• Go to a safe place and reach out to someone you trust for help and support.
  
  
• If you wish, you can call 911 to report the sexual assault to the police.
  
  
• Call the Sex Abuse Treatment Center’s (SATC) 24-hour hotline at 524-7273. We can offer you the support, care and advocacy you may need right now.  The SATC worker can help you with medical care, reporting to the police, informing family or friends, and your other questions or concerns.
• For TTY assistance for the hearing impaired, call 535-7627 during business hours (Monday-Friday, 8 a.m.-4:30 p.m.). We can help you directly this way.
• For TTY assistance after hours, call the SATC hotline 524-7273 and Physician’s Exchange will assist you in contacting the SATC on-call worker.
• If you don’t speak English, we can get an interpreter at no cost to you.
• Neighbor island 24-hour Hotline:
  • Big Island: 808-935-0677
  • Maui County: Toll Free 866-443-5702
  • Kauai:  808-245-4144
  
  
• Suspected cases of child sexual abuse by a family and/or household member should be reported to the Department of Human Services-Child Welfare Services. Call 832-5300.
  
  
• Medical Care and Evidence Collection: This service, called the acute forensic examination, is available to adults and minors, females and males. Examinations are done within 72 hours of a sexual assault at the Kapi`olani Medical Center for Women & Children.
  
  Medical care following a sexual assault is important even if you have no visible injuries. The acute forensic examination will:
  • Ensure that you are physically alright, and address concerns about the risks of sexually transmitted infections, pregnancy, and HIV.
  • Collect and preserve any evidence, even if you do not want to report the assault to the police.  Sometimes people change their minds and decide later that they want to pursue legal action.
  
  
  To Preserve Evidence:
  • It is best to not wash, bathe, douche, or brush your teeth (if oral activity took place). But even if you have cleaned up, you can and should still get a medical examination.
  • If you have not changed the clothing you were wearing at the time of the assault, keep these on as they can be collected at the time of the examination. If possible, bring a change of clothing but the SATC also has clothing available. If you do change, put each article of the clothing you were wearing in a separate paper bag and bring everything to the hospital.
  • Do not clean or disturb the physical location where the assault occurred.
  
  If you suspect that you were a victim of a rape drug, medical care for testing and collecting evidence as soon as possible is important. These drugs leave your system very quickly. 
  
  Although going to the hospital after a sexual assault may feel overwhelming, it is a safe place to get help. A SATC worker will stay with you the entire time.

• The examination is done in the Emergency Room of the Kapi`olani Medical Center for Women and Children (1319 Punahou Street).
• You can bring a friend or relative for support to the hospital.
• You can receive the SATC forensic examination even if you do not want to report to the police.
• Interpreters are available for those who have limited English ability or if you are hearing impaired.
• Crisis counseling is provided by the SATC worker during the medical exam.
• There is NO COST for the acute forensic examination or the crisis counseling.
• For more information, click here: The SATC Acute Forensic Examination

What if the sexual assault happened a while ago?

• Call the SATC hotline 524-7273 and a SATC worker can help you decide on the best course of action.
  
  
• You may still be able to report the assault to the police if it is within the statute of limitation. Call the SATC for further information on your reporting options.
  
  
• If you are worried about sexually transmitted infections, HIV or other medical concerns, even if it is over 72 hours since the assault, it is important to seek medical care. Adults can seek care from a private physician or nearby medical clinic. The SATC has a Pediatric Sexual Abuse Clinic for anyone under the age of 18.

Initial Report

The initial report is taken by a patrol officer. The duties of the officer at the time of a reported sexual assault are:

• To catch the assailant if still at the scene of the crime;
• To provide you with or request emergency medical care, if necessary;
• To gather information from you to:
• determine if what happened meets the elements of sexual assault;
• recover forensic evidence;
• secure the crime scene;
• locate the suspect;
• To preserve the crime scene and evidence;
• To prepare the necessary reports for the investigation by a detective who specializes in sexual assault crimes; and
• It is also the patrol officer’s responsibility encourage you to receive and direct you to medical attention and/or the acute forensic examination.

Interview by a Detective

Following the initial report, a detective from the Honolulu Criminal Investigation Division Sex Crimes Detail, will interview you for complete details of the crime.

