Philly’s only dedicated center for treating adult sexual assault never has enough funding, its leader says

Many patients come to Allison Denman after the worst experience of their lives. As the clinical director and forensic nurse manager of the Philadelphia Sexual Assault Response Center, Denman runs the only dedicated resource for conducting adult rape exams in the city.

During her three years at the not-for-profit center, she has launched a training program for sexual assault nurse examiners (sometimes known as SANEs), which has trained more than 100 nurses in the last two years to help address a severe shortage of such expertise in the health-care system. The need is great, considering that someone is sexually assaulted in the U.S. every 68 seconds.

Students learn how to perform an exam on a patient who has experienced sexual assault, using real people pretending to be patients. They must know how to provide medical care for injuries, administer medicine to prevent sexually transmitted infections (which only works within 72 hours of the assault), and collect evidence for police if the person decides to pursue charges (which mostly needs to happen within five days). And all of this care requires sensitive, thoughtful, and specific training to avoid retraumatizing the patient.

The center on East Hunting Park Avenue near Front Street is staffed around the clock seven days a week, and provides free sexual assault exams to more than 300 patients, both female and male, per year.

“We have patients who come to us from miles and miles away, out in the suburbs especially, and they’re saying, ‘There wasn’t anywhere else for me to go,’ or ‘The wait was going to be really, really long, and I couldn’t wait that long. I have kids, I have a job,’” Denman said.

To Denman, caring for people who have experienced trauma, and providing that care in an empathetic and sensitive way, is not what makes the job hard. Instead, it’s watching the vast majority of rape cases go unprosecuted in Pennsylvania and the constant struggle to get resources and to make health systems aware of the importance of giving patients access to this type of exam by trained providers.

Since she joined the Philadelphia Sexual Assault Response Center — also known as PSARC — Denman has tried to “raise the flag about the desperate, urgent need for support for, if not PSARC, then something to protect the right of access for this type of medical care for patients.”

Denman came to this work after witnessing violence in her family growing up. To this day, she wonders how her life would have been easier if she had access to adults who could listen to and validate what she had experienced.

At 18, she became an emergency medical technician (EMT). Denman met crime victims and realized how few had access to a specially trained person who help them heal from and cope with what had happened.

After a sexual assault, patients often undergo an exam, sometimes known as a “rape kit,” to collect DNA and any other evidence if the survivor chooses to press charges.

Even if they don’t press charges, crime victims often need medical care for their injuries, and medications to prevent pregnancies and sexually transmitted diseases. The exams can be intrusive, both physically and emotionally, as a provider examines patients internally and asks questions about their health and sexual history.

Examiners need specialized training to perform trauma-informed care so that they aren’t “accidentally mishandling patients in a way that is permitting further harm to happen,” Denman said.

The need for such care far exceeds the number of nurses specially taught to perform sexual assault exams. According to the International Association of Forensic Nurses, only 17% to 20% of U.S. hospitals have a nurse on staff with such training.

PSARC, which was established in 2011, has contracted with Philadelphia hospitals to administer rape kits to hospital patients if there is no SANE on staff, but does not have such an arrangement with hospitals outside the city limits. In Montgomery County, Jefferson Abington Hospital is the only facility that has a SANE program. In Bucks County, the only place to offer it is Doylestown Health.

Denman said she has instructed students from many places on how to conduct a sexual assault exam, including North Carolina, South Carolina, Ohio, and Massachusetts.

Even if hospitals offer SANE exams, some patients may choose to get a free exam at PSARC, she said, as two-thirds of U.S. women who used private insurance to cover a rape kit after sexual assault end up paying out-of-pocket expenses, which average more than $300.

The sexual assault training takes two days, during which students learn how to perform a pelvic exam.

Scripted scenarios offer tutorials in trauma-informed language choices. They learn how to avoid dehumanizing instructions, such as asking patients to place their feet in “foot rests,” not “stirrups.”

Denman insists that the patient models are a diverse group, representing different ages, body types, and stories of sexual assault. Using live patients makes training much more effective, she said, because they can give active feedback to students about discomfort or what would make them feel better.

“People aren’t just learning how to do a pelvic exam with speculum insertion on a bottle or on a piece of paper. They’re practicing that on a real vagina,” she said.

Denman spends much of the rest of her time fighting for funding. At the moment, her only funding comes from the state, “which is nowhere near the amount of money needed to take care of patients,” she said. The state gives up to $1,000 per patient PSARC treats, which doesn’t cover the total cost of operating the clinic, and Denman relies on Drexel University — of which PSARC is part — to make up the rest. “We don’t get any funding from the city,” she said.

It can be thankless, exhausting, and gutting work. To prevent burnout, Denman does belly dancing, and sees a therapist once a week.

“My therapist, I’ll brag about her like somebody brags about their hairstylist,” she said. “She’s fabulous.”

Denman also leans on her network of other forensic nurses, who understand the burden — and the value — of the heavy work they all do.

But she worries what will happen if funding gets even worse.

“What happens when none of us exist anymore?” she said.