1. The Adolescent Victim of Sexual Assault Karen D. Coleman, RN SANE Coordinator Victims Assistance Services

2. Sexual Assault in NYS 2,206 victims of forcible rape (and 10,359 victims of other sex offenses) were 17 and younger in New York State in 1997 (Bureau of Statistical Services of the New York State Department of Criminal Justice Services). Rape Crisis Centers across the state provided services to 3,991 survivors 18 and younger during the 1997-98 contract year (Rape Crisis Program of the New York State department of Health, Bureau of women's Health)

3. Westchester SANE Statistics

4. Adolescent Statistics for 2001 31 cases in 2001, only 1 male 19 of 31 knew perpetrator (61%) 4 of 31 lived in residential placement (13%) 10 of 31 had genital injuries (32%) 10 of 31 had non-genital injuries (32%) 12 of 31 occurred in the victims home (39%)

5. Adolescent Statistics 11 of 31 are African-American (35%) 12 of 31 are Caucasian (39%) 7 of 31 are Latino ( 23%) 2 are mentally delayed, 2 required psych. hospitalization, 1 required acute care hospitalization, 1 was incarcerated, 1 case had multiple perpetrators

6. Factors that Increase Vulnerability Lack of communication about relationships, sexual activity Lack of education and awareness on subject of sexual assault Feelings of betraying family member or friend by “telling” Intimidation by adult authority Failure to seek health care

7. Consents Minors in New York State, can give consent for all components of sexual assault care if they can understand the risks and benefits of the proposed treatments (informed consent). Minors who can give informed consent can also refuse to consent to such services.

8. Reporting Healthcare providers may not report rape or statutory rape committed against their patients to the police (unless the patient sustained a gunshot or life threatening stab wound. No report (CPS) should be made of minors who engage in consensual sex with a non-relative, or who are raped by a peer or by a stranger, unless the rape was the result of parental or guardian abuse or neglect.

9. DOCUMENTATION OF INJURIES

10. TEARS T Tear (laceration) or tenderness An injury in the soft tissues, resulting from ripping, crushing, overstretching, pulling apart, bending, and shearing; lacerations result from blunt force; in contrast, cuts come from sharp objects. E Ecchymosis (bruise) Irregular hemorrhagic areas of the skin; the color is blue-black changing to greenish brown or yellow; it is caused from extravasation of blood into the skin or mucous membrane A Abrasion A scraping away of a portion of skin or mucous membranes from injury or mechanical means R Redness (redness) A form of macula with diffused redness, caused by capillary congestion S Swelling (edema) A local or general accumulation of fluids in the tissues

11. The Body Diagram is essential to completely document physical injuries.

13. The clock is used to assist in documentation of the areas of injury.

19. Suction Neck Injury 15 Year old with suction marks to the neck that occurred during rape.

20. The kit contains 13 envelopes, blood collection equipment, necessary paperwork and detailed instructions.

21. Role of the SANE in the Hospital Medical Assessment Evidence Collection STD Prophylaxis Emergency Contraception HIV PEP Health Education

22. Role of the SANE in the Courtroom Fact witness Grand Jury testimony Educate the Jury Criminal Trial Testimony

23. How to Access a SANE Rape/sexual assault victim is triaged E.D. Staff calls VNA @ (914) 666-7079* VNA contacts SANE on call SANE arrives at hospital within 60 minutes SANE Nurse is available 24 hours a day * Call (914) 345-9111 for an advocate to come and stay with the victim

24. Reminders Photographs remain with the medical chart in a sealed envelope. Each photo should be labeled with patient name, MR#, date, time, and photographer's name. Do not place in rape kit. Utilize police photographer if indicated Document location of all injuries on body diagram. Ok to use familiar terms (i.e. “size of a quarter”, “cottage cheese”) Be careful not to use laceration and cut interchangeably!

25. Karen D. Coleman, RN SANE Coordinator Victims Assistance Services 2269 Saw Mill River Road, Bldg. #3 Elmsford, NY 10523 (914) 345-3113 (914) 345-3513 Fax