Brenner said. “We’re trained to deliver the best possible care, using evidence-based research, and securing that chain of custody for evidence for the prosecution.”
Brenner, James and Trujillo all describe a marked difference in care provided to victims of domestic violence and sexual assault with the SART program.
“When you see people coming in and talking, it’s definitely different,” Trujillo said. “I’ve been in communities where they don’t have (a SART program) at all and ... the professionals in the community don’t know where to send them, people don’t want to come in, we know there’s victims out there, but we can’t help them.”
There are also indicators that SART programs result in a higher likelihood of effectively prosecuting the perpetrator of the assault.
The Sexual Assault Response Team includes a law enforcement official, a sexual assault nurse examiner and a victim advocate who work together to assess and treat injuries; document the crime and gather forensic evidence; and assist the victim in handling the physical, psychological and emotional effects of the assault. According to a study conducted by professor Andre Rosay and Tara Henry in 2008 for the University of Alaska Anchorage Justice Center, “sexual assault nurse examinations are important in responding to sexual assaults — both in treating victims and in collecting forensic evidence. The presence of genital injury, as documented in an examination, can be a factor in the prosecution of a sexual assault case.”
The study showed that “overall, 32 percent of reported cases were referred, 22 percent were accepted, and 17 percent resulted in a conviction” and posits that the higher rates are based largely on the identification of wounds during forensic examination, as well as evidence collected, like DNA samples.
According to another study completed by the Justice Center with the Alaska State Troopers, “evidentiary factors were the most important reasons for not accepting charges that had been referred.”
The abilities to identify and document injuries and effectively collect evidence were the focus of last week’s SANE training, with James and Trujillo not only speaking on the topics and showing images, but also providing hands-on training with a colposcope on both a dummy and live model.
The two also demonstrated proper methods for conducting a forensic exam to find signs of trauma from sexual assault both externally and internally. Methods taught include not only the medical aspects, but also how to interact with a victim in a way that does not exacerbate trauma while conducting an invasive examination.
“The way we teach this is to really focus on helping the victim on taking control back over what’s happening to them as part of the SART process,” Trujillo said. “They made a decision to come in and report what’s happened and the nurses, we train them to effectively work with that victim, to help them to regain control, to understand what happened to them, to make sure that they’re OK, and make sure they don’t have an infection, and just get them ready to go back and kind of think about where they’re at and get them involved with services in the community.”
Brenner has high hopes for the program in Juneau, not just for the higher standards of care for victims of sexual assault, but also for the ability to do more to prevent it. The 11 nurses should be fully certified within the year, she said, after further practice and sitting for an exam.
“Hopefully by getting this program started, we can do more community outreach for these victims and prevention and intervention afterward.”
James believes having a SART program helps not only the victims of sexual assault, but the community as a whole.
“It’s important to take care of the people in your community because this is so much more common, being sexually assaulted is so much more common than anyone ever imagines, and it’s so destructive, ultimately, to the health of the community,” James said. “And in this way we can start to help to break that, so that’s why it’s hugely important for the health of the community.”