An Investigation into a Large, Suburban, Academic Hospital’s Sexual Assault Response Program

Authors

DOI:

https://doi.org/10.29173/jafn925

Keywords:

sexual assault, sexual assault nurse examiner (SANE), Sexual violence, emergency department

Abstract

This study aims to profile sexual assault (SA) patients, their hospital encounters, and to identify resources necessary for effective management. It is a descriptive, retrospective chart review of all patients >18 who presented to the emergency department with a diagnosis of sexual assault or rape between January 1, 2015 and July 1, 2024. Demographics, hospital stay, and assault characteristics were extracted from patients’ medical records. Odds ratios were calculated with logistic regression models. P-value of <0.05 was considered significant. 309 patients were included, majority of whom were female (89.0%), White (65.3%), and non-Hispanic (76.1%). Nearly all patients requested a SAFE exam (86.1%), and 10.5% left before arrival of the SAFE examiner. Law enforcement was involved in 43.0% of the cases. Many patients (37.5%) had pre-existing psychiatric comorbidity; 18.8% with depression and 7.1% with PTSD. Records showed 10.4% of assaults occurred in a group home, nursing facility, rehab facility, or shelter. Patients with psychiatric history had 0.40 times the crude odds of requesting a SAFE exam, and 0.38 times the crude odds of obtaining HIV testing compared to their counterparts. Patients with no known relationship with their assailant had 2.53 times adjusted odds of completing a sexual offense evidence kit compared to those with a known relationship with their assailant. This study highlights the importance of offering mental health resources and group/nursing home support from the emergency department (ED). This study illustrates focus areas for in-hospital interventions of SA-response programs and provides  deeper understanding of SA patients for ED physicians.

References

References

A National Protocol for Sexual Assault Medical Forensic Examinations (NCJ 228119). (2024). U.S. Department of Justice, Office on Violence Against Women.

Bruce, M. M., Kassam-Adams, N., Rogers, M., Anderson, K. M., Sluys, K. P., & Richmond, T. S. (2018). Trauma providers’ knowledge, views, and practice of trauma-informed care. Journal of Trauma Nursing, 25(2), 131–138. https://doi.org/10.1097/JTN.0000000000000356

Campbell, R., Bybee, D., Kelley, K. D., Dworkin, E. R., & Patterson, D. (2012). The impact of Sexual Assault Nurse Examiner (SANE) program services on law enforcement investigational practices: A mediational analysis. Criminal Justice and Behavior, 39(2), 169–184. https://doi.org/10.1177/0093854811428038

Chalmers, K., Parameswaran, R., Dussault, N., Farnan, J., Oyola, S., & Carter, K. (2023). Impact of sexual assault survivor identity on patient care in the emergency department. Journal of Interpersonal Violence, 38(3–4), 3244–3278. https://doi.org/10.1177/08862605221104522

Ciancone, A. C., Wilson, C., Collette, R., & Gerson, L. W. (2000). Sexual Assault Nurse Examiner programs in the United States. Annals of Emergency Medicine, 35(4), 353–357. https://doi.org/10.1016/S0196-0644(00)70053-9

Clarke, V., Goddard, A., Wellings, K., Hirve, R., Casanovas, M., Bewley, S., Viner, R., Kramer, T., & Khadr, S. (2023). Medium-term health and social outcomes in adolescents following sexual assault: A prospective mixed-methods cohort study. Social Psychiatry and Psychiatric Epidemiology, 58(12), 1777–1793. https://doi.org/10.1007/s00127-021-02127-4

Cole, J., & Logan, T. K. (2008). Negotiating the challenges of multidisciplinary responses to sexual assault victims: Sexual assault nurse examiner and victim advocacy programs. Research in Nursing & Health, 31(1), 76–85. https://doi.org/10.1002/nur.20234

Cowdery, C., Halloran, D., Henderson, R., Allen, M. K. M., O’Shea, K., Woodward, K., Rifai, S., Cohen, S. A., Chowdhury, M. A. B., Zeretzke-Bien, C., Walter, L. A., & Elie-Turenne, M.-C. (2024). User experience of access to sexual assault nurse examiner and emergency contraception in emergency departments in the United States: A national survey. Western Journal of Emergency Medicine, 25(2), 291–300. https://doi.org/10.5811/westjem.18405

Crime in the United States. (2019). U.S. Department of Justice, Federal Bureau of Investigation.

