Contested Discourses in Multidisciplinary Sexual Assault Response Teams (SARTs)

Abstract

This qualitative study explored how law enforcement officers, forensic nurses, and rape crisis advocates who are members of coordinated service delivery models such as Sexual Assault Response Teams (SARTs) describe their process of engaging with one another and managing their differences in professional orientation, statutory obligations, and power. Using semi-structured interviews with 24 SART responders including rape crisis center advocates, law enforcement, and medical personnel, we examined the ways that SART members discursively construct one another’s role in the team and how this process points to unresolved tensions that can manifest in conflict. The findings in this study indicate that interdisciplinary power was negotiated through discursive processes of establishing and questioning the relative authority of team members to dictate the work of the team, expertise in terms of knowledge and experience working in the field of rape response, and the credibility of one another as qualified experts who reliably act in victims’ and society’s best interests. Implications of these findings for understanding and preventing the emergence of conflict in SARTs are discussed.

Keywords

sexual assault support seeking intervention

Every year in the United States, 1.3 million women are raped (Black et al., 2011). Rape is a traumatic life event, which may result in a variety of health and mental health consequences for victims, such as unintended pregnancy, exposure to sexually transmitted infections (STIs), physical injuries, post-traumatic stress disorder, anxiety, and depression (Campbell, 2008; Kilpatrick, & Acierno, 2003). The experience of rape often brings victims into contact with service providers such as health care workers, mental health practitioners, and criminal justice system representatives. Therefore multiple service providers embedded in different service sectors each play a crucial role in responding to victims’ legal, medical, or emotional needs following an assault. Table 1 provides additional information about the roles of each of these service providers in responding to rape. Having numerous providers involved can make the experience of seeking help feel disjointed and confusing for victims at a time when they may be particularly vulnerable. Victims report that they are negatively affected when service delivery systems are fragmented and flawed (Campbell, 2008; Martin, 2005, Ullman, 2010).

Table 1.

Typical Roles and Organizational Contexts of SART Members.

Member^a	Role	Organization
Rape Crisis Advocate	Provide emotional support for victim. Promote victim rights. Ensure victims’ full range of needs are met. Accompany victims during forensic exams or law enforcement interviews. Provide follow-up services. May be a volunteer.^b	Rape crisis center or other community agency. Some communities also have victim advocates employed by law enforcement or prosecution agencies.^c
Sexual Assault Nurse Examiner, Forensic Medical Examiner	Assess and treat injuries. Attend to health care concerns post-assault (e.g., STDs, pregnancy). Collect evidence. Testify in court about injuries and other evidence.	Hospitals, medical centers, and occasionally by rape crisis centers or other community-based agencies that administer forensic-medical exams for victims.
Criminal Justice System: Law Enforcement (e.g., police officer, detective), Prosecutor	Investigate reports of crime. Interview victim, suspect, and witnesses. Collect evidence. File report detailing the results of the investigation. Prosecutor determines whether charges should be issued and presents case in court.	Police departments, sheriff’s office, tribal, military, campus police, etc. County or state prosecutor’s officers.

Note. SART = Sexual Assault Response Team.

Some SARTs include others on the team, including but not limited to staff from forensic laboratories, emergency medical services, child protection agencies, mental health agencies, and other social service agencies.

To provide 24-hr services, many rape crisis centers utilize volunteers, all of whom complete training requirements, typically 40 to 60 hr.

Rape crisis advocates’ interactions with victims are often protected as confidential communications, while victim advocates may be required to pass along information to law enforcement or prosecution.

The Sexual Assault Response Team (SART) model, an emerging community-level strategy for coordinating the delivery of services to victims, is predicated on the ability of providers from different fields of practice to come together, find common ground, and collaborate in their services for victims. If, however, the process of coordination is contested, teams may not be able to realize the intended benefits of using a multidisciplinary model. This study explored how SART members discursively position themselves and others in the context of interdisciplinary engagement to better understand whether these teams are able to productively manage their disciplinary differences and capitalize on the benefits of using a multidisciplinary model.

Background and Significance

Although numerous advances have improved the societal response to rape in recent decades, practitioners and researchers both point to continuing problems of inadequate services for victims. For example, conviction rates for sexual assault remain low, with only an estimated 3% to 10% of sexual assaults resulting in a conviction (Alderden & Ullman, 2012; Tjaden & Thoennes, 2008). Victims continue to report insensitive, victim-blaming, and dismissive treatment by law enforcement officers and other service personnel (Campbell, 2008; Patterson, 2011; Patterson, Greeson, & Campbell, 2009). In an ongoing effort to improve services, communities are turning to coordinated service delivery models such as SARTs (“SART Toolkit,” n.d.).

