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Survivor Services

  • Legislation should provide that survivor services are not conditional upon filing a report with the police, or upon the survivor’s decision to testify or to work with prosecution regarding the case, and that all services are available to all victims of sexual assault, without discrimination. (See: Gender-Based Violence Laws in Sub-Saharan Africa, p. 44)

Example: The United States’ Violence Against Women Reauthorization Act of 2013 creates a new purpose area which allows funds to be used for projects serving LGBTQ victims. Sec. 101. Section 41411 of the Act adds sexual assault victims to groups protected under the housing protection sections.

  • Legislation should provide for a coordinated community response for survivors of sexual assault. (See: Coordinated Crisis Intervention, StopVAW, The Advocates for Human Rights.)
  • Legislation should require the state to develop and fund comprehensive services for survivors. Services should include: one rape crisis centre for every 200,000 population; programs for survivors of sexual assault; survivor witness programs; elderly survivor programs; sexual assault survivor hotlines; and incest abuse programs. (See:UN Handbook 3.6.1 and 3.6.2.) The legislation should include a plan to provide survivors with this information. (See: Minnesota, USA Statute §611A.02; The Rape Victim Assistance and Protection Act (1998) of Philippines)

Studies have shown that Sexual Assault Referral Centres which provide intergrated services by specially trained practitioners who coordinate with both hospitals and court systems have been rated highly by the majority of survivors. Survivors particularly appreciated: access to female practitioners; case tracking and follow-up by the centre; advocacy services; and the opportunity to get information easily such as by telephone. See: Kelly, Promising practices in addressing sexual violence (2005) App. 1.

Department of Health, Home Office and the Association of Chief Police Officers, A Resource for Developing Sexual Assault Referral Centres (SARCs)(2009). Available in English.

AEquitas, The Prosecutor’s Reference on Violence Against Women, a US-based resource for prosecutors and their allied professionals, published Malios and Markowitz, Benefits of a Coordinated Community Response to Sexual Violence (2011) in their Strategies newsletter. Available in English

See: Case Study on Thuthuzela Care Centers in Justice Module.

Example: The Prevention and Elimination of Violence Against Women and Gender Violence (2008) law of San Marino requires the state to provide specialized social services for victims of sexual violence that are easily accessible to victims and which employ specifically trained staff. Ch.1 Art.4

For example, the Prevention and Elimination of Violence Against Women and Gender Violence (2008) law of San Marino requires the state to provide specialized social services for victims of sexual violence that are easily accessible to victims and which employ specifically trained staff. Ch.1 Art.4

 Example: Italian Law No. 38/2009 on Urgent Measures Regarding Sexual Violence (2009) (Italian only) provides funding for a national 24-hour hotline to provide skilled counseling and legal assistance to victims and additional funds to support projects for victims of sexual and gender violence.

  • Legislation should provide for coordinated sexual assault response teams or programs to give survivors a broad range of necessary care and services (legal, medical, and social services) and to increase the likelihood that the assault can be successfully prosecuted. Such programs or teams should include a forensic examiner, a sexual assault advocate, a prosecutor, and a law enforcement officer. All responding actors should follow specific protocols that outline their responsibilities in treating and providing services to survivors of sexual assault. (See: Sexual Assault Response Teams, The Advocates for Human Rights)

Example: Sexual assault nurse examiners (SANE) who have advanced education in the forensic examination of sexual assault survivors are utilized in many US communities. These communities have found that victims are not re-traumatized by long waits for medical exams and insensitive gathering of forensic evidence when sexual assault nurse examiners work with victims. The use of these sexual assault nurse examiners has increased the rate of successful prosecutions, especially in non-stranger cases and child sexual assault cases, because a more thorough documentation of evidence using specialized medical tools can support a victim’s account of an assault by establishing a lack of consent, and, in the case of a child, can gather evidence that will increase the number of guilty pleas so that a child doesn’t have to testify.

A study in US urban hospitals found that patients seen by a SANE were more frequently tested for sexually-transmitted disease, receive pregnancy prophylaxis, and be referred to a rape crisis center, where they could receive information and legal assistance, thus providing a direct link to the justice system. Bechtel et.al., “The impact of sexual assault nurse examiners on the evaluation of sexual assault in a pediatric emergency department,” Pediatric Emergency Care, 24 (2008): 442-47.

