Sexual Assault Forensic Exam Payment Practices Study: Reports of Practices from the Field

Transcription

1 Sexual Assault Forensic Exam Payment Practices Study: Reports of Practices from the Field Janine Zweig, Co-Principal Investigator (UI) Darakshan Raja, Research Associate (UI) Megan Denver, Research Associate (UI) Lisa Newmark, Co-Principal Investigator (GMU)

2 Acknowledgements This project was supported by Award No WG-GX- 0011, awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions expressed in this presentation are those of the author(s) and do not necessarily reflect those of the Department of Justice, or the Urban Institute, its trustees, or its funders.

3 The Criminal Justice System and Victims of Sexual Assault If the justice system is to accomplish its missions, it needs victims to report crimes and provide evidence For many reasons, victims of sexual assault are often reluctant to report to law enforcement -National surveys estimate reporting rates from 20% (Tjaden & Thoennes, 2006) to 50% (Truman, 2011) It s critical to collect physical evidence of sexual assault quickly while it s still available -The Sexual Assault Forensic Medical Exam collects forensic evidence, provides medical services to victims, and can help link them to victim services

4 Exams and Reporting Requirements Prior to the Violence Against Women Act (VAWA) of 2005, victims access to free forensic exams could be conditioned on reporting to law enforcement This practice presented victims with three difficult options: -Make an immediate decision to report to law enforcement, or -Assume financial responsibility for exams, or -Lose the opportunity to collect valuable information for investigation and prosecution, as well as receiving health care and victim services

5 VAWA 2005 Regulations The VAWA reauthorization of 2005 required all jurisdictions to pay for sexual assault forensic exams, regardless of whether victims cooperated with law enforcement investigations, by January Based on the theory that more victims will undergo the exam if they re not pressured on the reporting decision, and will be more likely to file an official report after the exam if they ve had time to think it over States that are not compliant risk losing grant funding through the STOP Violence Against Women Formula Grant Program. No evaluation has been performed on implementation practices related to the VAWA 2005 regulations since the 2009 deadline.

6 Study of Payment Policies and Practices Funded by the National Institute of Justice Partnership between the Urban Institute, George Mason University, and the National Sexual Violence Resource Center of the Pennsylvania Coalition Against Rape

7 Purpose of Study Understand how sexual assault forensic exams are paid for throughout the country; Identify best practices in providing free exams for both reporting and nonreporting victims; Examine the obstacles related to policy and practice and identify ways to overcome them; and Provide helpful information to states and localities across the nation.

8 Research Questions To what extent are victims of sexual assault being charged, either directly or indirectly, for the cost of exams? What agencies are responsible for paying for forensic exams? What are the payment practices? For example, do victims pay up front and get reimbursed, or never have to pay out of pocket? Does the extent to which victims are willing to cooperate with law enforcement affect whether or not they receive free forensic exams or how the exam process is conducted? Are Jane Doe rape kits or anonymous reporting procedures used to encourage victims who have not yet made a police report to undergo a sexual assault forensic exam?

9 Research Questions (Continued) Is medical care becoming more accessible to sexual assault victims? Are counseling and advocacy referrals part of the exam process? Do non-english speakers encounter greater obstacles to receiving sexual assault forensic exams than English speakers? What challenges to adherence with regulations exist? What works well when addressing regulations?

10 Potential Implications Findings from this study will: Increase knowledge in the field about how VAWA 2005 regulations are implemented Identify challenges to implementation Identify innovation and what works well when it comes to implementation Improve the field s understanding of how regulations affect victims who participate in sexual assault forensic exams, including victim participation in the criminal justice process, satisfaction, and safety Identify potential strategies for improving implementation procedures and better serving the needs of victims

11 Study Design State-level survey response rates: State STOP Administrators (SSA) State Crime Victim Compensation Administrators State Sexual Assault Coalitions Respondents/ total number 52/56 44/53 47/58 Response rate 93% 83% 81% Community-based sexual assault service providers: 442/1,535; 29% response rate

12 Study Design (Continued) Case Studies of States and Localities Victim focus groups Semi-structured in-person interviews with: Health-care based exam providers Victim service advocates Law enforcement and prosecution Fund administrators

