Sexual Assault Response Team Goals and Motivations for Development.

Sexual Assault Response Teams (SARTs) are community-based, multidisciplinary interventions that strive to coordinate the response to sexual assault. SARTs consist of sexual assault responders (e.g., rape crisis advocates, police, forensic examiners/Sexual Assault Nurse Examiners, and prosecutors) and seek to increase responder collaboration to improve survivors' help-seeking experiences. There is a lack of empirical research examining factors underlying SARTs' goals and what leads communities to form SARTs. Therefore, this study sought to examine the goals and motivations present in SART development using a multiple-methods approach with a national random sample of n = 172 SARTs. Exploratory factor analysis (EFA) was used to examine factors underlying SART goals, and qualitative thematic analysis was used to explore what motivators drove SART formation. Both qualitative and quantitative analyses underscored the importance of improving the accessibility and quality of services, improving the treatment of survivors, and increasing responder collaboration. The qualitative findings offered additional insight into the importance of community education and various community contextual factors (e.g., funding and policy requirements) that influence SARTs. Findings inform future research and practice on SART goals and functioning, such as how SART goals may relate to team structure, effectiveness, and capacity-building opportunities.

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.

Rape Crisis Victim Advocacy: A Systematic Review.

While rape crisis center (RCC) advocacy is generally regarded as valuable, there are no prior systematic reviews of the advocacy literature. This review examined RCC advocacy service provision, perceptions and impact of advocacy, and challenges and facilitators to effective service provision. Databases related to health and social sciences were searched including Academic Search Complete, PsychINFO, PubMed, CINAHL, ProQuest, Science Direct, OAlster, WorldCat, and MEDLINE. Empirical articles written in English that examined RCC advocacy service provision and/or impact in the US were included. The researchers reviewed abstracts and titles, and then full texts. Forty-five articles met criteria, were summarized, and double checked. Findings demonstrate advocacy is multi-faceted, beneficial, and challenging. Advocates work directly with survivors and interact with other responders on behalf of survivors. Specifically, advocates provide emotional support, safety plan, support survivors in making decisions, and assist them in navigating other systems. While advocates are generally regarded positively by survivors and responders, some responders have concerns about advocates. In addition, advocates sometimes report victim-blaming and being ill-equipped to meet survivors' needs. Finally, advocates face specific challenges in their work with survivors and responders. Future research using diverse methodological approaches is needed to understand advocacy utilization and reach; survivors' perceptions of advocacy; marginalized survivors' experiences; connections between specific services, implementation, and outcomes; and effective strategies for advocates' interactions with other responders. Additional resources to help advocates serve all survivors effectively and equitably; to support evaluator-practitioner partnerships; and to share unpublished data on advocacy may help contribute to improvements in advocacy practice.

Police decisions to found sexual assault cases: The influence of community-level factors and space.

Previous research has examined the influence of individual- and case-level factors on police decisions in sexual assault cases, with little attention paid to community-level factors. This study examined the association between community-level factors and police decisions to found sexual assault cases. Founding is the first decision officers make and determines whether a case is investigated. An archival data set of N = 8015 sexual assaults reported to a Midwestern city police department was used. Ordinary least squares (OLS) regression was first used to examine the relationship between six community-level factors and founding rates within the city's 77 communities. Geographically weighted regression (GWR) was then used to examine whether these relationships varied by space. OLS results revealed communities with a greater proportion of Black residents, Latinx residents, Asian residents, and higher income had significantly higher founding rates. GWR results replicated these findings indicating these relationships varied significantly by space throughout the city. In contrast to the OLS, GWR results indicated communities farther from a rape crisis center had higher founding rates. Findings underscore the importance of analyzing localized effects and examining individual-, case-, and community-level factors on sexual assault case outcomes in the criminal legal system.

Reflecting and rejuvenating our work, together: One team's consideration of AJCP publications on gender-based violence.

Community psychology has long valued reflexive praxis as a critical part advancing our research and action. In this Virtual Special Issue (VSI), we, a group of community psychologists and gender-based violence (GBV) researchers at many different points in our careers, reflected on GBV publications that have appeared in AJCP. We examine the ways in which community psychology broadly and articles in AJCP more specifically have conceptualized GBV as a sociocultural issue, how GBV intersects with other oppressions and forms of violence, the tension when systems that aspire to support survivors are inequitable and focused on ameliorative change, and the importance of interventions being locally informed and locally driven. By highlighting selected GBV-focused articles published in AJCP, this VSI discusses (a) understanding and transforming culture via robust research and local partnerships, (b) targeting effective interventions for survivors, (c) invoking systems and targeting change in institutional environments, and (d) making connections between local efforts and broader social movements. To continue to move forward, we conclude we must reflect, embrace methodological plurality, partner, and push for structural change. Reflective questions regarding research and action are offered, to address gender-based violence.

