Author: Anne P. DePrince, PhD

Author of "Every 90 Seconds: Our Common Cause Ending Violence Against Women" (forthcoming from Oxford University Press), Anne is Distinguished University Professor of Psychology and Director of the Center for Community Engagement to advance Scholarship and Learning (CCESL) at the University of Denver. She directs the Traumatic Stress Studies Group.

On Accountability After Sexual Victimization

June 9, 2021

During Colorado’s legislative session, issues related to violence and abuse were front and center, from Senate Bill 88’s focus on the statute of limitations after child sexual abuse to the sunset review of the Sex Offender Management Board.

Both the Senate bill and the sunset review focused attention on the importance of accountability after sexual abuse and assault to individual survivors and our communities.

Accountability matters for many reasons, including because sexual victimization is prevalent and often met with denial. Let’s take a look.

How prevalent is sexual victimization?

Approximately 27% of girls and 5% of boys have already been sexually abused or sexually assaulted when they are 17 years old, according to national surveys.

Looking to individuals from age 12 into adulthood, the Bureau of Justice Statistics (BJS) National Crime Victimization Survey (NCVS) estimates that more than 450,000 (459,310) people were sexually assaulted or raped in 2019 alone. These hundreds of thousands of people translate into roughly 1.7 individuals sexual assaulted or raped per 1,000 people. This estimate is in line with the previous 4 years of data collected in the NCVS: From 2015 to 2019, an average of 463,634 people were sexually assaulted or raped each year.

What role does denial play in sexual violence?

Since at least the 1980s, researchers have documented denial as a strategy used by people who sexually offend. More than a psychological defense, denial is part of a set of responses that further the harm of sexual violence.

Psychologist Dr. Jennifer Freyd and her colleagues have described these strategies as Deny, Attack, Reverse Victim Offender (DARVO), and developed a measure of these behaviors. With that measure, they established that DARVO is a pattern of responses to which people, especially women, are commonly subjected upon confronting others about wrongdoing.

Next, Freyd’s research team used a set of experiments to test the impact of DARVO on perceptions of victims and offenders in scenarios that described intimate partner violence. The results were striking: Participants exposed to DARVO strategies “perceived the victim to be less believable, more responsible for the violence, and more abusive; DARVO also led participants to judge the perpetrator as less abusive and less responsible.”

As someone who studies the impact of sexual and other forms of intimate violence on victims and survivors, I can tell you that we hear time and again from survivors in our research studies about the harm of denial. Indeed, survivors have told us and other research teams around the globe about how critical accountability and belief are to healing.

Consider what we learned when my research team interviewed more than 200 women who were sexually assaulted in the previous year about the reactions they got to disclosures. We discovered that friends and family commonly responded to disclosures with negative reactions. For example, they blamed victims, treated them differently, took away their control. Another research team examined 51 studies like ours on reactions to sexual assault disclosures. Across studies, negative reactions to disclosure were linked with worse mental health outcomes, such as more severe posttraumatic stress disorder (PTSD) symptoms. The researchers concluded, and I agree, that women disclose sexual assault with the expectation of getting help and support. Being met with negative reactions, like DARVO, furthers harm.

And make no mistake, the harm of sexual abuse and sexual assault is serious. Research by my team and others across the country have documented that sexual violence has serious immediate and long-term psychological and physical health consequences as well as impacts in other areas of life, such as at school and work. From PTSD and suicidality to chronic health problems and poor school performance, survivors and our communities pay a high price for sexual abuse and assault.

What are pathways to accountability?

When researchers ask survivors what is important after victimization, their answers vary, ranging from material and practical support, safety, and recognition of the harm caused to accountability for the offender, prevention, and to be valued and heard. 

Though survivors tend to name a broad mix of restorative and retributive outcomes, public emphasis often veers towards the criminal legal system — whether its the propagation of the rape myth that survivors report to the police right away or actions that make Title IX campus investigations more closely mirror criminal proceeding.

The reality is, however, that sexual abuse and assault are vastly under-reported to law enforcement relative to other crimes. For example, back in 2011, researchers described phone interviews with 3,001 women from across the country as part of the “National Women’s Study – Replication.” Of those three-thousand women, 526 reported having been raped. Only 15.8% of women – or fewer than one in six – had reported the most recent rape to the police. Sadly, that rate was no different from those seen in the 1990s.

The Traumatic Stress Studies Group has looked at these issues in Colorado, including in research funded by the National Institute of Justice.1 In that study, we recruited 228 women aged 18 and older who were sexually assaulted in the previous year, and who had disclosed the sexual assault to at least one formal support person, such as a healthcare provider, victim advocate, or the police.

