Sexual Assault Response Team Goals and Motivations for Development

Abstract

Sexual Assault Response Teams (SARTs) are community-based, multidisciplinary interventions that strive to coordinate the response to sexual assault. SARTs consist of sexual assault responders (e.g., rape crisis advocates, police, forensic examiners/Sexual Assault Nurse Examiners, and prosecutors) and seek to increase responder collaboration to improve survivors’ help-seeking experiences. There is a lack of empirical research examining factors underlying SARTs’ goals and what leads communities to form SARTs. Therefore, this study sought to examine the goals and motivations present in SART development using a multiple-methods approach with a national random sample of n = 172 SARTs. Exploratory factor analysis (EFA) was used to examine factors underlying SART goals, and qualitative thematic analysis was used to explore what motivators drove SART formation. Both qualitative and quantitative analyses underscored the importance of improving the accessibility and quality of services, improving the treatment of survivors, and increasing responder collaboration. The qualitative findings offered additional insight into the importance of community education and various community contextual factors (e.g., funding and policy requirements) that influence SARTs. Findings inform future research and practice on SART goals and functioning, such as how SART goals may relate to team structure, effectiveness, and capacity-building opportunities.

Keywords

sexual assault intervention prevention adult victims

Sexual Assault Response Teams (SARTs) are community-based, multidisciplinary interventions that coordinate in responding to sexual assault survivors (Greeson & Campbell, 2013, 2015; National Sexual Violence Resource Center [NSVRC], 2011). SARTs consist of stakeholders including, but not limited to, rape crisis advocates, medical professionals/forensic examiners/Sexual Assault Nurse Examiners (SANEs), police, and prosecutors (Greeson & Campbell, 2015; NSRVC, 2011). The SART model was developed through efforts to address problems with the response to sexual assault, such as responders’ negative treatment of survivors, low prosecution rates, and adversarial relationships among responders.

The overall purpose of SARTs is to better respond to sexual assault survivors by improving coordination among sexual assault responders. SARTs may aim to increase the accessibility of services for survivors, streamline the help-seeking process, improve responders’ treatment of survivors in systems, improve evidence collection and medical care, increase prosecution rates and perpetrator accountability, increase community awareness and understanding of sexual assault, and improve multidisciplinary relationships (Greeson & Campbell, 2013, 2015; Koon-Magnin et al., 2023; NSVRC, 2011, 2018). Since there is no one singular SART model, teams may vary in their implementation (Campbell et al., 2013; Greeson et al., 2016). Teams may adopt formal structures to guide their work, such as mission statements, subcommittees, protocols, or bylaws (Campbell et al., 2013; Greeson & Campbell, 2013, 2015; NSVRC, 2011). SARTs also engage in multidisciplinary training, through which various responders and stakeholders educate one another about their roles; meetings, protocol development, and revision; and case review, whereby responders come together to discuss specific sexual assault cases (Greeson & Campbell, 2015).

SARTs may also convene for a variety of reasons and may adopt diverse goals to guide their work. While SART practitioner resources (e.g., Barry & Cell, 2009; NSRVC, 2018) outline goals such as increasing access to services, improving the treatment of survivors, holding perpetrators accountable, raising community awareness, and building relationships among responders, research has not examined the extent to which these goals are prioritized in practice.

One prior study has looked at SART goals empirically. Greeson and Campbell (2015) organized 11 diverse goals into three thematically driven domains of (a) “improving survivors’ help-seeking experiences,” (b) “prevention education,” and (c) “improving legal outcomes,” based on prior practitioner work on SARTs’ goals. They found that goals related to improving victims’ help-seeking were rated highest in importance by SART informants, followed by prevention education, then improving legal outcomes (Greeson & Campbell, 2015). However, there may be other ways of understanding SARTs’ diverse goals that better reflect SARTs’ experiences; thus, further research is needed to best summarize SARTs’ diverse goals.

Current Study

The aim of this multiple-methods study was to examine SARTs’ goals and motivations for development. This addresses two notable gaps in the SART literature. First, there is a lack of empirical research on factors underlying SARTs’ goals. SART goals were conceptualized based on practitioner guidelines, but these guidelines may not reflect how SART goals actually operate in practice. As such, the quantitative portion of this study uses exploratory factor analysis (EFA) to identify factors underlying SARTs’ goals. This empirical approach can serve as a foundation for future research on SARTs’ goals and their relationships to other constructs. This will also offer practitioners a clearer understanding of how goals operate within SARTs in practice. The second gap is the lack of research on why SARTs form. Therefore, the qualitative portion of this study examines what motivated communities to create a SART. While a community may form a SART because of the goals already described, additional factors may also influence their creation. Examining different motivations for building SARTs may offer more insight into how these motivations relate to SART functioning and effectiveness. Findings may help technical assistant providers better tailor their support to SARTs based on teams’ respective reasons for forming.

To address these two gaps in the literature, a multiple-methods research design was chosen. Multiple methods designs allow the use of different research methods, either sequentially or concurrently, to address similar research questions or different parts of the same research question (Morse, 2003). Multiple methods research is distinct from mixed methods research in that multiple methods research does not require the integration of different methodologies (Anguera et al., 2018). Rather, the two methodologies could stand alone as their own individual projects (Morse, 2003), yet they are used jointly to provide a richer and more illustrative exploration of a topic. This multiple methods study employed both quantitative and qualitative methods to examine the following interrelated research questions:

(1) What are the common factors among different SART goals? (quantitative)

(2) What are the motivations for SART development? (qualitative)

Method

Participants

Researchers utilized secondary data collected from a national study of SARTs (the same dataset as Greeson & Campbell, 2015). This original national study’s purpose was to examine SART structure, implementation, facilitators, and barriers to SART effectiveness (Campbell et al., 2013). Prior to the original study, there was no existing U.S. national registry of SARTs from which researchers could sample; therefore, a sampling frame was constructed through five different strategies. First, researchers contacted organizations through two national registries of organizations that were likely to participate in SARTs: The International Association of Forensic Nurses’ registry of SANEs programs and SANE-SART.com’s registry of SANE-SART member organizations. Second, the research team contacted those subscribed to the NSVRC SART listserv. Third, the research team reached out to state sexual assault coalitions to determine whether coalitions had lists of SARTs in their states. Fourth, researchers conducted a review of literature on SARTs and SART practitioner materials. Fifth, researchers conducted a Google search to detect other existing SARTs. These five strategies identified 864 SARTs across the country.

