How Did SARTs Evolve?
A glimpse into the history of SARTs offers a portrait of passionate individuals, agencies, and coalitions who called for a fundamental rethinking of how sexual assault victims were treated, the way evidence was collected, and how cases were managed. The histories reveal how survivors of sexual violence and community leaders (advocates, law enforcement officers, forensic laboratory scientists, health care professionals, and prosecutors) bridged boundaries and developed integrated systems that were victim centered and legally sound. Their stories are about foresight, tenacity, planning, training, and creativity. Moreover, their stories demonstrate that positive social change often follows on the heels of multidisciplinary collaborations.
Several federal agencies help support and develop SARTs, including the following:
These agencies fund research on evidence-based practices, support the development of multidisciplinary training guidelines, fund agencies to provide customized technical assistance, and promote the distribution of materials to help inform and establish SARTs throughout the Nation.
Sweeping changes have been made to sexual assault statutes since the 1970s that shift the focus from victims to perpetrators. The reforms have
Although these reforms are significant, the concrete outcomes for victims and society have been disappointing.1 In short, criminal rape reform laws do not appear to have deterred sexual assault, enhanced its prosecution, or increased conviction rates.2
Much of the information in this section is adapted with permission from Jessica E. Mindlin and Susan H. Vickers, 2007, Beyond the Criminal Justice System: Using the Law to Help Restore the Lives of Sexual Assault Victims, Victim Rights Law Center, which was adapting material from I. Seidman and S. Vickers, 2005, "The Second Wave: An Agenda for the Next Thirty Years of Rape Law Reform," Suffolk University Law Review 38(2): 467492 (2005).
Research indicates that societal attitudes haven't kept pace with statutory reform.3 Many are confused about what constitutes consensual sex, ambivalent about criminal sanctions for sexual assault not involving physical injuries, and unclear about the boundary between sex and rape.4
Unfortunately, some in the criminal justice system continue to rely on outdated and erroneous notions of sexual assault victims and perpetrators. For example, they may view vulnerable or marginalized victims (e.g., victims with a history of substance abuse, intellectual disabilities, or undocumented immigration status) as less credible.
As a result, sexual assault victims often face the same hurdles that they did before the advent of rape law reform.5 Jurors still expect immediate complaints by victims and expect them to show signs of a struggle, even though "resistance" has been eliminated as a statutory element of the crime.6 In addition, trial, appellate, and state supreme courts are still arguing over the same issues: the meaning of consent, degrees of force, the victim's role as an active or passive participant, and a survivor's right to privacy.7
To be successful in championing sexual assault victims' rights in both the criminal and civil arenas, the outcomes from the past 30 years of rape law reform in the criminal system cannot be ignored. Those advocating for sexual assault victims must learn from the failures as well as the successes. Although statutory reforms have not produced significant changes in outcomes within the criminal justice process to date, the law can serve as a tool for victim healing and recovery.
Rape reform laws, by themselves, do not persuade victims to report or to seek services. Victims need to know that when they disclose their sexual assaultswhen they reach out for helpthey will be met with timely, compassionate, and competent responses for as long they need them. To turn statutory breakthroughs into practical applications, many communities form SARTs to monitor and evaluate interagency responses, address criminal justice objectives, and make victims' medical, legal, and advocacy needs a priority.
History of SARTs
This section highlights historical milestones in improving the response to sexual assault and presents examples of how SARTs have evolved in different communities from the 1970s to today. These chronicles are a testament to the many teams throughout the country that have transformed isolated and fragmented responses into holistic and collaborative partnerships to better serve victims and bring criminals to justice. The histories shown here and others are found on the National Sexual Violence Resource Center's Web site. To add your community's SART history to the online collage, go to the SART History page.
In the 1970s
In 1972, Ann Burgess, a psychiatric nurse, and Lynda Holmstrom, a sociology professor, arranged to be on call day and night to interview and counsel rape victims who came to the emergency room of a Boston, Massachusetts, hospital. They noted that some of the victims' symptoms resembled those of combat veterans and coined the term "rape trauma syndrome." Although the term was not universally accepted until years later, rape trauma syndrome eventually became a conceptual framework that underscored the importance of better victim services in both the health care and criminal justice systems.
