Analyzing Sexual Assualt Treatment Center

Sexual Assault Treatment Center

Describe the social problem for the community

Sexual assault is a criminal sexual act, either physical or otherwise, committed by a perpetrator against a victim (usually a child) using physical, intimidation/force, or emotional manipulation. Sexual assault subjects the victim to the perpetrator's demands through use of coercion, force, manipulation or explicit/implicit threats. Sexual assault is considered criminal because the act is committed against a victim without seeking his or her consent. Sexual assaults are also considered wrong and criminal regardless of the relationship between the perpetrator and the victim or the religion, culture, sex, sexual orientation or age of the victim. In case the victim is a child, sexual assault is termed as sexual abuse. In sexual abuse an adult uses his or her position of power to satisfy their desires. As mentioned earlier, sexual assault can be with or without physical contact and it may involve anything that is sexual in nature from touching, fondling, kissing and/or penetration. Incest is another form of sexual assault. In the case of incest, the perpetrator has a direct familial relationship with the victim (maybe a brother, father, uncle or grandfather, etc.). There are many other classifications or terms used to denote different types of sexual assault including voyeurism/exhibitionism, sexual harassment, incest, sexual abuse, crime of sexual nature, sex offence, sexual contact, rape, child prostitution, and child pornography (Gouvernement du Quebec, 2016).

As mentioned above, rape is a common form of sexual assault. The legal definition of rape is sexual penetration of a female without first gaining their consent. The United States Federal Bureau of Investigation (FBI) defines rape as physical penetration of the anus or vagina (no matter how slight) with either an object or any part of the body, or the penetration of the mouth by the sexual organ of the abuser, without the victim's consent (RAINN, 2009).

According to a report released by Amnesty International in 2005 there is an ambivalent attitude towards rape, with as many as thirty percent of people believing that in rape, females are often completely or partly responsible for being raped if they acted in a flirtatious manner. The same report noted that a quarter out of a thousand individuals surveyed believed that females were somewhat to blame for being raped if they were intoxicated or had worn clothes that showed a lot of skin. Most of the participants in the survey did not have any idea about the number of women raped every year in the United Kingdom (Cybulska, 2007). Thus, this report helped reveal two important things regarding rape. First, is that many people in the Western World think that rape is not common in their countries, second is that many people think that women are partly responsible for their sexual assault.

Even in cases where the perpetrator did not use physical violence, victims often still take a lot of time to heal. Obviously, the effects or severity of sexual assault are different among different victims. There are also other factors that should also be taken into account when looking at the healing process; these include the circumstances surrounding the assault and the type of assault. The effects of an assault may range from mental problems to physical health problems. The victim may also suffer from emotional difficulties. Child victims might feel betrayed by the perpetrators, especially if their abusers are close family members (people whom they trusted). The effects of sexual assault are not easy to handle, but professional help can help them deal with the consequences. If the victim is an adult, he or she should take steps to learn about the different kinds of care available to help rape victims through the healing process. There are instances when factors such as feelings of shame or guilt; fear of the reaction of parents; fear of the abuser; or even fear of retaliation might cause the victim to not speak out about an assault.

However, it should be noted that speaking out go a long way in helping one to heal his or her wounds. Thus, it is crucial for one to open up about an assault to someone of authority who can take steps to help (Gouvernement du Quebec, 2016). This is where the Sexual Assault Treatment Centre can help.

Normative needs

When one is sexually assaulted, he or she has 3 major care needs: psychosocial, medical and forensic (Welch, 2005). Forensic examination is done as soon as the victim reports the assault, unless there is a need for medical care to take precedence. This examination is done to collect incriminating DNA evidence. Medical needs may include: taking care of the injuries, screening for HIV or other Sexually Transmitted Infections, counseling, offering emergency prophylaxis and/or contraception. The majority of victims often need further referral to Victim Support organizations, Social Services, Law enforcement or any other organizations that might provide further help following an assault.

Perceived Needs

Question: What do you think are the needs of sexually assaulted individuals?