In asking you about the crime, the detective will guide you to describe what happened before, during, and following the incident. You may want to avoid recalling details of the assault, and some questions may seem intrusive or embarrassing. But these details are an essential part of the investigation and needed for criminal prosecution.

The purpose of the interview is to get an honest and detailed account of the assault to investigate and prosecute the case.  Tell the simple truth. Be as accurate as possible with details of the assault; if you can't recall something, just say so. It is okay; do not guess or speculate about what happened. 
 
It is important that you do not leave out information which you believe may weaken your case. For example, you may find it embarrassing to describe the clothing you were wearing.  You may fear being judged as "deserving the rape" because of clothing. Keep in mind that how you dress or behave does not give anyone the permission or right to sexually assault you. Or, you may not want to talk about alcohol or drug use for fear that these activities may place you in an bad light or even in trouble.  Withholding any information can hurt the investigation and prosecution of your case.  At times, the questions asked by the detective may seem insensitive or even judging. The detective asks these questions to try to resolve conflicting information and identify evidence to back up the account given.

Children’s Justice Center

A program called the Children's Justice Center coordinates the reported cases of child sexual assault. Interviews of children may be conducted at the Children's Justice Center facility, which is a comfortable, home-like place with age-appropriate rooms.

As children do not always relate events as directly as adults, more than one interview by a detective may be needed before the child feels safe discussing the incident. Often interviews with children are videotaped or observed from behind a two-way mirror. This is done to reduce the need for re-interviews by others involved in the case. Detectives receive specialized training in working with child victims and are aware of the extra care and sensitivity needed to work with the young.  A child psychologist may be brought in to assist the detective with an interview of a very young child or one with special needs.  A SATC crisis counselor is present at the Children’s Justice Center to provide support to the child victims and to the family at the time of the forensic interview.

Child abuse or neglect is defined in Chapter 350/Hawaii Revised Statutes as follows:
 
 “The acts or omissions of any person who, or legal entity which, is in any manner or degree related to the child, is residing with the child, or is otherwise responsible for the child’s care, that have resulted in the physical or psychological health or welfare of the child, who is under the age of 18, to be harmed, or to be subject to any foreseeable, substantial risk of being harmed.”  

Making a Report:

• If abuse or neglect of a minor is suspected, call the Department of Human Services, Social Services Division, Child Welfare Services (CWS) at the following numbers:
• On Oahu:  832-5300 (24 hours a day)
• On the neighbor islands:  1-800-494-3991 (24 hours a day/toll free) 

Common Questions About Reporting to Child Welfare Services (Mandated Reporter Booklet, Department of Human Services, January 2003)

1. What if I’m not sure about reporting?
   
   You can consult with the Department of Human Services regarding your concerns or observations. You do not need to be prepared to prove that abuse or neglect has occurred before making a report.  If the child has shared information with you about the abuse or neglect, this is enough for you to call.
   
   
2. What happens following my report?
   
   If the report is accepted for investigation, a CWS worker will be assigned to investigate to determine if the child has been harmed or is at risk of harm.  The worker will gather as much information as possible by talking to the child, family members, and if necessary, others in the community. Within 60 days of the date the report is assigned for investigation, a decision must be made whether the report is confirmed or not.  You will be contacted regarding the outcome of your report.
   
   
3. Will the police get involved?
   
   A report of suspected child abuse or neglect or substantial risk of child abuse or neglect must be made to CWS or the police.  Depending on the circumstances of the report and harm to the child, the police may become involved whether at the request of the department or by a determination by the police that they need to take immediate action and/or conduct an investigation.
   
   
4. Will the family find out who made the report? 
   
   The Department makes every reasonable effort to maintain the confidentiality of a reporter who requests that his/her name not be released.  Anyone reporting in good faith is immune from liability.

The first step of the forensic examination is collecting clothing (if it was worn during the assault). The SATC worker will have you disrobe on a large sheet of paper in order to catch and preserve anything that may drop as you disrobe.  Your clothing will be placed into evidence; if you do not have extra clothing to change into following the examination, the SATC will provide you with a change of clothes.

