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SEXUAL ASSAULT and the FAMILY JUSTICE CENTER §Nancy E. O’Malley District Attorney, Alameda County, CA.

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Presentation on theme: "SEXUAL ASSAULT and the FAMILY JUSTICE CENTER §Nancy E. O’Malley District Attorney, Alameda County, CA."— Presentation transcript:

1 SEXUAL ASSAULT and the FAMILY JUSTICE CENTER §Nancy E. O’Malley District Attorney, Alameda County, CA

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4 Every day, those working against sexual assault violence encounter the human pain resulting from that violence

5 The reasons and justifications are the same for communities to come together to create a Family Justice Center and coordinate their response to domestic violence and sexual assault

6 Coordination must have at its core, a commitment by participants to develop a response which places the survivors’ safety and well-being at the forefront while enhancing offender accountability

7 At times, the impetus to coordinate efforts arises out of a frustration with fragmentation of policies and activities within the criminal justice system as well as the victim advocacy field

8 Recognizing and acknowledging WITHOUT JUDGEMENT, the realities of the current community response to sexual assault is the first step to overcoming personal and professional barriers

9 The last couple of decades has been a time of tremendous development in the field of sexual assault

10 §Development of “confidentiality” statutes and protections §Forensic technologies and expertise §Stronger tools for law enforcement §More tools for prosecution

11 §Tougher sentencing laws §Sex offender registration §Federal Violence Against Women Act §Increased recognition of Sexual Assault Survivor’s Bill of Rights §Better research about sex offenders

12 Improvements in individual response can include: §Increased victim safety, support and restoration; §more calls to police and victim service programs; §more arrests and cases charged as felonies; §less offender recidivism

13 Sexual Assault Response at the FJC

14 The impact of sexual assault on the victim / survivor of the crime

15 The affect sexual assault violence has on the fabric of our modern society Longitudinal studies show the effect on survivor AND her children

16 The affect sexual assault violence has on the fabric of our modern society Sexual assault in relationship is one form of DV and the emotional and psychological impact is great

17 Community-based victim service programs and justice system agencies often initiate coordinating efforts.

18 THE SAME PARTNERS AT THE FAMILY JUSTICE CENTER WILL BE PARTNERS TO RESPOND TO SEXUAL ASSAULT

19 FJC / COMMUNITY PARTNERING §Individuals §Organizations l criminal justice system agencies DADA PolicePolice l medical providers l community based victim service programs RAPE CRISIS CENTERSRAPE CRISIS CENTERS Victim-Witness Assistance CentersVictim-Witness Assistance Centers

20 FJC / COMMUNITY PARTNERING Organizations l Child based counseling groups §Media §Schools / Churches

21 RECOGNIZING THE IMPACT OF THE CRIME ON THE SURVIVOR

22 Post Traumatic Stress Disorder RAPE TRAUMA SYNDROME: COMMON REACTIONS AND MANIFESTATIONS AS WELL AS STATISTICAL PREDICTORS OF DURATIONS COMMON REACTIONS AND MANIFESTATIONS AS WELL AS STATISTICAL PREDICTORS OF DURATIONS OF PTSD / RTS OF PTSD / RTS

23 ONE WHO SURVIVES THE CRIME WILL MANIFEST SYMPTOMS OF POST TRAUMATIC STRESS IDENTIFIED AS RAPE TRAUMA SYNDROME

24 What Helps with Healing? §Counseling §Social support l Those who received counseling and had strong social support showed no difference in the level of depression or social adjustment 12 months post assault

25 What helps? Con’t Those who participation in the criminal justice system demonstrated a greater level of self-esteem. §Feelings of taking charge §Feelings of standing up for self §Feelings of worth §CHOICE CA law: survivor choice, “Jane Doe”

26 Who are the Collaboratives

27 SART Sexual Assault Response Team §District Attorneys / County Prosecutors §Law Enforcement Agencies §Hospitals l MLPs l SANEs l SAFEs §Rape Crisis Centers §Victim-Witness Consultants

28 SART Provides a continuum of services for the sexual assault survivor, which typically begins at the hospital where law enforcement interviews and a medical, forensic examination is conducted

