Help Victims Heal

I won't be a victim forever. I will always remember, but ultimately, I'll move on
. . . soothed by the fact that my soul is strong and my spirit unbreakable.¹

—Victim

Sexual violence poses significant challenges to victims' physical, emotional, spiritual, and sexual well-being. A number of factors have an impact on victims' healing, including²—

• The facts surrounding the sexual assault.
• Victims' abilities to cope with emotionally challenging situations.
• Stressful events preceding sexual assaults.
• Support systems already in place.

This section reviews methods used to ease recovery (e.g., encouraging victims to take control, creating a directory of referral resources), address victims' specific concerns (e.g., safety, health care), and recognize signs of recovery.

Ease Recovery

You can help victims in the way you respond to them and also by adjusting the makeup of your SART and its services to create a victim-centered approach.

• Responding to Victims
• Tailoring Your Services

Responding to Victims

This section provides a few tips to keep in mind when working with victims:

• Be aware that victims may know little about the criminal justice system and may find it intimidating, confusing, or frightening.
• Understand that trauma may cause victims to make incomplete, inconsistent, and untrue statements and know how to address the problems that may arise as a result of this.
• Encourage victims to take control.
• Foster victims' resilience.

Encourage Victims To Take Control

Allowing victims to make informed decisions and to take charge of their next steps goes a long way toward helping victims heal.

Start by asking simple questions:

• What would you like to be called?
• Where do you prefer to sit?
• Is there anything that I can get for you?
• Would you prefer the door open or closed?

Continue by determining other ways to help victims regain control:³

• Help identify and address the victim's safety needs.
• Make suggestions that can increase safety—for example, ask if victims feel safe being alone and if there is anything that would increase their sense of safety.
• Give victims as much control as possible, such as letting victims decide when and where they want to talk and in what order to do things.
• Give victims information to help them make informed decisions.
The Right Tool
Gaining Insight, Taking Action: Basic Skills for Serving Victims with Disabilities (Video and Guidebook)
Highlights how to communicate effectively with crime victims, the challenges faced by underserved victim populations, and the relationship between substance abuse and victimization.



• Explain processes (e.g., examinations, interviews, investigations) and who or what will be involved before beginning them.
• Maintain a nonjudgmental attitude to help victims regain power and control—individuals who perceive judgment may immediately relinquish control to others to avoid further judgments.
• Help victims identify their strengths.
• Treat victims as individuals rather than as cases.

Foster Resilience

Resilience is "the capacity to bounce back: to withstand hardship and repair oneself."⁴ There is no one way for a person to build resilience because there is an array of behaviors, thoughts, and actions associated with recovery.⁵ Victims can bolster their resilience by setting aside adequate time for sleep, staying connected with people who care, and taking time to do things they enjoy, such as reading, watching a movie, talking with a friend, listening to music, or going for a walk.⁶

Encourage victims to—

• Establish or reestablish routines.
• Avoid major life decisions such as switching careers or jobs in the acute crisis stage.
• Develop realistic goals and do something regularly to advance the goals.
• Find ways to measure and acknowledge personal growth.
• Talk with others who have similar experiences (through forums such as support groups).

Tailoring Your Services

Having a victim-centered approach requires you to look comprehensively at victims' needs and recommend how various agencies in your SART could best provide for each need in a coordinated fashion. Such an approach might mean that you minimize the number of victim interviews, assist with restitution, provide safe places for victims to wait when they are attending court hearings, inform them about victim rights, find ways to reimburse victims for transportation or parking costs, and so forth.

To tailor your SART's services to best address sexual assault victims' needs, first consider—

• Developing interagency protocols.
• Creating a shared language.
• Developing a directory of resources.
• Coming up with a pool of written materials for victims.
• Establishing support networks.

Interagency Protocols

Proactively address victims' needs by developing interagency protocols and having extended partnerships with agencies serving diverse populations. By formalizing responses and expanding community alliances, you can provide victims with customized support that can go a long way in helping them attain a sense of safety and justice.