Interviewee's answer: Medical care; counseling and support; and lastly justice through the conviction of perpetrators, which will go a long way in the healing process of the victim (Mosugu, 2016).

Relative need

There are several similarities between sexual assault and domestic violence. In the majority of domestic violence case the victims are women (about 85%) (Ministere de la Securite publique, 2000); women also form the majority of those who are sexually assaulted (about 90%) according to a 2003 report (Appalachian State University, 2016). One other similarity between sexual assault and domestic violence is the need to speak out about the issues. Regardless of the violence or assault that takes place, the victim needs to speak out about it. Many victims have been continually abused for long periods of time just because they were embarrassed, ashamed or feared the perpetrators. It is important for the victim to speak out about the problem, regardless of whether it is domestic violence or sexual abuse or he/she might end up in an unending cycle of abuse or violence. Not only the victim but also the witnesses and friends to the victim should speak out (Gouvernement du Quebec, 2016).

Section 2: Literature review

In a 2009 study, researchers looked into whether Army unit support (which reflects the quality of relationships between service members in a unit) protects servicemen and women against sexual assault or harassment during deployment. The study participants' numbered 1674 and were members of the Ohio National Guard, who had reported being deployed at least once in the last twenty years. The study was conducted using a telephone survey. The servicemen and women who were recruited for the study completed measures of psychosocial support, unit support, and sexual harassment / assault. Logistic regression analysis was utilized to find odds of sexual assault or harassment. Approximately 13.2% of the servicemen and 43.5% of the servicewomen who participated in the survey reported sexual harassment, approximately 18.8% and 1.1% of women and men respectively also reported being sexually assaulted in their most recent tour of duty. In cases where there was a higher unit support, there was a lower likelihood of sexual assault or harassment during deployment. Thus, programs aimed at improving cohesion amongst unit members have the potential to decrease sexual assaults or harassment significantly (Walsh, et al., 2015).

When the Congress passed a law to repeal the ban on women servicing in combat, many thought that there would be an increase in sexual assault or harassment within the military. Many were concerned with the issue because not many studies were or have been done to investigate ways through which sexual harassment or assault against servicewomen could be reduced during deployment. This study can be utilized to further investigate and come up with more ways through which sexual harassment and assaults can be reduced during deployment. A properly done scientific study would help in delivering assault or harassment prevention policies and programs that are more effective and that have a higher likelihood of reducing rape or harassment cases.

In another study, researchers qualitatively looked into the experiences of United States Army Servicewomen and the perceptions of how MST (Military Sexual Trauma) was reported and the associated services. From mid-2011 to early 2012, about twenty-two telephone interviews were conducted with United States servicewomen who had been deployed between the years 2002 and 2011. The data was then analyzed thematically using modified grounded theory methods. The researchers concluded that the following factors contributed to Military sexual trauma: lack of consequences for abusers; military culture and deployment dynamics. The interviewees ascribed low military sexual trauma reporting to concerns about stigma and confidentiality; and negative responses or blame from supervisors and peers. Cohesion among unit members was cited as being both a barrier and a facilitator to MST reporting. Awareness and availability to military sexual trauma services during deployment varied for different units and different tours of duty. Obstacles to seeking care were the same as those to reporting and entailed stigma and confidentiality concerns. Several avenues were identified by the authors to deal with MST including heavier punitive measures suggested against abusers (Burns, Grindlay, Holt, Manski, & Grossman, 2014).

This paper will help the Sexual Assault Treatment Centre to understand the factors that impede victims from reporting sexual abuse and find ways to make it easier for victims to speak out. Other barriers found in the above 2012 MST study will help policymakers understand MST better and how to prevent it.

