Improving Formal Support After Sexual Assault: Recommendations From Survivors Living in Poverty in Canada.

Despite the extensive and often long-lasting sequelae of sexual assault, a significant majority of survivors do not seek assistance from formal support sources, such as police, medical or mental health professionals, and community-based agencies. While growing attention has been directed toward understanding the help-seeking barriers faced by sexual assault survivors, few studies have explored the experiences of survivors living in poverty and how help-seeking can be improved for this marginalized population. The present study sought to understand these issues from perspectives of survivors themselves. Women sexual assault survivors who self-identified as living in poverty (n = 15) were recruited from community-based agencies in the Greater Toronto Area, and participated in semistructured interviews focused on their personal decisions around help-seeking and broader views on access to and quality of formal assistance. Two research questions were of interest. First, what can be done to encourage service use among survivors living in poverty? Second, what is needed to improve the quality of assistance they receive? Thematic analysis revealed three key themes around which participants' recommendations centered: (a) increased accessibility of information, (b) improved training for formal support providers, and (c) greater opportunities for empowerment. Practical implications of these findings improving the service utilization rates and experiences of formal help-seeking among marginalized women survivors of sexual assault are discussed.

The relationship between interpersonal trauma history and the functions of non-suicidal self-injury in young adults: An experience sampling study.

Non-suicidal self-injury (NSSI) has been reported to serve a range of functions for individuals who engage in it. Despite considerable variation in NSSI functions between individuals, limited attention has been paid to exploring relationships between NSSI functions and other characteristics of self-injuring individuals, such as trauma history. This is despite allusion to trauma history in the suggested etiology of some NSSI functions (e.g., anti-dissociation, self-punishment). The present study used a 21-day online daily diary to explore possible relationships between common NSSI functions and past interpersonal trauma in community young adults (n = 38). The interpersonal boundaries and anti-dissociation functions significantly related to interpersonal trauma severity in multiple regression analyses; the interpersonal boundaries function continued to significantly relate to interpersonal trauma severity when controlling for the number of NSSI functions endorsed.

The influence of stereotypical beliefs, participant gender, and survivor weight on sexual assault response.

The present study explored the influence of survivor weight and participant gender, rape myth acceptance, and antifat attitudes on perceptions of sexual assault. Using an online survey tool, a community sample of 413 adult Canadian residents reviewed a hypothetical sexual assault scenario and completed a series of evaluations and attitudinal questionnaires. Generalized linear model analyses revealed that participants were more likely to hold the survivor responsible, excuse the perpetrator's actions, and respond more negatively toward the survivor and more positively toward the perpetrator when the survivor was depicted as thin versus overweight. Interactions were found between rape myth acceptance and survivor weight, gender and survivor weight, and gender and antifat attitudes, for certain dependent variables. In addition, men and those with higher levels of rape myth acceptance and antifat attitudes were found to make more negative evaluations of the survivor and more positive evaluations of the perpetrator. Recommendations for future research and interventions are discussed.

Measuring hope: is hope related to criminal behaviour in offenders?

In contrast to growing regard for the psychological construct of hope in medical and psychological arenas, hope has not yet found a permanent place in the field of criminology. Traditionally, treatment programs and risk assessment tools have focused on the deficits that criminal offenders possess. However, the orientation of our approach to corrections has recently shifted to embrace more strengths-based, offender-focused programming designed to rehabilitate offenders. The assessment for risk for recidivism has been slower to make this transition and use research supporting the use of more dynamic risk factors for reducing reoffending. This study investigates the nature of hope in offenders in relation to their risk for future criminal behaviour. The results indicate that hope is indeed related to the risk for reoffending. The information obtained through this research will inform researchers and clinicians about the nature of hope in a correctional population and its relation with risk for future criminal behaviour.

Sexual offenders' state-of-mind regarding childhood attachment: a controlled investigation.

Attachment experiences have been regarded as significant by researchers and clinicians attempting to explain the etiology of sexual offending. Although initial studies have revealed some promising evidence, there are a number of theoretical and methodological problems with this preliminary body of work. While addressing these limitations, the goal of the present study was to investigate state-of-mind regarding childhood attachment among subtypes of sexual offenders, comparing them to both a sample of nonsexual offenders and to the documented patterns of nonoffenders. Sixty-one sexual offenders (extrafamilial child molesters, incest offenders, and rapists) and 40 nonsexual offenders (violent and nonviolent) were administered the "Adult Attachment Interview." Results indicated that the majority of sexual offenders were insecure, representing a marked difference from normative samples. Although insecurity of attachment was common to all groups of offenders, there were important differences in regard to the specific type of insecurity. Most notable were the child molesters, who were significantly more likely to be Preoccupied. Rapists, violent offenders, and, to a lesser degree, incest offenders were more likely to be Dismissing. Although still most likely to be Dismissing, nonviolent offenders were comparatively more Secure.

Comparisons of sexual assault among older and younger women.

This study examined the nature and extent of coercion, violence, and physical injury among older victims of sexual assaults (55 years and older) and compared these with the sexual assault victims of mid-age (31-54 years) and younger women (15-30 years). The results of this investigation reveal that older victims of sexual assault are more likely to be living alone at the time of the attack. In addition, older victims of sexual assault tended to report higher rates of vulnerabilities such as psychiatric and cognitive disabilities than did younger female victims. In contrast to younger victims, elder sexual assault victims are also more likely to be assaulted in their own home and one-quarter of older victims require ambulance involvement. Although the use of weapons was most likely in the sexual assaults of younger women, the use of physical violence and restraint was common and equally likely among all three groups. Similarly, vaginal penetration and the presence of physical trauma were just as likely in elder victims as in younger victims of sexual assault. These results reveal new information about the nature and extent of violence and coercion in elder female sexual assaults. The vulnerability of the older victims illustrated in this investigation raises a number of research questions about these women's prior history of victimization and future safety.