Importantly, this means that the sample of women we interviewed were unique in that they had all disclosed to a formal support person. Yet, only 42% of those women had reported to law enforcement.

Thus, even among women willing to disclose the sexual assault to someone formal and talk to a researcher about their experiences, still only a minority had reported the incident to law enforcement.

After the initial interview, we invited women back to talk with us again 3, 6, and 9 months later. At each interview, we asked them about sexual assaults that had occurred since the previous interview; and if so, whether they had reported to law enforcement.  

Two out of every five women (40.6%) we interviewed were sexually assaulted at least once in the subsequent nine months. Yet, at each interview, only a small minority (9-18%) of women had reported new sexual assaults to the police.

These findings make plain that survivors do not necessarily report new incidents of sexual assault – even if they have previously disclosed to service providers or reported to law enforcement.

And of course, even if sexual assault cases are reported, the vast majority will not end in prosecution or accountability in the criminal legal system.

Take-Aways

Research findings on denial, the prevalence of sexual victimization, and police reporting offer us at least two important take-aways for thinking about accountability.

First, denial is a strategy used against victims, which makes a firm commitment to accountability of central importance to supporting survivors.

Second, sexual victimization is terribly common; however, many women do not engage with the criminal legal system for a host of reasons. Legal options outside the criminal system are essential to accountability, making efforts such as those undertaken in Senate Bill 88 to expand civil legal options especially important.

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Note: This post was adapted from text submitted as written testimony in response to HB 1320.

1 National Institute of Justice Grant #2012-W9-BX-0049. The views expressed are those of the authors and do not necessarily represent the views or the official position of the National Institute of Justice or any other organization.

Growing Despite Trauma

June 9, 2021

by Adi Rosenthal, 3rd Year Graduate Student, TSS Group

Most trauma research focuses on the many negative impacts of trauma exposure, such as post-traumatic stress disorder, poorer physical health, and disruptions to social relationships. But psychologists have also studied positive outcomes after trauma, called posttraumatic growth. Think: new appreciation for life, strengthened relationships with others, increased sense of personal competence. Between 30-70% of survivors report some level of growth following trauma exposure, and this growth is associated with less post-trauma distress.

Dr. Richard Tedeschi, who coined the term post-traumatic growth, described that “experience of pain produces the most far-reaching searches for meaning.” Tedeschi recognized that trauma often forces survivors to re-evaluate their views of the world. We all have existing beliefs and assumptions that help us navigate our day-to-day lives. Over time, these beliefs get refined based on our experiences. However, when a traumatic event violates existing beliefs, we are pushed to adjust. Consider that intimate partner violence and sexual assault don’t make sense, aren’t fair, and challenge views of the world as a just place. Yet, survivors of interpersonal violence report better relationships as a result of their trauma. In the face of having to reevaluate views of themselves and others, survivors find ways to accept support from others and strengthen some interpersonal relationships.

How survivors think about their experiences may be key to understanding posttraumatic growth. Years of research have shown that the way individuals process and think about their traumatic experience impacts coping. This is why a big part of trauma-focused therapy involves processing one’s thoughts about the traumatic event. Post-trauma appraisals are survivors’ beliefs and emotions related to trauma exposure, such as experiences of shame, fear, betrayal, self-blame, anger, and alienation. Post-trauma appraisals have been found to predict posttraumatic stress disorder (PTSD) symptoms, dissociation, and depression.

We wondered whether some kinds of posttraumatic appraisals are more likely to contribute to posttraumatic growth over time than others. As part of the Women’s Wellness Project, the TSS Group interviewed 216 adult women who had disclosed a sexual assault in the previous year to a formal support person, such as a doctor or victim advocate. At the start of the study, women reported on their post-trauma appraisals by indicating to what extent they agreed with statements such as “I must have done something really awful to make this happen” and “I am disconnected from people.” They also reported on post-traumatic growth by rating how much they experienced change in various areas (e.g., “I can better appreciate each day”) as a result of the traumatic event. Post-traumatic growth was assessed initially and then again 3, 6, and 9 months later.

What did we find?

Post-traumatic appraisals of betrayal and alienation were particularly important for post-traumatic growth, according to our preliminary analyses. As illustrated in the figure below, women who reported more betrayal after the sexual assault also indicated more initial post-traumatic growth. Women who reported more alienation after the sexual assault described more post-traumatic growth over time. Self-blame, shame, fear, and anger did not predict post-traumatic growth.

