SAVI Advocate Guide
VOLUNTEER ADVOCATE MANUAL
REFERENCES AND RESOURCES FALL 2020
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CONTENTS
SAVI Main Office Information ...... 4 Mount Sinai Hospital – Manhattan ...... 5 Harlem Hospital - Manhattan ...... 5 Metropolitan Hospital – Manhattan ...... 6 Lenox Hill Hospital – Manhattan ...... 6 Mount Sinai EHHOP Mental Health Clinic – Manhattan ...... 7 Mount Sinai – Queens ...... 7 Elmhurst Hospital - Queens ...... 8 Queens Hospital Center - Queens ...... 8 Mount Sinai - Brooklyn ...... 9 On Call Shifts ...... 12 Expectations ...... 12 Transportation to and From the ED ...... 13 Troubleshooting ...... 14 DEBREIFING CASES ...... 17 Quick Reference: TimeFrames ...... 18 When You Get Called From The SAVI Call Center ...... 19 When You Get To The Emergency Department ...... 19 Breaking Confidentiality ...... 20 Medical Procedures ...... 21 Discuss Informed Consent Regarding Medical Exam And Evidence Collection ...... 21 Discuss Police Reporting Options ...... 22 Explain Survivor Packet ...... 22 Follow-Up Counseling ...... 22 Office of Victims Services (OVS) ...... 23 Assess Other Concrete Needs ...... 24 The Advocate Report Form ...... 24 Addendum: Advocating During A Public Health Crisis ...... 25 Phone Advocacy ...... 25 In Person Advocacy During a Public Health Crisis ...... 26 COVID-19 Specific Concerns for Survivors ...... 26 Additional Resources ...... 28
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SAVI MAIN OFFICE INFORMATION
Physical Address Hours
40 East 98th Street, #1E Monday – Friday 9:00am-5:00pm
New York, NY 10029 Closed on the following holidays:
Mailing Address New Year's Day
One Gustave L. Levy Place, Box 1670 Martin Luther King Jr. Day
New York, NY 10029 President's Day
Phone Numbers Memorial Day
212-423-2140 (Main) Independence Day
212-423-2150 (Silva/Volunteer Coordinator) Labor Day
646-629-1471 (Silva Cell phone) Thanksgiving Day
Christmas Day
Call Center Phone Number: 1-800-418-7828
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MOUNT SINAI HOSPITAL – MANHATTAN
Address Hours SAVI Responds to Cases 1468 Madison Avenue (at 100th Street) 24 hours a day, 7 days a week New York, NY 10026 Debriefing Phone Numbers Silva Sergenian/Liz Conboy Adult ED: 212-241-6639 212-423-2150 Pediatric ED: 212-241-7151
Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: SAVI
Survivor Packet Location: Inside the SAFE room Cabinet
HARLEM HOSPITAL - MANHATTAN
Address Hours SAVI Responds to Cases 506 Lenox Avenue (at 135th Street) Weekdays from 6pm-8am (ED entrance 137th Street b/t Lenox & 5th) Saturdays and Sundays 24 Phone Numbers hours Adult ED – 212-939-2250 All Federal Holidays are Pediatric ED - 212-939-2240 covered 24 hours Debriefing Silva Sergenian/Liz Conboy 212-423-2150 Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: Harlem Hospital Social Work
Survivor Packet Location: Adult ED – Packets are in the blue binder at the main nurse’s station. This blue binder is labeled “domestic violence” and includes the survivor packets and Harlem Hospital’s own DV information. Pediatric ED – ask Head Nurse for packet.
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METROPOLITAN HOSPITAL – MANHATTAN
Address Hours SAVI Responds to Cases 1901 First Avenue Weekdays from 6pm-8am New York, NY 10029 Saturdays and Sundays 24 (at 97th Street between 1st & 2nd Avenues) hours Phone Numbers All Federal Holidays are Adult ED - (212) 423-6466 covered 24 hours Labor & Delivery - (212) 423-6417 Debriefing Silva Sergenian/Liz Conboy 212-423-215
Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: Social Work staff at Metropolitan
Survivor Packet Location: There are no SAVI Survivor packets at this hospital. Please be sure to have extra materials to give to a survivor
LENOX HILL HOSPITAL – MANHATTAN
Address Hours SAVI Responds to Cases 100 East 77th Street Weekdays from 6pm-8am New York, NY 10021 Saturdays and Sundays 24 (between Park and Lexington Avenues) hours Phone Numbers All Federal Holidays are Adult ED - (212) 434-3042 covered 24 hours Labor & Delivery - (212) 434-2560 Debriefing Silva Sergenian/Liz Conboy 212-423-2150
Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: SAVI Staff
Survivor Packet Location: Adult ED –at the OB/GYN room, in labor and delivery – at the nurse’s station
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MOUNT SINAI EHHOP MENTAL HEALTH CLINIC – MANHATTAN
Address Hours SAVI Responds to Cases 17 E 102nd Street, 7th Floor Saturdays 9:00am-1:00pm New York, NY 10029 Debriefing Phone Numbers Silva Sergenian/Liz Conboy
212-423-2150
Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: SAVI Staff
Survivor Packet Location: Ask at the Clinic Manager (CM) – packets are in the white CM box.
MOUNT SINAI – QUEENS
Address Hours SAVI Responds to Cases 25-10 30th Ave, Astoria, NY 24 hours a day, 7 days a week Phone Numbers Debriefing Adult ED (718) 267-4285 Jessica Ramirez
(718) 808-7471
Send Advocate Report Form / OVS form to: SAVI Main Office
Follow Up Contact with the Survivor Done by: SAVI Staff
Survivor Packet Location: Ask at the clerk’s desk for the packet.
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ELMHURST HOSPITAL - QUEENS
Address Hours SAVI Responds to Cases 79-01 Broadway Weekdays from 6pm-8am Elmhurst, NY Saturdays and Sundays 24 Phone Numbers hours Adult ED (718) 334-3054 All Federal Holidays are Pediatric ED (718) 334-3000 covered 24 hours Labor and Deliver: (718) 334-3300 Debriefing Psychiatric ED: (718) 334-3680 Alpana Patel 718-334-1418
Send Advocate Report Form / OVS form to: leave in the Social Work office (room B-1-09)
Follow Up Contact with the Survivor Done by: SAVI Staff and Elmhurst Social Work
Survivor Packet Location: Packets are located in the social worker’s office (room B-1-09)
QUEENS HOSPITAL CENTER - QUEENS
Address Hours SAVI Responds to Cases 82-68 164th Street Weekdays from 6pm-8am Jamaica, NY Saturdays and Sundays 24 Phone Numbers hours Adult ED (718) 883-3090 All Federal Holidays are covered 24 hours Debriefing Jessica Ramirez (718) 808-7471
Send Advocate Report Form / OVS form to: SAVI main office
Follow Up Contact with the Survivor Done by: SAVI Staff
Survivor Packet Location: Ask the Head Nurse for the packet.
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MOUNT SINAI - BROOKLYN
Address Hours SAVI Responds to Cases 3201 Kings Hwy 24 hours a day, 7 days a week Brooklyn, NY 11234 Debriefing Phone Numbers Silva Sergenian/Liz Conboy Adult ED - (718) 252-3000 (212) 423-2150
Send Advocate Report Form / OVS form to: SAVI main office
Follow Up Contact with the Survivor Done by: SAVI Staff
Survivor Packet Location: Ask the Head Nurse for the packet.
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THE SINGLE BIGGEST PROBLEM IN COMMUNICATION, IS THE ILLUSION THAT IT HAS TAKEN PLACE.
-GEORGE BERNARD SHAW
Communicating clearly is the bedrock of the work that we do. SAVI sees on average approximately 550 cases a year in the Emergency Departments we serve, and we have roughly 150-200 active advocates at any given time. There are a lot of moving parts and the nature and sensitivity of the work we do necessitates that we are in continuous communication with each other.
It is ALWAYS our goal to communicate our policies and expectations to you clearly. Please be sure to thoroughly read all emails that are sent from the Volunteer Coordinator, as this is the primary means by which important information will be conveyed.
We ask as well, that you communicate with us clearly and in a timely manner. This includes for debriefing, as well as questions you have, concerns about anything at all, and suggestions. We do not wish for you to have questions unanswered, concerns unaddressed, and we welcome all feedback!
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ON CALL SHIFTS
EXPECTATIONS
1. Each advocate is expected to sign up for 2 shifts each month.
2. You should be ready and available to receive a call up to 30 minutes before your shift starts. You may not be asked to leave for your shift early, but sometimes it is necessary for us to be able to reach you by phone beforehand.
3. Be available for your full shift. Please try not to make plans for immediately after the end of your shift. It is advisable to plan for a 30-minute buffer at the end of your shift. This will allow time for troubleshooters to arrange a smooth handoff with another advocate in cases where the survivor will be in the ED past your shift.
