Jennifer Van Der Horn, MHA, BSN, RN
Jennifer Van Der Horn, MHA, BSN, RN, has over 16 years of nursing experience, focusing primarily on critical care and emergency room/ trauma. For the past five years, Jennifer has been a nurse leader, her current role being the Clinical Director of Critical Care. In her current role as Director, Jennifer is also tasked with writing the Department of Nursing policies and procedures, enriching her background in evidence-based practice research and writing. She earned her Master’s Degree Health Care Administration from Grand Canyon University, her Bachelor’s Degree in Nursing from Thomas Edison State University, and her Associates Degree in Applied Science in Nursing, from Mercer County Community College. Jennifer is married and has three children, four cats, and two dogs. She is an active member of the American Association of Critical Care Nurses, the New Jersey chapter of the Organization of Nurse Leaders, and the ASPCA. In her spare time, Jennifer loves to read and run.
Statistics in the United States for sexual assault are staggering. Rates of sexual assaults of college students are higher than our national rates. 20-25% of college women, and 15% of college men, will become victims of sexual assault, during their college attendance. National conversations have focused on the need for colleges and universities to intervene and prevent these occurrences. The federal government has mandated campuses actively implement comprehensive prevention strategies to address this epidemic. As caregivers, teachers, advocates and policy makers, nurses are in a unique position to make significant contributions to the prevention of college sexual violence. This can be done through the use of scholarship, skills and empathy to guide colleges and universities through complex policy issues, and through scholarship, teaching and advocacy, can help transform college campuses into communities where far fewer students will experience sexual assault.
Upon completion of this course the nurse will
- Understand the statistics related to sexual assault on college campuses
- Will have knowledge of the perpetrators and risk factors of sexual assaultWill become knowledgeable how
- college and universities can tackle the risks factors
- Understand the recommended prevention strategies
Understand the role of the Nurse in prevention of sexual violence on college campuses
The statistics for sexual assault in our country are staggering. As many as one in five women and one in 71 men will experience rape in their lifetime in the United states and one in three women and one in six men have experienced some form of contact sexual violence in their lifetime. As many as 51.1%, of female victims report they have been raped by an intimate partner, and 40.8%, report being raped by an acquaintance. Up to 52.4% of male victims report being raped by an acquaintance while, 15.1%, report they were raped by a stranger. Almost half of multi-race women and more than 45% of American Indian/Alaska Native women have been subjected to some form of contact sexual violence. 91% of rape and sexual assault victims are female and nine percent are male. In 8 out of 10 occurrences of rape, the victim knew the perpetrator and 8% of rapes occur in the workplace. 5
Rates of sexual assault of college students are higher than national rates. 20-25 percent of college women and 15% of college men become victims of sexual assault during their college attendance. In 2002, a study found 63.3% of men, at one university, who self-reported rape or attempted rape, admitted to committing repeat rape. As many as 90% of sexual assault victims do not report assault and as many as 27% of college women experience some form of unwanted sexual contact. Almost two thirds of college students experience sexual harassment. 5
National conversations have focused on the need for colleges and universities to address sexual assault and other forms of sexual violence on U.S. college campuses. Administrators,
counselors, law enforcement and prevention advocates struggle with efforts to intervene and prevent these occurrences. A recent federal mandate requires campuses to actively implement comprehensive strategies and programs to address the epidemic of sexual violence on college campuses and includes targeted prevention programs addressing sexual assault, dating violence, intimate partner violence and stalking behaviors. Because of this recent scrutiny, university faculty and staff must face the dilemma of better understanding the motivations and risk factors associated with both individuals and groups, committing these types of attacks. Understanding these risk factors can provide administrators, conduct officers, law enforcement, prevention advocates, and counselors with insight into preventative education and informed policy and procedures, with the goal of reducing sexual assault in the college setting. 1
Risk Factors for Sexual Violence on College Campuses
Primary prevention strategies need to include an understanding of root factors associated with sexual violence on college campuses. Commonly cited characteristics of sexual violence on college campuses include:
- Men are the majority of perpetrators
- At least 50% of sexual assault involves the use of alcohol
- Members of all-male organizations, for example, fraternities and athletes, have less healthy attitudes and behaviors related to sexual assault. 1
The American College Health Association defines sexual violence as a continuum of behaviors as opposed to a single deviant act. By addressing behaviors occurring throughout the continuum, it is more likely that sexual violence can be prevented.
Gender-based sexual violence on college campuses is not the result of a few “bad apples” that have worldviews and behaviors that shape a healthy and enlightened group of young adults, but instead lies in the subtle development of negative and unhealthy ideas about sexuality. These include degrading and/or non-consensual encounters, objectification, obsessive and possessive desires, depersonalization and dehumanizing thoughts. all of which have become pervasive in our American culture. 1
The Risk Factors
Commonly cited characteristics of sexual violence on college campus can be incorporated with high risk attitudes, behaviors and experiences into 12 risk factors for sexual violence on college campuses. These risk factors are identified by Brunt et al and also referred to as the “Dirty Dozen.” 1
This risk factor describes an individual or group who turns away from specific, shared and individual traits and characteristics and instead focuses on differences. These individuals or groups have a pervasive tendency to undervalue unique aspects of human existence in others, and lack an ability or willingness to see their thoughts, behaviors and characteristics in others. When they make an attempt to understand others, it is usually a superficial understanding, based on their expectations of how the other person should view the world. They often make comments or remarks with the intent to undermine self-esteem and diminish or trivialize appearance, personality and intelligence. Objectification brings focus on the attributes of individuals, at the expense of an informed understanding of their personality, emotions and psychology. They often categorize a complex individual into the easiest or most common attributes.
