Discharge, Follow-up, and Ongoing Patient Care

Medical Care Key Points

  1. Sexual assault is a health care issue and has potential health consequences, including but not limited to:
    • Risk for sexually transmitted infections (STI);
    • Unintended pregnancy;
    • Chronic pain;
    • Somatic disorders;
    • Behavioral changes that impact physical health such as substance use disorder;
    • sexual dysfunction; and
    • Suicide.
  2. It is critical to refer patients for follow-up care, including assessment of injuries from the assault, STD testing, hepatitis B and/or HPV initial or subsequent vaccinations and monitoring for HIV nPEP side effects.
  3. Links to national protocols for adults and pediatrics:
  4. The biological evidence preservation handbook: Best practices for evidence handlers.
  5. The Centers for Disease Control and Prevention (CDC) recommends follow-up appointments:
    • Within 1–2 weeks post assault for STI testing if patients did not receive STI prophylaxis.
    • 1–2 months for patients who received STI prophylaxis.
    • 3 months, and 6 months for HIV testing.
  6. Patients should repeat a pregnancy test at 3 weeks following the exam if they have not had any bleeding since the sexual assault examination, regardless of whether they received pregnancy prophylaxis.
  7. Providers should strongly encourage appropriate follow-up medical care after the initial sexual assault assessment.
  8. Seek to reduce barriers to follow-up medical care by offering examinations in your program and/or contacting patients (with their consent) within 2–3 days following the exam to remind them of follow-up care needs and answer their medical questions.

Sexual Assault Evidence Tracking Program (Track-Kit)

Track-Kit is an online program that allows the survivor to track the status and location of the sexual assault evidence collection kit. The medical provider should give the patient the Track-Kit card which contains:

  • The Track-Kit
  • The unique Track-Kit barcode and
  • A temporary password which will allow the survivor to log in for the first time.

The medical provider must enter the collection details into the statewide electronic tracking system not later than two business days after the date the examination is performed. (Government Code Section 420.035 (a)).

For questions about Track-Kit, please contact STACS DNA at 855-239-0677 or support@stacsdna.com. For more information about the Texas Sexual Assault Evidence Tracking Program, please visit the DPS website.

Advocacy Key Points

  • The presence of a sexual assault advocate (as defined by Texas Government Code §420) during the medical forensic examination is a crime victim’s right in Texas.
  • The sexual assault advocate is separate and distinct from the law enforcement or judicial victim advocate or liaison.
  • The role of an advocate extends beyond the emergency department.
  • The advocate connects patients who have been sexually assaulted and their non-offending support persons to resources.
  • Virtual advocacy may be available.
  • They provide options for comprehensive services available in the survivors’ surrounding community and serve as a link to local systems a patient may encounter.
  • This assistance is critical to the ongoing care and healing process.
  • To locate the nearest rape crisis center, call the Rape, Abuse, Incest National Network (RAINN) hotline at 1-800-656-HOPE or utilize the crisis center locator via the Texas Association Against Sexual Assault website.
  • To locate your nearest children’s advocacy center (CAC), utilize the CAC search.

Counseling Key Points

  • Sexual assault is a traumatic event that may include, but is not limited to, depression, anxiety, substance use disorder, suicidal thoughts, and post-traumatic stress disorder (PTSD).
  • Sexual assault advocates will connect patients to specialized sexual assault counseling as needed.
  • It is critical to refer patients to resources that specialize in sexual assault counseling.
  • Sexual assault advocates can provide verbal and written information about 24-hour sexual assault advocacy resources.
  • Consider contacting patients, with their written permission, 2–3 days following the initial examination to assess their mental health and remind them of advocacy services.
  • The presence of a trained sexual assault advocate at the time of the medical forensic assessment will make it easier for patients to contact advocacy services.