Literature Review – Part 1

Commissioned by The Ministry of Women’s Affairs

Authors: Elaine Mossman, Jan Jordan, Lesley MacGibbon,Venezia Kingi, and Liz Moore

For a PDF [2.4 MB], click HERE

 

Return to Responding to sexual violence research reports

 

Contents

List of Tables
List of Boxes
Acknowledgements
Executive Summary

PART ONE: Overview of adult sexual violence and good practice
1    Introduction
1.1    Project overview
1.2    Approach to reviewing the literature
1.3    Structure of report

2    Overview of sexual violence
2.1    Terms and definitions
2.2    Nature of sexual violence
2.3    Legal framework for sexual violation offences
2.4    Victim/survivor needs

3    Overview and critique of good practice
3.1    What does good practice relate to?
3.2    What are the criteria used to judge good practice?
3.3    What are the outcomes against which good practice is evaluated?
3.4    Who has the power to define good practice?
3.5    Use of good practice in this review

PART TWO: Summary of the literature
4    Medical system
5    Mental health system
6    Criminal justice system
7    Support services

PART THREE: Summary
8    Good practice services for adult survivors of sexual violence

Appendix: Methodology – search criteria and sources of references
References

List of Tables

Table 1: Key issues for service delivery for victim/survivors from diverse groups
Table 2: Access issues for victim/survivors who have disabilities
Table 3: Key issues for service delivery for victim/survivors from diverse groups
Table 4: Needs and priorities of different parties
Table 5: Māori and counselling
Table 6: Inquisitorial and adversarial justice systems
Table 7: Arguments for and against the use of restorative justice
Table 8: RESTORE restorative justice programme
Table 9: Continuum of service delivery: support services
Table 10: New Zealand guidelines
Table 11: Good practice programmes and services
Table 12: Common good practice principles of delivery 

 

List of Boxes

Box 1: New Zealand legal definition of sexual violation
Box 2: Incidence and prevalence of sexual violence – measurement issues
Box 3: Promising practice criteria
Box 4: Good practice principles in the provision of medical services
Box 5: Health outcomes of violence against women
Box 6: Good practice recommendations for hospital emergency rooms
Box 7: Good practice recommendations for primary health care providers
Box 8: Good practice principles for performing a forensic medical examination
Box 9: Summary of Accident Compensation Corporation principles of good practice
Box 10: Good practice recommendations for mental health crisis intervention
Box 11: Effective long term mental health interventions
Box 12: Consumers’ perspective’s on good practice for mental health services
Box 13: Good practice principles for police
Box 14: Good practice guidelines for prosecutors (victim-based)
Box 15: Good practice guidelines for prosecutors
Box 16: Good practice guidelines for non-government organisation specialised sexual violence support services
Box 17: Australian Centre for the Study of Sexual Assault – Rape Crisis Online initiative
Box 18: Australian Centre for the Study of Sexual Assault – ‘Another layer of trauma’ workshop
Box 19: Australian Centre for the Study of Sexual Assault – co-ordination of community services

 

 

 

Acknowledgements

We would like to acknowledge the help and support we have received from members of our research team: Dr Tess Moeke-Maxwell who provided Māori expertise and support throughout the project; Associate Professor Peggy Fairbairn-Dunlop who provided quality assurance and advice from a Pacific perspective.

We would also like to acknowledge and thank the Ministry of Women’s Affairs staff for identifying and supplying the literature and providing valuable feedback on the various drafts of the report: Dr Denise Lievore, the Research Manager, Nicole Benkert, Research Co-ordinator and Lynda Byrne, Senior Policy Analyst.

Important advice and feedback on this work was also provided by the members of the project advisory group. This group was made up of representatives from the Ministry of Justice, New Zealand Police, the Secretariat of the Taskforce for Action on Sexual Violence, the Accident Compensation Corporation, Te Puni Kōkiri, the Ministry of Pacific Island Affairs, the Ministry of Social Development, Te Ohaakii a Hine – National Network Ending Sexual Violence Together (TOAH-NNEST) and the National Collective of Rape Crisis. We would also like to acknowledge the advice and support provided by the members of the project steering group.
Finally we would like to acknowledge and thank Professor Rachel Jewkes for peer reviewing the final report and providing insightful and valuable comments.Executive summary
Part one: Overview of adult sexual violence and good practice

 

Executive Summary

 

1    Introduction

This report responds to a request by the Ministry of Women’s Affairs to the Crime and Justice Research Centre to conduct a critical literature review outlining international and New Zealand perspectives on good practice for services that respond to adult survivors of sexual violence.

With regard to medical, criminal justice, mental health and support systems at different post-assault periods and in relation to diverse social and cultural groups, the specific objectives of this review were to:

• identify and critique good practice models within and across systems, internationally and in New Zealand
• describe factors that promote good practice within and across systems
• identify New Zealand guidelines for dealing with adult victim/survivors of sexual violence.

 

The literature reviewed was that supplied by the Ministry of Women’s Affairs following a comprehensive search by ministry staff to identify a variety of relevant literature. The findings from the literature review will contribute to the Government’s considerations for policy and practice responses for victim/survivors of adult sexual violence in New Zealand.

By definition, a literature review can cover only written material. The information in the review, including the summary tables, should be read as a list of practices on which literature is available and that have been evaluated or otherwise deemed as good practice according to various criteria, rather than a definitive or complete list of good practices.

2    Overview of sexual violence

Sexual violence is a broad term that covers a continuum of sexual offending behaviours. The focus of this review is on services for victim/survivors of sexual violence, with particular attention given to literature relating to responses to victim/survivors of sexual violation. For the purposes of this review, the legal definition of sexual violation used is as outlined in section 128 of the Crimes Act 1961, which covers rape and unlawful sexual connection.

Sexual violence can occur in a range of contexts, but universally it is recognised as being predominantly a crime in which the victim is female and the perpetrator is male. The common perception of rape is that the perpetrators are strangers and/or recent acquaintances, and it is this notion of rape that is most commonly thought of as ‘real rape’. It is this form of sexual violence that much policy and practice tends to be built around. However, rather than strangers, the majority of rapes are committed by men who are known to victim/survivors as date rapes, acquaintance rapes or marital rapes. There is also often a lack of recognition that much sexual violence involves repeated assaults by the same (and sometimes different) perpetrators, with a significant overlap between victim/survivors who have experienced both rape and domestic violence.

Incidence and prevalence
Rates of sexual victimisation among the population are an important indicator of the level of service provision that is required. The most recent New Zealand Crime and Safety Survey (NZCASS), undertaken in 2006, found a 12-month prevalence rate of 3 percent for individuals aged 15 years or older who had experienced one or more occurrences of sexual victimisation in 2005. This equated to 6.4 incidents per 100 adults (9 per 100 women, 3 per 100 men) that year.

Some groups of the population are at higher risk of sexual victimisation than others. New Zealand research indicated those at higher risk included:

• women
• younger women (15–24 years)
• Māori women.

Reporting and conviction rates
In New Zealand, estimates suggest just one in ten victim/survivors report sexual violence to the police. According to New Zealand Police data on recorded crime, this equates to just over five cases per 10,000 of population per year (equates to 2,364 cases in 2007/08). Moreover, among those who do report to the police there can be substantial attrition. This means only a small proportion of victim/survivors are choosing to access the criminal justice system.

Legal framework for sexual violation offences
There have been several significant reforms of the New Zealand legal system over the last two decades related to how crimes of sexual violence are dealt with in the criminal justice system. Despite these reforms there are still concerns that rape victims’ experiences of the criminal justice system have not substantively improved and that a ‘justice gap’ remains. In response to some of these concerns, the Ministry of Justice recently issued a discussion paper to solicit the public’s views about several proposed legislative amendments to the current law on sexual violence (Ministry of Justice, 2008).

Victim/survivor needs
The literature on effective service delivery for those who have experienced sexual violence presents findings as if victim/survivors were a homogenous group. It is likely that many of the findings will also relate to diverse populations of victim/survivors. However, good practice in service delivery requires an understanding of the unique needs of diverse populations of victim/survivors, particularly when these groups are often over-represented as users or potential users of sexual violence services. While the needs and issues of each group have been presented as distinct groups, there will of course be overlaps between groups (e.g. young, Pacific, transgendered sex workers), which would result in accumulated needs and in some cases increased risk.

Whilst acknowledging the importance of cultural competence in service delivery, guidelines note that it is important to consider each client as an individual and not make assumptions regarding the type of cultural approach that is appropriate or desirable for that person. It is also useful to consider the extent to which approaches considered culturally appropriate may also be good practice for all victim/survivors.
 

Table 1: Key issues for service delivery for victim/survivors from diverse groups

Group	Key issues
Māori	Involvement of culturally appropriate supports and extended family Adherence to Māori models of health and well-being Māori personnel in existing services and the development of Māori services
Pacific	Involvement of extended family Provision of relevant information about formal services in Pacific languages and English Ensuring confidentiality Pacific personnel in existing services and the development of Pacific services. Understanding of the role of the church
Young adult	Confidentiality – especially in relation to parental disclosure
Male	Reassurance and counselling about masculinity and sexuality Dealing with issues around historical offences
Gay, lesbian, bisexual, transgender, intersex	Impact of homophobia of service providers Transgender counselling
Victim/survivors with disabilities	A range of access issues in relation to diverse disabilities Gaining informed consent of people with intellectual disabilities may be difficult The caretaker, family member or friend accompanying the victim/survivor may be the perpetrator Being recognised as credible by police and prosecution
Rural	Isolation – social and geographic Lack of service provision Familiarity, confidentiality and anonymity issues
Sex-worker	Multiplicity of social problems that can include drug abuse and social isolation Fear of public exposure and prejudice of mainstream services pose problems in accessing services
Ethnic, migrant, refugee	Diverse needs dependent on pre-migration experiences Language and communication difficulties, leading to issues around ascertaining informed consent and gaining evidential information Social isolation

 

3    Overview and critique of good practice

In reviewing what is considered ‘good practice’, it is important to distinguish between two distinct applications.

• The type of service delivery: This is the particular type of adult sexual violence services that have been identified as good practice. This could be either a general category (e.g. forensic nursing) or a particular programme (e.g. Sexual Abuse Nurse Examiners programme).
• The principles of delivery: Good practice can also refer to principles of delivery (e.g. culturally appropriate or victim-centred). These principles can relate to a number of types of programmes and are critical factors in achieving successful outcomes.

