It happens all the time: In a small town in Ohio, Lisa, 15, goes to a party at her best friend's house. Her friend's 21-year-old cousin is there, and he's brought along some alcohol. The kids drink; Lisa gets sick. Upstairs by herself, she vomits and passes out. When she awakes, the cousin is with her. He tells her that he's going to help her, but he takes her into the next room and rapes her. Lisa tells her best friend, but the friend doesn't believe her. For the next three years, silence defines Lisa's life.

It happens all the time: 18 percent of American women report being sexually assaulted in their lifetimes, according to the Rape, Abuse, and Incest National Network (RAINN) in Washington, DC. It happens here: the Rhode Island State Police report 416 rapes in 2002, up from 311 a decade ago, and this doesn't take into account any other form of sexual assault. Perhaps most disturbingly, such assaults happen far more often than anyone knows since, like Lisa, the majority of victims don't come forward.

Imagine for a moment if you were in Lisa's position. You'd probably be distraught, upset, and angry, perhaps even inexplicably ashamed. You'd probably assume that you should go to the police, but you'd wonder, what happens next? Police are
supposed to catch criminals and courts to deliver justice. They might be able to help you, but they aren't necessarily going to be sensitive about it. The criminal justice system's handling of sex crimes is probably a mystery, so you don't know what to expect. You've already learned that not everyone is going to believe you and that not everyone can be relied upon for support. The last thing you'd want is an investigation and trial that would only make things worse.

It's because of situations like this that the Sexual Assault & Trauma Resource Center of Rhode Island (SATRC), a Providence-based nonprofit agency, launched an initiative last year that is meant to provide a more effective response. The new effort, known as the Sexual Assault Response Team (SART), is a collaborative effort in which the center works with police and the Rhode Island Attorney General's office to coordinate the response after victims -- who are referred to the program by hospitals statewide, participating police departments, or by calling the SATRCor its hotline -- report an instance of sexual assault. For her part, program coordinator Melissa Alexander says SART has filled a need within Rhode Island's criminal justice system by bringing together the disparate agencies that respond to sexual assaults.

Anecdotal evidence suggests that SART programs are beneficial, but a comprehensive study of such efforts has never been conducted. Now, a grant of nearly $160,00 from the National Institute of Justice will enable the Sexual Assault and Trauma Resource Center to measure the effectiveness of the Sexual Assault Response Team. As part of a two-year study, the SATRC and a Boston-based research group called BOTEC will compare the outcomes of cases with and without the response team's participation.

SART programs have become more common nationally since the mid-'90s, triggered by the recognition that a lack of communication often characterized relations between police, prosecutors, hospitals, and victims in sexual assault cases. "What we see is that still, even in this day and age, adult victims of sexual assault do not fare well in the criminal justice process," says Peg Langhammer, executive director of the Sexual Assault & Trauma Resource Center.

The typical handling of sex crimes remains fragmented in communities without a response team. Victims are often passed from the hospital to the cops and prosecutors with little explanation of how their case is being conducted. Different individuals repeatedly ask them the same uncomfortable questions. Since most victims of sexual assault already fear being doubted, they may perceive every additional blunt question as another indication of disbelief. And once cases make it to a prosecutor's office, they may sit on a desk for more than a month, as the victims wonder whether if they have been abandoned by the legal system altogether. It's a lonely and harrowing experience, not to mention an unwieldy way of responding to a crime.

By making the entire process more efficient, Sexual Assault Response Teams make it less traumatic for victims. A volunteer advocate from the Sexual Assault & Trauma Resource Center is assigned to every assault victim over 14 who goes to a hospital for a forensic exam in Rhode Island. Referrals are also available through police departments in Pawtucket, Cranston, Woonsocket, Warwick, Burrillville, and elsewhere.

Among other things, it is this advocate's job to offer the services of the SART program to the victim. The advocate can help a victim to get evaluated and treated, facilitate interviews with the police, follow the case through the court system, and attempt to answers any questions. The SATRC also serves as a sort of home base, where these discussions can take place in a safe and comfortable environment.

Similar efforts are taking place elsewhere, including Massachusetts, where a new Statewide Sexual Assault Prevention and Intervention Network brings together rape counselors, law enforcement, and other officials in responding to sex crimes. The response, however, still needs improvement in most communities across the US. Meanwhile, as op-ed columnist Bob Herbert wrote in the New York Times in April 2002, because of a lack of systematic procedures for collecting and processing DNA evidence, "There are tens of thousands of rape kits sitting uselessly on shelves across the nation, waiting for someone to analyze them."

Lisa, who didn't seek charges against her assailant, now works for the Sexual Assault & Trauma Resource Center as an advocate, going to the emergency room at Women & Infants' Hospital in Providence every Friday evening to provide initial support and information to female sexual assault victims. If they want to press charges, she refers them to the SART program. "The power of programs like SART," says Lisa, "is that they prevent people from going through what I went through -- which is the years of silence that keep you from ever healing."

