Sex Assault Examinations

Sex Assault Examinations
We were approached by the US Dept of Justice, Office on Violence Against Women, to contribute to a recommended national protocol on sexual assault forensic (evidence) examinations. They are collecting recommendations from female victim/survivor groups and those who work with them and also want input from male victim/survivor groups for a new policy on doing the "rape/assault" examinations that are part of the legal process.

They are interested in representing male victim issues in this policy. We have a week to provide some input. On behalf of the board, I am requesting any ideas, suggestions, etc. that you have about the way things should be conducted when an adolescent, adult or child is brought to a health care professional with a possible complaint of sexual abuse/assault.

This can include professionals in the emergency room, law, social services and others who work with abused/assaulted individuals.

Under the Violence Against Women Act of 2000, the Attorney General is required to:

1. Evaluate existing standards of training and practice for health care professionals performing sexual assault forensic examinations and develop a national recommended standard of training;
2. Recommend sexual assault examination training for all health care students; and
3. Review existing protocols on sexual assault forensic examinations, develop a recommended national protocol, and establish a mechanism for its dissemination.

The draft introduction includes the following:

The Office on Violence Against Women (OVW) is working currently on the mandate to develop a national protocol (the other components will be addressed at a later date). In creating a draft protocol, OVW consulted with sexual assault crisis centers; State and Tribal sexual assault and domestic violence coalitions and programs; and programs for criminal justice, forensic nursing, forensic science, emergency medicine, law, and social services. The Office is now seeking feedback on the draft from many other individuals, organizations, and associations.
Please email your comments to me in the next week at [email protected]

Thanks,
Ken
 
I guess the first part is convincing EVERYONE involved from the different agencies that men can be raped too.

I belive that there is still a large section of society that can't figure out how a man couldn't resist somehow.

And the same goes for teenagers as well.

Dave
 
Lloydy wrote:
I guess the first part is convincing EVERYONE involved from the different agencies that men can be raped too.


My sense is that the Office on Violence Against Women already understands and accepts this premise. I'm hoping we can add something to their recommendations that will help men and boys through the process of reporting sexual abuse/assault and the subsequent problems victims and survivors endure.

Unfortunately, I haven't heard from anyone regarding their experiences or recommendations. I've only got a few more days to pull this together and if any of you would like to contribute to the recommendations, please post here or email me directly at [email protected]

Thanks,
Ken
 
Ken,

I never reported my sexual abuse, but here are some random thoughts.

The reporting process should not subject the victim to repeated questioning about how they might have caused the abuse.

There should be no reference to the victim's (or the accused's) sexual orientation at all. Ever.

No matter the age of the victim his privacy should be protected.

When authorities suspect/confirm child abuse in a home, the boys in the family should receive the same level and type of protection that the girls do. Children must be made and kept safe.

Does the Office have any authority over support stuctures for victims? Men should have access to social services for sexual abuse/assault victims equal to the services available for women victims. Children should have specialized services available.

Not exactly a random thought, but if it's within their purview, the Office should create/maintain programs to allow male survivors and professionals who work with us to explain in schools, etc. that male victimization is real. Adolescent boys will have a very difficult time with reporting as it is, and I think this might help some of them. I wonder if it would have helped me.

Thanks,

Joe
 
Ken,

When a man, boy or teen comes to a health care professional for any type of examination related to suspected or possible sexual assault/sexual abuse, the training received by the professional will be essential in helping the victim.

Here are a couple of possible recommendations for adding to exam protocols and training:

1. Examiner must have specialized training in the
particular characteristics of male victims of sexual abuse; including the difficulty of disclosure as related to homophobia.
This one suggestion to my mind cannot be emphasized enough. Even the hint of disapproval or negative feelings from a professional about the idea of sexual contact between males is enough to insure the continued denial of resources to the men who suffer.

2. Any man, boy or teen being examined for possibility of sexual abuse/assault needs to have the ongoing support of a trained, volunteer fellow male survivor of sexual abuse.
Even the possibility of some sort of sexual abuse of a male is enough to warrant this forensic procedure, as the suggestion itself is damaging to the victim.

3. Men and boys examined for possible sexual abuse must be given absolute assurance of anonymity, confidentiality and privacy to the fullest extent possible.

4. Examination of men for sexual abuse/assault must be approached from the attitude of treatment and eventual recovery from the effects of the sexual abuse/ or suspicion of sexual abuse.
Any man presenting for examination must be considered as a candidate for treatment, either for sexual abuse or the effects of being considered as a possible male victim of abuse.

