"Feel the need to prepare for Armageddon even though I do not believe it will happen": Women Veterans' Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms.

AIMS: Firearm purchasing increased within the U.S. during the coronavirus disease 2019 pandemic. While rates of firearm ownership and suicide are elevated among women Veterans compared to women non-Veterans, no studies have examined if and how firearm beliefs and behaviors changed among women Veterans during the pandemic. We examined women Veterans' changes in firearm beliefs and engagement in firearm behaviors during the early pandemic era. METHOD: 3,000 post-9/11 era women Veterans were invited to participate in a survey. 501 respondents (May-December 2020) comprised the sample for this concurrent nested mixed-method analysis. Thematic analysis and log-binomial regression were used. RESULTS: 13.88% (n = 69) of women Veterans in our sample reported changes in their firearm beliefs; 22.15% (n = 109) reported engaging in firearm behaviors. The most prevalent reported behaviors were making household firearms more accessible (16.13%) and purchasing ammunition (11.97%). Smaller percentages reported carrying a firearm more frequently (6.71%), loading previously unloaded firearms (5.69%), or purchasing a firearm (4.24%). Thematic analysis suggested firearm behaviors were likely driven by a perceived increased need to protect oneself, family, and property due to: (1) uncertainties brought on by the pandemic; (2) pandemic-related threats necessitating self-defense, preparedness, and self-sufficiency; (3) political, social, and racial unrest and protests. PTSD symptom severity and military sexual assault history were associated with higher prevalence of changes in firearm beliefs and engagement in firearm behaviors during the pandemic. DISCUSSION: Consideration of women Veterans' prior experiences and pandemic-related factors may be necessary to contextualize firearm discussions and inform future research. Given associations of military sexual assault and PTSD symptoms with firearm beliefs and behaviors, it may be crucial to ensure that such discussion are trauma-informed.

An evaluation of a rapid conversion to teleSANE in response to COVID-19.

Sexual Assault Nurse Examiners (SANEs) provide expert, comprehensive medical forensic care to patients who present for services following a sexual assault. Because SANEs are not consistently available, telehealth technology is being explored as a means to provide access to this expert care (i.e., teleSANE). During the COVID-19 pandemic, teleSANE offered additional potential benefits by reducing the length of time spent and number of providers in patient exam rooms, the need for personal protective equipment that was in high demand and short supply, and provider anxiety related to providing in-person care. In the summer of 2020, the Massachusetts SANE program rapidly and temporarily converted five hospitals from in-person SANE care to teleSANE. An evaluation team interviewed 23 providers using a rapid research and evaluation methods approach to assess the temporary model and inform the future of SANE care. Evaluation findings reveal it is possible to rapidly and temporarily convert hospitals from in-person to teleSANE care in a time of broad uncertainty, and that such a change requires intensive and thoughtful planning; a shared commitment to being supportive, flexible, and responsive; and specific experience and expertise. Considerations for communities exploring how best to ensure consistent, equitable access to SANEs are discussed.

Population-Level Trends in Emergency Department Encounters for Sexual Assault Preceding and During the COVID-19 Pandemic Across Ontario, Canada.

Importance: Lockdown measures and the stress of the COVID-19 pandemic are factors associated with increased risk of violence, yet there is limited information on trends in emergency department (ED) encounters for sexual assault. Objective: To compare changes in ED encounters for sexual assault during the COVID-19 pandemic vs prepandemic estimates. Design, Setting, and Participants: This retrospective, population-based cohort study used linked health administrative data from 197 EDs across Ontario, Canada, representing more than 15 million residents. Participants included all patients who presented to an ED in Ontario from January 11, 2019, to September 10, 2021. Male and female individuals of all ages were included. Data analysis was performed from March to October 2022. Exposures: Sexual assault, defined through 27 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, procedure and diagnoses codes. Main Outcomes and Measures: Ten bimonthly time periods were used to compare differences in the frequency and rates of ED encounters for sexual assault between 2020 to 2021 (during the pandemic) compared with baseline prepandemic rates in 2019. Rate differences (RDs) and age adjusted rate ratios (aRRs) and Wald 95% CIs were calculated using Poisson regression. Results: From January 11, 2019, to September 10, 2021, there were 14 476 656 ED encounters, including 10 523 for sexual assault (9304 [88.4%] among female individuals). The median (IQR) age was 23 (17-33) years for female individuals and 15 (4-29) years for male individuals. Two months before the pandemic, ED encounters increased for sexual assault among female individuals (8.4 vs 6.9 cases per 100 000; RD, 1.51 [95% CI, 1.06 to 1.96]; aRR, 1.22 [95% CI, 1.09 to 1.38]) and male individuals (1.2 vs 1.0 cases per 100 000; RD, 0.19 [95% CI, 0.05 to 0.36]; aRR, 1.19 [95% CI, 0.87 to 1.64]). During the first 2 months of the pandemic, the rates decreased for female individuals (4.2 vs 8.3 cases per 100 000; RD, -4.07 [95% CI, -4.48 to -3.67]; aRR, 0.51 [95% CI, 0.44 to 0.58]) and male individuals (0.5 vs 1.2 cases per 100 000; RD, -0.72 [95% CI, -0.86 to -0.57]; aRR, 0.39 [95% CI, 0.26 to 0.58]). For the remainder of the study period, the rates of sexual assault oscillated, returning to prepandemic levels during the summer months and between COVID-19 waves. Conclusions and Relevance: These findings suggest that lockdown protocols should evaluate the impact of limited care for sexual assault. Survivors should still present to EDs, especially when clinical care or legal interventions are needed.

