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Deborah Howell (Host): Sexual assault. It's a widespread problem that is often taboo to discuss. How should you handle a sexual trauma? In this episode of lemonade, we discuss how and when to get help, why college freshmen are more often victims of assault and ways to find healing.

I'm joined today by Jessica Clayton, a Forensic Nurse who helps lead the Assault Response Team at Mitchell County Regional Health Center in Osage, Iowa.

And she's here to talk to us today about sexual assault awareness and what to do after a sexual assault. This is Lemonade, the family medicine podcast from Mitchell County Regional Health Center, reminding you that when life gives you lemons, make lemonade. I'm Deborah Howell. And you know, health care challenges can happen at any time, but you can be prepared to handle even the most challenging situations or help others handle those challenges.

Thanks for joining us, Jessica. Great to have you.

Jessica Clayton, RN, SANE-A, SANE-P (Guest): Thank you. Thanks for having me.

Host: So to get the ball rolling. What is a forensic nurse?

Jessica: Yeah. So I'm a nurse, an RN who went through extra training to be able to take care of patients who are victims of sexual assault, domestic violence, human trafficking. We take a 40-hour course for adults and adolescents and a 43-hour course for pediatrics and as a job, we not only do we take care of our patients medically, but we can also collect any type of DNA evidence.

So that way, if they do choose to prosecute after an assault, they have the possibility to get some evidence taken from them that kind of helps strengthen the case. So yeah, we just got this extra training that we can help patients out in those situations.

Host: Admirable work that you do every day. Now, Jessica, can you tell us what is or is not consent?

Jessica: So what consent is, is just giving permission Where consent kind of gets a little is if there is somebody that's under the influence of alcohol or influence of drugs or incapacitated in any way, shape or form.

So for consent between two people, they have to give that permission to somebody else. Whether that be most of the time we look at it like in a sexual assault aspect did they give that other permission, that other person permission to have sex with them or touch their body. Where it gets kind of gray is when, you know, obviously if, if alcohol is involved or drugs are involved, people really should not be giving consent to anything.

And people should just assume that if they're under the influence of drugs or alcohol, that they're not able to give consent. But yeah, it can be kind of tricky when it comes to that.

Host: Yeah, for sure. And while we're talking about definitions, what is rape and what can it consist of? And can men be raped?

Jessica: Absolutely. So what rape is, is somebody doing something to your body or putting something into your body without your consent. Men can be raped. Children can be raped. Anybody can be raped. I think people think that rape is just sex. And really it could mean a combination of different things. It could be somebody touching me inappropriately.

It could be somebody putting their fingers inside my body without consent. It could be somebody putting an object in my body without consent. Those are all just examples of what rape is. And I think people think that women are the only ones that can be raped, but that's not true. Men can be raped. It could be between two men. It could be between a man and a woman. So every age, every person, every gender is at risk for rape.

Host: It's such a sensitive, but such a necessary topic, what to do if you're raped. Where do you go and what age groups can hospitals see?

Jessica: After an assault, we do suggest that people do go to their local ERs. Each hospital is a little bit different on what age group they do want to see. But most facilities in Iowa, you do not need parental consent to be seen at the hospital, if you are over the age of 12. You can come into the clinics, you can go right to the ER.

I think people think that when they go to the ER, you have to be in an emergency situation and they don't think, you know, a rape is an emergent situation. But it definitely is. That's where you can go to get nurses like myself that will come in and to take care of you after that situation. If you go to the clinic obviously there are providers there that can get ahold of one of us specially trained nurses to come in. Most assaults don't occur during the nine to five when a clinic is open. And so we do, you know, tell patients just to go right into their local ERs. And most hospitals in the US do have some sort of a SANE nurse there which is a sexual assault nurse. And they can come in and they don't have them there, they do have to have the resources to get the patient to help that they need.

So going into the hospital, the sooner, the better over the age of 12, what's nice, is that not only do they not need parental consent, but it's a service that it's free. They don't need their parents, you know, to sign any paperwork and worry about that you know, insurance is going to be billed or anything like that. So that's all part of that service. When it comes to pediatric patients under the age of 12, there's not a lot of facilities that will actually see those patients. We do still recommend that if there is a sexual assault concern, that the family does bring their child into either the clinic or the ER, and if they don't have a pediatric nurse that can see them, it is our responsibility then to make sure that we get them to where they need to go so that they can be seen by a specially trained pediatric nurse. I'm actually one of those nurses that can do that here. So in Mitchell County if I'm available, I'm able to see those patients.

Host: Great. Now, what can hospitals offer in terms of services and what can they do if a patient presents, what should a patient expect?

Jessica: Sure. So. What happens when they come into the ER, they do call what's called an advocate, if the patient wants. And what an advocate does is they are just kind of that friendly face that comes in and sits with you. Explains, you know, the whole process to you, offer you services even outside of the hospital.