Cucciare, M. A., Mengeling, M. A., Han, X., Kennedy, K., Torner, J., & Sadler, A. G. (2022). Experiencing sexual assault and/or stalking-related behavior is associated with binge drinking and substance use consequences in deployed U.S. servicewomen. Women’s Health Issues, 32(4), 402–410. https://doi.org/10.1016/j.whi.2021.12.002

Derhammer, F., Lucente, V., Reed, J. F., & Young, M. J. (2000). Using a SANE interdisciplinary approach to care of sexual assault victims. Joint Commission Journal on Quality Improvement, 26(8), 488–496. https://doi.org/10.1016/S1070-3241(00)26041-0

ECLI-VIBES. (2023). ECLI-VIBES: Support and empower now. https://eclivibes.org/

Ericksen, J., Dudley, C., McIntosh, G., Ritch, L., Shumay, S., & Simpson, M. (2002). Clients’ experiences with a specialized sexual assault service. Journal of Emergency Nursing, 28(1), 86–90. https://doi.org/10.1067/men.2002.121740

Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient (2nd ed.). (2013). American College of Emergency Physicians. https://www.acep.org/siteassets/uploads/uploaded-files/acep/membership/sections-of-membership/forensic/sexual-assault-e-book2.pdf

Fiske, E., Reed Ashcraft, K., Hege, A., & Harmon, K. (2021). An interprofessional course on trauma-informed care. Nurse Educator, 46(4), E50–E54. https://doi.org/10.1097/NNE.0000000000000935

Forkey, H., Szilagyi, M., Kelly, E. T., Duffee, J., Council on Foster Care, Adoption, and Kinship Care, Council on Community Pediatrics, Council on Child Abuse and Neglect, Committee on Psychosocial Aspects of Child and Family Health, Springer, S. H., Fortin, K., Jones, V. F., Vaden Greiner, M. B., Ochs, T. J., Partap, A. N., Davidson Sagor, L., Allen Staat, M., Thackeray, J. D., Waite, D., & Weber Zetley, L. (2021). Trauma-informed care. Pediatrics, 148(2), e2021052580. https://doi.org/10.1542/peds.2021-052580

Gilmore, A. K., Walsh, K., Frazier, P., Meredith, L., Ledray, L., Davis, J., Acierno, R., Ruggiero, K. J., Kilpatrick, D. G., Jaffe, A. E., & Resnick, H. S. (2019). Post-sexual assault mental health: A randomized clinical trial of a video-based intervention. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260519884674

Gilmore, A. K., Walsh, K., Frazier, P., Meredith, L., Ledray, L., Davis, J., Acierno, R., Ruggiero, K. J., Kilpatrick, D. G., Jaffe, A. E., & Resnick, H. S. (2021). Post-sexual assault mental health: A randomized clinical trial of a video-based intervention. Journal of Interpersonal Violence, 36(21–22), 10614–10637. https://doi.org/10.1177/0886260519884674

Greeson, M. R., & Campbell, R. (2013). Sexual Assault Response Teams (SARTs): An empirical review of their effectiveness and challenges to successful implementation. Trauma, Violence, & Abuse, 14(2), 83–95. https://doi.org/10.1177/1524838012470035

Hassam, T., Kelso, E., Chowdary, P., Yisma, E., Mol, B. W., & Han, A. (2020). Sexual assault as a risk factor for gynecological morbidity: An exploratory systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 255, 222–230. https://doi.org/10.1016/j.ejogrb.2020.10.038

Hayden, S. R., Barton, E. D., & Hayden, M. (1997). Domestic violence in the emergency department: How do women prefer to disclose and discuss the issues? Journal of Emergency Medicine, 15(4), 447–451. https://doi.org/10.1016/S0736-4679(97)00070-X

