Survivor Services

Case Study: Expanding the Role of Nurses in Improving Post-Rape Care in a Resource-Constrained Hospital in Rural South Africa- The Refentse Project

The Refentse Project, located in a 450-bed hospital in South Africa, improved post-rape care in a rural South African hospital. The project managers ensured the success of the project and buy-in of senior management staff with a comprehensive institutional and multi-sectoral approach. A Project Advisory Committee, consisting of hospital management, health care providers, social workers, and police was formed. The Committee drafted a Hospital Rape Management Policy based on national guidelines. Importantly, trainings were held for senior management and healthcare providers on attitudes on rape. In addition, trainings increased the role and capacity of nurses in providing post-rape care. Victim services were improved by offering post-rape services in one location in the hospital. The Refentse Project also conducted community awareness on the services available for rape victims and the importance of seeking immediate medical care following an assault.

Prior to the Project, the role of nurses was limited to taking vital signs and pulling charts. After Project training nurses were able to document the rape history, provide post-exposure prophylaxis or PEP section on page 57 ], pregnancy testing, treatment, trauma counseling, and referral to support services. Patient interviews indicated a successful increase in victim-centered, private, and streamlined services. The project demonstrated that improvements can be made for a low cost ($58USD per patient after initial set-up) and using existing staff and infrastructure.

The success of the project demonstrates that expanding the role of nurses is a key strategy for increasing access to comprehensive post-rape care, especially in a rural area where there are few doctors. The study also found that improvements were needed in the administration of PEP; namely, to provide rape victims with the full 28-day regimen, anti-nausea drugs, and medication counseling on the initial visit since many rape victims will not return to the hospital to receive the full dose after the initial treatment. See: Kim et. al., The Refentse Model for Post-Rape Care: Strengthening Sexual Assault Care and HIV Post-Exposure Prophylaxis in a District Hospital in Rural South Africa, (2009). Available in English.

CASE STUDY: United Kingdom: More Rape Convictions Due to Improved Survivor Services and Police Partnership with Survivor Support Network

In Cleveland, United Kingdom, rape conviction rates were reported to have improved by 10% in 3 years. Police cited the opening of the Sexual Assault Referral Centre in 2007 as a big step forward in improving survivor care, including 24-hour access to specially-trained crisis workers, emergency contraception, sexual health advice and referral to rape counselors. The Centre’s private, hospital-like environment and trained counselors support victims and police come to the centre to interview them. Evidence is collected quickly and thoroughly. The police attributed the improved conviction rates to police partnership with prosecutors, hospitals and volunteer service providers.

“In the course of any investigation we liaise closely with the [prosecutors] and counsel to ensure that prosecutions are pursued wherever possible and victims can also receive support from an independent sexual violence advisor. These specially trained advisors are employed by voluntary sector agencies to provide a high level of support to rape victims and to ensure that victims are fully aware of criminal justice procedures,” said the Head of Crime for Cleveland Police. 

Access to the full range of Sexual Assault Referral Centre services is assured even in cases where the victim does not wish to make a report to the police. 

See:  Cleveland’s Success in Rape Convictions, 10/06/2009.

Case Study: A Review and Evaluation of Multi-Sectoral Responses (“One-Stop Centres”) for Gender-Based Violence in Kenya and Zambia

A 2012 study concluded that sexual assault victims fare best when one-stop centres are affiliated with hospitals.  When one-stop centres are owned or closely affiliated with hospital services, victims have better access to clinical services and were more satisfied  with not only the largely free medical care they received but also the privacy and empathy offered by staff. In addition, when medical services are linked with legal and police services, opportunities for good legal outcomes for survivors result. One-stop centres should offer close collaboration with police, should ensure proper evidence collection and storage, and should include legal advice and court preparation along with medical and psycho-social support. In addition, services to child victims should be better integrated into all levels of service. See: Keesbury et al., A Review and Evaluation of Multi-Sectoral Responses (“One-Stop Centres”) For Gender-Based Violence In Kenya and Zambia (2012).

CASE STUDY: The Philippines’ Rape Victim Assistance and Protection Act of 1998

The Philippines’ Rape Victim Assistance and Protection Act of 1998 provides numerous protections for victims of sexual assault.  It requires the government to coordinate its agencies with non-governmental organizations in order to establish and operate rape crisis centres in every province and city to “assist and protect rape victims in the litigation of their cases and their recovery.” (Sec.2) The law mandates the establishment of a women’s desk in every police precinct in order that a police woman is available to investigate sexual assault cases. The law also requires that the preliminary investigation of women rape victims must be assigned to female prosecutors. It provides for closed-door proceedings if necessary to ensure a fair trial and the best interests of the parties, and for the non-disclosure of identities and circumstances of cases if that also supports the best interests of the parties. (Sec. 5) Finally, the Act provides that evidence of a complainant’s past sexual conduct and reputation shall not be admitted unless, and only to the extent that, the court finds that this evidence is material to the case. (Sec. 6) The Act also mandated the formulation of necessary regulations within 90 days, and appropriated funds to establish and maintain the centres, with the important stipulation that the necessary amount to maintain the centres be included annually in the General Appropriations Act. (Sec. 7)

Case Study:  Trauma-Informed Care

Trauma-informed care treats survivors with a history of trauma by including recognition of the traumatic event(s) in their lives.  Advocates can modify treatment of survivors based upon how a trauma survivor may perceive what is happening. 

Past traumatic experience will provoke  “triggers,” which cause the survivor to re-live the emotions experienced in the past, often in an overwhelming and frightening way.

A trauma-informed approach should be employed in sexual assault services, especially considering that many survivors have been repeatedly assaulted.

The following are key elements when developing trauma-informed sexual assault services:

• Create a collaborative approach that acknowledges that a survivor knows her life best and which respects her feelings.
• Create an environment of trust. Allow the survivor to voice her feelings about her experiences.
• Give the survivor a chance to tell you how best to work with her and what would make her more comfortable.
• If the survivor seems difficult, remember that her difficult behavior may have kept her safe in the past.
• Provide consistent boundaries to increase the survivor’s sense of security.

Adapted from: Washington Coalition of Sexual Assault Programs, Creating Trauma-Informed Services: A Guide for Sexual Assault Programs and Their Systems Partners (2012). Available in English.