In this CVR podcast series, we talk with those doing research and serving victims and learn about the work they've done together.

Tell Us About It, Episode 33, Measuring the Impact of a Survivor-Centered Approach

A convo with Dr. Lauren Cattaneo and Dr. Amanda StylianouDec 01Time: 28:40

Dr. Lauren Cattaneo and Dr. Amanda Stylianou discuss their work to measure the impact of a survivor-centered approach to victim services at Safe Horizon in New York City.  Drs. Cattaneo and Stylianou discuss the nature of survivor-centered practice with victims of intimate partner violence, the measures used to determine the effect of that approach, and how data was gathered in the course of victim services. This project revealed that using a survivor-centered approach had a measurable impact on victims’ sense of safety-related empowerment—even after a single session.

For more see Cattaneo LB, Stylianou AM, Hargrove S, Goodman LA, Gebhard KT, Curby TW. Survivor-Centered Practice and Survivor Empowerment: Evidence From A Research–Practitioner Partnership. Violence Against Women. July 2020. doi:10.1177/1077801220935196

Transcript:

Susan [00:00:00] Welcome to “Tell Us About It: Victim Research Convos,” a podcast from the Center for Victim Research with support from the Office for Victims of Crime. On each episode of “Tell Us About It,” we talked to researchers and practitioners about their work, the tools being built for use in the field, and how we can work together to build an evidence base for victim services.

Susan [00:00:20] Today, we’re talking with two authors of a research report that looked at survivor-centric practice and survivor empowerment, Lauren Cattaneo and Amanda Stylianou. Welcome to you both, and can you please tell us a little bit about yourselves? Lauren, let’s start with you.

Lauren [00:00:37] Hi, good afternoon. This is Lauren Cattaneo and I am an associate professor of psychology at George Mason University.

Susan [00:00:45] Amanda?

Amanda [00:00:47] Hello, I’m Dr. Amanda Stylianou, and I am the director of quality improvement at Rutgers University Behavioral Health Care.

Susan [00:00:55] Lauren, can you tell us a bit about your project?

Lauren [00:00:59] Sure. So the domestic violence field has for a long time advocated what folks refer to as a survivor-centered approach. But we didn’t have a lot of empirical evidence behind the impact of such an approach. And so this project aimed to look at the effect of a survivor-centered approach on victim-reported outcomes. So, what kind of impact does survivor-centered work actually have?

Susan [00:01:31] So in recent years, there has been a lot of talk about survivor-centered victim services. How did you all define that, for purposes of this exploration? Amanda?

Amanda [00:01:42] Yes, multiple scholars have written extensively about a survivor-defined approach in this field, and our work was heavily influenced by many of these scholars. So, Dr. Cattaneo, Dr. Goodman, who’s also a coauthor on this research, Dr. Davies, Dr. Lyon, Dr. Thomas,  Dr. Kulkarni, just to name a few. Additionally, this research was conducted in partnership with Safe Horizon in New York City, the nation’s largest victim assistance program. And the Safe Horizon team has done considerable work in identifying key components of survivors-centered practice and then providing their staff with comprehensive training, ongoing supervision, and advocate-survivor observations focused on that approach. So for this study, we utilize the survivor-defined practice scale. This is a scale developed by Dr. Goodman, Dr. Thomas, Dr. Cattaneo and other colleagues. The SDPS assesses respondents’ perception of the degree to which their advocates help them achieve the goals they’ve set for themselves, how they have facilitated a spirit of partnership, and show sensitivity to their individual needs and styles. If researchers or practitioners are interested in utilizing the tool, it is available for free on the Center for Victim Research website. It’s also important to note that for this study, we measured survivor-defined practice as an approach, not a specified model. And that was really a purposeful decision. Survivors require individually tailored responses that are based on their own individual goals, needs, and circumstances, so an intervention can’t be standardized. Nevertheless, scholars and practitioners have strongly urged uniform approaches to the work, irrespective of the particular context setting or survivor presentation. And the survivor-defined approach is recognized by practitioners in the field as the gold standard. Therefore, we wanted to understand whether survivors’ perspectives of the adherence to a survivor-defined approach resulted in changes in safety-related empowerment across a diverse sample of survivors.