Hollender, M., Almirol, E., Meyer, M., Bearden, H., & Stanford, K. A. (2023). Sexual Assault Nurse Examiners lead to improved uptake of services: A cross-sectional study. Western Journal of Emergency Medicine, 24(5), 974–982. https://doi.org/10.5811/westjem.59514

Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006; NSDUH Series H-58). (2023). Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report

Khadr, S., Clarke, V., Wellings, K., Villalta, L., Goddard, A., Welch, J., Bewley, S., Kramer, T., & Viner, R. (2018). Mental and sexual health outcomes following sexual assault in adolescents: A prospective cohort study. The Lancet Child & Adolescent Health, 2(9), 654–665. https://doi.org/10.1016/S2352-4642(18)30202-5

Ledray, L. E., & Simmelink, K. (1997). Efficacy of SANE evidence collection: A Minnesota study. Journal of Emergency Nursing, 23(1), 75–77. https://doi.org/10.1016/S0099-1767(97)90070-2

Lee, J. A., Majeed-Ariss, R., Pedersen, A., Yusuf, F., & White, C. (2019). Sexually assaulted older women attending a U.K. sexual assault referral centre for a forensic medical examination. Journal of Forensic and Legal Medicine, 68, 101859. https://doi.org/10.1016/j.jflm.2019.101859

Lonsway, K. A. (2010). Trying to move the elephant in the living room: Responding to the challenge of false rape reports. Violence Against Women, 16(12), 1356–1371. https://doi.org/10.1177/1077801210387750

Marsac, M. L., Kassam-Adams, N., Hildenbrand, A. K., Nicholls, E., Winston, F. K., Leff, S. S., & Fein, J. (2016). Implementing a trauma-informed approach in pediatric health care networks. JAMA Pediatrics, 170(1), 70–77. https://doi.org/10.1001/jamapediatrics.2015.2206

Medel-Herrero, A., Smiley-Jewell, S., Shumway, M., Reidy, D. E., & Bonomi, A. (2023). Advances in diagnostic codes to document sexual assault in health care service. Health Services Research, 58(4), 807–816. https://doi.org/10.1111/1475-6773.14021

Mercier, É., Nadeau, A., Brousseau, A.-A., Émond, M., Lowthian, J., Berthelot, S., Costa, A. P., Mowbray, F., Melady, D., Yadav, K., Nickel, C., & Cameron, P. A. (2020). Elder abuse in the out-of-hospital and emergency department settings: A scoping review. Annals of Emergency Medicine, 75(2), 181–191. https://doi.org/10.1016/j.annemergmed.2019.12.011

Morgan, R., & Thompson, A. (2021). Criminal victimization, 2020 (NCJ 301775). U.S. Department of Justice, Bureau of Justice Statistics.

Morra, C., Nguyen, K., Sieracki, R., Pavlic, A., & Barry, C. (2024). Trauma-informed care training in trauma and emergency medicine: A review of the existing curricula. Western Journal of Emergency Medicine, 25(3), 423–430. https://doi.org/10.5811/westjem.18394

Murugan, V., Holzer, K. J., Vaughn, M. G., Carbone, J. T., Jackson, D. B., & Bitter, C. C. (2021). Coding of sexual assault by emergency physicians: A nationally representative study. Western Journal of Emergency Medicine, 22(2), 291–296. https://doi.org/10.5811/westjem.2020.12.49045

New York State Department of Health. (n.d.). 50 SAFE designated hospitals in New York. NYS Health Profiles. https://profiles.health.ny.gov/hospital/designated_center/SAFE%2BDesignated%2BHospital

Rennison, C. A. (2002, August). Rape and sexual assault: Reporting to police and medical attention, 1999–2000 (NCJ 194530). U.S. Department of Justice, Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/rsarp00.pdf

