15. Discovering Forensic Medical Services

[00:00] Hello, welcome to the Adventist Healthcare New Podcast. I'm Shana, joined with Nimit. Hi, Shana. Hi, Nimit. How are you doing? Good. How are you doing? Good. Thanks for joining us.

[00:20] today. Absolutely. Well, we have an interesting topic today. We are joined by Jessica Foles. She is the clinical director of forensics at the Forensic Medical Unit at Shady Grove Medical Center. Welcome, Jessica. Hi, thank you for having me. Thank you for coming. We are going to talk about what the Forensic Medical Unit is.

[00:40] Is that Shadygrove, what they treat, what kind of special unit that is? Cause I don't think a lot of people know what that is. So it'd be an interesting, informative topic today. Jessica, can you tell us a little bit about you and your training and your interest in forensics in the forensic medical unit? Sure, of course. I started off as a nurse.

[01:00] in 2006 in critical care and came to Adventist healthcare in 2007 where I was an emergency department nurse for just shy of a decade. During that time I really fell in love with working with a patient population. Those who had experienced sexual assault found that that was really a passion of mine.

[01:20] in something that I felt like I was really good at and connecting with people and having that skill set. So in 2015, I decided to go back to school because I really wanted to serve this population even more than I had been and finished my doctor of nursing practice.

[01:40] and I'm a family nurse practitioner. I graduated in 2019 with that.

[02:00] do there. 2015 was really a special year for the Forensic Medical Unit. That's the year we've really started working hard and had the manpower to expand beyond sexual assault. So starting in the mid-90s, the Forensic Medical Unit became the place for people who experience sexual violence.

[02:20] violence regardless of their age to come for a medical forensic exam. In 2015, we really expanded our program to include people who have experienced domestic violence and that's kind of where we started and human trafficking. After that, the sky kind of became the limit and we felt like anyone who had experienced violence

[02:40] violence, be it abuse, assault, neglect. We really wanted to work with those patients and offer them everything that we had in our expertise. So now the forensic unit serves really anyone who has experienced intimate partner violence, again, sexual assault or abuse. We have a program for vulnerable.

[03:00] vulnerable and older adults. We also have a program for people who have experienced human trafficking. And this is really holistic and comprehensive, and we work in an interdisciplinary way that enhances the support and services provided to these patient-populae.

[03:20] patients. Wow, that's a lot. Yeah, that is. So why is it important to have such a special unit and especially trained nurses and staff for this? Well, we're really fortunate, first of all, that we do a lot of places in the nation here in the United States.

[03:40] even across our own state, don't have access to forensic nurses like we have at Adventist Health Care. Forensic nursing really has its own theoretical framework and the forensic nurses that we have on our team have the skills that are necessary not only to physically perform.

[04:00] the medical forensic examination itself, but do this in a person-centered, trauma-informed way. And why that's really important is because that's what sets us apart in our skills as a specialty really. I think that's great. I think we're fortunate to have been in this healthcare.

[04:20] have a specialized unit like that with special trained nurses. You know, I had the fortune to work close to your department and whenever we had a need in our units or other units as well, you know, we could easily reach out and say, hey, we have a potential patient that we could potentially use your services for. I think having those specialized nurses who are dedicated on this.

[04:40] specific departments is extremely beneficial. I think that's highly valuable for us.

[05:00] type of population that we serve. I read so many articles about the pandemic causing an increase in those types of cases and just an increase in violence. I think that COVID definitely had an impact. I also think that we have really great community partners and have established relationships.

[05:20] championships, for example, with the Montgomery County Family Justice Center, with the Montgomery County Police. And those people who have these experiences and encounter them first are now given the opportunity to come and at least speak with us or come and check in and have an exam with us. And so I think that those

[05:40] collaborative partnerships really have helped weave a safety net that is a lot tighter than it used to be. Is Shady Grove Medical Center one of the only hospitals or E.D.'s, E.R.s that have sort of a specially trained unit like that in Montgomery County or around close by. We are the only hospital

[06:00] hospital in Montgomery County. So, Shady Grove Medical Center houses the forensic medical unit that does these examinations for Montgomery County. We are one of the few in the entire nation that is staffed all the time. So we have full-time forensic nurses, which I'm really proud to see.

