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When No One Believes You: Redesigning Rape Kits and Responses to Sexual Assault. Antya Waegemann This publication accompanies the MFA thesis project of Antya Waegemann, conducted at the School of Visual Arts in New York City. Editor: Jamie McGhee Author: Antya Waegemann Book design: Antya Waegemann Š2019 by Antya Waegemann
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When No One Believes You Redesigning Rape Kits and Responses to Sexual Assault.
Antya Waegemann
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TABLE OF CONTENTS Foreword 8 Lexicon of Terms 10 Goals & Objectives 13
Hypothesis and Problem Statement 15 Language and Scope 19 Audience 20
Background 31 Sexual Assault in 2019 What is a Rape Kit?
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Research & Insights 51
Methodology 52 Insights 82
Design Opportunities 85
Inside the Kit: A Public Experience 86 SAFE: A Public Resource App 98 Hark: An Over-the-Counter Rape Kit 108 Code: A DNA Detecting Device 122 RN Advocate: A Rape Kit for ER Nurses 128 Allay: Rape Kit Tracking 140
Conclusion 153
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FOREWORD I have listened to the radio every morning before I go to work, and over the past 7 years, I have heard, over and over again, about the injustices women face, from catcalling, sexual harassment, sexism and the pay gap, to domestic violence, sexual assault and murder. Each new story made me so angry that a pit formed in my stomach. Why was this happening? Why was this happening almost everywhere in the world? Why were women facing so many injustices and why was so little being done about it? I first heard about rape kits it was probably in the same way that most other people have: through Law & Order Special Victims Unit (SVU). The show made it clear that the rape kits were a grueling and difficult process, but it also made it clear how important they were in bringing justice to the victims. As I listened to the news every morning, I began to hear more and more stories about rape kits that were not being tested. Victims had not only undergone the trauma of being sexually assaulted, but had also been brave enough to get a rape kit - only to have it ignored or thrown out. It made me so upset. How could society possibly do this? How could this be allowed? As I began my journey into becoming a designer at the School of Visual Arts, I slowly caught on
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to the power of design. I had always been interested in social impact issues and focused most of my life on urban planning and environmental studies, but I was also tired of learning about problems and not being able to do anything about them. Design has changed this. Design has the power to solve problems, and it has the power to change the way people think and behave. By simply placing something in front of a user to interact with, and idea can become a reality. It can give them a new way to look at the world, or a way of thinking that they are not usually used to. Over the past year, I have dedicated my time to using the power of design to shift responses and behaviors around sexual assault through the redesign of and around the rape kit. This book is a summary of my graduate thesis work over the past year. It is also intended to be a guide for those who are working in sexual assault reform and justice by providing a set of case studies and possible design opportunities that could change the way society and the current system respond to sexual assault.
SarahMorris|GettyImagesEntertainment
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LEXICON OF TERMS Collapsed Immobility:
Rape:
A trauma-related response where the person faints or collapses as a defense mechanism.
The penetration, no matter how slight, of the vagina, anus or mouth, with any body part or object without the consent of the victim.
Dissociation: A trauma-related response often expressed in “freezing” as a defense mechanism against an overwhelming or traumatic experience like sexual assault.
Jurisdiction: The practical authority granted to a legal body to administer justice within a defined area of responsibility. In the United States, areas of jurisdiction apply to local, state and federal levels. For example, Brooklyn is a jurisdiction, New York State is a jurisdiction and they all have the authority to make decisions around sexual assault based on their areas and constituents.
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Rape Kit: The kit that is provided to sexual assault victims to help them collect DNA evidence and their story after an assault in order to form a case against the perpetrator. A kit typically contains anywhere between 10-16 evidence collecting “steps”including swabbing, nail scraping and collecting clothing.
Sexual Assault: An act in which a person intentionally touches another person sexually without that person’s consent. It can include rape (forced vaginal, anal or oral penetration), groping and other forms of touching.
Perpetrator:
Sexual Assault Forensic Examiner (SAFE):
Someone who has intentionally touched another person sexually without their consent.
Registered nurses or doctors who have completed specialized training and clinical preparation in the medical forensic care of a sexual assault victim with a trauma-informed approach.
Sexual Assault Forensic Exam:
Victim:
The process of collecting evidence with a rape kit from the victim who has experienced sexual assault.
Someone who has experienced a form of sexual assault.
Violence Against Women Act: Sexual Assault Kit (SAK): See “Rape Kit.”
Sexual Assault Nurse Examiner (SANE): Registered nurses who have completed specialized training and clinical preparation in the medical forensic care of a sexual assault victim with a trauma-informed approach.
Tonic Immobility:
A United States federal law signed on in 1994 that provides funding towards the investigation and prosecution of violent crimes against women, imposes automatic and mandatory restitution on those convicted, and allows civil redress in cases prosecutors choose to leave un-prosecuted. It has included funding for rape kits, court and police training, federal victim assistants, sexual assault services programs, civil legal assistance for victims and violence on campus grants.
Tonic immobility (TI) describes a state of involuntary paralysis in which individuals cannot move or, in many cases, even speak. In animals this reaction is considered an evolutionary adaptive defense to an attack by a predator. It has been observed in soldiers in battle as well as in victims of sexual assault. Also known as “rape-induced paralysis.”
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GOALS & OBJECTIVES 13
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The first is to raise awareness around sexual assault responses and the process of the forensic exam/rape kit.
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The second is to imagine an integrative healthcare and criminal justice system.
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The third is to envision and create futuristic scenarios that lead to constructive discussions of what responses to sexual assault should look like.
GOALS & OBJECTIVES
Hypothesis and Problem Statement This work has multiple goals and numerous objectives under one main idea: shifting responses to sexual assault and sexual assault victims through designs around the rape kit. This thesis has researched, designed for and considered many different stakeholders or agents involved in the rape kit process. However, the work has remained centered around a greater goal of designing for the victim and the victim’s experience. In order to achieve this greater goal, three three sub-goals form essential building blocks in reimagining the way responses to sexual assault could be: 1.
The first is to raise awareness around sexual assault responses and the process of the forensic exam/rape kit. 2. The second is to imagine an integrative healthcare and criminal justice system. 3. The third is to envision and create futuristic scenarios that lead to constructive discussions of what responses to sexual assault should look like. Sexual assault is legally considered a crime, and therefore something for which a victim can seek justice, and a perpetrator can be caught and punished. However, the low rates
of reporting and the equally low conviction rates depict a very different story. A story in which responses to sexual assault treat it as an inconvenience rather than a crime. This response isn’t completely unwarranted, as sexual assault can be an extremely difficult crime to convict and pursue. It often can only be framed as “he said, she said” and, as will be discussed later, consent can be a difficult term to prosecute with little physical evidence. This is where rape kits and the forensic exam become extremely important. Rape kits, also known as the sexual assault kit or the forensic exam, become the only form of evidence for victims of sexual assault to prove that a crime existed, and therefore are a crucial component to prosecuting sexual assault and criminal convictions. The current policies, procedures, and physical design of the rape kit, don’t allow for optimal responses and the treatment of sexual assault as a crime, nor do they have a victim-centered approach. This thesis hypothesizes that, by redesigning the rape kit and products around the kit, sexual assault will be treated as a crime and victims will be treated as victims who deserve justice. 15
This thesis hyp by redesigning and products a sexual assault as a crime and be treated as deserve justice. 16
othesizes that the rape kit round the kit, will be treated victims will victims who 17
91%
of the victims of rape and sexual assault are female
9%
of the victims of rape and sexual assault are male
90%
of the perpetrators of rape and sexual assault are male 18
National Sexual Violence Resource Center and the Center for Disease Control
GOALS & OBJECTIVES
Language and Scope Before continuing, it is important to establish certain terms around the language, scope and context of this thesis. 1. The visual redesign of the rape kit is important in investigating this hypothesis. However, this is a systemic issue. To address the contributing factors to the failure of the rape kit as it is, the work also focuses on the many policies and procedures that live within the larger healthcare and judicial system the kit operates in. 2. This thesis is looking at sexual assault and rape kits within the context of the United States. 3. While victims of sexual assault are not only women, but can also be men or non-binary individuals, this thesis will focus largely on female victims because of the frequency with which women experience sexual assault, and the lack of a robust discussion about gender being a problem in sexual assault.
4. It will use the term “rape kit” when referring to the sexual assault forensic kit or sexual assault forensic exam (which is typically what medical professionals use) to allow this body of work to reach a broader audience and increase transparency around the system. 5. This thesis also will use the term “victim” rather than “survivor,” to describe someone who has experienced sexual assault. It is understood that it should be entirely the decision of the assaulted person to decide whether they prefer being called a survivor or a victim, but as this thesis will focus on the injustice of sexual assaults, it’s important to use the word victim in order to call out sexual assault for what it really is: a crime.
