Contested Discourses in Multidisciplinary Sexual Assault Response Teams (SARTs)

The Role of Discourse

One of the challenges for teams in health and human service contexts is finding productive ways to manage disciplinary boundaries and capitalize on the knowledge bases of different fields of practice (Opie, 2000). Each rape responder centers certain aspects of the victim’s experience and in doing so draws on particular theoretical frameworks and bodies of knowledge that are influenced by organizational and professional contexts (Martin, 2005). For example, SANEs attend to victims’ health and well-being pursuant to their identity as nurses and their training in the medical field. However, no matter how well theorized and researched, each field’s perspective is incomplete. Collaborative teamwork offers an opportunity to pool different perspectives and learn from the knowledge brought by each discipline, but only if responders find ways to engage deeply and respectfully with their differences (Opie, 2000). Research on conflict in SARTs suggests that engaging across disciplinary boundaries is actually fraught with difficulty despite the unifying discourse about working together in a team.

In this study, we focused on the way SART members described the process of engaging with one another across disciplinary boundaries. We explored how SART members described the team, themselves, and others. We paid close attention to contested discourses because these represent domains where SART members may not have achieved the ideal of engaging productively with disciplinary differences. Through exploring these contested discourses, we sought to gain insight into important barriers to the process of cross-disciplinary engagement.

Discourses are shared systems of ideas and understandings about the world or about a particular phenomenon (Fairclough, 2003; Gee, 2005). Multiple discourses develop about a phenomenon, but only certain discourses become situated as dominant. This process occurs through the medium of language and within contexts of power, both the interpersonal power embedded in the relationships of those involved in the interaction and the power of the ideas and discourses themselves (Gee, 2005). We drew on discourse analysis to explore the ways that language was used to convey and negotiate meaning and how power shaped that process. Within discourse analysis, the focus is on language-in-action, or how language is used to both reflect and construct reality (Gee, 2005). Analysis, for example, might explore how language is used to give meaning or value, signify an identity or perspective, or to privilege certain knowledge.

Scholars suggest that challenges in the process of interdisciplinary engagement can arise as a result of the history of specialization in professional fields (Hall, 2005). As fields of practice developed, they adopted differing theoretical orientations, values, practices, and cultures, which are then transmitted through education and training programs. The service systems are also differentially situated in terms of power, access to resources, and professional authority, which creates a situation in which each field attempts to legitimize its unique ideology and protect its turf from incursion (Hall, 2005; Jones, 2006). Hardy and Phillips (1998) explored the various ways in which power, whether in the form of formal authority, control of resources, or discursive legitimacy, was used to shape interorganizational communication. Power influenced how issues were defined and also operated to marginalize less dominant and more threatening perspectives. The services systems involved in SARTs are not equal in their power or status (Martin, 2005). As a result, the knowledge and perspectives of some team members may be discursively discounted while others are given greater weight.

In this study, we started with the assumption that the work of interdisciplinary engagement is carried out through discursive processes. If, for example, a core component of interdisciplinary engagement is the need to productively manage differences in professional orientation, statutory obligations, and power, SART members’ discursive constructions of themselves and others both perform and reflect their negotiation of these differences. In this study, we explored how SART members described the process of engaging across disciplinary differences, with particular attention to contested discourses of interdisciplinary engagement.

Data Collection

This study used qualitative methods because the research questions focused on language, situated meaning, and the discursive processes of interdisciplinary engagement in SARTs, all topics that are best explored through open-ended data collection and analysis methods. The first author conducted semi-structured interviews with providers involved in systematic efforts to coordinate service delivery among rape crisis centers, health care, and law enforcement agencies consistent with the idea of SARTs. The study was approved by the University of Washington Institutional Review Board.

