Author: Anne P. DePrince, PhD

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:

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.

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.

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.

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.”

***

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.

by Anne P. DePrince, PhD and Leslie Hasche, PhD

From the Democratic presidential debate stage to op-ed pages, the affordable housing crisis hitting communities across the country has received much needed attention.

As a trauma psychologist and social worker, we applaud the national spotlight on housing affordability. Yet, that’s only part of the conversation we need to have to develop effective housing solutions. Now we need to talk about the role that abuse and exploitation play in housing instability, from adolescence to adulthood — and as our research team recently discovered, even into older adulthood.

The vast majority of youth experiencing homelessness say they left home to escape child abuse. This is especially true for LGBTQ youth who are more likely to be abused and kicked out of their homes than their peers. Once on the streets, sexual and physical victimization is common. Victimization on the streets then contributes to serious and costly health problems, such as depression, PTSD, and substance abuse.

In adulthood, domestic violence drives housing instability and homelessness among women and their children. Women fleeing their abusers may spend time in shelters or move multiple times. Women may also face tremendous economic instability when leaving abusers, making it difficult to get basic needs met, including finding and keeping housing.

Among older adults, our team’s new research points out risks that a lack of affordable housing is poised to create a perfect storm that leads to the exploitation of older adults. Nationally, concerns for affordability and accessibility of housing for older adults is only increasing. Plus, older adults who experience homelessness also face physical and sexual victimization that could be reduced by reentering housing. Housing insecurity is a pressing issue for older adults, and it becomes more complicated by the potential risk for victimization within one’s own home.

…we have to grapple with the ways that abuse and exploitation create housing instability.

Our team reviewed police reports of abuse and exploitation of more than 500 older adults. Nearly one in ten of the police reports described situations where another person – most often a family member – was exploiting an older adult’s residence in ways that put the older adult’s housing at risk.

What we read in police reports lined up with what practitioners working with older adults to prevent and respond to elder abuse also noticed. To get a sense of these cases, imagine an adult daughter living in her aging mother’s apartment in violation of the terms of the lease, which says only the mother can live there. By violating the lease, the older adult risks eviction. That housing instability can put their psychological and physical wellbeing at risk. Once evicted, the older adult will face housing shortages. She might find herself homeless, living out of a car or moving from shelter to shelter, making it difficult or impossible to access assistive medical devises. Or imagine an adult grandchild who sells drugs out of his grandfather’s living room. The grandchild stops people from coming over to the house, including the person the grandfather called to repair the roof. Unaddressed, that small leak grows into a chronic moisture problem that affects the older adult’s health.

Researchers have long recognized that people providing care for older adults may feel entitled to their resources, which can lead to exploitation. The current shortage of affordable housing in many communities may increase the likelihood that family members and other trusted adults exploit access to older adults’ residences.

From adolescence to the older adult years, abuse and exploitation are tangled up with housing issues. Solutions to the national housing crisis cannot focus on affordability alone. Instead, we have to grapple with the ways that abuse and exploitation create housing instability. Effective housing policies have to also work to decrease child abuse and domestic violence. At the same time, housing conditions can affect risk for victimization, as seen among youth living on the streets. There are hints that older adults maybe the next group to fall victim to exploitation because of the housing crisis. We need policies that address affordability and availability of housing for all Americans across the life span at the same time as abuse and exploitation if we are to end the housing crisis in America.

***

Acknowledgements

Our research on older adults was supported by the National Institute of Justice [Grant #2013-MU-CX-0032]. 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 the Denver Forensic Collaborative for At-Risk Adults for their collaboration to make research with older adults possible, particularly Denver City Attorney’s Office (especially Linda Loflin Pettit), Denver District Attorney’s Office (especially Maro Casparian), Denver Human Services-Adult Protective Services, and Denver Police Department; and the Traumatic Stress Studies Group. 

Even though I had friends, I was still lonely.