Susan [00:03:54] Lauren, can you tell us a bit about what you learned during this during this research project?

Lauren [00:04:00] Sure. So what we found was that even after one session from a community-based program, there was evidence that survivor-defined practice, increased victims’ sense of safety-related empowerment, and specifically what we found varied in terms of the subscale of the scale, measuring safety related empowerment. So there are three aspects of safety-related empowerment as measured by this subscale I’m sorry, by this scale. One is internal tools, and that is the kind of psychological sense that I know what my next steps are on the path to keeping safe, so feeling that sense of agency and confidence about being able to move toward safety. A second is expectations of support, so to what extent does the survivor feel that community programs and the support that she needs will be there in order to help her keep safe? And then there’s a third subscale, which is called tradeoffs, and that has to do with how much do I have to give up to keep safe? And so there are lots of kind of impossible double binds that survivors find themselves in where in order to make a move toward becoming safer, they have to give up something else. And so those are the three aspects of empowerment that we measured, and what we found was that in the aggregate, safety-related empowerment increased after one session and that that increase was driven by two of the three subscales. So people tended to increase their sense of internal tools that they know what to do to keep safe and expectations of support that they’ll have the support they need to move toward those goals. Their sense of tradeoffs did not change after a single session. And importantly, over and above that, that general increase after one session, the more the survivor felt that the session was survivor-defined as measured by that SDP measure that Amanda talked about, the greater the increase in safety-related empowerment on those two subscales.

Susan [00:06:17] Great!

Lauren [00:06:17] I should actually also mention let me add one thing there, that we also measured lots of other aspects of the situation that the survivor was bringing was coming for help with. And the changes in empowerment were over and above that impact. So over and above the severity of the violence that the survivor was dealing with, over and above the symptoms of post-traumatic stress disorder they were dealing with, over and above those things survivor-defined practice really mattered.

Susan [00:06:49] Wow, really exciting results. What interested each of you in this project from the get go? And how did you come to work together on it? Amanda?

Amanda [00:07:01] Absolutely. You know, for me, as a social worker who has, you know, professionally grown up in the feminist domestic violence movement, the the commitment to a survivor-centered approach has always been important to me. And yet, as Dr. Cattaneo has mentioned, there are really few studies that have explored to what extent the survivor-centered approach contributes to survivors’ well-being. And so this is really important work for our field. First and foremost, because we want to test our theories to ensure that our practices are, in fact, creating outcomes that are important to survivors. And also because the field is experiencing increased pressure from funders, from politicians, from donors to provide evidence of the impact of services on survivor well-being. So this particular research project started at Safe Horizon. It was Safe Horizon’s idea to conduct this study to ensure their community-based programs, survivor-defined work, was leading to increases in safety-related empowerment for survivors. And Dr. Cattaneo has a history of working with the organization as a partner in research. And so the organization reached out to ask Dr. Cattaneo if she would partner on this particular project. And that’s really kind of the starting point for the community research or partnership for the project. And Dr. Cattaneo, maybe you you can share a little bit about why you agreed to partner on it.

Lauren [00:08:29] Sure. So my my background is in community psychology, so I’m really interested in — my interest in psychology has really always been about approaches to addressing social problems and how psychology can contribute to fueling, supporting, facilitating efforts to address social problems. And so what that often involves is partnership with either community organizations — well, community organizations who are on the front lines of dealing with social issues and the clients that they serve. And so my connection with Safe Horizon started years ago, maybe I would say 10, 11 years ago at this point when they approached me, when they were developing and kind of fleshing out their sense of what they wanted to do around survivor-centered practice. They were a key moment in articulating their approach. And they reached out to me based on something that I wrote, which, if you were a researcher, you know, is a jaw dropping experience. No one ever reaches out to you because they happen to read something you wrote. So from the very beginning, I have experienced that partnership as really rich and as a community psychologist, it’s exactly the kind of work I want to be involved in. So Safe Horizon is endlessly thoughtful about what they do, really interested in exploring the impact of what they do, and using research as a tool both to refine what they do, think further about what they do, and then gather evidence in order to gain resources to do what they do. And all of those things are goals that are really consistent with why I like research at all. So I also want to say that Lisa Goodman, who is an author on this project, too, that she worked very much in partnership with community organizations in Boston in our project that predated this one, developing those measures. So the measure of survivor-defined practice and the measure of safety-related empowerment also came out of community researcher partnership and involve the voices of survivors. And so we really felt solid in thinking about those ways of defining these important concepts. And so when Safe Horizon offered me the opportunity to take these measures and see if we actually found the impact that we hoped among their clientle, I was excited to be part of that.

