Emergency Nurses' Experience Providing Care and Perceptions About Using Telemedicine for Sexual Assault Patients.

Most emergency medical clinicians are not trained to conduct forensic sexual assault exams yet are often the first to care for survivors of recent sexual assault. Before the implementation of live sexual assault nurse examiner (SANE) consultation provided via telemedicine ("teleSANE") in one state, results of an online survey of emergency nurses (N = 116) found only 13% felt extremely confident providing quality forensic sexual assault examinations. Two-thirds of emergency nurses felt using teleSANE during sexual assault care would support their clinical decision-making skills. Findings suggest that teleSANE may be a promising strategy to improve access to specialized sexual assault care.

Characteristics and Dynamics of Cyberstalking Victimization Among Juveniles and Young Adults.

Using the nationally representative Ipsos online KnowledgePanel, the sample included three hundred thirty-six 18- to 28-year-olds who retrospectively reported first cyberstalking incidents as juveniles (9- to 17-year-olds) or adults. Half of the sample first experienced cyberstalking as juveniles and half first experienced it as adults. Juveniles were more likely to have more than two perpetrators in the same episode, to experience more violent threats, and to avoid people because of what happened. Few reported the incident to the police, with juveniles less likely to report it to the police. Cyberstalking of juveniles appears just as or more serious than cyberstalking of adults.

Including Patient Voices in Continuing Medical Education: One Provider's Experience.

In 2021, UpToDate began offering continuing medical education (CME) planned and delivered by patients. The patient-authored medical topic reviews focus on lessons learned from interactions with the healthcare system and emphasise quality of life for those living with specific conditions. Having access to the patient voice at the point of care provides clinicians with a perspective that can improve patient-provider communication and promote shared decision-making. Participants who viewed the patient-authored topics were emailed a survey about the content; several responses indicated that the new topics were useful in clinical practice. While positive responses demonstrate that clinicians value the patient perspective, we also received replies from participants and from the patient authors themselves indicating there is more work to be done in developing patient-led CME. As more patients are invited to join the conversation, their expertise will be increasingly recognised as integral to CME.

Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors.

INTRODUCTION: Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as "teleSANE") during sexual assault examinations is a promising new practice to address this issue. PURPOSE: The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs. METHODS: Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs. RESULTS: Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover. DISCUSSION: Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.

Reducing Falls in Older Women with Urinary Incontinence.

Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.

"If you don't send me five other pictures I am going to post the photo online": A qualitative analysis of experiences of survivors of sextortion.

In this study, we explored survivors' experience with sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors). We conducted in-depth telephone interviews with 48 adults aged 18 to 25 who had been targets of sextortion. Nearly half of participants were minors at the time of the sextortion incident. Data were analyzed using thematic analysis, which resulted in four major dimensions. The dimensions identified were the emotional connections between victims and perpetrators, the nature of the threats, societal responses, and integrating the sextortion into their life stories. The findings emphasized the multidimensional nature of this phenomenon. There was a wide range of emotional connections, from brief connections to close intimate relationships or strong friendships. Some threats remained unfulfilled, while other were carried out. Some threats were one-time and some lasted for years. Societal responses were central in participants' narratives, with most participants actually turning to their peers and parents for support. Many expressed thankfulness for the opportunity to tell their story during the interviews. For the majority of participants sextortion was perceived as a central event in their lives, one that changed them forever. Listening to the voices of survivors helps professionals understand these harmful situations.

Statutory Rape: Case Characteristics When Offenders are Younger Than 21 Years of Age Versus Older.

Statutory rape laws are intended to protect adolescents from harm as a result of sexual activity with older individuals. In this pursuit, many, but far from all, states' statutory rape laws differentiate younger and older offenders. In effect, many of these states differentiate offenders who are 21 and older from those who are under 21. It is unknown, however, whether and how the dynamics of statutory rape vary depending on the age of the offender. To explore the contribution of offender age to the dynamics of statutory rape, data were collected from the records of 105 statutory rape cases referred to a child abuse assessment center over a 63-month period. Records included detailed reports on case history and victims' family history, mental health and health-risking behaviors, medical examination results, and forensic interview summaries. Cases of offenders11.Because these cases are under investigation, "offenders" here refers to "suspects." For ease of reading, we use "offenders" to be consistent with prior research terminology. under 21 were compared to the cases of offenders 21 years and older. Compared to cases of younger offenders, cases of offenders 21 years and older more often involved slightly older adolescent victims. Independent of age, victims with offenders 21 and over compared with offenders under 21 were over six times as likely to have a prior history of a high, versus low, number of psychosocial problems and were seven times more likely to experience multiple forms of coercion versus no coercion by the offender. Findings suggest that statutory rape prevention, policy and response strategies should consider the critical ways that case characteristics and victims differ according to this key offender attribute.