Theoretical, purposive sampling was used to identify potential interviewees, with particular attention paid to ensuring approximately equal representation from the three primary SART disciplines of criminal justice, health care, and rape crisis advocacy. Potential interviewees were located by reviewing state and national resources related to SARTs, including selected state lists of SARTs, rape crisis centers, and SANE programs and the list of presenters for the National SART Training Conference. A small number of interviewees were identified by other participants as potential contacts. Identified individuals were contacted by email with details about the study. Those interested contacted the first author, who provided informed consent materials and scheduled a time for the interview. This strategy resulted in 24 interviews including seven with health care professionals (mostly forensic examiners like SANEs), seven with criminal justice professionals (primarily law enforcement officers), and 10 advocates employed by rape crisis centers. To increase our ability to triangulate responses, we attempted to recruit multiple rape responders from the same SART; in four communities, we were able to recruit multiple participants. A portion of the sample (n = 11) not only had experience working within a SART but also served in a role providing technical assistance and support to SARTs on a state or national level. Almost all the interviewees were female (n = 23). This is consistent with the gendered composition of rape advocates and forensic nurses but is less reflective of the overall gendered composition of law enforcement (Martin, 2005). The sample was located in primarily urban and suburban contexts in 11 states within the United States.

Most interviews (n = 21) were conducted by telephone with the remaining (n = 3) conducted in person. All interviews were recorded with permission using a digital audio recorder. The semi-structured interview guide used focused on the following topics: SART structure and context and the perceived benefits and challenges of SART. Examples of interview guide questions included, “Can you tell me about an incident where you experienced or observed tensions or conflict among members of the SART team?” and “Why do you think there are conflicts in the team?” Prompts and follow-up questions were used to probe deeper and elicit further detail. Interviews ranged in length from 45 to 110 min.

Data Analysis

All interviews were transcribed, checked for accuracy, and entered into Atlas.ti (v.6.0) for the purposes of data management and retrieval. The first author, in consultation with the research team, reviewed the transcripts multiple times, developed codes that reflected emerging concepts related to the way respondents described and understood conflict within SARTs, and engaged in extensive memo writing to record and track the evolving analysis. As concepts were refined through this process, multiple data matrices (using Excel 2010) were created. These matrices were used to systematically explore how concepts emerged within and across the data sources (Ayres, Kavanaugh, & Knafl, 2003; LeGreco & Tracy, 2009; Miles & Huberman, 1994). For example, one matrix listed each discussion of conflict, organized in rows by respondent, color coded by the respondent’s profession, and paired with contextual information about the respondent and the discursive content of their conflict-talk in columns. Relevant passages in Atlas.ti were marked with codes that reflected the matrix categories to facilitate an iterative process of developing, refining, and checking emergent concepts. The matrix process provided a systematic way to compare and contrast the concepts across the full data set and to check interpretations against the data. The matrix allowed the authors to review all the discussions of conflict by looking within a column, to sort by discursive characteristics of the conflict-talk using the codes developed, and to look for patterns within individuals by looking across rows and within profession by referencing the color coding.

Authority

One of the discursively contested domains centered on the issue of authority: Who had the right to name the goals of the team and to define appropriate roles and behavior for each of the fields represented on SARTs? Negotiating authority occurred within a context of differing structural access to resources and distinct disciplinary orientations to power.

Assertions of authority within SARTs privileged certain actors and created systematic inequities between the disciplines. For example, one law enforcement officer claimed, “The most important piece of your SART is your law enforcement agency, because without them nothing else is going to be able to progress” (21). By placing law enforcement as the central and most important discipline, the officer discursively privileged the work of the criminal justice system and claimed the authority to elevate investigative work as a primary goal for the whole SART.