Susan [00:11:07] Well, you two really described a long term, deep relationship that can lead to this kind of beneficial collaboration that just keeps growing the field. Really exciting. Now, how did you structure the process to see whether these survivor centered practices made a difference to the people served? I know you mentioned a little bit about that before, but Lauren, can you go into that a little further?

Lauren [00:11:35] Sure. So we had two hypotheses based on our understanding of both Safe Horizons’ understanding of what they do and why, and also the previous research we had done with these measures, which was not a lot and all cross-sectional, but gave us some ideas about how it should look. So the two hypotheses were, first, whether survivor-defined practice was related to greater survivor satisfaction. And then second, whether survivor-defined practice was related to improvement in survivor safety-related empowerment over the course of that single session, controlling for all of those other things that might play a role: demographic, severity of violence, and PTSD symptoms. And so we worked with Safe Horizon to identify the best setting. They provide services in lots of different ways at Safe Horizon, and we identified their community-based programs as the best place to start to look at this. And so we were able to survey survivors at two time points in those community-based programs. One was before their very first session, and that was one reason why that was a good place to use for this study, was that people were really doing their very first session, intake with Safe Horizon there, and then after that very first session. And so the outcome of interest — safety-related empowerment was measured using this tool that was developed in collaboration with Dr. Lisa Goodman, Dr. Thomas, and colleagues in Boston. It’s called the MOVERS, and that was measured before and after that first session. And then survivor, other survivor variables were primarily measured after the session. There were a couple measured before, but for the most part afterward.

Susan [00:13:29] Amanda, how did you work with the staff at Safe Horizon to gather the data? It’s not something I think that most frontline victim service providers are used to.

Amanda [00:13:40] Absolutely. As you mentioned, Safe Horizon led the data collection process for this research project. So any domestic violence survivor that was seeking services from the organization’s community-based programs were the recruitment pool for the study. And Safe Horizon has a research and evaluation team, so they played the role of the evaluator. And on the days when the organization’s evaluation staff were available, the evaluators reviewed the community program intake calendar to see who the new, who the new survivors would be for that day. The intake appointments were screened by the Safe Horizon evaluation team to see based on that initial intake paperwork if the survivor met the criteria for the study, and if the survivor met the requirements for the study, then the Safe Horizon evaluator would alert the community program advocate. When the advocate called the survivor to confirm that day’s appointment, they would inform the survivor about the evaluation project and assess the survivor’s interest in participating in the study. If the advocate was not available to reach the survivor via phone, then the evaluator would travel to the site prior to the appointment, approach the survivor in the waiting room, explain the project, and ask whether or not the survivor wanted to participate. In addition, survivors were provided a $20 gift card for the baseline data collection survey and then an additional $20 gift card for the survey completed immediately following the session with the DV advocate. There was a total of 261 survivors that were asked to participate in the study, and the Safe Horizon evaluation team was able to get 73 percent of those survivors to agree to participate. I think this is a great example of doing community partnership research, because when you’re working with the community and the community is there and invested in the work, it inspires survivors to want to be a part of that process. And I think this is a great example of how effective that can be in research.

Susan [00:15:51] That’s a great lesson because that was a great rate of return, or rate of participation. What challenges did you face in carrying out this work? Amanda, since you were more on the ground, I’ll start with you there.