ATTITUDES ABOUT SEXUAL assault have been shifting for decades, particularly since efforts to diminish violence against women intensified in the '60s and '70s. Rape is no longer the taboo subject that it once was, and being a victim is less of an automatic cause for shame. But even though nonprofits like the Sexual Assault & Trauma Resource Center have made significant strides, sexual assault remains a major problem -- as evidenced by ongoing headlines about gang rapes in Pakistan, the kidnapping of young girls, and the number of children molested by priests.

"It used to be that somebody was raped or sexually assaulted every minute," says Jamie Zuieback, spokeswoman for the Rape, Abuse and Incest National Network, citing Justice Department statistics. "Then it was every 90 seconds, and now it's every two minutes. We've come a long way, but we have a long way to go."

The Sexual Assault & Trauma Resource Center was established in 1973 to provide advocacy for assault victims. The center, based in Providence's Jewelry District, has a staff of 26 and, among other efforts, runs counseling and educational programs. The agency's budget, $1.6 million in 2002, mostly comes from state and federal grants, with additional funding from foundations, corporations, and the United Way.

In the '90s, staffers at the SATRC began to recognize that victims who wanted to press charges for sexual attacks often had to undergo horrific ordeals in the process. It was possible for someone who had been raped a short time earlier to wait three hours in the emergency room before being examined, and the mishandling of evidence was routine. Busy, tired examiners often did not know what to look for and had little interest in the meticulousness required for the forensic exam of a rape victim. In a scenario where physical evidence can make or break a case, these forensic exams were often treated with appalling carelessness.

The same lack of sensitivity and attention to detail also existed among some law enforcement officials. Zuieback recounts the story of a young sexually abused child who was asked by the officer handling his case if he had been sodomized. The child had never heard the term before, so he said no. It took work with an abuse advocate trained in counseling children before the real story came out and the perpetrator could be charged. "I don't think there's a law enforcement official out there who doesn't want to put as many bad guys in jail as possible," says Zuieback, "but they need the right tools to work with."

Faced with inadequate care and limited support, many victims chose to remain silent: two-thirds of all sexual assaults are never reported, according to RAINN, (www.rainn. org). The effects of silence, however, can be devastating. Sexual assault is an inherently isolating experience, since it damages the victim's sense of trust in other people. Not talking about it only makes the sense of isolation worse. Lisa began to recover from her own attack when she became a counselor for a rape crisis hotline in college, handling calls from people who were seeking help after years or even decades of silence.

"One thing that is very common," she says, "is a feeling of guilt that you didn't come forward, and that the person you let get away with it is going to hurt someone else." Pressing charges might help alleviate this sense of responsibility, but, says Lisa, most of the victims with whom she talks remain reluctant to turn to the legal system. "They already have some idea of what they're in for . . . some idea that they won't be believed . . . some idea that it's going to go on forever, and they don't want the experience to be that central in their lives for the amount of time it would take to get through it," she says. However, of the people she has counseled who do want to press charges, every single one was comforted by, and enthused about, the Sexual Assault Response Team program.

Once assault victims decide to press charges, their cases are turned over to Melissa Alexander or Colette Laffan, staffers at the Sexual Assault & Trauma Resource Center. To press charges, the victim must make a statement to the police. The first and perhaps most important step for the SART is to set up an interview in which the victim can do just that. By arranging a single occasion when the police detective, prosecutor, and anyone else who needs information from the victim can participate in an interview, the advocate reduces the number of times the victim must repeat the traumatic details of his or her assault.

Seventy percent of those aided by the SATRC are children, so perhaps it's no surprise that the SART interview process is based on the Children's Advocacy Center, a model for assisting younger victims. The centerpiece is a consolidated approach for gathering information and evidence, in which one person questions the child, rather than exposing him or her to a battery of interviews. The small, cozy room at the SATRC has a large one-way mirror through which representatives of other agencies can watch the interview. The interviewer also has a wireless earphone through additional questions can be suggested. The child's responses are videotaped -- and the tape can be used as testimony in court.

Within the SART program, as with the CAC, all of the players involved in the case -- usually the police detective, the prosecutor, and the SART advocate -- meet initially and trade information without the victim present, so as to be able to ask informed questions during the consolidated interview. This process is beneficial not only to the victim, but also to law enforcement officials working on the case. "Getting the official statement is up to me as an investigator," says Detective Wayne Richardson of the Burrillville police. "But nobody's perfect, and I might miss something. The advantage of having the prosecutor right there is for filling in the gaps."

From there, the SART advocate, the prosecutor, and the police work together until a case is closed. The victim often ends up developing a relationship with the prosecutor and the investigator, which actually makes each of their jobs easier. As Richardson explains, defendants who feel comfortable with the people working on their cases are much more likely to communicate with them, making it easier for prosecutors and detectives to track down information.

