Hope G. Miller BSN RN CA-CP SANE Sierra Medical Center University Medical Center of El Paso SANE What is a SANE and How the Medical Forensic Sexual Assault Exam Can Aid in Recovery and Mental Health “But He’s My Boyfriend” How Coercion and Manipulation Can Lead to Human Trafficking FYI…. As many as 2.8 million children run away each year in the US. Within 48 hours of hitting the streets, one third of these children are lured or recruited into the underground world of prostitution and pornography. The National Center for Missing and Exploited Children The average number of victims for non-incestuous pedophiles who molest girls is 20, for pedophiles who prefer boys 100. The Association For the Treatment of Sexual Abusers (ATSA) An average serial child molester may have as many as 400 victims in his lifetime. Child Sexual Abuse Prevention Study Child pornography is one of the fastest growing crimes in the US right now. Nationally, there has been a 2500% increase in arrests in 10 years. FBI What is a SANE? (Texas) A Sexual Assault Nurse Examiner is a registered nurse who has been specially trained to provide comprehensive care to sexual assault patients, who demonstrates competency in conducting a medical forensic exam and has the ability to be an expert witness Certified through the Texas Office of Attorney General to conduct exams on Adult, Adolescent and Pediatric patients – recertify every 2 years Acute exams within 96 hours of assault/abuse Exception would be if the patient has been sequestered Medical ALWAYS comes before forensic – a patient’s life is more important than “evidence” What is a Medical Forensic Exam? Four parts to a medical forensic sexual assault exam History of Assault Head to Toe Assessment Detailed Ano-Genital Exam Evidence Collection The medical forensic exam is not considered an emergent or life saving procedure The patient must provide informed consent for an exam to be conducted To force an exam on an non-consenting patient – even a minor – would be to assault them again How Can Having an Exam Help? It gives the patient an opportunity to have their story documented in their own words Exception to Hearsay Rule – Medical diagnosis and treatment It gives the patient peace of mind to know that their body is okay It is normal for an adolescent/adult female to not have genital injuries due to having an estrogenized hymen If there are injuries they usually will be minor and not need intervention and will heal on their own It gives them the opportunity to be given pregnancy and STI prophylaxis that day and also for future serial STI testing It can help to start the healing and recovery process The exam is patient centered and patient driven – we do not do anything that they do not want to do As an active participant in the exam they do not feel like a victim because they are in control of what happens to their body How Can Having an Exam Help? Assurance and verbal reinforcement that what happened to them was not their fault – no matter the circumstances They will be connected to a local rape crisis advocate while at the hospital (STARS – Sexual Trauma and Assault Response Services) The advocate will serve as a support person for the patient both during their visit and thereafter and can connect them to many services as well as helping them to apply for crime victims compensation The SANE should not have contact with the patient after the exam There is the possibility of collecting DNA or other evidence in the kit that could help the case Known and Unknown Assailant – CODIS (DNA database) It is important to understand that the medical forensic sexual assault examination is the beginning of the process and is only one piece of the puzzle – no “evidence” does not mean there is not a case What Can YOU Do? Rape/Sexual Assault is the only crime in the United States that is perpetually blamed on the victim Rape Culture - a concept where rape is pervasive and normalized due to societal attitudes about gender and sexuality When a person tells you that they have been raped, sexually assaulted or sexually abused – no matter if it happened yesterday or 20 years ago….. Listen Believe Help What is Human Trafficking? A form of modern day slavery/involuntary servitude Adults and Children – Men and Women Rural, Suburban, Urban, Local and International – Worldwide Sex Trafficking, Child Pornography Labor Trafficking: Nanny’s, Maids, Sweatshop Workers, Janitors, Restaurant Workers, Migrant Farm Workers, Fishery Workers, Hotel and Tourist Industry Workers, Beggars… Debt Bondage – Working Off a Debt How is a Person Trafficked? Force – physical restraint or physical harm: violence, rape, beatings, physical confinement may be used to break down victim’s resistance Fraud – False promises re: employment, wages, working conditions. Better life, marriage, fame and fortune Coercion – Threat of serious harm to them or loved ones, physical restraint or threat of abuse of the legal process These only apply if the person being trafficked is an adult When an individual under the age of 18 provides sexual services in exchange for anything of value, human trafficking has occurred regardless of whether force, fraud or coercion were used. Trafficking Versus Smuggling Trafficking: Force, fraud or coercion is used – victim may have offered consent initially but was then exploited by trafficker Human trafficking is a crime committed against an individual A person does not need to be moved physically to be a victim of human trafficking Smuggling: Consent is given by individual Crime is against a country and its borders Illegal transport across transnational border Human Trafficking Statistics Estimated 27 million victims worldwide – more than any other time in history Yearly profits generated by human trafficking worldwide = 32 Billion. Unlike drugs - victims can be “sold” again and again. More than 70% of victims are female and half are children/adolescents Up to 800,000 persons are trafficked each year across international borders – 20% of those people pass through Texas = 160,000 year Texas OAG