4. You are expected to attend to any case you are called for up to 30 minutes before the end of your shift.
• If you are called less than 30 minutes before the end of your shift, call the troubleshooter.
5. You will attempt to find coverage if you are unavailable to cover your scheduled shift.
6. You can expect that we will do all that we can to respect your time and not call you too soon, or hold you longer than you are available.
7. You are expected to contact the troubleshooter in the event that you are no longer available for your shift.
SHIFT TIMEFRAMES
8:00am – 2:00pm 2:00pm – 8:00pm 8:00pm-2:00am 2:00am-8:00am
SIGNING UP FOR SHIFTS
To sign up for shifts, you may log into the online portal: https://mountsinai.vsyslive.com/, you may also email Silva with specific shift requests.
Shifts should be chosen by the 15th of the month prior.
FINDING COVERAGE FOR SHIFTS
If you need to make any changes for your scheduled shift(s), and it is prior to the first of the month in which the shift falls, you may contact Silva to make the change. If you need to make any changes for your scheduled shift(s), and it is after the first of the month in which the shift falls, then you are expected to reach out to the other advocates to find coverage or to swap shifts. To do this, you can send an email to the listserv: [email protected] Let the Volunteer Coordinator know as soon as you have found coverage.
If you have a very last-minute change (outside of normal business hours), you should always contact the troubleshooter about the change.
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TRANSPORTATION TO AND FROM THE ED
Uber
Once you are cleared and ready to go on call you will be invited to use the SAVI Uber account. Michael Gross (SAVI’s Financial Coordinator) is the point person for Uber invitations.
Please note that you should always check to make sure you are hailing rides on the correct account (it often happens that after going on a case someone forgets to switch account payment method for their next personal ride). If you accidentally pay for a personal ride using the SAVI account, please contact Uber customer service to switch payment method.
Tipping: you may tip your Uber driver up to 15%.
SAVI Car Service Accounts
SAVI has accounts set up with three different car services that you may use. You may call the dispatcher and request a ride, telling them upon requesting the ride that it is under SAVI’s account and giving them the account number.
Tipping: you do not need to tip in any of the below car services – the tip is included in the price charged to SAVI.
• New Family Car Service (212) 749-7777 – Account #116 • Barona’s Car Service (718) 424-7400 – Account #138 • Red Cap Car Service (718) 658-5252 – Account #8751
Hailing a Yellow Cab or Other Car Service
You may hail a yellow or green cab, or call another car service and pay out of pocket. If you do so, please obtain the receipt and mail to the receipt and reimbursement voucher to SAVI (along with your advocate report form).
Tipping: you may tip up to 15%.
Driving Your Own Car
If you have your own car and feel comfortable using it, SAVI will reimburse you for parking charges and tolls.
NOTES ON SAFETY
• Always verify that the car that has arrived is for you before you get in. • Ask the driver who they are there for, rather than asking if they are there for you and telling them your name.
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TROUBLESHOOTING
TROUBLESHOOTERS
Seasoned advocates and they are available from 8:00pm to 8:00am on weekdays, and 24 hours on the weekends (8:00pm Friday night through 8:00am Monday Morning)
BACK UP TROUBLESHOOTERS
SAVI staff and they are available from 6:00pm to 8:00am on weekdays, and 24 hours on the weekends (8:00pm Friday night through 8:00am Monday Morning)
DAYTIME TROUBLESHOOTING
From 8:00am to 6:00pm weekdays troubleshooting is covered by Silva Sergenian, unless otherwise noted/communicated with you.
WHEN WOULD YOU TALK WITH A TROUBLESHOOTER?
⇒ There is a last-minute change to your availability/you cannot make your on-call shift. ⇒ You have missed a call about a case from the call center or the troubleshooter. ⇒ Questions arise during a case and you don’t know how to answer. ⇒ You need another advocate to relieve you at the end of your shift. ⇒ You want to add yourself to a shift last minute.
HOW WILL I KNOW WHO IS MY TROUBLESHOOTER?
Troubleshooter information can be found in the following places:
1. Vsys Online 2. Monthly Schedule (sent on Fridays) 3. Monday Confirmation Email 4. By Calling the call center 5. Calling Silva’s Cell phone and listening to the voicemail greeting
HOW DO I GET IN TOUCH WITH THE TROUBLESHOOTER?
The best way to initiate contact with a troubleshooter is to call them. Once you have made the initial contact, you and the troubleshooter should agree on how you wish to continue communicating (i.e. by phone or text). Please do not text your troubleshooter to initiate contact, as it can be easily missed.
Sometimes you may find that there is little or no cell phone reception while you are in the ED. In these cases, it is absolutely appropriate for you to ask to use one of the desk phones at the nurses’ station.
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TROUBLESHOOTING ROSTER
BACK UP TROUBLESHOOTERS
Silva Sergenian 646-629-1471
Lynn Frederick Hawley 646-285-4710
Angie Fernandez 646-734-6675
Jessica Ramirez 917-583-8029
Chelsea Bodansky 646-629-2048
TROUBLESHOOTERS
Sylvia Altreuter 212-741-6310
Trisha Belle 347-331-4969
Shirley Caro 718-781-8751
Devin Columbus 718-986-7267
Danielle Davis 917-622-8875
Abbey Foote 315-720-9043
Robin Gordon 914-261-1400
Courtney Hart 203-980-7181
Amy Kossoy 917-757-3054
Angie Lozada Joaquin 757-605-8057
Mary Napier 917-375-6422 (Cell), 212-831-6860 (Home)
Erin Nebel 563-564-1888
Binh Nguyen 713-367-8508
Annamaria Santamaria 646-691-7805
Caitlin Walker 347-622-6265
PLEASE NOTE
New troubleshooters are sometimes added during the year and you should always refer to the confirmation email for the contact information for your troubleshooter.
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DEBREIFING CASES
Communication is key in your volunteer work with SAVI. We rely on you to communicate with us clearly and in a timely manner.
Debriefing is done not only to give you an opportunity to discuss the case and how you are coping with supporting a person who has experienced trauma, but also to gather important information for following up with the patient.
TO COMPLY WITH HIPAA, PLEASE CALL THE ED COORDINATOR BEFORE YOU LEAVE THE HOSPITAL, AND LEAVE A MESSAGE WITH THE FOLLOWING CASE INFORMATION:
• Your Name and phone number • The hospital you responded to • Type of Case (i.e. SA or IPV) • Name of Survivor (spell it out) • Survivors Medical Chart Number • Survivor’s Phone Number and if it is safe to call
ED COORDINATORS
Manhattan Hospitals
Silva Sergenian/Liz Conboy: (212) 423-2150
Elmhurst Hospital Center
Alpana Patel: (718) 334-1418
Mount Sinai Hospital of Queens and Queens Hospital Center
Jessica Ramirez: (718) 808-7471
WHAT TO EXPECT
ED coordinators will try to call you back by the next business day to debrief. Sometimes it is helpful to let them know when a good time to reach you is. If it has been more than 5 business days since your case and you have not been able to connect with the ED coordinator, please let Silva know.
Be sure to have your advocate report form handy to debrief (unless it has been left at Elmhurst).
OTHER TIMES YOU SHOULD CALL THE ED COORDINATOR
There may be instances when you will still need to call the ED Coordinator to pass along information, even if you have not had contact with a patient. These circumstances include:
• You arrived to the hospital for a case but the patient had already left. • A case you were called for turns out not to be a SAVI case (e.g. – family violence/domestic violence but not IPV)
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QUICK REFERENCE: TIMEFRAMES
EVIDENCE COLLECTION
Evidence collection can be done up to/within 96 hours (4 days) of the sexual assault. Some places may collect evidence up to 120 hours after assault.
Efficacy of evidence collection can be impacted by time, as well as changing of clothes and showering/bathing.
Evidence will be held at the hospital for a minimum of 20 years.
DRUG FACILITATED SEXUAL ASSAULT (DFSA) EVIDENCE COLLECTION
DFSA evidence collection can be done up to/within 96 hours (4 days) of the sexual assault.
* Normal toxicology that is run by the hospital is NOT the same thing – it will often not test for many of the substances/drugs used in DFSA.
EMERGENCY CONTRACEPTION
Emergency contraception should be taken within 72 hours (3 days) of the sexual assault.
It can be taken up to 120 hours (5 days) but efficacy drops significantly.
HIV PEP
Within 1 hour but not more than 36 hours (1.5 days).
The ED should provide the first weeks’ worth of medication, and then the survivor will need a follow up appointment to arrange for the remainder.
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WHEN YOU GET CALLED FROM THE SAVI CALL CENTER
THE CALL CENTER WILL LET YOU KNOW THE FOLLOWING:
o Hospital
o Contact Name
o Type of Case CONFIRM CASE INFORMATION:
Be sure to call the hospital after you receive the call from the Call Center to confirm the case information.