Amanda [00:16:07] Yeah. The largest challenge of the project was completing the data collection, right? I think that’s true of many research studies. And the project was funded by Safe Horizon, right, and their team conducted the data collection and having the Safe Horizon team conduct the data collection had numerous benefits to the project, right? And to me, really, the biggest benefit was that the team already had that relationship with the domestic violence advocates. And so it really minimized the need for the researchers to have to get buy-in from the team. However, it meant that there was limited availability for the evaluation team to conduct the data collection, that they were doing this on top of their already full-time job. And we addressed this challenge by utilizing a detailed tracking sheet of recruitment attempts and then engaging in ongoing calls between Safe Horizon and the research team so that we could really together problem-solve data collection barriers as they rose. And as we mentioned, by the end of the project, they successfully recruited over 170 survivors to complete the study.

Susan [00:17:15] Lauren, were there any other challenges that you observed?

Lauren [00:17:20] Yeah. So I would just say for people who are interested in academic partnerships with community-based organizations, there is, uh, some significant challenge on the academic side in terms of how the rate at which these kinds of projects go. So they tend to be slow because they are so rich and evolve so much and so many of the challenges that Amanda mentioned. And so for me, one of the tensions I’m always kind of carrying is what are the things that I’m expected to do in the academic context? And then what community-based work is like. And in particular, I always need to be involving my graduate students and whatever I’m doing and they need to be learning from it, but it often doesn’t kind of fit within their time schedule of whatever they’re doing. And so I was able to have my grad students work on pieces of this and help them see what community-based research is like through that, but they didn’t get kind of the output that they might if they were involved in another kind of project like publications and stuff like that at the same speed. So that’s a challenge on the academic side.

Susan [00:18:29] Huh? You know, that’s something I had — I wouldn’t have thought of, and yet a lot of us think, oh, you could always use graduate students without realizing that, no, that’s actually a very thoughtful process, too.

Lauren [00:18:42] Yeah, they have their — graduate students have a really pretty rigid timetable and they have things that they need in order to successfully get through the program, and you can’t always get those things on the timetable. They need it from community-based work.

Susan [00:19:00] Lauren, did anything surprise you about the results of this work, given your long term involvement in looking at survivor-centered practices? Anything surprise you?

Lauren [00:19:12] I was hopeful, but I guess in the end surprised that we found a — that we found a significant change in the aggregate after just one session. That was one thing that we really struggled with in designing the project, because we know that a lot of the really meaningful work with survivors happens through building relationships over time, painstakingly. And in one session, while advocates can do amazing work in one session and there can be a connection and there can be so much warmth expressed, etc., it’s one session in a very long story that this survivor is grappling with. And so I was pleased and surprised that we found such clear results after just that single session.

Susan [00:20:02] Amanda, anything surprise you?

Amanda [00:20:05] You know, as Dr. Cattaneo was mentioning, doing researcher community work is long and it’s hard work, right? In the ideal world, we would have had a million dollar grant that would have paid for this with an entire full-time research team, and it would have been much quicker to accomplish. And yet, I think there was a lot that we were able to accomplish because of the community partnership and because everyone on that team knew how to work with survivors, knew how to talk to survivors, and were very personally committed to this research. You know, as Dr. Cattaneo mentioned, it was thrilling to be able to go to the team and say, you know, you know, day in and day out the impact that you’re having on these survivors and here the numbers to support it. Yes. Right. Your work is impactful even after one session. You are significantly increasing safety-related empowerment for survivors. And the way we design the research was to really do this from a survivor perspective. So, right, it was self-reported from the survivors: their level of safety-related empowerment, their perception of how survivors entered that interaction was between the survivor and the advocate. So to really be able to say right from the perspective of the survivor, when you are survivor-centered, it impacts their safety-related empowerment. And that’s really important research, but it’s deeply important to the field and really supports the work that they’re doing day in and day out. And so it was really an exciting process to be a part of from start to finish.

Susan [00:21:50] I think this was just a thrilling project. But now I’m wondering what should happen next? What do you all think would be the next steps for you or other researchers or other practitioners to build on the great results here? And I don’t know who wants that one first. Lauren, I’ll start with you.

