Drinking, Diversity, and Discrimination: Campus-Level Factors that Influence Students' Risk of Experiencing Sexual Assault.

College students' individual-level risk factors for sexual assault victimization have been studied for decades, but fewer studies have looked at whether and how campus-level factors, such as campus-level rates of discrimination and campus diversity, might also influence student victimization risk. Identifying these broader factors can inform efforts to develop more effective campus-level sexual assault preventive interventions. We conducted a secondary analysis of data from a large, multi-campus health and well-being survey (N = 309,171 students across 474 US campuses) to explore how campus-level factors shape students' risk of experiencing sexual assault after accounting for students' individual-level risk factors. Using mixed-effects logistic regression, we examined the influence of campus-level factors (e.g., campus sexual orientation demographics and gender diversity) on students' odds of experiencing sexual assault, after accounting for individual risk factors (e.g., sexual and gender minority status). Although some campus characteristics, such as enrollment size, had small significant effects on students' odds of experiencing sexual assault, we found larger significant effects from aggregated campus-level rates of binge drinking, campus diversity (particularly regarding sexual orientation and gender), and discrimination. These findings suggest that comprehensive campus sexual violence prevention would benefit from strategies that promote safe and inclusive campuses, especially for students with marginalized sexual and gender identities.

"It Made Me Feel Like Someone Wasn't Doing Their Job:" Sexual Assault Kit (SAK) Victim Notifications and Institutional Betrayal by the Criminal Legal System.

In the United States, sexual assault survivors are advised to have a medical forensic exam and the collection of a sexual assault kit (SAK) to preserve biological evidence (e.g. semen, blood, saliva, hair) if they are considering reporting the assault to the police. Law enforcement personnel are supposed to submit the SAK (also known as a "rape kit") to a crime laboratory for forensic DNA testing, which can help identify or confirm the identity of the offender. However, police do not routinely submit SAKs for testing, and large stockpiles of untested kits have been found in police storage throughout the United States. Public outrage has prompted many cities to submit these older rape kits for DNA analysis, and this testing has identified thousands of suspected perpetrators. Police and prosecutors are re-opening these older sexual assault cases, which requires reestablishing contact with survivors who made the initial report years ago - a process referred to as "victim notification." In this study, we conducted qualitative interviews with survivors who received a SAK victim notification and participated in the re-investigation and prosecution of their cases. We explored how survivors reacted to this de facto admission of an institutional betrayal and the emotions they felt during and after the notification. Participants experienced considerable emotional distress (e.g. PTSD, anxiety, fear), anger and betrayal, and hope after they were recontacted by the police. Implications for making victim notifications more trauma informed are discussed.

Victim Notification Protocols for Untested Sexual Assault Kits: Survivors' and Advocates' Perspectives on Law Enforcement-Led Outreach Methods.

Current estimates suggest there are 300,000-400,000 untested sexual assault kits (SAKs) in police department storage facilities throughout the United States. As these kits are being discovered and then submitted for forensic DNA testing, legal system personnel may recontact victims. These "victim notifications" involve informing survivors their kits were previously untested, sharing the results of new DNA testing, and asking for their engagement in reinvestigating and prosecuting the case. Typically, victim notifications are conducted by police, and survivors are connected with victim advocates soon thereafter. In this study, we interviewed survivors about their experiences of being notified by the police. We also interviewed about their work supporting survivors. Both survivors and advocates expressed strong concerns about police conducting notifications without an advocate present.

Organizational Readiness and Response During COVID-19: Reflections From a Sexual Assault Agency Serving a Predominately African American Community.

The coronavirus disease 2019 (COVID-19) pandemic forced victim service organizations to establish new service provision protocols to include remote/telehealth services. We conducted N = 12 qualitative interviews with sexual assault advocates working in an urban agency in a predominately African American U.S. city to understand how they adapted services to meet the needs of their community. A thematic analysis revealed this organization was under-prepared for prolonged interruption of in-person services. Even though this agency was able to create telehealth options, many clients did not have the financial and technological resources to utilize these services. Advocates reported that survivors expressed a strong preference for in-person services, which afford more privacy and confidentiality. The pervasive digital divide within this urban community limited survivors' access to comprehensive services and jeopardized their safety.

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.

Open science and data sharing in trauma research: Developing a trauma-informed protocol for archiving sensitive qualitative data.

