The justice system is failing victims and survivors of sexual violence

Tammi Walker, Alison Foster, Rabiya Majeed-Ariss and Miranda Horvath on a role for psychologists in improving processes and protection around rape cases. The justice system in England and Wales continues to fail survivors of sexual violence. Official figures from the Crown Prosecution Service and Police highlight the ongoing problem of attrition of rape cases from the criminal justice system. Here, we outline the limitations of the endless cycle of reviews in response to the poor treatment of survivors. We argue that solutions which could lead to significant improvements for survivors of sexual violence are possible

Improving understanding of the scale and nature of child sexual abuse Characteristics and experiences of children and young people attending Saint Mary's Sexual Assault Referral Centre, Greater Manchester A review of 986 case files

This report brings together evidence collected from the case files of children and young people aged 0–17 attending Saint Mary’s Sexual Assault Referral Centre (SARC) in Greater Manchester for a forensic medical examination following disclosure or suspicion of sexual abuse. The data relates to all 986 forensic medical examinations of under-18s living in the Greater Manchester area who accessed the service between April 2012 and March 2015. Data was retrospectively extracted from the paper case file of each ‘service user’, including background and demographic data about them, the route by which they were referred to the SARC, the nature of the child sexual abuse (CSA) reported to have taken place, and the people suspected of committing it. The choice of data extracted was based on the ‘data collection template’, a core dataset developed by the Centre of expertise on child sexual abuse (CSA Centre) to standardise and improve agencies’ recording of data about CSA. Established in 1986, Saint Mary’s SARC is the UK’s largest single-centre SARC. It was the first of its kind, developed to provide high quality medical examinations in a designated and specialised space for men, women and children who had experienced sexual assault. The findings generated through the study have wider relevance because they represent the experiences of a large number of children for whom there were concerns about sexual abuse. It is important to emphasise, however, that they are not representative of CSA in other settings or locations. The vast majority of victims of CSA do not disclose their abuse and are not identified by professionals, and many of those who are identified do not attend a SARC. Furthermore, medical examinations of children at a SARC are provided following disclosure or suspicion of contact sexual abuse; experiences of non-contact CSA are, therefore, not represented in the study

Measuring the Long-term Support Needs of Adult Service-users at Saint Mary’s Sexual Assault Referral Centre

This article outlines a feasibility study to investigate the potential of measuring the support needs of adult service users of a sexual assault referral centre (SARC). A self-completion questionnaire was designed with the aim of capturing these needs, as well as how they change over time and with support provided. The questionnaire underwent revisions following consultations with organisations representing survivors. Survivors of sexual assault who attended Saint Mary’s SARC were invited to complete a questionnaire at three-month intervals after their first visit to the SARC. The process of recruitment was necessarily complex, potentially compounding the issue of low response: only 18 participants completed the questionnaire at the first time point, and only nine of those completed a follow-up questionnaire three months later. The responses demonstrated the value of connecting information gathered by forensic physicians with a social survey. This study design reduced the potential of re-traumatisation by avoiding the need for participants to revisit any details of the alleged assault. More work is required to understand what methods will help establish an enduring commitment to completing follow-up questionnaires from a population dealing with the aftermath of trauma

Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study

Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications

Exploring the similarities and differences amongst service users with and without learning disabilities attending Saint Marys Sexual Assault Referral Centre

From Wiley via Jisc Publications RouterHistory: received 2021-12-11, rev-recd 2023-02-23, accepted 2023-07-14, epub 2023-07-28Article version: VoRPublication status: PublishedFunder: NHS England Health and Justice Team; Grant(s): n/aBackground: People with learning disabilities are over‐represented amongst Sexual Assault Referral Centre service users. This work aims to explore the similarities and differences between service users with and without learning disabilities. Method: Medical notes of 52 service users likely to have a learning disability were compared with 52 service users not likely to have a learning disability (according to the Learning Disability Screening Questionnaire); all of whom attended Saint Marys SARC for a forensic medical examination during a 12‐month period. Results: Significant associations were found between the likelihood of learning disability and relationship to perpetrator; location of assault; alcohol use; time taken to present to SARC; domestic violence; self‐harm; suicide attempts and mental health service involvement. Conclusions: People with learning disabilities in the sexually assaulted population are more likely to present with intersecting vulnerabilities emphasising the need for timely, accessible and appropriate patient‐centred care for this group

Measuring the Long-term Support Needs of Adult Service-users at Saint Mary’s Sexual Assault Referral Centre

This article outlines a feasibility study to investigate the potential of measuring the support needs of adult service users of a sexual assault referral centre (SARC). A self-completion questionnaire was designed with the aim of capturing these needs, as well as how they change over time and with support provided. The questionnaire underwent revisions following consultations with organisations representing survivors. Survivors of sexual assault who attended Saint Mary’s SARC were invited to complete a questionnaire at three-month intervals after their first visit to the SARC. The process of recruitment was necessarily complex, potentially compounding the issue of low response: only 18 participants completed the questionnaire at the first time point, and only nine of those completed a follow-up questionnaire three months later. The responses demonstrated the value of connecting information gathered by forensic physicians with a social survey. This study design reduced the potential of re-traumatisation by avoiding the need for participants to revisit any details of the alleged assault. More work is required to understand what methods will help establish an enduring commitment to completing follow-up questionnaires from a population dealing with the aftermath of trauma

The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study – the MiMoS Study

Background Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed. Aim To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres. Setting and sample Staff and adult survivors in English sexual assault referral centres and partner agency staff. Design A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5). Findings There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma. Limitations The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic. Conclusions People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have ‘complex’ needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault. Future work Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21. Trial registration This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347