Call the contact number given to you by the call service and let them know you are calling from SAVI.
Use the SAVI Hospital Call Sheet to get the case information. Also be sure to get the name of the contact person you speak to.
WHEN YOU GET TO THE EMERGENCY DEPARTMENT
REPORT TO THE CONTACT PERSON:
Upon your arrival at the ED, report to the contact person or charge nurse and get information about the status of the case and where you can find the survivor. In addition to the Advocate, a social worker might also be called depending on the case and the hospital. In these instances, also report to the social worker and follow their lead.
INTRODUCE YOURSELF TO THE SURVIVOR:
Explore the survivor’s immediate needs (emotional, medical and/or legal). Ensure that the survivor receives the most comprehensive care possible in a safe, supportive and respectful environment.
PROVIDE CRISIS COUNSELING, INFORMATION AND GENERAL ASSISTANCE:
Use your active listening skills to provide crisis intervention. Some points to keep in mind while providing emotional support are:
• Allow the survivor to vent. Just listen.
• Normalize feelings. Help the survivor understand that the feelings they are experiencing are common reactions to sexual assault and/or domestic violence. It is also common to have conflicting feelings (e.g., love and fear, guilt and anger, hope and sadness).
• Reflect; focus on feelings and support survivor’s strengths.
• Increase sense of safety and control (e.g., explain the different steps that will take place)
• Decrease shame, self-blame and isolation. Remind the survivor that IT WAS NOT THEIR FAULT
• Keep your own agenda out.
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• Reinforce that the survivor did not deserve to be assaulted under any circumstances.
• The survivor is not alone. HELP IS AVAILABLE!
• Ask the survivor if there is someone they would like you to contact.
ADVOCATE FOR THE SURVIVOR’S WISHES TO BE HONORED REGARDING WHO IS IN THE EXAMINING ROOM AT ANY GIVEN TIME:
Although co-survivors may sometimes be a comforting presence, be mindful that it may be difficult for the survivor to respond freely to questions regarding medical history and details of the assault when co-survivors are in the room. It is also a good idea if the Advocate has a chance at some point to talk to the survivor alone in case there is information that the survivor wishes to keep private.
THE POLICE SHOULD NEVER BE PRESENT DURING THE MEDICAL HISTORY-TAKING OR THE EXAM.
BREAKING CONFIDENTIALITY
During your interview, you signed a “Statement of Confidentiality”, agreeing to respect confidential information received while performing your duties as an Advocate. Two exceptions to this agreement are:
1) When child abuse or neglect is suspected (including children who witness domestic violence)
2) The survivor expresses suicidal or homicidal thoughts or plans.
In these instances, you are responsible for informing the ED staff of the situation. However, the information is still confidential outside the ED setting. (Remember that the ED staff is responsible for contacting the Administration for Children’s Services (ACS) and you should not be asked to do so). Please report this information to the Program Coordinator during your debriefing.
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MEDICAL PROCEDURES
Provide information and explain options regarding medical procedures (e.g., questions that will be asked, right to refuse parts of treatment). Also ask the survivor if they want you to stay in the room during the medical exam. There are three main components of the medical procedure:
MEDICAL HISTORY
A series of questions designed to determine what kind of treatment and evidence collection are needed.
TREATMENT
A head-to-toe physical exam with particular care to areas that hurt or show signs of bruises, abrasions or other injuries. In cases of sexual assault, it might also include a pelvic and/or rectal exam and testing and prophylactic treatment for STDs or pregnancy. Make sure the physician explains to the survivor what is going to happen and why.
EVIDENCE COLLECTION
Evidence is collected while the above two steps are taking place. It entails documenting information and gathering specimens for evidence. (In cases of sexual assault an Evidence Collection Kit might be completed if it is done within 96 hours of the assault).
ENSURE THAT THE MEDICAL STAFF DISCUSSES MEDICAL FOLLOW-UP
The medical follow-up could include: repeat pregnancy test to detect pregnancy from the rape; offering emergency contraception (EC); STI follow-up testing and treatment; HIV testing and counseling; and treatment of additional trauma-related symptoms. Follow-up medical treatment can be received through the hospital clinics or survivors’ private physician.
CONCERNS ABOUT MEDICAL STAFF
If the medical staff is not following appropriate procedures, not respecting the survivor’s rights or is insensitive toward the survivor, address the issue(s) with the staff without the survivor present. Be assertive in advocating with the staff, but if your efforts fail, do not become confrontational. Rather, inform the Program Coordinator during debriefing and SAVI will be responsible for any further follow-up.
DISCUSS INFORMED CONSENT REGARDING MEDICAL EXAM AND EVIDENCE COLLECTION
The survivor has the right to refuse any part of the treatment or evidence collection process. Explain that collecting the evidence does not mean the survivor needs to file a report or prosecute. They have three options:
1) Consent to evidence collection and release it to the police by filing a report or filing a report and pressing charges
2) Consent to evidence collection but not have it released to the police. Advise them that the hospital will hold the kit for a minimum of 20 years, per New York State Statute.
3) Decline consent to evidence collection.
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DISCUSS POLICE REPORTING OPTIONS
Advocate for and support the survivor’s decision whether or not to report the crime to the police.
WHEN IS IT MANDATORY TO REPORT TO THE POLICE?
⇒ When there is an injury by a deadly weapon (e.g. – use of a gun, grave injury by a sharp object) ⇒ When child abuse or neglect is suspected (this is not the same as a child being present)
You will NEVER be the one mandated to report to the police in these cases, this is the responsibility of the hospital staff.
ARE YOU ALLOWED TO BE PRESENT WHILE THE POLICE ARE TALKING TO THE SURVIVOR?
If the survivor decides to file a police report, please remember that in cases of sexual assault you have the right to stay in the room while the survivor is being interviewed by the police (see Detective Memo #20 in your portfolio). This does not pertain to IPV cases, where you may be asked to leave while they speak with the patient.
Maintain confidentiality when dealing with the police and don’t give your opinion regarding what occurred. Also do not provide information unless the survivor has asked you to share that information.
If the police officers or the detectives are not respecting the survivor’s rights or are being insensitive toward the survivor, address the issue(s) without the survivor present. Be assertive in advocating with law enforcement officials, but if your efforts fail, do not become confrontational. Rather, inform the Program Coordinator during debriefing and they will be responsible for any further follow-up.
EXPLAIN SURVIVOR PACKET
Use the survivor packet, which is conveniently stored in the Emergency Departments. Know its contents and discuss it with the survivor (don’t just hand it to the survivor when s/he leaves). There are packets in both English and Spanish. Sometimes hospitals run out of the survivor packets, it is always a good idea to carry an extra copy or two of the packets in your portfolio just in case.
Some of the hospitals may have their own patient information for domestic violence survivors. Feel free to share this information with the survivor as well. If there are no packets available please inform the SAVI Program Coordinator during the debriefing.
FOLLOW-UP COUNSELING
Stress the importance of follow-up counseling. Research has shown that the sooner the survivor starts counseling, the better. Find out if it’s OK and safe for the survivor to be contacted. If the survivor gives consent, someone either from SAVI or from one of the hospitals will follow-up to provide additional support.
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OFFICE OF VICTIMS SERVICES (OVS)
New York State Office of Victim Services offers compensation to survivors under the following circumstances:
• Sexual assault survivors must have an evidence collection kit done and/or file a police report
• Domestic violence survivors must file a police report to be eligible for OVS
Forensic Exam Eligible for OVS
Evidence Eligible for OVS Collection Immigration Sexual Assault
Police Report Eligible for OVS status does NOT affect NONE OF THE NOT Eligible for ABOVE OVS eligibility. Police Report Eligible for OVS or DIR Intimate Partner Violence NO Police NOT Eligible for Report or DIR OVS
Advocate should offer assistance to survivors in filling out this application while they are in the ED. If they do not feel like filling it out, that is okay. The survivor can take it home with them (if safe).
OVS TIPS
• It does not need to be completed in full at the moment the survivor is in the ED. However, you do want to make sure to get the following: o Signature and date on the last page of the application (page 4 of 4) o Initials (section 9a and 9b) and signature on the HIPAA page • Do not promise that they will receive money right away! The paperwork needs to be processed and an investigator assigned – much like in an insurance claim. • OVS is a payer of last resort – which means that it covers only what insurance, restitution, workers compensation, and other types of compensation do not cover. • If the survivor is not interested in filling it out and ask to take the form home instead – let them! The most important thing is that they have been told this resource is available to them. • Completed applications go with your Advocate Report Form – either mailed after debriefing or left at the hospital (i.e. Elmhurst).
