Best Practice FAQs

Best Practice FAQs

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What is “forensic compliance?”

The term “forensic compliance” refers to specific provisions that first appeared in the 2005 reauthorization of the Violence Against Women Act, known as VAWA 2005. They were designed to increase access of sexual assault victims to a medical forensic examination, and they remain in place under the VAWA 2013 reauthorization.

These provisions read as follows:

Nothing in this section shall be construed to permit a State, Indian tribal government, or territorial government to require a victim of sexual assault to participate in the criminal justice system or cooperate with law enforcement in order to be provided with a medical forensic exam, reimbursement for charges incurred on account of such an exam or both [42 U.S.C.A § 3796gg-4(d)(1)(2005)].

There are two key requirements of forensic compliance. Specifically, VAWA states that sexual assault victims must be provided with access to a medical forensic exam:

(1) Free of charge, and

(2) Without requiring them to cooperate with law enforcement or participate in the criminal justice system.

VAWA 2013 retains these key provisions from VAWA 2005, and it clarifies that victims cannot be required to pay any out-of-pocket costs to obtain a medical forensic exam. Under VAWA 2005, jurisdictions were allowed to bill victims for the cost of the exam as long as they were fully reimbursed. However, this option was eliminated in VAWA 2013.

All US states, territories, and tribal governments must certify compliance with these VAWA provisions to retain their eligibility for STOP grant funds.

For more information, please see two Online Training Institute (OLTI) modules: (1) The Earthquake in Sexual Assault Response: Implementing VAWA Forensic Compliance and (2) Opening Doors: Alternative Reporting Options for Sexual Assault Victims.

What is the purpose of forensic compliance? Why should we offer medical forensic exams for victims who do not want to talk with law enforcement?

Most sexual assaults are not reported to law enforcement. One key goal of VAWA forensic compliance is therefore to increase reporting and criminal justice participation, perhaps counterintuitively by not requiring this as a condition for victims to obtain a medical forensic examination. A related goal is to improve sexual assault case outcomes. Several studies have found that sexual assault cases that involve a medical forensic exam conducted by a trained examiner are more likely to result in charges being filed, a conviction, and a longer average sentence (Campbell et al., 2012, 2014; Crandall & Helitzer, 2003). Even when victims might be unable to testify about their own sexual assault, they may be willing to testify on behalf of another victim who was assaulted by the same person. All these factors can help to improve case outcomes, and communicate to victims that they are valued and respected.

As a second goal, forensic compliance was designed to improve access to health care. Prompt medical care in the aftermath of a sexual assault may reduce the risk of chronic health problems such as depression, eating disorders, and alcohol or substance abuse, as well as pelvic pain which is experienced by many victims (American College of Obstetricians and Gynecologists, 2019). Many sexual assault victims are motivated to have a medical forensic exam based on their need for health care, rather than evidence collection (DuMont et al., 2009). Forensic compliance builds on this common motivation, by ensuring that victims can access health care – including a full medical forensic examination – without requiring law enforcement contact or criminal justice participation.

A third goal of VAWA forensic compliance is to connect victims with advocacy services and other supportive resources. Sexual assault victims will frequently be offered the services of an advocate when they have a medical forensic examination, but this is less likely for victims who seek other forms of health care. The importance of advocacy services cannot be overstated. Advocates can provide sexual assault victims with crisis intervention and emotional support, as well as information on reporting options and other available services. Research has consistently shown that victims who receive this type of supportive response have lower rates of post-traumatic stress, and are less reluctant to seek further help (Campbell, 2006; Wasco et al., 1999).

For more information, please see two Online Training Institute (OLTI) modules: (1) The Earthquake in Sexual Assault Response: Implementing VAWA Forensic Compliance and (2) Opening Doors: Alternative Reporting Options for Sexual Assault Victims.

American College of Obstetricians and Gynecologists (2019). Sexual Assault: ACOG Committee Opinion No. 777. Obstetrics & Gynecology, 133, 296-302.

Campbell, R. (2006). Rape Survivors’ Experiences With the Legal and Medical Systems: Do Rape Victim Advocates Make a Difference? Violence Against Women, 12, 30-45.

Campbell, R., Bybee, D., Townsend, S.M., Shawn, J., Karim, N., & Markowitz, J. (2014). The Impact of Sexual Assault Nurse Examiner (SANE) Programs on Criminal Justice Case Outcomes: A Multisite Replication Study. Violence Against Women, 20 (5), 607-625.