While an individual who objectifies and depersonalizes others is concerning, it becomes drastically more concerning when it becomes institutionalized and traditionalized by a group. All-male groups, for example, teams and fraternities, are high-risk but other single-sex organizations and coed clubs/organizations can also negatively illustrate this risk factor. They serve to re-inforce negative attitudes and reduce understanding, further objectifying individuals and creating an ideal environment for growth.
Examples can include sitting outside of facilities and residence halls, to cat-call women walking back to residence halls, in the early morning creating a “walk of shame,” for women presumed to be sexually active, organizations engaging in salacious party themes that promote anonymous, depersonalized sexual encounters and even a group of men at a bar or party encouraging the targeting of women based on a characteristic as part of a bet or entertainment.
The process of “hogging” describes men seeking women who are overweight or unattractive to satisfy competitive or sexual urges. The overweight women are depersonalized as lazy, unattractive or socially unacceptable to separate the individual from the potential target.
Another example is the objectification of rape victims, by non-perpetrator groups, through the acceptance and promotion of rape myths by denying the humanity of the victim, holding her responsible for alcohol or drug-related behavior connected to the incident, or removing her from the group for reputational concerns. This depersonalization builds up when even groups of women reject their own gender group and see other women in stereotypical ways, seeing themselves as exceptions to their gender and believing the woman’s behavior was causal in provoking the attack. 1
2. Obsessive or Addictive Pornography or Sex Focus
This risk factor overlaps with Factor 1. Individuals or groups with a tendency toward objectification will likely have a motivation to be a consumer of depersonalizing and violent pornography and, inversely, use of pornography can reinforce the tendency towards objectification. Research has shown, exposure to sexually explicit material, can be correlated with negative outcomes, including an increase in sexual perpetration and support of rape myths. Exposure to pornography can also exacerbate aggressive tendencies in those at high risk for this type of behavior.
All pornography is not the same and the concern arises when an individual or group is consuming violent pornography. In violent pornography, the focus is on power and control. As pornography has become more acceptable, the level of brutality and degradation of women has intensified. Arguments have been made that pornography can cause a predisposition of some males to desire or intensify a desire for rape, undermine internal/social inhibitions against acting on rape desires, and undermine potential victims’ ability to avoid or resist rape.
Individual signs of pornography addiction can include interference with social activities, work attendance, class or study, financial difficulties, hygiene problems and the inability to decrease usage or take a break. Group signs might include an athletic team that regularly visits a strip club or has a climate in the organization encouraging impersonal or coercive sex. 1
3. Threats and Ultimatums
This risk factor includes an individual or group making threats and demands to meet their needs. “If/then ultimatums conclude with potential loss of face to peers, financial hardship, status or outing of sexual identity. Groups may use hazing or other ultimatums to gain compliance. These threats and ultimatums escalate and become a problem-solving approach for the group, acquiring what they desire through coercive action.
The abuse or attacker sets up ultimatums or threats to their victim using coercion or verbal aggression. This is done to isolate the target from help or support and creates a sense of fear or danger, increasing the likelihood of compliance. Examples might include the threat to share personal information, a naked photograph or a video of sexual activity, if the victim does not comply. A threat might involve the use of a position to threaten discrediting if they report sexual violence or harassment. Fraternities and sororities can use intimidation and coercion as an organization. The pressure for conformity to group norms is extensive and leads to a student being unable to maintain a choice or control of a situation. This desire to conform to group norms, to achieve membership, creates a dangerous environment and the cultivation of unhealthy attitudes about gender, sex and relationships. This implied threat, losing social status and membership, is real for a student considering reporting an incident related to the organization or its members. 1
4. Misogynistic Ideology
This risk factor is the pervasive belief that the female gender is less worthy of respect or consideration, compared males. This might include strongly held beliefs that women are not good for anything more than sex, along with a disregard for their opinions or desires. These beliefs are reinforced through peer and primary family support. Many societal factors reinforce gender hierarchies, including, media depictions, religious and social conventions and historical experience that subjugate and marginalize women. This masculine ideology is often associated with sexual aggression, hostile beliefs about women, the desire to be in control and an acceptance of violence against women. There can be a fear of the individual not living up to these existing standards of masculine ideology. 1
5. Grooming Behaviors
Numerous grooming and approach behaviors can occur with the goal of lessening a victim’s ability to advocate for their safety. An individual might attempt to disempower a partner or re-establish an ended relationship. Grooming behaviors can be utilized to increase vulnerability of a target of sexual violence, including stalking or tracking a person’s movements, blocking an exit with physical presence or the threat of violence or the isolation of an individual or group away from friends and acquaintances. Other grooming techniques can be the use of embarrassment, attacking of self-esteem with negative remarks, insults, or objectification.
Grooming behaviors in social settings might include environments with an unequal mix of gender participants, gender segregation during the event and men treating women with a lack of respect and degrading jokes, loud music limiting conversation and access to dirty bathrooms only. These techniques use a climate that lessens a person’s access to support and safety. 1
6. Using Substances to Obtain Sex
Individuals or groups often make use of alcohol or other drugs, attempting to lower resistance and defenses of those targeted for sexual behavior. It is well established that 50-75% of sexual assault incidents on college campuses are associated with alcohol or other drugs.
Alcohol use by college students is prevalent and often incudes high risk use including drinking games, taking shots and the negative consequences of taking advantage of or being taken advantage of sexually.
