Objective: Sexual assault victims are advised to have a medical forensic exam (MFE) to address postassault health concerns (e.g., injuries, sexually transmitted infections, pregnancy) and a sexual assault kit (SAK) collected to preserve forensic evidence of the crime. Since these exams were created in the 1980s, there has been more focus on the utility of MFEs to police and prosecutors, which may not be consistent with survivors' needs. The purpose of the current study was to explore why adult sexual assault victims seek MFEs. Method: We partnered with all state-funded sexual assault nurse examiner programs in a midwestern state to collect prospective data for 9 months. Forensic nurses recorded information about all adult sexual assault patients (N ϭ 783) who sought care regarding (a) their stated reasons for seeking an MFE, (b) their postassault disclosures, and (c) their decisions to have sexual assault kits collected and released to law enforcement. Results: K-mode clustering identified 3 subgroups of sexual assault patients defined by their reasons for seeking an MFE. Cluster 1 (50.9% of the sample) sought care for primarily health-focused reasons; Cluster 2 (37.2%) sought MFEs because they wanted to pursue criminal investigation and prosecution; and Cluster 3 (12.4%) sought care because they were unsure whether they had been sexually assaulted. Conclusions: The extent to which MFEs are framed as a component of criminal investigations, there is a substantial risk of losing the opportunity to provide postassault health care to a large subpopulation of sexual assault survivors.

Introduction The International Association of Forensic Nurses (2018) affirms the importance of evidence-based, trauma-informed, patient-centered forensic nursing services that engage patients as autonomous decision makers. Past research indicates that forensic nurses consistently respect patients' choices and control as they navigate the decisions of medical forensic examinations (MFEs) and sexual assault kit (SAK) collection. Building on that work, this study examined which options patients decline and what factors are associated with those declination decisions. Method We collected prospective data from seven state-funded sexual assault nurse examiner programs. Forensic nurses recorded information about all adult sexual assault patients (N = 783) regarding four primary decisions: whether to have a MFE, whether to consent to all parts of the MFE or to decline specific services, whether to have a SAK collected, and whether to release the SAK to law enforcement for forensic DNA testing. Results Most patients consented to a MFE (95%), to all parts of the MFE (81%), to SAK collection (99%), and to release the SAK for forensic DNA testing (80%). Younger patients and those with disabilities were more likely to decline some options. Patients who had not disclosed the assault to others before seeking sexual assault nurse examiner care were also more likely to decline a MFE. Whether patients sought post assault care for more health-focused reasons or legally focused reasons was associated with declination decisions. Conclusions Healthcare providers should communicate clearly about each step in post assault care and allow patients to decline services as they choose.

Trafficked youth have numerous needs that must be addressed to give them opportunities to rebuild their lives. Few organizations offer comprehensive services to meet all these needs, which forces survivors to seek out services from multiple organizations and puts them at risk for not receiving important services. This study highlights the needs of organizations in an interagency task force that serve trafficked youth to identify barriers and generate potential solutions to service provision challenges. We conducted a mixed-methods needs assessment by conducting interviews with 15 service providers belonging to a regional human trafficking task force, which revealed a need for more services for trafficked youth, particularly in criminal justice and gender-based violence organizations. Implications of these findings include a need for centralized referral processes and more prevention services, such as a youth drop-in center and educational interventions.

While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors’ help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers’ trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors’ needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services ( N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors’ needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.

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