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GOALS & OBJECTIVES
Audience Design often encompasses and reaches many audiences rather than one. In the case of rape kits, the audience spans across many industries as well as the general public. Because sexual assault is a societal issue, this work is intended to speak to society at large. However, a specific set of stakeholders or agents who interact with the rape kit and are key to its success from the moment it is revealed to the victim to the the moment it is placed in evidence storage. These agents include victims, nurses/doctors, law enforcement (police) and lab technicians (forensic scientist). As each of these agents has a specific job interacting with the rape kit, it’s important to understand each one’s goals and point of view in order to reveal valuable insights that can be transformed into useful design interventions. The proposed designs moving forward will address insights from these populations:
The General Public
1. The General Public 2. Sexual Assault Victims 3. Healthcare Professionals (SANE nurses, emergency room nurses and doctors) 4. Law Enforcement (Police officers and Special Victims Units detectives The rape kit sits in a precarious and complex system at the center of these different agents, all of whom may have different interactions with the rape kit, but all who share the same goal of performing at their best. Therefore, the proposed designs and interventions are intended to heighten each agent’s performance and experience when interacting with the rape kit or design solution. All of the stakeholders have very different environments, goals and experiences around the rape kit. 20
Law Enforcement
GOALS & OBJECTIVES
Sexual Assault Victim
Nurses and Doctors
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GOALS & OBJECTIVES
The Public Goals:
Feeling:
They want to understand why sexual assault is happening and what they can do to help victims of sexual assault personally and in their community.
Especially with the recent news and media coverage around sexual assault, many people understand the severity of it and the frequency with which it occurs. Women, women of color, and the LGBTQ population understand this the most as they are often the communities that are the primary victims and those who understand the severity/frequency the most. These communities are tired of hearing about it, devastated when they do hear about it, frustrated with the lack of care and action from society and are desperate for positive change around it. The public outside of these communities does not always understand sexual assault, the severity of it, the frequency of it or their role in it nor do they want to hear or talk about it.
Environment: The environment for this group can be anywhere, such as public spaces, work spaces or homes.
Early Considerations: What are ways to bring more transparency around sexual assault and rape kits, and what are possible solutions to ensure that sexual assault is better understood?
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Preston Gannaway for The Washington Post
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NBC News
Jayme Gersh
GOALS & OBJECTIVES
The Victim
hen for BuzzFeed News
Goals:
Feeling:
They want to feel safe, they might even want help, they might want justice, but they’re not always sure how to get it.
The victim experienced an immense amount of trauma. This trauma that they experience during the sexual assault can be manifested in three ways: Tonic immobility, dissociation or collapsed immobility. They are also probably feeling some sort of shame are confused. They may be blaming themselves, and using these three reactions as further reason to blame themselves.
Environment: A sexual assault can occur anywhere. Where it happens often depends on the situation. According the the Rape, Incest, and Abuse National Network (RAINN), 2.5% of rapes are committed by a relative, 6% by a person the victim cannot remember, 19.5% by a stranger, 33% by a current or former partner, and 39% by an acquaintance. Because the majority of sexual assaults occur with people that the victim knows and trusts, the environment might be a place where the victim felt safe.
Early Considerations: What are the immediate needs and desires of victims after an assault, and does the environment they are in and have to go to for help matter?
Wall Street Journal
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Tonic immobility 1 - the victim experiences
involuntary paralysis preventing their ability to move or speak
2. Dissociation 2 - an adaptive response to a threat where the victim “freezes”
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Collapsed immobility - the victim faints or loses consciousness. These responses are heavily centered around the moment of the assault but can carry on afterwards. As the victim is in a state of trauma after the assault, it can be very difficult to to make complex decisions. Most victims also report feeling shame, embarrassment and a fear of reporting or telling anyone about what has happened to them.
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Francine Russo, Sexual Assault May Trigger Involuntary Paralysis, Scientific American. Accessed January, 2019, https://www.scientificamerican.com/article/sexualassault-may-trigger-involuntary-paralysis/
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Ruth A. Lanius, “Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research.” European Journal of Psychotraumatology. Vol 6. May 9, 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439425/
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GOALS & OBJECTIVES
Nurses Goals:
Feeling:
They are on the job and want to do their best to help the patient (victim), make them feel safe, make sure they are healthy and be competent at the necessary task.
They feel passionate about their work and performing at their best. They might also be incredibly overwhelmed with their caseload, as well as with the time it takes to help a sexual assault victim and perform the forensic exam. They are always being pulled in different directions and onto different patient cases. Often, they may feel torn between wanting to help sexual assault victims but feeling the pressure to help more medically “immediate or urgent� patients.
Environment: The emergency room is a high stress environment that allows for little sensitivity from those who work there. It requires an immense amount of their time, energy, and emotion. It also requires teamwork, coordination and communication with other emergency room staff and patient advocates, all of which is usually in an open, shared room rather than a private one.
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Early Considerations: Are there ways to make the forensic exam and rape kit easier and less time consuming for the nurses and doctors to handle in the chaotic environment of the emergency room?
Hackensack UMC
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Griffin Moores/The News Leader
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GOALS & OBJECTIVES
Law Enforcement Goals:
Feeling:
They are on the job and want to do their best to record/report the case, fill the victim’s requests/ needs or catch the perpetrator with competency and control.
The police also feel a great sense of pride in their work and roles. They want to help maintain justice and peace within their community and precinct. However, like the emergency room nurses and doctors, police feel overworked, overwhelmed and frustrated with the little resources they are given to complete their goals.
Environment: Sexual assault cases touch various parts of the police network. They are given to police who participate and enforce chain of custody (those who are with the rape kit throughout most of the process) and might catalog or record information, and then Special Victims Unit (SVU) who are in charge of learning more about the case and pursuing it as requested by the victim or city. Like the emergency room, the police stations and offices can be chaotic and require focus and prioritization.
Early Considerations: What are ways to incentivize the police to be trauma-focused, interested in solving sexual assault cases and treating sexual assault like the crime that it is?
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2 BACK GROUND
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BACKGROUND
Sexual Assault in 2019 Every 92 seconds, someone in the United States is sexually assaulted.3 Sexual assault and rape are so common that 1 in every 4 women experience some form of sexual assault in their lifetime. The frequency of sexual assault is not unique to the United States, nor is it a new phenomenon. This is a clear indication of centuries of a patriarchal society that values the power of men more than the agency of women. This is most manifested in the way sexual assault is prosecuted and investigated today, where less than 1% of rapes or sexual assault cases end in conviction. Rarely does society or the media punish the perpetrators the way they blame the victims. So, if we know that many women experience sexual assault in their lifetime, why don’t we have a number of how many men are committing these crimes? When we read about sexual assaults in the news, how do they depict the women or victims and how do they depict the men or perpetrators? Typically you might read a story like, “Father of four attacks, rapes and murders his wife” or you might read, “Troubled woman experiences sexual assault.” It’s important to consider within this research and thesis investigation that many of the resources that the work is drawn from still lie within this patriarchal framework of humanizing the perpetrator and blaming the victim. 3
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Within 2018 alone, there was an immense amount of media coverage around sexual assault, from the Kavanaugh hearings to Harvey Weinstein to the #metoo movement. Many of us may have heard about and even watched the Supreme Court hearings with Justice Brett Kavanaugh and Christine Blasey Ford. In a public hearing much like the one with Anita Hill, 30 years ago, Christina Blasey Ford came forward with claims that Brett Kavanaugh, a Supreme Court nominee at the time, had sexually assaulted her. She came forward not only to prevent his nomination, but also to tell her story and to let Americans ask, once again, is sexual assault a crime that we as a society judge to be bad enough that the perpetrator should be punished? Unfortunately, like most sexual assault cases, it was not. Justice Brett Kavanaugh became a Supreme Court Justice just as Justice Clarence Thomas became one back in 1991 when Anita Hill spoke out. What did this show? It revealed what most women already knew: 1) Sexual assault is still not seen as a heinous enough crime, 2) unless there are multiple “credible” victims, nothing will be done to the perpetrator, and 3) the perpetrator’s story is more valuable and believable than the victim’s.
“About Sexual Assault,” Rape, Abuse and Incest National Network (RAINN), accessed October, 2018, https://www.rainn.org/about-sexual-assault.
Every 92 seconds, someone in the United States is sexually assaulted. 33
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While someone saying “no� is understood as not consenting, there are many ways to express you are not consenting that may not always be explicit or vocal.
BACKGROUND
The Sexual Assault Landscape Sexual assault is extremely prevalent in American society; it becomes apparent in the gender power roles, sexual stigma, and standards that we set up as a society and all experience as children, adolescents and adults. Sexual assault is defined by the United States Department of Justice as, “any non-consensual sexual act proscribed by Federal, tribal, or State law, including when a victim lacks capacity to consent.” 4
One of the most difficult areas of sexual assault surrounds the definition of consent. Consent can be defined as a clear “yes” to a sexual activity, touching or act. To expand on this, the Department of Women’s Health describes consent to mean:
However, each state has its own definition of sexual assault and it can also differ by jurisdiction. It is generally recognized as any crime in which the offender subjects the victim to sexual touching that is unwanted or offensive. This line of unwanted, offensive and without consent can be incredibly tricky, which is one of the reasons that sexual assault, while recognized as a crime, struggles to be responded to as a crime. Some examples that are given to describe sexual assault include: 1) fondling, kissing or making unwanted bodily contact, 2) forcing another person to perform or receive oral sex, 3) forcing a tongue, mouth, finger, penis or an object on another person’s anus, penis vagina or mouth, and 4) forced masturbation.5
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You know and understand what is going on (you are not unconscious, blacked out, asleep, underage or have an intellectual disability) You know what you want to do You are able to say what you want to do or don’t want to do You are aware that you are giving consent (and are not impaired by alcohol or drugs) 6
It can become really complicated because, while someone saying “no” is understood as not consenting, there are many ways to express you are not consenting that may not always be explicitly vocal. The multifaceted forms of nonconsent make sexual assault challenging for the victim to report or tell someone else about, but also challenging for the police and law enforcement to decipher the parameters of the crime.
