Chapter 1: Course
Introduction
Chapter 1 provides an overview
of the PREA standards relevant to medical care of sexual abuse victims, as well
as additional PREA standards with which you should be familiar.
Chapter 2: Detecting,
Assessing, and Responding to Sexual Abuse and Harassment
Chapter 2 provides information
about the dynamics, prevalence, and incidents of sexual abuse in a confinement
setting. It also describes your role in responding to inmate sexual abuse.
Chapter 3: Preserving
Physical Evidence of Sexual Abuse
Chapter 3 explains the Forensic
Medical Examination (FME), the role of the Sexual Assault Nurse Examiner
(SANE), and your role in preserving physical evidence.
Chapter 4: Reporting Allegations and
Suspicions
Chapter 4 discusses your role in reporting
sexual abuse. It also provides information regarding the confidentiality of
such reports.
There are several resources available to help
you better understand the PREA standards and your role in preventing,
detecting, and responding to inmate sexual abuse:
In this section, you
learned that the purpose of this course is to assist agencies in meeting the
requirements of PREA Section 115.35 Specialized training: Medical and
mental health care.
You also learned what is expected of you to
complete the course.
You are now ready to begin the Medical Care
for Sexual Assault Victims in a Confinement Setting Course.
PREA requires that all medical health care
practitioners comply with certain standards to:
• Protect inmates from sexual abuse
• Respond to sexual abuse incidents in an effective and
systemic way
• Provide inmates and staff a safe way to report misconduct
and abuse
In this section, you will learn to:
• Identify the purpose of PREA
• Define common terms used within the PREA standards as
defined by the U.S. Department of Justice (USDOJ)
Prison Rape
Elimination Act
PREA was passed unanimously by Congress in
2003 and mandated the development of national standards for correctional
facilities to enhance the sexual safety of inmates.
Created by the USDOJ, these standards address:
• Prevention
• Detection
• Response to incidence of sexual abuse and sexual
harassment
Each standard has specific compliance
requirements, and compliance will be determined through facility audits.
PREA Standards
While you should be
aware of all the PREA standards as described within the Federal Register,
this course will focus on the standards that are specifically related to the
provision of medical care and the role and responsibilities of the medical health
care practitioner
Before we take a look at the PREA standards,
you should first review some key definitions for terms that are used throughout
the standards.
PREA standards apply to these four types of
confinement facilities:
Definitions:
Facility Types
Adult Prisons/Jails
Prison: An institution under Federal or State
jurisdiction whose primary use is for the confinement of individuals convicted
of a serious crime, usually in excess of one year in length, or a felony.
Jail: A confinement facility of a Federal,
State, or local law enforcement agency whose primary use is to hold persons
pending adjudication of criminal charges, persons committed to confinement
after adjudication of criminal charges for sentences of one year or less, or
persons adjudicated guilty who are awaiting transfer to a correctional
facility.
A facility
primarily used for the confinement of juveniles pursuant to the juvenile
justice system or criminal justice system.
Lockups
A facility that contains holding cells, cell
blocks, or other secure enclosures that are:
1. Under the control of a law enforcement, court, or
custodial officer; and
2. Primarily used for the temporary confinement of
individuals who have recently been arrested, detained, or are being transferred
to or from a court, jail, prison, or other agency
• Community confinement facilities
Community Confinement Facility
A community treatment center, halfway house,
restitution center, mental health facility, alcohol or drug rehabilitation
center, or other community correctional facility (including residential
re-entry centers), other than a juvenile facility, in which individuals reside
as part of a term of imprisonment or as a condition of pre-trial release or
post- release supervision, while participating in gainful employment,
employment search efforts, community service, vocational training, treatment,
educational programs, or similar facility-approved programs during
nonresidential hours.
Definitions: Sexual
Abuse
In relation to PREA standards, sexual abuse
includes:
• Sexual abuse of an inmate by another inmate
• Sexual abuse of an inmate by a staff member, contractor,
or volunteer
It is important to remember that PREA only
refers to incidents involving inmates. Sexual abuse or harassment occurring
between two staff members is covered under other laws and policies
Definitions: Acts of
Inmate on Inmate Sexual Abuse
Sexual abuse of an inmate by another inmate
includes any of the following acts if the victim does not consent, is coerced
into such an act by overt or implied threats of violence, or is unable to
consent or refuse:
• Contact between the penis and the vulva or the penis and
the anus, including penetration, however slight
• Contact between the mouth and the penis, vulva, or anus
• Penetration of the anal or genital opening of another
person, however slight, by hand, finger, object, or other instrument
• Any other intentional touching, either directly or
through the clothing, of the genitalia, anus, groin, breast, inner thigh, or
the buttocks of another person, excluding contact incidental to a physical
altercation
Definitions: Acts of
Staff on Inmate Sexual Abuse
Sexual abuse of an inmate by a staff member,
contractor, or volunteer includes any of the following acts, with or without
consent of the inmate:
• Contact between the penis and the vulva or the penis and
the anus, including penetration, however slight
• Contact between the mouth and the penis, vulva, or anus
• Contact between the mouth and any body part where the
staff member, contractor, or volunteer has the intent to abuse, arouse, or
gratify sexual desire
• Penetration of the anal or genital opening of another
person, however slight, by hand, finger, object, or other instrument, that is
unrelated to official duties or where the staff member, contractor, or
volunteer has the intent to abuse, arouse, or gratify sexual desire
Sexual abuse of an inmate by a staff member,
contractor, or volunteer includes any of the following acts, with or without
consent of the inmate:
• Any other intentional contact, either directly or through
the clothing, of or with the genitalia, anus, groin, breast, inner thigh, or
the buttocks, that is unrelated to official duties or where the staff member,
contractor, or volunteer has the intent to abuse arouse, or gratify sexual
desire
• Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the previously described activities
• Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in the presence of an
inmate
• Voyeurism by a staff member, contractor, or volunteer
Sexual harassment includes:
Voyeurism
Voyeurism by a staff member, contractor, or volunteer means an invasion
of an inmate’s privacy by staff for reasons unrelated to official duties, such
as:
• Peering
at an inmate who is using a toilet in his or her cell to perform bodily
functions
• Requiring
an inmate to expose his or her buttocks, genitals, or breasts
• Taking
images of all or part of an inmate’s naked body or of an inmate performing
bodily functions
Definitions: Sexual
Harassment
• Repeated and unwelcome sexual advances, requests for
sexual favors, or verbal comments, gestures, or actions of a derogatory or
offensive sexual nature by one inmate directed toward another
• Repeated verbal comments or gestures of a sexual nature
to an inmate by a staff member, contractor, or volunteer, including demeaning
references to gender, sexually suggestive or derogatory comments about body or
clothing, or obscene language or gestures
Voyeurism Invasion of an
inmate’s privacy by staff for reasons unrelated to official duties
Sexual Harassment Repeated
and unwelcome sexual advances, requests for sexual favors, or verbal comments,
gestures, or actions of a derogatory or offensive sexual nature.
Sexual Abuse Any sexual act
that the victim does not consent to, is coerced into such an act by overt or
implied threats of violence, or is unable to consent or refuse.
Section Summary
The
purpose of PREA is to prevent, detect, and respond to incidents of inmate
sexual abuse and harassment.
In this section, you learned about:
• The purpose of PREA
• Common terms and definitions used in the PREA standard
Section Overview
There
are 43 PREA standards, not including those related to audits. Six of
these standards are specifically related to medical health care:
• Section 115.21 Evidence protocol and forensic
medical examinations.
• Section 115.35 Specialized training: Medical and
mental health care.
• Section 115.61 Staff and agency reporting duties.
• Section 115.81 Medical and mental health
screenings; history of sexual abuse.
• Section 115.82 Access to emergency medical and
mental health services.
• Section 115.83 Ongoing medical and mental health
care for sexual abuse victims and abusers.
In this section, you will learn to describe
the PREA standards that specifically relate to medical health care.
Section 115.21 Evidence protocol
and forensic medical examinations.
