Coordinated Crisis Intervention

Although the term "coordinated community response" is used most often in connection with efforts to combat domestic violence, coordinating the responses of various actors within the community to sexual violence and assault can have significant benefits. In addition, efforts to combat sexual assault require the involvement of multiple actors within the community to be truly effective. Efforts to coordinate responses to sexual assault have often started with the medical system.

In the 1970s in the United States, for example, medical professionals and advocates who worked with rape victims started working to address the inadequacies in the way in which victims of sexual assault were treated at hospitals. Sexual assault victims who came to the emergency room had to wait for hours in a public area to be seen by a doctor. Doctors and nurses were not trained to collect evidence in a way that would ensure it could be used in a criminal proceeding. Doctors and nurses who performed exams were not trained in the collection of forensic evidence, and emergency room staff often failed to gather and document all relevant evidence. Even when the victim received proper medical care, her "emotional needs all too often were overlooked, or even worse, the survivor was blamed for the rape by the ED staff." As Ledray explains further:

Typically, the rape survivor was faced with a time-consuming, cumbersome succession of examiners for one exam, some with only a few hours of orientation and little experience. [Emergency room] services were inconsistent and problematic. Often the only physician available to do the vaginal exam after the rape was male. While approximately half of rape victims were unconcerned with the sex of the examiner, for the other half this was extremely problematic. Even male victims often prefer to be examined by a woman, as they too are most often raped by a man and experience the same generalized fear and anger towards men that female victims experience.

From Linda E. Ledray, Evidence Collection and Care of the Sexual Assault Survivor: The SANE-SART Response, August 2001; Kristin Littel, Sexual Assault Nurse Examiner (SANE) Programs: Improving the Community Response to Sexual Assault Victims, Office for Victims of Crime (April 2001).

At the same time, sexual assault advocates began recognizing the need for coordination of the responses of different actors within the community to sexual violence. A victim of sexual assault not only requires proper medical care, but also immediate crisis counseling services, support during medical examinations, assistance throughout legal proceedings, and referral to mental health providers for potential long-term care.

In the United States, this increased attention to the response to sexual assault victims led to the development of Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Team (SART) programs and protocols. A SANE is a trained nurse who is on-call in emergency rooms, agencies, clinics, or independent SANE centers. This nurse is trained in the proper collection of medical evidence and on issues concerning sexual assault, and must follow protocols concerning evidence collection and treatment and care of the victim. A SART program often includes a SANE, a sexual assault advocate, a prosecutor, and a law enforcement officer. The individuals on the team work together to ensure that the victim is provided with all necessary care and services, and to ensure that sexual assaults can be more successfully prosecuted.

Although SANE/SART programs are the form such coordinated and standardized responses have taken in the United States, other countries have approached the issue by focusing on the development of protocols that standardize health care provider responses to sexual violence. While there are added benefits to having specially-trained individuals available to provide an immediate response to the needs of victims, the use of standardized protocols can itself significantly improve the quality of treatment and support of victims and of the evidence collected. From World Health Organization, First World Report on Violence and Health 166 (2002).

The benefits of SANE/SART or equivalent programs, Ledray explains, include better collaboration between medical personnel and law enforcement, higher reporting rates, shorter examination times, better forensic evidence collection, more complete documentation, and improved prosecution. The coordinated effort by the SART also helps to speed up the collection of evidence, thus making the process easier for the victim, and the efficacy of collecting evidence.

Adapted from Linda E. Ledray, Sexual Assault Nurse Examiner (SANE) Program, Sourcebook on Violence Against Women 243, 243 (Claire M. Renzetti et al. eds. 2001); American College of Emergency Physicians, Evaluation and Management of the Sexual Assaulted or Sexually Abused Patient (June 1999); World Health Organization, First World Report on Violence and Health 166 (2002).

For a collection of research and reports on coordinated crisis intervention, click here. 

Also, see the United Nations expert group report entitled "Good practices in legislation on violence against women" Section 6 on protection, support, and assistance to survivors.  For the Russian version of the report recommendations, click here.