Helping Victims Of Sexual Abuse
Surveys Indicate More Needs to be done in Virginia’s Emergency Rooms and Private Practices

By Lisa Suhay

Having control over your life wrenched away through an act of sexual violence is so transformative, victims suffer its effects long after the initial assault. Just knowing these long-term effects on victims has propelled Stacey Plichta through her career as a researcher. Recently, she was a key member of a team whose study will help improve the way Virginia emergency departments and private doctors assist victims of sexual abuse.

“This kind of research is important because healthcare providers need to be trained and have the resources to evaluate, assist and document incidents of sexual assault,” said Plichta, who has been a member of the College of Health Sciences faculty at Old Dominion University since 2001. An associate professor of community and environmental health, she was recently named graduate program director.

Thumbing through a copy of the report she helped generate, Plichta added, “Long term, this kind of study helps patients who have suffered sexual abuse, which is often the underlying cause of disorders such as depression, chronic fatigue and sexual dysfunction.”

A Mandate from the General Assembly
Funded by the Virginia Department of Health (VDH), the study was conducted by a team of researchers that included five faculty members from Old Dominion. Its genesis was the Virginia General Assembly’s adoption in 2004 of Senate Joint Resolution 131, requiring that the health department study the statewide response to sexual assault victims and the prevention of sexual assault. The mandate was to examine the responses, prevention programs and activities of law enforcement agencies, sexual assault crisis centers and other advocacy and support services, medical personnel and the judicial system and to develop a plan with recommendations for improvement. The VDH contacted the university for assistance in conducting surveys of emergency departments and community-based medical practices as a significant piece of the overall study.

“That was pretty progressive of them,” Plichta said. “I was very impressed with the legislature on this decision. I was, if anything, surprised to learn there were SANE (Sexual Assault Nurse Examiner) nurses available at so many hospitals, because they don’t contribute to a hospital’s profit margin. We are in a time of bottom-line thinking, so this was a good surprise.” Not all of her team’s findings, however, were of a positive nature.

Prior to their surveys, little information was available about the extent to which emergency departments (EDs) are prepared to provide care for victims of sexual violence. Plichta’s research team contacted all 82 publicly accessible EDs in Virginia to examine the structural and process factors that are in place to assist victims.

Her team included the following faculty from the university’s Center for Family Violence Education and Research: Brian Payne, Tancy Vandecar-Burdin, Randy Gainey and Diane Carmody. Also in the group were Yan Zhang, a former student of Plichta’s who is now a faculty member with the Division of Health Services Research, Department of Family and Community Medicine, at Texas Tech University; Rebecca Odor, director of sexual and domestic violence prevention with the Virginia Department of Health’s Center for Injury and Violence Prevention; Addie Magnant, the wife of a former ODU doctoral student, who served as a research assistant; and Shani Reams, sexual violence services coordinator with the Virginia Sexual and Domestic Violence Action Alliance.

In order to collect the necessary data, Plichta had to think not only outside the box, but also beyond the realm and timetable of conventional phone surveys. Magnant was enlisted due to her status as a new mother. “We needed someone to make calls from midnight to about 4 a.m. because that is when emergency room directors and head nurses tend to end their shifts. Addie had a new baby, so I knew she was up at those hours,” Plichta explained.

The surveys led to some interesting conclusions.

“I wasn’t surprised when we found that, in general, Virginia’s EDs are providing needed medical services to victims,” said Plichta. “However, less than half are consistently doing so with specially trained personnel like forensic nurses. The majority are not training their medical staff specifically for dealing with victims of sexual violence.”

Inadequate Resources and Training
According to the Plichta team study, at least half of Virginia’s emergency departments “do not have the needed resources in place to effectively assist victims and most (80 percent) do not provide regular training to their medical staff about sexual violence. Further, almost one-quarter do not have a relationship with a local rape crisis center.” What’s missing, the study notes, is a full level of services victims need, which would include counseling, evidence collection by a trained nurse and links to other services that offer care for victims. The team also found that the EDs do not consistently screen their patients for violence victimization (particularly men) and thus may be missing an opportunity to assist some victims.