In another study, researchers investigated sexual assault history versus two health risk behaviors (engaging in sexual acts and hazardous drinking) to manage consequences in a sample of 1620 female university students. The researchers found that anxiety and depression were the mediators between sexual abuse and the two health risk behaviors. Among CaucAsian-American students, there was evidence of moderated mediation, this was however not the case for African-American and Latin American women. The link between anxiety/depression and sexual assault was also found to be mediated through the utilization of sexual behavior as an affect control approach. This was the case for all ethnic groups. The researchers concluded that there is a need for sexual assault experiences to be looked at more carefully considering the fact that the figures or effects might be different between different ethnicities. In addition, the need to evaluate the effects of sexual assault on different post assault experiences such as psychological adjustments and health risk behaviors was also highlighted (Littleton, Grills-Taquechel, Buck, Rosman, & Dodd, 2013).

This study will help assault treatment workers in the center make sure that assault victims are monitored for different health risk behaviors linked to sexual assault. This is owing to the suggestion that there is a need for healthcare professionals to be more careful in evaluating the health risk behaviors among the abused and to be aware of the fact that there might be variations in the motives and risk factors for such behaviors among victims from different ethnic extractions. Even though only two health risk behaviors (hazardous drinking and engaging in sexual acts) were considered for the study, it provided an example of the kind of post-assault risk behaviors.

Another group of researchers investigated the development of sexual identity among MSM (men having sex with men) in Lebanon, the stigma that these men experienced and the manner in which their social engagement and mental well-being was shaped by how they handled this stigma. Semi-structured interviews were done with thirty-one MSM. The researchers used content analysis to identify trending content themes. While many of the men who were interviewed reported being quite comfortable with their sexual orientation and that they had revealed their orientation to their parents and families, the majority of them somewhat struggled with their sexuality, usually because of perceived stigma from others or because they were internally conflicted about the immorality of homosexuality in religion. The majority of participants reported experiencing some form of ridicule or verbal abuse or being treated as lesser being by those around them. Many had devised different ways of coping with stigma including: withdrawal from relationships so as to reduce exposure to stigma; and social avoidance by trying to act as heterosexuals and limiting their orientations and interactions with other MSMs to the internet. The researchers of this study concluded that effective coping with sexual stigma is central to the mental and social well-being of men having sex with men in Beirut, a situation that is much similar to what was experienced by LGBT communities in the Western World (Wagner, et al., 2013).

The majority of cases of sexual violence, assault, or harassment involve female victims and such actions are less likely to be perpetrated against gay male victims. However, this paper looks at harassment from a different angle. The conclusions of this paper would provide a useful background for the Sexual Assault Treatment Centre staffs to help male victims, who are not sexual victims in the conventional sense, rather victims who are suffering from mental trauma because of their orientation (sexual).

Another study looked at the efficacy and feasibility of RRFT (Risk Reduction through Family Therapy) in reducing trauma-associated psychological problems and substance abuse risk among adolescent sexual assault victims. The researchers in this study utilized a randomized controlled trial on a sample of 30 adolescents aged between thirteen and seventeen years who had experienced sexual assault and their care givers were randomized to either TAU (Treatment as Usual) or RRFT conditions. The adolescents completed test of psychological problems (i.e. depression, stress disorder, posttraumatic stress disorder and general externalizing / internalizing symptoms), substance abuse risk factors (for example family functioning), substance abuse, and engaging in risky sexual conduct. These measures were completed at baseline, post treatment and later during the 3-month and 6-month follow up. Multiple regression models used showed huge reductions in general internalizing symptoms, depression, parent-reported Post-traumatic stress disorder, substance abuse and substance abuse risk factors among adolescents in the Risk Reduction through Family Therapy conditions relative to those who were in the Treatment as Usual conditions. However, huge baseline variations in functioning between TAU and RRFT call for caution in interpreting the findings between the two groups. This is because the study focuses on the replication of feasibility results and improvements within groups among the RRFT adolescents (Danielson, et al., 2012).

