This article was downloaded by: [Monash University Library] On: 03 February 2015, At: 18:26 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Association Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vzch20
Rape on Campus: Community Education and Services for Victims a
b
c
Barbara Estabrook M.S. , Ruth Fessenden , Mary Dumas M.S. & Thomas C. McBride M.D.
d
a
University Health Services, University of Massachusetts , Amherst, Massachusetts, 01003, USA
b
Rape Task Force, University of Massachusetts , USA
c
University Police Force, Department of Public Safety, University of Massachusetts , USA
d
University Health Services, University of Massachusetts , USA Published online: 07 Apr 2011.
To cite this article: Barbara Estabrook M.S. , Ruth Fessenden , Mary Dumas M.S. & Thomas C. McBride M.D. (1978) Rape on Campus: Community Education and Services for Victims, Journal of American College Health Association, 27:2, 72-74, DOI: 10.1080/01644300.1978.10392827 To link to this article: http://dx.doi.org/10.1080/01644300.1978.10392827
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Rape on Campus: Community Education and Services for Victims* BARBARA ESTABROOK, M.S.,t RUTH FESSENDEN,$ MARY DUMAS, M.S.,§ and THOMAS C. McBRIDE, M.D.** University o f MassachusettsfAmherst Abstract
Downloaded by [Monash University Library] at 18:26 03 February 2015
Rape is an issue which must be addressed by college health workers. It is.prevalent on college campuses in overt and subtle forms, and requires interventions on several levels. This paper describes community and professional education and training, victim counseling and advocacy, police liaison, and medical services, all o f which are provided within a context o f ongoing collaboration among agencies involved.
Introduction As our society begins to understand and address the issue o f rape, there are active roles for colleges and universities to play, both in the provision of care for victims and in community education about sexual assault and i t s prevention. Provision for victim care i s necessary because campuses are places where victims may be concentrated. Although rape i s perpetrated upon people o f all ages, in one study the majority (27%) o f victims who reported were students.l The potential rapist looking for young, trusting victims may find college campuses an excellent target area. The potential population in need o f care, furthermore, i s not limited to victims o f the stereotypic violent attack. Many states now define rape as intercourse without the victim’s consent, thus including many situations which differ from the type o f assault usually associated with the term “rape.” In this broader sense, any number o f factors common to the college setting may unwittingly foster inappropriate sexual behaviors or unwanted sexual encounters. Among these are perceived peer pressure, alleged faculty pressure,2 and substance abuse by offender and/or victim. Yet another group may be in need o f services, particularly counseling-those who were assaulted as children, who may have buried feelings which resurface and need to be dealt with. Finally, although the vast majority o f reporting victims are women, males are also victimized. Thus, there may be many victims for whom care must be provided. Obviously, since there are also so many potential victims, a second area o f concern i s rape prevention. While comprehensive security services must be provided and women advised to be cautious and aware, there are broader issues to address. These include factors such as those mentioned above which may promote dehumanizing behavior by or towards students. In the education and socialization o f young women for new *Based on a Problem Oriented Session presented at the FiftyFifth Annual Meeting, American College Health Association, Philadelphia, Pennsylvania, April 22, 1977. tHealth Educator, University Health Services, University of Massachusetts, Amherst, Massachusetts 01003 $Everywoman’s Center Rape Counselor, Convenor, Rape Task Force, University o f Massachusetts §Sergeant, University Police Force, Department o f Public Safety, University o f Massachusetts **Medical Director, University Health Services, University o f Massachusetts 72
ro!es in society, colleges can help them develop the independence and assertiveness to deal more effectively with sexual harassment. Furthermore, men and women need to understand the social currents o f exploitation and violence which cause rape, and the forces which make society so reluctant to acknowledge and deal with the problem. Institutions o f higher learning can help develop models to increase awareness, reduce dehumanizing behaviors, and reduce the incidence o f rape.
