Contested Discourses in Multidisciplinary Sexual Assault Response Teams (SARTs)

Sexual Assault Response Team Goals and Motivations for Development

Sexual Assault Response Teams (SARTs) are community-based, multidisciplinary interventions that strive to coordinate the response to sexual assault. SARTs consist of sexual assault responders (e.g., rape crisis advocates, police, forensic examiners/Sexual Assault Nurse Examiners, and prosecutors) and seek to increase responder collaboration to improve survivors' help-seeking experiences. There is a lack of empirical research examining factors underlying SARTs' goals and what leads communities to form SARTs. Therefore, this study sought to examine the goals and motivations present in SART development using a multiple-methods approach with a national random sample of n = 172 SARTs. Exploratory factor analysis (EFA) was used to examine factors underlying SART goals, and qualitative thematic analysis was used to explore what motivators drove SART formation. Both qualitative and quantitative analyses underscored the importance of improving the accessibility and quality of services, improving the treatment of survivors, and increasing responder collaboration. The qualitative findings offered additional insight into the importance of community education and various community contextual factors (e.g., funding and policy requirements) that influence SARTs. Findings inform future research and practice on SART goals and functioning, such as how SART goals may relate to team structure, effectiveness, and capacity-building opportunities.

The Working Relationship Between Emergency Room Nurses and Medical Rape Victim Advocates: A Qualitative Examination of Nurses' Perceptions of the Influence of Nurse Training and Experience on Nurse-Advocate Interactions

Nurses and medical advocates respond to sexual assault survivors seeking hospital services. Ideally, both providers work collaboratively. However, this does not always happen. Extant research on the nurse-advocate relationship focuses on Sexual Assault Nurse Examiners (SANEs). This study examines how ER nurses perceive their training and experience influence the working relationships between emergency room (ER) nurses (not exclusively SANEs) and medical advocates. Key findings indicate nurses perceive increased training improves (a) role understanding, (b) trust, (c) respect, (d) rapport, and (e) appreciation. Less training was associated with poorer role understanding and trust.

Physicians and nurses professional relationship with criminal investigation in dealing with survivors of sexual abuse: a scoping review

Survivors of sexual abuse and their families seek help from criminal law enforcement agencies and health professionals to obtain justice and health care. Many communities have implemented multi-professional collaborative models so that the victim's well-being is assured and the truth is established. However, there is a general lack of evidence on how to best articulate these teams with the healthcare professionals caring for the survivors.Therefore, this Scoping Review was conducted in order to analyze and to map the barriers and facilitators of the relationship between health professionals and the criminal investigation team in the care of survivors of sexual abuse. The methodology proposed by the Joanna Briggs Institute for Scoping Reviews was used, and the Bronstein five dimension model of interprofessional collaboration served as the basis for the analysis of barriers and facilitators. Quantitative, qualitative and mixed studies, primary and secondary sources, text and opinion documents were included. Content analysis was performed on the main findings of the collected studies. Twelve articles were identified and analyzed. Collaboration, communication, hierarchy, skills, confidentiality, and leadership emerged as key themes. Multidisciplinary Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Teams (SARTs) were implemented to coordinate care, but conflicting goals and values among professionals posed challenges. Communication failures and inadequate information sharing hindered collaboration. Neutral leaders who coordinate teams, minimize groupthink, and improve decision-making were found to be valuable. Engaging across disciplinary boundaries and addressing power dynamics were challenging but could be addressed through facilitation and conflict resolution. This review highlights the importance of effective collaboration and interaction within teams and with other professionals in the care of sexual abuse survivors.

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.

"Just Bring Us the Real Ones": The Role of Forensic Crime Laboratories in Guarding the Gateway to Justice for Sexual Assault Victims

Throughout the United States, hundreds of thousands of sexual assault kits (SAKs; also termed "rape kits") have never been submitted by law enforcement personnel to a crime laboratory for forensic DNA testing. Prior research indicates that negative stereotypes about victims influence police decisions to submit kits for testing, but forensic crime laboratory personnel may also be involved in SAK submission decisions. The purpose of the current study was to explore the communication and collaboration between police and crime lab personnel regarding SAK submissions within a community with large numbers of unsubmitted rape kits. Drawing from 3 years of ethnographic observations and longitudinal qualitative interviews, we found that the police department's crime lab did not have sufficient resources to test all rape kits in police custody, which is a problem forensic laboratories are facing throughout the United States. However, we also found that access to this limited resource was controlled by crime lab personnel and their rape myth beliefs about which victims and which cases were considered worthy of the time, effort, and attention of the criminal justice system. Lab personnel emphasized that police should only submit "real" cases for forensic DNA testing, which they typically defined as physically violent stranger-perpetrated sexual assaults; "shady" cases did not merit testing, which they defined as known-offender assaults, reports made by adolescent victims, and cases in which the victim may have been engaged in sex work. We noted marked similarities in police and lab personnel's rape myth acceptance, and stakeholders readily agreed that they did have a common understanding about which victims were not credible and therefore which SAKs did not merit testing. We discuss these findings in light of recommendations from the National Academy of Sciences for the independence and autonomy of the forensic sciences from law enforcement.

