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What Really Happened? A Validation Study of Rape Survivors' Help-Seeking Experiences With the Legal and Medical Systems

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Much of what is known about rape survivors' experiences with the legal and medical systems has come from victims' accounts; rarely have researchers collected "the other side of the story" to find out what system personnel say did or did not happen in these interactions. In the current study, rape survivors who sought emergency medical care were interviewed before their hospital discharge about what services they received and how they were treated by social system personnel. Corresponding accounts were then collected from doctors, nurses, and police officers. There was significant interrater reliability between the survivors and legal and medical system personnel regarding what services were or were not provided ("service delivery") and if system personnel engaged in "secondary victimization" behaviors (i.e., statements/actions that could be distressing to victims). However, police officers and doctors significantly underestimated the impact they were having on survivors. Victims reported significantly more post-system-contact distress than service providers thought they were experiencing.
... When victims face negative reactions from the police or victim support agencies, they are less likely to report and seek help (Ullman 1999). In addition to the fear of being blamed for what happened to them (Heath et al. 2013;Kilpatrick, Edmunds, and Seymour 1992;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011), victims often choose not to report due to fear of reprisal (Allen 2007;Felson and Paré 2005;Wolitzky-Taylor et al. 2011), and fear of disbelief or humiliating treatment by the authorities (Allen 2007;Bachman 1998;Campbell 2005;Fisher, Cullen, and Turner 2000;McGregor et al. 2000;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011). One deep concern that victims have with the criminal justice system is the concern of not being believed and, as a consequence, of being treated unjustly by the authorities (Allen 2007;Bachman 1998;Campbell 2005;Fisher, Cullen, and Turner 2000;McGregor et al. 2000;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011). ...
... In addition to the fear of being blamed for what happened to them (Heath et al. 2013;Kilpatrick, Edmunds, and Seymour 1992;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011), victims often choose not to report due to fear of reprisal (Allen 2007;Felson and Paré 2005;Wolitzky-Taylor et al. 2011), and fear of disbelief or humiliating treatment by the authorities (Allen 2007;Bachman 1998;Campbell 2005;Fisher, Cullen, and Turner 2000;McGregor et al. 2000;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011). One deep concern that victims have with the criminal justice system is the concern of not being believed and, as a consequence, of being treated unjustly by the authorities (Allen 2007;Bachman 1998;Campbell 2005;Fisher, Cullen, and Turner 2000;McGregor et al. 2000;Parti, Szabó, and Virág 2016;Wolitzky-Taylor et al. 2011). ...
... Accurate, evidence-based, and accessible education is key to understanding the dynamics of sexual violence, including victim/survivor behavior. Without up-to-date knowledge, professionals cannot conceive of the special characteristics of rape, such as that victims tend to have fragmented memories (Campbell 2005), as well as the possible reasons behind late reporting (Jordan 2004) and having no physical evidence (Sommers et al. 2013;Adams, Girardin, and Faugno 2001;Baker et al. 2010;Beh 1998;Bowyer and Dalton 1997). Insufficient and/or inaccurate education of professionals may impede the victim's trust and protection from revictimization throughout the procedure. ...
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While rape historically remains underreported all over the globe, and criminal justice factors contribute to this problem, we investigate unique circumstances that might influence reporting inclinations by Hungarian victims of sexual violence. Among other possible factors, victim-blaming, institutional desensitization, and a lack of trust in the criminal justice system and in the community are discussed. The in-depth interviews (n = 22) with law enforcement and criminal justice professionals conducted in 2018 in Hungary reveal roots of underreporting in the complexities of the criminal justice system: there is a failure to prioritize victims’ needs—mental care services, physical and privacy protection—and a focus instead on solely providing legal justice. The further deficits that can be found among professionals’ attitudes and behaviors in the courtroom are products of the following: a lack of standardized protocols in addressing the needs of victims; a dearth of technical and evidence-based knowledge and training; a lack of supervision and trauma-informed services to practitioners; high caseloads; a focus on the goal of high conviction rates; not providing open communication toward victims; and a shortage of standardized protocols in dealing with victims.