Possible Factors Supporting Cross-Agency Collaboration in Child Abuse Cases: A Scoping Review.

Cross-agency collaboration for responding to child abuse cases is critical for the safety and wellbeing of children. However, working effectively across organizational boundaries can be difficult, especially where there are considerable disciplinary differences. Accordingly, many jurisdictions have put in place policies and processes to support cross-agency collaboration across groups responding to severe child abuse. The aim of this scoping review was to highlight key factors that may influence the quality of cross-agency collaboration in severe child abuse cases. A systematic search comprising 57 empirical studies examining the facilitators and/or barriers to cross-agency collaboration in child abuse cases was undertaken identifying eleven factors. This review found the most commonly cited factor was the need to reconcile the different roles/mandates of workers with their roles in a cross-agency response. A clear cross-agency protocol that establishes agreed procedures was also a commonly cited factor, along with cross-agency training, and communication and information sharing practices. This scoping review highlighted the lack of high-quality evidence that could be used to assess the effectiveness of policies and processes to support cross-agency collaboration for child abuse cases, and targeted areas for future research to enhance the quality of evidence for this common type of program/intervention.

CME in the Time of COVID-19: Educating Healthcare Professionals at the Point-of-care and Improving Performance Outcomes.

UpToDate® is a point-of-care clinical resource used by nearly 2 million clinicians worldwide. Users in the USA and other regions can obtain continuing education credits after researching clinical questions at the point-of-care. As part of the CME credit redemption process, participants provide feedback on the information researched during the UpToDate® learning activity. We examined the impact of UpToDate® searches on clinical decision-making related to COVID-19. Between January 1 and 31 August 2020, UpToDate® added more than 40 topic reviews on various aspects of COVID-19 diagnosis and management, and developed new methods for delivering COVID-19 content to our learners. During the observation period, participants accessed COVID-19-related topic reviews over 7.5 million times. Data collected from CME activity evaluations and user feedback suggested that the learning activity had a significant impact on clinical decision-making. Over 94% reported that they modified their management strategies as a result of using UpToDate®, and 97% reported that use of UpToDate® led to improvement in care. These findings support the benefit of self-directed, point-of-care learning activities on the clinical management of patients during a global pandemic.

Storytelling-Plots of resilience, learning, and discovery in emergency management.

Almost everyone can relate to the experience of telling a story. This article explores how storytelling is being used to identify risks and create hazard mitigation strategies, as well as how it can promote learning within the field of emergency management. Storytelling is both a pedagogical tool and an invaluable resource for practicing emergency managers. This article illustrates the ways in which the process of telling a story enables participates to talk about stressful concerns, internalize complex concepts, and even have fun. The article explores how storytelling drove the public process leading to the adoption of hazard mitigation plans, and how eight types of stories, as defined by the American humorist Kurt Vonnegut, can strengthen emergency management education. This article also explores how research suggests that storytelling can provide an effective way for both the tellers of story and their listeners to find meaning in events, provide context to what is being taught, transmit emotion along with information, develop a professional identity, build empathy and compassion, and help with remembering events and lessons learned. The authors have a long history of utilizing storytelling and present this article in order to share and explore storytelling as applied to the discipline of emergency management.

Using Telehealth for Pediatric, Adolescent, and Adult Sexual Assault Forensic Medical Examinations: An Integrative Review.

OBJECTIVE: Improved access to qualified nurse examiners to perform sexual assault forensic examinations is needed. This integrative review examines the current research literature on synchronous "real-time or live" telehealth support and guidance during pediatric, adolescent, and adult sexual abuse/assault forensic examinations. METHODS: Informational databases (CINAHL, Health Source: Nursing/Academic Edition, Medline, PsychInfo, and Violence & Abuse Abstracts) were searched, and research articles including live telehealth for sexual assault survivors were reviewed (n = 98). RESULTS: Review of the articles resulted in the inclusion of seven studies that utilized live video telehealth during the sexual assault forensic examination. CONCLUSION: The current research literature supports the premise that synchronous telehealth is a promising modality for this patient population. However, the lack of large comprehensive studies warrants additional research to understand outcomes and develop best practices. Additional research studies are needed to evaluate the effectiveness, cost, and criminal justice impact of this intervention.

