Federal and State Activities
Federal Programs and Initiatives
Administration on Aging (AOA)
The AOA (www.aoa.gov) provides home and community-based services to millions of older
persons through the programs funded under the Older Americans Act. They are
well-known for management of programs which provide home-delivered meals
programs or nutrition services in congregate settings, adult day care, and other
social services to older Americans. However, they also fund the long-term care
ombudsman program, which is designed to prevent abuse of residents in nursing
homes and similar facilities by investigating complaints, and by providing a
regular community presence in facilities.
Centers for Disease Control and Prevention (CDC)
The CDC (www.cdc.gov) provides surveillance data, supports community development and research
on prevention of sexual assault, and offers technical assistance. The CDC
published a comprehensive compendium of training materials for health
professionals: Intimate Partner Violence and Sexual Assault: A Guide to
Training Materials and Programs for Health Care Providers (Osatlin and Short,
1998). The authors identified 36 sets of training materials intended to show
providers how to identify and treat partner violence and sexual assault. Few of
the programs are sufficiently detailed to be useful to providers in performing
medical evidentiary examinations.
CDC staff at the National Center for Injury Prevention and Control (NCIPC) have
substantial experience in the field of sexual assault.
Injury Center staff work with their counterparts at the National Institute of Justice
and in other offices within USDOJ on a variety of projects. They supported the
first National Violence Against Women Survey, which provides estimates of
intimate partner violence, sexual violence, and stalking, and are now developing a
pilot test for an ongoing national survey.
For several years, CDC has provided national leadership in the effort to improve
the consistency and comparability of data on violence against women. They are
pilot testing uniform definitions and recommended data elements on intimate
partner violence, and are working to develop similar standards for sexual
violence.
The Injury Prevention Center has an active research and dissemination program
and agenda that includes attention to prevention of sexual violence and child
maltreatment. Beginning in FY 2000, the CDC initiated projects to implement
and evaluate culturally appropriate early intervention and prevention programs to
prevent intimate partner and sexual violence among racial and ethnic populations.
They also administer funding and technical assistance for health departments in
states and territories to develop rape prevention and education programs, that will
include training programs for professionals.
The Injury Center is promoting development of a public-private network of
training and technical assistance resources, many of which proved useful in the
development of this report. In 1999, the CDC awarded a grant to the
Pennsylvania Coalition Against Rape to establish the National Sexual Violence
Resource Center (NSVRC). The Center provides resources, training materials,
and information to State and national sexual assault organizations and coalitions,
as well as to community-based programs. Its extensive collection of materials is
easily accessible online (www.nsvrc.org.)
CDC, along with more than a dozen partner organizations, supported the
American College of Emergency Physicians (ACEP) in the development of a
basic protocol for conducting medical evidentiary examinations of adult and
pediatric/adolescent patients.
Health Resources and Services Administration (HRSA)
Bureau of Health Professions (BHPr)
The Bureau of Health
Professions in the Health Resources and Services Administration (www.hrsa.gov) has extensive data and analytic initiatives related to the
number and type of health professions training programs and students.
Most data on health professions training programs is obtained from relevant
professional organizations, including the Association of American Medical
Colleges (AAMC), the American Association of Colleges of Nursing (AACN),
and other professional entities. For the most part, the data from professional
associations is insufficiently detailed to provide a picture of what course-work
related to sexual assault or medical evidentiary exams is available to students in a
given type of training program.
The National Health Service Corps (NHSC) offers a detailed clinical training
module on Child Abuse, Neglect and Domestic Violence for students and
providers in rural and urban, inner-city areas. Funding for a General Preventive
Medicine residency program at the University of Texas Medical Branch included
elective rotations in forensic psychiatry and medical management.
The Division of Nursing obtained survey data collected by the AACN in 1999
that provides information on the curriculum content of baccalaureate nursing
programs. The information was used by a HHS consortium to examine how
women's health and sex/gender issues are taught in the academic and clinical
course of study for baccalaureate nursing students. HRSA and others in HHS
have worked with schools of nursing to assist development of improved
curriculum content related to violence against women.
The Division of Nursing funded the College of Nursing at Seton Hall University
in New Jersey to develop a new specialty in violence prevention that will educate
students to become Sexual Assault Forensic Examiners. The Division has also
supported development of training materials for nurse-midwife program faculty
and providers on caring for survivors of sexual assault, elder abuse or child abuse.
