FCASV Insight June 2018

Sexual Violence and the Baker Act

By: Eva Fiallos-Diaz, LCSW

A cornerstone of sexual violence advocacy is empowering survivors as a means of healing. This includes restoring the autonomy they lost during their assault(s). This value is shared by the social work profession, which asserts (NASW Code of Ethics, 2017) that we must honor our clients’ rights to self-determination. Limits to self-determination can be made in situations that pose threats to the lives of the individuals, or others. However, the way in which trauma plays out for survivors, as they attempt to cope, can often be misinterpreted and result in unnecessary and re-traumatizing involuntary commitments.

In Florida, the Baker Act is the mental health law that covers involuntary examinations and commitments. There are no minimum age criteria, which means even children in Florida may be held for up to 72 hours regardless of guardians’ wishes. According to the Department of Children and Families’ 2015/2016 Annual Report (2017), there were 194,354 involuntary examinations, and involuntary examinations has more than doubled (105.50% increase) in the last 15 years. This was significant even after controlling for Florida’s population growth during the same period. One in six of those involuntary examinations were for children under the age of 18, and slightly more than half were initiated by law enforcement (50.86%). According to the WJXT News4Jax I-TEAM (Gardner, 2017), another growing trend we’re seeing in Florida is schools initiating Baker Acts of minors.

During an involuntary inpatient placement, a survivor may be confined, isolated from their support systems, and given medications to sedate their seemingly “crazy” behavior. These events can be particularly triggering to survivors of sexual violence and counterproductive to efforts in supporting their mental health and healing. Perpetrators of sexual violence often confine, isolate, and use drugs to facilitate their assaults. They are also more likely to prey on individuals who are institutionalized in mental health facilities or have histories of mental illnesses. According to a research paper published in Psychological Medicine, 40% of women with mental illnesses had suffered rapes or attempted rapes in adulthood and 53% attempted suicide as a result of the assaults (Khalifeh, Moran, Borschmann, & Dean, 2015).

Professionals may find that they are uncomfortable when survivors express intense emotions. Survivors expressing anger and defiance are more likely to be turned away from services, have the police called, and be Baker Acted. It is also important to note that there are racial and ethnic disparities in the diagnosis of psychotic disorders, with African American/Black and Latinx/Hispanic populations disproportionately diagnosed at a rate of three to four times higher than White Americans (Schwartz & Blankenship, 2014). Another reality is that professionals may not receive training on handling trauma, and they are taught to conduct suicide assessments at the mention of suicidal ideation.

Common symptoms of trauma after a sexual assault include but are not limited to:

• Cognitive and mood symptoms (avoidance, depression, trouble recalling events, disassociation)
• Arousal symptoms (hypervigilance, startle reflex, sleep disturbances, outbursts of anger)

• Self-harm (substance abuse, cutting, indiscriminate/risky sexual encounters)

Ways that advocates can promote alternatives to involuntary commitment include:

• Early discussions about the different ways survivors may react post sexual violence
• Personal safety plans with survivors and their loved ones (based on triggers that may present themselves)
• De-escalation through crisis intervention skills (validating, mirroring, providing appropriate coping tools)
• Referrals to trauma-informed, culturally specific, holistic healing therapies
• Availability of 24 hour helplines

For more on this topic, we invite you to join us for our rural call.
Sexual Violence and the Baker Act
June 6, 10:30-11:30 a.m. ET
Call in: 1-800-791-2345, Code: 16005

References
Christy, A., Guenther, C., Jenkins, K., Ringhoff, D., and Rhode, S. (2017). The Baker Act: The Florida

Mental Health Act Fiscal Year 2015/2016 annual report. Florida Department of Children and Families.

Gardner, L. (2017). I-TEAM:Number of children held under Baker Act growing. WJXT News4Jax.
Retrieved May 16, 2017 https://www.news4jax.com/news/i-team-number-of-children-held-under-the-baker-act-growing

Khalifeh, H., Moran, P., Borschmann, R., & Dean, K. (2015). Domestic and sexual violence against patients with severe mental illness. Psychological Medicine, 45(4), 875-886.

National Association of Social Workers. (2008). Code of ethics. Retrieved May 16, 2018, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Schwartz, R. C. and Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133-140.

