• Provide patients with timely access to examinations, trained examiners and quality care
• Secure the physical and emotional safety of the patient
• Recognize each patient has unique capacities and strengths to heal
• Offer comfort, encouragement and support
• Provide information about the exam process and links to resources to further address needs
• Involve patients in decision making, to the extent possible
• Ensure appropriate confidentiality

Adapted from the National Protocol on Sexual Abuse Medical Exams Pediatric, April 2016.

For emergent examinations, we would prefer that all patients be seen in the Billings Clinic Emergency and Trauma Center for an exam by one of our Sexual Abuse Nurse Examiners. SANE exams are performed when the abuse occurred in the past 5 days.

SANE = Sexual Abuse Nurse Examiner. Our nurses have over 80 hrs of specialty training and are on call 24 hours every day of the week.

CARE = Child, Adolescent and Adult Recovery Examinations. These exams are performed when the alleged abuse occurred more than 5 days ago. We also perform follow-up examinations after the emergency room visits to ensure coordination of care, further laboratory studies and referrals.

The CARE Program team coordinates care with multiple agencies in Billings and the surrounding areas. These agencies include:

• Children’s Advocacy Center
• Billings Clinic Pediatrics
• The Children’s Clinic
• Riverstone Health
• Department of Children and Family Services
• Behavioral Health
• Center for Children and Families
• All branches of law enforcement

This team approach emphasizes the safety and care of each individual. We work together to help facilitate the healing of every patient.

• Confidentiality is key to our appointments. All documentation is secured and we make every effort to ensure patient privacy.
• Check-in at Billings Clinic Downtown in the Family Medicine department on the 3rd Floor.
• Our exams may take up to 2 hours. Photographs and/or videography may be performed.
• Patients are interviewed initially and this is followed by a physical exam with special attention to any areas of concern.

Outpatient Physician Medical Director
Our physician is trained in both pediatric and adult sexual abuse. The physician director is responsible for all out-patient medical evaluations. Our physician is part of the multi-disciplinary team at the Yellowstone Valley Children’s Advocacy Center.

Registered Nurses
Our nurses are trained in both pediatric and adult sexual abuse.

Emergency and Trauma Center Physicians
Emergency and Trauma Center physicians provide acute care and emergent evaluation of sexual assault cases <120 hrs. They place referrals for outpatient follow-up. The emergency physician will request a SANE (sexual abuse nurse examiner) when abuse is suspected.

• CARE program services are provided in Family Medicine in the Primary Care department on the 3rd floor of Billings Clinic. This is a quiet family medicine office and exams are held in the late afternoon for additional patient privacy.
• The exam room is equipped with an electronic medical table. We have a colposcopy and digital camera for photo-documentation. We have laboratory testing available in our office and also in the clinic laboratory. Evidence collection kits are also available if necessary.

• We will always work to ensure that each visit is private and confidential. Each record is placed in a private folder that is not accessible to general medical staff. All medical exams and documentation are performed after obtaining appropriate consent from the patient or guardian. We have security on staff that can be notified if there are any direct concerns about safety while on our campus.

• Call the Centralized Intake for Department of Children and Family Services at 1-866-820-5437.
• Call your local branch of law enforcement.
• If there is emergent concern or witnessed abuse, please call 911.
• For non-emergent medical exams, call our CARE program at 406-435-7177.