13 What funds are used to pay for SAFEs and who administers funds? 22 states: Compensation funds are used and administered by compensation agencies 5 states: Law enforcement funds are used and administered by law enforcement 3 states: Prosecution funds are used and administered by prosecution 1 state: Either law enforcement or prosecution funds are used and administered by same agency (depends on county)

14 What funds are used to pay for SAFEs and who administers funds? (cont.) 8 states: Special funds are used n=4, Administered by victim compensation agencies n=2, Administered by state-level prosecution institute or local prosecution agencies n=1, Administered by a state-level office of victim services n=1, Administered by Department of Health 3 states: Department of Health and/or Mental Health funds used n=2, Administered by same agency n=1, Administered by state-level sexual assault coalition 1 state: STOP funds are used and administered by state-level office of victim services 1 state: Other

15 What funds are used to pay for SAFEs and who administers funds? (cont.) 7 states: blend funding sources: 3 states: use both special funds and victim compensation funds (but do not distinguish between these funds) administered by the victim compensation fund administrator 4 states: Use hybrid models depending on whether victim reports to criminal justice 2 use law enforcement funds administered by law enforcement for reporting victims and compensation funds administered by compensation agencies for nonreporting victims 1 uses law enforcement funds administered by law enforcement for reporting victims and a special fund administered by a state-level office of victim services for nonreporting victims 1 uses compensation funds and victim s insurance for reporting victims administered by the compensation agency and a special fund for nonreporting victims administered by the compensation agency

16 Use of Victim Compensation Funds Victim Compensation Median amount spent on forensic exam claims in 2010: $717,270 Median amount spent on all claims in 2010: $5,594,288 Median percentage of forensic exam claims: 14% Average amount spent per claim varies widely by state (from $234 to $1,125). The median for the sample is $601. N=26 victim compensation fund administrators from states where compensation is used to cover SAFEs

17 Victim s Insurance Billed? N=47 state-level sexual assault coalitions

18 SAFEs Conducted By: N=47 state-level sexual assault coalitions

19 In states where both trained and untrained staff conduct SAFEs: N=36 state-level sexual assault coalitions

20 Does your state require forensic exam kits to be stored? N=47 state-level sexual assault coalitions; N=52 state STOP administrators

21 How long if the case was reported to law enforcement? N=31 state-level sexual assault coalitions (28 valid responses); N=36 state STOP administrators

22 How long if the case was reported to law enforcement? SSA: ranges from 1 month to 30 years Average of 6.3 years Coalition: ranges from 2 to 50 years Average of 21 years

23 How long if the case was not reported to law enforcement? N=31 state-level sexual assault coalitions (27 valid responses); N=36 state STOP administrators (25 valid responses)

24 How long if the case was not reported to law enforcement? SSA: ranges from 1 month to 30 years Average of 31.5 months Coalition: ranges from 1 month to 10 years Average of 18.5 years

25 Models Used for Nonreporting Victims No law enforcement involvement: medical facilities perform the exam and securely store the evidence 43 percent Law enforcement storage only: medical facilities perform the exam and transfer the evidence to a local, county, or state law enforcement agency 62 percent N=47 state-level sexual assault coalitions

26 Models Used for Nonreporting Victims Anonymous/blind reporting: information is provided to law enforcement without identifying information about the victim or perpetrator. The victim may or may not have a forensic medical exam, but law enforcement stores any evidence that is provided. 36 percent Other 16 percent N=47 state-level sexual assault coalitions

27 Percentage of Jurisdictions Using Models

28 Models that Work Best for Providing Exams Without Having to Report to LE? N=47 state-level sexual assault coalitions

29 Models that Present the Biggest Challenge for Providing Exams Without Having to Report to LE? N=47 state-level sexual assault coalitions

30 Models that Work Best for Providing Exams Free of Charge? N=47 state-level sexual assault coalitions

31 Models that Present the Biggest Challenge for Providing Exams Free of Charge? N=47 state-level sexual assault coalitions