The Rape Task Force A t the University o f Massachusetts/Amherst, an interagency Rape Task Force was formed in an attempt to address raperelated issues outside the context o f any particular victim’s care. Agencies represented include the medical, mental health and health education components o f the University Health Services, the police force, residence halls, religious groups, campus drop-in center, women’s and men’s centers, and other concerned staff and students. This task force approach has helped improve communication among campus agencies. Priorities include: interagency coordination, a “multiple entry” system for victims, support for the development o f a counselor-advocate program, and community education. The balance o f this paper describes, with emphasis on the role o f the college health service, educational programs for the community and professionals, and medical, police, counseling and advocacy services for victims. Education The Rape Task Force sponsors and provides education on rape and related issues for the university community and for i t s staff members who are dealing with victims. Community education has a dual focus. First, information about available services and procedures i s provided, in order to encourage victims t o seek care and t o increase reporting. These are emphasized as protective acts for the individual and for the community as a whole. The second goal o f community programming i s to explore the larger issue o f rape and personal and societal attitudes. Discussion topics include myths and facts about rape, why it occurs and to whom. Participants are encouraged to examine their own beliefs and‘behaviors, and to think about ways indiJ.A.C.H.A.
Downloaded by [Monash University Library] at 18:26 03 February 2015
RAPE
viduals and the university can combat the problem. This type o f discussion i s triggered by films and values clarification exercises, and pursued in facilitated small groups to maximize comfort in sharing around this sensitive issue. Heightened understanding is hoped to increase concern for personal and public safety, sensitivity to victims’ problems, and awareness o f currents in our society which condone and perpetuate rape. Delivery o f many o f these programs has been in conjunction with a peer sexuality education program. This provides the important broader context for the issue o f rape and offers valuable community contacts. lnsewice truining for university staff involved with victim care covers all procedures o f victim care and tries t o prepare workers for dealing with victims’ specific characteristics and needs. (Burgess and Holmstrom’s description o f rape trauma syndrome is a valuable re~ource.)~ For example, victims may be very agitated, but frequently seem very calm, which may seem to deny the rape experience. It i s vital that victims feel they have credibility, and support from caregivers. Although the caregivers are not in the position to determine whether an incident was actually rape, they must proceed as if each incident is rape, regardless o f their own interpretation o f events. Training sessions also provide an opportunity for exploration o f personal beliefs and feelings which may affect victim care, such as lack o f information, unresolved personal feelings about rape or sexuality, sudden realization o f personal or family vulnerability, or reactions o f great curiosity or sexual stimulation. Fears, guilt, or old mythology about rapes and victims cannot be allowed to turn into blame o f the victim for the rape, or t o interfere with care and sensitivity. Cross-training among participating agencies has contributed to greater understanding and appreciation o f various roles and their interface, and thus has enhanced collaboration for both planning and individual victim care. Counseling and Advocacy It i s evident that many rape victims never obtain medical or legal care. The reasons may be many: these services may be unknown or perceived as unhelpful or even harmful; the victim may not feel a need for assistance or may hesitate to seek it because o f guilt or fear o f insensitive treatment. Whether the assault i s a recent occurrence or has taken place some time in the past, virtually all victims seem to have a need t o work it out, to deal with feelings o f fear, guilt, anger, sexuality, and relations with family and others. Burgess and Holmstrom have identified “rape trauma syndrome” describing short and long-term reactions t o rape.4 A t the University o f Massachusetts, it was evident from reports o f residence hall staff, women’s centers, and other sources that many victims were not receiving the help available. A counselor/advocate program was developed to provide an alternative access to assistance, t o help victims through medical and legal processes, and t o provide a means o f helping them cope with the disruption o f l i f e and other issues. The program has been all-volunteer since i t s inception, and is independent o f any particular agency although i t s closest ties are with the campus women’s center, where a paid staff member provides coordination for the program plus a contact for other agencies. The group carefully selects new members. (Some are rape victims themselves, and most have previous counseling experience.) A training course o f approximately 40 hours i s conducted early each fall semester, and inservice education and case-sharing are ongoing. Preservice and inservice training include sessions with medical and mental health staff members o f the University Health Services and other agency personnel, and ongoing liaison among these caregivers i s maintained with regard to individual cases and also through the Rape Task Force. VOL. 27, OCTOBER 1978
