Sexual Assault Treatment Centers Research Articles

Prevalence of Adult Female Genital Trauma After Acute Sexual Assault: The Need for a Universal Definition of Genital Trauma.

Examination of the adult female genitalia after an acute sexual assault may reveal findings interpreted by the examiner as injuries, which may be linked to later legal outcomes. There is no consistent definition in the literature regarding what findings constitute genital trauma after sexual assault. We studied how the prevalence of genital trauma is impacted by the inclusion/exclusion of various genital findings reported in the literature. A retrospective descriptive chart review of the sexual assault forensic records from a provincial regional sexual assault treatment center was conducted over a 4-year period and included 67 female patients, 12 years old and over, who reported being sexually assaulted in the previous 72 hours and received a complete forensic examination. We studied the prevalence of genital trauma, using eight definitions of trauma, as well as the percentage of each type of genital finding within this population. The prevalence of genital trauma in this population ranged from 52%, the majority, to 31% of women, depending on the definition of trauma utilized. Forty-one percent of the findings, the greatest number overall, were redness. Bruises, abrasions, and tears (lacerations), the components of blunt force trauma, accounted for 4%, 15%, and 14% of the findings, respectively. A universal definition of what findings constitute genital trauma after acute sexual assault is required if the examiner, as expert witness, is to compare findings in a given case with the broader literature and assist the court in ensuring an informed process of decision making.

A confirmatory test for sperm in sexual assault samples using a microfluidic-integrated cell phone imaging system

Rapid and efficient processing of sexual assault evidence to accelerate forensic investigation and decrease casework backlogs is urgently needed. Therefore, the standardized protocols currently used in forensic laboratories can benefit from continued innovation to handle the increasing number and complexity of samples being submitted to forensic labs. To our knowledge, there is currently no available rapid and portable forensic screening technology based on a confirmatory test for sperm identification in a sexual assault kit. Here, we present a novel forensic sample screening tool, i.e., a microchip integrated with a portable cell phone imaging platform that records and processes images for further investigation and storage. The platform (i) precisely and rapidly screens swab samples (<15 min after sample preparation on-chip); (ii) selectively captures sperm from mock sexual assault samples using a novel and previously published SLeX-based surface chemistry treatment (iii) separates non-sperm contents (epithelial cells and debris in this case) out of the channel by flow prior to imaging; (iv) captures cell phone images on a portable cellphone-integrated imaging platform, (v) quantitatively differentiates sperm cells from epithelial cells, using a morphology detection code that leverages Laplacian of Gaussian and Hough gradient transform methods; (vi) is sensitive within a forensic cut-off (>95% accuracy) compared to the manual counts; (vii) provides a cost-effective and timely solution to a problem which in the past has taken a great deal of time; and (viii) handles small volumes of sample (20 μL). This integration of the cellphone imaging platform and cell recognition algorithms with disposable microchips can be a new direction toward a direct visual test to screen and differentiate sperm from epithelial cell types in forensic samples for a crime laboratory scenario. With further development, this integrated platform could assist a sexual assault nurse examiner (SANE) in a hospital or sexual assault treatment center facility to flag sperm-containing samples prior to further downstream testing.

(188) Clinically Significant New or Worsening Pain is Common Six Weeks after Sexual Assault: Results of a Large-Scale Cohort Study

Many adult women sexual assault (SA) survivors report persistent pain triggered by the assault, yet to date no large-scale longitudinal studies of adult women SA survivors have been performed. In this analysis, we evaluated the severity and distribution pain symptoms during the first six weeks after SA among women participating in an ongoing, large-scale, multisite study that enrolls women SA survivors in the immediate aftermath of assault and evaluates health outcomes over time. Women ≥ 18 years of age (n= 549) who presented to one of 14 sexual assault treatment centers in the immediate aftermath of assault were enrolled. In the immediate aftermath of assault, moderate or severe pain (severity score ≥ 4 on a 0-10 NRS) was reported by 394/549 (72%) of women. Clinically significant new or worsening pain (pain increase of ≥ 2 on a 0-10 NRS in comparison to reported pain during month prior to assault (assessed at one-week follow-up) was present in 76% of women SA survivors one week after the assault and 54% of women SA survivors six weeks after the assault. Most women SA survivors reported pain in many body regions, with a mean of 8 (SD = 6) body regions with pain at the time of initial exam, 8 (SD = 7) body regions with pain at one-week follow-up, and 5 (SD = 6) at 6 week follow-up. The most common body regions affected by persistent pain were the back (49%), neck (43%), and head (41%). These data indicate that clinically significant new or worsening pain, with pain in a number of body regions, is present in most women sexual assault survivors in the weeks after assault. Research is needed to determine the mechanisms responsible for this pain, and to identify preventive/treatment interventions.

A Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South Africa

ABSTRACTChild sexual abuse is endemic in South Africa, driven by high levels of gender-based violence and underscored by structural and social factors. This article aims to develop an understanding of the process of disclosure in a sample of female children and their caregivers. In-depth semistructured interviews were conducted with 31 female children aged 8–17 years and their caregivers at 3 intervals after presentation to a sexual assault treatment center. Nearly half of the children failed to disclose the sexual abuse immediately, fearing caregivers’ reaction. Most children purposefully disclosed to a confidant through a process of identifying an intermediary to tell caregivers on their behalf. The process of disclosure was influenced by multiple factors, such as a fear of the caregiver’s reaction and disbelief, which is related to parental style. Disclosure was found to be a dynamic process that unfolds and not a single or static event and influenced by multiple factors which all impact on recovery. Our findings highlight the need to address social norms on sexual abuse in order to improve responses to disclosure to facilitate post-sexual-abuse adjustment for the child and the family.

An Examination of Victim, Assailant, and Assault Characteristics among Cases Classified as Predatory Drug-Facilitated Sexual Assault

IntroductionDrug-facilitated sexual assault (DFSA) can be characterized as predatory, where the survivor is covertly or forcibly administered an incapacitating or disinhibiting drug. The purpose of our study was to determine what factors, if any, are associated with cases classified as predatory DFSA. MethodsCases were classified on toxicological testing as predatory where there was an unexpected drug(s) found and non-predatory where a drug(s) found had been voluntarily consumed or no drugs at all were found in collected urine samples. ResultsOne hundred eighty-four suspected intentional drugging cases were seen at one of seven participating hospital-based sexual assault treatment centers. Urine specimens were analyzed from 178 of these cases, of which 48.9% were classified as predatory. In a logistic regression model, the odds of having experienced a predatory DFSA were lower if the survivor was a student or assaulted by a single assailant, but higher if the survivor self-reported mental health problems in the previous 6 months or that the mode of suspected drugging was a recreational drug or non-alcoholic drink (versus an alcoholic drink). ConclusionsThese differences in survivor, assailant, and assault characteristics between cases classified as predatory and non-predatory DFSAs may have important implications for intervention and prevention.

Nonoffending Guardian Assessment of Hospital-Based Sexual Abuse/Assault Services for Children.

In circumstances in which child sexual abuse/assault is suspected, pediatric guidelines recommend referral to services such as multidisciplinary hospital-based violence treatment centers, for specialized medical treatment, forensic documentation, and counseling. As little is known about how such services are perceived, the objective of this case report was to measure the satisfaction of nonoffending guardians of child sexual abuse/assault victims who presented for care at Ontario's hospital-based sexual assault treatment centers. Of the 1,136 individuals who reported sexual abuse/assault and were enrolled in a province-wide service evaluation, 58 were 11 years old and younger. Thirty-three guardians completed a survey. Ratings of care were overwhelmingly positive, with 97% of respondents indicating that they would recommend these services. Nonetheless, it is important to evaluate these pediatric sexual assault services frequently to ensure ongoing optimal, family-centered care.

