Sex abuse centers survive in isles on limited funding
The problem of a lack of money is magnified on the neighbor islands
During the early morning hours of a summer day in 2001, a Honolulu woman was raped by a man she knew.
Still in shock, she took a shower and went to work. All the while, confusion filled her mind of what had just happened to her hours earlier.
At lunch the woman, who requested to remain anonymous, called the Sex Abuse Treatment Center at the Kapiolani Medical Center for Women & Children for help.
A crisis worker advised her to undergo an examination at the hospital and guided her through the intake process. "It was almost like she was this angel. I went to work and felt like I was out of my body. ... She was like an anchor," she said.
This is the kind of feedback that keeps staff members at the Sex Abuse Treatment Center going. But they also know that they are not reaching everyone who needs help.
That is why the center, which provides services to sex assault victims statewide, plans to request more funding from lawmakers next year to provide better service and outreach to victims.
Executive Director Adriana Ramelli said she plans to ask lawmakers for $2 million in state general funds for fiscal year 2006-2007, a 54 percent increase from $923,783, the amount the center has received from the state annually since 1996.
"There's still a number of people who are unaware of our services, and people that can't access our program because we're not doing a better job that we can be doing," Ramelli said.
Hawaii Sex-abuse Numbers
» 574 new sex assault victims sought treatment last year at the Sex Abuse Treatment Center at the Kapiolani Medical Center for Women & Children. Fifty victims were male and 524 victims were female. Of those victims:
» 30 percent were younger than 10 years old at the time of the assault.
» 60 percent were younger than 17 years old at the time of the assault.
» 89 percent of the time, sex assault victims knew the person who assaulted them.
» All victims under age 10 knew their attackers.
» 91 percent of victims 18 years old and older knew their attackers.
Source: Sex Abuse Treatment Center
Inadequate funding for the Sex Abuse Treatment Center has affected each county, according to Executive Director Adriana Ramelli. Here are some ways that each county is affected:
» Staff problems appears most prevalent with the 24/7 crisis services. There are not enough crisis workers and forensic examiners to provide immediate care to sexual assault victims.
» Victims are placed on a wait list to receive counseling.
» Inadequate staffing limits prevention and education services offered to school-age children.
» A crisis counselor is not based on Molokai and Lanai. The number of crisis workers serving Maui, Lanai and Molokai dropped to two from five.
» A high turnover rate for psychiatrists and recruitment.
» Prevention and education programs are only offered to middle and high school students. Only 2.5 staff members are available to educate students on Oahu.
» General education to the community on sexual assault is almost nonexistent.
Source: Sexual Violence Strategic Planning Group 2005 report called "Shaping Tomorrow: The Future of Sexual Violence Programs in Hawaii"
Funding for statewide sex assault services has remained "flat" over the years because it has not been considered a high priority, said Dr. Linda Rosen, deputy director of the state Department of Health, Health Resources Administration.
"We have had limited success in increasing their funding," Rosen said. Issues that have been considered higher priority include the Felix consent decree, emergency services and disaster preparedness.
Although annual funding for the treatment center through state general funds has remained stagnant, it has received supplemental funding in recent years from the rainy day fund, Victims of Crime Act Fund and other sources of state funding.
But Ramelli said it is not enough. "That's still a Band-Aid approach," she said.
The treatment center also receives additional funding through private donations and grants. However, Ramelli said they cannot rely on them to come in year to year. The "piecemeal" funding approach is affecting the sustainability of services, she said.
In 1998 the treatment center became the master contractor for statewide direct services and administrative and capacity-building services, according to a report by the Sexual Violence Strategic Planning Group, which is comprised of service providers, state and county officials and community stakeholders. The Department of Health's Maternal and Child Health Branch allocates state funding to the treatment center.
Ramelli said they were forced to dip into allocated state general funds -- which is meant to be used for direct services for sex assault victims -- to cover administrative responsibilities. Of the $923,783, about $678,000 was used to fund direct services, while the remaining amount was used to cover administrative responsibilities. "In essence, we took on state responsibility without the funding to do it," she said.
"With the funding, a lot has been accomplished. However, it came out of funding that was initially there for direct services. That money was always intended to provide crisis counseling and education and prevention," Ramelli said.
Still, the center has made a difference for many women.
Embarrassed to turn to her family and friends for help, the woman who was attacked by an acquaintance said crisis workers and therapists at the treatment center comforted her and were there for her.
The assault, she said, shattered her dignity and self-esteem, leaving her in a fragile state.
She waited for a month before a therapist at the treatment center was available to see her. "When I had to wait, it was the worst experience. I just cried. I curled up in a ball. It was really, really bad," she said.
She took time off from work, went into seclusion, became hyper-vigilant and did not trust anyone. "It was a dark time," she said.
Through counseling sessions, the woman, now 31, said she regained her dignity, sense of self and personal tools to better cope with what had happened to her. Without the treatment center, "I wouldn't be who I am now," she said. The woman continues to see a therapist at the treatment center.
About 60 percent of the victims who come to the center are minors, Ramelli said.
Clinical manager Evie Yanagida of the Sex Abuse Treatment Center said inadequate funding has affected services, mainly on the neighbor islands. The treatment center subcontracts with various agencies, including the YWCA and Child & Family Service, which provide sex assault services on the neighbor islands.
On the Big Island, only one part-time therapist is available to provide counseling to victims in Kona from Waimea to Kau. Also, there are no educators available in West Hawaii, Yanagida said. On Kauai there is no prevention and education staff available, she said.
"The biggest impact has been on prevention and education," Yanagida said.
"On the neighbor islands, prevention and education has essentially been marginalized. Some of the neighbor islands have appealed to their county to come up with funds for education and prevention. That's hit and miss. There is no guarantee that funds will be there year to year," she said.
In July the responsibility of administering programs for the prevention of sexual violence and treatment of sex assault victims was transferred to the Department of the Attorney General from the Department of Health.
With the department's ties to law enforcement and crime assistance, Rosen said she hopes they will be successful in advocating for more funding for the treatment center.