By Amanda Hernández, Stateline.org

After years of pressure over lost or untested sexual assault kits, a growing number of states are adopting systems to track the kits — giving survivors a way to follow their evidence through the justice process.

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But despite nearly $400 million in federal support since 2015, backlogs persist, and some states still lack basic oversight. And now, advocates fear such financial support is on shaky ground.

There are an estimated 49,248 untested kits across the country, according to data collected by the Joyful Heart Foundation, a nonprofit advocacy group. Although the exact number of backlogged kits nationwide is unknown, a 2022 report from the nonpartisan Congressional Research Service that summarized existing research found backlog estimates ranging from 90,000 to 400,000 kits.

After a sexual assault, a survivor may choose to undergo a forensic exam, during which a trained health care professional collects evidence over the course of several hours.

That evidence — which may include clothing, photos of injuries, blood, urine and DNA samples — is compiled into what’s commonly known as a rape kit or sexual assault kit. The kit is then sent to a crime lab for further testing.

Test results are sometimes returned to investigators who check for DNA matches in national or state databases. A match could connect the case to other sexual assaults or link a suspect to another crime.

But processing a single kit can take days, months or even years, depending on when they are submitted and how much other work crime labs have. In some states, there are no laws requiring law enforcement to send rape kits to a lab within a specific time frame or mandating how quickly those kits must be tested.

Survivors are often left in the dark. They may not know if their kit was tested, whether a suspect was identified, or if their case is moving forward.

That silence — the uncertainty about what happened to the kit — has long been the norm in many parts of the country.

“We have betrayed at least a generation of survivors in the way that the criminal justice system and the larger public have responded to sexual assault,” said Rachel Lovell, an associate professor of criminology and the director of the Criminology Research Center at Cleveland State University. Lovell has conducted extensive research on the impact of untested rape kits in Ohio.

The goal of tracking systems is straightforward: bring transparency to a process that for decades left survivors without answers. These systems allow victims to log in and track the status of their kits — from collection to testing to storage — and offer law enforcement agencies a tool to identify and prevent testing backlogs, and strengthen criminal investigations.

At least 37 states and Washington, D.C., have established or committed to establishing a rape kit tracking system, according to the End the Backlog website run by the Joyful Heart Foundation. The foundation supports survivors of sexual assault, domestic violence and child abuse.

Two more states — New Jersey and Pennsylvania — announced plans this year to build their own tracking systems. In New Jersey, a new law gives the attorney general’s office until Aug. 1 to set up the tracking system. Pennsylvania officials are preparing to launch a statewide inventory of kits to better understand the scope of the backlog before developing their system.

A handful of other states have also enacted or are considering legislation to support their sexual assault kit tracking programs.

In Arizona, for example, Democratic Gov. Katie Hobbs signed a bill into law in May requiring all police departments in the state to use a system called “Track-Kit.” The new law primarily affects the Phoenix Police Department, which opted out of using the system in 2016. That department is expected to launch the platform later this year.

At the federal level, support for kit testing and tracking has often come from the National Sexual Assault Kit Initiative, or SAKI, which has awarded nearly $400 million to 96 grantees, including local and state agencies, across 44 states since 2015.

But the program’s future has not always been certain.

In January, the federal Office of Management and Budget had listed the National Sexual Assault Kit Initiative as a program whose funding would be frozen, before walking back the widespread freeze amid legal challenges.

President Donald Trump’s proposed budget for fiscal year 2026 would maintain funding for the Sexual Assault Kit Initiative at $51.5 million, according to a new report from the nonpartisan think tank Council on Criminal Justice.

But a separate round of federal Department of Justice grant cuts in April has raised concerns about the stability of broader support services for survivors. That round of cuts affected a variety of grant programs, including domestic violence shelters, trauma counseling, legal assistance and hospital advocacy.

The timing is especially concerning, advocates say, as victims of crime face growing obstacles to accessing state-provided support. In many states, victims seeking financial compensation encounter long delays, burdensome paperwork or are disqualified entirely by narrow eligibility rules.