Two graphs display the pattern of posttraumatic growth across four time points. The first graph shows the pattern for women who reported high and low betrayal. The second shows the pattern for women who reported high and low alienation.

What does this mean?

Experiencing more betrayal and alienation may require women to reevaluate interpersonal relationships, more so than other appraisals directed at the self, such as shame. For example, betrayal appraisals include items such as “If the person really cared about me that person would not have done what they did” and “Someone important (such as a parent, lover, friend) should have kept me safe.” Recognition of these relational violations likely challenges views of interpersonal relationships. Similarly, alienation appraisals, such as “I am disconnected from people” and “I can’t get close to people” reflect feelings of isolation and rejection following sexual assault. Both of these appraisals challenge views that relationships with close others are necessarily safe and supportive. Following sexual assault, betrayal and alienation may lead survivors to actively seek new relationships and connections with others, resulting in relational growth captured in the posttraumatic growth measure (e.g., “I put more effort in my relationships”).

So what?

Findings suggest that post-trauma experiences of alienation and betrayal may be particularly important to consider among service providers. For instance, there may be value in helping clients think through changed views of interpersonal relationships in building (or rebuilding) and strengthening their social support networks. Because post-traumatic growth is linked with reduced distress among survivors of sexual assault, a better understanding of what leads to growth can provide vital direction for survivors and providers.

***

Note: This research was funded by the National Institute of Justice [Grant #2012-W9-BX-049]. The views expressed are those of the authors and do not necessarily represent the views or the official position of the National Institute of Justice or any other organization.

Thank you to our community partners who made this research possible, particularly Denver’s Sexual Assault Interagency Council.

Evolving Perspectives

May 10, 2021

Science and discovery require learning to see the world all around us in new ways.

Focusing on trauma and violence requires truth-telling about the harm that humans cause each other as well as curating hope, joy, and mindfulness of the moment.

Here are some images from my photo practice through which I seek to do both: Learn to see the world in new ways while curating hope, joy, and mindfulness.

Tracking COVID-19 Impacts and Legal Needs in Colorado

November 10, 2020

by Anne P. DePrince & Adi Rosenthal

As the world reeled from the first wave of the coronavirus in the Spring, lots of conversations turned towards concern about the impact on victims/survivors and victim service agencies.

To track these concerns, we started to ask victim service providers to share what they saw as the biggest coronavirus impacts on victims/survivors and their agencies. Since May, we have asked these questions each month as part of our collaboration with LINC — the Legal Information Network of Colorado.

Here’s a snapshot of what we’ve learned so far from providers’ responses.

A Preliminary Snapshot of COVID-19 Impacts

Each month’s data reflect the views of about 20 victim service providers, many of whom work in and around the Denver Metro Area.

First, let’s look at what providers have to say about impacts on clients. The figure below shows the percent of responses that fell into five of the themes that emerged. The most common theme since May have been concerns about clients’ getting their economic/basic needs met (yellow line). This is consistent with providers’ ongoing concerns about whether clients have enough resources (orange line).

As illustrated above, providers also noted impacts on victims/survivors in terms of changes to the court systems and technological challenges. These two issues are, of course, inter-related as victims/survivors (as well as lawyers and advocates) have worked to keep pace with technology used in remote adaptations to COVID-19 that have varied across jurisdictions.

Next, let’s look at what providers have noticed about impacts on agencies. As illustrated below, one of the clearest and most persistent impacts on agencies has been the lack of face-to-face contact, which can make providing services more difficult and be more isolating for staff.

The figure above also shows concerns early on about public-facing communications as agencies worked to make clients aware of options and get information out remotely. Those impacts looked like they were dropping off in August and September, but seem to have resurfaced in October as COVID-19 cases increased and many communities began to anticipate new restrictions. Echoing impacts on clients directly, providers also noted that agencies are affected by changes to the court system and limited resources for clients.

What’s Next? Monitoring Legal Needs around the State

We’ll keep asking about COVID-19 impacts, particularly as the Fall’s record number of cases ushers in growing uncertainty. We will also continue ongoing efforts to monitor crime victims’ legal needs in Colorado. You may have heard someone asking you to fill out a survey on barriers facing clients to getting their legal needs met. When you and colleagues fill out those surveys, we summarize the responses for the LINC Steering Committee for use in guiding the development and implementation of LINC.