Section 115.21 requires the agency to follow a
uniform evidence protocol to ensure that all physical evidence is preserved
when investigating allegations of sexual abuse. The standard also provides
guidance on who will perform the forensic examination.
Section 115.35 Specialized
training: Medical and mental health care.
This standard requires agencies to train all full- and part-
time medical and mental health care practitioners who work regularly in
its facilities on certain topics. These topics include:
• Detecting signs of sexual abuse and sexual harassment
• Preserving physical evidence of sexual abuse
• Responding professionally to victims of sexual abuse and
harassment
• Proper reporting of allegations of sexual abuse and
harassment
Additionally, if the agency employs any
medical staff conducting forensic exams, those staff members are required to
receive appropriate training.
Section 115.61 Staff and agency
reporting duties.
This standard requires all staff to be trained
in the responsibilities of reporting sexual abuse or sexual harassment.
This standard identifies the important role of
the medical health care practitioner as a confidential resource for inmates to
discuss/disclose incidents of sexual abuse or sexual harassment.
Section 115.81 Medical and mental
health screenings; history of sexual abuse.
Section 115.81 requires that inmates be asked
about any prior history of sexual victimization and abusiveness during intake or classification
screenings.
Additionally, if a screening is positive for
sexual abuse, the standard requires that the inmate be offered a follow-up
meeting with a medical or mental health care practitioner within 14 days of the
intake screening.
Section 115.82 Access to emergency
medical and mental health services.
This standard requires that all victims of
sexual abuse receive free access to emergency medical treatment and crisis
intervention services in a timely manner.
The nature and scope of the services is
determined by medical and mental health practitioners according to their
professional judgment.
Section 115.83 Ongoing medical and
mental health care for sexual abuse victims and abusers.
This standard requires that victims of sexual
abuse receive access to ongoing medical and mental health care consistent with
the community level of care for as long as such care is needed.
It also mandates that agencies attempt to
conduct a mental health evaluation of all known inmate abusers within 60 days
of learning of their abuse histories and offer appropriate treatment.
In this section, you learned to describe the following PREA
standards that relate specifically to medical health care:
Section Summary
• Section 115.21 Evidence protocol and forensic
medical examinations.
• Section 115.35 Specialized training: Medical and
mental health care.
• Section 115.61 Staff and agency reporting duties.
• Section 115.81 Medical and mental health
screenings; history of sexual abuse.
• Section 115.82 Access to emergency medical and
mental health services.
• Section 115.83 Ongoing medical and mental health
care for sexual abuse victims and abusers
Section Overview
There are some additional PREA standards that
are applicable to medical health care practitioners, including:
• Section 115.11 Zero tolerance of sexual abuse and
sexual harassment; PREA coordinator.
• Section 115.31 Employee training.
• Section 115.32 Volunteer and contractor training.
• Section 115.33 Inmate education.
• Section 115.41 Screening for risk of victimization
and abusiveness.
• Section 115.42 Use of screening information.
• Section 115.43 Protective custody.
• Section 115.51 Inmate reporting.
• Section 115.62 Agency protection duties.
In this section, you will learn to describe
these additional standards.
Section 115.11 Zero tolerance of sexual
abuse and sexual harassment; PREA coordinator.
This standard requires the agency to establish
a zero- tolerance policy for sexual abuse and sexual harassment.
It also requires that the agency employ or
designate an upper-level, agency-wide PREA coordinator with sufficient time and
authority to develop, implement, and oversee agency efforts to comply with the
PREA standards in all of its facilities.
Section 115.31 Employee training.
Section 115.31 requires all employees who have
contact with inmates receive training concerning sexual abuse or sexual
harassment in facilities, including specified topics, with refresher training
to be provided on an annual basis thereafter.
Section 115.32 Volunteer and contractor
training.
This standard requires that all volunteers and
contractors who have contact with inmates be trained on their responsibilities
under the agency's sexual abuse and sexual harassment prevention, detection,
and response policies and procedures, in recognition of the fact that
contractors and volunteers often interact with inmates on a regular, sometimes
daily, basis.
Section 115.33 Inmate education.
Section 115.33 requires that information
explaining the agency’s zero tolerance policy regarding sexual abuse or sexual
harassment be provided to inmates.
It also requires that agencies document inmate
participation in these education sessions.
Finally, agencies must make key information
regarding sexual abuse and harassment readily available and accessible (via
posters, orientation materials, etc.) to inmates.
Section 115.41 Screening for risk of
victimization and abusiveness
This standard requires facilities to screen
inmates during intake and during an initial classification process for risk of
being sexually abused by other inmates or being sexually abusive toward other
inmates.
Section 115.42
Use of screening information.
This standard requires agencies to use the
information from the risk screening process to inform housing, bed, work,
education, and program
assignments with the goal of keeping inmates determined to be at risk of sexual
victimization separate from inmates at risk of being sexually abusive.
Section 115.43 Protective custody.
Section 115.43 addresses involuntary
segregated housing by
requiring that it be used only after an assessment of all available housing
alternatives has shown that there are no other means of protecting the inmate.
If segregated housing is used, the inmate will
have all possible access to programs and services for which he/she is otherwise
eligible, and the facility should document any restrictions imposed.
The standard also states that involuntary
segregated housing shall not ordinarily exceed a period of 30 days. In cases
where involuntary segregated housing is needed for longer than the initial 30 days,
the agency shall review the situation every 30 days to determine if ongoing
involuntary segregated housing continues to be needed.
Section 115.51 Inmate
reporting.
This standard
requires agencies to provide multiple ways for inmates to privately report
sexual abuse and sexual harassment, retaliation by other inmates or staff for
reporting sexual abuse and sexual harassment, and staff neglect or violation of
responsibilities that may have contributed to sexual abuse.
Section 115.62 Agency protection duties. This standard requires that an agency must act
immediately to protect an inmate whenever it learns that he or she faces a
substantial risk of imminent sexual abuse.
Section Summary: PREA standards that are
applicable to medical health care practitioners include:
• Section 115.11 Zero tolerance of sexual abuse and
sexual harassment; PREA coordinator.
• Section 115.31 Employee training.
• Section 115.32 Volunteer and contractor training.
• Section 115.33 Inmate education.
• Section 115.41 Screening for risk of victimization
and abusiveness.
• Section 115.42 Use of screening information.
• Section 115.43 Protective custody.
• Section 115.51 Inmate reporting.
• Section 115.62 Agency protection duties.
In this section, you learned to describe these
standards.
Section Overview
Sexual assault is a personal and destructive crime. Its effects
can be psychological, emotional, and physical.
As a medical health care practitioner, you must be aware that
there is no one “normal” reaction to sexual abuse.
In this section, you will learn to describe the prevalence of
sexual abuse in confinement settings.
You will also have an opportunity to review personal accounts of
abuse
Sexual Abuse in Confinement
Settings
Sexual abuse in confinement settings typically occurs when no
one is around to see or hear it, particularly at night and in areas that are
difficult to monitor. Upon arrival at a facility, inmates are sized up for vulnerabilities
by other inmates and perhaps by predatory staff.
Inmates who have been victimized once are likely to be sexually
abused again during their incarceration.
Sometimes, survivors are marked as property by gang members or
serve as likely targets for future attacks. Many survivors are forced into
servitude, including prostitution arrangements with other prisoners or staff.
Protective Pairing
The phenomenon of "protective
pairing" (also called "hooking-up") mimics the dynamics of
domestic violence, both in the behavior of the perpetrator and the effect on
the survivor.
In protective pairings, a more powerful
prisoner offers protection to a less powerful prisoner in exchange for sex.
These relationships are often overtly
abusive or violent, but still may seem like the safest option for an inmate
attempting to avoid more violent assaults or gang rapes.
Women Typically Have Unique Issues
In women’s prisons, a significant danger
stems from the unchecked power of the corrections staff. Male officials are often
allowed to watch female inmates when they dress, shower, and use the toilet.
Some staff members routinely engage in verbal degradation of prisoners under
their supervision, while others abuse their authority by offering privileges
for sexual favors, coercing vulnerable inmates, or raping prisoners whose
safety they are supposed to protect.