The SATC doctor will then ask your medical history, including allergies, medications, and medical problems.  As part of the exam, you will be asked about the assault and about specific sexual acts. These questions are needed to find out how to best help you medically and for evidence of  the incident.

During the physical exam, the doctor will look for physical injuries on your body.  The doctor will then examine your genitals for trauma, debris, and any abnormalities. The doctor will take pictures of any injuries and will document findings in a medical-legal record. (A speculum examination is not conducted on young girls.)

• It is important to remember that most times, there will be no injuries or physical findings from the exam. Lack of injury to the genital area does not mean sexual penetration did not happen or that you consented to the sexual activity.  

Depending on the history of the incident, for evidence the doctor may take:

• swabs for DNA analysis;
• hair samples (both head and pubic hair);
• fingernail scrapings; and
• a blood sample

You will also be offered testing and treatment for sexually transmitted infections (STIs) and for pregnancy. If you choose this, swabbing for cultures for the STIs and urine for a pregnancy test will be collected. The doctor will discuss preventive treatment for STI’s and pregnancy if you are not protected by birth control.

Testing and treatment for HIV is NOT done as a standard part of the acute forensic examination, but testing is available later through the SATC office, which is an anonymity-guaranteed testing site.  But if you are considered high risk for having been infected, the doctor will discuss your options and treatment may be made available.

If you suspect that you have been drugged, the physician will offer to do a urine test for drugs. Common rape drugs are GHB and Rohypnol.
 
Once the exam is completed, the doctor will discuss the results, advise you on follow-up care, and answer questions you have.

Counseling is an important follow-up service after the forensic examination. The SATC offers therapy to any victim of a sexual assault and to family members and significant others.  

Other useful Information:

• The acute forensic examination often takes three to five hours to give the necessary support and care.
• Child-care arrangements should be made before arrival at the Kapi`olani Medical Center Emergecy Room.
• Interpreters are available if you have limited English or you are hearing impaired.
• Information shared with SATC is held confidential unless disclosure is required by law.
• The acute forensic examination and release of evidence requires consent by you or your legal guardian.  Minors 14 to 17 years old can consent to the exam without parental consent.

Will I be charged for the acute forensic examination?

The acute forensic examination described above is free to you. 

If you need medical care beyond the scope of the SATC forensic examination (e.g., x-rays, cat scan, stitches), you will be moved to the Emergency Room for the care you need.  Fees for these services are not covered by the SATC.  At the time of registration, you will be asked about insurance coverage in case a claim needs to be filed. 

If you filed a police report, the SATC worker will tell you abut seeking assistance through the State of Hawaii Crime Victim Compensation Commission (CVCC). You can also call 587-1143 directly for information on victim compensation.  The CVCC may have financial assistance for those without insurance or for the out-of-pocket expenses for the insured. If you do not have insurance and did not file a police report, the hospital social worker may be able to help you figure out available options for help.

• This exam is by appointment only. Call the SATC office at 535-7600 Monday – Friday, 8 a.m. – 4:30 p.m. to schedule an appointment.

• Exams are conducted at the Kapi`olani Medical Center for Women and Children Emergency Room at 1319 Punahou Street.  

• Crisis Counseling is available during the examination.

• Suspected cases of child sexual abuse by a family and/or household member should first be reported to the Department of Human Services-Child Welfare Services (DHS-CWS) at 832-5300. If the case is accepted for investigation, DHS-CWS can refer the child to SATC for an exam.

• Information shared with SATC is held confidential unless disclosure is required by law.

• There is no charge for the examination.

What will happen at the Kapi`olani Medical Center for Women & Children for the Pediatric Sexual Abuse Medical Examination?

Upon arrival, the young person will be registered as a patient of the Kapi‘olani Medical Center. The parent or legal guardian will sign consent forms for treatment. A SATC worker will be present to assist during the exam and provide counseling to the young person and any family or other support persons present.  Feel free to discuss with this worker any feelings and reactions about the sexual abuse and ask any questions about the medical procedures. This SATC worker can also assist with questions or concerns about reporting to the police if desired.
 
What is included in the Pediatric Sexual Abuse Medical Examination?

