The Role of Structural and Case Factors on Interprofessional Collaboration on Sexual Assault Response Teams

Purpose: Pervasive in the research and clinical literature on sexual assault nurse examiner (SANE) programs is the assumption that integrating SANEs into a multidisciplinary team (SART) with law enforcement and advocacy organizations is imperative for optimal outcomes (Campbell et al., 2005; Derhammer, Lucente, Reed, & Young, 2000; Ledray, 2001; U.S. Department of Justice, 2004). Opportunities for interprofessional conflicts always exist when working with multidisciplinary teams and this may be especially salient with SARTs because of the diversity of team members (Crandall & Helitzer, 2003; Hatmaker, Pinholster, & Saye, 2002; Martin, 2005; Riger et al., 2002), and thus the different professional orientations toward victims (Martin, 2005). The purpose of this study was to examine structural and case factors that promote or inhibit collaboration on SARTs.

Methods: The proposed project is a multiple-case study of the three active SARTs in one state, using concurrent mixed-methods procedures. Data was collected with three methods: (1) In-depth structured interviews with SART Coordinators, (2) Telephone surveys with SART professionals (n = 79), and (3) Observations of Interagency Council meetings. Data from the telephone surveys are presented in this analysis. The primary output variable was computed from a modified version of the Index of Interprofessional Collaboration (IIC, Bronstein, 2002). Responses to open-ended questions were entered into NVivo (v.2) for management of coding, and the researcher used an iterative process of analyzing data into codes and categories (Straus & Corbin, 1998).

Results: The sample was composed of the following percentages of individuals from the sampled professional groups: 27.8% medical, 30.4% law enforcement, 13.9% prosecutor or victim advocate in the prosecutor's office, and 27.8% rape crisis victim advocate. Significant differences in scores on the modified IIC were found by the professional groups. Specifically, victim advocates rated interprofessional collaboration lower for their SART than medical providers and criminal justice personnel. Structural factors (i.e., professional allegiance, issues related to maintaining victim confidentiality, and power disparity between the professions) were significantly related to scores on the IIC. Moreover, an effect of the type of case (e.g., less difficult to prosecute vs. more difficult to prosecute) was found on ratings of interprofessional collaboration. Specifically, interprofessional collaboration was rated significantly lower for a case that involved victim alcohol use and a known offender than a case that did not involve victim alcohol use and a stranger offender (i.e., more complex cases).

Implications for research and practice: Even with the best intentions, group work requires attention to working relationships. Greater attention to the conditions that maximize constructive conflict and minimize destructive conflict is needed in the research and practice literature on SART. The findings of the study support the need for initial and ongoing joint training among professionals working on SART. Discourse on interdisciplinary work must address how individuals can maintain professional integrity while working on multidisciplinary efforts. The study findings also stress the importance of professionals learning to distinguish between interpersonal and professional conflicts. Within the current academic environment, elective courses can provide opportunities for interdisciplinary contacts (Gilbert, 2005).