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Beyond the Status Quo: Supported Self-Collection after Sexual Assault (Episode 9)
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Content warning: This episode discusses sexual violence, forensic evidence collection, and the barriers Survivors face within legal and health systems.
In this episode of Beyond the Rape Kit: Canada's Forensic Frontline, we sit down with Victoria Donkin, social worker and health equity researcher at She Matters, a Survivor-led organization working to improve access to justice and care for people impacted by sexual violence. Victoria is leading the first Canadian research examining the feasibility of supported self-collection of sexual assault evidence. She takes us through what these kits are, what they are not, and what it would take to make them work within Canadian health, forensic, and legal systems.
Together, we look at how early evidence kits are already used in the UK, Australia, and Kenya, unpack the chain of custody and admissibility questions that come with self-collection, and put the harder concerns on the table directly. Does supported self-collection replace forensic nurses, or does it reach Survivors the current system never touches? Who holds the chain of custody when the person in the room is a trained support worker rather than a forensic nurse? And can a practice stand up in court before it has ever been tested there?
A must-listen for forensic nurses, front-line health workers, community advocates, legal practitioners, policymakers, and anyone thinking about what access to evidence looks like outside the norm.
Recommended
Transcript
Introduction to 'Beyond the Rape Kit'
00:00:07
Speaker
This is not just another medical podcast or true crime series. This is the voice of forensic nursing in Canada. This is Beyond the Rape Kit, Canada's Forensic Frontline.
00:00:20
Speaker
We're the Canadian Forensic Nurses Association.
Role and Awareness of Forensic Nursing
00:00:23
Speaker
We're pulling back the curtain on what really happens trauma meets healthcare, when survivors seek justice, and when nurses stand at the front lines of both.
00:00:32
Speaker
Follow us today Spotify, Facebook, LinkedIn, and Blue Or check us out on the Canadian Forensic Nurses Association website.
Challenges in Forensic Access for Survivors
00:00:50
Speaker
Welcome back to Beyond the Rape Kit, where we explore the intersections of health, justice, and forensic nursing. Across Canada, we know many survivors of sexual assault live hours from a nearest hospital that might offer a sexual assault forensic exam. We know communities, especially rural and remote places, have no access to sexual assault nurse examiners or forensic nurse examiners at all.
00:01:13
Speaker
And even when services do exist, survivors often wait long times. There's hospital closures, transportation barriers, and let's face it, there's a general mistrust of the medical and legal systems.
00:01:27
Speaker
Forensic nurses know that these barriers exist. And we also know it might mean that crucial evidence, especially DNA, might be lost simply because care wasn't accessible in a timely way.
Introduction of Self-Collection Kits
00:01:39
Speaker
Today, I'm talking about a new development in response to these problems and in response to sexualized violence. Something that grew out of advocacy and survivor demand to try something different.
00:01:51
Speaker
This is a supported self-collection sexual assault evidence kit. That's pretty cool. These kits, now emerging in parts of Canada, are designed to expand access to time-sensitive DNA evidence collection when maybe a full forensic medical exam just isn't possible, isn't accessible, or isn't available.
00:02:12
Speaker
I think that sounds pretty cool. But I know there's still a lot of questions and I know there's some concerns that we need to discuss and we need to analyze a little more carefully. As forensic nurses, we are critical
Insights from Victoria Duncan on Trauma
00:02:23
Speaker
thinkers. So today I'm going to unpack what these supported self-collection kits really are and what they're not and what we think maybe the future of their use in Canada might be.
00:02:36
Speaker
So I'm bringing with me today Victoria Duncan, a social worker who specializes in trauma and resiliency, and she's a health equity research at She Matters, which is a survivor-led organization working to understand and improve access to justice and care for people who are impacted by sexual violence.
00:02:54
Speaker
Victoria is currently leading research examining the feasibility of supported self-collection of sexual assault evidence in Canada.
Sustaining Forensic Nursing Services
00:03:02
Speaker
Well, that's pretty cool. We're actually doing some research on this. So Victoria, welcome.