 

The next issue is to understand the criteria used to identify a type of programme or principle of delivery as being ‘good practice’. This is difficult when there is no agreed definition of what constitutes a ‘good practice’, ‘best practice’ or ‘promising practice’ in respect of sexual violence service provision. However, a review of other fields revealed a range of different types of criteria. This included good practice identified through:

• proven effectiveness based on research evidence
• practice reflected in current trends with promising initial reports
• knowledge-based practice that recognises the validity of experience of professional practitioners and the lived experience of service users.

 

The most practical and relevant set of criteria for sexual violence was that developed by the Australian Centre for the Study of Sexual Assault to identify ‘good practice programmes’. The centre’s criteria value ‘evidence’ and ‘knowledge-based practice’ but within a flexible framework as outlined below.

• Compulsory criteria:

-    have a clear focus: have a clearly defined conceptual framework, clear aims, and clear desired outcomes
-    take account of contemporary research and practice developments in the field of sexual assault
-    position diversity as key to the development, understanding and delivery of good practice models
-    demonstrate a sensitivity towards the barriers faced by victim/survivors in disclosing and reporting sexual assault, and other difficulties, if relevant
-    include processes of accountability and evaluation.

• Optional criteria:

-    are replicable (that is, able to be used by others)
-    have been evaluated as successful.

 

Unfortunately, whilst advocating this set of criteria as the most useful to the sexual violence sector, there was seldom sufficient information in the literature reviewed to evaluate initiatives against these criteria.

In reviewing the literature on good practice four final points should be considered.

• Goals and priorities against which good practice has been measured: There is much diversity in the needs and priorities of the various people and agencies involved (e.g. the victim/survivor, medical care provider, police, prosecutors and the court, mental health providers, community support groups). Whilst they may overlap, in some cases they may also be in conflict. For example, good practice according to support agencies may be that the victim/survivor’s emotional needs be paramount at a time when the police require intensive questioning. Good practice for police is that which assists in the timely collection of uncontaminated forensic evidence, when a support agency might advocate that a victim/survivor’s physical desire for a shower and a drink is the priority. An awareness of the different goals and priorities against which good practice is being measured is, therefore, an important consideration.

• Input from victim/survivors in defining good practice: Typically it is professional organisations and government departments that have the resources and power to make decisions and write policies regarding good practice, as opposed to the victim/survivors themselves who are most aware of their interests and needs. However, it is important that there is input from victim/survivors, otherwise organisations are in danger of devising systems that may be internally efficient but ineffective in terms of responsiveness to the needs of their client groups.
• ‘Best’ practice or ‘good’ practice. Not only might what is best for victim/survivors be different from what is best for the police or other organisations, but what is best for particular victim/survivors may differ according to, for example, cultural background, gender or urban/rural context,. There is, accordingly, a growing tendency to move away from identifying ‘best’ practice to acknowledging a range of ‘good’ practices instead.
• Applicability to New Zealand context. There is limited research on the effectiveness of adult sexual violence services; what there is tends to come from overseas researchers, based on evaluations of programmes and initiatives in their jurisdiction. Hence, whether these findings are applicable to the New Zealand context, and in particular for Māori victim/survivors, must be considered.

 

Part two: Summary of the literature
The second part of this report presents a review of available literature on what is considered good practice across the four main service systems with which victim/survivors are likely to come in contact: medical, criminal justice, mental health and community support systems. Published New Zealand practice guidelines that prescribe how services should respond to adult victim/survivors of sexual violence are highlighted.

 

4    Medical system

Immediately following a rape, a victim/survivor needs to have any medical needs met, but for those who wish to bring the offender to account there may also be a need for forensic evidence to be collected. The co-occurrence of these needs results in the convergence of two different systems.

• Medical system – assessing and treating health concerns.
• Criminal justice system – collecting forensic evidence.

 

These two systems both involve medical intervention and are typically addressed together in what is referred to as the ‘forensic medical examination’. There is good coverage in the sexual violence literature on what is considered good practice in conducting a forensic medical examination, who should conduct it, where it should be conducted and the conditions under which it should be conducted.

Longer-term medical needs of victim/survivors may include ongoing treatment for sexual and reproductive health problems, pain syndromes, eating disorders and gastro-intestinal problems.

New Zealand guidelines located – medical system
The following New Zealand guidelines on how health care professionals should respond to adult victim/survivors of sexual violence were identified.

Sexual violence–specific guidelines The Medical Management of Sexual Assault (DSAC, 2006) Generic guidelines with relevance to victim/survivors of sexual violence Family Violence Intervention Guidelines: child and partner abuse (Ministry of Health, 2002) Screening, Risk Assessment and Intervention for Family Violence Including Child Abuse and Neglect (Standards New Zealand, 2006) Pacific Cultural Competencies: literature review (Ministry of Health, 2008)

The generic guidelines provide the limited information available for appropriate ways of responding to victim/survivors from diverse groups including Māori and Pacific people.

Good practice programmes and services – medical system
International sources of literature identified the following as a good practice programme.

Forensic nursing – the use of specially trained forensic nurses providing 24-hour, first-response care to sexual assault patients in hospital or non-hospital settings.

Good practice principles of delivery – medical system

The review of the literature on good practice principles of delivery of medical care to victim/survivors is largely limited to international sources. The World Health Organization has published several general principles that should be considered as indicators of good practice in the provision of medical services to victim/survivors of sexual violence (WHO, 2003).

• The health and welfare of the patient (victim/survivor) is the foremost priority.
• Ideally, the health care and legal (forensic) services should be provided at the same time and place by the same person.
• Health workers should receive special training in providing services for victim/survivors of sexual violence and should also have a good understanding of local protocols, rules and laws applicable to the field of sexual violence.
• There should be a constructive and professional relationship with other individuals and groups treating and assisting the victim/survivor or investigating the crime.
• Health workers should be free of bias or prejudices and maintain high ethical standards in the provision of these services.
• Resource constraints may preclude the possibility of service provision in an ideal environment, but it is possible to improve the quality of existing facilities by ensuring they are accessible, secure, clean and private.

Hospital emergency rooms
No statistics are available on the proportion of victim/survivors treated in hospital emergency rooms in New Zealand, but at least some are referred there for forensic medical examinations or because of emergency medical needs. Good practice principles for emergency rooms based on United States research are:

• provide rape crisis advocates – let people know that they are available, so they do not have to ask
• provide comprehensive treatment, including pregnancy testing, screening for sexually transmitted infections including HIV/AIDS, and crisis counselling – if the hospital is unable to deliver, make referrals
• screen for sexual violence in the emergency room – both verbally and on intake forms
• have more specially trained clinicians
• provide better training for clinicians who handle sexual assaults – needed if the hospital is not a certified sexual assault forensic exam centre of excellence
• decrease waiting time in the emergency room.

Primary health care
In New Zealand, non-specialist primary health care for victim/survivors is typically delivered through community-based medical centres by the local general practitioner, Family Planning or Sexual Health Clinic. These medical centres can provide acute post-rape care and longer-term and/or follow-up care. These groups provide health care to the majority of victim/survivors who require medical care but do not wish to report their sexual assault to the police. Very limited literature was located about primary health care service providers working with victim/survivors of sexual violence. Information is limited to that included in the New Zealand knowledge-based practice guidelines listed above, of which the guidelines published by Doctors for Sexual Abuse Care (DSAC, 2006) are particularly useful.

The only other literature located on good practice recommendations for primary health care providers was based on Australian experiences. This included the following recommendations.

• Ensure that all discussions about sexual violence occur in a safe place where interruptions that could violate confidentiality cannot occur.
• Establish a relationship of trust by empowering the victim/survivors and supporting them to make their own decisions on treatment and recovery.
• Consider the traumatic potential of a range of procedures such as cervical smear and gynaecological examinations.
• Inform the victim/survivor that sexual assault is a crime and a violation of their human rights.
• Provide psychological support and appropriate referrals.
• Keep records in a form to provide victim/survivors’ information to specialist sexual assault agencies, legal or other services within the community at the victim/survivors’ request.

Forensic medical examination
There was good coverage in international and New Zealand literature on good practice principles for performing a forensic medical examination.

• Victim-centred approach

-    Informed choice and consent – victim/survivors should be provided with sufficient information to decide whether they want the examination, who will perform it and who will be present. It is important that they feel in control of the process
-    Ongoing communication – there should be ongoing communication between the medical practitioner and victim/survivors, explaining what each step involves and what its purpose is.

• Conducted when?

-    As soon as possible – to maximise the collection of forensic evidence and to avoid the victim/survivor experiencing unnecessary delays.

• Conducted by whom?

-    A specialist trained examiner – skilled not just in the collection of evidence, but also in understanding the impacts of sexual assault, and able to conduct the examination in a way that minimises the risk of secondary victimisation
-    A female examiner.

• Conducted how?

-    Respectfully – conducted in a professional but caring manner
-    Providing support – involvement of advocates/women’s non-government organisations throughout, including proactive follow-up.

• Conducted where?

-    An appropriate environment – an environment that is safe, private, respectful and caring, and that is well equipped and has sterile conditions to ensure no contamination of evidence.

5    Mental health

Rape is considered to be one of the most severe types of trauma. Research indicates that in the aftermath of sexual assault some women may experience relatively short-term effects, while others will have chronic, long-lasting symptoms.

In New Zealand, crisis intervention by health professionals may be delivered by ‘on-call’ specialist sexual violence service crisis workers and counsellors and/or specialist sexual abuse doctors at the time of the forensic medical exam. Long-term interventions are delivered by counsellors or psychologists who are affiliated with specialist sexual violence services or working independently in the community. Many will be Accident Compensation Corporation (ACC) registered counsellors who can provide government-funded counselling to victims of sexual abuse, including sexual violation. Victim/survivors also receive treatment through non-specialist, mainstream mental health services, particularly if they have pre-existing mental health concerns.

New Zealand guidelines located – mental health
New Zealand mental health practitioners have access to the recently published and comprehensive ACC guidelines on how criminal justice professionals should respond to adult victim/survivors of sexual violence.

Sexual violence–specific guidelines  Sexual Abuse and Mental Injury: practice guidelines for Aotearoa New Zealand (ACC, 2008).

Good practice programmes and services – mental health
The literature on the types of mental health programmes that are most effective for victim/survivors of sexual violence is sparse. The review highlighted a gap in knowledge about what types of counselling therapies or modalities are used in New Zealand and by whom.

Limited international sources identified the following.

Trauma-focused cognitive behavioural therapy approaches (e.g. prolonged exposure treatment, stress inoculation training and cognitive processing therapy) – for reducing short-term post-rape fear and anxiety symptoms.