Alcohol and other substances are frequently used by college students to relax, reduce social anxiety and increase enjoyment. Alcohol is used in the setting of parties to reduce inhibitions and ensure those in attendance have a good time.
Substances not only contribute to the majority of assaults on college campuses, but also to unhealthy attitudes and increased vulnerability. Alcohol contributes to misperceptions of sexual interest between individuals and leads to the ignoring of cues and refusal, contributing to victim-blaming and regretted sex. In a group setting, alcohol increases conformity to the group norms, through reducing inhibitions and individual judgement, and increasing group bonding. In more extreme cases, individuals or groups use substances to facilitate sexual assault.
More subtle use of substances can include hosting social events or parties providing high volumes of free alcohol and serving to underage students more vulnerable during the transition period to college. Communal alcohol sources for example punch can be made stronger or mixed with illegal or prescription drugs. 1
7. Hardened or Inflexible Point of View
This risk factor involves an individual or group with an intractable point of view or system of beliefs that is highly defended against rational debate or change. These beliefs might include misogynistic ideology, and any argument or attempt to dissuade the individual or group from these beliefs, reinforces them further and leads to a perceived attack.
Hardening occurs when the individual begins to selectively attend to his or her environment and filters out material or information that is not in alignment with his or her beliefs. This hardened viewpoint can expand to sexual assault and male perpetrators engage in victim-blaming to justify the assault. There is minimization of and denial of the validity of other viewpoints and the individual’s world view must be accepted by others and is offered as the only logical view. These individuals often seek out others with the same perspective, for further validation, allowing for the creation of groups that are self-reinforcing and unaccepting of alternative perspectives and viewpoints, creating an opportunity for pressure in maintaining conformity. In group settings, those with opposing viewpoints are filtered out and there is a disregard for the impact of their behaviors on others. 1
8. Pattern of Escalating Threat Strategies
The individual or group of individuals continues to escalate behavior towards higher levels of violence. They demonstrate predatory thinking, grooming behaviors, practice and testing, to “test the waters,” before moving toward more dangerous behaviors. There is an increase in concerning behaviors, including misogynistic statements, stalking, threats or ultimatums, and the use of alcohol to lower a victim’s defense mechanisms. This occurs despite attempts by the institution to address concerns through conduct action, education and prevention efforts. The individual or group is determined in their focus of violence and they continue to move toward a negative outcome, despite efforts to dissuade them from these negative actions.
Stalking behaviors can progress from exploratory behaviors to intensive and invasive techniques, including hyper-intimacy, proximity and surveillance, invasion, pursuit, intimidation, harassment, coercion, constraint and aggression. For example, the behavior may start with and ex-boyfriend following a target to her classes and escalates to a magnetic GPS device attached to her car.
In sexual –addictive predatory or paraphilic behaviors, a student may initially be comfortable flashing private parts anonymously in public places, escalating to masturbation or masturbation during contact with nonconsenting others.
Subtle hints or vague, intimidating behaviors may be the initial action, but non-compliance of the target can result in escalation of threats. Intimidation can begin with notes and phone calls and can escalate to social media attacks or driving by her apartment and throwing something at her window.
Grooming behaviors, described in risk factor 5, frequently create environments of escalating threat and increase the likelihood a student will allow the behavior to continue. Social organizations may begin with open and inviting environments and progress to elite environments to reinforce the need to conform to be socially accepted. This risk factor is about an increase in initial behaviors. 1
9. Lack of Empathy
This factor describes an individual or group that lacks empathy for others. It overlaps with risk factor 7, as it also describes a hardened and inflexible point of view. The individual or group are narcissistic and lack awareness of the societal, community or personal harm they potentially cause others. They are unable to see the world from another’s perspective and are often patronizing or paternalistic, presuming to know what another needs and imposing actions on him or her. This lack of empathy, often results in frustration when a student is questioned regarding belief and behaviors, and they are unable to see the relevance of other viewpoints, other than those informed by their personal experience. They do not understand how their behavior or attitudes are a problem for others, and often feel a sense of entitlement to have the freedom to think as they like and resist the idea of taking responsibility for viewing how their actions may affect others. If their belief system involves intolerance, sexism and oppression, it can contribute to rape attitudes. Perpetrators of sexual assault have higher levels of hostility toward women, lower levels of empathy, and often hold traditional gender-role stereotypes.
Addressing this risk factor, in individuals or groups lacking empathy for others, is necessary for behavioral change. Change can occur when the individual or group sees the benefit as being for their own good. It helps them feel more connected with those around them.
A sorority may distance themselves from the assault of one of their members; using the rationale she had a drinking problem, a lengthy sexual history or a promiscuous personality. The most common way both male and female students account for harm to women, is by attributing them to women’s mistakes. They avoid criticizing the party scene or men’s behavior within it.
They also justify or deny sexual violence, or deny personal vulnerability, by limiting behaviors considered to be rape, and blame rape victims for their own victimization. They often use rape myths to justify or deny men’s sexual violence and women may use them to deny personal vulnerability to rape. An example might be an endorsement that, if there are no bruises on a woman, she is unable to claim rape and then justify coercing a woman into having sex as being acceptable as long as he does not leave bruises on her. If a woman endorses rape myths, she may rationalize that only promiscuous women get raped and feel she can avoid it by not sleeping around. 1
10. Sensation-Seeking Behaviors
In this instance, the individual or group is focused on achieving pleasure and sensation as their primary goal. This outlook resists discussion and change, with the central desire of experiencing pleasure here and now. There is an addictive nature to this type of pursuit and is often at the expense of social standing, finances and moral codes. They seek varied, novel, complex and intense sensations and experiences, making them willing to take physical, social, legal and financial risks for the sake of the experience. The behavior may coincide with impulsivity and risk taking. Research has shown sexually aggressive behaviors are most common when the perpetrator is experiencing intense emotions and a lack of forethought and planning with their actions. There is a lack of focus on consequences for behavior, beyond the immediacy of the act. This can coincide with risk factor #9 in their inability to see their beliefs and values from the perspective of others.