Some interviewees indicated that if the work of some responders is privileged, other disciplines were disadvantaged. A nurse offered a critique about how the claim to authority differs for advocates and nurses:

I would say your prosecutor and your sheriff . . . hold the power to make or totally break you . . . Advocacy is really at a disadvantage because they’re not always invited to the table, they’re not automatically going to be there. And nursing may not automatically be there either if law enforcement feels the [Emergency Room] physicians are doing an adequate job. (12)

This nurse suggested that the criminal justice system held greater power to define how other disciplines responded to rape victims and to define the work flow of a coordinated response. Another participant from an advocacy background echoed the concern that advocates, in particular, are structurally disadvantaged by saying,

On a very basic level most advocates just realize “hey, we don’t have a lot of explicit power in this situation, we have to have the cooperation of other people.” Unfortunately some of those other disciplines, it’s less obvious [that they need to cooperate] . . . there are times that they can stonewall and in theory still get their job done. (13)

Participants described attempts to direct the actions of other responders under the guise of enforcing professional autonomy or protecting one’s “turf.” As one advocate described, “When I first came into this position, our advocates and the prosecutor’s office had that sort of territorial battle going on around whose client this was, who it belongs to” (13). The advocate illustrated that SART members jockey for authority and control over the process of responding to victims. The focus on contesting turf boundaries may explain the advocate’s depersonalization of the victim, as indicated by the ownership metaphor and the term it. Turf struggles reflected tensions between the disciplines about the ideal response to sexual assault victims and each service system’s role in that response. One nurse explained her frustration at those in other fields who tried to direct her work:

Whether or not something that I write [in medical records] may impact a possible trial in a very small percentage of the cases is not a concern that I have when I’m caring in the acute phase of the patient. And I think that that’s very difficult for some non-medical people to understand, like how can I—“how can you write down that they have a history of mental problems or substance abuse? It could hurt them in court.” Well I feel like understanding that my role as a health care professional has to include assessing for those things is really important to all the team members and also being respectful of that and understanding that you’re not going to tell me that I can’t write something down in the medical record. (22)

The nurse rejects the idea that rape responders from other fields have the authority to direct the practice of nurses in terms of their focus of care and the documentation they create.

Another kind of turf struggle arose when a responder was perceived as overstepping the boundaries of their role. For example, a law enforcement officer described the consequences of advocates going outside what his colleagues perceived to be the appropriate role for advocates:

We have one advocate that would always say “hey, can you give this case to [well-liked detective]?” Well, that’s not her job to do that. When you start shopping around detectives, it pisses off the other detectives because the sergeant’s like, “What? My lead detective ain’t good enough?” Well, you know, you’re going to get into that conversation and that’s not good. (18)

The advocate’s effort to influence the internal function of case assignment within law enforcement was perceived as an inappropriate boundary incursion. Similarly, a nurse described an incident in which she perceived an advocate as overstepping her role:

She questioned what the nurse was doing in front of the victim, so I brought that up to the gal in charge of the advocates at the rape crisis center. I said, “I don’t need her saying, ‘Well, aren’t you going to do this? Or don’t you need to do this?’ You’re there to support the victim. You’re not there to direct how the nurse does whatever the nurse does.” (7)

In these quotations, law enforcement and nurses claimed the authority to admonish advocates for overstepping boundaries. These boundaries, of course, are socially constructed, and in these circumstances, advocates may have felt that they were enacting their own professional responsibilities to advocate that victims received the best services possible.

Other structural components of authority derive from the very way that disciplines approach their work. An advocate described the authority law enforcement commanded by recalling a conversation she had with an officer who explained,

You know, police officers are taught to take charge and be in charge. They have a badge. They have a gun. Someone at a crime scene or at an accident or whatever has to take charge and that’s what we’re taught to do . . . To get into a pissing match with a law enforcement officer about who’s in charge is going to get you nowhere. (9)

The ability to claim authority and take charge is, in fact, an important skill for officers who may encounter tense, chaotic situations requiring them to act quickly to maintain order and protect the public. Advocates, however, defer authority to the victim to affirm and support the victim’s right to have power over decisions about her own healing. These opposing orientations to authority are deeply rooted in professional norms and may contribute to an unequal playing field when disciplines come together in the context of a SART.

