Following assault, nurse examiners can play an important role in a survivor's health and well-being.

A variety of resources are available to those who experience sexual assault, including the Relationship and Sexual Violence Prevention Center on the University of Missouri campus and True North in the Columbia community at large.

Another option is to seek medical support from MU Health Care. We sat down with Jennifer Delp, a sexual assault nurse examiner, who can help connect people with advocacy and counseling services as well as conduct sexual assault forensic exams.

Caoilinn Goss: What can someone expect if they come in for a forensic exam?

Jennifer Delp: "It’s very patient-focused. We want to make sure that our patients get the best care that they can get and that they regain some of the control that they lost through the assault itself. So it very much becomes what they need in that moment, as far as beginning to put their health back together, but also regaining some of their power.”

According to Delp, individuals looking for support from SANE staff check in through the regular emergency department, and after an emergency room nurse takes their vitals, they will be directed to a separate waiting room where they can safely wait for the SANE providers.

Exams are designed to meet the needs of the person who experienced the assault. Options include having a survivor’s advocate present with them in the emergency department when the exam is performed and patients have full autonomy in deciding whether to involve law enforcement. SANE providers offer forensic evidence collection or just a physical exam to determine the patient’s health and safety.

Caoilinn Goss: Historically, under-reporting has been a huge issue with sexual assault. What are some of the reasons for that?

Jennifer Delp: “One of the things that I see often is survivors are not even sure if what happened to them would be considered a sexual assault by somebody else. So, sometimes they don’t report because they’re just not sure that because they don’t think it’s a sexual assault, that it truly is a sexual assault. For example, if a survivor was on a date with someone and they started having sexual relations, and then they withdrew consent, but the person that they were having relations with continued. Does that qualify as a sexual assault?”

“Sometimes it's not reported because they feel like they did something maybe that brought it on to them. For example, If a survivor was out walking late at night, by themselves, and was then assaulted, they feel like they maybe shouldn't have been in that position and so they feel guilty."

"Sometimes they're embarrassed, especially when we see that our survivor is a non-female gender, they feel like they shouldn't have been assaulted, they should be stronger than that or there's a lot of pressures that society puts on on our male population. And so they feel like embarrassed to come in report that something has happened to them. Sometimes they're just afraid: what are the ramifications going to be? Especially if they know their assailant. Are they going to face some backlash from that?”

“Sexual assault is a very much a power as type of assault, as opposed to truly a sexual act, it's about taking some of these power away and that power can be taken away through manipulation just as much as the physical act itself.”

Caoilinn Goss: Another thing that’s often a fear or a barrier to reporting is privacy and cost? So, how are SANE exams and any STI treatment or emergency contraception handled by insurance?

Jennifer Delp: “When we fill out our paperwork when you present for a forensic exam, that is all sent through separate billing through the state, and that reimbursement comes through the state of Missouri, through the Victims Fund, so your insurance company doesn't get a bill for that. A lot of our survivors don't want to report because they don't want their parents to know and they're still on their parent's insurance, your parent's insurance does not get a bill for that.”
“It's all completely separate paperwork, it does not go into the same section of the electronic medical record, that everything else does. So tomorrow, if you came in and you had broken your leg, nobody's going to see the information that I put in your chart today about your sexual assault.”

“The state of Missouri does have a fund for our survivors set up that provides things such as lost wages. If you need to take time off of work, it helps to fund medical care for follow up care, it helps to provide transportation to court. It can help establish a safe place to live if it's a domestic violence situation.”

Caoilinn Goss: For people who don’t want to go to the police with a report – what would you tell them about why it could still be empowering and important to come for a forensic exam?

Jennifer Delp: “Even if you report anonymously, and you say I don't want to prosecute this, but I do want to report it. That can help law enforcement later on, if there's an establishment of a pattern with a particular assailant. So, if the same person name gets mentioned multiple times in an anonymous report. While we can't prosecute for each of those individual reports, it does kind of give law enforcement that like red flag of, 'oh, we need to look at this person a little bit closer because we've heard this name before.' So you may not be in a place where you want to prosecute for yourself, but sometimes just getting that information out there can help that next person. So think and consider those things.”

While the SANE program is nurse-focused, Delp says any healthcare provider that goes through the forensic evidence training can become a safe care provider.

MU Health currently has four trained SANE nurses that work with pediatric cases, and 15 nurses that work with adults and teens. There’s also a mentorship program for healthcare providers interested in undergoing the training.