"It Made Me Feel Like Someone Wasn't Doing Their Job:" Sexual Assault Kit (SAK) Victim Notifications and Institutional Betrayal by the Criminal Legal System.

In the United States, sexual assault survivors are advised to have a medical forensic exam and the collection of a sexual assault kit (SAK) to preserve biological evidence (e.g. semen, blood, saliva, hair) if they are considering reporting the assault to the police. Law enforcement personnel are supposed to submit the SAK (also known as a "rape kit") to a crime laboratory for forensic DNA testing, which can help identify or confirm the identity of the offender. However, police do not routinely submit SAKs for testing, and large stockpiles of untested kits have been found in police storage throughout the United States. Public outrage has prompted many cities to submit these older rape kits for DNA analysis, and this testing has identified thousands of suspected perpetrators. Police and prosecutors are re-opening these older sexual assault cases, which requires reestablishing contact with survivors who made the initial report years ago - a process referred to as "victim notification." In this study, we conducted qualitative interviews with survivors who received a SAK victim notification and participated in the re-investigation and prosecution of their cases. We explored how survivors reacted to this de facto admission of an institutional betrayal and the emotions they felt during and after the notification. Participants experienced considerable emotional distress (e.g. PTSD, anxiety, fear), anger and betrayal, and hope after they were recontacted by the police. Implications for making victim notifications more trauma informed are discussed.

Organizational Readiness and Response During COVID-19: Reflections From a Sexual Assault Agency Serving a Predominately African American Community.

The coronavirus disease 2019 (COVID-19) pandemic forced victim service organizations to establish new service provision protocols to include remote/telehealth services. We conducted N = 12 qualitative interviews with sexual assault advocates working in an urban agency in a predominately African American U.S. city to understand how they adapted services to meet the needs of their community. A thematic analysis revealed this organization was under-prepared for prolonged interruption of in-person services. Even though this agency was able to create telehealth options, many clients did not have the financial and technological resources to utilize these services. Advocates reported that survivors expressed a strong preference for in-person services, which afford more privacy and confidentiality. The pervasive digital divide within this urban community limited survivors' access to comprehensive services and jeopardized their safety.

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.

Evaluation in the Real World: Decision Points and Rationales in Creating A Rigorous Study Designed to Convey Ecologically Valid Findings.

Rigorously evaluating community-based interventions for multiply marginalized populations is fraught with challenges under the best of circumstances. This manuscript describes the methodology chosen to evaluate an innovative model designed to help survivors of intimate partner violence obtain safe and stable housing. We justify the choice of evaluation design from a community psychology perspective and detail why we believe the multi-method, multi-source design, that also focuses on social context, will maximize ecological validity and, therefore, propel the scale-up of the intervention if it is found to be effective. Longitudinal data are being collected from program recipients over time, the advocates who worked with them, agency service records, and monthly documentation of agency resources on hand that can impact services provided. Special attention is focused on capturing contextual information that can impact program success. While randomized control trials are still too often heralded as "the gold standard" for measuring intervention effectiveness, we maintain that the current design, which was developed in partnership with key community stakeholders, holds more promise when evaluating many community-based programs.

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.

Evidence of the Construct Validity of the Scale of Economic Abuse.

This study investigated the construct validity of the Scale of Economic Abuse (SEA). Evidence of construct validity was assessed by examining the relationship between the SEA and an economic outcome, financial resources, as perceived by participants. A sample of 93 women with abusive partners were recruited from a domestic violence organization and interviewed 3 times over a period of 4 months. Hierarchical linear modeling was used to examine the relationship between economic abuse and financial resources over time, controlling for the effects of physical and psychological abuse. The findings indicate that baseline economic abuse was significantly related to baseline financial resources, and within-woman change in economic abuse was significantly predicted change in financial resources over time. The findings suggest that the SEA measures what it is intended to measure: an economic dimension of intimate partner abuse that has damaging economic consequences.

"This Time It Was Different:" Creating a Multidisciplinary, Trauma-Informed, Victim-Centered Approach to Sexual Assault Cold Case Investigations and Prosecutions.

