Issues of Victim Confidentiality on Sexual Assault Response Teams (SART)

Purpose: The process of professionalization socializes individuals to have strong allegiances to their own profession (D'Amour et al., 2005; Waugaman, 1994). Hall (2005) noted that different professional values may be an obstacle for collaboration; one of these differences involves the importance different professions place on client confidentiality (Hall, 2005; Ovretveit, 2000; Reese & Sontag, 2001). Problems may occur on teams when different professionals operate under different confidentiality policies (Ovretveit, 2000). The purpose of this study was to examine how professionals involved with a SART understand and navigate different professional statutory requirements for victim confidentiality, and to examine the role of these requirements on perceptions of interprofessional collaboration.

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 Coordinators, initial responders, and professionals who have worked on sexual assault cases in conjunction 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. There was a significant negative correlation between the perception that victim confidentiality posed a particular challenge to coordination among professionals and the quality of interprofessional collaboration, Kendall tau = -.294, p < .01. Among those professionals who reported that victim confidentiality did not pose a challenge to coordinating among professionals, explanations for why this was the case were elicited. Among those professionals who reported that victim confidentiality did pose a challenge to collaboration, professionals described the obstacle as the limiting of information sharing between professionals. Thus, different professional obligations for maintaining victim confidentiality had the potential to create conflict and tension among SART professionals. Client-level information exchanges were decidedly one-way from other professional groups to victim advocacy. Some professionals viewed the one-way information pathway as evidence of a lack of reciprocity, which engendered some frustration in other professionals.

Implications for research and practice: Unresolved tension over sharing information contributed to perceptions of lower collaboration. Greater education and discussion on the counselor-client privilege and how it prohibits victim advocates from sharing information with other professionals is needed. 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. Community service providers involved in SARTs would appreciate and could benefit from formal evaluation of team processes and outcomes.