In addition to our ongoing work, we are gathering input from victims/survivors and providers about legal needs and barriers facing clients outside the Metro Denver area. We are in the process of inviting Colorado agencies to share information about the survey with clients and staff. This short survey study closes on December 1, 2020. For more information, reach out to us at legalstudy@du.edu.

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Traumatic Stress Studies Group Team Members standing on a bridge

Sharing Research in Socially-Distanced Times

November 10, 2020

The pandemic has only amplified the importance of doing research into the causes and consequences of violence as well as effective responses. However, sharing that research looks different these days.

In the Fall, our team typically heads off to the Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS) to share our work with other researchers and practitioners. Instead of logging miles this year, however, we’re logging on to a remote meeting.

The findings that we’re sharing at the remote ISTSS Annual Meeting reflect the breadth that is characteristic of our team’s work — as I hope you’ll see below across five poster presentations led by graduate student team members. From measuring service needs to developing a better understanding of revictimization risk, we hope there’s something for everyone in these posters. (Click on the picture of the poster to open a pdf version of the work.)

Needs and Concerns of Caregivers Involved in Child Abuse/Neglect Investigations

Two posters focused on understanding the needs and concerns of caregivers involved in child abuse and neglect investigations.

Adi Rosenthal led our team’s efforts to gather information about the service needs of families involved in child abuse and neglect investigations — and barriers to getting those needs met. She described that “We developed a measure for assessing the service needs and barriers across a wide range of services (i.e., physical health, mental health, school, and social, and basic needs) for families involved in child abuse or neglect investigations. The measure appears to be a promising assessment and captured high rates of unmet service needs: 94% of caregivers reported at least 1 unmet need and 39% reported at least 5. Caregivers reported an average of 7 barriers to getting their service needs met.”

Recognizing a research gap that has implications for practice, Maria-Ernestina Christl set out to develop a way to measure failure-to-protect fears. She summarized that, “Women involved in a child abuse investigation who had a history of intimate partner violence reported fears related to failure-to-protect laws. These fears were found to be related to economic dependence on the offender, racial identity, and their perceptions of the child abuse investigation.”

Revictimization

Three of the posters built on our team’s longstanding focus on revictimization.

Naomi Wright described findings from one of the studies that drew on interviews conducted over 9 months with women who had a recent unwanted sexual experience: “This study explored whether we could predict which women experienced another unwanted sexual experience. In particular, we wanted to understand whether social betrayal helped predict revictimization in addition to women’s other circumstances.”

Another study, led by Julie Olomi, tackled methodological limitations that have limited research on information processing and revictimization. Julie described, “Current methods seeking to interrupt the association between childhood interpersonal violence and revictimization by examining how women perceive and respond to risk using written, audio, or video vignettes have led to mixed results and not yet translated to effective, long-term interventions. This study sought to address this gap and introduces a novel risk recognition and response task asking participants to monitor and provide social skills feedback on a chat room conversation between a man and a woman to mask the focus on risk detection and response.”

Finally, Naomi Wright previewed findings from our team’s collaboration with Dr. Kim Bender (Graduate School of Social Work, DU). Naomi noted that “This study with young people experiencing houselessness found that young people who experienced violence or abuse before leaving home were more likely to also experience violence after leaving home. Psychological distress (i.e., depression and PTSD symptoms) were explored as a link between violence experiences before and after leaving home.”

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Out of the Frying Pan into the Fire: Victimization of Young People Before and After Leaving Home

September 23, 2020

By Naomi Wright (TSS Group), Tara Milligan (Graduate School of Social Work, DU), Kim Bender (Graduate School of Social Work, DU), Anne P. DePrince (TSS Group)

COVID-19 has renewed public attention to the U.S.’s “pre-existing condition” of houselessness, which has only worsened with recent COVID-19-related layoffs and job loss.  Emerging evidence suggests those without housing may be at greater risk for infection with COVID-19. As researchers of interpersonal violence and abuse, we have had longstanding concerns about another health risk of housing instability: interpersonal victimization and revictimization.

Unfortunately, little research is available on youth experiences of violence and factors that might affect risk of revictimization after leaving home. Thus, we wanted to answer three questions:

  1. At what rate do youth experiencing houselessness report victimization before and after leaving home?
  2. Are youth who experience victimization before leaving home more likely to later experience victimization after leaving home?
  3. Could the connection between victimization before and after leaving home be explained by symptoms of psychological distress?