A Qualitative Examination of Collaborative Infrastructure within Sexual Assault Response Teams.

Sexual assault response teams (SARTs) are multidisciplinary interventions that seek to improve the response to sexual assault in their community. SARTs bring together relevant stakeholders (e.g., sexual assault advocates, medical/forensic examiners, police, prosecutors) to coordinate the response to sexual assault and improve survivors' help-seeking experiences. SARTs may adopt various infrastructures to guide their team (e.g., case review, subcommittees), but little is known about how infrastructure influences SART effectiveness. Therefore, this qualitative study examined the helpful versus challenging aspects of SART infrastructure. Interviews from a national random sample of 169 SART leaders revealed helpful versus challenging aspects of mission statements, formal protocols, subcommittees, team roles, trainings, meetings, and case review. Participants believed infrastructures have positive influences on interdisciplinary relationships, team efficiency, and creating improvements in responding to sexual assault. However, certain infrastructures were difficult to implement for some teams. Additionally, some infrastructures can have unintended consequences, such as exacerbating team conflict. Findings suggest that SARTs may benefit from first focusing on infrastructures that build trusting interdisciplinary relationships and widespread buy-in prior to implementing accountability-focused measures (e.g., protocols, case review).

Who Helps the Helpers? Social Support for Rape Crisis Advocates.

Secondary exposure to trauma may have negative effects on rape victim advocates' well-being. Self-care can help to mitigate these negative effects on advocates' well-being, and prior research suggests that social support is an especially important aspect of advocates' self-care. However, there is a lack of research on how rape crisis advocates access and receive social support in relationship to their advocacy work. Therefore, semistructured qualitative interviews were conducted with 15 rape crisis advocates who volunteered for a rape crisis center in Chicago to understand how they accessed social support from informal and formal support providers, and when they did receive support, what was helpful versus unhelpful. Data were analyzed using thematic content analysis. Results revealed that many advocates were able to seek out and receive positive instrumental and emotional social support that nurtured them and their work. However, advocates also experienced a variety of barriers to obtaining positive support from informal support providers, including fear of burdening providers and a reluctance or lack of preparedness of their support providers to speak about the issue. Advocates emphasized the need for rape crisis centers to provide resources for their informal social support systems in order to encourage helpful responses. In addition, advocates praised the rape crisis center for its built-in formal support structures, but also encouraged the organization to seek broader representation of persons from minority backgrounds among their advocates and mentors. Implications and future directions for research and rape crisis centers are also discussed. The present study highlights the importance of social support systems for advocates and potential barriers that may be addressed to reduce service provider burnout and vicarious trauma.

Stressors of Rape Crisis Work From the Perspectives of Advocates With and Without Sexual Assault Victimization History.

Rape crisis centers largely rely on volunteers for delivering emergency room advocacy to survivors of sexual assault. Volunteer advocates bear witness to trauma as part of their role, such as when listening to details of sexual assault. This exposure may negatively affect advocates long term, which may lead to secondary traumatic stress and vicarious traumatization, and possibly reduce their ability to provide quality services and remain in their role. In addition, some advocates may be survivors of sexual assault themselves. Survivors may differentially experience the toll of advocacy work. The present qualitative study sought to identify stressors that advocates face within their role, aspects of stressors unique to survivors who advocate, and the effects of stressors on advocates. Semistructured interviews were conducted with 18 current volunteer advocates, 11 of whom identified as survivors, from three rape crisis centers. Findings demonstrated stressors associated with self-evaluation; rules or expectations of the role (including the crisis nature of the role); witnessing lack of client support; helplessness around sexual assault as a systems issue; identifying with the client; witnessing the physical and emotional impact on clients; and being reminded of their own assault. Results also revealed how these stressors and advocacy overall influenced advocates. Unique aspects of stressors to survivors arose in the way advocates experienced the stressors. In addition, survivors exclusively described being reminded of past trauma within advocacy work. Findings have implications for supporting advocate well-being by better understanding the stressors that may lead to negative outcomes and informing individual coping, training, and overall organizational support of advocates. Such measures may ensure retention of volunteers and maintain quality advocacy services.