An example of this might be a male college student who obsessively uses pornography, and then begins to look for increased sensation-seeking, through sexual behavior with others, or a group of men who view sexual activity as conquests and may keep numbers and enter into competitions with others, to see who can reach the highest score. The key concept in this risk factor is habitualization of the behavior. Increased sexual conquests, pleasure and experiences become a driving force. 1
11. Obsessive and or Addictive Thoughts or Behaviors
Sexual addiction is increasing on college campuses. There is a tendency to focus on a goal at the cost of other reasonable behaviors. This risk factor can overlap with other factors, but is unique, due to the focused pursuit on thoughts related to sexually aggressive or violent behavior. The thoughts these individuals experience, are repetitive in nature and the individual ruminates on them with an inability to redirect focus on other topics. There is often an underlying insecurity and a clinging to the desperate and short-sighted need for something, accompanied by a great fear of not getting it. In some cases, there may be a history of early childhood or teenage sexually addictive behaviors. These thoughts and behaviors are perceived as being outside of the control of the person experiencing the impulses. There is a lack of satisfaction and the need to pursue some new habitual experience.
Paraphilic behaviors must also be considered with any sexual violence. These are mental disorders involving sexual urges, fantasies and behaviors that involve non-human objects, children or other non-consenting individuals, and suffering or humiliation. The range of behaviors is wide and can range, between voyeurism and exhibitionism, to sexual sadism. The risk for violence can increase exponentially, depending on the paraphilic behavior as well as sexual fantasies and urges.
An example might be a student who remains obsessive with someone he has dated or recently met at a party, despite clear messages the woman does not want the attention or pursuit. The stalker goes too far and to greater lengths to procure his victim. 1
12. Past Experience
The American College Health Association defines sexual violence as a learned behavior in 2008. Past experiences can serve to increase risks of perpetration and future abuse. Past behaviors and experiences, that are possible contributors to a predisposition for sexual violence, include, past physical abuse, past sexual abuse, being the victim or witness of a sexual assault, substance abuse, sexual addictive behaviors and impulses, family or societal support for rape or assault, negative masculine attitudes and past relational experiences. Past behaviors are known to be predictive of future behaviors.
With college staff and faculty more aware of the risk factors, they have an opportunity for early prevention education, more effective intervention and informed sanctioning and educational events for groups or individuals involved in assault. 1
A national public health priority identified, in Healthy People 2020, by the Department of Health and Human Services, 2010, sets the reduction and prevention of sexual violence, experienced by college students as critical. To achieve national improvements, among the young adults who experience disproportionate rates of sexual violence, will require careful attention toward college environments, and the primary context in which this violence occurs and is sought. 1
Tackling Risk Factors
Brunt et al have identified a frame work to help guide colleges and universities tackle identified risk factors:
1. Develop Bystander Intervention Efforts
The 2013 Violence Against Women Act identifies bystander intervention, as being a safe and positive option that can be carried out, by an individual or group of individuals, to prevent harm or intervene when there is a risk of dating violence, domestic violence, sexual assault or stalking.
Bystander intervention training must include efforts to assist students in identifying potential existing problems, including those outlined by the DD-12. These programs must help students establish healthy expectations and social norms, related to their own and others’ behaviors to be effective. Through recognizing factors in the DD-12, as red flags for sexual violence, and an understanding of the influence of groups in conforming to false norms, bystanders will become more likely to recognize problems and utilize learned skills to intervene and prevent sexual violence.
Bystander programs have been shown to be effective in shifting attitudes related to males and masculinities when these types of techniques are incorporated.
Faculty, staff and students need to be educated about the risk factors for sexual violence. With forthcoming conversations regarding behaviors and attitudes across the spectrum of sexual violence and addressing hesitancy to report, people are empowered to both respond to and report incidents. Many people have the concept that a person may have snapped and acted out of context, when in reality, violence is evolutionary and there are indicators occurring along the way that a person is becoming sexually aggressive. 1
2. Teach Otherness and Empathy
Efforts focusing on the healthy development of empathy in college students, have the ability to potentially influence multiple aspects of the campus community, to reduce sexual assault. Finding ways to increase men’s empathy toward rape survivors, may lower their likelihood of being a perpetrator of rape. Students with more highly developed empathy skills, are more likely to respond positively to peer disclosures of victimization and respond negatively to attitudes that support myth rape. The use of mentors in high-risk populations can be an effective way to role model behaviors associated with sexual assault, intimate partner violence and stalking. Scenarios can be a powerful tool to assist students in changing attitudes and behavior by assisting them to understand what survivors might feel. 1
3. Address Micro-aggressions
The biggest challenge in addressing micro-aggressions is the understanding that these slights are frequently unintentional. A student may see his stalking behavior as positive attention toward the object of his infection or see cat calling as a positive compliment for a woman who is well-dressed. This creates a dual problem; of the person being unaware the comment is offensive to the receiving person, and the reaction of defensiveness, when being confronted with the behavior. These small, unintentional, everyday micro-aggressions have a cumulative effect, and the volume and continual experiences, become cumulative for the individual experiencing them. Students must understand, it is not only what the individual has experienced from them, but what the individual has already experienced, during the same day, or over a short period of time. The cumulative effect of micro-aggressions can be considerable over time. Educational programs should include discussion of the unintentional impact of rape jokes, objectification, and slurs against race, gender and sexual orientation. Key to this training is that the impact of these statements is separate from intent. Few men see themselves as possible rapists or perpetrators and the goal is to increase empathy and understanding that unintended jokes or comments can result in harm. 1
4. Train Conduct Staff and Hearing Boards
It is essential to train those involved in Title IX investigations and coordination of compliance is essential. The Association of Title IX Coordinators and Administrators, is a place where training is provided for colleges and universities. Hearing boards must receive training to operate competently. The hearing board must be familiar with basic rules of evidence regarding relevance, credibility and rape shield rules, as well as, be versed in an analytical approach to determining if a policy has been violated. There must be training on questioning and deliberation techniques. There should be an understanding of Rape Trauma Syndrome and common rape myths. Hearing boards need to be sensitized to what the victim is experiencing and the fact they may be traumatized by the recalling of events.