Department of Justice, Sexual Assault. Accessed in March, 2019. https://www.justice.gov/ovw/sexual-assault
5 FindLaw, 6
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Sexual Assault Overview. Accessed in March,, 2019. https://criminal.findlaw.com/criminal-charges/sexual-assault-overview.html
Department of Women’s Health, Sexual Assault and Rape. Accessed in March, 2019. https://www.womenshealth.gov/relationships-and-safety/sexualassault-and-rape/sexual-assault
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BACKGROUND
The History of Sexual Assault Sexual assault has been around since the beginning of human existence. Some of the earliest documented cases of sexual assault are from writings of ancient Greece, the Bible, letters from early explorers and art from various tribes. Like most history, sexual assault and rape have mostly been described in the past from the view of men. As Sharon Block, a professor of history at the University of California, Irvine and author of Colonial Complexions:Race and Bodies in EighteenthCentury America states, “The historic rapes that ‘mattered’ are the only ones where men saw themselves damaged.” 7 In the United States, sexual assault and rape as crimes and heinous acts gained recognition in society and in the law mostly in the 1970s. This was largely due to the female activists throughout the country who helped build coalitions and new support structures for victims that could encourage new laws and systemic reform.8 After having demoralizing and misogynistic experiences with law enforcement, society and the medical system, these activist women established some of the first rape crisis centers in the early 1970s. This movement helped launch some of the first standardizations and medical procedures to collect evidence from sexual assault victims and also allowed for the first psychologists to study and publish their findings on the effects of rape trauma.
and using their sexual history against them in a trial or case. It wasn’t until 1986 that the Federal Sexual Abuse Act was passed, criminalizing marital rape on a national level but still allowing for states to decide what that meant.9 As of April 2014, eight states in the US still have marital rape exemptions, not including states without exemptions that simply prosecute marital rape differently.10 In 1994, the Violence Against Women Act (VAWA) was formed. Under the leadership of then Senator Joe Biden. It was developed in recognition of the severity of violence against women and the need for a national strategy that otherwise had not existed to help women. It includes tough provisions to hold offenders accountable, and programs that provide resources and services to victims.11 It also includes funding for rape kits, court and police training, federal victim assistants, sexual assault services programs, civil legal assistance for victims and violence on campus grants. However, even with something like the VAWA, today there is still no concrete national rape law in the United States, due to a 2000 ruling, United States v. Morrison, that found that parts of the Violence Against Women Act of 1994 were unconstitutional.
However, during this time, the law did not recognize rape within marriage to be illegal, and did not protect victims against the law exposing
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History.com, When Sexual Assaults Made History. Accessed in February, 2019. https://www.history.com/news/sexual-assault-rome-slavery-columbus-jim-crow
8 The 9 10 11
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Advocates for Human Rights: Stop Violence Against Women, Sexual Assault in the United States. Accessed in February, 2019. http://www.stopvaw.org/national_ sexual_assault_laws_united_states Jennifer A. Bennice and Patricia A. Resick, Marital Rape: History, Research, and Practice. Trauma, Violence & Abuse, Vol 4 Issue 3. July 2003, Pages 228-246. Aequitas, Statutory Compilation Rape and Sexual Assault Laws. The Committee on National Statistics and the Bureau of Justice Statistics. June, 2012. Obama White House, VAWA Factsheet. Accessed in March, 2019. https://obamawhitehouse.archives.gov/sites/default/files/docs/vawa_factsheet.pdf
1978 First rape kit is introduced.
Late 1970s First SANE programs.
1986 Federal Sexual Abuse Act passed.
1994 Violence Against Women Act (VAWA) passed. Provides legal and financial protections for sexual assault victims.
2005 Reauthorization of VAWA. Allocates funds to to prevent victims of domestic violence from becoming homeless and ensures they have access to the justice system.
2013 Part of reauthorization of VAWA. Sexual Assault Forensic Evidence Reporting Act (SAFER). Provides funding to states to address the sexual assault kit backlog. 37
BACKGROUND
Rape Culture In order to understand the trauma of rape and going through getting a rape kit, it’s crucial to understand what rape culture really is and what the system that supports it looks like. The gender differences surrounding sexual behavior and understanding the role of pleasure and sex in our society are immensely important in the way we respond to sexual assaults. After all, we are some of the only mammals that have sex for pleasure and this pleasure plays a massive role in sexual relations and in the power dynamics encoded into it. For example, it is more common for men not to consider the pleasure of a female sexual partner when they are not in a long-term relationship, whereas women were found to consistently consider the man’s pleasure. This builds a power hierarchy. In her investigation of sexual relationship dynamics around pleasure, lawyer Deborah Rhode explains how studies found that men and women had very different expectations when it came to sexual pleasure when “hooking up” or not in a traditional relationship.12 She gives examples of where men had responded expressing little care as to whether women experienced pleasure during sex, and that similarly women felt as though they didn’t have the right to orgasm when it was just a hookup. These types of sexual interactions that are perpetuated in the media and entertainment 12
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are often how we learn what is sexually “appropriate” and what is not. This cultural behavior and thought process is an example of how women are often objectified, and can shed light onto why rape is rarely taken seriously or really considered and tried as a crime in the way it should be. Currently, while sexual assault occurs every 92 seconds, “of major felonies, rape is the least reported, least indicted, and least likely to end in conviction.” 13 A heavy majority of sexual assaults and rapes are experienced by women, and so it is unsurprising that if we as a society feel as though women don’t have agency or the right to sexual pleasure, then we would also have a hard time viewing rape and prosecuting rape as a serious crime. The way in which women and sexual assault victims are treated is extremely important in understanding the ways society sees fit and acceptable to respond and acknowledge sexual assault. In Not That Bad, Roxane Gay compiles various stories from sexual assault victims that not only tell their personal experiences, but thread a single narrative through the idea that no matter what the experience, almost all women find ways to cope with their trauma by thinking, Well, it wasn’t that bad. It could have been worse. My pain is not as significant as someone else’s. This is all tied to the societal negligence of women’s pain, and the way women are taught
Deborah L. Rhode, What Women Want: An Agenda for the Women’s Movement. (New York: Oxford University Press, 2014), 69. The Advocates for Human Rights: Stop Violence Against Women, Sexual Assault in the United States. Accessed in February, 2019. http://www.stopvaw.org/ national_sexual_assault_laws_united_states Rhode, What Women Want, 121.
BACKGROUND
to ignore the crimes and injustices committed against them because their voice is less important than a man’s, their story less valid, and their sole purpose is constrained within a man’s desire. One author, So Mayer, describes how, “if you survive, you have to prove it was that bad; or else, they think you are.” 14 This passage expresses the deep pressure and fight that women are expected to face even after experiencing trauma and a crime committed against them. If they choose to admit what happened to them and come forward as a victim, they have to plead their case in every way possible, proving without a shadow of doubt that what happened to them was bad, in order to avoid and push against the automatic assumption that instead they are the bad ones. When it comes to sexual assault, victims are guilty until proven innocent, immediately cast as responsible for the crime committed against them unless they can prove otherwise.
physically react builds the decisions we make in the criminal justice system and towards criminal activity. He articulates how people frequently jump to conclusions, fill in gaps in information to create coherent stories out of their beliefs, and then label others to fit into these stories.15 He describes how “the labels we give victims can make a big difference in how their cases are handled. Is this a poor person or a rich person, a black or a white woman, a retiree or an infant? It matters every step of the way, from the dispatch call up through the trial.” 16
Even though society has largely built these constructs and determined the way in which we respond to sexual assault victims, there are many other elements of how we think and how our brains work that elevate the poor responses and procedures that exist today. In Unfair: The New Science of Criminal Injustice, author Adam Benforado explains the ways in which the brain, our instincts and way we
14
Roxane Gay, Not That Bad: Dispatches from Rape Culture. (New York: Harper Collins, 2018), 130.
15
Adam Benforado, Unfair: The New Science of Criminal Justice. (New York: Penguin Random House, 2015), 10-11.
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Benforado, Unfair, 15.
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Less than 1% of reported rapes result in a conviction and fewer than 3% result in incarcertion. 40
BACKGROUND
Rape in the Justice System While 1 in every 4 women has experienced sexual assault and rape, only ⅓ of rapes are actually reported.17 There are many reasons women don’t report rape: they are not believed, they know their assailant and fear reporting them, or they fear the social backlash they may receive from family, friends, school or work. Additionally, less than 1% of reported rapes result in a conviction and fewer than 3% result in incarceration.18 These low numbers make it very difficult for victims of rape to believe in the justice system or that they are valued by society. Further, more often than not women are blamed for the rape. In one 2013 case, a schoolteacher raped a 14-year-old student but was not convicted because the judge claimed she was “older than her chronological age and was as much in control of the situation.” 19 The general pattern has been that women asked for or deserved the rape based on their appearance and actions, but little is often said about the assailant’s behavior, nor is action taken against him.
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Rhode, What Women Want, 121.
18
Rhode, What Women Want, 121.
19
Rhode, What Women Want, 124-125.
20 Gay,
Not That Bad, 184.
Another injustice is the way rape is seen within the system of law. One case looked at an attorney who collected money from his friends for a football game and was disbarred from practicing law because he kept the money for himself. However, a different senior attorney was found to repeatedly sexually harass a female attorney and was not disbarred because the court did not find his groping to be conduct involving “moral turpitude.” 20 What does it say when mismanagement of money is seen to be a worse crime that the violation and abuse of a female body? All of the ways in which cases aren’t prosecuted or are dismissed, when what people recognize as petty crimes are prosecuted to the fullest extent of the law, illustrate that society does not consider crimes against women to be crimes. It instead sends the message that women’s lives are somehow less valuable than men’s and that there must be good reason why a man would rape or sexually assault, usually because the woman was “asking for it.”
