Beyond roofies: Drug- and alcohol-facilitated sexual assault.

ABSTRACT: Substance use in victims of sexual assault, whether voluntary or involuntary, changes the aftermath and recovery process significantly, affecting the way memories are processed and recalled, the chances of developing significant mental health complications, and the disclosure reactions that the survivor receives. Clinicians must understand these differences in order to provide the best possible care to survivors. This article provides an overview of these topics, detailing some of the nuances of interviewing, testing, and the physiology of memory formation and how that affects the outcomes of prosecution in these crimes.

Human trafficking: The relationship between government efforts & survivor punishment.

Human trafficking is a global public health and human rights issue, although it remains unknown how governmental-level systems impact survivors of human trafficking. Survivor punishment (where federal or local officials arrest, fine, imprison, deport, or otherwise punish survivors) is evident even with global promotion of survivor-centred approaches to human trafficking. This study serves as an initial investigation of how government involvement in survivor services and prevention progress are related to survivor punishment. This cross-national study utilised the 2011 Human Trafficking Indicators. Although this dataset heavily relies on the U.S. TIP reports, our analyses are guided by a human rights framework that recognises the importance of prevention and partnerships in mitigating the vulnerability of survivors. Multiple logistic regression was conducted to determine factors associated with survivor punishment. Findings indicate that countries categorised by the U.S. as showing substantial prevention progress have a lower likelihood of survivor punishment (OR = 0.30; 95% CI [0.15, 0.62]). Government survivor service offering was not significantly associated with punishment (OR = 0.65; 95% CI [0.33, 1.28]). Findings call for the development of global measures resulting from international partnerships to characterise stocks and flows of human trafficking, as well as the quality and effectiveness of governmental efforts and partnerships.

Featured counter trafficking program: The law enforcement first responder protocol.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficking children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Law Enforcement First Responder Protocol, which trained law enforcement to recognize youth engaged in sex work as survivors of commercial sexual exploitation, rather than as "prostitutes", and to connect these survivors immediately with social services, advocates, timely medical care and ongoing follow-up.

A Qualitative Study Of Sexual Assault Survivors' Post-Assault Legal System Experiences.

Following sexual assault, survivors may turn to the civil or criminal justice systems in pursuit of some form of legal justice. Informal support providers (SPs) often play a large role in survivors' post-assault experiences and recovery, including providing support during survivors' decision to pursue legal justice and in navigating the system. Yet, this has not been thoroughly examined in research, particularly through a dyadic lens. Using qualitative dyadic data from 45 survivor-SP matched pairs (i.e., friend, family, or significant other), the current study addresses this gap by looking broadly at survivors' post-assault experiences with the criminal and civil legal systems. Of the 45 pairs in the sample, the current study presents findings from a subsample of 28 survivors and 13 SPs regarding post-assault legal system experiences. Our findings suggest that survivors and SPs consider the perceived strength of their case, perceptions of police, and the possibility of institutional bias when deciding to report the assault to the police. Interviews revealed that reasons for legal system involvement extend beyond pursuance of perpetrator prosecution, such as filing for custody of their children after leaving a domestic violence situation or seeking financial compensation. Many survivors who had interactions with the police and legal system experienced secondary victimization, while a few survivors had positive experiences, despite their expectations. We recommend improved access to survivor advocates and suggest directions for future research stemming from findings.

[Minor Victims of Violent Acts in the Context of the Victim Reparation Law]. / Minderjährige Opfer von Gewalttaten im Verfahren des Opferentschädigungsgesetzes.

Objective: A descriptive analysis of victim compensation applications for children and adolescents as well as sociodemographic and trauma-specific information concerning victims and perpetrators. Method: We did analysis of 100 victim-compensation application files based on a self-developed category system. Results: The files included solely interpersonal trauma, 59 % of which are type II trauma. The most frequent form is sexual violence. The perpetrators stem mostly from children's homes or peripherals. 79 % of the victims received a diagnosis of a mental disorder, most often posttraumatic stress disorder. Conclusions: Sexually abused children and adolescents make up the majority of the target population in OEG-related trauma outpatient units. Such outpatient units should therefore offer a specific expertise in treating sexually abused children and adolescents.

