Healing Beyond Justice for Teen Sexual Assault Survivors

Teresa Huizar: Hi, I’m Teresa Huizar, your host of One in Ten.  In today’s episode, Healing Beyond Justice for Teen Sexual Assault Survivors, I speak with Dr. Jessica Shaw, associate professor of community and applied developmental psychology at the University of Illinois, Chicago.  Now, if you’re a listener of the show, you’re already conversant in the ways that adolescent sexual assault cases come into the system.  The teen reports or shows up at a hospital or ER, CPS or law enforcement or both investigate and a decision is made whether or even how to pursue the case.  But where does the prosecutor fall in that equation?  In a small number of states, prosecutors are notified of the case at the same time as law enforcement and CPS.

The question researchers set out to examine was, how much does that actually impact case outcomes?  As you will hear, not as much as we might hope. What does it mean for victims that so few cases are charged and so few are able to be prosecuted? How do we think about the role of criminal justice? Which is a crucial factor for community safety, but perhaps one with fewer survivor level impacts.

And what does all of this mean for the way that we provide services to teens who need our help today?  I know you’ll be as interested in this conversation as I was. Please take a listen.

 

Hi Jessica. Welcome to One in Ten.

 

Jessica Shaw: Thanks so much for having me.

 

TH: So how did you come to this work looking at adolescent sexual assault and prosecution rates? And we’re gonna get into the mandatory reporting piece in a minute, but just how did you come to that whole area of interest for your research?

 

JS: Sure. So I’m a community psychologist by training, which is a field that many folks are not quite as familiar with.

Community psychology is a field that came to be in the mid 1960s, and it was really developed in response to sort of the zeitgeist of that moment, knowing all the things that were happening in terms of people recognizing social inequity wanting to change the world around them. And a lot happening at the federal level in terms of deinstitutionalization and folks moving out of institutionalized clinical settings into communities.

And so wanting to figure out how do we work with folks? How do we make sure they have what they need? And so the field of community psychology put this in a bit of a nutshell that’s created to really understand programs, policies, systems, broader context, and to work towards health, wellbeing, and even really big ideas like liberation for all.

So my training as a community psychologist really guides my work, and I’m a gender-based violence researcher, so take the values of that field and direct it towards understanding how systems respond to sexual assault and how we might be able to improve them, make them a little bit better.  Specifically in terms of looking at adolescent sexual assault.

This work for me, focusing on this age group, started in graduate school. I think my master’s thesis focused on looking at adolescents. We just know that there are really high rates of victimization among adolescents when we look at adults, one in three adults been sexually victimized in their lifetime, had that experience when they were a teen.

So this just being a really important group of folks that oftentimes is pushed to the margin in research and really in the systems that we’ve built, they’re not necessarily designed to respond to adolescents specifically. So just that there’s something really important here about focusing on this particular age demographic.

I think in a broader way, most all of my work is designed in direct response to the informational needs and the practice and policy decisions that my community partners are trying to make. And so I know we’re dig into the mandatory reporting piece in a bit, but almost everything I do is working with folks to figure out what are you grappling with, what are you trying to make decisions around, and how can research help inform that decision making?

 

TH: So I really appreciate the focus on the practical application of this work. I think that’s important because we do have listeners that are outside the US and may not know what we’re talking about when we talk about mandatory reporters. Can you just briefly describe that so that people can understand what we’re gonna be talking about throughout the rest of the conversation?

 

JS: So as we’re talking about mandatory reporting today, we’re really referring to legislation that is across all 50 states in the United States, that requires certain individuals to report certain incidents to certain agencies. I know that certain people, certain settings, certain, but it’s because there’s a pretty high degree of variation across different states, across how organizations are sort of putting that legislation into practice and even among individuals.

But the idea is that there are certain incidents that where there suspected child abuse or neglect,  and some of the motivating factors in mandatory reporting laws is to ensure that those young people are protected and kept safe, and even some ideas of how we might be able to prevent harm coming their way.