REGARDING ASSAULTS THAT TAKE PLACE OUTSIDE OF NEW YORK STATE:
In order to be eligible for compensation through NY State OVS, the assault has to have occurred in NY State. If the assault occurred in another state, there will be applicable victim service compensation for each state. This can be discussed with the survivor in more detail upon follow up.
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ASSESS OTHER CONCRETE NEEDS
Assess if survivor needs a change of clothing (available in the ED), a safe place to go, and transportation.
If the survivor needs a safe place to go, help them decide whether shelter is an option for them, or if they have any friends or family they can stay with.
If necessary, money for transportation may be provided by the Nurse in Charge or Administrator on Duty (AOD).
Stay in the Emergency Department Until Your Duties Have Been Completed.
There are many situations in which a survivor may remain in the ED for an extended period of time. Use your judgment for when it is appropriate to leave. Always make sure that all your duties as an Advocate have been completed. If you are unsure about leaving, feel free to contact your troubleshooter to discuss.
THE ADVOCATE REPORT FORM
BEFORE you leave the hospital, complete the SAVI Advocate Report Form. Please make sure to include client’s telephone number and address.
You will need to complete this form even if you were relieved by another advocate at the end of your shift. We need a complete record for each advocate who responded to a case. You can get survivor information from the patient’s chart. If you are out of report forms, please let the troubleshooter know, or contact Silva to let her know what supplies you need.
The completed Advocate Report Form and OVS application should be taken home in order for you to debrief with the Program Coordinator. It is important for you to NOT mail the Report Form until AFTER you debrief with the Program Coordinator. Please mail the form as soon as possible after debriefing.
THE ONLY TIME YOU SHOULD LEAVE THE REPORT FORM AT THE HOSPITAL IS WHEN YOU ARE AT ELMHURST HOSPITAL.
WHEN RESPONDING TO CASES AT ELMHURST HOSPITAL, THE ADVOCATE REPORT FORM AND OVS APPLICATION SHOULD BE LEFT ON THE DESK IN THE SOCIAL WORKERS OFFICE (ROOM B-1-09)
NOTE REGARDING FORMS AND HIPAA
Advocate Report Forms cannot be faxed from a public fax machine and patient/case information cannot be sent by email or text. These will violate the confidentiality of the survivor.
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ADDENDUM: ADVOCATING DURING A PUBLIC HEALTH CRISIS
PHONE ADVOCACY
2020 ushered in the need to address how to advocate over the phone. It is entirely possible that you will need to advocate by phone for some portion of your time volunteering with SAVI. That being said, our mission remains the same, to serve patients in the ED, and we will hopefully see minimal delays to our being able to provide Advocates in person. In the following section you will find information that will be relevant and important to know in how to advocate by phone.
LOGISTICS FOR SPEAKING WITH THE SURVIVOR OVER THE PHONE:
First, speak with the hospital contact as usual. In some instances, you may be connected directly to the hospital contact by the call center. We have asked that the call center connect you directly to the hospital contact whenever possible, so as to avoid you waiting on hold for long amounts of time.
Relay to staff that you will be advocating by phone and will need to speak with the survivor via phone.
Some hospitals will have phones in the room where the survivor is assigned and the call can be forwarded there or the Advocate can be given the direct number of the room. Some will NOT have a phone in the area where the survivor is (e.g. IPV survivors not in a closed-door room, survivors not able to be triaged to a room per se because of overcrowding with the corona virus). The ED staff will best know what options can be employed in those situations.
CALLING THE SURVIVOR ON THEIR PHONE
You can call a survivor’s cell phone IF YOU BLOCK YOUR NUMBER or you can call the call center to ask them to patch you through to a survivor’s number. In other words, call STAT and explain you are the Advocate and need to be connected to the following number
If calling the survivors phone directly from your own, dial *67 before the area code and phone number when you dial and that will block the caller ID.
Discuss with the medical staff and the patient that advocating over the phone may take place over a few phone calls - we do not expect you to necessarily be able to stay on the line the whole time they are in the ED. At the start, talk with the staff about connecting back with a survivor after a certain period of time/prior to discharge.
USING A TRANSLATOR OVER THE PHONE
It may be necessary to employee the use of a language line while doing phone advocacy. In order to do this, you will need to initiate a three-way call between yourself, the survivor and the interpreter line. Please familiarize yourself on how to do this with your phone model.
How to Call the Mount Sinai Language Line
Dial 1-800-264-1552 Access ID: 828099
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Typically, you have to provide your life number (however you do not have one as a volunteer) and provide other relevant information (e.g. that you are a Sinai volunteer, describe the situation for which you will need translation). If the patient is at a Mount Sinai hospital, you may be asked to provide the MRN, however if you do not have it just say you don't have it. The translator will call the patient's number.
IMPORTANT REMINDERS
Please do all of the following – even if you were unable to speak with the survivor!
1. Get follow up contact info so that SAVI or Hospital staff can follow up with the patient later on. 2. Fill out an advocate report form 3. Leave a message for the ED coordinator 4. Debrief the case with the ED Coordinator
IN PERSON ADVOCACY DURING A PUBLIC HEALTH CRISIS
In the event of a transition back to in person advocacy, either full time or at will, here is some of the information you may need to know to keep you, the patients and the staff healthy. The information included below is current to this document’s publication (November 2020), and you may find up to date policies and resources for Mount Sinai Hospital here: https://www.mountsinai.org/about/covid19/staff-resources
PERSONAL PROTECTIVE EQUIPMENT
Advocates should be provided with a surgical mask to wear while working with the patient in the ED. This has been deemed sufficient for those who are not involved in patient procedures. Mask will be provided on site, and we recommend that you check in with the Nurse Manager, Charge Nurse or your hospital contact person to ask (before you arrive) where you will be able to obtain the mask.
If you would like more (e.g.: gown or face shield) you may ask but it may not be available or it may be reserved for those who are performing procedures. You may bring your own additional PPE, though please know that the hospitals may make you change surgical masks to the ones they provide when you arrive.
COVID-19 SPECIFIC CONCERNS FOR SURVIVORS
WORKING WITH SURVIVORS WHO NEED TO SHELTER IN PLACE/QUARANTINE
Throughout the COVID-19 crisis there has been much discussion about working with survivors of domestic and intimate partner violence that need to shelter in place, or quarantine, in potentially dangerous environments. In addition to the normal safety concerns, we are now working with survivors who have additional COVID-related stressors such as health concerns or economic concerns, loss of support system, and so on.
• Safety planning will be vital in IPV cases.
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• Some resources that would normally be available in person (e.g. Family Justice Centers and other community-based organizations) may be operating remotely only but are still an important resource • Safe Horizon is still operating their IPV survivor services and can still be contacted for DV shelter housing. DV Shelters remain open, though with greater strains on their capacity.
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ADDITIONAL RESOURCES
Please find many additional resources that might be helpful for the survivor in the table below. These resources are not all included in the survivor packet, so please help identify what resources might be useful for the survivor and have them write the information down in the packet.