Counseling for victims includes helping with short and long-term reactions, as mentioned above, and referral for therapy t o the mental health service if appropriate. In their advocacy role, the counselor-advocates may inform, prepare, assist, and accompany victims who are receiving medical care or who are involved in reporting or testifying in a case. The counseloradvocate may help the victim inform friends, family, employers, professors, and any others needing t o know about changes in behavior, attendance, etc. Assistance in securing child care, transportation, safe housing, and the like may also be given. Counselor-advocates also offer a support group each semester to give victims the chance to help and be helped by others coping with the same problems. Medical Care Medical care for rape victims i s a unique combination o f care and collection o f legal evidence, an unfamiliar situation involving special examination procedures, scrutiny o f work by police and courts, and the possibility o f court appearance. This provides special challenges t o health professionals. Complete protocols for victim care have been published elsewhere5-13 and local requirements may vary, but several points o f care should be highlighted. Although for legal reasons a physician must carry out all parts o f the examination, nursing personnel contribute vital support and education to the victim. As soon as the victim enters the health care facility, the provision o f a secure, private setting helps the victim regain a sense o f control over the surroundings. Then, a brief history i s recorded to guide the examination process. Data to be gathered include whether the victim has washed, douched, urinated, or changed clothing since the alleged assault; the nature and location o f penetration, blows or other wounds or injuries, date o f last menstrual period, and contraceptive use by victim or assailant to determine the likelihood o f pre-existing or resulting pregnancy. Explanation o f the rationale for some o f these personal questions can ease the procedure for the victim. With the victim’s consent, physical examination proceeds. This includes observation o f the patient and clothing during disrobing, both for clues to location o f injury, and evidence. Any external or internal trauma i s assessed and vagina, anus, and mouth examined. Examination i s always difficult for the victim, since it may be interpreted as yet another invasion, and extra sensitivity i s essential. For collection o f evidence, samples o f any moist areas should be coltected and tested for semen. (This may also be located using a Wood’s lamp.) Any areas o f pubic hair holding or matted with fluid should be clipped and studied. Combing the victim’s pubic hair may yield a sample o f the assailant’s pubic hair. Because of the relatively small numbers o f rape victims and the decreased possibility o f contact with one o f them if the medical s t a f f i s large, needed measures may be unfamiliar; thus, it i s helpful to set up a rape examination k i t with all necessary materials, and t o adopt a protocol so that all needed measures are taken. Possibilities o f V D and pregnancy are assessed. A prophylactic dose o f pencillin i s administered, a measure advocated by many sources because o f the high incidence o f V D in victims, and sometimes low attendance at follow-up visits. Post-coital contraception i s also considered. Venereal disease testing done immediately will only determine preexisting conditions and may not be necessary if prophylactic treatment has been given. Follow-up visits are scheduled for V D and pregnancy testing and also for attention to bruises that might become visible sometime after the attack and initial examination. Inpatient admission and mental health services should also be made available. 73
COLLEGE H E A L T H
Downloaded by [Monash University Library] at 18:26 03 February 2015
Finally, confidentiality i s crucial. Reporting the attack to police is urged, but it cannot be done without the victim’s consent. Again, nursing staff can assist in the process of reporting. To maximize confidentiality in court, recording all rape examination data on a separate page is recommended so that only that and not the whole medical record would go to court.
Interagency coordination is an ongoing process; although communication between agencies is definitely improved, there are issues of continuing concern. Agencies sometimes have differing priorities which may come into conflict in the course of a victim’s care. Also, the issue of rape i s of great concern to many students who approach the task force willing to devote energy to the problem. To date, the task force has not found ways to make good use of that energy, and to be sure that the issue o f rape i s dealt with in a constructive way on campus. We conclude that a comprehensive program of rape prevention and care i s a necessity on a college campus, and that formal coordination among involved agencies and concerned persons i s an effective means of addressing this vital issue.
Police Liaison Effective liaison with police can greatly aid the victim, and facilitate collection o f evidence important to court testimony. Although confidentiality should be strictly maintained by the health facility, reporting to the police i s encouraged. It may ease reporting for the victim if it i s understood that this does not constitute a commitment to prosecute, and that reporting can help protect other potential victims. Even if prosecution does not follow, patrol patterns can be modified or a profile pieced together. Anonymous reporting may also be a possibility; or preferably a nurse or counselor can be used as an intermediary, allowing the police background information and follow-up capability not gained from anonymous reporting. Local or campus police can be of assistance in establishing and updating the medical protocol for collection of evidence and can advise on legal matters. The police may also be of assistance during the actual collection of evidence. If a trained female officer i s available, her presence in the examining room may increase the victim’s sense of support and security, and increase continuity of evidence. Police may also be able to furnish a trained photographer to record any injuries; such photographs not only serve to refresh the physician’s memory, but may be useful evidence or a legal tool for prosecution. Summary and Conclusions The multifaceted approach to the problem of rape being ‘ developed a t the University of MassachusettslAmherst seems to have had some positive results. The community and professional education programs have been in great demand, with good attendance and thoughtful participation. Numbers of identified victims seeking health or police services have re- mained constant; the University Health Services see 12 to 15 victims a year, and the police have three to five reported rapes (occurring on the campus proper). However, the services of counselor-advocates have been sought by much greater numbers (more than 50 a year, a large number of whom had been raped several months or even years previous to this contact). This support mechanism/alternative resource thus seems to be filling a previously unmet need.