Sexual Violence Trends before and after Rollout of COVID-19 Mitigation Measures, Kenya.

COVID-19 mitigation measures such as curfews, lockdowns, and movement restrictions are effective in reducing the transmission of SARS-CoV-2; however, these measures can enable sexual violence. We used data from the Kenya Health Information System and different time-series approaches to model the unintended consequences of COVID-19 mitigation measures on sexual violence trends in Kenya. We found a model-dependent 73%-122% increase in reported sexual violence cases, mostly among persons 10-17 years of age, translating to 35,688 excess sexual violence cases above what would have been expected in the absence of COVID-19-related restrictions. In addition, during lockdown, the percentage of reported rape survivors receiving recommended HIV PEP decreased from 61% to 51% and STI treatment from 72% to 61%. Sexual violence mitigation measures might include establishing comprehensive national sexual violence surveillance systems, enhancing prevention efforts during school closures, and maintaining access to essential comprehensive services for all ages and sexes.

Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study.

BACKGROUND: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. OBJECTIVE: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. METHODS: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator's office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. RESULTS: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing-related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff's limited technical knowledge to perform certain technical tasks was challenging. CONCLUSIONS: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements.

Incidence of Emergency Department Visits for Sexual Abuse Among Youth in Hong Kong Before and During the COVID-19 Pandemic.

This cohort study assesses the incidence of emergency department (ED) visits in Hong Kong, China, for sexual abuse among youth before and during the COVID-19 pandemic.

Sexual violence in a Colombian municipality: Victims' and offenders' characteristics, 2011-2020 / Violencia sexual en un municipio de Colombia: características de las víctimas y de sus victimarios, 2011-2020.

Introduction: Sexual violence is a public health problem included in political and social agendas worldwide. It is a medical emergency seen in health services, which are the main source of record-keeping by means of public health surveillance systems. Objective: To analyze the sociodemographic characteristics of victims of sex offenses and their offenders in the municipality of Envigado, Antioquia, between 2011 and 2020. Materials and methods: This was a descriptive cross-sectional study that analyzed all the sexual violence records reported in the Envigado Public Health Surveillance System for gender and intrafamilial violence (file code INS-875) during the 2011-2020 period. Results: A total of 807 cases of sexual violence were recorded between 2011 and 2020; 62.0% were cases of sexual abuse against persons under 18 years of age, and 82.3% of the victims were adolescent women suffering sexual violence exerted by relatives. The main aggressors were men (99.1%) with a median age of 26 years. Conclusion: Sexual violence has increased over time and in 2020, the year of population confinement due to COVID-19, the rates in women and in the life courses of early childhood, adolescence, and youth were the highest during the study period.

Introducción. La violencia sexual es un problema de salud pública inscrito en las agendas sociales y políticas a nivel global. Representa una urgencia médica que se atiende en los servicios de salud, lo que los convierte en la principal fuente de su registro en los sistemas de vigilancia en salud pública. Objetivo. Analizar las características sociodemográficas de las víctimas de violencia sexual y de sus victimarios en el municipio de Envigado, Antioquia, entre el 2011 y el 2020. Materiales y métodos. Se hizo un estudio transversal descriptivo a partir de todos los registros de violencia sexual notificados en el Sistema de Vigilancia en Salud Pública de la violencia de género e intrafamiliar de Envigado (código de ficha INS-875), durante el periodo 2011-2020. Resultados. Se registraron 807 casos de violencia sexual entre 2011 y 2020; el 62,0 % correspondió a casos de abuso sexual a personas menores de 18 años; el 82,3 % de las víctimas estaba constituido por mujeres adolescentes agredidas por familiares; los principales agresores fueron hombres (99,1 %), con una mediana de edad 26 años. Conclusión. La violencia sexual es un problema en aumento; en el 2020, año del confinamiento poblacional por la Covid-19, las tasas en mujeres y durante la primera infancia, la adolescencia y la juventud, fueron las más altas del periodo de estudio.

