Sexual assault as a social problem in communities

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).

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.

The hypothesis tested for the study were as follows:

H0 = The treatment center has no effect on the post-traumatic symptoms of the participants

H1 = The treatment center has an effect on the post-traumatic symptoms of the participants.

The table below illustrates the results from each set of participants for the sexual assault treatment center and those going through normal treatment.

Treatment Center

Normal Treatment

8

6

6

4

9

5

6

3

10

4

7

5

3

4

6

7

9

5

8

6

10

3

7

7

5

4

9

6

10

5

Anova: Single Factor

SUMMARY

Groups

Count

Sum

Average

Variance

Treatment Center

15

7.533333

4.266667

Normal Treatment

15

74

4.933333

1.638095

ANOVA

Source of Variation

SS

df

MS

F

P-value

F crit

Between Groups

50.7

1

50.7

17.17258

0.000285

4.195972

Within Groups

82.66667

28

2.952381

Total

29

The method selected was a one-way ANOVA as the variable under consideration was the general relief level that the participants experienced subsequent to going through their respective treatments. The results from the ANOVA analysis give us a P-value of 0.000285. This value is significantly lower compared to the chosen alpha level of 0.005. This is indicative that there is a significant effect and therefore the null hypothesis is rejected. As a result, this indicates that the treatment center had a positive impact on the general post-traumatic symptoms of the participants. The second important aspect of the result from the ANOVA analysis is the F value. In this case, the F value, 17.17, is much higher compared to the F critical value, 4.20, given in the table above. Therefore, this implies that the null hypothesis ought to be rejected. As a result, this indicates that the treatment center had a positive impact on the general post-traumatic symptoms of the participants.

The following graphs illustrate the different success rates of the different treatment options gone through by the participants:

As illustrated above, the sexual assault treatment center appears to have a greater success rate and more effective compared to the normal treatment success rate. The trend line of the sexual assault treatment center is greater and higher compared to that of the normal treatment. Therefore, this indicates that the sexual assault treatment center had a positive impact on the experiences and post-traumatic symptoms of the participants. The outcomes prove that the systems theory can indicate the effect of the interventions employed. In particular, it is indicative of how effective it is with offering relief to victims, in this case being war veterans as well presently serving army members who have experienced sexual abuse and suffer from trauma. The treatment center plays a significant role in educating and empowering these victims of sexual trauma. As indicated in the results, the war veterans came out with more relief from participating in the treatment center.

Limitations

Are you aware of any limitations in your proposed evaluation?

There is absence of control. The evaluation is also of little scientific value courtesy of lack of direct comparisons or other material that can be directly used to make inferences. The selection, maturation, history and interaction of the experimental variable and the selection will affect the internal validity of the design.

Are there any concerns about measurements?

None.

Issues of internal validity?

Some of the issues that are not easy to measure are the unique events that will occur before the initial and after the 2nd measurement. Also, the issue of maturation has to be taken into account. It is the processes within clients which can be taken as a function of the passing of time, i.e. since the project can last for up to nine months or more, most participants in the evaluation may improve regardless of the kind of treatment they are receiving.

Are there any ethical issues that may be involved in undertaking the evaluation?

There was no ethical issue in the evaluation process. Major ethical issues such as anonymity, confidentiality, risk of harm, informed consent, voluntary participation and the right to services were all taken into account.

Impact:

Where would you go from here?

The next most logical phase would be to use our findings to improve the program. One of the most common complaints by agencies funded by donors is that the majority of donors want to give their monies to new and innovative programs instead of the usual everyday activities. To prevent this in our center, we will utilize the findings to innovate our systems and services and repackage the entire program if need be, to find new and better ways of taking care of the victims we receive at our center. This will help us to not only retain our current funders but it might also help us to get new ones.

How and by whom would your evaluation be best used?

The findings can be used internally to improve our services. They can also be used externally to encourage funders and others to support the program or come up with similar programs of their own to help sexual attack victims (Sullivan & Coats, 2000).

Are there any program or policy changes that might be justified by your evaluation?

Yes. It is important to use the evaluation findings to bring about positive changes in the community. For instance, there could be a policy change in which we would start rewarding those who were most helpful to the victim. For example, if the First Responder was mentioned as being supportive and helpful to an assault victim, he or she should be identified and rewarded for a job well done, so as to encourage others to be equally helpful.

What first step could be taken to implement these changes?

The first step in implementing this policy change would be to make it known to all. Awareness of a rewards scheme would motivate many people to be helpful. It would also encourage officers to be more open to offering not only the help that is required of them but also going beyond and giving emotional support wherever the need exists.