00:03:08
Speaker
Thank you for having me. It's no surprise, I think, to anybody that's listening that sexual assault reporting rates remain low in most parts of the world, including Canada. So many barriers exist for survivors, even when living in a rural or remote community isn't one of those barriers.
00:03:25
Speaker
So if, and ah we know this is a big if, a forensic exam service even exists in the community, access to the timely exam often requires lengthy waits in overcrowded, maybe not so trauma-informed emergency departments.
00:03:40
Speaker
I know most forensic nursing and sexual assault examiner programs struggle to keep a 24-7 schedule and are often reliant on nurses who are working on call. We know the current system, the way we've designed it, isn't sustainable and additional resources that are needed are really not being invested into hiring more specialized forensic nurse examiners, acknowledging them, paying them, and treating them the way I think they deserve.
00:04:04
Speaker
So then what's a victim to do when we know that DNA evidence degrades quickly? Victoria, let's start with what is a supported self-collection evidence kit or what should we even be calling it?
00:04:15
Speaker
What is it? What is it not?
Global Use of Self-Collection Kits
00:04:17
Speaker
Yeah. So a supported self-collection kit or supported self-collection, we really see as a supplementary tool. It's definitely not a replacement for any full forensic medical exam. It can't replace STI or pregnancy testing. Its purpose is very specific, and it's what you were mentioning. It's to preserve that time-sensitive DNA evidence when a survivor can't access a sexual assault nurse examiner or a kit in itself. So a lot of survivors, when they do go to the hospital, there actually isn't a kit available or there aren't SANE's on call at that time.
00:04:54
Speaker
And so what we're examining at She Matters is if self-collection or supported self-collection is something that can exist within the Canadian context. And part of that work is consulting with community leadership, first responders, health care staff, legal professionals, forensic experts, community orgs, anyone really that um is working with survivors.
00:05:19
Speaker
And to understand whether supported self-collection is something that's needed within the community on a survivor level and what it could look like in terms of an actual protocol. And internationally, i would say supported self-collection usually involves a specific kit that's tamper evident and it would allow a survivor to self-swab. And so this kit could include something like swabs, drying tubes, detailed instructions, documentations, materials that they would need to seal. And there's often a trained support staff present. And so supported self-collection is really intended to be more so a bridge that would allow a survivor to collect evidence that would then otherwise be lost.
00:06:06
Speaker
So if I understand it correctly, um these kits per se are essentially a couple of swabs and some instructions and then some evidence tape and basically how do you collect this the swabs and
International Implementation and Guidelines
00:06:22
Speaker
seal it up. And it's really primarily meant for, guess, vaginal or genital, anal, oral swabs.
00:06:29
Speaker
Yeah, I think that's a helpful way to look at it. And I think that's actually the starting point of what we're exploring in this research. So broadly, supported self-collection is envisioned as an easy way for someone or a survivor to use a kit that then can be sealed, as you're saying, with tamper-evident packaging to preserve that DNA when the full forensic exam isn't available or accessible.
00:06:53
Speaker
um But I think importantly, exactly what is in the kit is still open and it's still a critical question for us. And that's what we're exploring with the help of our consultants and forensic experts.
00:07:06
Speaker
So I understand that there are some of these types of self-collection processes, kits, whatever we want to call them, in the UK, Australia, maybe some parts of USA, and i think even Africa, which might be a slightly different approach. What do they look like in other countries?
00:07:26
Speaker
Yeah, so versions of this do exist internationally, and they're often called different things and embedded in different systems. And so in the UK, they're typically referred to as early evidence kits or EEKs, um and they're used when a survivor can't immediately access that full forensic exam at a sexual assault center. And so these kits are highly standardized and they're integrated within their health care and forensic pathway.
00:07:52
Speaker
And so from our research, what we've seen is that it appears that court documents and lab processes don't actually differentiate whether the sample has been self-administered by the survivor themselves or clinician administered. What matters most, it seems, in these contexts are that the collection followed an approved standardized protocol with clear chain of custody.
00:08:13
Speaker
And then in Australia, we see something very similar as well. So EEKs are actually embedded within the hospital based response, particularly in rural and remote communities.
