Tailoring care, advancing justice: predictors of forensic and legal engagement in survivors of sexual violence.

Background: One of the primary challenges faced by survivors of sexual abuse and assault is the fragmented nature of care. This begins immediately after the assault and continues throughout their recovery journey. To address this, specialized sexual assault referral centers (SARC) were established in Israel, providing comprehensive medical, legal, and emotional support. This study examines the association between these centers and survivors' consent to forensic examination and filing of police complaints.

Methods: This retrospective cohort study analyzed data from 616 cases of sexual abuse and assault reported at the SARC at Bnai Zion Medical Center between January 2016 and May 2022. Data included demographic information, assault characteristics, treatment details, and survivors' consent to forensic examination and police complaint filing.

Results: Four distinct profiles of sexual assault survivors were identified. The first profile included survivors who consented to both forensic examination and police complaints. This group was characterized by shorter intervals between the assault and arrival at the center, being accompanied by friends or family, more often agreeing to receive medication and experiencing more incidents involving more than one attacker. The second profile included survivors who consented to forensic examination only, and it consisted mainly of young women who arrived unaccompanied, later after the assault, expressed more willingness to receive medications and often involved single perpetrator assaults with alcohol use. The third profile involved survivors who filed only a police complaint and were characterized by lower rates of alcohol use during the assault and less frequent receipt of medication. The fourth profile comprised survivors who refused both forensic examination and police complaint, primarily young females who arrived unaccompanied and often reported experiencing forced vaginal or anal penetration. Key predictors of group membership included time since the assault, biological sex, assault type, alcohol use, medication, presence of an informal escort, and multiple perpetrators.

Conclusions: The study underscores the importance of a victim-centered, trauma-informed approach to care, highlighting the need for tailored interventions to address the specific needs and barriers of each survivor profile. The findings suggest that timely access to medical care and supportive services is significantly associated with survivors' decisions to consent to forensic examinations and file police complaints.