What really happened? A validation study of rape survivors' help-seeking experiences with the legal and medical systems

"I Want to Be Heard": Rape Victims' Encounters With Swedish Police

Interactions with police are vitally important to victims' ability to process their trauma. This study focused on the experiences of victims who reported a rape to police in Sweden. Thirteen women participated in interviews; the material was analyzed using inductive thematic analysis. Findings include lack of information and the role of luck in finding an understanding officer; some found comfort, and some felt violated once again. Long processing times bound participants to their trauma. Findings highlight the need for improved knowledge of trauma among police, victims' needs for information and rights to support, and structural barriers that need to be addressed.

"Nothing Was Done": Experiences of continued sexual abuse after disclosing to a mandated reporter among youth in the United States

BACKGROUND

Disclosing ongoing child sexual abuse (CSA) to a mandated reporter should facilitate youth safety. Unfortunately, youth may continue to experience abuse after disclosure, although little research has examined this phenomenon.

OBJECTIVE

We aimed to understand when and why the child protection process fails after youth disclose to a mandated reporter.

PARTICIPANTS AND SETTING

Hotline support specialists completed an online survey about 124 anonymous hotline chats with youth whose abuse continued after a prior disclosure to a mandated reporter.

METHODS

We thematically analyzed support specialists' open-ended descriptions of information disclosed by the victim in their chat.

RESULTS

In most cases (71 %), the abuse was seemingly not reported or not investigated. Mandated reporters' belief of the victim and minimization of abuse affected reporting decisions. Some mandated reporters tried to address the abuse directly with the perpetrators, endangering victims. Rarely, mandated reporters did not report to respect the victim's wishes. In 24 % of cases, the victim described an investigation that did not result in protection. Victims indicated that investigators "sided to the perpetrator" or said there was not enough evidence. Some victims recanted, often in fear. In 6 % of cases, formal actions were taken but did not provide long-term protection. Victims described temporary cessation of abuse that resumed because their guardian(s) allowed the perpetrator to access them.

CONCLUSIONS

Disclosing to a mandated reporter can engender traumatic experiences without resulting in long-term safety. Professionals need additional training to increase their knowledge of CSA and respond in ways that prioritize physical and emotional safety.

Conducting Virtual Interviews With Sexual Assault Survivors and Their Informal Supports During COVID-19 and Beyond

The current paper describes the author's experience conducting virtual interviews with sexual assault survivors and their informal supports (e.g., family, friend, partner) during the COVID-19 pandemic, drawing on past and present interviewing experiences with this population, and the recent literature on best practices for virtual interviewing and survivor/trauma-informed research methods. The experience of pivoting from past projects using face-to-face interview methods to doing virtual interviews with this population is presented and critically analyzed. Potential advantages and drawbacks of various methods and adaptations for doing virtual interviews in a dyadic sample of survivors and their informal supports are described to facilitate future research using virtual methods with sexual assault survivors and their informal supporters. Issues related to access (e.g., e.g., age, gender, race, ability, poverty) to interview participation are also noted as in need of more consideration. Finally, the impact on interviewers of doing this work in virtual versus face-to-face contexts is discussed.

Adult Sexual Assault Patients' Experience of the Physical Examination Component of the Medical Forensic Examination: A Scoping Review to Identify Gaps in the Research Literature

We undertook a scoping review of published research literature that reported on adult sexual assault patients' experience of the physical examination component of the medical forensic examination (MFE). Eligible papers were those reporting data about the physical examination component of the MFE from the adult patient's perspective, published in the period January 2000 to March 2022 in peer reviewed journals and reports containing original research data published from a tertiary institution. Twelve papers were identified. The review identified a gap in the literature regarding the patient's experience of the physical examination component of the MFE. The existing literature is limited but suggests that some patients find the examination empowering and reassuring, restoring a sense of bodily control; however, for others it is an intrusive, violating experience that they endure. A more patient-centered sexual assault service appears to have a therapeutic value in itself, but more research is warranted as existing research is very limited and often from a proxy. In particular, more research on patients' self-reported experience of the MFE, including specific aspects of the examination and the experience of male and gender nonconforming victim-survivors, is needed. A better understanding, from the point of view of the patient, of the benefits of attending, may encourage victim-survivors to seek a health response and, possibly, report to police. It may also be time to assess the impacts of certain aspects of the forensic examination, rethink standard evidence collection processes, and consider enabling more acceptable options for victim-survivors including self-collection of intimate samples.

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.

Experiences of dehumanizing: Examining secondary victimization within the nurse-patient relationship among African American women survivors of sexual assault in the Upper Midwest

Despite calls recognizing the need for culturally sensitive responses to minimize the occurrence of secondary victimization for African American women following an experience of sexual assault, few studies have focused on hearing from African American women survivors about their experiences receiving healthcare services in a hospital setting following sexual assault. Employing critical ethnography as our methodology and using intersectionality theory as a lens, we centered the voices of African American women survivors about their experiences receiving nursing care in urban acute care or hospital settings in the Upper Midwest of the United States following sexual assault. In this qualitative study, 30 African American women survivors were interviewed using in-depth, semi-structured interviews about their post-sexual assault care. Interviews were analyzed using thematic analysis. An important theme identified focused on survivors' experiences of dehumanization when receiving healthcare services following sexual assault. These experiences included: discrediting, dismissing, shaming, and blaming. To mitigate and prevent secondary victimization in the future, we present practice and education change recommendations for nurses, and healthcare providers more broadly, based on the voices of African American female survivors of sexual assault.