00:08:24
Speaker
And they're actually also piloting supported self collection within mining sites. And so in parts of New South Wales and Australia, the clinical guidelines explicitly authorize the use of these early evidence kits when a forensic examiner isn't available or when there would be the possibility of transfer delays that would risk um that degradation of the DNA. So again, the emphasis is really on standard standardization with clear instructions and documentations and secure handling. so that once the evidence does reach the forensic lab or the core, the focus is primarily on integrity rather than who physically collected the swab.
00:09:07
Speaker
And then you mentioned in parts of Africa. So in Kenya, there's also a really important example. And um it was in response to major barriers to accessing full forensic exams. And so the University of Leicester, in partnership with the Wangu Kanja Foundation, developed a supervised forensic self-collection model for those low-resource health care settings.
Potential for Canadian Self-Collection Kits
00:09:29
Speaker
And so survivors were supported by a trained clinic staff member um who were they were then provided with follow-up links. for care and counseling after the self-collection process. And they did a pilot study and found, or like validation trials found that the kits were both easy to use and that the DNA was viable even if it was recovered up to 72 hours post-assault. So really promising findings there.
00:09:58
Speaker
It's got me thinking about how we do some of our processes right now in accessing a forensic nurse examiner or SANE. I know that often when survivors arrive at the emergency department, they're actually given a urine container. So if they have to urinate, we can actually collect it early, even before the forensic nurse is called in often. possibly this is something else they could give them, like here's a urine cup and a swab kit and go do this while you wait for the forensic nurse. Is that the concept here?
00:10:26
Speaker
Or is it like go to the drugstore and pick up a kit? It's definitely not go to a drugstore and pick up a kit. I think the way that we're envisioning it with our early consultations, we're still doing consultations and will be for the next six months. But how we envision it, it would be a survivor entering a community organization. So whether that is a walk-in clinic, whether it is a hospital or a sexual assault center or even a friendship center or an indigenous health organization, it's and there would be a support staff available to help guide them through the process. But it would not be something that they would then take home. It would be sort of done in a controlled setting with support staff available.
00:11:07
Speaker
So I guess in summary, the self-collected, supported self-collected kits seem to be an option, if the better option of a more thorough forensic exam isn't available or immediately accessible. And you mentioned they're not going to be in pharmacies because that's what I first thought when I heard self-collection kit. I'm like, oh, I go to the pharmacy like I do for a plan B now. i go and get a... And I remember when we made that change in Canada from you could only access emergency contraceptive pills or plan B. from like youth clinics and public health and walk-in clinics.
00:11:42
Speaker
And then it was and it was prescription before that. And then we put it to over the counter. And I remember having a bit of a fit because I worked in sexual health and I was like, well what are we going to do? They're not going to get tested for STIs. They're not going to get the birth control counseling that comes with it. And I don't know that we've seen that like actually play out. We know that when patients have questions, they will come forward, whether it's a pharmacist or a healthcare provider or even a health line, and say, hey, what else do I need to do? But at least I'm not pregnant because I got that quickly. I'm seeing a similarity here in that they can collect this evidence and at the same time access or be offered the supports when it's supported, like in a clinical environment or like a friendship center, where there's someone who's not just like, here, do a kit.
00:12:31
Speaker
There's also the like, let there's other things we need to think about now, not just this kit. We need to think about other things. is is that how it's being envisioned and rolled out that concept yeah i think that concern comes up a lot and again i'm going to re-emphasize this a thousand times these kids are definitely not meant to replace that full medical care and it should never be positioned that way in our consultations it's been really clear that survivors seek medical care after sexual assault for so many different reasons that have nothing to do with evidence or even reporting And things like you mentioned, like STI testing, and pregnancy prevention, mental health supports, or simply just any kind of support outside of the DNA collection. And so any model that centers only evidence and ignores all the needs that a survivor would have post-assault would be, i would think, harmful.
00:13:21
Speaker
And i think the way we're thinking about it is that medical care and long-term supports will always remain foundational. And these kits or self-supported self-collection in general is meant to sit alongside that care, not instead of it. um and so...