OBJECTIVE: The open science movement seeks to make research more transparent, and to that end, researchers are increasingly expected or required to archive their data in national repositories. In qualitative trauma research, data sharing could compromise participants' safety, privacy, and confidentiality because narrative data can be more difficult to de-identify fully. There is little guidance in the traumatology literature regarding how to discuss data-sharing requirements with participants during the informed consent process. Within a larger research project in which we interviewed assault survivors, we developed and evaluated a protocol for informed consent for qualitative data sharing and engaging participants in data de-identification. METHOD: We conducted qualitative interviews with N = 32 adult sexual assault survivors regarding (a) how to conduct informed consent for data sharing, (b) whether participants should have input on sharing their data, and (c) whether they wanted to redact information from their transcripts prior to archiving. RESULTS: No potential participants declined participation after learning about the archiving mandate. Survivors indicated that they wanted input on archiving because the interview is their story of trauma and abuse and it would be disempowering not to have control over how this information was shared and disseminated. Survivors also wanted input on this process to help guard their privacy, confidentiality, and safety. None of the participants elected to redact substantive data prior to archiving. CONCLUSIONS: Engaging participants in the archiving process is a feasible practice that is important and empowering for trauma survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Supporting sexual assault survivors with disabilities: Tracing disclosure and referral pathways to postassault health care services.

National epidemiological data indicate that nearly 4 in 10 victims of recent sexual assaults have physical, cognitive/developmental, or mental health disabilities, which can make navigating postassault help seeking more challenging. To streamline services, many communities have created sexual assault nurse examiner (SANE) programs for comprehensive health care, crisis intervention, medical forensic evidence collection, victim advocacy, and legal referrals. SANE programs are recommended as the national best practice for postassault care, but there is virtually no U.S.-based research on whether survivors with disabilities seek these services. The present study sought to identify the disclosure and referral pathways that successfully connected sexual assault survivors with disabilities to SANE programs for postassault care. Forensic nurses in one midwestern state recorded information about all adult sexual assault patients (N = 755) who sought care during a 9-month window of data collection. Survivors with disabilities were significantly less likely than those who did not have disabilities to disclose to informal support providers (e.g., family, friends) and those individuals were unlikely to suggest to survivors with disabilities that they seek postassault health care. Survivors with disabilities were significantly more likely than survivors who did not have disabilities to disclose to formal help sources and to be referred to SANE programs by other formal community services, typically the police. A strong referral network from law enforcement to SANE programs is important, but survivors who do not wish to pursue criminal investigation need reliable pathways to postassault health care. Strategies for promoting community awareness of SANE services are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Right to Say No: Why Adult Sexual Assault Patients Decline Medical Forensic Exams and Sexual Assault Kit Evidence Collection.

INTRODUCTION: The International Association of Forensic Nurses (2018) affirms the importance of evidence-based, trauma-informed, patient-centered forensic nursing services that engage patients as autonomous decision makers. Past research indicates that forensic nurses consistently respect patients' choices and control as they navigate the decisions of medical forensic examinations (MFEs) and sexual assault kit (SAK) collection. Building on that work, this study examined which options patients decline and what factors are associated with those declination decisions. METHOD: We collected prospective data from seven state-funded sexual assault nurse examiner programs. Forensic nurses recorded information about all adult sexual assault patients (N = 783) regarding four primary decisions: whether to have a MFE, whether to consent to all parts of the MFE or to decline specific services, whether to have a SAK collected, and whether to release the SAK to law enforcement for forensic DNA testing. RESULTS: Most patients consented to a MFE (95%), to all parts of the MFE (81%), to SAK collection (99%), and to release the SAK for forensic DNA testing (80%). Younger patients and those with disabilities were more likely to decline some options. Patients who had not disclosed the assault to others before seeking sexual assault nurse examiner care were also more likely to decline a MFE. Whether patients sought post assault care for more health-focused reasons or legally focused reasons was associated with declination decisions. CONCLUSIONS: Healthcare providers should communicate clearly about each step in post assault care and allow patients to decline services as they choose.

Partnering With Oppressive Institutions for Social Change: Roles, Ethics, and a Framework for Practicing Accountability.

Community psychology is driven by the values of social justice, action, and accountability to oppressed groups, with a large body of literature devoted to understanding how to work in partnership with communities through participatory methodologies (e.g., community-based participatory research, participatory action research). However, some community psychologists may work in partnership with oppressive institutions (e.g., the criminal justice system) in order to transform these institutions toward greater equity and justice. In this conceptual review, I explore the unique challenges and opportunities of partnering with oppressive institutions for social change. First, I define oppressive institutions as those that are hierarchy-enhancing under social dominance theory and draw on theories of social change to explain when and why we might choose to partner with these institutions in research and action. I then review case studies of the ethical dilemmas community psychologists have faced in such partnerships. Finally, I propose a conceptual framework for practicing accountability when partnering with hierarchy-enhancing institutions. This framework includes specific practices that research/evaluation teams might incorporate into their relationships with institutional partners and communities impacted by the institution.