estimates that one out of every 5 human trafficking victims travels through Texas – major destination and transit state Interstates, US/Mexico Border, Fort Bliss Child/Adolescent Statistics In the US: 300,000 children/adolescents are at risk each year for sexual exploitation – at least 100,000 of them are being used for prostitution Average age of child/adolescent entering prostitution = 12 to 14 years old Life expectancy of child/adolescent exploited for prostitution = 7 years Only 1% of child victims are rescued These numbers are probably lower than actual fact Prostitution Versus Trafficking Trafficking may be hard to prove or prosecute if the victim is legally old enough to provide consent for sex A victim who is underage cannot legally provide consent for sex (even if they say it was consensual) There is no such thing as a child (adolescent) prostitute – there is only prostitution of a child which is trafficking and always against the law Victims can be difficult to identify – 43% of reported HT cases investigated by LE occurred in private residences. Understanding, preventing and identifying victims will require that people change the way they view the crime The best way to prevent, identify and rescue is through awareness and education Who is at Risk? Human trafficking, like sexual abuse knows no socioeconomic boundaries Persons who have been sexually abused are more likely to be targeted Sexual abuse and Interpersonal Violence (DV) are huge push factors for human trafficking Persons who tend to be on the periphery of society Foster Home Runaways/Throwaways Developmentally Disabled Psychological Illness Adolescents and Risks Adolescents are more at risk due to several factors: Identity vs. Confusion (Erickson’s Psychosocial Stages): Trying to find out who they are and where they fit in Tend to be risk takers Focused on peers – less parental interaction, supervision Lack the knowledge and judgment skills that come with age and experience – If it seems too good to be true, it probably is! Traffickers will frequent places where adolescents go without supervision Mall Social Media American Adolescents & HT Adolescent girls are especially at risk for being drawn in by a male who will pretend to be their boyfriend (Romeo pimp) and then use coercion and manipulation to exploit the relationship for their personal and financial gain o “Love addiction” – they may view their trafficker/pimp as their boyfriend and/or their protector, “Baby daddy” o Trauma Bonding, Stockholm Syndrome – “brainwashing” Traffickers/Pimps are master manipulators Maslow’s Hierarchy of Needs (for pimps) A large percentage do not see themselves as victims and believe that they are there by choice Adolescent Mental Health Victims may be subjected to physical, sexual and psychological abuse – they could require multiple services depending on the length of time and severity of abuse they have endured Safety, Shelter, Basic Necessities Counseling – Months or Years Medical Care – Possibly Extensive Legal Services Transitional and/or Long Term Housing Advocacy Education Financial Assistance Job Skills/Job Training Life Skills Training Child Care Translation Services Etc. Identifying Traffickers/Pimps Warning Signs – If 3 or more apply to a relationship = Red Flag Fancy Cars, Clothes or Jewelry Frequently spends nights away or out of town Acts out the hip hop or gang/pimp culture Claims to own a business or has a job that you cannot visit He has dreams of making it big and being successful – he will encourage her to become part of HIS dream Her dreams and goals for life will be put on hold for his He pulls her in and everything becomes “we” in her conversation – when a person internalizes a dream they will work harder to achieve it Secludes her from family and friends by moving her away Attempts to fast track the relationship – moving away and talking of marriage within a short time frame Decreasing healthy relationships with others – her circle becomes smaller and smaller Gets to know HER dreams and goals and dangles them like a carrot inevitably Carries multiple cell phones Identifying Victims Tired during the day from working all night Suddenly has expensive things – high end name brand purse, diamond bracelet, name brand clothes or nails and hair done on a regular basis Increasingly interested in or talks a lot about his dream – “we’re going to….” Older boyfriend, usually one not in school Morals and values have slowly expanded New tattoo, barcodes or branding of initials – his name, “Daddy” or saying showing ownership “property of” Carries multiple cell phones Keeps eyes down while in public, avoids eye contact Starts to become secluded – you see her less and less Signs of physical abuse Submissive or appears fearful, anxious or nervous Screening Questions Have you ever exchanged sex for food, shelter, drugs or money? Have you ever been forced or asked to have sex against your will? Have you been asked to have sex with multiple partners? Do you have to meet a quota of money before you can go home? Have you or a family member been threatened in any way? What are your working and living conditions like? Can you come and go as you please? What Can You Do? It is only through education and awareness that human trafficking may be prevented It is also through education and awareness that victims may be identified and rescued – they are “hiding” in plain sight Educate yourselves and your peers/colleagues about human trafficking and help spread awareness If you are in a position to do so – ask questions Use extreme caution Do not confront a pimp/trafficker Do not try to rescue a victim You may need to involve security or call 911 If the person is under 18 and you suspect they are being abused or trafficked you do not need the patient’s permission to report it or to call law enforcement – you must move to protect them - the burden of proof is not ours Rebecca Bender – Survivor Rebecca Bender.mp4 National Human Trafficking Resource Center 1.888.3737.888 www.acf.hhs.gov/trafficking 24/7/365 170 Languages Thank You! Questions?