This literature review was undertaken as part of the project Comparing Sexual Assault Interventions which is funded by the European Union through the DAPHNE III Programme 2007-2013. The project goal is to improve the effectiveness, appropriateness and humanity of sexual assault services by reviewing current practice and taking on board user attitudes to interventions following sexual assault, and therefore decrease the social, mental and health harm caused to the victims of sexual assault. The scope of the project is limited to women aged over 16.
The purpose of the literature review was to identify models of intervention for women who have experienced sexual assault across European Union Member States, EFTA, EEA and ascension countries
Methodology for the literature review
The literature review included peer reviewed articles in academic and scientific journals and grey literature. The literature search was undertaken for peer reviewed articles in English, French and Spanish using specific keywords. Grey literature was identified through survey questionnaire and telephone interviews carried out by the project, searches of specific websites, project partners and publication references. Only articles and documents that fulfilled the defined inclusion criteria were examined.
Key findings of the literature review
What the literature tells us about the prevalence of sexual assault:
- Legal definitions, rape myths and public perceptions all impact on sexual assault reporting levels.
- There are different methodologies for estimating prevalence levels, including those based on self-reporting in population-based surveys and those based on official crime statistics.
- All methodologies are likely to underestimate the real numbers as many assaults are unreported and some forms of sexual violence may be not be perceived by victims or perpetrators as an offence.
- Studies included in this review in various European countries and using different methodologies found lifetime prevalence rates for sexual assault of between 6.8% and 33.2%.
What the literature tells us about vulnerability to sexual assault
- There is some evidence that certain population groups are more vulnerable to sexual assault. These include adolescents, young women, those with disabilities, homeless, sex workers, women on low incomes, women who were previously victims of sexual abuse or assaults, and lesbian, gay, bisexual, transgender and intersex people.
- The evidence on ethnicity as a factor that increases vulnerability to sexual assault is not conclusive.
What the literature tells us about services for women who have experienced sexual assault
- Responding to sexual assault requires addressing multiple dimensions of care from medical, psycho-social and legal sectors.
- Various models are used to meet forensic, medical, psychosocial and criminal justice needs in different countries and regions within countries.
- How service providers respond to women can have profound consequences for receiving appropriate care and later adjustment and recovery.
- Centralised or co-ordinated models (e.g. Sexual Assault Referral Centres) offer services for health, forensic and psychological needs in a single location.
- Integrated models offer services for women who have suffered sexual assault together with services for other forms of violence against women and children.
- Most of the literature focuses on understanding urban patterns of sexual assault and services.
- When designing models for intervention, ‘one-size-fits-all’ models are not recommended.
Results of the review and areas for further action
- There is little systematic evaluation of sexual assault services.
- Sexual assault requires a multifaceted response to medical, psychological and legal needs, which complicates measuring the effectiveness of services globally and, instead, services should be evaluated against multiple domains.
- Given the lack of systematic evaluation and the different types of evidence available, it is not possible to develop a methodologically sound hierarchy or framework which directly compares the effectiveness of different interventions and service models.
- Individual evaluations on the effectiveness of strategies in terms of their impact on reducing the incidence of sexual assault were not found.
- There is evidence that having service providers in one location and training and specialisation in sexual assault reduced the risk of secondary victimisation of women by professionals when reporting sexual assault.
- Findings from the United States support specialisation and training in forensic examinations for sexual assault cases.
- Evidence shows negative experiences are related to long waits for the examination and the examiner appearing to disbelief.
- There is evidence that training and specialisation in sexual assault, either in the form of specialised service provision or by specialised professionals, will be more likely to offer victims thorough medical care.
- There is evidence of the benefits of cognitive behavioural therapies, especially in terms of PTSD outcomes.
- This review did not find evidence on whether sexual assault services delivered in services which also cover a range of other forms of violence against women and children are more or less effective than those services that only specialise on sexual assault.
- More evaluations should be conducted in lower resource settings.