Sexual assault services delivered by SANEs.

Sexual Assult Nurse Examiner (SANE) programs have become the standard of care for sexual assault victims in many urgent care settings. This study examines SANE clinical nursing practices at one Canadian sexual assault urgent care centre.

Stranger and acquaintance sexual assault of adult males.

This study examined victim and assault characteristics and the nature and extent of coercion, violence, and physical injuries among adult male victims of sexual assaults. Client records of three groups presenting to a sexual assault care center were included: males assaulted by a stranger (n = 64), males assaulted by an acquaintance (n = 81), and females assaulted by an acquaintance (n = 106). Study results revealed that male victims of sexual assault tended to be young, single men who reported high rates of vulnerabilities such as homelessness and physical, psychiatric, and cognitive disabilities. Male stranger assailant victims were more likely to experience assaults involving weapons and physical violence. Injuries sustained by victims and services delivered at the sexual assault care center were similar for both male and female clients. The results of this study reveal new information about violence in male sexual assaults and the vulnerability of the male victims.

Acute forensic medical procedures used following a sexual assault among treatment-seeking women.

Despite the negative physical and mental health outcomes of sexual assault, a minority of sexually assaulted women seek immediate post-assault medical and legal services. This study identified the number and types of acute forensic medical procedures used by women presenting at a hospital-based urgent care centre between 1997 and 2001 within 72 hours following a reported sexual assault. The study also examined assault and non-assault factors associated with the use of procedures. It was hypothesized that assault characteristics resembling the stereotype of rape would be associated with the use of more procedures. The multiple regression indicated that injury severity, coercion severity, homelessness, and delay in presentation were significantly associated with the number of procedures received. Findings provide partial support for the hypothesis that post-assault procedures would be associated with the stereotype of rape, and highlight homeless women as a group particularly at risk for not receiving adequate medical treatment following a sexual assault.

An exploration of childhood victimization and family-of-origin characteristics of sexual offenders against children.

A comparison of the childhood victimization experiences and family-of-origin characteristics of 33 sexual offenders against children, 66 violent offenders, and 25 nonviolent offenders participating in assessment or treatment at a forensic division of a Canadian psychiatric hospital was undertaken using a semistructured interview designed specifically for this study. Overall, 31.5% of the sample reported contact sexual abuse (i.e., oral, vaginal, or anal) by age 14. Sexual offenders against children reported significantly more sexual abuse than both violent and nonviolent offenders and were more likely to have been sexually propositioned and exposed to. Sexual offenders against children were also more likely to report physical discipline as the primary type of discipline in the home. Analyses of the variables concerning characteristics of parents, siblings, and significant others also indicated significant differences between groups. Implications of these findings on the intergenerational hypothesis are discussed as well as their relevance for treatment.

Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression.

This study compared process-experiential and cognitive-behavioral psychotherapy in the treatment of major depression in a researcher allegiance-balanced randomized clinical trial. Sixty-six clients participated in weekly sessions of psychotherapy for 16 weeks. Clients' level of depression, self-esteem, general symptom distress, and dysfunctional attitudes significantly improved in both therapy groups. Clients in both groups showed significantly lower levels of reactive and suppressive coping strategies and higher reflective coping at the end of treatment. Although outcomes were generally equivalent for the 2 treatments, there was a significantly greater decrease in clients' self-reports of their interpersonal problems in process-experiential than cognitive-behavioral therapy.

Immediate and delayed treatment seeking among adult sexual assault victims.

There is a growing body of literature which seeks to better understand the needs of sexual assault victims presenting for specialized treatment. This study explored aspects of immediate and delayed treatment seeking among 1118 women who presented for treatment to a specialized sexual assault care centre within a large urban hospital. Variables related to demographic and assault-specific characteristics were examined for association with immediate (within 12 hours) or delayed (after 12 hours) treatment seeking. Results indicate the severity of the attack prompted women to seek treatment earlier and that women who were assaulted by a known perpetrator were more likely to delay seeking assistance. Findings are conceptualized under the rubric of sociological and feminist frameworks with suggestions for additional research.

Efficacy of a 2-year-old sexual assault nurse examiner program in a Canadian hospital.

INTRODUCTION: The purpose of this study was to describe a sexual assault nurse examiner (SANE) program at a hospital-based sexual assault care center in Ontario, Canada, and assess its efficacy in comparison with physician examiners. METHODS: Data obtained from the hospital records of 515 women who came to a Toronto sexual assault care center were examined. A number of variables relevant to this assessment of services were examined, including client demographics and presenting history, aspects of the sexual assault, and characteristics of the treatment. RESULTS: Average assessment times were shorter for victims seen by SANEs than for victims seen by physicians (approximately 3(1/4) hours versus 4 hours). Physicians had more interruptions (25.1%) than did SANEs (20.0%). Client characteristics and presentation were similar regardless of who provided care, with some exceptions. DISCUSSION: The results of the study support the utility of the SANE model as an efficient program for the assessment and treatment of victims of sexual assault.