A year-old partnership between Billings Clinic and the Billings Police Department has dramatically changed the way domestic abuse in Yellowstone County is investigated and prosecuted.
The team-up has provided resource connections, specialized care for survivors and the evidence needed to convict their attackers. Yellowstone County Domestic Violence Investigator Katie Nash believes it’s working.
“The goal was to get victims the medical attention they needed in a way that could be useful for the criminal case, and at the same time making sure referral systems were in place to get victims additional resources,” said Nash. “And, that victims would not incur the cost of the forensic exams by linking the process to grant funding.”
Survivors of domestic abuse often minimize being strangled or choked by their aggressors and Nash believes that it could be due to a lack of visible external injuries. Little do victims realize, even if they survive being strangled, it’s the internal injuries from strangulation that could take their life weeks after the attack.
“Billings Clinic really stepped up, recognizing the need to offer these victims/patients specialized attention,” said Nash. “The Clinic said they would absolutely find the capacity to do these forensic exams.”
Nash recalls the early stages of this collaboration between the Clinic, BPD and the county attorney’s office starting in 2022, saying the process grew organically over several years.
Nash said Billings Clinic paid for their forensic nursing team to attend specialized training with criminal justice personnel, and “the partnership has continued to grow.”
Billings Clinic’s Forensic Nursing Program launched their nonfatal strangulation (NFS) exams in collaboration with BPD in March 2024.
This is in addition to the sexual assault nurse exams (SANE) administered by forensic nurses since the Forensic Nursing Program’s beginning in 2001. The forensic nursing team has helped approximately 2,800 survivors in that time.
In 2024, the team of 17 specially trained, on-call forensic nurse examiners cared for 140 sexual assault patients, including 98 adults and 42 children, and performed 24 non-fatal strangulation exams, including 19 adults and five children.
This year the team has cared for 131 sexual assault patients, including 84 adults and 47 children, and have administered 36 non-fatal strangulation exams, including 30 adults and six children.
“These numbers reflect more than just case load; they reflect the trust survivors place in our team and the critical intersection of health care, forensic science and trauma-informed support,” said Forensic Nursing Program Clinical Coordinator Bridget Nelson.
“Forensic nurses occupy a unique space between health care and the justice system,” she said.
Forensic nurses are not only trained in trauma-informed care, but in meticulous forensic documentation that can later support criminal investigations or court proceedings. They’re not just collecting evidence — they listen to, believe in and advocate for their patients.
“We walk with patients through some of the worst moments of their lives and help them begin to regain control,” she said. “We really want them to be able to feel like they’re having some semblance of their power back, because that was all just taken away from them.”
Amplifying survivors’ voices is why BPD Domestic Violence Investigator Kristi Funk joined the department this year.
“I have a cousin who unfortunately passed from a domestic violence relationship. So, it’s really important to me,” said Funk. “She wasn’t being heard when she was going through her stuff, and, you know, now she’s just watching from above. So, I feel like my goal is to help people be heard.”
She and Nash, who’s been a domestic violence investigator since 2012, attend training conferences every year to develop new, innovative ways to reach domestic violence victims. Most recently, Funk said they developed QR codes to reach and help victims.
“We’re trying to make it to where there’s a discrete way to get them help that they need,” she said. “We’re just always trying to think of ways to keep our victims safer and coming up with new ideas to make it so they feel more comfortable coming forward.”
Funk said it is “so important” for domestic abuse victims to come forward for help. She said out of 495 risk assessments administered with domestic abuse victims in 2024, 73% (about 361) of victims reported experiencing strangulation. And about 55% of victims reported being strangled more than once.
Nelson emphasized the importance of victims of strangulation to seek help, because “non-fatal strangulation is a strong predictor of future lethal violence.” According to the Training Institute on Strangulation Prevention, a victim who has been strangled by a partner is up to seven times more likely to be killed by that partner in the future.
“Even when visible injuries are absent, the internal damage from strangulation can be devastating; including brain injury, stroke and lasting psychological trauma,” said Nelson. “It takes just seconds to lose consciousness and minutes to die.”
Nelson said it’s important for victims not to dismiss symptoms such as hoarseness, confusion or neck pain.
“Strangulation is often minimized, even by victims themselves. But it’s one of the most dangerous things we see,” said Nelson. “Our job is to detect and document what others might miss and intervene before it escalates.”
There’s a lot of “inner conflict” individuals go through, officer Funk said, before they decide to seek help. It can be “really scary” for victims to come forward, because they often are financially dependent on the other person or scared of repercussion from their partner.
“But so is living your life as a shell of a person,” said Funk. “Nobody deserves to be treated with unkind hands, or words for that matter.”
In Billings, it became simpler for survivors of abuse to find the help and resources they need in one location with the opening of the Northern Lights Family Justice Center in February, a project officer Nash was a proponent of launching. Northern Lights Family Justice Center is located inside the YWCA, at 909 Wyoming Ave.
In Montana, it became easier to prosecute aggressors for their actions eight years ago, when Montana became the 45th state to pass a felony strangulation law, which took effect May 19, 2017. Previously, prosecutors charged offenders with aggravated assault, which they said created a high bar for conviction.
“With an aggravated physical assault, the victim has to either have lacerations or broken bones or be in fear of serious injury or death,” said Nash.
Strangulations were previously overlooked, because they may not have shown injuries externally.
“This law has allowed us to say, ‘You might not think it’s serious, but we know that it is serious,’ so we can charge it appropriately,” she said. “Montana was playing catch up as far as having a standalone strangulation statute. We’re just catching up with best practices nationally.”
Since that legislation was signed into law, strangulation of a partner or family member has consistently remained one of the most common felony offenses for men sentenced in Montana.
From 2018 through 2024, just over 500 men were sentenced for strangulation, according to data pulled from the Montana Department of Correction. About a quarter of those men were sentenced in Yellowstone County.
Nash views the BPD’s budding collaboration with Billings Clinic, and Northern Lights Family Justice Center with Billings’ YWCA as big steps forward in advocating for survivors of domestic abuse.
Collaboration, she said, “is vital.”
“There’s not one single cause of domestic violence, and so there can’t be just one single solution. If we could legislate our way out of this, we would have done it by now,” said Nash.
“It really does take everybody working together and working well together, collaborating. My job is not the same as a community-based advocate’s job, but if I do my part and they do their part, then it compounds. It’s vital.”
Those in Billings who need immediate help from domestic violence can reach the local YWCA by calling 406-245-4472 or texting 406-702-0229. The National Domestic Violence Hotline can also be called at 1-800-799-7233, and abuse survivors can also reach the organization directly via its website.
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Lillian Palmer
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