... Empathetic responses are also key to the development of self-empathy, compassion, and selfacceptance, as well as a sense of self-worth (Moor, 2007;Paivio & Laurent, 2001). Moreover, possibly for the very first time, the survivor is freed from any guilt or shame that she might have internalized from the critical social environment as well as from prevalent rape myths (Campbell, 2005;Gagnon et al., 2018;Moor, 2007;Suarez & Gadalla, 2010). Subsequently, the internal blaming voices are silenced and replaced by self-compassion. ...
... It is worthwhile to note the similarities between the present recommendations for a curative therapeutic relationship within sexual assault therapy and survivors' expectations from other support providers (e.g., Kirkner et al., 2017;Munro-Kramer et al., 2017;Starzynski et al., 2017;Ullman, 2014;Ullman & Townsend, 2008). Simply stated, the clear implication is that all agents to whom survivors turn for help, from mental health providers and rape crisis center counselors, to legal and law enforcement personnel, should provide the most empathic, validating, respectful, caring, and supportive alliance possible (Ahrens et al., 2009;Campbell, 2005;Dworkin et al., 2019). This will ease their recovery and prevent re-traumatization Gagnon et al., 2018). ...
... The study presents a comprehensive set of treatment requirements, jointly endorsed by both survivors and therapists, that were previously presented separately from one perspective or the other. In doing so, it expands the practice of voicing survivors' own articulation of their treatment needs following trauma (Campbell, 2005;Gagnon et al., 2018). ...
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The goal of the present study was to refine sexual assault therapy through the examination of the level of agreement between survivor and therapist assessments of key recovery-promoting therapeutic interventions. This is the first study to explore the level of agreement between those who partake in the treatment process from either position. Semistructured interviews were conducted in this qualitative study with 10 survivors and 10 experienced therapists. The results document considerable concurrence between them regarding relational and trauma processing treatment components alike. Together, these reports outline key effective interventions, both common and specific in nature, concomitantly supported by both groups.
... The most important reasons victims give for not reporting their rape are not wanting other people to find out about the incident typically out of fear of negative reactions such as blame or stigmatization (Heath et al., 2013;Kilpatrick et al., 1992;Parti et al., 2016;Wolitzky-Taylor et al., 2011), fear of reprisal (Allen, 2007;Felson & Pare, 2005;Wolitzky-Taylor et al., 2011), and fear of disbelief or bad treatment by the authorities (Allen, 2007;Bachmann, 1998;Campbell, 2005;Fisher et al., 2000;McGregor et al., 2000;Parti et al., 2016;Wolitzky-Taylor et al., 2011). Supporting the findings above, from a large sample of victims and eight basic reasons for failing to report, Cohn and colleagues (2013) established three main factors of causes: not wanting others to know, the nonacknowledgment of rape, and criminal justice concerns. ...
... Research involving victims, members of the criminal justice system, members of the healthcare system, and rape victim advocates all suggest that rape victims typically have a negative experience of interacting with police, legal, or support personnel, due to the insinuation of blame and disbelief in their line of questioning or behavior (Campbell, 2006;Campbell et al., 2001;Maier, 2008). Interviews with personnel also show that those dealing with rape victims underestimate their potentially negative impact and are unaware of the effect they are having on victims (Campbell, 2005). Next, we turn to the Hungarian case in order to discuss the presence of the abovementioned factors and how they may hinder rape reporting. ...
Article
Alarmed by research that reveals Hungary as having one of the lowest reporting rates in cases of sexual violence in Europe, this article provides an overview of the research that explains why, historically, sexual violence has been and continues to be underreported all over the globe, from law enforcement and criminal justice perspective. Furthermore, we describe the unique circumstances that might influence Hungarian victims of sexual violence to make formal reports. Among other possible factors, we discuss rape myth acceptance, victim blaming, feminist activism, institutional betrayal, and media representations of rape. In an effort to provide insight into Hungarian gender politics, this article raises salient theoretical works on gender ideology and gender policy in contemporary Hungary. This article concludes with a discussion on what implications such research in Hungary may have on a global understanding of sexual violence reporting.
... This results in long wait times for survivors, with most waiting in a busy ED for 4−10 hours, all while being instructed not to eat, drink, or use the bathroom so as to maintain any potential physical evidence of the assault. Survivors treated by ED medical providers (i.e., non-SANE) also often experience significant gaps in the specific services provided (e.g., emergency contraception, STI prophylaxis), as well as insensitive and harmful interactions with medical providers (see Campbell, 2005;Campbell & Raja, 2005;Shaw et al., 2017). ...
