MDTs improve the response to sexual assault by creating positive relationships and collaborations among sexual assault responders.100,101 Police, rape crisis center advocates and staff, SANEs, and prosecutors are the most common active members of MDTs;102 however, many other disciplines are involved in the response to sexual assault, thus MDT membership is frequently more diverse. Most MDTs are composed of representatives from 5 to 15 different organizations.103 The diversity of SART membership is illustrated in Table 2.
Table 2. Active Membership in SARTs*104 (Greeson & Campbell, 2015)
|Sexual Assault Stakeholder Group||% of SARTs With Active Membership From This Group|
|Rape crisis center staff||94.8%|
|Sexual assault nurse examiner or sexual assault forensic examiner||90.1%|
|Domestic violence agency||73.3%|
|Advocate from the victim witness unit in the prosecutor’s office||64.0%|
|Other medical personnel||61.0%|
|Other social services (e.g., drug abuse or welfare)||60.8%|
|Children’s Advocacy Center||50.0%|
|Higher education (i.e., a college or university)||40.1%|
|Corrections (including probation and parole)||28.7%|
|Sex offender treatment||17.0%|
|Schools (grades K through 12)||8.1%|
|Victims/survivors (representing the perspective of victims/survivors only and not an organization on the SART)||4.7%|
*These data do not include MDTs that served child victims exclusively.
**This included related task forces or coalitions; the attorney general’s office; dispatch; and the FBI.
It is valuable for MDT membership to include representation from all stakeholder groups that play a role in the response to sexual assault. This will help ensure a comprehensive and coordinated cross-system response in your community. Below is a list of different stakeholder groups to consider for MDT membership. These cross-discipline relationships can bring a variety of skills to support SANE program development, implementation, and ongoing operation, and Table 3 provides specific benefits of their inclusion.
Adult Protective Services/Long-Term Care Resident Protection: Many programs are mandated to report abuse of people with disabilities to the authorities as specified by state law. In many cases, reports involving adults are made to adult protective services (APS). Staff from your local APS can assist you in understanding your program’s responsibilities under mandatory reporting laws, including who within the program is a mandated reporter; under what circumstances reports must be filed; and the appropriate process to follow when making a report. Moreover, having a relationship with local APS staff helps ensure survivors’ needs are met when reports are made. In some states, if the sexual assault or abuse occurs while an individual is living in a long-term care facility, the abuse needs to be reported to a long-term care ombudsman.
Deaf victim service organizations: There is a small, but growing number of agencies that provide Deaf-centered services to Deaf survivors in the United States. These organizations are run by and for Deaf people and provide victim services that are rooted in the culture and language of the Deaf community. The majority of these agencies are stand-alone, Deaf-specific victim services organizations. To a lesser extent, some programs are run out of general Deaf social service organizations or community victim service organizations. These programs provide the Deaf community with emergency hotlines, crisis intervention, medical and legal advocacy, counseling and other supportive services, peer support opportunities, and community outreach and education. These organizations can provide training on Deaf culture; assess your program’s cultural and language access; provide suggestions for trauma-informed American Sign Language interpreters in your area; and help you develop relationships with the Deaf community in your area.
Disability Abuse Response Team (DART): These specialized teams respond to abuse or neglect of persons with disabilities, and it is important that they coordinate the response with the SART when there are allegations of sexual abuse and assault. APS should know if a team exists in your community.
Child Advocacy Centers (CAC): These centers, developed in the early 1980s, are based on the multidisciplinary team concept. Some CACs are hospital-based, some are community-based. CACs are composed of members from criminal justice, law enforcement, child protective services, mental health services, child abuse-trained medical personnel, advocacy services, and specially trained forensic interviewers. The goal of the CACs is to minimize the interviewing of children while providing the team with all the information needed to adequately investigate abuse allegations and protect the child.
Child Protection: Inclusion of child protection/welfare benefits the victim, the agency, and the MDT partners. Since a family member or acquaintance commits most sexual victimization of minors, child welfare/protection is often an integral part of the investigation with law enforcement. Collaborative investigations by child protection/welfare and law enforcement, in partnership with the other MDT partners, maximizes the sharing of critical information through a trauma-informed and developmentally appropriate process. Having child protection/welfare on the MDT promotes not only the criminal justice outcomes, but also the safety and well-being of minors and their families.