Shared Language

It is critical to develop a shared, common language for trauma terms. Language that minimizes, distorts, or obscures sexual assault can cause additional injury. The word choices of law enforcement officers, judges, advocates, parents, journalists, prosecutors, and health care professionals send messages that can either describe the reality of victims' trauma or perpetuate myths about rape that insidiously affect all victims and the criminal justice outcomes of their cases.

For example, during the 1970s, Ann Burgess and Lynda Holmstrom identified symptoms and reactions to sexual violence as rape trauma syndrome. This identification was an important development that gave attention to the impact of sexual assault, but the term "syndrome" is problematic when attempting to define trauma within a legal context. For instance, "syndrome" labels victims by a cluster of vague symptoms and behaviors. When those symptoms and accompanying behaviors are inconsistent with public expectations, jurors may view victims' conduct as evidence of their lack of credibility. To offset this, the term "counterintuitive behavior" has been used in a legal context to describe victims' responses that could differ from conventional expectations.

Directory of Resources

Take an inventory of existing local services to document agencies that currently respond or could respond to victims of sexual assault. Then compile that information into a directory and use it as a communitywide, multidisciplinary referral tool. Halton, Canada, has a particularly unique directory because it includes a comprehensive list of community agencies and documents each agency's commitment and accountability in the response to victims (see the Halton protocol and directory online).

Compiling, screening, and organizing resources can be extremely time consuming. Even more challenging is the fact that resources can become quickly out of date. To offset this possibility, the Denver Victim Services Network created an online resource directory, which provides a comprehensive list of governmental and community-based organizations and allows users to search by services provided, victim type, language, culture, ethnicity, and other options. Service providers can request and print a report from search results and give it to victims or service providers who do not have access to the Internet.⁷

Written Materials

Gather written materials designed to help victims through the recovery process. In some cases, this means creating your own.

Consider developing informational brochures and pamphlets to help victims understand common reactions to sexual violence. The materials can cover coping strategies, long-term stress reactions, support systems, criminal and civil justice systems, medical issues, resources for financial assistance, and so forth. See the Resources section for examples of brochures that can be adapted to specific communities. Coping With Sexual Assault, an example of a longer document, provides information about medical, legal, and emotional issues.

Support Networks

Create a victim support network in your community. Approaches to developing victim support networks can vary.⁸ For example, a California SART organization facilitates a psycho-educational support group to provide participants with information on confidentiality, safety, and models of self-care. In Texas, a government-based support group, through the Dallas Police Department's Cold Case Unit, provides information and support to victims whose inactive cases have been reopened based on DNA findings (see Cold Case Program–TX, in this toolkit). In Colorado, a law enforcement advocate cofacilitates a support group with a counselor from a nonprofit agency (see Cold Case Program–CO in this toolkit.)

Address Specific Concerns

SART agencies can be a gateway to assistance for victims, prioritizing confidentiality and privacy needs while providing seamless referrals for victims' emotional, mental, legal, medical, spiritual, and practical needs, regardless of which agency responds first.

This section reviews how to address specific concerns that victims may have following an assault:

• Safety.
• Health Care.
• Confidentiality.
• Finances.
• Legal Issues.

Safety

Be aware of where victims would feel the safest during appointments and interviews. Although victims may be physically safe, they may not feel safe. They may be afraid of returning home or of running into their offenders. They may worry about the safety of family members, especially if the attacker is known and has threatened them. Signs that victims do not feel safe may include looking over their shoulders, fearing the thought of being alone, feeling they have to constantly watch what they say and do, and feeling something bad is going to happen.

Be prepared to help victims struggle through the many questions they may have that affect their feelings of safety:

• Should I report the assault to police?
• Do I need to move? Can I afford to move?
• Will I have to leave campus?
• Will the perpetrator come back? Has he or she been apprehended and jailed?
Read More
In This Toolkit: Advocates


• What do I do if I see him or her again?
• Does my attacker think he or she can still live with me?