Staff members may use visits with children,
the need for hygiene products or food, access to schooling or employment, and
threats about release dates to coerce women inmates into unwanted sexual
contact. These encounters are often cast as consensual relationships, or worse,
considered to be the result of inmates manipulating staff.
Inmate on inmate sexual abuse in women’s
prisons is also common, albeit largely invisible. Similar to domestic violence
in lesbian relationships, such assaults are often minimized or eroticized by
staff. Perpetrators hide behind the perception that women in prison simply form
their own family structures, without regard to the abusive nature of many such
relationships.
Prevalence
Based on an analysis of data compiled by the
Bureau of Justice Statistics in 2011 and 2012, approximately 80,600 adults in
prisons and jails in the United States suffered some form of sexual abuse
(defined using PREA definitions) while incarcerated during the preceding year.
This analysis suggests 4.0% of the
prison population and 3.2% of the jail population suffered sexual abuse during
that year. In some prisons, nearly 9% of the population disclosed sexual abuse
within that time; in some jails the corresponding rate approached 8%.
Sexual Abuse Survivor
Stories
Protecting
prisoners from sexual abuse remains a challenge in correctional facilities
across the country. Too often, in what should be secure environments, men,
women, and juveniles are sexually abused by other inmates and staff.
Knowledge Review
It is estimated that the actual
prevalence of sexual assault for the corrections populations in the United
States is likely higher than most statistics would suggest. Why do you think
that is?
The actual prevalence of sexual assault for the corrections populations in the
United States is likely higher than statistics suggest because:
• People in lockups and under community
supervision, which includes those housed in community confinement facilities,
are not included in the BJS figures
• These statistics only
represent those incidents that were reported
Section Summary: Inmate
sexual abuse occurs at a higher rate than many realize. This abuse can lead to
damaging psychological, emotional, and physical effects.
In this section, you learned about the
prevalence of sexual abuse in confinement settings.
Section Overview: Each
instance of sexual abuse is different. The nature of the assault influences its
effect on the victim.
Medical health care practitioners must understand
the dynamics of sexual abuse, and the way that it affects victims, so that they
can respond effectively.
In this section, you’ll learn to:
• Identify
the characteristics that put inmates at risk for sexual abuse
• Describe
the effects sexual abuse
High-Risk Inmates: The Bureau of Justice
Statistics (BJS) Report identified risk factors for both inmate on inmate and
staff on inmate sexual victimization. The rates of reported inmate on inmate
sexual victimization were significantly higher for inmates who had the
following characteristics:
• Being
white or multi-racial
• Having a
college education
• Serious Psychological Distress
According to the Sexual Victimization in
Prisons and Jails Reported by Inmates, 2011-12, inmates with serious
psychological distress reported high rates of inmate on inmate and staff sexual
victimization.
Among State and Federal prison inmates, an
estimated 6.3% of those identified with serious psychological distress reported
that they were sexually victimized by another inmate. In comparison, among
inmates with no indication of mental illness, 0.7% reported being victimized by
another inmate.
Similar differences were reported by jail
inmates. An estimated 3.6% of those identified with serious psychological
distress reported inmate on inmate sexual victimization, compared to 0.7% of
inmates with no indication of mental illness.
Rates of serious psychological distress in
prisons (14.7%) and jails (26.3%) were substantially higher than the rate
(3.0%) in the U.S. non- institutional population age 18 or older.
Having a sexual orientation other than heterosexual
• Experiencing
sexual victimization prior to coming to the facility
• SYouth
In 2007, the BJS estimated that 60,500 Federal
and State inmates had been sexually abused at their current facility in the
past year alone, and that 25,000 county jail inmates had been sexually abused
at their current jail in the past 6 months.
Youth are at even higher risk. In 2010, the
BJS reported that nearly 1 in 8 youths confined to a juvenile detention
facility were victimized at that facility in the preceding year – 80% of them
by staff. Nationally, the estimates of actual sexual assaults in detention
facilities are some 15 times higher than the number of official reports filed
for the same time period.
erious psychological distress Youth
The
rates of reported staff sexual misconduct were lower among inmates who were
white and 25 years old or older, whereas the rates were higher among inmates
who had a college education and who experienced sexual victimization before
coming to the facility.
Why They Are at RiskJust
as in the community, sexual abuse – whether perpetrated by other inmates or by
staff – is a means to achieve power and control.
Sexual abuse survivors come from all
demographic groups and walks of life. However, members of marginalized groups,
such as people who identify as lesbian, gay, bisexual or transgender (LGBT) and
people with mental illness, are disproportionately targeted.
Youth are also at heightened risk,
particularly when housed with adults. In addition, inmates who are non-violent,
inexperienced in the ways of prison life, gender non- conforming, and small in
stature are vulnerable to sexual abuse.
Which of the following
characteristics put inmates at high risk for sexual victimization?
Age, Having A Sexual Orientation Other
Than Heterosexual, History of Sexual Abuse, And Serious Psychological Distress.
Effects of Sexual Abuse
Sexual abuse is a destructive, catastrophic,
life-changing, and traumatic event.
While each victim responds uniquely, he or
she is likely to experience problems that are:
• Physical
• Emotional
• Cognitive
• Psychological
• Social
• Sexual
Short-Term Effects
Victims of sexual abuse will experience a range of emotions in
the weeks following the incident.
Within weeks of abuse, you may see victims showing signs of the
following behaviors:
• Phobias – preoccupation with
personal safety, reluctance to leave the room, fear of being alone, reluctance
to participate in activities or relationships which are similar to the trauma
• Mood
swings – happy to angry, anxiety,
sense of helplessness, irritability or outburst of anger, difficulty
concentrating, hyper- vigilance, exaggerated startle reactions
• Denial – efforts to deny assault
took place and/or minimize impact, avoiding thoughts or activities associated
with trauma
• Hesitation
in forming new relationships
• Flashbacks – intense psychological or
physiological distress at exposure to cues associated with the traumatic event
Long-Term Effects
In the long-term, if a victim is unable to
overcome the trauma, he or she may negatively cope with the victimization by:
• Dulling
their senses with substances
• Acting
out their pain by re-victimizing others within the correctional institution or
in the community
• Being
self-destructive
• Displaying
anger towards the inmates, legal system, family, and friends
• Displaying
hyper-vigilance to danger
• Being
fearful of new and risky situations
• Experience
sexual dysfunction, engaging in sexual behavior but with decreased or increased
enjoyment and arousal
• Engaging
in sexually promiscuous and/or aggressive behavior.
Immediate Effects
Following an incident, victims are often in a state of shock or
disbelief, or in a state of panic. Within hours of abuse, you may see the
following behaviors from the victims:
If you interact with victims immediately
after an incident of sexual abuse, they may be extremely emotional:
• Appearing
hysterical and/or verbalizing feelings of sadness or anger
• Displaying
a range of feelings, including crying, sobbing, smiling, restlessness,
tenseness, and joking
• Appearing
distraught or anxious; expressing rage or hostility against those attempting to
care for them
Being very
expressive
• Remaining Controlled, Numb, and/or in Shock and Disbelief
If you interact with victims immediately
after an incident of sexual abuse, they may demonstrate no emotions at all:
• Masking
or hiding feelings behind a calm, composed, or subdued effect
• Presenting
themselves in a flat affect, quiet, reserved manner
• Having
difficulties expressing themselves
Remaining
controlled, numb, and/or in shock and disbelief
These
reactions are perfectly normal. Do not expect a sexual abuse victim to act in
any particular way, and do not make snap judgments concerning the validity of a
report or an account of events based on the mannerisms of the person talking
about it.
Trauma and the Brain: The
biological impact of trauma on the brain is demonstrable and long-lasting. An
experience that is perceived by the victim to be life threatening will disrupt
the stress-hormone system of the brain.
Traumatic events stay “stuck” in the brain’s
subconscious (limbic system, brain stem) where they are inaccessible by the
conscious areas (frontal lobe) and can result in Post- Traumatic Stress
Disorder (PTSD).