See: Sexual Assault Nurse Examiner Programs: Improving the Community Response to Sexual Assault Victims (2001))

For a video on how to start a sexual response team in a rural area, click here.

Sexual assault nurse examiners have been rated highly by survivors, cost less than doctor examinations, produced more thorough evidence than non-SANE, and were associated with higher conviction rates than pre-SANE cases. See: Kelly, Promising practices in addressing sexual violence (2005) App. 1.

US Department of Justice’s Office for Victims of Crime, The Sexual Assault Nurse Examiner (SANE) Development and Operation Guide (1999) provides guidance for developing SANE programs, including information on policies, procedures, staffing, and implementation strategies. Available in English.

The International Association of Forensic Nurses aims to provide leadership in forensic nursing practice by developing, promoting, and disseminating information internationally about forensic nursing science. It offers a number of tools on its website, such as: Sexual Assault Forensic Examiner Technical Assistance; a SANE Development and Operation Guide; and a National Protocol for Sexual Assault Medical Forensic Examinations. Available in English.

AEquitas, The Prosecutor’s Reference on Violence Against Women, a US-based resource for prosecutors and their allied professionals published Markowitz, A Prosecutor’s Reference: Medical Evidence and the Role of Sexual Assault Nurse Examiners in Cases Involving Adult Victims (2010). Available in English.

Case Study: Expanding the Role of Nurses in Improving Post-Rape Care in a Resource-Constrained Hospital in Rural South Africa- The Refentse Project

The Refentse Project, located in a 450-bed hospital in South Africa, improved post-rape care in a rural South African hospital. The project managers ensured the success of the project and buy-in of senior management staff with a comprehensive institutional and multi-sectoral approach. A Project Advisory Committee, consisting of hospital management, health care providers, social workers, and police was formed. The Committee drafted a Hospital Rape Management Policy based on national guidelines. Importantly, trainings were held for senior management and healthcare providers on attitudes on rape. In addition, trainings increased the role and capacity of nurses in providing post-rape care. Victim services were improved by offering post-rape services in one location in the hospital. The Refentse Project also conducted community awareness on the services available for rape victims and the importance of seeking immediate medical care following an assault.

Prior to the Project, the role of nurses was limited to taking vital signs and pulling charts. After Project training nurses were able to document the rape history, provide post-exposure prophylaxis or PEP section on page 57 ], pregnancy testing, treatment, trauma counseling, and referral to support services. Patient interviews indicated a successful increase in victim-centered, private, and streamlined services. The project demonstrated that improvements can be made for a low cost ($58USD per patient after initial set-up) and using existing staff and infrastructure.

The success of the project demonstrates that expanding the role of nurses is a key strategy for increasing access to comprehensive post-rape care, especially in a rural area where there are few doctors. The study also found that improvements were needed in the administration of PEP; namely, to provide rape victims with the full 28-day regimen, anti-nausea drugs, and medication counseling on the initial visit since many rape victims will not return to the hospital to receive the full dose after the initial treatment. See: Kim et. al., The Refentse Model for Post-Rape Care: Strengthening Sexual Assault Care and HIV Post-Exposure Prophylaxis in a District Hospital in Rural South Africa, (2009). Available in English.

 

CASE STUDY: United Kingdom: More Rape Convictions Due to Improved Survivor Services and Police Partnership with Survivor Support Network

In Cleveland, United Kingdom, rape conviction rates were reported to have improved by 10% in 3 years. Police cited the opening of the Sexual Assault Referral Centre in 2007 as a big step forward in improving survivor care, including 24-hour access to specially-trained crisis workers, emergency contraception, sexual health advice and referral to rape counselors. The Centre’s private, hospital-like environment and trained counselors support victims and police come to the centre to interview them. Evidence is collected quickly and thoroughly. The police attributed the improved conviction rates to police partnership with prosecutors, hospitals and volunteer service providers.

“In the course of any investigation we liaise closely with the [prosecutors] and counsel to ensure that prosecutions are pursued wherever possible and victims can also receive support from an independent sexual violence advisor. These specially trained advisors are employed by voluntary sector agencies to provide a high level of support to rape victims and to ensure that victims are fully aware of criminal justice procedures,” said the Head of Crime for Cleveland Police. 