And so the necessity of reporting certain things to specific agencies to attempt to intervene upon and stop that harm.

 

TH: Now, what gave you the idea to begin to look at the way in which mandatory reporting interfaces with this issue of adolescent sexual assault?

 

JS: So as I mentioned in the opening today around how I got introduced to this content area overall and being a community psychologist by training and really how I approach the work and seeing social science as a tool towards social justice and change.

So science, not an end of itself, but how can we do science to form ongoing work? This project and its emphasis on mandatory reporting and adolescent sexual assault came directly from the informational needs of my community partners. So I was a part of a statewide task force that brought together many different disciplines who are part of the response to sexual assault for young people, for adolescents specifically, to better understand one another’s role in that response and how they could improve what they were doing. So this included folks for Children’s Advocacy Centers, this included prosecutors, police officers, crime lab personnel, sexual assault nurse examiners, medical providers, Department of Child Protection Services, just all these separate entities.

They were coming together to try to understand who was doing what and how they could help young people understand more about what they could expect should they encounter any of these entities. And so my role there was really as the researcher to listen to where folks are trying to make decisions or maybe they didn’t have empirical evidence or research informing those choices.

To bring that research into the room to bring it to life and say what that says about decisions being made. And then I’m always in those moments listening for times when people have questions about what might be happening, and there’s no current research that exists. That’s really how my entire program of research is designed, is I designed research and evaluation to answer those questions.

And so that’s how this project emerged just in those task force meetings, from the very beginning, mandatory reporting came up for folks.  Not necessarily understanding how other people were engaging in the process. I would say a huge need to understand how to relay this to young people, so when that young person engages with a sexual assault nurse examiner at a hospital, what can that sexual assault nurse examiner tell that young person about what they can expect next?  And so we didn’t really know a lot about mandatory reporting within this context. There’s really no prior research on it at all. And the particular model that was being used in the setting was very interesting in that it legally included police and prosecution in that response, which doesn’t, it’s not that way in all states across the country.

And what we know from prior research is many sexual assault cases do not go forward in the criminal legal system because they don’t go to the prosecutor’s office at all. I know this will probably impact some of this a bit more.

 

TH: I was gonna say, I think maybe we’ll pause here. Maybe we’ll pause here and just kind of level set for people because listeners are in all states. And so everybody’s state as you’re saying, because laws are variable, is a little bit different. And so in all states, if somebody suspects child sexual abuse, they can report that to child protection. In some states, they can also report or are required to report that to law enforcement or there’s cross reporting and if they report it to one, the other reports to them.

In a much smaller pool of states, in addition to law enforcement, prosecutors are included in those mandatory reports, and you happen to be in one such state. Is that right?

 

JS: That’s right.

 

TH: So in some ways, this created its own, well, very interesting study, but also its own funnel because you’re talking about an unusual set of circumstances looking across 50 states, which is one in which ostensibly prosecutors are getting these cases from the earliest minute. Just in the same way law enforcement or child protection would be.

 

JS: That’s right. And I think that in many states we think that this happening in a really linear fashion, and it is more complex than that.

So some of the literature prior research talks about, and even in my own writing, have talked about, cases oftentimes don’t get from that police investigation to the prosecutor’s office for the consideration of charges. And it makes it seem like those two entities operate quite independently. So in many places there’s a lot of conversation happening between police departments and prosecutors’ offices, and they together make a decision whether there’s a formal referral or not.

But regardless, it’s that sticking point of from the police doing their investigation to a referral to the prosecutor and the prosecutor deciding whether to make a charge or not. That’s where so many cases fall through, and so this particular policy requires police and prosecution to see all those cases.

So the chance that it sort of leaps over that place. So we see that high point of attrition.

 

TH: You know, it’s an interesting thing because I think if people are not intimately involved in the system, I think they think it happens like on Law and Order, right? They think that every case in which a teen reports sexual assault, that case is gonna go forward and there’s going to be some outcome from their reporting.