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BACKGROUND
What is a Rape Kit? What is a rape kit? A rape kit (also known as a sexual assault kit or sexual assault forensic kit) is a box of tools that help collect evidence for a victim who has experienced a sexual assault. It is intended to gather as much DNA from the perpetrator after the assault in order to help a victim pursue a case against them. There is no standard kit, so every kit looks different, and it is up to each jurisdiction to decide what the kit looks like and what components it will include. Contents vary but tend to include: instructions, instruction and evidence protecting envelopes or bag, swabs, combs, and any containers that collect body fluids. Each kit has a unique number assigned to it and all of the evidence that is collected is placed in envelopes or bags and then sealed closed with this unique number. There are also no standard procedures or processes for performing the exam (the exam refers to the process of collecting the kit), so every hospital and jurisdiction is different.
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Rape kits are important in telling the victim’s stories so most hospitals and nurses will tell you that they will never turn someone away from getting a rape kit, no matter how long it has been after the assault. However, rape kits are found to have the strongest evidence when it is collected immediately and some states and jurisdictions don’t accept evidence that has been collected 96 hours after an assault. The success of the evidence also suggests not using the bathroom after the assault, not showering, and not changing clothes. This is important but often information that victims don’t learn about until they arrive at the hospital and certainly something that the general public is less aware of.
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History Imges Outlet
Chicago Police Star
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BACKGROUND
History of the Rape Kit Rape kits were first developed in the 1970s by a Chicago police sergeant and chief microanalyst, Louis Vitullo, who recognized the increased sexual assaults but the difficulty in pursuing them as crimes.21 The “Vitullo Evidence Collection Kit” as it was known then, was very similar in its form to the current kit - it was a cardboard box that included instructions for swabbing, slides and a small comb. The initial kit was soon expanded into a more comprehensive kit by a woman who herself had experienced sexual assault, Martha Goddard. At the time, much like today, the women’s movement and its growing popularity allowed Goddard to bring awareness to the kit and the ongoing issue of sexual assault when there wasn’t any sort of base to establish a standardized protocol to collect or share forensic evidence.
many of the problems with the current kit. First, that it was primarily designed by a man, and second, that it was not human-centered design, or designed for the victim, but instead designed for the evidence interpreters. During the same time as the development of the rape kit, the SANE programs began to develop as well. In the 1970s, the first Sexual Assault Forensic Examiner (SAFE) programs started to appear. 22 After hospitals noticed a need to develop a more comprehensive and empathetic forensic exam around the rape kit, they started to train nurses, who are now known as Sexual Assault Nurse Examiners (SANE).
Although both Martha Goddard and Louis Vitullo designed the first rape kits, including what they would look like and contain, the kit ultimately became known as the “Vitullo kit” because officials working on the kits decided that forensic experts should have the final say on its design features. This history can in fact explain
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Jessica Ravitz,”The Story Behind the First Rape Kit,” CNN, accessed March, 2019, https://www.cnn.com/2015/11/20/health/rape-kit-history/index.html
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International Association of Forensic Nurses, Accessed on March 2019. https://www.forensicnurses.org/
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BACKGROUND
The Rape Kit Process The rape kit, while a forensic collecting mechanism, is rather medical in its form and process. Generally, rape kits and the forensic exam are only performed in emergency rooms, and performed by an emergency room doctor or nurse. Your general practitioner cannot perform the exam or give you the kit. They are typically performed by what is called a Sexual Assault Nurse Examiner (SANE). SANE nurses go through extensive training around the sexual assault forensic exam/rape kit, which includes 40-96 hours of training. The training covers medical, psychological and forensic aspects of the exam and walks nurses through what the victim may be experiencing, making the exam more victimcentered and less traumatizing. A 2005 study 23 by sexual assault researchers found that SANE nurses and programs are effective in: 1) promoting the psychological recovery of survivors, 2) providing comprehensive
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and consistent postrape medical care, 3) documenting the forensic evidence of the crime completely and accurately, 4) improving the prosecution of sexual assault cases by providing better forensics and expert testimony and 5) creating community change by bringing multiple service providers together to provide comprehensive care to rape victims. The rape kit can be a relatively complicated item and exam because it requires the involvement of many different organizations and agents. There is no standardization in its process, but they don’t differ too greatly between states and jurisdictions. Typically, the kit passes between the hospital nurse, the victim, a police officer and detective, and a lab technician.
Rebecca Campbell, Debra Patterson and Lauren F. Lichty, The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs: A Review of Psychological, Medical, Legal, and Community Outcomes, Trauma, Violence and Abuse Journal, Vol. 6 Issue 4.. October 1, 2005.
Let’s look more closely at kit’s journey:
The kit is either stored in the hospital or at the police station.
If it’s stored at the police station, when the victim goes to the hospital, the police are notified and bring a kit to the hospital and wait there until the exam is complete;
The exam is performed.
This includes a nurse breaking the seal of the box, filling out all of the paperwork and collecting the evidence, placing it back in the box, signing off on it and sealing it with an evidence label;
The kit is passed on to the police officer.
Typically the officer has been waiting in the hospital in the chain of custody , who then takes the kit back to the police station;
The kit either then goes into storage or it is sent to the lab to be tested; If it is tested, it is brought by the police to the forensic lab.
It’s then signed off in the chain of custody to the lab tech. Then the lab begins testing;
The lab records and sends the results to the police.
This includes all notes and findings, and may enter necessary DNA into CODIS, the criminal DNA system;
The police then go to pick up the kit and evidence from the lab.
Finally they place it in evidence storage or hand it off to a detective before storing it.
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Violence Against Women Act Funds States and Jurisdictions with: • • • • •
Sexual assault prevention programs Advocate programs Police training Hospital/SANE training Prosecutors
Funds Victims with: • • • • • • • • •
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Legal assistance STI Testing Pregnancy Test Healthcare Housing Counseling Rape kit exam costs Legal protection for immigrants Nondiscrimination protection for LGBTQ
BACKGROUND
Rape Kit Policy There is no standard policy around rape kits in terms of their procedures and processes. However, some important policies, such as the Violence Against Women Act (VAWA), have helped the progress of rape kits. VAWA has created funding for each state, requiring sexual assault forensic exams to be free of charge. The costs cover the rape kit and forensic exam, as well as any medical costs (for a general health exam for STIs, wounds etc.) and any necessary medications (Plan B, pregnancy test, HIV or STI prevention). This is a huge victory for sexual assault victims as it allows them to partake in the exam and receive a rape kit without having to worry about paying for it or whether their insurance will cover it. It grants the victim a moment of ease during a traumatic scenario, letting them know that they matter and their care is important. The problem? The public and thus sexual assault victims rarely know about this. Because of the lack of transparency in sexual assault planning and resources, victims often don’t seek help because of a lack of insurance, fear of their legal status or general understanding of how expensive hospital
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visits are. To make matters worse, not every hospital explains to victims when they arrive that rape kits are an option and that they are free of cost, preventing many victims from obtaining the rape kit and forensic exam. As for testing kits, there are currently around 400,000 rape kits that are sitting in police custody and are not tested.24 This has to do with many different factors including: 1) a lack of federal and state policy requiring kits to be tested, 2) budget constraints for police and the expensive cost of testing in forensic labs, and 3) the immense amount of time and resources it takes to obtain, process, test and store rape kits. VAWA has helped initiate various testing legislature, especially around requiring states to test their backlogged kits, but it is still up to each state and each jurisdiction to decide how and when they will test their rape kits.
End the Backlog, Accessed on November, 2018.. http://www.endthebacklog.org/backlog/what-rape-kit-backlog
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Methodology
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RESEARCH & INSIGHTS
Literature Review In collecting comprehensive information on sexual assault and rape kits, it was helpful to begin with literary research. This included reading over 20 books, journal articles, and newspaper articles. The literature spanned a wide range of topics in order to build a better understanding of rape kits, sexual assault, violence against women, sociological perspectives of the criminal justice system, sexual assault cases, stories from victims, gender studies and the role of sex in the economy and society. The literature began broadly with searches for highly cited work within sexual assault research, and narrowed based on works cited within those readings and based on word of mouth from sexual assault experts and researchers.
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RESEARCH & INSIGHTS
Conversational Interviews Conversational interviews took place at the beginning of the thesis exploration, particularly aimed at subject matter experts. This included police officers, Special Victims Unit (SVU) detectives, professors and researchers specializing in sexual assault and rape kits, hospital nurses, SANE nurses, policy makers, district attorneys, lawyers, social workers, advocates, and victims. Conversational interviews vary from traditional interviews in that they are slightly less structured and allow for more discovery and open conversation. With each interviewee, I performed preliminary research on their area of expertise, which allowed for initial directed questions and led the conversation to more observational insights regarding their feelings and experiences. For example, rather than ask a police officer, “What barriers do you experience with rape kits?” the question may be, “Tell me about your typical day or interaction with rape kits.” This broader question allows the interviewee to go through the process in their minds as if they are doing it in front of you, and provides the opportunity for commentary that may better explain how the person is feeling during that time that they may otherwise not have mentioned. The conversational interviews sparked the initial iterations and ideation for the thesis.