5. The examination process of male victims of sexual abuse must be treated first as a health concern, emotional, psychological and physical well-being of the man must remain the top priority and governing principle of each facet of each procedure.
Any legal, criminal, civil, social or organizational concerns must be kept separate from and held as less important than the total well being of the victim.

6. All health care professionals having contact with possible male victims of sexual abuse must have on-going contact with male victims who are in the process of recovery from their own abuse.
This in order that the mechanisms of denial and self blame peculiar to male victims be kept fresh and in focus. The experience of a male survivor must be considered as invaluable in any decision or judgement regarding the possibility of the occurence of sexual abuse.

7. Procedures relevant to the examination of the male victim must be kept to the minimum needed to verify/confirm the possibility of actual abuse.
Physical exams, rectal, genital, oral and others must be explained from a medical/treatment/diagnosis point of view. The candidate for the exam should have an opportunity to review and consider proposed methods of examination. This review and consideration will not be understood as complete unless accompanied by the counsel and support of another male victim of sexual abuse in recovery.

8. Men being examined for signs of sexual abuse should always have the opportunity to specify the gender of the health care professional.

9. As part of the training of health care professionals they will be put into contact with survivor based organizations from which to build a network of trained volunteers who thenselves have been sexually abused and have begun to recovery.

10. The training of health care professionals should be considered as incomplete until and unless there is a corresponding amount of training, funding and support of the necessary volunteer support system of other male survivors. The financial and material support of survivor organizations should be considered as an investment in the training system for health care professionals working with male survivors of sexual abuse.

11. All men presenting as possible candidates for examination for sexual abuse must be given materials ensuring they have free, confidential access to trained professionals and/or volunteer organizations relating to male sexual abuse, such as 800 numbers, web sites, free anonymous drop in clinics, telephone counselling, suicide hot lines, offices available to provide legal protection and support.

12. In the training of health care professionals the topic of male sexual abuse should be considered as a separate and unrelated area from the matters of female sexual abuse as the effects and treatments for each in some ways counter indicate each other.

13. Policies and procedures related to the development of training protocols for the diagnosis and treatment of male sexual abuse must be removed from under the purview of the office of women. As much to better serve the women as to better help the men.

Ken, I don't know if any of this is what they're asking for. There is a lot I could say about the actual content of the matter covered, but I guess I'll rely upon an informed professional community for that input.

Hope this helps. Any questions or comments or matters for elucidation would be most welcome as some of these thoughts are not yet fully formed in my head. I would appreciate any feedback or discussion to help me more fully develop my own perspective.

Thanks, Ken, for the reminder to sit down and make my contribution to this important matter.


Your brother,
 
Ken - In my area, NOVA (National Organization of Victims Assistance) is usually included for a victim of sexual assault and abuse. I would like to see included during the exam, a male survivor who can relate to the victim and his family. This is not currently happening, I believe. It would not necessarily be through NOVA. It could be through anyone [ even an MS.ORG rep in areas we have reps]. Particularly with the families presenting at the hospital or to the police b/c they may least understand, be the most defensive ("are you SURE this happened? are you sure it was so-and-so") and, in wanting this whole thing behind them, may unwittingly cause more damage.

If anything pops up, I get back!! Thanks!

Howard
 
Good points raised there.

I was treated as a liar from the moment I opened my mouth, but it has to be said that things were different ( I hope ) in 1964.

In an institution, like a boarding school, I think an outsider must be available to represent the victim. A local social worker at least, or as Howard suggests, someone from a Survivors / Rape Crisis organization.

It would be good to see on the Mission Statement ( everyone has a mission statement now don't they ? ) or someting similar, that is given to the inmates, pupils or whatever, that in the event of any accusation of SA or physical abuse, then the people in charge are legaly bound to call in higher authority.

The charity I work at provides counseeling for adults, over 16yo. But they do help with younger children by having a therapist talk to the youngsters prior to appearing in any court action.
"Therapy" isn't actually done as the child needs to be raw and emotional in court, and any healing would possibly alter their demeanour and therefore the outcome.
It might sound brutal, but I believe this needs to be done, the healing starts right after the sentencing.
This also needs to be done very carefully by skilled therapists.

Danny's point 5 is also crucial.

Dave
 
Ken,

I know that you wanted to hear from us via e-mail but maybe this is just as good in that we can see what others are suggesting and we can add weight where we think that it's needed.

I think that it's great that they are asking organiztions such as ours for direction in this matter. And, that you are asking us for our input.
I don't think that I could add anything new here that hasn't already been said, but I would emphazise the need for someone who is caring, to be assigned to, and "walk" with, the person making the complaint or who has been suspected of having been assaulted.