Section 3: Logic Model

Sexual Assault Treatment Center Fayetteville, NC (Close to Fort Bragg) logic model

Theories in literature supporting the model

In spite of the complexity of this situation, many functional theories continue to develop. Research on long-term effects concentrated on finding and describing the links between incidences of sexual abuse and an expected or observed long-term effect (Russell, 1986). The lack of specific effects led to efforts by researchers to come up with "traumatic" themes that classify the responses of assault victims. However, this new system still lacked the explanatory and predictive power that could come with an actual formal theory. Closely related to the approach to come up with traumatic themes were the efforts made to determine the factors that moderate or mediate long-term effects (e.g. family functioning, social isolation and parental support). The existence of these factors in a child victim either exacerbates or diminishes the long-term effects of sexual abuse. Despite the lack of a formal theory, three theoretical ideas are evolving to explain the different effects of child abuse: (1) cognitive behavioral and social learning theory, which explains the incidence of post-assault sexual behavior problems, repetition of trauma, PTSD, denial, anxiety and depression (Berliner & Saunders); (2) developmental theory, which illustrates various addictive and personality disorders in adults and the attributions of the same to their children (Celano, 1992); and (3) attachment theory, which explains disturbances in self-concept, chronic negative affect, revictimization and disordered adult relationships (Alexander, 1992)

Section 4: Testable questions

What (exactly) are we doing?

How are we doing it?

Who is receiving our services?

How can we improve?

Part 2

Section 1: Measurement Model

Impact measures

For the purpose of finding out if the program will bring about the envisaged social benefits, it must be evaluated. Evaluation is not only important to determine the success of the program, but also to find out the impact of the center to the victim's lives. Learning from the experiences of our clients at our center, will help us improve our services. There is no need for us to continue to use our resources on a program that is not effective or useful to victims.

Evaluation is also vital for the provision of evidence of the effectiveness of the program to its financiers, for it would create a sense of fulfillment, and invest more into the program. Many would agree that these are good enough reasons to assess out program.

Main outcome objectives: Immediate and long-term

Continue providing factual data and info to community members about sexual assault and sexual assault recovery

Continue providing crisis services to victims

Continue helping sexual assault victims and their loved ones to feel full emotional support

Helping sexual assault victims to understand the recovery process

Providing referrals to relevant agencies such as law enforcement and VCTs (Voluntary Counseling and Testing) centers

Continue providing advocacy and support services to the many victims who would like to be involved in our program

Increase the number of clients receiving legal and court accompaniment by 25%

Increase the number of victims receiving crisis counseling by 25%

Duration of measuring each of them for this evaluation?

All evaluations will be conducted after nine months of work with the participants.

Who will do the measurements and why?

Scholars who have designed and have previously worked in sexual assault prevention programs are best placed to assess this program (Gidycz, et al., 2001). This is owing to the fact that they can give recommendations on different ways to improve the program and they can also more objectively evaluate the program's effectiveness based on their experiences with similar programs and on their thoughts on the objectives, functions and how they think this program should be run.

Section 2: Function model

Is it known how clients will contact and move through the services?

Yes.

Flow chart showing the above

How does the project work toward accessibility, availability, affordability and acceptance in the minds of the target population?

Accessibility

Very little detail of the types of services available to sexual assault victims appears both online are offline. Several studies have documented variations in the quality and types of services offered at various centers. In our target population, assault victims are provided with information on treatment options available and on STI testing. The practice of testing for sexually transmitted diseases is controversial since any infection detected would indicate prior exposure and may not be related to the assault. However, almost all clinical experts agree that a provider should emphasize the need for a follow up STD evaluation and treatment for at risk clients. All this information and information on services are offered on booklets and online for easier accessibility. The fact that the center targets the local veteran and active servicemen and women in the area also means it is quite accessible to those it is targeting.

Affordability and availability

When a sexual assault or abuse victim is brought to a clinic or hospital, clinical staff will usually evaluate and respond immediately to any life-threatening or serious injuries. However, the decision to conduct an official evidentiary collection examination must be made by the patient within the ambit of state and local government laws (AHRQ, 2016). If the patient agrees to evidentiary examination, he or she will also have to sign a written consent. In the project not all sexual assault victims will be charged for the additional clinical evidentiary examinations. This is in contrast to other programs that do not offer such services free of charge, ending up in assault cases not being reported or if they are reported, the prosecution is not able to gather sufficient evidence to get a conviction.

