DDES INFO MEMO 2004-03
Acrobat version of DDES
Info Memo 2004-03
Background Information on the Sexual Abuse Response
Developed by the Sexual Assault/Domestic Violence
Industry Training Advisory Group
Wisconsin Department of Health and Family Services
The Department of Health and Family Services (DHS
) works to improve
communication through the development of protocols ensuring systems
collaboration and training on documentation of critical information. By
facilitating the exchange of information, we can make better choices
about what services are appropriate when remedying situations of abuse,
neglect and exploitation.
The Sexual Abuse Response Protocol (see next three pages) developed
by the Departmentís Sexual Assault/Domestic Violence Industry Training
Advisory Group is an example of efforts to improve communication. The
Training Advisory Group, serving in an ad hoc capacity, was convened for
the first time on November 29, 2001. The group, comprised of long term
care providers, regulators, law enforcement, sexual assault and domestic
violence advocates, experts in cognitive impairments and members of the
state ombudsman program, met monthly through spring 2002. The group goal
was development of training on sexual assault and domestic violence for
the Long Term Care Industry and Elder Abuse/Adult Protective Services
Programs. The training programs were designed to provide needed
information, skills and resources for staff of Wisconsin nursing homes,
community-based residential facilities, adult family homes, and
residential care apartment complexes on responding to or investigating
allegations of abuse or neglect. Included forms of abuse are sexual
assault and physical violence of residents by others (such as family
members, visitors) within those facilities.
The training was initially piloted in February 2002 at a DHS
sponsored training for staff from the Departmentís Bureau of Quality
Assurance (BQA), the Board on Aging and Long Term Care (Ombudsman
program) and interested others. Trainers included a police detective, a
Sexual Assault Nurse Examiner (SANE), both a sexual assault and domestic
violence advocate and attorneys from the state Departments of Justice
and Health and Family Services. In August 2003, DHS
on the protocol to long term care providers representing facilities from
throughout the state. The protocol has been adapted by the Wisconsin
Coalition Against Sexual Assault (WCASA) for inclusion in a manual
developed for law enforcement, victim advocates and elder abuse
interdisciplinary teams on how to properly respond to domestic violence
and sexual assault, including incidents occurring in facility settings.
Training on the manual was provided by WCASA to the target audiences in
six regions of the state during the spring of 2004. The Department will
incorporate the protocol in future training of staff from BQA, the
Ombudsman program and long term care facilities. The Department will
also provide technical assistance to facilities working to incorporate
the protocol as part of the entityís internal policies and procedures.
For additional information about the Sexual Abuse Response Protocol,
please contact DHS
employees Linda Dawson or Jane Raymond. Linda is the
Departmentís Deputy Chief Legal Counsel and may be reached via email
or by phone at (608) 266-0355. Jane is the Departmentís
Elder Abuse Specialist and may be reached via email at email@example.com
or by phone at (608) 266-2568.
Background on protocol development provided by J.
Raymond, May 17, 2004
Suggested Sexual Abuse Response Protocol
Developed by the SA/DV Industry Training
Wisconsin Department of Health and Family
- ENSURE VICTIMíS PHYSICAL AND EMOTIONAL SAFETY
- Develop systems that avoid victim re-traumatization.
- Ensure that facility staff responding to a reported sexual
assault incident are trained to sensitively and appropriately
handle any report.
- Ensure throughout the entire process the thorough and
accurate documentation of information, observations and
- Ensure that records and any physical evidence are collected,
preserved and protected.
- Provide assistance and support to all victims and hold
abusers accountable by conducting adequate and complete
STEP 1: Facility designates a resident contact person to
respond to victim needs.
- The facility administrator must designate a resident contact
- The contact person must have specialized training in
responding to disclosures of sexual assault and in assessing
the primary emotional and physical safety needs of a victim.
- If the designated contact person is not a facility employee,
a Memorandum of Understanding (MOU) must be developed with the
individual or outside agency that agrees to serve as the first
point of contact for a resident victim.