This lack of research means interventions currently available may or may not be the most appropriate ones to respond to a victim/survivor’s needs.

Good practice principles of delivery – mental health
Comprehensive guidelines for New Zealand mental health practitioners are provided in the ACC guidelines referred to above. The practice guidelines are organised into two parts. Part one: Principles and recommendations comprise 12 principles and recommendations designed for work with sexual violence victim/survivors within bicultural New Zealand. The recommendations are based on the best practice identified by the research. In Part two: Practice guide, the research findings are elaborated and greater detail is provided to support the 12 principles and recommendations.

Mental health crisis intervention
Counselling is beneficial through all stages of recovery, but crisis intervention during the initial stages immediately after rape is crucial to the health and well-being of victim/survivors. A combination of New Zealand and international sources identified the following good practice guidelines for mental health crisis intervention.

• Where possible, gather background information before arrival at the victim/survivor’s location.
• Restore psychological safety by reassuring the victim/survivor that they are now safe.
• Assess the needs of the victim/survivor (information, medical care, counselling, support, legal assistance).
• Seek only the history required, avoid re-traumatising the victim/survivor by requiring them to verbalise and ‘re-live’ the trauma unnecessarily.
• Correct misattributions.
• Provide information to the victim/survivor, including medical status, common reactions to assault and how to obtain further help.
• Distress can result in a limited capacity for the victim/survivor to make decisions. It may be necessary to transfer normal responsibilities and obligations to another individual. However, avoid inappropriately taking over decisions for the victim/survivor that risk replicating the dynamics of the assault.
• Restore and support effective coping.
• Show concern and empathy and encourage hope.
• Arrange for follow-up intervention as necessary.

Consumer perspectives on mental health care
New Zealand research with victim/survivors of sexual violence resulted in the following recommendations for support agencies and counsellors providing both crisis and long-term mental health care and support.

• All districts should have a well-publicised 24-hour crisis service available for rape/sexual assault victims, with personal service guaranteed (as opposed to reliance on answer-phones at night).
• Support agencies should ensure that all services are provided and conducted in an empowering and validating manner in order to avoid secondary victimisation.
• A limited number of appropriate counsellors should work as part of a multidisciplinary team with police and doctors to provide integrated service delivery.
• The availability of specialised rape/sexual assault counsellors within any generic support agency should be facilitated. These need to be carefully selected people, trained with a thorough knowledge and understanding of the needs and effects of rape, as well as an awareness of police and court processes.
• Counsellors should be flexible in adapting their style to the victim/survivor’s needs, to ensure that the survivor retains a sense of their own power and autonomy within the therapeutic relationship.

 

6    Criminal justice system

The criminal justice system is the network of courts and legal processes that deals with the enforcement of criminal laws, including the laws that prohibit sexual violation. Key components and players are the complainant (the victim/survivor of the sexual violence), the accused (the perpetrator), the police, lawyers, judges and the court system itself. The collection of forensic evidence is also part of this system but is addressed in this review as part of the medical system.
Key concerns for the criminal justice sector in New Zealand and internationally are the low rates of reporting, prosecution and conviction of sexual violence offences and the potential secondary victimisation of victim/survivors who engage with this system.

New Zealand guidelines located – criminal justice system
The following New Zealand guidelines on how criminal justice professionals should respond to adult victim/survivors of sexual violence were identified.

Sexual violence–specific guidelines Adult Sexual Assault Investigation Policy (New Zealand Police, 1998) Generic guidelines with relevance to victim/survivors of sexual violence Prosecution Guidelines (Crown Law Office, 1992) Restorative Justice in New Zealand: best practice (Ministry of Justice, 2004)

Good practice programmes/services – criminal justice system
International sources of literature identified the following as good practice.

• A dual focus on supporting the victim/survivors of violence and bringing the perpetrator to justice.
• Specialised ‘violence against women’ units staffed by specially trained personnel, who enable women to feel supported and work to prevent secondary victimisation.
• Safe and confidential environments for women to report violence.
• Consistent procedures in investigations of violence, and in protecting victim/survivors from secondary victimisation.
• Police co-ordination with other services in a co-operative, multi-agency response.
• Compulsory, ongoing and accredited training on issues surrounding violence against women.

 

New Zealand and overseas researchers have identified several factors related to the prosecution phase of sexual offending that were valued by victim/survivors. These factors are:

• victim/survivors are informed of case progress and have sufficient time to re-read statements
• waiting times and delays are minimised
• prosecutors meet and establish rapport with the complainant before the trial
• prosecutors are familiar with the facts of the case and provide courtroom advocacy that does ‘justice’ to the complainant’s account.

 

These practices mirror many of the principles of good practice that have been developed for overseas lawyers working with clients who have experienced sexual violence.

7    Community support systems

A variety of support services are available in the community for victim/survivors of sexual violence. These include services that specialise in supporting victim/survivors of sexual violence, and non-specialist services that victim/survivors can also access for support. However, little is known about how well these support services meet the needs of victim/survivors.

New Zealand guidelines – support systems
No guidelines were located that specifically outlined good practice for support agencies working with victim/survivors of sexual violence.

Good practice programmes and services – support systems
Literature on the types of community support services that are most effective for victim/survivors of sexual violence was inconsistent with some areas covered better than others (e.g. there was extensive literature on sexual assault referral centres (SARCs) and very little on other specialist services). SARCs have attracted much attention and built up a strong body of evidence. Other types of intervention have received less attention and their effectiveness is unknown. Limited international sources identified the following.

Good practice principles of delivery – support systems
Rape Crisis Network Europe has compiled key dimensions of good practice for community agencies supporting victim/survivors of sexual violence. The key dimensions are:

• ideological foundations – recognition that the organisational ethos guides service delivery
• a client-centred approach – action that focuses on the needs of the woman in crisis
• accessible services – offering a broad range of supports for victim/survivors
• promoting awareness and values – challenging myths about sexual violence
• improving societal responses to sexual violence – through education, awareness raising, advocacy and lobbying.

 

8    Summary and overview

In summary, in regards to the medical system there are comprehensive New Zealand guidelines related to the medical care of victim/survivors. There is good coverage in the literature on good practice for conducting a forensic medical examination. Forensic nursing is an initiative that has been implemented overseas and reviewed favourably. Its applicability to New Zealand would need to be assessed carefully, particularly the status of nurses in court as ‘ordinary witnesses’. There is a paucity of literature in relation to non-specialist primary health care.

The criminal justice system in New Zealand has undergone significant reform and the legal framework continues to be reviewed. There is a police policy for the investigation of adult sexual violence offences, which includes many of the good practice principles of delivery identified in this review. The extent to which the policy has been implemented and is adhered to is less clear. Specialisation is recognised as good practice particularly within the criminal justice systems, and the introduction of specialist adult sexual assault teams within police is clearly positive. However, specialisation is still limited within the police and has not extended to the prosecution section of the criminal justice system.

There are comprehensive practice guidelines for the mental health care of victim/survivors in New Zealand that are easily accessible to all practitioners. There is very limited research internationally or in New Zealand about which types of mental health interventions are the most effective for victim/survivors.
New Zealand has a very pro-active network of specialist sexual violence support services with good links with other agencies, and a range of other non-specialist sexual violence victim support agencies. No practice guidelines were located in relation to support services in New Zealand, although it is not known whether individual agencies have their own ‘in-house’ documents.

This review has found that effective interventions with adult victim/survivors of sexual assault have received little research attention overseas, and in New Zealand this is limited to the efforts of just a few researchers. However, a plus of this New Zealand research is the priority given to the voice of the victim/survivor. Areas in most urgent need of research attention include:

• locating or developing guidelines for community support agencies working with victim/survivors of sexual violence
• developing guidelines for prosecutors working with victim/survivors of sexual violence
• developing guidelines and services to respond effectively and appropriately to Māori victim/survivors, particularly in relation to the criminal justice system
• developing guidelines and services to respond effectively and appropriately with other diverse groups of victim/survivors
• ensuring better monitoring and evaluation of the extent to which existing policies and guidelines have been implemented and adhered to
• obtaining ongoing feedback from victim/survivors on how effectively and appropriately services are responding to their needs.

 

The good practice highlighted in this review has relied heavily on overseas research. The unique characteristics of New Zealand mean it will be essential to carefully assess this practice for its applicability to New Zealand, particularly before any decisions regarding implementation are made. Consideration of diverse population groups and their needs is also essential, and collaboration with local groups and communities will ensure service delivery fits the local context.

Ensuring adult victim/survivors of sexual violence have access to the optimal services to assist in their recovery and well-being is crucial. This review has identified a variety of good practice programmes and principles of delivery for adult victim/survivors of sexual violence. Providing we critically assess who has identified these practices, on what outcomes and with what criteria, and ensure that the needs of victim/survivors remain paramount, then we are making a promising start.

Part one: Overview of adult sexual violence and good practice

1    Introduction

This report responds to a request by the Ministry of Women’s Affairs to the Crime and Justice Research Centre to conduct a critical literature review, outlining international and New Zealand perspectives on best practice for services that respond to adult survivors of sexual violence.

1.1    Project overview

As part of its work to improve women’s well-being, the Ministry of Women’s Affairs is leading a research project on effective interventions for adult victim/survivors of sexual violence. The project has four interrelated work streams, comprising:

• a study of pathways from crisis to recovery, focusing on individuals who have experienced sexual violence as adults and their experiences with a variety of support sources (Kingi and Jordan, 2009)
• an environmental scan of agencies and key informants that respond to victim/survivors, focusing on systemic, organisational and other contextual factors that influence systems’ and agencies’ responses (Mossman et al., 2009b)
• a retrospective analysis of attrition of sexual violation incidents recorded by the New Zealand Police (Triggs et al., 2009)
• this literature review of good practice in service delivery for services that respond to adult victim/survivors of sexual violence (the literature review).

 

The findings from these work streams will contribute to the Government’s considerations for policy and practice responses for victim/survivors of adult sexual violence. The Ministry of Women’s Affairs is leading the research in partnership with the Ministry of Justice and New Zealand Police.

In May 2008, the Ministry of Women’s Affairs contracted researchers from the Crime and Justice Research Centre, Victoria University of Wellington, to undertake all four work streams.

1.1.1    Objectives
With regard to medical, criminal justice, mental health and support systems at different post-assault periods and in relation to diverse social and cultural groups, the specific objectives of this work stream are to:

• identify and critique good practice models within and across systems, internationally and in New Zealand
• describe factors that promote good practice within and across systems
• identify New Zealand guidelines for dealing with adult victim/survivors of sexual violence.