Acceptance

This project works towards acceptance through community activities. Such activities include plans to equip vulnerable members of the community with self-defense strategies, awareness, and knowledge. These techniques collectively form the risk reduction techniques. Other strategies are focused on the likely perpetrators and they are aimed at reducing the odds that a person will act in a sexually violent manner. We also have bystander prevention techniques whose goal is to enable changes in social norms by empowering women and men to intervene and prevent sexual assaults. Other prevention techniques address laws, policies, and social norms to decrease the likelihood of occurrence of sexual violence. These strategies collectively aim to put sexual violence into public discourse and to enable members of the public to become aware of what is happening around them and to take actions to prevent sexual assault or help sexual assault victims (CDC, 2016).

How the target population would interact with the program that would influence the results of the program evaluation you propose?

The target population will be interacting with us at the center. A patient would only be chosen for evaluation if he or she had recovered to a point where he or she is emotionally stable. Lack of emotional stability would affect the evaluation of the results. In fact, in would be unethical to attend to patients who have not yet fully recovered as participants in the evaluation. On the other hand, if the patients are showing signs of recovery and voluntarily agree to participate in the evaluation they would be allowed. A sample made of such patients would provide findings that would be more objective compared to a sample of patients who are emotionally unstable.

Section 3: Method and Design

The main concern in developing a methodology towards acceptance of the victims or vulnerable members is to create defense, aversion to violence and awareness perceptions amongst victims, perpetrators and 'bystanders' respectively. Towards such ends, "System Theory" could play a vital role. "System," in the theory refers to the interconnections between different elements cohabiting in a social premise. Examples of such a structure could be a family, school, office or military establishment, and the like. The accent would be on identification of the particular level that causes unbecoming behavior and induces malfunction (mental or physical damage) at individual or familial levels. Such interventions then aim to regulate violent behavior as outcomes (Minuchin, 1974). Consequently, an unbalance in the affected level is rectified to maintain and sustain the balance and functionality of the entire social 'system' under threat.

Any system consists of subsystems at different levels. A disruptive behavior in any of the levels may cause the system to malfunction. Interventions or curative methodologies seek out the subsystem that allows or even propagates violent actions. Following such identification, therapists deploy "systems approach" theories and practices to measure the effect of the interventions deployed. This approach is used as long as they continue to bring positive outcomes without affecting the system functionality. Thus, the "system theory" has a limited but practical approach to problem solving (providing relief to the victims). At the point where the theory becomes ineffectual, other methods can be accessed. However, the strength of this approach lies in being able to address the victims as well as the perpetrators simultaneously (Blume, 1996)..

As regards the 'bystanders', media and communication can play a vital role in educating and empowering those not directly involved in the violent act. They can become messengers, inhibitors or effective supporters of the victims by testifying against the attackers. Thus the deployment of collective might of therapists (of System theory) coupled with communication usage can provide relief from violent acts in systems (Blume, 1996).

Evaluation

This research study used a convenience sample. A total of 30 individuals agreed to participate in this research study. All participants in this study were above the age of 18 years. The participants of the research study included not only war veterans but also individuals currently serving at the army and experiencing trauma. All of the participants had to have experienced some form of sexual abuse in their lifetime and experiencing trauma or post-traumatic stress syndrome because of the incident or facing trauma as a result of their sexual orientation. Half of the participants were placed directly into the treatment center while the other half were taken to normal therapy. Outcomes of the research study were undertaken on two counts. The short-term outcome measurement done after a period of 10 weeks while the long-term outcomes were assessed after 26 weeks. The systems theory approach was employed in this research study. The questions were all rates and ranked to give an overall score of 1-10 with 1 being ineffective and 10 being extremely effective and successful. These results were then collected and taken into consideration to examine the effectiveness of the treatment.