Resnick, H. S., Acierno, R., Amstadter, A. B., Self-Brown, S., & Kilpatrick, D. G. (2007). An acute post-sexual assault intervention to prevent drug abuse: Updated findings. Addictive Behaviors, 32(10), 2032–2045. https://doi.org/10.1016/j.addbeh.2007.01.001

Rosen, T., Elman, A., Clark, S., Gogia, K., Stern, M. E., Mulcare, M. R., Makaroun, L. K., Gottesman, E., Baek, D., Pearman, M., Sullivan, M., Brissenden, K., Shaw, A., Bloemen, E. M., LoFaso, V. M., Breckman, R., Pillemer, K., Sharma, R., & Lachs, M. S. (2022). Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. Journal of the American Geriatrics Society, 70(11), 3260–3272. https://doi.org/10.1111/jgs.17967

Rosen, T., Mehta-Naik, N., Elman, A., Mulcare, M. R., Stern, M. E., Clark, S., Sharma, R., LoFaso, V. M., Breckman, R., Lachs, M., & Needell, N. (2018). Improving quality of care in hospitals for victims of elder mistreatment: Development of the Vulnerable Elder Protection Team. Joint Commission Journal on Quality and Patient Safety, 44(3), 164–171. https://doi.org/10.1016/j.jcjq.2017.08.010

Rothman, K., Salivar, E. G., Roddy, M. K., Hatch, S. G., & Doss, B. D. (2021). Sexual assault among women in college: Immediate and long-term associations with mental health, psychosocial functioning, and romantic relationships. Journal of Interpersonal Violence, 36(19–20), 9600–9622. https://doi.org/10.1177/0886260519870158

Schmidt, E. K., Beining, A., Hand, B. N., Havercamp, S., & Darragh, A. (2022). Healthcare providers’ role in providing sexual and reproductive health information to people with intellectual and developmental disabilities: A qualitative study. Journal of Applied Research in Intellectual Disabilities, 35(4), 1019–1027. https://doi.org/10.1111/jar.12861

Sex Offenses and Offenders: An analysis of data on rape and sexual assault. (1997). Bureau of Justice Statistics. https://bjs.ojp.gov/library/publications/sex-offenses-and-offenders-analysis-data-rape-and-sexual-assault

Smith, S.G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J. (2018). The National Intimate Partner and Sexual Violence Survey. National Center for Injury Prevention and Control. https://stacks.cdc.gov/view/cdc/60893

Sobsey, D., & Doe, T. (1991). Patterns of sexual abuse and assault. Sexuality and Disability, 9(3), 243–259. https://doi.org/10.1007/BF01102395

Suffolk County, New York. (n.d.). United States Census Bureau. https://www.census.gov/quickfacts/fact/table/suffolkcountynewyork/HCN010217

Tepper, M., Dowdell, E., & Speck, P. (2022). Trauma-informed care. In Introduction to forensic nursing. STM Learning.

Ullman, S. E. (2016). Sexual revictimization, PTSD, and problem drinking in sexual assault survivors. Addictive Behaviors, 53, 7–10. https://doi.org/10.1016/j.addbeh.2015.09.010

Ullman, S. E., Relyea, M., Peter-Hagene, L., & Vasquez, A. L. (2013). Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addictive Behaviors, 38(6), 2219–2223. https://doi.org/10.1016/j.addbeh.2013.01.027

Vogt, E. L., Jiang, C., Jenkins, Q., Millette, M. J., Caldwell, M. T., Mehari, K. S., & Marsh, E. E. (2022). Trends in U.S. emergency department use after sexual assault, 2006–2019. JAMA Network Open, 5(10), e2236273. https://doi.org/10.1001/jamanetworkopen.2022.36273

Downloads

Published

2025-12-11

How to Cite

Courtepatte, A., Agoglia, H., Tepper, M., & Cohen, D. (2025). An Investigation into a Large, Suburban, Academic Hospital’s Sexual Assault Response Program. Journal of the Academy of Forensic Nursing, 3(3), 54–86. https://doi.org/10.29173/jafn925

Similar Articles

1 2 3 4 5 6 7 > >> 

You may also start an advanced similarity search for this article.