Also during this decade, the Federal Government created the first government-sponsored victimization survey. The National Crime Survey (now called the National Crime Victimization Survey) gathered crime data from individuals and households throughout America, an approach that differed from the Federal Bureau of Investigation's (FBI) Uniform Crime Reports (UCR), which included only a compilation of statistics reported to law enforcement agencies. According to the National Victim Assistance Academy Textbook, this survey "made it devastatingly clear that the rates of child abuse, rape, and domestic violence were much higher than imagined."8
Alarming Rates of Sexual Assault AddressedKansas City, Missouri (1973)
The Kansas City Missouri Police Department formed a long-range planning committee to study reported forcible rapes and to address the alarming rates of sexual assault in its jurisdiction. As a result of this study, the Metropolitan Coordinating Committee for Rape Treatment and Prevention was formed on a multicounty, bistate level, with 67 members representing 5 counties (about 50 square miles) on both sides of the Missouri state line. This interagency collaboration was one of the first and largest SARTs in the United States. Advocates, social workers, medical personnel, law enforcement, and researchers forged alliances and Saint Luke's Hospital became the first private sexual assault treatment center in the Nation. The designated sexual assault facility offered victims anonymity and did not require them to go through the criminal justice process. When the program began, 139 victims were treated at the hospital; by the following year, that figure had almost tripled.
Source: Jean Morgan, 1974, "Rape Treatment Center Opens at St. Luke's," The Johnson County Sun (August 3).
Full-Service Forensic Exam Facilities DevelopedHonolulu, Hawaii (1974)
Prior to 1974, victims in Honolulu were taken to a city morgue to have sexual assault forensic exams performed. That rather chilling practice prompted the Kapiolani Hospital to create an ad hoc committee to study whether it could establish an in-house center for treating sex abuse victims. The feasibility study revealed that there were not only gaps in services, but also fragmentation. Medical care provided by city and county physicians consisted primarily of checking for physical injuries. It did not include tests and treatment for sexually transmitted infections or respond to victims' reproductive health concerns. If victims went to their private physicians after a sexual assault, they generally received better medical care but evidence collection was either not done, incomplete, or improperly collected. Moreover, some hospitals automatically reported the incident to the police regardless of the victims' intentions. The hospital applied for and was granted a certificate of need from the State Health Planning and Development Agency, which enabled it to open the center to provide victims of sexual assault with crisis intervention, advocacy services, forensic medical exams, and criminal justice assistance. Law enforcement and the hospital signed a memorandum of understanding (MOU) and the prosecuting attorney's office gave a verbal agreement to support the team model.
Source: Paula Chun, 1978, "The Development of the Sex Abuse Treatment, Kapiolani-Children's Medical Center," paper presented at the Annual Conference of the Western Branch of the American Public Health Association, Honolulu, Hawaii.
Sexual Assault Nurse Examiner Programs CreatedMemphis, Tennessee; Minneapolis, Minnesota, and Amarillo, Texas (19751979)
Prior to 1975, most nurses were doing everything but the pelvic portion of the sexual assault exam to minimize victims' waiting time at the hospital. A study showed that victims generally preferred female nurse examiners when they had just been assaulted by male perpetrators. Unfortunately, the only available hospital physicians often were males.
To consistently meet victims' trauma-related health care needs, including their preference for female examiners, and to better serve criminal justice objectives, nurses were specially trained as sexual assault nurse examiners (SANEs), who would perform the entire exam. The first SANE program started in Memphis in 1976, followed by programs in Minneapolis (1977) and Amarillo (1979). Since the 1970s, SANEs have not only become a core component of SARTs nationally, SANEs also have been instrumental in starting SARTs in many communities.
SANE Development and Operation Guide Reviews SANE development, operations, policies, and procedures.
Victim Advocacy Begins on CampusFort Collins, Colorado (1974)
Colorado State University started its team approach through the Office of Women's Programs in 1974. Advocate teams composed of trained students, faculty, and staff referred victims to appropriate resources and helped them choose the resources that would best meet their physical, emotional, and legal needs on campus. This initial step brought together community- and campus-based services to help tailor responses to each student's needs.
