According to RAINN — the nation's largest anti-sexual violence organization — women aged 18 to 24 are four times more likely to experience sexual violence than women of any age. These statistics are alarming, but they show the growing need for campus-based resources to help respond to gender-based violence. The Center for Survivors and Sexual Assault Healthcare Program at Michigan State University are working to fill that need while also serving as models for other institutions.

To measure the prevalence of relationship violence and sexual misconduct, or RVSM, among students, faculty and staff at MSU, the university launched its first Know More Campus Survey in 2019. This was also the first survey to measure these themes across the full population of a higher education institution.

This survey established a baseline for understanding what MSU community members were experiencing and what needs existed for additional survivor-centric resources. From there, leaders at MSU were able to determine the effectiveness of campus resources and identify gaps.

“The Know More survey showed us that 38.9% of undergraduate women and 41.4% of graduate women had experienced sexual assault in their lifetime, and 24.8% of undergraduate women and 12% of graduate women had experienced it since being on campus,” says Rebecca Campbell, professor of psychology, co-chair of the Relationship Violence and Sexual Misconduct Expert Advisory Workgroup and adviser to MSU’s president. “The highest form of victimization was sexual harassment.”

Upon reviewing the results of this survey, the RVSM Workgroup — led by Campbell and Andrea Munford, deputy chief of the Community Support Bureau in the MSU Department of Police and Public Safety and adviser to the president — developed a strategic plan, putting in place several initiatives that would better position the university to respond to and prevent gender-based violence within five years.

Through the strategic plan, the workgroup introduced initiatives such as creating the MSU Sexual Assault Healthcare Program and expanding services offered by the Center for Survivors — a program that provides therapy, advocacy and support services for survivors of sexual assault.

These models have been a steppingstone for other universities in Michigan and across the nation to build more support on their campuses that better serve survivors and their health.

Creating safer spaces for care

Survivors often may not feel comfortable turning for help after experiencing harm. MSU’s Sexual Assault Healthcare Program is an on-campus 24/7, free and confidential health care program that provides immediate care for people who have been assaulted.

“We strive to provide the greater community with low-barrier access options to receive health care and support following a sexual assault in a trauma-informed manner while protecting the patient’s privacy and confidentiality,” says Danielle Fenton, associate director and lead sexual assault nurse examiner in MSU’s Sexual Assault Healthcare Program.

Opened in 2021, this program is the first of its kind on a college campus. It is equipped with a team of certified sexual assault nurse examiners and a private medical facility to make post-assault care as comfortable as possible for survivors.

To protect privacy, one patient at a time is welcomed into the Sexual Assault Healthcare Program suite. A separate waiting room is available if another patient arrives.

The Sexual Assault Healthcare Program was developed by Center for Survivors staff, the Capital Area Sexual Assault Response Team, the MSU SANE Advisory Board, the MSU RVSM Expert Advisory Workgroup, the International Association of Forensic Nurses and Jenifer Markowitz, an internationally recognized expert in forensic nursing.

A statewide Sexual Assault Nurse Examiner Advisory Board was formed and chaired by Campbell, who leads MSU’s RVSM workgroup and advises the president on RVSM matters.

“We are grateful so many survivors and advocates throughout Michigan participated in the planning process for this program,” Campbell says. “With their guidance, our program staff are providing quality health care to survivors of all genders, survivors with disabilities, members of the LGBTQIA+ communities and survivors from different racial, ethnic and cultural groups.”

When a patient is ready, a medical examination and evidence collection takes place in the exam room. Medical advocates can accompany a patient into the exam room to continue to provide support throughout the process.

When receiving post-assault health care, the first 120 hours are critical for the collection of evidence. Under Michigan law, all victims have the right to a sexual assault examination kit, or rape kit, up to five days following a violent encounter.

Nurses in the Sexual Assault Healthcare Program, or SAHP, provide medical forensic exams and offer choices for survivors. Forensic nurses can, with the consent of the patient, collect DNA evidence and photograph injuries sustained during an assault. The evidence kit can be stored in the facility for up to 10 years. This extended storage time allows survivors to have additional time to decide whether they would like to proceed with legal action.

The SAHP is located in the Student Services Building inside the Center for Survivors suite. When patients arrive, a nurse greets them and contacts an on-call advocate. Once the advocate arrives, they explain resources, support and options, and offer to accompany the patient during the exam.

At the beginning of the exam, a nurse speaks with the patient to gather information about the assault and their medical history. Patients decide what parts of the exam they want to participate in and are advised about options for medications that can be administered to prevent common sexually transmitted infections, emergency contraception and nausea medication.

“Witnessing the bravery of those who take the first step in seeking help after experiencing sexual assault fills me with pride,” says Fenton. “The patient is the one who ultimately decides what services they would like to access.”

According to Fenton, doing this work is not easy and comes with its share of challenges. She notes that sexual assault nurse examiners can experience secondary trauma and burnout.