74
Acknowledgement
The authors would like to acknowledge the assistance of Barry Averill and Jane Zapka, DSc.; who reviewed drafts and made pertinent and helpful suggestions. References 1. Brown BA: Crime Against Women Alone. Memphis, Tennessee Police Department, 1974. Cited in Brownmiller S: Against Our Will: Men, Women and Rope, New York’Simon and Schuster, 1975. 2. “Yale faculty members charged with sexual harrassment in suit,” New York Times, August 22, 1977, p. 30 3,. Burgess AW and Holmstrom LD: Rape: Victims of Crisis. Bowie, Maryland, Robert J. Brady Co., 1974 4. /bid 5. Alleged Rape An Invitational Symposium. J Reprod Med, 121135-1 4 4 , 1 9 7 4 6. Braen GR: The Rape Exuminotion. North Chicago: Abbott Laboratories. 1976 7. Enos WF: The medical examination o f cases o f rape, J Forensic Sci 1 7 5 0 - 5 6 , 1 9 7 2 8. Evrard JR: Rape, the medical, social and legal implications. AmerJ ObstetGYnec 111:197-199J lg71. 9. Halleck SL: The physician’s role in the management of sex offenders, JAMA 180:273-278,1962 10. Hayman CR, Lanza C: Sexual assault on women and girls, Amer Obstet Gynec 1971 11. Massey JB, Garcia CR, Enrich J P Jr: Management o f sexually assaulted females,Amer/ ~ b s t e Gynec t 38:29-36,1971 12. Medical Procedures In Cases of Suspected Rape. Technical Bulletin Number 14, American College of Obstetricians and Gynecologists 13. Sternbach GL: Treatment o f rape victims. Emergency Medico/ 1976 14. Braen, op cit
-
i
’
/ . A .C. H.A
.
Journal of American College Health Association Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vzch20
Rape on Campus: Community Education and Services for Victims a
b
c
Barbara Estabrook M.S. , Ruth Fessenden , Mary Dumas M.S. & Thomas C. McBride M.D.
d
a
University Health Services, University of Massachusetts , Amherst, Massachusetts, 01003, USA
b
Rape Task Force, University of Massachusetts , USA
c
University Police Force, Department of Public Safety, University of Massachusetts , USA
d
University Health Services, University of Massachusetts , USA Published online: 07 Apr 2011.
To cite this article: Barbara Estabrook M.S. , Ruth Fessenden , Mary Dumas M.S. & Thomas C. McBride M.D. (1978) Rape on Campus: Community Education and Services for Victims, Journal of American College Health Association, 27:2, 72-74, DOI: 10.1080/01644300.1978.10392827 To link to this article: http://dx.doi.org/10.1080/01644300.1978.10392827
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Rape on Campus: Community Education and Services for Victims* BARBARA ESTABROOK, M.S.,t RUTH FESSENDEN,$ MARY DUMAS, M.S.,§ and THOMAS C. McBRIDE, M.D.** University o f MassachusettsfAmherst Abstract
Downloaded by [Monash University Library] at 18:26 03 February 2015
Rape is an issue which must be addressed by college health workers. It is.prevalent on college campuses in overt and subtle forms, and requires interventions on several levels. This paper describes community and professional education and training, victim counseling and advocacy, police liaison, and medical services, all o f which are provided within a context o f ongoing collaboration among agencies involved.
