The purpose of the study was to examine: (1) which entities pay for sexual assault medical forensic exams (MFEs) in state and local jurisdictions throughout the United States, and the policies and practices around determining payment; (2) what services are provided in the exam process and how exams are linked to counseling, advocacy, and other services; (3) whether exams are provided to victims regardless of their reporting or intention to report the assault to the criminal justice system; (4) how MFE kits are being stored for victims who choose not to participate in the criminal justice system process; and (5) whether Violence Against Women Act (VAWA) 2005 requirements are generally being met throughout the country.
National surveys were conducted to obtain state-level information from state Services Training Officers Prosecutors (STOP) administrators (SSA Data, n = 52), victim compensation fund administrators (Compensation Data, n = 26), and state-level sexual assault coalitions (Coalitions Data, n = 47). To inform potential respondents about the study, in February 2011, a member of the project team attended the annual Association of Violence Against Women Act Administrators (AVA) meeting to conduct a presentation on the study, and in June 2011, a webinar was conducted with state-level coalition leaders through the National Sexual Violence Resource Center (NSVRC). In early July 2011, the AVA and NSVRC both sent email notifications to their respective members to introduce the researchers and encourage voluntary participation by their constituents. During the same week, researchers sent one-page letters to all potential state-level survey respondents including information about the study's purpose and goals, as well as unique names and passwords with the survey web address, so users could log in and complete the survey. After approximately two weeks (late July 2011), researchers began mailing reminder letters and sending reminder emails over the next two months. In mid-September 2011, researchers attended NSVRC's National Sexual Assault Conference and distributed information and surveys to coalitions and local sexual assault service providers to increase participation. In addition to having paper copies available and postage-paid mailing envelopes for respondents to take with them, researchers also set up four laptops for participants to take the survey on site. In September 2011, researchers transitioned to making calls to non-responding SSAs, compensation fund administrators, and state-level sexual assault coalitions to request their participation. In addition, the AVA and NSVRC periodically sent reminder emails to their constituent groups as well. As a final effort, researchers mailed paper surveys with paid postage envelopes and website log-in information to any remaining state-level personnel.
Researchers also conducted a survey of local community-based victim service providers (Local Provider Data, n = 489). In early July 2011, researchers mailed a letter introducing the study to potential respondents. Another batch of mailed letters was sent the first week of August. At the National Sexual Assault Conference in September 2011, fourteen local community-based victim service providers took the survey on-site. In addition, researchers learned of two dozen new agencies, were able to spread the word and generate interest in the project, and updated contact information for merging or changing organizations. Finally, researchers mailed postcards to service providers (briefly summarizing the project and log-in information) multiple times as an alternative method of contact. Given the size of the sample, researchers were not able to conduct follow-up phone call reminders to local providers.
A total of 19 local jurisdictions across six states were selected for case studies. Researchers designed the case study process in each state to consist of one day interviewing state-level personnel, followed by one day at each of the three selected local jurisdictions.
the victim compensation fund administrator, state STOP administrator, state coalition director (or an appointed staff member) and sometimes crime lab or other state justice agency personnel, at the state level, and;law enforcement, prosecution, victim advocacy staff, and healthcare-based exam providers at the local level.
Finally, researchers concluded each local jurisdiction visit with a focus group with victims of sexual assault.
Surveys were distributed to potential respondents in all 50 states, the District of Columbia, and United States territories that held state-level positions. Contact information was publicly available for the Services Training Officers Prosecutors (STOP) grant program administrators (SSAs) (SSA Data, n = 52), as was information for victims compensation fund administrators (Compensation Data, n = 26), though the National Association of Crime Victim Compensation Boards (NACVCB) provided updated information as needed. The National Sexual Violence Resource Center (NSVRC) provided contact information for state coalitions (Coalitions Data, n = 47).
The NSVRC also provided researchers with contact information for local sexual assault service providers (Local Provider Data, n = 489) from a national database that they maintain. From an original list of 1,674, the sample was reduced to 1,641 due to duplicate agencies. After initial mailings were sent out, the sample decreased again due to agencies closing, incorrect/outdated mailing information, satellite offices, agencies outside the project scope (such as centers providing domestic violence service only), or agencies where Violence Against Women Act (VAWA) would not be applicable (such as military-based agencies). The final number of potential respondents was 1,107.
Based on the survey results, researchers constructed detailed state profiles for all 50 states, the District of Columbia, and the United States territories. Researchers were interested in selecting locations for case studies that varied on several criteria, and the profiles included information on geography, designated funding sources for medical forensic exams and who administers those payments, whether victim's insurance is used, the model for storing kits for victims who did not report the assault to the police, the percent of jurisdictions with sexual assault response teams (SARTs), who provides most medical forensic exams (trained or untrained medical personnel), tribal populations, challenges and successes, and jurisdictional issues. Six states were selected, along with four back up states.
All state-level Services Training Officers Prosecutors (STOP) administrators, state-level victim compensation fund administrators, state-level sexual assault coalitions, and local community-based victim service providers in the United States between July and December of 2011.
The survey of state Service Training Officers Prosecutors (STOP) administrators (SSA Data, 106 variables, n = 52) and the survey of state-level sexual assault coalitions (Coalitions Data, 101 variables, n = 47) both include variables on laws or policies that provide for free of charge medical forensic exams (MFE), anonymous reporting, required reporting to law enforcement, and requirements for medical facilities conducting MFEs to follow chain of custody procedures. Other variables ask about what works well under their current system and known issues. Additional variables in the SSA data ask about where and how sexual assault exam kits are stored, and when and how STOP funds are used, what STOP exams cover (including fees for the MFE, emergency room fees, pregnancy tests, sexually transmitted disease testing, follow-up treatment, and counseling). The Coalition data includes additional variables asking about law enforcement procedures and procedural models for law enforcement.
The survey of victim compensation fund administrators (Compensation Data, 29 variables, n = 26) includes variables on whether special procedures are used for medical forensic exams, what victims can receive compensation for, reasons a compensation request might be denied, and reasons why compensation may vary.
The survey of local community-based victim service providers (Local Provider Data, 85 variables, n = 489) includes variables that describe the area they serve (large, medium or small city, suburban or rural, small town or combination of small towns, college or university, or tribal area). Other variables ask about the policies of their locality, including whether MFEs are provided free of charge, whether reporting to the police is mandatory, if the victim can ask to use a pseudonym or report the assault anonymously, and whether medical facilities store sexual assault evidence. Additional variables ask about who stores MFEs and where they are stored, as well as variables on challenges faced and what is currently working well.
The response rate for state Services Training Officers Prosecutors (STOP) administrators was 93 percent. The response rate for state crime victim compensation fund administrators was 83 percent. The response rate for state sexual assault coalitions was 81 percent. The response rate for local sexual assault service providers was 40 percent.