Services for victim/survivors of sexual assault
Little research has been done on the services that currently exist for victim/survivors of sexual assault. Yet high quality services can minimise the harm experienced by the victim/survivor. This paper summarises the international and national literature that exists on sexual assault services. It focuses on the needs of victim/survivors, on existing interventions, and data on the services that currently provide these interventions.
Services for victim/survivors of sexual assault form an essential component of the effort to provide an adequate response to sexual violence in Australia. High quality sexual assault services can minimise all forms of harm experienced by the victim/survivor, including long-term physical and psychological harm, many of which are likely to compound in the absence of an appropriate and timely response. Furthermore, it is being increasingly recognised that there is a need to strengthen the quality of existing services that support and provide care to women and girls who have experienced sexual violence (World Health Organization [WHO], 2004).
However, there has been little research on the services that currently exist for victim/survivors of sexual assault. Both in Australia and internationally, very little research has been carried out to assess either the effectiveness of specialist sexual assault services, or the ability of generalist health services in meeting the perceived needs of victim/survivors. Indeed, the Australian Bureau of Statistics ([ABS], 2004) identified the evaluation of programs that seek to respond to sexual assault as one of the three highest priority areas for new research and data collection in the field.
This paper begins to address this gap by providing a summary of the international and national literature that exists on sexual assault services. The paper focuses on three key areas. Firstly, the perceived needs of victim/survivors are identified. Secondly, literature on the existing interventions that are perceived to address these needs, and data on their effectiveness are reviewed. Currently, most of these interventions are therapeutic or counselling interventions. Finally, data on the services that currently provide these interventions, with patterns of service usage, barriers to using these services, and the characteristics of these services that victim/survivors find particularly valuable are identified. The paper will end by making some recommendations for primary health care providers working with victim/survivors of sexual assault.
The paper employs a gendered, health and human rights perspective and an 'ecological framework' to inform the overall aim of investigating current intervention programs for victim/survivors of sexual assault. A multilevel ecological perspective informed by a gender and human rights perspective is considered the most appropriate model for understanding interpersonal violence including sexual violence (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). The ecological framework recognises the multifaceted nature of sexual violence and encourages exploration of the relationship between individual and contextual factors. Sexual violence is seen as the product of multiple levels of influence on behaviour from the level of the individual, to relationships, community and society.
The general term 'sexual violence' will be used interchangeably with the specific terms used in the various research papers and reports cited throughout the paper. 'Survivors' will include both adult survivors of childhood sexual assault (infancy to 17 years of age), who are frequent users of counselling services in Centres Against Sexual Assault and their equivalants, as well as survivors of adult sexual assault. The most common reason survivors contact CASAs is to access counselling services (National Association of Services Against Sexual Assault [NASASV], 2000)
Sexual violence is a human rights issue. Sexual violence violates the notion that victims are full human beings 'born free and equal in dignity and rights'. Among other rights violations, sexual violence transgresses the right of victim/survivors to enjoy the highest attainable standard of physical and mental health (Astbury, 2005). Health service providers therefore have a particular responsibility to identify, understand and ameliorate the harmful health effects of sexual violence.
Jill Astbury is the Research Professor in the School of Psychology at Victoria University. Her research focuses on the links between human rights violations and a range of health outcomes. In particular, she is interested in the impact of all forms of gender-based violence on women's mental and reproductive health.