Bridging the Gap Webinar Series A Picture Is Worth 1,000 Words: Picture Tools to Support the Forensic Exam Process for Survivors with Disabilities Shirley Paceley, Blue Tower Training Teresa Tudor, Illinois Department of Human Services Voice of Survivors • “I waited for hours in the Emergency Room because they couldn’t figure out how to get me on the table.†• “l told the doctor my legs can’t go in those things and he sent me home and said I refused the exam.†• “I heard the nurse ask the advocate how to do the exam.†History • SAFEta webinar. • Illinois Imagines Team. • SANE Coordinator for State. • Getting the photographs. Shifting Focus #1 Initial Goal • Provide medical staff with a tool to explain, show, and simplify the exam process. Shifting Focus #2 Input from Public Policy Committee & Statewide Team • Expand the audience to include self- advocates and victim advocates. • Had to be creative about expanding pictures. • Local Rape Crisis Center involvement. Expanding Our Input • Office of Violence Against Women. • International Association of Forensic Nurses. • Intention to make it flexible outside of Illinois. Another Shift in Focus Messaging: • Primary goal is to make sure the survivor is okay (medical care). • Secondary goal is evidence collection. • Core value is promoting choice. Materials Developed: Medical Staff • Picture Guide to the Exam After Sexual Assault with notes. • Instructional guidelines. • Sexual Assault Treatment Checklist. • Sexual Assault Evidence Collection Guide. Materials Developed: Victim Advocates* • Picture Guide to the Exam After Sexual Assault with notes. • Instructional guidelines. *Disability and Victim Services Advocates Materials Developed: Self-Advocates • Picture Guide to the Exam After Sexual Assault with notes. • Victims’ Rights regarding the Exam after Sexual Assault. Uses of Materials • Educate medical staff. • Educate advocates. • Educate self-advocates. Uses of Materials • Post-disclosure to help survivor decide if she wants an exam. • At hospital to explain exam and ask for consent. • During exam to explain each step. A Comprehensive Approach Medical Connec&on Evidence Care Collection Communica&onClarityChoices Consent PICTURE GUIDE To The Exam After Sexual Assault Sample Slides Hello, my name is ______ I am a medical advocate from _______. I can help support you throughout the exam and provide valuable information. Is it okay with you that I stay? A medical staff will meet you, introduce themselves and talk about what happened to you. • Provide any other information you have: – Is there a SANE? – Do you know the examiner? – Is she nice? If yes, share any reassuring comments you can give. • Support the person in expressing her preferences and needs. You may say something like, “It is important for you to let medical staff know how you can best be worked with and any accommodations you may need. You are the expert on your body and your needs, so you can help them.†Victim Advocate Notes Hello, my name is _____. I am a SANE (Sexual Assault Nurse Examiner) or other medical staff. I am here to make sure you are ok. • Introduce yourself to the patient. Let her know that you are sorry that this happened and reinforce that it is not her fault. Find out what you can about any needed accommodations so that you can prepare ahead for the exam. • Accommodations could be related to communication and/or to a physical disability—for instance, you may need extra people or lifting devices to assist the patient to the exam table. Assure the patient that you will do what you can to accommodate her needs. Medical Staff notes A special nurse or other medical staff will come and tell you their name. They will tell you about the exam. You may ask for what you need. • You can tell the medical staff anything you need so you can participate in the exam, such as: – an ASL Interpreter – asking medical staff to repeat things – help getting on the table • You have a right to any accommodations you need to be able to have information, communicate, and have the exam. • The advocate and medical staff should help you get what accommodations you need. Self-advocate notes If you say okay, your equipment may be looked at for evidence. If you say okay, the medical staff may take your clothes and put them in paper bags. This only happens if you are wearing the same clothes that you were wearing during the assault. Next, if it is okay with you, the medical staff may wipe the inside of your mouth with a cotton swab. The next step of the exam may be for the medical staff to comb your hair for evidence. Remember, you can say yes or no. The medical staff may wipe other areas of your body, based on what happened to you. You can say yes or no to this part too. The medical staff may need to scrape or swab under your fingernails. You may say yes or no to having this done. A special light may be used during the exam. The medical staff will use the light to look at your body to see if any areas glow. They will use a cotton swab on any areas that glow. The medical staff will turn the lights out when using the special lamp. The medical staff will not leave you. The medical staff will look over your body to see if you are hurt or having any pain. You can say yes or no to any part of this. We want you to be as comfortable as possible as the medical staff look for injuries. Please let the nurse know if anything she does makes you feel uncomfortable or hurts. A camera may be used to take pictures during the exam. You can say yes or no to having the pictures taken. Based on what has happened to you, the medical staff may look at your genitals. I can be beside you to support you during this part too. If you are a female, a tool called a speculum may be used. The speculum will be placed inside your vagina if that is okay. This will help to see if you are okay inside. Next Steps for Illinois • Broader distribution • Training • Revise consent forms Lessons Learned • Listening ears and eyes • Values of voices of people with disabilities • Flexibility • Identification of audience • Collaboration How to Access Resources for Medical Staff: Alternate Positions American Congress of Obstetricians and gynecologists (ACOG) http://www.acog.org/About_ACOG/ ACOG_Departments/Women_with_Disabilities/ Interactive_site_for_clinicians_serving_women_with_disabilities Click on Part 2: The GYN Examination, GYNHealth Screening, Sexually Transmitted Disease and Skin Examination How to Access the Tools § The tools can be found on the Illinois Imagines website: http://www.illinoisimagines.com How to Contact the Speakers Shirley Paceley (217) 875-8890 spaceley@maconresources.com http://www.bluetowertraining.com Teresa Tudor (217) 558-6192 teresa.tudor@illinois.gov QUESTIONS YOU ARE SO BRAVE! THANK YOU.