To answer these questions, we conducted preliminary analyses of data collected as part of a five-year collaborative study led by Dr. Kimberly Bender. The larger study tested a mindfulness training to reduce risky substance use and victimization among young people (age 18-20) residing at a Denver-area shelter. As part of that larger study, 245 young people living at a shelter participated in research interviews that asked about experiences of violence and abuse before and after leaving home as well as symptoms of posttraumatic stress disorder (PTSD) and depression. Finally, we asked some questions about their personal characteristics—such as time away from home, gender, and number of moves between cities after leaving home— that have been linked in previous research to increased risk for victimization.

Here are a few things we learned.

At what rate do youth experiencing houselessness report victimization before and after leaving home?

Nearly all young people (218 out of 236 youth; 92%) interviewed were victimized before leaving home. Three-quarters (183 out of 243 youth; 75%) were victimized after leaving home. The majority of young people reported violence in both settings (176 out of 237 youth; 72%). The figure below represents the distribution of violence experiences.

For comparison, in a 2018 research study with college students, who are approximately the same age as the young people in this sample, only 16% of the students reported experiencing violence or abuse in their lifetime.

Of the 218 young people victimized before leaving home, 198 (91%) experienced physical abuse, 99 (45%) sexual abuse, and 211 (97%) emotional abuse. We counted up the number of types of victimization young people reported: Before leaving home, youth experienced an average of 2.14 out of 3 of these types of victimization (SD = .88, range = 0-3).

Among the 183 young people victimized after leaving home, youth were most likely to experience conventional crime (155 youth; 85%) followed by peer victimization (111 youth; 61%), electronic victimization (108 youth; 59%) and sexual victimization (90 youth; 49%). Youth reported an average of 1.9 out of 4 types of victimization (SD = 1.47, range = 0-4).

Several factors were linked to victimization that warrant attention. Youth who had been away from home longer or moved more times between cities were more likely to be victimized while unstably housed than other youth in the sample. Young people who identified as cisgender women were significantly more likely to experience victimization than young people who identified as cisgender men. Young people who identified as transgender or gender non-binary had wide variation in experiences of victimization.

Are youth who experience victimization before leaving home more likely to later experience victimization after leaving home?

In short: yes. As has been found in many other populations, young people in this study who reported experiencing more victimization before leaving home also reported significantly more victimization after leaving home. The upward-trending dotted line in the figure below provides a visual representation of the relationship between victimization before and after leaving home.

Could the connection between victimization before and after leaving home be explained by symptoms of psychological distress?

Yes, at least partially. Young people’s levels of psychological distress seemed to play a role connecting victimization before and after leaving home. Specifically, young people who experienced more types of victimization before leaving home reported more symptoms of posttraumatic stress disorder (PTSD) and depression; in turn, youth with more symptoms of psychological distress reported more victimization after leaving home. 

The path to revictimization through PTSD symptoms was significant. 

The path to revictimization through depression symptoms was also significant.

Limitations to consider

These findings provide preliminary evidence that childhood victimization may increase psychological distress, and in turn, revictimization among young people experiencing houselessness. However, an important limitation has to be considered. We measured victimization and psychological distress at the same time; therefore, it’s possible that revictimization increased symptoms rather than symptoms increasing revictimization.  

So what? We can better support youth experiencing houselessness by addressing the effects of childhood victimization and supporting trauma-informed care 

 The best supports for young people experiencing houselessness try to address the many facets of their complex social, material, physical, and psychological needs. These findings point to the importance of determining whether young people have a history of childhood victimization in order to support interventions for psychological distress and to ensure safety – but waiting until young people are living in shelters makes this more difficult.  Early-life preventative programs as part of schools, child welfare, and foster care systems could serve as universal points of screening and intervention.

Research also shows that it is common for people who have been victimized to cope with their experiences by using substances or have difficulty regulating their emotions and attention. All of these issues can make accessing and using services more challenging. One way to help young people get services despite these challenges is to focus on trauma-informed models of care. Such trauma-informed programs go beyond providing for basic needs, or building skills to be productive citizens, to also support the emotional, physical, and relationship wellbeing of unstably housed young people. Trauma-informed practices also use universal design in day-to-day practices to account for the cognitive or social effects of trauma. For example, visual aids could accompany verbal explanations to help with attention and remembering the information later. Another approach is the use of harm-reduction models that are most helpful to youth whose strategies for coping may be mistaken as deliberate misconduct.

Our hope is that the current study’s findings can be one brick in the pathway to understanding and reducing revictimization among young people experiencing houselessness. We do not doubt that building a route to reduce the risk to unhoused youth will require significant advocacy, collaboration within communities, and efforts toward larger social change.

