8 minute read
The ever expanding hope for Center of Hope
BY GREG LINDBERG
PHOTO BY CHRISTINE PETKOV
Center of Hope is a program that provides a space for sexual assault victims through safe and secure processes administered by a certified Sexual Assault Nurse Examiner (SANE), also known as a forensic nurse. Center of Hope is available in Greater Lafayette through IU Health Arnett and Franciscan Health and has expanded to surrounding hospitals, including IU Health Frankfort and IU Health White Memorial.
Center of Hope was established at IU Health Methodist and other hospitals in Indiana with the recognition of the need for full-time forensic nurses who can appropriately and professionally assist victims with medical care, mental health assistance and more. IU Health Methodist, Riley Children’s Hospital and IU Ball Memorial have staffed Centers of Hope that began as on-call programs.
The shortage of forensic nurses was made apparent to IU Health, and it immediately emphasized the importance of raising awareness and supporting the center through donations. Though the program has spread throughout the state, the success of having available trained forensic nurses has been met with the need for services in other locations and encouragement to crime victims to reach out for guidance. Recognizing the need, the IU Health Foundation quickly stepped in to provide funding.
The funding provided by the foundation and the Indiana Criminal Justice Institute (VOCA Grant) made it possible to establish IU Health’s first Center of Hope in the West Central Region at IU Health Arnett Hospital in 2018. With the support and help of the IU Foundation, the Center of Hope was able to expand to IU Health White and Frankfort in 2020, allowing forensic nurses to provide care at all of the locations so that patients are not required to travel.
According to Megan Shupe, MSN, RN, CEN, SANE-A, “Center of Hope is a broad term used by many organizations that offer services to victims of crime in terms of the medical forensic programs.” This includes programs based in hospitals or community locations with trained forensic nurses who provide the medical legal exams to victims of crime.
Shupe came to IU Health Arnett in 2012 and recognized forensic nurse services were not available. She quickly inquired how she could bring Center of Hope services to the region. It took time for Shupe to share her mission to the top of the chain at IU Health Arnett, but she stayed vigilant.
“I was lucky to be a part of an interview for a director position in the emergency department where they were bringing on some new people. So, several years back, I asked some questions to the candidates in the interview, and I chose my vote based on the person that was going to support my mission. So, when he was appointed, he got me in front of the executive leadership team,” Shupe says.
“Within two weeks of his start date, I presented the idea to them, and it was a unanimous yes. So they were never saying no. They weren’t being asked appropriately, or they didn’t know what they were saying no to before. But once they had the information, it was absolutely that we needed to do this. And so we moved forward, and we started at IU Health Arnett where we have gotten a lot of grant funds from various sources over the years.”
Shupe next tackled funding, and the VOCA Grant and the IU Health Foundation have provided more than $800,000 in funding since 2018. IU Health Foundation funding is made possible through donations, and those donations made it possible to expand services to two critical access hospitals at IU Health White Memorial in White County and IU Health Frankfort in Clinton County. This change allowed for dedicated space for equipment, so a patient doesn’t have to be transferred to a single location.
Shupe says her mission has always been to do better, and even though Center of Hope services have expanded, there still is a lot of work due to the state and national shortage of forensic nurses. She says a major part of the issue is that the program typically demands forensic nurses to be on call.
To help address the problems with the current model — and the burnout inherent in an on-call model — Shupe has been advocating for full-time positions. Due to budget constraints and other issues, Shupe has worked hard for compromises, such as two newly added full-time forensic nurse positions in the emergency department. These nurses can make victims of crime their full patients of priority.
Elaborating on Center of Hope services, Shupe says, “Our primary patient population is sexual assault and domestic violence, child abuse, elder abuse or neglect, maltreatment, all of those things (including) human trafficking. We can provide medical legal exams to any patient who has been a victim of crime, including injuries from impaired driving, stabbings, gunshot wounds, etc.”
Shupe’s primary goal for victims of crime is the immediate vetting, with the hope that in triage patients would be placed in a room with a space for them to have privacy to talk about what has happened to them. Through her years of experience running Center of Hope programs, Shupe understands every patient may have different primary concerns, which can include infections, injuries, safety, and the forensic portion of the exam that includes photographs, body mapping, and swab collection for potential DNA. The goal is to provide comprehensive care based on each individual patient’s needs and concerns.
Shupe explains that at discharge a patient is given a resource folder that contains information about local, state and national resources that a patient may need or choose to utilize at some point after their discharge.
“We review the contents prior to discharge and make notes along the way to assist patients in remembering what each resource may be able to assist them with. We spend a lot of time educating patients about safety, follow-up and how to access resources should their needs change after discharge.”
Center of Hope data show that 138 sexual assault victims were cared for in 2018. Numbers have not consistently increased, in part due to a decline in reporting in 2020-2021 due to COVID and a decrease in reporting of crimes to law enforcement. Sources report many different reasons for the decrease in reporting; fear of not being believed and lack of prosecution are common reasons.
Shupe has been working with sexual response teams, community events, and other partners to help spread the word about Center of Hope services and also allow people to feel more empowered to tell their story and come forward to report what has happened. Shupe includes, “The barriers that victims face when they chose to report crimes, the response or lack of response or resources are the things that we hope to change through our work on Sexual Assault Response Teams and community outreach events.”
Even with these efforts, there still are large gaps throughout the state when it comes to access to services. Shupe shares as example, “I had a homeless shelter worker call me from Kokomo, Indiana, and she had been working two hours on finding a place to send somebody who had presented to their shelter, who was in need of an acute exam.
“We obviously accepted that patient and she came to us, but two hours of phone calls to find what you need is heartbreaking.”
Helping to eliminate access issues like this, Shupe hosts a callout about six times in an effort to recruit new forensic nurses who are well-informed of the education requirements and the level of commitment necessary to be successful. ★
Forensic nurse requirements:
Trained in adult, adolescent and pediatrics including two didactic courses, 40 hours each
15 hours on intimate partner violence training
Clinical hours for each of those patient populations to become competent providers
A new forensic nurse will complete 150 to 300 hours of additional training. Once they have been practicing independently for at least two years, they can sit for a professional certification exam, such as, SANE-A or SANE-P, which is similar to other professional certifications and sets those nurses apart as the “cream of the crop” and as true experts in their area of expertise. A professional certification is not required to practice as a forensic nurse.
Responsibilities for forensic nursing include providing trauma-informed care, performing medical-legal examinations, performing photo-documentation of injuries, providing preventative treatment for pregnancy and STIs, and providing extensive education before discharge. Other duties include creating safety plans, serving as an expert witness in legal hearings, participating in board and council meetings, and providing prevention education through community outreach.
More information regarding the IU Health Foundation and the Center of Hope can be found at iuhealth.org.