Trauma affects the following three areas of
the brain:
• Frontal lobe:
seat of conscious memory, chronological information. The frontal lobe is our
conscious brain. It controls memory and our ability to chronologically order
events.
During trauma, this can become dissociated
from the rest of the brain, preventing a victim from remembering or preventing
them from speaking about their memories.
• Limbic
system: controls emotion, fear response, sensory
memories. Limbic System
The limbic system controls our emotion – and specifically our fear
response and sensory memories.
The limbic system is made up of two parts:
the amygdala and the hippocampus.
The amygdala is a small region of the limbic
system that plays a primary role in the formation and storage of memories
associated with emotional events. It is also where the response to those
emotions starts. For example, increase in heart rate, respiration, and the
stress- hormone release.
Trauma can cause the amygdala to become
hypersensitive and trigger those responses to normal stimuli. Also keep in mind
the reminders of trauma can also spark the same reactions.
All conscious memory is processed through the
hippocampus. However, the hippocampus is highly sensitive to the
stress-hormones released by the amygdala. This means that when the amygdala is
active, it interferes with the victim’s
ability to remember events.
• Brain stem:
controls instinctive reactions (fight/flight/freeze) Brain Stem
The brain stem controls our instinctive
reactions. This is where the “fight or flight” response comes from. It is
important to note that there are actually three instinctive reactions: fight,
flight and freeze
Rape Trauma Syndrome: Two
therapists, Ann Burgess and Lynda Holmstrom, coined the phrase “Rape Trauma
Syndrome” to describe the series of symptoms that are experienced by victims.
They separated the clusters of reactions into
two stages:
1. An acute, immediate phase of
disruption and disorganization
• Emotional
reaction : Victims
describe a wide range of emotions immediately following an assault. The
physical and emotional effect of the incident may be so intense that the victim
feels shock and disbelief.
When the shock and disbelief begin to
dissipate, the primary feeling is fear – fear of physical injury, mutilation,
and death.
Other feelings range from humiliation,
degradation, guilt, shame, and embarrassment to self-blame, anger and revenge.
The range of strong feelings can result in wide mood swings.
Victims vary in the style of expressing their
feelings:
• In
the expressed style, the victim may demonstrate feelings by being restless,
becoming visibly tense, or crying or sobbing when describing specific details
of the assault
• In
the controlled style, the feelings of the victim may be masked or hidden; they
may exhibit a calm, composed, or subdued effect
• Physical
reaction: Many
victims report a general feeling of soreness all over their body. Others
specify the body area that was the focus of the assailant’s
force such as throat, chest, arms, or legs.
Victims also report physical symptoms
specific to the area of the body that was the focus of the sexual assault:
• Victims
forced to have oral sex may describe irritation to the mouth and throat
• Victims
forced to have vaginal sex may have vaginal discharge, itching, a burning
sensation during urination, and generalized pain
• Those
forced to have anal sex may report rectal pain and bleeding in the days
immediately following the rape
Rape victims may have difficulty with
disorganized sleep patterns. Some cannot fall asleep or if they do, may wake up
during the night and be unable to fall back asleep.
Victims who have been attacked while sleeping
may awake each evening at the time the assault took place. It is not uncommon
for victims to scream out in their sleep.
Eating pattern disturbances are sometimes
experienced by rape victims. Some may have a marked decrease in appetite
following the rape. They may have stomach pains or food may not taste right.
Frequently victims feel nauseated just
thinking of the assault. It is important to determine whether the symptom of
nausea is related to the emotional reaction following the rape or is, for
women, a reaction to anti- pregnancy medication
• Behavioral
reaction: As
people do in other crisis situations, victims of sexual assault may react with
fear and confusion.
They may have difficulty in problem solving and in mobilizing
the strength to accomplish daily tasks.
The ability to absorb new information is greatly impaired.
The acute phase usually lasts from a few days to a few weeks.
Victims are extremely vulnerable emotionally during this stage and the
immediate response of those around them is very important
• Underground stage: The underground stage is a time period during
which victims attempt to return to their lives as if nothing had happened.
During this period, they may try to block
thoughts of the assault from their minds. They may not want to talk about the
incident or any of the related issues. They just want to forget about it.
This period may be characterized by difficulty
in concentrating and some depression.
Some people may remain in this underground
stage for years and may appear “over it,” despite the fact that the emotional
issues are not resolved.
Avoidance is the common theme of this stage.
The victim deliberately tries to avoid any reminders of the rape.
2. A long-term process of reorganization: In trying to understand
the effect the trauma has on one’s life, the survivor undergoes a period of
“reorganization” that involves a struggle to make sense of what happened, find
safety, and cope with new concerns that are caused by the event.
The
long-term process of reorganization often begins with a return to emotional
turmoil. The event which triggers the new phase of turmoil may be seeing the
assailant again, the arrival of a subpoena, a dream or nightmare, or a certain
smell.
Fear and
phobias may develop. They may be related specifically to the appearance of the
assailant or to the circumstances of the attack. Sometimes phobias can be much
more generalized. Eating and sleeping disturbances can re-emerge, as can dreams
and nightmares. Violent fantasies of revenge may also arise.
Despite the
great difficulties, these reactions are a normal part of the process of
integrating the experience and of reorganizing a life, which has been seriously
disrupted.
There are a
number of factors that influence the reorganization process. Some important
factors are the nature of the assault, and the developmental stage, social
network, and cultural background of the victim.
The length of each phase can vary, and people
may move back and forth between stages.
Which
of the following staments describe the potential physical effects of sesual
abuse?
BECOMING NAUSEOUS,
DEVELOPING sympotoms
specific to the area of the body that was the focus of the assault.
Distrubance ineating
and sleepeing patterns.
Inability to remember
some or all the datails related to the assault.
Section Summary
It is critical that you understand the
dynamics and effects of sexual abuse so that you can effectively detect and
assess signs of sexual abuse and respond appropriately to victims.
In this section, you learned about:
• The
characteristics that put inmates at risk for sexual abuse
• The
physical, psychological, and emotional effects of sexual abuse.
Section Overview: When
an inmate is sexually abused, PREA standards call for a response that:
• Provides
victim-centered care
• Uses
a coordinated, team approach to provide that care
You play an essential role in responding to
incidents of sexual abuse and sexual harassment.
In this section, you will learn to:
• Explain
the benefits of a coordinated response to a sexual abuse incident
• Describe
the role of the medical health care practitioner in responding to the medical
needs of a sexual abuse victim
Knowledge Review What do
you think are some of the benefits of providing a coordinated response to
victims of sexual abuse?
A
coordinated response ensures that all relevant personnel communicate with each
other to successfully respond and document the response to an incident of
abuse.
The
benefits of a coordinated response include:
• A consistent focus on the common goals
of a victim- centered response
• The avoidance of duplication of efforts
between personnel
• Creation of greater trust in the response
process by inmates and staff
• Enhancement of a reporting culture
What
do you think are some of the benefits of providing a coordinated response to
victims of sexual abuse.
A Coordinated Response: PREA
Section 115.65 mandates a coordinated response to sexual abuse incidents:
The facility shall develop a written
institutional plan to coordinate actions taken in response to an incident of
sexual abuse, among staff first responders, medical and mental health
practitioners, investigators, and facility leadership.
To meet this compliance requirement,
facilities should prepare a Sexual
Assault Response Team (SART). This team should respond to any incident of sexual abuse
or harassment using a systemic approach.
SART: (Sexual Assault Response Team )The
SART is composed of all individuals involved in the coordinated response,
including:
• Staff
first responders
• Medical
health care staff
• Mental
health care staff
• Investigators
• Facility
leadership
Cohesion of this team and the streamlining of
communication between the members help to ensure a coordinate response and
victim-centered approach to care.
The SART is
composed of all individuals involved in the coordinated response, including:
• Staff
first responders
• Medical
health care staff
• Mental
health care staff
• Investigators
• Facility
leadership
Cohesion of this team and the streamlining of
communication between the members help to ensure a coordinate response and
victim-centered approach to care.
