# Presentation: 329163

## SART on the Reservation

- A Cultural Perspective to Program Development
- Karen Cook, RN, FNP
- Northern Navajo Medical Center

## Program development began with a $100,000. Grant from the Department of Justice, Office for Victims of Crime to establish 1 of 2 SANE pilot programs on Indian Country.

First priority – seek support for program from Medical and Nursing staff.

Identified core group of professionals committed in becoming SANE providers, nursing support services, victims advocates.

Approach local law enforcement for support.
Establish SART team by inviting tribal, federal law enforcement, local women’s shelter, tribal prosecutors office and U.S. Attorney’s office to participate. 

- First priority – seek support for program from Medical and Nursing staff.
- Identified core group of professionals committed in becoming SANE providers, nursing support services, victims advocates.
- Approach local law enforcement for support.
- Establish SART team by inviting tribal, federal law enforcement, local women’s shelter, tribal prosecutors office and U.S. Attorney’s office to participate.

**NORTHERN NAVAJO SEXUAL ASSAULT PROGRAM**

- SART on the Reservation- a cultural perspective to program development

## NEEDS ASSESSMENT

- American Indians have a rape/sexual assault victimization rate three times that found among the general population age 12 or older in the United States.

- SART on the Reservation- a cultural perspective to program development

## NEEDS ASSESSMENT

- All sexual assault exams performed in the ED
- Exams done by NNMC staff – if ED provider locums MD– OB/GYN MD or Family Medicine MD called in
- Most ED nurses and MDs not trained how to collect, dry and assemble kits

- SART on the Reservation- a cultural perspective to program development

## NEEDS ASSESSMENT – CON’T

- Sexual assault victims often have long wait.
- Concern for underreporting in all areas identified above.
- Recognition that a formalized SANE/SART program will see increased numbers as a result of quality, confidentiality, and culturally sensitive care.

- SART on the Reservation- a cultural perspective to program development

## NORTHERN NAVAJO SART PROGRAMRESOURCES

- STRENGTHS IDENTIFIED
- Support from Leadership Advisory Council, CEO, Clinical Director, Medical and Nursing staff.
- Multidisciplinary child protection team in place in which to model SART after
- Hospital infrastructure of medical records, paging system, and primary care and mental health clinics to provide follow-up services will support mission statement of SANE program.
- Cooperation from local and federal law enforcement.
- Cooperation from women’s shelter and domestic violence task force.

- SART on the Reservation- a cultural perspective to program development

## RESOURCES

- SANE Guidelines and Program Development published by the DOJ
- Albuquerque SANE Collaborative
- Community Readiness Assessment Tool
- Supportive and Enthusiastic Staff

- SART on the Reservation- a cultural perspective to program development

## PROJECT GOALS

- To provide timely, thorough, and professional forensic evidence collection, documentation, and preservation of evidence for sexual assault victims in an effort to reduce trauma through the use of appropriately trained sexual assault nurse examiners who can refer these victims for immediate and follow-up medical care counseling.

- SART on the Reservation- a cultural perspective to program development

## PROJECT GOALS

- To enhance the ability of law enforcement agencies to obtain evidence that will aid in the successful prosecution of sexual assault cases.
- To develop community-based, multi-disciplinary Sexual Assault Response team.
- To provide training and technical assistance for I.H.S. RN’s to become SANE’s

- SART on the Reservation- a cultural perspective to program development

## PROJECT GOALS

- To provide training and technical assistance for law enforcement, prosecutors, and medical personnel to become effective members of SART’s
- To function as demonstration project for other tribal communities who may wish to replicate SANE/SART

- SART on the Reservation- a cultural perspective to program development

## PROJECT GOALS

- To explore the unique need in Indian communities to have SANE’s who are trained to work with both adults and children

- SART on the Reservation- a cultural perspective to program development

## WHO ARE THE NAVAJO PEOPLE

- Not all Native Americans are the same
- Defined by their:
- 	History
- 	Demographics

- SART on the Reservation- a cultural perspective to program development

## DEMOGRAPHICS

- Size of reservation
- Distribution of population
- Economics of the reservation
- Quality of the roads
- Lack of transportation
- communication

- SART on the Reservation- a cultural perspective to program development

## DEMOGRAPHICS

- Shiprock Service Unit represents the Northeastern area of the Navajo reservation.  The Indian Health Service is divided into a National network, which is then subdivided into Service units.
- The Shiprock Service Unit services a population of 55,000 Navajo people.

