Handbook on Sexual Violence (102 page)

In Study 5, Campbell
et al
. (2009) conducted in-depth qualitative interviews with victims/survivors who received post-assault medical forensic exams in the focal SANE programme. The vast majority of survivors characterised their experiences at the SANE programme as positive, empowering and healing. The nurses and advocates worked together as a team to help survivors begin the process of reinstating control over their bodies and their lives. The programme links survivors to advocacy and support services at the rape crisis centre (with which this SANE is organisationally linked) so that they have the resources they need to focus on their own well-being and recovery. This attention to helping survivors heal indirectly affected their willingness to participate in legal prosecution. When survivors are not as traumatised, they are more willing and capable of participating in the prosecution process. In addition, survivors often had questions about the medical forensic exam and the process of criminal prosecution, and when SANE programme nurses and advocates provided patients with this information, it gave survivors more hope and confidence about their legal cases, which also indirectly contributed to increased victim participation.

However, positive experiences with the SANE programme did not guarantee that survivors would have similarly positive experiences with the legal system. The survivors interviewed in Study 5 had three distinct patterns of experiences with the criminal justice system. First, there were cases in which the victim wanted the case to be prosecuted, but criminal justice system personnel did not prosecute the case, which we termed
rejected cases
(n=7). These survivors described their experiences with the legal system as hurtful,

disappointing, and disempowering. For example, a 21-year-old white woman who was assaulted by her ex-boyfriend, whom she had recently broken up with, described how she was hurt when the detectives treated her as if she was lying:

They were just like non-reaction. No, ‘how are you doing with this? Are you OK?’ . . . they were just, kind of, they were victim-blaming. They were kind of looking at me like well, you had control of this situation. You should have did this or you should’ve done that. Well, that’s not what happened. There are a lot of women who don’t even report it, but you’re gonna sit here and treat me like crap because you think that I’m lying?

Second, in some cases, the victims wanted the case dropped, but the criminal justice system personnel forwarded the case despite the victims’ expressed desire to drop (termed
dragged cases
) (n=4). These survivors also characterised their contact with the legal system as frustrating, disempowering and hurtful. It appeared that law enforcement (and the forensic nurses) had serious concerns about potential lethality in these cases and therefore did not respect victims’ wishes not to pursue prosecution. Finally, there were cases in which the criminal justice system’s response matched the victims’ wishes (termed
matched cases
) (n=9). These survivors had positive experiences with law enforcement, noting that the care and empathy they received from police helped them participate more fully in the investigation and prosecution process.

In the last study in this project, Study 6, the research team interviewed the forensic nurses in the focal SANE programme regarding their work with their patients and with local law enforcement. This SANE programme maintains a philosophy that patient care – not supporting law enforcement or building legal cases – is their primary goal. This SANE programme does not pressure their patients to report to law enforcement, and instead they emphasise that it is the survivors’ choice and either way, the forensic nurses will be there to care for them. Therefore, it is entirely consistent with this SANE programme’s practice that Campbell
et al
. (2009) did not find a direct link between SANE involvement and victim participation – there should not be. The forensic nurses’ role is to provide care to their patients and, as it turns out, this can have an
indirect
benefit on victim participation in the criminal justice system. In SANEs’ work with law enforcement, the evidence collected from victims and suspects, and all accompanying documentation, was made immediately and easily accessible to law enforcement so that it could be used to inform their investigation. In their ongoing case consultations with police, the forensic nurses provided information about medical forensic evidence in general, and injuries in particular, and encouraged law enforcement to conduct a thorough investigation of the case, regardless of the medical forensic evidence findings. These findings are consistent with the Study 3 and 4 results that SANE involvement in a case is associated with increased investigational effort.

This 12-year analysis of criminal justice system case outcomes revealed that more cases were moving through the system to higher levels of disposition

(i.e., guilty pleas or guilty convictions) after the implementation of a SANE programme. The quasi-experimental design and supplemental data collection used in this project allowed Campbell and colleagues to conclude that these effects are reasonably attributable to the efforts of the SANE programme and not due to other changes over time in this community. The SANE programmes’ work with law enforcement and their patients, though separate and philosophically distinct, is mutually reinforcing and provides instrumental resources for successful case prosecution.

Conclusions

This
chapter has highlighted the experiences of victims who sought help from formal social systems and the difficulties they encounter. But it is important to remember that many victims, indeed most, do not seek help from the legal, medical and mental health systems. When these survivors are asked why they do not, they say that they are concerned about whether they would even get help and that they are worried about being treated poorly (Patterson
et al
. 2009). Unfortunately, empirical research suggests this apprehension is probably warranted. At the same time, for some victims social system contact is beneficial and healing. The challenge then is to address the underlying problems in our social systems so that good care is more consistently provided to all victims, who have survived all kinds of assaults. Collaborative, multi-system innovations, such as SANE programmes, are changing the community response to rape. These interventions are not necessarily easy to implement as they require extensively trained medical personnel for their staffing, but the US Department of Justice (2004, 2006) has invested considerable financial resources in supporting training and technical assistance. Indeed, a primary long-term goal of the International Association of Forensic Nurses is enhancing the sustainability of existing SANE programmes and supporting their expansion to geographically diverse areas in the United States and in other countries (IAFN 2010b). Although there are few studies that provide empirical data to guide such expansion, it appears that SANE programmes are most successful when they are formed as part of a true multidisciplinary collaborative effort to improve community resources for survivors (Campbell
et al
. 2005). The reason why SANE programmes have the potential to change the community response to rape is their focus on the needs of survivors, first and foremost. That philosophy can be manifest in many types of community interventions, including, but by no means limited to, SANE programmes. The trauma associated with negative post-assault help-seeking can be prevented and our communities can be more effective in helping survivors heal from rape.

Further reading

For a comprehensive review on the challenge rape survivors face when they contact the legal and medical systems, Patricia Yancey Martin’s
Rape Work: Victims, Gender, and Emotions in Organization and Community Context
(2005) is an excellent resource. Amanda

Konradi’s
Taking the Stand: Rape Survivors and the Prosecution of Rapists
(2007) provides an in-depth look at rape victims’ involvement with the American legal system. For comprehensive how-to manuals for the creation of sexual assault nurse examiner (SANE) programmes, see http://www.ojp.usdoj.gov/ovc/publications/infores/sane/sane guide.pd
f or http://www.ncjrs.gov/pdffiles
1/ovw/206554.pdf. Another great resource for practitioners working on the community response to sexual assault is the State of Oregon Attorney General’s Sexual Assault Task Force Manual, available by contacting them at http://oregonsatf.org.

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