Your Role: Now
that you are familiar with the benefits of a coordinated response, let’s take a
look at your role in responding to incidents of sexual abuse.
The remainder of this section will focus on
the actions that you should take to meet PREA standards and appropriately
provide care.
During their intake screenings, which are
conducted pursuant to PREA Section 115.41, inmates will be asked about their
histories of prior sexual victimization and abuse.
PREA
Section 115.81 requires that any inmate who is identified as a past sexual
abuse victim, whether it occurred in an institutional setting or in the
community, is offered a follow-up meeting with a medical or mental health care
practitioner within 14 days of the intake screening.
If an inmate discloses prior sexual
victimization or abuse, you should provide the appropriate referral for
treatment, based on your professional judgment
Medical Screening
Confidentiality and Follow-Up
Any information related to sexual victimization
or abusiveness that occurred in an institutional setting shall be strictly
limited to medical and mental health practitioners and other staff, as
necessary, to inform treatment plans and security and management decisions.
Additionally, you must obtain informed
consent from inmates before reporting information about prior sexual
victimization that did not occur in an institutional setting, unless the inmate
is under the age of 18.
Finally, the USDOJ notes that the follow-up
meeting described in Section 115.81 is intended to emphasize immediate health
needs and security risks. If it is determined through the follow-up meeting
that further treatment is not warranted, the agency is not required to provide
such services
Why Screening Information Is Important: The
information obtained during medical health reception and intake screenings can
be vital to keeping inmates safe.
By asking questions during intake screenings,
the agency can ensure that all inmates receive the medical health treatment
they need.
Additionally, prior sexual victimization or
prior sexually abusive behavior, especially in an institutional setting, is an
important factor to consider when making security and management decisions,
including housing, program, education, and work placements for inmates.
In that situation, the inmate has a right to
determine how or if the medical or mental health practitioner may share that
information with other staff.
Responding to a Sexual Assault: Victims
of sexual abuse require care from professionals trained to treat the trauma
associated with that abuse. However, in most cases the fa Facility Health Care Staff Some facilities, such as
small jails and community confinement facilities, may provide only first aid
and crisis intervention.
Larger jails and prisons may have the
capacity to provide comprehensive health care, as well as follow-up care.
cility’s health care staff is the first point of
contact for medical assistance.
At a high-level, your role in responding to
an incident of sexual abuse involves:
Assessing and Coordinating Care: If
acute care is provided at the facility, you should strive to preserve all
forensic evidence to the extent possible prior to the FME.
For example, if the victim’s clothing needs
to be removed to provide care, you should ensure that the clothing is packaged,
labeled, sealed, and then included with other forensic evidence in a way that
maintains the chain of custody.
Chapter 3 contains more information about
your role in preserving evidence.
If the victim is going outside the facility
to a local examination site for the FME, you should work with other corrections
staff to arrange transport for the victim to/from the site and security to/from
the site and during the exam.
You must also document all provided services
in the inmate’s health record.
It is also recommended that you know your
agency’s process for contacting and/or making referrals to a SAFE/SANE, local
hospital, or rape crisis center.
Finally, you should ensure the coordination
of necessary care, such as emergency contraception, HIV testing, crisis
counseling, and/or medications.
Communicating with Other Responders : Examples
of communications between you and other responders include:
• Conferring
with the forensic examiner and investigator if there is a question as to
whether an FME is appropriate
• Communicating
with the forensic examiner regarding follow-up medical instructions
If an external examination site is used,
administrators may assign you a role in:
• Communicating
with staff at the external site regarding the imminent arrival of the victim
• Informing
the forensic examiner about any acute or emergency medical services that were
provided
• Sharing
your agency’s policies and practices with the local hospital or rape crisis
center so that they understand what takes place at the facility before the
inmate is transported to them
Providing/Coordinating Follow-Up Care: In
accordance with PREA Section 115.83, you are also responsible for ensuring the
ongoing medical care for sexual abuse victims.
You will likely be responsible for
coordinating and scheduling follow-up services, such as sick call clinic,
mental health visits, outside consultations, and follow-up testing.
Additionally, you may participate in an
incident review, along with the health administrator and medical director.
Treating the
Physical Consequences of Sexual Abuse: Because sexual abuse
perpetrators often use coercion, intimidation, and threats to facilitate an
assault, victims may have few visible physical injuries. However, there are
some victims who are physically injured during a sexual assault.
Other physical consequences of sexual abuse
include:
• Pregnancy
(for female victims)
• Exposure
to HIV/AIDS and other sexually transmitted infections
As mandated by PREA Section 115.82, victims
of sexual abuse must have timely, unimpeded, no-cost access to emergency
medical treatment and crisis intervention services, the nature and scope of
which are determined by medical health care practitioners according to their
professional judgment.
Immediate Response: If
a report of sexual abuse is made within 96 hours of the alleged assault and the
case involves penetration and/or exchange of bodily fluids, the inmate will be
seen by a medical health care practitioner within 2 hours of the report.
These timelines are guidelines to be followed
and may differ from one agency to the other.
Inmates alleging other types of sexual abuse
will be seen immediately.
Your
Responsibilities during the Immediate Response
You should inform the inmate that washing,
brushing teeth, changing clothes, urinating, defecating, drinking, or eating
prior to the FME may compromise the collection of evidence.
You should also provide the inmate with
information about the need for further medical evaluation to:
• Determine
the extent of injuries
• Test
for and treat sexually transmitted infections
• Determine
the need for post-exposure prophylaxis for sexually transmitted infections
• Determine
the need for pregnancy prevention, if applicable
Additionally, ensure that the inmate is given
the opportunity to further discuss the FME with a mental health care
practitioner or a victim advocate, if available, before deciding to undergo the
exam.
Finally, you must not disclose information
about the victim’s
(or the perpetrator’s)
sexually transmitted disease status or the fact that either requested or had an
HIV test.
Section Summary: Your
responsibilities when responding to a sexual abuse incident include, but are
not limited to:
• Assessing
the victim’s acute medical needs
• Communicating
with other responders
• Coordinating
or providing follow-up medical care
In this section, you learned about:
• The
benefits of a coordinated response to a sexual abuse incident
• Your
role in responding to and providing medical care to inmate victims of sexual
abuse
You should now be ready to take the
End-of-Chapter assessment.
For test:
1)
Rates of reported inmate on inmate sexual
victimization were significantly higher for inmates who had which of the
following characteristics? Select all that apply.
A history of mental illness
A sexual orientation other than heterosexual.
2) 2 If you interact with a victim immediately
after an incident of sexual abuse, and he presents himself in a quiet, reserved
manner and does not appear to be physically injured, you can safely assume that
he does not need medical attention.
False
3)
When responding to an
incident of sexual abuse, your approach should be victim-centered and:
o
coordinated.
4)
When providing an
immediate response to a sexual abuse victim, you should encourage the inmate to
wash and change clothing prior to the FME.
o
False
5)
If acute care is
provided at the facility, your role requires you to:
o
preserve all forensic
evidence to the extent possible prior to the FME
Section Overview: The purpose of an FME is to gather physical
evidence of a sexual assault.
The exam also provides victim-centered care by addressing the
needs of inmates who report sexual abuse.
In this section, you will learn to:
• Identify the components of the FME
• Explain the role of the SANE in the FME
process.
An FME is both a medical and a legal
physical examination. The goals of the FME are:
• Provide interventions that improve the
physical and mental health and well-being of sexual assault survivors
• Decrease the acute and long term
effects of the assault
• Help to return the victim to their
previous functioning state
• Retrieve evidence to support an
allegation of sexual assault for future prosecution
The examination, collection of
evidence, and documentation of injury may be necessary either to substantiate
an allegation or to help strengthen a case.
SANEs and SAFEs are specially trained medical
professionals who, in addition to performing the FME, can also testify in any
legal proceedings related to the examination.
The SANE or the SAFE who performs the FME is
required to ensure that the chain of custody and integrity of samples are
maintained so that the evidence will be admissible in court.
