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As the number of sexual assault survivors around the state increases, many groups designed to provide aid and support are underfunded or wrapped up in bureaucratic complexity.

Sexual assault survivor advocates, as well as medical and forensic practitioners, voiced their struggles to a state task force addressing the needs of sexual assault survivors in an online hearing Wednesday.

The Missouri Rights of Victims of Sexual Assault Task Force began its series of online hearings with a focus on Missouri's complex funding and billing structures.

The hearing was centered around funding recommendations to support sexual assault victims and investigations, with practitioners detailing their struggles to secure funding and reimbursement for services.

The 13-member task force heard from six witnesses, ranging from sexual assault victim advocates and nurses to a forensic scientist.

Victoria Pickering, a sexual assault survivor advocate with the Metropolitan Organization to Counter Sexual Assault, said the lack of resources behind processing sexual assault cases hinders the ability of advocacy groups to help survivors.

"For a lot of survivors, it's like living in limbo," Pickering said. "While someone might be focused on trying to move forward, trying to make changes in their life — get a new job, move to a new home, things like that — there's always kind of this feeling in the back of someone's mind."

The Missouri Rights of Victims of Sexual Assault Task Force was created in July 2020 after SB 569 was signed into law.

The task force is charged with collecting feedback and recommendations from state and local law enforcement, victim services, forensic science and health care practitioners to help develop "future best practices or clinical guidelines regarding the care and treatment of survivors," according to the law.

Additionally, the task force must study nationally recognized best practices and recommend a method for tracking and investigating complaints made against the handling of sexual assault reporting and investigations.

The task force must also make recommendations for documentation informing sexual assault survivors of their rights.

SB 569 also requires the task force to determine if there are needs for additional staffing at rape crisis centers, as well as costs and methods for satisfying those needs.

Jennifer Dochler, a spokesperson for the Missouri Coalition Against Domestic and Sexual Violence, said there has been resounding support for additional staffing, which would help provide more consistent 24/7 service at rape crisis centers.

"Even though there was approximately 14,000 people who reached out in 2020 for services, agencies, because of capacity issues, had a fewer number of individuals who received services and a greater number of individuals who were turned away," Dochler said. "In our ideal world, no one who is in crisis, in need, would be turned away."

Pickering also said there is an increasing demand for services, noting a time when MOCSA was called to provide advocacy for eight victims over the course of nine hours.

Each advocacy case takes about six hours as the advocate joins the survivor for initial medical testing and treatment, she said.

"If this continues to happen in a more consistent manner at that capacity, to respond to that many accusations is not sustainable for our organization or other organizations like us," Pickering said.

With volunteers out because of the pandemic, Pickering said staff has been stretched thin to cover other obligations, such as advocacy as survivors go through the criminal justice system and educational outreach or professional training.

Kristie McAninch, a sexual assault survivor advocate at Green Hills Women's Shelter, said the number of people seeking assistance from the shelter so far this year has increased 100 percent from last year.

Dochler told the task force that funding from the Department of Social Services needs to be increased and restructured to allow the crisis centers to more freely decide how the funding can be spent.

Pickering also supported flexible funding, which she said would allow for more programming based on individualized needs.

McAninch said in her rural area of service, community stigma, child care, transportation and a lack of sexual assault nurse examiners pose challenges for sexual assault survivors, but state regulations don't allow funding to adequately address those areas.

In addition to more survivors seeking help, Dochler said there is increased demand as the state Attorney General's Office addresses a backlog of cold case sexual assault kits and volunteers are suspended amid the COVID-19 pandemic.

Bryan Hampton, a forensic scientist at St. Charles County Police Department Criminalistics Laboratory, said sustainability of lab resources will be crucial for aiding in sexual assault criminal cases.

Hampton said a lack of lab resources like personnel are the biggest cause for the state's backlog of rape kits as forensic scientists have to prioritize some cases over others.

He suggested the task force look into permitting more funding for state crime laboratories.

The task force also heard testimony on the difficulties survivors face in paying for sexual assault treatment at hospitals and the struggles hospitals face in keeping a sexual assault nurse examiner on staff.

Andy Wheeler, vice president of federal finance for the Missouri Hospital Association, said the costs associated with treating sexual assault survivors are complicated by a split between the forensic exam claim, which goes to the Department of Public Safety, and the medical treatment claim, which goes to private insurance companies.

Wheeler said it's difficult to split the bill, but even more complicated by regulations that dictate what services can be billed depending on whether a physician or nurse provided them.

Dawn Day, a sexual assault nurse examiner at Mercy Hospitals, said while medications may be covered by reimbursement through DPS, the tests a nurse has to run to administer the medications are often not covered.

A pregnancy test, for example, would be required before a sexual assault victim receives emergency contraception from the hospital, but is not covered.

Day said the reimbursement is also not consistent among hospitals depending on how they report treatment.

Wheeler said it's also expensive for hospitals to have sexual assault nurse examiners as the training costs a total of around $20,000 in rural areas, which often don't see many survivors.

Day said even initial certifications run $300-$500 per nurse.

State Sen. Jill Schupp, a member of the task force, said there are many challenges related to how Missouri handles sexual assault cases and providing resources to survivors.

"These are among the most heinous of crimes I can imagine," Schupp said. "We want to make sure that we're doing everything that we possibly can to take care of those survivors and hold those perpetrators to account."

Wednesday's hearing was the first of four already scheduled by the task force. The remaining three are in September and also focus on particular topics.

The next task force hearing will be Sept. 14 and will be focused on standards and practices. That will be followed by a hearing on survivor privacy Sept. 22 and a hearing on evidence collection Sept. 28.

Schupp said the topics for each hearing were decided after discussing the needs and goals of sexual assault survivors and their supporters.

In addition to public hearings, the task force is collecting public comments through an online form at surveymonkey.com/r/MORightsTaskForce through Sept. 30.

The task force's work will culminate in a report, detailing its findings and any majority and dissenting opinions, provided to the governor and Missouri General Assembly by the end of the year.

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