Appendix B. Creation of Sexual Assault Response Teams

 
Determine how the SART is activated. Activation procedures should take into account that victims enter the “system” at different points (e.g., through a call to 911 or a 24-hour advocacy hotline, arrival at a health care facility, or disclosure to a community professional). The SART must determine how to publicize its services to community professionals who may have frequent contact with individuals disclosing sexual assaults. These professionals might include, but are not limited to, private physicians, health clinic staff, mental health and social service program staff, personnel serving persons with disabilities, substance abuse treatment program staff, school personnel, personnel from faith-based communities, corrections and probation staff, and staff from residential living programs and emergency shelters. It also should publicize its services more broadly to the public, explain the dynamics of sexual assault, and encourage victims to seek help.  
 
Plan SART response to varying circumstances facing victims. The team should consider and plan for modifications to the exam process to address specific needs and concerns of victims. For example, in order to respond to non-English-speaking victims, team members must be able to speak their language or promptly arrange for certified interpretation. For victims thought to have cognitive disabilities, team members must know who to contact for assistance and ensure they receive the same access to services that other victims would obtain. Some victims may request advocates and other responders of a specific gender or from specific cultures. Procedures should be in place to ensure response to minors follows jurisdictional statutes. SARTs should be prepared to deal with multijurisdictional coordination issues that may arise when assaults occur on military sites or to soldiers in the field, school campuses, tribal lands, prisons, and residential programs. Involving relevant agencies as soon as possible according to agreed-upon procedures may help quickly determine who has jurisdiction over a case and how to best assist each victim.
 
Meet regularly. Outside of an immediate response, the SART should meet regularly[2] for two distinct purposes. The first is to review immediate response in individual cases in order to improve overall team performance. These reviews allow team members the opportunity to give each other feedback on effectiveness of response during the exam process, problems needing resolution, and areas needing improvement. Cases are typically reviewed anonymously, [3] without using victims’ names or other identifying information.[4] During these discussions, it is important that the team respect the confidentiality of information in patients’ medical records and shared with community-based advocates. Secondly, the SART can utilize meetings of members to maintain and enhance the quality of the SART. This task involves addressing system issues, such as creating and revising policies and procedures in response to local changes in governmental or community-based agencies, scientific or technological advances, and feedback from victims. It also involves sharing general information related to the SART and facilitating the continuing education of the team.
 
Although it might be difficult to involve all relevant responders in SART meetings (e.g., crime labs may be a considerable distance from the community and lack resources to respond to local inquiries), consider options such as teleconferencing to include their perspectives. 

Encourage education for SART members on coordinated response during the exam process

For example:
  • Discipline-specific training that advances responder skills and emphasizes a team approach is crucial.
  • Multidisciplinary training sessions can describe the SART process, stress the need for a prompt exam, explain the roles and challenges of each discipline, emphasize a victim-centered approach, and make clear where coordination among disciplines is needed and how it should occur. They can describe multidisciplinary policies, interagency agreements, standardized forms, and other related materials.
  • Multidisciplinary training can also build members’ understanding of needs, values/beliefs, and practices of specific populations in their community. They can raise awareness of how different populations respond to disclosures of sexual assault and work to build the capacity of involved professionals to be sensitive to the needs of victims from those populations.
  • Cross-training sessions are useful to allow responders from one discipline to educate those from another discipline about the specifics of how they intervene in these cases and answer questions that may arise. For example, law enforcement investigators can educate examiners and advocates about what is involved in a thorough investigation, stressing that the forensic exam of the victim is but one part of the investigation. In jurisdictions that border Indian Country, Federal prosecutors can educate other responders regarding Federal Indian law and how it applies to sexual assault cases.
  • Multidisciplinary trainings and cross-trainings can provide a forum for staff from different agencies to get to know and respect one another, build common goals, and increase their comfort in working together. Collaboration among agencies and individuals can provide responders with a broader network of support as they do this work. These trainings can also stress the difficulty of working on sexual assault cases and the secondary trauma that responders can experience. They can facilitate discussion among responders about self-care and preventing or coping with secondary trauma, so they in turn can provide optimal interventions and assistance to victims.
  • There are more informal educational opportunities and tools that can foster coordination among SART members. For example, all key responders, especially those newly involved in sexual assault cases, may find it useful to tour sites and offices involved in SART response. Such tours and discussions with site/office staff can help build knowledge of what response by each discipline entails and the logistics of that response. Sharing related educational materials and literature is an easy way to continuously expand the base of common knowledge among SART members. Tools such as flow charts and discipline-specific checklists that help SART members understand the continuum of response and appropriately coordinate their interventions may also be useful.
Trainers. In addition to involving representatives from health care, advocacy, law enforcement, prosecution, the judiciary, and crime and toxicology laboratories as SART trainers, include defense attorneys to educate participants on defense tactics. Utilize local agencies and leaders that serve specific populations to educate the SART on the needs of residents and services they offer relevant to victims of sexual assault.
 
Outreach to rural, remote, and poor communities. It may be difficult for rural, remote, and poor communities to offer training for SART members, due to lack of resources and/or expertise. States, Territories, and tribes may want to consider forming specialized teams that can offer multidisciplinary training consistent with cutting-edge practices across all of their jurisdictions. These teams can work with local responders to ensure that the training sessions they offer address unique community needs and challenges.
 

[1] A more indepth discussion of SART development and maintenance than is provided is beyond the scope of this document. However, resources do exist on this topic. For example, numerous jurisdictions have published guidebooks on organizing a SART and/or protocols for SART response. Some sexual assault coalitions offer information, technical assistance, and training for communities interested in starting SARTs. Since 2001, a national SART training conference has been held biannually (see www.sane-sart.com for information).
[2] “Regularly” is locally defined. Some teams meet monthly, while others meet every 6 weeks or quarterly. Teams might meet on a regular basis for case review and get together less frequently to discuss more systemic issues.
[3] In California, there is a law to protect discussions of individual cases during SART meetings. These discussions are technically characterized as medical quality-assurance activities.
[4] Case reviews usually include only those SART members typically involved in immediate response. But, even if all or most SART members were involved in a particular case and were aware of victims’ identity, there is still no reason to reveal victims’ identity during SART case reviews. SARTs may choose not to take notes about cases reviewed to ensure that the case-related information is not shared with anyone outside of the meeting. In situations where victims’ identity might be easily deduced during a case review by members not involved in response (e.g., if there had only been one case handled during the time period being reviewed), comments should be kept as broad as possible and avoid case specifics. In communities where residents tend to know each other and news about crime travels quickly, it may be challenging to not inadvertently reveal victims’ identify during SART case reviews. SARTs in these jurisdictions should consider how to best approach case reviews in a way that reduces the likelihood of revealing victims’ identify.