Restorative Justice for Survivors of Sexual Violence Experienced in Adulthood: A Scoping Review

Sexual violence (SV) is a widespread human rights issue. Survivors of SV often experience profound dehumanization and poor health outcomes when their trauma is not properly addressed, rendering it critical that they are honored and empowered within subsequent processes of healing and seeking justice. With adjudication through the criminal legal system largely underutilized due to retraumatization, scrutiny from law enforcement professionals, and high rates of case closure, restorative justice (RJ) has emerged as a promising option for survivors to repair harm and experience accountability. Little is known, however, regarding the best practices for its use in cases of SV. To meet this need, a scoping review was conducted to identify the best practices for the implementation of RJ after instances of SV experienced in adulthood. Following the search methodology outlined by the JBI Manual for Evidence Synthesis for scoping reviews, 15 articles met search criteria, including four empirical studies and 11 nonempirical research materials spanning five academic disciplines. Best practices and structures for RJ were subsequently identified, including key phases for appropriate implementation. This review can be used to create increasingly productive RJ processes for SV survivors, which is particularly important for those coming from marginalized communities facing structural inequities, as well as survivors on university campuses. As researchers, we have the power to use science to propel society toward the creation of more efficacious healing spaces for survivors of SV, and optimizing safe RJ processes plays a key role in bringing this to fruition.

Differential Treatment of Sexual Assault Cases by US Army Law Enforcement Personnel

Using data received through the Freedom of Information Act, this observational study explores whether Army law enforcement personnel do not find probable cause in sexual assault cases at higher rates than in other serious crimes. The study compares sexual assaults, homicides, robberies, and assaults in the Army from 2008 to 2014 and July 2015 to 2017. For the first period, the study finds that the odds are 5.30 times greater that Army law enforcement will not find probable cause in a sexual assault case when compared to other crimes, and for the second period the odds are 4.39 times greater.

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

Patient Advocates' Perspectives on the Care of Sexual Assault Survivors in Chicago-Area Emergency Departments

Emergency departments (EDs) providing care and forensic examinations for sexual assault (SA) survivors are often supported by SA patient advocates. This study explored advocates' perspectives regarding problems and potential solutions in SA patient care through a focus group with 12 advocates. Thematic analysis identified two major themes: provider-patient interactions and ED-hospital systems. Challenging aspects of provider-patient interactions included (a) provider attitudes and (b) disempowering behaviors. Within ED-hospital systems, themes included time constraints, efficiencies, and hospital preparation. Advocates surveyed were optimistic about an increased presence of SA nurse examiners and enhanced protocols and provider training to improve survivors' experiences.

Beyond Obstacles: Toward Justice for Victims of Sexual Violence in Hungary. A Literature Review

Alarmed by research that reveals Hungary as having one of the lowest reporting rates in cases of sexual violence in Europe, this article provides an overview of the research that explains why, historically, sexual violence has been and continues to be underreported all over the globe, from law enforcement and criminal justice perspective. Furthermore, we describe the unique circumstances that might influence Hungarian victims of sexual violence to make formal reports. Among other possible factors, we discuss rape myth acceptance, victim blaming, feminist activism, institutional betrayal, and media representations of rape. In an effort to provide insight into Hungarian gender politics, this article raises salient theoretical works on gender ideology and gender policy in contemporary Hungary. This article concludes with a discussion on what implications such research in Hungary may have on a global understanding of sexual violence reporting.

An evaluation of a rapid conversion to teleSANE in response to COVID-19

Sexual Assault Nurse Examiners (SANEs) provide expert, comprehensive medical forensic care to patients who present for services following a sexual assault. Because SANEs are not consistently available, telehealth technology is being explored as a means to provide access to this expert care (i.e., teleSANE). During the COVID-19 pandemic, teleSANE offered additional potential benefits by reducing the length of time spent and number of providers in patient exam rooms, the need for personal protective equipment that was in high demand and short supply, and provider anxiety related to providing in-person care. In the summer of 2020, the Massachusetts SANE program rapidly and temporarily converted five hospitals from in-person SANE care to teleSANE. An evaluation team interviewed 23 providers using a rapid research and evaluation methods approach to assess the temporary model and inform the future of SANE care. Evaluation findings reveal it is possible to rapidly and temporarily convert hospitals from in-person to teleSANE care in a time of broad uncertainty, and that such a change requires intensive and thoughtful planning; a shared commitment to being supportive, flexible, and responsive; and specific experience and expertise. Considerations for communities exploring how best to ensure consistent, equitable access to SANEs are discussed.

