COEUR d'ALENE - Although researchers estimate that nearly 1 in 5 women in the United States report having been raped at some time during their lifetimes, sexual assault remains one of the most underreported crimes in America.

Susan Carbon, director of the U.S. Department of Justice's Office on Violence Against Women, shared those statistics in September when she testified at a U.S. Senate subcommittee hearing entitled "Rape in the United States: The Chronic Failure to Report and Investigate Rape Cases."

North Idaho sexual assault service providers - law enforcement, medical, legal, and victims advocates - understand the situation well.

It is not a failure of any agency, but rather, a societal crisis that requires a collaborative community effort to resolve.

"In order to bring justice for victims and accountability for their perpetrators and to prevent the crime in the first instance, we must produce a shift in the conscience of our nation," Carbon told Senate committee members.

Since last year, service providers in North Idaho have put into place several initiatives designed to enhance assistance available to sexual assault victims.

"When victims feel supported, believed by somebody, they tend to be more willing to report to law enforcement," said Tracy Rudd-Heilig, Sexual Assault Program Coordinator at the North Idaho Violence Prevention Center in Coeur d'Alene.

The private nonprofit, called the Women's Center until last year, has been advocating for victims of domestic violence and sexual assault since 1977. They work closely with other agencies throughout Idaho's five northern counties to provide free and confidential services to men, women, children and families who are victims of violence. The decision whether to file a police report is always left to the victim.

Reports of sexual violence in the region

Since the start of this year, the North Idaho Violence Prevention Center has received 77 calls related to sexual assaults. Some come from victims looking for someone to talk to, others have questions about whether they should report something to the police, or they are inquiring about the free counseling or domestic violence shelter services the center offers.

Rudd-Heilig said they are seeing an increase in the calls they are receiving. Violence prevention center advocates have responded to nine hospital advocacy cases since the start of the year.

The center also hears from "secondary victims": Parents, siblings, children, anyone who has been collaterally affected by a sexual assault on someone they know.

"People don't realize how far-reaching sex abuse or assault is," Rudd-Heilig said.

Most victims don't report these crimes to police, Heilig said, and if they do, it's not the first place they go to tell someone what happened to them.

"They think they won't be believed, or they'll be blamed for it," she said.

The Coeur d'Alene Police Department has received 16 sexual offense reports since January; six of those have been reports of rape.

The Kootenai County Sheriff's Department has taken 10 rape reports since the start of the year.

A common myth that often feeds into victims' feelings of shame and self-blame is that for many people, the word "rapist" evokes an image of "a man hiding in the bushes with a knife," Rudd-Heilig said.

It's important for the community to be educated and aware that predators "don't look like monsters," Rudd-Heilig said. Debunking that myth will make it less challenging for victims trying to decide whether to disclose the attacks they've experienced, and get help. It will also help get sex offenders off the streets if they go to trial.

"The community needs to be aware of it because they're the jury," she said.

Attacks by strangers account for just 3 percent of sexual assaults, said Bridget Eismann, Crime Victim Advocate with the Post Falls Police Department's Victim Services Unit.

Eismann's agency - formally known as O.A.S.I.S. (Officers and Advocates Sharing Intervention Services) - offers free counseling, shelter, advocacy and other support services to victims of violent crimes.

They have not seen an increase in sex crime reports in Post Falls, Eismann said.

"The concerning factor for us is that our adult sex crimes aren't being reported, and that means they're not coming in for services. They're not looking for help," she said. "The big thing is, we want victims to know it's not their fault, and there is help for them."

One of the barriers that may keep victims from reaching out, Eismann said, is the misconception that they will have to file a police report if they seek medical care, guidance, shelter or support.

"We like them to be reporting, and the primary reason is that we want to get sex offenders off the street," Eismann said.

But, like the policy of the North Idaho Violence Prevention Center, the decision whether to file a report is always left up to the victim, she said.