Lauren [00:22:14] Okay, let’s see. I think one really important research direction stems from one of the things I talked about a moment ago, which is what we know about the importance of building relationships. So this was a study about a single session. It makes it a lot cleaner to study, but it does not capture the richness of what we know advocates actually do over time. And what we know from survivors matters so much. So we need to build on both — build on these results by looking at a larger dosage, if you think of it as a kind of an intervention dosage response, right? So looking at a larger dosage of survivor-centered practice and then also looking at outcomes that go beyond just right after the session, because obviously, you know, people process what they’ve heard. They go home or they they go on about their lives the next couple of weeks and they may feel differently about the impact that interaction had on them a week later than they did right at the end of the appointment. And so we need to both kind of — I would say it’s kind of a zooming out we need to do both in terms of that survivor-centered relationship and in terms of the impact that it has on survivors.

Susan [00:23:30] Amanda, how about you?

Amanda [00:23:33] I think in terms of what the practice fields could think about is are there ways that they can utilize these tools, right? Again, remembering that there are free tools to look at survivor-defined practice in their organization and to see how it leads to increases in safety-related empowerment for survivors. For so long, the field has been concerned with very valid concerns about what it would mean to measure our impact. You know, concerns about what should outcomes look like? Who defines those outcomes? And, you know, part of that is really wanting to stay rooted to a survivor-centredness, that an outcome is going to look different for every survivor and that every survivor can’t completely control the entire outcome. And yet what I think from the practice perspective I really appreciated about this project is that both of these tools were developed in partnership with survivors and were tools that really allowed us to remain survivor-centered, right? Looking at a sense of safety-related empowerment can look different to every survivor, but it allowed them the opportunity to provide that information based on their own perception, rather than saying rearrest or calls to 911 that really don’t represent well the survivors’ experience. And so I think these are really helpful tools that organizations can start to use in their own work to demonstrate the impact that they’re having and support the field in collecting that information at a much larger scale.

Susan [00:25:17] Thank you. Are there any other thoughts that you’d like to leave with our listeners? Lauren?

Lauren [00:25:28] I guess what I’d like to say is, is that we are well aware that a research project like this where you’re honing in on specific ingredients and specific outcomes does not capture the richness of what actually happens between survivors and advocates. And that I am I am constantly in awe of what advocates manage to do with few resources and lots of other pressures around them, and that it’s been thrilling to be able to provide some documentation and kind of evidence that even though that the essential agree ingredients of that larger picture really do have a significant impact. And so there’s something to say to back up what many people I would say already would have said was true.

Susan [00:26:21] Amanda?

Amanda [00:26:22] I was going to say, Dr. Cattaneo, since you spoke to practitioners, maybe I’ll speak to researchers. You know what, I think of many conversations I’ve had with researchers or doctorate students over time that really are committed to this work and aren’t kind of sure, like, how do you make this happen and where do you start? And so to continue to encourage those researchers to remain committed to that work, reach out to community partners, know that it takes time, right? This is not like you’re going to call a community organization and by week two you’re going to have this research project fleshed out. But identify who are the organizations in your area that are doing work that’s important to you and begin to develop those relationships, go to some of their events that they host, right? Make some phone calls, go out for coffee chats. Lauren and I, as an example, talk and work on projects and a variety of basis and it’s those types of relationships that can lead to these projects and their work, but the payoff is very important in the end to the field. So encouraging researchers who are driven by this work to continue it.

Susan [00:27:36] Well, this has been such a fascinating look at how research can be engaged as the field of victim and survivor support continues to evolve. Thank you both for your time today.

Susan [00:27:51] We hope you enjoyed this episode of “Tell Us About It.” If there are research or practice experts you’d like us to interview or research tools you’d like us to feature on this podcast, email us at podcasts@victimresearch.org.

Closing [00:28:06] “Tell Us About It” is a production of the Center for Victim Research funded by the Office for Victims of Crime’s Vision 21 Initiative through Cooperative Agreement Number 2016-XVGX-K006. The Office for Victims of Crime is part of the U.S. Department of Justice’s Office of Justice Programs. However, the points of view and opinions discussed on this podcast are those of the host and expert contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.