Health Care

Sexual assault victims present a wide range of symptoms to health care practitioners:

• Skipping or racing heartbeat or chest pressure.
• Dizzy spells, headaches, fainting spells, or light headedness.
• Muscle tension in the neck and head.
• Hyperventilating, smothering or choking sensation, or lumps in the throat.
• Tingling, numbness, or shaking or trembling of the hands and legs.
• Nausea, vomiting, or diarrhea.
• Sweating, hot flashes, or chills unrelated to temperature conditions.
• Rashes resulting from excessive sweating.
• Sensitivity to light, sound, touch, temperature, and taste.

Victims also can experience adrenalin rushes, sleepiness, unexplained crying, emotional numbness, feelings of being trapped, helplessness, panic reactions, nightmares, flashbacks, racing thoughts, heightened or dulled perception, and complete or partial amnesia. Thoughts of suicide, eating problems/disorders, substance abuse, or self-mutilation also may occur.

In addition, sexual violence is linked to numerous adverse chronic health conditions, such as arthritis, chronic neck or back pain, frequent migraines or other types of headaches, visual problems, sexually transmitted infections, chronic pelvic pain, increased gynecological symptoms, peptic ulcers, and functional or irritable bowel disease.

It is important to choose mental health counselors and rape crisis advocates who understand the impact of sexual assault. For example, some women use drugs or alcohol to self-medicate following sexual assault. If counselors do not understand the impact of sexual assault, they may see alcohol or drug use as the most serious problem to address and may not focus on the assault as part of a victim-centered approach.

How can SARTs help address victims' health care concerns? Develop medical protocols for treatment, referrals, and reporting. Establish training programs and protocols for hospital personnel on the rights and needs of sexual assault victims. On a systems' level, work to provide seamless local services by addressing—

• The kinds of services that are provided by medical professionals and institutions locally and regionally.
• The need for health care protocols and training, such as those involving medical forensic exams, substance abuse treatment, and followup medical care.
• Health care issues specific to the sexual abuse of older victims and individuals with disabilities.
• Cross-cultural service delivery, including campus health services, military medical providers, and indigenous or native healers.

To proactively address victims' followup health care needs, make sure to take the following steps:¹²

• Educate patients on how to care for their injuries.
• Discuss the signs and symptoms of sexually transmitted infections, including HIV, and reinforce the need for the victim to seek treatment should any occur.
• Explain the importance of taking all prescribed medications as directed.
• Discuss the side effects of prescribed medications.
• Explain the physical, psychological, and behavioral responses that patients may experience.
• Inform patients of their legal rights.
• Give patients written documentation regarding treatments received, tests performed, and dates and times of followup appointments.

Confidentiality

Although all victims of crime have the right to confidentiality, victims of sexual violence have a pronounced interest in privacy. For example, victims of sexual violence have a deep need for autonomy and for control over their bodies, the private details of their lives, and the decisions they must make relative to the assault (including when or whether to report).¹³

Consider the following policies to protect victims' confidentiality:

• Prevent victims' names, addresses, telephone numbers, and personal identification information from being publicized.
• Establish relationships with victims based on trust, respect, and informed consent. Victims must understand the difference between a general desire to keep certain information private and statutory privileges governed by state/federal/tribal regulations. For example, privacy protections may be found in state or federal statutes, tribal codes, campus codes of conduct, administrative regulations, court rules, and state or federal constitutions.¹⁴
• Proactively address privacy rules and regulations, evidentiary privileges and waivers, and state and federal constitutional rights (including crime victims' rights amendments and statutes).
The Right Tool
Victims' Rights and Services Project Find state-specific statutes regarding victim issues.


• Let victims know how privileged communications may be waived and the consequences of a waiver. For example, you could describe the types of records and information that may be at risk for exposure: counseling documents, medical records, employment information, school/education records, residential/professional information, and documents pertaining to personal property.