Breaking down the barriers

While area agencies that serve sexual assault victims have long worked together as they respond to reports of sex crimes, since last year, there is now a more official, coordinated community response to sexual violence.

Various organizations, including the cities of Coeur d'Alene, Post Falls, St. Maries, Spirit Lake, and Hayden; the Kootenai County Prosecutors office; the U.S. Attorney's office, The Coeur d'Alene Tribal Police, and Kootenai Medical Center, joined forces last year to form a Sexual Assault Response Team, or SART.

"It helps victims in that there is a more uniform, consistent response to any sexual assault," said Bernie LaSarte, the STOP Violence Program Manager for the Coeur d'Alene Tribe. "It's an educational benefit for all those programs as well, if we can learn from each other, we can help victims even more."

The SART model also helps address cross-jurisdictional issues that may arise, LaSarte said.

The Tribe received federal grant funding to support a SART effort that will benefit agencies and crime victims throughout the region. The grant money pays for free joint training for all sexual assault service providers, and special training for SANE (Sexual Assault Nurse Examiners) at Kootenai Medical Center.

Carbon, director of the U.S. Department of Justice Office on Violence Against Women, told Senate members last year that research shows that when a SART is involved, sex crime cases have more evidence available and greater victim participation. She said SARTs have been found to enhance the quality of medical care received by victims and improve the quality of forensic evidence collected.

SART cases are 1.7 times more likely to result in an arrest, and 3.3 times more likely to result in the filing of charges. Other studies show convictions are more likely when SART intervention takes place.

A major component of the SART model is the use of specially trained nurses who can provide medical care to victims while collecting forensic evidence.

Sexual Assault Nurse Examiners are a new addition to the emergency room staff at Kootenai Medical Center.

Wendy Masten, a registered nurse and chair of the ER's sexual assault committee, said SANEs help ease the trauma experienced by victims in need of medical care following a sex crime.

The SANE program went into effect at midnight on Jan. 1, and they had their first case that morning, Masten said.

Before the program went into effect, a sexual assault victim had to wait to speak with a nurse, a physician, and perhaps several other care providers during the course of their ER visit.

"They had to tell their stories over and over," Masten said. "A sexual assault is a very intimate crime. To have to tell your story again and again, it's dehumanizing, when you've already been violated."

The SANEs stay with the victims if they are interviewed by police, and while they see a physician.

"We're there the whole time for them to provide support, referrals, medication," Masten said.

If a case goes to court the SANE will be there as well, and will testify when necessary.

There are six SANEs on staff at Kootenai Medical Center. At this point, they are only seeing patients who are 14 years and older, and just up to 96 hours post-assault. That's the best time to collect evidence, Masten said.

The SANEs have seen 10 cases so far this year at Kootenai Medical Center.

A victims advocate, like Rudd-Heilig or another member of her team from the North Idaho Violence Prevention Center, is also always called in under the SART model.

Another new tool being used to help victims is what sex assault service providers call the "Jane Doe Protocol."

There is a federal law that allows community law enforcement agencies to allow some sexual assault victims to report the crimes anonymously.

Agencies in Kootenai County, including Kootenai Medical Center, put the protocol in place in January 2010. SANEs are able to offer the anonymous reporting option to victims who are 18 and older, provided a weapon was not used during the commission of the crime.

The evidence is collected, and is held for up to five years.

"The nice thing is that we can get that evidence, and have it for when a person gets stronger and they're ready to come forward," said Post Falls Crime Victim Advocate Eismann. "That's really important to us. We want to help victims, but we also don't want anyone else to get hurt."

Embarrassment, fear of retaliation, and often a misconception about the nature of sexual assault as a crime, are just a few of the reasons victims don't reach out. It's especially challenging for victims whose sexual assaults are related to domestic violence, Eismann said.

She said they see cases where a husband has raped his wife, and violently injured her.

"It can take a lot of conversations to help her understand it was rape," Eismann said. "The biggest picture for all of our agencies is that all victims know we believe them, and we're here to help them, and make sure they get the support that they need."