So you want to address sexual harassment and assault in your organization? Training is not enough; Education is necessary

Institutional Courage in the College Context: A Mixed-Methods Analysis of Campus Victim Advocate Perceptions and Experiences

How institutions of higher education respond to campus sexual assault impacts the well-being and academic success of student survivors. Researchers at the Center for Institutional Courage developed an 11-step framework for campuses to respond to sexual assault in a manner that minimizes harm. This mixed-methods study uses the framework to understand college victim advocate perceptions of campus response to sexual assault. Results from a national survey and four focus groups found that advocates identify courageous response efforts as strong relationships across campus units, availability of trauma-informed services, and when resources were available to meet students' direct needs. The critical role of leadership throughout the framework was also identified. Implications for policy and practice are discussed.

Racial Discrimination as a Traumatic Bedrock of Healthcare Avoidance: A Pathway Through Healthcare Institutional Betrayal and Mistrust

Objectives: Experiences of racial discrimination within the healthcare system are potentially traumatic events (PTEs) that have been associated with lowered perceived trust in healthcare providers, ongoing symptoms of PTSD and depression, and anticipated healthcare avoidance. Based on the BITTEN trauma impact model, we test a pathway such that greater past healthcare discrimination would be associated with anticipated future healthcare avoidance among BIPOC college students. We posited that this direct relationship would be sequentially mediated by healthcare institutional betrayal (HIB) during one's worst healthcare event and subsequently reduced trust in healthcare. Methods: Our model was tested in a subsample of undergraduate students, all of whom self-identified with at least one minoritized racial or ethnic identity (n = 472). Participants reported on their past experiences with racial discrimination in healthcare. Each then chose and described their worst and/or most traumatic previous healthcare experience. Subsequently, they indicated if this experience included acts of HIB and/or led to medical mistrust. Finally, they reported on the degree to which they anticipated engaging in future healthcare avoidance. Results: Our model explained 31% of the variance in anticipated healthcare avoidance. As hypothesized via BITTEN, greater HIB during one's worst or most traumatic healthcare experience and resulting mistrust in healthcare sequentially mediated the relationship between past experiences of healthcare racial discrimination and anticipated future healthcare avoidance. However, a direct relationship between racial discrimination in healthcare and anticipated healthcare avoidance was retained. Conclusions: Racial discrimination is a potentially traumatic experience associated with deleterious health outcomes. Current results suggest that healthcare discrimination may drive BIPOC college students' future healthcare avoidance both directly and through experiencing increased healthcare institutional betrayal during one's worst healthcare experience and resultant mistrust in healthcare. Due to the crucial role both discrimination and HIB experiences may play in healthcare outcomes, greater organizational adoption of anti-racist trauma-informed healthcare and the enactment of deliberate system-level repair strategies post discrimination and/or HIB is critical. Understanding the interplay of racial discrimination, HIB, and medical mistrust is also likely to help us address and repair system-level factors leading to anticipated healthcare avoidance behavior among BIPOC emerging adults.

Increasing Sexual Violence Reporting and Disclosure in Higher Education Institutions: A Proposed Approach to Critically Analyze the Internal Organizational Context

AIMS

This article explores the underreporting of sexual violence (SV) in higher education, highlighting serious implications for survivors who may silently cope with its aftermath instead of accessing crucial resources.

METHODS

We utilize Bolman and Deal's four-frame model for organizational change to assess how internal factors within organizations may influence reporting of SV. The four frames-symbolic, structural, human resources, and political-offer a systematic analysis of the internal organizational context in higher education institutions concerning SV reporting.

RESULTS

Our suggested approach offers concrete dimensions and probing questions for examination. Derived from a qualitative study, our recommendations align with Bolman and Deal's four-frame model, aiding in assessing the organizational environment. This approach assists stakeholders in identifying barriers/facilitators in the internal organizational context of higher education institutions, enabling effective planning for improved SV reporting/disclosure.