The findings from the literature review will contribute to the Government’s considerations for policy and practice responses for victim/survivors of adult sexual violence in New Zealand.

1.2    Approach to reviewing the literature

1.2.1    Sourcing the literature
The literature reviewed was supplied by the Ministry of Women’s Affairs following a comprehensive search by ministry staff to identify a range of relevant literature. The scope of the literature review, combined with the tight time-frame for completing the report, did not allow for an exhaustive analysis of all relevant literature produced over recent decades. Details of the search criteria and sources of references are in the Appendix.

The parameters for the review were as follows.

• The review focused on intervention services for adult victim/survivors of sexual violence.,
• The review was primarily limited to international literature published in the past five to seven years to reflect substantial changes in responses to sexual violence in recent years.
• All relevant New Zealand literature was included. Very few victim/survivor sexual violence services have been evaluated. Therefore, New Zealand literature is also included that relates to victims in general, providing it had relevance for victim/survivors of sexual violence.

 

It is important to note that the focus of this review is on the services and needs of victim/survivors of sexual violence. The services and needs of sexual violence offenders were not reviewed.

1.2.2    Scope of the literature review
The review primarily focuses on literature relating to sexual violence, with minimal inclusion of generic literature that could have some relevance to sexual violence, such as material on Māori mental health and education, or on different types of trauma-based therapy. Māori models tend not to be tested or evaluated within a Western framework.

1.2.3    What can and cannot be inferred from a review of literature
By definition, a literature review can cover only written material. There is a question about who determines the types of practices that are evaluated and/or written about in the professional literature. There may be other responses (e.g. therapeutic approaches) that are endorsed by practitioners and survivors, but have not been described or evaluated by knowledge-makers.

The information in the review, including the summary tables, should be read as a list of practices on which literature is available and that have been evaluated or otherwise deemed as good practice according to various criteria, rather than a definitive or complete list of good practices.

The reviewers were not asked to critically assess gaps in New Zealand services, to evaluate New Zealand services against good practice standards, or to determine what types of practices used in other countries might be suitable for implementation or adaptation in the New Zealand context. This report should not be seen as conclusive evidence of good practice or as endorsing any particular practices.

1.3    Structure of report

Part one of the report provides important background information, including an:

• overview of sexual violence (chapter 2)
• overview and critique of good practice (chapter 3).

 

Part two reviews the literature on good practice in relation to the four key systems that respond to victim/survivors of sexual violence. The systems are the:

• medical system (chapter 4)
• mental health system (chapter 5)
• criminal justice system (chapter 6)
• support services system (chapter 7)

 

Part three brings together the New Zealand guidelines identified for dealing with victim/survivors of sexual violence (chapter 8). It also summarises what are considered good practices in responding to adult survivors of sexual violence, based on the literature that has been reviewed. There is consideration of the New Zealand context with a note that good practice identified overseas is only good practice in New Zealand if it works within this context.2    Overview of sexual violence
This section provides an overview of sexual violence. It outlines terms and definitions relevant to this report and presents a general overview of the characteristics and prevalence of sexual violence.

 

2    Overview of sexual violence  

 

2.1    Terms and definitions

2.1.1    Sexual violence
‘Sexual violence’ is a broad term that covers a continuum of sexual offending behaviours. The Ministry of Women’s Affairs has a particular interest in what is considered good practice in responding to victim/survivors of ‘sexual violation’ (i.e. rape or unlawful sexual connection as outlined in section 128 of the Crimes Act 1961 – see Box 1).

Box 1: New Zealand legal definition of sexual violation

2.1.2    Victim/survivor terminology
Considerable discussion and debate have surrounded the concepts of ‘victimisation’ and ‘survival’ (Gregory and Lees, 1999; Jordan, 2005b, 2008; Kelly, 1988; Lamb, 1999), with these terms often being viewed dichotomously. From the 1970s onwards, some feminists and rape crisis agencies strongly rejected the use of the word ‘victim’. This was viewed as denoting passivity and accepting the objectification of women who had been raped. Instead the term ‘survivor’ was embraced since it more appropriately recognised and affirmed women’s abilities to manage, survive and integrate their experience of sexual assault through the recovery process. However, for women who have lived through these experiences, the position is not always so clear.

The issue of victim/survivor terminology was raised in a recent New Zealand study of women who had been raped by a serial rapist (Jordan, 2005b; 2008). Based on comments from those interviewed, Jordan noted that using (2005b: 552), ‘the terms “victim” and “survivor” in an oppositional manner may appeal to some strains of feminist political thinking yet do not resonate fully with women’s lived experience’.

What the women’s accounts demonstrated is that (Jordan, 2005b: 552), ‘even at the very moment that they were being victimized, they were in survival mode. They were simultaneously victims and survivors’.

Throughout this review the term ‘victim/survivor’ has been used to reflect the fact that experiencing sexual violence is an act of victimisation and has to be acknowledged as such. However, being victimised does not mean those raped should have to assume the ‘victim’ label with all its negative connotations; conversely, survival is neither assured nor necessarily immediately apparent: some women may always deem it a ‘work in progress’.

2.2    Nature of sexual violence

Sexual violence can occur in a range of contexts, but universally it is recognised as being predominantly a crime in which the victim is female and the perpetrator is male (Gavey, 2005; Kelly, 2005; Lievore, 2004). The common perception of rape is that the perpetrators are strangers and/or recent acquaintances, and it is this notion of rape that is most commonly thought of as ‘real rape’. It is this form of sexual violence that much policy and practice tends to be built around (Kelly, 2005). However, rather than strangers, the majority of rapes are committed by men who are known to victim/survivors (Heenan and Murray, 2006; Lievore, 2003; Jewkes, Sen and Garcia-Moreno, 2002) as date rapes, acquaintance rapes or marital rapes (Daane, 2006).

There is also a lack of recognition that much sexual violence involves repeated assaults by the same (and sometimes different) perpetrators (Lievore, 2005; Heenan and Murray, 2006), with an overlap between rape and domestic violence (Howard et al., 2003) and that the impacts of rape and domestic violence are cumulative (Fanslow and Robinson, 2004; Kelly, 2005).

There are certain personal, social and economic characteristics that are seen to increase the risk of victimisation. These include youthfulness; homelessness; poverty; social isolation; being a sole parent; refugee status; victim/survivors with physical, mental and intellectual disabilities; incarceration; marriage/cohabitation; and being a sex worker (Harcourt et al., 2001; Kelly, 2005; Jewkes, Sen and Garcia-Moreno, 2002; Mayhew and Reilly, 2007; Stermac and Paradis, 2001;and Nosek et al., 2004).

The lack of research into issues surrounding male rape (Chapleau, Oswald and Russell, 2008; King and Woollett, 1997; Jewkes, Sen and Garcia-Moreno, 2002) means that it is difficult to present any generalised commentary in respect of risk factors for men. However, most of the above risk factors involve ‘victim vulnerability’ in one form or another, and in that regard are likely to be applicable to both male and female victim/survivors.

These characteristics are reviewed in more detail below.

2.2.1    Incidence and prevalence of sexual violence
Rates of sexual victimisation among the population are an important indicator of the level of service provision that is required. The main method for estimating this is through national victimisation surveys where participants are asked to disclose personal experiences of all types of crime, including sexual violence, regardless of whether it has been reported to official sources.

When reviewing incidence and/or prevalence of sexual violence some key issues about measurement need consideration. Two measurement issues are outlined in Box 2.

The 2006 New Zealand Crime and Safety Survey (NZCASS) found a 12-month prevalence rate of 3 percent for individuals aged 15 years or older who had experienced one or more occurrences of sexual victimisation in 2005. This equated to 6.4 incidents per 100 adults (9 per 100 women, 3 per 100 men) that year. While the coverage of sexual victimisation was broader than sexual violation as defined for this review, it was reported that about a quarter of those incidents were related to ‘forced’ sexual intercourse or attempted forced sexual intercourse (Mayhew and Reilly, 2007). These rates were higher than had been found in the previous New Zealand National Survey of Crime Victims in 2001 where 12-month incidence rates for women were 4.5 per 100 and for men were 0.2 per 100 (Morris et al., 2003).

Box 2: Incidence and prevalence of sexual violence – measurement issues

Gender
As noted in the introduction to this section, the vast majority of offenders are male regardless of the gender of the victim, and the vast majority of victim/survivors are female.

The 2006 NZCASS found that women were twice as likely to be sexually victimised as men; 12-month prevalence rates were 4 percent for women and 2 percent for men (Mayhew and Reilly, 2007). The 2001 New Zealand National Survey of Crime Victims found the lifetime prevalence of sexual assault was 19 percent for women and 5 percent for men.

Age
Younger women were found to be at higher risk of sexual violence in the 2006 NZCASS. The researchers found that 12 percent of women in the age group 15 24 years reported at least one sexual incident in 2005 compared with the average of 4 percent for women overall (Mayhew and Reilly, 2007).

Ethnicity
In New Zealand, Māori women have been identified as being at higher risk of sexual violence. The 2006 NZCASS found Māori women had a 12-month rate of sexual victimisation – double the average of all New Zealand women. Twelve-month incident rates were also higher for Māori women in the 2001 New Zealand National Survey of Crime Victims (7 percent for Māori women compared with 5 percent for New Zealand European women and 3 percent for Pacific women).

This higher rate of sexual victimisation for Māori women was less evident for lifetime rates of sexual victimisation according to the 2001 New Zealand National Survey of Crime Victims. When lifetime rates are considered, Pacific women had a lower rate than both New Zealand European and Māori women (6 percent compared with 20 percent and 23 percent respectively), although the authors cautioned that this low rate for Pacific women could be an artefact of the research methods used (Morris et al., 2003).

Higher rates for sexual victimisation for indigenous peoples are not unique to New Zealand. In the United States, Tjaden and Thoennes (2000) found higher rates for indigenous American Indian and Alaskan Native women. Indigenous communities in Australia have also found rates 16–25 times higher for their women (Memmot et al., 2001). Tjaden and Thoennes (2000) also found a similarly low rate for ethnic minority groups (African American and Asian/Pacific Island).

In understanding these high rates of victimisation of Māori, the Ministry of Health (2002), in relation to family violence, points to the complexity of the issue. It notes that violence occurs within the historical context that reshaped the foundations of Māori society through the process of colonisation. It also occurs within a contemporary context of socio-economic disadvantage, which can be linked to a health status that is poorer than that of other ethnic groups within the New Zealand population (Ministry of Health, 2002: 13).