Campus Sexual Violence Prevention and Response: Lessons from a Pandemic to Inform Future Efforts.

The COVID-19 pandemic forced institutions of higher education to transition and work in ways that were new and innovative. Even though most colleges and universities transitioned to a virtual platform, the issues that students face continued, including sexual violence (SV). For many campus prevention and response professionals, reaching students during the pandemic posed unique challenges. The COVID-19 pandemic began when the project team was 18-months into a 4-year grant to administer and evaluate the efficacy of a SV prevention and response app, uSafeUS®, at 15 4-year colleges. In this paper, we describe the transition of engaging students with the app in traditional in-person settings to remote and hybrid learning settings. The project team, in collaboration with the campus partners, devised new ways to use the app to support victims of SV and their allies, along with campus professionals in their efforts to support students. These efforts included changes to collaboration (e.g., virtual platforms) and student engagement strategies. We describe how the lessons learned from this transition are important for continuing to engage campus communities in SV prevention and response, even as campuses slowly transitioned back to hybrid and in-person activities. The knowledge gained from this transition are attributable to an ongoing and open collaboration between campus practitioners and the project team.

Looking at COVID-19 effects on intimate partner and sexual violence organizations in Canada through a feminist political economy lens: a qualitative study.

OBJECTIVES: Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery. METHODS: We interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens. RESULTS: We identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care. CONCLUSION: A feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.

RéSUMé: OBJECTIFS: Les organismes de lutte contre la violence conjugale et la violence sexuelle, comme les hébergements pour femmes, jouent un rôle crucial dans la promotion de l'égalité des genres au Canada. La COVID-19 a remis en question le mode de fonctionnement de ces organisations. Cette étude a examiné la manière dont les organismes de lutte contre la violence conjugale et sexuelle au Canada ont été affectés par la COVID-19 et les conséquences sur la prestation de services. MéTHODES: Nous avons mené des entrevues avec 17 intervenantes de première ligne et membres de la direction d'organismes et de programmes de lutte contre la violence conjugale et sexuelle à travers le Canada. Les données ont été analysées à l'aide d'une analyse thématique et en appliquant une optique d'économie politique féministe. RéSULTATS: Nous avons identifié les thèmes suivants : 1) adaptation; 2) difficultés financières; 3) ingéniosité; 4) difficultés à établir des liens; 5) réduction du champ d'action; et 6) charge de travail. CONCLUSION: Un cadre d'économie politique féministe permet d'examiner l'impact genré de la pandémie et des mesures connexes sur le personnel. La pandémie a eu des répercussions sur les organismes de lutte contre la violence conjugale et la violence sexuelle au Canada, sur le personnel qui y travaille et sur la qualité des relations entre le personnel et les clients. Les organisations de lutte contre la violence ont souffert d'un sous-financement chronique et leur personnel, majoritairement féminin, a été sous-payé, ce qui a nui à leur capacité de répondre aux besoins des femmes. L'apparition du COVID-19 a non seulement aggravé ces problèmes, mais a aussi entraîné un changement d'orientation vers des tâches plus liées à la pandémie, ce qui a limité encore davantage le champ d'action des organismes. Il reste à voir si les adaptations, les innovations et la persévérance dont font preuve ces organisations et leur personnel peuvent faire pencher la balance en faveur d'une politique et de résultats plus équitables.

An evaluation of a rapid conversion to teleSANE in response to COVID-19.

Sexual Assault Nurse Examiners (SANEs) provide expert, comprehensive medical forensic care to patients who present for services following a sexual assault. Because SANEs are not consistently available, telehealth technology is being explored as a means to provide access to this expert care (i.e., teleSANE). During the COVID-19 pandemic, teleSANE offered additional potential benefits by reducing the length of time spent and number of providers in patient exam rooms, the need for personal protective equipment that was in high demand and short supply, and provider anxiety related to providing in-person care. In the summer of 2020, the Massachusetts SANE program rapidly and temporarily converted five hospitals from in-person SANE care to teleSANE. An evaluation team interviewed 23 providers using a rapid research and evaluation methods approach to assess the temporary model and inform the future of SANE care. Evaluation findings reveal it is possible to rapidly and temporarily convert hospitals from in-person to teleSANE care in a time of broad uncertainty, and that such a change requires intensive and thoughtful planning; a shared commitment to being supportive, flexible, and responsive; and specific experience and expertise. Considerations for communities exploring how best to ensure consistent, equitable access to SANEs are discussed.