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Rebecca Campbell Professor in Psychology Michigan State University
Carlos Cuevas Professor of Criminal Justice Northeastern University
Dr. Jim Professor in Harvard Me
Ayan Ahmed Social Worker City of New York
Moriah Cohen Sexual Assault Program Coordinator Crime Victims Treatment Center
Kalimah Founder a Sexual Assau Holistic
Kim Day Forensic Nursing Director International Association for Forensic Nurses
Elizabeth Durovich Emergency Department RN Northwell Health
Jim Mulcahy Assistant District Attorney City of Cambridge, Massachusetts
Nicole Gorovsky Attorney Gorovsky Law
RoseAnn SANE Milford
Lynn Hecht Super Vice Pres Legal Mo
m Hopper n Psychology edical School
RESEARCH & INSIGHTS
Rachel Lovell Senior Research Associate Wayne State University
Stephen Montagna Anti-Violence Educator Institutional Change at UW Madison
h Johnson and Director ult Services for c Healing
Cavanaugh Quick Therapist, Advocate Rape Crisis, City of Albany
n Engbers E Nurse Hospital
Jenifer Markowitz Forensic Nursing Consultant Editor, Forensic Healthcare Online
t Schafran sident, Attorney omentum
Jonathan Kurland Attorney AEquitas
Reema Malhotra Title IX Coordinator Drexel University
Steven DeMarco Superintendent Police Officer City of Cambridge
Jennifer Long CEO and Attorney AEquitas
Debra Patterson Professor of Social Work Wayne State University
Jessica Shaw Assistant Professor in Psychology Boston College
Josie Torielli Director of Training NYC Alliance Against Sexual Assault
Cassidy Bartasi Emergency Room Nurse Hamptons, New York
Leon Gevargiz Detective New York Police Department
Craig O’Connor Assistant Director Dept. of Forensic Biology Office of Chief Medical Examiner NYC
Officer Cruz Officer New York Police Department
Bo Reese Senior Facility Scientist Center for Genome Innovation University of Connecticut
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“To what extent are we missing an opportunity for the survivors by having the kit framed around the medical profession?� Rebecca Campbell Professor of Psychology Michigan State University
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“We have tried really hard to make it not about that kit. It’s really not about that box, but it is entirely about that box. It’s a smaller piece of a complex puzzle, but a really important piece.” Kim Day Director of Forensic Nursing International Association of Forensic Nurses 58
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“The systemic victimization of those who report rape and get the kits is whay we call institutional betrayal.� Rachel Lovell Senior Research Associate Begun Center for Violence Research
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“For any trauma victim it’s not about what happened to you, it’s about what happens right after.” Ayan Ahmed Social Worker Office of the Mayor, City of New York 62
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Co-Creation Co-creation is a form of design research that allows users to help come up with solutions and discover other issues they may face that would otherwise not come up in interviews, surveys or observation. On November 19th, 2018 a co-creation session was held at A/D/O a co-working and design exhibition space in Greenpoint, Brooklyn. The event, titled “Redesign the Kit,” was a two hour workshop aiming to uncover what people know about rape kits and about where to go or what to do after a sexual assault. The workshop also asked what they would want rape kits to look like. Throughout the session, participants mapped out who they would turn to and what locations they would go to. They also shared experiences of past sexual assaults, what they felt like after an assault, and what responses from the system they wished existed. The co-creation session revealed many insights. All of the 10 participants had heard of but never seen a rape kit before.
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When it was revealed to them, they were confused and shocked by it’s intimidating appearance, the amount of paperwork that it included, and how medical, sterile and complicated it looked. All participants had no idea the exam had to be performed in the emergency room. All participants said they didn’t know where they would go or who they’d contact after an assault, but that they would probably “Google” what to do. However, if you Google, “where to get a rape kit,” “closest rape kit to me,” or “I’ve been raped what do I do?” the responses include pages of organizations and articles, rather than direct Google location links, making it difficult for the victim to navigate what to do as they sort through many written pages and responses.
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Racism in the System All of the 10 participants had no idea that the kit and forensic exam had to be done in the emergency room, and as one participant said, “As a black woman, going into the emergency is incredibly scary because you never know if you’ll come out alive.” First, what does it mean that for some, usually women of color, going into the emergency room elicits the possibility of dying? Shouldn’t everyone, no matter where you come from or what you look like, feel as though the healthcare system is actually there to help keep you alive? And if you don’t feel that way, but this is where you have to go to get a rape kit or forensic exam, why would you ever report the sexual assault or seek help? It seems as though there is clear systemic barrier - racism - in the healthcare system and within responses to sexual assault. This was echoed in an interview with subject matter expert Ayan Ahmed. She described a scenario where a sexual assault victim explained to the nurses in the hospital of how she “had entertained” her rapist. To her, a
black woman from Trinidad, this meant that she had gone along with his wishes to protect herself. To the entirely white staff she was speaking to, this meant she was an entertainer and her case was not worth investigating. To them, she had invited this upon herself. But as Ahmed says, “having someone that looks like you and that can communicate with you is a big deal. If you don’t speak the victim’s lingo or know the culture they’re coming from, you cannot advocate for them correctly.” SANE nurses have been found to be the most effective at treating sexual assault victims but many interviewees expressed concern that the majority of SANE nurses are white. This can be contributed to the fact that becoming a SANE nurse is entirely voluntary and can cost up to $1,500 to go through the 40-90 hour training, which nurses often have to pay on their own. This creates a barrier to access for those who may want to become a SANE nurse but are in lower economic brackets or can’t afford the training.
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Prototyping and Speculative Design Prototyping is essential to humancentered design solutions. Rather than handing someone a paper with a solution that they may not understand, putting a prototype in front of them to interact with can be incredibly powerful and produce effective change. The prototypes that were designed for this thesis were all based off of insights from the research. They then were presented to various stakeholders and tested for their effectiveness, their intuitive functions and the reactions they elicit. Based on these reactions and on user feedback, they were then modified or would be modified in future iterations. As a design tool, speculative design allows a designer to question and consider possibilities for the future and the role or impact of a specific topic by introducing a product or design that could exist in the future. For example, flying cars are a form of speculative design. Most people
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have heard of them either from movies, books, research, or the news. The idea of a flying car urges one to imagine a world where flying cars might exist. What does this world look like? Is this a world that we want? What are the constraints of this world and what allows for flying cars to exist? Even if the flying car doesn’t come to be, but in fact it triggers a discussion about space, air space and ownership of space, it is still a provocative and valuable design piece. Many of the design interventions included in this thesis use speculative design to help question why sexual assault responses and resources exist as they are today, and to depict what the world could look like if this were dramatically different.
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RESEARCH & INSIGHTS
Journey Mapping Journey mapping is a design tool that is used to build empathy with the user. It is easy to design a product or service that is intended to be a good experience for the user, but without journey mapping the different phases and the emotional path throughout the experience, it is hard to create an authentic experience. Typically a journey map is a multiple ideation process and isn’t something that is done once, but rather evolves over time and is constantly changed. It’s usually best to start out mapping the “current journey” or to see what the situation is currently like for the user. Depending on the product or situation, this might include laying out the user’s goals, what the phases the user goes through, who the user interacts with, what the user interacts with and anything else that could highlight an area of opportunity. Then the designer, usually with a team, will look for user pain points and areas of opportunities. Then the second part might begin, which is mapping out the ideal user journey. This would mean taking the current journey, and changing all of the factors, phases and feelings to depict what the user wants to feel, or the ideal experience for the user. Often design solutions lie somewhere in between these two journeys and help build empathy towards what the user is feeling when using the product rather than blindly designing.
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User Testing & Surveys In design, a design or product has little to no meaning unless it has been user tested. Something can be the most brilliant idea, but if it makes no sense once in the hands of the user, it is no longer brilliant. This thesis user tested many of the projects with the intended users. Because of the fragile and sensitive state of victims, as well as academic time constraints, none of the interventions were tested with victims the actual moment after a sexual assault occurred. If this work were to move forward it would aim to be tested in the actual environments and situations in which the users would use them, i.e. after a sexual assault has occurred. To work around this constraint, much of the user testing included target surveys for users that would allow them to react and provide feedback on the proposed design interventions.
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RESEARCH & INSIGHTS
Research Findings The year-long research of literature, conversational interviews, co-creation session and prototyping resulted in various insights and findings. They led to the proposed design interventions, which were then organized on a spectrum based on the audience and user, intended to reach all of the touchpoints of the rape kit process. Six main insights that drove the six design interventions that embody this thesis:
1. Designing for the public: There is little to no transparency around rape kits and the forensic exam. Research uncovered that most people hadn’t heard about rape kits outside from Law & Order SVU or vaguely in the news. Most people had no idea what a rape kit looks like or contains, and few even knew where to get one. In order to increase awareness around the rape kit and forensic exam and build empathy towards victims, a public exhibition called “Inside the Kit” was held in Union Square, which displayed the rape kit in its entirety along with facts about the rape kit.
2. Designing for sexual assault victims: Finding help after a sexual assault and figuring out where to get a rape kit is extremely difficult. In the co-creation session, participants were asked where they would go after a sexual assault and how they would find resources or a rape kit. All participants said they would “Google” where to go. However, finding out where to go and how to get a rape kit is very difficult, requiring the victim to do a lot of 82
deciphering and navigating. SAFE, is an app that acts as a 911 for sexual assault victims. It’s not an app you download, as part of your phone’s operating system, it provides direct connections to a hotline, the nearest hospitals with kits and the nearest police station.