Police investigations and funding

In jurisdictions that have worked to clear their backlogs, testing sexual assault kits has helped identify serial offenders, solve cold cases and connect assaults or other crimes to the same perpetrator.

Nationwide, testing supported by the federal Sexual Assault Kit Initiative has contributed to at least 1,538 convictions. Still, these types of crimes are vastly underreported to police.

Rapes and sexual assaults are notoriously difficult to investigate and prosecute, said Lovell, of Cleveland State University. But testing all rape kits can reveal patterns of criminal behavior over time and provide deeper insight into how, when and to whom these crimes are happening — ultimately helping improve support and case outcomes for survivors.

“By prosecuting sex offenders, you can also work to address violent crime more generally and solve past or future crimes with the addition of evidence and DNA,” Lovell told Stateline.

In her research on untested rape kits in Ohio, Lovell has found that since 2015 — when the Sexual Assault Kit Initiative launched — cases overseen by the Cleveland Police Department have been more likely to move forward in the investigative and prosecutorial process, with fewer being labeled as unfounded. Police reports, she said, also have become more detailed and trauma informed.

The initiative itself may not be the sole reason for these changes, Lovell said. Other factors, such as departmental policy changes or officer training, may also have played a role.

Although SAKI grants remain one of the primary sources of support for testing backlogged kits and building tracking systems, communities may face challenges sustaining progress once the federal dollars run out.

Capt. Tim Hegarty, division commander of the Office of Professional Standards at the Glynn County Police Department in Georgia, said local agencies must push through potential funding cuts.

“It falls back on agencies to do the job that they say they’re going to do, even when the money has dried up,” Hegarty said in an interview. “Doesn’t matter who’s in the (presidential) administration.”

Hegarty added that many departments across the country are still catching up when it comes to interviewing victims with sensitivity and investigating sex crimes.

“Law enforcement really has not advanced a great deal when it comes to dealing with these types of crimes,” Hegarty said. “It’s not the universal language when it comes to policing across the country.”

New statewide tracking systems

Other states are looking to strengthen existing programs through new oversight measures and stricter processing timelines.

Maine is one of the 11 states without a statewide rape kit tracking system. But state lawmakers are considering a bill that would create one and require law enforcement agencies and the state’s crime lab to inventory and test backlogged kits. The bill passed the House in mid-June and is currently under consideration by the Senate Appropriations Committee.

In Colorado, Democratic Gov. Jared Polis signed a bill in early June aimed at improving the state’s capacity to process sexual assault kits. The new law establishes the Colorado Sexual Assault Forensic Medical Evidence Review Board, which will evaluate the state’s medical, legal and criminal responses to sexual assault.

The governor and attorney general have until Aug. 1 to appoint board members. A preliminary report is due to lawmakers by Dec. 15.

The law also strengthens oversight of kit processing timelines. Law enforcement agencies must now provide survivors with updates on the status of their kits every 90 days. It also sets a new 60-day goal for crime labs to process forensic medical evidence, shortening the current 90-day goal.

As of May 31, 1,324 kits were backlogged, with an estimated testing turnaround time of about a year and a half, according to the state’s dashboard.

Alaska, which launched its statewide rape kit tracking system in 2023, considered a bill this year that would have expedited processing timelines for sexual assault kits. The bill passed the House without opposition but failed to advance through the Senate before the legislative session ended in May.

Although the number of untested kits has significantly declined since the state began inventorying them in 2017, 254 kits remained untested at the state’s crime lab in 2024 — up from 113 the previous year but well below the 3,484 recorded in 2017.

In Georgia, lawmakers considered a similar bill that would have established new rules for collecting, testing and tracking evidence from sexual assault kits. The bill did not advance before the legislature adjourned in April.

The Georgia Bureau of Investigation reported in December that 2,298 kits were tested between July 2023 and June 2024, with 480 kits still awaiting testing. Another 1,612 older cases submitted before 1999 were flagged for DNA testing, of which 837 had been tested as of June 2024.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Jariel Arvin, KFF Health News

On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.

Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.

On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen’s identity, KFF Health News is not using her last name.

“Hello. How are you feeling?” Johnson asked as she entered Ellen’s bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.

“It’s fine, except this cough I’ve had since junior high,” Ellen said.

Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.

Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.

Carefully, Johnson removed the bandage to examine Ellen’s toes. Her lower legs were red but cold to the touch, which indicated her condition wasn’t improving. Ellen’s two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen’s prognosis, recommending her for hospice.

“Our patient isn’t just the older adult,” Johnson said. “It’s also often the family member or the person helping to manage them.”

Stephanie Johnson examines her patient Ellen’ s foot. Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. ((Jariel Arvin for KFF Health News)/KFF Health News/TNS)

Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.

That means many older adults will be relying on other primary care physicians, who already can’t keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found.

According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.

Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.

“There are so many housebound older adults, and we’re barely reaching them,” Johnson said. “For those still in their private homes, there’s such a huge need.”

Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be.

“One of the things I’m most proud of is the role of nurse practitioners,” she said. “We step into places where other providers may not, and geriatrics is a prime example of that.”

Practice limits

Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner said, “but there are a lot of barriers in place.”

In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians.

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Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as “scope creep” in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.

Five states have granted NPs full practice authority since 2021, with Utah the most recent state to remove physician supervision requirements, in 2023. In March, however, Mississippi House Bill 849, which would have increased NP independence, failed. Meanwhile, 30 Texas physicians rallied to tamp down full-scope efforts in Austin.

“I would fully disagree that we’re invading their scope of practice and shouldn’t have full scope of our own,” Johnson said.

She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.

She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.

While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.

“We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That’s very much in the nursing domain,” she said.

That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.

Patient and family

In an office next to Ellen’s bedroom, Johnson called Ellen’s younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn’t coping.

Watt appreciated that Johnson had kept the family apprised of Ellen’s condition for several years, saying she was a good communicator.

“She was accurate,” Watt said. “What she said would happen, happened.”

A month after the consult, Ellen died peacefully in her sleep.

“I do feel sadness,” Johnson said, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.”

Jariel Arvin is a reporter with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from The SCAN Foundation .

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By CATHY BUSSEWITZ, Staff Writer

NEW YORK (AP) — Jeremy Didier had taken her son to a psychologist for a possible ADHD evaluation when she spotted an article about women with the condition. As she read it in the waiting room, she thought to herself: They’re describing me.

“Lots of risk-taking, lots of very impulsive behavior growing up,” Didier said. As the magazine described, she’d excelled in school but gotten in trouble for talking too much. She’d amassed too many speeding tickets as an adult. She turned to her husband and said, “I think I might have ADHD.”

Didier is now the board president of Children and Adults with Attention-Deficit/Hyperactivity Disorder, a nonprofit advocacy and support organization. Her realization mirrors the experiences of other adults who wonder if they have ADHD after a child’s diagnosis.

Attention-deficit/hyperactivity disorder is a neurodevelopmental condition characterized by inattention, hyperactivity or a combination of the two. Common symptoms such as trouble concentrating or sitting still can create challenges at work.

People with ADHD are often passed over for promotions, said Andrew Sylvester, a psychiatrist at UCHealth, a hospital in Longmont, Colorado. Difficulties with attention may lead the mind to drift during meetings, and cause someone to miss important discussion nuances. The disorder may interfere with organization, planning and remembering details.

Yet some adults think of having ADHD as a source of personality strengths and ways of thinking that benefit employers. Diagnostic manuals may call it a disorder, but it also can be a superpower, they said.

“Our brains work differently and so we’re more likely to be able to think outside the box and come up with different things, and sometimes that’s because we’ve had to do that in order to to survive,” Didier said.

Here are some ways to cope with and channel ADHD in the workplace.

Finding community

Getting diagnosed with ADHD doesn’t always lead to a quick fix. While doctors often recommend medication and therapy, not everyone can take medication, and those routes don’t necessarily eliminate all symptoms.