Campbell, R., Patterson, D., & Bybee, D. (2012). Prosecution of Adult Sexual Assault Cases: A Longitudinal Analysis of the Impact of a Sexual Assault Nurse Examiner Program. Violence Against Women, 18 (2), 223-244.

Crandall, C. & Helitzer, D. (2003). Impact Evaluation of a Sexual Assault Nurse Examiner (SANE) Program. Washington, DC: National Institute of Justice, US Department of Justice.

DuMont, J., White, D., & McGregor, M.J. (2009). Investigating the Medical Forensic Examination From the Perspectives of Sexually Assaulted Women. Social Science & Medicine, 68, 774-780.

Wasco, S.M., Campbell, R., Barnes, H., & Ahrens, C.E. (1999). Rape Crisis Centers: Shaping Survivors’ Experiences With Community Systems Following Sexual Assault. Paper presented at the biennial conference of the Society for Community Research and Action, New Haven, CT.

Does VAWA require communities to offer anonymous reporting?

One area of frequent confusion is the mistaken belief that VAWA requires communities to offer anonymous evidence collection and storage. This is not the case. As described in the Frequently Asked Questions (FAQs) about STOP Formula Grants published by the US Department of Justice, Office on Violence Against Women (OVW):

States are not required to institute anonymous reporting. Some states are instituting it voluntarily. Under VAWA 2005, states are only required to ensure that a victim receives access to a forensic examination free of charge regardless of whether the victim chooses to report a sexual assault (for any reason) to law enforcement or cooperate with the criminal justice system.

In other words, anonymity is not required in order to meet the “letter of the law” for VAWA forensic compliance. However, it can be used to achieve the “spirit of the law,” by increasing victims’ access to a medical forensic exam.

For more information, please see two Online Training Institute (OLTI) modules: (1) The Earthquake in Sexual Assault Response: Implementing VAWA Forensic Compliance and (2) Opening Doors: Alternative Reporting Options for Sexual Assault Victims.

When victims have a medical forensic examination, but they aren’t sure about reporting, should they be required to talk with a law enforcement officer?

No. When victims have a medical forensic exam, but they have not (yet) decided to talk with law enforcement or participate in an investigation, some communities have a practice of allowing officers to make personal contact with the victim, so they can introduce themselves, offer their services, and confirm the victim’s non-participation.

It is easy to understand why officers might want this type of contact, because it gives them a chance to establish rapport with victims, and ensure the information about reporting options has been presented fairly. They can also demonstrate their competence and compassion for victims. It can be frustrating for officers to feel “shut out” of the process, especially if their law enforcement agency pays for the costs of a forensic medical examination.

Yet the forensic compliance provisions of the Violence Against Women Act (VAWA) are clear that sexual assault victims must have access to a medical forensic exam without requiring them to “cooperate with law enforcement” or “participate in the criminal justice system.” If victims are willing to talk with an officer, this can provide an opportunity for the officer to make contact with the victim and offer information. But, if victims are not willing to talk with an officer, they should never be forced to.

For more information, please see two Online Training Institute (OLTI) modules: (1) The Earthquake in Sexual Assault Response: Implementing VAWA Forensic Compliance and (2) Opening Doors: Alternative Reporting Options for Sexual Assault Victims.

When a health care provider is required to report a sexual assault to law enforcement, does this mean the victim is required to speak with an officer?

Again, no. When a health care professional is mandated by law to report a suspected sexual assault or injury to law enforcement, it must be clear that victims do not have the option of deciding whether this report will be made. The report is legally mandated.

However, victims do get to decide whether they want to talk with an officer or provide any information to law enforcement in connection with the report. In other words, just because a mandated report is filed, this does not mean the victim is required to personally talk with an officer. This would be inconsistent with VAWA forensic compliance provisions, which require that sexual assault victims have access to a medical forensic exam without requiring them to participate in the criminal justice process; talking with law enforcement would constitute such required “participation.”

For more information, please see two Online Training Institute (OLTI) modules: (1) The Earthquake in Sexual Assault Response: Implementing VAWA Forensic Compliance and (2) Opening Doors: Alternative Reporting Options for Sexual Assault Victims.