Abstract
The importance of research-informed practice for the field of sexual assault has been stressed by academics and practitioners alike. However, there are few examples of researcher–practitioner partnerships in the literature, therefore providing minimal guidance for this process. This article describes a researcher–practitioner partnership that was successful in using evaluation data to guide practice and policy decisions regarding the development and implementation of a new sexual assault kit for the state of Michigan. Cousins’s practical participatory evaluation theory was used as the guiding framework for the evaluation. Data collection methods included focus groups with practitioners from five, regionally dispersed health care settings in Michigan, and surveys with forensic scientists throughout the state’s regional laboratory system. This case study highlights how researchers and practitioners worked together for data collection, analysis, and dissemination to support research-informed practice in this state. Lessons learned and future recommendations for forming researcher–practitioner partnerships to improve the response to sexual assault are discussed1.
Sexual assault is a pervasive problem, as national epidemiological data suggest one in five women will be sexually assaulted in their lifetime (Black et al., 2011; Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007; Tjaden & Thoennes, 2006). Following this traumatic experience, survivors may choose to access services from the criminal justice and/or medical systems (Campbell, 2008; Clay-Warner & McMahon-Howard, 2009; Du Mont, White, & McGregor, 2009). Regardless of which system victims encounter first (legal or medical), the interdependent nature of these services will likely result in contact with both systems; if presenting at the hospital, survivors are often strongly encouraged to report to police, and if filing a police report, survivors are often transported to a hospital for health care and forensic evidence collection (Martin, 2005). In fact, it is the medical forensic exam (MFE) that frequently dominates victims’ post-assault help-seeking experiences, with a particular focus on the sexual assault kit (SAK) (Martin, 2005). The MFE includes the collection of the patient’s clothing, a complete head-to-toe physical examination; a visual assessment of the genitals for trauma; specimen collection from body surfaces such as skin, hair, nail clippings, and points of contact with the perpetrator; and blood draw and urine samples for drug analysis (Campbell, Patterson, & Lichty, 2005; U.S. Department of Justice, Office on Violence Against Women, 2013). The SAK is a major component of the MFE as it provides step-by-step instructions and necessary equipment (e.g., swabs, envelopes) 2 for the collection of forensic evidence.
The SAK used in the state of Michigan had not been updated since the 1980s, which was concerning given the key role the SAK can have in a criminal justice system investigation and prosecution (see, for example, Strom & Hickman, 2010). As part of several statewide initiatives to improve care for sexual assault survivors and to institute evidence-based practices (Sexual Assault Resource Analysis [SARA] Project (PI: Campbell, R.), 2009, 2010, 2011), state leaders convened a collaborative working team to develop a new SAK. Recognizing the need for research-informed practice, a team of researchers from Michigan State University was asked to evaluate the efficacy of the newly redesigned SAK. State partners agreed to produce a limited number of newly redesigned SAKs to be used on a pilot basis for evaluation purposes. The evaluation findings would then be used to inform the final revisions of the SAK prior to its statewide dissemination. The purpose of this article is to describe this practitioner-focused, research-informed collaborative project and to showcase how evaluation theory was used to guide key decisions made throughout the process. Before presenting this case study example, we will provide a brief review of the literature on the “science–practice gap” and how it manifests in sexual assault research and services. Then, we will present researcher–practitioner partnerships as one way of attending to this science–practice gap and acknowledge the dearth of examples and case studies in the current literature on forming and implementing these partnerships.
The need for research-informed practice in the response to sexual assault has recently received significant attention (see Backes, 2013; Koss, White, & Kazdin, 2011; Office for Victims of Crime [OVC], 2013; U.S. Department of Justice, 2011). The OVC released a report in 2013 documenting the “urgent need to expand the knowledge base . . . about effective response” to sexual assault and identified “research, development of evidence-based practices, and program evaluation as the foundation” of this knowledge, and “of successful victim services policy and practice” (p. 1). The OVC was not alone in identifying the need for research and evaluation to inform sexual assault services. The National Institute of Justice (NIJ) also prioritized “creating a cumulative knowledge base” through “supporting research grounded in science and theory” (Backes, 2013, p. 748) to have a better understanding of sexual victimization and also to improve the response for survivors. Both OVC and NIJ noted the substantial “science–practice gap” in the community response to sexual assault: Science could be providing empirically informed data and resources to improve practice, but practice continues to operate independently from scientific research and scholarship (see also Kazdin, 2008; Miller & Shinn, 2005; Wandersman, 2003). In fact, Koss et al. (2011), in reviewing sexual assault services, found that the majority of programs and interventions have not been adequately evaluated. So although services may be available to survivors of sexual violence, it is frequently unknown whether these services are fulfilling their intended purpose.
