Sexual Assault Victims FAMSAC Patient Centred Practices

1. Sexual Assault Victims  FAMSAC Patient Centred Practices FAMSACForensic and Medical Sexual Assault Care Dr Vanita Parekh Cassandra Beaumont-Brown RN RM Start by looking at a fairly typical case of sexual assault Try to see it from the patient perspective How we may address them and indeed focus on them as the first priority Look at some data with regard to future changes Start by looking at a fairly typical case of sexual assault Try to see it from the patient perspective How we may address them and indeed focus on them as the first priority Look at some data with regard to future changes

2. A common scenario 19 year old woman Celebrating friend�s birthday At a pub Chats to some people at the next table Offered a lift to a party Driven to an oval Vaginally and orally raped Left in the car park

4. Contd. She walks to some nearby houses Asks for some help Police are contacted Police attend Taken to SACAT offices

6. Her situation She is stunned by what has happened �Acute Rape Trauma Syndrome� Access to care difficult She made it to the police Non-reporting is the norm

7. Common concerns Confidentiality Paramount Family and significant others knowing about the assault People outside her family knowing she had been sexually assaulted Blame People thinking it was her fault or that she was responsible Medical Concerns Becoming pregnant Contracting a sexually transmitted infection not including HIV/AIDS Contracting HIV/AIDS

8. Accessing care Need high levels of organisational ability Acute Rape Trauma Syndrome Transport Ambivalence Male survivors unlikely to access care

9. Common concerns male survivors Majority of literature is based on female SA Male sexual assault survivors own requirements Common sexuality misconceptions HIV common concern PEP More likely to have injuries Less likely to report

10. Victim gender The history of males reporting in the ACT thro AFP has been very low. These are men accessing medical care probably underreoprtedThe history of males reporting in the ACT thro AFP has been very low. These are men accessing medical care probably underreoprted

11. Ability to access careAge of victim at time of assault By CARAU under 14By CARAU under 14

12. Concerns of the patient/ Concerns of the services

13. Some FAMSAC concerns Serious injuries? Forensic medical examination? Collect evidence ASAP Emergency contraception Sexually transmitted infections Patient safety Emotional support ��.

14. Addressing the needs of the survivor Think about their situation Address their concerns Report to a nation Female and male survivors ? Patient centred approach

15. The ACT situation (prior to July 2001) Access to care difficult Different sites of specialised care Forensic (SACAT) Injury (A&E) STI Contraception (Family Planning) Counselling Seek out care Forensic medical practitioners recruitment unsuccessful

16. Moving to the patientLocation of assessment Patient centered approach incorporates all aspects of care and moving to the patientPatient centered approach incorporates all aspects of care and moving to the patient

17. Moving to the patientCall-out nature of service 24 hour service Large component is after hours24 hour service Large component is after hours

18. Addressing medical needsEmergency Contraception and HIV PEP PEP to males EC and PEP address the medical needs if appropriatePEP to males EC and PEP address the medical needs if appropriate

19. Biting the bullet ACT government backing

20. ACT Government backing Dr Klara Soos Senior health policy adviser People making the service Contract Provide coordinated/integrated sexual assault care �Doctors receive training to a nationally accredited standard� ? Lead to patient centred care

21. What is FAMSAC? Integrated medical and forensic sexual assault care service Based at The Canberra Hospital Established in July 2001 Budget initiative Coordinated service for sexual assault victims

22. Working with other agenciesReferral Agency

23. Juggling together The patient picks the balls Reporting formal or Anonymous reporting Information given to the patient to make a choice about reportingReporting formal or Anonymous reporting Information given to the patient to make a choice about reporting

24. Patient choiceForensic Vs. Medical Only Examination

25. FAMSAC nurse coordinator Coordinates care for victims Provides specialist nursing follow up care 85% in 24-48 hrs Maintains supplies for medical practitioners Education program organisation Court support for doctors Maintaining a database Service planning decisions Barriers to follow up Community Considerations

26. Community considerationsAssailant identity Most sexual assaults from known assailantsMost sexual assaults from known assailants

27. Community considerations Location of assault

28. Medical implicationsVictim�s Body Site Penetrated

29. Medical implicationsCondom Use Unknown minor detailUnknown minor detail

30. FAMSAC doctors Dedicated educated clinicians Sexual assault care medical practitioners Ongoing education Forensically aware Sample collection Expert witness training Prepared to go to court Extensive experience in women�s health Extensive experience in men�s sexual health Cohesive group

31. Patient Survey (N=50) 198 Voluntary survey Anonymous Carried out at follow up 100% patients felt they were treated with respect 92% enough procedural information 8% not answered

32. Patient Survey (N=50) 198Comments �found the advice helpful at a difficult time� �I feel like they really care about me� �I was respected, educated and supported� �I was given lots of information to take home, that helped a lot�

33. Follow up Free, easily accessible, on their terms All found it satisfactory 85% at 24-48hrs 66% at 3/12 �I was told things I wouldn�t have known to ask about�

34. Where to from now ?-Our wish list Database Identify patient concerns Review our practice Adapt to patient needs Track patients through the system Local data FAMSAC Australia Equity of care across the nation