And I think one of the things that your literature review pointed out, and I think helpfully is really for sexual assault overall, but including adolescent sexual assault, that just isn’t the way that it is. As you point out, there’s this funnel of attrition essentially, in which a larger number of cases get reported, then a smaller subset get referred, a smaller subset than that are charged and a smaller subset than that are actually prosecuted. And an even smaller subset than that get a criminal conviction. And so when you were looking at that funnel, I think you raise an interesting point about what we need to, how we need to talk with teens, I think, about what to expect when they’re making a report so that we’re managing some expectations along the way. Even as we’re researching and looking at this, can you talk a little bit about why you think that  you noticed that there was this sticking point? Where you saw this sort of radical drop off between things that were being referred from charges, right?

And then those in which a charging decision was actually made. So kind of stopping there. So here’s the number of total reports, people are making reports. They were referring these on. There’s a referral, but then not as many. Do you see charges being referred onto prosecution to take up and prosecute?

There are a lot of reasons why that might be the case, but why do you think that was such a sticking point?

 

JS: So I think in this particular study or in some of the other studies that have found that sticking point, let’s say at the point of police just referring to the prosecutor, or we could say that sticking point is like, yes, they get to the prosecutor, but then they’re not charged.

This particular point where we see the higher rates of attrition oftentimes occurred in that particular place because of how jurisdictions are talking with one another. So overall cases don’t go forward, right? We know this from decades and decades of research looking at the criminal legal system, response to sexual assault. This is true of cases of involving adults, cases involving young people like children and with adolescents, we don’t have a great deal of research that focuses on them specifically, but overall cases don’t go forward.

And this is wrapped into, you say my explanation for it. So if we look at just broader oppression and the context in which gender based violence occurs, and knowing this is something that relies on different power hierarchies and who has value within our society and within our culture. What undergirds this violence occurring in the first place, and then how systems respond to it.

Where we see that exact point of attrition depends on how their system is operating. So we’re within a jurisdiction where the police are operating pretty independently and are independently deciding whether to refer a case onto the prosecutor. The cases might get to the prosecutor, but then the prosecutor decides not to charge.

If it’s a place where they’re talking to one another much more regularly, the prosecutor might give that messaging back to police of like, there’s really no need to refer this. We’re probably not gonna charge it. And so it’s like where exactly that point of attrition is can differ a little bit. But there’s a fair amount of research that conceptualizes this in different ways, but one of them being a downstream orientation where every criminal legal system actor is thinking about what will happen at the next point.

A police officer would say, well, I’m not gonna refer the case because the prosecutor’s not gonna charge it. And the prosecutor will say, I’m not gonna charge this case because there’s no way a jury will convict. And so with that final goal being a conviction that oftentimes they’re looking for that next step and using that as a reason to not go forward with referring or charging the case.

 

TH: It’s interesting ’cause I think that does happen and I think that if people might focus a little more on what they could do next to strengthen the case, it might help with that. But it’s an interesting point that, and these are not unknowledgeable people, right? If you act in the system every day, you do have insider knowledge about what cases are likely to go forward and what cases aren’t.

But you know, I think we hope for situations in which law enforcement and prosecutors are working together, and if the case has some areas that need to be strengthened, there’s an opportunity to look for additional corroborating evidence, take additional witness statements, do the kinds of additional legwork that might strengthen that, but I’m not gonna keep going down that rabbit hole ’cause I could talk about it for a while. I wanna get back to your study for a second, but one of the things that I am wondering is that, you know, you decided to look at mandatory reporting more specifically, and you took a population, which was it, I thought the whole way you went about this was actually quite interesting in terms of selecting a hospital, first of all, and deciding to look at their records and looking at an age range, which, if I’m remembering right, was 12 to 19, so  that you could actually see the effects of mandatory reporting and not, because the 19 year olds are not subject to mandatory reporting laws, right?

So can you just talk a little bit more about your overall approach to the study and what were you expecting to find? What were your hypotheses going into the study and what did you actually find?

