PROJECT 2: Penn State University's Translational Center for Child Maltreatment Studies (TCCMS)

PROJECT 2: ABSTRACT Survivors of sexual abuse/assault (SA) require timely, skilled, trauma-informed health care to address injuries, risk of infection/pregnancy, forensic evidence collection to aid justice outcomes, and to provide psychological support essential to healing. SA trauma can have devastating impacts on individual health and poses great costs to society. Adolescents are particularly vulnerable to SA victimization due to their developmental stage. Therefore, it is essential that adolescents who experience SA have access to specialized compassionate, trauma-informed health and forensic care to mitigate trauma and that promotes healing and justice. Due to a national shortage of forensic health care specialists, great disparities exist in individuals’ access to quality SA care. The Sexual Assault Forensic Examination Telehealth (SAFE-T) program aims to decrease disparities by providing expert sexual assault nurse examiner (teleSANE) care to rural and underserved hospitals through telehealth technology. TeleSANEs provide 24/7 support to local nurses and patients during SA exams, ensuring best practices, proper evidence collection, and a supportive experience exists for the patient. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Adolescent Evaluation is a multi-site (rural and urban) study designed to evaluate the impact of the SAFE-T model on adolescent care quality, healthcare and advocacy service utilization, health and well-being, and prosecutorial decision-making. Using a pre-post implementation design, we will prospectively gather data from 176 adolescents who receive SA care from our 8 established partner hospitals and compare SAFE-T (n=117) to usual care (UC; n=59) prior to SAFE-T implementation. Additional interdisciplinary community data will provide key information for this evaluation. The aims of this evaluation will: 1) Test SAFE-T vs. UC differences in forensic SA care quality by assessing survivor experience of care and through independent expert review of examination evidence and documentation; 2) Examine group differences in short and long-term health and well-being outcomes such as PTSD, school/work engagement, health care and advocacy service utilization, risk-taking, and coping; 3) Examine pre- and post-SAFE-T group differences in prosecutorial decision-making and case progression by interviewing district attorneys about key elements (i.e. survivor participation in seeking justice outcomes, quality and availability of forensic evidence) that influence decision-making; and 4) Conduct an economic cost- benefit analysis (CBA) of the SAFE-T model implementation using high quality, interdisciplinary data, monetization of study outcomes (e.g., health and mental healthcare utilization, program cost-benefit, retention of SANEs, survivor engagement in school/work), and efficiency/effectiveness of justice processes. This represents the most comprehensive evaluation of telehealth to improve SA access and quality of care for adolescents. The findings will elucidate the influence of forensic SA telehealth consultation on care quality, health and well-being, and resolution of trauma to support a healthy transition to adulthood.