Some Area Health Education Center Program (AHEC) and Geriatric Education
Center Program (GEC) grantees are offering education programming related to
sexual assault and elder abuse.
Maternal and Child Health (MCH) Bureau
In 1997, HRSA's Maternal and Child Health Bureau supported the
American College of Emergency Physicians (ACEP) in an effort to develop a
consensus-driven national training protocol for performing medical evidentiary
examinations of victims of sexual assault. The ACEP worked in collaboration
with more than a dozen other public and private entities in drafting material, and
subsequently published a protocol in 1999. The protocol continues to be widely
used within the emergency medicine community (ACEP, 1999) and as a guide for
many of the protocols being developed by States.
HRSA's MCH Bureau also supports program interventions to prevent child
maltreatment, including child abuse and neglect. It funds the Children's Safety
Network (CSN), which provides training, technical assistance and resources to
state and local departments of public health, maternal and child directors and
staff, injury prevention and control directors, and health professionals. Available
resources include a State-by-State statistical summary of costs associated with
child sexual, physical, and mental abuse and related deaths. The CSN Web site is
www.csneirc.org.
Bureau of Primary Health Care
Another HRSA activity related to domestic violence is the Bureau of Primary
Health Care, Office of Minority and Women's Health profile of programs that
addresses domestic violence at community health care organizations supported by
the Bureau of Primary Health Care. The February 1992 publication, Healing
Shattered Lives: An Assessment of Selected Domestic Violence Programs in
Primary Health Care Setting, is designed to encourage primary health care
providers to treat domestic violence among their client base and to engage
providers, administrators, policymakers and others in a coordinated, communitywide
response to domestic violence.
Other HRSA Resources and Initiatives
There are two additional HRSA activities that, while related to domestic violence
issues, provide good prototypes for possible future work related to sexual assault
and medical evidentiary examinations:
- The HRSA Action Plan to Prevent Family and Intimate Partner Violence trains managers and program officials on domestic violence to heighten awareness of family, and to pave the way for changes to be made in health care and professional training settings.
- In 2000, HRSA's Office of Minority Health worked with the Bureau of Primary Health Care and others to coordinate delivery of two satellite provider training programs that were targeted to providers in the Community and Migrant Health Center Programs and others serving rural and inner-city areas. The training featured an inter-cultural approach and was designed to raise awareness, build provider skills, define resources, and develop community partnerships.3
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA (www.samhsa.gov) is currently sponsoring the Women, Co-Occurring Disorders and Violence (WCDV) Study, which began in 1998 and
will be completed in September, 2003. This study is the first Federal effort to
address the significant lack of appropriate models of integrated services for
women with co-occurring substance abuse and mental health disorders who
have experienced trauma. The study is generating empirical knowledge on the
development of trauma focused comprehensive, integrated service approaches
and the effectiveness of these approaches for women.
National Institutes of Health/National Institute of Mental Health
(NIH/NIMH)
In 1997, in response to a congressional request, NIH(www.nih.gov) established an NIH Child Abuse and Neglect
Working Group (CANWG) consisting of the major research Institutes and
Offices supporting research in the field. CANWG has worked to review NIH
research efforts in child abuse and neglect, clarify Institute responsibilities to
differentiate areas of overlap, identify accomplishments and future research
needs, coordinate child abuse-related research across NIH, plan conferences and
workshops, and develop funding mechanisms. The CANWG has met with
representatives of other Federal agencies including the Administration for
Children and Families, National Institute of Justice, Office of Juvenile Justice
and Delinquency Prevention, Department of Education, and the Department of
Defense. The Committee's review revealed that $33.7 million is devoted
primarily to child abuse and neglect research and another $48 million is relevant
to understanding the precursors and consequences of abuse and neglect.
NIMH (www.nimh.nih.gov) sponsors a broad array of research related to the psychosocial impact of
sexual and physical assault; development and testing of treatment protocols and
training programs; research on preventive interventions to reduce posttraumatic
mental disorders; training of mental health researchers; and research on the
organization, delivery and effectiveness of care to victims. In 1995, NIMH
issued a Program Announcement to solicit research on Violence and Traumatic
Stress. One of the three major areas addressed was victims of child abuse, rape,
sexual assault, family violence, and other kinds of interpersonal violence and
crime. NIMH has issued fact sheets on Post-Traumatic Stress Disorder and
Helping Children and Adolescents Cope with Violence and Disasters.