SPECIAL VICTIMS DIVISIONS
Agency Phone Location Services
NYPD Special Victims Report (212) 267-RAPE (7273) Phone service/ Available 24-hours Line Citywide Questions regarding police reporting answered
NYPD Special Victims Unit – (718) 520-9363 112th Pct., Same as above Queens Forest Hills
24-HOUR HOTLINES
Agency Phone Location Services Safe Horizon (800) 621-HOPE (4673) Citywide • Many languages www.safehorizon.org or • Crisis intervention (212) 577-7777 (FYI: • DV Shelter referral both of these numbers • Emergency money connect to the same • Relocation service) • Legal/court advocacy NYC Antiviolence Project (AVP) (212) 714-1141 Citywide • English and Spanish www.avp.org support available to LGBTQ and HIV-Affected survivors of any type of violence • Crisis Counseling • Short or long-term counseling • Police, court, and social services advocacy
NYC Well (888) NYC- WELL (692- Citywide • Multilingual and www.800lifenet.org 9355), press 2 multicultural helpline for crisis intervention and https://nycwell.cityofnewyork.us Spanish: referrals for mental (888) 692-9355, press 3
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health and/or substance Mandarin, Cantonese, abuse and Korean: • Mobile crisis intervention (888) 692-9355, press 4 team • Texting help service for TTY for hearing impaired: teens: text to 65173 Call 711 • Online crisis chat available (in English only)
National Suicide Prevention (800) 273-8255 Nationwide • Support for people in Hotline distress, prevention and https://suicidepreventionlifeline.org/ Spanish: crisis resources (888) 628-9454
TTY: (800) 799-4889
Samaritans Suicide Prevention (212) 673-3000 Citywide • 24 Hour Confidential http://samaritansnyc.org/ hotline • Phone counseling
Rape Abuse and Incest National (800) 656-HOPE (4673) National • Crisis intervention Network (RAINN) Hotline • Counseling www.rainn.org • Referrals • Online Chat
Childhelp National Child Abuse (800) 4-A-CHILD • Crisis counselors, with Hotline (800) 422-4453 interpreters in over 170 www.childhelp.org/hotline languages. • Provides crisis intervention, information, and referrals
National DV Hotline (800) 799-7233 National • All languages www.thehotline.org • Crisis intervention (800) 787-3224 (TTY) • Shelter referral • Referrals • Online Chat
National Human Trafficking (888) 373-7888 National • Resources and assistance Hotline for victims and survivors https://humantraffickinghotline.org/ TTY: 711 of human trafficking • Project Safe (855) 234-1042 Citywide • Free emergency lock (part of safehorizon.org) repair/replacement TDD: (800) 810-7444
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Korean American Family Service (718) 460-3800 Citywide • Korean & English Center • Crisis intervention www.kafsc.org • Court advocacy • Job Training • Housing • Children and Youth services
OTHER RESOURCES
American Society for the (866) 816-4804 Citywide • Can assist survivors with Prevention of Cruelty to pets that may have been Animals (ASPCA) involved in domestic https://www.aspca.org/nyc violence situations, with emergency veterinary care, pet food, and transport. Barrier Free Living NYC Counseling and Support: Citywide • Provides shelter, www.bflnyc.org (212) 533-4358 transitional housing, and support counseling to Domestic Violence individuals with Shelter: disabilities who are (212) 400-6470 survivors of domestic violence and/or are DV Hotline: homeless. (800) 799-7233 (800) 787-3224 (TTY)
Gay Men’s Health Crisis (800) 243-7692 Citywide • Monday-Friday, 2pm- www.gmhc.org 6pm • Provides information about HIV/AIDS, STDs, post-exposure prophylaxis (PEP), and sexual resources such as testing, healthcare, and counseling. Jack Martin Fund Clinic (212) 241-6159 • Mount Sinai’s outpatient (212) 241-7968 and inpatient treatment for adults and children with infectious diseases. • Follow up care for HIV PEP regimen. • Testing for STIs
30 www.Loveisrespect.org Hotline: Nationwide • For teens and young (866) 331-9474 adults • Support and advocacy, TTY: (866) 331-8453 local referrals, crisis counseling over the Online chat available as phone or via chat well on the website
Mount Sinai Women’s Health (212) 241-7952 • Follow up gynecological and OB/GYN medical care
New York City Bar Legal Referral English: (212) 626-7373 Citywide • Discuss legal questions Service with a referral counselor www.nycbar.org/get-legal- Spanish: (917) 832-1927 who will direct you to a help/ lawyer. Hours: • Once referred – there will Monday -Friday be an initial consultation 8:30am-5:30pm with the lawyer for a cost of $35 for up to 30 minutes.
NY Legal Assistance Group (212) 613-5000 Citywide • Free civil legal services to www.nylag.org New Yorkers who cannot Hours: afford private attorneys See website
Planned Parenthood (212) 956-7000 Citywide/Nation • Clinics located in all five www.plannedparenthood.org Or wide boroughs (800) 230-7526 • Exams, birth control, testing, abortion services, family planning Sanctuary for Families (212) 349-6009 Citywide • Counseling (Individual, www.sanctuaryforfamilies.org group, family, child, etc.) Hours: • Legal Services (Order of Monday-Friday Protection, Divorce, 9:00am-5:00pm Immigration, Public Benefits, etc.) • Urban Justice Center (646) 602-5600 Citywide • Offers direct legal http://www.urbanjustice.org/ services and advocacy for homeless individuals and those individuals living at/below poverty.
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NYC DISTRICT ATTORNEY’S OFFICES
Agency Phone Location Kings County DA (Brooklyn) Hotline DA Action Center www.brooklynda.org (718) 250-2340 350 Jay Street, 16th Floor Domestic Violence: Brooklyn, NY 11201 (718) 250-3300 Human Trafficking: (718) 250-2770 Teen Dating Violence: 718-250-3321 Victim Services: 718-250-3820
New York County DA General Information: Main Office (Manhattan) (212) 335-9000 One Hogan Place www.manhattanda.org Domestic Violence: New York, NY 10013 (212) 335-4308 Harlem Office Human Trafficking: 163 West 125th Street (212) 335-3400 New York, NY 10027 Sex Crimes: Washington Heights Office (212) 335-9373 530 West 166th St. Witness Aid Services Unit: Suite 600A (212) 335-9040 New York, NY 10032
Queens County DA General Information: Main Office: www.queensda.org (718) 286-6000 125-01 Queens Boulevard 24-hour hotline: Kew Gardens, NY 11415 (718) 286-6580 Special Victims Bureau: 80-02 Kew Gardens Road (718) 286-6505 Kew Gardens, NY 11415 Domestic Violence: (718) 286-6550
Bronx DA General Information: Main Office www.bronxda.nyc.gov (718) 590-2000 198 E. 161st Street Domestic Violence: Bronx, New York 10451 (718) 838-7358 Child Abuse/Sex Crimes: (718) 838-7382
Richmond County DA General Information: 130 Stuyvesant Place, 7th Floor (Staten Island) (718) 876-6300 Staten Island, NY 10301 www.statenislandda.org Domestic Violence Coordinator: (718) 556-0577
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NYC FAMILY JUSTICE CENTERS
All Centers are open Monday through Friday from 9:00am to 5:00pm, no appointment is necessary. Spoken translation services are available at every center.
Services available include: Case managers (for safety planning, advice and referrals for public benefits, housing, and shelter); counselors/therapists/psychiatrists; economic empowerment services; lawyers; domestic violence prevention officers from the NYPD (can assist in filing police reports and getting police paperwork), Prosecutors (can provide information about criminal cases); NYC Sheriff’s Office (assist with serving civil court documents); and child care.
Borough Phone Location Manhattan 212-602-2800 80 Centre Street 4/5/6 train to Brooklyn Bridge-City Hall J/Z train to Chambers Street N/Q/R train to Canal Street 1/2/3/A/C train to Chambers Street Buses: M5, M9, M22 and M103
Queens 718-575-4545 126-02 82nd Avenue E/F train to Kew Gardens-Union Turnpike Bus: Q10, Q37, Q46, and Q60
Brooklyn 718-250-5111 350 Jay Street A/C/F/R train to Jay Street 2/3/4/5 to Borough Hall Bus: B25, B26, B38, B54, B57, B61, B62, B67, B75 and B103
Bronx 718-508-1220 198 East 161st Street, 2nd Floor 4/B/D to Yankee Stadium Bus: BX1, BX2, BX6, BX13
Staten Island 718-697-4300 126 Stuyvesant Place Close to the St. George Ferry Terminal Staten Island Railroad to St. George Bus: multiple lines.
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Chief of Detectives Memo #20
POLICE DEPARTMENT CITY OF NEW YORK
December 19, 1994
From: Chief of Detectives
To: All Detective Borough Commands and Staten Island Detective Operations
Subject: RAPE CRISIS COUNSELORS PRESENT DURING INTERVIEW OF SEXUAL ASSAULT VICTIM
1. A recent legal opinion on the permissibility and advisability of excluding rape crisis counselors from detectives’ interviews of sexual assault victims indicates that the counselor shall be present unless the victim objects.
2. Executive Law S642 (20a) states that “…a social worker, rape crisis counselor, psychologist or other professional providing emotional support to the victim, unless the victim objects to the presence of such person and requests the exclusion of such person form the interview, …shall be present during the interview of the victim. “(Emphasis added.) The statute’s use of the word “shall” indicates that the counselor must be allowed in the room, unless the victim objects to his or her presence. The Department must comply with this law, and could be civilly liable for a failure to do so.
3. Civil Practice Law and Rules S4510 also establish privilege of confidentiality between a rape crisis counselor and his or her client. Like any of the legally recognized conversation includes a third party who is not part of the privilege. Therefore any conversation between the counselor and the victim in the presence of the detective is not part of the privilege. Any private conversation outside the Detective’s presence would be privileged.
4. To ensure compliance with the executive law whole also empowering the victim the following policy will be effective immediately:
The assigned investigator will inform the victim in a professional manner of the following:
a. The counselor is a volunteer and not a member of the police department. b. Express the Detectives preference for interviewing the victim alone (e.g. I feel it is better for the case.) If applicable. c. Inform victim in a sensitive manner that it is her choice whether or not the counselor remains in the room. d. Inform victim the confidentiality privilege that exist between the counselor and the victim ceases during the Detective interview. Any prior private conversations between the counselor and victim are privileged.
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5. In addition, the name and rape crisis program phone number of the counselor will be entered on the dd5 indicating whiter they were present during the interview or excluded by the victim.
6. Detectives are reminded of their responsibility to ensure that rape crisis information is provided to the victim when no counselor is present and that this is documented on a dd5.