Source: Communications with Chris Linder, Director, Women's Programs and Studies, Colorado State University.
Partnerships Formed Between Law Enforcement and AdvocatesLogan, Utah (1976)
The Community Abuse Prevention Services Agency (CAPSA) began in 1976 in Utah as a group of women who met under the sponsorship of the State University Women's Center. Law enforcement worked closely with CAPSA to assist with victims' needs, providing a foundation for broader community partnerships and collaboration with health care and other community organizations in the future.
Source: Communications with Kathryn Monson, Community Abuse Prevention Services Agency, North Logan, UT.
In the 1980s
In 1980, the American Psychiatric Association added posttraumatic stress disorder (PTSD) to the third edition of its Diagnostic and Statistical Manual of Mental Disorders. Exposure to rape, torture, and severe war zones were defined as catastrophic events that can result in PTSD.
In December 1982, President Ronald Reagan appointed a Task Force on Victims of Crime. This task force published 68 recommendations for improving the treatment of crime victims.9 The recommendations were directed at both the public and private sectors, including the criminal justice system. (New Directions from the Field: Victims' Rights and Services for the 21st Century, a 1998 report, reviewed the progress made in meeting the 1982 recommendations.)
In 1987, Howard and Connie Clery established Security on Campus, Inc., following the tragic robbery, rape, and murder of their daughter Jeanne at Lehigh University in Pennsylvania. The organization provides resources for victims and service providers and works to raise national awareness about crime and victimization on college campuses.
In 1988, OVC established the Victim Assistance in Indian Country (VAIC) discretionary grant program to assist American Indian tribes in developing reservation-based victim assistance programs in remote areas of Indian Country. Since its inception, VAIC has touched the lives of thousands of American Indians requiring victim assistance services in Indian Country, where the highest ethnic crime rate exists in the United States.10
During the same year, case law set precedence for using expert testimony to explain the behavior and mental state of adult rape victims. State v. Ciskie (751 P.2d 1165 (Wash. 1988)) ruled that expert testimony can be used to show why victims of repeated physical and sexual assaults by intimate partners would not immediately call the police or take other action.
Joint Medical/Legal Victim Interviews ConductedSan Luis Obispo County, California (1980)
Laura Slaughter, M.D., in collaboration with a group of nurses at San Luis Obispo County General Hospital, organized the first SART-like team in California in 1980. The team of law enforcement officers, sexual assault advocates, and on-call trained physicians conducted joint interviews to minimize the number of times victims were required to repeat (and often relive) the painful facts of their cases.
Source: California Coalition Against Sexual Assault, 2001, California Sexual Assault Response Team Manual, Chapter 1, Sacramento, CA: California Coalition Against Sexual Assault.
SART Institute EstablishedSanta Cruz County, California (1985)
Beginning in 1985, the Santa Cruz County District Attorney consulted with the local rape crisis center and formed a task force after he learned of San Luis Hospital's model and of a sexual assault nurse examiner (SANE) program in Houston, Texas. The models were combined to form California's first formalized SART. In 1987, Cabrillo College's SART Institute was created, serving as a catalyst to memorialize SARTs and to help replicate the SART model nationally.
Community-Based Exam Facility StartedMemphis, Tennessee (1988)
In 1988, the Rape Crisis Comprehensive Program (RCCP), an early pioneer for SART models, began to expand its multidisciplinary partnerships and services through collaborative agreements with local hospitals. The agreements mandated that when victims of sexual assault appeared at an emergency department and did not need medical intervention, they would be immediately transported to RCCP (the designated exam facility) and met by sexual assault forensic nurse examiners. This procedure reduced victims' waiting times to less than an hour and provided care in a private and comfortable location. During the same year, RCCP and the University of Tennessee (Memphis) collaborated to integrate educational materials related to the forensic medical-legal evaluation of victims of interpersonal violence into the curriculum for physicians and nurses.
In the 1990s
During the early part of the 1990s, the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) required health care facilities to have protocols on rape as well as other violent trauma. The commission revised the initial standards in 1997 to require health care facilities to teach staff how to recognize and respond to violent trauma, including sexual assault.11 During this time, the JCAHO standards were underscored when the American College of Emergency Physicians created Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient to promote consistency and best practices in the care of patients who had been sexually assaulted or abused.