Access to the full range of Sexual Assault Referral Centre services is assured even in cases where the victim does not wish to make a report to the police. 

See:  Cleveland’s Success in Rape Convictions, 10/06/2009.

 

 

 Example: The country of Malaysia’s one-stop centre, which brought together service for victims of domestic or sexual violence, was designated a “good practice” in the Secretary-General’s In-Depth Study on All Forms of Violence against Women (2006). Victims are seen in private rooms, receive counseling and referrals to shelters, and access to police who have an office on premises.

 

One-stop centres may not be located country-wide, making access difficult for some victims.

Case Study: A Review and Evaluation of Multi-Sectoral Responses (“One-Stop Centres”) for Gender-Based Violence in Kenya and Zambia

A 2012 study concluded that sexual assault victims fare best when one-stop centres are affiliated with hospitals.  When one-stop centres are owned or closely affiliated with hospital services, victims have better access to clinical services and were more satisfied  with not only the largely free medical care they received but also the privacy and empathy offered by staff. In addition, when medical services are linked with legal and police services, opportunities for good legal outcomes for survivors result. One-stop centres should offer close collaboration with police, should ensure proper evidence collection and storage, and should include legal advice and court preparation along with medical and psycho-social support. In addition, services to child victims should be better integrated into all levels of service. See: Keesbury et al., A Review and Evaluation of Multi-Sectoral Responses (“One-Stop Centres”) For Gender-Based Violence In Kenya and Zambia (2012).

 

Example: Promising new initiatives can increase access to post-rape care in conflict, remote, or natural disaster-affected areas. For example, Heal Africa in eastern Congo provides a mobile emergency response team for reaching survivors of sexual violence within 72 hours following the assault. The team provides emergency medical care, including post-rape kits with PEP and emergency conception supplies. The team consists of a physician or a nurse and several female counselors who have been trained in trauma counseling and PEP. Individuals with serious injuries are transported to the hospital. The team, active in a conflict-ridden area, consists of those viewed as politically neutral so that trust can be established wherever they go. The teams also bring supplies and training to fellow providers in conflict areas. See: UNICEF, Partner Heal Africa treats survivors of sexual violence in eastern DR Congo, (2010) and Harris and Freccero, Sexual Violence: Medical and Psychosocial Support (2011).

CASE STUDY: The Philippines’ Rape Victim Assistance and Protection Act of 1998

The Philippines’ Rape Victim Assistance and Protection Act of 1998 provides numerous protections for victims of sexual assault.  It requires the government to coordinate its agencies with non-governmental organizations in order to establish and operate rape crisis centres in every province and city to “assist and protect rape victims in the litigation of their cases and their recovery.” (Sec.2) The law mandates the establishment of a women’s desk in every police precinct in order that a police woman is available to investigate sexual assault cases. The law also requires that the preliminary investigation of women rape victims must be assigned to female prosecutors. It provides for closed-door proceedings if necessary to ensure a fair trial and the best interests of the parties, and for the non-disclosure of identities and circumstances of cases if that also supports the best interests of the parties. (Sec. 5) Finally, the Act provides that evidence of a complainant’s past sexual conduct and reputation shall not be admitted unless, and only to the extent that, the court finds that this evidence is material to the case. (Sec. 6) The Act also mandated the formulation of necessary regulations within 90 days, and appropriated funds to establish and maintain the centres, with the important stipulation that the necessary amount to maintain the centres be included annually in the General Appropriations Act. (Sec. 7)

 

 

  • Legislation should provide that survivor services are not conditional upon filing a report with the police, or upon the survivor’s decision to testify or to work with prosecution regarding the case. (See: Gender-Based Violence Laws in Sub-Saharan Africa, p. 44)
  • Legislation should require that law enforcement, prosecutors, and judicial personnel, medical sexual assault response teams, and social service professionals who serve victims of sexual assault receive regular training on best practices and updated techniques in investigation, handling and prosecution of sexual assault cases and in the support and advocacy of sexual assault survivors. Legislation should require state funding of such training. 

Example: A report by the Inter-American Commission on Human Rights entitled  Access to Justice for Women Victims of Sexual Violence in Mesoamerica 2011 found that countries in Central America and Mexico must increase funds for specialized training of judges and prosecutors to increase the accessibility of the  justice system to women and children victims of sexual violence.

