Megan R. Greeson

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes.

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital womens clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of womens lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed.

Development of the Scale of Economic Abuse

Economic abuse is part of the pattern of behaviors used by batterers to maintain power and control over their partners. However, no measure of economic abuse exists. This study describes the development of the Scale of Economic Abuse, which was designed to fill this gap. Interviews were conducted with 103 survivors of domestic abuse, each of whom responded to measures of economic, physical, and psychological abuse as well as economic hardship. Results provide evidence for the reliability and validity of the scale. This study is an important first step toward understanding the extent and impact of economic abuse experienced by survivors.

The Impact of Family and Community Violence on Children's Depression Trajectories: Examining the Interactions of Violence Exposure, Family Social Support, and Gender

This longitudinal study used multilevel modeling to examine the relationships between witnessing intimate partner violence (IPV), community and school violence exposure (CSVE), family social support, gender, and depression over 2 years within a sample of 100 school-aged children. We found significant between-child differences in both the initial levels of depression and the trajectories of depression; depression over time was positively associated with change in witnessing IPV and CSVE and negatively associated with change in support. Two significant 3-way interactions were found: Gender and initial support, as well as gender and initial witnessing IPV, both significantly moderated the effect of change in witnessing IPV on the childrens depression over time.

Sexual Assault Response Teams (SARTs): An Empirical Review of Their Effectiveness and Challenges to Successful Implementation

Historically, the response of the legal, medical, and mental health/advocacy systems to sexual assault has been inadequate and uncoordinated. To address this problem, communities have developed coordinated sexual assault response teams (SARTs) to address these problems. SARTs are community-level interventions that seek to build positive relationships and increase collaboration among sexual assault responders. SARTs hope to improve both the community response to sexual assault victims and the processing of sexual assault cases through the criminal justice system. This article has three aims: to summarize the historical development of SARTs in the United States, to review the empirical literature on SARTs’ effectiveness at improving multidisciplinary relationships, legal outcomes, and victims’ help-seeking experiences; and to review the empirical literature on the challenges SARTs face, which may hamper their effectiveness. Findings suggest that SARTs are a promising practice, but face many challenges; further methodologically rigorous research is needed to more fully understand these interventions. Implications for policy, practice, and future research are discussed.

The Effects of Community and Family Violence Exposure on Anxiety Trajectories During Middle Childhood: The Role of Family Social Support as a Moderator

This 2-year longitudinal study investigated the relations between community and school violence exposure, witnessing intimate partner violence (IPV), family social support, and anxiety, within a sample of 100 school-age children (39% female, M age = 9.90 years). Using multilevel modeling, we found heterogeneity across children in terms of their initial levels of anxiety and their trajectories of anxiety over time. Initial community and school violence exposure and witnessing IPV were both positively associated with initial levels of anxiety. Over time, change in both community and school violence exposure and witnessing IPV positively covaried with anxiety. Further, gender, initial family social support, and change in family social support significantly moderated the effect of change in community and school violence exposure on anxiety.

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.

Coordinated Community Efforts to Respond to Sexual Assault: A National Study of Sexual Assault Response Team Implementation

Sexual Assault Response Teams (SARTs) bring together sexual assault responders (e.g., police, prosecutors, medical/forensic examiners, rape victim advocates) to coordinate and improve the response to sexual assault. Ultimately, SARTs seek to improve sexual assault victims’ experiences of seeking help and sexual assault case outcomes in the criminal justice system. To date, there are hundreds of SARTs across the United States and yet, there has been no nationally representative study of how SARTs are implemented. Therefore, the current study used a multistep process to create the first sampling frame of SARTs and then studied how SARTs are structured and function within a random sample of SARTs. Findings reveal commonalities as well as variation across SARTs. Most SARTs rated improving legal outcomes, improving victims’ help-seeking experiences, and prevention/education as important goals, yet most prioritized their time and energy toward victims’ experiences. SARTs’ membership varied, with an average of 12 organizations involved in the SART, and 75% of SARTs having active membership from police, prosecutors, rape victim advocates, and medical/forensic examiners. SARTs were moderately formalized and most SARTs engaged in most collaborative processes (e.g., multidisciplinary cross-training, case review, policy/protocol development, and review) on an as needed basis. Finally, results revealed that some types of cross-system coordination in responding to victims/cases were quite frequent, whereas other types of coordination were quite infrequent. Implications for future research and supporting the development and sustainability of SARTs 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.

Beyond Deficits: Intimate Partner Violence, Maternal Parenting, and Child Behavior Over Time

Exposure to intimate partner violence (IPV) has negative consequences for children’s well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers’ parenting. The current study employed path analysis to examine the relationships among IPV, mothers’ parenting practices, and their children’s externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant relationship, such that IPV lead to higher authoritative parenting and lower child behavior problems. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women’s and children’s well-being in the context of IPV are discussed.

Rape Survivors’ Agency Within the Legal and Medical Systems

Many rape survivors seek help from the legal and medical systems post-assault. Previous studies have examined how social system personnel treat survivors, but less attention has been paid to how survivors attempt to shape their interactions with these systems. The purpose of this qualitative study was to examine rape survivors’ agency—the active process in which they engaged to alter their experiences with the legal and medical systems. In-depth face-to-face interviews were conducted with 20 female rape survivors who had contact with the police and a Sexual Assault Nurse Examiner (SANE) program. Analytic induction was the guiding analytic approach. Findings indicate that this group of survivors engaged in three agentic processes in their interactions with the legal and medical systems: compliance in order to increase the likelihood their case would achieve what they deemed to be a successful outcome, defiance through noncompliance in order to protect themselves from further harm, and defiance by challenging the response to their case in order to alter the response to their case. Based on these findings, possible strategies for facilitating survivors’ participation and agency during their help-seeking experiences (e.g., systemic changes to empower survivors, improving the responsiveness of system personnel to survivors’ needs) are discussed. Implications may be of particular interest to rape-victim advocates and legal and medical personnel.