Vulnerability and revictimization: Victim characteristics in a Dutch assault center
Introduction
In the Netherlands, one in eight women and one in twenty-five men have ever been raped,1 and 45% experienced a form of family violence.2 Sexual and family violence cause numerous negative health problems such as sexually transmitted infections (STIs), pregnancy complications and unwanted pregnancies, depression, post traumatic stress disorder (PTSD), substance abuse and an increased risk of suicide.3, 4, 5
Unfortunately, many victims do not seek help from legal, medical and mental health services. Victims are afraid that formal systems will not help them or will psychologically harm them.6 When they do seek formal help, the care provided often does not meet the victims' medical and psychological needs. Victims often perceive the care providers' attitudes and communication as negative.7 Instead of feeling they are given the opportunity to press charges, they are ashamed, are afraid of the perpetrator and fear they will be blamed by the police, who will probably not take the assault seriously enough.8, 9 Most reported sexual assaults are not prosecuted in court.7 As a consequence, victims feel misunderstood and miss out on the care they need.
To improve care for victims of violence, assault centres have been set up. In these centres, medical, psychosocial and legal services work together to provide the best possible care. Assault centres report promising outcomes on victims' help-seeking experiences: victims are satisfied with the care providers' attitude; care providers indicate that their communication skills have improved, resulting in a less traumatic care process; legal outcomes appear to improve; and there is enhanced communication among collaborating organizations.10, 11
A Centre for Sexual and Family Violence (CSFV) was set up in Nijmegen in 2012 as one of the first assault centres in the Netherlands. The Centre provides medical, forensic and police care at an Emergency Department. A case manager conducts psychosocial follow-up care to prevent problems such as PTSD, depression and revictimization. Literature on whether or not services for sexual and family violence should be combined shows that these services share needs, goals and expertise, but there is some concern that combined services lead to diminished effectiveness, lack of attention and lack of funding for sexual assault specifically.12 We believe that care for these victims could be based on the same interprofessional, integrated approach. Both family and sexual violence are considered gender-based violence: both share risk factors and health consequences, and both evoke feelings of fear, shame and guilt and increase the risk of future violence.13, 14, 15, 16 Both victim groups are often characterized by vulnerability, defined as being female, being young, having an intellectual disability or suffering from mental illnesses.17, 18
We wanted to find out whether our three target groups, namely adult and minor victims of sexual violence and adult victims of family violence, share background characteristics and care needs. Our research questions are: 1. What are the similarities and differences between adult victims of sexual and family violence with regard to vulnerabilities and use of services? 2. What are the similarities and differences between minor and adult victims of sexual assault with regard to vulnerabilities and use of services? 3. Do victim, assault and perpetrator characteristics influence reporting rates? This knowledge of assault centre populations can help existing and new centres to improve their care delivery.
Section snippets
Setting
The study was performed at the Centre for Sexual and Family Violence Nijmegen (CSFV), which provides interprofessional care for victims of sexual and family violence. The CSFV was set up as a collaborative network involving the Emergency Department (ED) of the Radboud University Medical Center, the District Police Department, the Community Health Services and an academic Primary Health Care Centre. Acute care takes place at the ED and is conducted by an ED physician and nurse. Initially, urgent
Results
In its first three years, 121 victims of acute sexual and/or family violence presented to the Centre for Sexual and Family Violence (Table 1). Seventy per cent of these had experienced sexual violence. Their male-female ratio was 1:16. Forty per cent were minor victims. The majority of victims had undergone vaginal, oral and/or anal penetration. One in five had been assaulted by more than one perpetrator.
Thirty per cent was a victim of family violence with a male-female ratio 1:11. Most victims
Discussion
Our most important finding is that victims of sexual violence and family violence show similar characteristics that indicate vulnerability: they are female, have high rates of psychosocial problems and/or intellectual disability and, in many cases, have experienced prior abuse. Remarkably, minor victims of sexual violence show the same characteristics. Despite their young age, a considerable percentage of them have experienced prior violence and have seen the involvement of Child Protection
Conclusion
Both minor and adult victims of sexual and family violence belong to vulnerable groups that are prone to revictimization. Combined care in one assault centre ensures that victims can make use of the same services and knowledge of gender-based violence. One of the major aims of assault centres is to prevent revictimization, which might be facilitated by adequate psychosocial follow-up care and reporting. The victims' needs in these matters deserve further research.
Conflict of interest statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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