Assessing the Reliability and Validity of the Chinese Sexual Assault Symptom Scale (C-SASS)

The purpose of this research is to establish and verify the psychometric and structural properties of the self-report Chinese Sexual Assault Symptom Scale (C-SASS) to assess the trauma experienced by Chinese victims of sexual assault. An earlier version of the C-SASS was constructed using a modified list of the same trauma symptoms administered to an American sample and used to develop and validate the Sexual Assault Symptom Scale II (SASS II). The rationale of this study is to revise the earlier version of the C-SASS, using a larger and more representative sample and more robust statistical analysis than in earlier research, to permit a more thorough examination of the instrument and further confirm the dimensions of sexual assault trauma in Chinese victims of rape. In this study, a sample of 418 victims from northern Taiwan was collected to confirm the reliability and validity of the C-SASS. Exploratory factor analysis yielded five common factors: Safety Fears, Self-Blame, Health Fears, Anger and Emotional Lability, and Fears About the Criminal Justice System. Further tests of the validity and composite reliability of the C-SASS were provided by the structural equation modeling (SEM). The results indicated that the C-SASS was a brief, valid, and reliable instrument for assessing sexual assault trauma among Chinese victims in Taiwan. The scale can be used to evaluate victims in sexual assault treatment centers around Taiwan, as well as to capture the characteristics of sexual assault trauma among Chinese victims.

Male Victims of Adult Sexual Assault

This descriptive study aims to provide new information about the services used by sexually assaulted men and adolescent boys presenting to specialized hospital-based sexual assault programs and further insight into the factors that may be associated with their victimization. Information was collected from 38 male clients aged 12+ presenting to 29 sexual assault treatment centers in Ontario, Canada over 12 months. Variables were examined across 6 domains: time to presentation, client sociodemographics, assailant characteristics, assault characteristics, physical health consequences, and service delivery and utilization. A substantial minority of participants reported vulnerabilities such as young age; being Aboriginal; being transgendered, unemployed and/or on disability; working in the sex trade; and living on the streets, in a rehabilitative center, or in a correctional facility. Almost one-third identified or were documented as having a disability and, for most of these victims, it was either psychiatric in nature or developmental delay. All participants accepted at least one service offered; 86% used five or more services, most commonly those related to health care on-site such as crisis counseling, treatment of injuries, and referral for follow-up care for supportive counseling, injury redocumentation, and testing for sexually transmitted infections. These findings reveal that male clients' uptake of specialized sexual assault services is significant and it is, therefore, important to provide access to a comprehensive range of psychological, medical, and forensic treatment options and referrals to other community services for ongoing support. Implications for future research and practice are discussed.

A Comparative Analysis of Victims of Sexual Assault With and Without Mental Health Histories

Sexual assault is a common and serious health issue that is underreported and has low follow-up rates. The myriad of psychological sequelae of sexual assault are well documented; however, there is a dearth of literature on the prevalence of preexisting mental health issues in survivors of sexual assault. This exploratory study compares victims seen at a sexual assault treatment center with and without preexisting self-reported mental health histories. The rates of preexisting mental illness in sexual assault victims are significant. Implications for clinical practice and research are discussed.

Factors Associated With the Sexual Assault of Students

Research suggests that students experience high levels of sexual assault, but studies addressing how they differ in their experiences from other sexual assault victims are virtually nonexistent. To address this gap, information was collected from consecutive individuals, aged 16 years or older, presenting to one of 7 hospital-based sexual assault treatment centers in Ontario from 2005 to 2007. Of the 882 victims seen during the study period, 32% were students. Relative to other sexual assault victims, students were more likely to be aged 16 to 18 years and 19 to 24 years versus 25 years and older. They were more likely to be living alone, with family of origin, a partner or spouse, or a nonrelative than on the street or in a shelter or institution. They were also more likely to report having consumed over-the-counter medication in the 72 hours prior to examination. Student victims were less likely than nonstudent victims to report having a disability and having used street drugs. Implications for research, education, and practice are discussed.