Then, SARTs from this sampling frame were randomly sampled to determine eligibility, and if eligible, they were recruited to participate in the study. In order to be eligible for the study, SARTs had to participate in a multidisciplinary response to sexual assault, meet regularly, and serve adult survivors. SARTs were contacted by phone and email, and eligibility screening and recruitment continued until the target sample size was reached. In total, 268 teams were successfully contacted; of these, 81 were not eligible and 172 participated.

Individuals who were recruited served as a leader or coordinator on the SART. If a leader was unavailable to participate, a longtime member or other recent leader was recruited. Overall, the research team contacted, obtained consent from, and conducted interviews with 172 SART leaders and longtime members, with a response rate of 92%.

Measures

SART Goals (Quantitative)

Participants reported what goals they prioritized on their SARTs, which was measured through a 20-item list of goals such as “to increase prosecution rates,” “to reduce negative treatment of victims by primary responders,” and “to improve the quality of relationships among stakeholders.” This list was created based on the researchers’ prior experiences with SARTs and sexual assault response (e.g., providing advocacy services and collaborating with multiple local communities’ SARTs), literature on SARTs and coordinating councils, and feedback from community partners. For the full list of goals, see Table 1. Participants then rated the extent to which each goal was a priority using a four-point Likert scale (1 = Not a primary goal; 2 = Somewhat important; 3 = Very important; 4 = A primary goal).

Table 1.

Original 20 Items of SART Goals Scale.

How important is it:

To reduce barriers to seeking medical/forensic services post-assault?

To reduce barriers to seeking advocacy services post-assault?

To improve the quality and comprehensiveness of medical/forensic services that are offered to survivors who seek help from the medical system?

To improve the quality and comprehensiveness of advocacy services that are offered to survivors who seek help from advocates?

To reduce negative treatment of victims by primary responders?^a

To educate primary responders about responding to sexual assault?

To improve primary responders’ attitudes toward sexual assault victims?

To improve primary responders’ skills in responding to sexual assault?

To hold responders accountable for responding to sexual assault appropriately?

To increase coordination among stakeholders?^b

To increase communication among stakeholders?

To increase stakeholders’ understanding of one another’s roles and limitations?

To improve the quality of relationships among stakeholders?

Note. SARTs = Sexual Assault Response Teams.

Primary responders refer to victim advocates, medical/forensic examiners, police, and prosecutors.

Stakeholders refer to community partners who work on sexual assault issues.

Motivations for Forming SART (Qualitative)

The qualitative portion of the interview focused on what led communities to develop a SART. This was explored with participants through one open-ended qualitative question: “What was the main reason for forming the SART?” The data collected through this question were analyzed using adapted thematic analysis (Braun & Clark, 2006), which will be discussed in greater detail in the data analysis section.

Procedure

Interviews were conducted with SART leaders or longtime members over the phone, lasted around an hour (M = 68.24 min, SD = 16.73), and were audio recorded with the consent of participants. Phone interviews consisted of both quantitative questions examining SARTs’ processes and structure as well as qualitative questions exploring what barriers and facilitators impact their team’s ability to achieve goals. Upon completing the phone interview, participants were offered the opportunity to receive findings after the study was concluded.

Data Analysis

Quantitative

EFA was utilized to examine the common factors among SARTs’ prioritized goals. EFA comprises a series of analytic processes to ascertain the interrelationships among a set of items or variables (Pett et al., 2003; Tabachnick & Fidell, 2018). The number of factors to retain was determined through multiple strategies, including generating a scree plot, examining the cumulative percentage of variance extracted by the factors, running a maximum likelihood test (Pett et al., 2003), and conducting parallel analysis (Wood et al., 2015). A combination of these strategies was utilized to determine factor retention to mitigate the risk of under- or over-factoring. Principal axis factoring with oblique rotation was run in IBM SPSS Statistics (Version 23) in order to achieve a simple structure. Oblique rotation (direct oblimin) was utilized (Pett et al., 2003), as it was assumed that SART goals would be correlated with one another. After the factors were extracted and rotated, any items with factor loadings less than <0.4 (Pett et al., 2003) were removed from the matrix, and any cross-loading items were retained on the factor with which the item is most conceptually related. Lastly, remaining items were checked for internal consistency using Cronbach’s alpha.

Qualitative

Thematic analysis was used to explore qualitative data on SARTs’ motivations for starting their teams. Thematic analysis is an iterative approach through which broader themes are developed inductively by identifying patterns within a qualitative set of data (Braun & Clark, 2006). This process consisted of open coding, codebook development, application of the codebook, and theme write-ups. First, qualitative data from the question “What was the main reason for forming the SART?” was open coded independently by two analysts to summarize the key ideas from a portion of the data; the primary analyst (first author) open coded all of the data, and the secondary analyst (third author) open coded a portion of the data. Then, a codebook of themes was developed from patterns that emerged from the open codes. Once the codebook was developed, it was tested independently by the two analysts. Then, using QSR NVivo 12, the two analysts coded all interviews independently using the codebook and reviewed and discussed data together to obtain consensus on differences in coding.

