Creating safe places outside of the EDtcfv.org/wp-content/uploads/2019/02/Marks-Paul-Eloise-House-Lesso… · September 2013-SB 1191 (a)Except as otherwise provided by Subsection

Creating safe places outside of the ED:Community based forensic care

PAULA MARKS RN, SANE-A

JENNY BLACK BSN, RN, SANE-A, CA-SANE

© 2018 THE SAFE ALLIANCE 1

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Introductions


Paula Marks- Forensic Nursing Manager at the SAFE Alliance

Jenny Black- Director of Forensic Nursing at the SAFE Alliance



Why would you want to see sexual assault patients outside of a

hospital?

Patient benefits

No costReduced wait

timesPrivacy

Appointments available

Peaceful environment

Wraparound service

availability

Appropriate medical referral

Follow up


Trauma informed staff


Community Benefits

Increased investigation

and prosecution engagement

Cost savings to hospitals

Interagency coordination

Amplifies nurse’s voices


Risk

Medical Emergencies

Psych Emergencies


Medical Emergencies

Average time of

presentation is 36 hours post assault

Referral criteria

• Intoxication

• Active psychosis

• Needs ED treatment

EMS on site assessment

Flash assessment


Psych Emergencies

Deescalate

Know your available options

• MHOs

• Community agencies

• EDs

SI assessment


Models


Family Justice Centers

Co-located services –

health care, advocacy, law enforcement

One Safe Place –Ft. Worth

Maricopa county –Phoenix

New Orleans Family Justice

Center


Community based forensic clinics

Courtney’s Safe Place - Plano

Eloise House - Austin

Child Abuse & Forensic Services – Beaumont

Crisis Center – Birmingham


HistoryELOISE HOUSE


September 2013-SB 1191(a)Except as otherwise provided by Subsection (a-2), after [After] a sexual assault survivor arrives at a health care facility following an alleged sexual assault, the facility shall…provide care to the survivor in accordance with Subsection (b)…

(2)the survivor is entitled, at the survivor ’s option:

(A)to receive the care described by Subsection (b) at that facility, subject to Subsection (b-1); or

(B)to be stabilized and to be transferred to and receive the care described by Subsection (b) at a health care facility designated in a community-wide plan as the primary health care facility in the community for treating sexual assault survivors.


SARRT Working Group Jan 2014Wait time less than 2 hours from medical clearance to exam

No fees to survivors

24/7 exam availability at stand alone facility/traveling van, not a hospital

All basic needs attended to – food, drink, ride to safe location

All SAFEs by certified SANEs

Drop in child care during exam and legal proceedings

Forensic response, not just sexual assault

All wet kits – include blood and urine for non reports


Conclusion

The community needed additional group(s) to supplement SANE services in our community.

Community-based models were most appropriate for our community.


SafePlace Nursing Program?Once the SARRT determined that a community-based response was best andthat additional resources were needed to meet the demand, several community partners asked if SafePlace would be interested in starting a program.

And the wheels started turning…


Questions to be answeredIs it ethical to have a DV/SA program doing forensic exams?

Will the evidence hold up in court?

Is it consistent with our mission?

How will it impact advocacy?

How will we pay for it?

Can we provide services at the quality survivors deserve?

Who else is doing it and how?

Is there a better option?

Is there community support?

Is there internal support?

Do we have the expertise and resources required to sustain a program?


The Process• Prosecutors—will evidence hold up in court?

• Law enforcement—will they contract for services?

• Hospitals—is there a need or desire for additional coverage?

• Survivors—How would changes impact them? What are their needs and wants?

1. Talk to key community partners to get key

questions answered.

• Discuss consistency with mission/strategic plan

• Assess expertise

• Assess risk

2. Talk to leadership of organization to garner

support

• Internet research

• Cold calls

• Word of mouth

3. Look for similar programs across the

country


Proposal to SafePlace BoardBuilding and supplies to open forensic clinic

Find donor to cover costs

Begin interviewing nurses/build pool

Bring nursing coordinator on full-time

Negotiate contracts with local law enforcement

Begin program development

Proposed start date: Fall 2015

Estimate: 100 Exams in 1st Year


Start up benefactor

Peace, Love, and

Happiness Foundation


March 2015Emergency SARRT

◦ Nursing group practicing at SDMC gave notice to APD and TCSO that services would cease on 5/29/15

◦ Community partners requested that we begin services 5/30/15

◦ With only one nurse hired and no building yet delivered, we agreed


We Have 60 Days To Do What?!