For simplicity’s sake, this course will only
use the term “SANE” when referring to the role and responsibilities of the SANE
or SAFE. and is adapted to the needs
and circumstances of the victim (age, gender, disabilities, culture,
orientation, history of trauma, consent for exam, support available, etc.).
If the sexual abuse is reported within 96 hours,
( Timing of the FME
The time period during which an FME
is considered to be appropriate varies geographically, so you should check with
your area SANE.
However, it is generally agreed
that if the sexual abuse incident is reported within 96 hours (or 120 hours in
some jurisdictions), an FME should be conducted.) an FME of the victim may yield usable evidence.
It is important to prepare the victim prior to
beginning any procedure, but it is particularly important in advance of a FME
because of the nature of the exam and the potential for re-traumatization. This
process aids in the restoration of his or her physical and emotional sense of
predictability and control over what is happening.
Components of the FME: The
FME includes:
• Collection
of medical forensic history from the patient
• Head-to-toe
examination to look for signs of trauma
• Collection
of forensic evidence
Each of these components, as well as the
SANE’s role in each, is discussed in more detail on the following pages.
Collection of Medical Forensic History:
1. The SANE assesses (and, if
appropriate, treats) the victim’s immediate medical or mental health needs
2. The SANE documents patient
consent:
The patient must provide informed consent for
each part of the procedure.
If the patient does not consent, the
examination will not be conducted.
(in
extenuating circumstances, this may require next-of-kin consent or court order)
3. The SANE gathers the victim’s
medical history, including:
a. Patient information
b. History of assault
c. General medical history (surgeries,
pregnancies, etc.)
Detailed Description of
the Assault
The SANE
will gather the following details:
• Date and time of sexual
assault(s)
• Pertinent patient medical
history
• Recent consensual sexual
activity
• Post-assault activities of
the patient
• Assault-related patient
history
• Suspect information (if
known)
• Nature of physical
assault(s)
• Description of assault(s)
4. The SANE gathers the victim’s
clothing
The Head-to-Toe Examination: The
exam begins with a general physical examination, including:
• Vital
signs
• Physical
appearance, general demeanor, behavior, condition of clothing upon arrival
• Observation
of palpable tissue injuries and foreign materials (grass, stains, dried or
moist secretions, etc.)
Anogenital Examination
The SANE conducts an examination of external
and internal genitalia for injury, foreign materials, and foreign bodies.
This exam includes:
• Buccal
sample
• Oral
swab and smears
• Pulled
head hairs
• Collection
of foreign fluids
• Pubic
hair combings
• Pulled
pubic hair
• Rectal
swabs and smears
• Penile
or vaginal swabs and smears
• Trace
evidence (including fingernail scrapings, etc.)
This process is often intrusive and can be
considered violating by victims. Keep this in mind when interacting with them
both before and after the exam.
Collection of Forensic
Evidence:
A SANE is trained in evidence collection for
the purpose of eventual prosecution. Therefore, the SANE will collect and
preserve the evidence available and package it appropriately for that purpose.
Additionally, the SANE will offer prophylaxis
and emergency contraception if this was not done at the facility.
Finally, all requested information is filled
out, and the SANE will provide discharge instructions and referrals that will
be given to you for further action.
Which of the following are components of the FME?
There are three components of an FME:
1. collection of medical forensic history,
2. the head-to-toe exam,
3.
and the
collection of forensic evidence. Select Next to continue.
Chapter
4: Reporting Allegations and Suspicions
It is essential that you understand your
obligations to report any and all allegations or suspicions of inmate sexual
abuse or harassment.
In this section, you will learn to describe
the PREA requirements for reporting inmate sexual abuse or harassment
Reporting
Risks: Victims perceive
several risks in reporting their sexual abuse:
• Assumption of agency disbelief
• Expectations that they will be placed in
segregated housing, protective custody, or transferred
• Fear of being labeled “homo” or “punk” or
“snitch”
• Fear that their reputation among other
offenders may be damaged in a way that may actually affect their safety
• Predators will often view admission of
victimization as signs of weakness, so reporting may put victims at further
risk
• Awareness of staff perception that inmates
cannot be “real” victims because sexual behavior in jails and prisons is
consensual, or that inmate victims deserve their fates
Risk of Filling Formal Complaint: To
be labeled a “snitch” in prison is dangerous, and survivors who file formal
complaints often face intense retaliation from perpetrators and their
associates.
Such dangers are especially troubling as
survivors are only given access to follow-up services – such as crisis
counseling, medical care, timely testing and treatment for sexually transmitted
infections and pregnancy – if they are willing to file a sexual abuse report.
For the most part, medical and mental health
staff members are not permitted to maintain confidentiality regarding sexual
assaults, increasing the likelihood that a survivor will be too scared to seek
help.
Likewise, inmate communication with outside
agencies tends to be monitored, sometimes by the very staff that perpetrated
the abuse.
OBLIGATION TO REPORT: You are required to report any of the
following immediately:
• Any knowledge or suspicion of sexual abuse
• Any information you receive regarding an
incident of sexual abuse that occurred in an institutional setting
• Retaliation against inmates or staff who
reported abuse
• Any staff neglect or violation of
responsibilities that may have contributed to an incident of sexual abuse or
retaliation unless otherwise precluded by Federal, State, or local law.
Reporting Methods: Inmates Section 115.51 Inmate reporting.
(a)
|
The agency shall provide multiple internal ways for inmates to
privately report sexual abuse and sexual harassment, retaliation by other
inmates or staff for reporting sexual abuse and sexual harassment, and staff
neglect or violation of responsibilities that may have contributed to such incidents.
|
(b)
|
The agency shall also provide at least one way for inmates to
report abuse or harassment to a public or private entity or office that is
not part of the agency, and that is able to receive and immediately forward
inmate reports of sexual abuse and sexual harassment to agency officials,
allowing the inmate to remain anonymous upon request. Inmates detained solely
for civil immigration purposes shall be provided information on how to
contact relevant consular officials and relevant officials at the Department
of Homeland Security.
|
(c)
|
Staff shall accept reports made verbally, in writing,
anonymously, and from third parties and shall promptly document any verbal
reports.
|
(d)
|
The agency shall provide a method for staff to privately
report sexual abuse and sexual harassment of inmates.
|
PREA Section 115.51 requires that there be multiple
reporting methods available for inmates to report sexual abuse or harassment,
retaliation for reporting, and staff neglect or violation of regulations.
Specifically, Section 115.51(c) states that: Staff shall accept reports made verbally,
in writing, anonymously, and from third parties and shall promptly document any
verbal reports.
Internal Reporting Channels (to Staff) Verbally, followed by documentation in report in writing
External Reporting
Channels Inmates must have
access to at least one oexternal avenue for reporting that is not affiliated
with the agency
The agency must accept
third-party reports
Reporting Methods:
staff: PREA Section 115.51(d)
requires agencies to provide a method for staff to privately report sexual
abuse or harassment of inmates.
These methods must allow for private reporting that is outside
the organizational chain of command and, in many cases, anonymous.
You need to know your agency’s policies and methods for
reporting allegations or suspicions of sexual abuse.
Summary: In this section, you
learned about the requirements for reporting inmate sexual abuse and
harassment.
Specifically, PREA standards require you to report:
• Any knowledge or suspicion of sexual abuse
• Any information you receive regarding an
incident of sexual abuse that occurred in an institutional setting
• Retaliation against inmates or staff who
reported abuse
• Any staff neglect or violation of
responsibilities that may have contributed to an incident of sexual abuse or
retaliation unless otherwise precluded by Federal, State, or local law
As a medical health care practitioner, you must know your role
in reporting inmate sexual abuse and harassment.
In this section, you will learn to:
• Explain the phrase “code of silence” and how
such codes influence the reporting of inmate sexual abuse and harassment
• Describe your role in reporting inmate sexual
abuse and harassment
Code
of Silence: Before we take a look at your specific reporting responsibilities,
let’s first examine the issue of a code of silence. A code of silence is an informal
institutional or organizational culture that says members of the group will not
inform on or give evidence or testimony against other members of the group,
even though actions of the other members may involve breaches of policy or even
the criminal law. Both inmates and staff are
capable of creating or participating in these codes.
