experts. Some of the recommendations are based on empirical research. Although research has been and continues to be done in many areas related to the medical forensic exam, much more research needs to be done to evaluate the impact of the exam process and specific exam components on victim well-being and criminal justice outcomes. For this revision, OVW solicited input from technical assistance providers representing the relevant disciplines, such as forensic nurses, doctors, prosecutors, law enforcement, advocates, and civil attorneys, as well as the National Institute of Justice. We also held a webinar with relevant experts. The national protocol recommends, rather than mandates, methods for conducting the medical forensic exam.18 It serves as an informational guide to communities as they develop or revise their own protocols.19 In no way does it invalidate previously established jurisdictional protocols, policies, or practices. About This Document Organization. Protocol recommendations are organized into several broad sections: A) overarching issues, B) operational issues, and C) the examination process. Each section builds on information presented in 15 Such consultation was required under Section 1405 of the Violence Against Women Act of 2000, Public Law 106-386. 16 Protocols reviewed varied in scope, focus, targeted audiences, and level of detail. Most addressed to some extent exam and evidence collection procedures, drug-facilitated assault, evidence integrity, and evaluation and care for STIs, HIV, and pregnancy. Some also addressed roles of involved responders, multidisciplinary coordination, reporting, crime lab testing, court testimony, issues related to victims’ needs, working with specific populations of victims, payment for the exam, and crime victims’ compensation. 17 The scope of this protocol is limited to the sexual assault medical forensic exam of adult and adolescent victims. A separate protocol should be developed on child exams. Not only is child sexual victimization a complex topic in and of itself, but response to child victims can be considerably different from response to adult and adolescent victims. 18 The protocol has no regulatory purpose and is not intended to nor does it provide legal advice. (Statement adapted from the Hawaii State Sexual Assault Protocol for Forensic and Medical Examinations, Introduction, 1999.) 19 Those involved in the development of this protocol strove to create a document that addressed the many issues facing communities across the nation related to the exam process. However, there may be instances where the document falls short of adequately addressing specific needs or challenges facing a jurisdiction or a specific population of victims. See appendix A on customizing protocols for ways that jurisdictions can address these limitations when they are developing/revising their own protocols. 14 previous sections and comprises tasks to be addressed, issues to be considered and related recommendations. Although an effort has been made to avoid repetition of information throughout the document, there are instances where data are repeated for clarity or emphasis. The appendixes discuss the topics of protocol customization by jurisdictions and creation of sexual assault response teams. Protocol foundation. This protocol is based on a belief that it is possible, with a victim’s consent, to simultaneously address the immediate health needs of a victim and the future needs of the justice system. Key principles underlying response to sexual assault victims as discussed in this document include: • Recognition of victim safety and well-being as paramount goals of response. • Recognition that victims know far more about themselves and their needs than responders. • Respect for victims’ right to make their own choices. • Recognition that providing victims with information about their options during the exam process, expected consequences of choosing one option over another, and available resources can help them make more informed decisions. • Recognition that all victims, regardless of differences in backgrounds and circumstances, and regardless of their decision to report the crime or not, have the right to receive a high-quality medical forensic exam and to be treated with respect and compassion. • Respect for victims’ right to confidentiality. • Recognition of the importance of victims’ feedback to improving the exam process. Another important principle is recognition that the vast majority of sexual assaults are committed by assailants known to victims. Historically, sexual assault committed by nonstrangers was not taken seriously and interventions were less than adequate. It is imperative that all involved responders acknowledge that sexual assaults committed by persons known to victims are as grave a crime as those committed by strangers. Responders should be aware that victims’ reactions to an assault are affected by a multitude of factors: one of them being the prior relationship between the victim and the offender. They should also understand that many variables may affect the relevance of certain types of evidence to a particular case, including whether an assault was committed by a stranger, a known offender who claims no sexual contact with the victim, or a known offender who claims the victim consented to the contact.20 Use of Terms