Child Protective Services (CPS) is often the entry point for abuse cases involving children, as mandated reporting usually initiates the investigation by the team. The CPS worker coordinates the investigation into the allegations of abuse and neglect that are received by the mandated reporting hotline. In some communities, CPS workers have additional specialized training in child growth and development as well as physical and sexual abuse.
Indian Child Welfare: Indian Child Welfare is an agency created to assure that the interest of the tribe and the rights of the Indian child who has to interact with the system are protected. The Indian Child Welfare workers oversee the day-to-day implementation of tribal child welfare laws and the Indian Child Welfare Act. They attempt to ensure that if an Indian child needs to be placed in the foster care system, that placement is with an Indian family. Basically, they assure that the Indian child's and the tribe's rights are protected throughout the response system. Many of the Indian Child Welfare workers are Indian and have devoted their careers to serving tribal communities. As such, these workers are familiar with the languages, customs, traditions, familial structures, and child-rearing practices of the tribal communities they serve. An Indian Child Welfare worker should be a mandatory member of any MDT that serves tribal communities.
Clergy/faith community: The community team may want to consider involving local faith-based organizations in the MDT. These organizations can assist with outreach and cultural issues that impact the communities they serve. Often, parishioners may not be reporting to conventional agencies or systems. Clergy and faith-based organizations can also assist with disseminating the message about SANE services.105
Sexual Assault Victim Advocacy Centers: Sexual Assault Victim Advocacy Centers provide counseling, crisis intervention, support, advocacy, referrals, hospital and court accompaniment, hotline management, and many other services to support survivors of sexual violence and their significant others. Centers can be community-based, hospital-based, or located on college and university campuses. Some states have organized training and certification requirements for advocates who work in these centers. Advocates provide confidential services, and in many communities, adult victims have legally protected privileged communication with advocates. As a part of the MDT, rape crisis advocates help maintain the victim-centered approach for the team and represent the interests of the victim throughout the process. They also provide ongoing support across the lifespan to survivors and their friends and family.
Systems-based advocacy: Victim advocates can also be employed as part of law enforcement agencies, prosecutors' offices, and military installations. These advocates play various roles in making sure survivors receive services and support. It is important for survivors to be informed about the function of the advocates and whether their communication is confidential in the same manner it is with a sexual assault center advocate. In addition to providing support to the victim, these advocates also represent the interests of law enforcement and prosecution.
Corrections: Participation in the development and implementation of a SART in a correctional setting can assist in providing a coordinated response within these facilities. The facility-based SART will help identify the core responders when a sexual assault occurs, create a standardized protocol for activating team members, and educate those unfamiliar with the special circumstances faced within a correctional institution. Many times the response to a sexual assault may require assistance from resources outside the jail or prison. Coordinating and meeting with external partners can assist the facility internally as they develop their response.
Crime lab: Collaboration among an established or emerging SANE program, the crime laboratory, and other members of the MDT is an essential component of the successful delivery of sexual assault forensic services. Only through regular dialogue can important information regarding the collection and testing of physical evidence be exchanged in the thorough and timely manner necessary to ensure maximum forensic use of these items for the generation of critical investigative leads in systems such as the Combined DNA Index System (CODIS). SANEs collect the evidence that the crime laboratory analyzes, so both should work to optimize the procedures for collecting, preserving, transporting, and testing items. Because SANEs and crime labs must often negotiate the gap between the medical and law enforcement elements of sexual assault responses, and because they operate independently within different agencies, collaboration is essential if both parties are to operate in concert to maximum effect in support of a victim of sexual assault. Within this partnership, the SANE program has a platform in which to communicate the unique requirements, demands, and restrictions of the medical/hospital setting while the crime laboratory can offer feedback to the SANE program regarding various aspects of evidence documentation, collection, and preservation and chain-of-custody requirements.
Culturally specific community-based organizations: If you have an organization that represents a cultural or ethnic population in your community, their participation in the MDT may facilitate increased awareness for members to access services and for services to be more acceptable to the population.
Civil attorneys: Teams should include a civil attorney who can advocate for the legal rights of the victim throughout the response. This may be a local attorney, or some communities have agencies that fund a victims' rights attorney who can participate on the team.
