Coordinated Services for Rape Victims: Exploring Negotiation of Power and Difference in Multidisciplinary Service Delivery Models

Background/Purpose: Sexual assault is an experience that often brings victims into contact with numerous service systems, including healthcare, criminal justice, social service and mental health. Historically, these systems have operated independently, often creating a disjointed, confusing, and distressing experience for victims (Martin, 2005). Communities have made efforts to improve the help-seeking experience for victims by coordinating their response across multiple disciplines, often known as Sexual Assault Response Teams. These multidisciplinary teams are often marked by conflict that interferes with the team's ability to successfully work together to provide services to rape victims (Cole & Logan, 2010). This study explores how structural dynamics of power and disciplinary differences are implicated in conflict within multidisciplinary services and how the failure to successfully negotiate these tensions may compromise the ability of teams to coordinate services.

Method: Using an interpretive approach, analysis drew on three sources of data: 1) semi-structured interviews with 30 professionals involved in coordinating services for rape victims using a stratified sampling process to ensure a balanced distribution of nurses, police, and advocates, 2) multiple observations of two teams as they engaged in coordination meetings, and 3) documents related to multidisciplinary services (e.g. manuals, policies, brochures). Transcribed interviews, observational field notes, and documents were analyzed using an iterative within case and cross-case analysis (Miles & Huberman, 1994) paying particular attention to discursive issues of language and practice in the negotiation of conflicts.

Results: Analysis revealed that conflict in teams occurred along three distinct avenues: 1) linguistic, philosophical, and definitional disagreements about what constitutes rape and how to think about rape victims, 2) discordant strategies for structuring the provision of services and 3) struggles to claim power and authority within the team. Team-generated strategies for coping with conflict rarely explicitly examined power relationships and other structural processes within the multidisciplinary team. Instead team members tended to conceptualize conflict as an individual or isolated event by attributing the conflict to an incident of misunderstanding or identifying conflict with an individual on the team. Teams usually managed conflict by a) focusing on the need to build interpersonal relationships, b) enforcing “turf” boundaries, c) engaging in unobtrusive mobilization, and d) resigning to silence.

Implications: This study indicates that issues of disciplinary discourse and power processes shape both the manifestation and response to conflict in multidisciplinary teams. These findings suggest that adopting an individualized approach to conflict prevented these teams from attending to the root causes and structural dynamics shaping their work together. Instead, these teams would benefit from ongoing efforts to engage with their disciplinary differences as information that can be used to create a more holistic understanding of victims and their needs post-assault. This would require that teams explicitly discuss and attend to the ways that power shapes their work and their relationships with one another. Social workers are well positioned to lead these kinds of conversations given their training in group facilitation, thinking across micro and macro contexts, and recognition of structural and interpersonal power dynamics.