The Pediatric Sexual Abuse Medical Examination will be performed by a SATC physician. This doctor is trained to provide medical care that is specialized for young victims of sexual assault and abuse. The exam is done in a room set up for the specialized medical exam.

The first step will be the gathering the young person’s medical history by the doctor. Next, depending on the age of the young person, the doctor will ask about the sexual abuse incident and the specific sexual acts that occurred. A parent who is present may also be asked questions if the  sexual assault was described to this parent. These questions are to find out how to best help medically and to document the incident for legal purposes.

During the physical exam, the doctor will check for external physical injuries and examine the young person’s genital area for trauma. The doctor may take photos for medical evaluation and to document injuries.  In addition, there will be an evaluation for sexually transmitted infections and, if necessary, treatment will be provided.

Once the examination is completed, the doctor will discuss the results of the exam and provide recommendations for follow-up medical care.  Testing and treatment for HIV is not done as a standard part of the pediatric sexual abuse examination, but testing is available later through the SATC office, an anonymity-guaranteed testing site.  If the young person is considered high risk for infection, the doctor will discuss options available.

Counseling is an important follow-up service after the sexual abuse exam. The SATC offers therapy to any victim or family member.   

• Rohypnol - (aka: Roofies, forget pill, date rape drug)
• An illegal extremely powerful sleeping pill (10x valium)
• White, dime-sized pill sold in a bubble packaging with “Roche” label
• No smell, taste, or color when dissolved in liquid (20 seconds)
• Can cause relaxation, sleepiness, dizziness, unconsciousness, memory loss, nausea, confusion, and more
• Gamma-Hydroxybutyrate – (aka: GHB, Liquid X)
• Central system depressant
• Usually a liquid with no smell or color, with a slightly salty taste
• Can cause dizziness, nausea, vomiting, blackouts, amnesia, problems seeing and breathing, euphoria, and more
• Ketamine – (aka: Special K, Vitamin K, Breakfast Cereal, Super K)
• Veterinary sedative
• Can come in liquid, pill or powder form
• Can cause hallucinations, impaired motor function, convulsions, vomiting, trance-like state, respiratory problems, memory problems, and more
• Ecstasy – (aka: X, XTC, Adam, MDMA)
• An illegal drug with both stimulant and hallucinogenic effects
• Commonly found in tablets in many shapes and colors
• Can cause hallucinations, teeth clenching, blurred vision, impaired judgment, tremors, and more

Are there any warning signs?

• You may start to feel “woozy” and feel as if you are more intoxicated than you would normally feel after drinking the same amount.
• You may recall having a drink but do not remember anything afterward.
• You may feel fuzzy and experience a lapse in memory.
• You may experience nausea, dizziness, and black-outs.
• You may feel as though you had sex but you can’t recall the details. 

What should I do if I think I have been drugged and sexually assaulted?

• Get to a safe place and ask a friend to help you.
• Get immediate medical help; you can call 911 and ask for an ambulance if necessary.
• You can call the SATC hotline at 524-7273 for help.
• You can call 911 to report the sexual assault.

Is alcohol considered a rape drug?

• While alcohol is not technically considered a “rape drug,” it can cause impaired judgment and can contribute to a sexual assault incident.
• In over 35% of sexual assaults, the offender is intoxicated according to the Bureau of Justice Statistics, of the U.S. Department of Justice.

How can I reduce the risk of rape drugs?

• Do not leave beverages where you can not see them.
• Do not take any beverage, including alcohol, from someone you do not know well and trust.
• At a bar or club, accept drinks only from the bartender or server.
• At parties, do not accept open-container drinks from anyone.
• Be alert to the behavior of friends and ask them to watch out for you. Anyone appearing to be extremely intoxicated after consuming only a small amount of alcohol may be in danger.
• Share this information with friends and talk about ways to look out for each other at parties and social events.
• If you suspect someone has consumed a date rape drug or sedative-like substance, take them to a hospital emergency room or call 911 for an ambulance.  Get a urine sample as soon as possible.

1. Immediate or Acute Phase (lasts from days to weeks after the assault)
   
   During the first days following an assault, you may feel stunned or dazed.  You may feel shock and a sense of numbness.  You may actively try to block out the experience and associated feelings.  Eventually, though, you may find it impossible to suppress the feelings, and a time of considerable distress may follow.
   