Both OVC (2013) and NIJ (Backes, 2013) recommend the formation of researcher–practitioner partnerships as one way to close this gap. These collaborations allow for researchers to develop a deeper understanding of the needs and perspectives of community practitioners while also allowing practitioners to be involved in framing research questions so that the resulting data are, in fact, policy-relevant and useful (McEwen, 2003; T. P. Sullivan, McPartland, & Fisher, 2013; Wandersman et al., 2008). In addition, community practitioners may be more likely to adopt and use the products of the research as they are more relevant to the community and feel a sense of ownership in the findings (Amo & Cousins, 2007; Patton, 2008).
There are numerous published resources on strategies for creating research–practitioner partnerships in the community response to sexual violence (for example, see Davidson & Bowen, 2011). However, this literature tells how to form these partnerships, but does not show how it is actually done in practice. In other words, researchers have offered numerous insights into what should be done to form and be successful in operating researcher–practitioner partnerships and why, but case studies of what has actually been done—and to what successes—are generally lacking (cf. Busch-Armendariz, Johnson, Buel, & Lungwitz, 2011; M. Sullivan, Bhuyan, Senturia, Shiu-Thornton, & Ciske, 2005). Accordingly, if researcher–practitioner partnerships are to be a possible solution for addressing the science–practice gap, additional illustrative examples and case studies are warranted to model what this process looks like in action and to provide lessons learned and recommendations from these efforts.
A Multidisciplinary Approach: Using Evaluation Theory to Guide the Researcher–Practitioner Partnership Process
Before presenting the current case study, it is essential to first identify the framework that guided the evaluation and collaborative process. The field of evaluation has developed an array of theories to guide evaluation decision making from initial concept development through dissemination and use of the findings. Evaluation theories do not attempt to explain substantive phenomena by defining the relationships between related constructs; instead, “evaluation theories are intended to provide evaluators with the bases for making the myriad of decisions that are part of designing and conducting an evaluation” (Miller, 2010, p. 390). Cousins’s practical participatory evaluation (P-PE) theory is one such model. In general, participatory evaluation is a collaborative process among individuals who have a stake in the evaluand (i.e., that which is being evaluated; Amo & Cousins, 2007; Cousins & Whitmore, 1998), and in particular, Cousins’s P-PE theory is one variation that emphasizes the importance of evaluation use (Amo & Cousins, 2007; Cousins & Whitmore, 1998). P-PE was selected as the guiding framework for the Michigan pilot SAK evaluation because of its focus on collaborative, participatory processes that aid in the development and support of researcher–practitioner partnerships. P-PE also emphasizes the use of evaluation findings to improve practice.
P-PE’s goals of practicality and use call for stakeholder participation from multiple groups to facilitate program, policy, and/or organizational decision making (Cousins & Whitmore, 1998). Stakeholders are typically defined as individuals with a vested interest in the evaluand (see Cousins & Whitmore, 1998, for a discussion). However, P-PE is flexible and maintains that stakeholder involvement may differ across projects with regard to who has control of the evaluation process: Decisions may lie entirely with the evaluator, or with the practitioners, or somewhere in between. Projects may differ in stakeholder selection: The evaluation may include any and all stakeholders with ties to the evaluand, or may be restricted to a select set of primary users. Finally, P-PE projects may differ in depth of participation: Stakeholders may act only as consultants with no actual decision-making power or responsibility, or they may play an essential role in all aspects of the evaluation. These dimensions are certainly related, but they can also be considered independent of one another (see Cousins & Whitmore, 1998). Wherein a specific project lies on each of these continua should be determined based on what will maximize use of the evaluation findings and process.