So for example, we use our crisis intervention group, and they will come in and sit with a patient. They'll explain the whole process of, you know, what not to expect with a bill and they'll set you up with counseling, if you need it, safe housing, if you need it, a safety plan if you need it.

So we do get them very much involved with us. And then as nurses, what we do then is when we come in, our main goal is just to take care of that patient medically. So we want to make sure that there's no injuries. That there's nothing, you know, in the medical standpoint that we need to worry about.

If the patient does want to, we will do a sexual assault exam and use what's called a sexual assault kit to collect any type of evidence from that patient, if, if we're able. Usually we try to tell patients that this could be a process that could last up to a few hours. It could maybe go one hour.

It could maybe go four hours, depending on the extent of the exam. And then we do offer at the end of all of our exams, medications to help prevent STDs, as well as pregnancy prevention medications, if needed be. So that patients don't end up leaving that situation with something more than, than what they had bargained for for sure.

And then we also do provide follow-up for them as well. And that's all services that are covered. And nobody has to worry about, but mainly we just want to check that that person is okay.

Host: Great. Now, as we all know, so many sexual assault victims just don't go to the hospital out of fear. Will a patient get in trouble if they're intoxicated or abused drugs, are an illegal immigrant or so many other reasons?

Jessica: Nope. If they come into our hospital with a sexual assault claim, they will not get in trouble for anything. So we have a, a teenage population that are so afraid to go into the hospital because they think that they're going to get in trouble because maybe they were drinking or maybe they were at a party or, or something to that effect or using drugs.

And that is absolutely not the case. We will not ever charge anybody for any type of illegal activity if they are coming into the hospital because we just want our patients to know that we're going to take care of them. They're not going to get in trouble. We don't call their parents. We don't, you know? And that's why it's kind of nice that it's a free service because then there's no bills that are gonna show up on the insurance claims.

There's absolutely no way of anybody finding out that this had happened to them, without them, you know, wanting that information out there.

Host: I just wish every teenager could be hearing this right now. It's such important information. So what's too long of a wait to be seen after an assault. Is there a timeframe for that?

Jessica: Well, what we, is if we're going to be collecting evidence, we do want to see our patients, you know, the sooner after the assault, the better. We do have a timeframe though of five days. Sometimes we can see a patient up to seven days after, you know, kind of, depending on how many times they've showered, how many times have they done other activities.

Usually we do recommend though no more than five days after the assault. In saying that though it could be, you know, a few weeks after the assault and it doesn't mean that that person still can't get some sort of help. So even though we may not be able to collect evidence because it's been past that five to seven day area, we still want patients to come in and talk to us so that we can get them set up for resources, set up for follow-up appointments, just to make sure that there aren't any STDs and STD testing.

So, it's just very important that no matter how long that this had happened, we still want to make sure that we do take good care of you.

Host: Absolutely. And Jessica, why is outreach so important?

Jessica: I think a lot of people in small towns don't think that these things can kind of happen. And so we do try to go out and educate people on what is rape, what to do if there's rape, because they don't realize what kind of resources we even do have. Most people, when I say I'm a SANE nurse, they kind of look at me like, what the heck does that mean or if I say I'm a forensic nurse, you know, they, they think I work for the police officers and, you know, so there's just so much out there that people don't realize and what we can do and that there is help. We do as a group, go into a lot of the schools to educate students. And saying, hey, you can come in, come and see us.

You're not going to get in trouble if this happens. One of the big things, you know, I'll say is, don't be a rapist. This is what rape means. What does consent look like. Because people just don't know what that means or what it doesn't mean; we really tried to be proactive the best that we can and educate, and hopefully someday prevent some of these things from happening.

And if we can't prevent it, then letting people know that, hey, we're here, we're here to help. This is what we can do for you. And, and we'll take good care of you.

Host: Oh, that is so wonderful and so needed. Does this happen in our area? And if so, how often do these things happen?

Jessica: We know that statistically that one in four women and one in 10 men have experienced some sort of sexual violence in their in their lifetime. Unfortunately, not a lot always come in for help because they don't realize that there is that help. And I, I feel like in our smaller communities, people are so afraid to come in and talk to us because they're afraid that their name is going to be out there.

And everybody's going to talk about it and I can assure you if I were to go out and talk about something that happened to somebody, I would lose my job. So it, we know that it's happening. You know, even in the state of Iowa, every 98 seconds, somebody is being assaulted. So, I can't think that, you know, our small town communities are immune to this.

I just think that people are not coming in for help, because of all of those other things that we kind of talked about of getting in trouble or what about my parents? Are they going to find out that this happened? And there's a lot of guilt and a lot of shame that happens when it comes to somebody after they have been raped. And so, I just don't think we see it.

Host: And Jessica, what age groups are more of a target? For example, why are college age freshmen often a target?

Jessica: So between the ages of 12 and 17 years old, that's kind of where the majority of the victims in that age group. In fact, between 11 and 19 is they're four times the higher risk than any other age group. it comes to college freshmen, we find that one in 14 women and one in 14 men in college are assaulted and the highest risk being the first three months of going to college.