 

JS: I wanna say really quickly, and maybe we’ll have time to come back to this a little bit later, when you talk about that decision making and always thinking about like, is the prosecutor gonna charge, will the jury convict? Some of the work that I’ve done with different communities is really help trying to get us to think differently around what is justice?

Because the criminal legal system put such a heavy emphasis on a successful prosecution being when there is a conviction and the focus on justice and final outcomes when for survivors in particular, and actually most folks who come into contact with the criminal legal system, procedural justice is what’s so important. So sometimes there’s a conviction, but people are still really unhappy with that process.

And so we can maybe come back to this a little bit later to talk about what is procedural justice and how do we maybe set down this hyper fixation on the final adjudication status? Really think about how do we treat folks with respect throughout the process and make sure we’re doing it in a good way that sees them as people and treats them as they should be treated.

So for this particular study, we’re indeed including in our sample folks between the ages of 12- and 19-years-old, those age parameters were selected because in the state in which this work was done at 12-years-old, folks are able to go to a hospital and consent to having care from a sexual assault nurse examiner independently.

And then if they’re under the age of 18, mandatory reporting applies to these cases. And so the way that the SANE program who was treating these patients operated was taking this state law that said you have to report suspected child abuse or neglect to child protection services.

They applied it to any person who they treated under the age of 18. So within that like 12 to 17 age category, we have all those folks for whom the mandatory reporting response would be initiated if they sought care. And so we wanted to be able to compare how their cases are going forward in the criminal legal system as compared to people for whom the mandatory reporting response does not apply.

So that’s when we pulled in 18- to 19-year-olds. Now we’re looking at 12 to 19. And then the other thing we were really mindful of was in the focal state, the age of consent for folks to legally consent to sexual contact is 16. Of course we should be saying, well, wait a minute. If it’s sexual assault, then whether they consent or not doesn’t matter because it was non-consensual.

But as I’m sure your listeners know, really significant implications for how prosecutors see and treat these cases. If they’re under the legal age of consent, just demonstrating contact is enough versus if they’re over the age of consent, you also have to show it’s non-consensual. So we ended up splitting up these cases involving 12- to 19-year-old survivors into three different groups, the 12- to 15-year-olds who could get this care for whom mandatory reporting applied and who cannot legally consent. And then we compared them to 16- to 17-year-olds for whom mandatory reporting also applies, but they can legally consent to sex.

And then 18- and 19-year-olds who can legally consent to sex and for whom mandatory reporting does not apply. So if the mandatory reporting response or policy in of itself was having an impact on how cases go forward, we would expect all the cases involving 12- to 17-year-olds to look more similar to one another and how they go forward as compared to 18- to 19-year-olds.

But by having that middle group of 16- and 17-year-olds, if they ended up, which they did,  looking more like the 18- to 19-year-olds, it wasn’t a mandatory reporting policy that’s sort of pushing these cases forward. There’s something else that’s happening there.

 

TH: Well, and we’ll get into what you think might be happening there, because I think that in one sense, I wish I could say I was surprised by the findings and I wish we were in a world where I thought 12 to 17 year olds were treated the same when there were allegations of sexual assault. But I have to tell you, I wasn’t surprised. And when I read it, I was disappointed that I wasn’t surprised by that. I was hoping to be surprised by the outcome of the study, but I still think even with that, it’s well worth delving into because of some of what you did find.

And I think that there is some, I’m gonna say encouraging actually, data on the lower end of that. Age wise, the 12- to 15-year-olds, yes, not every case goes forward. Not every case is charged. Not every case gets a criminal conviction, but I think you are talking about numbers that make it well worth the endeavor to try. I think with 16-year-olds and up, the sadness there is that the hill is a very steep climb. Just from the outset. And so let’s talk about the numbers a little bit. What did you find, and I realize age wasn’t the only factor. There are some other factors that the paper points out that we’ll talk about in a minute, but can you just sort of frame for people what your findings actually were beyond the fact that mandatory reporting itself, in other words, telling prosecutors too, didn’t seem to be dispositive in whether or not the cases went forward to criminal conviction.