In this researcher–practitioner partnership, the research/evaluation team was tasked by state funders to “design and implement a statewide, multi-site evaluation on the use of the new sexual assault kit (SAK) to inform the development of a new statewide sexual assault protocol and improve the kit contents in the future.” This objective placed the control of the evaluation process primarily with the evaluation team. The evaluation team drew on state agency stakeholders to understand how the new kit would be used across the state. Then, the evaluation team constructed an evaluation proposal that briefly outlined the design. 3 Once the proposal was approved by state partners, the evaluators maintained key decision making throughout the evaluation and elicited feedback from community partners throughout the process. Specifically, in terms of stakeholder selection, a select set of primary users including a sample of medical providers and crime lab personnel, as well as state policy makers, were active in the evaluative process. The evaluators chose to focus on a limited number of stakeholders because of the time-sensitive nature of the project. In addition, relatively few individuals are active in the response to sexual assault; it was important to not overtax this community by asking all stakeholders to be active in the evaluation. 4 Finally, stakeholder’s depth of participation varied; medical providers and crime lab personnel were purposively selected to provide expert consultation that could best inform evaluation findings, ultimately promoting use whereas state policy makers were responsible for key decision making leading up to and including statewide dissemination of the new SAK.
Our primary goal was to produce findings on the usability of the newly redesigned SAK for both medical providers conducting sexual assault forensic exams and for forensic laboratory personnel processing and analyzing the SAK contents. We needed to assess whether the pilot SAK was user friendly, efficient, and appropriate for experienced and new practitioners alike who would be using it to conduct a sexual assault MFE (i.e., medical providers) or analyzing its contents post collection (i.e., forensic lab personnel). We also needed to know ways in which the pilot SAK could be improved—what in the pilot SAK is working? What is not working? What else could be provided (or changed, or removed) to make the job of medical providers and lab personnel easier, more efficient, and more accurate? These findings could then be used to inform policy decision making, specifically the revision of the pilot SAK for statewide dissemination. Of utmost importance was that the findings attended to the specific information needs of the practitioners responsible for the creation and implementation of the new SAK (e.g., adequate detail of recommended changes) and that the findings were amenable to immediate and direct use in guiding this statewide change effort (i.e., presented in an easy-to-understand way).
Evaluating the Pilot SAK: Developing an Evaluation Design
Michigan is a geographically diverse state with its smallest county encompassing only 0.1% of the state’s population (Alger county had 9,601 residents in 2010) and its largest county encompassing nearly 20% of the state’s population (Wayne county had 1,820,584 residents in 2010; U.S. Census Bureau, 2010). Accordingly, it was important to represent urban, rural, and mid-sized communities in the evaluation. 5 In addition, several different health care settings and health care providers routinely conduct MFEs with the SAK. Survivors may be treated by sexual assault nurse examiners (SANEs). SANEs are unique in that they have received specialized training in the intricacies of forensic evidence collection, expert witness testimony, and patient-centered trauma-informed crisis intervention and care (U.S. Department of Justice, Office on Violence Against Women, 2013). SANEs may provide their services in a hospital or may operate independently in a community-based setting. Alternatively, survivors may be treated by traditional hospital emergency departments by physicians or physician assistants. Therefore, to understand the usability, utility, and quality of the new SAK, it was necessary to pilot test it across these different community settings (i.e., urban, rural, or mid-sized), health care settings (i.e., hospital- or community-based), and health care providers (i.e., SANE or non-SANE). The evaluation team, in conjunction with our state partners, purposively selected five sites throughout Michigan. The selected sites used the pilot SAK kits from early June 2011 through August 2011 (i.e., the newly designed, pilot SAK was used for any/all sexual assault patients presenting for care and consenting to forensic evidence collection). Pertinent contextual information regarding the five selected sites is presented in Table 1.
Contextual Elements of Selected Medical Sites.
Note. SANE = Sexual assault nurse examiner.