Developing Trauma-Informed Research Methods: Using Proxy Respondents to Assess Sexual Assault Survivors' Experiences Seeking Medical Forensic Exams.

In research on sexual assault victims' help-seeking, proxy data sources are often utilized because outreach to survivors immediately postassault may increase a study's risk-to-benefit ratio. Victim advocates and services providers are common proxy respondents, but empirical research comparing the accuracy of their information is needed. We collaborated with seven sexual assault nurse examiner (SANE) programs to collect de-identified, paired data from nurses and advocates regarding the help-seeking experiences of N = 744 adult victims. Using pairwise McNemar tests, we found statistically significant agreement on victim demographics, assault characteristics, and victims' decisions regarding medical forensic exams, sexual assault kit (SAK) collection, and release of SAKs for forensic DNA testing. Nurses and advocates had different information regarding victims' disclosure histories and their reasons for seeking SANE care.

"This Isn't Just a Police Issue": Tensions between Criminal Justice and University Responses to Sexual Assault among College Students.

Sexual assault among college students is both a crime and a civil rights violation under U.S. federal Title IX policy, which prohibits discrimination on the basis of sex in educational institutions. The current study sought to understand the extent to which the criminal justice system influences university Title IX proceedings, as well as potential consequences of this influence. For this study, we conducted in-depth qualitative interviews with a sample of 22 multidisciplinary, nationally-recognized subject matter experts in the area of campus sexual assault response. The results indicated that criminal justice concepts and goals are indeed being conflated with and influencing university Title IX proceedings. Participants also reported that criminal investigations are often prioritized over or seen as higher quality than Title IX investigations. As a result, participants described diminished educational and civil rights protections for survivors. We discuss how the community psychology values of social justice, promoting health and well-being, and accountability to oppressed groups can guide future efforts to reduce the spread of criminal justice influence into Title IX, improve existing Title IX proceedings, and explore alternative models of accountability beyond traditional criminal and civil approaches.

A State Census of Unsubmitted Sexual Assault Kits: Comparing Forensic DNA Testing Outcomes by Geographic and Population Density Characteristics.

A growing number of U.S. cities and states have large numbers of unsubmitted sexual assault kits (SAKs) in police property facilities. Prior research conducted in large urban cities has found that testing these kits yields a sizable number of DNA profiles that meet FBI eligibility for upload to the national criminal DNA database CODIS (Combined DNA Index System) and uploaded profiles return a substantial number of matches to existing criminal profiles in CODIS. It is unknown whether these findings are unique to large urban cities with high crime rates. The purpose of current study was to document forensic testing outcomes from a state census of previously unsubmitted SAKs, which included large urban-suburban centers, as well as smaller cities and rural counties. We inventoried all previously unsubmitted SAKs in Michigan (N = 3422 SAKs) and submitted all kits for forensic DNA testing. A total of n = 1239 SAKs had a DNA profile that met eligibility for upload into CODIS (36.2% unconditional, 56.5% conditional CODIS eligible rate) and n = 585 SAKs yielded a CODIS Hit (17.1% unconditional, 47.2% conditional CODIS hit rate). These rates are consistent with studies from urban areas suggesting approximately half of SAKs tested yield a CODIS profile and approximately half of those uploaded profiles yield a hit. We compared SAK forensic testing outcomes by geographic and population density characteristics, and although rates were often higher in larger metropolitan areas, the obtained rates in micropolitan and rural areas suggest testing is warranted in smaller jurisdictions as well.

Stressors and Drinking in Sexual Minority Women: The Mediating Role of Emotion Dysregulation.

Sexual minority women are at elevated risk for exposure to stressors (both traumatic and discriminatory) and have higher rates of alcohol consumption and problems. The psychological mediation framework (Hatzenbuehler, 2009) suggests that both general (e.g., traumatic events to which minorities and nonminorities may be exposed) and minority-group-specific (e.g., discrimination) stressors contribute to psychopathology through mediators such as emotion dysregulation. Guided by this framework, the present study longitudinally examined the relationship between stressors and problematic drinking outcomes (i.e., binge drinking and alcohol-related problems), as mediated by emotion dysregulation, in sexual minority women (SMW). It addressed two research questions: (1) whether stressors longitudinally predict problematic drinking outcomes in SMW, as mediated by emotion dysregulation, and (2) for which specific forms of stressor (i.e., traumatic events and/or discrimination) this mediational relationship is present. Young adult women (N = 1057) who identified as lesbian or bisexual completed annual measures of daily heterosexism, traumas, and drinking outcomes for four years, and completed a measure of emotion dysregulation during the third year of data collection. We found an indirect relationship between discrimination and problematic drinking outcomes via emotion dysregulation. These findings are consistent with the psychological mediation framework (Hatzenbuehler, 2009) and suggest that SMW group-specific processes such as discrimination may be especially important in conferring risk for problem drinking via emotion dysregulation. Clinicians are advised to assess unique stressors faced by SMW and their potential contribution to problematic drinking outcomes, and to target emotion dysregulation in alcohol treatments.