CONCLUSIONS

A thorough analysis is essential for understanding factors influencing campus SV reporting. Our proposed critical analysis and recommendations serve as a starting point to identify organizational barriers/facilitators, informing the revision of SV policies and processes, including reporting.

POTENTIAL IMPACT OF IMPROVED SEXUAL ASSAULT REPORTING IN HIGHER EDUCATION INSTITUTIONS ON FORENSIC NURSING AND SURVIVORS/VICTIMS ALLIES

Enhanced reporting of sexual assault in higher education benefits forensic nurses and allies, like student affairs, advocacy groups, unions, SV coordinators, health centers, equity departments, human rights officers, and administration. Improved analysis of institutional and cultural contexts allows for tailored services to better meet survivors' needs. Increased reporting should lead institutions to higher service utilization, requiring careful planning for resource allocation.

Institutional Betrayal in Military and Veteran Populations: A Systematic Scoping Review

BACKGROUND: Institutional betrayal (IB) refers to the wrongdoings, encompassing both action and inaction, committed by institutions against their affiliated individuals. Military members are particularly vulnerable to IB due to strong social identification with the military, values of loyalty and self-sacrifice, dependence on the institution, the military power structure and legal system, and the complexity of morality in an occupation centered around war. AIMS: This review examines the state of IB literature within the military/Veteran population, identifying research gaps and implications for future policy and clinical care. METHODS: Conducting a systematic scoping literature review across seven databases resulted in 16 eligible publications out of 44 found. RESULTS: Findings indicate a high prevalence of IB experiences within the studied population, correlating with increased psychiatric symptoms and clinical features. The existing literature primarily focuses on military sexual trauma, with limited exploration of IB in the context of combat, politics, return from deployment, illness, military exposures, and moral injury. CONCLUSIONS: Future research should expand on IB in other military experiences, evaluate intervention efficacy and policies, and validate a standardized IB measure. These insights highlight the need for provider education, revised assessments, and interventions tailored to address the complex impact of IB on military and Veteran populations.

The Role of Gender and Sexuality in the Experience, Internalization, and Mental Health Correlates of Sexual Victimization Stigma

The stigma associated with sexual victimization (SV) can add to the psychological burden on survivors. We compared experiences of SV and SV stigma by survivor gender and sexuality and evaluated the relevance of public and internalized sources of this stigma to their psychological functioning. An online survey containing measures of SV type (sexual harassment and assault), public SV stigma, internalized SV stigma (self-blame, self-shame, anticipated-shame), and psychological functioning (depression, anxiety, stress, and post-traumatic stress disorder [PTSD] symptomatology) was completed by 877 women and 211 men aged 18 to 66 years (M = 30.2, SD = 8.06), of whom 73.9% were heterosexual and 26.1% identified as a sexual minority (same-sex-attracted, bisexual, pansexual, or asexual). Sexual harassment and assault were more prevalent in women and sexual minority men. Analysis of Covariance (ANCOVA) with age and SV frequency as covariates also revealed poorer psychological functioning in sexual minority men, and higher levels of SV stigma in sexual minority women and men. Multigroup path analyses further showed that exposure to public stigma was associated with poorer psychological functioning, that internalized stigma partly mediated these associations, and that the magnitude of the associations (particularly those involving self-shame and anticipated shame) was often greater in men and sexual minorities. The results add to our understanding of the role of gender and sexuality in the experience, internalization, and psychological impact of SV-related stigma on survivors. The results also highlight the need for societal shifts toward acknowledging and validating experiences of SV in men and sexual minorities, alongside women, and the development of intersectionality-informed interventions for SV stigma in survivors.