7. Detectives are reminded not to get in to a confrontation in the presence of the victim. The counselor’s role is to support the victim not to conduct the interview. If the counselor is interrupting the interview process, the Detective should request in a professional manner to speak to the counselor outside the interview room to establish ground rules during the interview.
8. Any problems arising due to the conduct of a counselor should be reported to the Commanding Officer of the Special Victims Liaison Unity at 646-610-7272.
Joseph R. Borrelli Chief of Detectives
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SAMPLE OVS FORM SAMPLE OVS FORM SAMPLE OVS FORM SAMPLE OVS FORM Read Application for Compensation How to Apply for New York State Office of Victim Services Compensation before filling out this form. Please print. Answer all questions. It is a crime to file a false claim!
Victim Assistance Program Use Only OVS VAP ID# Program Name/Phone Advocate Name/Email 099 SAVI 1 Tell us about the victim. Last Name First Name MI Social Security # Date of Birth Check here if you do not have one. Doe Jane __1 2__ 3__ - __4 __5 - __6 __7 __8 __9 01/01/1970 Mailing Address: 123 First Avenue, Apt. 123, New York, NY 10001 Street Apt. # (or P.O. Box) City County State (or Foreign Country) Zip Code Race/Ethnicity: x White Black Asian Hispanic American Indian/Alaskan Native Pacific Islander/Native Hawaiian Other Multi-Race Marital Status: x Single Married Divorced Separated Widowed Lives with partner Gender: Male x Female Was the victim disabled at the time of the crime? Yes x No Unknown How did you first hear about the Office of Victim Services? Police Hospital District Attorney x Victim Assistance Program Radio/TV Brochure/Poster Internet Other 2 If you are not the victim, and you are signing this claim, you are the claimant. Tell us about you. (See “Who can sign the claim?” on the instructions page.) Last Name First Name MI Social Security # Date of Birth Check here if you do not have one. ______- __ __ - ______Mailing Address:
If patient is under 18 years old, the parent or guardian must fill out #2. Street Apt. # (or P.O. Box) City County State (or Foreign Country) Zip Code
What is your relationship to the victim? (Check only one.) Parent Spouse Child Legal Guardian Attorney Other (Explain):
3 Tell us about the crime. (Check only one.) Check off Assault for IPV, or Sexual Assault. The victim died because of: The victim was injured because of: The victim lost essential personal property Motor Vehicle (DUI/DWI) x Assault Stalking because of: Sexual Assault Kidnapping Motor Vehicle (Other) x Burglary Arson Child Physical Abuse/Neglect Terrorism Motor Vehicle (DUI/DWI) Criminal Terrorism Child Sexual Abuse Arson Arson Motor Vehicle (DUI/DWI) Robbery Motor Vehicle (not DUI/DWI) Mischief Human Trafficking Motor Vehicle (not DUI/DWI) Human Trafficking Human Trafficking Fraud/Financial Other Homicide: Child Pornography Robbery (No injury) Crime Other (Explain): Other (Explain): Where did the crime happen? (Check only one.) Work Owned residence x Apt. Bldg. Public Street Subway/Bus Parking Lot Restaurant/Bar School/School grounds Shopping Mall Other (Explain): Was this a crime related to domestic violence?...... Yes x No Unknown Was this a crime related to bullying?...... Yes x No Unknown Was this a crime related to elder abuse/neglect?...... Yes x No Unknown Was this a hate crime?...... Yes x No Unknown Was the victim driving a livery cab when the crime happened? ...... Yes x No Unknown Was the victim’s property lost or damaged while trying to prevent or stop a crime against someone else or while helping the authorities stop the crime? .... Yes x No
Crime report # needed for IPV. Can be gotten during follow up. Crime Report #: ______1234 Police or criminal justice agency reported to:______NYPD, 23rd Precinct County where crime happened: Manhattan Date of crime: ______12/01/16 Date crime was reported: ______12/01/16 If more than 7 days between the date of crime and date the crime was reported, explain why: ______
If more than 1 year between the date of crime and the date you are filing this claim, explain why: ______Describe the crime in your own words: ______Put BRIEF description______of the crime here. I.E.______"I was sexually assaulted______Rev. September 2015 by a stranger who broke into my home." 4 Tell us about the suspect. Suspect’s name (if you know): Has the suspect been arrested for this crime? ...... x Yes No Has the suspect been prosecuted for this crime? ...... Yes No x Not Yet Does the suspect live in the same house as the victim OR is the suspect a member of the victim’s family? ...... Yes x No Has the court issued an order of protection in this case? .. Yes x No (If Yes, attach a copy.) Has the DA asked the court to order restitution? Yes No x Not Yet Did the court order the suspect to pay restitution?...... Yes (Amount $ ______) No x Not Yet NOTE - If you are eligible for compensation, the OVS may be able to reimburse for the expenses listed below. These items should also be requested as part of court ordered restitution. Applicants are encouraged to share this information with prosecutors if there is a criminal case. See the Court Ordered Restitution Information page for important information about restitution. 5 Tell us about your expenses related to this crime. (Check all that apply.) x Medical/Ambulance Loss of Support Lost Wages Personal Transportation Crime Scene Cleanup (Death Claim Only) DV Shelter Medical/Counseling Security Device/System Vocational/Rehabilitation Moving/Storage Court x Counseling Funeral/Burial x Essential Personal Property Other (Explain): 6 List any essential personal property, like cash, eyeglasses, or clothing that needs to be replaced because of this crime. (If none, skip to 7.) Describe what was lost/damaged: Cost Describe what was lost/damaged: Cost
1. ______Cell Phone $ ______250.00 3. ______$ ______2. ______Shirt $ ______50.00 4. ______$ ______3.______Pants $ ______100.00 6. ______$ ______Homeowner/Renter Insurance Company Policy or ID # Deductible $ Auto/Other Insurance Company Policy or ID # Deductible $ — If there were no injuries and you are only asking for essential personal property benefits, skip to 15. — 7 Tell us about the victim’s or the parent’s employment and insurance for Lost Wages. If you do not want us to contact your employer, you cannot ask to be reimbursed for Lost Wages. (Skip to 8.) Was the victim/parent of hospitalized minor victim employed when the crime happened? x Yes No (If No, skip to 8.) Did the victim/parent of hospitalized minor victim miss work because of the crime? Yes x No Was the victim/parent self-employed? Yes No (If Yes, attach copies of last year’s federal tax return and all schedules.) Employer’s Name, Address, and Phone #: ABC Store, 123 Main Street, New York, NY 10001 ( 212 ) 123-4567 Employer Street City State Zip Code Phone # Other Employer’s Name, Address, and Phone #: ( ) Employer Street City State Zip Code Phone # Name, Address, and Phone # of doctor who certified victim could not go to work: ( ) Doctor Street City State Zip Code Phone # Tell us about any insurance company that will cover the victim’s lost time at work. (If none, write “None” below and skip to 8.) Policy or ID # or “None” Policy or ID # or “None” 1. Unemployment Insurance 5. Workers’ Compensation
2. Disability Insurance 6. Other insurance
3. Pension Plan 7. Social Security Benefits (ssn SSN required) ______- __ __ - ______4. Other insurance 8. SSI Benefits (ssn required) SSN ______- __ __ - ______8 If the victim died, fill out below if you have any burial expenses. (If not, skip to 9.) Also, attach a copy of the funeral home contract, other bills for burial expenses, and a photocopy of the Death Certificate, if you have them.
Name of Funeral Home: _ Phone #: ( )
Address: Street City State Zip Code
Rev. September 2015 Page 2 of 4 9 If the victim was injured or died because of this crime, fill out below. Describe the victim’s injuries, briefly: Put BRIEF description of victims injuries here. I.E. "I have cuts and ______bruises on my face and body where he struck me while raping me." Did the victim receive any medical treatment? x Yes No (If No, skip to section10.) Tell us about the health professionals who treated the victim for injuries related to this crime: Full Name Complete Address Phone # First Hospital ______Mount Sinai Hospital ______1468 Madison Avenue, NY, NY 10029 (______212 ) 241-6500______Other Hospital ______(______) ______First Doctor (not in hospital) ______Dr. John Doe ______1468 Madison Avenue, NY, NY 10029 (______212 ) 241-6500______Other Doctor ______(______) ______
First Dentist ______(______) ______
Victim’s Counselor ______(______) ______10 Tell us about the victim’s dependents or others who depended on the victim for support. (If none, skip to 11.) Name Social Security # Date of Birth Relationship to Victim Dependent Judy Doe __0 __0 __0 - 0__ 0__ - __0 __0 __0 __0 1/01/2000 Child Address Are you the legal 123 First Avenue, Apt 123, New York, NY 10001 guardian? x Yes No Name Date of Birth Relationship to Victim Other Social Security # ______- __ __ - ______Dependent Address Are you the legal guardian? Yes No Name Date of Birth Relationship to Victim Other Social Security # ______- __ __ - ______Dependent Address Are you the legal guardian? Yes No If more than 3 dependents, attach a separate sheet and check here:
11 Did anyone besides the victim receive counseling because of this crime? (If no, skip to 12.) Who received counseling? Relationship to Victim Insurance company billed for counseling Policy or ID #
Counselor’s name, address and phone #:
Who else received counseling? Relationship to Victim Insurance company billed for counseling Policy or ID #
Counselor’s name, address and phone #:
If more than 2 people received counseling because of this crime, check here and attach a separate sheet to describe.