My friends didn’t understand my reactions.

There was a huge void inside me.

These are some of the ways that survivors describe feeling alienated after trauma, particularly after intimate violence such as sexual assault or domestic violence.

Several years ago, we developed the Trauma Appraisal Questionnaire (TAQ), which measured alienation and other common posttraumatic appraisals (such as self-blame and shame). The alienation scale included items that reflected survivors’ experiences of being disconnected from themselves and others.

Over the years, we observed that alienation was linked with many different forms of psychological distress; whereas, other reactions, such as shame, are linked with specific kinds of distress. For example, feeling more alienated was associated with worse PTSD, depression, and dissociation symptoms. Yet, shame was linked specifically to PTSD and not to depression or dissociation. The links between alienation and posttraumatic symptoms showed up in adult and adolescent survivors of child abuse as well as domestic violence survivors.

The recurring pattern led us to ask if alienation might play a particularly important role in more severe and complex trauma responses. Thus, we tested whether alienation could distinguish people with similar trauma histories who have had different symptom trajectories as part of a collaboration with Dr. Rafaele Huntjens (University of Groningen, Holland) and Dr. Martin Dorahy (University of Canterbury, New Zealand). In a sample of people diagnosed with either PTSD or Dissociative Identity Disorder (DID), alienation appraisals distinguished the two groups. Specifically, the group diagnosed with DID reported more severe alienation than people diagnosed with PTSD. This work suggested that alienation may play a role in initiating and/or maintaining serious and complex responses to trauma.

Yet, we were left wondering if the TAQ alienation items might just be measuring something about social support, loneliness, or even just a more general difficulty identifying emotions (called alexithymia) – each of which could also be linked with posttraumatic distress. If something like social support could better explain symptoms than alienation, that would change how to make sense of the implications of the findings for coping and healing.

And that’s how we get to this issue’s new research finding!

Rachel McIlveen and Dr. Donncha Hanna brought a team together in Northern Ireland for a study that involved 100 college students as well as 93 adults seeking services who had survived trauma (McIlveen et al., 2019). They asked participants questions about trauma history, alienation, social support, loneliness, and alexithymia while also measuring PTSD and depression symptoms.

They found that alienation was associated with posttraumatic stress in both the student and clinical samples, even when they took into account social support, loneliness, and alexithymia. (You can read  about the study here.) This finding suggests that there is, indeed, something important about the feelings of disconnection that survivors experience for understanding psychological distress that can’t be explained by these other factors, such as loneliness.

These findings make me think about the actions that advocates take every day to communicate – in big and small ways – to survivors that they are not disconnected; that they are not alone; that someone does understand.

And then I think back to the Denver Triage Study, which looked at the impact of community-coordinated responses to domestic violence several years ago. Women who got phone calls from victim advocates after domestic violence had less severe PTSD and depression symptoms than women who did not receive phone calls more than a year after the violence occurred. But, the women who got the phone calls didn’t necessarily talk to the advocates who called or seek out services. So, why did a phone call make a difference?

For some women, the phone call reassured them that they were not alone. I recall a woman describing that she hadn’t answered the call or called the advocate back. Yet, she said that the call meant something to her. Because of the call, she knew people in the community cared about the violence she had survived; people cared what had happened to her; and she had somewhere to turn later as needed.

All these years after the Denver Triage Study, I can’t help but wonder if the simple dignity and humanity of someone reaching out after violence can lessen the alienation that survivors feel. And in turn, help them cope and heal in the aftermath of violence.

Reference

McIlveen, R., Mitchell, R., Curran, D., Kyer, K., Corry, M., DePrince, A.P., Dorahy, M. & Hanna, D. (advance online, November 2019). Exploring the relationship between alienation appraisals, trauma, posttraumatic stress and depression. Psychological Trauma: Theory, Research, Practice, and Policy. http://dx.doi.org/10.1037/tra0000523