When Institutions Harm Those Who Depend on Them: A Scoping Review of Institutional Betrayal

The term institutional betrayal (Smith and Freyd, 2014) builds on the conceptual framework of betrayal trauma theory (see Freyd, 1996) to describe the ways that institutions (e.g., universities, workplaces) fail to take appropriate steps to prevent and/or respond appropriately to interpersonal trauma. A nascent literature has begun to describe individual costs associated with institutional betrayal throughout the United States (U.S.), with implications for public policy and institutional practice. A scoping review was conducted to quantify existing study characteristics and key findings to guide research and practice going forward. Multiple academic databases were searched for keywords (i.e., "institutional betrayal" and "organizational betrayal"). Thirty-seven articles met inclusion criteria (i.e., peer-reviewed empirical studies of institutional betrayal) and were included in analyses. Results identified research approaches, populations and settings, and predictor and outcome variables frequently studied in relation to institutional betrayal. This scoping review describes a strong foundation of published studies and provides recommendations for future research, including longitudinal research with diverse individuals across diverse institutional settings. The growing evidence for action has broad implications for research-informed policy and institutional practice.

Beyond reporting: proactive strategies for safer scientific fieldwork

Fieldwork is crucial for science but poses heightened risks of gender-based harassment and assault. Current practices prioritize post-incident reporting, despite the demonstrated potential of preventive approaches. We recommend proactive practices, training strategies, and systemic policy changes to build safe and inclusive fieldwork settings from the outset.

"It Made Me Feel Like Someone Wasn't Doing Their Job:" Sexual Assault Kit (SAK) Victim Notifications and Institutional Betrayal by the Criminal Legal System

In the United States, sexual assault survivors are advised to have a medical forensic exam and the collection of a sexual assault kit (SAK) to preserve biological evidence (e.g. semen, blood, saliva, hair) if they are considering reporting the assault to the police. Law enforcement personnel are supposed to submit the SAK (also known as a "rape kit") to a crime laboratory for forensic DNA testing, which can help identify or confirm the identity of the offender. However, police do not routinely submit SAKs for testing, and large stockpiles of untested kits have been found in police storage throughout the United States. Public outrage has prompted many cities to submit these older rape kits for DNA analysis, and this testing has identified thousands of suspected perpetrators. Police and prosecutors are re-opening these older sexual assault cases, which requires reestablishing contact with survivors who made the initial report years ago - a process referred to as "victim notification." In this study, we conducted qualitative interviews with survivors who received a SAK victim notification and participated in the re-investigation and prosecution of their cases. We explored how survivors reacted to this de facto admission of an institutional betrayal and the emotions they felt during and after the notification. Participants experienced considerable emotional distress (e.g. PTSD, anxiety, fear), anger and betrayal, and hope after they were recontacted by the police. Implications for making victim notifications more trauma informed are discussed.

Perceptions of Institutional Response to Sexual Assault Amongst College-Based Victim Advocates

Federal law in the United States mandates that institutions of higher education address sexual assault within their communities. Colleges and universities have increasingly hired full-time professionals to manage response efforts, including campus-based victim advocates. Campus-based advocates provide emotional support, help students access and understand report options, and ensure students receive appropriate accommodations. Very little is known about the experience or perceptions of campus-based victim advocates. In this study, 208 professional campus-based advocates from across the United States completed an anonymous online survey focused on their perceptions of campus response to sexual assault. Multiple regression analysis was applied to investigate how psychosocial factors (burnout, secondary trauma, and compassion satisfaction) and organizational factors (perceptions of leadership, organizational support, and community relational health) were associated with advocate perceptions of institutional response to sexual assault. Findings indicate that while advocates experience burnout and secondary trauma, and have lower than average compassion satisfaction scores, these psychosocial outcomes do not influence their perception of response efforts. However, all the organizational factors significantly contribute to how advocates view response. The more positively advocates viewed leadership, campus support, and relational health, the more positive they viewed the response efforts on campus. In order to improve response efforts, administrators should engage in meaningful training on sexual assault, include campus advocates in high-level discussions of campus sexual assault and ensure appropriate resources are provided to advocacy services.

Diversity Wanted! Utilizing Transdisciplinary Scholarship on Structural Inequality to Educate Psychology Graduate Students

INTRODUCTION

The scholarship of teaching and learning (SoTL) should promote diversity, equity, inclusion, and social justice for the next generation of psychologists.

STATEMENT OF THE PROBLEM

I worry that the SoTL propagates an exclusionary field that becomes increasingly irrelevant in our diverse society given that graduate curricula largely exclude scholarship on structural inequality.

