Beyond the Backlog: Creating the SAFE Q&A

Today we have a guest post from Rebecca Carman, LCSW, a social worker with the Elmhurst Hospital Center SAFE program in New York City. Identifying a need to compile and share the best practices for responding to sexual assault victims in the hospital, she created The SAFE Coordinator’s Handbook in 2010. The handbook has been used by professionals across the country and internationally to better respond to victims of sexual violence. Today, the author shares the impetus behind the handbook and what went into making it happen.

I came to work at Elmhurst Hospital Center as Coordinator of the Sexual Assault Forensic Examiner (SAFE) Program in 2004. As you may know, these Emergency Department-based programs ensure state-of-the art care for victims of sexual assault.

My role was to coordinate the 24-hour SAFE on-call team, take care of basic program administration and serve as in-house consultant. Gaining momentum nationwide for the past decade or so, SAFE programs—also known as SANE or SAE programs–are a welcome advance: they ensure sensitive and expert care to victims of sexual assault, reduce waiting times and strive for restoration of safety and control to patients.

Elmhurst Hospital, my then-new place of employment, is one of the eleven facilities comprising the New York City Health and Hospitals Corporation system. Its busy emergency room serves one of the most diverse areas of New York City. On my first day I was given a large green accountant’s ledger: the social worker previously in my position logged patient and SAFE-related information, entered month by month.

At the time, only a fraction of its lined pages were full.

A few things soon became abundantly clear: there was a steep learning curve to this position, the stakes of ‘not knowing’ felt exceedingly high and, other than the basic SAFE training, I couldn’t find any quick, easy resource to reach for during times of confusion.

I began what eventually became The SAFE Coordinator’s Handbook: Lessons Learned in Queens with modest aims–to provide our home team of examiners with rough guidelines regarding cases presenting at Elmhurst. I would jot down notes on the different kinds of situations presenting in our emergency room. Then, I’d seek out colleagues within our hospital system and around the city to solicit ideas of what best practices should be.

Early on, one of the Assistant District Attorneys from the Queens DA’s office, Eric Rosenbaum, did a presentation at Elmhurst about the legal process as it applies to SAFE operations–how it all works, what to expect after our SAFE patients have left the hospital. There was a lively question and answer session afterwards; the whole exchange was recorded and became the kernel around which the handbook eventually grew.

Years before, working in an entirely different setting (post 9/11, in the trauma education program Comfort for Kids run by Mercy Corps) I had had a fortuitous meeting with a knowledge management specialist in the financial world. I saw how powerful gains could occur when everyone in a given organization or field has access to cutting edge knowledge–especially knowledge generated from the bottom up–and human resources specifically devoted to this end.

Having worked in a host of non-profit agencies, naturally it was troubling to me that front-line workers in human services often struggle along without this crucial support. Supervision, mentoring, training, emerging research, reflection–much that has to do with learning is whittled away–in the meantime, the human predicaments seem more and more dire.

Distress at this state of affairs drove a number of projects I did before starting The Safe Coordinator’s Handbook. For example, I interviewed NYC providers and compiled their advice and tips into user-friendly, accessible activity books suitable for professionals and paraprofessionals alike–one focused on children and trauma and one about teens and conflict resolution, both published by the Bureau for At-Risk Youth.

The philosophy was not to position myself as an expert, but rather to learn from those with longtime experience in the field, read whatever I could get my hands on, then distill my discoveries down to manageable, accessible prose.

Soon enough, I had a 50 page document and began to wonder if it might prove useful to those beyond our hospital setting. I spoke to my grant manager at Department of Criminal Justice Services, mentioning I’d been working on this project. He in turn put me in touch with Jean Fei, then a director of training at the New York State Coalition Against Sexual Assault. Jean became the project’s champion, shepherding it through many rounds of reviews and applications for funding.

Through it all, sexual assault patients kept arriving at Elmhurst. They arrived from down the street and distant lands, some victims of chronic abuse within their families, some casualties of Internet interactions gone awry, or immigrant restaurant workers, trying to get home at 3am. Speaking many tongues and with a host of worldviews, they presented our SAFE team with every imaginable circumstance and situation.

Their diversity, along with the fact that SAFE practices draw on widely disparate and continuously evolving fields–medicine, forensics, social work, law enforcement and criminal justice among them–prompted a realization. Unless we learn from one another, it’s practically impossible to master it all!

As its lengthy acknowledgements suggest, The SAFE Coordinator’s Handbook owes its existence to the time and expertise of many throughout New York City and state. In ‘capturing’ knowledge and making it accessible to those on the front lines serving victims of sexual assault, I believe this project is a perfect fit with Joyful Heart’s mission. In 2010, JHF decided to design, print, and distribute the handbook; from my point of view a miraculous end to this story, and one that, I hope, shines yet another beam of light into the darkness that surrounds the issue of sexual assault.

Rebecca Carman is a social worker with the Elmhurst Hospital Center SAFE program and maintains a private practice in psychotherapy in New York City. A .pdf version of The SAFE Coordinator’s Handbook is available from the Joyful Heartwebsite. If you would are interested in receiving hard copies for your program, please email

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