The Feasibility of a Novel Recruitment Protocol for Collecting Survivor Data via Disclosure Recipient Referrals

The current arricle describes a novel recruitment protocol for collecting data from sexual assault and intimate partner violence survivors referred to research studies by individuals to whom they had previously disclosed. Challenges in both recruiting participants and interpreting data are described. Only 35.8% of cases had usable data for both survivors and disclosure recipients, suggesting that this referral method had limited success in recruiting matched pairs. Suggestions for modifications to improve the protocol for future research are offered. Potential advantages and drawbacks of various methods for recruiting dyads are described in order to facilitate future research on survivors' disclosure processes, social reactions, and the influence of social reactions on survivor recovery.

"It's Hard to Show Empathy in a Text": Developing a Web-based Sexual Assault Hotline in a College Setting

To increase access to counseling and advocacy services and respond to changes in communication preferences, many victim service programs are expanding their traditional telephone hotlines and adding web chat or text hotlines. However, there is little research available about these web and text-based hotlines. We examined program data collected in the first year of operation of a web-based crisis hotline for sexual assault survivors at a large Midwestern university in the United States as part of a larger evaluation project. We examined how often the web-based chat hotline was used and explored patterns of use by time of day and month, comparing to records from the phone hotline operated by the same campus-based victim service program. We also conducted interviews and two group discussions with volunteers and staff about their experiences with providing crisis intervention in a web-chat medium. Findings suggest that the web-based crisis hotline is being used frequently, nearly as often as the telephone hotline and doubling the total number of crisis contacts the organization had in the year prior to adding the web-based chat hotline. Staff and volunteers identified a number of advantages of a web-based hotline, including increased privacy and accessibility for survivors. Difficulty identifying and conveying emotions in the web-chat context was one of the primary challenges described by staff and volunteers. Operating the web-hotline, therefore, requires additional training for volunteers and staff on how to translate crisis intervention skills into a text-based medium. Suggestions for how to communicate effectively in text-based crisis intervention are discussed, along with other considerations for designing a web or text hotline.

Sexual assault survivors' engagement with advocacy services during the COVID-19 pandemic

Sexual assault advocates provide support to survivors as they navigate medical, legal, housing, and other complex systems. However, social distancing measures enacted in response to coronavirus disease 2019 (COVID-19) forced changes to traditional advocacy services. The current study aimed to understand how the COVID-19 pandemic transformed survivors' engagement with sexual assault advocacy services. Semi-structured interviews were conducted with 12 sexual assault advocates from a community-based advocacy organization in Detroit. Thematic analysis was employed to uncover emergent themes reflecting COVID-19's impact on survivors' engagement with advocacy services. Three themes were identified: (1) Disruption to advocacy services; (2) difficulty obtaining tangible resources; and (3) desire for COVID-related support, information, and resources. This study highlights the needs of sexual assault survivors during the COVID-19 pandemic and explores how public health emergencies have the potential to exacerbate the needs of this vulnerable population. Implications and future directions for service provision and research are considered.

A Procedural Justice Theory Approach to Police Engagement with Victim-Survivors of Rape and Sexual Assault: Initial Findings of the ‘Project Bluestone’ Pilot Study

In England and Wales, public trust in the police has been damaged by a series of police failings in rape and sexual assault investigations, officer sexual offending, and a police culture of misogyny. Feminist scholars have analysed why police investigations of rape and sexual assault cases rarely result in a charge and documented the poor experiences many victim-survivors have of the police process. In this article, we outline how this scholarship may be integrated into procedural justice theory to advance our understanding of the impact of how officers engage with victim-survivors on their feelings of the status and value as survivors of sexual violence within the nation and society police represent, as well as on their trust in the police and willingness to (continue) engaging with police, or report future victimisation. We present tentative evidence from a pilot study (‘Project Bluestone’) in one English police force that suggests a feminist scholarship informed Procedural Justice framework is a promising tool for assessing and improving police practice in engaging with victim-survivors of rape and sexual assault. The article concludes with directions for future research.

Digital Dating Abuse Among a National Sample of U.S. Youth

Digital dating abuse is a term used to describe physical, sexual, or psychological/emotional violence that occurs between romantic partners through the use of texting, social media, and related online mediums. Survey data were obtained from a nationally representative sample of 2,218 American middle and high school students (12-17 years old) who have been in a romantic relationship. About 28% of students in a relationship in the previous year had been the victim of digital dating abuse. Males were more likely to report having experienced it (32% compared to 24%), though no other demographic differences emerged. Several covariates did emerge as significantly related to experience with digital dating abuse, including depressive symptoms, sexual intercourse, sexting, and being the victim of cyberbullying. Experiencing offline dating abuse was by far the strongest correlate. Implications for prevention and policy within schools and the community are discussed, along with considerations for future research in this important area.

Developing Trauma-Informed Research Methods: Using Proxy Respondents to Assess Sexual Assault Survivors' Experiences Seeking Medical Forensic Exams

In research on sexual assault victims' help-seeking, proxy data sources are often utilized because outreach to survivors immediately postassault may increase a study's risk-to-benefit ratio. Victim advocates and services providers are common proxy respondents, but empirical research comparing the accuracy of their information is needed. We collaborated with seven sexual assault nurse examiner (SANE) programs to collect de-identified, paired data from nurses and advocates regarding the help-seeking experiences of N = 744 adult victims. Using pairwise McNemar tests, we found statistically significant agreement on victim demographics, assault characteristics, and victims' decisions regarding medical forensic exams, sexual assault kit (SAK) collection, and release of SAKs for forensic DNA testing. Nurses and advocates had different information regarding victims' disclosure histories and their reasons for seeking SANE care.