[06:20] say I think sets us apart. Absolutely. Yes. In that this is what people do. We are eating, sleeping and breathing this every day. In 2015, when I started full-time with the Forensic Medical Unit, we had around 250 patients for the year. Last year, we either

[06:40] saw through consultation, acute visits, or follow-ups just shy of 3,000. So I think that speaks to how when you have the service available and accessible to people, there really is a need. And I'm sure there's a lot of awareness about it too now. We're probably seeing more cases just because

[07:00] where people are more aware of things and know where to ask the right questions and who to ask the right questions to as well. And that includes healthcare providers as well. When you have an awareness not just among the public, which we have actually noticed that more and more people come in and we ask how did you get to us or how did you know what to do to come here

[07:20] for help and people will say my friend told me that they came here. The other thing is educating healthcare providers. We've noticed an increase even in primary care providers or OB-GYNs in the community that will give us a call and say hey I have this patient, do you mind speaking with them or can I send them in? So there really is.

[07:40] is an increased level of awareness on multiple levels. Sad that we need services like that, that this exists, but it's good to know that it's here and we're right here in the community for them with a lot of services, not just to help them physically, but as you mentioned, you have an interdisciplinary team that can help them in a couple of different ways.

[08:00] You've spent a lot of time educating other nurses, especially across the world. Even in places like Brazil, we've helped train these specially trained nurses. Why do you advocate for this? You mentioned you have sort of a passion for it, but what kind of drives you to this?

[08:20] form that takes. It affects people and it affects their health, it affects their well-being. There's actually a study that if you're not familiar with it, I would encourage every listener because whether you know someone who has experienced some type of violence or abuse or if you're just curious and that's why you're listening.

[08:40] to this podcast to look up Dr. Vince Foletti's ACE study, and this was done through the Kaiser Foundation in the 90s. And what he found was that people who have experienced trauma, and if that trauma goes unaddressed, it has direct correlation and links to heart disease, cancer,

[09:00] obesity and the list goes on. And so we're really talking about not just one isolated event that has happened, but we're talking about what is the person's trajectory. How does it affect their wellbeing long term over the next 5, 10, 20 years? And what can we do to support people?

[09:20] just collect the evidence, which is obviously an important piece of what we do, right? But how can we help put them on a path to wellness? And so having said all of that, circling back to why do I advocate for this other places? Because we're all people and that really is why, because if violence and abuse affects us,

[09:40] affects people and their wellbeing and their health. And we have the ability to maybe teach healthcare providers how to respond in a meaningful way. Studies have shown that actually that is oftentimes the primary goal of people in their health-seeking. It's not a judicial outcome, which is what most people

[10:00] think is what our primary focus is and what we do. And that is a part of it. But that healing and what contributes to that healing looks different for everyone. And so really that is why I advocate for this across the world because even if there aren't systems in place, judicial systems, law enforcement systems,

[10:20] that can support people who have experienced these things. If we can teach healthcare providers safety planning, if we can teach healthcare providers how to interact in a trauma-informed way and how to just be there, how to support them, this can in itself can create meaningful gene impact. And be impactful, yeah. You know, we've talked about that in previous episodes about

[10:40] Not only are our doctors and our nurses and other treatments there to help people physically, but that there are other things to help with their wellbeing, with their mental wellness, with their emotional and spiritual health, that those are things that are equal to the physical health. Their physical health impacts.

[11:00] their wellbeing and impacts their mental health and their emotional and spiritual health too. And that you have to look at the person as whole, that they're not just the physical, that there's all these other things that we have to think about and treat them. So I love what you guys are doing. It really does make an impact. Yeah, I think it's a combination of both physical and emotional.

[11:20] emotional well-being. You take care of the physical part, obviously, making sure that the patient and the person is healthy, but there's a whole emotional aspect of it that your team is fully trained and has equipment to provide the resources to the community.

[11:40] fibrous, the emotional part is not so easy and many often historically ignored and we're just getting better and better by the year. And acknowledging that is really an important part of what we do, acknowledging what someone has experienced, addressing again their physical needs is obviously a key part.