3. Designing for sexual assault victims: The medical design and setting of the current rape kit, prevents it from being a victimcentered process. Only 30% of sexual assault victims report their crime. Why? Research throughout this project found that the current design of the rape kit prevents many victims from reporting or seeking help. As Rebecca Campbell, Professor at Michigan State University and possibly the most well-known researcher in sexual assault said, “To what extent are we missing an opportunity for the survivors by having the kit framed around the medical profession?” This sparked the question, what would the rape kit look like if it was taken out of the emergency room and medical setting? This resulted in a speculative rape kit designed for the victim: Hark. Hark is an over-the-counter rape kit that can be purchased at any pharmacy or drugstore, able to be performed in any space that feels safe to the victim.
4. Designing for healthcare professionals: There are too many agents involved in the entire process of the rape kit. The current rape kit passes between a police officer, a nurse, the victim, a nurse, back to the police, possibly to a lab technician if it’s tested and then back to the police again. What if there
RESEARCH & INSIGHTS
was a way to lessen the number of agents the kit interacts with, in order to streamline the process, make the victim more comfortable and focus on pursuing their perpetrator? Currently, a rape kit can take anywhere from 3-10 hours, which includes swabbing the victim for foreign DNA (DNA that is not their own) at least six times. When this process is complete, the kit is sent for testing. However, it may not have successfully obtained foreign DNA in the collection process and testing can take weeks, months or years. Code is a design that is a speculative product for nurses and doctors performing the rape kit and forensic exam. It instantly reads DNA to allow the user to know whether foreign DNA has been detected, and then it immediately scans or “tests” the DNA and sends the results to the national criminal DNA database, CODIS.
5. Designing for healthcare professionals with no forensic and sexual assault training: The majority of rape kits are performed by emergency room nurses and doctors who do not have training in the forensic exam, sexual assault or rape kits. It has been found that SANE nurses are the most effective in improving the forensic exam and rape kit process but only 13% of hospitals have SANE nurses. Therefore, kits are typically performed by emergency room nurses and doctors, many which have never seen the kit before and have no training in trauma-informed approaches for sexual assault victims. The kit that is placed before them, is incredibly time consuming and when it is opened, looks like a pile of bills. There are over 20 pages of paperwork to fill out, and each of the 13-16 envelopes also contains
forms of the front. The lack of training and the complexity of the rape kit often lead nurses and doctors to become frustrated and overwhelmed, which sometimes leads them to discourage victims from obtaining a forensic exam. RNA, RN Advocate is a redesign of the rape kit that is paired with a patient-facing app. The kit utilizes color, visual language and guides to simplify the process for emergency room nurses and doctors, and the app allows the patient to follow along and assist the nurse or doctor through the process.
6. Designing for law enforcement and an integrative system: Few police are testing or tracking rape kits because the process involves too many people and it’s expensive to test kits. There are currently over 400,000 untested rape kits in the United States. This can be contributed to many factors, including a lack of legislature mandating testing, compounded by the immense effort required to test, a sufficient budget to test and a general unwillingness to believe victims. After interviewing forensic lab directors, SANE nurses and police, it became clear that there is a gap in communication among the different agents that also contributes to the outcome of what happens to the kit. Allay is a design solution to help track rape kits and ensure that there is more accountability in their testing. Driven by a digital platform installed on each agent’s preferred device, Allay is a service that allows for easy scanning of rape kits, the ability to add information to a case, and the ability for the police, nurses, victim and lab technician to track the kit at any time.
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Inside the Kit A Public Rape Kit Exhibition Most people have heard of rape kits and know what they do. They’ve learned about them through watching TV and programs like Law & Order SVU, or they’ve heard about them in the news, about the backlogs or CNN’s recent spotlight on their destruction. However, if you ask someone, “Do you know where to get a kit or what a kit looks like?” then almost everyone will respond with, “I have no idea.” There is a clear gap in knowledge, access and transparency around rape kits and the forensic exam. It’s unclear who to contact, where to look and, if you’re lucky enough to find a hospital that has them, what’s going to happen. Sexual assault is an extremely common crime - one in three women experience it in their lifetime. One in three. Statistically, that means that you most likely know someone who has been sexually assaulted, if not more than one person. So, how do we make rape kits, which are an important solution to this crime, more accessible, more digestible and more visible for the public to understand? Could this visibility help prepare sexual assault victims for what’s ahead, and allow friends and family to better help them? “Inside the Kit” is a public exhibition of the
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rape kit that took place in Union Square, New York on March 24th, 2019. It consists of three parts: 1) a structure and sign that provides facts about the rape kit and forensic exam, 2) a structure visibly laying out all of the components of the rape kit as an exhibition, and 3) an area where people can rummage through the rape kit items in the box. The exhibition was intended to reach a broader public audience, and was held in a high traffic public space like Union Square in order to reach the most viewers. Many campaigns around sexual assault or rape kits are centered around the victim. This is incredibly important, but it leaves a gap in knowledge for those who have not experienced sexual assault, but who may benefit from knowing more about the rape kit and the forensic exam. The design of the structures underwent many initial iterations and concepts before being built. There had been a plan to design an enclosed space for the rape kit exhibit to make it into a place of consent. However, after speaking with many sexual assault professionals it became clear that if this was to be an awareness exhibition and campaign, it needed to be loud and clear. Sexual assault needed to be prominent and the rape kit needed to be incredibly visible.
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The kit displayed in “Inside the Kit� is from Massachusetts. It contains 16 steps, or 16 envelopes. While there is no standard kit, most are relatively similar. For example, New York State has 15 steps and the envelopes look identical to those from Massachusetts. Over 40 participants came to the exhibition and read the different facts, interacted with the exhibited rape kit, sparked discussion around rape kits and sexual assault and signed up to get involved. Most people were interested in learning more and wanted to know about possible solutions to change the rape kit, and many people wanted to know how to get involved in order to push for change.
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The images above show the layout of the kit when everything is taken out of the box but also when the contents are taken out of the envelopes. There were interactive components as well. Anywhere this is an arrow, the user could detach the component from the wall (attached by velcro) and look more closely at what the tool is or what the paperwork say. The interactive component aimed to let people explore the contents more freely and deeply. There are so many envelopes and components in the rape kit that it can often be overwhelming, especially to go through when it’s in the box as a pile. Laying all of the envelopes and the contents out in a wall-like setting was to show the scale of the contents in the box in the least intimidating way, but also so that viewers could carefully learn and analye each step.
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SAFE A Sexual Assault Emergency Response App What happens after a sexual assault?
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You have just been sexually assaulted. You may know the person, you may not. You’re sitting there in a complete state of shock and trauma. This can be manifested in three ways: 1) Tonic immobility - your body experiences involuntary paralysis where you cannot move or speak, 2) Dissociation - an adaptive response to a threat where you “freeze,” or 3) Collapsed immobility - where you faint or lose consciousness. You’re able to get a place where you feel safe, or at least a place where you understand what just happened to you. You might not be able to process it, but you know you need help. What do you do?
National Network (RAINN) is the closest to a one stop shop resource, it still takes a certain amount of patience and navigation to learn about support options before making a call to the hotline. What about hospitals? Only 13% of hospitals in the United States have Sexual Assault Forensic Examiners (SAFE), which means that less than ¼ of hospitals in the country have nurses who are trained in sexual assault and in performing sexual assault exams (rape kits). Many hospitals have rape kits even without the trained SANE nurses, but just as many hospitals don’t even provide the rape kits.
Victims of sexual assault have four main options to take action: 1) call a hotline, 2) call 911 or go to the emergency room to get a rape kit, 3) call or go to the police to report the crime or 4) look up your options. Currently, no single resource provides these options to the victim, and in the process of searching for any of these options (aside from 911, which we all know instinctively) a bit of research is required. While the Rape, Abuse, and Incest
This can lead to, in some cases, victims driving many hours to different hospitals, waiting in multiple emergency rooms and often being turned away or giving up. Victims experiencing this type of trauma don’t always have the emotional capability or patience to make difficult decisions as they are still in a state of survival. But, what if there was a way to make their first step and choice after an assault clear, transparent, accessible and empowering?
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The 911 for Sexual Assault SAFE is an emergency response app for those who have experienced sexual assault, for those who are helping someone who has experienced sexual assault, or for those who want to be prepared in the case of a sexual assault. In the same way we know to stop, drop and roll in a fire or call 911 when in danger, what if we knew to open the SAFE app and get the help that we need after a sexual assault? SAFE is not an app that you download, it’s built into your phone’s operating system. It’s always there when you need it and you know it’s there. The app consists of 3 main features: 1) Call a hotline, 2) Go to the hospital (one that has rape kits and trained sexual assault staff) or 3) Go to the police. Let’s look at each one. Call a hotline. There are national and local hotlines for sexual assault victims to call, and the app would connect to the National Sexual Assault Hotline. Hotlines are crucial for being instant connections and, in general, excellent resources for victims thanks to their staff members, who have been trained staff in trauma-informed approaches, who help
the victim feel heard and who help them figure out what the best form of action or support is for them. Go to the hospital. As mentioned, only 13% of hospitals have trained Sexual Assault Nurse Examiners and not all hospitals have kits or perform the forensic sexual assault exams. The near impossibility of finding a hospital often leads victims to travel to many hospitals before getting help and they often give up. This direct connection to a hospital that has kits and trained staff will increase the rates of victims actually receiving kits andhelp, and will improve the victim’s experience. Go to the police. This option will allow victims to learn about their options if they want to go to the police and report the crime. Many victims don’t report because of police responses and reactions, and this connection and partnership would allow police to develop relationships with sexual assault organizations, would incorporate further sensitivity training and could lower the stigma against reporting.