Agency for Healthcare Research and Quality (AHRQ)
AHRQ (www.ahrq.gov) has awarded $5.5 million for four extramural research projects to
evaluate health care interventions with the purpose of improving treatment and
outcomes for victims of domestic violence. This research should assist health
care organizations with evidence-based findings about the most effective
treatment approaches for domestic violence victims. The studies are intended to
develop new knowledge in the prevention of domestic violence, improve the
identification of female patients at risk, and evaluate outcomes and effectiveness
of health care interventions designed to treat domestic violence victims.
AHRQ has also issued a new evaluation instrument that hospitals can use to
assess the quality and effectiveness of their domestic violence programs
(http://www.ahrq.gov/research/domesticviol/). Hospitals can use this instrument
to assess how well hospital-based programs provide training for health care
professionals in recognizing domestic violence, patient screening to determine
their risk of domestic violence and future injury, and interventions, including
medical treatment and victim advocacy services and followup.
HHS Violence Against Women Act Steering Committee
The HHS Violence Against Women Act Steering Committee meets bimonthly
and is managed by the HHS Office on Women's Health in the Office of the
Secretary. Meetings are attended by staff from HHS Agencies and Offices, as
well as by staff from USDOJ. The Committee's primary focus is promoting
exchange of information and collaboration on issues related to intimate partner
violence, but most members share a strong interest in sexual assault and child
abuse as well.
Stop Family Violence Fundraising Stamp
The Stop Family Violence postal stamp was unveiled by the Secretary, HHS
on June 14, 2003, to raise awareness and generate money for the victims of
domestic violence. The price of the stamp is 45 cents, with the difference
between the sales price of the stamp and the underlying postage consisting of a
tax-deductible contribution. By using this stamp on their cards, letters, and
packages, customers will contribute to a nationwide fight against domestic
violence.
U.S. Department of Justice (USDOJ)
USDOJ (www.usdoj.gov) has developed an impressive and useful array of scientific papers
related to sexual assault and forensic issues. These include published survey
findings and statistical analyses, white papers, conference summaries, and other
reports and training materials. The primary resources on sexual assault at the
Office of Justice Programs (OJP) are managed by the following offices:
National Institute of Justice (NIJ)
NIJ is the research, development, and
evaluation agency of the USDOJ, and is solely dedicated to researching crime
control and justice issues. NIJ funds a range of research, including an annual
solicitation for Research on Sexual Violence, that allows for awards of up to
$1,000,000 to support research on sexual violence in understudied populations,
drug-facilitated sexual assault, and the effect of criminal justice reforms
(including use of DNA evidence) on the outcomes of sexual assault cases.
The NIJ is currently funding an evaluation of the Sexual Assault Response
Team (SART) model in Rhode Island. Outcomes for victims and perpetrators
will be compared in communities that have SART programs and those that do
not. The study will be completed at the end of 2004.
The NIJ also supports a number of projects in collaboration with the CDC,
including development and analysis of the National Violence Against Women
Survey.
Bureau of Justice Statistics (OJS)
OJS is the source for national police
statistics on sexual assault and conviction rates used in this report. Its mandate
within USDOJ is to compile and analyze data on crime, criminal justice, and
crime victimization. Its Sourcebook of Criminal Justice Statistics, 2000,
compiles statistics from more than 100 sources to profile all aspects of criminal
justice in the United States and is published in hard copy, CD-ROM format, and
online (USDOJ, NCJ, 2001).
Office for Victims of Crime (OVC)
OVC was established under the 1984
Victims of Crime Act (VOCA) to oversee programs that benefit victims of
crime. It funds state victim assistance and compensation programs, and
supports training programs to educate criminal justice and allied professionals
regarding the rights and needs of crime victims. It operates a comprehensive
program of training, technical assistance materials, and publications related to
rape and sexual assault, and manages a Speakers Bureau for contacting experts
on sexual assault issues. In 1999, the OVC published an online and hard copy
guide for development of SANE programs (Ledray, 1999). A more recent
publication, Sexual Assault Nurse Examiner (SANE) Programs: Improving the
Community Response to Sexual Assault Victims, provides an overview of SANE
programs and their contributions to improving community response to victims,
and identifies promising practices and practical guidelines for establishing a
SANE program (USDOJ, NCJ, 2001).