Without the Sexual Assault Response Team, victims would have to wade through this process by themselves. In the hospital, a woman would have to wait to be examined in the emergency room, and unless her condition was critical, the wait would probably take hours. She would have to spend her time in the ER without eating, drinking, showering, or urinating, since any of these things might damage evidence. A 1991 study of sexual assault victims found that the only doctor available to give the exam was often male, and for about half of the victims (male as well as female), the idea of being examined by a man shortly after being assaulted by one was horrifying.

Upon release from the hospital, the victim might have nowhere to stay if she was assaulted by someone at her home. A hundred other logistical problems could arise: the police interview might be set in a dangerous or uncomfortable location for the victim, or it might be inaccessible if she doesn't have a car. The victim might feel like she isn't being believed. With no apparent end in sight, she might drop the charges out of frustration. Crucial to SART programs is the assumption that victims are much less likely to go through a trial, or even press charges at all, without them.

In the Rhode Island program -- where 34 cases were pending in December 2002 -- the response team advocate remains in touch with the victim, calling her monthly with general support, referrals for therapy, and information on how to navigate the criminal justice system. Often, the best thing that a SART advocate can do is to keep the victim in touch with the way her case is being handled. As Alexander explains, "When cases go from the police to the attorney general, they often end up sitting on a desk for a month or more until they're dealt with. Part of our job is just to call the attorney general's office to be able to inform the victim of what the status of things is, so that they don't feel like everyone forgot about them."

TWENTY-FIVE YEARS AGO, a nurse named Linda Ledray started a program in Minneapolis to improve the treatment of sexual assault victims in hospitals. Her program put nurses trained as sexual assault specialists in each post-assault forensic exam, attempting to ensure that victims received appropriate care and that all possible evidence was properly collected. The program was a wild success and was taken up around the country. There are now more than 400 such sexual assault nurse-examiner (SANE) programs listed on the national Web site, www.sane-sart.com (in many places, the SANE program was given the SART acronym).

Within the world of sexual assault response programs, the distinction between SANE and SART is vital. "Advocates can't do what we do," says Jan Kraft, a spokeswoman for Ledray's original program in Minnesota. While advocates provide support and knowledge, nurses have the more concrete task of gathering physical evidence as thoroughly as possible. Also, as Kraft points out, calling SANEs "advocates" can make them sound biased.

Linda Fairstein, former chief of the sex crimes prosecution unit of the Manhattan District Attorney's office, calls sexual assault nurse-examiners, "a critical positive part [of an effective response to sexual assault] because they are trained not only to examine a victim, but to take care of the forensic parts of the exam that are not necessary to a medical exam." In Rhode Island, the Sexual Assault & Trauma Resource Center hopes the Sexual Assault Response Team will eventually include a SANE component. Part of the reason for the delay is the cost and complication of adding a SANE element; the program would require nurses, training, certification, and hospital participation, none of which come easily or cheaply.

Greater national consistency in the conduct of forensic exams is another step that would improve the response to sexual assaults. "Right now, when a rape kit is taken, it may need to go to a state database, and then the state database might do some comparison with an FBI database, and right now they are all on different systems," explains the Rape, Assault, and Incest National Network's Jamie Zuieback. "If we had one system across the country, it would be much easier to compare local evidence with evidence in national courts." A proposal to standardize rape kits made it to Congress last year, but it wasn't voted on. It will probably be reconsidered this year.

Twenty or even 10 years ago, the outlook remained pretty grim for a rape victim who wanted to press charges. Now, with programs like SARTs and SANEs becoming more prevalent, reporting a sexual assault can be a far better experience than it once was. Peg Langhammer of the Sexual Assault & Trauma Resource Center notes that even if the process doesn't yield a conviction, "The victim might still think, 'I'm glad I went through that anyway, I felt really supported by the process, I felt supported by law enforcement, by the prosecution, clearly by the victim advocate, [and] I didn't get what I wanted, but I'm really glad that I did it.' "

After being raped when she was 15, Lisa never pressed charges against her attacker. Her best friend refused to believe her, so she remained afraid to tell anyone else what had happened, and by the time she came to terms with her past, she was unwilling to go through the ordeal of a trial. Despite her work as an advocate, she says she probably wouldn't have come forward even if a SART-like program had existed when she was assaulted. She thinks that if she had told her parents, though, her mother would have encouraged her to call the police and go to the hospital, "and if that had happened, then the SART would have been a huge help to me and my family."

This gets to the heart of the Sexual Assault Response Team program. It's obviously difficult to entirely prevent sexual assaults from occurring, but the more people come forward, the more frequently justice can be served. As it stands, the criminal justice system can only help those who are already brave enough to break the silence.

Izzy Grinspan can be reached at elizabeth_grinspan@brown.edu.

Resources for victims of sexual assault
The Rape, Abuse, and Incest National Network (RAINN)
National Sexual Assault Help-line: (800) 656-HOPE
Web site: www.rainn.org

The Sexual Assault & Trauma Resource Center of Rhode Island
Phone number: (401) 421-4100
Web site: www.satrc.org

Victims of Crime Help-line: (800) 494-8100

Issue Date: February 14 - 20, 2003