Sexual Assault Awareness Month: Weaving Our Stories Exhibit Pictures

Weaving Our Stories was a clothing exhibit that traveled to three different Tallahassee, FL locations (a local art gallery and two universities) during SAAM 2018. This powerful display featured the outfits, or similar outfits to those, worn by survivors during their assaults. These outfits represented various individuals and cities throughout our state, via our certified sexual assault centers. Our exhibit was titled "Weaving Our Stories" to symbolize the strength that stems from sharing our stories, creating community, instilling hope, and promoting healing across our entire state.

Visit our Facebook page to view more pictures and check out our recap video!

LeMoyne Center for the Visual Arts display

Florida Agricultural & Mechanical University display

Florida State University display

Program Highlight: Crisis Center of Tampa Bay

The Crisis Center of Tampa Bay Sexual Assault Services (SAS) provides 24/7 medical forensic exams and advocacy, accompaniment, information and referral, community awareness, system coordination, and growth groups to residents of Hillsborough County 24/7, 365 days a year. The center averages about 30 medical forensic exams a month to survivors, within 120 hours of the incident. Additionally, all advocacy services are provided to an average of 25 additional survivors monthly who fall outside the 120 hour window.

SAS makes it a priority to provide outreach and information to special populations. These populations include: human trafficking survivors, people with disabilities, migrant workers, college and university students, and people who are homeless, as well as provide empowerment groups to girls and young women. Each advocate concentrates on a special population and forms relationships with service providers that inspire cross training and collaboration. Additionally, advocates participate in events in the community such as health and resource fairs, as well as specialized events like Tampa Pride.

Advocates and nurse examiners team up together to provide local hospitals with training on the services SAS provides along with important information on what to do if a survivor should present at the Emergency Department. SAS nurse examiner and advocate teams will provide medical forensic exams and advocacy services on site at the hospital for those survivors who cannot be transported to the Crisis Center. Of course the only caveat is the survivor has to be able to consent.

The advocates work closely with law enforcement in order to connect with them when they bring survivors to the center, as well as when the advocates are assisting survivors through the legal process. Advocates attend various community events sponsored by law enforcement to show their support. This is especially helpful when a victim who presents as a non-report, changes their mind and wants to report. Law enforcement will come to the center to interview the survivor and having a relationship, either with the advocate or with the center, is helpful. SAS keeps medical forensic exams on site for one year so the survivor can have the time needed to make the best decision for them.

SAS advocates are amazing and work tirelessly to make a difference. Given the opportunity, they will work with a survivor during the medical forensic exam, at a human trafficking rescue, at the law enforcement interview, assist with Crime Victim’s Compensation and injunctions, make referrals to counseling, assist with financial needs, and support survivors through a deposition, trial, verdict, and sentencing. The advocates know that the support they provide to a survivor makes them better victim witnesses for the prosecution and gives survivors the support needed to continue on their healing journeys. SAS advocates know if their caseloads are low, they need to be out in the community, as only 20% of survivors disclose. Their goal is to make that percentage grow by providing outreach to ensure people know about our services.

See You on the Beach in Naples, FL for FCASV’s Biennial Training Summit!

FCASV's Reaching Out. Coming Together. Summit in Naples, FL is right around the corner.

The conference, June 13-15, features:
• 3 nationally renowned keynote speakers
• More than 30 workshops and 3 film screenings
• 8 themed tracks, including Human Trafficking, Children and Youth, and Legal Issues

Be sure to use #FLComeTogether when posting on social media during the conference!

We'll see you there standing in solidarity with survivors and service providers who perform this vital work every day.

Upcoming Events and Trainings

FCASV Rural Call: Sexual Violence and the Baker Act

June 6, 2018

10:30-11:30 a.m. ET
Call in: 1-800-791-2345, Code: 16005

40-Hour SANE Training

June 11-15, 2018
Naples, FL

For more information about the training, visit fcasv.org.

Expert Witness Training

June 12, 2018
Naples, FL

Focusing on the use of expert witnesses to explain the effects of sexual violence perpetration at trial, this training is open to attorneys as well as experts in the field of victim response, such as sexual assault nurse examiners (SANEs), therapists, counselors, law enforcement officers, and seasoned advocates.

For more information about the training and to register, visit fcasv.org.

One-Day Advanced SANE Training

June 12, 2018
Naples, FL

Morning session: Anatomy Review and Variation Recognition / Injury Identification
Afternoon session: Discharge Planning and Prophylaxis Medication

For more information, visit fcasv.org.

Reaching Out. Coming Together. Biennial Training Summit

June 13-15, 2018
Naples, FL