Office on Violence Against Women
This Office works with others in the
Office of Justice Programs to implement a variety of programs authorized by
the Violence Against Women Act. One of these is the STOP Violence Against
Women Formula Grant Program, which provide funds to state, tribal, and local
governments, and to community-based agencies. States may choose to use the
funds for any of a number of listed purposes, including development of
specialized domestic violence and sexual assault units, and for the training of
sexual assault forensic medical personnel examiners in the collection and
preservation of evidence, analysis, prevention, provision of expert testimony,
and treatment of trauma related to sexual assault. The Office supports a limited
program of research on sexual assault issues.
Under the Violence Against Women Act of 2000, the Attorney General is
required to develop national recommendations for a protocol for sexual
assault forensic examinations. The Violence Against Women Office has
convened national experts and solicited advice from technical sources and
the public. The Office is working with medical experts, advocates, experts
from the criminal justice system, forensic scientists, and with others at
USDOJ and HHS, in the development of a protocol. The recommended
national protocol is anticipated to be completed in December, 2003
(USDOJ, 2003).
The DNA Analysis Backlog Elimination Act
The DNA Analysis Backlog Elimination Act of 2000 (42 U.S.C. § 14135
(2000)) provides Federal funding of $45 million over 3 years to States for
DNA sample analysis. The money is intended to enable labs to hire the
additional personnel needed to eliminate backlogs and to decrease
processing times. To be eligible, States must promise to implement a
comprehensive plan for the expeditious analysis of DNA samples,
including those collected but not analyzed prior to enactment.
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State Programs and Initiatives
Reporting Requirements
In 48 States, physicians and other health
professionals are required to report known or suspected instances of actual or
suspected child abuse and most states also require physicians to report if they
believe that elder abuse has occurred (Children's Bureau, HHS, 2002). Four
States (California, Colorado, Rhode Island, and Kentucky) specifically require
physicians to report intimate partner abuse (National Academy Press, 2002).
Practice Protocols and Standardized Evidence Collection Kits
Background research conducted by the Department of Justice, derived from
State and professional materials, has documented that there are approximately
35 States which have or are developing practice protocols on sexual assault
for use in the State, and approximately 45 States that have or are developing
State standardized evidence collection kits and forms.
Mandatory Educational Requirements
A few States have established
mandatory educational requirements for health professionals. California,
Iowa and New York require health providers to receive training on
identification and reporting of child abuse and neglect. Alaska, Florida, and
Kentucky require training to familiarize providers with intimate partner
violence and community resources; and Iowa mandates two hours of training
every five years on identification and reporting of elder maltreatment
(National Academy Press, 2002).
Promotion of SART/SANE Programs
Facilitated by the support from the
USDOJ Office for Victim Services, SART programs now reach into at least
two dozen States. Many states have vigorously adopted SART/SANE
programs, including Texas, Wisconsin, Colorado, and Pennsylvania. For
example, Texas provides financial support and technical assistance for
development of SANE/SART training programs and has a full time unit to
encourage SANE training programs. The State of Rhode Island is
participating in a study funded by NIJ to evaluate the effectiveness of their
SART program.
State Supported Training Models
Training models have been developed
with State support in Alaska, California, Ohio and Texas. As an example, the
California Medical Training Center at the University of California (UC)-Davis
is a product of the State legislature, which passed laws which mandate
reporting of sexual assault and abuse by health professionals, and which also
acted to provide financial support for a statewide system. The program is
based at the UC (Davis) Medical School, and provides specialized clinical
training for examination and treatment of four types of victims (sexual assault,
child abuse and molestation, domestic violence, and elder abuse). The CMTC
offers training to physicians, nurses, emergency responders and other
professionals. Training is offered on site, in hospitals and other facilities
around the State, and through distance learning facilities available through
college, hospital or law enforcement training networks. Trainees include
physicians, nurses, law enforcement officers, Emergency Medical Service
(EMS) personnel and others. Medical technology is used to link rural
providers with specialized consultation services, and faculty are able to offer
their services as expert witnesses.
3. These training sessions on domestic violence are available from the HRSA Information Center or 1-888-ASK-HRSA.
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