Relationship to offender
There is growing evidence that sexual violation is more often than not committed by someone known to the victim/survivor (Kelly, 2005). This may include current and ex-intimate partners, close family members, neighbours, acquaintances, professionals (e.g. medical and criminal justice officials) and others in positions of authority or power (Kelly, 2005; Special Rapporteur, 1996; Jewkes, Sen and Garcia-Moreno, 2002).

The 2001 New Zealand National Survey of Crime Victims reported that
three-quarters of those who had reported being sexually victimised had known the offender (Morris et al., 2003). The 2006 NZCASS found that over a third of sexual offences were committed by current partners.

2.2.2    Reporting to the police and conviction rates
Research evidence suggests that very few victim/survivors of sexual violence report what happened to the police. Moreover, among those who do report to the police, there can be substantial attrition (Kelly, 2002; Kong et al., 2003; Lievore, 2005; Mayhew and Reilly, 2007; Morris et al., 2003).

Reasons for not reporting identified in the literature (Epstein and Langenbahn, 1994; Gilmore and Pittman, 1993; Gregory and Lees, 1999; Kelly, 2002; Kelly, Lovett and Regan, 2005) include:

• apprehension over the police response, fear of not being believed, etc.
• guilt, shame, embarrassment, self-blame
• fear of negative reaction from family, friends or partner
• apprehension concerning going to court, cross-examination etc.
• being actively dissuaded from doing so by family, friends etc.
• denying to themselves that what they experienced was rape.

 

Kelly, Lovett and Regan (2005: 7) have defined attrition as, ‘the process by which rape cases drop out of the legal process, thus do not result in a criminal conviction’. Research that these authors conducted for the British Home Office revealed the four critical points where attrition occurs are:

• the decision to report
• the police investigation phase
• the prosecution filtering system
• acquittal at trial.

 

The authors found that the highest attrition of rape cases occurred at the earliest stages, with between half and two-thirds dropping out at the investigative stage (Kelly, Lovett and Regan, 2005).

Rates of reporting
The 2006 NZCASS found that only 9 percent of the sexual offences that respondents disclosed in the survey were reported to the police (Mayhew and Reilly, 2007). The best estimate of what this equates to in terms of population numbers and the scale of response required is provided by the New Zealand recorded crime statistics. These statistics suggest that in 2007/08 there were 2,364 recorded sexual attacks (including sexual violation), which translates to 5.6 cases per 10,000 of population (New Zealand Police, 2008). It should be noted that police data include crimes against victims of all ages, whereas the NZCASS was limited to those 15 years or older (Mayhew and Reilly, 2007).

Rates of convictions
A recent Ministry of Justice discussion document reported that, in New Zealand, the rate of convictions for offences that go to trial is lower for sexual offences compared with other crimes. Between 2004 and 2006 the rate of conviction for all sexual offences that went to trial was 46 percent compared with 55 percent of all violent crimes, and 70 percent for total crime (Ministry of Justice, 2008: 2).

2.3    Legal framework for sexual violation offences

It is useful to consider the New Zealand legal framework under which the sexual violation offences committed against victim/survivors are processed. There have been several significant reforms of the New Zealand legal system over the past two decades, resulting from concern over the way in which crimes of sexual violence are dealt with in the criminal justice system.

From the 1970s onwards, legal definitions of rape have been criticised for their failure to reflect women’s experiences of sexual assault and violation both in New Zealand and internationally (Gavey, 2005; Kelly, 1988; Walklate, 1995; Young, 1998). Criticism of narrow legal definitions of rape led to many jurisdictions introducing legal reforms in this area (Kelly, 2005; Lord and Rassel, 2000; Regan and Kelly, 2003). In New Zealand pressure mounted from feminist groups to change the law, with such moves being supported by findings from the first major study in New Zealand of rape laws and procedures (Young, 1983a, 1983b).

The most significant changes occurred in 1985 when significant amendments were made to the Crimes Act 1961, Evidence Act 1908 and Summary Proceedings Act 1957, including the following.

• The broad category ‘sexual violation’ was introduced, incorporating rape as traditionally defined and adding offences described as ‘unlawful sexual connection’. In practice this meant sexual violation offences were redefined to include forced anal and oral sex, using any object able to be used for that purpose.
• Sexual violation was made gender neutral, recognising both the possibility of male victim/survivors and female offenders.
• Spousal immunity was abolished – no longer could men use the fact that the victim/survivor was their wife as an automatic defence against rape charges. This allowed, in principle at least, the possibility of men being convicted on charges of marital rape.
• A requirement was introduced specifying that the grounds for a belief in consent needed to be ‘reasonable’.
• Changes were made to court and trial procedures in order to make giving evidence less traumatic for victim/survivors and limiting the publication of incident and personal details.
• The ‘corroboration warning’ was removed, which had required the judge to warn of the dangers of convicting based in the victim/survivor’s uncorroborated evidence.

 

As subsequent commentators have noted, these legal changes have not always yielded in practice what they offered in principle (McDonald, 1994). For example, in relation to consent, in practice the victim/survivor has to demonstrate that their lack of consent was apparent, preferably by physical resistance. Mounting criticism has been voiced of the way this effectively places the burden of proof on the victim/survivor (Adler, 1987; Kennedy, 1992; Lees, 1997; Scutt, 1997; Smart, 1989; Temkin and Krahé, 2008).

Similarly, earlier amendments made through the Evidence Amendment Act 1977 saw a partial rape shield created with the inclusion of a particular rule that evidence may not be given, nor the complainant cross-examined, about the complainant’s prior sexual history with any person other than the accused without the prior leave of the court (Young, 1983a, 1983b). The scope for such judicial discretion, it has been argued, leaves room for personal bias and the influence of rape myths to affect such decisions (McDonald, 1994).

More recently the New Zealand Evidence Act 2006 sought to extend the rape shield to provide a complete bar on any evidence being allowed regarding the complainant’s ‘reputation’ in sexual matters (McDonald, 2009). While this has been welcomed in principle, concern has been voiced that this also may be compromised in practice (McDonald, 2009).

Legislation has also been introduced specifically aimed at mandating the provision of services to victims of crime. In New Zealand this is evident in the Victims of Offences Act 1987 and the Victims’ Rights Act 2002 and, more recently, the Victims Charter 2008.

However, despite significant legislative and procedural changes, concern has been increasingly expressed that rape victim/survivors’ experiences of the criminal justice system have not substantively improved and that a ‘justice gap’ remains (Gregory and Lees, 1999; Jordan, 2001, 2004; Kelly, Lovett and Regan, 2005; Lea, Lanvers and Shaw, 2003; Temkin, 1997; Temkin and Krahé, 2008). In response to some of these concerns, the Ministry of Justice has recently issued a discussion paper to solicit the public’s views about proposed legislative amendments to the current law on sexual violence (Ministry of Justice, 2008).

2.4    Victim/survivor needs

High-quality service delivery is crucial in meeting the crisis and longer-term needs of victim/survivors to minimise the harm experienced and to promote future safety and well-being. Understanding the specific needs of victim/survivors is an important first step in ensuring the various services are set up to meet these needs.

2.4.1    Intervention stages and victim/survivors’ needs
Rape and sexual violence are crimes where the adverse physical, mental, emotional and spiritual sequelae for the victim/survivor may be endured for many years after the initial assault: some consequences may become apparent immediately after the attack while others may surface after a delay. For this reason, rape victim/survivors may need different types of interventions at different times.

Key times when intervention may be required include the following.

• Acute or crisis response: To ensure physical safety and provide immediate medical care and emotional support. Also, after the offence is reported, to provide support during the obtaining of forensic evidence, and police interviewing (Burgess and Hazelwood, 2001; Olle, 2005).
• Short-term needs: To provide a co-ordinated response in relation to advocacy support, medical care, mental health needs and police involvement (where relevant) (Olle, 2005). This may include support during court preparation and managing trial processes and outcomes.
• Long-term needs: Counselling and support to manage any post-traumatic stress disorder (PTSD) effects. Some victim/survivors may not be ready to access counselling support until years after the sexual assault, or will become more aware of the effects over time.
• Delayed effects: These could result from the reporting or notification of historic sexual assaults (Olle, 2005), as well as from changing responses to, and awareness of, situations inducing fear, vulnerability etc. over time.

2.4.2    Needs of diverse population groups
Most research on effective service delivery for those who have experienced sexual violence treats the findings as if victim/survivors were a homogenous group. It is likely many of these findings will relate to women from diverse cultures and to men, boys and other populations of victim/survivors. However, it is important to review the distinctive and separate needs of these diverse groups to understand better when this might not be the case, and to consider when specialist services would be more appropriate.

Very little research was located on the specific needs and/or types of services for victim/survivors of sexual violence from diverse population groups. Where appropriate, material presented has been supplemented with that describing the more general needs of particular groups. In highlighting culturally appropriate ways of working, it is useful to consider the extent to which such approaches may also be good practice for all victim/survivors.

Māori victim/survivors
This report gives special attention to the practices that are appropriate and effective for Māori victim/survivors of sexual violence. This attention is warranted for two reasons.

As noted in the section 2.2.1, Māori women are over-represented as victims of sexual violence – they have been found to experience sexual violence at up to twice the rate of other women in New Zealand. Hence, it is vitally important to better understand what comprises effective services for Māori victim/survivors.

On signing of the Treaty of Waitangi in 1840, a special relationship was established between Māori as tangata whenua (people of the land) and the Crown. A key aspect of the Treaty is that Māori are afforded the right to access services that have been constructed and implemented with the particular interests and needs of whānau (extended family), hapū (clan or sub-tribe) and iwi (tribe) in mind, and that measures taken strengthen the ability of whānau, hapū and iwi to control their own development and achieve their own aspirations (Ministry of Social Development, 2002). Hence, in reviewing good practice for services for Māori victim/survivors of sexual violence these rights must be taken into consideration.

With these two factors in mind, it is clear that a key component of good practice for any of the systems of service delivery that victim/survivors come in contact with (medical, criminal justice, mental health and/or community support systems) will be their cultural relevance and effectiveness for Māori victim/survivors.

In considering whether a service or system is culturally relevant, it is important to understand the differences in Māori world views of justice, health and well-being from that of the dominant European culture in New Zealand society. These differences and their implications for good practice in relation to medical, criminal justice, mental health and community support systems are reviewed in Part two of this report.