Refining Sexual Assault Treatment: Recovered Survivors and Expert Therapists Concur on Effective Therapy Components

The goal of the present study was to refine sexual assault therapy through the examination of the level of agreement between survivor and therapist assessments of key recovery-promoting therapeutic interventions. This is the first study to explore the level of agreement between those who partake in the treatment process from either position. Semistructured interviews were conducted in this qualitative study with 10 survivors and 10 experienced therapists. The results document considerable concurrence between them regarding relational and trauma processing treatment components alike. Together, these reports outline key effective interventions, both common and specific in nature, concomitantly supported by both groups.

Victims of sexual offences: aspects impacting on participation, cooperation and engagement with the interview process

The way in which police officers interview sexual offence victims is pivotal to how their cases proceed through the criminal justice system (CJS). However, such interviews have previously been found to be lacking in overall quality, with some interviewers finding them technically difficult and stressful to conduct. In addition, victims often feel disbelieved, unsafe and/or uncomfortable during their police interview. The present study provides insight into the personal experiences of five female adult rape/sexual assault victims regarding their police interviews and the aspects that encouraged them to cooperate and engage during the interview process. Following semi-structured interviews, interpretative phenomenological analysis (IPA) was used to identify three key themes: (i) heading into the unknown, (ii) difficulty of talking about the crime and (iii) helpful and unhelpful interviewer approaches. Implications for practice are discussed, together with the need to further our understanding of this specialist area of police work.

Comparing Rape Myth Acceptance Among Police Trainees and Medical Students: A Preliminary Danish Validation of the Updated Illinois Rape Myth Acceptance Scale

Identifying rape myths among criminal justice and medical professionals is central to preventing secondary victimization. We present the first preliminary Danish validation of McMahon and Farmer's updated Illinois Rape Myth Acceptance scale using samples of police and medical trainees. Exploratory and confirmatory factor analyses result in a 14-item, four-factor measure that demonstrates acceptable model fit, satisfactory convergent and discriminant validity, and good internal consistency. Although reported rape myth acceptance is generally low in both samples, some subscale scores vary across professional groups, thereby identifying specific targets for intervention in different occupational contexts. Further tests of the scale are recommended.

Trauma, social media, and #WhyIDidntReport: An analysis of twitter posts about reluctance to report sexual assault

Recent social trends regarding sexual violence and gender have included elements of "hashtag activism," which involves using social media tools for cultural awareness and change. For example, the Twitter hashtag: #WhyIDidntReport was created for survivors of sexual victimization to share their barriers to reporting. In this project, 600 tweets attached to this hashtag were analyzed using a combination of grounded theory and content analysis methods. Results were organized into a conceptual map, with a central category (power), connected to three other ecological categories (culture, community systems, and relationships) and one category of survivor experiences. Each category has subcategories which illustrate certain contextual and internal barriers to reporting assault. The model shows how these barriers intersect and interact, and often further traumatize those who have been assaulted. The model offers implications for professionals working with those who have survived sexual trauma, as well as those studying the dynamics of abuse.

The problem with assumptions: Revisiting "The dark figure of sexual recidivism"

What is the actual rate of sexual recidivism given the well-known fact that many crimes go unreported? This is a difficult and important problem, and in "The dark figure of sexual recidivism," Nicholas Scurich and Richard S. John (2019) attempt to make progress on it by "estimat[ing] actual recidivism rates . . . given observed rates of reoffending" (p. 171). In this article, we show that the math in their probabilistic model is flawed, but more importantly, we demonstrate that their conclusions follow ineluctably from their empirical assumptions and the unrepresentative empirical research they cite to benchmark their calculations. Scurich and John contend that their analysis undermines what they call the "orthodoxy in academic circles" (p. 173) of low sexual recidivism rates among individuals convicted of sexual offenses, but we underscore that their article does not analyze data in the traditional sense; instead, it just interprets past scholarly work through the use of strong assumptions in a way that, for practitioners, is likely to be opaque and misleading (and, for us, strays into speculation, argument, or advocacy and away from objective research). Our simple calculations show that their findings are highly sensitive to their assumptions, and we conclude that courts and others should recognize Scurich and John's work for what it is-a set of complex hypotheticals that are no more reliable than what judges and lawyers accomplish on their own by simply recognizing the basic problem that not all sexual offenses are reported.

Understanding the Barriers of Violence Victims' Health Care Use

Violence is a leading cause of death among U.S. adults under age 45. There are also 3.3 million living violence victims, most of whom forgo formal health care when injured. We developed and tested a framework to understand why. We argue that violence victims must consider their need for care and three situational factors of victimization that may serve as barriers for care seeking: the victim's relationship to the offender, their victimization history, and the offense committed (sexual vs. nonsexual). In analyses of 9,912 violent victimizations from 8,635 participants in the National Crime Victimization Survey from 1993 to 2017, we found that injury severity and situational factors of victimization independently and interactively predict formal health care use. Even when serious injury occurs, victimizations involving known offenders, repeat victimizations, and sexual violence are less likely than their counterparts to result in formal health care use. We discuss the implications of these findings for victims and health care providers.