Results

Of the 172 participants, over half (55%) identified as rape crisis center (RCC) advocates or staff, 24% identified as medical/forensic examiners/SANEs, 5% identified as prosecutors, 5% identified as advocates within the victim’s witness unit of the prosecutor’s office, 4% identified as police, and 7% identified as another stakeholder group (e.g., neutral SART coordinator, Children’s Advocacy Center [CAC] director). Participants overwhelmingly were current or former coordinators of their SART (94%), while the remaining 6% reported being long-time or general members. The majority of participants identified as White (89%), followed by Black or African American (5.2%), Native American or Alaskan Native (2.3%), Hispanic or Latinx (2.3%), or Multiracial (1.2%). Additionally, approximately 95% of participants identified as women and 5% identified as men. At the time of the interview, the average length of time SARTs had been in operation was about 8 years (M = 8.08, SD = 5.63), and participants reported having been on their team for about 5 years on average (M = 5.08, SD = 4.40). See Table 2 for participant demographics and Figure 1 for a visualization of similarities and differences across the quantitative and qualitative findings.

Table 2.

Participant Demographics.

Characteristic	Total (N = 172)
Age M (SD)	42.46 (10.9)
Gender n (%)
Woman	163 (95%)
Man	9 (5%)
Race/ethnicity n (%)
White	153 (89%)
Black/African American	9 (5.2%)
Native American or Alaskan Native	4 (2.3%)
Latinx/Hispanic	4 (2.3%)
Multiracial	2 (1.2%)
Discipline/role
RCC advocates/staff	95 (55%)
Medical/forensic examiners/SANEs	42 (24%)
Prosecutors	8 (5%)
Advocates within victim’s witness unit of prosecutor’s office	8 (5%)
Police	7 (4%)
Another stakeholder group^a	12 (7%)
Length of time on SART M (SD)	5.08 (4.40)
Length of SART operation	8.08 (5.63)

Note. RCC = Rape crisis center; SANEs = Sexual Assault Nurse Examiners; SARTs = Sexual Assault Response Teams.

For example, Neutral SART coordinator, CAC director.

Figure 1.

Similarities and differences in the qualitative and quantitative findings.

Quantitative Findings

In assessing the factorability of the 20-item list of SART goals, a correlation matrix was generated. Three items (“To increase prosecution rates,” “To increase reporting of sexual assaults to the police,” and “To educate the general public about sexual assault/rape and the services that are available to victims in your community”), were removed because they did not have sufficient inter-item correlations with other items within the matrix (i.e., less than 0.3; Tabachnick & Fidell, 2018). Two additional items (“To reduce barriers to seeking mental health services post-assault” and “To improve the quality and comprehensiveness of mental health services that are offered to survivors who seek help from the mental health system”) were removed because they did not meet the minimum criteria of measures for sampling adequacy criteria of .6 (Tabachnick & Fidell, 2018). After removing the five aforementioned items, Bartlett’s Test for Sphericity revealed a statistically significant chi-squared value of 1197.106 (p < .005) and Kaiser-Meyer-Olkin was 0.842, which suggests factorability of the matrix.

After conducting EFA with oblique rotation, two items (“To improve local organizations’ policies and procedures regarding sexual assault” and “To provide a victim-centered response to sexual assault”) were dropped due to low factor loadings (i.e., < 0.4; Pett et al., 2003). Several strategies were utilized to determine how many factors to retain. The scree plot suggested retaining four factors, cumulative percentage of variance criteria suggested retaining two factors, maximum likelihood significance test suggested five, and parallel analysis suggested three factors. Given the different conclusions drawn from these strategies, EFA was conducted several times while retaining a range of factors (i.e., two, three, four, and five). Ultimately, the three-factor model was chosen because it had strong factor loadings, minimal cross-factor loadings, and was the clearest conceptually.

Factor 1 consisted of four items pertaining to improving the quality and accessibility of services (e.g., “To improve the quality and comprehensiveness of medical/forensic services that are offered to survivors who seek help from the medical system”). Factor 2 consisted of five items pertaining to improving responder treatment and attitudes toward survivors (e.g., “To improve primary responders’ attitudes toward sexual assault victims”). The final Factor 3 consisted of four items pertaining to multidisciplinary collaboration among sexual assault responders (e.g., “To increase stakeholders’ understanding of one another’s roles and limitations”). The factor loadings, M, and SD for each item can be found in Table 3. Cronbach’s alpha for Factors 1, 2, and 3 were α = .78, α = .87, and α = .85, respectively, thus demonstrating sufficient internal consistency.

Table 3.

Factor Loadings, M, and SD for 13-Item SART Goals Scale.

Subscale and Item	Factor Loading	M ^a	SD
Factor 1: Quality and Accessibility of Services
To reduce barriers to seeking medical/forensic services post-assault?	0.700	3.33	0.72
To reduce barriers to seeking advocacy services post-assault?	0.671	3.27	0.70
To improve the quality and comprehensiveness of medical/forensic services that are offered to survivors who seek help from the medical system?	0.611	3.22	0.89
To improve the quality and comprehensiveness of advocacy services that are offered to survivors who seek help from advocates?	0.625	3.24	0.73
Factor 2: Responders’ Treatment of and Attitudes Toward Survivors
To reduce negative treatment of victims by primary responders?	−0.665	3.64	0.60
To educate primary responders about responding to sexual assault?	−0.834	3.51	0.65
To improve primary responders’ attitudes toward sexual assault victims?	−0.830	3.46	0.70
To improve primary responders’ skills in responding to sexual assault?	−0.786	3.51	0.63
To hold responders accountable to responding to sexual assault appropriately?	−0.584	3.28	0.76
Factor 3: Multidisciplinary Collaboration
To increase coordination among stakeholders?	0.610	3.53	0.65
To increase communication among stakeholders?	0.914	3.43	0.68
To increase stakeholders’ understanding of one another’s roles and limitations?	0.733	3.24	0.74
To improve the quality of relationships among stakeholders?	0.653	3.28	0.70

Note. SARTs = Sexual Assault Response Teams.