Expertise

Interviewees used language to construct some disciplines as lacking expertise to justify particular conceptions of how SARTs should be structured and operated. Advocates and nurses questioned the rape-specific expertise of law enforcement officers. Law enforcement and nurses, to a lesser degree, expressed reservations about the experience and skill of advocates. Neither advocates nor law enforcement questioned nurses’ expertise. Teamwork-specific expertise was also discussed, specifically focusing on whether team members had an understanding of each discipline’s role in responding to rape.

Both advocates and nurses positioned law enforcement officers as often lacking rape-specific knowledge and expertise. They described feeling as if law enforcement officers did not understand the dynamics of rape, nor possess sufficient skills for investigating rape, and therefore engaged in troubling, victim-blaming behavior. One advocate explained, “Often, our initial contact isn’t with the detective at all, it’s with a patrol officer, who lacks some of the skills and training that detectives who work these cases all the time have” (4). This lack of confidence in the expertise of patrol officers prompted advocates in this community to develop a practice of steering victims away from making contact with the police until the advocate could arrange a meeting with a more skilled detective. Although on the surface, the advocate’s avoidance of patrol officers may seem relatively benign, it could undermine law enforcement’s relationship with the victim, hinder law enforcement’s ability to pursue an investigation in a timely manner, strain relationships between advocate organizations and the police, and not address the underlying concerns about patrol officers’ level of skill and training in interviewing rape victims.

Attributions about lack of expertise sometimes posed more direct challenges to coordinating services for a victim. A nurse explained her outrage at witnessing a particularly distressing interaction stemming from an officer’s lack of rape-specific experience and expertise:

This was not an interview . . . this was an interrogation. I couldn’t think of an appropriate way to, like, get them out of the room, interrupt things and get them out of the room and say, “What the heck are you doing? I mean, this is totally inappropriate!” But that really kind of—it frosted my cake. I was really upset about that. (7)

The nurse continued to describe the difficulty she had figuring out how to intervene in the inappropriate behavior without damaging the overall relationship between nurses and law enforcement: “My focus is on the victim, but I don’t want to damage the relationship that our team has with the law enforcement by saying, ‘You guys are way out of line here!’” When faced with an immediate manifestation of law enforcement’s lack of rape-specific expertise and training, nurses and advocates described shifting their focus away from attending to the victim and onto managing the work of law enforcement. As an advocate stated, dealing with unskilled police officers or others “that aren’t educated on [sexual assault], that kind of puts some pressure back onto the advocates in trying to do the education while we’re in the middle of supporting a survivor” (20). The burden of providing education to responders who lack expertise, in this way, interfered with the provision of services to victims but also became an opportunity for team members to enhance their own authority through the management of unskilled responders.

Some law enforcement participants, and nurses to a lesser degree, similarly positioned advocates as lacking necessary skill and knowledge. For example, one detective said,

Most people in my office are 35+ years old. I’d say your average advocate is probably 22, 24. You have a generation gap . . . You know the cop has been on the street, been shot at and has seen some horrific things and you have someone fresh out of college . . . So I think the age difference, the experience difference, you start to get clashes. (18)

This perceived lack of life experience may be interpreted by law enforcement as a lack of professional expertise, a dynamic that is perhaps magnified by age differences and the use of volunteers as advocates in many communities. By describing advocates as young and inexperienced, some interviewees marginalized the contributions and expertise of advocates.

Advocates described feeling as if the other disciplines did not understand and value the specific knowledge and skill they had to offer victims. To counteract doubts about their expertise, advocates described feeling as if they had to prove their worth. One advocate with over 20 years of experience in the field illustrated this by saying,

Instead of seeing us as professionals in a field with lots of experience and study, they see us as just survivors of rape . . . And so that has risen its head from time to time, you’re not educated, and you’re not professionals . . . We are, I think, trying as best we can to show that we’re professionals, that we’re not just hand holders. (6)

This quotation illustrates the discursive dilemma of expertise for advocates. Certain kinds of knowledge and experiences were legitimized as expertise, such as professional training and work experience. Expertise accrued through other means, including having experienced rape, was devalued. Advocates, then, distanced themselves from the idea of the expertise derived from the experience of victimization to gain acceptance as experts in a more traditional sense.