HIV Postexposure Prophylaxis Use Among Ontario Female Adolescent Sexual Assault Victims: A Prospective Analysis

This study examined the use of HIV postexposure prophylaxis (PEP) among sexually assaulted adolescent females. We analyzed data from the HIV PEP Project, an implementation and evaluation of a program of universal offering of PEP to sexual assault victims of all ages. Baseline and follow-up data were collected prospectively from consecutive clients seen at 18 hospital-based sexual assault treatment centers in Ontario, Canada from September 2003 to January 2005. Among 386 at-risk female adolescents, we examined the provision and uptake of and adherence to PEP, and factors related to antiretroviral acceptance and completion. Most adolescents were single (94.5%), living with family (68.0%), and attending school (67.4%). Slightly over two-fifths (42.7%) accepted and one-third (33.6%) completed the 28-day course of PEP. Factors associated with PEP acceptance were health care provider encouragement, being a student, and being moderately-to-highly anxious. PEP completion was associated with being white and an assailant known less than 24 hours. Our findings highlight the importance of the health care provider's role in counseling sexually assaulted female adolescents about HIV PEP use. The results also suggest that at-risk adolescents not enrolled in school and those from culturally diverse backgrounds may require additional supports.

Population-based study of police-reported sexual assault in Baltimore, Maryland

Objective To document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances. Methods Between 1997 and 1999, the city's sexual assault treatment center treated 1,038 victims (age ≥ 13 years). Data were extracted from forensic narratives. Analysis was restricted to frequency tables and bar graphs. Incidence was calculated based on 1998 population figures. Results The incidence of sexual assault among females aged 13 years or older was 117 per 100 000. Seventy percent of patients were less than 30 years old. Fifty-three percent tested positive for alcohol/drugs. Two thirds sustained physical or genital injury; 30% sustained both. The most common pre-event circumstances were walking/being followed (27%) and visiting a friend's home (24%). Conclusion This study revealed a high prevalence of physical/genital injury, supporting the call for an injury severity scale for sexual assault and for increased substance abuse counseling and educational/health resources to mitigate sexual assault and offer meaningful response when such crimes occur.

So Few Convictions

This study examines the role of client-related characteristics in the legal processing of sexual assaults. Data were collected from the hospital and legal records of 187 women who presented to a sexual assault treatment center and the police of a large Canadian city in 1994. The data analyses revealed that cases involving older women and women who did not physically resist the assailant were less likely to have resulted in a charge. However, women who were known to the assailant for more than 24 hours (including current or previous partners) were more likely to see their cases forwarded for prosecution.

Sexual assault victims' compliance with follow-up care at one sexual assault treatment center

To determine whether patients who receive emergency care at a sexual assault treatment center (SATC) follow suggested guidelines for prevention and/or treatment of associated sexually transmitted diseases (STDs). The research was a descriptive study of 26 adult victims of sexual assault who had been treated initially at a SATC. A nine-item questionnaire was designed to query participants by telephone 6 to 8 weeks after their initial care for sexual assault. Participants were questioned about their compliance with the suggested medication regimen and follow-up medical attention. In addition, health insurance coverage information was retrieved from participants' records to ascertain possible patterns of compliance by availability of health insurance. Participant perceptions of the nursing care received in the SATC also were elicited. Data were analyzed with frequencies and percentages, as well as qualitative categorization procedures. Twenty-six women, aged 19 to 43 years (mean = 27), participated in the study. Seventy-three percent reported taking all of the prophylactic medication prescribed or given to them at the SATC, whereas only 50% had made and kept a recommended follow-up appointment with a physician. No association could be determined between compliance with the suggested follow-up protocol and the availability of health insurance. Reasons for not following suggested protocols varied greatly. Of particular importance for those who were noncompliant were the implied misunderstandings related to the need to take medications after a sexual assault. Although concern has been expressed in the literature regarding sexual assault victims' compliance with follow-up regimens for the prevention and treatment of STD, the findings from this study indicate that compliance, particularly with medication protocols, may be higher than expected. However, continuing work is needed to ensure that all victims receive all recommended information regarding follow-up care during the first encounter with the nurse and that the rationale for follow-up care is fully understood by the patient. Nurses who interact with victims of sexual assault are in the best position to enhance compliance with follow-up regimens by identifying victims who may be at risk of noncompliance.

