Victim confidentiality on Sexual Assault Response Teams (SART)

Logistics and Interdisciplinary Expertise of a Sexual Assault Response Team: A Case Study Through Observations and Interviews

To more effectively respond to sexual assault in the United States, some jurisdictions have created sexual assault response teams (SARTs). SARTs involve members of multiple agencies tasked with responding to sexual assault within a jurisdiction, such as law enforcement, advocates, prosecutors, and sexual assault nurse examiners (SANEs). Despite hundreds of jurisdictions utilizing SARTs, and the Department of Justice establishing guidelines, SARTs vary across jurisdictions in their form and function. To clarify this, the current research outlines two studies to better understand the logistics and functioning of one SART. In Study 1, for over nearly 2 years, SART meetings were observed and notes were taken on representation of agencies, time spent on cases, and possible challenges. Overall, the SART met consistently, with representation of major stakeholders at each meeting. Stakeholder agencies remained consistent and most time spent in the meetings was on case review. In Study 2, 10 members of SART were interviewed to assess perceptions of SART. These interviews were independently qualitatively coded for both factual and thematic codes. Areas of focus included perceived logistics of the SART and expertise of members that make up an effective SART. Overall, on average, members had been part of the SART for 3.5 years, felt required to attend the meetings as part of their role, and shared that all members (i.e., law enforcement, district attorney, victim advocates, and SANEs) had expertise on differing subjects that effectively made the SART work well. Importantly, qualitative perceptions from members of the SART (Study 2) lined up with the independent observation of SART meetings (Study 1). Ultimately, the results from this body of research could delineate specific actions that a jurisdiction implementing a SART could utilize.

Views on Interprofessional Collaboration in a Dutch Sexual Assault Center: A Qualitative Study Among Workers

Purpose

As the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.

Methods

In this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.

Results

Participants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline's competences.

Conclusion

Building collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.

Rape Crisis Victim Advocacy: A Systematic Review

While rape crisis center (RCC) advocacy is generally regarded as valuable, there are no prior systematic reviews of the advocacy literature. This review examined RCC advocacy service provision, perceptions and impact of advocacy, and challenges and facilitators to effective service provision. Databases related to health and social sciences were searched including Academic Search Complete, PsychINFO, PubMed, CINAHL, ProQuest, Science Direct, OAlster, WorldCat, and MEDLINE. Empirical articles written in English that examined RCC advocacy service provision and/or impact in the US were included. The researchers reviewed abstracts and titles, and then full texts. Forty-five articles met criteria, were summarized, and double checked. Findings demonstrate advocacy is multi-faceted, beneficial, and challenging. Advocates work directly with survivors and interact with other responders on behalf of survivors. Specifically, advocates provide emotional support, safety plan, support survivors in making decisions, and assist them in navigating other systems. While advocates are generally regarded positively by survivors and responders, some responders have concerns about advocates. In addition, advocates sometimes report victim-blaming and being ill-equipped to meet survivors' needs. Finally, advocates face specific challenges in their work with survivors and responders. Future research using diverse methodological approaches is needed to understand advocacy utilization and reach; survivors' perceptions of advocacy; marginalized survivors' experiences; connections between specific services, implementation, and outcomes; and effective strategies for advocates' interactions with other responders. Additional resources to help advocates serve all survivors effectively and equitably; to support evaluator-practitioner partnerships; and to share unpublished data on advocacy may help contribute to improvements in advocacy practice.

What can Campuses Learn From Community Sexual Assault Response Teams? Literature Review of Teams' Purpose, Activities, Membership, and Challenges

Sexual assault is a public health issue, with college-age students reporting high levels of victimization. Following an increase in national attention and federal initiatives, college and universities' sexual assault response efforts are being examined. The practice of community sexual assault response teams (SARTs) may provide campuses with a model strategy to coordinate campus and community service delivery and planning, still underdeveloped or missing at many institutions. This literature review summarizes in side-by-side fashion the most current empirical literature about community SARTs and campus team approaches (CTAs) in four domains: (1) defined purpose, (2) activities to achieve purpose, (3) membership, and (4) challenges to functioning. Two searches were conducted. The community SART inclusion criteria were (a) an empirical study focusing on community SARTs as the level of analysis, (b) located in the United States, (c) published between 2010 and 2017, and (d) written in English. The inclusion criteria for the CTA were (a) an empirical study on CTAs to sexual assault and/or intimate partner violence as the level of analysis and (b) written in English. Eight articles met the criteria for community SARTs, and six articles met the criteria for CTAs. Differences between community SARTs and CTAs included community SARTs shared and more discretely defined purpose and subsequent activities. Further directions offered for the conceptual and practical development of a CTA to address sexual assault include the need for clearer definition of a team's purpose leading to response-focused coordination of activities.