"The Global Sense of Disaster was Synchronized With my Own Disaster": Implications of the COVID-19 Crisis on the Wellbeing of Survivors of Sexual Violence.

The present study is designed to improve our understanding of the impact of the COVID-19 pandemic, as collective trauma, on the wellbeing of survivors of sexual violence (SV). The data are based on an online qualitative survey about the experiences of 39 survivors and a thematic analysis of ten in-depth interviews with service providers in Israel. The findings reveal that the pandemic and restrictive measures are associated with increased risk for participants' wellbeing, caused directly by pandemic characteristics, as well as indirectly through the denial of access to coping resources. Paradoxically, the pandemic also offers relief, given the widespread restrictions imposed on the entire population and the general crisis atmosphere. The service providers' perspective indicates an increased demand for services as well as for their adjustment. These findings highlight the vulnerability of individuals with a history of SV and the need for accommodation of frontline SV services for health crises.

Post-Assault Health Care for Sexual Assault Survivors During COVID-19: A Mixed Methods Analysis of Service Rates in a Predominately African American Community.

This study examined how the COVID-19 pandemic affected sexual assault healthcare services in a predominately African American U.S. city. In mixed methods research design, we used quantitative interrupted time series modeling to evaluate changes in service rates for three core post-assault healthcare services-medical forensic exams (MFEs), medical advocacy MFE accompaniment, and counseling-from January 2019 through June 2021. We also conducted qualitative interviews with 12 sexual assault advocates to understand how their clients were impacted by COVID and how their agency adapted services to respond to the needs of their community. Both the quantitative and qualitative data revealed marked disruptions in service provision. The number of MFEs, medical advocacy accompaniments, and counseling sessions significantly decreased during the pandemic's initial surge, and survivors feared seeking hospital-based health care due to concerns that they might contract COVID-19 in hospital emergency departments. The number of MFEs performed by program staff did not return to pre-pandemic levels during this study's observation period, but the number of medical advocacy accompaniments and counseling sessions did significantly rebound. Counseling services eventually exceeded pre-pandemic levels as agency staff supported clients with both assault- and COVID-related trauma and loss. These results underscore the need for community-based sexual assault healthcare services, so that if public health emergencies limit the availability, accessibility, and safety of hospital emergency department care, sexual assault survivors have other settings for obtaining post-assault health care.

Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices.

Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce.Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.

Examining organization and provider challenges with the adoption of virtual domestic violence and sexual assault interventions in Alberta, Canada, during the COVID-19 pandemic.

OBJECTIVES: In Canada, calls to domestic violence and sexual assault hotlines increased during the COVID-19 pandemic as stricter public health restrictions took effect in parts of the country. Moreover, the public health measures introduced to limit the transmission of COVID-19 saw many health providers abruptly pivot to providing services virtually, with little to no opportunity to plan for this switch. We carried out a qualitative research study to understand the resulting challenges experienced by providers of domestic violence and sexual assault support services. METHODS: Twenty-four semi-structured interviews were conducted to gather in-depth information from service providers and organizational leaders in the Canadian province of Alberta about the challenges they experienced adopting virtual and remote-based domestic violence and sexual assault interventions during the COVID-19 outbreak. Interview transcripts and field notes were analysed using a thematic analysis approach. RESULTS: Our findings highlighted multiple challenges organizations, service providers and clients experienced. These included: (1) systemic (macro-level) challenges pertaining to policies, legislation and funding availability, (2) organization and provider (meso-level) challenges related to adapting services and programmes online or for remote delivery and (3) provider perceptions of client (micro-level) challenges related to accessing virtual interventions. CONCLUSIONS: Equity-focused policy and intersectional and systemic action are needed to enhance delivery and access to virtual interventions and services for domestic violence and sexual assault clients.

Development of the Duquesne University School of Nursing Sexual Assault Nurse Examiner Training Model.