The1990s also brought about significant federal legislation that directly affected the response to sexual violence:
SARTs in the National ForefrontTulsa, Oklahoma (1994)
Tulsa's SANE program received a Ford Foundation Innovations in State and Local Government Award in 1994. The award recognized Tulsa's SANE/SART as an exemplary program that collaborated with law enforcement officers, advocates, forensic laboratory specialists, and prosecuting attorneys. The national media coverage of the award brought multidisciplinary response to sexual violence to the forefront for many communities that were previously unaware of the need for it. This, in turn, brought about training and replication efforts that led 22 states to establish or improve their own multidisciplinary forensic exam response.
Source: Communications with Kathy Bell, RN, Director of Tulsa SANE Program, January 2006.
SART Protocols and GuidelinesMontgomery, Alabama (1996)
In 1996, the Montgomery Sexual Assault Response Team, established by the Council Against Rape, developed a comprehensive, communitywide, multidisciplinary approach for responding to sexual assault. The team comprised the city police and sheriff's department, the district attorney's office, the Council Against Rape, the domestic violence program, the state forensic laboratory, the hospital, the victim's compensation board, and forensic nurses. A procedure manual outlined the responsibilities of all of these disciplines. The team met monthly to review cases (victims were assigned identifying case numbers to protect their privacy).
Protocols for Rural AreasFairbanks, Alaska (1997)
In 1997, Fairbanks developed communitywide SART guidelines with local and state law enforcement, the advocacy center, the district attorney's office, and the local hospital's administration. The guidelines were established to better meet the needs of a highly rural and very large area with only one community hospital and one military hospital.
The SART system in Alaska helps to ensure that supportive infrastructures are in place to promote victim safety and healing. To help maintain this victim-centered response, advocates are called to the hospital on every case and team interviews with nurse examiners and law enforcement are conducted when possible. (Sometimes, special circumstances make a team interview inappropriate.) To meet the needs of military personnel, Fairbanks Hospital has contracts with the local military bases to provide forensic exams when military personnel become victims of sexual assault.
Source: Communications with Angie Ellis, Forensic Nurses Association of Alaska, Fairbanks Memorial Hospital, December 2005.
Statewide Coordination of SARTs and SANEsAugusta, Maine (1998)
In 1998, the Maine Coalition Against Sexual Assault hired a statewide SANE coordinator to ensure that efforts to create SARTs statewide were in line with the work already being done by SANEs. The coordinator reached out to hospitals, recruited nurses, organized the SANE training programs, and set up the first files on SANEs. In 2000, Maine became one of the first states to pass a statute providing victims with the option of anonymous reporting.
Source: Communications with Doreen Fournier Merrill, Public Policy and Member Services Coordinator, Maine Coalition Against Sexual Assault, Augusta, Maine.
In the 21st Century
At the turn of the century, several high-profile civil tort suits against the Catholic Church dealt with sexual assaults committed by professionals. With successful civil litigation, more and more cases of sexual assault by professionals were considered for criminal prosecution. The Victim Rights Law Center, created in 2000, was one of the first law centers in the Nation dedicated solely to serving the legal needs of sexual assault victims.
National standards for core SART responders also took root. In 2004, the Office on Violence Against Women (OVW) developed a National Protocol for Sexual Assault Medical Forensic Examinations to help health care providers, law enforcement officers, advocates, and others address the health needs of victims of sexual assault and minimize any additional trauma to victims caused by the reporting process. In 2006, OVW created a companion to the protocol, the National Training Standards for Sexual Assault Medical Forensic Examiners, to provide a framework for specialized education of medical forensic examiners to meet the health care, information, and forensic needs of adult and adolescent sexual assault patients presenting for medical forensic exams.
In 2003, the DNA InitiativeAdvancing Criminal Justice Through DNA Technologywas announced. It provides increased funding, resources, online training, and assistance to SART members who are core responders as well as to defense lawyers and judges.
