This document summarizes a call to a survivor hotline regarding a case of child sexual abuse. [1] The caller is the mother of a 6-year-old victim, Joe Victim, who she found performing a sexual act on a younger sibling. [2] The plan is for the mother to consent to a SANE exam for the victim and for the advocate to report the incident to law enforcement as required. [3] The victim only lives with their mother, father and sibling, and the mother has ensured the perpetrator, a cousin, will no longer be around the victim.

1. Arise Survivor Contact Sheet
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2. Filling out our Survivor Contact Sheet is an essential component of taking a call on the
hotline. Doing so ensures all information is available to determine the type of services we
can offer the caller.
A Call from a Law
Enforcement Agency or a
Hospital
Who is calling the
hotline?
Who You Are
Time of Call
Who is the
Victim?
Jane Advocate
5/22/10 8:00
Joe Victim
What happened? 575-226-4665
Acute Pediatrics is checked
because the victim is a
03/28/06 05/20/10
minor and the incident
occurred within the past
Mom found Joe Victim performinghours. act on a younger sibling. Mom is extremely concerned and wants
72 a sexual
to know what is going on with her son.
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3. More Information
About the Victim
4
Plan of Action
Because the victim is
6 years old, Mom is able to When did you
Who is the nurse for SANE exam.
consent
onWhere are you
call responding contact the SANE
Does the Survivor is
to meeting the
the incident?Because the victim Nurse?
want6to report are
victim? required old, you this
years
the incidentreport
to
to
incident to Law
SANE NursePolice?
the Enforcement. 8:15
9:00
This is a case of Child
Sexual Abuse.
You must complete SIDE B.
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4. Has this been
Information
reported to the
about the Victim
Statewide Central
& Guardian(s)
Mom & Dad VictimIntake?
Information about Mother and Father
Mom & Dad Victim Law Enforcement575-226-4665
Involved New Mexico State Police
n/a Who is n/a
perpetrating on Jane Advocate
the Victim?
NM State Police J. Doe
n/a Is the Child safe?
John Perpetrator
Cousin
Mom will not allow John Perpetrator around Joe Victim anymore.
Joe Victim only lives with Mom, Dad, and younger sibling.
Mom made call to Law Enforcement about Joe Victim’s behavior. Is very concerned.
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