- SART on the Reservation- a cultural perspective to program development

## GOVERNMENT

- Sovereign nation
- Democratic society
- 	Navajo Council is the chief governing authority
- President/Vice President elected every 4 years
- Elected Counsel members
- Local Chapter houses

- SART on the Reservation- a cultural perspective to program development

## Language

- Written
- Oral tradition
- Passed down from elders to children

- SART on the Reservation- a cultural perspective to program development

## CLAN SYSTEM

- Establishes identity

- SART on the Reservation- a cultural perspective to program development

## PERSONAL SPACE

- Greeting
- Living space
- Eye contact

- SART on the Reservation- a cultural perspective to program development

## HARMONY

- Female – special gift to parents
- Taught by women in the family: mother, aunts, sister, grandmother
- Puberty ceremony
- IT TAKES A VILLAGE TO RAISE A CHILD

- SART on the Reservation- a cultural perspective to program development

## TABOO’S

- Appropriate behavior
- Family relationships
- Sexual Assault on the female
- Worst offense is incest

- SART on the Reservation- a cultural perspective to program development

## CULTURAL SENSITIVITY ISSUES

- Ceremonies and ceremonial markings
- Sacred days
- Victim – is not just the patient
- 	- The whole family as well as the  extended family are involved

- SART on the Reservation- a cultural perspective to program development

## THE VICTIM

- Self-esteem/self worth
- Depression
- Anger
- denial

- SART on the Reservation- a cultural perspective to program development

## HEALING

- Thru ceremonies performed by Medicine People
- Sweat lodge
- Prayers
- Herb use
- Diet

- SART on the Reservation- a cultural perspective to program development

## PUTTING IT TOGETHER

- Contact Nationally recognized SANE trainer (Appendix of Guidelines and Program development)
- Offered training to RN’s on Navajo Reservation
- Collaborate with community members to form SART

- SART on the Reservation- a cultural perspective to program development

## TRAINING

- 40 hour didactic training offered on site
- 7 RN’s, NP’s, PA and CNM
- 5 advocates
- 10 RN’s from across Navajo reservation
- Work with Albuquerque Rape Crisis Center to Train 4 Victim Advocates.

- SART on the Reservation- a cultural perspective to program development

## COLLABORATE

- Identify SANE programs in New Mexico
- Collaborate with Albuquerque SANE program to precept Nurses (minimum of 3 exams)
- New Mexico is establishing standards of practice of SANE’s in State.
- Utilize existing standards to develop policies and procedures

- SART on the Reservation- a cultural perspective to program development

## THE BEGINNING

- Work with NNMC leadership to identify ‘space’ in which SANE program could operate.
- Identify equipment needed to provide services.  Exam table, colposcope, office equipment.

- SART on the Reservation- a cultural perspective to program development

## Policies and Procedures

- Utilize national standards in a Federal Facility
- Problems:
- 		- use of digital equipment
- 		- storage of SANE records
- 		- call schedule for staff already working
- 		40 hours in the facility

- SART on the Reservation- a cultural perspective to program development

## TIME LINE

- First meeting held to determine staff interest
- 			March 3, 2002
- Training:
- 			Last week of July, 2002
- SANE providers to work with Albuquerque SANE program:
- 			October-December 2002
- Equipment arrives:
- 			December, 2002
- Victims Advocates trained:
- 			January, 2003
- Program begins 24 hour coverage
- 			February 8, 2003                                         END.

- SART on the Reservation- a cultural perspective to program development