Scale range: 1 = Not a primary goal, 2 = Somewhat important, 3 = Very important, 4 = A primary goal.

Diverging perspectives exist regarding the appropriate sample size for EFA. However, researchers have shown that blanket recommendations regarding total sample size or number of items per factor are over-generalized, and instead, minimum sample size is dependent on a variety of issues, including the number of factors and size of the factor loadings (Winter et al., 2009). Winter et al. (2009) Monte Carlo work indicates that a sample size of n = 172 is sufficient in the current study, given the number of variables (final = 13), the small number of factors (3), and the high factor loadings (all >0.6).

Qualitative Findings

The qualitative component of this multiple-methods study examined the motivations to form a SART. A total of 7 of the 169 participants with transcripts reported that they were not part of efforts to bring SART together. Therefore, these results focus on the remaining 162 participants who were involved and, consequently, able to recall what motivated the formation of their team. The data revealed four themes related to goals for improvement (improving the processing of cases through the criminal justice (CJ) system, improving inadequate access and response to survivors, responder collaboration, community education) and four themes related to contextual factors (visibility of cases, related programs, funding requirements, policy compliance, and SART “champions”) that led sexual assault responders to form their SART.

Improving Processing of Cases Through the CJ System

SARTs came together to improve how cases are processed through the CJ system. Participants reported issues with poor evidence collection by medical personnel, not preserving the chain of evidence and poor investigations. According to one medical/forensic examiner, emergency room (ER) physicians were not “as up to date on all the latest information as far as forensic and medical examination and what they’re looking for in the examination. . .steps are skipped, evidence is thrown out, stuff wasn’t collected right” (66). SARTs worked on correcting processes to improve CJ outcomes, namely prosecution and conviction rates. A prosecutor noted the need to strengthen investigations to improve prosecution: “we were having a tremendous problem obtaining convictions on any of these types of cases. . .the investigative part of it was basically non-existent. . .we wanted to improve the investigation so that we had a better shot at our prosecution” (137).

Improving processes and outcomes within the CJ system also required targeting issues with how responders worked together. Some responders formed their SART because they believed responders needed to work together more effectively to improve evidence collection, investigation, and prosecution. One RCC advocate/staff member said, “the hospital would not collect evidence correctly, the law enforcement would get mad, prosecutors couldn’t file a case because we didn’t have a good flow. . .of communication between those, especially those three um agencies” (143). Thus, SARTs aimed to improve participation and outcomes in the CJ system by also boosting responders’ collaboration.

Improving Inadequate Access and Response to Survivors

A major motivation for SART formation was addressing shortcomings in their services for and treatment of survivors. This included expanding the accessibility of services. SARTs formed to reduce barriers (e.g., geographic factors and limited response personnel) that forced survivors to travel far distances and wait hours for medical care. An RCC advocate/staff member from a rural community said:

Prior to our SART opening up if there was a sexual assault, um victims would have to be transported to another county which depending on which county, could be up to an hour, to an hour and a half transport. . .we wanted to be able to serve those victims locally and make sure there weren’t any barriers (85).

In addition to mitigating issues with accessing medical services, SARTs were also developed to address barriers to accessing advocacy services specifically. An RCC advocate/staff member described how the medical system impeded medical advocacy for survivors: “we weren’t having a lot of referrals to our advocacy center and the hospital wasn’t calling 100% of the time to dispatch [an] advocate, when they did have a victim present to the hospital” (108). Consequently, SARTs formed to increase access to needed post-assault advocacy services.

Communities also created SARTs to improve how survivors were treated interpersonally by responders. According to some participants, SARTs sought to be more “victim-centered,” “trauma-informed” and/or “emotionally supportive” to survivors. One RCC advocate/staff member whose SART convened to create a victim-centered response defined a “victim-centered response” as “the victim’s not alone. That we’re gonna go through the process with them. . .That we believe them. That we’re not going to judge them. Um, that we’re gonna explain the process to them and then ask them to tell us what they think, what do they wanna be involved with and keeping them updated every step of the journey” (92).

Similarly, participants also described needing to form SARTs because some responders had been treating survivors in a cold, victim-blaming, or otherwise insensitive and retraumatizing manner. For example, a medical/forensic examiner recalled how hospital emergency departments treated survivors poorly. Survivors were “shoved into a corner waiting for the doctor. . .and, due to you know, no standardizations, often police officers said that they had to maintain in the room while the exam was being done. . .victims were again feeling like they were becoming secondary victims” (66). Such traumatizing practices led responders to form SARTs in hopes of making the response more emotionally supportive and trauma-informed.

Some SARTs also believed that being more victim-centered could also help achieve other goals, such as improving participation and outcomes in the CJ system. One RCC advocate/staff member shared how a victim-centered approach could influence the CJ process: “We hope it will eventually improve upon the reporting and prosecuting rate. That victims feel a little more supported from all disciplines to be able to get the strength to be able to prosecute and go through with it” (48). Even so, other SARTs asserted that victim-centered goals should ultimately supersede CJ system goals. An RCC advocate/staff member recalled how their team formed to improve survivors’ help-seeking experiences, regardless of the legal outcomes:

we can better serve those victims as a team to make sure that those cases were getting handled appropriately, and that we had better turnout in the end. Even if that meant that the court case itself didn’t pan out as well, as far as like a prosecution, but the victim still felt that they were believed and they got justice in a different way than if it didn’t turn out that way. . .Because of, of what the system had done for the victim. (80)

Thus, many SARTs formed to improve both the response to survivors and the processing of cases in the CJ system, but differed in how they viewed those goals as relating to one another.