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DESIGN OPPORTUNITIES
Initial Prototypes
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Initial Prototypes
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Adding Transparency The app’s general purpose is to provide transparency around victim response options immediately after an assault and help battle the stigma and shame surrounding seeking help. Currently, only ⅓ of sexual assault victims report their assault. Many cited not reporting because of shame, not feeling believed or not feeling like anything would be done if they did report. However, reporting isn’t necessarily the same as getting a rape kit though. Reporting an assault means that it is reported with the police, whereas getting a rape kit is still a form of reporting and response, even if the victim doesn’t pursue anything further with police. According to RAINN, around 30% of victims who report also get a rape kit. With SAFE, not only would victims have easier and clearer access to resources and options after a sexual assault, but transparency around and awareness of resources would also increase, as would a collective understanding of how to help those we know or love who have been sexually assaulted. On a larger scale, what would it mean if we treated sexual assault with the same emergency that we treat to fires and “911” emergencies? Sure, victims
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can currently call 911 when they’ve been sexually assaulted, but responding to a sexual trauma victim requires different training than treating someone who has been in a car accident does. In fact, including an emergency response resource or outlet that requires traumainformed approaches could improve the way that we respond to other emergencies. Who is to say that someone who experienced a car accident or an attempted murder doesn’t also face the types of trauma a sexual assault victim experiences? Could creating transparency around sexual assault response in fact alter our entire health care system and the way that we respond to trauma?
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Hark An Over-the-Counter Rape Kit What do you want to happen after a sexual assault? Imagine you have just been sexually assaulted. You’re in a state of shock. Maybe the perpetrator was someone you knew. Maybe you’re combing your brain for reasons why it happened to you. “Was I drinking too much? Should I not have gone there with him? I kissed him, so was I allowing for it to happen? I shouldn’t have done this, I shouldn’t have done that.” You’re shocked, you’re scared, you’re shaken. You might want to tell someone, but you’re ashamed, and you don’t want them to think it’s your fault. This is the thought process that many sexual assault victims go through after they’ve been assaulted, and it contributes to the reason why many victims don’t report their assault. Even though one in three women experience sexual assault, which is an alarmingly frequent rate, only 30% of those victims end up reporting the assault. Most women don’t report because they feel shame, they don’t have the accessibility of understanding of their resources to report, they don’t want to involve medical professionals or police, and many believe that nothing will happen if they do. The current process of getting a rape kit and forensic exam is anything but pleasant. It is done 108
in the emergency room of a hospital, usually the last place a trauma victim wants to be, and can take anywhere from 3-10 hours to complete. Most hospitals try to get sexual assault victims into a private room, but often you only have a light curtain separating you from the other patients. Because only 13% of hospitals have the trained Sexual Assault Nurse Examiners (SANE), if a victim goes to the hospital after their assault to get a kit, and there isn’t a SANE nurse, the forensic exam and rape kit will be performed by an emergency room nurse or doctor. These nurses and doctors may have never performed - or even see - the kit before and who may be tending to up to three other patients, with less emotional and mental ability or energy to focus on the sexual assault victim. When the appropriate nurse or doctor is ready to perform the exam, the victim will undergo a traumatizing process where they are photographed, they are swabbed, their clothes are taken, and they’re often shivering in a small hospital gown. But what if there was a way to make reporting, and getting a rape kit more centered around the victim’s needs?
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An over-the-counter rape kit Hark is a speculative over-the-counter rape kit that is available at any major pharmacy. Small and discreet, Hark is designed to be approachable and comforting for victims of sexual assault. The kit includes the necessary evidence-collecting components such as swabs, nail scrapers and DNA slides. It also incorporates a data card, so that the victims can record their story and photograph any injuries in a place of their own comfort. Hark puts the rape kit process in the hands of the victim and removes the stigma, judgment and long process of the current rape kit and forensic exam. Hark isn’t just a rape kit - it’s a service. It has been found that the most effective experiences with the forensic exam occur when a SANE nurse is present, so Hark utilizes SANE nurses to
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help perform the forensic exam, collect the evidence properly and ensure that the victim is comfortable, believed, and able to receive any necessary medical treatment. After the sexual assault occurs the victim has four main options for obtaining the rape kit. They can 1) have a friend or family member pick one up from the pharmacy, 2) have one delivered to them in a one-hour window through the app, website or phone number, 3) purchase one themselves from the pharmacy or 4) order one through SAFE, the sexual assault emergency app. Once they receive the kit, they will read the instructions to either download the Hark app that will trigger the start of
their forensic exam by calling for an on-call SANE nurse, or will provide the number to call if the victim doesn’t download the app. When the victim calls a SANE nurse, the nurse will ask them their preferred location for the exam. This could be in the victim’s home or anywhere they feel safe, and if they prefer a medical setting, the SANE nurse will tell them the nearest Hark facility, where the victim will meet them. As the victim waits for the SANE nurse, they can read more about the process and what will happen in the onboarding material or watch the introduction videos on the app. Once the nurse arrives, they will perform the exam, allowing the victim to feel not only more comfortable but also more powerful and in control in their preferred setting.
Hark ensures that this process is on the victim’s terms -not the hospital’s, and not the police’s. Having a SANE nurse perform the exam makes sure that evidence is being collected according to each state’s policies and procedures, that the evidence is not tampered with and that chain of custody is maintained. After the kit is complete, both the victim and SANE nurse sign the digital form, confirming that the evidence was collected honestly. When the kit is sealed, the SANE nurse brings the kit to the Hark partnered police station, to pass onto the police for testing and to record the kit and evidence into a case if the victim chooses to pursue a case. The victim can track the kit at any time through the app, and ask questions to their Hark case representative. 113
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Creating a victim-centered approach The current system around rape kits is not victim-centered, is not traumainformed and discourages women from reporting sexual assaults. Victims are expected to endure the long, tedious process in the emergency room, then answer countless questions from countless strangers, reliving their trauma as they navigate the stigma surrounding their situation. Just as many women want to buy a pregnancy test or Plan B without
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the judgement of strangers, and take them in the privacy of their own homes, couldn’t sexual assault kits also be as accessible and private? Hark restores agency to victims and acts as a step towards changing the way incidents of sexual assault are reported, and the way society responds to and perceives victims.
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A DNA Detecting Device What is it like to perform a forensic exam? The current forensic exam and rape kit can take anywhere between 3 and 10 hours. This is partly because of the extreme detail and care that a nurse must take when collecting evidence and treating the victim. But is also due to the current design of the rape kit, which requires at least 10 and up to 16 steps, including swabbing the victim and collecting nail scrapings and combings over and over again. The goal of the forensic exam and rape kit is to collect DNA evidence to better build a case against the perpetrator. However, not every exam yields DNA that is different from the victim’s and that can be used in a case. It can be extremely frustrating for the victim, the nurse and the lab technician to spend time collecting and testing DNA samples only to then find no useful results. What if there was a way that when collecting the DNA evidence, the nurse was able to see whether they have collected samples that are foreign DNA to the victim’s? And what if the DNA could be tested and scanned immediately, removing the extra role of the lab tech in the process?
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A DNA detecting device Code is a speculative product that collects and tests DNA. It consists of two parts, 1) the DNA collecting device and 2) the charging and testing device. With the DNA collecting device, a sterile smart swab is placed into the product. First, a sample of the victim’s DNA is taken and programmed into the device so that it can determine when DNA is foreign, or not the victim’s, which is often the most difficult part of testing. The nurse will then insert a new sterile swab into the victim’s mouth or genital area depending on the assault. When the device detects foreign DNA, using smart scanning technology, it will beep and flash a light. The swab is then placed into the charging device, which scans the DNA and uploads the scan into the Code system, allowing the police to then analyze it and see if they have a match or if they can match it to a potential perpetrator. Finally, the swab is then bagged and placed into evidence.
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Making the exam worth it Many police credit the 400,000 untested rape kits to budget restraints and other system barriers. In order to test the kits, they must go to forensic labs where lab technicians and scientist sift through 16 separate envelopes in search of even just one foreign DNA sample. It can be incredibly time consuming and doesn’t always yield results. Code not only ensures that the victim and nurse know at the moment of the forensic exam whether DNA has been found, but also makes sure to instantly scan it into the system, speeding up the process for police to pursue the case and find justice for the victim. Perhaps with new technologies, victims will be reassured that the traumatizing process of the forensic exam was worth it, and police will be incentivized to go after perpetrators knowing that they have DNA from the start of the case.
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RN Advocate A Rape Kit Designed for Emergency Room Nurses The forensic exam is completely overwhelming It takes just over one and a half minutes to remove all of the 16 envelopes (each a step in the process) from a rape kit box. Doctors and nurses have described the kit as containing far too much paperwork, being incredibly time consuming and causing a lot of work and pressure. SANE nurses have been trained in the rape kit and understand the importance of each step, but when an emergency room nurse and doctor perform the exam, just taking out all of the steps can become overwhelming. In some cases, interviewees described how emergency room nurses and doctors discourage sexual assault victims from doing the forensic exam - or even turn them away
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altogether - because they don’t want to go through the process of collecting the evidence over a 3-10 hour time period, or because they have far too many other emergency room cases that might appear to be more urgent. But what if there was a way to design the rape kit so that emergency room nurses and doctors who are not trained in the forensic exam are still willing to participate in it, maybe not enjoying the process, but at least finding it less burdensome?
