The Turning Point rape crisis center in Plano is designed to be a place where survivors of sexual assault feel safe.
Outside each door, there’s a white noise machine for privacy during therapy sessions. Survivors also get a little stuffed puppy that looks like Brooks, the 6-year-old Maltese-Yorkie mix who’s the unofficial mascot of the center.
Brooks is the service dog of Courtney Underwood, a sexual assault survivor and the namesake of the Turning Point’s 24-hour clinic: Courtney’s SAFE Place.
When Underwood was 15, she was raped at knifepoint by her pastor.
"It was completely out of the blue and violent, and I didn’t know what to do, and when I looked for help in Dallas, there was none," Underwood said.
Underwood has made it her mission to make sure others have the resources she didn’t, including access to a sexual assault nurse examiner.
Observers say there aren’t enough certified nurse examiners in Texas — only a few hundred. A bill introduced this spring in the Texas Legislature would make it easier for survivors to get access to specialized nurses. Other bills in the state legislature address sexual assault, including more funding to ease the backlog of untested rape kits.
The nurse examiners, also called SANEs, conduct forensic medical exams in a way that supports patients by giving them control. Robyn Bowles, the SANE program manager at the Turning Point clinic in Plano, says this prevents additional trauma.
Everything's about consent, Bowles said. "Every part of the exam we’ll ask, 'Is it OK if I look in your ears, your eyes, your nose?' We try to base the exam around not a script, but the feedback we’re getting from that patient."
Exams start with a conversation where patients can share their trauma in their own words. Then, the nurse collects evidence.
"We have head and hair combings," Bowles said. "Oral swabs. The known saliva sample, which is how the crime lab identifies the patient's own DNA and compares it to any foreign DNA that might be on the body."
Because there's a shortage of nurses trained to work with people who’ve been sexually assaulted, some patients travel up to two hours for an exam at the Turning Point.
This lack of access impacts more than sexual assault survivors. Since the nurses are trained to testify in court, Underwood says it also can affect the outcome of a criminal trial.
"When you have a SANE on a case, that’s the highest predictor of successful prosecution," Underwood says. "They’re trained not only to collect the evidence and to support that survivor, they’re trained to testify, and they know walking into an exam room, the full picture of what this case can look like."
Some Texas lawmakers are trying to make it easier for patients to get access to examiners.
State Sen. Jane Nelson, R-Flower Mound, has sponsored a bill that would increase access to examiners through telemedicine. A medical provider would perform an exam while consulting with a sexual assault nurse examiner via video conference.
Underwood is intrigued by telemedicine, but says it’s a bandage on the bigger issue of the lack of trained nurse examiners. Underwood says Texas needs more of these examiners and she wants every community to have a clinic — a place like Courtney’s SAFE Place.
"I just want survivors to know that they’re coming into a place that’s built for them and designed for them," Underwood said. "It’s a safe place for them to begin to heal, so they’ll be supported. They’ll be believed.
"I hope that they can also look at my journey and see that there is hope on the other side."