Introduction As our society begins to understand and address the issue o f rape, there are active roles for colleges and universities to play, both in the provision of care for victims and in community education about sexual assault and i t s prevention. Provision for victim care i s necessary because campuses are places where victims may be concentrated. Although rape i s perpetrated upon people o f all ages, in one study the majority (27%) o f victims who reported were students.l The potential rapist looking for young, trusting victims may find college campuses an excellent target area. The potential population in need o f care, furthermore, i s not limited to victims o f the stereotypic violent attack. Many states now define rape as intercourse without the victim’s consent, thus including many situations which differ from the type o f assault usually associated with the term “rape.” In this broader sense, any number o f factors common to the college setting may unwittingly foster inappropriate sexual behaviors or unwanted sexual encounters. Among these are perceived peer pressure, alleged faculty pressure,2 and substance abuse by offender and/or victim. Yet another group may be in need o f services, particularly counseling-those who were assaulted as children, who may have buried feelings which resurface and need to be dealt with. Finally, although the vast majority o f reporting victims are women, males are also victimized. Thus, there may be many victims for whom care must be provided. Obviously, since there are also so many potential victims, a second area o f concern i s rape prevention. While comprehensive security services must be provided and women advised to be cautious and aware, there are broader issues to address. These include factors such as those mentioned above which may promote dehumanizing behavior by or towards students. In the education and socialization o f young women for new *Based on a Problem Oriented Session presented at the FiftyFifth Annual Meeting, American College Health Association, Philadelphia, Pennsylvania, April 22, 1977. tHealth Educator, University Health Services, University of Massachusetts, Amherst, Massachusetts 01003 $Everywoman’s Center Rape Counselor, Convenor, Rape Task Force, University o f Massachusetts §Sergeant, University Police Force, Department o f Public Safety, University o f Massachusetts **Medical Director, University Health Services, University o f Massachusetts 72
ro!es in society, colleges can help them develop the independence and assertiveness to deal more effectively with sexual harassment. Furthermore, men and women need to understand the social currents o f exploitation and violence which cause rape, and the forces which make society so reluctant to acknowledge and deal with the problem. Institutions o f higher learning can help develop models to increase awareness, reduce dehumanizing behaviors, and reduce the incidence o f rape.
The Rape Task Force A t the University o f Massachusetts/Amherst, an interagency Rape Task Force was formed in an attempt to address raperelated issues outside the context o f any particular victim’s care. Agencies represented include the medical, mental health and health education components o f the University Health Services, the police force, residence halls, religious groups, campus drop-in center, women’s and men’s centers, and other concerned staff and students. This task force approach has helped improve communication among campus agencies. Priorities include: interagency coordination, a “multiple entry” system for victims, support for the development o f a counselor-advocate program, and community education. The balance o f this paper describes, with emphasis on the role o f the college health service, educational programs for the community and professionals, and medical, police, counseling and advocacy services for victims. Education The Rape Task Force sponsors and provides education on rape and related issues for the university community and for i t s staff members who are dealing with victims. Community education has a dual focus. First, information about available services and procedures i s provided, in order to encourage victims t o seek care and t o increase reporting. These are emphasized as protective acts for the individual and for the community as a whole. The second goal o f community programming i s to explore the larger issue o f rape and personal and societal attitudes. Discussion topics include myths and facts about rape, why it occurs and to whom. Participants are encouraged to examine their own beliefs and‘behaviors, and to think about ways indiJ.A.C.H.A.
Downloaded by [Monash University Library] at 18:26 03 February 2015
RAPE
viduals and the university can combat the problem. This type o f discussion i s triggered by films and values clarification exercises, and pursued in facilitated small groups to maximize comfort in sharing around this sensitive issue. Heightened understanding is hoped to increase concern for personal and public safety, sensitivity to victims’ problems, and awareness o f currents in our society which condone and perpetuate rape. Delivery o f many o f these programs has been in conjunction with a peer sexuality education program. This provides the important broader context for the issue o f rape and offers valuable community contacts. lnsewice truining for university staff involved with victim care covers all procedures o f victim care and tries t o prepare workers for dealing with victims’ specific characteristics and needs. (Burgess and Holmstrom’s description o f rape trauma syndrome is a valuable re~ource.)