Date on Master's Thesis/Doctoral Dissertation

5-2024

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Promotion and Behavioral Sciences

Degree Program

Public Health Sciences with a specialization in Health Promotion, PhD

Committee Chair

Combs, Ryan

Committee Member

Wendel, Monica

Committee Member

Harris, Lesley

Committee Member

Lorenz, Katherine

Author's Keywords

sexual violence; crisis response continuum; trauma-informed crisis response; post-traumatic stress; sexual victimization

Abstract

Sexual violence (SV) is a highly prevalent public health and human rights concern impacting communities across the United States. SV is associated with a myriad of adverse physical, reproductive, sexual, mental, behavioral, financial, and social health outcomes which may be acute or chronic. Health challenges associated with post-traumatic stress and post-traumatic stress disorder are particularly common among victims and survivors of SV. Engagement in early psychological/psychosocial intervention strategies may prevent or reduce PTSD-related symptomatology after experiencing an SV encounter. Despite the availability of crisis response and support options to support individuals who have experienced SV, significant barriers exist across social ecology to meaningful access and engagement, leading to significant underreporting of SV, as well as underutilization of available crisis response services and resources. Lived experience perspectives from individuals who have experienced SV are critical for learning more about how to overcome barriers to care and crisis response engagement, and to address adverse health outcomes after SV. This qualitative descriptive study engaged adults who identified as having experienced contact SV (n=20) in semi-structured narrative interviews to learn more about their experiences with and perspectives regarding formal and informal crisis response and support networks. Interviews were analyzed using reflexive thematic analysis methods. Three manuscripts were developed based on qualitative data collected. The first manuscript explored survivors’ experiences with post-assault crisis care delivered by nonprofit human services organizations (NPHSO) and leveraged lived experience to make targeted recommendations for improving access to and quality of crisis response services. The second manuscript reported findings specific to survivors’ experiences with crisis response services offered by criminal justice systems (CJS). The third manuscript considered how social responses to SV disclosures from informal social support providers may support or obstruct survivors’ recovery trajectories. The findings of this study indicate that crisis response services frequently fail to align with the priorities, objectives, and immediate needs experienced by survivors following a violent encounter. Participants expressed a significant lack of confidence in crisis response services, particularly those associated with the criminal justice system (CJS), to deliver compassionate, understanding, and supportive care. Consequently, many survivors opted not to engage with law enforcement, emergency departments, or crisis counseling altogether. To restore this eroded trust, participants proposed a variety of recommendations for enhancing crisis response services, ranging from improving communication strategies and outreach efforts to implementing substantial policy reforms and systems transformations. As individuals with lived experience, survivors of SV offer invaluable insights into the effective strategies for supporting individuals in urgent need of post-assault care. This dissertation follows a three-manuscript format and has seven chapters. Chapter one introduces the topic and provides a brief background. Chapter two offers an extensive review and synthesis of the literature. Chapter three explains the methodological approaches used, as well as the theoretical, conceptual, and epistemological underpinnings of the study. Chapters four through six present three distinct manuscripts developed with the findings of the study. Finally, chapter seven discusses the three manuscripts, as well as presents implications for policy, practice, and future research directions.

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