Responder Collaboration and Coordination

Participants also identified the desire to improve responder collaboration and coordination as a key motivation for forming SARTs. Participants reported that when responders did not work together, it negatively impacted their response to sexual assault because there was a greater likelihood of letting “things fall through the cracks” (Medical/forensic examiner, 36). Referring to the lack of understanding and coordination between different responders, one medical/forensic examiner shared:

when our advocates responded to sexual assault cases in the, the emergency department there was a lot of confusion about. . . what the role of the advocate is, what the role of the officer is, and how to best work together so that the survivor gets what they need (89).

A prosecutor mentioned a similar lack of understanding between police and victim advocacy, saying “we noticed that there was a huge divide among those organizations. . .it was clear one didn’t know what the other was doing” (10). Others reported a lack of referrals among responders as a reason that led to SART formation (e.g., advocacy not getting called to respond to a survivor at a hospital). As such, responders developed their SART to encourage effective collaboration. SARTs sought to standardize procedures for how stakeholders work together; increase knowledge of one another’s roles and responsibilities; and offer more multidisciplinary activities to improve their response (e.g., case review).

Some participants discussed increasing responder collaboration and coordination to improve experiences for survivors. According to an RCC advocate/staff member,

the simplest reason is to just get us all on the same page, understanding each other’s roles and like the differences in our roles, you know, so like through understanding each other better, understand that we’re not trying to work against each other, and then, uh, ultimately providing better services to the survivors ‘cause when you look at how many people are at that table, those are all people that a survivor could come in contact with so getting us all on the same page is gonna improve the services to survivors. (79)

Others also connected the need for better coordination with improving the processing of cases through the CJ system. Participants felt that responder collaboration created a more cohesive dynamic that not only improved processes around evidence collection and investigation of cases but also encouraged survivors to participate in the CJ system. As one RCC advocate/staff member described multidisciplinary collaboration as facilitating CJ system participation:

if a victim meets me as an advocate or a counselor and knows that I have a working relationship with the different agencies, police, prosecution, hospital and all that, that we work together, that I understand the system, and that I can help them understand the system, it’s not quite as scary. . .we’re really kinda all on the same page. . . not only do we make them feel better just by them knowing that we work together, but also that we’re able to exchange information at the meetings that allow us to serve the victim better. (45)

Through improving multidisciplinary collaboration, SARTs could also improve the response to survivors and processes and outcomes in the CJ system.

Community Education and Awareness

While not mentioned as frequently as other goals and motivations, some SARTs also convened to better educate their communities about the issue of sexual assault. According to participants, community education included raising awareness about what sexual assault is, how to respond to sexual assault, resources for survivors, and survivors’ rights. SARTs aimed to educate both individuals and organizations (e.g., university counseling centers and school administrators) on these topics. According to one RCC advocate/staff member, their SART’s guiding motivation was to combat the misconceptions held by community members about gender-based violence:

they have a very rural mentality, very small town mentality. Um and so, bad things like that don’t happen here. Um, so a lot of it is community education. . .that domestic violence happens here. Sexual assault happens here. And we need to say it’s not okay and we need. . .stakeholders to go in and say “we”re not going to tolerate this’. So a lot of it has been education to you know that whole, again that victim blaming. (143)

Given the lack of awareness about sexual assault, some SARTs formed to help educate communities, thus strengthening prevention and intervention efforts against sexual violence.

Visibility of Cases

While the prior four themes related to SARTs forming because of a goal they aimed to achieve, the remaining five themes represent contextual factors, or the circumstances and needs within a community that influenced the creation of a SART. For some SARTs, the team formed because sexual assault was highly visible in their community at that time (i.e., due to a high incidence of sexual assault cases). This visibility of cases exposed the need for an improved response. Indeed, one RCC advocate/staff member shared, “we saw a really high number of sexual assault crimes in our community and. . .we didn’t feel like we had adequate facilitation for it” (127). Similarly, other SARTs convened in response to high-profile case(s) that gained community and media attention. An RCC advocate/staff member recalled:

there were some pretty public cases of sexual violence that were not handled very well in the media. And I think they involved particular groups that were, um, often thought of as high-risk groups, and maybe, athletics or the Greek system, and so, people were, unconcerned and thought that we’d have a better coordinated university response. . .that’s why we’re formed in the first place. (65)

These visible cases revealed the endemic nature of sexual assault in communities and exposed flaws in their existing response, which responders then used to justify SART development.

Related Programs

Another contextual factor that drove SART formation was the co-development of other related programs that addressed sexual or interpersonal violence (e.g., SANE/forensic nursing programs, Child Advocacy Centers, and domestic violence programs). In some cases, existing programs led to the development of SARTs. For example, one participant shared that once their community had a SANE program, the next logical step was to develop a SART. A CAC director discussed how the establishment of the CAC led stakeholders to recognize a need to extend similar services to adults: “CAC was established and shortly after that is when our SART team was formed. . .their intention was to make sure adult victims were receiving services as well as the child victims” (88).

Just as existing programs helped prompt SART development, SARTs were also formed in order to facilitate the development of other related programs. For some communities, a primary goal for developing a SART was to implement other related interventions: “we were looking at developing SANE programming in the community. . .that was kind of our reason for coming together and um, having the different parties you know sit down at the same table and kind of talk through what we wanted a SANE program to look like in our community” (RCC advocate/staff, 99). By developing a SART as a precursor to related programs, responders felt they would then be better equipped to develop other necessary interventions for survivors.

Funding Requirements

SARTs were also developed to meet funding sources’ recommendations or requirements to develop a multidisciplinary response team. For some teams, this requirement came through funding awarded to one specific sexual assault stakeholder (e.g., RCC, SANE program, or local police department). For example, one RCC advocate/staff member shared that their SART formed through a “grant requirement that, uh, we had as part of our sexual assault center. . .to form a, a multidisciplinary group that could come together. . .to improve services to victims of sexual assault” (141). Other communities were required to assemble a team through statewide funding initiatives to improve interventions for sexual assault survivors. A medical/forensic examiner discussed their state receiving a rural federal grant to develop SARTs: “the [state] applied, received the grant, and then contacted several hospitals, um, within the state to form SANE programs and then one of the requirements was that you form a SART team” (111). Most participants who mentioned developing their SART due to funding requirements did not specify that their community held an intrinsic desire to develop a SART. However, some participants did acknowledge benefits to having a multidisciplinary response, in addition to the funding mandates: “our grants require it, but it sure makes a difference in our ability to help our clients” (RCC advocate/staff, 102). Therefore, while some communities developed SARTs out of funding obligations, many indeed found great value in having a coordinated multidisciplinary response.