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Acknowledgements: The research described here was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number NIH 1 R15 DA039355-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Welcoming a New Team Member

September 23, 2020

With September comes the start of our Fall Quarter at the University of Denver. One of the most exciting parts of kicking off an academic year is when new graduate students join our team.

This year, the TSS Group gets to welcome Becky Suzuki to our team.

A first-year doctoral student in the Department of Psychology’s clinical program, Becky joins returning graduate team members Naomi Wright, Adi Rosenthal, and Maria-Ernestina Christl.

As is our team’s tradition, we invite you to get to know Becky through the following brief Q&A!

Q: Welcome to the TSS Group. Tell us about yourself, please!

Welcome Becky!

Becky: Hello! I am originally from the Denver area and very excited to be coming back to Colorado after a long hiatus. I graduated from Haverford College in 2016, after which I completed a Fulbright fellowship in Germany and served with AmeriCorps in Memphis, TN. For the past two years I lived in Brooklyn with my twin sister and worked at the NYU School of Medicine doing anxiety and trauma research. In my free time I like to do puzzles, ride my bike, read, and look at pictures of dogs on the internet.

Q: As a first year graduate student in the Clinical Psychology Program, what are your current research interests?

Becky: I am interested in how structural inequities in access to services affect the care and recovery of survivors of sexual violence. I am particularly interested in developing interventions that may better serve those who do not regularly interact with the mental health care system. I am committed to practicing community-engaged research that centers the experiences of people from marginalized communities.

Q: What drew you to the TSS Group?

Becky: I worked at the TSS group for one summer as an undergraduate and was impressed by the lab’s commitment to developing relationships with community organizations and service providers. In the years since, I have come to believe that community engagement is essential to conducting research that has real-world applications. I was also very drawn to to the lab’s commitment to an anti-racist and feminist approach to research.

Q: What do you hope to accomplish as a member of the TSS Group?

Becky: I am most excited to learn from my colleagues and conduct work that has a real impact on the Denver community. I hope to develop into a researcher who can contribute to the lessening health disparities for women and children.

***

Need and Barriers Facing Caregivers in Child Abuse Investigations: Preliminary Finding from a New Measurement Tool

September 23, 2020

by Adi Rosenthal, 3rd Year Graduate Student, TSS Group

Each year in the United States, about 3.5 million children are the center of child abuse or neglect investigations. These children are arguably our country’s most vulnerable. Often, the well-being of these children can be supported by providing services to their caregivers based on families’ needs.

Unfortunately, caregivers involved in child welfare say they receive fewer services than they want and need, and they face barriers to accessing those services.

Many researchers have examined the mental health service needs of families involved in child welfare, but caregivers’ needs reach beyond psychological. Families also have physical health needs, such as medical care and access to healthy food; school-based needs such as tutoring, extra-curriculars, and testing for learning disorders; basic needs such as food, clothing, shelter; and needs related to social support from their friends and community.

Caregivers face numerous barriers in getting these needs met, including skepticism about services and fear of judgement as well as external barriers, such as lack of financial resources and services not being available.

Unfortunately, measures that get at families’ diverse needs and barriers haven’t been available, leaving researchers and service providers unable to formally assess the caregivers’ needs, and in turn, address them.

The TSS Group set out to create a measure of service needs and barriers across service areas, which we’re calling the Checklist of Service Needs and Barriers (C-SNAB). We drafted items for this measure based on previous research about families’ needs. The measure included several areas: basic needs (such as clothing, diapers, and other non-food items, paying bills, housing), physical health (such as medical care, access to healthy food, insurance), school-based services (such as tutoring, extra-curriculars, and testing for learning disorders), mental health (such as therapy for child or caregiver, substance use treatment, parenting support), and social support (such as mentorship, support from a religious or cultural community). The measure also includes a checklist of barriers for caregivers to indicate what makes access to services challenging. This checklist includes logistic barriers (such as not having a computer or transportation), structural barriers (such as services not being available or not being affordable), and barriers related to stigma or uncertainty about services.

Next, we asked 32 caregivers of children involved in abuse or neglect investigations to fill out C-SNAB in order to examine how well the measure, designed based on past research, picked up on the day-to-day barriers and needs facing caregivers.

Here’s what we learned.

The C-SNAB seemed to capture the breadth of needs and barriers families faced. Nearly all (94%) of the caregivers interviewed had at least one unmet service need. On average, caregivers reported experiencing 4 unmet service needs.