Inmate Code of Silence
A code of silence between inmates may be due to:
• Belief that nothing will come from the report
• Loyalty to other inmates
• An “us against them” attitude
• A fear of retaliation from other inmates
• A fear of retaliation from staff
Staff Code of Silence
A code of silence between staff may be due to a belief that:
• Nothing will come from the report
• Trust between staff is critical to staff
safety on the job, and reporting may damage that trust
• Other staff would not be involved in staff
sexual misconduct
• Staff sexual misconduct does not warrant the
response in agency policy
• It may harm their camaraderie
Effects of a Code of
Silence
A study found that 46% of the experienced officers interviewed
witnessed misconduct but concealed it because they feared being ostracized,
fired, and blackballed.
These elements are most relevant to correctional agencies as
they seek to assess their agency’s culture and address the highly explosive subject
of allegations of staff sexual misconduct with inmates.
The Financial Cost of Upholding a Code of Silence
Baron v. Hickey (2003) highlighted the great costs that a highly
active code of silence can create.
The story behind this case involves an officer who reported his
supervisor for playing cards with inmates. He was harassed by his co-workers in
retaliation. They referred to him as a rat, threw cheese at him, posted
derogatory posters on his locker, put feces on his car, and slashed his tires.
He complained on 30 separate occasions, but the harassing
officers were never disciplined. He finally resigned, declaring that he was
forced into it, and claimed constructive discharge.
He sued the agency and was awarded $500,000 for harassment,
which was affirmed on appeal.
Your Reporting
Duties: PREA
Section 115.61 requires all staff to be trained in their duty to report inmate
sexual abuse or harassment.
Specifically, this standard mandates that, apart from reporting
to designated supervisors or officials, you must not reveal any information
related to a sexual abuse report to anyone other than to the extent necessary,
as specified in agency policy, to make treatment, investigation, and other
security and management decisions.
Additionally, the standard states that, unless otherwise
precluded by Federal, State, or local law, you must inform inmates of your duty
to report and the limitations of confidentiality at the initiation of services.
Section 115.61 Staff and agency
reporting duties.
(a)
|
The agency shall require all staff to report immediately and
according to agency policy any knowledge, suspicion, or information regarding
an incident of sexual abuse or sexual harassment that occurred in a facility,
whether or not it is part of the agency; retaliation against inmates or staff
who reported such an incident; and any staff neglect or violation of
responsibilities that may have contributed to an incident or retaliation.
|
(b)
|
Apart from reporting to designated supervisors or officials,
staff shall not reveal any information related to a sexual abuse report to
anyone other than to the extent necessary, as specified in agency policy, to
make treatment, investigation, and other security and management decisions.
|
(c)
|
Unless otherwise precluded by Federal, State, or local law,
medical and mental health practitioners shall be required to report sexual
abuse pursuant to paragraph (a) of this section and to inform inmates of the
practitioner's duty to report, and the limitations of confidentiality, at the
initiation of services.
|
(d)
|
If the alleged victim is under the age of 18 or considered a
vulnerable adult under a State or local vulnerable persons statute, the
agency shall report the allegation to the designated State or local services
agency under applicable mandatory reporting laws.
|
(e)
|
The facility shall report all allegations of sexual abuse and
sexual harassment, including third-party and anonymous reports, to the
facility's designated investigators.
|
Your Role: You must understand that the agency tolerates
neither a staff code of silence nor the mishandling or inappropriate sharing of
information (i.e., spreading rumors or conveying information to individuals who
have no need to know).
It is critical that you understand exactly
what, when, how, and to whom you are required to report allegations or
suspicions.
There will be some instances when your
responsibilities will differ based on the type of offense or the persons
involved. For example, your reporting requirements are different if the
incident involves a victim under the age of 18 or a victim considered a
vulnerable adult under a State or local vulnerable persons statute (e.g.,
statutes that address the mentally ill, mentally or physically disabled, or the
elderly)
Reporting Helps to Ensure
Safety and Security: When you consistently and fairly report inmate sexual abuse
and harassment, and inform inmates of their responsibility to report such
activity as well, you are doing your part to help ensure the safety and
security of the facility and the safety of the individual being abused or
threatened with abuse.
Maintainig Confidentiality: Confidentiality is essential in developing
the trust and confidence needed for victims and practitioners.
You should be aware that the confidentiality of records
(including forensic evidence and photographic and video images) are intricately
linked to the scope of the victim’s consent.
Remember, no matter who reports an incident of sexual abuse, it
is vital that you keep their information and identity secure, as the general
policy on client confidentiality applies. However, there are limits to
confidentiality and one of those limits relates to the requirement to report
sexual abuse allegations.
As
a medical health care practitioner, you can ensure confidentiality by following
PREA standards, other Federal, State and local laws, and your code of ethics.
Increased Understanding of Confidentiality
The basics of maintaining confidentiality include:
• Knowing what information is confidential
• Knowing with whom you can share confidential
information
• Being aware of your surroundings and who may
be listening when you are discussing a case of sexual abuse
You must also be aware of some additional considerations to
increase your understanding of confidentiality, including laws that:
• Pertain to privileged communications between
the victim and sexual assault or rape crisis counselors
• Limit the confidentiality rights of minors
For example, in some areas, minor victims have the right to
grant or withhold consent to an FME but not to keep the result of the exam
private from their parent or legal guardian.
Which of the following statements are true
regarding your role in reporting inmate sexual abuse and harassment?
1. Unless otherwise precluded by Federal, State, or
local law, you must inform inmates about the limitations of confidentiality
before the initiation of services.
2. Unless otherwise precluded by Federal, State, or
local law, you must inform inmates of your duty to report sexual abuse and
harassment.
3. You must not reveal any information related to a
sexual abuse report to anyone other than to the extent necessary to make
treatment, investigation, and other security and management decisions.
Summary: This section provided information about your role as a medical
health care practitioner in reporting inmate sexual abuse and harassment.
You also learned how inmate and staff codes of silence can
affect reporting.
OVERVIEW: There is always paperwork
involved in sexual abuse and harassment reports. It is critical that you
document each and every allegation and suspicion.
In this section, you will learn to explain strategies for
creating or generating sexual abuse or harassment report documentation.
CREATING/GENERATIONG
DOCUMENTATION: All documentation you
create or generate must be as thorough, detailed, and accurate as possible.
Even if you are unsure
whether or not abuse or harassment has actually occurred, you have a duty to
document the report. And, depending on the recipient, you may need to document
differently.
There are two main types
of documentation:
• Confidential
medical records
• Official
reports
Both types of
documentation can be subpoenaed for court.
RECORDS AND RETRIEVAL STRATEFIES: When creating or
generating records of sexual abuse or harassment reporting, consider the
following:
• What is the safest way to store and retrieve
the records?
• What is the most efficient way to store and
retrieve records?
• Are the records paper or electronic?
• Who has access to the records?
• Who will require access to the records?
You should refer to your agency’s policies and procedures for
storing and retrieving records.
When
you are creating or generating records, you should consider the safest and most
efficient way to store and retrieve them. Select Next to continue.
A code of _SILENCE is an informal culture in
which members of a group will not inform on or give evidence or testimony
against other members of the group
Unless otherwise precluded
by Federal, State, or local law, when must you inform inmates about the
limitations of confidentiality?
ACA: American Correctional Association
Agency: The unit of a State, local, corporate, or nonprofit authority,
or of the Department of Justice, with direct responsibility for the operation
of any facility that confines inmates, detainees, or residents, including the
implementation of policy as set by the governing, corporate, or nonprofit
authority.
Agency Head: The principal official of a facility
Behavioral Health Care Practitioner
A
behavioral health professional who, by virtue of education, credentials, and
experience, is permitted by law to evaluate and care for patients within the
scope of his or her professional practice. A “qualified mental health
practitioner” refers to such a professional who has also successfully completed
specialized training for treating sexual abuse victims.