 

JS: For those who are interested in the research design behind all of it, I’ll just briefly mention this is what’s called a Causal Comparative Design, and this is a design that we use when we have naturally occurring groups or groups where we can’t assign people to categories. So for those of you with more research background or training, we oftentimes use random assignment.

We randomly have some people have something and we randomly have other people not have it. So we get closer to identifying cause and effect. With this, we can’t quite do that because mandatory reporting status, whether mandatory reporting applies to someone or not, is based on their age. And so those other variables, Teresa, that you were mentioning, we include those to rule them out.

We say we wanna rule out these other things to really get at this relationship between mandatory reporting status, which is based on age and how cases go forward.  So when we look at the patterns and the findings themselves, so the big piece here that we were trying to look at is whether mandatory reporting results in more cases moving forward in the criminal legal system.

And the first thing that we found is that younger mid range end, so 12- to 17-year-olds are much more likely, statistically, significantly more likely to have their case referred to the prosecutor’s office as compared to 18- to 19-year-olds. So what this is essentially telling us is that the policy is being implemented as it should be, right?

Because the law says in this particular state, once Child Protective Services receives these cases, they have to refer them to police and prosecution. So that first question of like, do we see more cases ending up there if they had mandatory reporting required? And the answer is yes.

It means okay, the policy is being implemented as intended.

 

TH: I think that that in itself actually should give us a little tiny peace of mind because this isn’t a case when the outcome isn’t what we wanted. It’s not a case of nobody saw it, nobody looked at it, right? That’s not what we’re seeing that the problem is, so we have to look elsewhere for what’s preventing us from having the outcomes we might like, because it’s not that these just all fell through the cracks and they never got where they were intended to go.

 

JS: That’s right. Once the cases got to the prosecutor’s office, and this is really, I think the key question in this study is, okay, if the cases are getting there, that’s the policy says they have to do, does it mean that more cases are being charged and ultimately resulting in a conviction?  And the answer is not really.

It sort of fizzles at that point. So what we’re looking at is, is if the case has mandatory reporting status, is it more likely to be charged and convicted?  Recall that cases with mandatory reporting statuses everybody in that 12- to 17-year-old age group, and the answer is no, because with those six, particularly those cases involving 16- and 17-year-olds, we see the patterns in terms of the number of cases being charged and then ultimately convicted, look much more similar to 18- and 19-year-olds instead. So while the 12- to 17-year-old are all getting to the prosecutor, once they’re there, the legal age of consent, that’s where we see this bifurcation of what the groups look like and what’s more so predicting whether a case ends up being charged and goes onto conviction is if the person who harmed the young person was a family member, the number of days between the assault and exam, so how quickly the person went in for care and the number of perpetrators. So it was no longer whether it was mandatory reporting or not. It was other features of the case that really determined how far it went.

 

TH: I think that one of the things that this help unpacked, and I think it’s interesting, so if you look at adult numbers for conviction, for example, that’s about 9-10% of cases ultimately wind up there. And I thought your lit review covered that very well. If you look at younger children, 12- to 15-year-olds, then according to your paper, in terms of charging, 30% conviction, basically half that, right?  Not great, but better than adults, right?

And significantly really better. It’s really at that point that we’re talking about 16-years-old and over, where it just completely falls apart and the numbers are kind of, or well, not kind of, they’re just appalling, you know, 15% charging at 18- and 19-year-olds and then convictions at 3%.  I mean.  I think that this raises some really fine questions far beyond mandatory reporting in regard to just overall, how are we treating those cases and are we sort of looking for reasons not to pursue them?

I mean, they are more complicated cases. They’re more likely to involve drugs or alcohol, they’re more likely to raise issues of consent. They’re more likely to have lots of features in them that make them very complicated cases. At the same time, I don’t think anybody can be satisfied with those types of numbers.

