Pilot program offers lessons from military on supporting sexual assault survivors

With the spate of sexual assault allegations now dominating the headlines, it’s easy to forget that less than a decade ago, we saw similar news coming out of the armed services. Those pieces culminated in the acclaimed 2012 documentary “The Invisible War,” which recounts the stories of numerous veterans who survived sexual assaults while in the military, and the inadequate response by the US Department of Defense to their complaints.

In the wake of the film’s release, Congress passed laws and the Pentagon enacted reforms aimed at mitigating the military’s culture of hyper-masculinity and its deeply ingrained tendency toward reflexive victim blaming, shaming, and retaliation.

{mosads}Measures included prohibiting individuals with felony sexual assault convictions from receiving enlistment waivers, creating a special victims unit to investigate and prosecute sexual assault claims, and implementing policies to prevent retaliation against survivors who report their assaults.

As we contemplate how to respond to the pervasiveness of sexual violence, the military’s response — or at least one part of it — offers a lesson in how to respond appropriately when a victim seeks treatment after an assault. In 2013, the US Navy joined a Massachusetts-based pilot program that provides expert forensic nursing care via the National TeleNursing Center for victims of sexual assault being treated in locations without sexual assault nurse examiners (SANE) on site.

SANE nurses have specialized training, education, and experience in providing quality forensic medical-legal examinations and patient-centered care to survivors. Given high staff turnover due to deployments and transfers to other installations, it is challenging to keep SANE nurses on staff at military hospitals (though other emergency healthcare providers in civilian settings can also face this problem).

Funded by a U.S. Department of Justice demonstration grant, the program ensures that a SANE nurse is immediately available via webcam to both patients and attending clinicians, and a rape survivor who wants forensic evidence collected during the exam will not have to wait hours for a qualified SANE nurse to be called to the hospital.

The pilot program is in place at naval base hospitals at 29 Palms and Camp Pendleton, the latter of which has consistently received some of the largest number of sexual assault reports over the past five years. Results thus far are promising. When a service member visits hospitals at 29 Palms or Camp Pendleton for treatment of sexual assault, they are given the option of having forensic evidence collected during their treatment and exam.

If they do want a forensic exam, the TeleNursing support is explained to them. If they are comfortable with having a SANE nurse present via webcam, they are asked to consent to the services of a SANE nurse and the exam proceeds.

In the past 18 months, 57 people were offered tele-SANE services at these bases and approximately 80 percent of them agreed to have a SANE nurse present via webcam throughout their exams — which can take up to six hours. Many expressed gratitude that their needs were taken so seriously that a sexual assault expert was consulted by medical staff.

Additionally, instead of the fear that clinicians with limited experience often feel before completing a forensic rape exam, clinicians with TeleNursing support reported feeling more confident and competent in caring for rape survivors. Regardless of whether a SANE nurse is present throughout the exam, advocates from the naval base also provide a full range of support to rape survivors, which includes accompanying them to the hospital.

Sexual assault survivors in the military often have no choice but to live with, work alongside, or report to the people who have assaulted them. Sometimes they must do this in under battlefield conditions, adding unimaginable stress to a situation already fraught with life-threatening danger, stress, and trauma. At minimum, those who are willing to put their lives on the line in service to our country surely deserve the highest quality of care.

But as the broader public learns more about the pervasiveness of sexual assault, we must scale our responses to meet the need. Strategic investment in technology and innovations that advance public health and safety could make this service available to everyone who needs it.

Gina Scaramella is the executive director of the Boston Area Rape Crisis Center, the largest such center in New England.