Consequences of Presence of Forensic Nurses in Health Care System: A Qualitative Study

Background:

Nursing is a vital element in providing safe and effective care. Forensic nursing is one of the specialties in this discipline which, in addition to creating more satisfaction in nurses, is considered essential in holistic, quality, and safe care. This study aimed to describe the consequences of the presence of forensic nurses in the health system.

Materials and Methods:

This qualitative study was conducted between 2017 and 2018 in Iran. Semi-structured interviews were performed with 18 participant experts in the field of health and law. The interviews were analyzed using the inductive content analysis approach proposed by Graneheim and Lundman.

Results:

The consequences of the presence of nurses in the health system were summarized into two categories: positive and negative consequences. The positive consequences consisted of improved performance, better legality of nurses, the calmness of nurses, prevention of patients' rights violations, advancement comparable with developed countries, reduced costs, increased accuracy and speed in dealing with forensic cases, improved performance of Iranian Legal Medicine Organization and increased employment. On the other hand, the negative consequences were role conflict with other involved professionals and nursing shortage. Participants included nurses (with different specialties), nurse lawyers, forensic medicines, forensic midwives, a judge, and a medical lawyer.

Conclusions:

If planners and policymakers have a positive attitude toward the presence of forensic nurses, we can anticipate better forensic services for clients through the development of systematic educational programs, the formation of forensic teams, and the expertise of this profession can provide many benefits.

Factors Associated With and Barriers to Disclosure of a Sexual Assault to Formal On-Campus Resources Among College Students

Sexual assault on college campuses occurs at high rates, but disclosure to formal on-campus resources remains low. This study used a mixed methodological survey to explore demographic and social characteristics of students who formally reported their assaults and those who did not and examined barriers to formal disclosure. Responses revealed that students who disclosed to formal on-campus resources suffered frequent polyvictimization, had high rates of physical and emotional consequences, and were mostly White women involved in campus organizations. Barriers to formal resource utilization were identified at the individual, interpersonal, organizational, and community levels.

The Promise Initiative: Promoting a trauma-informed police response to sexual assault in a mid-size Southern community

AIMS

A mixed-methods study details a multidisciplinary team's efforts to assess and transform police response to sexual assault in a mid-size community.

METHOD

A police department-wide survey (n = 331) determined baseline levels of officer exposure to trauma-informed training, rape myth acceptance, and awareness of community and nationwide sexual assault movements to understand officer attitudes towards factors influencing sexual assault investigations. These data, in conjunction with SAMHSA's (2012) trauma-informed assumptions, were leveraged to develop and adopt trauma-informed policies that would enhance the police department's response to sexual assault.

RESULTS

At baseline, few officers reported receiving trauma-informed interviewing training (21.8%) or having knowledge of local SAK, #MeToo, or #TimesUp movements (10.0%, 7.2%, 3.9%, respectively). Chi-square analyses suggested officer knowledge of community SAK movement, personal investment in learning about sexual assault, and understanding of trauma were higher in officers with versus without training; of concern, officers with more sexual assaults on their caseload were more likely to endorse rape myths. Training understanding was related to lower rape myth acceptance.

CONCLUSIONS

Policy changes, including adding trauma-informed training to the Police Academy, were implemented by the MDT to promote a system-wide trauma-informed approach to sexual assault and ensure community safety.

Measuring experience and outcomes in patients reporting sexual violence who attend a healthcare setting: a systematic review

BACKGROUND

Obtaining perspectives from those seeking healthcare after sexual violence on care and how it is delivered is important.

OBJECTIVES

To systematically identify any existing patient-reported outcome and experience measures (PROMs and PREMs) for patients attending healthcare services after sexual violence. Also, to identify key themes regarded by patients as priorities for delivering a high-quality service.

DESIGN

Systematic review (PROSPERO registration RD42016050297).

DATA SOURCES

Eight electronic bibliographic databases from inception to March 2017. 'Grey' literature also searched. Search words included patient view, patient experience, PROM/PREM, sexual violence, rape.

REVIEW METHODS

Studies of any design, with participants of any gender and aged 13 years or older were included; studies only assessing the views of service providers were excluded. Appraisal tools assessed for study quality. Healthcare outcome data were assessed across the quantitative studies and key experiences across qualitative papers; Framework Analysis was used to synthesise the qualitative studies.

RESULTS

From 4153 identified papers, 20 fulfilled criteria for inclusion: 10 qualitative, 8 quantitative and 2 mixed methods. No validated measure of assessing patient experience or outcome was identified. The synthesis of qualitative studies led to the assignment of two overarching themes around the importance of patient-focused and trauma-focused communication, and of care which enhances patient empowerment. A paucity of research within certain patient groups who experience sexual violence, in particular men and LGBT (lesbian, gay, bisexual and trans) patients was noted.