29 SART Continuum of services continues through survivor contacts with law enforcement and attorneys who are involved in the investigation and prosecution process

30 Need for coordination & standardization §Reduce amount of time survivor is at the hospital §Advocate to provide psycho-social support (RTS) and ensure appropriate treatment §Law enforcement obtain statement and identification as quickly as possible §Prosecution successfully prosecute sex offenders in that community

31 Addressing survivor’s needs §Survivor’s participation will be part of her (his) healing, rather than re-traumatization §Self-esteem will increase; self-blame will decrease §Survivor will find the compartment in her (his) psyche to place the experience and lead a happy, healthy life §Survivor more likely to cooperate with prosecution

32 What really happens in SART? §Rape Crisis Advocate §Law Enforcement §Trained Forensic Examiner l Knows what to look for l Consider that this model will depend upon where these services are offered….so connected by the dots or on site l Space at Justice Center will also impact where the examinations are done

33 Process and Procedures for the Sexual Assault Nurse Examiner (SANE/SAFE) §Patient presents to the SANE/SAFE for an evidentiary examination (Hospital, Justice Center, Clinic/Private)-Medical Director role §Notification of Law Enforcement-Per Community Protocol §Notification of Rape Crisis Advocate (Justice Center, or MOU with agency) §Consent-Written and verbal §Examination-Room and examine table, equipment (camera) §Evidence Collection and the Kit §Report (the paper work) §Chain of Evidence §Case Review §Court testimony

34 What really happens in SANE room at the FJC or the ER? §Medical Screening l Completion of ED chart, FJC-Protocol §State Protocols l Collection of forensic evidence l Collection of biological references l Screening and prophylaxis for STD and pregnancy

35 Adjuncts to the Sexual Assault Exam §Digital or Colposcopy-tools with the capacity to capture images, and magnification (Camera is portable) §Toluidine Blue- nuclear stain used to identify & confirm or support visible physical findings

36 Patient Centered Care Compassionate Coordinated Competent Collaborative Patient Centered

37 §"The background should not detract from the subject of the photo. Extraneous material or information should be limited in the photo. 5/3/2015 Background of the Photographs

38 §"The presence of distracting things and the viewer may be deemed inflammatory by a judge rending an opinion as to a photos admissibility to evidence.” §Warm colors such as red, orange etc. will inflame or make the person look yellow...Hence you never paint the newborn nursery yellow as all your baby's will look yellow. Use cool colors such as blue or green or gray. § Faugno 2009 & Olshaker /3/2015 Background of the Photographs

39 5/3/ Filter on the software, Not the camera….

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42 Characteristic Injuries in Consent & Non-consensual Intercourse Mounting Injuries l Occur at first contact in an attempt to penetrate l Occur at ’clock on the posterior fourchette l Injuries include tears, micro abrasions, lacerations l Injuries independent of lubrication, relaxation or inebriation l Anderson, McClain, Riviello (2006)

43 Ano-Genital Injury §Does not tell you if from trauma or medical issues §Does not tell you if from consensual or non- consensual sex §Does tell you there is an injury §The expert will need to speak to the history and time frame given to the examiner

44 §33-44% of victims who are physically assaulted by their partners are also sexually assaulted §In severely abusive relationships, violent forcible sexual assault occurs twice monthly and is the least likely form of assault to be reported

45 §In Spousal / Intimate Partner Sexual assault, there are often no findings of genital trauma §Research tells us 40% of sexual assault patients will not have genital injury §Lack of finding does NOT indicate lack of assault l Need an expert to explain

46 What the Expert Can Say §Injuries consistent with history §40% of all sexual assaults result in no genital trauma l Baker 2008 §Injury is consistent with the time frame as stated §Be sure that you are talking apples to apples when using the research to support your findings or case issues

47 The Examination §The strength is in the examination §Patient time spent with the examiner §Completion of the examine and evidence kit §Explaining this to the jury § How long was the patient with you? § Time from admission to discharge?

