Problem: Many colleges and universities offer sexual assault programs and services. Nonetheless, most young women do not report incidents of violence and therefore do not get the kind of care they need to manage the immediate and long-term physical and mental health consequences.
Background: A psychiatric nurse by training, Angela Frederick Amar is accustomed to treating battered patients; indeed, many patients who have psychiatric illnesses have a history of violence.
Yet one patient stands out in her memory, largely because she spurred Amar to change the trajectory of her career and dedicate her life to researching broad-scale interventions to help the millions of women who are victims of abuse.
To Amar, the patient seemed in many ways to be a mirror image of herself. She was in her late 20s—about the same age Amar was at the time—and, like Amar, was a single woman living in New Orleans.
Yet unlike Amar, she was severely depressed, in large part because she was trapped in an abusive relationship. Suicide, she felt, was her only way out. As Amar listened to her story, a familiar adage ran through her mind: “There but for the grace of God go I.”
After the session, Amar turned to a coworker and said: “That could have been me.” Amar’s coworker responded, in essence, “That is me.” She then confided in Amar that she was also being battered by boyfriend and didn’t know how to get help.
“I said, ‘How come you never told me?’” Amar recalled. “And the coworker replied, ‘How come you never asked?’ I had no response.”
Amar, PhD, RN, an associate professor at the William F. Connell School of Nursing at Boston College and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar program (2008-2011), has been responding to the silent epidemic of interpersonal violence ever since.
One of her first responses was to switch professional gears. Amar left her job in clinical practice and decided to become a nurse educator and researcher. She earned her master’s degree in nursing at the Louisiana State University Medical Center and then her doctorate degree at the University of Pennsylvania.
While writing her dissertation on dating violence among young women, she discovered that very few victims sought professional help—and she began to wonder why.
In the decades since, she has learned that the low reporting rate can be explained in part by flawed cultural definitions of interpersonal violence. Most victims define rape as an assault perpetrated by the proverbial stranger in the bushes, Amar said. The reality, however, is that most offenders know their victims and commit the crime indoors, in what are presumed to be “safer” confines. As a result, victims have trouble equating assault by a friend or acquaintance with rape. Moreover, victims may downplay sexual assault as a kind of “rite of passage” that women go through in the transition to adulthood. And they may recoil from speaking up due to fear that they will be scrutinized, or even blamed, for the assault.
Speaking up, however, is the critical first step to accessing needed support and services. One in four college-age women is sexually assaulted, and consequences range from post-traumatic stress syndrome, depression and anxiety to stress-related headaches and backaches, increased alcohol consumption, and difficulties in intimate relationships and at school.
Amar began to wonder how to help victims get the support they need. “It’s not enough to say to young women: ‘Report! Report! Report!’ if the conditions in which they would report are inadequate,” Amar said. “We need to change those conditions to encourage victims to speak up.”
Solution: In 2008, Amar was named an RWJF Nurse Faculty Scholar. She used the financial support provided by the fellowship to explore campus conditions for victims of interpersonal violence at various colleges and universities. She and her research team analyzed the policies and procedures in place at higher education institutions around the country to assess on-campus sexual assault programs and services for students. They did this by emailing electronic surveys to college administrators and students to assess the effectiveness of existing programs.
She found that the colleges and universities had education and service programs in place but that they did not adequately address student needs or encourage all victims to report crimes.
Prevention programs, for example, were more focused on “stranger danger” than the more typical kind of assault by friends and acquaintances. Few programs taught potential victims how to avoid assaults by a known offender. Few programs were targeted toward potential offenders or bystanders. And colleges and universities often marginalized sexual assault as a “women’s issue” rather than a campus-wide problem.
In addition, colleges with religious affiliations did not address the full range of the problem, and lesbian, gay, bisexual or transgendered students at those institutions lacked access to appropriate support services.
For their part, students reported that they wanted to see administrators do a better job of integrating sexual assault education into curricula, take more public stands against the problem, and publish the names of alleged perpetrators. Amar also found that many students were more apt to seek help from friends than from the support services found on college campuses.
Amar plans to publish her findings next year. She hopes they will serve as a foundation for the development of policies and programs that can be used at colleges and universities nationwide. Recommendations include on-campus sexual assault response teams comprised of trained professionals who are able to respond to all alleged incidents; task forces that oversee campus-wide sexual assault policies; medical amnesty for victims who come forward to report abuse after breaking campus rules on alcohol; and mandatory and ongoing prevention education that is fully integrated into college curricula.
Amar’s effort to draw more attention to the problem got a boost from the federal government this spring, when the Department of Education published a letter calling for an end to sexual harassment and sexual violence. “The sexual harassment of students, including sexual violence, interferes with students’ right to receive an education free from discrimination and, in the case of sexual violence, is a crime,” the April 4 letter stated.
The government’s position, she said, will spur more administrators to take a more serious look at the problem, and perhaps adopt some of Amar’s forthcoming recommendations. Amar’s goals don’t end there. In the future, she plans to study campus sexual assault adjudication processes; interventions for young women about how to prevent sexual assault and respond when it occurs; and how to engage men in preventing sexual assault.
It has been a long time now since Angela Amar’s battered co-worker left her speechless. But spurred by that incident, she is much more ready to help others like her today. After decades of research into how to help women report abuse, she now has a long and informed answer to the question of how to help victims get the help they need.
RWJF Perspective: The Robert Wood Johnson Foundation strives to improve the health and health care of all Americans. As part of this goal, the Foundation supports the Nurse Faculty Scholars program, which aims to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to young faculty. Amar has used her RWJF Nurse Faculty Scholar grant to conduct badly need research into an issue that matters deeply to her.
RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
Unengaged patients can incur costs of up to 21% higher than patients who are highly engaged in care. This suite of materials from RWJF's AF4...
This month the Johns Hopkins Bloomberg School of Public Health published a special issue of its magazine devoted to food.
The LEAP project identified 30 primary care practices that use health professionals and other staff in ways that maximize access to their se...
A national conversation highlighting efforts to improve care transitions, reduce avoidable hospital readmissions, and lift overall quality o...
Learn how The Robert Wood Johnson Foundation is dedicated to building a culture of health in Risa Lavizzo-Mourey's 2014 annual message.
The Health and Medical Care Archives at the University of Michigan's Inter-University Consortium for Political and Social Research is the of...
Team members, grantees, and guests discuss breakthrough ideas that will allow us to move toward solving challenges in health care.
Adverse working conditions contribute substantially to the risk of depression for working-age adults, according to new research from a team ...
Hilary Levey Friedman, author of Playing to Win: Raising Children in a Competitive Culture, writes about youth sports.
RWJF President and CEO Risa Lavizzo-Mourey, MD, discusses how the Foundation will work across professions and sectors to create a culture of...
RWJF Nurse Faculty Scholar Jennifer Bellot writes about losing her grandmother to complications from a medical error.