Human rights of refugee-survivors of sexual and gender-based violence with communication disability.

Article 19 of the Universal Declaration of Human Rights (United Nations, 1948 ) states that all people have the right to seek, receive and impart information using any means. Ensuring that people with communication disability achieve this right is inherently challenging. For people with communication disability, who are refugee-survivors of sexual and gender-based violence (SGBV), additional human rights are challenged, including the right to education, protection from discrimination, a safe place to live, security of person and legal protection. Their experiences and needs, however, are poorly understood. This paper reports on a literature review of the intersectionality between SGBV, being a refugee and having a communication disability, and a preliminary investigation of the situation of refugee-survivors of SGBV with communication disability, in Rwanda. The project involved 54 participants, including 50 humanitarian and partner organisation staff and four carers of refugees with communication disabilities, from two locations (camp-based and urban refugees). Findings from both revealed that, for people with communication disability, barriers are likely to occur at each step of preventing and responding to SGBV. Moreover, stigmatisation of people with communication disability challenges SGBV prevention/support and people with communication disability may be targeted by SGBV perpetrators. SGBV service providers acknowledge their lack of knowledge and skills about communication disability, but wish to learn. Findings highlight the need for increased knowledge and skill development, in order to improve the situation for refugee-survivors of SGBV with communication disability.

The Subjective Court Experiences of Intimate Partner Violence Victims: Does Motherhood Matter?

Many women with children experience intimate partner violence (IPV). These survivors are particularly important to assist, because countless have complex safety concerns related to their children. Mothers' concerns about their children have been shown to impact their decision making related to abuse, but researchers have not closely explored what happens during mothers' interactions with help sources. This study examined whether women with (n = 98) and without (n = 44) children differ in a) their court experiences through their perceptions of procedural and distributive justice, and b) the context of their lives surrounding the court experience. We also explored the relationship between contextual factors and procedural and distributive justice. Results indicate participants were relatively satisfied with their court experiences, despite experiencing reabuse, danger, and fear throughout court processes. Mothers reported significantly higher levels of distributive justice and contact with the abusive partner than non-mothers. However, mothers did not differ significantly from non-mothers with regard to procedural justice, fear, danger, reabuse or reliance on the abusive partner. Results of multiple regression analyses indicated the interaction between fear and motherhood significantly predicted participants' perceptions of distributive justice, as did the interaction between danger and motherhood. In these interactions, mothers' fear and perceptions of danger were not related to their perception of distributive justice. However, non-mothers who reported higher levels of fear and danger perceived less distributive justice. Results suggest mothers and non-mothers enter the system with similar life contexts, and that these contextual factors impact their perceptions of court outcomes differently.

World Trade Center Health Program; Amendments to Definitions, Appeals, and Other Requirements. Final rule.

In 2011 and 2012, the Secretary, Department of Health and Human Services (HHS), promulgated regulations designed to govern the World Trade Center (WTC) Health Program (Program), including the processes by which eligible responders and survivors may apply for enrollment in the Program, obtain health monitoring and treatment for WTC-related health conditions, and appeal enrollment and treatment decisions, as well as a process to add new conditions to the List of WTC-Related Health Conditions (List). After using the regulations for a number of years, the Administrator of the WTC Health Program identified potential improvements to certain existing provisions, including, but not limited to, appeals of enrollment, certification, and treatment decisions, as well as the procedures for the addition of health conditions for WTC Health Program coverage. He also identified the need to add new regulatory provisions, including, but not limited to, standards for the disenrollment of a WTC Health Program member and decertification of a certified WTC-related health condition. A notice of proposed rulemaking was published on August 17, 2016; this action addresses public comments received on that proposed rulemaking, as well as three interim final rules promulgated since 2011, and finalizes the proposed rule and three interim final rules.

The experiences of survivors and trauma counselling service providers in northern Uganda: Implications for mental health policy and legislation.

