American Journal of Community Psychology, Vol. 26, No. 3, 1998 The Community Response to Rape: Victims' Experiences with the Legal, Medical, and Mental Health Systems1 Rebecca Campbell2 University of Illinois at Chicago This research examined how the legal, medical, and mental health systems respond to the needs of rape victims. A national random sample of rape victim advocates (N = 168) participated in a phone interview that assessed the resources available to victims in their communities. as well as the specific experiences of the most recent rape victim with which they had completed work. Results from hierarchical and iterative cluster analysis revealed three patterns in victims' experiences with the legal, medical, and mental health systems. One group of victims had relatively positive experiences with all three systems, a second group had beneficial outcomes with only the medical systems, and the final group had difficult encounters with all three systems. Multinominal logistic regression was then used to evaluate an ecological model predicting cluster membership. Community-level factors as well as features of the assault and characteristics of the victims predicted unique variance in victims' outcomes with the legal, medical, and mental health systems. These findings provide empirical support for a basic tenet of ecological theory: environmental structures and practices influence individual outcomes. Implications for ecological theory and interventions to improve the community response to rape victims' needs are discussed. KEY WORDS: rape victims; community response; rape victim advocates. 1The author thanks Ana Mari Cauce, Bill Davidson, Chris Keys, Deborah Salem, and Sarah Ullman for their helpful comments on this paper; the members of the Community Response to Rape Project for their assistance in data collection; and the rape victim advocates who participated in this study for their time, expertise, and feedback on this manuscript. This research was the first-place recipient of the Society for Community Research and Action (Division 27 of the American Psychological Association) 1997 Dissertation Award, William S. Davidson, II, Chair. 2A1I correspondence should be addressed to Rebecca Campbell, Department of Psychology, University of Illinois at Chicago, 1007 West Harrison, Chicago, Illinois 60607-7137. 355 0091-0562/98/0600-0355$l5.00/0 © 1998 Plenum Publishing Corporation 356 Campbell When women go public with their stories of rape, they place a great deal of trust in our social systems as they risk disbelief, scorn, shame, punish- ment, and refusals of help (Madigan & Gamble, 1991). How these inter- actions with system personnel unfold can have profound implications for victims' recovery (Kerstetter, 1990). If women receive the services they need, and are treated in an empathic and supportive manner, then our social systems can work as effective catalysts for healing (Estrich, 1987: Fairstein, 1993; Golding, Siegel, Sorenson, Burnman, & Stein, 1989; Madi- gan & Gamble, 1991; Parrot, 1991; Russell, 1990; Warshaw, 1988; Wyatt, Notgrass & Newcomb, 1990). Conversely, if victims do not receive the serv- ices they want and are treated in an insensitive manner, then interactions with community personnel can magnify feelings of powerlessness, shame, and guilt for rape victims (Feldman-Summers & Palmer, 1980; Madigan & Gamble, 1991). These negative experiences have been termed "the second rape" or "secondary victimization" (Madigan & Gamble, 1991). Analysis of these interactions between victims and social systems may uncover ways to promote a community response to rape that is psychologically beneficial to victimized women. Community resources for rape victims are often piecemeal and unco- ordinated as different systems perform different functions. For example, victims go to the hospital for the rape exam and evidence collection; to the police station to meet with a detective; to the state's attorney to discuss prosecution; to the rape crisis center for information and crisis counseling; and to many other agencies as well. Not surprisingly. research in this area is likewise diffused across disciplines and methodologies. Typically, each sys- tem—legal, medical, mental health—is studied in isolation. From the per- spective of the victims, however, these lines of demarcation may not be as distinct, meaningful, or useful. This flurry of activity is about one event in their lives, one trauma that is then parceled out among many for attention. Focusing on how the legal, medical, and mental health systems respond to victims' needs increases our understanding of victims' experiences with community systems. By taking this more holistic view of how communities respond, we can begin to see what victims experience and evaluate how well our social services are responding to their needs. A primary obstacle in the development of this holistic view of victims' experiences has been the recruitment of survivors who have sought com- munity services. Rape victims are often difficult to identify and the emo- tional trauma of sexual assault often leaves them reluctant to discuss their experiences with researchers. An alternative sample to consider is rape vic- tim advocates. Most communities in the United State have a rape crisis center with staff members who work as community-based advocates, help- ing victims negotiate the process of interacting with each community system Community Response to Rape 357 (Webster, 1989). Advocates explain the services that are available to victims, determine what victims want from each system, and then work to bring about outcomes consistent with their needs. Through this process, rape vic- tim advocates become privy to a great deal of information about both rape victims' needs and how service systems respond to victims. In this research, a national random sample of rape victim advocates was recruited to address two issues. First, this study sought to identify pat- terns of victims' experiences across multiple community systems. Advocates were asked to describe the most recent sexual assault case they had com- pleted, and what actions were taken in that case by the legal, medical, and mental health systems. In describing these interactions, three dimensions were considered: (a) What services were provided to victims by each sys- tem?; (b) Did those outcomes fit with victims' needs (i.e., did the system respond in a manner that was consistent with victims' wishes)?; (c) How readily available were those services? This information was used to develop clusters profiling different patterns of community response to sexual as- sault. The second goal is to determine what factors predict different expe- riences: Which victims receive which services? A multi-level model predicting cluster membership was evaluated. Presented first is an overview of existing literature on rape victims experiences' with social systems that examines research on service delivery in each major community system. Then, extending this work, an ecological model predicting victims' experi- ences with the legal, medical, and mental health systems is described and evaluated. RAPE VICTIMS' EXPERIENCES WITH COMMUNITY SYSTEMS The Legal Processing of Rape Cases Prosecuting a rape is a complicated process, which starts with reporting the assault to the police. This initial report may be given to a detective for a more detailed investigation. In some jurisdictions, this report/investigation is automatically forwarded to the prosecutor, but in others, the police de- cide whether to forward the report. The prosecutor then chooses whether to authorize an arrest and press charges—either for the original charge of sexual assault or a lesser offense (e.g., simple assault, reckless endanger- ment). These charges may be dropped later, but if not, the accused rapist has the choice of pleading guilty to the charged offense, or, if a bargain has been struck, to a lesser offense, or going to trial. If he is convicted at the trial, the judge may choose either probation or jail as punishment. With a system this complex, it is to be expected that some cases will slip through the cracks, and indeed over half of reported rapes are filtered out 358 Campbell of the criminal justice system (Galvin & Polk, 1983; LaFree, 1980). Which cases proceed, and which are filtered out, is influenced by multiple factors. At the community level, the resources allocated to address sexual assault and the coordination of those services increase prosecution efforts (Fairstein, 1993; U.S. Department of Justice, 1994). The type of rape is also significant, as several studies have found that stranger rapes are investigated more thor- oughly and are less likely to be filtered out of the system than nonstranger- rape cases (Fairstein, 1993; Finkelhor & Yllo, 1985; Kerstetter, 1990; Madigan & Gamble, 1991; McCahill, Meyer, & Fischman, 1979: Russell, 1990). Assaults that involve the use of a weapon and result in physical injuries to the victim are more likely to be pursued (LaFree, 1981: Kerstetter, 1990; Rose & Randall, 1980). Characteristics of the victim also influence case dis- position. Victims who are perceived as less credible are more likely to have their cases rejected for prosecution (Rose & Randall 1989). In a similar vein, Madigan and Gamble (1991) suggested that system workers distinguish be- tween "good victims" and "bad victims." "Good victims" show visible, expres- sive signs of trauma (e.g., crying) and are receptive to help from system personnel. Consequently, they may receive