Widening the Lens: An Ecological Review of Campus Sexual Assault.

Varying prevalence rates of sexual violence across colleges and universities indicate the need to understand institutional factors underlying such variation; however, research often focuses exclusively on individual risk and protective factors, which both under theorizes and under explains the phenomenon of campus sexual assault. In this review, we propose that broadening to include campus- and contextual-level factors is necessary to fully explain campus sexual assault. Using an ecological approach, we identify and synthesize research related to campus-level variation in sexual violence, including availability of campus services and resources for survivors, institutional risk factors such as alcohol and party culture, athletics, and fraternities, and the impact of policies at the state and federal levels. Suggestions are made for conducting additional research at the campus level and implications of reframing campus sexual assault from an institutional lens are discussed, including the importance of this approach for practice, evaluation, and policy.

The Frequency, Nature, and Effects of Coerced Debt Among a National Sample of Women Seeking Help for Intimate Partner Violence.

This study examines the frequency, nature, and effects of coerced debt, defined as non-consensual, credit-related transactions that occur in intimate relationships where one partner uses coercive control to dominate the other. The sample includes 1,823 women who called the National Domestic Violence Hotline. Results suggest that coerced debt, from both coercive and fraudulent transactions, is a common problem and is significantly related to control over financial information, credit damage, and financial dependence on the abuser. This study supports the need for policy reform and victim services aimed at addressing coerced debt, thereby mitigating a potentially significant economic barrier to safety.

A Trauma-Informed Approach to Sexual Violence Research Ethics and Open Science.

The practice of ethics in social science research is a reflexive process of self-review to define a profession's collective responsibility in the face of changing norms and expectations. In recent years, we have seen transformative changes in how society thinks about supporting sexual assault survivors, and how the scientific community thinks about our obligations to society. Decades of research on trauma and its impact has raised awareness about the needs of victimized individuals, giving rise to the trauma-informed practice movement, which emphasizes that service providers must center survivors' well-being in all interactions, decisions, and program practices. The field of sexual assault research helped give rise to this movement and provides empirical support for its guiding tenets, and in this article, we explore how to bring these ideas full circle to begin articulating trauma-informed principles for research. A trauma-informed perspective on research challenges scientists to go beyond the requirements of the Belmont Report (1979) and institutional review boards' (IRB) regulations to develop research procedures that fully support survivors' choice, control, and empowerment. Such reflection on participants' rights is particularly important given the open science movement sweeping academia, which calls on scientists to share their data publicly to promote transparency, replication, and new discoveries. Disseminating data could pose significant safety, privacy, and confidentiality risks for victims of sexual assault, so we need to evaluate what open science means within a trauma-informed framework. In this article, we examine three key stages of the research process-participant recruitment, data collection, and dissemination-and consider how trauma-informed principles could help, but also could complicate, research practices. We explore these tensions and offer potential solutions so that research on sexual trauma embodies trauma-informed practice.

Advocacy Services for College Victims of Sexual Assault: Navigating Complicated Confidentiality Concerns.

Recent policy reforms related to campus sexual assault may pose confidentiality concerns for victims. The current study aimed to understand current issues in providing confidential advocacy services for college victims of sexual assault, as well as the differential roles that campus-based and community-based advocacy play for college victims. For this qualitative study, semi-structured interviews were conducted with 22 national experts on campus sexual assault from a variety of disciplinary backgrounds. The results indicate that campus-based advocates face challenges in maintaining confidentiality of victims' information, whereas community-based advocates are more likely to have legal confidentiality protections. Consequently, participants noted that an ideal advocacy model for college victims might be one in which campus- and community-based services are closely coordinated to ensure access to services that are both confidential and meet the unique needs of college students. Implications for advocacy services are discussed, as well as future directions for research and evaluation on the effects of evolving policy aimed at improving institutional responses to sexual assault.