Previous research in northern Uganda found high levels of trauma-related difficulties amongst the conflict-affected population. There is international evidence that psychological therapy can reduce depression, as one of the psychological effects of trauma, but very limited literature regarding the experiences of trauma counselling in Sub-Saharan Africa. The current British Academy and Leverhulme-funded research investigated the experiences of service users and providers of trauma services in Kitgum and Gulu, northern Uganda. It also examined their implications for mental health policy and legislation. A decision was made to utilise qualitative methodology to highlight the in-depth experiences of participants. The researcher's carried out interviews with 10 women and 10 men survivors attending trauma services in Kitgum and Gulu. The researchers also interviewed 15 key informants in Kitgum, Gulu and Kampala including trauma counselling service providers, ministers, cultural leaders and mental health professionals. The authors report the findings of the research based on thematic analysis of the interviews. Themes included the experiences of survivors, bearing witness and instilling hope, constraints to service provision, stigma and abuse, holistic approach, service providers doing their best, specialist populations, limited understanding, training and skills development, gaps in service provision and mental health policy and legislation. The interviews resulted in a clear indication that counselling and medication was valued by service users, and that service providers felt the treatments that were provided improved depression, and increased empowerment and engagement in social activities. However, the authors argue that there was a limit to the benefits that could be achieved without using the holistic approach that the survivors requested. Thus, in cases of trauma arising from conflict, there is a clear need for the state to ensure reparation and/or justice for the atrocities witnessed by and perpetrated against survivors. This might include the provision of compensation, which would help to meet social needs and reduce feelings of shame and anger.

The Goals of IPV Survivors Receiving Orders of Protection: An Application of the Empowerment Process Model.

Protection orders (POs) are a widely recommended and commonly used intervention for intimate partner violence (IPV), but evidence for their effectiveness is mixed. This mixed methods study used the framework of empowerment to explore the goals of petitioners who seek POs, and the extent to which one group of experts considers these goals to be a good fit with the court's intent. We collected data in three phases: (a) We conducted a qualitative study to generate a list of goals (n = 10); (b) we administered the list to a sample of IPV survivors (n = 157); and (c) we surveyed a group of attorneys (n = 10). Results showed that petitioners endorse many goals for seeking POs and that while their highest priority goals relate to safety, other nearly universally endorsed goals are more psychological in nature, such as moving on with one's life. Petitioners also use the orders to navigate complex relationships, helping themselves to set boundaries in addition to sending a clear message to respondents. Our group of lawyers viewed petitioners' highest priority goals as a relatively good fit with the system, but was fairly pessimistic about the likelihood of success. Petitioners' ratings of progress toward their goals, at the time of the PO hearing, differed markedly from lawyers' perceptions. Implications for research and practice are discussed.

Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care.

PURPOSE: The study objectives are to examine prevalence of current smoking, and to assess the association of both health insurance (HI) and access to care with smoking cessation among cancer survivors. METHODS: We performed an analysis from a cross-sectional study of cancer survivors aged 18-64 years using nationally representative data from the 2009 Behavioral Risk Factor Surveillance System survey. We assessed the prevalence of current smoking among cancer survivors. Also, in a subset excluding never smokers, we assessed cessation status of cancer survivors operationalized as comparing current to former smokers. RESULTS: The study population (N = 18,896) was predominantly 45-64 years of age, female, and white. The prevalence of current smoking was substantially greater among cancer survivors without HI (40.9 %) than for those with HI (19.5 %). Cancer survivors with no HI had 2-fold greater adjusted odds of not quitting cigarette smoking compared to those with HI. Among those with insurance, cancer survivors who did not have regular health care provider or could not see doctor due to cost or had their last routine checkup ≥1 year ago had 60-80 % fold greater adjusted odds of not quitting cigarette smoking compared to cancer survivors who had better access to health care. CONCLUSIONS: Cancer survivors without HI have substantially greater current smoking rates compared with those with HI. Among cancer survivors with HI, those who experienced health care access-related problems had lower cessation rates than their counterparts. IMPLICATIONS FOR CANCER SURVIVORS: Smoking cessation needs to be recognized as a crucial component of preventive care for cancer survivors. Continuous patient engagement and cancer-patient-centered strategies are urgently needed to achieve optimal results for quit rates particularly for young cancer survivors who are most susceptible to current smoking.

