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WASHINGTON -- If students are raped at the University of Michigan, in most cases a nurse who specializes in sexual assaults can asses and treat them right at the campus health center, rather than sending them to the local hospital, a program that institution officials said makes survivors feel more comfortable and shows a commitment to these kinds of issues.

At the annual American College Health Association conference here Wednesday, representatives from Michigan walked through the benefits of offering sexual assault nurse examiners, or SANE, at the campus clinic. They are specially trained to conduct sensitive exams after a sexual assault, and to do it in a way that makes the survivor feel comfortable.

Instead of hiring new employees, or taking away clinicians from their normal duties, the institution shares the University of Michigan Hospital emergency room's 10 SANE nurses, who examine victims at the health center, not the emergency room.

Students later reported seeking out the health center because it felt more comfortable and less chaotic compared to the emergency room, said a University of Michigan physician, Susan Ernst. It was also more conveniently located, she said.

The exams are only offered at the health center until about 2 p.m., because the center closes at 5 p.m. and rape kits can be a lengthy process. After that hour, students are redirected to the emergency room again.

This practice started in late 2015, after student activists complained to the university administration that it needed to do more to combat campus sexual violence. Several years ago Michigan participated in an Association of American Universities survey that at the time was one of the biggest studies of campus sexual assault. The survey of 27 campuses, both public and private, revealed about 23 percent of female undergraduates had at some point been the victim of some unwanted sexual contact. A survey that Michigan conducted independently yielded similar statistics.

After the results were revealed to campus, students who were upset about these issues met with President Mark Schlissel, who in turn went to the health center staffers, who brought the SANE system to the health center.

The health center aggressively marketed the shift. It worked  with some medical students, who “took over” Snapchat to advertise it, a live stream that was viewed thousands of times in just six minutes, Ernst said. Getting buy-in from students, and their lobbying, can help bring about campus change, she said.

Ernst said in an interview after her session that the number of students receiving those exams has gone up in the past several years, but the cause could not necessarily be traced to the change to offering them on campus. The number of exams, both at the emergency center and campus health clinic, tends to skyrocket in the fall around football season. In November 2017, there were 17 total recorded exams in both facilities.

“I think it just shows that we care about these issues, and it creates a certain culture,” she said.

But Michigan seemingly lucked out in terms of bankrolling this deal. It borrows the nurses from the emergency center, and many of the other expenses are paid for either by the existing health-center fee that all students pay, by the state or through nonprofit donations (such as clothing for survivors).

Students also pay for nothing in this system -- the cost of the drug regimen that the Centers for Disease Control recommends following a sexual assault is covered by the university.

Other states and institutions lack those resources. One audience member pointed out, for instance, that in her home state of Rhode Island, almost no nurses are SANE-certified, so the universities would need to invest there.

Also complicating matters are the reporting requirements. While federal law doesn’t require clinicians to tell other administrators about a sexual assault, a Michigan state law does require physicians to report to police officers in the case of sexual assaults. To that end, only nurses and nurse-practitioners interact with sexual assault victims at the university, Ernst said.

Each state will have its own reporting requirements, too.

“This has been helpful, though, in so many ways,” Ernst said.

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