Launceston General Hospital Clinical Guideline SMDS ID: P2011/0286-001 WACSClinProc5.

18/09 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Sexual Assault Services New Guideline Sexual assault services in the North and Northwest of Tasmania Nurses, medical officers, LGH Sexual assault services, sexual assault forensic examination, SAFE (sexual assault forensic examiner), service principles Sexual Assault Forensic Examination WACSClinProc5.19/09 Emergency Contraception and Chlamydia Prophylaxis following Sexual Assault WACSClinProc5.17/09

Purpose: To provide a collaborative response to clients who have suffered a sexual assault. Sexual Assault Clinical Services Network Laurel House Sexual Assault Forensic Examination LGH Tasmanian Police Sexual Health Services/General Practitioner

Laurel House The role of the Laurel House on call crisis worker includes co-ordinating the response, obtaining the basic history and determining the individual needs of the person presenting. They act as an advocate for the client, providing information about options and legal processes. They are proficient with dealing with the emotional needs of the clients, and at providing support during the time of forensic medical examination/consultations. The crisis worker is an essential team member in the acute setting and longer term care of persons who have been sexual assaulted. Launceston General Hospital Launceston General Hospital provides sexual assault forensic examination by either a medical officer, sexual assault forensic nurse examiner or other specialty practitioners as required. Services provided include: forensic medical examination, emergency contraceptive management, medical management of any physical injuries, Chlamydia prophylaxis and referral for screening and management of sexually transmissible infections. Sexual Health Services or General Practitioner Provide expert sexual health clinical services, counselling and education, includes testing, treatment and follow-up of sexually transmitted infection.

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Role of the Launceston General Hospital Designated Space The Launceston General Hospital agrees to provide a suitable room for the care of persons experiencing recent sexual assault. This space may be utilised by Laurel House, the Tasmanian Police Service and LGH Sexual Assault Forensic Examiner (SAFE) for the purpose of interview, counselling and performance of clinical examination. This room will provide a relaxed environment with an adjacent clinical area suitable for performing sexual assault forensic examination. It will contain a private shower and toilet. It will have appropriate dedicated storage for paperwork, clinical materials and other goods required (including clothing and toiletries). On occasions, this room will be required by Road Trauma Support for counselling purposes. Precedence will be given to SAFE clients. SAFE Staffing The Department of Womens and Childrens Services (WACS) at the Launceston General Hospital is the fund holder for SAFE services for the North and Northwest of Tasmania for 2008/2009. WACS co-ordinates the SAFE roster. WACS will be responsible for submitting the list of accredited providers to the credentialing committees of the LGH and North West Regional Hospital (NWRH). The SAFE service to the North of Tasmania employs medical and nursing staff employed by the LGH or DHHS who are registered medical practitioners or registered nurses who have completed appropriate training and/or who have extensive experience in the area. The SAFE service to the Northwest of Tasmania will be provided by subcontracted external providers. All clinicians providing sexual assault forensic examination should engage in ongoing training and peer consultation. The SAFE Special Interest Group will meet regularly to provide opportunity for ongoing knowledge and skill development and peer support. New participants to the service will be mentored by experienced SAFE clinicians until they feel comfortable with the policy and practices of the service. Child Victims of Sexual Assault The collection of forensic evidence and/or assessment and treatment of child sexual assault injuries will be co-ordinated between SAFE service and the Department of Paediatrics. If the Paediatrician is competent in sexual assault forensic examination then the SAFE may not be required. Paediatric staff who are confident in the medical examination of the child but not the forensic examination, will require the support and assistance of a trained SAFE. In non acute cases, a Medical Officer (from General Practice) who is an experienced paediatric SAFE may be the most appropriate person to examine the child. This examination may occur at the LGH, where a procedure room on 4K can be arranged or at the Doctors rooms. A request for this service may be made by a Co-Director of WACS or by the designated LGH SAFE.

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Optimal Time Frame for Forensic Examinations No longer than four hours should lapse between the request for a sexual assault forensic examination and the undertaking of this examination. However, this may be reasonably delayed if: the gathering of forensic evidence is not time critical (assault occurred longer than 72 hours prior. In anal rape, sperm detection is optimal under 4 hours) when a non urgent, physical examination only, is requested. By negotiation with the Laurel House Worker, the client, and the SAFE or After Hours Nurse Manager (LGH) the examination may be scheduled for a mutually suitable time. All requests for an examination will be granted. Strategies may include the examination being undertaken by SAFE services of another area if the service is unable to be provided. If no alternative arrangement can be made, this situation must be discussed with the CEO (LGH). Launceston General Hospital SAFE Service Principles Responses to victims of sexual assault will be offered within a framework consistent with the following principles: Every person who has been sexually assaulted should be offered high quality counselling and timely appropriate medical services All services will work collaboratively to focus on the safety, physical and psychological needs of the client The clients right to privacy and confidentiality will be respected at all times Comprehensive information about all processes and options will be offered to clients in a way which is non-judgemental, appropriate and clear. This information will be delivered in a way sensitive to the clients culture, age, disability, gender and sexuality The clients ability to give informed consent to any action or procedure will be facilitated and respected at every stage of the process In recognition of the abuse of power and loss of control inherent in sexual violence, all efforts to return the clients sense of personal control and choice will be supported and encouraged as soon as possible and throughout. Services will reflect a philosophy which locates the responsibility for sexual assault solely with the offender In supporting the sexual assault client, the caregiver should be guided by the following approached: convey belief in the client, validate the clients experiences and resulting effect, acknowledge the difficulty in talking about the assault, normalise responses by explaining they are common responses, give the client permission to talk about the assault in their own word and time, affirmation of the clients strengths and resilience. Documentation and record keeping should meet the requirements of the Launceston General Hospital, the Tasmanian Police, the Forensic Science Service of Tasmania and referring agencies. The need for confidentiality, security and respect for the clients choice should be paramount.

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All Staff Positions accountable for a) compliance with the policy: medical officers and sexual assault forensic nurse examiners b) monitoring and evaluation of the policy: LGH sexual assault service c) development and revision of the policy: LGH sexual assault service Attachments

References: New South Wales Department of Health 2005, Sexual Assault Services Policy and Procedure Manual (Adult) Online: http://www.health.nsw.gov.au/policies/pd/2005/PD2005_607.html

Royal Australian and New Zealand College of Obstetricians and Gynaecologist 2004, Medical responses to adults who have experienced sexual assault: an interactive educational module for doctors, RANZCOG

Performance Indicators: Provision of 24 hour on call SAFE service to the North and Northwest of Tasmania. Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years by the LGH Sexual Assault Service. Medical officers and sexual assault forensic nurse examiners, LGH Sexual Assault Service Medical officers and sexual assault forensic nurse examiners, LGH Sexual Assault Service

Developed By:

Stakeholders:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: 4 July 2011

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