Achieving just outcomes: forensic evidence collection in emergency department sexual assault cases

Muldoon, Katherine A.; Drumm, A.; Leach, Thomas J.; Heimerl, M.; Sampsel, Kari

doi:10.1136/emermed-2018-207485

Cited by 18 publications

(19 citation statements)

References 19 publications

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“…In previous studies, we have identified that approximately two thirds of eligible case complete a Sexual Assault Evidence Kit, and one third release it to police [34].…”

Section: Discussionmentioning

confidence: 99%

“…This study was conducted in Ottawa, Ontario, the fourth largest city in Canada with a census metropolitan population of 1.3 million. At the time of the study, there were 2650 COVID- 19 [34]; crisis counseling; and risk/threat assessment and safety planning. There were no reductions or changes to program staffing, procedures, or services since the COVID-19 pandemic began, except for an increase in personal protective equipment (e.g., universal masking) as part of the hospital-wide policy.…”

Section: Study Settingmentioning

confidence: 99%

“…While many agencies have begun to offer services remotely [32], in-person visits are critical for sexual assault and domestic violence cases involving treatment for physical injuries (e.g., fractures, lacerations, strangulation), HIV post-exposure prophylaxis [33], or forensic evidence collection (Sexual Assault Evidence Kit, also known as the "rape kit"), for those wishing to pursue legal action [34]. The increased reliance on remote care may also pose a risk to those living with controlling or abusive partners, as they may not have a safe space for a remote consultation with a service provider.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

Muldoon

Denize

Talarico

et al. 2021

BMC Med

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Background There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. Methods Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. Results Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79–0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93–0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient’s home, 40.00% assailant’s home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). Conclusion This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.

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“…In previous studies, we have identified that approximately two thirds of eligible case complete a Sexual Assault Evidence Kit, and one third release it to police [34].…”

Section: Discussionmentioning

confidence: 99%

Section: Study Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

Muldoon

Denize

Talarico

et al. 2021

BMC Med

Self Cite

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“…Patients who are below 16 years of age are transferred to the pediatric sexual assault clinic at the Children's Hospital of Eastern Ontario. The SAPACP is the only facility in the region that administers the Sexual Assault Evidence Kit (SAEK, also known as the "rape kit") and is a main point of care to transition from the health care system into the legal system to pursue prosecution (Muldoon, Drumm, Leach, Heimerl, & Sampsel, 2018). The SAPACP works closely with several community-based programs including Ottawa Victim Services and the Ottawa Rape Crisis Center to ensure that survivors are supported following their encounter with the hospital.…”

Section: Settingmentioning

confidence: 99%

Geographies of Sexual Assault: A Spatial Analyses to Identify Neighborhoods Affected by Sexual and Gender-Based Violence

Muldoon

Galway

Reeves

et al. 2019

J Interpers Violence

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Emergency departments are a common access point for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the neighborhoods they return to. The objectives of this study were to describe the patient population that present for a sexual or partner-based assault and explore the geographic distribution of cases across the Ottawa-Gatineau area. Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (January 1 to December 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using six-digit postal codes converted into Canadian Census Tract units to identify geographic areas with concentrated cases of SGBV. Concentrated areas were defined as Census Tracts with seven or more SGBV cases within a single calendar year. In 2015, there were 406 patients seen at the SAPACP and 348 had valid postal codes and were included in the analyses. More than 90% of patients were female and 152 (43.68%) were below 24 years of age. More than 70% knew their assailant and the most common locations of the assault were at the survivors’ home (31.03%), assailants’ home (27.01%), or outdoors (10.92%). Eight concentrated areas were identified including three in the downtown entertainment district, three lower income areas, one high-income neighborhood, and one suburb more than 20 km from downtown. The findings from this study describe the typical clinical presentation of sexual and domestic assault survivors and also challenge geographic stereotypes of where survivors live and what areas of the city are most affected by SGBV. Using residential information provides a survivor-centric approach that highlights the widespread nature of SGBV and supports the need for population-based approaches to improve care for survivors.

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“…As described in the EMJ paper by Muldoon and colleagues, the collection of forensic evidence by specially trained clinicians may increase the effectiveness of legal prosecution, and is often assumed to be a ‘just’ or, in other words, desired outcome 2. The decision to obtain, and then process, forensic evidence, however, must be an individual, personal decision made by each and every survivor, informed by their own priorities, values and needs, and supported non-judgementally by emergency healthcare providers acting in a trauma-informed manner.…”

mentioning

confidence: 99%

A just outcome, or ‘just’ an outcome? Towards trauma-informed and survivor-focused emergency responses to sexual assault

Alpert

2018

Emerg Med J

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Achieving just outcomes: forensic evidence collection in emergency department sexual assault cases

Cited by 18 publications

References 19 publications

COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

Geographies of Sexual Assault: A Spatial Analyses to Identify Neighborhoods Affected by Sexual and Gender-Based Violence

A just outcome, or ‘just’ an outcome? Towards trauma-informed and survivor-focused emergency responses to sexual assault

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