~ For example, victims may be very agitated, but frequently seem very calm, which may seem to deny the rape experience. It i s vital that victims feel they have credibility, and support from caregivers. Although the caregivers are not in the position to determine whether an incident was actually rape, they must proceed as if each incident is rape, regardless o f their own interpretation o f events. Training sessions also provide an opportunity for exploration o f personal beliefs and feelings which may affect victim care, such as lack o f information, unresolved personal feelings about rape or sexuality, sudden realization o f personal or family vulnerability, or reactions o f great curiosity or sexual stimulation. Fears, guilt, or old mythology about rapes and victims cannot be allowed to turn into blame o f the victim for the rape, or t o interfere with care and sensitivity. Cross-training among participating agencies has contributed to greater understanding and appreciation o f various roles and their interface, and thus has enhanced collaboration for both planning and individual victim care. Counseling and Advocacy It i s evident that many rape victims never obtain medical or legal care. The reasons may be many: these services may be unknown or perceived as unhelpful or even harmful; the victim may not feel a need for assistance or may hesitate to seek it because o f guilt or fear o f insensitive treatment. Whether the assault i s a recent occurrence or has taken place some time in the past, virtually all victims seem to have a need t o work it out, to deal with feelings o f fear, guilt, anger, sexuality, and relations with family and others. Burgess and Holmstrom have identified “rape trauma syndrome” describing short and long-term reactions t o rape.4 A t the University o f Massachusetts, it was evident from reports o f residence hall staff, women’s centers, and other sources that many victims were not receiving the help available. A counselor/advocate program was developed to provide an alternative access to assistance, t o help victims through medical and legal processes, and t o provide a means o f helping them cope with the disruption o f l i f e and other issues. The program has been all-volunteer since i t s inception, and is independent o f any particular agency although i t s closest ties are with the campus women’s center, where a paid staff member provides coordination for the program plus a contact for other agencies. The group carefully selects new members. (Some are rape victims themselves, and most have previous counseling experience.) A training course o f approximately 40 hours i s conducted early each fall semester, and inservice education and case-sharing are ongoing. Preservice and inservice training include sessions with medical and mental health staff members o f the University Health Services and other agency personnel, and ongoing liaison among these caregivers i s maintained with regard to individual cases and also through the Rape Task Force. VOL. 27, OCTOBER 1978
Counseling for victims includes helping with short and long-term reactions, as mentioned above, and referral for therapy t o the mental health service if appropriate. In their advocacy role, the counselor-advocates may inform, prepare, assist, and accompany victims who are receiving medical care or who are involved in reporting or testifying in a case. The counseloradvocate may help the victim inform friends, family, employers, professors, and any others needing t o know about changes in behavior, attendance, etc. Assistance in securing child care, transportation, safe housing, and the like may also be given. Counselor-advocates also offer a support group each semester to give victims the chance to help and be helped by others coping with the same problems. Medical Care Medical care for rape victims i s a unique combination o f care and collection o f legal evidence, an unfamiliar situation involving special examination procedures, scrutiny o f work by police and courts, and the possibility o f court appearance. This provides special challenges t o health professionals. Complete protocols for victim care have been published elsewhere5-13 and local requirements may vary, but several points o f care should be highlighted. Although for legal reasons a physician must carry out all parts o f the examination, nursing personnel contribute vital support and education to the victim. As soon as the victim enters the health care facility, the provision o f a secure, private setting helps the victim regain a sense o f control over the surroundings. Then, a brief history i s recorded to guide the examination process. Data to be gathered include whether the victim has washed, douched, urinated, or changed clothing since the alleged assault; the nature and location o f penetration, blows or other wounds or injuries, date o f last menstrual period, and contraceptive use by victim or assailant to determine the likelihood o f pre-existing or resulting pregnancy. Explanation o f the rationale for some o f these personal questions can ease the procedure for the victim. With the victim’s consent, physical examination proceeds. This includes observation o f the patient and clothing during disrobing, both for clues to location o f injury, and evidence. Any external or internal trauma i s assessed and vagina, anus, and mouth examined. Examination i s always difficult for the victim, since it may be interpreted as yet another invasion, and extra sensitivity i s essential. For collection o f evidence, samples o f any moist areas should be coltected and tested for semen. (This may also be located using a Wood’s lamp.) Any areas o f pubic hair holding or matted with fluid should be clipped and studied. Combing the victim’s pubic hair may yield a sample o f the assailant’s pubic hair. Because of the relatively small numbers o f rape victims and the decreased possibility o f contact with one o f them if the medical s t a f f i s large, needed measures may be unfamiliar; thus, it i s helpful to set up a rape examination k i t with all necessary materials, and t o adopt a protocol so that all needed measures are taken. Possibilities o f V D and pregnancy are assessed. A prophylactic dose o f pencillin i s administered, a measure advocated by many sources because o f the high incidence o f V D in victims, and sometimes low attendance at follow-up visits. Post-coital contraception i s also considered. Venereal disease testing done immediately will only determine preexisting conditions and may not be necessary if prophylactic treatment has been given. Follow-up visits are scheduled for V D and pregnancy testing and also for attention to bruises that might become visible sometime after the attack and initial examination. Inpatient admission and mental health services should also be made available. 73
COLLEGE H E A L T H
Downloaded by [Monash University Library] at 18:26 03 February 2015
Finally, confidentiality i s crucial. Reporting the attack to police is urged, but it cannot be done without the victim’s consent. Again, nursing staff can assist in the process of reporting. To maximize confidentiality in court, recording all rape examination data on a separate page is recommended so that only that and not the whole medical record would go to court.
