The Safe Place room is small, meant to feel non-threatening to kids. There are Disney characters on the walls, and stuffed animals to hold. But no decorating scheme can soften the horror of what brings people here: This room at Martin Luther Hospital in Anaheim is set up to treat children following sexual assault.
The 9-year-old girl raped at a park near her Lake Forest home last weekend was brought here by police to be examined and counseled. Officers, meanwhile, began the search for her assailant.
At Safe Place, she was greeted by a nurse and interviewed by a trained specialist, then examined with child-sized equipment designed to assess injury and collect physical evidence.
The post-assault process she went through is one that hundreds of children have undergone at the center since it opened four years ago.
The hospital is the only medical facility in Orange County specifically geared to assisting young sexual assault victims. While Safe Place was designed to serve kids, the need for sexual assault care for adults has been so great that they are also brought here. Of the 43 assault victims examined last month, 18 were children.
Exams and treatment at Safe Place are just the first of many stages involved in the healing process for assault victims, according to experts.
It is a process that involves family members and often specialized counseling to come to terms with what has happened.
"We pride ourselves that when victims arrive here it's the beginning of the healing process," says Elizabeth Grimley, a physician and emergency room medical director at Martin Luther. "And we take it all the way to court. They have to know how to deal with the court system because you can have all the evidence in the world, but if you don't know how to deal with the D.A.'s office or the courts, it may not do you any good."
Grimley says about 30 nurses and five full-time physicians undergo 30 hours of special training to treat sexual assault victims at the center. They must know anatomy, how to collect evidence, how to treat victims compassionately and how to testify in court.
Most of the victims treated by Safe Place are brought by police as soon as possible after the assault.
"In the case of the Lake Forest girl, they called ahead and said they were en route with a 9-year-old acute rape victim," says Beth Winokur, a registered nurse and department manager of emergency services at the hospital.
Typically, Winokur says, police call ahead and report the time the assault occurred and how long they think it will take to get to the hospital.
"We then call in a medical counselor, and we do a very brief interview, sometimes with the parent, sometimes not," Winokur says. "Usually the younger ones do better with the parents in the room, but sometimes they do better with the parents out of the room, especially if mom keeps crying. They don't want to cause any more grief to their parents."
Winokur says timely exams are important not only to help the victim but to help police in their investigations and court cases. Next to treating the victim, the gathering of evidence is the top priority at the center.
If the exams are not done quickly, the evidence is gone. Damaged tissue heals quickly, and trace evidence--secretions, saliva, finger nail scrapings--is lost. The evidence collected is forwarded to the Orange County Crime Lab and is used to secure convictions.
"These guys who rape are predators," Grimley says. "But they don't rape just one, they rape again. Sometimes you might not have enough evidence to convict after one victim, but the evidence found might help convict for the next one. You can put together a case from several different victims."
The 9-year-old from Lake Forest has been helpful in recounting the incident to help detectives find her assailant, but many kids younger than 9 have trouble doing so, Winokur says. She estimates that about 10% of the cases she sees involve children younger than 9.
"We recently saw a victim as young as 2 months," she says. "We see a lot of 3-, 4- and 5-year-olds. For some reason we saw a rash of rapes last July: nine in 34 hours."
Since opening in October, 1991, the center has handled about 1,200 cases. With backing from the Martin Luther Hospital Foundation, the Hospital Guild and Disneyland, Grimley and Winokur established the center initially to help child abuse victims.
But, as the center evolved and word of its services spread, Safe Place began handling primarily sexual assault cases. It now has about 35 cases each month.
Police decide whether a victim will be taken initially to Safe Place or to one of two county-run examination facilities, one at the Orangewood Children's Home in Orange, and another in a Laguna Hills office park.
The Child Abuse Services Team, a program within the county's children and family services unit, handles chronic abuse cases, domestic violence and sexual assault exams at the two county-run facilities. Those who are taken first to Safe Place are usually referred to the county team for in-depth follow-up care and counseling.