Overcoming the "Holy Hush": A Qualitative Examination of Protestant Christian Leaders' Responses to Intimate Partner Violence.

Described as a "holy hush," past research has noted a general silence about and reluctance to address intimate partner violence (IPV) in religious congregations. To explore this, we interviewed 20 Protestant Christian religious leaders about how they understood and responded to IPV. Based on a thematic content analysis, our study revealed some of the challenges, tensions, and complexities that may be barriers to leaders speaking about and responding to IPV, and also the ways religious leaders in our sample attempted to overcome these challenges. For example, results revealed religious leaders understood violence on a gradation from less to more severe, and linked a need for and type of response to the level of violence. Throughout, religious leaders expressed a tension between their leadership role and responding to IPV. Furthermore, religious leaders acknowledged their need for greater training and connections to service providers, however, they reported not currently being connected to other IPV resources or organizations in the community. We discuss how the findings illuminate challenges and tensions for religious leaders in responding to IPV and how some leaders in this study were navigating these tensions to respond. We also discuss how findings may inform future research and the development of trainings and protocols for religious leaders and congregations on responding to IPV, promoting survivor safety, and fostering a greater understanding of IPV. Implications for collaboration with other community-based IPV organizations are also discussed.

Using Social Network Analysis to Identify Successful Relationship Patterns Within Sexual Assault Response Teams (SARTs).

The current study used social network analysis (SNA) to examine relationships within three effective Sexual Assault Response Teams (SARTs) that coordinate the response of legal, medical, and advocacy organizations to sexual assault. Within each SART, organizations reported on each other member organization valuing their role, serving as a resource to their work, and communication outside of official meetings. Across the SARTs, there was high connectedness and reciprocity and low to moderate dependence on one organization to drive relationships. However, there was dependence on a subgroup of organizations to drive additional communication relationships. Implications for managing relationships in SARTs are discussed.

Anogenital and Physical Injuries in Adolescent Sexual Assault Patients: The Role of Victim-Offender Relationship, Alcohol Use, and Memory Impairment.

Prior research has documented high rates of anogenital and physical injuries among adolescent sexual assault patients. Although a number of factors related to rates of injury detection in adolescents have been identified, there may be additional features of the assault that are disclosed in the patient history that could be important indicators of injury risk. The purpose of the current study was to expand this literature by examining whether factors that are salient in sexual assaults committed against adolescents-victim-offender relationship, substance use, and memory impairment-are associated with documented anogenital and physical injury rates. Results indicated that victim-offender relationship, substance use, and assault memory are significantly related to the number of anogenital injuries and, particularly, the number of physical injuries detected in adolescent sexual assault patients. These results highlight the importance of a comprehensive patient history, including assessment of alcohol and drug use and memory impairment, to guide the medical forensic examination.

Pathways to help: adolescent sexual assault victims' disclosure and help-seeking experiences.

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

Coordinated Community Efforts to Respond to Sexual Assault: A National Study of Sexual Assault Response Team Implementation.

Sexual Assault Response Teams (SARTs) bring together sexual assault responders (e.g., police, prosecutors, medical/forensic examiners, rape victim advocates) to coordinate and improve the response to sexual assault. Ultimately, SARTs seek to improve sexual assault victims' experiences of seeking help and sexual assault case outcomes in the criminal justice system. To date, there are hundreds of SARTs across the United States and yet, there has been no nationally representative study of how SARTs are implemented. Therefore, the current study used a multistep process to create the first sampling frame of SARTs and then studied how SARTs are structured and function within a random sample of SARTs. Findings reveal commonalities as well as variation across SARTs. Most SARTs rated improving legal outcomes, improving victims' help-seeking experiences, and prevention/education as important goals, yet most prioritized their time and energy toward victims' experiences. SARTs' membership varied, with an average of 12 organizations involved in the SART, and 75% of SARTs having active membership from police, prosecutors, rape victim advocates, and medical/forensic examiners. SARTs were moderately formalized and most SARTs engaged in most collaborative processes (e.g., multidisciplinary cross-training, case review, policy/protocol development, and review) on an as needed basis. Finally, results revealed that some types of cross-system coordination in responding to victims/cases were quite frequent, whereas other types of coordination were quite infrequent. Implications for future research and supporting the development and sustainability of SARTs are discussed.