Interagency coordination is an ongoing process; although communication between agencies is definitely improved, there are issues of continuing concern. Agencies sometimes have differing priorities which may come into conflict in the course of a victim’s care. Also, the issue of rape i s of great concern to many students who approach the task force willing to devote energy to the problem. To date, the task force has not found ways to make good use of that energy, and to be sure that the issue o f rape i s dealt with in a constructive way on campus. We conclude that a comprehensive program of rape prevention and care i s a necessity on a college campus, and that formal coordination among involved agencies and concerned persons i s an effective means of addressing this vital issue.
Police Liaison Effective liaison with police can greatly aid the victim, and facilitate collection o f evidence important to court testimony. Although confidentiality should be strictly maintained by the health facility, reporting to the police i s encouraged. It may ease reporting for the victim if it i s understood that this does not constitute a commitment to prosecute, and that reporting can help protect other potential victims. Even if prosecution does not follow, patrol patterns can be modified or a profile pieced together. Anonymous reporting may also be a possibility; or preferably a nurse or counselor can be used as an intermediary, allowing the police background information and follow-up capability not gained from anonymous reporting. Local or campus police can be of assistance in establishing and updating the medical protocol for collection of evidence and can advise on legal matters. The police may also be of assistance during the actual collection of evidence. If a trained female officer i s available, her presence in the examining room may increase the victim’s sense of support and security, and increase continuity of evidence. Police may also be able to furnish a trained photographer to record any injuries; such photographs not only serve to refresh the physician’s memory, but may be useful evidence or a legal tool for prosecution. Summary and Conclusions The multifaceted approach to the problem of rape being ‘ developed a t the University of MassachusettslAmherst seems to have had some positive results. The community and professional education programs have been in great demand, with good attendance and thoughtful participation. Numbers of identified victims seeking health or police services have re- mained constant; the University Health Services see 12 to 15 victims a year, and the police have three to five reported rapes (occurring on the campus proper). However, the services of counselor-advocates have been sought by much greater numbers (more than 50 a year, a large number of whom had been raped several months or even years previous to this contact). This support mechanism/alternative resource thus seems to be filling a previously unmet need.
74
Acknowledgement
The authors would like to acknowledge the assistance of Barry Averill and Jane Zapka, DSc.; who reviewed drafts and made pertinent and helpful suggestions. References 1. Brown BA: Crime Against Women Alone. Memphis, Tennessee Police Department, 1974. Cited in Brownmiller S: Against Our Will: Men, Women and Rope, New York’Simon and Schuster, 1975. 2. “Yale faculty members charged with sexual harrassment in suit,” New York Times, August 22, 1977, p. 30 3,. Burgess AW and Holmstrom LD: Rape: Victims of Crisis. Bowie, Maryland, Robert J. Brady Co., 1974 4. /bid 5. Alleged Rape An Invitational Symposium. J Reprod Med, 121135-1 4 4 , 1 9 7 4 6. Braen GR: The Rape Exuminotion. North Chicago: Abbott Laboratories. 1976 7. Enos WF: The medical examination o f cases o f rape, J Forensic Sci 1 7 5 0 - 5 6 , 1 9 7 2 8. Evrard JR: Rape, the medical, social and legal implications. AmerJ ObstetGYnec 111:197-199J lg71. 9. Halleck SL: The physician’s role in the management of sex offenders, JAMA 180:273-278,1962 10. Hayman CR, Lanza C: Sexual assault on women and girls, Amer Obstet Gynec 1971 11. Massey JB, Garcia CR, Enrich J P Jr: Management o f sexually assaulted females,Amer/ ~ b s t e Gynec t 38:29-36,1971 12. Medical Procedures In Cases of Suspected Rape. Technical Bulletin Number 14, American College of Obstetricians and Gynecologists 13. Sternbach GL: Treatment o f rape victims. Emergency Medico/ 1976 14. Braen, op cit
-
i
’
/ . A .C. H.A
.
