Prosecution of adult sexual assault cases: a longitudinal analysis of the impact of a sexual assault nurse examiner program

"Having One Person Tell Me I Didn't Do the Wrong Thing": The Impact of Support on the Post-Sexual Assault Exam Experience

Social support following a sexual assault (SA) may help minimize or prevent the myriad of negative sequelae impacting individuals who experience SA. Receiving a SA exam may provide initial support during the SA exam and set up individuals with needed resources and supports post-SA exam. However, the few individuals who receive a SA exam may not stay connected to resources or support post-exam. The purpose of this study was to understand individuals' post-SA-exam social support pathways including individuals' ability to cope, seek care, or accept support following a SA exam. Interviews were conducted with individuals who experienced SA and then received a SA exam through a telehealth model. The findings revealed the importance of social support during the SA exam and in the months that followed. Implications are discussed.

Silenced Survivors: A Systematic Review of the Barriers to Reporting, Investigating, Prosecuting, and Sentencing of Adult Female Rape and Sexual Assault

Sexual victimization of adult women remains an underreported crime. This systematic review identified and synthesized the barriers to reporting, investigating, prosecuting, and sentencing cases of sexual assault and rape against adult women in Western countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted on August 3, 2023, across databases including PsycINFO, MEDLINE, Cochrane Library, Scopus, ProQuest Central, Web of Science, MedNar, and ProQuest Dissertations & Theses. Studies meeting the inclusion criteria provided relevant information on the decision not to formally disclose, investigate, prosecute, or convict incidents of sexual assault and rape of adult women. We included 28 studies and identified 70 barriers in total. Identified barriers were most prevalent to reporting, followed by investigating, prosecuting, and, lastly, sentencing. Key themes in the barriers included lack of trust in the criminal justice system, internal reactions, rape myths and societal norms, and perpetrator characteristics. The identified barriers emphasize an urgent need for reform of the criminal justice system's response to sexual assault and rape. Prioritizing victim-survivors' needs, enhancing transparency of the criminal justice system, and addressing attrition rates are crucial. Future studies need to engage with diverse population to address all victim-survivors' needs and provide further insights into the challenges across all stages of the criminal justice system to enhance the outcome of rape and sexual assault cases.

Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors

BACKGROUND

Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity.

AIM

To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens.

METHODS

We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board.

RESULTS

In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up).

CONCLUSIONS

These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.

A Strengths and Needs Assessment of Campus Sexual Assault Response

BACKGROUND

Sexual violence and sexual assault (SA) disproportionately affect the young adult population aged 18-24 years, half of which are enrolled in higher education. Campuses are tasked with providing a safe space for students and enacting an appropriate response to campus SA (CSA).

AIMS

As part of a grant-funded program to strengthen SA nurse examiner (SANE) services to those who experience SA on college campuses, we conducted a campus needs assessment and a campus website review for key messaging and analyzed the responses to identify strengths and gaps in campus resources related to CSA. These findings were the basis of individualized Campus Community Summary reports shared with participants from each campus.

METHODS

Guided qualitative interviews with interdisciplinary stakeholders across seven campus communities and campus website reviews were used to identify campus resource strengths, gaps, and recommendations for improvement.

RESULTS

Common strengths included awareness of campus programs and community services, leadership support for CSA activities, and community CSA response. Identified opportunities for improvement included strengthening interdisciplinary collaboration, solving transportation issues to obtain care, mental healthcare and advocacy services, awareness and resource messaging, and fighting stigma and bias. Campus websites reviews indicated gaps in key information about SANE care and how to access SANE services.

CONCLUSIONS

Numerous gaps and opportunities to strengthen campus SA awareness and coordination and access to a timely response to SA were identified. Addressing these gaps is essential to ensure quality care and services for individuals who experience SA on college campuses.

Pathway to Healing and Recovery: Alleviation of Survivor Worries in Sexual Assault Nurse Examiner-Led Sexual Assault Telehealth Examinations

INTRODUCTION

The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination.

METHODS

Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests.

RESULTS

Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing.

DISCUSSION

These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits.

Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography-a HIMSS-SIIM Enterprise Imaging Community Whitepaper

Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization's requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.

Beyond Forensic Evidence: Examining Sexual Assault Medical Forensic Exam Mechanisms that Influence Sexual Assault Case Outcomes

Despite the widespread use of sexual assault medical forensic exams (SAMFEs), practitioners and researchers continue to debate the role of SAMFEs and the evidence they provide in the investigation and prosecution of sexual assault cases. Using data from a review of sexual assault cases reported to police between 2015 and 2017 in two jurisdictions (n = 534), we use logistic regression examine whether the presence of a SAMFE predicts the likelihood of achieving criminal case processing outcomes and whether the relationship of the SAMFE with criminal case processing outcomes is moderated by other legal and extralegal case characteristics. We did not find evidence that the presence of a SAMFE in a case significantly predicts whether a suspect will be identified, arrested, or convicted overall, but we did find evidence of the SAMFE's injury documentation value for arrest. Researchers and practitioners should account for the multiple ways SAMFEs can influence decision-making in future research and policymaking.