While the response rate was high for the EDs (75 percent), Plichta said she was shocked by the overwhelming lack of response from directors of community-based medical practices. “Most didn’t bother returning our surveys and when we followed up by phone they said, ‘Our patients don’t get raped!’ What? It’s just not even on their radar. That’s incredible to me.”

The study also notes that Virginia’s emergency departments and doctors in private practice see only a fraction of the victims, many of whom choose not to seek medical help or file a report with local law enforcement agencies. The Virginia State Police Uniform Crime Statistics report for 2004 lists 5,187 victims (women and men) of reported incidents of violent sexual/forcible sexual assault. However, Plichta cites a 2003 VDH study that estimated the chances of becoming victims of sexual violence over one’s lifetime (among Virginia residents) were 27.6 percent for women and 12.9 percent for men. Applying these figures to U.S. Census data for adult Virginians, Plichta estimates that 26,000 women and 2,580 men were victims of sexual violence in 2003. These numbers are in keeping with many other studies, which have documented that sexual violence victimization is underreported nationwide, she added.

Need for Further Study
“The care-seeking rate for Virginia is low, and the reasons why so few victims seek medical care are worth exploring,” said Plichta. “One possibility is that the services may not be well prepared to assist victims.”

Payne, who serves as chair of ODU’s sociology and criminal justice department and the director of the university’s Center for Family Violence Education and Research, said he was “surprised and disappointed at some of the data that came up as a result of this study. Seeing that so many emergency facilities lack the rudimentary contacts and support systems necessary for helping the victims of abuse was disheartening. Obviously, more attention is needed in this area, including further study.”

Plichta agrees. “This is a subject that needs more of our focus and attention,” she said. “Fifty percent of all women will experience some form of violence in their life and 20 to 25 percent will be raped or sexually assaulted. Also, 30 to 50 percent will be physically or sexually assaulted by an intimate partner, while 18 to 20 percent will be abused sexually as children.”

She concluded, “Having those kinds of numbers in your head and seeing the faces of the victims will keep you going as a researcher, trying to find every way possible to help give them the tools and support to get their lives back.”

A Change in Academic Focus
Plichta’s interest in researching rape and domestic violence began when she was in college. Her roommate’s experiences as a rape counselor prompted her to shift her academic focus from engineering to pursue a bachelor’s degree in psychology and environmental design at the State University of New York at Buffalo.

“She was working in hell,” Plichta said of her roommate. “We talked a lot about what she was encountering. I could not imagine any greater horror than to go through, not only the abuse, but the aftermath and extensive long-term effects. I could not imagine anything worse than having control taken away like that. I changed my entire direction in life.” Plichta went on to obtain a doctorate in health services research at Johns Hopkins University.

Through her research and writing, Plichta has achieved a national and international reputation in the areas of domestic and sexual violence. She has presented more than 100 refereed papers at national and international conferences (many of these with students) and has been an invited speaker at numerous national and international symposia. Her journal articles, abstracts and technical reports are cited in more than 650 publications (almost all peer-reviewed), many of which have a direct impact on policy and service.

Some of her work on family violence is cited in clinical guidelines from the U.S. Preventive Task Force, clinical guidelines from the psychiatry profession and policy statements from the American Academy of Pediatrics. Plichta was part of a select group of family violence researchers that responded to the most recent U.S. Preventive Task Force Guidelines for screening for domestic violence (through the Family Violence Prevention Fund). More generally, her work is cited in articles appearing in first-tier journals such as JAMA, the American Journal of Public Health, and Medical Care.

Her work has also been cited in many international sources, such as World Health Organization publications, the British Medical Journal, the European Journal of Cancer, the Annales de Pediatrei (France) and Gac Sanit (public health journal of Spain).