LIMITATIONS

A broad definition of 'healthcare setting' incorporated a wide variety of venues limiting the applicability of findings in specific settings.

CONCLUSION

A validated and standardised approach to assess patient experience and outcome in healthcare settings after sexual violence is needed. Themes identified should be incorporated into PROM or PREM development. The review also suggests the need for a change in approach towards those who attend for healthcare after sexual violence to ensure patient autonomy.

The Sexual Stratification Hypothesis: Is the Decision to Arrest Influenced by the Victim/Suspect Racial/Ethnic Dyad?

The sexual stratification hypothesis suggests that criminal justice responses to sexual victimization will differ depending on the victim/suspect racial/ethnic dyad. Previous research examining the sexual stratification hypothesis has primarily focused on court processes, and the small body of literature examining arrest decisions is dated. There remains substantial opportunity for testing the sexual stratification hypothesis at response stages apart from the court level (i.e., arrest). Using quantitative data on 655 sexual assault complaints that were reported to the Los Angeles County Sherriff's Department (LASD) and the Los Angeles Police Department (LAPD) in 2008, this study examines the effect of the victim/suspect racial/ethnic dyad on the decision to arrest. Findings suggest that police consider the victim/suspect racial/ethnic dyad when making arrest decisions. In addition, victim characteristics, strength of evidence indicators, and measures of case factors predict the police decision to make an arrest.

The global three: A Malaysian lens on the challenges and opportunities facing restorative justice planning and implementation

From the rise of restorative justice to evidence-based approaches to reducing recidivism, the intellectual landscape of criminal justice has seen considerable change in recent decades. The result is that an increasing number of countries have tackled the task of shifting preexisting political institutions to confirm with these new understandings. This is, of course, no easy feat. A great number of challenges confront willing policymakers, a reality that often puts philosophy at loggerheads with practicality. Moreover, the political process of change is subject to the influence of cultural and institutional norms. In this paper, we look at one particular case study - that of Malaysia's juvenile justice system - to understand the challenges faced in changing criminal justice policy. We identify three primary categories of challenges and elucidate their shape and impact through the Malaysian example. We also briefly analyze potential opportunities to mitigate and overcome these challenges. Furthermore, we also conclude with several implications for future research that we deem are important to be taken place. In sum, we argue that criminal justice reform must be undertaken with an eye toward important societal and institutional norms, each requiring thoughtful analysis of complex local cases.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

An Exploratory Examination of College Students' Likelihood of Reporting Sexual Assault to Police and University Officials: Results of a Self-Report Survey

Despite the growing salience of sexual assault victimizations on college campuses, reporting of such events remains low. A better understanding of what affects students' reporting behavior and to whom they are likely to report victimizations can aid in developing policies and programs that promote reporting. Using a sample of 336 college students, this study uses hypothetical scenarios to examine the factors that affect individuals' likelihood to report sexual assaults to the police and to university officials. Results show that students are significantly more likely to report sexual assaults to the police than to university officials. In addition, wanting justice, trust in police and university officials, and a desire for services are among the most consistent factors that affect students' likelihood to report to both the police and university officials.

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.

Knowledge, Attitudes, and Beliefs of Prenursing and Nursing Students About Sexual Assault

Sexual assault has been identified as a major public health problem in the United States, yet little research has been done regarding nursing students' knowledge, attitudes, and beliefs about sexual assault. Lack of knowledge, or victim-blaming attitudes held by healthcare providers can be problematic for the care of the sexual assault victim, leaving them feeling upset and distressed after the healthcare encounter. Prenursing and nursing students were surveyed about their knowledge, attitudes, and beliefs about sexual assault. A knowledge test, the Illinois Rape Myth Acceptance scale, and the Attitudes Toward Rape Victims scale were utilized in the survey; 297 students completed the survey. Results indicate that rape myth acceptance is lower for nursing students in their last semester of college than in the prenursing group; and that last-semester nursing students held less victim-blaming attitudes toward rape victims than prenursing students. The knowledge test highlights problem areas that need to be addressed by nursing education to improve the care of sexual assault patients.

Physicians' Perceived Roles, as Well as Barriers, Toward Caring for Women Sex Assault Survivors

BACKGROUND

Sexual assault (SA) affects about 40% of women in the United States and has many mental and physical health sequelae. Physicians often do not address SA with patients, although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care.

METHODS

We performed a qualitative study using semistructured one-on-one interviews with 16 faculty physicians from five specialties: obstetrics and gynecology (n = 4), internal medicine (n = 4), family medicine (n = 1), emergency medicine (n = 3), and psychiatry (n = 4). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors.

RESULTS

Physicians described two main categories of roles: clinical tasks (e.g., testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g., providing support, acting as patient advocate). Physician barriers fell into three main categories: 1) internal barriers (e.g., discomfort with the topic of SA), 2) physician-patient communication, and 3) system obstacles (e.g., competing priorities for time).

CONCLUSIONS

Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors.

