Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement

Abstract

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Sexual violence in sport is an egregious violation of an athlete's right to safety and is unacceptable. It is a serious societal and public health issue that can affect any athlete and may have severe and long-standing negative impacts on an athlete's physical, psychological, and social well-being. The experiences of all members of sports organizations, including athletes, coaches, administrators, officials (referees), performance and training personnel, health care providers, and all staff, should be free from sexual violence.

Sports medicine physicians strive to create a safe environment for all athletes in a variety of sport and clinical settings. As the largest organization of sports medicine physicians in the United States, the American Medical Society for Sports Medicine (AMSSM) is dedicated to reducing sexual violence in sport through collaborative, multidisciplinary engagement.

Sexual violence in this document encompasses the definitions of both sexual harassment and sexual abuse as previously defined.¹Sexual harassment is any unwanted and unwelcome conduct of a sexual nature, whether verbal, nonverbal or physical. Sexual abuse is any conduct of a sexual nature, whether noncontact, contact, or penetrative, where consent is coerced/manipulated or is not or cannot be given.

RAISING AWARENESS OF SEXUAL VIOLENCE IN SPORT

AMSSM is committed to raising awareness of the following principles related to sexual violence in sport:

• Sexual violence can occur in the setting of other nonaccidental violence, including neglect, psychological violence, and/or physical violence through mechanisms of contact, noncontact/verbal abuse, bullying, discrimination, cyberbullying, and hazing. Efforts to reduce sexual violence in sport should include comprehensive strategies to create a safe culture that reduces all nonaccidental violence.
• AMSSM condemns the actions of sports medicine physicians and other health care providers or individuals who perpetrate sexual violence or passively facilitate sexual violence through inaction. Acts of sexual violence by physicians and other health care providers violate trust and abuse power, and many types of sexual violence are criminal acts.
• While the laws governing sexual violence vary by jurisdiction, all applicable local, state, federal, and international laws addressing sexual violence apply to sport settings. These laws include mandated reporting of incidents involving minors to legal authorities.
• Some adult victims may choose not to report sexual violence, but implementing safe reporting processes and providing support teams can help empower survivors to report such acts. Sports medicine physicians and other health care providers must understand the scope and limitations of their obligations around patient confidentiality in this area and should support development of safe, supportive reporting processes for their sports organizations, teams, and institutions.
• Organizations, teams, and institutions should ensure independent reporting mechanisms are available to help avoid inherent conflicts of interest that may be present.
• Sports medicine physicians should collaborate with sports organizations, teams, and institutions to evaluate and implement policies and procedures that will most effectively reduce sexual violence in sport within their organization.
• Sports medicine physicians should develop clinical competencies related to sexual violence that include the following:
• ○ Understanding psychological harassment and abuse, which is often the basis of sexual violence and all other forms of non-accidental violence;
• ○ Recognizing the clinical signs and symptoms of sexual violence;
• ○ Effectively addressing athlete disclosures of sexual violence in a clinical setting;
• ○ Reporting allegations of sexual violence to appropriate authorities while understanding applicable patient confidentiality laws and policies;
• ○ Using a multidisciplinary care team when treating or referring individuals impacted by sexual violence;
• ○ A willingness to assist teammates, coaches, athlete support staff, friends, and family.
• Sexual violence prevention training and education are important for all athletes, coaches, administrators, health care providers, and other members of sports teams and organizations. Important topics in available sexual violence prevention training curriculum include recognizing grooming behavior typically used by predators, identifying cultures and situations in sport that may have insufficient safeguarding standards, and establishing prevention efforts such as bystander intervention training.
• Those in positions of power and authority, in addition to peers, are identified in the scientific literature as perpetrators of sexual violence. One strategy to help limit known sexual predators from working or volunteering in sport is to require background checks for all who are involved in sport settings that involve athlete contact. International, national, and state registry systems could also be effective mechanisms to help identify perpetrators and to prevent them from moving from one sport organization to another.

AMSSM'S COMMITMENT TO REDUCE SEXUAL VIOLENCE IN SPORT

AMSSM commits to reducing sexual violence in all levels of sport (youth, high school, collegiate, elite, and professional) through the following actions:

• AMSSM created a “Sexual Violence in Sport Task Force” in 2019 to raise awareness and develop strategies for sports medicine physicians to reduce sexual violence in sport. The authors of this statement serve as members of this task force.
• Several AMSSM members are part of a multidisciplinary writing group currently developing an evidence-based report from the “Summit on Sexual Abuse in Sport” that took place in November 2018. This scientific publication will be an educational resource for sports medicine physicians on the health consequences of sexual violence, reduction strategies in sport settings, and care of affected athletes using a multidisciplinary team of providers.
• AMSSM will develop a set of educational resources for all sports medicine physicians and sports medicine fellowship trainees to:
• ○ Partner with administrators, other health care providers, legal advisors, community leaders, and others in sports organizations to establish sport-specific safeguarding policies, codes of conduct, independent reporting mechanisms, case management procedures, and prevention interventions that aim to reduce sexual violence in sport.
• ○ Help prevent sexual violence by understanding the contributing roles of psychological and physical violence, supporting implementation of prevention measures such as bystander intervention training programs, and educating athletes and others to recognize grooming behavior and identify and avoid vulnerable situations in sport settings.
• ○ Establish examination and treatment polices that reduce risk of sexual violence in the clinical setting and educate athletes on their rights to safe health care.
• ○ Identify signs, symptoms, and health sequelae of sexual violence in athletes.
• ○ Implement treatment guidelines for athletes affected by sexual violence using a multidisciplinary care team.
• ○ Take appropriate steps when sexual violence is disclosed by an athlete and understand physician-patient confidentiality in these disclosures.
• ○ Know legal reporting requirements that will vary for minor and adult victims and may vary by local, state, federal, or international jurisdiction.
• ○ Understand Title IX and the Clery Act processes and reporting requirements in the American collegiate setting.
• ○ Emphasize peer accountability and reinforce the process of mandatory reporting of any physician or other health care provider identified or suspected as a perpetrator to law enforcement and medical licensing authorities.
• Recognizing that all types of nonaccidental violence can be harmful, AMSSM will also engage in collaborative efforts to create effective, multidisciplinary strategies to reduce psychological violence, neglect, and physical violence in sport.
• AMSSM recognizes that many national and international stakeholders both within and outside of sport are working to reduce sexual violence in sport and in society as a whole. AMSSM is committed to developing a long-term plan to work collaboratively with other health care providers and all stakeholders to reduce sexual violence in sport.