Sexual Assault Forensic Examiner Recruitment and Retention: Using Simulation to Teach a Trauma-Informed Interview

Traditionally, sexual assault nurse examiner training focuses on examination skills and evidence collection. Gathering history and supporting the patient in a trauma-informed approach are equally important components of postassault care. Simulation is an established tool in healthcare education; however, there is limited research on applying simulation to the training of sexual assault nurse examiners. The Sexual Assault Forensic Examiner Recruitment and Retention program developed and delivered standardized patient-simulated scenarios to teach elements of trauma-informed sexual assault interviews. Simulation allowed trainees the opportunity to practice interviews and receive direct feedback from the standardized patient actor and experienced examiners. Evaluation results showed that learners valued this opportunity, endorsing that it improved their ability to conduct a forensic interview. This innovative program introduced a framework for training new examiners on trauma-informed interview techniques, using standardized patients.

Development of multidisciplinary sexual assault centres in the Netherlands

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.

Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation

Nationally and internationally, providing competent and sustainable sexual assault nurse examiner/forensic nurse coverage has been a shared challenge. This project, "Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation," provides an example for assessment, construction, implementation, and evaluation of a business plan for a sustainable sexual assault nurse examiner/forensic nurse staffing solution. By using preexisting float pool positions and converting them to sexual assault nurse examiner emergency nurses, coverage for sexual assault nurse examiner examinations in a 16-hospital health system was established, which decreased sexual assault nurse examiner turnover related to burnout while increasing the sustainability of sexual assault nurse examiner nurses who provided quality care to patients who had experienced a sexual assault, domestic or intimate partner violence, elder or child abuse or neglect, assault, strangulation, or human trafficking. Implementation of the business plan resulted in a 179% increase in completed sexual assault nurse examiner examinations and a 242% increase in all types of completed forensic examinations from 2015 to 2019 as 7 new community hospitals were added to the health system. A sum of more than $20 000 allocated for training new sexual assault nurse examiners/forensic nurses was saved per year by using a sexual assault nurse examiner emergency nurse. By creating a supportive structure that fosters and sustains sexual assault nurse examiners/forensic nurses, both medical and mental health concerns can be addressed through trauma-informed care techniques that will affect lifelong health and healing as well as engagement in the criminal justice process for patients who have experienced sexual assault, abuse, neglect, and violence.

Child Sexual Assault Nurse Examinations and Prosecutorial Decisions to Accept or Reject Cases of Child Sexual Abuse

INTRODUCTION

Prosecution of child sexual abuse (CSA) cases provides safety for communities and justice for victims. Prosecutorial decisions are multifactorial and include the presence of a structured coordinated community response to outcries and access to skilled healthcare providers. This study examines the impact forensic nurse sexual assault examinations (SAEs) have on prosecution in a population of children seen at a child advocacy center (CAC).

METHODS

The authors examined case data from 553 cases of reported CSA, seen by a forensic nurse in a CAC.

RESULTS

Statistical analysis focused on prosecution decisions with and without SAE, with and without physical findings. Logistic regression determined prosecution occurred more often when SAE had been conducted (p = 0.026, OR = 1.732, 95% CI [1.068, 2.808]), regardless of examination findings.

LIMITATIONS

The limitations include a single location for data and the multifactorial reasons for prosecution of cases.

DISCUSSION

The multifactorial elements contributing to prosecutorial decisions are diverse. The formalized approaches in CACs historically show increased prosecution. Teasing out the impact of an SAE in a CAC may be reflective of positive CAC approaches. Regardless, a statistically significant finding of association uniquely with the SAE, with or without findings, implies more studies are needed to support the role of the forensic nurse in successful prosecutions of CSA cases.

Evolution of Forensic Nursing Theory--Introduction of the Constructed Theory of Forensic Nursing Care: A Middle-Range Theory

The constructed theory of forensic nursing care is a middle-range nursing theory developed from the integrated practice model for forensic nursing science, a conceptual framework. Theory evolution was achieved following a critique of the conceptual framework and through inductive and deductive reasoning. A review of nursing theory growth and significance of middle-range theories is presented as background information in understanding the importance of this emerging forensic nursing middle-range theory. The philosophical and theoretical foundations of forensic nursing are bolstered with the addition of three nursing theories, two healthcare models and one social theory. Links are made between theory components and the current state of forensic nursing. Assumptions and concepts are clearly defined. The middle-range theory provides three testable propositions to frame forensic nursing practice, education, and research. Research conducted on the propositions will expand the forensic nursing scientific base leading to enhanced evidence-based practice. A pictorial model illustrates the propositions as relational statements. The constructed theory of forensic nursing care affirms the focus of forensic nursing care is on the nurse-patient relationship and improved health outcomes. Additional results of forensic nursing care are improved forensic science and criminal justice system outcomes.