Academic Correlates of Unwanted Sexual Contact, Intercourse, Stalking, and Intimate Partner Violence: An Understudied but Important Consequence for College Students.

Sexual assault, partner abuse, and stalking are major problems on college campuses. Past research has demonstrated a host of physiological and psychological outcomes associated with victimization; however, there has been little research conducted on the potential academic outcomes associated with victimization. The purpose of this study was to measure the relation between academic outcomes and experiences of sexual violence, intimate partner violence, and stalking victimization among college students. A sample of 6,482 undergraduate students currently enrolled at one of eight universities in New England was surveyed using items from the subscales of the College Persistence Questionnaire (Academic Efficacy, Collegiate Stress, Institutional Commitment, and Scholastic Conscientiousness). All four types of victimization were associated with significant differences on academic outcomes after controlling for sex and year in school, with victimized students reporting lower academic efficacy, higher college-related stress, lower institutional commitment, and lower scholastic conscientiousness. Polyvictimization was also significantly correlated with outcomes, with the greater number of types of victimization experienced by students being associated with more negative academic outcomes. Implications for future research and campus response were discussed.

Psychopathology among adult survivors of child pornography.

BACKGROUND: The majority of studies investigating child pornography have focused on conceptualizing the problem and the harm of the crime, evaluating the risk for child pornography offending, or discuss preventive measures. Little is known about survivors of this type of crime. OBJECTIVE: This research explores the relationship between child pornography victimization and psychopathology in adulthood. Specifically, we examined the contribution of emotional reactions at the time of the crime and shortly after (guilt, embarrassment and avoidance) on psychopathology among adult survivors of child pornography. PARTICIPANTS AND SETTING: The study was conducted among 107 child pornography adult survivors, aged 18-63 (M = 39.48, SD = 12.31). All participants were sexually molested during the crime. METHODS: An online survey was completed by a convenience sample of adult survivors of child pornography. RESULTS: Findings indicate survivor's current age predicted current psychopathology symptoms. Survivor's emotional reactions of guilt and embarrassment at the time of the crime and shortly after were significantly associated with elevated psychopathology, above and beyond demographic characteristics and features of the crime. CONCLUSIONS: The present results suggest the way survivors of child pornography react to the crime might shape their mental health in the long term.

Using Telehealth for Sexual Assault Forensic Examinations: A Process Evaluation of a National Pilot Project.

INTRODUCTION: This project describes the first time live sexual assault nurse examiner (SANE) services were provided via telehealth to support site clinicians conducting sexual assault forensic medical examinations for adult and adolescent patients. It involved six sites in three states, including rural, tribal, military, and community hospitals. The purpose of this process evaluation was to determine the extent to which patients consent to telehealth technology, examine how the technology worked, and explore the types of assistance. METHODS: We reviewed information for sexual assault patients who presented at emergency departments (N = 215) and conducted telephone and online surveys with 178 clinicians who provided or received telehealth services. RESULTS: Between May 1, 2015, and March 31, 2018, 129 patients and site clinicians received services via telehealth and an additional 86 site clinicians received consultation advice via telehealth. Most patients consented and accepted SANE services via telehealth (86% overall and 97% in non-U.S. Navy sites). No significant technology problems were experienced for most interactions (92%). The assistance provided remotely by SANEs to site clinicians included guiding clinicians through history taking and documentation, forensic examination and evidence collection techniques, identifying and documenting injuries, and guiding clinical practice. Site clinicians reported, on average, a positive impact of the assistance on their confidence in providing an effective examination, their ability to provide their patient with the best care, and their sense of feeling supported. IMPLICATION: Results of this pilot suggest that using live telehealth services for sexual assault forensic examinations is a promising practice.

Investigating Public Perception of Occupational Therapy: An Environmental Scan of Three Media Outlets.

Using a phenomenological approach, this study investigated visibility and perception of the profession of occupational therapy in three media outlets. Content analysis occurred on LexisNexis Academic (LNA), Google Images, and Twitter platforms. Analysis of LNA identified the prevalence of articles about occupational therapy in domestic newspapers and similar media avenues, MaxQDA qualitative software coded Google Images from a search on occupational therapy, and AnalyzeWords evaluated Twitter feeds of four health care professions for presence and tone in a social media context. Results indicate that although occupational therapy is 100 years old, its presence in news and online platforms could be stronger. This study suggests that a clear professional identity for occupational therapy practitioners must be strategically communicated through academic and social platforms. Such advocacy promotes the profession, meets the next iteration of occupational therapy's professional vision, and allows occupational therapy to remain a prominent and formidable stakeholder in today's health care marketplace.