Repeated Sexual Victimization and Trauma Change During the Acute Phase of the Sexual Assault Trauma Syndrome

Victimization studies indicate that the risk of sexual assault is significant for women in America today and that sizable numbers of women are sexually assaulted more than once during their lives. This study proposed and tested alternative hypotheses about repeated sexual victimization and trauma change during the acute phase of the sexual assault trauma syndrome. Panel interview data were collected during a two-year period on 184 female victims (14 years and older) admitted to a sexual assault treatment center for initial and follow-up services. Controlling for initial trauma level and time between assessments, prior assault victims were more traumatized than first assault victims at follow-up. Prior and first assault victims had different patterns in short-term trauma change, with only the first assault victims decreasing in trauma. Prior mental health or substance abuse problems partially explained the observed effect of prior sexual assault on trauma change. Prior sexual assault, however, continued to affect trauma significantly in the condition where the repeated assault victim also had prior mental health or substance abuse problems at the time of the current assault.

The rape exam: beyond the hospital emergency room.

Data from 31 Florida post-rape examination sites reveal a number of dilemmas associated with rape exams. The sites include regular hospital ERs (N = 25), specialized sexual assault treatment centers (SATCs) on hospital grounds (N = 2), a nonhospital-based SATC, a proprietary OB/GYN clinic, a medical examiner's office, and a law enforcement crime lab. Open-ended interviews indicate that major problems with hospitals as exam sites stem from physicians' dislike of the exam and physician and hospital fears of legal and court entanglements. Prosecutors (and judges) are a major obstacle to nonphysician examiners. A challenge to rethink the post-rape exam, including where and by whom it is performed, is posed.

How adolescents perceive sexual assault services.

Because rape occurs more frequently in adolescence than at any other age, the adequacy of services for adolescent victims of rape is a public health concern. This survey found that adolescents had favorable attitudes toward sexual assault treatment centers but that a center's affiliation, staff, and policies on confidentiality would influence young people's willingness to use its services.

THE TRANSFORMATION OF TROUBLE: Police Certification and State Compensation of Sexual Assault Claims

This article is concerned with the transformation of private troubles into social and legal problems. It is argued that this transformation process involves a micro‐and macro‐politics of claims‐making. Data are presented on police certification and state compensation of sexual assault claims in a mid western state. The largest urban area in this state is distinguished by the collective claims‐making of antirape activists, and by the resulting presence of a sexual assault treatment center, which we expected would reduce the influence of racial characteristics on police certifications of innocence, while correspondingly increasing the influence of police certifications on the success of compensation claims. Our results confirm the above expectations. An implication of our findings is that black victims of intraracial sexual assaults are more likely to see their compensation claims succeed, and to see their troubles recognized as social and legal problems in those settings where macro‐level antirape efforts have been institutionalized in treatment and/or advocacy centers. More generally, our findings suggest that the transformation of private troubles into social and legal problems can be contingent on collective claims‐making in the context considered.

THE CRISIS IMPACT OF SEXUAL ASSAULT ON THREE VICTIM GROUPS

The traumatizing effect of rape and other forms of sexual assault on the victim has been documented in a variety of recent studies. The diversity of these studies with respect to their samples, data collcction methods, and measurement procedures makes it difficult to specify with precision (I) the effect of rape on adult vs. child victims, and (2) the cffect of rape vs. incestuous assault on child victims. The purpose of this research was to develop and apply a standardized assault impact assessment to a sample of victims admitted to a rape crisis treatment center. Three comparison groups compose the focus of this study: adult rape victims, child rape victims, and child incest victims. This article deals with the levels of trauma stemming from sexual assault in these groups and the implications of these findings for sexual assault treatment centers.

An Evaluation of a Center for Sexual Assault Victims

Sexual assault treatment centers have been established across the na- tion in recent years t o provide crisis and long-term services t o victims of rape and other forms of sexual assault. This article is based on an evaluation study of a particular sexual assault treatment center during its first year of operation. In- cluded are a history of the treatment center and a description of its goals, organizational structure, and service program. The final sections of the paper deal with an evaluation of the crisis and follow-up program for rape victims and a summary of recommendations for future program development. Implications of the evaluation results are discussed in terms of possible alternative models for designing sexual assault treatment centers.