Telephone interviews were conducted with key informants to identify advantages and disadvantages of various models of sexual assault provision and to discuss how transferable they are to different social and cultural settings with different delivery mechanisms and legislative frameworks.
Interviews were conducted a total of 20 stakeholders in seven different EU member states. Countries were selected to ensure a spread of geographical coverage across the EU.
The seven countries selected are as follows:
- UK: England and Wales
- Specialist services provided by statutory or public service providers to meet the needs of women who have been sexually assaulted were described by interviewees in three of the seven countries.
- These were complemented by services provided by NGOs.
- In three countries there were no specialised services for women who had been sexually assaulted. Instead women can seek help from hospitals, other health providers, the police, forensic medical departments, welfare services and NGOs.
- In Spain where regional governments are responsible for service delivery, different models including specialist services exist.
Factors contributing to the effectiveness of particular service models
- Specialised services for women who have been sexually assaulted were considered by most interviewees to be an effective form of service delivery in those countries that had these services. Several interviewees from countries that did not have specialised services also believed they were the most effective form of service delivery. Advantages cited by interviewees included:
- Combining medical and forensic examinations;
- An exclusive focus on sexual assault means women are more likely to disclose and seek help;
- Supporting collaboration between the police, the medical services, forensics, research and psychology;
- Pro-actively offering psychological help;
- Offering a range of services from a single centre makes them more accessible;
- Specialist staff who are respectful towards women.
- Other features that were considered by interviewees to make services effective included:
- 24 hour service provision, seven days a week;
- Specially trained staff;
- Independent and easily accessible language interpreters;
- The client/victim centred approach with compassionate staff;
- Childcare for clients;
- The ability to self-refer to services.
Factors that limit the effectiveness of services
- Interviewees identified a range of factors that could compromise the effectiveness of services, including specialist services. These included:
- High rates of non-reporting mean many women do not get help;
- Lack of trust in systems amongst women:
- Victim blaming attitudes of professionals;
- Lack of long term support, in particular psychological support;
- Time limits requiring the sexual assault to be reporting within a particular time frame;
- Inadequate resources for services;
- Ineffective and arbitrary judicial systems;
- Women having to wait long periods for medical and/or forensic examination;
- Variability in the quality and accessibility of services within different regions of the same country;
- Difficulties in staffing services round the clock;
- Perceived lack of independence of services from the criminal justice system;
- Lack of childcare;
- Lack of language support;
- Inadequate staff training.
Indicators of effectiveness and appropriateness of services
- There was broad agreement that indicators based on women reporting to the police, going through with cases and conviction rates are not appropriate because they are largely arbitrary in that they are dependent on judges and juries.
- Wellbeing and health indicators were considered important for example, sexual health, post-traumatic stress disorder symptoms, feeling informed and empowered to make decisions, ability to return to work.
- Service indicators were also considered important. These include: how satisfied women are with the service; whether women attend follow-up; the number of women who turn to services for support.
- Some services undertake user satisfaction questionnaires. However, these are not always returned and there are concerns that follow-up may cause some women distress.
- Data analysis quoted from services in Denmark and Austria suggested that client numbers and reporting levels are fairly stable.
Obstacles to service development
- Interviewees who said that services in their countries were inadequate cited a variety of factors that blocked or hindered the development of services. These included:
- The level of under-reporting means that the extent of unmet need is not known and that there is inadequate awareness of the real scale of the problem;
- Professional attitudes that blame victims;
- A lack of appropriate training of professionals;
- Expectations among professionals that sexual assault always involves obvious signs of struggle or violence;
- Lack of national protocols;
- Lack of recognition that the state needs to provide services in this area;
- Funding constraints;
- Lack of service infrastructure.
- There were shared contextual cultural and social actors described by interviewees from different countries. These include:
- Strong taboos about sexual assault and a tendency for victims to be blamed;
- Domestic violence is considered less stigmatised than sexual assault and, therefore, receives more attention from service providers;
- Many women who suffer domestic violence also suffer sexual assault but this is under-reported;
- Over representation of women from low social status groups in those accessing services, although there were different perceptions about whether this reflected a higher incidence of sexual assault in these groups or was because women from higher social status groups are less likely to access services;
- Recognition that some groups are less likely to access services so need special support to do so. These include sex workers, Muslim women, older women, Roma women and migrant woman;
- Women who have been trafficked for sexual exploitation required particular support;
- Recognition that women from ethnic minorities need particular support including independent interpretation, culturally aware staff and staff from outside their own communities to ensure confidentiality.
- Other contextual factors cited by interviewees included:
- Measures to raise awareness of sexual assault are needed;
- Legal definitions should be based on consent;
- Language needs to be consistent.
Transferability of services
- The fact that many contextual factors are shared between different countries, suggests that service models are likely to be transferable.
- Specialist services that are permanently open can be resource-intensive which is likely to limit their transferability to contexts where service infrastructure is less developed.
- Models based on having central services supported by satellites (sometimes known as a hub and spoke model) may be less resource intensive and, therefore, more transferable.
- The availability of specially trained staff is key to the transferability of specialised services.
- The ethnic make-up of the local population needs to be taken into account in considering service transferability to ensure the needs of particular hard to reach groups are taken into account, for example Roma women.
- The confidentially and anonymity of services is essential. Measures to ensure this need to be built into services for small, close-knit communities.
Types of support needed
- Interviewees who said that services in their countries were inadequate described a range of support measures as being potentially useful. The types of support included:
- Staff training on technical aspects of service provision and awareness raising to change the attitudes of professionals that blame women;
- Additional funding;
- Support through networks with organisations that provide similar services to share experiences and exchanges with other countries;
- Technical support to design services.