LITERATURE REVIEW

I detail the process of graduate curricular changes in my current department, with a focus on my new required graduate course, Diversity, Systems, and Inequality. I utilize scholarship from law, sociology, philosophy, women and gender studies, education, and psychology.

TEACHING IMPLICATIONS

I provide the structure and content of the course-including syllabi and lecture slides-as well as modes of assessment that promote inclusivity and critical thinking. I detail how current faculty can learn to incorporate the content of this work into their own teaching and scholarship through weekly journal clubs.

CONCLUSION

SoTL outlets can publish transdisciplinary, inclusive course materials regarding structural inequality, thus mainstreaming and amplifying such work for the benefit of the field and our world.

A peek behind the curtain: An integrative review of sexual harassment of nursing students on clinical placement

AIMS AND OBJECTIVES

This integrative review aimed at systematically searching, analysing and synthesising multiple sources of evidence, to build a temporal understanding of nursing students' experiences of sexual harassment whilst on clinical placement, and to discuss the social context which enables this.

BACKGROUND

Sexual harassment is highly prevalent in workplaces globally. Contemporary social understandings contextualise sexual harassment as a significant form of interpersonal violence. This is the first literature review to go beyond prevalence to synthesise the experience, implications and responses to sexual harassment encountered by student nurses on clinical placement.

DESIGN

Whittemore and Knafl's (2005) integrative review methodology is used to structure a rigorous analysis and synthesis of evidence.

METHODS

The PRISMA checklist supported sound reporting of the search strategy. Three databases (CINAHL, Scopus and Medline) were searched using a Boolean strategy. Papers with a significant focus on sexual harassment of nursing students in the clinical setting were included with no limitation on publication date. Papers were excluded if they were not published in English or were only published as abstracts.

RESULTS

A synthesis of 26 papers demonstrated that sexual harassment has significant impacts on student nurses and the nursing profession. The intimacy of close body care, dominant social perceptions of nursing as women's work and the sexualisation of nurses increase student vulnerability to sexual harassment. Workplace power imbalances further exacerbate sexual harassment and shape responses to incidents.

CONCLUSIONS

Sexual harassment of nursing students is widespread and impacts student well-being and learning.

RELEVANCE TO CLINICAL PRACTICE

Education is a strong protective factor and should target students, clinicians, clinical facilitators and academics. Attention to workplace culture, and processes that support disclosure and reporting, is also required to meaningfully address the sexual harassment of nursing students.

Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non-Nurse Leaders

AIM

This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders.

BACKGROUND

Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non-nurse leaders.

METHODS

Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation.

RESULTS

More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being.

CONCLUSION

Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.

Campus Sexual Harassment, Other Violence, and Racism, Oh my! Evidence From Black Women Undergraduates for a Culturally Competent University Approach to Title IX

Relevant for Title IX federal legislation, the purpose of the current study is to examine cultural betrayal (within-group perpetrator) and sexual harassment (SH) with other violence and racial discrimination on Black women undergraduates' mental health. In a 60-minute online study (N = 162), over 50% experienced campus SH and other violence and/or racial discrimination, with multi-victimization being related to anxiety and other mental health outcomes. Cultural betrayal SH did not predict mental health when controlling for between-group SH. Implications include the 2019 Critical-Interdisciplinary Sexual Violence Research Summit's comprehensive research agenda: Intersectional Approaches, Perpetration, Communications, Beyond Policy, and Sexual Violence and Equity.

Formal Reporting of Identity-Based Harassment at an Academic Medical Center: Incidence, Barriers, and Institutional Responses

PURPOSE

To examine the incidence of, barriers to, and institutional responses to formal reporting of experiences of identity-based harassment at an academic medical center.