For a video on violence against women based on gender identity and sexuality, click here.

Example: In El Salvador, Fundacion Justicia y Genero has been arranging virtual trainings to aid in the application and implementation of the Special Integral Law for a Life Free from Violence for Women which was approved in November 2011.  Fundacion Justicia y Genero organized trainings specifically for employees of the Attorney General’s office in which employees were trained in reasoning and arguing from a gender perspective.  The foundation’s goal is that participants will be able to identify and recognize structural forms of violence and sexist language.  Furthermore, the trainings focused on the Inter-American Convention on the Prevention, Punishment, and Eradication of Violence Against Women (Convention of Belem do Para) and the incorporation of gender perspective in judicial decisions.  See Fundacion Justicia y Genero (last acc.13 February 2013.)

  • Legislation should address sexual violence in the military by providing victims with safe and unbiased reporting mechanisms, accountability and monitoring or oversight mechanisms, requiring robust prosecution of offenders, and prohibiting any type of repercussion against victims.

Example: The Integral Law Against Violence Against Women (2012) in Nicaragua specifically includes in Article 8, among the forms of violence against women, acts of violence against women by public authorities, professionals, personnel and agents that pertain to public organs or institutions who seek to delay, obstruct, deny or impede women’s access to justice and to public policies. 

See: National Prosecuting Authority of South Africa, Uniform Protocol for the Management of Victims, Survivors, and Witnesses of Domestic Violence and Sexual Offences, a resource for service providers, traditional leaders, and others. The protocol includes a description of the domestic violence and sexual offence context in South Africa, its objectives, and a comprehensive set of minimum standards in service delivery, monitoring of services, and governance of service delivery. Available in English.

Case Study:  Trauma-Informed Care

Trauma-informed care treats survivors with a history of trauma by including recognition of the traumatic event(s) in their lives.  Advocates can modify treatment of survivors based upon how a trauma survivor may perceive what is happening. 

Past traumatic experience will provoke  “triggers,” which cause the survivor to re-live the emotions experienced in the past, often in an overwhelming and frightening way.

A trauma-informed approach should be employed in sexual assault services, especially considering that many survivors have been repeatedly assaulted.

The following are key elements when developing trauma-informed sexual assault services:

  • Create a collaborative approach that acknowledges that a survivor knows her life best and which respects her feelings.
  • Create an environment of trust. Allow the survivor to voice her feelings about her experiences.
  • Give the survivor a chance to tell you how best to work with her and what would make her more comfortable.
  • If the survivor seems difficult, remember that her difficult behavior may have kept her safe in the past.
  • Provide consistent boundaries to increase the survivor’s sense of security.

Adapted from: Washington Coalition of Sexual Assault Programs, Creating Trauma-Informed Services: A Guide for Sexual Assault Programs and Their Systems Partners (2012). Available in English.

 

Project Emerge, Accessibility and Trauma-Informed Review Tool (2009) This tool is designed to assess and guide improvement of an agency/programme’s ability to provide services that are both accessible and trauma-informed.Available in English

Disability Rights Wisconsin, Wisconsin Coalitions Against Domestic Violence and Sexual Assault (2011). A Practical Guide for Creating Trauma Informed, Disability, Domestic Violence and Sexual Assault Organizations. Available in English.

Example: The non-governmental organization KOFAVIV in Haiti works with women living in camps following the 2010 earthquake who have been victims of sexul violence. The advocates are victims of violence themselves and support the women to make a report and to obtain medical treatment as soon as possible. KOFAVIV also offers a safehouse for women and a follow-up program that maintains counseling and support services. KOFAVIV also works toward legal reform of Haiti’s rape law. Torgan, Seeking Justice for Haiti’s Rape Victims, 26 April 2012.

See a video on a project that is helping rape survivors after Haiti’s earthquake here.

 Example: The Criminal Law (Sexual Offences and Related Matters) Amendment Act (No.32) of South Africa  requires that national directorates on police, prosecutors and health must develop training courses for these professionals and include social context in the trainings, develop protocols, and provide for and  promote the use of uniform norms, standards and procedures to ensure that as many as possible are “able to deal with sexual offence cases in an appropriate, efficient and sensitive manner.” (Ch. 7, Part 4.)