Policy Compliance

Another contextual factor discussed by participants was the need to comply with policies and legislation that mandated a coordinated response to sexual assault. These mandates varied among communities. Some states directly required communities to specifically create a multidisciplinary response team, while others required communities to establish protocols for responding to sexual assault, which indirectly led to SARTs’ creation. Thus, some SARTs were developed solely to comply with policies. For example, an advocate within the victim’s witness unit in a prosecutor’s office explained “we just had some legislation pass that required that we have this team meet and so we’re meeting the mandate of the legislation” (129). Yet, for others, there was community interest in SARTs coupled with the policy requirements: “the primary purpose was for the law, and then probably the secondary was that um, there was enough interest in the law enforcement community to create. . .best practices as well” (Police, 163). Therefore, in some cases, these legislative mandates served as an impetus for SART development in communities where there was already existing interest in having a more coordinated response to sexual assault.

The Role of SART “Champions”

Finally, the development of SARTs was often driven by one or several stakeholders who “championed” (NSVRC, 2018; Campbell & Fehler-Cabral, 2020) the implementation of a coordinated team response to sexual assault. SART champions included stakeholders who recognized a need to improve the response to sexual assault, saw the value in a SART approach, and worked to get other sexual assault responders involved in their efforts. SART champions often came from entities that are typically involved in SART efforts: SANEs/medical, advocacy, police departments, or prosecutors.

SART champions were typically the first to buy into the idea of developing a SART, then got others to buy in, too. As one police officer explained: “one of the SART nurses. . .got a little bit of additional training on her own and initiated the idea of it and we just all kind of realized that it was a beneficial thing for everybody” (68). Additionally, the development of a SART was not solely undertaken by one entity. Indeed, it sometimes took several stakeholder groups to gain momentum for a SART. For example, one RCC advocate/staff member shared that efforts to create a SART were led by “one of the lead prosecutors on sexual assault cases. . .he probably was sergeant too of one of the larger law enforcement agencies, and myself, and. . .a nurse practitioner” (135). Ultimately, SART development relied on these passionate, motivated stakeholders who recognized the importance of providing a coordinated, improved response to sexual assault in communities and helped bring others onto the team.

Discussion

This study employed a multiple-methods approach to conduct the first exploration of the types of goals and motivations that contribute to SART development and implementation. Although data were analyzed separately, we have integrated our discussion across the two sources of data to illustrate key similarities and differences in the findings (see also Figure 1).

Similarities in Quantitative and Qualitative Findings

The quantitative and qualitative findings converge and complement one another in several ways. Both the qualitative and quantitative findings emphasize the importance of (a) improving how responders treat survivors interpersonally (e.g., minimizing victim blaming and being more victim-centered), (b) improving access and quality of services, and (c) promoting multidisciplinary collaboration in the response to sexual assault.

Interpersonal Treatment of Survivors

Both the quantitative and qualitative findings indicated that improving responders’ interpersonal treatment of and attitudes toward survivors are important to SARTs. In the quantitative findings, one of the three factors—“responders’ treatment of and attitudes toward survivors”—was composed of the following five goals: reducing the negative treatment of victims, educating responders about responding to sexual assault, improving responders’ attitudes toward victims, improving responders’ skills in responding to sexual assault, and holding responders accountable to an appropriate response. Similarly, these ideas were discussed within the broader qualitative theme of “inadequate access and response to survivors.” Within this theme, many SART leaders discussed how their SARTs were developed to promote a victim-centered, trauma-informed, and emotionally supportive response. These motivations arose from past issues with responders’ insensitive, victim-blaming, and/or retraumatizing treatment of survivors. These findings are also consistent with the extensive prior literature showing systems (primarily medical and CJ) responding in similarly negative ways (e.g., Corrigan, 2013; Fehler-Cabral et al., 2011; Long, 2018; Maier, 2008, 2012). Further, this study’s qualitative findings substantiate goals outlined by practitioner resources (NSVRC, 2018), which encourage SARTs to be victim-centered in their response.

While both the quantitative and qualitative data emphasize the importance of improving attitudes toward and treatment of survivors, there was one interesting difference. SART leaders who participated in the qualitative interviews discussed the importance of being victim-centered, whereas in the quantitative analysis, the item using similar language (“to provide a victim-centered response to sexual assault?)” was dropped from the EFA model. Although this item was dropped from the factor analysis, it was nevertheless endorsed in the qualitative interviews as an important goal underlying SARTs’ work. Thus, we believe that this may be a methodological issue with the quantitative data (see further discussion in the Limitations section) and should not be used to infer that victim-centered treatment is not important to SARTs.

Access and Quality of Services

Further, the aim of improving the quality and accessibility of services for survivors was present in both the quantitative and qualitative findings. In the quantitative findings, the factor “quality & accessibility of services” was represented by four items related to increasing access to medical/forensic and advocacy services as well as improving the quality of medical/forensic and advocacy services. Similarly, participants frequently discussed the motivation to reduce barriers to service accessibility by developing a SART (represented in the qualitative theme of “inadequate access and response to survivors.”). Indeed, many SARTs were formed to increase access to medical/forensic and advocacy services, mitigate long waits in the hospital ER, close geographical gaps in services, and increase cross-system referrals. Given that similar issues with service accessibility have been identified in existing literature (Campbell, 2008; Hardeberg Bach et al., 2021), it is understandable that addressing such issues would be priorities for SARTs.