Police and prosecutors recommend that sexual assault survivors have a medical forensic exam and the collection of a sexual assault kit (SAK; also known as a "rape kit") to preserve biological evidence (e.g., semen, blood, saliva, hair) if they want to pursue criminal prosecution. However, law enforcement personnel do not routinely submit SAKs to crime laboratories for forensic DNA testing. Instead, they often place untested kits in storage and close many of these reported cases after minimal investigation. Current estimates indicate there are 300,000 to 400,000 untested SAKs in law enforcement agencies throughout the United States. In response to this national problem, the U.S. Department of Justice created the Sexual Assault Kit Initiative (SAKI) Project to support kit testing, re-investigation, and prosecution of these "cold case" sexual assaults. The SAKI program also provides training and technical assistance to police, prosecutors, and victim advocates on how to use a multidisciplinary, trauma-informed, and victim-centered approach in cold case prosecutions. This study examined the extent to which one SAKI-funded site implemented these three guiding principles in their interactions with victims while prosecuting cold case sexual assaults. We conducted semistructured qualitative interviews with N = 32 sexual assault survivors from the first cohort of cold cases that were re-opened and prosecuted in this jurisdiction. Nearly all cases (n = 31) ended in a guilty plea or trial conviction, and the vast majority of survivors indicated that they had positive experiences with the SAKI team. Survivors noted that they were listened to, believed, supported, and well-prepared by a multidisciplinary team of practitioners who were personally invested in their cases and in their well-being. Implications for creating multidisciplinary, trauma-informed, and victim-centered approaches with other communities are discussed.

Building a culture of support: The use of a social norms campaign to create a trauma-informed campus community.

In 2019, (Michigan State University) conducted a campus-wide climate survey on relationship violence and sexual misconduct (RVSM; the 'Know More' Survey), which revealed that many students, faculty, and staff did not know where to go for help or how to support survivors. Objective: The authors collaborated on the design and launch of the 'Support More' Campaign in 2021-2022, a trauma-informed social norms campaign created to educate the campus community on how to respond to disclosures of RVSM and how to access campus-based services. Methods: Undergraduate students, graduate/professional students, faculty, and staff (n = 10,993) completed another 'Know More' Survey in spring 2022. Results: Nearly one-half of respondents reported being very or somewhat aware of the 'Support More' campaign. Respondents who had utilized campaign materials found them helpful. Conclusions: Social norm campaigns can help campus communities become aware of RVSM services and how to support survivors.

Victim Notification Protocols for Untested Sexual Assault Kits: Survivors' and Advocates' Perspectives on Law Enforcement-Led Outreach Methods.

Current estimates suggest there are 300,000-400,000 untested sexual assault kits (SAKs) in police department storage facilities throughout the United States. As these kits are being discovered and then submitted for forensic DNA testing, legal system personnel may recontact victims. These "victim notifications" involve informing survivors their kits were previously untested, sharing the results of new DNA testing, and asking for their engagement in reinvestigating and prosecuting the case. Typically, victim notifications are conducted by police, and survivors are connected with victim advocates soon thereafter. In this study, we interviewed survivors about their experiences of being notified by the police. We also interviewed about their work supporting survivors. Both survivors and advocates expressed strong concerns about police conducting notifications without an advocate present.

Open science and data sharing in trauma research: Developing a trauma-informed protocol for archiving sensitive qualitative data.

OBJECTIVE: The open science movement seeks to make research more transparent, and to that end, researchers are increasingly expected or required to archive their data in national repositories. In qualitative trauma research, data sharing could compromise participants' safety, privacy, and confidentiality because narrative data can be more difficult to de-identify fully. There is little guidance in the traumatology literature regarding how to discuss data-sharing requirements with participants during the informed consent process. Within a larger research project in which we interviewed assault survivors, we developed and evaluated a protocol for informed consent for qualitative data sharing and engaging participants in data de-identification. METHOD: We conducted qualitative interviews with N = 32 adult sexual assault survivors regarding (a) how to conduct informed consent for data sharing, (b) whether participants should have input on sharing their data, and (c) whether they wanted to redact information from their transcripts prior to archiving. RESULTS: No potential participants declined participation after learning about the archiving mandate. Survivors indicated that they wanted input on archiving because the interview is their story of trauma and abuse and it would be disempowering not to have control over how this information was shared and disseminated. Survivors also wanted input on this process to help guard their privacy, confidentiality, and safety. None of the participants elected to redact substantive data prior to archiving. CONCLUSIONS: Engaging participants in the archiving process is a feasible practice that is important and empowering for trauma survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Post-Assault Health Care for Sexual Assault Survivors During COVID-19: A Mixed Methods Analysis of Service Rates in a Predominately African American Community.

