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Sexual violence in sport: American Medical Society for Sports Medicine Position Statement
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  1. Jennifer Scott Koontz1,2,
  2. Margo Mountjoy3,4,
  3. Kristin E Abbott5,
  4. Cindy Miller Aron6,7,
  5. Kathleen C Basile8,
  6. Chad T Carlson9,
  7. Cindy J Chang10,
  8. Alex B Diamond11,
  9. Sheila A Dugan12,
  10. Brian Hainline13,
  11. Stanley A Herring14,
  12. B Elliot Hopkins15,
  13. Elizabeth A Joy16,
  14. Janet P Judge17,
  15. Michele LaBotz18,19,
  16. Jason Matuszak20,
  17. Cody J McDavis21,
  18. Rebecca A Myers22,
  19. Aurelia Nattiv23,
  20. Jeffrey L Tanji24,
  21. Jessica Wagner25,
  22. William O Roberts26
  1. 1Newton Medical Center, Newton, Kansas, USA
  2. 2Family and Community Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
  3. 3Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
  4. 4Bureau, FINA, Lausanne, Switzerland
  5. 5Health Service, Northwestern University, Evanston, Illinois, USA
  6. 6Portland State University, Portland, Oregon, USA
  7. 7Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California, USA
  8. 8Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  9. 9Sports Medicine, Stadia Sports Medicine, West Des Moines, Iowa, USA
  10. 10UCSF, San Francisco, California, USA
  11. 11Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  12. 12Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois, USA
  13. 13National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
  14. 14Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
  15. 15National Federation of State High School Associations, Indianapolis, Indiana, USA
  16. 16Office of Research, Intermountain Healthcare, Salt Lake City, Utah, USA
  17. 17Holland & Knight LLP, Boston, Massachusetts, USA
  18. 18InterMed, Yarmouth, Maine, USA
  19. 19Sports Medicine, InterMed, South Portland, Maine, USA
  20. 20Family Medicine, SUNY Buffalo, Buffalo, New York, USA
  21. 21Foundation 42, Los Angeles, California, USA
  22. 22Longs Peak Family Medicine, Longmont, Colorado, USA
  23. 23Division of Sports Medicine, Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
  24. 24Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
  25. 25National Collegiate Athletic Association, Indianapolis, Indiana, USA
  26. 26Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
  1. Correspondence to Dr Jennifer Scott Koontz, Newton Medical Center, Newton, Kansas, USA; jenniferscottkoontz{at}gmail.com

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 finalise 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 harassment
  • violence
  • sports medicine
  • prevention
  • Position Statement
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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 organisations, including athletes, coaches, administrators, officials (referees), performance and training personnel, healthcare 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 organisation of sports medicine physicians in the USA, 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.1 Sexual harassment is any unwanted and unwelcome conduct of a sexual nature, whether verbal, non-verbal or physical. Sexual abuse any conduct of a sexual nature, whether non-contact, 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:

  1. Sexual violence can occur in the setting of other non-accidental violence, including neglect, psychological violence and/or physical violence through mechanisms of contact, non-contact/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 non-accidental violence.

  2. AMSSM condemns the actions of sports medicine physicians and other healthcare providers or individuals who perpetrate sexual violence or passively facilitate sexual violence through inaction. Acts of sexual violence by physicians and other healthcare providers violate trust and abuse power, and many types of sexual violence are criminal acts.

  3. 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.

  4. 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 healthcare 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 organisations, teams and institutions.

  5. Organisations, teams and institutions should ensure independent reporting mechanisms are available to help avoid inherent conflicts of interest that may be present.

  6. Sports medicine physicians should collaborate with sports organisations, teams and institutions to evaluate and implement policies and procedures that will most effectively reduce sexual violence in sport within their organisation.

  7. Sports medicine physicians should develop clinical competencies related to sexual violence that include:

    1. Understanding psychological harassment and abuse, which is often the basis of sexual violence and all other forms of non-accidental violence.

    2. Recognising the clinical signs and symptoms of sexual violence.

    3. Effectively addressing athlete disclosures of sexual violence in a clinical setting.

    4. Reporting allegations of sexual violence to appropriate authorities while understanding applicable patient confidentiality laws and policies.

    5. Utilising a multidisciplinary care team when treating or referring individuals impacted by sexual violence.

    6. A willingness to assist teammates, coaches, athlete support staff, friends and family.

  8. Sexual violence prevention training and education are important for all athletes, coaches, administrators, healthcare providers and other members of sports teams and organisations. Important topics in available sexual violence prevention training curriculum include: recognising grooming behaviour 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.

  9. 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 organisation 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:

  1. 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.

  2. 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.

  3. AMSSM will develop a set of educational resources for all sports medicine physicians and sports medicine fellowship trainees to:

    1. Partner with administrators, other healthcare providers, legal advisors, community leaders and others in sports organisations 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.

    2. Help prevent sexual violence by understanding the contributing roles of psychological and physical violence, supporting implementation of prevention measures such as bystander intervention training programmes, and educating athletes and others to recognise grooming behaviour and identify and avoid vulnerable situations in sport settings.

    3. 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.

    4. Identify signs, symptoms and health sequelae of sexual violence in athletes.

    5. Implement treatment guidelines for athletes affected by sexual violence utilising a multidisciplinary care team.

    6. Take appropriate steps when sexual violence is disclosed by an athlete and understand physician–patient confidentiality in these disclosures.

    7. Know legal reporting requirements that will vary for minor and adult victims and may vary by local, state, federal or international jurisdiction.

    8. Understand Title IX and the Clery Act processes and reporting requirements in the American collegiate setting.

    9. Emphasise peer accountability and reinforce the process of mandatory reporting of any physician or other healthcare provider identified or suspected as a perpetrator to law enforcement and medical licensing authorities.

  4. Recognising that all types of non-accidental 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.

  5. AMSSM recognises 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 healthcare providers and all stakeholders to reduce sexual violence in sport.

Reference

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Footnotes

  • Twitter @doctorkoontz, @margo.mountjoy, @kabbott_pansky, @musicsports2001

  • Presented at This article is being simultaneously published in the British Journal of Sports Medicine, Clinical Journal of Sport Medicine, Sports Health and Current Sports Medicine Reports.

  • Contributors All authors contributed to the literature review, planning and iterative process in the development of this statement. The lead author wrote the original draft and then compiled edits for revisions throughout the iterative process as well as the final version. All authors approved of the final version of the statement.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work.

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