Pulse
Tending Victims, Tackling Crime
A northwestern Minnesota hospital takes on violence and abuse.
As late as 2005, northwestern Minnesota was a particularly troubling place for victims of violence and abuse. A paucity of health care providers trained to examine and treat child abuse and sexual assault victims in the area meant that victims often had to travel more than 200 miles to St. Paul for examinations and investigative interviews. “It was making the victimization worse,” recounts Thomas Heffelfinger, who then was U.S. attorney for Minnesota.
There was a dramatic need for such services in that part of the state, according to Heffelfinger: In 2002, about 1,100 child abuse cases and roughly 900 cases of rape were reported in northern Minnesota, where approximately 85 percent of the state’s Native American population happens to reside. Native American women are victimized by violent crime at a rate 2.5 times the national average, and Native American children have double the risk of being abused and neglected. From that need, an idea was born.
In 2005, Heffelfinger and his team conceived the idea of a hospital-based facility for victims of violence and abuse. They reached out to Red Lake tribal leaders and North Country Health Services’ president Jim Hanko, who offered to house what would become the Family Advocacy Center at North Country Regional Hospital in Bemidji. They also asked for the support of county attorneys and police chiefs in the area and consulted with Carolyn Levitt, M.D., founding director of the Midwest Children’s Resource Center, a child-abuse advocacy and examination center in St. Paul. Funding came from federal grant monies, the Mdewakanton Sioux Community in Shakopee, and several private donors. The center, which opened in January 2006, serves a 17-county region in northwestern Minnesota.
The Medical Piece
By all accounts, the center is the first of its kind in the area and perhaps beyond. What makes it unique is that it serves victims of sexual assault, domestic violence, and child abuse in one location; it was developed by a tribal government in conjunction with nontribal organizations; and it focuses less on prosecution and more on care of the victim.
“A number of social service agencies and law enforcement units can do the evidence-gathering, but there is a medical piece missing to that,” says John Parkin, M.D., a pediatrician with MeritCare in Bemidji and medical director of the Family Advocacy Center since 2007. “Think of having a 6-year-old down at the county jail or prosecutor’s office doing an interview. It is not conducive to a meaningful exchange, and it’s certainly not comforting.” In addition, interviews with victims of child abuse, when conducted in a controlled setting such as a medical facility, are potentially admissible as evidence, Parkin says. Interviews done elsewhere could be classified as hearsay, and the child may be required to provide additional court testimony—a situation most families and prosecutors would want to avoid.
The center treats patients regardless of whether they want to report the incident to law enforcement. Most child abuse referrals come from child protection services or a concerned caregiver; sexual assault victims are often referred by North Country’s ER. Children who come to the center are examined and complete a videotaped interview with a forensic nurse trained to talk with pediatric patients. Parents or other caregivers receive information on counseling services, referrals for primary and dental care, and a plan for follow-up. In cases of sexual assault, a specially trained nurse will examine the victim for genital injuries, provide referrals for mental health services and primary care, prescribe medications to prevent pregnancy or treat STDs, and follow up days later to make sure the victim is getting assistance. Victims also learn where they can go for help if they feel unsafe.
Levitt says the benefit of the center being in the hospital is that victims can receive services in a neutral setting. “It provides an anonymity that you would not have if you had to go to a stand-alone facility on the reservation or elsewhere,” she says. For that reason, victims appear to be more likely to get help and report crimes, says the center’s executive director Robyn Trepanier.
Trepanier sees firsthand the difference the center can make in victims’ lives: “When you watch the interviews with the children, for example, it can be heart-breaking. Their heads are down. They don’t want to talk. Then when they finally do disclose, you see the energy change dramatically. The secret is out. They sit up. They develop a safety plan. They are devastated but also empowered, which hopefully gives them the courage to move on.”
Heffelfinger says that while the center helps victims, it also has a broader goal: “What happens far too frequently in crimes of child abuse and sexual assault is that people who are victims today become offenders or enablers tomorrow. And what we want to do is break the generational cycle of violence by helping victims recover.”
Facing Challenges
One challenge for the center has been funding. It opened its doors with more than $1 million, most of which has been used to cover three years of administrative and operational costs. Because fee-for-service medical reimbursement covers only about 30 percent of the center’s budget, dollars are dwindling.
Yet the center is clearly meeting a need. Trepanier notes that it was projected to serve 200 individuals in the first three years. As of July 2009, it had served 574 people. From January through March 2009, it saw a 35 percent increase in the number of people seen compared with the same period in 2008. “It has absolutely been meeting my expectations in terms of the number and diversity of children and women who have been served,” Heffelfinger says. “And it has provided a service in northwestern Minnesota that simply was not being provided before. Over the long term, we hope that translates to a better outlook for the patient and for the community in which they live.”
—Jeanne Mettner