00:13:40
Speaker
I think one of the reasons that community-based and healthcare-linked settings to have these supported self-collection kits would work so well is because they would already provide these sexual health services and follow-up care and referrals. So the message, at least we're trying to impart, is not here's a kit instead of care. It's more so here are your options.
00:14:00
Speaker
And i think what self-collection does really is to prevent evidence from being lost without forcing survivors into a full forensic exam or into systems they're not ready to engage with yet. Because I know you mentioned that earlier in your intro as well. There's some survivors um because of past harm might be a bit wary about going to a hospital or if it's not in their community. feel scared to have to then travel three, four, or five hours, or even you know on a flight to be able to then engage with these systems. So i think if anything, if done well, these models can actually increase access to care by creating a gentler entry point into medical and support services rather than just reducing care to just doing a kit.
00:14:47
Speaker
what research already exists about this approach? And I'm going to almost call it like an add-on piece or a value-added piece. When somebody comes into a clinic, let's say a sexual health clinic, Planned Parenthood type clinic, and maybe they say, i need sexual so or sexually transmitted infection testing. I think a standard question is, you know, was this consensual? And if they say, no, it's not, I can see this being offered as a, okay, so we definitely will do some treatment and pregnancy and STI prevention, maybe HIV prevention. And you also have this option here.
00:15:22
Speaker
What is the research saying in those other countries where it's been trialed and tested a little bit about, I guess, the uptake, the thoughts maybe from survivors, police, courts, all those other complicating factors?
00:15:34
Speaker
Yeah, so at least in Canada, there's currently no studies on supported self-collection, and that's exactly why this work is needed. so to our knowledge, our research is actually the first to explore self-collection in Canada. And again, we're examining if self-collection is a viable bridge gap solution, where might fit into our current systems, what it should look like in practice so that it is admissible in court, and to ensure survivor safety.
00:16:00
Speaker
And obviously we can draw from lessons in the international examples that we mentioned, like the work in Kenya, um that is finding that self-collection is viable in terms of preserving that DNA and is bridging these gaps to access for survivors in these remote communities.
00:16:17
Speaker
um But we want to make sure that this is something that can exist within our Canadian legal landscape and health care system with our set of provincial and territorial responsibilities, because Each province has different rules about evidence collection in Canada, whether that's different storage and reporting laws.
Development and Stakeholder Input in Canada
00:16:34
Speaker
And then, of course, different sectors, whether it's health care, forensic or law enforcement, they then bring different concerns and expertise to the table. And so that's why it's really important that we do this work collaboratively, um because having their input will really shape what this could look like in Canada so that it fits all of the different credentials that are necessary to make it possible.
00:17:00
Speaker
So how are the Canadian kits at this point being developed? Who's involved? Law enforcement, courts, are forensic nurses advising, survivor victim input?
00:17:14
Speaker
where Where are we at now Yeah, I think the hope is that people will want to engage in our research and that we'll be able to collect feedback from as many people as we can. We welcome forensic nurses to please consult with us so that we can get their input. um Like I said, our consultations are in early phases, but the hope is that we can get as many people as possible. So that would be forensic nurses, health care staff, police, first responders, forensic experts, legal experts, survivors themselves. as well as community organizations and community leadership, because each community looks so different. This is not meant to be a one size fits all, and there's going to be different concerns and different expertise. So we're hoping to attack this at all angles to make sure that whatever we do come up with is really comprehensive.
00:18:03
Speaker
This podcast is from the Canadian Forensic Nurses Association, supported by, and I'm aware of a lot of concerns and some backlash even from the forensic nursing community in general, that the introduction of these types of supported self-collection kits, maybe they negate the work that we do. I'm a forensic nurse myself.
00:18:24
Speaker
Does this replace me? um And how How do these kits work side by side, if that's what you're proposing, with a forensic nurse? you know Does this mean that governments are like, oh, we don't need the forensic nurses anymore. We can stop investing in them, despite the fact that they're not really investing in us. But we can stop investing in them and let's invest in this like supported self-collection kit instead.
00:18:48
Speaker
Right. think first and foremost, I want to take a moment to thank all forensic nurses, including yourself. The work is obviously not easy. And getting into this field to help support survivors is so admirable. And you are all extremely essential. um And you've been the cornerstone for survivors to be able to access justice. So it makes a lot of sense why that concern would come up. And I do think that there are some misconceptions about self-collection that really polarize self-collection versus forensic nurses.