Perceived Care Quality Among Women Receiving Sexual Assault Nurse Examiner Care: Results From a 1-Week Postexamination Survey in a Large Multisite Prospective Study

INTRODUCTION

This study examined the perspectives of female patients who had been sexually assaulted regarding the quality of care provided by sexual assault nurse examiners, including whether the patients' perspectives varied by their demographic characteristics and health status before the assault.

METHODS

A total of 695 female patients who received care from sexual assault nurse examiners at 13 United States emergency care centers and community-based programs completed standardized surveys 1 week after receiving sexual assault nurse examiners' care for sexual assault.

RESULTS

Most patients strongly agreed that the sexual assault nurse examiners provided high-quality care, including taking patients' needs/concerns seriously, not acting as though the assault was the patient's fault, showing care/compassion, explaining the sexual assault examination, and providing follow-up information. The perceptions did not vary by the patients' demographic characteristics or preassault health status.

DISCUSSION

Female patients who had been sexually assaulted and who were evaluated at 13 widely geographically distributed sexual assault nurse examiners' programs consistently reported that the sexual assault nurse examiners provided high-quality, compassionate care.

Piloting sexual assault care centres in Belgium: who do they reach and what care is offered?

BACKGROUND

Sexual assault (SA) is highly prevalent in Belgium. In order to mitigate the negative consequences for victims of acute SA, Sexual Assault Care Centres (SACCs) were piloted from October 2017 to October 2018 in three Belgian hospitals. SACCs offer medical and psychological care, forensic examination and the possibility to report to the police at the SACC.

OBJECTIVE

Aiming to improve SACC services, we quantitatively assessed the number and characteristics of victims attending the SACC, the SA they experienced, and the care they received over 12 months upon admission.

METHOD

Data on victims presenting at the SACC were routinely collected in electronic patient files by the SACC personnel between 25 October 2017 and 31 October 2019. These data were analysed in IBM SPSS Statistics 25.

RESULTS

Within the first year 931 victims attended the SACCs. Mean age was 24.5 years (SD = 12.8), and one-third were under 18. The majority were female (90.5%) and 63.1% presented for rape. About one-third of the victims were considered vulnerable due to previous SA (35.6%), prior psychiatric consultation (38.7%) or disability (8.5%). The assailant was known to the victim in 59.2% of the cases. Of all SACC presentations, 35.2% self-referred to the SACC while 40.9% were referred by the police. Two out of three victims attended the SACC within 72 h post-assault. Respectively 74.7% of victims received medical care, 60.6% a forensic examination, 50.2% psychological care, and 68.7% reported to the police.

CONCLUSION

Despite the absence of promotion campaigns, the SACCs received a high number of victims during the pilot year. Use of acute and follow-up services was high, although new approaches to offer more accessible psychological support should be explored. The big proportion of vulnerable victims warrants careful monitoring and adaptation of care pathways.

Rural Availability of Sexual Assault Nurse Examiners (SANEs)

PURPOSE

Sexual assault care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. Upon completion of SANE training, nurses can demonstrate their experience and expertise by obtaining SANE certification. Availability of nurses with SANE training or certification is often limited in rural areas, and no studies of rural certified SANEs exist. The purpose of this study is to describe rural SANE availability.

METHODS

We analyze both county-level and hospital-level data to comprehensively examine SANE availability. We first describe the geographic distribution of certified SANEs across rural and nonrural (ie, urban or suburban) Pennsylvania counties. We then analyze hospital-level data from semistructured interviews with rural hospital emergency department administrators using qualitative content analysis.

FINDINGS

We identified 49 certified SANEs across Pennsylvania, with 24.5% (n = 12) located in 8 (16.7%) of Pennsylvania's 48 rural counties. The remaining 37 certified SANEs (75.5%) were located in 13 (68.4%) of Pennsylvania's 19 nonrural counties. Interview data were collected from 63.9% of all eligible rural Pennsylvania hospitals (n = 63) and show that 72.5% (n = 29) have SANEs. Of these, 20.7% (n = 6) have any certified SANE availability. A minority of hospitals (42.5%; n = 17) have continuous SANE coverage.

CONCLUSIONS

Very few SANEs in rural Pennsylvania have certification, suggesting barriers to certification may exist for rural SANEs. Though a majority of hospitals have SANEs, availability of SANEs was limited by inconsistent coverage. A lack of certified SANEs and inconsistent SANE coverage may place rural sexual assault victims at risk of receiving lower quality sexual assault care.