Hire and train nurses

Buy equipment

Stock supplies

Source medications

Find a medical director

Credential with hospitals

Policies! Procedures!


NursesRecruiting started in April 2014

IAFN SANE course

Began with a group of ten

Met monthly – case reviews, charting walkthroughs, shared research and best practices, webinars

Mock exams

Clinicals

Media coverage brought more

Hired in May 2015


Equipment and suppliesCameras

Exam table

Colposcope

Vital signs

Computers, scanners, printers

Evidence lockup

Medical supplies

Sharps


Community partner contributions

St. David’s Medical Center: needles, syringes, chux, sharps containers, gloves, blood tubes, butterflies, blankets, trash cans, tourniquets, bandaids, gauze, alcohol swabs, sterile water bullets, urine specimen cups, biohazard bags, germicidal wipes, emesis bags, cotton swabs, specula, toluidine dye swabs, GOWNS

Austin Police: evidence refrigerator, great media presence

Medsavers: at cost antibiotics and emergency contraception


Individual donations


MedicationsNo cost to patients

Antibiotics

Emergency contraception

Pain relievers

Local pharmacy: Medsavers

Women’s health supplier: HPSRX

Medical director

Standing orders


And then there was paperworkPolicies Records

Procedures Insurance

Protocols ROIs

Guidelines Contracts

How tos Intake forms

Standing orders Onboarding

Translation Credentialing

Consents Nonreport

Discharge Invoices


Building a medical forensic record systemWeb Based Data Entry for:

Sexual AssaultStrangulationInterpersonal Violence

Additional features:

– Forms Printing– Culture & Lab tracking– Billing for exams, cultures/labs– Reporting and statistics– Encrypted Photograph storage– Role based users– Built in Peer Review process– Built in Addendum creation


Clinic design

We wanted a nonclinical clinic

What we got was a used construction trailer

With the help of an interior designer and a few upgrades, Eloise is a very comfortable alternative to an emergency department


Before


After


Contracts

TCSO Contract 8/24/2015

APD Contract 10/1/2015


Key to success in contractingRELATIONSHIPS!

Find the right people—they may not be the folks you think of

Educate when needed

Be patient

Requires trust


Friends in the Media


In the first 6 months:321 patients

40+ law enforcement agencies

30% increase in census for Austin/Travis County

215% increase in non-reports

97% of patients waited less than 2 hours (most waits in first month)

Negative ratio for wait times (more often than not, nurse and advocate arrive first)

325% increase in patients entering shelter


Does this model increase reporting?


Feedback from survivors

"I feel like coming to SafePlace was

the best decision I could have made

after the incident.”

“This is the most comfortable I’ve

been in a medical setting. I sat at the emergency room behind a curtain and counted the

feet walking by. I’m really glad I came

here.”

“I’ve been through a lot. From the time I walked through these

doors I felt nothing but love and security. I am

beyond satisfied. Coming today saved my life.

Rachel really did something I

needed. She gave me a hug only a

mother could give.”

From an adolescent: “ So

how do you become a forensic

nurse? How did you get a job

here? I want to do something that

helps people too.”


Feedback from partners

“This is such a nice facility for patients and their families to come to after an

assault. I feel so much more comfortable being with a patient in this

environment. It is clean, comfortable and it feels like home. Definitely beats

sitting in a hospital not feeling like a priority. You have taken such good care of this young girl. It's very obvious you

are passionate about what you do and she is your main focus.”

“I’m in awe of what y’all have done here. This is so much better for the victims we

serve. It is so obvious that you care deeply about survivors. We appreciate you.”


Eloise 2!


Lessons learned

Relationships are the most important

resource

If you build it, they will come…from everywhere

Patience is a virtue, especially with systems

change

We’ve removed barriers for survivors

(census increase, connection to other

services)

It’s required new thinking for agency

staff

Instead of why? Ask why not?


Questions? Comments?Paula Marks, RN, SANE-A

Forensic Nurse Manager

(512) 356-1608

[email protected]

Jenny Black, BSN, RN, SANE-A, CA-SANE

Director of Forensic Nursing

(512) 356-1530

[email protected]


mailto:[email protected]

mailto:[email protected]

Creating safe places outside of the EDtcfv.org/wp-content/uploads/2019/02/Marks-Paul-Eloise-House-Lesso… · September 2013-SB 1191 (a)Except as otherwise provided by Subsection

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