Conduct administrators, and boards trained in the continuum of sexual violence and related factors, can better evaluate student and organizational behaviors that are of concern. With an understanding of the root factors of sexual violence, staff can recognize concerns, early, and design educational sanctions to alter attitudes and behaviors in more positive ways. Identified risk factors, provide objective behaviors and attitudes, that can be observed and described in sexual violence incident reports and provide a common language to discuss incidents of sexual violence. 1
5. Monitor Campus Climates
Prior to a campus engaging its community in education or intervention programs, it must have an accurate understanding of issues related to sexual assault, stalking and intimate partner violence, as they contextually occur within its campus community. This understanding can assist a college campus in avoiding observational bias, only looking for what they are searching for, where it is easiest. The problems are the deeper issues contributing to violence against women on campus, with complicated and difficult to understand motivations. With the development of a better understanding of these issues on campus, a college has the opportunity to get ahead of the problem and offer solutions and interventions tied directly to specific, contextual factors on their campus. 1
6. Teach Affirmative Consent and Relationship Health
Identifying risk factors and developing a program similar to “Just Say No,” is not enough to decrease sexual violence on college campuses. A focus must be made to teach sexual consent and relationship health in an ongoing, affirmative, and engaging format. Students must understand the satisfaction and pleasure that comes with consensual and willing sex. This occurs with open communication, empathy and mutual trust. The focus should be on aspects of healthy sexuality, in a positive manner, as opposed to just telling students what not to do. 1
Recommended Prevention Strategies
In 2014, the White House established the Task Force to Protect Students from Sexual Assault, with the mandate to strengthen federal enforcement efforts and provide schools with tools to help prevent sexual violence. The CDC convened a panel of experts, in conjunction with the Justice Department’s Office on Violence Against Women, Sex Offender Sentencing, Monitoring, Apprehending, Registering and Tracking Office, and the Department of Education, to identify emerging and promising practices, to prevent sexual violence on U.S. college and university campuses.
The CDC worked, with the American Public Health Association, to bring public health knowledge and expertise, through working with key constituencies, including sexual violence prevention practitioners, college and university administrators, college and university sexual violence prevention educators, students, researchers, law enforcement, federal partners and sexual violence resource center, to outline a framework for campus sexual violence prevention efforts. This framework, “Sexual Violence on Campus: Strategies for Prevention,” includes five components and how to incorporate these best practices into prevention, planning and implementation. The Department of Education’s Title IX guidelines, outline federal guidance colleges and universities must follow, but more than compliance is needed to change the culture. 2
The 5 components for campus sexual assault prevention include:
1. Comprehensive Prevention
Strategies and approaches that complement and reinforce each other across a social ecological model
The basic organizational systems and structures that are needed to effectively implement sexual violence prevention strategies, on college and university campuses and address the complicated health and safety issue of sexual violence
A broad referral to the target audience, including recipients and observers of prevention messages, campaigns and strategies
4. Partnerships and Sustainability
The development of healthy working relationships with community partners and stakeholders, to help strengthen, coordinate and align prevention efforts to be more sustainable over time.
A public health practice that serves to identify what is and is not working with the programs, policies or practice. 2
The CDC uses a four-level social ecological model to promote the understanding of prevention strategies. The model exemplifies the connection between individual, relationship, community and societal factors.
A comprehensive approach requires primary and secondary prevention strategies that complement each other. Secondary support addresses the immediate and long term needs of a survivor of assault.
Opportunities for comprehensive prevention include:
- Implement efforts across the social ecological model, individual, relationship community and societal factors
Prevention strategies should take place at the individual, relationship, community and societal level. Activities across the social ecology will start complement and reinforce each other.
2. Incorporate principles of prevention
Prevention strategies should be comprehensive, with assurance the audience receives messages multiple times, to ensure adequate exposure to the intervention, using well-trained staff and varied teaching methods, developmentally appropriate for the audience and socio-culturally relevant to the audience, with a focus on positive relationships and using outcome evaluation, to determine if the prevention program is working
3. Use data to make decisions
Public health uses data, for informed decision-making in planning, implementing and evaluating prevention strategies. Data is also helpful in making a case for the need for staff positions and policies. Research findings about sexual violence on campus, including demographics, needs assessments, prevalence, reporting data, and climate surveys, can be used to tailor activities to specific communities on campus, making them more helpful.