A key finding in itself is the lack of written material that specifically outlines good practice in working with Māori victim/survivors of sexual violence. The exceptions to this are the sexual abuse and mental injury practice guidelines (ACC, 2008) and the guidelines for sexual abuse doctors (DSAC, 2006). Both these guidelines have sections dedicated to good practice in relation to Māori. There are also some guidelines for Māori victims of family violence of whom a proportion will have experienced sexual violence (e.g. Ministry of Health, 2002; Standards New Zealand, 2006). Other than these, material presented is limited to more generic models of Māori health and well-being and Māori perspectives on justice (Durie, 2001, 2003; Jackson, 1987, 1988, 1989; Ministry of Justice, 2001).

Applicability of Western feminist world views on violence against women to Māori culture
A Western feminist world view often begins from the premise of individual women’s equality, equity and human rights. Western feminists who offer an analysis of violence as men’s abuse of power and control over women offer an important but incomplete explanation of violence against Māori women, as they tend to obscure additional layers of cultural oppression and racism (Second Māori Taskforce on Whānau Violence, 2002). The collectivist nature of Māori society means that Māori values and practices focus on advancing the well-being and strengths of all group members, with a focus on communal success and responsibility (Paua Enterprises Ltd, 2006).

In the context of te ao Māori (a Māori world view), men and women are seen as essential parts in a collective whole: different, but complementary. The concepts of whakapapa (lineage or descent) and collective dynamic balance are also central to te ao Māori. The basic social unit of analysis is not at an individual level, but within the whakapapa groupings of whānau, hapū and iwi.

Colonisation, and its far-reaching impact on Māori, provides an important context for understanding and responding to violence against Māori women today. Western notions of individualism and gender relations, including views on male dominance within the home, had a drastic impact on women’s role and status and on Māori social structures. This includes the breakdown of whānau, which was previously women’s primary source of support, particularly in cases of domestic abuse, where violence was seen as an attack against the whakapapa (Balzer et al., 1997; Mikaere, 2006; Paua Enterprises Ltd, 2006).

When it comes to responding to violence against women, Māori women cannot be taken as separate from their whānau, hapū and iwi. Traditional Māori law was based on maintaining balance between whānau, hapū and iwi, including balance between women and men (Mikaere, 2006). Māori women have been active in responding to sexual violence since the 1950s. They have worked alongside as well as separate from men in responding to the needs of Māori as a whole. Some Māori researchers and activists acknowledge that some women receive negative messages from their whānau, and that it is not always safe for them to go to their families for help (Balzer et al., 1997). However, for many Māori the preferred response is to create non-violent communities by using cultural processes to improve collective well-being and promote the collective’s obligations and responsibilities to the individual.

Whakapapa is a collective process. This means that the individual must always be viewed and treated in context of the collective … Maōri are not isolated individuals. The connectedness and relationships from whakapapa make it imperative that the individual is treated in context of the collective. Rehabilitation and healing cannot happen without the rehabilitation of everyone. The whole whānau needs to heal from the impacts of violence and abuse. (Second Māori Taskforce on Whānau Violence, 2002: 9)

Diverse realities
Understanding a traditional Māori view is clearly important. However, it must also be recognised that there is much diversity within Māori iwi and communities. Professor Mason Durie (Ngāti Kauwhata, Ngāti Raukawa, Rangitane) is an eminent researcher and advocate in the areas of Māori health and mental health. He has written a key paper, Ngā Matatini Māori: Diverse Māori Realities, that argues policies and services for Māori should also consider the diverse social and cultural realities within which Māori live (Durie, 1995). Māori in New Zealand society today are not a homogenous group, they are as diverse and complex as other sections of the population, even though they may have certain characteristics and features in common (Durie, 1995). Māori sit on a continuum that ranges from those with more traditional lifestyle, beliefs and values to those with lifestyles, beliefs and values dominated by more contemporary Western influences. Hence, for all Māori to have access to appropriate services, a similar continuum of services must be available from which to choose.

Consideration of diverse realities is addressed in the recent Accident Compensation Corporation (ACC) guidelines, which state that when working with Māori clients it is important to consider each client as unique and not to assume that Māori models of therapy are appropriate or desirable for all Māori (ACC, 2008: 88).

Pacific victim/survivors
Pacific peoples in New Zealand consist of diverse ethnic groups with distinct similarities and differences (Koloto, 2003). The seven main Pacific groups are Samoan, Cook Islands, Tongan, Niuean, Fijian, Tokelauan and Tuvaluan (Statistics New Zealand, 2007a, cited in Tiatia, 2008). Although there are some similarities between these groups each has its own cultural beliefs, values, traditions, language, social structure and history. Moreover, within each group there are sub-groups such as those born or raised in New Zealand, those born and raised overseas, and those who identify with multiple ethnicities (Ministry of Health, 2008). Clearly this last sub-group also applies to Māori.

Researchers have discussed the issue of the effects of migration on Pacific peoples. Asiasiga and Gray (1998) comment that perhaps one of the most significant is the break in kinship ties and the loss of collective support. One result of this that the church has become a substitute for village communities (Epati, 1995) and often plays a central role in the lives of Pacific people.

Lifetime rates of sexual victimisation of Pacific people have been found to be lower than those for both New Zealand European and Māori (Morris et al, 2003), although, as noted in section 2.2.1 this low rate was thought to be an artefact of the research methods used.

There has been a dearth of research about sexual violence in respect of Pacific people living in New Zealand. Research on New Zealand Pacific victims of violence, family violence (of which sexual offences were a subset) and property offences by Koloto (2003) found Pacific peoples underused formal support services, preferring informal support systems, primarily family and friends (59 percent), neighbours (3 percent) and pastor/church members (3 percent).

As with Māori, caution has been raised against assuming that any one therapeutic model or approach will meet the needs of all Pacific clients (ACC, 2008: 89). ACC notes that there are differences between what is appropriate or defines safe practice within customary culture for the diverse groups involved (ACC, 2008). Also, as with Māori, Pacific cultures are based on the collective (extended family/aiga) rather than the individual and this must be acknowledged when meeting the needs of victim/survivors.

Young adult victim/survivors
Young adults form a significant group of known sexual assault victim/survivors. What little research has been done on this group, in New Zealand (Jackson, Cram, and Seymour, 2000) and in the United States (Black et al., 2008) suggests there is a low level of help-seeking behaviour following a sexual assault. Fears around the maintenance of confidentiality are a major barrier to accessing services. This has serious implications, given that adolescent girls and young women are at high risk of being victim/survivors of sexual assault (Tjaden and Thoennes, 1998). As well as the likelihood of experiencing emotional and mental health problems, untreated sexually transmitted infections and unwanted pregnancies, sexual assault is likely to have a significant adverse effect on this group of victim/survivors.

Male victim/survivors
Literature that specifically deals with male victim/survivors of sexual violence has begun to emerge over the past 20 years, although there is still a paucity of rigorous research studies in this area. A key issue, identified by a New Zealand counsellor, is that the extent of sexual violence against men is unknown, because so few report (Milne, 2005). Milne states, ‘statistics can’t show what people don’t talk about’ (p. 1).

Several issues related to male victim/survivors come through in the literature. It is important for service providers for this group to be aware of these.

• Men’s reluctance to report sexual violence is often closely associated with their fears surrounding their sexuality (Crome, 2006), feelings of shame (King and Woollett, 1997), and fears that once abused they themselves will become abusers (Milne, 2001).
• There is often a significant delay before men report sexual violence.
• Men who do report rape are more likely to have suffered more physical injuries and have often been assaulted by multiple attackers (Chapleau, Oswald and Russell, 2008; Crome, 2006; Davies and Rogers, 2006).

Gay, lesbian, bisexual, transgender and intersex victim/survivors
There is very little literature specifically on sexual violence and the gay, lesbian, bisexual, intersex and transgender (transsexual, fa’afafine and whakawahine) communities; what literature there is tends to deal with same-sex domestic violence (Levanthal and Lundy, 1999; Farrell and Cerise, 2006). A recent New Zealand study investigated the issue of sexual coercion among gay men, bisexual men and takatāpui tāne (Fenaughty et al., 2006). This is the only paper of its kind that focuses solely on men who have sex with men in New Zealand. However, rather than reviewing particular needs of this group, the paper focused more on the factors enabling sexual coercion to occur. It concluded that norms related to masculinity per se, rather than gay masculinity, were key to understanding sexual coercion among gay and bisexual men.

Reporting and help-seeking for incidents of sexual violence is low for these groups (Farrell and Cerise, 2006), with homophobia by police and community services identified as one of the major barriers (Levanthal and Lundy, 1999). Despite intersex people experiencing high rates of intimate partner and sexual abuse, the rate of reporting by or help-seeking for intersex people is the lowest of any of these groups (Pitts, Couch and Smith, 2006). Another particularly vulnerable group are transgendered individuals who work in the sex industry, so are at higher risk due to both their gender and their occupation. Difficulties in finding any type of employment have meant that a disproportionately higher number of transgendered individuals work in the sex industry (Jordan, 2005a).

Victim/survivors with disabilities
‘Victim/survivors with disabilities’ is a general term that in the early literature was used to describe survivors with a wide range of diverse characteristics and service needs (Sobsey and Doe, 1991; Sobsey, 1994, cited in Nosek et al., 2004). Types of disability vary to a great extent, and include sensory, physical, psychiatric and cognitive impairment (CROWD, 2008; Tyiska, 1998).

Those with intellectual or developmental disabilities appear to be at particularly high risk of sexual assault (Petersilia, 2001). For example, research conducted in Australia by the National Police Research Unit and Flinders University found that people with intellectual disabilities were ten times more likely to be sexually assaulted than people without intellectual disabilities (Brook, 1997).

Victim/survivors with disabilities often experience difficulties in accessing services for several reasons, as summarised in Table 2.
 

