Recognize the importance of victim services within the exam process

In many jurisdictions, sexual assault victim advocacy programs and other victim service programs offer a range of services before, during, and after the exam process (see below for a description of typical services). Ideally, advocates should begin interacting with victims prior to the exam, as soon after disclosure of the assault as possible. Victims who come to exam sites in the immediate aftermath of an assault are typically coping with trauma, anticipating the exam, and considering the implications of reporting. Most responders that victims come in contact with are focused on objective tasks. Law enforcement officials gather information and collect crime scene evidence to facilitate the investigation. Health care personnel assess medical needs, offer treatment, and collect evidence from victims. Victims must make many related decisions that may seem overwhelming. Advocates[1] can offer a tangible and personal connection to a long-term source of support and advocacy. Community-based advocates, in particular, have the sole purpose of supporting victims’ needs and wishes. Typically, these advocates are able to talk with victims with some degree of confidentiality, depending on jurisdictional statutes, while statements victims make to examiners become part of the medical forensic report.[2] When community-based advocates support victims, examiners can more easily maintain an objective stance.[3] 
 
Be aware of the extent of services. Services offered by advocates during the exam process may include: [4] 
  • Accompanying the victims through each component (advocates may accompany victims from the initial contact and the actual exam through to discharge and followup appointments);
  • Assisting in coordination of victim transportation to and from the exam site;
  • Providing victims with crisis intervention[5] and support to help cope with the trauma of the assault[6] and begin the healing process;
  • Actively listening to victims to assist in sorting through and identifying their feelings;
  • Letting victims know their reactions to the assault are normal and dispelling misconceptions regarding sexual assault;
  • Advocating for victims’ self-articulated needs to be identified and their choices to be respected, as well as advocating for appropriate and coordinated response by all involved professionals;
  • Supporting victims in voicing their concerns to relevant responders;
  • Responding in a sensitive and appropriate manner to victims from different backgrounds and circumstances and advocating for the elimination of barriers to communication;
  • Serving as an information resource for victims (e.g., to answer questions, explain the importance of prompt law enforcement involvement if the decision is made to report, explain the value of medical and evidence collection procedures, explain legal aspects of the exam, help them understand their options in regard to treatment for STIs, HIV, and pregnancy, and provide referrals); 
  • Providing replacement clothing when clothing is retained for evidence, as well as toiletries;
  • Aiding victims in identifying individuals who could support them as they heal (e.g., family members, friends, counselors, employers, religious or spiritual counselors/advisors, and/or teachers);
  • Helping victims’ families and friends cope with their reactions to the assault, providing information, and increasing their understanding of the type of support victims may need from them; and
  • Assisting victims in planning for their safety and well-being. 
Postexam, advocates can continue to advocate for victims’ rights and wishes, offer victims ongoing support, counseling,[7] information, and referrals for community services, assist with applications for victim compensation programs, and encourage victims to obtain followup testing and treatment and take medications as directed. They can also accompany victims to followup appointments, including those for related medical care and criminal and civil justice related interviews and proceedings. They can work closely with involved responders to ensure that postexam services and interventions are coordinated in a complementary manner and are appropriately based on victims’ needs and wishes.
 
Contact the victim service/advocacy program immediately.  Utilize a system in which exam facility personnel, upon initial contact with a sexual assault patient, call the victim service/advocacy program and ask for an advocate to be sent to the exam site (unless an advocate has already been called).[8] Prior to introducing the advocate to a patient, exam facility personnel should explain briefly to the patient the victim services offered and ask whether the victim wishes speak with the onsite advocate. Note that some jurisdictions require that patients be asked whether they want to talk with an advocate before the advocate is contacted.[9] Ideally, a patient should be assisted by the same advocate during the entire exam process.[10]

 
[1] To prepare them to competently provide sexual assault victim services, community-based advocates are typically trained according to the policies of the sexual assault advocacy agency where they are employed/volunteer and receive supervision related to their interactions with victims. In addition, many jurisdictions have specific requirements that community-based advocates must meet in order to fit within jurisdictional confidentiality or privilege laws. Advocates should meet these requirements. System-based advocates may be required to have specific credentials based on system and jurisdictional policies and laws.
[2] K. Littel, SANE Programs: Improving the Community Response to Sexual Assault Victims, 2001, p. 6.
[3] Ibid.
[4] This bulleted section was drawn partially from Iowa’s Sexual Assault: A Protocol for Forensic and Medical Examination, 1998, p. 7, and the 1989 Volunteer Manual of Virginians Aligned Against Sexual Assault (VAASA).
[5] Crisis intervention counseling is short term in nature, aimed at returning individuals to their precrisis state through the development of adaptive coping responses. Broadly, it entails establishing a relationship with the individual in crisis, gathering information about what is occurring, clarifying the problem, helping the individual identify options and resources and decide what needs to happen next, and clarifying actions that will be taken. (Adapted from the 1991 Women Helping Women Volunteer Training Manual, Cincinnati, Ohio.) Note: Crisis intervention is not intended to address longer term counseling and advocacy needs.
[6] See A. Burgess and L. Holmstrom, Rape Trauma Syndrome, American Journal of Psychiatry, 131, for a summary of the psychological, somatic, and behavioral impact of sexual assault on victims.
[7] Many advocacy agencies offer ongoing peer counseling to victims. Some also provide professional mental health counseling, but many refer victims to community or private agencies.
[8] Use community-based sexual assault victim advocates where possible. If not available, victim service providers based in the exam facility, criminal justice system, social services, or other agencies may be able to provide some advocacy services if educated to provide those services. Patients should be aware that government-based service providers typically cannot offer confidential communication.
[9] In very small communities, patients may know some or all advocates. Some patients may feel comfortable being supported by an advocate known to them while others may not. Patients concerned about anonymity should be provided with as many options as possible. For example, ask if they would like to speak with an on-call advocate on the phone prior to making their decision about whether they want an advocate present during the exam. Another option may be for the local advocacy program to partner with an advocacy program in a neighboring jurisdiction, so they can provide one another with backup to handle situations such as this one.
[10] Continuity of advocates can be challenging when response by other professionals is delayed, the exam process is lengthy, or travel to the exam site is considerable. Volunteers may or may not be able to continue providing services after the end of their on-call shift. 


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