Management of DNA evidence collected on adolescents in sexual assault investigations: A 10-year review from a large Italian rape centre

Little research is available on the actual forensic use of genetic analyses performed in sexual violence cases, despite their relevant role in legal processes. The present retrospective study aimed to contribute to filling this gap in research, evaluating the actual number of serological/DNA analyses that followed medical examination of female adolescent victims of sexual violence. The study was performed in a large rape centre in Milan (North Italy) by analysing all medical records of female victims of sexual violence aged 13–19 years in the period from January 2006 to December 2015. The total number of sexual assault victims examined aged 13–19 years was 599. In 473 of the cases, biological evidence had been collected. The gathering of biological evidence was accurately performed (double swab technique) in multiple anatomical regions on the victims’ bodies, and clothes were acquired when biological stains were present or could be present. Proper handling under chain of custody for all the items collected followed in every case. Despite all of this, serological/DNA analyses were requested in only 9/473 (1.9%) cases. Procedural issues possibly affecting the magistrates’ decisions not to use DNA extensively as an investigative tool are also discussed.

Women care in situations of sexual violence: an integrative literature review

Abstract Objective: to identify Brazilian and international scientific evidence about women in situation of sexual violence service by a multidisciplinary health team. Method: an integrative literature review carried out in four databases and in a digital library, with the following inclusion criteria: type of study, language and temporal cut. The final sample consisted of 34 studies. Results: nine categories emerged: service network; teamwork; health professional in the service network; qualification and training; comprehensiveness; protocols; services; access to services and support from managers. They were organized into potentialities, demands and weaknesses, constituting elements necessary for assistance effectiveness by the multidisciplinary team to women in situation of sexual violence. Conclusion an Implications for practice: despite the potential of providing women care in situations of sexual violence, weaknesses stand out as an incipient and inexistent articulation of the intersectoral care network, generating demands for the networks’ construction, articulation and sustainability. In addition, professional qualification and support of managers in the performance of public policies make possible care comprehensiveness, updates and service evidence.

Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Using Telehealth for Sexual Assault Forensic Examinations: A Process Evaluation of a National Pilot Project

INTRODUCTION

This project describes the first time live sexual assault nurse examiner (SANE) services were provided via telehealth to support site clinicians conducting sexual assault forensic medical examinations for adult and adolescent patients. It involved six sites in three states, including rural, tribal, military, and community hospitals. The purpose of this process evaluation was to determine the extent to which patients consent to telehealth technology, examine how the technology worked, and explore the types of assistance.

METHODS

We reviewed information for sexual assault patients who presented at emergency departments (N = 215) and conducted telephone and online surveys with 178 clinicians who provided or received telehealth services.

RESULTS

Between May 1, 2015, and March 31, 2018, 129 patients and site clinicians received services via telehealth and an additional 86 site clinicians received consultation advice via telehealth. Most patients consented and accepted SANE services via telehealth (86% overall and 97% in non-U.S. Navy sites). No significant technology problems were experienced for most interactions (92%). The assistance provided remotely by SANEs to site clinicians included guiding clinicians through history taking and documentation, forensic examination and evidence collection techniques, identifying and documenting injuries, and guiding clinical practice. Site clinicians reported, on average, a positive impact of the assistance on their confidence in providing an effective examination, their ability to provide their patient with the best care, and their sense of feeling supported.

IMPLICATION

Results of this pilot suggest that using live telehealth services for sexual assault forensic examinations is a promising practice.

Tested at Last: How DNA Evidence in Untested Rape Kits Can Identify Offenders and Serial Sexual Assaults

An increasing number of U.S. law enforcement agencies have disclosed that they have large numbers of untested sexual assault kits (SAKs; also called "rape kits") in police property storage. Whether previously untested SAKs should be tested for DNA evidence has been the subject of considerable public debate. To inform policy and practice regarding rape kit testing, the current study tested a sample of 900 previously unsubmitted SAKs from Detroit, Michigan, and documented the DNA forensic testing outcomes associated with those kits. We assessed how many SAKs yielded DNA profiles eligible for upload into CODIS (Combined DNA Index System), the federal DNA criminal database; how many resulted in a DNA match (termed a "CODIS hit"); and how many of those hits were associated to other sexual assault crimes (i.e., serial sexual assault hits). Overall, there were 259 CODIS hits, 69 of which had DNA matches to another sexual assault case. The potential utility of a DNA profile and CODIS hit may vary depending on whether offender was known or unknown to the victim, so we examined these outcomes separately for SAKs associated with stranger- and non-stranger-perpetrated sexual assaults. We also present six case study examples of how DNA testing and CODIS hits helped identify serial sexual assaults in both stranger and non-stranger sexual assault cases. Implications for rape kit testing policies are discussed.

Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada

OBJECTIVE

The purpose of this evaluation was to assess the efficacy of a training in improving competence to address sexual assault among Emergency Department (ED) staff, as well as to compare in-person and online training modalities.