00:19:17
Speaker
um And I think it's important to restate that self-collection didn't emerge because communities wanted less forensic nursing care. It really emerged from communities because they didn't have access to forensic nursing care. or sexual assault evidence kits at all. um And like you've mentioned, in a lot of places, survivors are expected to drive for hours or even be flown to a hospital post-assault.
00:19:40
Speaker
And so in those contexts, the question isn't really like kit versus nurse. It's more so something versus nothing. um And so these kits were first imagined for communities where the current system just simply isn't there. um But that also doesn't mean that self-supported self-collection wouldn't also be useful in places where SANS do exist. So like you mentioned before, even in urban centers, we know that there are long wait times and overcrowded emergency departments and forensic nurses ultimately stretched really thin.
00:20:13
Speaker
And I think that's a separate and critical conversation that you sort of mentioned about underfunding. Hospitals need more resources. and They need nurses to be paid more. And we need forensic services to be stronger. And none of that will go away with self-collection if it exists in our Canadian context. But I think what supported self-collection is trying to do is really create an alternative pathway that works in conjunction, not take away work from anyone.
Legal Integrity and Court Acceptance
00:20:41
Speaker
It's more so about preventing bottleneck systems that we already know are overworked and overwhelmed.
00:20:48
Speaker
And so the example that I often think about is walk-in clinics. Walk-in clinics weren't created to replace family doctors or to replace emergency departments. They really existed because not everyone has a family doctor. And then ERs were being flooded by non-emergency cases.
00:21:05
Speaker
And so that problem really existed because we didn't have enough doctors. So I see this as something similar that they can work in tandem. And also in an ideal world where this could function, I also could see supported self collection existing in hospitals with forensic nurses supporting this as well, if that is something that is in the community and and could help as well.
00:21:28
Speaker
So it's definitely not a replacement for forensic nursing care. It's meant to work in tandem.
00:21:34
Speaker
So when I think about it as a forensic nurse with my forensic nurse hat on, I think a lot about chain of custody. And I think about how are these kits going to be stored or who's responsible for the storage of these kits and who's responsible for maintaining that chain of custody, especially when it's not a forensically trained person. So if it's a support worker or if it's a clinician in a busy walk-in clinic or urgent care center,
00:22:03
Speaker
Where's the chain of custody piece here, if I'm thinking sort of forensically and what the the courts typically want to see? Yeah, so I think that's part of the work also, and we're hoping to consult with law enforcement as well, particularly around those questions of chain of custody and documentation, so that whatever proposed protocol we create with these different professionals would align with the legal realities so that survivors also aren't given these false assurances about how evidence might be used.
00:22:33
Speaker
um It also becomes a bit more complicated because there isn't a single national approach in Canada. There's different jurisdictional laws around chain of custody. So what we're currently seeing is that each province and territory does have different policies. In some regions, evidence can be collected and then submitted anonymously with no identifying information attached to it. But then in others, evidence can be collected and securely stored with a police report. In other way in other regions, it's more tightly linked. You do need to make a report when you have your DNA collected. So because of all of these differences across provinces, responsibility for storage does typically lie with RCMP and police or and sometimes a health care or forensic authority.
00:23:17
Speaker
um So chain of custody, for us, how we envision it would be maintained through the Actual kit components, so that would be the tamper evident packaging, clear documentation, control transfer processes, similar to how sexual assault evidence kits are currently handled once done at a hospital and then transferred to RCMP and police.
00:23:38
Speaker
So for us and how we envision it, it's it's not meant to override existing laws whatsoever. It's more so meant to be designed to fit within the current policies and to be transparent about what's possible for a survivor. So that doesn't promise options that don't actually exist within their jurisdiction.
00:23:56
Speaker
um Yeah, we just want to make sure that survivors can make informed choices based on how evidence needs to be stored and handled in their region. And so that's why, again, our consultations are so important to this process.
