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)
Acknowledgements
• This project was supported by Award No. 2010-WG-GX0011, 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.
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
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
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 2009.
-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.
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
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.
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?
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?
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
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
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
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)
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
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
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
Victim’s Insurance Billed?
N=47 state-level sexual assault coalitions
SAFEs Conducted By:
N=47 state-level sexual assault coalitions
In states where both trained and
untrained staff conduct SAFEs:
N=36 state-level sexual assault coalitions
Does your state require forensic
exam kits to be stored?
N=47 state-level sexual assault coalitions; N=52 state STOP administrators
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
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
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)
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
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
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
Percentage of Jurisdictions Using
Models
Models that Work Best for Providing
Exams Without Having to Report to LE?
N=47 state-level sexual assault coalitions
Models that Present the Biggest Challenge for
Providing Exams Without Having to Report to LE?
N=47 state-level sexual assault coalitions
Models that Work Best for
Providing Exams Free of Charge?
N=47 state-level sexual assault coalitions
Models that Present the Biggest Challenge
for Providing Exams Free of Charge?
N=47 state-level sexual assault coalitions
Jurisdictional Issues Related to
Payment of SAFEs
N=47 state-level sexual assault coalitions; N=52 state STOP administrators
Easier or More Difficult for NonEnglish-Speaking Victims?
N=47 state-level sexual assault coalitions
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
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
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
Top 5 Reports of Challenges Surrounding
Implementation of VAWA 2005
Coalitions
Law enforcement resists change
(38%)
SSA
Payment levels are too low
(17%)
State agencies have difficulty providing training (17%)
Payment levels are too low
(30%)
Prosecution resists change
(23%)
Paying agencies lack funds for free exams (23%)
State agencies have difficulty providing training
(23%)
Paying agencies lack funds for free exams (14%)
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
Top 5 Reports of What Works Well for
Implementation of VAWA 2005
Coalitions
SSA
Statewide mechanism for payment
(64%)
Statewide mechanism for payment
(65%)
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
(62%)
State laws are truly helpful to victims
(45%)
Medical personnel generally work well with victims
(58%)
Medical personnel generally work well with victims
(45%)
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
Perspectives on Change in Percentage of
Victims Getting Exams Since January 2009
N=47 state-level sexual assault coalitions; N=52 state STOP administrators
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
Perspectives on Change in Victims
Getting Medical Care Since January 2009
N=47 state-level sexual assault coalitions; N=52 state STOP administrators
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
Conclusions
 Who pays?
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
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
Stayed tuned for more . . .
Case study site visits are scheduled for spring
and summer 2012
Final reports and ASC presentation expected
fall 2012
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
210346.
• Truman, Jennifer (2011). National Crime Victimization Survey: Criminal
Victimization, 2010. Bureau of Justice Statistics Bulletin. NCJ 235508.