Finances

Although no amount of money can erase the trauma and grief suffered by victims of crime, financial assistance can be critical in helping victims through the recovery process. All 50 states, the District of Columbia, and 3 of the 5 U.S. territories have victim compensation programs established by law to compensate victims and families for financial losses caused by crime.¹⁵ For some victims, these funds can help preserve the stability and dignity of their lives; for many others, access to compensation can alleviate stress and trauma in the aftermath of victimization.

States and territories determine by law who will be compensated and how much the compensation will be. The vast majority of the money to fund compensation programs comes from offender fees and fines rather than taxpayer dollars, with about a third coming from federal Victims of Crime Act (VOCA) funds.

Most state laws require criminal justice officials to inform victims about the availability of compensation benefits. Typically, victims learn about these benefits and receive application forms from police, advocates, prosecutors, or medical and mental health professionals.

Various barriers prevent victims from accessing victim's compensation. The following guidelines, adapted from the Sexual Assault/Victims Compensation Assistance Program Manual,¹⁶ may reduce those barriers:

• Help victims with the claim process, which may require multiple conversations.
• Respect the victim's decision to file a claim, and explore their options with them.
• Coordinate with a broad range of community agencies that are best positioned to meet victims' financial needs, and develop guidelines for donations with your community partners well before services are needed. Through that coordination, you can consider adding the following benefits, if they are not already provided:
• Relocation expenses, which can include first and last month's rent if the offense occurred at the victim's residence.
• Installation or upgrade of alarm systems.
• Paid and unpaid leave to allow victims to obtain protective orders and seek counseling.
• Allowances for crime scene cleanup.
• Short- or long-term counseling for family members who witness sexual assaults.
• Employer and creditor intervention, when requested by victims.
• Reimbursement for what victims may have already paid to service providers.
• Travel expenses. The It Happened To Alexa Foundation, for example, assists sexual assault victims and their families with travel expenses during criminal trials.
• Consider creating a tracking system for claims to make sure that victims don't fall through the cracks.
• Assess your community's practices.¹⁷

In addition, Dr. Lisa Newark recommends outreach efforts that expand the reach of compensation programs to require communities to determine¹⁸—

• How well victims' financial needs are being met, regardless of the payment sources.
• What the most effective strategies are for helping victims access compensation.
• What other programs and entities pay crime-related expenses.

Legal Issues

Only 38.3 percent of rapes/sexual assaults were reported to police in 2005—the violent crime least often reported to law enforcement.¹⁹ In one study,²⁰ victims of rape gave the following reasons for not reporting—

• Rape: 23.3 percent said it was a personal matter, 16.3 percent feared reprisal, and 5.8 percent said the police were biased.
• Attempted rape: 16.8 percent said it was a personal matter, 11.3 percent feared reprisal, and 9.9 percent wanted to protect the offender.
• Completed and attempted sexual assault: 25.3 percent said it was a personal matter, 12.4 percent reported to a different official, and 11.3 percent feared reprisal.

The criminal and civil justice systems can work together to provide victims with resources for personal safety, privacy rights, and compensation for suffering and loss.²¹ For example, SARTs that create protocols and cross-training events for criminal and civil justice officials can support victims who are grappling with the following questions:

• If I report, do I lose control of whether the case is prosecuted?
• Can I file a police report and then not go any further with prosecution?
• Will my name be published in court documents or the newspaper?
• How long will the criminal process take?
• Do I need a protective order?
• Will the assault affect my immigration status?
• Can I break my apartment lease?
• How likely is a criminal conviction?

The key civil legal issues that sexual assault victims face include privacy, housing, education, safety, immigration, physical and mental health, employment, and financial benefits. Including a civil attorney on your SART should augment the response of traditional criminal justice and community-based programs. The criminal justice system is primarily concerned with assessing the guilt of an accused party, while the sole responsibility of civil attorneys is to protect the interests of sexual assault victims and address the concerns that affect their immediate and long-term well-being. It is critical that you understand the role of civil attorneys in the early stages of your SART's development.