[12:00] really important. But then we see people in follow-up as well. So we're able to interact over several periods of time. Yeah, encourage them and get them the support that they need. So what should people in our community know about sexual assault? You mentioned human trafficking. I think there are a couple of really important

[12:20] important take-home points about these things. One is that they don't occur in isolation. So someone who's experiencing sexual abuse can also be trafficked. Someone who's experiencing physical intimate partner violence might also be sexually abused by their partner. Oftentimes these things overlap and they don't come in.

[12:40] isolation. The other important thing to acknowledge, these forms of violence and abuse don't know socioeconomic status. They don't know race, culture. It occurs among everyone, which is unfortunate and might sound daunting, but I think it's important to acknowledge that you can't assume.

[13:00] that because someone makes a certain income, has a certain level of education, or has a certain profession that they haven't had these experiences in their life. And what's important is for us to create an environment that is safe and confidential and that they feel like they can come and disclose this, talk about this.

[13:20] and get some type of care. Is there any special research that you're helping with currently? Yes. We are currently engaged with several research partners. One, Dr. Katz-Cafidi from George Mason University is doing a

[13:40] national study on bruising and she published those findings several years ago. What's interesting is we call it the research practitioner partnership. So her area of specialty is original research and my area of specialty is translational research. So what does that mean? It means getting that research that's really great and scientific.

[14:00] to the patient. And that study is around how we are able to photo document specifically cutaneous injuries like bruises in people of color and why that is important for a couple of reasons. One, if you aren't using this alternative

[14:20] it light, it can be really difficult to get a photograph of a bruise that you can visualize in a picture. And that's important for a couple of reasons, mostly because having visible injury has a direct correlation with accurate judicial outcomes. So we are working with her where when

[14:40] of two sites in the country that will be implementing this alternate light for documentation of bruises. We also are working with Dr. Rachel Goodman-Williams, who is an assistant professor at Wichita State, looking at how we can improve how patients have

[15:00] access to police, meaning that if someone comes in and they were sexually assaulted, for example, don't want to report to the police for whatever reason, that they have the opportunity to speak at least to law enforcement in a non-threatening way and that we can help facilitate that anonymously so that they can get the answers that they need.

[15:20] to make a truly informed best decision for themselves around that. So I'm really excited about that research. And finally, we just wrapped up an analysis of toxicology testing for children who were able to disclose what happened to them, but there is suspicion that they were exposed to or administered some type of illicit substance.

[15:40] Wow, there's a lot of great research coming up, especially for a new, you know, as you mentioned earlier, those big research done in their early 90s. I think it's still fairly in your realm of specialty that we're studying more and more. So I think every bit of research helps a lot. Absolutely, and I really hope to continue that work.

[16:00] because we have such a robust team to support this kind of work and understanding how we can better serve this patient population. Yeah, it's also amazing because from what you're describing, you'd think that this type of unit and your highly specialized nurses and staff and highly trained nurses.

[16:20] and staff would be at like an academic medical center or larger facility or something like that. But Shady Grove Medical Center is a community hospital and it's right here in Montgomery County and it's available to everyone and everybody has access to it and that's just it's wonderful that we're able to do that and contribute to the community.

[16:40] community in that way. My team and I and I feel free to speak on their behalf in this respect. We feel really blessed to be part of Adventist healthcare as an organization because the mission of Adventist healthcare marries so well with the work that we do, who we serve, and really it is a diamond in the sky.

[17:00] the rough, I think. Yeah. Well, thank you, Jessica, for coming on today and thank you for doing all that you do. It's not easy work and I can really tell your passion for it and I'm just grateful that you came and you're helping educate us and educating the community. So thank you. It is an honor to be able to do this work and it's been a pleasure to be here. Thank you. Thank you.

[17:20] Well, thank you to our listeners for tuning in. We hope you enjoyed it. If you do want to learn more about Adventist healthcare, you can go to adventisthealthcare.com. If you want to learn more about Shady Grove Medical Center, you can go to adventistsgc.com. Nimit, thank you for joining us again. Absolutely. It's been a pleasure, like always.

[17:40] Jessica, we'd love to have you back to talk about other topics. So we hope you will come back. Thank you. I would love to. Thank you. And don't forget to subscribe on Apple or Spotify to get new episodes. And we will be back again soon. Thank you.

[18:00] Thanks for watching!