00:24:11
Speaker
So it sounds like there may be slightly different processes, not necessarily for the collection, but the storage and or handover of these kits to law enforcement and that those need to be developed probably individually at each policing agency, we know municipal or provincial or federal. that That could be a lot of work, but I think that forensic nurses and forensic teams are are up for the challenge. But have to ask, and this is the big question probably is, have these been tested in court yet? Like, do they stand up to legal scrutiny?
00:24:48
Speaker
Yeah, so as I mentioned earlier, in places like the UK and Australia, from what we've seen, there is no difference within these court documents about whether a survivor has self-collected or whether it's been clinician administered. But in Canada, this isn't as new as maybe sometimes it sounds. So Canadian courts are already accepting forms of self-collected evidence in sexual assault cases, so like underwear worn, condoms, clothing, bedding. things that survivors preserve themselves before ever interacting with police or health care systems.
00:25:21
Speaker
And from what we've seen and from the legal experts that we've spoken to so far, um courts aren't necessarily examining evidence by who collected it, but more so whether it was collected and maintained with well-established legal principles like relevance, continuity, and integrity. um And so again, when we think when we see that case law and when we're thinking about how we're creating this protocol with these consultations in mind, it's more so about ensuring accurate documentation, sealing, storage, and transference. um And so I think the argument is less about so that self-collection shouldn't exist. It's more so an argument to make sure that it's done carefully and transparently so that it protects survivors and that there isn't any additional protection additional harm.
00:26:13
Speaker
It makes me think, Victoria, about where forensic nursing started a little bit. This seems like it's thinking outside the box. And I can think 30 plus years ago when one of my mentors, Sheila Early, that many of us know of,
00:26:29
Speaker
challenged the current system and said, we can do something different. We can do something maybe survivor-centered. And that was introducing sexual assault nurse examiners to British Columbia, but then also to Canada and and spreading that word internationally. And I say, look at us now, 30 plus years later. We are often trying things that haven't been tested in court, like telesafe exams I'm not sure if they've gone to court. I don't think so. We recently did an interview about tele-safe. What a great concept. But I'm not sure that that's been tested in Canadian courts.
00:27:04
Speaker
So I think about it as sometimes we have to try something and see if it works. But then I think the fear of forensic nurses is if it doesn't work, have we maybe done more harm than good for these survivors because then it gets thrown out at court because it's never been tested in court. And I guess that's like the chicken and the egg. Like if it's never been tested, then how do you ever get it accepted? And then if it's never accepted, will it ever stand up?
00:27:32
Speaker
Exactly. Exactly. Yeah, I think that's a big question. And exactly like you're saying, the honest answer is that not everything we do in forensic health care has been tested in court before it's been implemented. because like you're saying, we want to be able to change systems to better support survivors. And to do that, sometimes we need to take a bit of a leap. And I think what brings me some comfort, though, is that Just like you're saying, many practices that are now considered standard like tele-safe or virtual forensic consultations were introduced in response to access gaps long before there was any case law specifically addressing them.
00:28:08
Speaker
So with self-collection here in Canada, there hasn't yet been a dedicated body of court decisions simply because the model hasn't been formally implemented or studied here. But that also doesn't mean that it sits outside of the law.
00:28:23
Speaker
courts don't pre-approve these tools. They assess evidence case by case using, well, like I mentioned earlier, things like relevance, continuity, and integrity. And forensic laboratories also work in a similar way. What matters to them is whether the samples were collected, packaged, and documented and transferred according to a standardized protocol.
00:28:44
Speaker
And so that's why a core part of our work is consulting with forensic scientists and labs and legal experts to ensure that we develop a proposed protocol that fits within there. And so from those consultations so far, the consistent feedback has been that if this process is clearly governed and is standardized, there shouldn't be any inherent barriers to labs processing this evidence or even being accepted in court.
00:29:12
Speaker
And like I mentioned before, also, there also is case law about self-collected evidence being accepted. And so from the information we have, we're hoping that the proposed protocol that we do develop will ensure that it can be admissible in court based on what we know so far.