METHODS

A total of 1564 staff from 76 EDs in acute care hospitals across Ontario participated in either on-site (n = 828 staff) or online (n = 736 staff) training sessions, of whom 1366 (87%) completed both a pre- and post-training questionnaire. Mean pre- and post-training scores measuring perceived competence in responding to victims/survivors of sexual assault were compared using paired t-tests. The mean gain score for in-person and online training was then compared using the Mann-Whitney U test. Finally, in-person and online participants' ratings of the training content and delivery were compared using the Mann-Whitney U test.

RESULTS

There were significant improvements for all 16 self-reported measures of competence following training. The mean gain in knowledge and skills was higher for in-person training participants. Participants in the in-person modality more strongly agreed that the information they learned would help in providing care for sexual assault victims/survivors, and were more satisfied with the training overall. However, these participants less strongly agreed that there was an appropriate amount of time allotted for the scope of material presented.

CONCLUSIONS

Overall, the training led to immediate improvements in ED staff perceived understanding and ability to address the needs of victims/survivors of sexual assault, with particular advantages to the in-person training.

Attributions of victim blame in stranger and acquaintance rape: A quantitative study

AIMS AND OBJECTIVES

To, on a sample of nurses and the general public, examine whether victim blame varies according to level of familiarly between victim and perpetrator. It also examines how Ambivalent Sexism and Rape Myth Acceptance impact on this.

BACKGROUND

Around one in five women will be victims of sexual assault during their lifetime. The majority are acquaintance rapes, and these victims are generally attributed more blame than victims of stranger rape. Research indicates that nurses hold similar attitudes on gender roles and victim blame as do the general public.

METHODS

Eighty-one participants read a story depicting a sexual assault of a woman by either a stranger or an acquaintance and completed scales measuring victim blame, Ambivalent Sexism and Rape Myth Acceptance.

RESULTS

The results of this study indicated that victim-perpetrator relationship, Benevolent Sexism, Hostile Sexism and whether the participant was a nurse contributed to the variance in attributed victim blame. Hierarchical regressions revealed that whether or not the participant was a nurse contributed to the variance in victim blame in the acquaintance rape condition, and Hostile Sexism and Benevolent Sexism contributed to the variance in victim blame in the stranger rape condition.

CONCLUSIONS

This paper gives a novel insight into attitudes involved in victim blame in rape cases and makes a unique comparison between nurses and the general public. Findings suggest that victim blame correlates primarily with aggressively sexist attitudes and that nurses generally attribute more blame to the victim of acquaintance rape.

RELEVANCE TO CLINICAL PRACTICE

This study has practical implications for the provision of medical services for victims of sexual assault, as it highlights problems in identifying and accessing rape victims, as well as recommending the sexual assault training of all practicing nurses.

Reporting Sexual Victimization During Incarceration: Using Ecological Theory as a Framework to Inform and Guide Future Research

The U.S. Department of Justice estimates that between 149,200 and 209,400 incidents of sexual victimization occur annually in prisons and jails. However, very few individuals experiencing sexual victimization during incarceration report these incidents to correctional authorities. Federal-level policy recommendations derived from the Prison Rape Elimination Act suggest mechanisms for improving reporting as well as standards for the prevention, investigation, and prosecution of prison-based sexual victimization. Despite these policy recommendations, sexual assault persists in prisons and jails, with only 8% of prisoners who experience sexual assault reporting their victimization. This review focuses on gaps in the existing research about what factors influence whether adult victims in incarcerated systems will report that they have been sexually assaulted. Using ecological theory to guide this review, various levels of social ecology are incorporated, illuminating a variety of factors influencing the reporting of sexual victimization during incarceration. These factors include the role of individual-level behavior, assault characteristics, the unique aspects and processes of the prison system, and the social stigma that surrounds individuals involved in the criminal/legal system. This review concludes with recommendations for future research, policy, and practice, informed by an ecological conceptualization of reporting.

The National Problem of Untested Sexual Assault Kits (SAKs): Scope, Causes, and Future Directions for Research, Policy, and Practice

Victims of sexual assault are often advised to have a medical forensic exam and sexual assault kit (SAK; also termed a "rape kit") to preserve physical evidence (e.g., semen, blood, and/or saliva samples) to aid in the investigation and prosecution of the crime. Law enforcement are tasked with submitting the rape kit to a forensic laboratory for DNA (deoxyribonucleic acid) analysis, which can be instrumental in identifying offenders in previously unsolved crimes, confirming identify in known-offender assaults, discovering serial rapists, and exonerating individuals wrongly accused. However, a growing number of media stories, investigative advocacy projects, and social science studies indicate that police are not routinely submitting SAKs for forensic testing, and instead rape kits are placed in evidence storage, sometimes for decades. This review article examines the growing national problem of untested rape kits by summarizing current research on the number of untested SAKs in the United States and exploring the underlying reasons why police do not submit this evidence for DNA testing. Recommendations for future research that can guide policy and practice are discussed.

