the right to be fully informed in order to make their own decisions about participation in all components of the exam process. Responders need to do all that is 26 In some areas, the community-based sexual assault victim advocacy program is a component of an umbrella organization serving additional populations (e.g., a dual sexual assault/domestic violence advocacy agency, a center for women, or a mental health agency). In others, the community-based sexual assault victim advocacy program is a stand-alone organization. 19 possible to explain possible options, the consequences of choosing one option over another, and available resources, as well as support victims in their choices. Medical personnel may refer to this as “patientcentered care.” Vulnerable adults: This term is used in this document to refer to adult individuals with impaired and/or reduced mental capacity who have difficulty or cannot comprehend events that occurred or will occur (e.g., the assault itself or initial response by professionals), questions they will be asked during the exam, or the exam process itself. Exam sites should have internal policies based on jurisdictional statutes governing consent for treatment for and evidence collection from such patients. This section presents issues that impact all or most of the sexual assault medical forensic exam process. The following chapters are included: • Coordinated Team Approach • Victim-Centered Care • Informed Consent • Confidentiality • Reporting to Law Enforcement • Payment for the Examination Under VAWA 22 23 1. Coordinated Team Approach Recommendations at a glance for jurisdictions to facilitate a coordinated team approach: • Understand that the purpose of the exam is to address patients’ health care needs and collect evidence when appropriate for potential use within the criminal justice system. • Identify key responders and their roles. • Develop quality assurance measures to ensure effective response during the exam process. Communities should ensure that victims, regardless of their backgrounds or circumstances, have access to medical, legal, and advocacy services. Use of a coordinated, multidisciplinary approach in conducting the medical forensic examination can afford victims access to comprehensive immediate care, help minimize trauma they may be experiencing, and encourage the use of community resources. Such a response can also enhance public safety by facilitating investigation and prosecution, thereby increasing the likelihood that offenders will be held accountable for their behavior and further sexual assaults will be prevented. Raising public awareness about the existence and benefits of a coordinated response to sexual assault may lead more victims to disclose the assault and seek the help they need.27 Understand that the purpose of the exam is to address patients’ health care needs and collect evidence when appropriate for potential use within the criminal justice system. The medical/forensic examination in its entirety addresses the medical and evidentiary needs of the consenting patient: • Conducting prompt examinations. • Providing support, crisis intervention, and advocacy. • Obtaining a history of the assault. • Performing a complete assessment. • Documenting exam findings. • Evaluating and treating injuries. • Properly collecting, handling, and preserving potential evidence. • Providing information, treatment, and referrals for STIs and pregnancy. • Providing follow-up care for medical and emotional needs as well as further forensic evaluation. • Providing language assistance services for limited English proficient, Deaf and hard-of-hearing individuals, and those with sensory or communication disabilities. It is also possible that examiners may provide the following as a routine part of their post-examination process depending upon the criminal justice system response: • Interpreting and analyzing examination findings. • Presenting findings and providing factual and/or expert opinion related to the medical forensic examination. Coordination among involved disciplines is strongly recommended to simultaneously address the needs of both victims and the justice system. Ensuring that victims’ needs are met often can increase their level of comfort and involvement with the legal system. Identify key responders and their roles. Two types of teams are recommended to facilitate a coordinated community response to sexual assault. Some form of a sexual assault response team (SART/SARRT) is useful to coordinate immediate interventions and services, including victim support, medical care, evidence collection and documentation, and the initial criminal investigation. A communitywide coordinating group (often called a “council”) can help promote efforts to improve comprehensive response to sexual violence, 27 This paragraph is drawn partially from American College of Emergency Physicians’ Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient, 1999, p. 7. 24 including prevention education and outreach,28 training and technical assistance, improvement of victim services, protocol development, public policy advocacy, dissemination of materials, and evaluation of the effectiveness of these efforts.29 A communitywide coordinating council may also oversee activities of a SART/SARRT. Military bases,