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A simplified rape kit RN Advocate is a redesigned rape kit for nonSANE emergency room nurses and doctors. It consists of a new visual redesign of the kit box, instructions for each step, minimized contents and a digital paired platform that instructs the nurse or doctor through the process. Rather than resemble a form or scary medical paperwork, the kit’s exterior utilizes color and bold text to appear more approachable for both the person performing the exam, and the victim. Both nurses and lab technicians talked at length about the number of steps that the
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kit contains; to those who are unfamiliar, it isn’t clear that you don’t have to complete all of the steps, only the ones pertaining to the victim’s account of what happened. This can cause trauma for the victim by putting them through unnecessary evidence-collecting steps, which keeps them in the emergency room for longer. On the lab tech end, this creates more work and increases testing costs, as they have to either test all of the steps or take the time to read through the account to determine what makes sense to test in order
to find the most DNA and build evidence for the case. RN Advocate color coordinates each step, differentiating what is essential to collect and test versus what depends on the victim’s account of events. The digital platform that is paired with the kit is intended first and foremost to be an additional guide for the nurse or doctor performing the exam. Each envelope includes a barcode. When the nurse or doctor scans it, the platform provides video and audio guides through each step, letting the nurse or doctor know that they are collecting
the evidence correctly, as well as which steps are essential and which are not. Each step also includes more visual and graphic depictions of what the steps ask so that they are easy to follow. The second component is a patient-facing app. The app is downloaded by the victim when they arrive in the hospital, and guides them through the process as it happens but also gives them the agency to guide the hospital nurse or doctor through the process.
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Making rape kits less cumbersome RN Advocate aims to bridge the gap between responsibility and desirability within the forensic exam. The forensic exam is a key component in changing the way that society responds to sexual assault, but its current design makes it an incredible hurdle for victims to receive and for nurses to perform. RN Advocate would improve the experience of the forensic exam for both the victim and the emergency room nurse and doctor. The forensic exam will never be something that is truly desirable in the same way that surgery is never desirable, but if the process is less traumatizing for the victim and easier to navigate for the nurse, perhaps it will encourage reporting and increase accountability.
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Allay A Digital Rape Kit Tracking System The problem of testing and tracking There are over 400,000 untested rape kits in the United States. It is primarily the responsibility of the police to decide whether to test rape kits or not, but there are many other factors are involved in this decision. For example, in most states, if the victim does not want to pursue a formal case against the perpetrator, the kit may not be tested. In some jurisdictions, if the police don’t see the case to be valid or don’t believe the victim, they will not test the kit. To intervene in the lack of testing, some states have implemented various policies that require police to test any new kits or test kits in the state’s backlog. However, whether the kit is tested or not, it can be extremely difficult for the victim to track where the kit is and what has happened to it. This creates great distress and distrust. In interviews with SANE nurses, many said that the most important part of the rape kit is recording the victim’s story. However, when a victim has recently experienced trauma and is in a state of shock, it might be hard to talk about 140
everything that happened. The forensic exam as it is only allows the victim to report their story once with the nurse or doctor in the stressful emergency room setting. They then have to repeat the story to the police and compare the written record which can both benefit and hurt the victim. As Director of Forensic Nurses for the International Association of Forensic Nurses Kim Day explains, “Sometimes there can be more DNA to be collected and I might not ask the right questions to the victim, and when the DNA goes to the lab, the labs might have more questions about the way the kits were collected or some of the swabs, but only certain labs maintain relationships with nurses to ask them.” This creates a barrier for the victim, nurse, police and lab technician to access information and contribute to the case. What if there was a way for the victim, nurses, police and lab techs to all track the kits?
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“The sharing of information between the lab and the prosecutors is another Bermude Triangle of complication. It can get really messy fast.� Rebecca Campbell Professor of Psychology Michigan State University
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A system that tracks rape kits Allay is a service and digital platform that makes it easier for police to track and test rape kits. It does so by scanning and tracking rape kits. It is a system that is sold along with the rape kits and is accessible to each individual that interacts with the kits (nurses, police, victim, detectives and lab tech). By requiring that all kits be tested and making it easier to scan and track them, Allay increases transparency around the whole process. It holds parties accountable for responding to sexual assault and treating it as the crime that it is. As a responsive digital software, it allows for easy scanning and one central database that is accessible to all users, limiting misinformation, limiting repetition and creating a more robust case file. Allay has three main components: 1) scanning capabilities – through QR codes and a responsive digital interface, users can easily scan along the way, 2) tracking capabilities – the software allows the user to track the kit at any time, showing where it is, when it got there and where it is supposed to go next and 3) the ability to add information – any user can add information to the case at any time to allow for a more robust case, empowering the victim to add information when they may feel calmer and safer, and allowing the nurse and lab technicians to communicate if needed. Some states have begun to implement tracking systems for rape kits. However these tracking systems don’t take into account all of the agents involved in the rape kit process and usually only allow a separate tracking for the victim. Allay is an integrated platform that unites all of the agents together around the rape kit process so that they can collaborate more seamlessly on the case rather than remain siloed in their own environment and task.
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The transparency of rape kits Allay pushes the idea that perhaps if kits could be tracked there could be more accountability around the responses to sexual assault and what happens to rape kits. The National Institute of Justice along with the International Association for Forensic Nurses created a “National Best Practices for Sexual Assault Kits” guide in 2017 and talked about the importance of a tracking system: “Agencies responsible for the custody of evidence should have a system to track evidence, preferably an electronic tracking system. The evidence should be tracked from the time of collection of the SAK [sexual assault kit], custody of the evidence by the law enforcement agency, submission to and analysis by the forensic laboratory, through disposition/storage or destruction. Many jurisdictions do not currently appropriate funding that would allow for robust information technology (IT) purchase and sustainment. There may also be obstacles to sharing data across agencies due to differences in types of information. For instance, a
lack of information sharing agreements and transaction protocols that would allow data from a laboratory’s evidence management system to speak to the Law Enforcement Case Management System (LECMS) frequently results in printed copies of forms being hand carried between agencies as the SAK is transferred. Law enforcement agencies and laboratories should partner to use one evidence tracking system.” Allay is designed to be one step towards increased transparency around the rape kit and the process it goes through, as well as an opportunity to open up channels of communications between all of the agents involved. Perhaps if information and procedures around the rape kit were more integrated and standardized, more would happen with it in terms of testing, or pursuing a case or perpetrator.
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Conclusion These six projects have all been part of an investigation into how designs around rape kits could shift responses to sexual assault and sexual assault victims. Each and every one of the projects would require further collaboration and feedback from the agents involved in the current process and would also need user research in their prospective use cases and continued iterations. After designing the different opporunities it became clear that the police and the emergency room are two largest barriers in sexual assault responses. In January of 2019 I trained to become a sexual assault advocate at the New York Presbyterian Hopsital at Columbia and what I heard over and over, was that police are extremely difficult to coordinate with, that few are trained in how to respond empathetically to sexual assault, and it is not a priority. To continue with this project it would be important to focus more on how to improve police communication and involvement. The emergency room was a significant barrier for both nurses and victims. Many victims want to seek professional help and want it in a healthcare setting, but talked about how the emergency room required incredible wait times, and was not the most calming environment after an assault. Additionally, nurses working in an emergency setting are in a state of triage and juggle many different patients with varying levels of emergencies that make it difficult for them to switch modes when helping a sexual assault victim. While Hark touches on this, with an on-demand and location varying SANE nurse, the next step would be to investigate the effectiveness of sexual assault clinics (there are only a few that offer rape 154
kits) and the possibilities that lie in allowing the rape kit to be performed in an environment that is dedicated to sexual assault. Funding is also a major concern. Most kits are funded under the Violence Against Women Act (VAWA), which allow for more accessibility around the rape kits. However, victims and hospitals are only reimbursed when there is a SANE nurse performing the exam, leaving both unfairly with the burden of cost for a systemic problem. In the future, it would be beneficial to further investigate how sexual assault responses could work under a different financial structure so that they are still freely available to victims, but that they produce profit in order to fund their improvements and training across the entire process. One point has become clear within this research: Sexual assault and sexual assault kits could benefit greatly from design. Whether it is redesigning the instructions and visual components of the rape kit, creating services that make the process more victim-centered, launching services and software that allow for better tracking and communication, or programming an app that provides resources to the general public, designs such as these will all increase transparency around sexual assault and rape kits. Although the topic is extremely prevalent in this new #metoo era, few solutions or opportunities have been proposed to address the frequency of sexual assault and lack of resources for sexual assault victims. Implementing even just one of the proposed designs could send the message that the American public does in fact care and believe sexual assault victims.
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Acknowledgement This book and work over the past year has been a labor of hope for a future that could look different. Throughout the research, the design, and the building of my thesis there are many people who have supported me, encouraged me, and participated in one way or another to make this thesis possible and as robust as it is. I am so grateful for the many friends, family, and academic mentors who have been my anchors and have helped me grow as a designer. Infinite thank yous to: Allan Chochinov, Jennifer Rittner, Andrew Schloss, Jamie McGhee, Evie Cheung, Ellen Rose, Carly Simmons, Eugenia Ramos, the VFL team, Ashley Valentine, Danielle Jakob, Saada Ahmed, the DOVE Advocacy Program, Charlotte Bonner, and my mom and sister.
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