Qualitative Analysis of Prosecutors' Perspectives on Sexual Assault Nurse Examiners and the Criminal Justice Response to Sexual Assault

OBJECTIVE

The aim of this study was to understand prosecutors' perspectives on the contribution of Sexual Assault Nurse Examiners (SANEs) to evidence collection and trials in sexual assault cases.

BACKGROUND

Several studies have suggested that a sexual assault case is more likely to progress in the criminal justice system when a SANE conducts the forensic medical examination. However, little is known about how prosecutors perceive SANEs and what they value about SANEs versus other medical professionals.

METHOD

Semistructured interviews, conducted in one jurisdiction with eight assistant district attorneys who prosecute sexual assault cases, included questions about the value of SANEs in evidence collection and trials. Interview transcripts were analyzed to identify common themes and variability among prosecutors.

RESULTS

Most prosecutors identified advantages for SANEs in evidence collection, trial preparation, and testimony. Specific advantages cited by one or more prosecutors included superior documentation, thoroughness of the physical examination, better identification of injuries, quality of relationships with patients, professionalism, skill in trial preparation and testifying, and credibility with jurors.

DISCUSSION

These findings help validate SANEs' contribution to the criminal justice response to sexual assault, despite the study's limitations in sample size and inclusion of only one jurisdiction. The study also suggests the value of further education about SANEs for prosecutors who may not have the opportunity to learn about the range of skills SANEs possess.

Now We Know: Assessing Sexual Assault Criminal Justice Case Processing in an Urban Community Using the Sexual Assault Nurse Practitioner Evaluation Toolkit

Campbell and colleagues developed an evaluation Toolkit for use by sexual assault nurse examiners (SANEs) to assess criminal case outcomes in adult sexual assault cases seen by SANE programs (Campbell, Townsend, Shaw, Karim, & Markowitz, 2014; Campbell, Bybee, et al., 2014). The Toolkit provides step-by-step directions and an easy-to-use statistical program. This study describes implementation of the Toolkit in Salt Lake County, the first site outside the pilot sites to utilize the program. The Toolkit revealed that, in Salt Lake County from 2003 to 2011, only 6% of adult sexual assault cases were successfully prosecuted. These findings prompted multiple community discussions, media attention, and a call to action to improve the investigation and prosecution of adult sexual assault cases. The primary purpose of this case report is to encourage other SANE teams and communities to use the Toolkit by sharing the successful experience of Salt Lake County in implementing the Toolkit.Video Abstract available for additional insights from Dr. Valentine (see Supplemental Digital Content 1, http://links.lww.com/JFN/A19).

Forensic nursing - Global scenario and Indian perspective

Sexual violence is a significant cause of physical and psychological harm and suffering for women and children. Although sexual violence mostly affects women and girls, boys are also subject to child sexual abuse. Nurse is the person who attends the victim first. In order to meet the rigid and ever-changing demands of providing care to the victim and complying with our confusing system of laws, the nursing should has been forced to expand into a Forensic nursing, specialty of its own. Nursing roles in the criminal justice service known by many names worldwide-Custody nursing, Prison/Correctional nursing, Immigration centre nursing, Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE), SARTs (Sexual assault response team), SARCs (Sexual assault referral centre) and FNDIs (Forensic nurse death investigator). In India the premier institutes like AIIMS New Delhi and The PGI Chandigarh, do not have forensic content in their nursing curriculum manuals. The WHO and IAFN have urged inclusion of forensic content in both undergraduate and postgraduate nursing programs. Forensic Nurse Specialist can provide direct services to individual clients, consultation services to nursing, medical and law-related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivered, and specialized diagnoses of specific medical conditions. Research Findings on the Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs suggests various improvements in each and every step in care of victim of sexual assault.

Can a workbook work? Examining whether a practitioner evaluation toolkit can promote instrumental use

In large-scale, multi-site contexts, developing and disseminating practitioner-oriented evaluation toolkits are an increasingly common strategy for building evaluation capacity. Toolkits explain the evaluation process, present evaluation design choices, and offer step-by-step guidance to practitioners. To date, there has been limited research on whether such resources truly foster the successful design, implementation, and use of evaluation findings. In this paper, we describe a multi-site project in which we developed a practitioner evaluation toolkit and then studied the extent to which the toolkit and accompanying technical assistance was effective in promoting successful completion of local-level evaluations and fostering instrumental use of the findings (i.e., whether programs directly used their findings to improve practice, see Patton, 2008). Forensic nurse practitioners from six geographically dispersed service programs completed methodologically rigorous evaluations; furthermore, all six programs used the findings to create programmatic and community-level changes to improve local practice. Implications for evaluation capacity building are discussed.

Is Online Learning a Viable Training Option for Teaching Sexual Assault Forensic Examiners?

