Sexual assault forensic services initiative: Eloise House program evaluation  (2018)

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In Texas only 9.2 percent of sexual assault survivors report their crime to law enforcement, 6.4 percent seek medical care, and 3.5 percent have a forensic examination. As a result, most survivors’ short-and-long term physical and mental health needs often go unmet, sometimes for years or decades. Sexual assault survivors are an under served and vulnerable population and may not access hospital services at all because of cost, health insurance status, or fear of insensitive responses from medical providers. Potential health  consequences  of  sexual  assault  victimization include acute injuries, like broken bones and strangulation injuries, as well as pregnancy, sexually transmitted infections,   gastrointestinal   disorders, migraines and headaches, chronic pain, depression,  anxiety, post-traumatic  stress  disorder,  eating  disorder,  sleep disorder,  suicidal  ideation,  and  substance  abuse; this strongly  indicates  the  need  for  immediate health care following an assault. Access to health care services after a sexual assault is limited and  often  prohibited  by  cost,  geographic  inaccessibility,  and  other  service  barriers. Medical forensic exams are typically provided in a hospital setting, which may result in additional costs, and long wait  times. Further, the  variation  in  quality  and  sensitivity  of   services  provided  has  been  well documented.

Eloise House, in Austin, Texas, is an innovative medical program created and administered by SAFE Alliance. SAFE Alliance is a non-profit organization with a vision of a just and safe community free from violence and abuse and a mission to lead in ending sexual assault and exploitation, child abuse and domestic violence. SAFE Alliance provides a broad range of survivor-centered services, including prevention, intervention, and advocacy for change. The goal of Eloise House is to increase medical access and decision-making for sexual assault survivors by providing forensic services administered by Sexual Assault Nurse Examiners (SANEs) in the community. These services are important because survivors may not want to report right away or may not initially want a SAFE at all. Survivors’ needs may change over time and the SANEs at Eloise House are able to meet them where they are and provide some continuity of care (follow-up) in regards to the survivor’s decision. SANEs provide important health care services including the coordination of assessment and treatment for injuries, sexually transmitted infections, pregnancy, and referrals for other concerns including mental health and substance abuse. SANEs also perform sexual assault medical forensic examinations to collect evidence for potential legal action against offenders. Eloise House is one of only a few community-based clinics in the US providing forensic exams and free comprehensive medical care to adult and adolescent sexual assault survivors.

Noël Busch-Armendariz of the Institute on Domestic Violence & Sexual Assault will lead an empirically-based, 12-month process evaluation project of Eloise House. The project will investigate the process of development and implementation of Eloise House, establish criteria to assess program fidelity, and enhance systems to monitor survivor access to and satisfaction with Eloise House services. The ultimate goal of the project is to create an evaluation guide that can be utilized by both Eloise House and other community-based SANE programs in the future.

Evaluation activities will include secondary data analysis and data collection with sexual assault survivors, SAFE staff, and multidisciplinary professionals within Austin, Travis County, and Central Texas to examine survivor access and trends in service provision.

The project deliverables will include an evaluation guide that will be available for community-based SANE programs to assess their efficacy and functioning. Eloise House will be evaluated using the evaluation guide.