This study examined how the COVID-19 pandemic affected sexual assault healthcare services in a predominately African American U.S. city. In mixed methods research design, we used quantitative interrupted time series modeling to evaluate changes in service rates for three core post-assault healthcare services-medical forensic exams (MFEs), medical advocacy MFE accompaniment, and counseling-from January 2019 through June 2021. We also conducted qualitative interviews with 12 sexual assault advocates to understand how their clients were impacted by COVID and how their agency adapted services to respond to the needs of their community. Both the quantitative and qualitative data revealed marked disruptions in service provision. The number of MFEs, medical advocacy accompaniments, and counseling sessions significantly decreased during the pandemic's initial surge, and survivors feared seeking hospital-based health care due to concerns that they might contract COVID-19 in hospital emergency departments. The number of MFEs performed by program staff did not return to pre-pandemic levels during this study's observation period, but the number of medical advocacy accompaniments and counseling sessions did significantly rebound. Counseling services eventually exceeded pre-pandemic levels as agency staff supported clients with both assault- and COVID-related trauma and loss. These results underscore the need for community-based sexual assault healthcare services, so that if public health emergencies limit the availability, accessibility, and safety of hospital emergency department care, sexual assault survivors have other settings for obtaining post-assault health care.

Supporting sexual assault survivors with disabilities: Tracing disclosure and referral pathways to postassault health care services.

National epidemiological data indicate that nearly 4 in 10 victims of recent sexual assaults have physical, cognitive/developmental, or mental health disabilities, which can make navigating postassault help seeking more challenging. To streamline services, many communities have created sexual assault nurse examiner (SANE) programs for comprehensive health care, crisis intervention, medical forensic evidence collection, victim advocacy, and legal referrals. SANE programs are recommended as the national best practice for postassault care, but there is virtually no U.S.-based research on whether survivors with disabilities seek these services. The present study sought to identify the disclosure and referral pathways that successfully connected sexual assault survivors with disabilities to SANE programs for postassault care. Forensic nurses in one midwestern state recorded information about all adult sexual assault patients (N = 755) who sought care during a 9-month window of data collection. Survivors with disabilities were significantly less likely than those who did not have disabilities to disclose to informal support providers (e.g., family, friends) and those individuals were unlikely to suggest to survivors with disabilities that they seek postassault health care. Survivors with disabilities were significantly more likely than survivors who did not have disabilities to disclose to formal help sources and to be referred to SANE programs by other formal community services, typically the police. A strong referral network from law enforcement to SANE programs is important, but survivors who do not wish to pursue criminal investigation need reliable pathways to postassault health care. Strategies for promoting community awareness of SANE services are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding How Domestic Violence Shelter Rules May Influence Survivor Empowerment.

Domestic violence shelters have historically gone beyond providing emergency residential space for survivors by assisting in obtaining future housing, employment, health care, child care, or legal services. Domestic violence shelters are expected to operate within an empowerment philosophy, with an understanding that survivors are self-determining, can identify their needs, and know what it takes to meet those needs. Recent research has indicated that, as many shelters have become more rigid in creating rules that survivors must follow to access and retain free temporary housing, the result has been survivors' feelings of disempowerment, the complete opposite of what was originally intended. This study builds on the small amount of research conducted regarding survivors' experiences of shelter rules by specifically examining how rules were perceived to affect empowerment. Seventy-three survivors from two domestic violence shelters were asked about their experiences around specific shelter rules relating to curfew, parenting, chores, time limits, food, alcohol, drugs, and medications. A transcendental phenomenological approach was used to analyze the qualitative data, seeking explanations of how survivors made meaning of the rules and how those rules influenced their empowerment. Among those survivors who found the rules problematic, three major themes emerged: (a) rules acted as barriers to carrying out their normal, day-to-day activities; (b) the shelter staff's flexibility with rules was based on contingencies; and (c) rules negatively affected their psychological well-being, and required them to engage in protective behaviors. Recommendations are made for the reexamination and restructuring of rules within domestic violence shelters.

The Right to Say No: Why Adult Sexual Assault Patients Decline Medical Forensic Exams and Sexual Assault Kit Evidence Collection.

