Appendix E
Overseas models of support services

1Appendix E provides an overview of the approaches taken to sexual violence support services overseas.

South Africa – a one-stop-shop model

2Thuthuzela Care Centres (TCCs)795 have been held out by the United Nations as a “best practice model”.796 TCC response centres are located in hospitals but were established by the Sexual Offences and Community Affairs Unit (SOCA) of the National Prosecuting Authority in 1998. SOCA is responsible for strategic policy and case management relating to sexual violence, namely through developing best practice and policies that improve prosecution rates. Accordingly, TCCs are designed “to address the medical and social needs of sexual assault survivors” but also to “reduce secondary victimization, improve conviction rates and reduce delays” in the criminal process.797
3TCCs are staffed 24 hours a day by specialised medical staff, social workers and Police. A victim assistance officer also explains the procedures and assists the victim throughout the medical examination and when reporting to Police. A site coordinator ensures follow-through of services, with the objective of such coordination being the prevention of secondary victimisation. Services include:798

4The management model of the organisation relies on an integrated effort of designated community-based service providers and government departments including Health, Treasury, Police, Justice, Education, Corrections and Social Development.

5TCCs have a close relationship with the specialist sexual offences courts in South Africa and are charged with increasing “communication between prosecutor, Police and victim”.799 The idea of the one-stop-shop model in these cases is not just to centralise medical and counselling facilities but to co-locate investigation and prosecution facilities, seeking to improve the victim’s experience while waiting for the justice process to begin.
6TCCs are credited with helping decrease the trial completion time for cases (from two years to just over seven months)800 and conviction rates that sit between 84 and 89 per cent.801 Literature from the TCC programme states that:802

at the heart of the success of the Thuthuzela approach is the professional medical and legal interface and a high degree of cooperation between victim and service providers from reporting through investigation and prosecution of the crime, leading up to conviction of the offender. This has led to an increase in conviction rates.

United Kingdom: specialist victim advocate providing a wraparound modelTop

7Sexual Assault Referral Centres (SARCs) are specialist medical and forensic services available to anyone who has been raped or sexually assaulted. They aim to provide a one-stop-shop service providing medical care and forensic examination in a single location. Once a rape or sexual assault is reported to the Police, the complainant is taken to the nearest SARC for forensic medical examination. The SARC may also have facilities onsite for the victim to give a Police statement, rather than at a Police station (although the model varies, for example, in some locations, the SARC is located beside a Police station with officers responsible for attendance at the relevant SARC). Support is funnelled through a dedicated crisis worker and may include long-term support such as counselling and advocacy, although this might be referred out to other agencies.

8SARCs are funded and run in partnership, usually between the NHS, Police and sometimes the voluntary sector. SARCs offer medical services to anyone, including those who do not wish to report the assault to the Police (self-referrals). Service users can then choose whether they would like to inform the Police at a later stage and have their samples stored whilst they are considering what to do next. Figures show that rates of reporting to the Police when a victim has used a SARC service are at least 77 per cent.803
9The distinguishing feature in the United Kingdom (England, Wales, and Scotland) is that since 2006, Independent Sexual Violence Advisors (ISVAs) – and also Independent Domestic Violence Advisors – are now available to support individual victims. ISVAs are located either in a SARC or within an alternative service provider. The Home Office provides ongoing funding for ISVAs, and in 2011, a framework for the qualification of ISVAs was announced.804
10The responsibilities of an ISVA are “providing crisis intervention and non-therapeutic support from time of referral; giving information and assistance through the criminal justice process if requested/required; providing other types of practical help and advice; and, working with partner agencies to ensure coordinated service planning on behalf of individual victims”.805 In other words, the services offered by an ISVA wrap around the victim to provide holistic support designed to meet the victim’s individual support and service needs at all stages in the victim’s experience.
11The benefits of this model are the knowledge and training of the ISVA and the continuity of support an ISVA can provide a victim into and beyond the justice process and/or alternative process. In addition, although the Police are not directly involved in either SARCs or with the ISVA programme, there is access to Police and Police processes. One evaluation of the model funded by the Home Office noted that “ISVAs were seen to be necessary to encourage victims to engage with key stages of the criminal justice sector (e.g., reporting to police, making a statement, attending court etc.)”,806 although it was acknowledged that ISVA activities “may not easily translate into a reduction in attrition” in terms of data that could link the role of the ISVA and victims’ decisions to remain in the justice system.807
12In the same evaluation, participant victims noted that they considered the support they received from an ISVA and the ongoing nature of that support beyond the victim’s decision whether or not to report to Police as positive aspects of their experience.808 The evaluation commented that multi-agency cooperation was an essential component of enabling the ISVA to have the resources to continue supporting the victim through and beyond the justice process.