INTRODUCTION: Lack of preceptors and hands-on training opportunities has long been an impediment to nurses pursuing sexual assault nurse examiner (SANE) practice and certification after completing a SANE didactic course. In addition, nurses in rural and underserved areas often lack the professional support and mentoring needed. To address this gap and increase the number of certified practicing SANEs, the Duquesne University School of Nursing (DUSON) received funding from the Department of Health Resources and Services Administration for a program designed to provide advanced nursing education to increase the number of nurses who are trained and certified as nurse examiners. APPROACH: The DUSON developed a hands-on clinical preceptor course and other support programming to supplement the existing SANE didactic course training. The goal was to create a comprehensive model that took students from initial SANE training through to certification. LESSONS LEARNED: In the first two- and three-quarter years of the program, 36 nurses achieved certification, and another 116 completed a didactic course and initial hands-on skills training and are preparing for certification. Approximately 41.5% of participants are from rural and/or underserved areas. Challenges included the adaptations required by the COVID-19 pandemic and engagement of nurses once they returned to their home institution to complete additional hours. CONCLUSIONS: The DUSON comprehensive model provides a solid pathway for nurses who want to become SANEs, and the structure of the program seems especially conducive for training nurses in rural and underserved areas.

Non-fatal strangulation and COVID-19 common symptoms and signs: considerations for medical and forensic assessment.

Emerging evidence suggests that an onset or escalation of interpersonal violence has been occurring during the COVID-19 pandemic, particularly among persons in intimate or familial relationships. Strangulation (or neck compression) is a common form of interpersonal violence and can result in serious adverse health outcomes, including death. The identification and attribution of injuries from non-fatal strangulation are complex, as there may be an absence of external signs of injury and their appearance may be delayed by many days. There is a heavy reliance on clinician identification of 'red flag' symptoms and signs, the presence of which necessitates urgent further assessment. Additional challenges arise when acute non-fatal strangulation symptoms and signs are shared with other clinical conditions. In such cases, differentiating between the conditions based on the symptoms and signs alone is problematic. We present the diagnostic challenges faced when conducting forensic assessments of COVID-19-positive and suspected COVID-19 (S/COVID) patients following allegations of non-fatal strangulation in the setting of physical and sexual assaults. The implications of shared symptoms and signs, for forensic clinicians, primary healthcare, and emergency practitioners, as well as other frontline service providers, are discussed.

Sexual assault survivors' engagement with advocacy services during the COVID-19 pandemic.

Sexual assault advocates provide support to survivors as they navigate medical, legal, housing, and other complex systems. However, social distancing measures enacted in response to coronavirus disease 2019 (COVID-19) forced changes to traditional advocacy services. The current study aimed to understand how the COVID-19 pandemic transformed survivors' engagement with sexual assault advocacy services. Semi-structured interviews were conducted with 12 sexual assault advocates from a community-based advocacy organization in Detroit. Thematic analysis was employed to uncover emergent themes reflecting COVID-19's impact on survivors' engagement with advocacy services. Three themes were identified: (1) Disruption to advocacy services; (2) difficulty obtaining tangible resources; and (3) desire for COVID-related support, information, and resources. This study highlights the needs of sexual assault survivors during the COVID-19 pandemic and explores how public health emergencies have the potential to exacerbate the needs of this vulnerable population. Implications and future directions for service provision and research are considered.

COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors.

BACKGROUND: There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. METHODS: Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. RESULTS: Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). CONCLUSION: This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.

On the Front Lines of the COVID-19 Pandemic: Occupational Experiences of the Intimate Partner Violence and Sexual Assault Workforce.

In the face of increasing risk for intimate partner violence (IPV) and sexual assault during the COVID-19 pandemic, there is an urgent need to understand the experiences of the workforce providing support to survivors, as well as the evolving service delivery methods, shifting safety planning approaches, and occupational stress of frontline workers. We addressed this gap by conducting an online survey of members of IPV and sexual assault workforce using a broad, web-based recruitment strategy. In total, 352 staff from 24 states participated. We collaborated with practitioner networks and anti-violence coalitions to develop the brief survey, which included questions about work and health, safety planning, and stress. We used chi-square, t-test, and ANOVA analysis techniques to analyze differences within position and demographic variables. For qualitative data, we used thematic analysis to analyze responses from four open-ended questions. The sample was majority female-identified (93.7%) and essential workers in dual IPV and sexual assault programs (80.7%). Findings demonstrated that since the pandemic began, IPV and sexual assault staff are experiencing more personal and professional stressors, perceive a decrease in client safety, and lack resources needed to help survivors and themselves. Common problems included a lack of food or supplies at home and work and housing and financial support for survivors. There was a 51% increase in the use of video conference for work, which contributed to workforce strain. Reductions in overall service capacity and a shift to remote service provision have implications for both survivors and staff. These findings suggest a critical need for additional training, infrastructure, and support for the IPV and sexual assault workforce. There is an urgent need to classify IPV and sexual assault staff as first responders and address the occupational stress associated with the COVID-19 pandemic.