In 2001, the Robert Wood Johnson Foundation (RWJF) named Susan Chasson, MSN, JD, an RWJF Community Health Leader in recognition of her work to change the way the health care system in Utah treated victims of sexual and physical abuse and assault.
The problem. Before changes were made in Utah, victims of sexual or physical violence—including adults, adolescents, and children—often had difficulty obtaining a thorough and patient-centered physical examination from a trained health care professional.
From aide to victim’s advocate. Chasson’s circuitous route to her destination as a reformer and advocate for victims of sexual and physical abuse and assault began in 1977—first as an occupational-therapy aide and then as a nurse’s aide in Charlottesville, Va.
“I dropped out of college,” she said. “I was very unhappy with my college experience—and the only place in town that paid more than minimum wage was the hospital. I found out that I really enjoyed nursing and worked my way through school as a nurse’s aide.”
After beginning her studies in Virginia, Chasson relocated to Denver and graduated in 1984 with a Bachelor of Science in Nursing from the University of Colorado, Denver. As a new registered nurse, she worked in the burn unit at the University of Colorado, followed by two years in a labor-and-delivery unit at the 196th Station Hospital, SHAPE (Supreme Headquarters Allied Powers Europe) in Belgium.
After returning to the United States, Chasson spent another year working on the burn unit at the University of Colorado, followed by a year at Crittenton Hospital Medical Center in Rochester Hills, Mich., a suburb of Detroit, before landing in Utah.
“I was following someone who had an academic career,” Chasson said, referring to her husband.
Chasson completed her graduate studies in Utah. In 1991, she earned a Master Degree in Nursing from the University of Utah in Salt Lake City, and became certified as a nurse midwife. In 1996, she earned her law degree from Brigham Young University in Provo.
Long emergency room waits for victims. While in the Detroit area, Chasson trained to be a volunteer at HAVEN, a domestic violence and sexual assault response center in Pontiac. Although she relocated before she was able to volunteer, she put her training to use in Utah, where she was a volunteer advocate for adolescent and adult victims of sexual assault.
But the experience left her disenchanted with the way victims of sexual assault were treated. They could wait up to seven hours in an emergency department for a physician to have enough uninterrupted time to complete an exam, and even then it often was not very thorough. A proper medical assessment—which involves getting a medical history, description of the assault, a physical exam, and written and photographic documentation of physical trauma—can take from 1–3 hours, according to Chasson.
“That is what inspired me to look at creating better models of providing health care to victims of violence,” Chasson said. She concluded that more victims would have access to thorough medical exams if nurses were trained to provide them.
In her first attempt to change the system in 1991, she taught her fellow midwives at Timpanogos Women’s Health Care in American Fork, Utah, to conduct forensic exams on victims of sexual assault. But the program failed, primarily because the midwives did not want to add additional nights of on-call duty to schedules already packed with delivering babies, Chasson said.
Creating homelike services for child victims. During the same time period, Chasson also was a member of a task force that analyzed how the medical and judicial systems treated children who were victims of sexual abuse. “What we found out was that the process of investigating child sexual abuse was probably for many children, more abusive than the original abuse,” Chasson said. “They were taken from location to location—none of them child friendly—and interviewed over and over again. If they got a medical exam (and most did not), frequently it was done by somebody who was not trained and did not know what they were doing.”
Those findings led Chasson to become part of a team that created the Utah County Children’s Justice Center in Provo in 1991. The child-friendly and homelike center serves children (and their families) who are victims of sexual or physical abuse.
Skilled professionals familiar with the judicial process interview the children, and the interviews are video recorded so that children only need to go through the process once.
Nurse practitioners from Primary Children’s Medical Center, who receive specialized training, conduct the forensic medical exams—a model of care that Chasson introduced and is now used at four other locations in Utah.
The Utah County Children’s Justice Center not only caters to children but also family members with services ranging from group therapy to help finding housing. “When a child discloses sexual abuse, it is not a child in crisis,” Chasson said. “It is a family in crisis.”
The state attorney general’s office provides the justice center with enough annual funding to pay for some salaries, while private donations cover other expenses. The Utah County Children’s Justice Center is one of 15 such facilities in Utah, though most do not provide on-site medical exams.
Community Health Leader perspective. In 2001, RWJF named Chasson an RWJF Community Health Leader, an award that recognizes individuals who overcome daunting obstacles to improve health and health care in their communities.
Chasson used the $100,000 award to build a 6,000-square-foot addition to the Utah County Children’s Justice Center. The addition included two exam rooms, three interview rooms, and separate spaces for training, group therapy, and administrative functions.
Thanks to the addition, there are now both interview and exam rooms on the first floor, which brought the facility into compliance with the Americans with Disabilities Act. “We will never have to carry a child upstairs for an exam,” Chasson said.
An evolving role. In 2004, Chasson added a part-time job as a statewide sexual assault nurse examiner (SANE) coordinator for the Utah Coalition Against Sexual Assault to her already full schedule. In this role, she teaches nurses and other health care providers throughout the state how to examine victims of sexual abuse and assault. While nurse practitioners or physicians examine children, hospital-based registered nurses now often examine adolescents and adults.
Chasson travels to small rural hospitals to provide on-site training. She often brings a paid model who poses as a patient, allowing the nurses to gain valuable experience conducting an exam.
“You need someone who knows how to identify and document trauma if you are going to go through the criminal justice system and prosecute cases,” Chasson said. “Having nurses trained to do this increases the likelihood that victims who go to a local community hospital will get the appropriate care.”
In 2012, Chasson joined forces with a prosecutor to teach police officers how to document the physical harm suffered in cases of strangulation. It is not an easy task because only about 15 percent of cases involve visible signs of physical trauma, according to Chasson. Most often the injuries are internal such as a sore throat or changes to a woman’s voice. And unless asked about strangulation specifically, victims often do not mention it to law enforcement officials. Strangulation is a strong predictor for when a domestic violence relationship may result in homicide. Yet most states do not routinely prosecute strangulation as a felony assault.
“If we can identify victims of violence early and get them appropriate health care and support, we are going to lower our health care costs as a nation,” Chasson said, explaining that research indicates victims of violence can develop poor health behaviors such as smoking, substance abuse, and overeating which result in life-long chronic health problems.
RWJF Perspective: RWJF recognized the first 10 Community Health Leaders in 1993. They are unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation’s most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations. For more information on the program see Program Results Report.
Under the RWJF Community Health Leaders award, each year RWJF has provided a $125,000 award to 10 individuals and their organizations ($105,000 supports a project at their organization and $20,000 goes directly to the leader for personal development). RWJF also connects the RWJF Community Health Leaders with each other so they can continue their work with the support and experience of their peers and previous award winners.
“Community Health Leaders are characterized by three specific traits—they are courageous, they are creative, and they are committed,” says National Program Director Janice Ford Griffin. “The Foundation recognizes the tremendous resource of experience among the leaders and we look forward to mining that resource as we consider future initiatives.”
“Through the Robert Wood Johnson Foundation Community Health Leaders award, we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind ground-breaking efforts in communities across the United States,” said Sallie George, MPH, program officer at RWJF. “These individuals remind us that one person can have a powerful impact on health and health care within their communities.”
The most recent round of leaders was chosen in the fall of 2012.