Using Social Network Analysis to Identify Successful Relationship Patterns Within Sexual Assault Response Teams (SARTs)

The current study used social network analysis (SNA) to examine relationships within three effective Sexual Assault Response Teams (SARTs) that coordinate the response of legal, medical, and advocacy organizations to sexual assault. Within each SART, organizations reported on each other member organization valuing their role, serving as a resource to their work, and communication outside of official meetings. Across the SARTs, there was high connectedness and reciprocity and low to moderate dependence on one organization to drive relationships. However, there was dependence on a subgroup of organizations to drive additional communication relationships. Implications for managing relationships in SARTs are discussed.

Structural, Organizational, and Interpersonal Factors Influencing Interprofessional Collaboration on Sexual Assault Response Teams

Sexual Assault Response Teams (SARTs) are multidisciplinary teams that coordinate multiple systems (e.g., medical, law enforcement, prosecutors, and rape crisis center advocates) to provide comprehensive care to victims and to collect high-quality forensic evidence to facilitate investigation and prosecution. Relatively little guidance is provided about effective teamwork strategies in resources on forming SARTs. Using in-depth surveys with the SART coordinators and telephone surveys (including close-ended and open-ended questions) with 79 professionals involved in three active, formal SARTs in one state, this study examined structural, organizational, and interpersonal factors that influence interprofessional collaboration on SART. Study findings indicate that perceived structural factors and interpersonal factors were significantly associated with SART members'/responders' perceptions of the quality of interprofessional collaboration on their SART. Findings suggest that individuals' perceptions of professionalization and power disparities between professions pose challenges to perceived interprofessional collaboration on SART. Compared with criminal justice and medical professionals, victim advocacy rated the level of collaboration on their SART significantly lower. The overall picture from the data was that SART professionals perceived mutual respect, trust, and commitment to collaboration to be pervasive on their SARTs, even though recognition of professional conflicts was also prevalent, suggesting that professionals understood that interpersonal conflict was distinct from professional conflict. Initial SART trainings should address the benefits of the team response, professional roles, and communication and conflict resolution skills, and ongoing training should provide professionals the opportunity to raise positive and negative examples of their collaborative efforts to explore existing tensions and constraints on the team for conflict resolution.

Exploring the Sexual Assault Response Team Perception of Interprofessional Collaboration: Implications for Emergency Department Nurses

There is little research on the dynamics of the sexual assault response team (SART) members' interprofessional collaboration (IPC) practice. The study purposes were to (1) explore the perceptions of IPC among SART members; (2) evaluate the use of Perception of Interprofessional Collaboration Model Questionnaire with the SART; and (3) discuss the implications of the Interprofessional Core Competencies for emergency department nurses and sexual assault nurse examiners. This cross-sectional mixed-methods study (n = 49) was implemented using 4 SART teams in a mid-Atlantic state. There were no statistically significant differences in the subscales within the group level using analysis of variance but offered some valuable insight and content analysis. Emergency department nurses collaborate with different agencies and discipline within their working environment. Understanding the basics of IPC and the perception of IPC within the SART may open doors to further appreciate the dynamics of this team.

Contested Discourses in Multidisciplinary Sexual Assault Response Teams (SARTs)

This qualitative study explored how law enforcement officers, forensic nurses, and rape crisis advocates who are members of coordinated service delivery models such as Sexual Assault Response Teams (SARTs) describe their process of engaging with one another and managing their differences in professional orientation, statutory obligations, and power. Using semi-structured interviews with 24 SART responders including rape crisis center advocates, law enforcement, and medical personnel, we examined the ways that SART members discursively construct one another's role in the team and how this process points to unresolved tensions that can manifest in conflict. The findings in this study indicate that interdisciplinary power was negotiated through discursive processes of establishing and questioning the relative authority of team members to dictate the work of the team, expertise in terms of knowledge and experience working in the field of rape response, and the credibility of one another as qualified experts who reliably act in victims' and society's best interests. Implications of these findings for understanding and preventing the emergence of conflict in SARTs are discussed.