The complex experience of child pornography survivors.

This research explores the complex experiences of survivors of child pornography production. The study was conducted among a convenience sample of child pornography adult survivors (N = 133), using an online survey which included a series of open-ended questions. Nearly half of respondents reported that they felt the production of sexual images caused specific problems that were different from the problems caused by other aspects of the abuse. Nearly half of the sample worried all the time that people would think they were willing participants or that people would recognize them, one-third refused to talk about the images and 22% denied there were images. The qualitative analysis identified three major themes which emerged from the survivor's perspective as adults: Guilt and shame, their ongoing vulnerability and an empowerment dimension the images sometimes brought. Recommendations for further research and additional implications are discussed.

Lessons Learned: Conducting Research With Victims Portrayed in Sexual Abuse Images and Their Parents.

Victims portrayed in sexual abuse images may be resistant to participate in research because of embarrassment or shame due to the sensitive nature and potential permanency of images. No studies we are aware of explore reactions to participating in research after this type of crime. Telephone interviews were conducted with convenience samples of parents ( n = 46) and adolescents who were victims of child sexual abuse ( n = 11; some of whom were portrayed in sexual abuse images), and online surveys were completed by adult survivors depicted in abuse images ( N = 133). The first lesson was that few agencies tracked this type of crime. This lack of tracking raises the question as to what types of data should be collected and tracked as part of an investigation. The second lesson was that few victims at the two participating agencies had been portrayed in sexual abuse images (4%-5%). The third lesson was that once possible cases were identified, we found relatively high percentages of consent to contact and interview completions. This implies that researchers and service providers should not be hesitant about conducting research after an investigation of child sexual abuse. The fourth lesson was that the vast majority of participants reported not being upset by the questions. We hope that the data presented here will encourage agencies to reconsider the types of data being tracked and will encourage researchers to conduct in-depth research with populations that are often difficult to reach to continue improving the professional response to child victimization.

Sextortion of Minors: Characteristics and Dynamics.

PURPOSE: Sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors) has been identified as an emerging online threat to youth, but research is scarce. We describe sextortion incidents from a large sample of victims (n = 1,385) and examine whether incidents occurring to minors (n = 572) are more or less serious than those experienced by young adults (n = 813). METHODS: We ran advertising campaigns on Facebook to recruit victims of sextortion, ages 18-25, for an online survey. We use cross tabulations and logistic regression to analyze incidents that began when 18- and 19-year-old respondents were minors (ages 17 and younger) and compare them with incidents that began at ages 18-25 years. Most minor victims were female (91%) and aged 16 or 17 when incidents started (75%). RESULTS: Almost 60% of respondents who were minors when sextortion occurred knew perpetrators in person, often as romantic partners. Most knowingly provided images to perpetrators (75%), but also felt pressured to do so (67%). About one-third were threatened with physical assaults and menaced for >6 months. Half did not disclose incidents, and few reported to police or websites. Perpetrators against minors (vs. adults) were more likely to pressure victims into producing initial sexual images, demand additional images, threaten victims for >6 months, and urge victims to harm themselves. CONCLUSIONS: Sextortion incidents were serious victimizations, and often co-occurred with teen dating violence. We describe resources so that practitioners can help victims find support and legal advice and remove posted images.

A national survey of characteristics of child advocacy centers in the United States: Do the flagship models match those in broader practice?

Child Advocacy Centers (CAC) emphasize developing effective cross-agency collaborations between workers involved in serious abuse investigations to foster improvements in agency outcomes, and to minimize distress, confusion and uncertainty for children and families. This study examined the characteristics of CACs, whether models in practice match the predominant model presented in the research literature. Directors of CACs in the United States that were members of the National Children's Alliance (NCA) mailing list (n=361) completed an online survey in 2016. While some core characteristics were ubiquitous across CACs, the data suggests that different types of CACs exist defined by characteristics that are not prescribed under NCA principles, but which are arguably relevant to the quality of the response. From the results of a cluster analysis, the researchers propose a typology of CACs that reflects the development and integration of centers: (a) core CAC services (i.e. interviewing & cross-agency case review); (b) an aggregator of external services, and (c) a more centralized full-service CAC. Further research is needed to understand how these variations may impact practice and outcomes; this is particularly important considering many CACs do not match the full-service models most commonly examined in the research literature, which limits the degree to which these findings apply to CACs generally. This article proposes further research framed by the need to better understand how different parts of the response impact on outcomes for children and families affected by abuse.