They are shockingly low unless you were in the child abuse space and would have some reason to already suspect that that’s about how it would fall out from sitting in case review and other things for, you know, I think most people would find in the general public would find those numbers to be shocking.

 

JS: I think that’s right and I think so as a gender-based violence researcher, I’ve been doing work in this area for about 20 years. And initially my roots are, I was actually a rape crisis advocate, so used to go to the hospital with survivors. I worked crisis hotline. That’s how I originally started doing work around gender-based violence.

And then really came into the research side looking a lot at policy and systems and how they’re doing what they’re doing. And I think that the majority of my work to be totally transparent, is delivering bad news.  Because I’m looking a lot at like how is the criminal legal system doing what it’s doing or how are different systems responding to folks?

And I think about a lot of my work looks at like, how can we look at systems that are sometimes propped up as though they are supposed to help folks, but oftentimes cause harm? It’s like how do we guard against some of that potential harm and then also dream about helping too? And so yes, I think these numbers, when we see them are discouraging.

They might feel bad, and I think one of the reasons that they might feel bad is when we think of our work entirely focused. This is bringing back the prior conversation I mentioned earlier around procedural justice is when we set our only metric of success as a conviction.  I think it’s problematic, because there’s so many different things that come into play in terms of whether a conviction is won or not.

And we know, I’m stepping onto the research and more into an anecdotal space, and folks might have their own experiences with this too, that sometimes survivors would get a conviction, but they’re still very unsatisfied with the process.  Or they won’t get a conviction, but because they felt respected, treated well along the way, that they feel good about how things happened.

And so this is a big idea, again, of procedural justice. And I think for folks listening to this and when you might see these numbers and say, wait a minute, like what do we do this for?  So while there might not be a conviction, what else is a part of what you do and how are you showing up for survivors and the young people that you serve?

 

TH: There are a couple of things I was thinking about as you were talking. One, I’d like to see the same study replicated in a community, ’cause you noted in the paper that the hospital, their same response while very valuable and wonderful, did not have a multidisciplinary component to it. And I think that it’s really key.

I think there’s a body of research on multidisciplinary teamwork and how that improves lots of things, including the criminal justice response. But I think aside from that, in the Children’s Advocacy Center space, one of the interesting, and I think beneficial mindset shifts over the years has been when we were started, because we were started by a prosecutor 40 years ago, there was a real emphasis right on criminal prosecution and its outcomes and a lot of time and money and energy was spent on that and should have been, we still need, whatever cases go forward, even if it’s 1%, they need to go forward in a way that is legally sound and where we’re not doing things that are legally harmful to victims. But one of the reasons we became as focused as we are on victim advocacy and mental health is really because we could see even in early days, I’ve been here at NCA 17 and a half years, I was the director of two CACs before that in my entire career, I can really see that pivot and frankly helped shape that pivot where we could just see that every case was not gonna go forward. And juries often do really inexplicable things. I mean, it’s not just those iffy cases that juries don’t know what to do with, so many cases, you know, you’d go sit in a courtroom with a victim, they would testify they’d be a rock star on the stand.

And what happened back in the jury deliberations would leave you gobsmacked.  And I think that those pivotal experiences helped me and I think have helped lots of CAC directors think about our work very differently because we knew we couldn’t promise and shouldn’t promise ever any particular criminal justice outcome.

And even if they were going to get it, it was gonna be a year, two years later, three years later, depending so far down the road, that it would have almost no impact on whether or not somebody had progressed in terms of healing or not, right? Because if you were gonna make your healing dependent on that, you were just never gonna heal because of the pace of it, even if successful.

And so I think that what you are talking about in terms of procedural justice, I think many of us have seen over and over again the fact that what is so powerful for kids, including teens, is to feel believed. To feel treated well and to feel like someone is attending to their support, and that in the end they’re able to get on with their lives and live healthy lives in which they thrive.