INTRODUCTION: The International Association of Forensic Nurses (2018) affirms the importance of evidence-based, trauma-informed, patient-centered forensic nursing services that engage patients as autonomous decision makers. Past research indicates that forensic nurses consistently respect patients' choices and control as they navigate the decisions of medical forensic examinations (MFEs) and sexual assault kit (SAK) collection. Building on that work, this study examined which options patients decline and what factors are associated with those declination decisions. METHOD: We collected prospective data from seven state-funded sexual assault nurse examiner programs. Forensic nurses recorded information about all adult sexual assault patients (N = 783) regarding four primary decisions: whether to have a MFE, whether to consent to all parts of the MFE or to decline specific services, whether to have a SAK collected, and whether to release the SAK to law enforcement for forensic DNA testing. RESULTS: Most patients consented to a MFE (95%), to all parts of the MFE (81%), to SAK collection (99%), and to release the SAK for forensic DNA testing (80%). Younger patients and those with disabilities were more likely to decline some options. Patients who had not disclosed the assault to others before seeking sexual assault nurse examiner care were also more likely to decline a MFE. Whether patients sought post assault care for more health-focused reasons or legally focused reasons was associated with declination decisions. CONCLUSIONS: Healthcare providers should communicate clearly about each step in post assault care and allow patients to decline services as they choose.

Domestic violence advocates' HIV prevention practices with women survivors: Frequency and barriers.

There is strong evidence of the association between being a survivor of domestic violence (DV) and the risk of acquiring HIV. Unfortunately, DV advocates often fail to adequately address this risk. Data from an online survey with a national convenience sample of 677 DV advocates from throughout the United States and territories were used to examine current practices and beliefs about HIV and DV. Encouragingly, advocates reported feeling comfortable discussing sex-related topics with their clients and largely rejected stigmatizing attitudes toward people living with HIV. However, only 16% of the advocates reported regularly engaging in at least half of the HIV prevention practices measured. Barriers to such practices were explored. Findings suggest advocates need further training and organizational supports to adequately address HIV with clients. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

An Examination of Domestic Violence Advocates' Responses to Reproductive Coercion.

Reproductive coercion (RC) is a form of intimate partner violence (IPV) that continues to lack adequate attention by both researchers and practitioners. RC is defined as "male partners' attempts to promote pregnancy in their female partners through verbal pressure and threats to become pregnant (pregnancy coercion), direct interference with contraception (birth control sabotage), and threats and coercion related to pregnancy continuation or termination (control of pregnancy outcomes)." This type of partner violence can have serious consequences on a survivor's health and well-being. Despite the fact that RC has been reported by many women experiencing IPV, and that this type of abuse appears to be disproportionately targeted against marginalized women, little is known about the extent to which advocates either proactively or reactively address it. To redress this, the current study involved a brief online survey sent to domestic violence victim service advocates across the United States and its territories. More than 700 advocates responded about their comfort, practices, and perceived barriers related to RC and survivors' sexual health. Despite identifying (a) low levels of discomfort when discussing most topics relating to RC and (b) few barriers to discussing RC, few advocates reported regularly engaging in RC-related practices. Both greater levels of discomfort and identification of more barriers were associated with less frequent coercion-related practice. Study implications highlight the need for more specialized advocate training, and organizational support for advocates to comfortably and safely provide information and support about RC to survivors.

A State Census of Unsubmitted Sexual Assault Kits: Comparing Forensic DNA Testing Outcomes by Geographic and Population Density Characteristics.

A growing number of U.S. cities and states have large numbers of unsubmitted sexual assault kits (SAKs) in police property facilities. Prior research conducted in large urban cities has found that testing these kits yields a sizable number of DNA profiles that meet FBI eligibility for upload to the national criminal DNA database CODIS (Combined DNA Index System) and uploaded profiles return a substantial number of matches to existing criminal profiles in CODIS. It is unknown whether these findings are unique to large urban cities with high crime rates. The purpose of current study was to document forensic testing outcomes from a state census of previously unsubmitted SAKs, which included large urban-suburban centers, as well as smaller cities and rural counties. We inventoried all previously unsubmitted SAKs in Michigan (N = 3422 SAKs) and submitted all kits for forensic DNA testing. A total of n = 1239 SAKs had a DNA profile that met eligibility for upload into CODIS (36.2% unconditional, 56.5% conditional CODIS eligible rate) and n = 585 SAKs yielded a CODIS Hit (17.1% unconditional, 47.2% conditional CODIS hit rate). These rates are consistent with studies from urban areas suggesting approximately half of SAKs tested yield a CODIS profile and approximately half of those uploaded profiles yield a hit. We compared SAK forensic testing outcomes by geographic and population density characteristics, and although rates were often higher in larger metropolitan areas, the obtained rates in micropolitan and rural areas suggest testing is warranted in smaller jurisdictions as well.