Like practitioner resources on SARTs (Barry & Cell, 2009; NSRVC, 2011, 2018), the current study also demonstrated the importance of improving the processing of cases within the CJ system. However, our qualitative findings differed slightly from the quantitative findings. In the qualitative data, participants discussed the importance of SARTs in improving evidence collection, investigation, and prosecution and conviction rates. Conversely, in the quantitative data, the two goals pertaining to the CJ system (increasing prosecution rates; increasing reporting of sexual assaults to the police) were dropped from the EFA model. Again, we posit that this is a measurement issue and should not be used to conclude that CJ improvements are not important to SARTs, when the qualitative data show it certainly is. Rather, the strong emphasis on CJ processes and outcomes in the qualitative data suggests that further measurement work is needed to better capture SARTs’ goals. Moreover, participants’ emphasis on needing to improve both CJ processes (e.g., investigation, evidence collection) and outcomes (e.g., prosecution and conviction rates) is consistent with existing literature demonstrating flaws in the CJ response to sexual assault (Spohn & Tellis, 2012) as well as research indicating that SARTs can improve police work on cases (Koon-Magnin et al., 2023).

Responder Collaboration

Finally, the qualitative and quantitative findings highlighted responder collaboration as key priorities for SARTs. The final EFA model included a “multidisciplinary collaboration” factor, which consisted of the following four items: increasing coordination, increasing communication, improving understanding of roles and limitations, and improving the quality of responder relationships. Likewise, the qualitative findings also underscored the importance of improving responder collaboration. In the theme of “facilitating responder collaboration and coordination,” participants discussed standardizing response procedures, increasing knowledge of responders’ roles and limitations, and engaging in multidisciplinary activities (e.g., trainings and case review). These initiatives were prioritized because responders had been ineffective at working together in the past, thus leading to a substandard response to survivors. This is also consistent with other empirical literature showing that issues with multidisciplinary collaboration may have a detrimental impact on the response to survivors (Campbell & Ahrens, 1998; Hoffman et al., 2023; Moylan et al., 2017).

Distinct Qualitative Findings

While the findings from this multiple-methods study largely complement one another, the qualitative findings offer additional insight beyond the quantitative findings into additional goals and contextual factors that led to SART formation. Specifically, the additional themes of community education and awareness, visibility of cases, related programs, funding requirements, policy compliance, and SART champions were unique to the qualitative interviews.

Community Education and Awareness

In the qualitative portion, SART leaders discussed creating a SART to achieve the goal of increasing education and awareness about sexual assault within their communities. Community education involved both individuals and community organizations, focusing on what sexual assault is, how to respond, and what resources exist for survivors. The qualitative findings differ from the quantitative findings in that one item about community education and awareness was dropped from the factor analysis due to insufficient inter-item correlations with other items within the matrix. Nevertheless, the qualitative findings suggest that this was indeed a factor contributing to SART formation; these findings also align with practice recommendations to engage in community education and awareness efforts to prevent sexual violence (NSVRC, 2018).

Contextual Factors

The qualitative findings also presented contextual factors underlying motivations to form a SART. The visibility of cases, specifically the high rates of sexual assault cases and/or poor treatment of survivors in high-profile cases, highlighted the need for stakeholders to improve their community’s response to sexual assault. This need, in turn, helped facilitate the creation of a SART. This seems to fit with broader frameworks on intervention adoption, which suggest that prevailing norms, beliefs, and attitudes about a condition affect stakeholders’ openness to an intervention (Mendel et al., 2008). Although high rates of sexual assault cases and high profile/visible cases are undoubtedly problematic (and distressing to survivors; Anderson & Overby, 2021), the resulting negative attention may ultimately motivate individuals and systems to change that were previously resistant.

The qualitative findings also suggest that some SARTs form alongside other related programs (e.g., Child Advocacy Centers, SANE programs) because they are required according to policy or funders’ expectations. This is consistent with broader frameworks on intervention adoption, which suggest that the “legal/policy environment” and the “resource/economic environment” (e.g., funding, momentum from other program adoption; Mendel et al., 2008) constitute social contexts that may enable or preclude interventions. However, this is unique to the SART literature, as practitioner resources on SART development may need more tailoring for unique contextual circumstances such as forming alongside other programs, and to address contexts in which SARTs were formed out of a policy or funding requirement.

In addition, participants discussed how their SARTs formed due to “champions” who motivated others to improve the community’s response to sexual assault. Other resources on gender-based violence prevention (Campbell & Fehler-Cabral, 2020; Dills et al., 2016; NSVRC, 2018) have similarly identified the utility of a “champion” in initiating prevention and intervention efforts. Identifying these different circumstances that lead to SART development may help to inform future research and practitioner resources on SART development and effectiveness (see Implications for Future Practice and Research section).

Interrelationships Among Goals and Motivations

Lastly, findings from this study also highlight the interrelated and complex nature of some seemingly distinct goals and motivations. For example, in the qualitative data, numerous SART leaders expressed that to be victim-centered, they needed to collaborate more to ensure a coordinated response for survivors. Furthermore, the findings also highlight complex relationships between improving the response to survivors and improving CJ processes and outcomes. SARTs believed that improving the treatment of survivors could increase survivors’ engagement in the CJ system and thereby contribute to better prosecution rates. This is consistent with findings by Rich and Seffrin (2013) that victim-centered police build stronger cases. However, SARTs also noted that CJ system goals should never supersede a victim-centered response and that victims’ needs must always come first.