Thank you for your part in all of this,

David
 
Ken: I am not sure what I can add as I never went to the authorities in 1958. I mean who could. But Like Outis I strongly believe that the victim should not be treated as a hustler and not a true victim. Too often I have heard men hear say the police or authorities want to know if you ever said no. What is a little child or young man gonna do. In addition they should not be questioned to see if the instigated the assault.

I know it Canada that victims are delt with by special units of the police who are trained in this sort of crime. I think that there should be an international set of guidelines for all responsible for this issue so that cross fertilization of what works can occur. This would minimize the risk of damage to the victim I think.

Just my two cents worth. Please keep us informed of how things go.
 
Recommendations for Training

Police and the health care/social service/probation system must begin to recognize the many different faces of sexual abuse. They should consider these aspects of abuse of minors:

1. Source of First Report:

a. Family member
b. Mandated reporter

i. School official
ii. Therapist
iii. Physician/medical workers

c. Other

2. Unit making first intervention

a. Police
b. Social Services, (Child Protective Services)
c. Juvenile Probation Department


3. Consider theVictims Situation and Source of Suspected Perpetrator (Perp Source)

a. Minor in place at home Perp Source: family member, ie: parent, sibling, grandparent, uncle/aunt, cousin;
b. Minor in place at home or in foster care/residential mental health facility Perp Source: known non-family care giver, ie: coach, teacher, priest, baby sitter;
c. Minor in place at home or foster care/residential mental health facility Perp Source: stranger
d. Minor in foster care/residential mental health facility Perp Source: staff, peer resident,
e. Minor awol from home or foster care/ residential mental health facility Perp Source: stranger/known non-family care giver or known family member
f. Minor awol from home or foster care/residential mental health facility involved as sex worker: - Perp Source: pimp or john


4. Training considerations:


a. Minors Need to be educated about saying no to any older person/adult especially in positions of authority, with info on how to report attempted abuse.

b. Family members & general public A public program of education of family members needs to be developed using schools and media with emphasis on:

i. recognizing the signs of abuse and its symptoms, ie: change in school performance, depression, angry outbursts, bed wetting, encoprisis, avoiding formerly trusted perp, inability to trust others
ii. that males are victims too (publicize FBI figure 1 out of 6 or 7 males experience abuse)
iii. how to report sexual abuse


c. Mandated reporters - professional training should include:

i. recognizing the signs of abuse and its symptoms, ie: change in school performance, depression, angry outbursts, bed wetting, encoprisis, avoiding formerly trusted perp, physical sensitivity to being touched or examined, loner behavior
ii. understanding cultural myths and their effect on male victims ie: males should fight back otherwise its their fault, males should be grateful for an older females sexual attention, males become homosexual when abused by males,
iii. understanding the special problems males have admitting or remembering abuse because a male bias against expressing emotions, shame, feeling at fault
iv. understanding the way symptoms attack a victims ability to trust others
v. understanding that sexual abuse trauma to males interferes with their sexual development often resulting in sexual identity confusion
vi. understanding the effects of hyper-sexualization and sexual identity confusion on males who have to also face homophobia and peer expectations of adolescent sexual behavior (ie: macho behavior)
vii. investigation techniques which do not add to the trauma of the victim


d. Intervention:


i. Police training should include awareness of the above as well as:

1. the need for training in sensitivity to male victims [comment too often the cultural myths mentioned above create a bias against males as the facts of the suspected abuse unfold this is true of adult males being abused by a spouse where the police officer will automatically side with the woman. Because of this, a male minor reporting an abusive situation must be taken seriously]
2. that many AWOL youth are running away from something often it is abuse in their home or foster home/residential mental health facility and sometimes it is sexual abuse
3. that minors involved in the sex industry are first of all, VICTIMS of sexual abuse, whether by their pimps or their johns The crime is being committed by the perpetrator not the minor. Police policy should be to target pimps who maintain minors on the street, and Johns who prey on them.
4. that male minors involved in the sex industry, are often acting out earlier abuse which has contributed to their being on the streets
5. that some male minors on the street, have been rejected/abandoned by their families for being or acting homosexual (whether because of sexual orientation or from sexual identity confusion) They are the VICTIMS of sexual abuse or abuse from neglect by their parents.
6. that children in foster care/mental health facility have a greatly increased chance of being victims of sexual abuse.
7. that criminal behavior such as drugs and stealing by minors working the street for sex is a part of their surviving on the street
8. that early intervention, first contact with a minor working on the street, is the best opportunity to provide services that will help the child, police should refer first time minors on the street to social services for help rather than criminalizing them in the probation system


ii. Social Services/Probation are the front-line investigators of reports of sexual abuse. They need training to:

1. be aware of all of the above
2. be aware of the need to provide specialized resources for victims of sexual abuse. [Comment, too often referrals are made to therapists who are not experienced in treating sexual abuse of males and the special problems that they present] Specialized resources should be identified and made available to all Social Workers and Probation Officers which should include experienced therapists, local non profit organizations providing services to street kids and to gay-lesbian-transgender youth, and 12-step organizations such as SA, Al-Anon, & teen Al-Anon programs


5. Coordination and Training of Investigative Services


a. Investigation. Forensic investigation of minor sex abuse victims should be done only through referral to a well planned multi-disciplinary investigation unit. At the very least it should be staffed by a District Attorney, Social Worker, and a Medical Health worker. [Comment: much like adult rape investigation units Minors need to be brought to experienced investigators as early as possible. An example of such a unit is the CALICO unit serving Alameda County in California]

b. Physical Examination. Physical forensic investigation should only be performed by an experienced and well trained medical facility, such as a local Childrens Hospital. The investigation should employ the LEAST INTRUSIVE method possible.. The guiding principle should be to provide medical and mental health support for the victim and to avoid retraumatizing the minor in the name of criminal investigation of the abuse offense.

c. Coordination of Services. Police, Social Services, Probation, Juvenile Courts must provide a system wide plan to deal with youth from first contact to providing adequate placement and subsequent therapeutic services. Emphasis must be made on EARLY INTERVENTION of AWOL youth before they become and are considered as seasoned veterans of the street, thus in the eyes of the system considered untreatable and who will only be dealt with when they graduate into the adult criminal system. [See Program being developed by the ICPC of the Alameda County Mental Health Department resulting from their Task Force on Minors Involved in Prostitution.]
 
Sorry Lloydy

I must object to:
"Therapy" isn't actually done as the child needs to be raw and emotional in court, and any healing would possibly alter their demeanour and therefore the outcome.
It might sound brutal, but I believe this needs to be done, the healing starts right after the sentencing.
It is Brutal - It is so wrong to with hold therapy and healing for any period of time just to benefit the prosecution case so they can present a child who is a wreck.

Any prosecutor who would do that to make his/her case better at the expense of the victim is...[I'm speechless] The prosecutor should make the case based on the evidence - not the emotional spin he/she gets at a cost to the child/victim.

It's just SO WRONG! As the child's advocate/attorney I would be raising hell all the way to the top to get the child immediate help.
 
Thad - I agree with immediate intervention; however, less than half the kids (under 12) I see are being served by prosecutors who take these very young victims, place them in out-of-home placements, seperating non-offending brothers and sisters; away from family visits for 6 months or more in order to "not contaminate" their testimonies. These kids sometimes feel more victimized by the system that's trying to protect them as if they are being punished for being victimized! Perhaps prosecutors need to more fully understand the dynamics of the emotional, psychological and social sexual abuse victim?

Howard
 
Thad
sorry, I didn't explain it fully.

The therapist does help the child, and the charity only does this with a few kids from about 14 to 16.

What they do is stretch out the early stages of therapy, maybe only a few weeks, and concentrate on building the childs confidence so they are more able to testify. And enable the child to talk about sexual aspects of the case with greater ease.

They tend to leave the recovery until after the trial - whatever it's outcome - and then the whole SA, and the outcome, can be dealt with as a whole, instead of an unexpected outcome completly altering the childs attitude towards recovery during the recovery process.

It's also done with the mercenary benefit - for want of a better phrase - of presenting the victim as a witness without the 'language' of therapy and recovery being used, and maybe swaying a jury into thinking that the victim "Isn't doing so bad after all"

My best friends daughter was raped, imprisoned, tortured and beaten for two years by her 'boyfriend', and the exact same thing was done with her at the age of 20. She was cared for, prepared for recovery, but not actually started on the process until after the trial.
Once he'd got 14 years, she was ready for her recovery.

Her dad was in court, and it broke his heart to see and hear her there. But he wouldn't have it any other way. Neither would she.
She had masses of support, but kept her 'raw edge'.

It's not a common practice by any stretch, and it's not as 'brutal' as I made it appear, I apologise for my choice of words and poor explanation.

But it's something I can see having a lot of merit, from both points.
Making a better witness, and starting recovery when the outcome is clear.

Dave
 
I sent in your comments to the Office on Violence Against Women and got back this reply:
This is extremely helpful- thanks so much!

Marnie Shiels, Attorney Advisor
Office on Violence Against Women
Hopefully, when the guidelines for investigating and treating victims of sexual abuse/assault come out, our input will be there to help.

Thanks for your thoughts and efforts in this.

Ken
 
Ken: Thanks for your efforts. I hope that we will be able to see them when they come out. I could use them up here it the frozen north to prod governments.
 
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