If those things happen, sort of no matter what happens on the criminal justice side. Which is both maddening, right?  Because for those kids who really want and need a criminal justice response, we want that for them. But on the other hand, I think it’s the most hopeful thing, right? That  ultimately it is hopeful that all of kids healing is not somehow hinged to the criminal justice response because nobody would ever heal if that were true.

So rant over. Soapbox over. Jessica, you have the floor. That’s my 2 cents on the subject.

 

JS: No, I think that’s exactly right. And having had the privilege to work with a pretty wide range of different communities across the country and sit in with multidisciplinary groups, I think there that, that what often happens is that the needs of the criminal legal system oftentimes dominate conversations on how to best respond to folks who have been harmed.

And I think it’s because they put such a heavy emphasis on the criminal legal system outcome.

So I think as best we can shift our compass or shift our central point, not saying we disregard necessarily criminal legal system outcomes, but really thinking about these young people and having them be at the center of our decision making in terms of how we’re designing our policies and our practices and engaging with them.

This study we’re talking about today is actually part of a broader project in which we also did interviews with survivors who had been sexually assaulted in focal state when they were between 12- and 17-years-old.

We could dig into that more if we’d like, but I raised that because so much of the way I do my work is trying to bring the voices of survivors into spaces where decisions are being made about them and for them without them having a voice. So yeah, let’s look at how are these cases moving through the system because these policies have been created in such a way, trying to encourage cases to go forward. So let’s see, are the policies being implemented as designed and if so, are they working? Let’s answer that question. But let’s also see how we can center survivors in this and hear from them directly as we dig in the other part of this project around their own decision making, what made them decide to seek care or not seek care, and how does that interface with mandatory reporting? And so I think whether we are on the practice side or for me on the research side, it’s for me, so key of who we center in this work and the values and how we approach it.

 

TH: The way in which teens talk about what matters to them is often in this really concrete and therefore very helpful way. For example, we have a system, our Outcome Measurement System, which is a client satisfaction tool, basically, which we have long had a caregiver component of that. We’ve long had an MDT component of that, but a few years ago we added a survey for youth, so 13- to 18-year-olds, so not down at 12, but one bump up.

And I have been just fascinated to read those when we ask ’em about their experience. For us, that’s centered at the CAC. So we’re asking them about their experience at the Children’s Advocacy Center.  And what themes come up over and over and over again are, I would say the following things: one, that they felt safe, so that sense of psychological and physical safety from the outset mattered.

And they take cues from the physical environment about that.  So I think that is really interesting and something for folks to think about. And for those communities who don’t have Children’s Advocacy Centers to really, I think a lot of times there’s this feeling that older teens will be fine wherever they’re interviewed at the hospital, at the police station, some other random kind of location.

And I think that there’s good reason to believe from what those same teams tell us that do come into Children’s Advocacy Centers, that would not be the case. That there are things about the physical environment that really matter to their sense of safety. I think the other thing that they bring up all the time is the issue of being believed.

That comes up in survey responses over and over and over again. Open-ended. Just writing in so and so-and-so believed me. It was the first time I felt somebody believed me. You know, and I think sometimes the power of the system response isn’t the outcome. Yes, criminally legally.  It’s the power of feeling that this group of people who should know, actually believe you from the earliest moment and mobilize support on your behalf.

And so when I think about all the things that we have now tens of thousands of those surveys and the types of themes that come up over and over again. It just makes me think that we’re sometimes putting burdens on ourselves even to create magical system outcomes that we can’t control where the things that kids are wanting from us, we can control.

We can control whether or not we believe them, and we message that we can control whether or not we interview them and provide services to them in a decent environment that makes them feel invited and warm. We can control whether or not we talk to their parents who are with them or caregivers or whoever’s brought them in a way that helps ’em be more supportive of them when they get back home.

We can set expectations for what the next step of the process is and keep them informed. And so for me, your study in some ways made me really think about, if we can’t give them every possible outcome that we’d like, what is it that we can provide concretely that’s more likely to create a better outcome ultimately for them?