Civil attorneys can help victims—

• Secure restraining orders.
• Obtain victim compensation.
• Break leases when the assault occurred at the victim's residence.
• Pursue disciplinary actions and reasonable accommodations at the victim's school.
• Protect the victim's immigration status.

Clarifying the role of civil attorneys is an important first step in integrating them into your SART and lays the foundation for fostering effective interagency relationships within civil and criminal justice.

Recognize Signs of Recovery

Some victims emerge from sexual assault feeling enhanced rather than diminished. They speak of spiritual development, stronger personal relationships, greater personal strength, deeper appreciation of life, and clarity about priorities.²²

Most people are familiar with the concept of posttraumatic stress disorder, which is the recurrent experience of psychological, psycho-physical, and/or social symptoms resulting from trauma or crisis. Posttraumatic growth, on the other hand, is the experience or expression of positive life change as an outcome of a trauma or life crisis. For example, some victims report that they have developed a keener sense of discernment, acquired enhanced motivation to make things better, developed new insights on life, acquired a stronger sense of independence that includes skills for maintaining safe boundaries, and increased their abilities to solve problems creatively.

Some victims have also reported more²³—

• Creativity and humor—strategies developed to process trauma.
• Assertiveness—the ability to take risks for their beliefs and rights.
• Sustained faith—an appreciation of the value and integrity of faith in difficult situations.
• Courage—a stronger sense and belief in their inner strength.

Healing occurs when symptoms are brought within manageable limits. Healing also brings with it a restored sense of self-esteem and the ability to reestablish important relationships.²⁴ This is a self-defined process, and for many victims of sexual assault it is life-long journey.

As part of the Michigan Coalition Against Domestic and Sexual Violence's Outcome Evaluation Strategies for Sexual Assault Service Programs, staff conducted interviews and focus groups with adult and teen survivors. Survivors were asked how they defined healing and how they will know when they are healed. A synopsis of their responses follows:²⁵

What healing feels like:

Teens: Feeling safe, strong, confident, joyful, and happy; having high self-esteem.

Adults: Feeling hopeful, strong, confident, and freed; experiencing a sense of justice; feeling able to support others; accepting what happened; refusing to live in denial; withholding blame; feeling real and authentic; having a sense of self-worth; working to make sense of the experience; connecting to others.

How you know when you are healed:

Teens: Enjoying life the way it is; handling other's reactions assertively; being able to trust; crying less often; not believing everything bad happens to oneself; believing that one can overcome the trauma; feeling more comfortable around males; feeling passionate again; knowing the incident was not one's fault; wanting to live again.

Adults: Finding that victimization becomes a smaller part of who one is; coming to terms with the trauma; reconnecting with one's surroundings and community; controlling one's addictions; pursuing goals; speaking out to others; embracing healthy sexual intimacy; living in the present; honoring one's feelings in relationships.

Resources

• For Victims
• For SARTs

For Victims

Online Resources

A Recovery Bill of Rights for Trauma Survivors
Focuses on ritual abuse and healing, but the resources can be adapted for sexual assault unrelated to ritual abuse.

Anniversary Reactions: A Survivor's Guide on How to Cope
Defines "anniversary reaction," illustrates two survivors' stories, recommends coping strategies for victims, and presents ways families and friends might help victims.

Civil Justice for Victims of Crime
Gives crime victims and those who work with them a basic understanding of the civil justice system.

Coping with Sexual Assault
Reviews medical, legal, and emotional issues following a sexual assault and describes how rape victims and their friends and families can obtain services. Specific long-term concerns, including physical problems, emotional and psychological concerns, posttraumatic stress disorder, depression, and relationship and sexual problems also receive attention.

Guidebook for Immigrant Victims
Provides basic information and a comprehensive referral list for documented and undocumented immigrants who are victims of crime.

What to Do When Someone You Love is a Victim of Rape
Provides information on how family and friends can help survivors.

If You Have Been Raped or Sexually Assaulted: Know Your Rights
Gives victims information about their legal rights in Washington State; can be adapted to other jurisdictions.