United States of America: linking wraparound care to justice outcomesTop

13The model that operates in almost every state is a federal government-funded Sexual Assault Response Team (SART) that is based around a Sexual Assault Nurse Examiner (SANE) but also uses the services of doctors, medical staff, Police, lawyers and other support service staff, thereby adopting a one-stop-shop model. The victim receives wraparound medical, social, and legal support, all free of charge. The model operates under the auspices of the Department of Justice.809
14The SART and SANE programmes have been linked to increased conviction rates and form part of other ongoing initiatives, including forensic examination outside of a hospital setting.810 The SART model has garnered a great deal of respect from the policing and legal communities to the extent that, in some courts, written evidence from a SANE-accredited physician is accepted, due to the credibility associated with these individuals.
15Evaluations of the SART and SANE programmes have linked the model to:811
16The one-stop-shop model is just one of the tools adopted in the United States to enhance the victim’s experience and address gaps in assisting victims. There are a range of additional programmes and projects that have been adopted and that have objectives linked to promoting justice outcomes as well as positive victim experience. One such example is the “You Have Options” programme, which helps identify serial perpetrators by providing victims with anonymous reporting options. This gives law enforcement agencies access to information that might not have otherwise been available, while allowing the victim more control over the decision of whether or not to report.812
17Another programme that is of interest is the American Bar Association’s Commission on Sexual and Domestic Violence.813 The Commission seeks to “increase access to justice for victims of domestic violence, sexual assault and stalking by mobilizing the legal profession” and plays a large role in promoting the Violence Against Women Act 1994. The Commission is a subsidiary of the American Bar Association and has five staff members with high-level legal backgrounds, 16 commissioners from around the country and 28 liaison staff from various sector bodies and interest areas, including the National Network to Prevent Forced Marriage and the Coalition Against Sexual Assault.814
18Funding for promotion and protection projects supplementary to the Act are authorised by US Congress and relevant non-governmental partners. The Commission undertakes a number of functions including:815

19The above model is one being driven from outside government and from within the legal community. The aim is to increase access to justice for victims of sexual violence. However, the methods employed do not necessarily directly assist victims post-crisis, which is a role left to the SART/SANE model identified above. The United States illustrates the use of complementary programmes working side by side, recognising that the wider victim experience impacts upon the participation of the victim in the justice process.

Victoria, Australia: strong cross-organisational relationshipsTop

20Despite having a large social service sector Victoria is a positive example of a well-coordinated and collaborative community sector characterised by a clear delineation of the role performed by community-based service providers on the one hand and government agencies on the other hand. Even the funding model adopted across Victoria was developed through consultation between government and community-based service providers, and it promotes flexibility in terms of service delivery within the framework of a fixed envelope of funding.

21Some of the features of multi-agency coordination in Victoria include dedicated Police investigators and liaison services to keep channels of communication open as victims pass between social and justice services. In addition, some services are co-located in multi-disciplinary centres that have several agencies working together. Protocols exist to manage relationships between government and community-based service providers such as the Protocol between the CASA Forum (Victorian Centres Against Sexual Assault Forum) and the Office of the Public Advocate.

22Within the sexual violence support sector, there are also levels of cooperation between agencies who take responsibility for a 24-hour phone line and a state-wide Sexual Assault Workforce Development programme, which, in the period from February to June 2015, ran at least 10 different training courses.

23Victoria is notable due to the scale of reform undertaken in areas of policing, legislation, funding and judicial practices and procedures. The strongest feature of the Victorian model is the degree of cross-organisational coordination that has been linked with successful reform of the sector.