Bisexual: A person who is
emotionally, physically, and romantically attracted to both men and women or
people regardless of their gender.
CFR: Code of Federal
Regulations
CO: Correctional Officer
Community Confinement Facility: A
community treatment center, halfway house, restitution center, mental health
facility, alcohol or drug rehabilitation center, or other community
correctional facility (including residential re-entry centers), other than a
juvenile facility, in which individuals reside as part of a term of
imprisonment or as a condition of pre-trial release or post-release
supervision, while participating in gainful employment, employment search
efforts, community service, vocational training, treatment, educational
programs, or similar facility-approved programs during nonresidential hours.
Contractor: A person who provides
services on a recurring basis pursuant to a contractual agreement with the
agency.
Detainee: Any person detained in a
lockup, regardless of adjudication status.
DHS: Department of Homeland
Security
DOC:Department of Corrections
DOJ: Department of Justice
Employee: A person who works
directly for the agency or facility.
Facility: A place, institution,
building (or part thereof), set of buildings, structure, or area (whether or
not enclosing a building or set of buildings) that is used by an agency for the
confinement of individuals.
Facility Head: The principal official of
a facility.
FME: Forensic Medical
Examination
Gay: Typically a man or boy,
who is emotionally, physically, and romantically attracted to other men or
boys. This term can also be used as a blanket term for both gay men and
lesbians.
Gender Nonconforming: A
person whose appearance or manner does not conform to traditional societal
gender expectations.
Inmate: Any person incarcerated or
detained in a prison or jail.
For
the purposes of this course, the term “inmates” refers collectively to persons
confined in prisons and jails, lockups, juvenile facilities, and community
confinement facilities, except when specifically discussing lockups, juvenile
facilities, or community confinement facilities.
Intersex: A person whose sexual or
reproductive anatomy or chromosomal pattern does not seem to fit typical
definitions of male or female. Intersex medical conditions are sometimes
referred to as disorders of sex development.
Jail: A confinement facility of
a Federal, State, or local law enforcement agency whose primary use is to hold
persons pending adjudication of criminal charges, persons committed to
confinement after adjudication of criminal charges for sentences of one year or
less, or persons adjudicated guilty who are awaiting transfer to a correctional
facility.
Juvenile: Any person under the age
of 18, unless under adult court supervision and confined or detained in a
prison or jail.
Juvenile Facility: A
facility primarily used for the confinement of juveniles pursuant to the
juvenile justice system or criminal justice system.
Law Enforcement Staff: Employees
responsible for the supervision and control of detainees in lockups.
Lesbian: A woman or girl, who is
emotionally, physically, and romantically attracted to other women and girls.
LGBT: Lesbian, gay, bisexual or
transgender
LMS: Learning Management System
Lockup: A facility that contains
holding cells, cell blocks, or other secure enclosures that are:
1. Under
the control of a law enforcement, court, or custodial officer; and
2. Primarily
used for the temporary confinement of individuals who have recently been
arrested, detained, or are being transferred to or from a court, jail, prison,
or other agency.
Medical Health Care Practitioner: A
health professional who, by virtue of education, credentials, and experience,
is permitted by law to evaluate and care for patients within the scope of his
or her professional practice. A “qualified medical practitioner” refers to such
a professional who has also successfully completed specialized training for
treating sexual abuse victims.
Mental Health Care Practitioner: A
mental health professional who, by virtue of education, credentials, and
experience, is permitted by law to evaluate and care for patients within the
scope of his or her professional practice. A “qualified mental health
practitioner” refers to such a professional who has also successfully completed
specialized training for treating sexual abuse victims.
NIC: National Institute of
Corrections
PL: Public Law
PREA: Prison Rape Elimination
Act
Prison: An institution under
Federal or State jurisdiction whose primary use is for the confinement of
individuals convicted of a serious crime, usually in excess of one year in
length, or a felony.
RCC: Rape Crisis Center
Resident: Any person confined or
detained in a juvenile facility or in a community confinement facility.
SAFE: Sexual Assault Forensic
Examiner
SANE: Sexual Assault Nurse
Examiner
SART: Sexual Assault Response
Team
Secure Juvenile Facility :A
juvenile facility in which the movements and activities of individual residents
may be restricted or subject to control through the use of physical barriers or
intensive staff supervision. A facility that allows residents access to the
community to achieve treatment or correctional objectives, such as through
educational or employment programs, typically will not be considered to be a
secure juvenile facility.
Security Staff: Employees primarily
responsible for the supervision and control of inmates, detainees, or residents
in housing units, recreational areas, dining areas, and other program areas of
the facility.
Sexual Abuse: Any sexual act that the
victim does not consent to, is coerced into such an act by overt or implied
threats of violence, or is unable to consent or refuse.
This
definition summarizes the full text of the definition contained in PREA Section
115.6 Definitions related to sexual abuse.
Sexual Harassment: Repeated
and unwelcome sexual advances, requests for sexual favors, or verbal comments,
gestures, or actions of a derogatory or offensive sexual nature.
This
definition summarizes the full text of the definition contained in PREA Section
115.6 Definitions related to sexual abuse.
SHU: Special Housing Unit
Transgender: A person whose gender
identity (i.e., internal sense of feeling male or female) is different from the
person’s assigned sex at birth.
USDOJ: U.S. Department of Justice
Volunteer: An individual who donates
time and effort on a recurring basis to enhance the activities and programs of
the agency.
Voyeurism: Invasion of an inmate’s
privacy by staff for reasons unrelated to official duties. This definition summarizes the full text of
the definition contained in PREA Section 115.6 Definitions related to
sexual abuse.
Youthful Inmate: Any person under the age
of 18 who is under adult court supervision and incarcerated or detained in a
prison or jail.
Youthful Detainee: Any
person under the age of 18 who is under adult court supervision and detained in
a lockup.
1.
The
practice of combining a positive outlook with critical thinking is called: Realistic optimism.
2.
A
study by Taiwan National University found that this approach can increase
happiness and resilience. Individuals who apply realistic optimism will be
pragmatic about a certain obstacle, but find creative ways to overcome the
challenge.
3.
The most resilient people tend to avoid
negative experiences: Negative experiences help build
resilience. Those who are most resilient have a healthy positivity ratio — a
system of weighing life’s victories against unpleasant experiences.
4.
Those who handle adversity well view
mistakes as: Mistakes
can be seen as opportunities to learn and grow. In fact, sometimes failure is
necessary to experience success. Keeping this in mind will help take the fear
out of tackling new challenges.
5. Drinking beet juice may boost endurance. A study from the UK revealed that
drinking two cups of beet juice before working out increased endurance by 16
percent. The nitrates in the juice can increase oxygen flow to muscles,
providing more energy.
6. Which age groups have the highest rate of bicycle deaths? 15-29 and 45 & up The Centers
for Disease Control also found that children and young adults aged 5-24 have
the highest rates of nonfatal bicycle injuries. Wearing a helmet and using
proper hand signals can help to avoid fatalities.
7. Which
of the following “feel-good” brain chemicals are released during exercise? Neurotransmitters Endocannabinoids Endorphins
All these chemicals may help with easing symptoms of depression. According to
Mayo Clinic, working out also
lowers immune system chemicals that could potentially make depression worse.
It’s a double whammy of benefits!
8. Often called “feel
good” hormones, what are endorphins? Neurotransmitters These neurotransmitters
are chemical messengers that help put pain in its place, make you feel better,
and cope with stress.
9. Which part of your body
produces the most endorphins? The pituitary gland, one of the star players in
your body’s hormone system, resides close to your brain and is responsible for
those zippy endorphins
10.Which foods can lead to
enhanced endorphin production? Chocolate and chili peppers as if chocolate and
chili peppers weren’t enticing enough, they can also augment the endorphins you
crank out. The hotter the chili pepper, the bigger the endorphin boost!
11.
Endorphins are as addictive as painkillers. Your brain’s
receptors take in both endorphins and powerful opiate medicines to bring your
body relief from pain. However, it’s the medicinal varieties (think
heavy-hitters like codeine and morphine) that carry the risk of addiction.