Table 2: Access issues for victim/survivors who have disabilities

Type of disability	Needs
Physical	Mobility/transport
Hearing	Communication (including hearing organisations not having text telephones) Interpreters and privacy (Obinna et al., 2005)
Cognitive	Communication (particularly if victims/survivor is ‘non-verbal’) (Tyiska, 1998) Safety within the organisation/institutional setting in which sexual violence most commonly occurs ( Goodfellow and Camilleri, 2003; Davis, 2000) Recognition of problem of abuse by caregivers (Blyth, 2002; Davis, 2000; Nosek et al., 2004; Tyiska, 1998)
All forms of disability	Being taken seriously by law enforcement agencies (Hoog, 2004; Lievore, 2005) Being recognised as ‘credible’ by police and prosecution (Hoog, 2004; Lievore, 2005) Health problems or disabilities often mask offending (Blyth, 2002, Davis, 2000; Nosek et al., 2004; Tyiska, 1998)

Rural victim/survivors
Issues of rurality are particularly pertinent for New Zealand with its low population and relatively few urban centres. A simple universal definition of rurality does not exist (Lewis, 2003). However, commentators recommend that it is more useful to consider rurality as being on a continuum and that the distinguishing features are an area with a varied population density and varying levels of health and social resources (Averill, Padilla and Clements, 2007).
Such characteristics result in a unique set of circumstances surrounding meeting needs for victim/survivors of sexual violence within these communities.

• Access to services – physical and social distance from medical, police and support services (Lewis, 2003; Neame and Heenan, 2004; Parkinson, 2008a, 2008b).
• Guarantee of confidentiality – in small communities the lack of anonymity creates problems around maintaining confidentiality (Neame and Heenan, 2004; Parkinson, 2008a, 2008b).
• Understanding offending as sexual assault – linked to greater conservatism and adherence to traditional gender roles (Neame and Heenan, 2004; Parkinson, 2008a, 2008b).
• Reporting to police – small communities may have only part-time police cover, if any (Neame and Heenan, 2004); police may have a close relationship with the offender and/or victim/survivor and their families.

Sex-worker victim/survivors
A New Zealand report recently published by the Christchurch School of Medicine included survey information from a large study of sex-workers across all sectors of the industry. This study reported that in the last 12 months 3 percent of sex-workers had been raped by a client, with two-thirds electing not to report it to police (Abel, Fitzgerald and Brunton, 2008). This is supported by research in other countries that has found that sex-workers, in particular street sex-workers, experience high levels of physical and sexual violence (Kong et al., 2003; Harcourt et al., 2001).

Sex-workers are affected by rape in the same way as other victim/survivors (Quadara, 2008). Despite sex work in New Zealand being decriminalised in 2003, stigma associated with the sex industry still exists, and sex-workers face prejudice from mainstream service providers. Fear of public exposure is also a significant barrier to accessing services.

Ethnic, migrant and refugee victim/survivors
United Nations estimates suggest 80 percent of all refugee women have experienced rape and sexual abuse (Mehraby, 2001, cited in Savage, 2003). However, minimal research was found specifically on ethnic, migrant or refugee victim/survivors of sexual assault.

An Australian study by Lievore (2005) included interviews with immigrant service providers, with a particular focus on victim/survivors from non-English-speaking backgrounds. Points raised were that:

• these women are doubly disadvantaged by poor outreach from the mainstream sectors and by community silencing
• choices of many immigrant women were constrained and shaped by their alienation from a range of legal, health and victim services
• these women will face different issues depending on their pre-migration experiences
• the impact of sexual violence on women from collectivist communities could have a profound effect on the way that decisions are made and on the appropriateness of service models (which are usually geared towards women from the dominant individualistic culture).

 

Sexual violence workshops held in New Zealand with ethnic, migrant and refugee communities, revealed immigration status can be an important barrier to accessing services. Some men do not apply for residence for female partners, which creates uncertainty and insecurity for women. This was seen to be compounded when there was a considerable age gap between the pair, or when the male partner is a New Zealander. Workshop attendees also pointed to the often extreme social isolation of ethnic, migrant and refugee women, who are geographically isolated from family and other support networks, and with interaction with external agencies often through their husbands (Ministry of Women’s Affairs, 2007).

In New Zealand, as elsewhere, refugees and new migrants do not come from a unified group, but come from many different countries. De Sousa (2007) argues that, in New Zealand, there is much that newer migrant groups and mainstream services can learn from the experiences of Pacific people who are a diverse group representing over 20 cultures.

Table 3: Key issues for service delivery for victim/survivors from diverse groups

Group	Key issues
Māori	Involvement of culturally appropriate supports and extended family Adherence to Māori models of health and well-being Māori personnel in existing services and the development of Māori services
Pacific	Involvement of extended family Provision of relevant information in Pacific languages Ensuring confidentiality Pacific personnel in existing services and the development of Pacific services Understanding of the role of the Church.
Young adult	Confidentiality – especially in relation to parental disclosure
Male	Reassurance and counselling about masculinity and sexuality Dealing with issues around historical offences
Gay, lesbian, bisexual, transgender and intersex	Impact of homophobia of service providers Transgender counselling
Victim/survivors with disabilities	A range of access issues in relation to diverse disabilities Gaining informed consent of people with intellectual disabilities may be difficult The caretaker, family member or friend accompanying the victim/survivor may be the perpetrator Being recognised as credible by police and prosecution
Rural	Isolation – social and geographic Lack of service provision Familiarity, confidentiality and anonymity issues
Sex-worker	Multiplicity of social problems that can include drug abuse and social isolation Fear of public exposure and prejudice of mainstream services pose problems in accessing services
Ethnic, migrant, refugee	Diverse needs dependent on pre-migration experiences Language and communication difficulties, leading to issues around ascertaining informed consent and gaining evidential information. Social isolation

Summary
The literature on services for victim/survivors typically treats them as if they were a single homogenous group: with a close reading of the literature by and about diverse populations of victim/survivors it becomes clear that there are distinct needs that must be considered. It is also significant that these groups tend to be disproportionately represented as victim/survivors of sexual violence.

With reference to the literature, any service or criminal justice procedure that formulates a good practice model in relation to diverse populations of victim/survivors should have cognisance of the key points summarised in Table 3. Neither this list of victim/survivor groups nor the issues highlighted are exhaustive, but are offered as a possible starting point for the incorporation of the diverse needs of victim/survivors into the concept of ‘good practice’. While the needs and issues of each group have been presented as distinct groups, there will be overlaps between groups (e.g. young, Pacific, transgender sex-workers), which would result in accumulated needs and, in some cases, increased risk.

 

3    Overview and critique of good practice

In a review of good practice for adult sexual violence services four key questions must be considered.

• What does good practice relate to – the type of programme or the way the programme is delivered?
• What are the criteria used to judge good practice?
• What are the outcomes against which good practice is evaluated?
• Who has the power to define good practice?

 

Each of these questions is considered below.

3.1    What does good practice relate to?

In reviewing the literature on adult sexual violence services, it is evident that good practice typically refers to one of two things.

• The type of service delivery: This is the particular type of adult sexual violence service that has been identified as good practice. This could relate to a general category (e.g. forensic nursing or specialised support services) or a particular programme (e.g. Sexual Abuse Nurse Examiners programme or Sexual Assault Referral Centres).
• The principles of delivery: Good practice can also refer to principles of delivery (e.g. culturally appropriate or victim-centred). Kelly (2005) refers to these as ‘promising elements’. These principles can relate to a number of types of programmes and are critical factors in achieving successful outcomes.

To ensure that the needs of victim/survivors are met, it is important that the required ‘components’ of service delivery are available, but also that these individual components are delivered in an effective manner.

3.2    What are the criteria used to judge good practice?

There is no agreed definition of what constitutes ‘good practice’, ‘best practice’ or ‘promising practice’ in respect of sexual violence service provision. The terms are used throughout the literature on sexual violence and service provision for victim/survivors, sometimes interchangeably within the same text (e.g. Rape Crisis Network Europe, 2003).

The only area where there appears to be consensus is in why we need to identify good practice – which is to guide people to examples of what works to achieve desired outcomes (Cannon and Kilburn, 2003). However, as will be seen in section 3.1.2, there is less agreement on which outcomes are most important.

Although there is no universally accepted definition of ‘good practice’, several projects from diverse fields have formulated a process for evaluating their practices, which have varying degrees of applicability to sexual violence response services.

Proven effectiveness based on research evidence
‘Best’ or ‘good’ practice is commonly applied to those services or elements of programmes that have proven effectiveness in achieving desired outcomes. To be proven, typically refers to programmes that have met a strict set of criteria associated with a certain level of research evidence. Two common criteria are:

• the effectiveness of the programme is demonstrated through experimentally designed research producing statistically significant results
• programme effects have been replicated by different researchers and/or transferred to different contexts using the same criterion as above.

 

Examples from different fields that require this level of research evidence and the associated best practice terms include:

• empirically supported treatments – to identify effective psychological interventions in the United States (Task Force of Division 12, 1993)
• model programmes – to identify effective family violence programmes (Cooper, Warthe and Hoffart, 2004)
• proven practice – in the field of family violence (Cannon and Kilburn, 2003)
• best practice – to identify effective family planning and reproductive health initiatives (Advance Africa, 2005).

 

However, some research studies that utilise different research methodologies or weaker designs (e.g. no randomly assigned comparison groups) may still provide useful evidence (Cannon and Kilburn, 2003). Hence, while ‘best practice’ is reserved for those studies achieving the highest level of research evidence, different terms are used to identify interventions or practices that are supported by varying levels of research evidence. For example ‘promising practices’ has been used to describe family violence programmes whose evaluations exhibit one or more design weaknesses (e.g. lack of control or comparison group) but still offer convincing results (Cannon and Kilburn, 2003); or for health initiatives that exhibit ‘inconclusive evidence of success or partial success’ (Advance Africa, 2005).

Unfortunately, very few adult sexual violence services or practices have been evaluated, let alone subject to experimental or even quasi-experimental design (Cooper, Warthe and Hoffart, 2004; Kelly, 2005). Indeed random allocation of victim/survivors to a ‘no treatment’ control would be considered inappropriate and unethical. This means relying solely on this type of research evidence may have limited value in identifying good practice in the field of adult sexual violence.

Wasco et al. (2004) reviewed some of the reasons for this lack of empirical evidence, based on difficulties they faced in their evaluation of sexual violence services in Illinois. These included:

• constraints around confidentiality and access to victim/survivors;
• difficulty getting ‘informed consent’ without using names of victim/survivors;
• inability to establish control groups of ‘non-users’
• many users of services were too distressed to take part in the evaluation questionnaires or interviews
• the need to work at a ‘hands-off distance’ through the staff at the sexual violence support services.

 

Ferguson (2003) argues that this lack of research evidence is not necessarily problematic. He points out that attempts to apply an evidence-based, ‘what works’ approach have been criticised for valuing the views of experts over those of service users (Ferguson, 2003). There is, in fact, growing recognition that ‘good’ or ‘best’ practice is socially constructed and must, therefore, always be open to debate (Ferguson, 2003; Glasby and Beresford, 2006). Other criteria for good practice are considered below.