This study assessed knowledge attainment of healthcare professionals who participated in a nationwide sexual assault forensic examiner training program developed by the International Association of Forensic Nursing. A comprehensive curriculum was divided into 12 modules that students accessed through an online learning management system. Using a one-group pretest-posttest design, we assessed students' knowledge attainment for all 12 online modules. The results showed that the mean posttest scores were significantly greater than the mean pretest scores for all 12 online modules. On over 40% of the modules, the students exhibited at least a 25% knowledge gain. This study also examined the predictors of knowledge attainment. Using a multiple linear regression model, we found that knowledge attainment was positively associated with a reliable Internet connection, students who were drawn to the training because it was of no cost to them, and those students with higher levels of motivation. By contrast, lower knowledge gains were significantly related to students who reported more work/personal barriers and those who were drawn to sexual assault forensic examiner practice because they, or someone close to them, have personal experience with sexual assault.

Improving the Credibility of Child Sexual Assault Victims in Court: The Impact of a Sexual Assault Nurse Examiner

The present study investigated the influence of a sexual assault nurse examiner's (SANE's) testimony on mock juror perceptions of a child or adolescent victim of child sexual assault. Community members (N = 252, 156 females) read a fictional criminal trial summary of a child sexual assault case in which the victim was 6 or 15 years old and the prosecution presented medical testimony from a SANE or a traditional registered nurse (RN), or did not present medical testimony. Mock jurors were more likely to render guilty verdicts when a SANE testified compared with the other two testimony conditions. In addition, pro-victim judgments (e.g., sympathy toward the victim) and negative defendant judgments (e.g., anger toward the defendant) mediated this relation. Finally, cognitive network representations of the case demonstrated that the RN and no-medical-testimony groups were similar and the SANE group was distinct from the other two conditions. We discuss these results in terms of the implications of SANE testimony in child sexual assault court cases.

Pathways to Help

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors’ disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged—and assisted—the survivors in seeking help. Throughout this process, the survivors’ disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors’ wishes; the adults made the victims seek help, which was also against the survivors’ preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims’ continued engagement with these systems.

Evaluating the legal impact of Sexual Assault Nurse Examiner programs: an empirically validated toolkit for practitioners

There has been sustained interest in the academic literature and in policy circles regarding how Sexual Assault Nurse Examiner (SANE) programs may bolster sexual assault prosecution rates in their communities, in addition to the health care they provide to their patients. To build evaluation capacity among forensic nurses so that they can evaluate their own programs, a practitioner-oriented, step-by-step evaluation toolkit (the SANE Practitioner Evaluation Toolkit) that can be used by SANE-A and SANE-P programs, and their community partners, to examine sexual assault prosecution rates in their local jurisdictions was created and validated. This article describes the process of creating and empirically validating the toolkit and presents the toolkit itself and accompanying resources that are available to practitioners. This article also provides recommendations regarding program readiness to engage in evaluation activities, without compromising program sustainability and patient care.

Victims' use of professional services in a Dutch sexual assault centre

BACKGROUND

Prior research endorsed the establishment of sexual assault centres in the Netherlands because of the potential benefit for victims' mental recovery. In 2012, the first Dutch sexual assault centre was founded at the University Medical Center Utrecht. The aim of the centre is to provide 24/7 coordinated and integrated services (i.e., medical, forensic, and psychological) in one location.

OBJECTIVE

The purpose of the present study was to describe demographic, background, and assault characteristics of victims seen at the centre within one week post-assault, and their use of post-assault services in order to improve current services.

METHOD

From January 2012 to September 2013, prospective data of 108 patients were collected. To describe the population included, frequency counts and proportions were generated for categorical variables.

RESULTS

The mean age was 21.3 years (SD=9.8). Most victims were female (91.7%). A large proportion of victims reported background characteristics known to increase the risk for post-traumatic stress disorder (PTSD) and revictimisation such as prior sexual abuse (32.4%), pre-existing use of mental health services (45.4%), and not living with both biological parents (61.7%). Most patients (88.9%) consulted the centre within 72 hours post-assault. The uptake of services was high: 82.4% received emergency medical care, 61.7% underwent a forensic-medical exam, 34% reported to the police, and 82.4% utilised psychological services.

CONCLUSION

To prevent revictimisation and PTSD, current psychological services could be improved with immediate trauma-focused treatments. Current forensic services may be improved with the use of standard top to toe forensic-medical examinations for both children and adults.

