Giannina Fehler-Cabral

Adult Sexual Assault Survivors’ Experiences With Sexual Assault Nurse Examiners (SANEs)

Sexual assault survivors often feel traumatized by the care received in traditional hospital emergency departments. To address these problems, Sexual Assault Nurse Examiner (SANE) programs were created to provide comprehensive medical care, crisis intervention, and forensic services. However, there is limited research on the actual experiences and emotional impact of sexual assault survivors who seek treatment from SANEs. This qualitative study examined twenty rape survivors’ experiences with forensic nurse examiners of a Midwestern SANE program. Findings suggest that SANEs provided survivors with care and compassion, clear explanations, and choices. Taken together, these positive experiences were perceived as “humanizing”. However, some survivors perceived forensic nurses as hurtful when they were not provided with choices, explanation, and/or acted cold and distant. Implications for future research on SANE care and practice are discussed.

Using Ecological Theory to Evaluate the Effectiveness of an Indigenous Community Intervention: A Study of Sexual Assault Nurse Examiner (SANE) Programs

In recent years, there has been renewed interest among community psychologists in indigenous interventions, which are programs created by local practitioners (rather than researchers) already rooted in their communities. Indigenous interventions have strong ecological validity, but their effectiveness is often unknown because so few are rigorously evaluated. The goal of this project was to use Kelly and Trickett’s ecological theory as a conceptual framework for evaluating an indigenous intervention and its mediating mechanisms of effectiveness. The focal intervention was a midwestern Sexual Assault Nurse Examiner (SANE) program, which provides post-assault medical care, crisis intervention, and medical forensic exams for sexual assault survivors. Prior studies of SANE programs have suggested that these interventions may help increase sexual assault prosecution rates. In this case example, we used a mixed methods design to determine if this program contributed to increased prosecution rates, and if so, why. Based on qualitative interviews with key stakeholders, we found substantial evidence for the Principle of Interdependence such that the SANE program strengthened the interconnections between the legal and medical systems, which contributed to increased prosecution. The intervention was effective in these outcomes because it promoted Cycling of Resources throughout the systems and fostered Adaptation of new roles for legal and medical personnel. Moving beyond this specific case example, this paper also examines cross-cutting advantages and struggles of using an ecological approach in the evaluation of indigenous community interventions.

Adolescent sexual assault victims and the legal system: building community relationships to improve prosecution rates.

Adolescents are at high risk for sexual assault, but few of these crimes are reported to the police and prosecuted by the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary interventions to improve post-assault care for victims and increase prosecution rates. The two most commonly implemented interventions are Sexual Assault Nurse Examiner (SANE) Programs and Sexual Assault Response Teams (SARTs). The purpose of this study was to determine whether community-level context (i.e., stakeholder engagement and collaboration) was predictive of adolescent legal case outcomes, after accounting for “standard” factors that affect prosecution success (i.e., victim, assault, and evidence characteristics). Overall, 40% of the adolescent cases from these two SANE–SART programs (over a 10-year period) were successfully prosecuted. Cases were more likely to be prosecuted for younger victims, those with disabilities, those who knew their offenders, and instances in which the rape evidence collection kit was submitted by police for analysis. After accounting for these influences, multi-level modeling results revealed that in one site decreased allocation of community resources to adolescent sexual assault cases had a significant negative effect on prosecution case outcomes. Results are explained in terms of Wolff’s (Am J Community Psychol 29:173–191, 2001) concept of “over-coalitioned” communities and Kelly’s (1968) ecological principles.

The National Problem of Untested Sexual Assault Kits (SAKs): Scope, Causes, and Future Directions for Research, Policy, and Practice.

Victims of sexual assault are often advised to have a medical forensic exam and sexual assault kit (SAK; also termed a “rape kit”) to preserve physical evidence (e.g., semen, blood, and/or saliva samples) to aid in the investigation and prosecution of the crime. Law enforcement are tasked with submitting the rape kit to a forensic laboratory for DNA (deoxyribonucleic acid) analysis, which can be instrumental in identifying offenders in previously unsolved crimes, confirming identify in known-offender assaults, discovering serial rapists, and exonerating individuals wrongly accused. However, a growing number of media stories, investigative advocacy projects, and social science studies indicate that police are not routinely submitting SAKs for forensic testing, and instead rape kits are placed in evidence storage, sometimes for decades. This review article examines the growing national problem of untested rape kits by summarizing current research on the number of untested SAKs in the United States and exploring the underlying reasons why police do not submit this evidence for DNA testing. Recommendations for future research that can guide policy and practice are discussed.

With care and compassion: adolescent sexual assault victims' experiences in Sexual Assault Nurse Examiner programs.

ABSTRACT In this study, we conducted in-depth qualitative interviews with 20 adolescent sexual assault patients aged 14–17 years who sought postassault medical forensic examinations at one of two Midwestern Sexual Assault Nurse Examiner programs. Our goals were to examine how adolescent victims characterized the quality of the emotional/interpersonal care they received and to identify specific aspects of Sexual Assault Nurse Examiner nursing practice that were helpful and healing. Overall, the patients had very positive experiences with both programs. The nurses were sensitive to their patients’ physical and emotional needs throughout the examination. The adolescents also noted that the nurses were compassionate, caring, and personable. Finally, the survivors deeply appreciated that the nurses believed and validated their accounts of the assault. These findings suggest that compassionate care must be developmentally informed, such that basic patient-centered practices (e.g., belief and validation) are age sensitive and age appropriate.