4. Employ a multi-sector approach
Public health also recognizes that it takes multiple perspectives and areas of expertise to address a complicated health and safety issue. Campus communities are made up of multiple disciplines and factors, that can be used create prevention focused, community response teams
5. Coordinate efforts across prevention and response
Prevention and response are equally important in the goal to end sexual violence on college campuses. Prevention staff needs to be aware of policies and practices, when responding to sexual violence, when it occurs on campus. Prevention staff should be able to make appropriate referrals, both on and off campus, to, meet the needs of survivors, and staff, focused on responding to violence, when it occurs, should be able to promote prevention messages also. Cross-training of staff is important to understand the roles and responsibilities of other staff, and both prevention and response staff, should be trauma informed. Response efforts need to be sensitive and avoid re-traumatizing survivors or blaming victims
6. Partner with community organizations and rape crisis centers
Collaboration with community-based rape crisis centers can ensure coordination of sexual violence prevention strategies in the community and on campus. Other community organizations that can be partnered with, include local law enforcement, organizations serving lesbian, gay, bisexual, transgender and square communities, victim service centers, legal aid, social services, health centers and domestic violence shelters
7. Work to address gender-based violence
Campuses must work to counter messages and attitudes that adhere to traditional gender norms. Prevention strategies can use gender equity, where males and females are treated fairly and similarly, as well as, promote healthy sexuality and intimate relationships on campuses. The strategies used in addressing gender violence, should also work to disrupt multiple systems of oppression, for example sexism, racism and homophobia.2
The CDC identifies several opportunities, for action, for campus infrastructure including the use of well trained staff, the use of standardized training, the hiring of dedicated prevention staff, the institutionalization of preventions, the creation of teams, work groups and committees, the fostering of relationships with referral services, the incorporation of violence prevention with other preventative programs, the use of a trauma-informed approach, and work against all types of violence.
The CDC also addresses diverse audiences in reaching prevention goals, and recommends the identification of champions, remembering the messenger matters, tailoring prevention efforts to specific communities, planning for differences in types of institutions, engaging parents, using proactive and social media, and encouraging active and visible bystanders.
The opportunity to build key partnerships, for sustainable prevention efforts, includes developing MOUs (memorandum of agreement or memorandum of understanding) with community partners, ensuring leadership buy in, creating permanent staff positions, engaging students in planning and programming, and partnering with health services.
The CDC identifies opportunities for evaluation of campus efforts, to include, rigorous evaluation of promising prevention programs, practices and policies, focusing outcomes on reduction in perpetration, creating a capacity for evaluation, valuing participant territory research, requiring logic models and theories of change, and building connections between research and practice. 2
The CDC has also produced an evidence-based framework, outlining evidence-based strategies, for preventing sexual violence in communities, using the current best available evidence to prevent or reduce violence. This can improve the health and well-being of communities, by outlining activities, public health and other stakeholders can use to reduce violence and violence-related risk factors in their communities. The framework includes primary prevention strategies, and also approaches, that can be used in responding to sexual violence after it has occurred. It is “STOP SV: A Technical Package to Prevent Sexual Violence.” This framework can be incorporated into college and university campuses.
S: Promote Social Norms that Protect Against Violence
Bystander training programs, to prevent sexual assault on college campuses, engage both men and women, as potential witnesses, to behaviors that lead to increased risk for violence and train them to safely intervene and speak out against social norms that support violence. Training students, faculty, staff and administrators, in bystander skills, is important in developing a comprehensive plan. Campuses should, also, implement media programs, modeling appropriate student behavior/conduct, including bystander skills and consent. Mobilizing men and boys can include engaging male coaches, sports teams and fraternity men, in learning healthy norms about masculinity, to prevent perpetration and support survivors.
T: Teach Skill to Prevent Sexual Violence:
This includes teaching students about healthy sexuality practices and the provision of definitions of consent. This can be done by the implementation of affirmative consent polices; meaning, consent to agreed sexual activity, is freely given, by all parties involved, through words and actions. Affirmative consent policies outline the definition of consent and make it known to students, staff and faculty.
O: Provide Opportunities to Empower and Support Girls and Women
Programs in leadership that build confidence and leadership skills, result in better education outcomes, during school, and better employment outcomes following college. This can contribute to women being more engaged in community and politics. Sorority women can implement programs, emphasizing strong voices and leadership skills, to change gender and social norms, that may contribute to sexual violence
Women’s Centers and Departments of Women’s and Gender studies, are examples of places that promote gender equality on campus and provide women with leadership opportunities, to reach their full potential, as well as, a safe place to learn and research sexual violence prevention. This presence of women’s center programing, and gender studies courses, on campus, serve to promote awareness of social justice, gender, race, economic status, sexual orientation and women’s health.
P: Create Protective Environments
Recommendations include developing and enacting a policy that includes prevention messages in new and transfer student orientation and campus tours, as an opportunity for prevention conversation. This conversation can be kept on-going through including prevention messages in classroom training, social norms campaigns and other events throughout the school year
Strong student codes of conduct should be widely available in student handbooks and student leaders, administrators, faculty and staff should reinforce codes of conduct, through modeling appropriate behavior. School leadership must consistently enforce student code of conduct.