Federal legislation in the 21st century bolstered SARTs' efforts to meet victims' needs for culturally specific, victim-centered responses through the Trafficking Victims Protection Act of 2000 (Public Law 106-386, Division A). The act ensures just and effective punishment of traffickers and protects human trafficking victims. Congress authorized the U.S. Attorney General to make grants to states, Indian tribes, units of local government, and nonprofit, nongovernmental victim services organizations to provide services to these victims.
Additional federal legislation both altered and advanced SART intervention and prevention efforts:
In This Toolkit:
SARTs report some challenges at the turn of the century. The Health Insurance Portability and Accountability Act (HIPAA) revised its privacy rule in 2000 to ensure that individuals' health information is properly protected while allowing the flow of health information as needed to provide high-quality health care. In some communities, health care facilities interpreted the standard to mean that sexual assault victim advocates could no longer be routinely dispatched to designated forensic medical exam sites.
SART Manager Position CreatedCleveland, Ohio (2001)
Cuyahoga County's SART is situated in the largest county in Ohio (approximately 1.4 million residents) and includes the city of Cleveland, which has one of the highest violent crime rates in the Nation. Cuyahoga County attempted to form a SART in 1998 but was unsuccessful. Another attempt to form a coordinated team began in 2001 with limited success. By 2004, the Cleveland Rape Crisis Center secured funding for a full-time SART manager for 2 years. With a SART manager at the helm, the Cuyahoga County SART grew to a team of 30with members from the FBI, emergency medical services, Cleveland Metroparks rangers, and college campuses. With SART leadership in place, the Cuyahoga County SART established 5 SANE programs, trained 2,600 law enforcement professionals, and hosted 2 community forums for more than 300 people.
Innovations Facilitated in Military ResponseNellis Air Force Base, Nevada (2003)
Nellis Air Force Base is located just minutes from the Las Vegas Strip on the edge of the city, an international destination and home to 27,000 military retirees. The Nellis Sexual Assault Prevention and Response (SAPR) program provides round-the-clock crisis response services for nearly 9,000 active duty, reservist, and guard members who live on the base and work with more than 23,000 family members and civilian employees. As a frequent host to international training exercises, dignitaries, and joint-service activities, the Nellis community also opens its doors to an average of 1,500 visitors and temporary duty airmen daily, swelling the potential SAPR target audience to more than 60,000 on a given day.
Nellis Air Force Base began planning and organizing for a coordinated community response to sexual assault in the latter part of 2003. By 2004, this response was in full swing. It includes collaboration with the Rape Crisis Center of Southern Nevada and has increased the competency of its personnel and the quality of its service delivery through military/civilian cross training, intervention, and prevention education programs.
Source: Communications with Suzanne Moore and Kristina Heick, Sexual Assault Prevention & Response, 99th Air Base Wing, Nellis AFB, Nevada, August 2006.
State's Attorney Responds to Overwhelming Sexual Assault ProblemChicago, Illinois (2003)
In January 2003, the Cook County State's Attorney took the lead in developing a SART in a densely populated county. He charged his office, members of the Chicago Police Department, members of the county's advocacy and medical communities, and the Illinois State Police Crime Lab with the task of forming a team to map solutions to the sexual assault problem. The resulting Cook County SART provides victims with comprehensive and specialized services and also helps identify, arrest, and prosecute offenders.
Source: Communications with Shauna Boliker, Chief, Sex Crimes Division, Cook County SART Team, Illinois.
Project Focuses on Safety for American Indian WomenThe Sexual Assault Offenders Demonstration Initiative (2005)
In 2005, the Office on Violence Against Women created the Safety for Indian Women from Sexual Assault Demonstration Initiative to enhance the response of tribal and federal agencies in addressing the high rates of sexual assault against American Indian women. The demonstration sites selected were Hannahville Indian Community (Wilson, Michigan), Navajo Nation (Window Rock, Arizona), Red Lake Band of Chippewa Indians (Red Lake, Minnesota) and Rosebud Sioux Tribe (Rosebud, South Dakota). The sites are working together to strengthen the tribal justice systems' immediate response to sexual assault, increase advocacy and services to victims, and strengthen the coordination between tribal and federal agencies.