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.

Examining cumulative victimization, community violence exposure, and stigma as contributors to PTSD symptoms among high-risk young women.

This study examines patterns of lifetime victimization within the family, community violence exposure, and stigma as contributors to posttraumatic stress disorder (PTSD) symptoms within a sample of 198 high-risk young women who are pregnant or parenting. We used cluster analysis to identify 5 profiles of cumulative victimization, based on participants' levels of witnessing intimate partner violence (IPV), physical abuse by an adult caregiver, and sexual victimization, all beginning by age 12. Hierarchical regression was used to examine these 5 clusters (ranging from a High All Victimization cluster characterized by high levels of all 3 forms of violence, to a Low All Victimization cluster characterized by low levels of all 3 forms), along with community violence exposure and stigma, as predictors of PTSD symptoms. We found that 3 of the cumulative victimization clusters, in comparison with Low All Victimization, were significant predictors of PTSD symptoms, as was stigma, while community violence exposure was not a significant predictor.

Beyond deficits: intimate partner violence, maternal parenting, and child behavior over time.

Exposure to intimate partner violence (IPV) has negative consequences for children's well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers' parenting. The current study employed path analysis to examine the relationships among IPV, mothers' parenting practices, and their children's externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant, such that higher IPV led to higher authoritative parenting and lower child behavior problems [corrected]. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women's and children's well-being in the context of IPV are discussed.

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

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

The effects of adolescent intimate partner violence on women's educational attainment and earnings.

Intimate partner violence (IPV) is a serious, widespread problem that negatively affects women's lives, including their economic status. The current study explored whether the financial harm associated with IPV begins as early as adolescence. With longitudinal data from a sample of 498 women currently or formerly receiving welfare, we used latent growth curve modeling to examine the relationships between adolescent IPV, educational attainment, and women's earnings. We found that women who had been victimized by a partner during adolescence obtained less education compared with nonvictimized women, with victimization indirectly influencing women's earnings via educational attainment. The findings support the need for intervention strategies aimed at preventing IPV and promoting women's educational and career development over the life course.

Sexual assault response teams (SARTs): an empirical review of their effectiveness and challenges to successful implementation.

Historically, the response of the legal, medical, and mental health/advocacy systems to sexual assault has been inadequate and uncoordinated. To address this problem, communities have developed coordinated sexual assault response teams (SARTs) to address these problems. SARTs are community-level interventions that seek to build positive relationships and increase collaboration among sexual assault responders. SARTs hope to improve both the community response to sexual assault victims and the processing of sexual assault cases through the criminal justice system. This article has three aims: to summarize the historical development of SARTs in the United States, to review the empirical literature on SARTs' effectiveness at improving multidisciplinary relationships, legal outcomes, and victims' help-seeking experiences; and to review the empirical literature on the challenges SARTs face, which may hamper their effectiveness. Findings suggest that SARTs are a promising practice, but face many challenges; further methodologically rigorous research is needed to more fully understand these interventions. Implications for policy, practice, and future research are discussed.

Adolescent sexual assault victims and the legal system: building community relationships to improve prosecution rates.

Adolescents are at high risk for sexual assault, but few of these crimes are reported to the police and prosecuted by the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary interventions to improve post-assault care for victims and increase prosecution rates. The two most commonly implemented interventions are Sexual Assault Nurse Examiner (SANE) Programs and Sexual Assault Response Teams (SARTs). The purpose of this study was to determine whether community-level context (i.e., stakeholder engagement and collaboration) was predictive of adolescent legal case outcomes, after accounting for "standard" factors that affect prosecution success (i.e., victim, assault, and evidence characteristics). Overall, 40% of the adolescent cases from these two SANE-SART programs (over a 10-year period) were successfully prosecuted. Cases were more likely to be prosecuted for younger victims, those with disabilities, those who knew their offenders, and instances in which the rape evidence collection kit was submitted by police for analysis. After accounting for these influences, multi-level modeling results revealed that in one site decreased allocation of community resources to adolescent sexual assault cases had a significant negative effect on prosecution case outcomes. Results are explained in terms of Wolff's (Am J Community Psychol 29:173-191, 2001) concept of "over-coalitioned" communities and Kelly's (1968) ecological principles.