Should Rape Kit Testing Be Prioritized by Victim–Offender Relationship?

Research Summary This study examined the DNA forensic testing outcomes from 894 previously untested sexual assault kits (SAKs) from Detroit, Michigan. At issue was how many of these SAKs would produce DNA profiles eligible for upload into CODIS (Combined DNA Index System), the national forensic DNA database maintained by the Federal Bureau of Investigation, and then how many would produce CODIS hits (DNA matches) to other crimes. Fifty-four percent of the SAKs associated with stranger-perpetrated sexual assaults yielded CODIS-eligible DNA profiles, producing 156 CODIS hits (DNA matches) and 51 hits matched prior sexual assault offenses in CODIS (i.e., serial sexual assault hit). Forty percent of the SAKs from nonstranger rapes had CODIS-eligible profiles, producing 103 CODIS hits and 18 serial sexual assault hits. CODIS entry rates and CODIS hit rates were equivalent between stranger and nonstranger SAKs; serial sexual assault hit rates were significantly higher for stranger SAKs. Policy Implications These results highlight the importance of testing both stranger and nonstranger SAKs as they have an equivalent likelihood of producing CODIS hits. The findings do not support policy recommendations that stranger-perpetrated SAKs should have testing priority over nonstranger SAKs. Prioritizing stranger SAKs may have unintended negative consequences on the utility of CODIS by limiting the number and type of eligible DNA profiles that are referenced in the federal DNA database.

Should Rape Kit Testing Be Prioritized by Victim-Offender Relationship?: Empirical Comparison of Forensic Testing Outcomes for Stranger and Nonstranger Sexual Assaults Campbell et al. Rape Kit Testing

Research Summary This study examined the DNA forensic testing outcomes from 894 previously untested sexual assault kits (SAKs) from Detroit, Michigan. At issue was how many of these SAKs would produce DNA profiles eligible for upload into CODIS (Combined DNA Index System), the national forensic DNA database maintained by the Federal Bureau of Investigation, and then how many would produce CODIS hits (DNA matches) to other crimes. Fifty-four percent of the SAKs associated with stranger-perpetrated sexual assaults yielded CODIS-eligible DNA profiles, producing 156 CODIS hits (DNA matches) and 51 hits matched prior sexual assault offenses in CODIS (i.e., serial sexual assault hit). Forty percent of the SAKs from nonstranger rapes had CODIS-eligible profiles, producing 103 CODIS hits and 18 serial sexual assault hits. CODIS entry rates and CODIS hit rates were equivalent between stranger and nonstranger SAKs; serial sexual assault hit rates were significantly higher for stranger SAKs. Policy Implications These results highlight the importance of testing both stranger and nonstranger SAKs as they have an equivalent likelihood of producing CODIS hits. The findings do not support policy recommendations that stranger-perpetrated SAKs should have testing priority over nonstranger SAKs. Prioritizing stranger SAKs may have unintended negative consequences on the utility of CODIS by limiting the number and type of eligible DNA profiles that are referenced in the federal DNA database.

Shelving Justice: The Discovery of Thousands of Untested Rape Kits in Detroit

In August 2009, approximately 11,000 sexual assault kits (SAKs; “rape kits”) were found in a Detroit police department storage facility, the vast majority of which had never been tested for DNA evidence. To address this problem, a multidisciplinary action research project was formed to bring together researchers and practitioners from law enforcement, prosecution, forensic sciences, medicine/nursing, and victim advocacy to develop evidence–based response strategies. In this paper, we will draw upon qualitative interviews with Detroit stakeholders, archival records, and ethnographic observations to examine the events surrounding the discovery of the rape kits and why police personnel did not view the accumulation of so many untested SAKs as a problem. Over the course of this three–year action research project, Detroit stakeholders worked together to enact local– and state–level reforms to test these kits and to prevent this problem from happening again.

Cold or caring? Adolescent sexual assault victims' perceptions of their interactions with the police

One-third of sexual assault cases that are reported to the police involve adolescent victims (Snyder, 2000), yet little is known about adolescent victims’ interactions with law enforcement. Through semistructured interviews with 20 adolescent sexual assault victims, this study sought to understand—from the perspectives of the adolescents—how the police interacted with them on an interpersonal level and the impact this had on the adolescents’ emotional well-being and engagement in the criminal justice system. Findings revealed that when the police engaged in behaviors that the victims perceived as caring, compassionate, and personable (vs. behaviors that were perceived as uncaring, insensitive, and intimidating), there was a positive impact on victims’ emotional well-being and criminal justice system engagement. Implications for improving adolescents’ help-seeking experiences are discussed.

Pathways to Help Adolescent Sexual Assault Victims’ Disclosure and Help-Seeking Experiences

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors’ disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged—and assisted—the survivors in seeking help. Throughout this process, the survivors’ disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors’ wishes; the adults made the victims seek help, which was also against the survivors’ preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims’ continued engagement with these systems.