It Happened To Alexa Foundation Home Page
Supports rape survivors through the trauma of the criminal trial, in the hopes that more survivors will go through with prosecution to put their perpetrators behind bars.

Dru Sjodin National Sex Offender Public Website
Provides public information about sex offenders throughout the country.

Rape, Abuse & Incest National Network
Operates a National Sexual Assault Hotline at 800–656–HOPE. The toll free line connects victims to more than 1,100 rape treatment programs nationally.

Recovering From Your Crime-Related Injuries (DVD)
Provides seriously injured crime victims with general information about the criminal justice system and strategies for coping with the negative emotions that often accompany victimization.

San Diego Victim Resource Pamphlet
Provides guidelines for San Diego sexual assault victims; can be easily adapted for victims from other jurisdictions.

Sexual Violence Survival Guide
Addresses commonly asked questions following sexual assault. The pamphlet can be helpful to victims and/or their families, friends, colleagues, spouses, or partners.

Sexual Assault Victimization
Provides an overview of sexual assault and the services generally available to victims.

Teen Tools: Sexual Assault
Provides an overview of sexual assault and describes what teens can do if they are victimized. It also provides information on how teens can help someone they know who has been sexually assaulted.

Print Resources

Ellen Bass and Laura Davis, 1992, The Courage to Heal, New York, NY: Harper Perennial Publishers. Has an appendix/chapter for partners of survivors.

Sharon E. Cheston, 1994, As You and the Abused Person Journey Together, Mahwah, NJ: Paulist Press.

John Courtright and Sid Rogers, 1994, Your Wife Was Sexually Abused (with discussion guide), Grand Rapids, MI: Zondervan Publishing House.

Yvette S. DeBeixedon, 1995, Lovers and Survivors: A Partner's Guide to Living with and Loving a Sexual Abuse Survivor, San Francisco, CA: Robert D. Reed Publishers.

Robert Larry Levine, 1996, When You Are the Partner of a Rape or Incest Survivor: A Workbook for You, San Jose, CA: Resource Publications.

Wendy Maltz, 1991, The Sexual Healing Journey: A Guide for Survivors of Sexual Abuse, New York, NY: Harper Perennial Publishers. Takes survivors step-by-step through one of the most challenging aspects of their recovery from sexual abuse. Based on Maltz's clinical work, this book includes groundbreaking exercises and techniques for survivors to work on alone or with their partners. 

Aphrodite Matsakis, 1998, Trust After Trauma: A Guide to Relationships for Survivors and Those Who Love Them, Oakland, CA: New Harbinger Publications.

For SARTs

HELP for Victim Service Providers (Web Forum)
Allows victim service providers and allied professionals to share ideas, suggestions, and recommendations concerning promising and best practices and victim issues.

National Center for PTSD
Helps U.S. veterans and others through research, education, and training on trauma and posttraumatic stress disorder.

National Sexual Violence Resource Center
Serves as the Nation's principle information and resource center regarding all aspects of sexual violence. The center provides national leadership, consultation, and technical assistance by developing and disseminating information on sexual violence intervention and prevention strategies.

OVC Directory of Crime Victim Services
Helps service providers and individuals locate nonemergency crime victim services in the United States and abroad. Service providers can search by location, type of victimization, service needed, and agency type.

Parameters of Privilege and Confidentiality when Collaborating with Community Partners: A Guide for Sexual Assault Counselors and Advocates
Supports sexual assault counselors/advocates in their collaborations with multidisciplinary teams throughout Pennsylvania, describes the role of sexual assault counselors/advocates, and reviews the parameters of confidentiality that a sexual assault counselor/advocate must honor in Pennsylvania.

Confidentiality and Sexual Violence Survivors: A Toolkit for State Coalitions
Helps state sexual assault coalitions develop confidentiality guidelines.

Protocol Checklist for Responding to Sexual Assault
Helps service providers follow proper protocol when responding to sexual violence; developed for colleges but can be adapted for other use.