- Possible appropriate contact persons include: Facility
Administrator, Director of Nursing (DON), Elder Abuse
Coordinator, Social Worker, Sexual Assault Service Provider (SASP),
or Community Advocate.
STEP 2: Facility becomes aware of a suspected sexual assault
that involves a resident.
- A sexual assault incident including physical or emotional
harm or exploitation may be disclosed by a victim, observed by
staff or another, or may be suspected.
- Determine whether sexual assault is current (that is, within
past 28 days).
- Reasons to suspect assaultive behavior include a change in
the victimís demeanor or condition, evidence of physical
trauma that is consistent with sexual assault, the existence
of other medical or physical evidence that may suggest sexual
assault, or there are injuries of unknown origin, and an
assessed possible cause includes sexual assault.
- If current, Sexual Assault Nurse Examiner (SANE)
examination may be able to collect forensic evidence; or other
physical evidence may be collected, preserved and protected.
- If not current, the facilityís actions in the
following steps may be modified, as appropriate, considering
reported assault occurred.
STEP 3: Victim is contacted.
- Regardless of the source of information, when there is a
report of an assault or when there is reason to suspect sexual
assault has occurred, the person designated by the facility
should contact the victim as soon as possible but within 24
hours to assess the immediate emotional and physical safety
needs of the victim.
- Victim safety needs must take into consideration whether the
assault is current and if a medical assessment is needed and
wanted by the victim.
- Further assessment should include what, if any, steps are
necessary to protect the victim from further trauma or harm.
STEP 4: Available internal and external resources are
contacted and made available to the victim and facility, as
- Facility social workers, mental health support persons,
community advocates (domestic violence or sexual assault),
sexual assault nurse examiners (SANE), law enforcement, adult
protective services (APS) and lead elder abuse agency workers,
regional ombudsmen and staff from the Bureau of Quality
Assurance (BQA) may serve as resources or otherwise provide
services or consultation to the facility and the victim.
- If the victim is competent or is capable of
- Does the victim desire support services such as advocacy,
counseling about options or specialized therapy? Does the
victim wish the facility to contact providers of those
- Does the victim wish the facility to contact law
- Does the victim desire to have a medical examination?
- Does the victim want any other persons notified, such as
persons within the family or close friends?
- If the victim has a guardian or is not capable of
- Has the guardian been notified, if not the suspected
- If appropriate, have all possible services, including
reporting to law enforcement, been discussed and offered to
the guardian on behalf of the victim? (See above for possible
resources and services.)
- What services does the guardian consent to? Follow up in
securing any services consented to by the guardian.
- If the person does not appear able to self-determine next
steps, does not have a guardian and the situation is not
life threatening, determine whether the person is competent or
in need of a guardian. You may wish to consult with your
county APS agency for advice on determining competency.
- If the person is not capable of self-determination, does not
have a guardian and the situation is life threatening,
obtain emergency medical care. If the individual is determined
incompetent by a physician, seek appropriate legal authority
(e.g., temporary guardianship or a court order) in order to
provide necessary services. The county APS agency can assist
in determining legal issues and ways to obtain needed
protections. Then proceed as follows.
- Assess the risk of continuing harm to the victim or
- If the victim is competent or capable of self-determination
AND there is no risk of further harm to the victim or others,
then the facility should follow the victimís wishes and
- If the victim or other clients or residents are at risk of
physical, emotional or financial harm (including death) by the
suspected perpetrator(s), then the facility should report the
alleged incident to law enforcement.
- It is recommended as a best practice, that facilities
provide notice of their reporting policies to all residents
STEP 5: The investigation continues.
- An investigation may be by law enforcement, the facility,
APS or any others responsible for such an investigation.
STEP 6: Aftercare or follow up.
- The facility should assess the after-care needs or wishes
for support services of the victim and the victimís family.
- The facility should evaluate their own internal intervention
processes of the case and determine whether gaps occurred or
where the process worked efficiently and make revisions as
- This may include providing information and referral,
medical, psychological or emotional care or other care.
- Consideration should be given to prevention strategies as
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