Interviewees also discussed expertise pertaining to the process of interdisciplinary coordination. One issue that was mentioned by participants from all disciplines was whether team members understood one another’s roles. For example, one law enforcement officer said,

An advocate might think, “Okay, you’re talking to that victim, and you’re asking them, ‘Well, did you have something to drink? What were you wearing?’” And they’re thinking, “How could the police do that?” . . . And [advocates] are so anti- you know: “Why would you ask that? It doesn’t matter.” Do I know that it doesn’t matter? You’re damn right I know it doesn’t matter, but that’s the stuff you need to know to go forward with the criminal prosecution and better for me to ask them now when you’re here one-on-one than it is to have it come out in the trial and to have them torn to shreds on the stand. (16)

This officer expressed her frustration that advocates assumed she is unskilled or biased, instead of considering that the role of an officer is to collect whatever information a prosecutor might need to try the case. As this participant suggested, the SART concept requires members to have the additional expertise of being knowledgeable about the role of each team member.

Credibility

Participants suggested that another contentious element is the ability of the service providers involved in SARTs to see one another as credible sources of knowledge. One participant who facilitates training for law enforcement officers on interdisciplinary responses emphasized the importance of credibility to the success of teams:

One of the key things is getting a core nucleus that is credible in the eyes of everybody on the team [and] is credible in the eyes of their own discipline. They’re educated, they care about it [rape]. You can kill a response team by putting the wrong people on it. (24)

SART responders, however, often struggled to see one another as credible, which posed a challenge to their ability to successfully engage and coordinate across disciplinary boundaries.

Law enforcement, for example, suggested that advocates’ willingness to believe all reports of rape undermined their credibility as did their general demeanor and way of interacting with victims. One law enforcement officer questioned the credibility of advocates by contrasting law enforcement’s focus on facts with advocate’s more emotionally attuned approach:

Most cops, especially first responders, and I have been one for 13 years, [think] “Get the facts, as much as you can. Get this one over and answer the next radio call.” So they’re not going to be touchy feely. Most cops are not touchy feely. I’m not touchy feely. I’m passionate about what I do, but I still think there’s a line there you don’t cross. (18)

This officer suggested that advocates lose their credibility when they let their empathetic and emotionally attuned approach bias them in favor of victims.

Credibility is also diminished when members of a SART witness what appears to be a systematic pattern of disrespectful treatment of rape victims from another discipline. For example, when advocates and nurses witnessed what they perceived as victim-blaming behavior by police officers, they found it hard to trust that law enforcement would be unbiased in their pursuit of justice in rape cases. One advocate questioned the credibility of law enforcement when she described ongoing concerns about detectives at one local jurisdiction:

Two detectives there are horrible with victims . . . we get numerous complaints about how they treat victims because most of the time and they’ve said it publicly they believe that most of these victims are making it up. And when you’ve got a detective whose job it is to investigate who truly believes that maybe 70 to 80 percent of sexual assault claims are false you’ve got a huge problem. (14)

Although this advocate framed the conflict around a few particularly difficult detectives, other participants made clear that tension between advocates and law enforcement over whether a rape was “real” was not uncommon. Speaking from her experience working with communities across the country, an expert on the criminal justice response to rape said,

When the victim advocates in that community are seeing victim after victim after victim who aren’t even reporting to the police because they’re afraid of what will happen to them, but clearly they’ve been raped, there’s such a gap there in understanding that advocates become really protective of victims and angry with police officers for re-victimizing them and police officers see that as interference. (24)

In other words, as advocates identified systematic mistreatment of victims, they lost faith in the credibility of law enforcement. These interdisciplinary doubts about credibility posed a significant challenge to the ability of disciplines to engage meaningfully with one another.