Denmark: one-stop-shop model with a focus on researchTop

24A key feature of the Danish response to sexual violence is a designated Centre of Excellence, which is usually located in a hospital, attached to a Centre for Rape Victims (CRV) and funded by the Ministry of Interior and Public Health and private organisations.816 While viewed as a Nordic model, there are similar research centres found in Ireland and in Jordan. They are well funded and nationally recognised as centres of research and innovative policy development in the field.
25The Centre of Excellence operates in conjunction with a CRV, which in turn provides specialist wraparound care for victims of sexual violence and education services. The CRV will treat victims aged 15 years or older who can consent to services (there is also a process for ad hoc court guardianship to be acquired in order to get consent for younger victims). All services are available 24 hours a day including provision for acute medical examination, evidence collection and care; Police questioning in a separate room; standardised routines for providing a referral to or establishing contact with a psychologist; sheltered accommodation for the first night; Police being on-call for collecting samples and written statements; and follow-up medical care and advice on contacting a lawyer. Statistics for the CRV model show significant rates of reporting. For example, in 2009, 65 per cent of victims who contacted a CRV made a formal Police report.817
26CRVs are run by multidisciplinary committees including representatives from Police, Department of Forensic Medicine, psychology and emergency medicine. They have close relationships with university and research bodies who undertake research projects relating to the utility of group therapy, countertransference and burnout, false Police reports, the provision of services to family members of victims and the risk of developing post-traumatic stress disorder.818
27Education projects have included the development of standardised practice guidelines for professionals, guidelines on dealing with media in high profile cases, development of a standard rape kit for collection of forensic evidence, and instructional videos for, amongst others, Police and nurses. In addition research findings have been presented at international conferences and work-shopped at a parliamentary level, highlighting the credibility attached to the work done and the implication that it is taken into account in policy development.819
28The so-called Nordic model illustrates the one-stop-shop model and also highlights the role of collaboration between those working directly with victims and researchers. The scope of research that has been undertaken by the Centres of Excellence is broad and relates to all aspects of the victim’s experience, including participation in the justice process, such as examining barriers for reporting sexual violence, considering the epidemiology of rape focusing on legal outcomes and developing new methods for detecting date rape drugs.820
795“Thuthuzela” is a Xhosa word (the second largest ethnic group in South Africa), meaning comfort.
796Laura Turquet and others Progress of the World’s Women 2011–2012: In Pursuit of Justice (UN Women, 2011) at 57.
797At 57.
798South Africa National Prosecuting Authority Thuthuzela Care Centre: Turning Victims into Survivors at 7.
799At 74.
800Turquet and others, above n 796, at 57.
801K Schenck-Gustafsson and others Handbook of Clinical Gender Medicine (Karger Medical and Scientific Publishers, Basel, 2012) at 121.
802South Africa National Prosecuting Authority, above n 798, at 6.
803Amanda Robinson Independent Sexual Violence Advisors: a process evaluation (Home Office, 2009) at 28.
804The Government Response to the Stern Review: An independent review into how rape complaints are handled by public authorities in England and Wales (Cabinet Office, March 2011) at 13.
805Robinson, above n 803, at 10.
806At 30.
807At 31.
808At 31.
809“SART Toolkit: Resources for Sexual Assault Response Teams” Office of Justice Programs <>.
810John Jungpa Park Sexual Violence Services: International Overview (Department of Health, UK, 2012) at 13.
811See “Responses to Sexual Violence: Effectiveness of SANE/SART” (30 May 2012) Office of Justice Programs: National Institute of Justice <>; CS Crandall and D Helitzer Impact Evaluation of a Sexual Assault Nurse (SANE) Programme (Albuquerque SANE Collaborative, Albuquerque, 2003); Campbell and others Systems Change Analysis of SANE Programs: Identifying the Mediating Mechanisms of Criminal Justice System Impact (Michigan State University, 2009).
816Health services in each county are responsible for establishing CRVs.
817Rikke Holm Bramsen “A Danish model for treating victims of rape and sexual assault: The multidisciplinary public approach” (The Second International Conference on the Survivors of Rape, Utrecht, 2 October 2010).
818Rikke Holm Bramsen, Ask Elklit and Louise Hjort Nielsen “A Danish Model for Treating Victims of Rape and Sexual Assault: The Multidisciplinary Public Approach” (2009) 18 J Aggress Maltreatment Trauma 886 at 896–897.
819At 898–899.
820At 886.