Article
Sexual Assault Nurse Examiners (SANEs) provide expert, comprehensive medical forensic care to patients who present for services following a sexual assault. Because SANEs are not consistently available, telehealth technology is being explored as a means to provide access to this expert care (i.e., teleSANE). During the COVID-19 pandemic, teleSANE offered additional potential benefits by reducing the length of time spent and number of providers in patient exam rooms, the need for personal protective equipment that was in high demand and short supply, and provider anxiety related to providing in-person care. In the summer of 2020, the Massachusetts SANE program rapidly and temporarily converted five hospitals from in-person SANE care to teleSANE. An evaluation team interviewed 23 providers using a rapid research and evaluation methods approach to assess the temporary model and inform the future of SANE care. Evaluation findings reveal it is possible to rapidly and temporarily convert hospitals from in-person to teleSANE care in a time of broad uncertainty, and that such a change requires intensive and thoughtful planning; a shared commitment to being supportive, flexible, and responsive; and specific experience and expertise. Considerations for communities exploring how best to ensure consistent, equitable access to SANEs are discussed.
... Sexual assault advocates are well-positioned to provide this information, as they work with dozens of survivors at any given time and can therefore offer overarching reflections on what their clients have sought, accessed, and needed during the pandemic. Interviewing advocates in a common approach in research on sexual assault survivors' engagement with community services (see Annan, 2011;Campbell & Salem, 1999;Campbell, 1998Campbell, , 2005Campbell, , 2006Maier, 2007Maier, , 2012Moylan, 2017;Ullman & Townsend, 2007, 2008 and their perspectives may be especially valuable during the frequently changing landscape of COVID-19 service provision. ...
Article
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.
... prosecution in addition to low levels of guilty verdicts in cases of rape (Campbell, 2005;Campbell et al., 2001;Daly & Bouhours, 2010;Seidman & Pakorak, 2011;Seidman & Vickers, 2005;Temkin & Krahe, 2008). This is highlighted by the fact that just five of every 1,000 individuals accused of rape will receive a felony conviction and/or incarceration-meaning 995 of them walk free (U.S. ...
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Sexual violence (SV) is a widespread human rights issue. Survivors of SV often experience profound dehumanization and poor health outcomes when their trauma is not properly addressed, rendering it critical that they are honored and empowered within subsequent processes of healing and seeking justice. With adjudication through the criminal legal system largely underutilized due to retraumatization, scrutiny from law enforcement professionals, and high rates of case closure, restorative justice (RJ) has emerged as a promising option for survivors to repair harm and experience accountability. Little is known, however, regarding the best practices for its use in cases of SV. To meet this need, a scoping review was conducted to identify the best practices for the implementation of RJ after instances of SV experienced in adulthood. Following the search methodology outlined by the JBI Manual for Evidence Synthesis for scoping reviews, 15 articles met search criteria, including four empirical studies and 11 nonempirical research materials spanning five academic disciplines. Best practices and structures for RJ were subsequently identified, including key phases for appropriate implementation. This review can be used to create increasingly productive RJ processes for SV survivors, which is particularly important for those coming from marginalized communities facing structural inequities, as well as survivors on university campuses. As researchers, we have the power to use science to propel society toward the creation of more efficacious healing spaces for survivors of SV, and optimizing safe RJ processes plays a key role in bringing this to fruition.
... When a victim reports that they have been sexually assaulted by an individual previously convicted of a sexual offense, the alleged offender is already known to the criminal justice system, which makes a difference at every stage of the process. The police are gatekeepers, and we acknowledge that they are notoriously reluctant to believe victims of sexual crimes (Campbell, 2005). If a report is made about an individual with a prior conviction for a sexual offense, however, that person's criminal record, which the police can easily access, will inevitably make the allegation seem more credible. ...
