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I was glad to learn that the
Office on Violence Against Women (OVW) is addressing the issue
of standards and protocols for rape exams (see related e-news
article). It is unfortunate that events of 9-11 delayed the
process, (the first focus group was slated to happen in Chicago
on September 13, 2001). This is an extensive undertaking for the OVW. The process is moving forward in a deliberate and
thoughtful manner, which certainly makes sense for an important
issue with such widespread implications.
As I travel around the country, it is obvious that such guidance
is sorely needed in this area. Practices vary widely and
protocols are sometimes nonexistent.
As an example, I recently provided training in a rural area of
Texas. Officers/deputies are extremely frustrated because the
County hospital had established a “Sexual Assault Response
Team.” Two of the counties had advocates (these agencies
referred to these system advocates as advocates but for clarity,
I will refer to them as crisis interventionists) working within
the Police Departments. When questioned, the crisis
interventionists stated they have confidentiality. The crisis
interventionists respond directly to the scene to immediately
assist the victim, providing immeasurable support at the scene
for the responding officers/deputies. In this case, if a
forensic examination is warranted based on the type of assault
and the length of time lapsed between the assault and the
report, the officer transports the victim to the County
Hospital. Hospital staff will only call a Rape Crisis Center
advocate after the officer and victim arrive at the hospital.
Because the advocates cover a very large geographical area, many
hours often pass before they arrive.
In an attempt to practice a team approach, the officers said the
forensic examiner will not begin the exam before the community
based advocate arrives. At that time, although the crisis
interventionist has already been working with the victim and
most likely established some level of trust and rapport, the
crisis interventionist is removed and replaced with the
community based advocate and the exam begins. Interestingly,
when questioned, the officers said that the examiner does not
appear to have any special training and they do not use a
colposcope. Clearly, this community has attempted to put
together a Sexual Assault Response Team to provide more
efficient, victim centered services. However, the officers and
crisis interventionists said it is common for the exam to take
6-8 hours. The officers’ response is to take the victim to
another hospital. I do not believe this is an acceptable answer.
Communities must identify all the stakeholders who should be
involved in appropriately responding to sexual assault. They
must collaborate to put together a system that works effectively
for everyone, especially the survivor. This “system” is clearly
not working for anyone. Depending on your community size and
resources, modifications to a traditional SART might need to be
made.
Another example I have heard over and over again, is the
frustration survivors and members of the SART experience when
there is a need for an interpreter or a person to assist with
some aspect of the examination. I have heard arguments that an
advocate cannot interpret or hold a ruler for example, because
the advocate would then become a witness. The advocate is a
witness regardless, the minute he/she becomes involved in the
investigation. A valid argument is that the advocate changes
roles, and now becomes focused on assisting the officer or
examiner, versus solely focusing on the needs of the victim.
But, what if it will take hours to find another person who
speaks the language of the survivor or one who can sign? Other
options must be available. Perhaps, a second advocate could
respond to take over the role of advocate. Or if that’s not
possible, how about explaining the situation to the survivor and
providing her with choices. It is clear that we have a lot of
work to do before we can say that we are truly operating as a
team or that collaborating goes beyond developing a protocol
that looks good on paper but cannot be practiced by those
working in the field.
I look forward to learning about the discussions and
recommendations from the Office for Violence Against Women about
rape exam standards and protocols. You can be sure that we will
share with you the OVW’s working document, as soon as it is made
available, and also let you know how to participate in the
dialogue as standardization moves forward. In the meantime,
there are many communities who are working hard to identify the
obstacles and improve their responses to sexual assault. |
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