The Michigan State Police has seven regional crime labs throughout the state, and any of those could have received a completed pilot SAK from one of the five selected medical sites that participated in the evaluation. In the end, six of the seven labs received a pilot SAK, and therefore were collaborative data collection sites for this evaluation. 6 During the two months of pilot SAK implementation at the five selected medical sites, the crime labs were asked to recognize all incoming pilot kits (identified with a red dot), analyze the kits according to standard procedures, and complete a lab tracking survey tool for each pilot SAK analyzed (described below). The tracking tool documented what was collected in each SAK, whether it was collected appropriately, and if evidence was not collected appropriately, what was the nature of the problem (e.g., collected when it was unnecessary, not collected when it was necessary, too many swabs used per collection site).
After utilizing the pilot kits for two months, focus groups were conducted with each of the five medical sites (see Figure 1 for the medical provider focus group script). During these focus groups, the facilitator asked questions regarding the number of MFEs conducted with the new kit at each site, the medical providers’ overall impression of the kit, the order of the content in the kits, the “widgets” (i.e., slides, smears, and swabs), the forms, and the instructions. The evaluators probed for information on what “worked” well in the pilot SAKs; what did not “work” so well; and what improvements could be made to improve the usability, efficiency, and accuracy of the SAK. For example, were the instructions easy to follow? Were the kit contents in a logical order? Were there enough specimen envelopes in the kit? During all focus groups, the evaluation team maintained a running transcript of the discussion and notes specific to recommended changes to the kit.

Medical provider focus group script.
In addition to the five medical provider focus groups, the evaluation team hosted one focus group with crime lab personnel (see Figure 2 for the crime lab focus group script). During this focus group, the facilitator asked questions regarding the crime lab technicians’ overall impression of the kit, the widgets, the forms, and the instructions, and relayed specific questions from the medical provider focus groups. For example, did the labeling on the exterior of the specimen envelopes provide enough information? Did the target rings on the slides provide improved samples? Were the forms filled out correctly so as to guide analysis? Again, the evaluation team maintained a running transcript and notes specific to recommended changes to the kit.

Crime lab focus group script.
Evaluating the Pilot SAK: Producing and Using the Evaluation Findings
The transcripts from each of the medical provider focus groups were reviewed to identify what health care providers felt “worked” well in the pilot SAKs and what needed to be improved. If participants reported liking something in the kit or related to the kit (i.e., it worked), their comment was identified as a segment (see Henderson & Segal, 2013 for a discussion of identifying different types of “segments” in visualizing qualitative data). Each segment included what they liked (i.e., the item), and what they liked about it (e.g., it was easier to use, it was an improvement over the previous design, it sped up the process). All segments were then placed into a spreadsheet organized by item and by site. For example, all segments related to the forensic evidence collection swab envelopes were grouped together. Figure 3 provides a sample of this spreadsheet. This visual representation of the data allowed for a comprehensive understanding of what kit items were liked within and across sites. The same process of data coding and visualization was used to analyze the transcript from the crime lab focus group.

Sample of “medical provider likes” table.
The notes on proposed changes to the kit, as well as things that medical providers did not like about the kits, were then reviewed for each medical provider focus group. Each suggested change, along with its rationale, was identified as a segment. A spreadsheet was created that listed all suggested changes from all the medical provider focus group sites. For each segment, color coding was used to indicate whether each site agreed (green shading), disagreed (red shading), or did not comment on the recommended change (no shading). If the site disagreed with the suggested change (red shading), a note was inserted with the reason for their dissent. The resulting visual representation of the data allowed for a comprehensive understanding of what was suggested by each site, agreement in suggestions across sites, disagreement in suggestions across sites, and the reason for dissent. Figure 4 provides a sample of this visualization (an “X” is used to indicate a green shaded box in the sample).

Sample of “medical provider recommended changes” table.
Similarly, the notes on proposed changes from the crime lab focus group were reviewed and a spreadsheet was created that listed all segments of suggested changes from all crime lab sites. 7 Again, for each segment, color coding was used to indicate convergence (green shading), divergence (red shading; with an explanation), and where there was no comment provided by the site (no shading). In addition, the lab tracking sheets were reviewed and found to confirm the findings from the crime lab focus group. Figure 5 provides a sample of this visualization (an “X” is used to indicate a green shaded box in the sample).

Sample of “crime lab recommended changes” table.