Caregivers commonly reported needs across more than just one service area. Basic needs showed up most frequently, followed by physical health, school-based needs, mental health needs, and social support.

Caregivers had the greatest unmet needs in the basic needs category, which included things like needing help paying bills or rent, getting diapers or clothing, and fixing things that are broken in their home or neighborhood. In fact, 50% of caregivers reported having unmet basic needs. This fits with past research that has shown families involved in child welfare investigations are disproportionality from low socioeconomic groups. This suggests that when families show up for child abuse investigations, they are likely to have high levels of economic needs.

Needs weren’t the whole story. Families faced many barriers – an average of seven, in fact! Most commonly, caregivers reported not being able to afford services, not being sure how to obtain them, not having enough time, and lack of availability of services in their community. 

Families described facing the greatest barriers in their efforts to get school-based, medical, and mental-health services. Accessing these kinds of services require navigating complex organizations, such as school boards and administrators, insurance companies, and often numerous different healthcare providers. This finding suggests that caregivers may benefit from warm hand-offs between providers and help navigating these complicated systems. Early and hands-on coordination of services could have a meaningful impact on the trajectories and wellbeing of families and children.

Take-Aways

Our work on this new measure indicates that caregivers involved in child abuse and neglect investigations have many unmet needs, which was not surprising given the sheer number of barriers they faced. Preliminary analyses suggest that the C-SNAP was an efficient and useful tool for gathering information about their needs and barriers.

This study has potentially important implications at this moment in time, when communities are grappling in new ways with how systems fail people of color. Families from Black Indigenous People of Color communities have long histories of being treated differently in child welfare and other systems. For example, twice as many black children in the child welfare system are placed in foster care compared to white children, even when the cases are similar. For black and minoritized caregivers, expressing their service needs could mean being blamed for those needs or invoke fear that their needs will be used against them or reinforce “disparaging stereotypes about Black family unfitness and need for white supervision”

We hope that the C-SNAB’s inclusion of service needs AND barriers conveys to families that difficulties aren’t reflective of something about them; rather, barriers to getting their family’s needs met are real and worthy of attention.  Supporting caregivers by reducing barriers and meeting their service needs is a critical path to improving child wellbeing and safety. Accurate assessment of these needs and barriers is a critical step.

***

Acknowledgments: This research was supported by a grant from the Colorado Evaluation and Action Lab to Anne DePrince and Julia Dmitrieva. Thank you to the project’s government partners as well as the Traumatic Stress Studies Group for making this work possible.

Tracking Victim Services in Colorado

August 12, 2020

by Anne P. DePrince & Naomi Wright

Would more money help?

More precisely: Would increases in funding for victim services across Colorado change service provision, improve organizational capacity to service victims, and improve collaboration across service agencies?

That kind of change is a tall order. But that’s what our colleagues at the Office for Victims Programs (OVP) wanted to know years ago as Colorado prepared for an increase in Victims of Crime Act (VOCA) Program funds from the federal government. The increases started in May 2016, when programs across the state received one-time infrastructure awards. In January 2017, overall funding for victim services increased through regular cycle grants.

With the timeline for funding changes in mind, our team looked back to 2015 to get a snapshot of crime victim services before any funding changes. In particular, we drew on grant reports, submitted quarterly by VOCA-funded agencies. Then, we followed the victim service story that unfolded in the quarterly grant reports until the end of 2019.

As great as grant reports may be for counting things, they don’t necessarily tell the story of day-to-day impact. That’s why we also interviewed 30 program or executive directors who were randomly selected from agencies with VOCA funding. Directors spoke with us multiple times between 2018 and 2020 to share their perspectives on the impact of VOCA funding on their agencies and crime victims.

Key Findings

The subtitle for this section should be something like, “Feeling Tired? We Have Some Graphs to Explain Why.”

From 2015 (before funding increases) to 2019, the average number of clients served by VOCA-funded programs significantly increased across the state. The change was what researchers call a large effect size — the kind of effect one dreams of finding in their own research, but rarely sees. Just look at yours, though, Colorado:

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Unpacking the graph above, the blue lines represent the average number of clients served each quarter by agencies who had VOCA funding from 2015 to 2019. The red lines are new clients. We focused on the 88 agencies who had funding across the whole five-year evaluation period in order to include a baseline before funding increased. This was a rigorous, though conservative, test of impact because we set aside data from more than seventy organizations who had VOCA funding for a subset of the evaluation period.