How Research Evidence is Defined, Acquired, and Shared Across Systems That Address Intimate Partner Violence

This exploratory study examined the flow of research evidence through systems that address intimate partner violence (IPV), including victim services, law enforcement, and criminal justice organizations. Qualitative interviews with representatives of these disciplines assessed how respondents define, acquire, and share research evidence. Findings suggest that research evidence is defined more broadly in the field than in academic settings, and is accessed primarily from trusted intermediaries within professional networks. State IPV coalitions and victim service providers are key intermediaries across sectors. Findings suggest the need for more tangible supports to support sharing of research information within and across service sectors.

The Role of Physical and Sexual Assaults on the Ability to Complete Work Responsibilities

Sexual and physical assaults have many serious and persistent negative impacts on individual health. There is now a considerable literature base identifying and discussing these health outcomes. Less is known about the mediating mechanisms that link these types of assault with later outcomes. This study examines the role of sexual and physical assaults in self-perceptions of individual health on missing or cutting back on work responsibilities. In particular, perceptions of both mental and physical health are investigated to further refine understanding of the different impacts of assault on survivor health and behavior. Using a sample of 3,791 adults aged 30 to 84 from the Midlife in the United States (MIDUS) study, results of the analyses indicate that sexual and physical assaults do not have a direct effect on missing/cutting back on work responsibilities but do have an indirect effect through perceptions of health. The results can inform academic research, as important impacts of assault may be masked if mediating mechanisms are not investigated. In terms of policy, adults who have difficulty carrying out work responsibilities should be assessed for their overall health and survivors of violence should be offered health-related services following a victimization experience.

A Qualitative Examination of Collaborative Infrastructure within Sexual Assault Response Teams

Sexual assault response teams (SARTs) are multidisciplinary interventions that seek to improve the response to sexual assault in their community. SARTs bring together relevant stakeholders (e.g., sexual assault advocates, medical/forensic examiners, police, prosecutors) to coordinate the response to sexual assault and improve survivors' help-seeking experiences. SARTs may adopt various infrastructures to guide their team (e.g., case review, subcommittees), but little is known about how infrastructure influences SART effectiveness. Therefore, this qualitative study examined the helpful versus challenging aspects of SART infrastructure. Interviews from a national random sample of 169 SART leaders revealed helpful versus challenging aspects of mission statements, formal protocols, subcommittees, team roles, trainings, meetings, and case review. Participants believed infrastructures have positive influences on interdisciplinary relationships, team efficiency, and creating improvements in responding to sexual assault. However, certain infrastructures were difficult to implement for some teams. Additionally, some infrastructures can have unintended consequences, such as exacerbating team conflict. Findings suggest that SARTs may benefit from first focusing on infrastructures that build trusting interdisciplinary relationships and widespread buy-in prior to implementing accountability-focused measures (e.g., protocols, case review).

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.

Reporting Sexual Assault: Survivors' Satisfaction With Sexual Assault Response Personnel

Although jurisdictions have attempted to improve their response procedures, sexual assault cases are often insufficiently investigated. This study examines the survey responses of 460 female sexual assault survivors regarding their experiences with response personnel. Overall satisfaction with response services was 66.1%. Victim advocates and forensic nurses received higher satisfaction ratings than did patrol officers, detectives, and State's Attorney's Office staff. The present study also found that 65% of the variance in overall satisfaction was accounted for by four personnel behaviors: respectful treatment, clearly explained procedures, believed their stories, and demonstrated cultural sensitivity. Policy implications and suggestions for future research 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.

The Influence of Community Sociocultural Context on Creating an Effective, Coordinated Response to Sexual Assault

Members of Sexual Assault Response Teams (SARTs) coordinate and improve the community response to sexual assault. A SART’s effectiveness is likely influenced by its sociocultural context, or the norms, values, and beliefs of the local community. However, this has yet to be empirically examined. We conducted a qualitative study to explore how sociocultural context may influence effectiveness within a sample of 169 leaders of 169 U.S. SARTs. SART leaders believed that specific norms and beliefs held by the general public in their community (rape myths and victim blame, denial of sexual assault happening locally, taboos against discussing sexual assault, and a male-dominated environment) delegitimized sexual assault as a problem that deserved public intervention. Leaders believed these led community members to resist the team’s efforts, by decreasing the community’s support and buy-in to the SART, interfering with efforts to make services accessible to survivors, and obstructing the SART’s ability to effectively respond to cases. And some leaders believed highly interconnected communities compromised the accessibility and objectivity of systems that respond to sexual assault. SARTs need to carefully tailor their efforts to improve accessibility of systems, and the response to sexual assault cases, to their unique local sociocultural context.

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.