Support Systems and Role of Forensic Nurses
00:29:34
Speaker
What I'm hearing is it sounds like these kits might be a bit of a bridge, a bridge to change, but also I'm thinking a bridge to accessing the additional supports and services. We already know that survivors don't come forward to medical care at all. don't come forward to policing at all.
00:29:55
Speaker
But maybe if they're like, hey, I know I can get this, you know, sexual assault kit that's notly not necessarily invasive at the local sexual health center, we can start there.
00:30:09
Speaker
And maybe there's people there who understand, or maybe there's medications and I can get my plan B or I can get my questions answered where maybe they weren't coming forward before. I know one of the impetus for some survivors coming forward is STI screening. They're very scared they're going to become pregnant or get an infection. um This adds to that. Is is that the concept here?
00:30:33
Speaker
Yeah, I definitely think so. And I think part of that is housing these supported self-collection kits or having supported self-collection an already trusted organization would really help with this. So in communities that we were talking about before that may not have a sexual assault center or a hospital nearby, If they know of a trusted community organization where they've already gone before or they have friends um who have gone there before and they have supported self-collection there, then they're more likely to go there and talk to someone. Even if they go and they realize that, you know, they're not eligible for supported self-collection, like if they have a physical injury and they really do need to go to a hospital, at least they've gone to someone that they know works at a trusted organization that can talk to them and help them walk them through the next steps that they need to go through.
00:31:21
Speaker
and may make the process feel a little less daunting and then get the care that they really do need in those follow-up supports as well.
00:31:31
Speaker
So just as forensic nurses many, many years ago filled a gap for survivors who might otherwise have had no access to care, potentially these supported self-collection kits might open that door to access to care. um And I do have to come back, though. Like, does this...
00:31:54
Speaker
something that's going to take away from the advocacy for forensic nurses. I'm already concerned saying support workers might do this work. Well, you know, I'm not sure that a volunteer with a support organization is the one to to support evidence collection when we have really highly trained forensic nurses doing some of this work already.
00:32:19
Speaker
Does this potentially withdraw some of that support that we're trying to advocate for to say, look, forensic nurses are experts. Meanwhile, on the other side, we're saying, but you can collect your own swabs.
00:32:30
Speaker
Right, I think at least for me personally, I'm gonna always advocate for more forensic nurses and I think they are absolutely essential. um Although self-collection could exist in communities that do have forensic nurses, and again, I still think that they can work alongside each other. i think the communities and the survivors that would benefit most from supported self-collection would be in communities where there are no forensic nurses, um but in communities that do and are lucky enough to have forensic nurses,
00:32:59
Speaker
I would hope that forensic nurses would want to support with self-collection and could be the ones supporting a survivor completing supported self-collection. But again, in those communities that don't, then there might be a trained staff member that will be the one to have to support them.
00:33:15
Speaker
um But no, I'm going to always advocate for better funding for forensic nurses and that they continue to exist because Ultimately, we will need full forensic exams regardless because self-collection is not going to be meant for every survivor. It's going to be meant for a subset of survivors that can't access that full forensic exam.
00:33:35
Speaker
You mentioned the word trained support person. h What does training look like and who does that? Yeah, so I think that's, again, another question we're hoping to answer with consultation. i think the most important parts that we're seeing so far in our consultations is that the trained support staff um would, one, be able to emotionally support a survivor through the process, be highly trained in the protocol that we are co-developing, and be able to walk a survivor through each step. And again, there would be a detailed instruction or a video that would guide the survivor through the process, but having that person there definitely helps and could also help with the continuity aspect for that evidence to then be admissible in court to say that there is a person who is trained on this protocol that was there to support. And I think they would also need to be trained on, of course, the chain of custody protocol. So
00:34:32
Speaker
having someone who knows what seals are necessary, what documentations are necessary, and to then there be a witness of, I got this evidence from a survivor and then I gave it to RCMP or police to have that person to actually bridge the evidence collection to maintain the chain of custody.
00:34:52
Speaker
um But the exact details of what exactly they'd be trained on is still up for question and is something that we're trying to research ourselves. Is there a risk that those people, the support people might go to court? And I know that we have some clinicians who who sort of put their hands up like, I don't really want to get involved in this because I don't want to ever go to court.