Sexual assault policies and reporting procedures should be easily accessible and navigational on college and university web sites
Polices reducing access to alcohol, on campus and in surrounding communities, can be useful for reducing rates of sexual assault. Excessive use of alcohol increases the risk for perpetration and victimization. Campuses can enact dry campus policies, not allowing alcohol to be consumed on campus, decreasing binge drinking, and colleges may institute drug/alcohol amnesty, for victims or bystanders, to decrease barriers to students in coming forward to report sexual violence.
SV: Support Victims/Survivors to Lessen Harms
Campus staff and faculty need to be trained in trauma-informed response, and campus policies and practices, to handle disclosures, when they occur, both compassionately and effectively. Faculty and staff should be prepared with a list of resources available to students and make appropriate referrals to counseling, advocacy, student wellness centers and campus or community law enforcement.
Survivors of sexual violence, who seek help or intervention, should encounter a system with coordinated, confidential support that addresses their needs, in a non-judgmental environment, and be made to feel confident and safe in reporting policy and available resources.
Perpetrators must be held accountable. Student conduct process and consequences must be transparent to students and faculty. Staff, students and campus law enforcement, must be knowledgeable about sexual violence policies, and the adjudication process, with the option to hold perpetrators accountable, through the local criminal justice process, that is separate from campus procedures.
The CDC acknowledges that, despite the fact that current evidence regarding what works to prevent sexual violence continues to develop, the above recommendations were informed by the best thinking in the field. The CDC recommendations can be used as broad guidance to help shape prevention planning, program development and other efforts towards sexual violence prevention, in college and university campuses. Application, of the content of the document, can serve as a foundation, for the development of intervention plans that will ultimately lead to important development, collaboration, implementation and evaluation of sexual violence prevention efforts at the college and university level. 2
What is the Role of Nursing in the Prevention of Sexual Violence on College Campuses?
What can nurses, nursing faculty and scholars do to prevent sexual violence on college campuses? As caregivers, teachers, advocates and policy makers, nurses are in a unique position to make significant contributions to the prevention of college sexual violence.
Nurses can, first, bring their expertise to the table. As promoters of public and community health, nursing can inform campus policies, by helping to shape, effective prevention practices, like those previously mentioned, including bystander intervention, improving faculty response to student disclosure of violence, and ensuring effective screening protocols are in place, especially in health care settings.
Despite a large body of nurse-driven research, showing that screening and counseling for students who have experienced interpersonal violence is effective, federal guidelines for colleges do not recognize student health centers as critical to the promotion of student health and safety that they are, and this needs to be changed.
Nursing professors have the knowledge of how to develop effective campus policies related to screening, referral and safety planning, for students at risk for sexual violence.
Nursing can also inform campus policy makers regarding the issue of balancing student autonomy, with the need to report crimes, to ensure community safety. They can develop thoughtful policies, drawing on extensive experience.
Nurses can study violence on college campuses more thoroughly, and active research can help shape evidence-based practices, to guide the prevention of interpersonal violence and care of its survivors. Best-care models can be developed for colleges and universities, built on science for screening and response to violence among college students.
Nurses can teach the enormous public impact of violence, across the lifespan, and ensure that nursing students understand how critical it is to address it as clinicians. Research has shown exposure to trauma, often has enduring psychological and physiologic consequences, throughout the lifespan and, nurses as teachers, can include information about relationship violence, sexual violence and stalking, so every nurse, graduates with the knowledge and skill to assess and refer patients, who have been exposed to violence.
Nurses can lead, by example, by being compassionate, competent and understanding that sexual violence raises many complicated issues, and at the center of every story, is an individual, who has been deeply affected by a traumatic experience and must be cared for.
Nursing has the combination of scholarship, skills and empathy to guide colleges and universities through these complex policy issues, and through scholarship, teaching and advocacy, can help transform college and universities, into communities where far fewer students will experience sexual assault and those who do, receive respect and care. 3
Sexual violence on college campuses is a significant problem. While we have increased rates of identifying and managing cases of assault, we have been less active in preventing violence. Effective prevention involves understanding the prevalence and seriousness of the problem, awareness of the societal and personal risk factors that foster and sustain it, and development and application of evidence-based policies and practices to counteract it and ultimately decrease the incidence of sexual violence on college campuses
Case Scenario #1
Alyssa is an 18 year-old female patient who presents to her Family Practice Clinic for a well-exam, prior to attending college, next month, out of state. Alyssa has questions regarding what sexual consent means, because she has been watching the news, and has seen several stories about sexual assault on college campuses. She wants to make sure she understands what consent means, in case she is confronted with this type situation, while she is in college. The following are questions Alyssa asks, with potential answers, to assist her in understanding what sexual consent is and is not.
- Can sexual consent be given without speaking?
Consent can be given or refused through non-verbal behavior. An example of non-verbal consent can be taking someone’s hand to lead them to the bedroom or placing your hand on their body. An example of non-verbal consent, would be pushing or pulling away from someone, ignoring advances or touches, or even looking away to disengage.
It is important to remember that if someone is scared, they may be unable to resist or say no, but this is not the same as consent.
Consent in most cases, is best, if given verbally.
2. Can a person give consent if they are under the influence of drugs or alcohol?
The legal answer to this question is no, though it is not unusual for a person to have one or two drinks, prior to a sexual encounter. If a person is under the influence, to the point of incapacitation, it may seem to be consent, when it is not. If a person is incoherent, unable to communicate clearly, can’t stand up without assistance, or so drunk they don’t know what is going on, and may not remember it, it is safest to assume you do not have consent. If it is likely this person will not remember anything the next day, it is best to stop and help make sure the person stays safe.