   During this acute phase, you may experience fears about your personal safety, anxiety, sleeping and eating pattern disturbances, intrusive thoughts, flashbacks, and mood swings.  There may be feelings of guilt, self-blame, shame, and anger.  There may also be physical reactions such as a general feeling of soreness or pain in a specific body area that was involved in the assault.  There may be such a flood of symptoms that you may feel out of control and as if you are “losing it” or “going crazy.”  However, it is important to know that this is a normal reaction to trauma and it will subside.
   
   
2. Outward Adjustment Phase (lasts from weeks to months following the assault)
   
   During this phase, you may experience pervasive feelings of fear or phobias specific to the circumstances of the assault such as fear of being alone or paranoia, and anxiety.  You may find yourself changing your social lifestyle.  You may limit time you spend outside your home, you may withdraw, move residences, or avoid being out alone.  You may have dreams and nightmares. Initially these dreams may be of sexual assault scenes in which you are powerless, but as time progresses the dream material may change and there may be mastery in your dream.  You may have feelings of guilt, shame and self-blame regardless of the circumstances of the assault, and you may find yourself replaying and reviewing in your mind what took place.  Some people experience sexual dysfunction including fear and avoidance of sex, problems with arousal and desire, and even flashbacks during sex.
    
3. Integration/Resolution Phase (lasts from months to years following the assault)
   
   You may find that symptoms you experience during the phase before may last for quite a while and may overlap into the resolution phase.  The most common long-term problems are fears about personal safety, anxiety, and intrusive recollections of the experience. But the images and feelings occur less often than during earlier stages.  As you integrate the experience into your life, you may find yourself more cautious, and more aware.  The goal is to find a new way of being in the world. While you may never be the same as you were before, you do not have to be less than you were before.  With the right support, you can emerge with newfound strengths and insights.

Why Did This Happen to Me?

This question may haunt you. Immediately following the assault, you may continually review the sequence of events and wonder how you might have handled the situation differently. One of the oldest and most persistent misunderstandings about sexual assault is that the victim was in some way to blame for the offense.

If a person was threatened at knife point and robbed, we would probably sympathize and support this person. Yet we often question a victim's integrity when the crime is a sexual assault. We are asking the wrong question. We need to ask: what right does one person have to sexually assault another?

Part of the recovery process is trying to understand why the assault occurred. It is important to understand what we can do to reduce risks in potentially dangerous situations. However, we must not be confused about who is responsible. Nothing you did or did not do gives another person the right to assault you. Nothing.  

Often there is little you can do to reduce risks. You may have been going about your daily routine -- walking home, getting out of your car, or sleeping in your own bed -- and still you were the victim of a random attack. Or more commonly, you may have trusted someone you knew, and this trust was violated.  Sexual assault is not the consequence of how you dress or how you behaved. You are not able to control the actions of other people. Without question, the person responsible for the assault is the assailant.  Recovery from “rape trauma” progresses at a more accelerated pace when you and your support systems understand this.

When Will I Feel Like Myself Again?

Many factors affect recovery from sexual assault. It is impossible to estimate how long it will be before you feel like yourself again.  Each situation is unique. Rape trauma is something that can be resolved and put into perspective, but it can never be forgotten. It is possible that after the initial crisis is over, there will be flashbacks of the assault. Assault related feelings may resurface.

Time alone does NOT heal wounds.  Here are some steps you can take to hasten your recovery from the psychological trauma of sexual assault:

• Acknowledge your feelings as real and legitimate; your thoughts and feelings are not crazy, irrational, or non-existent.
• Be open to reaching out to your family, friends, a Sex Abuse Treatment Center (SATC) counselor or therapist, and other willing professionals for information and support.  Be willing to ask as specifically as possible for the support you need.
• Be mindful to take care of your total person; that is, be aware of what you can do to strengthen yourself physically, emotionally, mentally, and spiritually.
• Learn to relax when you are feeling tense and frightened. If you need help in this area, your worker at SATC knows ways to help you relax and work through your fears.
• See yourself as capable of recovering. Take pride in the steps you are taking to help yourself.
• Give yourself time to feel better.