When someone experiences violence—whether physical, sexual, or emotional—the road to healing can be long and complicated. At Cherokee Indian Hospital Authority (CIHA), that journey begins with compassion, cultural understanding, and professional care. And for many victims, it begins with one of CIHA’s S.A.F.E. Nurses.
CIHA’s Sexual Assault Forensic Examiner (S.A.F.E.) Nurse Program is the most comprehensive and culturally responsive program of its kind west of Asheville. With three certified SAFE nurses on staff and new nurses continuously in training, CIHA is leading the way in Western North Carolina to provide trauma-informed care 24 hours a day, seven days a week.
Backed by a $1.2 million multi-year grant from the Indian Health Service, CIHA’s program was created to meet the critical need of offering support to victims of sexual abuse, human trafficking, elder and child abuse, and intimate partner violence in a way that is both clinically expert and culturally appropriate. The Project Grant was awarded through grant opportunity Domestic Violence Prevention Program: Forensic Healthcare Services for a 5-year period.
These nurses are trained to not only treat the immediate physical wounds of an assault, but to careful and compassionately treat the whole person. A S.A.F.E. nurse is a licensed medical professional, typically a registered nurse, who is specially trained to provide trauma-informed medical care and forensic evidence collection for individuals who have experienced sexual assault, physical abuse, or other forms of interpersonal violence. SAFE nurses are equipped to perform forensic exams, document injuries, collect legal evidence, and collaborate with law enforcement and advocacy services, all while prioritizing the physical, emotional, and cultural needs of the patient. From gathering medical and legal histories to offering forensic exams, STI testing and treatment, pregnancy prevention, and coordinated follow-up services with advocacy groups and law enforcement, S.A.F.E. Nurses ensure that every patient is seen, heard, and supported.
S.A.F.E. nurses are also specially trained to testify in court, ensuring justice can be pursued with the full weight of professional credibility.
Since the grant began in April 2023, CIHA’s S.A.F.E. Nurse Program has grown significantly by recruiting and training several new nurses in Adult/Adolescent SANE, Pediatric SANE, IPV, trauma-informed care, and human trafficking awareness. To address the unfortunate increase in need for the services S.A.F.E. Nurses provide in rural Western North Carolina, where specialized care is scarce, CIHA’s S.A.F.E. Nurse Program has been able to expand care beyond the Qualla Boundary to now serve both enrolled members and non-enrolled victims in Jackson, Macon, and surrounding counties through partnerships with REACH of Macon County, Western Carolina University, and the Jackson County Center for Domestic Peace. These partnerships were essential during the third quarter of the grant cycle when Jackson County’s S.A.F.E Nurse Program shuttered, leaving a devastating gap in services for victims in WNC. Without CIHA as an option for victims of abuse to receive care, Jackson and Macon counties were having to transport victims an hour away to Asheville, where they would spend long hours in the emergency room waiting for a SAFE Nurse to become available. This gap in care put a strain on organizations serving victims of abuse as they struggled to configure transport for victims and access to care in a timely manner to ensure evidence could be preserved for legal cases connected to the abuse. This kind of coordinated, responsive, expansion matters. Because when someone has just survived trauma, where they turn for help can make all the difference.
Between April 2023 and December 2024, the CIHA S.A.F.E. team supported:
73 victims of violence, with a total of 248 patient encounters
330 total initial patient contacts, including consultations
Breakdown of Cases:
Physical Assault / Intimate Partner Violence: 54 initial contacts, 17 involving strangulation, 77 follow-ups
Sexual Assault: 27 forensic exams (13 with kits collected), 54 follow-ups
Human Trafficking (Confirmed or Suspected): 6 initial contacts, 12 follow-ups
Pediatric Abuse/Maltreatment: 18 initial contacts, 36 follow-ups
Elder Abuse/Neglect: 5 initial contacts, 10 follow-ups
Consultations: 82 phone consultations community members, patients, and partnering agencies
The volume of care continues to grow in 2025, with new cases each month. Just between January and July 2025, CIHA provided:
12 SANE exams (9 with kits collected)
10 child abuse assessments
13 physical assaults (4 involving strangulation)
1 elder abuse assessments
50 follow-up visits
17 consultations with patients or partnering agencies
6 victims under the age of 19
5 victims age 19 to 24
5 victims older than 24 years of age
CIHA’s S.A.F.E. Nurse Program is more than clinical—it’s community-centered. Monthly program meetings began in February 2025, creating space for team education, case reviews, and visioning the program’s future. New office space has been organized to improve access to supplies, and educational materials have been updated and shared with the public. Recognizing the regional effort to serve victims across WNC, CIHA’s S.A.F.E. Nurse Program Coordinator Jennifer Peterson, MSN, FNP-C, SANE, attends monthly meetings with Jackson County’s SART team as well as with Jackson County Center for Domestic Peace as part of the MOU for CIHA providing services to victims. With more nurses in training and deepened relationships with law enforcement, schools, shelters, and advocacy groups, the future of trauma-informed care in WNC is being built—one patient at a time.
For the Eastern Band of Cherokee Indians and the broader region, this program is not just about response, but also about the resilience of community. It’s about reclaiming dignity, restoring health, and reimagining what healing can look like when culture and care walk hand in hand.
Need Help?
CIHA’s SAFE Nurse Program is available 24/7 for victims of violence and abuse. For support, or to learn more about available resources, contact CIHA or Analenisgi Behavioral Health Center at 828.497.9163 and ask to be connected to the SAFE Nurse on duty or visit the CIHA Emergency Room.