The Sexual Assault Nurse Examiner's Interactions Within the Sexual Assault Response Team: A Systematic Review

Many emergency department nurses care for the sexually assaulted victim, when sexual assault nurse examiner (SANE) programs are not available. Therefore, it is important for emergency department nurses to understand the roles of both the SANE and the sexual assault response team (SART). The purpose of this systematic review was to identify the current research on the integration of the SANE among the SART and evaluate the gaps in research of the SANE's role, attitude, behavior, and satisfaction within the collaborative SART. Studies published between 2004 and 2014 using key words were evaluated. A 3-stage search strategy revealed 582 articles. The articles were assessed and categorized according to Level of Evidence definitions. Twelve qualitative and mixed-methods studies were identified. Studies ranged from SART protocols or responses to situational factors to SANE relationships with other SART members. The review reflected the need for more research within the collaborative atmosphere of this multidisciplinary and interagency team that defines the SART, and the individual member's perceptions. Further studies are needed on the SANE's impact on patient outcome and the emergency department nurses role when a SANE or SART program is not available.

"Catching flies with honey": the management of conflict in Sexual Assault Response Teams

Sexual Assault Response Teams (SARTs) are models of service delivery characterized by coordination between rape crisis, health care, and criminal justice sectors. Expanding on research documenting the extent and nature of conflict in SARTs, this study qualitatively explores the strategies used to manage conflict and variations in the use of strategies between professions. Analysis of interviews with SART members (n = 24) revealed five types of strategies: (a) preventative strategies sought to prevent conflict and build capacity for resolving conflict, (b) problem-solving strategies identified and responded directly to conflicts, (c) forcing strategies involved one person attempting to force a perspective or solution on others, (d) unobtrusive strategies covertly worked toward change, and (e) resigned strategies limited direct responses to conflict to protect the coordination. Rape crisis advocates talked the most about conflict management strategies and were almost exclusively responsible for unobtrusive and resignation strategies.

Sexual Assault Response Teams (SARTs): mapping a research agenda that incorporates an organizational perspective

Multidisciplinary coordinated Sexual Assault Response Teams (SARTs) are a growing model of providing health, legal, and emotional support services to victims of sexual assault. This article conceptualizes SARTs from an organizational perspective and explores three approaches to researching SARTs that have the potential of increasing our understanding of the benefits and challenges of multidisciplinary service delivery. These approaches attend to several levels of organizational behavior, including the organizational response to external legitimacy pressures, the inter-organizational networks of victim services, and the negotiation of power and disciplinary boundaries. Possible applications to organizational research on SARTs are explored.

Interdisciplinary team communication among forensic nurses and rape victim advocates

Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.

Sexual assault response teams (SARTs): an empirical review of their effectiveness and challenges to successful implementation

Historically, the response of the legal, medical, and mental health/advocacy systems to sexual assault has been inadequate and uncoordinated. To address this problem, communities have developed coordinated sexual assault response teams (SARTs) to address these problems. SARTs are community-level interventions that seek to build positive relationships and increase collaboration among sexual assault responders. SARTs hope to improve both the community response to sexual assault victims and the processing of sexual assault cases through the criminal justice system. This article has three aims: to summarize the historical development of SARTs in the United States, to review the empirical literature on SARTs' effectiveness at improving multidisciplinary relationships, legal outcomes, and victims' help-seeking experiences; and to review the empirical literature on the challenges SARTs face, which may hamper their effectiveness. Findings suggest that SARTs are a promising practice, but face many challenges; further methodologically rigorous research is needed to more fully understand these interventions. Implications for policy, practice, and future research are discussed.

Sexual assault nurse examiners' perceptions of their relationship with doctors, rape victim advocates, police, and prosecutors

In response to the negative and inefficient treatment of rape victims by emergency room personnel, the first Sexual Assault Nurse Examiner (SANE) programs began in the late 1970s. While SANEs, doctors, rape victim advocates, police officers and prosecutors work together to ensure the most comprehensive and sensitive care of rape victims, they all have very different roles and objectives. This research explores SANEs' perceptions of their relationships with other professionals who treat or interact with rape victims. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states indicate positive relationships are marked by open communication, respect shown towards SANEs as well as rape victims, and a sense of appreciation among SANEs. On the contrary, negative relationships result when SANEs believe police treat victims poorly, when advocates overstep boundaries and question SANEs about evidence collection or the exam, and when prosecutors fail to properly prepare them to testify during a trial.