METHOD

The authors invited 4,545 faculty and medical trainees at the University of Michigan Medical School to participate in a 2018 survey about civility and respect. This analysis focused on respondents who indicated experiencing at least 1 form of identity-based harassment (sexual harassment, gender policing harassment, heterosexist harassment, racialized sexual harassment) within the past year, perpetrated by staff, students, and faculty or by patients and patients' families. The authors assessed the incidence of formally reporting harassment to someone in authority, barriers to reporting, and institutional responses following reporting.

RESULTS

Among the 1,288 (28.3%) respondents with usable data, 83.9% (n = 1,080) indicated experiencing harassment. Of the harassed individuals, 10.7% (114/1,067), including 13.1% (79/603) of cisgender women and 7.5% (35/464) of cisgender men, indicated they formally reported their harassment experiences. Among these reporters, 84.6% (66/78) of cisgender women and 71.9% (23/32) of cisgender men indicated experiencing positive institutional remedies. Many reporters indicated experiencing institutional minimization (42.9% [33/77] of cisgender women; 53.1% [17/32] of cisgender men) or retaliation (21.8% [17/78] of cisgender women; 43.8% [14/32] of cisgender men). Cisgender men were significantly more likely to indicate experiencing specific negative institutional responses, such as being considered a troublemaker (OR 3.56, 95% CI: 1.33-9.55). Among respondents who did not formally report harassment experiences, cisgender women were significantly more likely to cite concerns about institutional retaliation, such as being given an unfair performance evaluation or grade (OR 1.90, 95% CI: 1.33-2.70).

CONCLUSIONS

Most respondents who experienced harassment did not formally report it to anyone in authority. Many reporters faced institutional minimization and retaliation. These findings suggest a need to reshape institutional harassment prevention and response systems in academic medicine.

Violence victimization in Latina/o/x young adults: The multiplicative effects of cultural and high betrayal trauma

Latinas/os/xs experience pervasive rates of interpersonal violence victimization while also experiencing frequent discrimination and societal trauma (e.g., hate crimes). Betrayal trauma theory and cultural betrayal trauma theory provide frameworks for examining the distinct harm of violence perpetrated by a close other and by a member of the same marginalized group(s), respectively. However, no known research has examined the concurrent impacts of both forms of betrayal among Latina/o/x young adults. The current study examined the unique and multiplicative effects of high betrayal trauma (i.e., violence perpetrated by a close other) and cultural betrayal trauma (i.e., violence perpetrated by someone of the same marginalized group(s)) on psychological and physical health symptoms in Latina/o/x young adults. Latina/o/x undergraduate students (N = 208) participated in a 60-minute online survey assessing violence victimization, psychological symptoms, and physical health. Rates of victimization (91.35%, n = 190) were high across differing forms of violence. Interactions of high betrayal trauma and cultural betrayal trauma were significant for psychological, physical, and anxiety symptoms. Although there were no significant simple effects, the pattern of results suggested that being assaulted by someone who shares one's Latina/o/x identity was more strongly associated with psychological and physical symptoms when participants had not been assaulted by someone with whom they were close. The current study highlights the importance of culturally competent therapy for Latina/o/x survivors that incorporates the interpersonal and cultural contexts of victimization.

Academic Safety Planning: Intervening to Improve the Educational Outcomes of Collegiate Survivors of Interpersonal Violence

Demonstrated impacts of intimate partner violence (IPV) and sexual assault (SA) for college students include negative outcomes related to mental, physical, emotional, and academic well-being. As a result of increasing awareness of the long-standing epidemic of IPV and SA on college campuses, Institutions of Higher Education (IHEs) are expanding the services provided to survivors of IPV and SA, including campus-based advocacy services that are adapted from community models. Like community advocacy, campus-based advocacy services focus on empowerment, support, resource provision, and addressing safety needs. However, the unique context of higher education produces specific student-centered needs, including an increased focus on educational goals, academic accommodations, and safety planning. The current study seeks to shed new light on the specific foci and tasks of advocacy in the context of IHEs, related to what we call "academic safety planning," and to highlight the experience of student service recipients utilizing these forms of advocacy. Thematic analysis of 48 qualitative interviews with advocates (n = 23) and service users (n = 25) from five programs at three universities was used to discover practices applied by campus-based advocates and to understand student-survivor needs and preferences within academic safety planning. Findings reveal the core components of academic safety planning, which are: (a) Advocating for emotional and physical safety in the university context, (b) Assessing and identifying needed academic accommodations, and (c) rebuilding connections and institutional trust at school. These interviews reveal that academic safety planning has the potential to enhance the academic outcomes of survivors, which in turn could lead to important improvements in long-term personal safety, well-being, and economic security for student-survivors.