12 List any insurance covering the victim or the victim’s dependents. If no insurance, write “None” below. If you have applied but are not covered yet, write “Pending” under Policy or ID #. Policy or ID # Name of person(s) covered by this insurance: Primary Insurance Company
Major Medical Insurance Company
Other Insurance (Union, Dental, Vision, etc.)
Medicare
Medicaid
Workers’ Compensation
Auto Insurance
Other insurance
Rev. September 2015 Page 3 of 4 13 If the victim died, tell us about any life insurance and death benefits. (If the victim did not die, or does not have any life insurance or death benefits, skip to 14.) Company Name Address Phone # Policy or ID # Life Insurance ( ) Pension Plan ( ) Other Insurance/Plan ( ) Medicaid ( ) Workers’ Compensation ( ) If any other insurance or death benefits, list here: Do any of these policies cover the victim’s burial expenses? Yes No Has anyone applied for the Social Security Death Benefit? Yes No 14 Tell us about your financial situation. You MUST fill out ALL sections below. If none, enter zero (0). How many dependents do you have? 1 What is your total annual income (from ALL sources)? If you are not sure, estimate: $ 25,000 List ALL your assets and ALL your debts below. If you are not sure, estimate. Attach additional pages, if needed.
Your Assets – If none, enter zero (0). Your Debts – How much do you owe now? Savings, stocks, bonds $ 0 If none, enter zero (0). Real Property (house, etc.) $ 0 Mortgage $ 0 Proceeds from life insurance $ 0 Loans $ 0
15 Is a private lawyer (not DA) representing you? Yes x No If Yes: OVS Claim Civil Suit Both
( ) Lawyer’s Name Address Phone # 16 Authorization to speak with representative: If you would like to give permission to a family member, friend or other person to speak to OVS regarding your claim, enter here.
( ) Name of Person Address Phone # 17 Victim/Claimant’s Authorization: I ACKNOWLEDGE that accepting an award from the Office of Victim Services (OVS) creates a lien in favor of the State of New York on any recovery relating to the crime upon which this claim is based, including any judgment, settlement or order of restitution. I further authorize any funeral director, attorney, employer, police or other public authority, insurance company or any person who rendered services to the above, or having knowledge of the same, to furnish the OVS or its representatives the following information: Workers’ Compensation records, information relating to the crime or any injuries or death suffered as the result of the crime, and information relating to this claim. If an award is made, I authorize the OVS to make payments directly to the provider of services. I also authorize the OVS to share my information and records compiled for this claim with the local Victim Assistance Program (VAP) in order for the VAP to assist the OVS in processing my claim and making its determination. If a private lawyer has been indicated above, I also authorize the OVS to share my information and records compiled for this claim with the lawyer in order for him/her to act as my representative. I understand a separate Notice of Appearance from my lawyer will be needed in addition to this authorization. If a family member, friend or other person is indicated above, I authorize the OVS to share my information and records compiled for this claim with that person in order that they assist me with this claim. A photocopy of this authorization shall be deemed as effective as the original.
12/7/2016 ( 123 ) 456-7890 Claimant’s Signature Date Daytime Phone # Email: ______Language you prefer to speak: x English Spanish Simplified Chinese Traditional Chinese Haitian Creole Italian Korean Interpreter Needed: Yes x No Russian Other To process your claim, mail us the following documents. (Keep a copy for your records.) All bills and receipts for services listed on this form Your completed, signed claim form One completed HIPAA form for each service provider listed on this form (You can photocopy the HIPAA form.) Letters from any insurers denying or authorizing payment for the services listed on this form. Remember: You must bill your insurance company or benefits plan before the OVS can pay. Mail your documents to: New York State Office of Victim Services AE Smith Building 80 S. Swan Street Albany, NY 12210-8002
Rev. September 2015 Page 4 of 4 OCA Official Form No.: 960 **All information below must match the medical record.** *HIPAA* AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health] Patient Name Date of Birth Social Security Number Jane Doe 01/01/1970 XXX-XX-__6 __ 7 __ 8 __ 9 Patient Address 123 First Avenue, Apt. 123, New York, NY 10001 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8 2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address of health provider or entity to release this information: Mount Sinai Hospital, 1468 Madison Avenue, New York, NY 10029 (**or wherever care was received**) 8. Name and address of person(s) or category of person to whom this information will be sent: NYS OFFICE OF VICTIM SERVICES – AE SMITH BLDG., 80 S. SWAN ST., ALBANY, NY 12210-8002 9(a). Specific information to be released: Medical Record from (insert date) ______to (insert date) ______x Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. Other: ______Include: (Indicate by Initialing) ______Alcohol/Drug Treatment ______Mental Health Information Authorization to Discuss Health Information ______HIV-Related Information (b) By initialing here ______I authorize ______Mount Sinai Hospital Initials Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: NEW YORK STATE OFFICE OF VICTIM SERVICES ______(Attorney/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: At request of the individual for purposes of establishing This authorization will expire upon the termination of the eligibility for New York State Office of Victim Services individual’s eligibility for Office of Victim Services benefits. benefits. 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
All items on this form have been completed and my questions about this form have been answered. In addition, I have been provided a copy of the form. ______Date: ______12/7/2016 Signature of patient or representative authorized by law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. Europe Europe - continued Pacific Islands
Language Identification Card Use this Language Identification Card in a face-to- face situation to determine which language a person speaks. The Language ID Card lists the languages most frequently encountered in North America, grouped by the geographical region where they are commonly spoken.
• To use the Language ID Card efficiently, locate the geographical region where you believe the speaker may be from. (Pacific Islands, Europe, etc.)
• Show the person the languages listed for that region. The message underneath each language says: “Point to your language. An interpreter will be called. The interpreter is provided at no cost to you.”
North America, South America, and Caribbean India, Pakistan, and Southwest Asia Africa - continued Middle East Asia- continued
Asia
Africa
Printed on recycled paper. LLS 02/13 Resource Sharing Project CRISIS AND SUPPORT LINE TIP SHEET
THINGS WE CAN SAY IF A SURVIVOR ASKS "WHAT SHOULD I DO?" I believe you. How about we work together to come up It's not your fault. with a plan for coping with these bad I'm sorry this happened. times? I'm here for you. I'm glad you're alive. Lets brainstorm together some things that you think may help. Does that sound You deserve support right now. good? You are being so strong. You're amazing for pick up the phone and calling. BRAINSTORM HEALTHY Take your time... I'm here when COPING STRATEGIES you're ready. First, listen to what they have been using No need to thank me, you're as coping strategies. doing the real work. Honor yourself. Then, help the survivor decrease self- There is no right or wrong way blame for less healthy coping strategies. to feel. You don't deserve what Frame coping strategies as survival skills happened to you. which make the survivor adaptive and I am just going to be with you creative. in this moment. Discuss options for support. Just listening is helpful. Always encourage self-care. Resource Sharing Project AFTER A CALL ON THE CRISIS AND SUPPORT LINE
PHYSICAL GROUNDING Thank you for supporting Run cool or warm water over survivors! your hands. SURVIVORS DON'T ALWAYS Grab onto your chair as hard NEED TANGIBLE RESOURCES. as you can. Walk around slowly, noticing Often they just need someone to listen. each footstep. You just did that, and much more:
You helped them build emotional SOOTHING GROUNDING safety.
Say kind statements, like "You You normalized and validated their are a wonderful person." feelings. Think of your favorites color, You instilled hope for healing, animal, or TV show. pointed out strengths, and Picture people you care about. decreased their self blame. You helped debunk misconceptions MENTAL GROUNDING and gave them the facts. Think of something funny to You helped them brainstorm healthy jolt yourself out of your mood. coping skills and encouraged self- Describe your environment in care. detail. You helped them explore their options and validated their concerns. Thanks to Ashlee Owens for her collaboration. This project was supported by Grant No. 2008-TA-AX-K043 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and For more information, resources, and tools recommendations expressed in this publication are those of the author and do not necessarily reflect the views of the Department of check out www.resourcesharingproject.org Justice, Office on Violence Against Women. Resource Sharing Project CRISIS AND SUPPORT LINE TIP SHEET
HOW TO USE THIS GUIDE
Supporting sexual assault survivors on our 24-hour crisis and support lines is an important part of our advocacy practice. On these calls we are able to provide survivors with many different resources. For sexual assault survivors possibly the most important resource we can provide is listening and believing. When a survivor doesn't need a tangible resource, like shelter, it can feel like we didn't do our job or that we weren't able to help that survivor. But that is not true- listening, providing emotional support, and helping them talk through options is an essential part of our job.