The Impact of Judicial Reform on Crime Victimization and Trust in Institutions in Mexico.

This article studies the impact of judicial reform in Mexico. It does so using a survey about crime victimization and perceptions of insecurity (Encuesta Nacional Sobre la Inseguridad [ENSI]) collected in 2005, 2008, and 2009 in 11 Mexican cities, 3 of which implemented the reform in 2007 and 2008. This analysis shows that judicial reform not only reduces victimization but also lowers perceptions of security. Although we find that judicial reform has a negative effect on trust in the local and federal police, judicial reform reduces the probability of being asked by the transit police for a bribe.

Prosecuting Intimate Partner Sexual Assault: Legal and Extra-Legal Factors That Influence Charging Decisions.

Prosecutors play a crucial role in determining whether persons who are accused of intimate partner sexual assault (IPSA) will be sanctioned by the criminal justice system. Prosecutors have unconditional discretion at the initial charging stage because a case rejection decision is typically immune to review. Using qualitative data from 47 IPSA complaints that were referred to Los Angeles County or City prosecution in 2008, this study examines the factors that influence charging decisions. Findings suggest that prosecutors consider both legal and extralegal factors when making charging decisions and that various cultural, legal, and rape myths surrounding IPSA influence these decisions.

Keeping Victims Informed: Service Providers' and Victims' Experiences Using Automated Notification Systems.

Automated victim notification is often touted as an effective and efficient means for providing victims timely and accurate information of their offenders' court events and status changes at reduced burden to the criminal justice system. Today, 47 states, the District of Columbia, and Puerto Rico have some form of automated notification system. Researchers surveyed 1,246 service providers and 723 victims to examine their awareness and use of, satisfaction with, and experiences using automated notification systems. Findings indicate that service providers are aware of and use automated notification; however, less than one-quarter of victim respondents were registered for automated notification services. Service providers and victims who use automated notification services report high overall satisfaction; however, they also report challenges in using these systems. Service providers offer several recommendations for improving automated notification systems.

Cancer survivorship advocacy.

OBJECTIVES: To review the advocacy initiatives of major cancer-related organizations and coalitions that are working to effect funding, planning, and implementation of care and services for cancer survivors. DATA SOURCES: Web sites of cancer-related member organizations, advocacy associations' policy staff representatives, and published peer-reviewed health policy literature. CONCLUSION: Health care reform creates near endless opportunities for nurses to participate in and contribute to the development of public policy to support meeting the needs of cancer survivors. IMPLICATIONS FOR NURSING PRACTICE: Emerging public policy initiatives, including legislation and regulation created with professional nursing's contributions are most likely to reflect the needs of cancer survivors.

What are cancer survivors' needs and how well are they being met?

PURPOSE: This study sought to identify the needs and unmet needs of the growing number of adult cancer survivors. METHODS: Vermont survivor advocates partnered with academic researchers to create a survivor registry and conduct a cross-sectional survey of cancer-related needs and unmet needs of adult survivors. The mailed survey addressed 53 specific needs in 5 domains based on prior research, contributions from the research partners, and pilot testing. Results were summarized by computing proportions who reported having needs met or unmet. RESULTS: Survey participants included 1668 of 2005 individuals invited from the survivor registry (83%); 65.7% were ages 60 or older and 61.9% were women. These participants had received their diagnosis 2 to 16 years earlier; 77.5% had been diagnosed ≥5 years previously; 30.2% had at least one unmet need in the emotional, social, and spiritual (E) domain; just 14.4% had at least one unmet need in the economic and legal domain. The most commonly identified individual unmet needs were in the E and the information (I) domains and included "help reducing stress" (14.8% of all respondents) and "information about possible after effects of treatment" (14.4%). CONCLUSIONS: Most needs of these longerterm survivors were met, but substantial proportions of survivors identified unmet needs. Unmet needs such as information about late and long-term adverse effects of treatment could be met within clinical care with a cancer survivor care plan, but some survivors may require referral to services focused on stress and coping.