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What is the actual rate of sexual recidivism given the well‐known fact that many crimes go unreported? This is a difficult and important problem, and in “The dark figure of sexual recidivism,” Nicholas Scurich and Richard S. John (2019) attempt to make progress on it by “estimat[ing] actual recidivism rates . . . given observed rates of reoffending” (p. 171). In this article, we show that the math in their probabilistic model is flawed, but more importantly, we demonstrate that their conclusions follow ineluctably from their empirical assumptions and the unrepresentative empirical research they cite to benchmark their calculations. Scurich and John contend that their analysis undermines what they call the “orthodoxy in academic circles” (p. 173) of low sexual recidivism rates among individuals convicted of sexual offenses, but we underscore that their article does not analyze data in the traditional sense; instead, it just interprets past scholarly work through the use of strong assumptions in a way that, for practitioners, is likely to be opaque and misleading (and, for us, strays into speculation, argument, or advocacy and away from objective research). Our simple calculations show that their findings are highly sensitive to their assumptions, and we conclude that courts and others should recognize Scurich and John's work for what it is—a set of complex hypotheticals that are no more reliable than what judges and lawyers accomplish on their own by simply recognizing the basic problem that not all sexual offenses are reported.
Article
The way in which police officers interview sexual offence victims is pivotal to how their cases proceed through the criminal justice system (CJS). However, such interviews have previously been found to be lacking in overall quality, with some interviewers finding them technically difficult and stressful to conduct. In addition, victims often feel disbelieved, unsafe and/or uncomfortable during their police interview. The present study provides insight into the personal experiences of five female adult rape/sexual assault victims regarding their police interviews and the aspects that encouraged them to cooperate and engage during the interview process. Following semi-structured interviews, interpretative phenomenological analysis (IPA) was used to identify three key themes: (i) heading into the unknown, (ii) difficulty of talking about the crime and (iii) helpful and unhelpful interviewer approaches. Implications for practice are discussed, together with the need to further our understanding of this specialist area of police work.
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Introduction: Comprehensive healthcare for survivors of sexual violence is essential to prevent the diverse sequelae associated with the assault. In partnership with a local rape crisis center, we designed an educational module with the goal of training medical students on the basic needs of sexual assault patients with the aim to see if there was a significant difference in preparedness to counsel such patients. Methods: This quantitative quasi-randomized controlled study tested the effectiveness of an educational module on improving medical student preparedness for encounters with victims of sexual assault. A one-hour presentation, focusing on basic medical and legal knowledge regarding sexual abuse and compassionate patient-centered care, was provided to the intervention group during their compulsory Year 4 Emergency Medicine clerkship orientation. At the end of the month, students in the intervention and control groups were assessed using a standardized patient encounter simulating the presentation of a victim of sexual assault. Scores were determined by standardized patients, who utilized two checklists-one widely used for communication skills (KEECC-A) and the other focusing on sexual assault (WC-SAFE-specific). Results: For the KEECC-A, there was no significant difference in scores between the control and intervention groups (p=0.9257, 95% Confidence Interval [95%CI] 14.42,15.58]). The WC-SAFE-specific checklists were significantly different between the intervention and control groups (p=0.0076, 95%CI 3.79,4.21). Conclusion: Our sexual assault module increased preparedness of medical students for encounters with sexual assault victims and provide trauma-informed care.
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Sexual assault survivors are scrutinized in a manner unlike that meted out to any other victims of crime. Law enforcement officers or prosecutors may subject the survivor to a polygraph exam in an attempt to ascertain the truth or as a prerequisite to further investigation of the case. In a survey conducted with rape crisis centres across the United States, 63 centres in 17 states reported working with survivors of sexual assault who had been polygraphed. Rape crisis centres in 11 states reported that children had been polygraphed. This article examines the practice of polygraphing survivors of sexual assault.
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This research examined how the legal, medical, and mental health systems respond to the needs of rape victims. A national random sample of rape victim advocates (N = 168) participated in a phone interview that assessed the resources available to victims in their communities, as well as the specific experiences of the most recent rape victim with which they had completed work. Results from hierarchical and iterative cluster analysis revealed three patterns in victims' experiences with the legal, medical, and mental health systems. One group of victims had relatively positive experiences with all three systems, a second group had beneficial outcomes with only the medical systems, and the final group had difficult encounters with all three systems. Multinominal logistic regression was then used to evaluate an ecological model predicting cluster membership. Community-level factors as well as features of the assault and characteristics of the victims predicted unique variance in victims' outcomes with the legal, medical, and mental health systems. These findings provide empirical support for a basic tenet of ecological theory: environmental structures and practices influence individual outcomes. Implications for ecological theory and interventions to improve the community response to rape victims' needs are discussed.
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