00:35:15
Speaker
ah Might that be a component and maybe a barrier for some of this? I wouldn't see it necessarily as a barrier. i would see it as something that's an additional support to the survivor and the DNA that's been collected, because then you actually have a person that can attest to how the evidence was collected and what protocol is in place and how the evidence was handled. And I think the support person would then have to be trained on that in terms of how to present in court and how to testify to how the evidence chain of custody was maintained. So they would really be there to more so testify to the documentation.
Collaborative Development and Survivor Support
00:35:53
Speaker
Yes, the survivor handed me the evidence after it was collected, i sealed it I documented it, and then I handed it over to police or RCMP. They're more so speaking to that testimony.
00:36:06
Speaker
sounds like there's a number of things in terms of the process and protocol that still need to be worked out, at least within the Canadian context, but that those are, i don't think, insurmountable issues that you've that you've brought up. And now I guess we go back to the survivor.
00:36:24
Speaker
Today, if we have survivors saying, oh, that sounds like something I could have used. or next week, they say, oh I heard that podcast about like supported self-collection. I wonder where we can get that.
00:36:37
Speaker
<unk> Today, what should survivors know about supported self-collection evidence kits? Yeah, I think I would want survivors to know first and foremost that we see and hear them. We have heard from hundreds of survivors that the current pathways currently aren't available to them, and that is at its core why we're exploring this. We really want to expand choice and options for survivors. And again, self-collection doesn't replace that full forensic exam or medical care support. It's just one way of keeping safe. or um enabling DNA to be collected when time and access matter the most. I think I also want survivors to know that this work is being done really carefully and collaboratively. It's being and hopefully will be shaped by forensic nurses, legal experts, community organizations.
00:37:28
Speaker
and importantly by survivors themselves. The goal for us isn't to create any kind of shortcut or lower the bar, but more so to build pathways so that everyone can access justice. um So I think if there's one message I would want to give out to survivors, it's that you're being listened to and that the system doesn't have to stay the way that it is and that exploring new options is about honoring their realities and the realities of their communities rather than asking them to travel into systems that aren't accessible to them currently.
00:38:00
Speaker
And that hopefully with our research, we can implement self-collection in Canada so that there are these pathways for them. And that we'd love to hear from them also to help contribute to this research.
00:38:13
Speaker
Thank you so much for your time today, Victoria. I've really appreciated learning more about this. I think I came with some preconceived notions and maybe a bit of my back up a bit about this whole topic, because I think that we're still in a lot of question asking stage. We're in the exploration stage. And that's okay.
00:38:34
Speaker
So I want to thank you today for your time. This is certainly a new and emerging practice in the forensic health sciences and forensic nursing and really deserves a thorough conversation and exploring the possibilities, the opportunities and the challenges. Is there anything you'd like to add before we sign off?
00:38:52
Speaker
No, I would just like to thank you for the opportunity and thank you again for all the work that you do. It is essential. And I just feel so grateful to be able to speak to you today. Great. Thank you too, Victoria. And that is today's episode of Beyond the Rape Kit, Canada's Forensic Frontline. I want to thank Victoria Duncan, a social worker and the health equity researcher at She Matters, a survivor-led organization working to understand and improve access to justice and care for people impacted by sexual violence. Today we've talked about supported self-collection evidence kits and they might just represent a shift in how we provide care as a community and as a collective. Maybe it's a shift towards meeting survivors where they are, literally and maybe figuratively.
00:39:36
Speaker
As a part of a broader movement to expand access, reduce barriers and honour autonomy, I think this is a conversation worth having. So as these innovations grow, so do the conversations about what equitable trauma-informed care really should look like.
00:39:52
Speaker
Today we've gone beyond tradition and beyond the status quo and in fact beyond the rape kit. If you've recently been hurt, assaulted, stalked, or harassed, please seek medical care at your closest emergency department, connect with support services in your community, or your local police.
00:40:07
Speaker
I'm forensic nurse practitioner Hannah Varto, and this is Beyond the Rape Kit, Canada's Forensic Frontline, a podcast by the Canadian Forensic Nurses Association. Thanks for listening.
00:40:19
Speaker
Stay safe.