Didier floundered with a messy house and lots of yelling as she and four of her five children were diagnosed with ADHD. She experimented with medicine, diets and reward charts, and discovered what helped her the most: a community of parents who had children with ADHD.

“There’s nothing like talking to other people who are going through what you’re going through to help you feel … that you’re not alone,” she said.

Didier eventually became a social worker and now runs support groups for adults with ADHD, teaching skills they can use at work.

Some organizations have employee resource groups organized around neurodiversity to provide camaraderie and support to adults with ADHD, autism, dyslexia and other conditions.

GPS of the brain

People with ADHD often struggle with executive function, which Didier describes as “your brain’s GPS” for navigating your day. Executive function is a set of mental skills that includes making plans, managing time and flexible thinking. It also includes working memory, which helps us keep track of what we’re doing.

To keep from getting derailed, experts recommend breaking large tasks into chunks, writing detailed to-do lists and taking breaks.

Personal chef Bill Collins, 66, who was diagnosed with ADHD two years ago, writes structured lists when he’s making a meal for a client. He creates categories for kitchen areas — counter, stove and oven — and then lists tasks such as “chop carrots, boil water for pasta” underneath each category. Then he numbers each task so he knows exactly what to do, where and when.

“That’s how I got around my unknown ADHD early on, just making lists,” Collins said. “If it’s something I don’t want to do, I put it at the top of the list so I can be done with it.”

Another technique is called “body doubling,” which involves a pair of work colleagues meeting over Zoom or in-person to focus on completing projects. The two may choose to perform separate tasks — one might build a presentation deck while the other files tax reports — but help each other stay accountable.

“You’re just sitting there during that dedicated time, getting things done,” Didier said.

Insurance company Liberty Mutual provides an AI tool that helps break down large projects into manageable tasks and provides reminders about deadlines, to help employees with ADHD stay focused and organized, said Head of Benefits Verlinda DiMarino.

Getting through meetings

Meetings can be difficult for people with ADHD if their minds drift or they feel an urge to get up out of a chair. They also may struggle with impulse control and find it hard to wait their turn to speak.

Nicole Clark, CEO of the Adult and Pediatric Institute, a mental health practice in Stuart, Florida, suggests asking for meeting topics in advance and writing up talking points. If you think of questions during the meeting, write them down.

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Some employers use a voice-to-text service, projecting what a speaker is saying on a screen, which helps people with attention difficulties stay focused, Clark said.

Sylvester, the psychiatrist, recommends practicing active listening by repeating in your head what someone just said, or taking a brief time-out from a meeting to reset.

Tell them, “’I need five minutes. I’ll be right back.’ Get up and walk out. Do what you need to do,” he said.

Mariel Paralitici-Morales, chief medical officer of the Adult and Pediatric Institute, who has ADHD, sits close to whoever will be speaking to help sustain attention.

“Having something in my hand helps,” said Paralitici-Morales, who sometimes holds a fidget spinner. “If we have to talk, I found it’s easier for me to be the first one and break the ice” to keep herself from second-guessing what she planned to say.

Seek accommodations

People with an ADHD diagnosis can request accommodations at work through the Americans with Disabilities Act. Noise-canceling headphones may help. Consider asking for the ability to take a break every 20 minutes, Sylvester said.

“Set a timer for five to 10 minutes. Get up and walk around. Make some coffee. Go play with the dog,” he said. “When that timer goes off, go back to a 15 to 20 minute hard productivity cycle.”

Employees can also request a flexible schedule or ability to work from home, which can enable time for therapy or self-care.

Antoinette Damico, 23, who coordinates events at an executive search firm in San Francisco, said she practices meditation, writes daily goals in a journal and stays off short-form media to improve her concentration.

Celebrate your strengths

Having ADHD can be an asset in the workplace, and many CEOs and entrepreneurs are neurodiverse, Didier said.