Gender, Campus Sexual Violence, Cultural Betrayal, Institutional Betrayal, and Institutional Support in U.S. Ethnic Minority College Students: A Descriptive Study

Women and ethnic minorities are at increased risk for campus sexual violence (CSV). Due to inequality, within-group victimization in marginalized communities includes cultural betrayal. Universities commit institutional betrayal (e.g., inadequate prevention) and institutional support (e.g., sensitivity). With a campus climate survey, the purpose of the study is to characterize, by gender, U.S. ethnic minority undergraduates' CSV, cultural and institutional betrayal, and institutional support. Participants (N = 222) were a random sample of ethnic minority undergraduates. College women experienced higher rates of CSV and institutional betrayal. Universities can implement a research agenda that centralizes the role of oppression in CSV.

Who Is Okay? The Harm of One-Dimensional Appraisals of Women Scholars During COVID-19 & Beyond

In this essay, I detail how homogenizing appraisals of diverse faculty women during COVID-19 are harmful to all, including myself. I highlight how academic demands to be "talking heads" and not full human beings, though not new, is especially harmful in the current era. As a Black woman faculty dealing with the double pandemic of COVID-19 and anti-Black racism, the one-dimensional appraisals of women faculty exclude me: I am not a mother dealing with sexist overburden in household responsibilities that interfere with my work. Instead, I am dealing with isolation and loneliness, which I sublimate through work productivity. Resulting in shame, I also realize that universities could operate differently, recognizing women scholars for their diversity in identities, backgrounds, responsibilities, work styles, and personalities during the pandemic and beyond. Given that work productivity is not synonymous with well-being, I hope my colleagues know that, in this moment, I am not okay.

Who has to tell their trauma story and how hard will it be? Influence of cultural stigma and narrative redemption on the storying of sexual violence

Although survivors of sexual violence have shared their stories with the public on social media and mass media platforms in growing numbers, less is known about how general audiences perceive such trauma stories. These perceptions can have profound consequences for survivor mental health. In the present experimental, vignette-based studies, we anticipated that cultural stigma surrounding sexual violence and cultural preference for positive (redemptive) endings to adversity in the United States (U.S.) would shape perceptions. Four samples of U.S. adults (N = 1872) rated first-person narratives of 6 more stigmatizing (i.e., sexual violence) or less stigmatizing (e.g., natural disaster) traumatic events. Confirming pre-registered hypotheses, sexual violence trauma (versus other types of trauma) stories were perceived as more difficult to tell, and their storytellers less likeable, even when they had redemptive endings. Disconfirming other pre-registered hypotheses, redemptive (versus negative) story endings did not boost the perceived likelihood or obligation to share a sexual violence trauma story. Rather, redemptive (versus negative) story endings only boosted the perceived likelihood, obligation, and ease of telling other, less stigmatizing types of trauma stories. Findings suggest that sexual violence survivors do not benefit, to the same degree as other survivors, from telling their stories with the culturally valued narrative template of redemption. Clinical and societal implications of the less receptive climate for sexual violence stories are discussed.

Addressing Sexual and Gender Harassment in Pharmacy Education to Improve Provider Wellness and Patient Care

Research indicates widespread sexual harassment has not significantly decreased in health care over the last several decades. Attention focused on sexual harassment in the last few years has prompted a renewed conversation in health care about these complex issues and the unique challenges they present. Given the significant implications for individuals, organizations, and patient care, addressing harassment should be a priority. Pharmacy schools and supporting pharmacy organizations should proactively address sexual and gender harassment and provide education about this issue.