“As a team, we try to focus on our self-care, checking in with each other after providing exams and having healthy boundaries,” she says.

For every set of challenges, Fenton shares that there are many other parts of this work that keep her and her team inspired.

“We have the ability to focus all of our time and attention on the patient in front of us and giving our patients back the power that was taken from them,” she says. “Survivors and our team inspire me to strive for excellence every day, knowing that each interaction with a patient or survivor can have a profound impact on their healing journey.”

Building a robust program for survivors

Note: The Center for Survivors shared recent testimonials from survivors who have utilized the program’s services. The identities of the survivors will remain anonymous throughout this article, and their testimonials will be shared under the pseudonym “Survivor.”

MSU’s Center for Survivors and Sexual Assault Healthcare Program are recognized as national models for responding to sexual violence. Tana Fedewa, the center’s executive director, is making headway in developing this program to be a comprehensive resource for survivors to receive healing and begin taking steps to seek justice.

Fedewa was no stranger to this work when she took the lead of this team more than eight years ago. She joined the program after receiving her Master of Social Work from MSU and later completing internships in domestic violence and sexual assault programs.

“My entire career I have worked with survivors of violence, and I am very connected to this work,” she says. “The folks on my team are my inspiration. I have never before been a part of such a committed and innovative team.”

It was Fedewa’s vision, with the help of campus experts in RVSM topics, that has expanded the Center for Survivors to be a haven for survivors at MSU and also in the Greater Lansing community.

“When I began leading this unit in 2015, there were four full-time staff and nearly 100 trained crisis intervention volunteers at the Center for Survivors (formerly known as the Sexual Assault Program),” says Fedewa. “We have continued to add passionate, creative and highly skilled therapists and advocates to our team.”

The center now employees 28 full-time staff members as well as 100 crisis intervention volunteers, providing a range of free therapy, advocacy and crisis services that are available to anyone who has experienced sexual violence in their lifetime. It serves faculty, staff, students and community members, though therapy services are only available to MSU students.

Fedewa says one of her hopes is to continue expanding and adapting to meet the needs of survivors across the campus community.

“I cannot even begin to describe it; it has changed my life,” says Survivor 1. “I could barely get out of bed after my assault, and now my therapist has helped me want to live again and live fully.”

The center currently is funded through a federal Victims of Crime Act, or VOCA, grant administered by the state of Michigan as well as through donations and some university funding. Since 2015, this grant funding has increased from less than $300,000 per year to more than $1.7 million per year as the program has grown to meet the demand for additional therapy and advocacy services. VOCA funds have been contingent on a significant financial commitment from the university.

This funding has also been used to create a campus Sexual Assault Response Team and the Sexual Assault Healthcare Program. In addition, the Center for Survivors utilized these funds to create an intentional trauma-informed space on campus where a survivor can come to one location to have their healing and justice needs met instead of having to navigate multiple offices in different locations.

“I have an advocate who is supporting me through a current court case,” says Survivor 2, a recipient of advocacy services. “She is the best emotional support I could have asked for to help me through the process, from understanding what is being said to processing through my feelings to attending court with me. She is my first-touch person I reach out to whenever I have any questions or concerns about my case.”

The Sexual Assault Healthcare Program is located in MSU’s Student Services Building. The program is the first of its kind on a college campus.

“The center’s services are unique in our ability to provide wraparound, holistic care to survivors,” says Kathleen Miller, associate director of the Center for Survivors. “Survivors seeking therapy may also have an advocate go to court with them, attend a group or workshop, or utilize our trauma-informed interview room. The center is intentionally designed to be a central location for a survivor seeking help.”

The Center for Survivors provided close to 4,500 therapy sessions and nearly 2,700 advocacy services in 2022. Throughout the past several years, many at MSU have experienced challenges following the COVID-19 pandemic.

“The pandemic challenged us to re-envision how we serve clients at the Center for Survivors,” says Miller. “It increased our ability to offer telehealth services, which has been life-changing for many survivors seeking help.

“Additionally, the demand for our therapy services has traditionally been greater than our capacity,” says Erin Roberts, associate director of the Center for Survivors. “We have been able to secure more therapists to meet the demand in a timelier manner and recruit and hire a more diverse therapy team.”

Individuals who access the Sexual Assault Healthcare Program receive useful resources that inform them of their rights, educate them about the impact of trauma and connect them to aftercare services.

During the pandemic, the Center for Survivors expanded its crisis hotline's chat function. This is one of the efforts to increase accessibility to support, based on a study conducted by MSU researchers to determine the effectiveness of chat-based support.

The study findings, published in the Journal of Interpersonal Violence, are the first to report in a peer-reviewed journal the impact of these services compared to traditional hotlines offered by college campus support centers.

Since this study, the Center for Survivors has implemented and found success in providing this method to MSU faculty, staff, students and their families.