The suggested changes provided by the medical providers and crime lab personnel were then reviewed by the evaluation team to determine whether the suggested changes should be recommended to the funder and key state partners for revision. To determine whether a suggested change should be recommended, the following criteria were used:
The review of these tiers of recommendations was an iterative process. For example, a recommendation may have been articulated by only a few sites, but was both feasible and practical and so was included. Alternatively, a recommendation may have been articulated by most sites, but was not feasible or practical, so was not included. For example, only one medical site (Tier 2 requirement) recommended that the envelope labeling require the medical provider to indicate which side of the body a sample was taken from (i.e., left vs. right) and the specific location of the body (e.g., neck, breast, arm). However, this recommendation was logical and aligned with best practices (Tier 1), as well as was feasible (Tier 3), so it was included as a final recommendation. This review process resulted in a final list of combined recommended changes from the medical provider and crime lab personnel focus groups (see Figure 6). The tables of medical provider likes, medical provider recommendations, crime lab recommendations, and combined recommendations were all shared with the full collaborative stakeholder team so as to provide all available information that could assist in revising the SAK.

Sample of “combined recommended changes” table.
The primary aim of the pilot SAK evaluation was to determine the usability of the SAK across medical providers conducting the MFE and crime lab personnel analyzing the contents of the SAK. The evaluators set out to identify what in the pilot SAK “worked,” what did not “work” so well and needed to be removed or revised, and what was missing from the SAK that would make it easier to use, more efficient, and more accurate on statewide dissemination. Providing detailed information on the specific recommendations from this evaluation is beyond the scope of this article, but in general, the majority of recommendations focused on changes to be made to the forms in the SAK (e.g., changes in working order of material, omission of needed information, inclusion of unnecessary information), followed by changes to be made to instructions in the SAK (e.g., changes in the order of the steps given, providing more explicit instruction on some steps); other recommended changes, although less abundant, related to the “widgets” or SAK accessories (e.g., changes to labeling on the envelopes, changes in the size or different items) and the overall organization of the SAK (e.g., order of materials in the SAK, size of the SAK).
The key outcome we wish to highlight in this article is the use of the evaluation findings (rather than the substantive changes to the kit itself). An evaluation has its value in its findings being used; “the original promise of evaluation was that it would point the way to effective programming” (Patton, 2008, p. 32). Cousins’s P-PE was the guiding framework for this evaluation and emphasizes the importance of use with regard to the evaluation findings and the evaluation process (Amo & Cousins, 2007; Cousins & Whitmore, 1998). The present evaluation resulted in both. The greatest evidence of use was in terms of the evaluation findings being put into practice directly. As hoped and intended, key state partners revised the SAK in accordance with the evaluation recommendations prior to statewide implementation. Indeed, one state agency partner described the evaluation as a “roadmap of exactly what we needed to fix, so we fixed it.” This direct use and implementation of the evaluation findings into practice attends to the recent call for more research and evaluation to inform sexual assault services (Backes, 2013; Koss et al., 2011; OVC, 2013; U.S. Department of Justice, 2011).
Bridging the science–practice gap and encouraging future researcher–practitioner partnerships to produce research-informed practice, however, may include more than just direct use of the evaluation findings, but also a greater understanding of the evaluation process and its value. This too was evidenced in this evaluation as multiple state agency partners expressed how they now saw data in a different way, how “good data can help us make better decisions,” and “how data should be informing all the major decisions we make in victim services.” Furthermore, this project catalyzed some stakeholders to think about their work on a more macro level and consider, “what are we putting survivors through when they have an exam? Is each piece necessary?” This reflection on survivor experiences with the SAK then informed changes to the kit. For example, stakeholders engaged in extended conversation regarding the utility of combing and plucking pubic hairs, in relation to the discomfort this may cause the patient. Ultimately, stakeholders decided to include collection envelopes in the SAK for pubic hair combings and reference samples (i.e., plucked pubic hairs) but provided explicit instruction that hair combing and plucking were optional and provided extensive detail on specific circumstances when it may be needed.
Looking Forward: Lessons Learned
This evaluation utilized a researcher–practitioner partnership so as to produce empirical evaluation findings that could, and did, inform on-the-ground policy and practice. Through this process, the evaluators were able to see their work put to immediate use whereas practitioners (re)realized the benefit in having research evidence for the work they do. This project evidences the effectiveness of forming collaborative efforts between researchers and practitioners to produce science-informed practice and practice-informed science as the researchers adjusted their efforts based on the needs of the practitioners. This project also culminated in lessons learned to inform future researcher–practitioner partnerships in the field of sexual violence.