We do know that the majority of those are alcohol facilitated. And I think the reason why the college-age freshmen are kind of a target is for one, they they've been living under mom and dad's roof for a really long time and they're kind of naive and they're, they're getting out in the world and testing the waters and you know, going to parties.

And trusting everybody that they meet. And unfortunately the higher the age group, you know, people that have been in college for a few years, they kind of know about the freshmen and they're naivety and, and they actually target those students. There's some pretty scary documentaries out there that actually, they talked to some of these college aged seniors and, and how they preyed on these newer freshmen and brought up how naive they are.

And they don't know what their alcohol limits are because they've never drank alcohol before. And first three months is cause they just get out of being at home. And so kind of whooping it up a little bit, I guess.

Host: Exactly. Now I have a question. Do people who've been raped have to report to law enforcement and if they choose to report later, can they still do that?

Jessica: Yeah. So when it comes to law enforcement, patients do not ever have to report if they do not want to. If they don't want to, I, you know, use it as an anonymous case. There's a there's ways of doing that so that their name is not even on the top of the rape kits. There's, you know, different connections to how we can identify that patient later on if need be.

They can choose to talk to law enforcement at a later time if they want to. There are some restrictions to that though. Because if they wait too long that evidence may or may not still be there. I do know that there's quite a few laws out there, especially when it comes to like children and children, you know, having child abuse situations.

Those there's longer statute of limitations to those. Where as if it's an adult, the time limits are not as generous as, as if it were a child case. But in some places they can have up to a year later to report if they want to.

Host: Okay. Just a couple more for you, Jessica. What's going to happen to a person's kit if they don't talk to law enforcement. And how long will the kit be stored?

Jessica: So each place has a little bit different of a storage requirement. I do know that most of our rape kits don't they don't really do much with them. They they'll keep them. Unfortunately, if a patient does not report to law enforcement, that kit will not go anywhere. It just stays in the law enforcement evidence area.

And it's never, ever tested. So it just kinda sits there. Each county, each district, you know, depending on what their capability for storage is. I know there's some places that will get rid of a kit after six months. There'll be some that will keep it for a year. Some will keep them for multiple years.

It just depends on that law enforcement's capability of keeping those kits. So unfortunately if they don't report, there isn't much that will be there. It's just there so that if patient does decide to disclose later on, they can.

Host: Okay. And will their kit be tested and will they ever find out the results?

Jessica: If they report to law enforcement, it does get sent to our crime lab where they will actually test the kit there. But if they do not report to law enforcement, they will, the test, the kit will not be tested nor will they ever find out the results.

Unfortunately I do get a lot of patients that come in, come into the hospital and they ask me, can you tell me if I was raped? When will I find out the results of that kit? And if it's never reported, there is no way for them to find if there was any type of evidence. And I think too, a lot of people think, for them to say, yes, you were raped or not, there has to be some kind of a DNA evidence there. And that's not always the case. We may or may not get evidence, even if you came right away after the assault. We may or may not get any type of evidence and it doesn't mean that something didn't happen. So unfortunately, no, they will not find out the results of their test if they did not report.

We do in Iowa have a tracking system now that they can track their kits so they can actually see where their kits go from the minute they leave our hospital to law enforcement, and then if they do report to law enforcement, they can actually track that kit all the way to our crime lab. And then if that kit was going to be destroyed at a certain time, they will also be notified of that as well, so that they can decide if they do want to disclose or not. But yeah.

Host: Okay. All right. Good answer for that Jessica. Final question for you, which vaccines are important to consider?

Jessica: Any time we do recommend the HepB vaccination series because we do know that that can be spread through blood or fluids. Gardasil for for people is actually very good to help any prevent any HPV or cancers later on and the tetanus vaccine. So, after an assault, I always do ask patients if they've had those.

And if not, we do try to get them set up to be able to get those vaccinations. Unfortunately, there is no vaccine to help prevent like AIDS or gonorrhea or any type of STD, but that's why it's important to come to see us because you can actually get you medications hooked up to hopefully prevent those types of things from occurring later on.

Host: Sure. Well, Jessica, this is a lot of extremely important information. Thank you so much for pulling it all together for us and for all the good work you do every day, it's just been such a pleasure having you.

Jessica: I thank you. very so much for having me on and being able to talk about this. Cause I know that this is not an easy topic to talk about, but getting the word out there to our patients is just so important.

Host: It's absolutely crucial. And for more information about this topic or MCRHC, please email us at mcrhc.artatmercyhealth.com. Thanks for listening to them. The family medicine podcast from Mitchell County Regional Health Center, your trusted healthcare partner for life. If you found this podcast to be helpful, be sure to tell a friend and subscribe, rate and review this podcast.

Ben, check out the entire podcast library for additional topics of interest. And remember when life gives you lemons, make lemonade. I'm Deborah Howell. Have yourself a terrific day