The load is heaviest at Safe Place on weekends and evenings when the county facilities are closed. Of the 155 sexual abuse victims treated between June and October this year, about 40% were children.
Cathy Singletary, program manager of the Child Abuse Services Team, says if it weren't for Safe Place, the county would be hard-pressed to help victims after hours.
"We have one nurse practitioner who works for no pay on call after hours out of her commitment to help these victims," she says. "Without Safe Place, victims would show up at any number of hospital settings with untrained doctors who know little of pediatrics and little of children's anatomy. They would have to wait in traumatic settings. The whole focus of CAST and the Safe Place has been to reduce the trauma for the child."
Demand for services has increased because victims of assault are more likely to report the crime today, Grimley says.
"In the old days, the victim was treated like a perpetrator. Now with more compassionate treatment, more people are willing to report. And the detectives know the victims are going to get a good exam on a timely basis, and they'll be treated well. Word gets around, and they bring in victims."
An important component of evidence gathering at Safe Place is a fiber-optic colposcope. The colposcope can magnify the view of injuries up to 23 times, which means that a detailed exam can be made from outside the body. And it videotapes the exam and evidence for later use in court.
It is so thorough that Safe Place staff now find evidence in about 90% of the victims contrasted with the 10% rate before the scope was used, Grimley says. The scope is so effective that detectives urged the hospital to use the scope for all sexual assault cases.
Before the opening of Safe Place, victims throughout the county sometimes waited hours to be examined and then often were treated by doctors inexperienced in such cases, according to Winokur.
"People don't like to do rape exams," she says. "They take a long time, there's always a chance you'll get dragged into court and many doctors don't really know how to do them. We heard stories from detectives of victims waiting three and four hours before the exam. Some of the detectives are still afraid to call ahead and let us know they are coming because they're afraid we'll say no."
In addition to the physical exam, patients are asked questions from a five-page state Department of Justice form: Was the penis in the vagina or the rectum? Was there a foreign object? Was there biting or cutting? This information is kept with the colposcope videotaped exam and kept on file at Safe Place and handed over to the police.
Child psychiatrists and psychologists caution parents that healing from a sexual assault is a long-term, gradual process involving several steps.
"It's not just the child's problem but the whole family, as well as the neighborhood's," says Thea Reinhart, a family and child psychologist in Irvine. She says the stages of grief and healing typically occurring after sexual violence are denial, shock, depression, fear, anger and, finally, acceptance and resolution.
She suggests that parents help children by not trying to stop any of the stages but instead by guiding them along the way--and assuring them "we'll get through this together."
"Once they have been victimized, they may start acting out, or being quiet, or getting angry and aggressive," Reinhart says. "These are all normal and part of the trauma. Let them repair in their own way, by leaving the lines of communication open."
Tony King, an adult and child psychiatrist in Mission Viejo, says children who have experienced sexual violence need to feel safe all the time.
"Children need to know it won't happen again, so they need to get back to their normal activities as soon as possible without parents pushing them too fast. The family plays the most important part," he adds. "They are going through a lot, maybe feeling angry, feeling guilty. They must be calm and not act out. Pushing too fast could add to the trauma."
During her nearly 12 years of conducting sexual assault exams at Martin Luther, Winokur has seen more brutality than she cares to recount: burns, bruises, rips and scrapes.
"It makes you really mad," she says. "How could anyone do these things? One of the most brutalized victims I've ever seen was a 16-year-old runaway. You name the torture and she had it. I testified against the guy, and he is up for three life sentences. He's probably the most brutal rapist I've ever seen. But you know what? He looked like someone you wouldn't be afraid of getting in the car with."
Tragically, sometimes all the education about dangers and precautions parents take with their children aren't enough, she says.
"My youngest boy asked me, 'What does the bad man look like?' I said he looked like anybody else. And you know what the kicker is? It could be a bad woman who looks like anybody else."