Identify and Commit to a Guiding Framework or Orientation
Cousins’s P-PE was selected to guide this researcher–practitioner partnership and proved very useful. When the evaluation team reached a crossroad in deciding, for example, who to involve in the evaluation and to what degree, P-PE provided guidance. Indeed, this is the purpose of evaluation theory—to provide guidance for decision making throughout the evaluation process (see Miller, 2010). When faced with an ethical or methodological dilemma, members of the researcher–practitioner partnership can rely on their pre-selected theory, orientation, or model to provide guidance on how to move forward. For example, the evaluation team in this research–practitioner partnership initially drafted two proposals for state partners—one that included survivors as a key stakeholder group and another that did not. Survivors would have been an important stakeholder group to elicit feedback from for the evaluation as they are directly affected by the kit contents and process. However, the evaluation was under a strict timeline as a date for statewide dissemination of the new SAK was already set. If the evaluation findings were not complete prior to this date, they would not be able to inform revisions prior to the new SAK’s release. Recruiting and interviewing survivors as part of this evaluation would have extended the length of time needed to complete the evaluation and the findings would likely not have been completed by the SAK release deadline, negating their use. P-PE supports collaborative processes (i.e., involving survivors), but not at the expense of use (i.e., producing evaluation findings prior to the release date of the new SAK). The evaluation team used P-PE to guide their decision to not include survivors in the pilot SAK evaluation. 8
Without having selected a guiding framework upfront, these decisions may have been much more difficult to make. It is important to select a guiding framework that is flexible and meets the needs of the particular project and stakeholders. Finally, it is important to note that the selected guiding framework in principle, although not always in name, is explicit to all stakeholders involved. For example, in evaluating the new SAK in Michigan, all members of the researcher–practitioner partnership knew the high value placed on collaboration and use, although they could not name or articulate the tenants of Cousins’s P-PE. Community partners do not need to be trained in the intricacies of the selected theory, 9 but need to know how it is being applied to the collaborative process.
Be Aware of Other Community Change Efforts Occupying Stakeholder’s Time
In most communities, the same key players are frequently asked to be involved in an array of change efforts that monopolize varying amounts of their time and require varying degrees of their energy and attention. In many ways, community partners can be thought of as valuable limited resources, so it is important to determine whether there are other community change efforts underway that may be tapping into and depleting this valuable resource. For example, if community partners have been investing a great deal of time into another change effort to improve the community response to sexual assault, they may not be able to commit fully to your initiative. Their reluctance, hesitance, or delay in response may be because they are simply “spread too thin.” For example, although this researcher–practitioner partnership was working on the pilot SAK evaluation, many of the involved stakeholders were also part of an action research project investigating and responding to a stockpile of unsubmitted SAKs located in Detroit (see Campbell, Fehler-Cabral, Shaw, Horsford, & Feeney, 2014; Hulett, 2011). Knowledge of this separate, yet related, project informed how and when the evaluation team made requests of involved stakeholders so as to not overtax participating practitioners. We hope that this project and lessons learned from these efforts can serve as a blueprint for other communities hoping to implement similar research efforts. In doing so, we can begin to understand how “research is the road, not the roadblock, to victim-centered practice and policy” (OVC, 2013, p. vi).
Footnotes
Authors’ Note
Opinions, findings, and conclusions or recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect those of the Michigan Department of Community Health, Michigan Domestic and Sexual Violence Prevention and Treatment Board, or the U.S. Department of Justice.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by Grant 2010-VA-GX-0080 awarded by the Office for Victims of Crime, U.S. Department of Justice to the Michigan Department of Community Health. The production of the new Michigan sexual assault kits was supported by Grant 2009-EF-S6-0053 awarded by the Office on Violence Against Women, U.S. Department of Justice to the Michigan Domestic and Sexual Violence Prevention and Treatment Board.
1.
This research was conducted prior to the first author’s affiliation with the National Institute of Justice. This project was NOT supported by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect those of the Department of Justice.