 

JS: Yes.  And to hear that that’s primarily what you took from this study, I’m very excited to hear that because that’s a big part of this. It’s like, is really thinking about, whatever role you’re in, what is your realm of control? Because there are some big ideas in here. Like I would even invite us, and I know this will land differently with different audiences, but even consider like are mandatory reporting policies good?

But I know that’s a heavy and that’s a loaded question. And like I said, it lands differently with different audiences. We don’t have to unpack all of that, but to really think about as you’re raising, like who we’re centering in our work, what are the things we can control within my immediate environment to give them the things they need?

And you talked about so many of these important pieces of like believing them, of providing a safe environment, providing a warm context, connecting with them. All these sorts of things are so important and I couldn’t agree more of really encouraging and inviting folks to think about sort of their realm of control and what they can build and foster, I keep saying young people because we’re focused on adolescents today, but I would really say like all survivors, and I don’t wanna get too big and broad, but even all folks with whom we engage, right? Like how do we create environments that people can thrive in, where people feel beliefs, where people feel taken care of, and even introducing love, which can be a radical idea in some settings, right? To bring those into the work that we’re doing. I absolutely agree with what you said.

 

TH: So what’s next for you research wise?  You said this was a part of a larger study, but it sounds like you have many other research interests as well. What’s next?

 

JS: Yeah, so to be continued, right? I think what happens is because I’m so committed to building projects and response to informational needs.

So we have many manuscripts from this particular project. You can see where my priorities are anyway, so we have more to come from this particular project, we’re working on a couple different papers that really showcase the qualitative interviews that we did with survivors. Right now, I have a few different projects that are funded by the US Department of Justice, Office of Violent Violence Against Women, and we still have those grants.

I’m very excited to see how those projects are looking.  Yes, we’re still up and running. They’re looking at the use of telehealth technology to provide access to sexual assault nurse examiners. So in one of these projects, we are doing interviews with survivors who received sexual assault nurse examiner care, either in person or through telehealth to learn about their experience.

And we’re developing what we’re calling a patient experience assessment tool, which is just like a short survey, similar to what you described using with the folks that you’re serving at your CACs for SANE programs to use going forward. Most SANE programs don’t have the opportunity to hear from their patients, but their experiences, and so we piloted this tool with survivors. And then we work with survivors with this consultancy capacity where they provide us feedback on it and we’re revising it. So at the end of the project, that will be available to all sexual assault nurse examiner programs so they can get ongoing feedback from the patients they serve.

And then in the second project, also looking at telehealth, it’s looking at one specific telehealth SANE program that’s implemented in over 50 critical access hospitals in the Great Plains region of the United States to see from an organizational level for these hospitals. What is it like to try to implement this program?

How do they have to modify it to serve their patients best?  So historically, a lot of my work has been directly engaging the criminal legal system or sort of where these systems come together at this exact moment in time. I have a pretty heavy emphasis on the medical system, but moving  out and about and around all these different places to see how they’re responding to survivors and how we can improve them.

 

TH: You know, when you get those other papers published, we’ll have to have you back, ’cause I’m so fascinated by telehealth and we’ve had folks on talking about Telemental Health before, so I’m very interested in the telemedicine aspect of that and look forward to hearing especially about survivors experience with that and what they have to say about their experience with it.

So thank you so much.

There was so much we could have talked about. We could have talked about another hour, but I really, really appreciate you coming on board to have this conversation and also just to keep the focus on what these teens themselves are experienced, what they need, how we can best help them.

And I just so appreciate your work. So thank you so much and you’re welcome back anytime.

 

JS: Thank you so much for having me today. I really enjoyed it.

 

TH: Thanks for listening to One in Ten. If you like this episode, please share it with a friend or colleague and join us on YouTube at ‘NCAforCACs’ to watch this full conversation. For more information about this episode or any of our other ones, please visit our podcast website at oneintenpodcast org.