This guide was inspired by rural programs around the country and is meant to be used while you answer the crisis and support line. One side provides helpful responses and reflective language. This side will help you remember that listening and believing is an important part of your advocacy practice. Resist the urge to fill all the gaps with talking. Allowing silence can be powerful and gives the survivor time to formulate what they want to say. Using reflective responses helps you clarify with the caller what they mean and what they need.
The other side is for after you have completed the call. We have provided grounding techniques for you to use if you have a difficult or triggering call. We have also included a reminder list of what you actually did on that call. Supporting sexual assault survivors is important work! Tips for Active Listening
Active listening is one of the most important skills we use as advocates. We know how to navigate multiple systems, put together a support group with no budget, and to build relationships with community partners. The most important skill we have though, and the one we use with every survivor, is active listening. We may be the only person in a survivor’s life that they can speak to about their experiences of sexual violence, work through issues related to the abuse, and share ways that systems of oppression have impacted their experiences. When we actively listen to survivors we show compassion and support. This is the heart of advocacy and it won’t ever steer you wrong.
Becoming a good active listener takes practice and patience. It can be difficult to turn off the part of our brain that is thinking of the next thing to say or trying to remember what resource would be best. To be truly in the moment and able to hear the words as they come is not easy or effortless for any advocate. But in time, all advocates can develop this skill.
Active listening is a way to build connection with survivors and to show concern for their experiences and emotions. This skill can be used in every situation with survivors including one-on-one, group settings, over the phone, and in person. The goal of active listening is to show the survivor that you are listening and accepting what they are sharing and to encourage the survivor to speak as freely as possible about issues or topics that may be difficult to speak about including sexual violence and the lived experiences of oppression.
Often when we think we are actively listening what we are actually doing is thinking of what to say next or listening with a specific goal in mind. This is an understandable response as it often comes from a place of wanting to help the person in front of us. However when we aren’t actively listening we miss important opportunities to build trust and work collaboratively with the survivor.
Prior to meeting with a survivor or the start of your shift answering the crisis and support line take a few moments to center yourself. This opportunity to ground yourself in the moment and your advocacy practice will help you be fully present while you listen.
During the conversation there may be moments when the survivor is silent. Resist the urge to fill this silence with questions and comments. For some advocates being comfortable with silence is the most difficult part of active listening. In our everyday interactions we often find silence uncomfortable and seek to fill these quiet moments. In our advocacy practice silence can be a powerful tool. Silence is an opportunity for the survivor to gather their thoughts and try to articulate what they want to communicate. Allowing survivors the time and space to find the right words for themselves builds trust and puts control back in their hands.
There are four main skills involved in active listening: Reflecting, Encouraging, Summarizing, and Exploring. Below we provide information about each skill along with examples. We encourage you to incorporate these skills in to your work, while continuing to honor the individual needs of the survivor in front of you.
Reflecting
Reflecting is the skill of conveying your attention through non-verbal cues. Non-verbal cues are a visual way of showing that you are paying attention and actively listening. Non-verbal cues are a great place to start practicing because survivors are paying attention to these cues whether they know it or not. If you can’t visually show your attention then encouraging, summarizing, and exploring won’t work.
Resource Sharing Project, 2017 2 Whether over the phone or in person, you should not interrupt the survivor. This signals to the survivor that your contributions to the conversation are more important than theirs. Questions, comments, and minimal encouragers can always wait until the survivor has had the opportunity to convey the entirety of what they want to say.
For in-person advocacy, non-verbal cues may include making eye contact, nodding your head, and maintaining a posture which focuses energy towards the survivor. It is also important to not show signs of distraction like fidgeting, checking your phone, or watching the clock. Every survivor responds to non-verbal cues differently so be sure to pay attention to what the survivor responds to. Be aware of the cultural values of different forms of communications.
For advocacy over the phone, try making very brief statements or contributing minimal encouragers to show that you have noted what the survivor has said. A brief statement could include, “sounds difficult” or “yes, absolutely”. Minimal encouragers could include, “mm-hmm” or “uh-huh”. These are subtle ways you let the survivor know you’re still there, even though they can’t see you.
Reflecting also involves observing the verbal and non-verbal cues of the survivor. Notice what thoughts, feelings, and needs have been expressed and not expressed. Observe the survivor’s body language and tone of voice. Are they mumbling? Are they hunched over? Have they stopped making eye contact? Is their voice cracking? Use these observations to inform the conversation as you move forward.
Encouraging
Encouraging communicates to the survivor that what is being expressed is important to you and you want to hear more. Often this is a one-sentence statement or an action which prompts the survivor to continue sharing their thoughts, hopes, or needs.
Usually Encouraging occurs during a lull or interval when the survivor may be observing and deciding if you're really interested in hearing more information. Encouraging gently urges the survivor to tell you more about the topic and shows that you are not going to shy away from anything they share about their experiences of sexual violence and lived oppression.
Resource Sharing Project, 2017 3 For in-person advocacy, encouragement can look like a smile, raising your eyebrows, turning your head slightly, or shaking your head up and down. Sometimes silence itself can be the encouragement. By not jumping in to make our own statement we show the survivor that we want them to continue speaking.
For over the phone advocacy, try some of the statements below.
“I’d like to hear more about what you want." “If you feel safe, you can share more about...” "I’d like to hear more about how you feel."
Reflecting and Encouraging are crucial to active listening. Many conversations you have with survivors will only involve those two skills. Only when you feel like you have adequately reflected and encouraged should you move forward with summarizing and exploring. No matter where the conversation moves, you can always return to reflecting and encouraging.
Summarizing
Summarizing your understanding of what the survivor has shared assists our comprehension of the situation and shows our concern. As a result of generational or immediate trauma, survivors often do not have a linear way of sharing their experiences. Regardless of trauma, when people are nervous or excited they jump around in the conversation and it can be difficult to understand. Summarizing helps us have a mutual understanding of what has been shared even when our cultural experiences might be very different.
Resource Sharing Project, 2017 4 Taking the time to summarize what you understood and clarify with the survivor show that we care about understanding the situation and getting the information right. This helps us build trust in the conversation and encourages the survivor to share more.
When summarizing, always ask for feedback. In paraphrasing what the survivor has shared, we don’t always get all the information right. We might not have picked up on the tone of voice or word choice that was meant to convey anger, sadness, or joy. Survivors won’t always feel comfortable telling you that you misunderstood something so it is always best to preemptively ask.
Examples of summarizing statements:
“It’s important for me to fully understand what you just said. I heard you say…”
“Let me see if I understand you correctly and please correct me if I’m off. You believe ...”
"Let me know if this fits with what you were saying… it sounds like…”
Examples of asking for feedback:
“…did I get that right?” “…please tell me if I missed something.” “…did I hear what you were trying to say?”
Exploring
Exploring the topic is the last skill and one that you won’t use in every interaction. Exploring is when we ask clarifying and relevant questions to the survivor to help them work through the topic we are discussing. Not every survivor is ready for this step so always be open to just allowing the survivor to share their thoughts and not doing anything else.
Asking open-ended questions helps us understand the problem more thoroughly and helps the survivor flesh out their feelings. Being heard and having a voice is vital to moving through an issue and healing. Exploring is a safe way for survivors to work through all sides of a topic and feel heard.
Resource Sharing Project, 2017 5 Examples of open-ended questions:
“How did you come to that conclusion?” “When he said that, how did it make you feel?” “What outcome are you hoping for?”
Be careful not to investigate the topic or ask questions simply out of curiosity. Your questions should always serve the survivor’s best interests. Let the survivor steer the direction of the conversation and allow them to set the pace. You can always return to reflecting and encouraging.
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Active listening is a skill that you can hone with practice and attention. When you prioritize this skill in your advocacy practice, you will see that every service you provide will get better. Focusing on listening first makes our relationships with survivors stronger and we are more equipped to serve them. Inviting survivors to share experiences of sexual violence and lived oppression helps disrupt our cultural narrative of what is okay to talk about and how we seek support. Sexual assault survivors need to be heard, and we are here to listen.
This tip sheet was prepared by Leah Green, RSP Rural TA Specialist, with input from many Rural Grantees. For more information, contact [email protected] or visit www.resourcesharingproject.org/rural-training-and-technical- assistance.
Please note that this publication uses they/them/theirs in the singular to recognize there are more than two genders and affirm survivors who are transgender or who identify outside the gender binary.
This project was supported by Grant No. 2015-TA-AX-K018 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication are those of the author and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.
Resource Sharing Project, 2017 6