Exploring Correlates of Alcohol-Specific Social Reactions in Alcohol-Involved Sexual Assaults

Disclosing pre-assault drinking may influence reactions sexual assault survivors receive from their support networks. Such reactions likely affect survivor's post-assault adjustment. Thus, it is important to identify assault and disclosure characteristics related to disclosing one's drinking and receiving social reactions that specifically comment on pre-assault alcohol use. This exploratory study examined demographic, assault, and disclosure factors as predictors of both survivors' decisions to disclose their pre-assault alcohol use and social reactions survivors received related to their pre-assault alcohol use. Out of survivors who were drinking at the time of the assault, those with more education and who reported greater alcohol impairment or resistance during the assault were more likely to disclose pre-assault alcohol use. As expected, this study found that of women disclosing pre-assault drinking, those with more education and more violent assaults received more negative social reactions specifically commenting on their use of alcohol prior to the assault. Such negative reactions were more common for those telling parents, police, or medical professionals. Women with less education received more positive and negative social reactions that commented specifically on their use of alcohol prior to the assault. Interestingly, results showed that disclosing pre-assault alcohol use in greater detail was related to positive social reactions specific to preassault drinking and experiencing greater alcohol impairment at the time of the assault was associated with both positive and negative social reactions specific to pre-assault alcohol use. Implications for research and intervention are provided for survivors disclosing alcohol-related sexual assaults.

Criminal Justice Considerations for Unsubmitted and Untested Sexual Assault Kits: A Review of the Literature and Suggestions for Moving Forward

One of the latest reforms to the criminal justice response to sexual assault involves changes to the submission and testing of sexual assault kits. Across the United States, thousands of kits have either not been submitted to a laboratory or tested by a laboratory, prompting criticisms that victims of sexual assault have not received justice for the crimes perpetrated against them. Jurisdictions across the country have reevaluated their responses to sexual assault, including their investigations and submission and testing of sexual assault kits. It is critical that future efforts respect the recommendations of jurisdictions that have spearheaded earlier reforms and are guided by victim-centered and trauma-informed principles. This article reviews recent research that has been conducted on changes in processing sexual assault kits, provides examples of different approaches to address unsubmitted and untested kits, and suggests ideas for future research and practice to consider as this area moves forward.

Victim Advocates' Perceptions of the Role of Health Care Workers in Sexual Assault Cases

Victim assistance officials work to ensure that victims can overcome the negative consequences of victimization. In performing these activities, they collaborate with a number of professionals from seemingly disparate fields. Among others, they often work with various health care professionals. In this article, attention is given to the barriers that may limit effective collaboration between health care professionals and victim assistance professionals. A total of 44 sexual assault crisis center workers completed a survey assessing collaboration barriers. Results suggest that the types of barriers arising vary among specific types of health care providers. One set of barriers arises when collaborating with health care professionals such as nurses and hospital workers. Another set of obstacles arises with mental health workers. Implications are provided.

When a Cleared Rape Is Not Cleared: A Multilevel Study of Arrest and Exceptional Clearance

As rape remains one of the most underreported and least likely to be cleared of the violent crimes, it is of paramount importance to understand the factors associated with the likelihood of a case being cleared by law enforcement. This study uses data from the National Incident-Based Reporting System (NIBRS) and the Law Enforcement Management and Administrative Statistics (LEMAS), and a multilevel modeling approach to examine the relationship between victim, offender, incident, and police department characteristics contrasting the two types of clearance: arrest and exceptional clearance. The latter occurs due to reasons outside of law enforcement's control and despite being considered cleared, the offender is not arrested, charged, nor turned over for prosecution. Of the 16,231 cleared rapes in 238 departments, nearly half (47%) results in exceptional clearance when the victim refuses to cooperate or when prosecution is declined. Incident-level variables have a greater effect on the likelihood of exceptional clearance than victim and offender variables. The department explained a nontrivial amount of variation in the dependent variable, as 37% of the variance in type of clearance was between-department variation. Implications for future research on exceptional clearance and NIBRS are discussed.

Police Officer Schema of Sexual Assault Reports: Real Rape, Ambiguous Cases, and False Reports

While extensive research has studied sexual assault reporting behaviors and described negative experiences with the criminal justice system among victim-survivors, fewer studies have explored police officer attitudes, knowledge, and thought processes that may affect victims' perceptions of negative interactions and unsatisfactory outcomes within reported sexual assault cases. This study explores police officer understanding of the definition of sexual assault and characteristics that influence their perceptions and response. Ten police officers were interviewed within one police department in a midsized city in the Great Lakes region. The study uses a modified grounded theory approach. Findings suggest that officers employ distinct schema of reported sexual assaults. Case characteristics, perceived credibility of the victim, and types of evidence formed categorizations of false reports, ambiguous cases, and legitimate sexual assaults. Police officers describe the ways in which perceptions of the case may or may not influence the response and point to areas for improvement within police procedure. The study findings provide insight into recommendations for improved police interviewing and response to reported sexual assaults.