3. What if I give consent first , and then, later, change my mind?
You have the freedom to give consent and withdraw consent. This can include consent in the middle of a sexual act. An example would be saying you want to have sex with a person and, then halfway through, you change your mind. Telling that person you are uncomfortable or have changed your mind is okay. You can ask to take a break or do something else.
4. What if I want to consent to one thing but not another?
Any form of sexuality is your personal choice. It should include only things you are comfortable with. For instance, you could start by consenting to kissing and making out, but this does not mean consent to anything else. You might consent to sex, but that doesn’t mean consent to oral sex. Make sure you understand what you and your partner are comfortable, and not comfortable with, doing, before doing it. Consenting to sex, one time does, not imply consent at a later time.
5. What if someone says no when they are sober, but later says, yes, when they are drinking or high?
It is common for people to change their minds all of the time, but is suspicious if alcohol or drugs are influencing that change. Again, if the person is saying yes, stumbling around, slurring words or unable to remember where they live, then that yes, is more than likely, not true consent. Get the person home safe and sound, and check on them the next morning.
6. Can I say no if I am in a relationship with someone?
You can always say no. Your body belongs to you, regardless of what your relationship status is. This applies even if you have had consensual sexual encounters before. You can say, no, at any time. If you hear, no, even if it is something you have done before, pushing or pressuring a partner to do it again, is not okay.
Any sexual advance or act should only occur after clear consent is given and students often are unclear regarding what giving consent means. To assist in breaking the cycle of sexual assault on college campuses, it is important to assist all incoming college students in understanding sexual consent. Nurses are often in a unique position to educate students on sexual consent. 4
Robert comes to the college campus health center and requests information regarding information on sexual assault. Robert’s best friend is facing charges of sexual misconduct and Robert does not understand what constitutes sexual misconduct. He does not want to find himself in a similar situation. As the nurse educator at the clinic, you give Robert a pamphlet explaining a spectrum of unwanted sexual behaviors. You offer to review the pamphlet with Robert and he agrees. You review the following information with Robert:
Sexual assault is any unwanted sexual advance and can range from harassment, for example a comment or joke, unwanted physical touch, a sexually explicit photograph, or material, shared without consent, to more violent acts, like rape.
You, also, review the following legal definitions with Robert:
Any behavior determined offensive or unwelcome, and that, is detrimental to the physical, emotional and psychological well-being of the recipient or witnesses.
Any unwelcome behavior that is sexual in nature and committed in the absence of consent. It includes consent that is accomplished through manipulation, intimidation, coercion or physical force
Any unwelcome sexual behavior or requests for sexual favors that make the receiving person uncomfortable. It can be verbal, physical or visual
Any sexual contact, or behavior, occurring without consent of the victim, including fondling, touching, penetration or forcing the victim to perform sexual acts.
This is a form of sexual assault that includes penetration without consent. This includes even the slightest penetration, of the vagina or anus, with any body part or object, and includes any oral penetration, by a sex organ, of another person, also without consent
Date rape is a forcible sexual assault, occurring during a voluntary social engagement, when a victim did not intend to engage in specific sexual activity, and offers verbal or physical resistance. This applies, even if both parties knew each other, and the victim willingly accompanied the perpetrator on a date.
Intimate Partner Violence
Applies to physical violence, sexual violence, and stalking, psychological aggression and coercive acts, by either a current or former intimate partner.
Sexual abuse refers to any type of unwanted sexual activity or contact with a minor.
Drug-Facilitated Sexual Assault
This involves the use of alcohol and drugs to compromise a person’s ability to consent to sexual activity or behavior
Robert then asks you what he should do if he observes anyone in these types of situations.
You respond by providing Robert with information regarding bystander intervention, including tips for what to do and what not to do.
If you are at a party, and you see something occurring, that might be wrong, for example,
someone leading a drunk person upstairs, you should get help from another person, if available, and intervene. You should not intervene alone unless you have to
2.You should make a scene if you suspect something bad is happening. Drawing the attention of more people, will increase the likelihood the behavior will end. Do not assume that someone else will step in.
3.Trust your instinct. If you think something is wrong, it likely is. If you are under the influence, find someone who is not, to help you.
4.Do stay in a group and buddy up. Have a plan to check in with each other and make sure you have a designated sober person in the group.
5.If someone is in a bad situation, and doesn’t realize it, create a distraction. Step up with some food or say it’s time to go somewhere else. This can give the person an excuse to get themselves out of the situation. Do not assume they can get out of the situation themselves and do not worry about embarrassing them
6.Do call 911 if you are concerned regarding someone’s safety. Don’t wait to intervene. Call 911 or a resident assistant and stay on the phone.
Robert thanks you for the information and tells you he feels like he now better understands unwanted sexual behavior and understands how to both avoid it and intervene if he sees it happening.
It is important for college students to be aware of the broad behaviors that constitute unwanted and illegal sexual behaviors to avoid becoming a perpetrator or a victim. It is also important to teach students about the importance of bystander intervention. Nurses are in a unique position to assist students in attaining and utilizing this information to assist in the prevention of sexual assault on college campuses. 4
Course Content - Chapters, Topics & Quizzes:
Successful completion of this course will provide the learner with one (1) contact hour. This continuing nursing education activity was approved by the Virginia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation To receive credit for this course you must pass this test with a score of 80% or higher. No individual in a position to control content for this activity has any relevant financial relationships to declare. Contact hours will be provided for the completion of this activity from September 10, 2018 until September 18, 2020.