48 The Victim Interview: Essential Evidence The sexual assault investigation is unlike any other type of criminal investigation due to the uniquely intimate and invasive nature of the crime. Unlike many cases, the victim interview is the most essential piece of evidence you will have in your case Medical Findings

49 THE FJC §All the “players” are there §Service delivery is more comprehensive & appropriate §Survivors can receive treatment without shame, judgment or other negative, non- verbal communications l Avoid a “clinic” mentality

50 BAY AREA WOMEN AGAINST RAPE “BAWAR” Oldest Rape Crisis Center in America

51 DeafHope Providing sexual assault services to victims who are deaf

52 Located at the FJC §Rape Crisis Advocate l Confidential Communication Privilege §Victim-Witness Advocates l Criminal Justice support / VOC advocacy §Medical – Forensic MLP §Public Health l STD Screening §Law Enforcement §Prosecution §SEM Network -- SPA (Safe Place Alternative)

53 THE FJC §HIPAA l The Health Insurance Portability and Accountability Act of l996 l Confidentiality of records / treatment l The “Privacy Rule” is a series of regulations enacted to protect health information that became effective in April of 2003.

54 Medical v Forensic §Insurance §Equipment §Record maintenance §Drug safety §Medication §Policy and Procedures ………..

55 WHO CAN WORK IN A STAND-ALONE SART CENTER §Forensic l SANE/RN under Standardized procedures- Need a medical director §Forensic AND Medical l PA l NP l MD l SANE under supervision for medical

56 FJC & Sexual Assault What Can We Do? §At a minimum, re-test for SDT §Document healing wounds §Follow-up re testing: HIV §Support for victim and others “Who” is not the question; the question is: “How bad is it”

57 FJC & Sexual Assault What Can We Do? §Appointments can be scheduled §Practitioner can assess needs of victim before s/he arrives §Practitioner can access records from where the victim receives 24/7 care (only in house records) §Confidentiality §KINDER, GENTILER TREATMENT §Access to the team providers for the best care ……

58 Coordination Among Agencies: §Development of proactive legislation §Development of multidisciplinary protocols and training §Systemic analysis of jusice response based on case outcomes and victim satisfaction §Community education and media initiatives

59 CAN LEAD TO SYSTEMIC CHANGES §Better and more comprehensive interventions §Few related homicides l DV Deaths: 2000 = = = = = 3 (w/2 suspicious)2006 = 3 (w/2 suspicious) §Increased community intolerance for these crimes

60 National Judicial Education Program §New Materials for In-Person Judicial & multidisciplinary Education on Cases Involving Adult Victims of Sexual Assault 4/2011 §http://www.legalmomentum.org/our-work/njep/mat- for-jd-edu/http://www.legalmomentum.org/our-work/njep/mat- for-jd-edu/

61 §http://www.cdc.gov/std/treatment/default.ht m?source=govdeliveryhttp://www.cdc.gov/std/treatment/default.ht m?source=govdelivery §CDC 2010 Treatment Guidelines §http://www.evawintl.org/http://www.evawintl.org/ §End Violence Against Women International §http://www.evawintl.org/ForensicComplian ce.aspx (Technical Assistance with Compliance)http://www.evawintl.org/ForensicComplian ce.aspx

62 Virtual Forensic Facility Article: Article: /258/sexual-assault.html /258/sexual-assault.html 2011 Medical Findings

63 EMTALA §“If an individual presents to a dedicated emergency department and requests services that are not for a medical condition, such as preventive care services (immunizations, allergy shots, flu shots) or the gathering of evidence for criminal law cases (e.g., sexual assault, blood alcohol test), the hospital is not obligated to provide a MSE under EMTALA to this individual.” exual+assault exual+assault 5/3/2015

64 Seeking Informed Consent for Patients §There are two essential but separate consent processes—one for medical evaluation and treatment and another for the forensic exam and evidence collection §Informed consent process includes making patients aware of the impact of declining a procedure, as it may negatively affect the quality of care and the usefulness of evidence collection § National Protocol /3/2015

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66 Acknowledgements: Hillary Larkin, PA-C Diane Faugano Acknowledgements: Hillary Larkin, PA-C Diane Faugano

67 ALAMEDA COUNTY FAMILY JUSTICE CENTER 470 – 27 TH Street Oakland, CA ALAMEDA COUNTY FAMILY JUSTICE CENTER 470 – 27 TH Street Oakland, CA


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