Domestic violence or other crime-specific victim services: Some communities have programs that provide care to specific victim populations, such as domestic violence or human trafficking survivors. Many of these victims will also be sexual assault survivors. Their involvement in an MDT helps provide comprehensive services to all survivors.
Disabilities services agencies: Organizations that serve people with disabilities exist in virtually every community. They range from county-run boards for people with developmental disabilities to independent living centers that promote the independence of people with any disability to community mental health centers. Partnering with disability organizations can increase your program’s capacity to serve survivors with disabilities. Staff from these organizations can provide training on disability; help assess and build the physical and programmatic accessibility of your program; and assist in the development of protocols for asking about any accommodations survivors need to fully participate and resources for providing those accommodations.
Education system representatives: The MDT can benefit from including representatives from both public schools and from colleges and universities in the community. School-age victims may need the support of educators to make sure they feel supported enough to stay in school. Colleges and universities also represent a high risk population for sexual assault. Members of the MDT can be teachers, school counselors, or psychologists. For colleges and universities, representatives of their Title IX office may want to be involved.
Judicial system: The team may have a representative from the judicial system. In some communities, this may not be possible if the members of the judiciary feel their participation would create a conflict of interest.
Law enforcement: In a vast majority of reported sexual assaults, law enforcement is the gateway into the criminal justice system. This critical position can be an influence on whether victims of sexual assault remain engaged in the process or decide to drop out. As part of an MDT, law enforcement can ensure they are continually coordinating and communicating with other disciplines to ensure victims receive a coordinated and supportive response—no matter how the victim wishes to proceed. Law enforcement's position in the MDT can provide training to other members; create trust and dispel myths by explaining the investigative process and legal restrictions they face; identify and fill gaps in the services to victims; and work as a team member to identify and secure additional resources. At the same time, law enforcement can receive critical training and understanding on the forensic exam, victim trauma, and prosecutorial standards, and membership can help with the development of departmental policies that are victim-centered.
Medical system: Hospitals and medical service providers are important to include in the MDT because they are a major access point for victims who disclose rape and sexual assault. Their input is essential in order to make sure that when a victim does disclose, protocols are in place to activate the MDT response. Medical providers also need to know when and under what circumstances they will be required to provide a higher level of care for sexual assault patients.
Military: The military has specific requirements related to reporting and additional resources available to its members. It is important that local SARTs partner with local military installations and National Guard Bureaus so the special resources are used and military members' special needs are addressed.
Social services/tribal social services: Social service providers should be involved in the MDT to make sure services and resources are available for survivors who qualify. These services may include housing, food, child care, and even education for victims.
Prosecution: The prosecution can assist MDT members in understanding the basics of the criminal justice system, both in criminal law and procedure. Because the law is constantly in flux, prosecutors can also update MDT members on changes as they occur. Issues including how to handle and package sexual assault kit items so they will be admissible in court should be discussed at MDT meetings. (MDT members should use caution when asking prosecutors to comment on civil issues, such as civil liability, how to respond to subpoenas, and disclosure of medical records, because prosecutors are practitioners of criminal and not civil law and do not represent individual members or agencies on the MDT. Questions about matters other than criminal law or procedure should always be referred to the individual or agency attorneys.) Prosecutors should contribute to discussions of inter-agency system issues and provide the prosecution perspective on cases and protocols. In turn, prosecutors benefit from MDT participation in learning how cases flow through the system, the basics of sexual assault exams and protocols, and the related scientific research, which will make a more effective presentation in court.
Researcher/evaluator: Researchers/evaluators can oversee ongoing evaluation of the MDT. They can also design and execute research in partnership with the SART or MDT to answer important questions for the MDT (e.g., if a new response protocol improves victims’ help-seeking experiences). Local universities may have researchers/evaluators open to collaboration.
Senior services programs: Communities may have special programs for seniors that provide various services, including transportation, help with medication, housing, and disability accommodation support.
Sex offender treatment: The purpose of sex offender management is to detect and deter offenders who fail to comply with the conditions of community supervision. The role of sex offender treatment programs can be diverse. Details can be found in the SART Toolkit.
Victims/survivors: Many teams will have a representative who is a survivor of sexual assault. Their role is to provide a unique perspective and keep the team focused on the needs of the victim. It is important to work closely with victim service providers to make sure the team is supportive of the survivor and that the survivor's participation does not create harm.