The use of telemedicine to deliver healthcare in remote or challenging sessions is not a new concept.  According to the American Telemedicine Association, this technology has been around for the past 40 years and in that time has grown in popularity and usage.  There are several reasons why; advocates for telemedicine say it can reduce costs, expand the reach for health care providers, and in many cases, improve the quality of interactions with patients.[1] In 2012, OVC began to explore the use of telemedicine to deliver forensic-medical examination support for sexual assault patients in rural, tribal, military, and correctional communities.

Research suggests that programs that use Sexual Assault Nurse Examiners (SANEs) or Sexual Assault Forensic Examiners (SAFE) to conduct forensic examinations of sexual assault victims contribute to higher prosecution and conviction rates.[2]  Many jurisdictions around the country (nearly 600) have instituted SANE programs, which are often part of a Sexual Assault Response Team or SART. SARTs are multidisciplinary teams that usually include the SANE or SAFE, a prosecutor, a victim advocate, a law enforcement officer, and often times, a crime lab.  SANEs and SAFEs receive intensive classroom and clinical training, which covers evidence collection, injury detection methods, chain-of-evidence requirements, methods to avoid re-traumatizing a victim during an examination, and other topics.

This collaborative approach for responding to sexual assault has produced numerous best practices that—

  • Enhance the quality of health care for individuals who have been sexually assaulted;
  • Improve the quality of forensic evidence;
  • Increase law enforcement’s ability to collect information, file charges, and refer to prosecution; and
  • Increase prosecution rates over time.

Unfortunately, there are many jurisdictions within the United States that do not have access to trained SANEs, SAFEs, or SARTs due to distance challenges and a lack of resources. Rural and tribal communities are particularly prone to these challenges. Even when professionals in these communities have received training, it can be very difficult to maintain an adequate number of trained medical personnel. Often there are too few cases being reported to maintain a satisfactory level of training and competency. Without access to trained, compassionate, and competent SAFEs, sexual assault victims may not only experience additional trauma caused by the exam, but the evidence may be collected incorrectly or findings may be misinterpreted and ultimately impede the criminal investigation.

Telemedicine offers a manageable solution to problems associated with providing health care at a distance. Telemedicine technology uses video conferencing, remote monitoring equipment, and electronic health records to link patients in remote areas to medical providers located elsewhere. There are many jurisdictions around the country using telecommunication technologies to improve access to medical services that would not be available otherwise. This is evident in the area of child sexual abuse. States such as Florida, Georgia, California, and Utah are all using some aspect of telemedicine to deliver sexual assault forensic examinations to children in rural or tribal areas. A study conducted by the University of California–Davis found that the use of telemedicine to assist in the examination of sexually assaulted children in rural communities resulted in significant positive changes in the methods of examination and evidence collection. The research indicated that it helped to improve the overall quality of the exams.[3]

OVC, with support from the National Institute of Justice (NIJ), issued a solicitation in 2012 to develop a national telemedicine center for sexual assault victims and provide support to four pilot sites.  The goal of this project was to create an entity that could provide a community of support for sexual assault clinicians to increase their confidence, competence, and retention and to support quality care for sexual assault patients.  The Massachusetts Department of Public Health SANE Program was awarded the grant.

After two years of training, protocol development, and equipment purchase and testing, the National Sexual Assault TeleNursing Center (NTC) formally opened its doors in the fall of 2014.  The NTC is now able to provide 24/7 remote clinician-to-clinician assistance. The first pilot site to “go live” was the Naval Base at Twenty-Nine Palms, California.  This hospital had just started a SANE program and felt that the support provided by the NTC was just what they needed to improve and enhance their forensic-medical services to victims of sexual assault.  A tribal site, the Hopi Health Care Center in Arizona and a rural site, Lakeside Sutter Hospital in California have also been selected. The individuals directing those programs hope that this new service will encourage victims of sexual assault to come forward and report their assaults.  These sites intend to go live in early 2015.  The NTC hopes to add a correctional facility to its list of pilot sites in the near future.

No one entity can provide all of the expertise necessary to make a venture like this successful.  The NTC is supported by numerous collaborative partners that provide subject matter knowledge in the areas of victim advocacy, as well as tribal, military, correctional and rural cultures.  In addition, this project includes an evaluation component to document its development and ensure that it is being carried out in the manner in which it was intended.

OVC is energized by the outpouring of support and encouragement from the victim services field in introducing this innovative approach to reaching underserved victims of sexual assault.  OVC’s ultimate goal is to ensure that all victims of sexual assault have access to a trained SANE or SAFE and receive a forensic medical exam performed with compassionate care and expert ability.   A report on the progress of the TeleNursing Center’s implementation is due in late 2015.

[1] American Telemedicine Association, www.americantelemed.org

[2] See, for example, Impact Evaluation of a Sexual Assault Nurse Examiner (SANE) Program (pdf, 129 pages), December 2003, and Systems Change Analysis of SANE Programs: Identifying the Mediating Mechanisms of Criminal Justice System Impact (pdf, 202 pages), January 2009.

[3] Using Telemedicine to Improve the Care Delivered to Sexual Abused Children in Rural, Underserved Hospitals, Pediatrics, Volume 123, No 1, January 2009. Kristen J. MacLeod, MD, et al.

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