SECOND EDITION FORENSIC VIGTIMOLOGX EXAMINING VIOLENT CRIMES IN INVESTIGATIVE AND LEGAL CONTEXTS } BRENT E. TURVEYAcademic Press isan imprint of Elsevier ‘The Boulevard, Langford Lane Kidlington, Oxford, OXS 168, 225 Wyman Steet, Waltham, MA 02451, ISA First edition 2008 second edition 2014 Copyright © 2014, 2009 Elsevier Inc.All rights reserved. No par of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording. or any information storage and retrieval system, without permission in writing from the publisher. 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AAs suggested, forensic nurses are often a “frontline professional with respect to making vicim contact subsequent 10 the commission of a violent crime ‘This primarily has to do with the way victims enter the justice system. In many cases, victims will report their assault directly to the police. Or they may show up ata local emergency room or medical clinic seeking treatment, When law enforcement is involved at the outset, officers will take an initial report from victims and then immediately refer victims to a clinic or hospital emergency room that performs forensic examinations. Bear in mind that not every situation is the same, not all victims are able to ‘move under their own poveer, and each department may have its own policies and procedures to follow, So not everyone artives at forensic examination the same way, Subsequent to their initial report to law enforcement or presenta- tion to medical personnel, some victims are transported by the police or emer gency medical services; some are transported by friends and family; and some drive themselves. Once the report to the police has been made and the alleged victim arrives, the forensic nurse should begin the examination. It starts with obtaining consents, biographical intake information, a medical history, and finally a history of events leading up to and surrounding the crime. CONSENT FORMS Once the patient arrives at the exam location and the forensic nurse has made his or her introductions, along with any additional staff that may be assisting, itis necessary to obtain the patient's informed consent. Forensicexaminers are best off if they begin by explaining the entire forensic medical examination procedure, along with the necessity of evidence collection, to patients, no mat- tet what their age. This will empower patients, involve them in the process, and give them an opportunity to think of and ask questions. Consent to treat must be obtained before any evidence collection or treatment takes place. This is in keeping with the NIJ (2013), which stipulates the follow- ing (p. 5): Informed consent: Patients should understand the full nature of their consent to each exam procedure. By presenting them with relevant information, in « language they understand, patients are in a positionConsent Forms (@ty to make an informed decision about whether to accept or decline a procedure. However, they should be aware of the potential impact of declining a particular procedure, as it may negatively affect the quality of care, the usefulness of evidence collection, and, ultimately, any criminal investigation and/or prosecution. They should understand that declining a particular procedure might also be used against them in any justice system proseeding. If a procedure is declined, reasons why should be documented ifthe patient provides such information. Recommendations for health care providers and other responders to request patients’ consent during the exam process: ‘= Seek te informed consent of patients as appropriate throughout the exam process, ‘= Make sure policies exist to guide the process of seeking informed consent from specific populations, Consent forms may vary from one institution to another, but often include consent to conduct a forensic medical examination, including the collection of evidence, urine specimen with drug testing as needed, collection of blood for lab work as needed, use of a colposcope to assist with injury identification, forensic photography (colposcope and digital photography), use of recording equipment, and consent for emergency contraception. Ifthe victim is a minor, then the parent or guardian will need to sign in his or her place. ‘This is a good time to take stock of the fact that not every victim will react the same way to the procedures involved in the forensic medical exam, let alone the prospect. As explained in the NIJ (2013), victims’ perceptions and reactions may be influenced by a variety of circumstances (p. 30); ‘Adapt the exam process as needed to address the unique needs and circumstances of each patient, Pationts' experiances during the crime land the exam process, as well as their post-assault needs, may be affected by multiple factors, such as: Age. Gonder and/or porcoived gondor idontity/gonder expression. Physical health history and current status. ‘Mental health history and current status. Disability, Language needs for limited English proficient patients, Deaf and hard-of-hearing individuals, and those with sensory or communication disabilities. Ethnic and cultural beliefs and practices. Religious and spiritual beliefs and practices. = Economie status, including homelessness.SC) CHAPTERS: Forensic Nursing: Objective Victim Examination Immigration and refugee status. Sexual orientation. Military status, History of previous victimization, Past experience with the criminal justice system, Whether the assault involved drugs and/or aleohol Prior relationship with the suspect, if any. Whether they were assaulted by an assailant who was in an authority position over them. = Whether the assault was part of a broader continuum of violence and/or oppression (e.g., intimate partner and family violence, gang, violence, hate crimes, war crimes, commercial sexual exploitation, sex and/or labor trafficking), = Where the assault ozcurred. ‘= Whether they sustained physical injuries from the assault and the severity of the injuries. = Whether they were engaged in illegal activities at the time of the assault (e.g.. voluntary use of illegal drugs or underage drinking) or have outstanding criminal charges. ‘= Whether they were involved in activities prior to the assault that traditionally generate victim blaming or self-blaming (e.g., drinking alcohol prior to the assault or agieeing to go to the assailant’s home) = Whether birth control was used during the assault (e.g, victims may already have been on a form of birth control or the asrailant may have used a condom). = Capacity to cope with trauma and the level of support available from families and friends, ‘= The importance they place on the needs of their extended families and friends in the aftermath of the assault. = Whether they have dependents who require care during the exam, were traumatized by the assault, ot who may be affected by decisions patients make during the exam process. = Community/cultural attitudes about sexual assault, ite vietime, and offenders. = Frequency of sexual assault and other violence in the community and historical responsiveness of the local justice system, health care systems, and community service agencies. Clearly, the level of trauma experienced by patients can also influence their initial reactions to an assault and to post-assault needs. While some may suffer physical injuties, contract an STI, or become pregnant os a result of an assault, many others do not, The experienceof psychological trauma will be unique to each patient and may be ‘more difficult to recognize than physical trauma. People have their own method of coping with sudden stress. When severely traumatized, they can appear to be calm, indifferent, submissive, joculat, angry, ‘emotionally distraught, or even uncooperative or hostile towards those ‘who are trying to help. Forensic nurses and other assisting staf are admonished to be sensitive about these factors in the process of obiaining consent. as well as dui itself, A judgmental, coercive, oF inflexible approach is not advised, nor is it professional THE INTAKE FORM the intake form establishes the informational foundation upon which to stant prioritizing different aspects of an eventual forensic medical exam (see igure 5-2). 1 also acts as a valuable face sheet, giving case asics at a glance for fuuure reference. Intake information includes biographical data about the patient, those invelved in the case, and a thumbnail sketch of the crime and FIGURE 5.2 ‘hariaJimetson peepares an inte frm anda sel seul a patent ey |