SARTs are multidisciplinary service delivery teams that bring together law enforcement, prosecutors, Sexual Assault Nurse Examiners (SANEs) or other medical personnel, and rape crisis advocates to coordinate their response to victims of sexual assault. Typically, SARTs coordinate care during the acute, post-assault period, which may include medical treatment, evidence collection, and initial investigation of a criminal complaint, crisis intervention, and provision of referrals for ongoing support (“SART Toolkit,” n.d.). In addition, representatives from each service delivery sector often meet on a regular basis to monitor the community-level coordination of services (Campbell, Greeson, Bybee, & Fehler-Cabral, 2012). SARTs vary widely in their structure, membership, operation, and even what name they give themselves (Greeson & Campbell, 2013; “SART Toolkit,” n.d.).

Evidence regarding SARTs suggests that there are benefits of a coordinated model, including increased communication between service providers, shorter wait times at hospitals, and better forensic evidence collection (Campbell & Ahrens, 1998; Greeson & Campbell, 2013; “SART Toolkit,” n.d.). Empirical evaluations, however, show mixed evidence of the effect of SARTs on prosecution-related outcomes (Nugent-Borakove et al., 2006; Wilson & Klein, 2005).

SARTs operate in the context of a long history of tension between rape responders from different disciplines, particularly rape crisis advocates and law enforcement officers (Martin, 2005). This tension is, in part, rooted in the watchdog role that advocates developed in response to the historically poor handling of rape cases by service systems. Research suggests that tension and conflict among the providers involved in a SART response is routine (Cole & Logan, 2008, 2010; Crandall & Helitzer, 2003; Greeson & Campbell, 2013). Conflict in SARTs has been linked to poor role understanding, a lack of clear boundaries between the roles of the various team members, and differing obligations and norms around confidentiality and information sharing (Cole, 2011; Cole & Logan, 2008; Crandall & Helitzer, 2003). SART members have stated that these conflicts have a negative impact on the ability of the team to coordinate services (Cole & Logan, 2010), which is consistent with team conflict literature that links conflict with decreased team productivity and team member satisfaction (De Dreu & Weingart, 2003).

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.

Method

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.

Results

All participants described examples of the challenge of engaging with one another across disciplines. One participant suggested that these challenges were an inevitable, and perhaps necessary, part of coordinating across different disciplines:

The very thing we want [with SARTs], everybody to bring different points of view and different insights based on different roles, obviously, it’s not always going to be harmonious, right? (Laughs) It’s built in! (13, advocate)¹

Others suggested that even when the process of engaging is relatively smooth,

everyone knows that tensions between disciplines are there . . . as you start to dig into how things work, and what went wrong, those tensions are going to have to come out, and have to be dealt with. And it’s a difficult thing to do. (17, nurse)

We identified three discursively contested domains that challenge the ability of SART members to engage productively: authority, expertise, and credibility.

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.

Discussion

The findings in this study indicate that interdisciplinary power was negotiated through discursive processes of establishing authority, expertise, and credibility. Previous research on the causes of conflict in SARTs focused on role ambiguity, differing professional norms, and case-related factors (Cole, 2011; Cole & Logan, 2008, 2010). This study builds upon these findings by exploring in depth the ways that SART members discursively construct one another’s roles in the team, and how these processes point to unresolved tensions that can manifest in conflict. SART responders draw on patterns of language and belief related to questions of professional authority, expertise, and credibility. In other words, these findings suggest that it is not just ambiguity and differences in professional norms but the way that those differences are negotiated in relation to the distribution of power within the team.

The key to successful teamwork is finding a way to engage without “marginalizing or suppressing” any service delivery system’s perspective (Opie, 2000, p. 6). This process requires an honest exploration of how power influences team interactions and the relative value placed on various professional knowledge bases (Opie, 2000). This suggests a need for assessing how power is negotiated in the SART context. The service systems involved in SARTs do not have equal access to power and resources as several interviewees acknowledged. Advocates, for example, must rely on other systems to provide them access to victims or invite them into their spaces (such as when hospitals invite rape crisis advocates into the emergency room to speak with victims). In addition, rape crisis centers often use volunteers, typically young and female, to ensure that an advocate is available whenever a rape is reported, while hospitals and law enforcement agencies are staffed continuously to respond to a wide variety of community needs. Reliance upon volunteers, as well as the age and gender composition of volunteer advocates, may create an additional dimension of power imbalance for advocates. As these differently positioned service systems come together, they each struggle to establish authority to define the terms of their own work as well as the work of the team.