Future of SARTs
Successful and emerging reforms in the collaborative response to sexual violence include victim-driven decisions to report or not report sexual assault to law enforcement, forensic medical/legal exams provided without using victims' insurance,12 orders of protection for sexual assault cases involving ongoing relationships, broader terms of restitution (including court-ordered payments by offenders sentenced to prison),13 and collaborative responses for those victims sexually assaulted by professionals.
Hundreds of ideas and recommendations for SARTs to consider are documented in New Directions from the Field: Victims' Rights and Services for the 21st Century, which calls on the United States to14
With these efforts, SARTs can chart new directions that creatively address emerging issues. If you are using this toolkit to develop, enhance, or expand your response to sexual violence, choose a course of action that is relevant to your community. Perhaps that course of action involves uniting with new allies, making a new commitment to sustain your program by developing strategic funding streams, or formalizing a system that strengthens your response during times of change.
What if . . .
Attorney General Guidelines for Victim and Witness Assistance
Establishes guidelines to be followed by officers and employees of U.S. Department of Justice investigative, prosecutorial, and correctional agencies in how to treat victims of and witnesses to crime.
Handbook on Justice for Victims
Helps criminal justice agencies and others who meet with victims implement victim service programs and develop victim-sensitive policies, procedures, and protocols. The handbook also applies to those to whom victims reach out in their immediate circlefamily, friends, and neighborsand to various informal, spontaneous, and indigenous support structures.
The History of the Crime Victims' Movement in the United States
Reviews victimology, victim compensation, the women's movement, the criminal justice system, victim activism, and other victim-related topics.
How to Plan and Implement a State Oral History Project
Helps organizations capture the scope and breadth of key historical activities through oral history projects and reviews lessons learned from past experiences.
New Directions from the Field: Victims' Rights and Services for the 21st Century
Examines how victims' rights and services have been realized since the 1982 Final Report of the President's Task Force on Victims of Crime and presents recommendations regarding what the Nation should strive to achieve for victims in the 21st century.
1 See David P. Bryden, 2000, "Forum on the Law of Rape," Buffalo Criminal Law Review 3: 317, 320321; Cassia C. Spohn, 1999, "The Rape Reform Movement: The Traditional Common Law and Rape Law Reforms," Jurimetrics Journal 39: 119, 128130.
2 See Cassia Spohn and Julie Horney, 1992, Rape Law Reform: A Grassroots Revolution and Its Impact, New York, NY: Springer, 77104; Stacy Futter and Walter Mebane Jr., 2001, "The Effects of Rape Law Reform on Rape Case Processing," Berkeley Women's Law Journal 16: 72, 8385.
3 Ibid., 173.
4 Stephen J. Schulhofer, 1998, Unwanted Sex: The Culture of Intimidation and the Failure of the Law, Cambridge, MA: Harvard University Press, 2.
5 Patricia Tjaden and Nancy Thoennes, 1998, Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey, Washington, DC: U.S. Department of Justice, National Institute of Justice, 2, 5.
6 David P. Bryden and Sonja Lengnick, 1997, "Rape in the Criminal Justice System," Journal of Criminal Law and Criminology 87: 1194, 1196.
7 Ibid.; Susan Estrich, 1987, Real Rape, Cambridge, MA: Harvard University Press, 4243.
8 Office for Victims of Crime, 2002, "Scope of Crime/Historical Review of the Victims' Rights Discipline," Chapter 1, National Victim Assistance Academy Textbook, Washington, DC: U.S. Department of Justice, Office for Victims of Crime.
9 President's Task Force on Victims of Crime, 1982, Final Report of the President's Task Force on Victims of Crime, Washington, DC: President's Task Force on Victims of Crime.
10 Office for Victims of Crime, 1999, Victim Assistance in Indian Country (VAIC) Training and Technical Assistance, Washington, DC: U.S. Department of Justice, Office for Victims of Crime.
11 Connie Monahan and New Mexico Coalition of Sexual Assault Programs, 2004, A SANE Strategic Plan for New Mexico, Albuquerque NM: New Mexico Coalition of Sexual Assault Programs.
12 The Violence Against Women Act of 2005 prohibits states and U.S. territories from requiring a police report if they use VAWA STOP grants funding to pay for exams.
13 The Violence Against Women Act of 2005 provides civil legal assistance for victims to obtain restitution.