“We bring all kinds of unique talents to our workplaces. Hyper-focus, lots of energy, resilience, the ability to multitask,” she added. “There’s something about people with ADHD that seems to unmask or give us a greater capacity for creativity and innovation.”

Damico also thinks her ADHD provides some advantages. When she’s interested in a topic, she can be extremely focused, reading extensively and talking about the topic nonstop, a trait others with ADHD report.

“It can generate a real passion in you that is a bit unique,” she said. “It really creates this grit in me in terms of when I really want to accomplish something, there’s this boost of energy.”

Share your stories and questions about workplace wellness at cbussewitz@ap.org. Follow AP’s Be Well coverage, focusing on wellness, fitness, diet and mental health at https://apnews.com/hub/be-well

July stargazing is certainly a late show, but it’s worth losing some sleep over because it’s now prime time for summer constellations.

I suggest lying back on a reclining lawn chair and letting it all soak in. The brightest actual star in the sky this month is Arcturus, perched high in the western sky as night falls. Arcturus appears to be at the tail of a giant kite, formally known as the constellation Bootes, the hunting herdsman. Not far away, check out the great Hercules globular cluster with a telescope. The attached July star map will help you. The Hercules cluster, otherwise known as Messier object 13, is a spherical cluster of thousands and thousands of stars around 25,000 light-years away. It’s a stargazing summer classic!

(Mike Lynch)

In the eastern heavens, you’ll see more of the prime stars of summer on the rise. The best way to find your way around that part of the sky is to locate the “Summer Triangle,” made up of three bright stars, the brightest in each of their respective constellations. You can’t miss them. The highest and brightest star is Vega, also the brightest star in a small constellation called Lyra the Lyre. The second-brightest star on the lower right is Altair, the brightest in Aquila the Eagle. The third-brightest at the left corner of the summer triangle is Deneb, the brightest star in the tail of Cygnus the Swan. A large part of Cygnus is known as the “Northern Cross” because that’s what it really resembles.

In the northwest sky, look for the Big Dipper hanging from its handle. The Big Dipper isn’t an official constellation but the very bright rear end and extended tail of Ursa Major, the Big Bear. The fainter Little Dipper, also known as Ursa Minor, the Little Bear, is standing on its handle (or tail), just to the upper right of the Big Dipper. The moderately bright star Polaris, also known as the North Star, is at the end of the Little Dipper’s handle.

In the south-southeastern evening sky this month is the classic constellation Scorpius the Scorpion, which really looks like a scorpion! In higher northern latitudes though, the beast’s tail never rises above the horizon. Not far from Scorpius in the lower southeast sky is one of my favorite constellations, Sagittarius the Archer. It’s supposed to be a half-man, half-horse shooting an arrow, but it looks much more like a giant teapot.

As lovely as our summer evening skies are this month, we’re a bit planet-challenged. The only naked-eye planets visible before midnight are Mars and, just barely, Mercury. Mars resides this month in the low southwestern sky as evening twilight fades but slips below the horizon shortly after. Outside of its obviously ruddy tinge, it doesn’t have much to offer visibly right now. Even with a larger telescope, all you’ll see is an orange-red dot. It’s just so far away this month, over 174 million miles away.

Planet watching is slightly better in the early morning , both before and during the opening of morning twilight. Before twilight kicks in, look for a lone moderately bright “star” in the low southeast sky. That’s Saturn, nearly 900 million miles away. It would be a little brighter, but the thin and highly reflective ring system is still on edge from our vantage on Earth, but slowly, over the next several years, the angle between the ring system and the planet will open up again.

Shortly before morning twilight kicks in, the extremely bright planet Venus emerges above the eastern horizon, continuing its stint as this summer’s “morning star.” Venus is going to have some company this month. In late July, Jupiter jumps into the predawn sky right on the heels of Venus.

The full moon this month is on the 10th. It has several nicknames. It’s most commonly known as the Buck Moon because new antlers begin to sprout from buck deer during this time of year. Summer full moons take a very low path across the celestial dome, mirroring the low path the sun takes in the winter.

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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