The Impact of Sexual Assault Nurse Examiner Programs on Criminal Justice Case Outcomes: A Multisite Replication Study

To address the underreporting and underprosecution of adult sexual assaults, communities throughout the United States have implemented multidisciplinary interventions to improve postassault care for victims and the criminal justice system response. One such model is the Sexual Assault Nurse Examiner (SANE) Program, whereby specially trained nurses provide comprehensive psychological, medical, and forensic services for sexual assault. In this study, we conducted a multisite evaluation of six SANE programs (two rural programs, two serving midsized communities, two urban) to assess how implementation of SANE programs affects adult sexual assault prosecution rates. At each site, most sexual assaults reported to law enforcement were never referred by police to prosecutors or were not charged by the prosecutor's office (80%-89%). Individually, none of the sites had a statistically significant increase in prosecution rates pre-SANE to post-SANE. However, when the data were aggregated across sites, thereby increasing statistical power, there was a significant effect such that cases were more likely to be prosecuted post-SANE as compared with pre-SANE. These findings suggest that the SANE intervention model does have a positive impact on sexual assault case progression in the criminal justice system. Nevertheless, there is still a pressing need for improvement as the vast majority of both pre-SANE and post-SANE resulted in nonreferral/no charges filed.

A cross-sectional study on the effect of post-rape training on knowledge and confidence of health professionals in South Africa

OBJECTIVE

To determine whether a national training program on post-rape care in South Africa resulted in improvements in knowledge and confidence in health professionals, and to distinguish baseline factors related to these changes in knowledge and confidence.

METHODS

Data for this cross-sectional study were collected over four training sessions in 2008 using questionnaires and multiple choice question papers given to 152 health professionals. Information was collected on demographics, service provision, and previous training. The change in knowledge and confidence was calculated from baseline and post-training scores. Factors related to these changes in knowledge and confidence were tested through the development of two models.

RESULTS

Seventy-four percent of the health professionals (n=112) who attended the training had completed all components of the data collection. The average age of the professionals was 41.6 years, 71% were females, and 68% nurses. Health professionals showed significant increases in percentage knowledge (40% at baseline vs 51% post training; P<0.001) and confidence (67% at baseline vs 80% post training; P<0.001) after the training. In the final multivariate models, empathy was significantly associated with a change in knowledge (coefficient -1.2; 95% CI, -1.9 to 0.4; P=0.005), while the facility level and baseline knowledge and confidence were significantly associated with change in confidence.

CONCLUSION

The training program was found to improve levels of knowledge and confidence in health professionals. Rollout of this program is critical with expansion into undergraduate curriculums.

The neuroscience of memory: implications for the courtroom

Although memory can be hazy at times, it is often assumed that memories of violent or otherwise stressful events are so well encoded that they are effectively indelible and that confidently retrieved memories are almost certainly accurate. However, findings from basic psychological research and neuroscience studies indicate that memory is a reconstructive process that is susceptible to distortion. In the courtroom, even minor memory distortions can have severe consequences that are partly driven by common misunderstandings about memory--for example, that memory is more veridical than it may actually be.

Building a solid foundation for sexual violence research: applying lessons learned to inform research priorities

The extant research on sexual violence has developed into a substantial body of knowledge, in large part supported by federal funds from agencies such as the Centers for Disease Control and Prevention (CDC), the National Institute of Justice (NIJ), and National Institutes of Health (NIH) components. Overall, NIJ has dedicated over US$20 million in research funds to study sexual violence resulting in more than 60 studies and multiple topic-specific research-to-practice meetings. From an initial study on the criminal justice response to rape in 1973 to present-day initiatives on multidisciplinary responses, forensic sciences, and methodological queries, NIJ has made a significant contribution to current knowledge in the field of sexual violence. A strength of the program is its use of an interdisciplinary approach, encompassing the perspectives of those within the field of research and practice to guide the development of its research program. This article details the history and development of NIJ's program of research, highlighting key studies and their contribution to the field, and provides a framework for the continued study of sexual violence.

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.

With care and compassion: adolescent sexual assault victims' experiences in Sexual Assault Nurse Examiner programs

In this study, we conducted in-depth qualitative interviews with 20 adolescent sexual assault patients aged 14-17 years who sought postassault medical forensic examinations at one of two Midwestern Sexual Assault Nurse Examiner programs. Our goals were to examine how adolescent victims characterized the quality of the emotional/interpersonal care they received and to identify specific aspects of Sexual Assault Nurse Examiner nursing practice that were helpful and healing. Overall, the patients had very positive experiences with both programs. The nurses were sensitive to their patients' physical and emotional needs throughout the examination. The adolescents also noted that the nurses were compassionate, caring, and personable. Finally, the survivors deeply appreciated that the nurses believed and validated their accounts of the assault. These findings suggest that compassionate care must be developmentally informed, such that basic patient-centered practices (e.g., belief and validation) are age sensitive and age appropriate.

Mock juror perception of sexual assault nurse examiner testimony

The perception of a sexual assault nurse examiner's (SANE) testimony in a criminal rape trial was investigated. Men and women undergraduates (N = 138) read a fictional criminal trial summary of a rape case in which medical testimony from a SANE or a registered nurse (RN) was presented, or no medical testimony was presented. Results indicated that mock jurors were more likely to render guilty verdicts when a SANE testified than when an RN testified, and this relationship was fully mediated by perceived credibility of the nurse as well as provictim perceptions. Results are discussed in terms of the impact of SANE involvement in legal proceedings.