Background: Engaging victims of sexual assault in acute and post-acute sexual assault services is vital for their immediate and longer term wellbeing, but is also a major challenge for practitioners and services. Methods: A practice-based scoping review was conducted to identify barriers to engagement. After search limiters were applied, 339 articles were screened at various levels, resulting in 27 articles, which were reviewed by two reviewers and appraised for quality and relevance. Results: Eighteen key barriers were identified within the four categories of: service and system barriers, health professional barriers, person/survivor barriers, and person context barriers. Conclusion: The identified barriers provide a useful guide for practitioners as key issues to address or consider when seeking to promote greater victim/patient engagement in acute and post-acute sexual assault services. The need for a “victim centred response” is highlighted..