If you’re a long-time Trauma Research Notes reader who has grown fond of thinking skeptically about data, you might find yourself wondering, “Sure, services went up, but maybe that would have happened anyway as Colorado’s population grew or agencies built on their 2015 momentum.” We hear you and applaud your skepticism. We wondered about that too, so we ran some analyses to see if there was evidence that Colorado victims services were simply on an upward service trajectory that would have happened with or without VOCA funding increases. We don’t think that’s the case. Here’s why: Below is a graph that shows the average number of clients served per quarter across years. When we compared the years, there was no significant difference between 2015 and 2016. However, a significant change in services occurred in 2017, after agencies had time to put their one-time grants to use and regular cycle funding increased.

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Significant changes in the average total clients served per quarter are indicated with ** (p<.01) and *** (p<.001).

While those data provide evidence that agencies had improved organizational capacity to serve more clients, other data showed changes in services themselves.  Below is a figure that illustrates the significant increase over time in the average number of clients who 1.) received information and referrals; 2.) criminal/civil justice system assistance, and 3.) personal advocacy or accompaniment. Agencies maintained shelter/housing and emotional support/safety service levels over the five years.

pic3 There was also evidence that agencies expanded services to minoritized and marginalized communities. For example, the number of clients who identified as Black, Hispanic/Latinx, Lesbian/Gay/Bisexual/Transgendered, and Deaf/Hard of Hearing increased over time. This was echoed in interviews with Directors, who described the ways that VOCA funding increased agency capacity to serve diverse crime victims — from freeing up funds that could then be used for interpretation services to hiring bilingual staff.

Directors also offered evidence of improved collaboration. For example, the vast majority of Directors said in 2018 that VOCA funding had increased their capacity to collaborate with other agencies. By Fall 2019, Directors were significantly more likely to describe their agencies as maximizing their overall funding and resources through collaboration with other agencies. Here’s how they described things:

“We wouldn’t have even been there [in a collaborative workgroup] if not for the VOCA funds in most respects.

“We have some long-term very solid collaborative relationships in the community, but I think the, VOCA’s focus on civil legal services in the past couple of years has had enormous significance in the ability to think creatively, to, as a collaborative kind of leadership, to think creatively of how could we serve more people, how could we serve folks better, how do we get at a different type of need that we haven’t been able to do before.”

“We’ve been able to collaborate more with other offices to learn more and to figure out how to do some of the seemingly simple things, like updating our intake form so that it’s the most inclusive intake form possible. We’re able to collaborate with other entities to make sure that we’re representing folks in the correct way or at least providing them with a space to represent themselves in a comfortable way.”

But remember the subheading of this section because the counterweight to the many gains was evidence that agencies are straining under the ever-growing demand for their services as they try to also improve services to meet a broader range of client needs (e.g., mental health). For example, the majority of Directors indicated VOCA funding had improved their agencies’ capacity to serve crime victims initially, but their views changed by Fall 2019. In the Fall, 43% of Directors said their agencies were only able to maintain current capacities with VOCA funding, not further increase, as illustrated in the figure below.

impact

Take-Aways

Since 2015, agencies across Colorado used VOCA funding to expand services to crime victims. This evaluation revealed evidence that increases in VOCA funding for victim services were associated with measurable change in line with many of the priorities identified by OVP back in 2015, such as (but not limited to):

  • increases in number of clients served;
  • increases in specific kinds of services, such as criminal-civil legal system assistance; and
  • improved collaboration;

To sum things up, the last word goes to a Director who spoke with our team —

“VOCA funds are really integral to our ability to operate and function.”

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Acknowledgements: Thank you to members of the Traumatic Stress Studies Group for their contributions to this evaluation. The evaluation was funded by a contract from the Office for Victims Programs, State of Colorado.

Naming Relationship Abuse

June 15, 2020

Psychologists have a role to play in educating the public about relationship abuse. At least, that’s what we believe in the Traumatic Stress Studies Group.

Graduate students Adi Rosenthal and Maria-Ernestina Christl took up that education charge when they penned a commentary for The Denver Post, entitled Tiger King, Abuse, and Coercive Control.

Their opinion piece used the wildly popular Netflix docu-series Tiger King to point out dynamics of abuse in intimate and work relationships. Whether or not you’ve binge-watched the series, their commentary illustrates the applications of research on dependence and betrayal (including findings from our team) to the public’s understanding of abuse.

As Adi and Maria-Ernestina point out, “Long after the hype of Tiger King runs its course, the realities of interpersonal abuse and coercive control remain and require the attention of the public.”

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