SARTs generally have a variety of goals, including improving the response to victims, providing compassionate care, and increasing the likelihood of offender accountability (Greeson & Campbell, 2013). SART members may hold different beliefs about the primary goal of the team and may struggle to position themselves and others in such a way as to influence the work of the team. Discourses of authority, credibility, and expertise may, therefore, signal a disjuncture in rape responders’ understanding of how and what their SART should be doing. Our analysis suggests that SART members may privilege their own preferred goals and may justify their vision of the team’s work by positioning those with differing goals as lacking in authority, credibility, or expertise.

This analysis has a number of implications for communities using coordinated models of service delivery like SARTs. For example, communities using a SART model should have explicit discussions on a regular basis about issues of authority, expertise, and credibility. The outcome of these discussions should be a locally crafted agreement about the working of the team. Likewise, SARTs may need to implement a system that supports working through professional differences, perhaps in the form of a neutral team leader/coordinator that can focus on fostering engagement by explicitly attending to the underlying power dynamics in the team.

SARTs may also benefit from regular opportunities to engage at times when the team is not in the midst of providing services to a victim. By undertaking lower-stakes conversations, teams have the opportunity to delve deeper and explore how team members engage across disciplines. Creating a climate that fosters critical self-awareness, analysis of power, and honest exploration of discourses of authority, expertise, and credibility is likely to build teams that honor and respect professional differences. This kind of climate takes humility, trust, a willingness to acknowledge that perspectives that challenge one’s own professional norms need to be heard, and the commitment to be accountable for the ways, big and small, that one’s professional perspective may be responsible for some of the conflict that occurs on these teams. Research suggests that teams with higher levels of trust and that attend to the emotional needs of team members have less conflict and are more likely to see positive benefits as a result of disagreements (De Dreu & Weingart, 2003).

In addition to having implications for SART practice, the analysis presented here suggests avenues for future exploration and study. Future research should explore more deeply the reasons that providers question one another’s expertise and credibility. Understanding how SART members seek to resolve differences, particularly when those efforts are successful, is also a crucial direction for future research. Better understanding the reasons why team members contest authority, expertise, and credibility may illuminate opportunities for intervening to manage conflict in SARTs.

Although research generally suggests that conflict adversely affects team effectiveness and team member satisfaction (Cox, 2003; De Dreu & Weingart, 2003), further research should attempt to elucidate whether and how team-level functioning affects victims’ experience receiving services, willingness to continue seeking formal assistance, psychosocial well-being, and criminal justice outcomes. Furthermore, research could help identify whether and when SARTs are able to capitalize on conflict as a way to continually improve service delivery. Alternatively, researchers could also explore cases where SARTs do not seem to struggle as acutely around issues of authority, expertise, and credibility to identify factors and practices that contribute to discourses of mutual trust, respect, and engagement.

Footnotes

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 research was supported in part by National Institutes of Health (NIH) Multidisciplinary Pre-Doctoral Clinical Research Training Program (TL1 RR 025016).

Notes

Author Biographies

Carrie A. Moylan, PhD, is an assistant professor in the Department of Social Work at Binghamton University. She received her PhD in social welfare from the University of Washington. Her research centers on sexual assault and specifically examines community and campus efforts to prevent and respond to sexual violence.

Taryn Lindhorst, PhD, LCSW, is the Carol LaMare Associate Professor of social work at the University of Washington. Her research focuses on the social construction and reinforcement of inequality, especially as this relates to issues of violence against women and health.

Emiko A. Tajima, PhD, is an associate professor and associate dean for academic affairs at the University of Washington School of Social Work. She received her PhD in social work from Bryn Mawr. Her scholarship focuses on domestic violence and children, immigrant and refugee populations, and methodological issues in interpersonal violence research.

References

Alderden

M. A.

Ullman

S. E.

(2012). Creating a more complete and current picture: Examining police and prosecutor decision-making when processing sexual assault cases. Violence Against Women, 18, 525-551. doi:10.1177/1077801212453867

Ayres

Kavanaugh

Knafl

K. A.

(2003). Within-case and across-case approaches to qualitative data analysis. Qualitative Health Research, 13, 871-883. doi:10.1177/1049732303013006008

Black

M. C.

Basile

K. C.

Breiding

M. J.

Smith

S. G.

Walters

M. L.

Merrick

M. T.

Stevens

M. R.

(2011). The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/violenceprevention/nisvs/

Campbell

(2008). The psychological impact of rape victims. American Psychologist, 63, 702-717. doi:10.1037/0003-066X.63.8.702

Campbell

Ahrens

C. E.

(1998). Innovative community services for rape victims: An application of multiple case study methodology. American Journal of Community Psychology, 26, 537-571. doi:10.1023/A:1022140921921

Campbell

Greeson

Bybee

Fehler-Cabral

(2012). Adolescent sexual assault victims and the legal system: Building community relationships to improve prosecution rates. American Journal of Community Psychology, 50, 141-154. doi:10.1007/s10464-011-9485-3

Cole

(2011). Victim confidentiality on Sexual Assault Response Teams (SART). Journal of Interpersonal Violence, 26, 360-376. doi:10.1177/0886260510362895

Cole

Logan

T. K.

(2008). Negotiating the challenges of multidisciplinary responses to sexual assault victims: Sexual assault nurse examiner and victim advocacy programs. Research in Nursing & Health, 31, 76-85.