Tips for Social Workers, Counselors, Health Workers, Teachers, Clergy, and Others Helping Victims of Rape, Domestic Violence, and Child Abuse
Describes how to respond to victims/survivors of violence; meant for those who may have limited formal training on violence against women and children.

Toolkit to End Violence Against Women
Provides concrete guidance to communities, policy leaders, and individuals engaged in activities to end violence against women.

Violence Against Women Online Resources
Provides service providers with up-to-date information on interventions and ways to stop violence against women.

Notes

1 Colorado Coalition Against Sexual Assault, 2003, Toward Healing and Justice: A Handbook for Survivors of Sexual Assault, Denver, CO: Colorado Coalition Against Sexual Assault.

2 American Psychological Association, Discovery Health Channel, 2002, The Road to Resilience,  Washington, DC: American Psychological Association.

3 Some of these recommendations are taken from Kentucky Association of Sexual Assault Programs, 2008, Responding to Sexual Violence: A Guide for Professionals in the Commonwealth, Frankfort, KY: Kentucky Association of Sexual Assault Programs.

4 Colorado Coalition Against Sexual Assault, Toward Healing and Justice: A Handbook for Survivors of Sexual Assault.

5 Russ Newman, 2002, "Professional Point: The Road to Resilience," Monitor on Psychology 33(9): 62.

6 Thema Bryant-Davis, 2005, Thriving in the Wake of Trauma: A Multicultural Guide, Westport, CT: Praeger Publishers, 37.

7 For more information on using Denver's online directory, see Using Technology to Enable Collaboration.

8 National SART Listserv discussion, July 2005.

9 Communication with Mary Pat DeWald, RN, MSN, APN, CCRN, SANE, Women's Health Nurse Practitioner, Forensic Clinical Nurse Specialist.

10 E-mail correspondence with Jane Morgan-Kidd, June 28, 2007, www.jaynemorgankidd.com.

11 E-mail correspondence with Faith MacIntyre, Florida, June 28, 2007.

12 World Health Organization, 2003, Guidelines for Medico-Legal Care for Victims of Sexual Violence, Geneva, Switzerland: World Health Organization, 71.

13 Jessica Mindlin and Liani Jean Heh Reeves, 2005, Confidentiality and Sexual Violence Survivors: A Toolkit for State Coalitions, Portland, OR: National Crime Victim Law Institute, 11–12.

14 Ibid.

15 National Center for Victims of Crime, 2006, Networks 21(1–2): 15.

16 Pennsylvania Coalition Against Rape, 2006, Sexual Assault/Victims Compensation Assistance Program Manual, Enola, PA: Pennsylvania Coalition Against Rape, 24–26.

17 Ibid., 41–42 (see the sample assessment tool).

18 National Center for Victims of Crime, Networks, 21.

19 Shannan M. Catalano, 2006, Criminal Victimization, 2005, Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

20 Callie Rennison, 2002, Rape and Sexual Assault: Reporting to Police and Medical Attention, 1992–2000, Washington DC:  U.S. Department of Justice, Bureau of Justice Statistics.

21 Jessica Mindlin and Liani Jean Heh Reeves, 2005, Rights and Remedies: Meeting the Civil Legal Needs of Sexual Violence Survivors, Portland, OR: Center for Law and Public Policy on Sexual Violence, 18.

22 Washington Coalition of Sexual Assault Programs, 2006, Research & Advocacy Digest 8/3(April).

23 Dean G. Kilpatrick, 2002, "Mental Health Needs: Trauma Assessment and Intervention," National Victim Assistance Academy Textbook, Washington, DC: U.S. Department of Justice, Office for Victims of Crime.

24 Judith Lewis Herman, 1992, Trauma and Recovery (see Dr. Mary Harvey's Criteria for the Resolution of Trauma at bottom of page), New York, NY: Basic Books.

25 Chris Sullivan and Suzanne Coats, 2000, Outcome Evaluation Strategies for Sexual Assault Service Programs: A Practical Guide, Okemos, MI: Michigan Coalition Against Domestic and Sexual Violence, 21.

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