Practice that reflects current trends
In situations where research evidence is limited, other criteria and terms have been developed to identify potentially useful practice that may have more applicability to identifying good sexual violence services practice.

• Worth watching – this has been used in the family violence field to identify programmes that have not been comprehensively evaluated but where initial reports offer encouraging results (Cooper, Warthe and Hoffart, 2004).
• State of the art – refers to practices in family planning and reproductive health initiatives that reflect new trends and current thinking in the field (Advanced Africa, 2002, 2005).
• Innovative practices – are cutting-edge approaches in family planning/reproductive health initiatives that reflect new, possibly untested thinking. They can come in the form of pilot programmes or experimental projects. The promise of an innovation is based on speculation and lessons learned from other practices (Advance Africa, 2002; 2005).

Criteria from within the sexual violence sector
Within the sexual violence field, ‘best/good practice’ is often either not defined or used in a wholly subjective way (e.g. in a Rape Crisis Network Europe study, where the aim was to identify ‘good practice’ in the non-government organisation sector: the term was defined as being, ‘action that proved successful or achieved positive outcomes for users of their services’ (Rape Crisis Network Europe, 2003: 7).

There is often no explicit definition given, nor is there any explanation of the criteria used in the study, for determining what constitutes ‘good’ or ‘best’ practice’ in any particular context (Lovett, Regan and Kelly, 2004). This is so even where the term is a vital component of the study, discussion paper or journal article in question, for example in Sexual Assault Referral Centres: developing good practice and maximising potentials (Lovett, Regan and Kelly, 2004).

Within the sexual violence sector, ‘evidence-based’ practice is considered where available. However, either due to its limited availability, or perhaps to priority given to views of victim/survivors and practitioners, the ‘knowledge-based’ practice described by Glasby and Beresford (2006) is also commonly used to identify ‘best/good’ practice. ‘Knowledge-based’ practice recognises the validity of experience of practitioners and the lived experience of service users. Examples within the sector include the following.

• Professional opinion: Best or good practice is sometimes identified as a result of expert opinion. Within the field of sexual violence, this could be based on the clinical judgement of expert health professionals (e.g. The Medical Management of Sexual Assault (DSAC, 2006)). It could also be the opinion of a researcher recognised as an expert in the area following a review of available literature and their experience in the field (e.g. Promising Practices Addressing Sexual Violence (Kelly, 2005)).
• Service users (victim/survivors): Recommendations for good practice for support agencies, medical emergency room and counsellors and criminal justice systems based on the experience of the victim/survivors themselves (e.g. Campbell, 2005; Fry, 2007; Jordan, 1998).
• Government review: Amnesty International Australia published a comprehensive review of international ‘good practice’ to inform a national plan to eliminate violence against women (including sexual violence). The criterion it used was whether the practice or initiative had reached the policy implementation stage, from which it could be inferred that the initiative had passed the scrutiny of governmental review (Amnesty International Australia, 2008).

 

Perhaps the most practical set of criteria has been established by the Australian Centre for the Study of Sexual Assault, valuing ‘evidence’ and ‘knowledge’ based practice but within a flexible framework. It used the criteria presented in Box 3 to identify ‘promising practices’.

Box 3: Promising practice criteria

Compulsory criteria Have a clear focus: have a clearly defined conceptual framework, clear aims and clear desired outcomes. Take account of contemporary research and practice developments in the field of sexual assault. Position diversity as key to the development, understanding and delivery of good practice models. Demonstrate sensitivity towards the barriers faced by victim/survivors in disclosing and reporting sexual assault, and other difficulties, if relevant. Include processes of accountability and evaluation. Optional criteria Be replicable (i.e. able to be used by others). Have been evaluated as successful. (ACSSA, 2008)

 

3.3    What are the outcomes against which good practice is evaluated?

The question of defining ‘good practice’ in relation to services for victim/survivors of sexual violence necessitates consideration of the diverse needs and priorities held by the various people and agencies involved. These are the outcomes of relevance to the various parties against which best practice is measured. While these may overlap, in some cases they may be in conflict. This derives from each agency having its own role and professional agenda, and all parties having potentially different desired outcomes. Table 4 presents the key needs and priorities held by the different parties.

At times the needs of (or outcomes for) the victim/survivor may be at variance with the responsibilities and roles of the agencies involved, as evidenced in the following examples.

• Immediately following a recent attack, the processes around investigating the crime, making a statement and providing forensic evidence may not aid in meeting the victim/survivor’s immediate needs for safety, comfort and security. Instead such procedures may add further distress, and bring with them the risk of secondary victimisation (Orth, 2002).
• At the very time a rape victim/survivor is seeking to be believed and validated, the police will be intent on obtaining proof and verification that the victim/survivor is telling the truth (Jordan, 2001, 2008). This may mean the police’s questioning style and attempts to obtain factual information will be experienced as interrogatory and disbelieving, placing an onus on police to ensure a validating approach is adopted.
• Similarly, the victim/survivor will be interacting with institutions and systems oriented towards professional control and procedural efficiency at a time when the victim/survivor is struggling in the aftermath of rape to regain a sense of autonomy and personal agency (Jordan, 2001, 2008). This can result in their feeling controlled and subordinated to organisational processes, placing an onus on all agencies involved to treat them with respect, keep them informed and maximise their choices.

 

Table 4: Needs and priorities of different parties

Group	Key needs and priorities
Victim/survivor	Immediate needs are for safety, validation, medical treatment, washing and changing, contacting family/friends, dealing with trauma, and reassurance about subsequent health issues Long-term needs may include psychosocial support, managing post-traumatic stress disorder impacts (that can affect sleep, eating, mental health, work, relationships and lifestyle), preparation for court, support in court and debriefing following court
Medical care providers	Immediate role is to assess and treat medical needs, and collect forensic evidence where required Longer-term involvement with overseeing the well-being and recovery of the victim/survivor, may be required to provide expert testimony in a prosecution
Police	Immediate role is to collect admissible and reliable evidence from crime scene and witnesses, including the victim/survivor Longer-term role involves conducting a proper investigation; arresting and charging the offender(s); providing protection for the victim/survivor
Prosecutors and the court	Overall aim is to ensure that the rule of law is maintained and the interests of justice are upheld. This is achieved by ensuring, for example, that reliable and admissible evidence is put before the court; that appropriate charges are filed in relevant cases; that any convictions are safely and rightly obtained; that appropriate sentences are handed down; and that witnesses (including the victim/survivor) are properly convened, prepared and supported
Mental health providers	Immediate aim is to alleviate short-term distress Longer-term role involves providing timely and effective treatments to prevent long-term adverse mental health impacts
Support services	Immediate aim is to provide crisis support for the victim/survivor, supporting their emotional well-being and acting as an advocate during police and medical processes Longer-term role may include serving as an advocate for the victim/survivor throughout police investigation and court processes: provision of ongoing counselling; preparation and support for court, and debriefing afterwards; providing support for partners and other family members

It is also possible that there may be clashes between the priorities of the different organisations involved, at various stages in the process. For example, the support agencies may be advocating for the victim/survivor’s emotional needs to be paramount at a time when the police require intensive questioning, or for the victim/survivor’s physical desire for a shower and a drink to be enabled, when this could disrupt or contaminate the evidential examination.

An essential component of any consideration of evaluating services for victim/survivors of sexual violence is an appreciation of the multiplicity of outcomes for the various people involved in the process. However, the paramount consideration has to be the welfare and well-being of the victim/survivor. Without that consideration as a guiding principle, the issue of ‘good practice’ is little more than a discussion about the desirable practices identified by different groups in order to achieve their own particular imperatives.

3.4    Who has the power to define good practice?

Considering that the concerns and priorities of the various groups involved in service provision for adult victim/survivors of sexual violence are not always the same and sometimes are in conflict, it raises the question of who determines good practice, and in whose interests?

Typically, professional organisations and government departments have the resources and power to make decisions and write policies regarding good practice, as opposed to victim/survivors, who are most aware of their own interests and needs. Without input from victim/survivors, organisations are in danger of devising systems that may be internally efficient but ineffective in terms of responsiveness to the needs of their client groups. Therefore, in reviewing good practice it is important to consider whether what is published is what the victim/survivor would consider best practice in terms of their needs.

Defining best practice within professional organisations can also be problematic.
In the mental health field for example, it is accepted that different individuals will respond to different types of treatment and that a range of counselling models can be effective (Wampold, 2001). Hence, the identification of a particular model as ‘best’ practice might imply that it is better than other models, when this is likely to be contextually dependent.

‘Best’ or ‘good’ practice: Not only might what is best for victim/survivors be different from what is best for the police or other organisations, but what is best for particular victim/survivors may differ according to cultural background, gender and urban/rural context, for example. Furthermore, attributing something to be the best forecloses room for challenge and improvement; and what is judged best practice at one point in time may not be so judged in the years to follow (Calder, 2000). There is, accordingly, a growing tendency to move away from identifying ‘best’ practice to acknowledging a range of ‘good’ practices instead (see, for example, Amnesty International Australia, 2008; Kelly, 2005; Regan and Kelly, 2003).

A final and important consideration is the country or culture on which good practice is based. As noted earlier, there is limited research on the effectiveness of adult sexual violence services. What there is tends to come from overseas researchers, based on evaluations of programmes and initiatives in their jurisdiction. Hence, whether these findings are applicable to the New Zealand context, and in particular for Māori victim/survivors, must be considered.

3.5    Use of good practice in this review

Having considered the above four issues, we decided to:

• refer to ‘good’ practice rather than ‘best’ practice
• distinguish between good ‘principles of delivery’ and good ‘types of service delivery’
• use a range of good practice criteria (i.e. all available literature in the field of sexual violence services), including evidence-based, knowledge-based and practice reflecting current trends
• where good practice is identified, note what this has been based on (victim/survivor’s perspective or research evidence) and, where possible, relate it to the New Zealand context.
  

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Disclaimer

This report was commissioned by the Ministry of Women’s Affairs. The views, opinions and conclusions expressed in the report are intended to inform and stimulate wider debate. They do not represent government policy.
 

Published in October 2009
by the Ministry of Women’s Affairs | Minitatanga Mō Ngā Wāhine
PO Box 10 049, Wellington, 6143, New Zealand
Phone: 0064 4 915 7112
Fax: 0064 4 916 1604
Email: mwa@mwa.govt.nz
Website: www.mwa.govt.nz

ISBN 978-0-478252-43-9 (Print)
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