Cole

Logan

T. K.

(2010). Interprofessional collaboration on Sexual Assault Response Teams (SART): The role of victim alcohol use and a partner-perpetrator. Journal of Interpersonal Violence, 25, 336-357. doi:10.1177/0886260509334406

10.

Cox

K. B.

(2003). The effects of intrapersonal, intragroup, and intergroup conflict on team performance effectiveness and work satisfaction. Nursing Administration Quarterly, 27, 153-163.

11.

Crandall

C. S.

Helitzer

(2003). Impact Evaluation of a Sexual Assault Nurse Examiner (SANE) Program (No. NCF 203276). U.S. Department of Justice. Retrieved from http://www.ncjrs.gov/App/Publications/abstract.aspx?ID=203276

12.

De Dreu

C. K. W.

Weingart

L. R.

(2003). Task versus relationship conflict, team performance, and team member satisfaction: A meta-analysis. Journal of Applied Psychology, 88, 741-749. doi:10.1037/0021-9010.88.4.741

13.

Fairclough

(2003). Analysing Discourse: Textual Analysis for Social Research. New York, NY: Routledge.

14.

Gee

J. P.

(2005). An introduction to discourse analysis: Theory and method. New York, NY: Routledge.

15.

Greeson

M. R.

Campbell

(2013). Sexual Assault Response Teams (SARTs): An empirical review of their effectiveness and challenges to successful implementation. Trauma, Violence, & Abuse, 14, 83-95. doi:10.1177/1524838012470035

16.

Hall

(2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19, 188-196. doi:10.1080/13561820500081745

17.

Hardy

Phillips

(1998). Strategies of engagement: Lessons from the critical examination of collaboration and conflict in an interorganizational domain. Organization Science, 9, 217-230. doi:10.1287/orsc.9.2.217

18.

Jones

(2006). Multidisciplinary team working: Collaboration and conflict. International Journal of Mental Health Nursing, 15, 19-28. doi:10.1111/j.1447-0349.2006.00400.x

19.

Kilpatrick

D. G.

Acierno

(2003). Mental health needs of crime victims: Epidemiology and outcomes. Journal of Traumatic Stress, 16, 119-132. doi:10.1023/A:1022891005388

20.

LeGreco

Tracy

S. J.

(2009). Discourse tracing as qualitative practice. Qualitative Inquiry, 15, 1516-1543. doi:10.1177/1077800409343064

21.

Martin

P. Y.

(2005). Rape work: Victims, gender, and emotions in organizational and community context. New York, NY: Routledge.

22.

Miles

M. B.

Huberman

(1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.

23.

Nugent-Borakove

M. E.

Fanflik

Troutman

Johnson

Burgess

O’Connor

A. L.

(2006). Testing the Efficacy of SANE/SART Programs: Do they make a difference in sexual assault arrest & prosecution outcomes? (DOJ No. 214252). Washington, DC: U.S. Department of Justice.

24.

Opie

(2000). Thinking teams/thinking clients: Knowledge-based teamwork. New York, NY: Columbia University Press.

25.

Patterson

(2011). The linkage between secondary victimization by law enforcement and rape case outcomes. Journal of Interpersonal Violence, 26, 328-347. doi:10.1177/0886260510362889

26.

Patterson

Greeson

Campbell

(2009). Understanding rape survivors’ decisions not to seek help from formal social systems. Health & Social Work, 34, 127-136.

27.

SART Toolkit: Resources for Sexual Assault Response Teams. (n.d.). Retrieved from http://ovc.ncjrs.gov/sartkit/about.html

28.

Tjaden

Thoennes

(2008). Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey (No. NCJ 210346). Washington, DC: U.S. Department of Justice.

29.

Ullman

S. E.

(2010). Talking about sexual assault: Society’s response to survivors (1st ed.). Washington, DC: American Psychological Association.

30.

Wilson

Klein

(2005). An evaluation of the Rhode Island Sexual Assault Response Team (SART) (No. 210584). U.S. Department of Justice. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/210584.pdf