32 Jurisdictional Issues Related to Payment of SAFEs N=47 state-level sexual assault coalitions; N=52 state STOP administrators

33 Easier or More Difficult for Non- English-Speaking Victims? N=47 state-level sexual assault coalitions

34 Victims Never Pay? Based on your best estimation, what percentage of victims in your state get forensic medical exams free of charge without having to pay anything out of pocket at any point in the process? N=47 state-level sexual assault coalitions; N=52 state STOP administrators

35 Victims Reimbursed? Based on your best estimation, what percentage of victims in your state get forensic medical exams free of charge through reimbursement for out-ofpocket expenses the victims paid? N=47 state-level sexual assault coalitions; N=52 state STOP administrators

36 Law Enforcement Report Required? Based on your best estimation, what percentage of victims in your state get free forensic medical exams (either the victim never pays or gets fully reimbursed) without requiring them to report to law enforcement or participate in the criminal justice process? N=47 state-level sexual assault coalitions; N=52 state STOP administrators

37 Top 5 Reports of Challenges Surrounding Implementation of VAWA 2005 Coalitions SSA Law enforcement resists change (38%) Payment levels are too low (30%) Payment levels are too low (17%) State agencies have difficulty providing training (17%) Paying agencies lack funds for free exams (14%) Prosecution resists change (23%) Paying agencies lack funds for free exams (23%) State agencies have difficulty providing training (23%) Law enforcement doesn't work well with victims (12%) Law enforcement doesn't work well with SA agencies (12%) I m not sure (12%) N=47 state-level sexual assault coalitions; N=52 state STOP administrators

38 Top 5 Reports of What Works Well for Implementation of VAWA 2005 Coalitions SSA Statewide mechanism for payment (64%) Medical personnel generally work well with sexual assault agencies (47%) State laws are clear about which agencies should pay for exams (47%) State laws are truly helpful to victims (45%) Medical personnel generally work well with victims (45%) Statewide mechanism for payment (65%) State laws are truly helpful to victims (62%) Medical personnel generally work well with victims (58%) State laws are clear about which agencies should pay for exams (58%) Medical personnel generally work well with sexual assault agencies (54%) N=47 state-level sexual assault coalitions; N=52 state STOP administrators

39 Perspectives on Change in Percentage of Victims Getting Exams Since January 2009 N=47 state-level sexual assault coalitions; N=52 state STOP administrators

40 Perspectives on Change in Percentage of Victims Reporting to CJS Since January 2009 N=47 state-level sexual assault coalitions; N=52 state STOP administrators

41 Perspectives on Change in Victims Getting Medical Care Since January 2009 N=47 state-level sexual assault coalitions; N=52 state STOP administrators

42 Perspectives on Change in Ability of State to Provide Exams Free of Charge Since January 2009 N=47 state-level sexual assault coalitions; N=52 state STOP administrators

43 Who pays? Conclusions Findings indicate Victim Compensation funds are most commonly used fund source (27 states) 11 states have a special fund revenue stream Is the payment process working? Common challenges in implementing VAWA 2005: law enforcement resistance, insufficient payment levels and funds to pay for exams, and state agencies having trouble providing training Common reports of what is working well in implementing VAWA 2005: statewide mechanism for payment, and state laws that are clear and truly helpful to victims

44 Conclusions (continued) Some of the more commonly reported practices: Law enforcement reporting requirements seem to be uncommon Trend toward more victims getting exams, but police reporting rates may not have risen much Untrained personnel do perform some exams, but exams are more likely to be performed by trained personnel Storage practices and retention periods vary widely, with no agreement on which are optimal or most challenging Non-English-speaking victims may face additional obstacles in obtaining exams

45 Stayed tuned for more... Case study site visits are scheduled for spring and summer 2012 Final reports and ASC presentation expected fall 2012

46 References Tjaden, Patricia, and Nancy Thoennes (2006). Extent, Nature, and Consequences of Rape Victimization: Findings From the National Violence Against Women Survey. National Institute of Justice Special Report. NCJ Truman, Jennifer (2011). National Crime Victimization Survey: Criminal Victimization, Bureau of Justice Statistics Bulletin. NCJ