Limitations

Certain methodological limitations must be considered in this study, particularly around whose perspectives are represented in the findings. Participants consisted of SART leaders or stakeholders identified by SART leaders, and therefore the findings do not capture the perspectives of others on the SART who may have had different notions of why their team formed. The sample was also predominantly women-identifying and white. While this seems to be reasonably reflective of the population responding (primarily SANEs and RCCs), future studies should work to obtain more diverse samples. This may have particular relevance when exploring SART goals and motivations. For example, given the CJ system often poses significant harm to people of color, members of the LGBTQ+ community, undocumented immigrants, and others, individuals within these groups may seek support and justice outside of these systems. Therefore, it is possible that a more diverse sample may have been more likely to recognize the need for alternatives to providing accountability and safety outside the CJ system and have used this as a reason to form a SART. Moreover, this study’s eligibility criteria included SARTs that were currently active; as such, perspectives from SARTs that had formed and later ceased operations were not captured. Thus, it is possible that motivations to form may have differed for SARTs that were established, and then later discontinued their work.

Regarding the quantitative analysis, some limitations exist around the coverage of the CJ system’s response to cases. While the EFA provides valuable support for some of the key factors underlying SARTs’ goals, it does not fully capture CJ system related to goals; the qualitative data confirm that this is indeed a gap. In the initial measure, only two goals related to CJ system processing of cases were present, and both were focused on outcomes (e.g., increasing prosecution rates, increasing sexual assault reporting), not CJ processes (e.g., improving evidence collection and investigation). These items were then removed during EFA due to low factor loadings. Given the absence of procedural goals in the original measure, future measurement studies should expand their item list to capture these goals. Moreover, it is possible that participants believed CJ outcomes were quite important, but were hesitant to endorse CJ system outcomes as a “primary goal” if they were concerned that CJ outcomes should never supersede victims’ choices. This is especially pertinent considering the sample was primarily composed of RCC advocates/staff and SANEs, who have less control over CJ processes and outcomes. Given this, they may have been more likely to endorse other goals (such as improving the treatment of survivors) beyond those focused on investigation and prosecution. These considerations may explain why CJ goals had not loaded with other items. Future quantitative research on SARTs’ goals can build from these lessons to establish stronger measures.

Lastly, one item about being victim-centered (“To provide a victim-centered response to sexual assault”) was dropped from the EFA model due to low factor loadings. We posit some possible reasons why this item was not retained in the final model. The lack of specificity of what exactly “victim-centered” means may have led to this issue. “Victim-centered” is often used in both practitioner and scholarly literature; however, without more context, participants may have considered this item unclear or had multiple interpretations of the term. In addition, being “victim-centered” is cross-cutting across a variety of issues. Victim-centered responses are accessible, provide high-quality services, treat survivors well, and provide excellent investigation and prosecution of cases, all while prioritizing survivor choice (NSVRC, 2011). Thus, it is possible that the item did not load well because it was not distinctly related to any one factor but rather related somewhat to multiple factors. While this is an important term to practitioners, it is also important that researchers continue to operationalize exactly what “victim-centered” means.

Implications for Future Practice and Research

Understanding the types of goals and motivations for SARTs can inform future research on the structure and development of teams. Since SARTs vary in how they are structured (Greeson et al., 2016), future research can explore whether SART structure is related to the specific goals and motivations SARTs emphasize, as it is possible that teams may have more stakeholders from a certain perspective or may engage in certain collaborative activities that align best with their goals. For example, teams with the goal of improving processing cases through the CJ system may have a greater representation of police and prosecutors in their work, or teams with the goal of increasing collaboration may be more likely to engage in cross-training or protocol development in order to improve the way responders work together. Future research may also examine whether SARTs that are driven by certain goals are more effective and/or sustainable than others. Since limited research exists on the extent to which SARTs are effective in improving the response to sexual assault in communities, it is possible that teams that formed for specific reasons (e.g., to improve their collaboration or provide a more victim-centered response) may be more effective than others.

This study underscores the need for further measure development. Given that the few items specific to CJ system outcomes (i.e., increasing prosecution rates and reporting to the police) were dropped due to low factor loadings in EFA, it is possible that another factor might have emerged if the measure contained more items related to goals in the CJ system. Thus, future measure development and refinement should include procedural goals in the CJ system (e.g., evidence collection and investigation; survivors’ engagement) in addition to outcomes.

This study also has important considerations for practice around SART development and implementation. It is possible that the work SARTs have to undergo in order to get their team up and running may vary, depending on why they formed. For instance, SARTs that developed to comply with policies or funding requirements may need to work together more to build relationships, learn about how to respond to sexual assault together, and garner support for a multidisciplinary approach, whereas SARTs that were developed because responders collectively wanted to improve their work, may not need to put in the same amount of effort to build relationships and buy-in in order to get the SART operating. Therefore, this study can also inform applied knowledge on how SARTs may be developed and brought into operation.

Footnotes

Declaration of Conflicting Interests

The author(s) declared a potential conflict of interest (e.g., a financial relationship with the commercial organizations or products discussed in this article) as follows: There are no reported conflicts of interest associated with this manuscript, and the ideas presented in this document belong to the authors and do not reflect those of the U.S. Department of Justice.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This research was supported by a grant from the National Institute of Justice (2010-WG-BX-0010).

ORCID iDs

Annie Wegrzyn

Megan R. Greeson

Author Biographies

Annie Wegrzyn, PhD, is an Assistant Professor of Psychology at Susquehanna University. Her research focuses on community-based responses to gender-based violence. Her recent research has examined multidisciplinary collaboration among sexual assault responders, trauma-informed care, and the vicarious impacts on professionals who work with gender-based violence survivors.

Megan R. Greeson, PhD, is an Associate Professor of Community Psychology at DePaul University. She conducts collaborative community-based research and evaluation to understand and improve how individuals, organizations, and communities address gender-based violence. Her current projects focus on the civil legal system response to survivors of sexual assault.

Jessica Rice, BA, is a psychology graduate from DePaul University. At DePaul, her research focused on topics related to trauma, specifically, trauma related to children and trauma from sexual assault. She intends to pursue a Clinical Psychology PhD in order to continue to explore her research interests related to trauma.

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