Violence and Vulnerability of Female Migrants in Drop Houses in Arizona

This qualitative research study examines the experiences of immigrant women crossing the U.S./Mexico border and the proliferation of “drop houses” in Arizona as a new phenomenon, one that is often marked by kidnappings and sexual assault. Little research has been published on the violence women face on their journey, and the drop houses have almost completely escaped scholarly analysis. We argue that the drop houses must be seen as a consequence of a “state of emergency” declared by policy makers that led to changes in U.S. national and local immigration policies that fueled what we call a “chain reaction of violence.”

Perceptions of sexual assault victims/survivors: the influence of sexual history and body weight

The intersection between a woman's body weight and sexual history and the victim blaming attitudes of future health care providers was investigated. University undergraduate students (N = 91) enrolled in programs associated with the provision of health care read 1 of 4 patient files of a woman reporting a rape as well as 2 distracter files. Results showed that, for overweight rape victims/survivors, study participants' antifat attitudes were correlated with victim blaming attitudes. Male participants held the attacker significantly less responsible than did female participants if the victim/survivor had several previous sexual partners. Findings suggest that body weight should be considered as a contributing factor in attitudes toward rape victims/survivors, and the gender of the health care provider can be a factor in the post-assault treatment of overweight rape victims/survivors.

Sexual assault training in the military: evaluating efforts to end the "invisible war"

Sexual assault is an insidious problem in the United States military. In 2005 the Department of Defense (DoD) created the Sexual Assault Prevention and Response Office, which centralizes responsibility for sexual assault training. However, this training initiative has undergone little evaluation by outside researchers. Addressing this need, we analyzed responses from over 24,000 active duty personnel who completed the 2010 DoD Workplace and Gender Relations Survey. We assessed whether sexual assault training exposure (None, Minimal, Partial, or Comprehensive) predicted accurate knowledge of sexual assault resources and protocols. Using a social-ecological framework, we investigated whether institutional and individual factors influenced Service members' training exposure and judgment of training effectiveness. According to our results, exposure to comprehensive training predicted lower sexual assault incidence and superior knowledge. However, comprehensive training differed as a function of military branch, rank, gender, and sexual assault history. Judgments of training effectiveness also varied across these dimensions. Our results highlight the importance of considering context, gender, and victimization history when evaluating institutional efforts to end sexual violence. The DoD's 2010 annual report on military sexual assault concluded that "most Active Duty members receive effective training on sexual assault" (p. 104). Our results cast doubt on that assertion.

Women's center staff perceptions of the campus climate on sexual violence

BACKGROUND

Sexual assault is a major public health problem disproportionately affecting women on college and university campuses. As sexual assault is often unreported, survivors may not have the access to resources and services that are helpful in healing. Campus-based women's centers provide a comfortable place and resource to address women's issues on campus. Individuals who work in these centers have open communication channels with students and a role in the administrative structure that may provide a unique understanding of survivors, the student environment, and the institutional context regarding sexual assault.

OBJECTIVE

The purpose of this study was to understand the perceptions of campus-based women's center staff on college and university campuses, specifically regarding campus-based responses to sexual assault.

METHODS

Participants responded electronically to six open-ended survey questions. Data were analyzed using a qualitative content analysis approach to identify key themes present within the data.

RESULTS

Key concepts identified included respect, trust, confidentiality, trained professionals, and comprehensive and consistent response.

CONCLUSIONS

The findings provide an early description of the perceptions of staff in campus-based women's centers related to prevention, reporting, and response to sexual violence on campuses and can be used to inform campus policies and practices as well as forensic and college-based nursing practice.

Campus Sexual Misconduct: Restorative Justice Approaches to Enhance Compliance With Title IX Guidance

Campus response to sexual violence is increasingly governed by federal law and administrative guidance such as the 1972 Title IX, the 2011 Dear Colleague Letter (DCL), and the 2013 Violence Against Women Act. Educational institutions are directed to expand disciplinary responses and establish coordinated action to eliminate sexual violence and remedy its effects. Compliance fosters a quasi-criminal justice approach not suited to all sexual misconduct and inconsistent with developing practice in student conduct management. This article envisions restorative justice (RJ) enhancements to traditional student conduct processes that maintain compliance, expand options, empower victim choice, and increase responsiveness to DCL aims. The article (1) defines sexual violence and sexual harassment within the DCL scope, (2) elaborates the DCL position on permissible alternative resolutions and differentiates mediation from RJ, (3) sequences action steps from case report to finalization, including both restorative and traditional justice pathways; and (4) discusses building support for innovation beginning with existing campus response.

Cold or caring? Adolescent sexual assault victims' perceptions of their interactions with the police

One-third of sexual assault cases that are reported to the police involve adolescent victims (Snyder, 2000), yet little is known about adolescent victims' interactions with law enforcement. Through semistructured interviews with 20 adolescent sexual assault victims, this study sought to understand--from the perspectives of the adolescents--how the police interacted with them on an interpersonal level and the impact this had on the adolescents' emotional well-being and engagement in the criminal justice system. Findings revealed that when the police engaged in behaviors that the victims perceived as caring, compassionate, and personable (vs. behaviors that were perceived as uncaring, insensitive, and intimidating), there was a positive impact on victims' emotional well-being and criminal justice system engagement. Implications for improving adolescents' help-seeking experiences are discussed.