Intimate Partner Violence Service Delivery and Trauma-Informed Care Strategy for Support

by Dr. Anchal Goyal Edited by Tabitha M. Chapman, AMFT


Law enforcement and service providers serve an important role in the management of domestic violence victims. Law enforcement primarily focuses on maintaining the role of objective factfinders while conducting bias free investigations of reported criminal activity. Conversely, victim services personnel primarily focus on advocating for the rights and needs of victims regardless of the outcome of investigative processes. Often, the measure of success for law enforcement is the arrest of an offender for the highest level of crime followed by a conviction with the maximum allowable sentence (U.S. Department of Justice, 2019). However, studies indicate that many victims do not experience resolution of reported crimes by these standards. Thus, it is important to ensure meaningful access to advocacy and intimate partner violence services for victims at every stage of the criminal justice process (U.S. Department of Justice, 2019). Research shows that access to comprehensive victim services at the time of reporting to law enforcement may enhance victims’ safety, the healing process, and their ability to participate in the criminal justice process (Goodson, Garza, Franklin, Updegrove, & Bouffard, 2020; The International Association of Chiefs of Police, 2019).


Importance of Trauma-informed care


Domestic violence (DV) is a potentially traumatizing experience that has devastating psychological and physical consequences (Sullivan, 2018). Typically, DV services, such as emergency shelter and court advocacy, focus on survivor concerns in the immediate aftermath of DV incidents as well as offer longer term support through hotlines, advocacy/case management, counseling, and other supportive services (Kulkarni, 2019). In addition, the public institutions and service systems that are intended to provide services and supports to domestic violence victims are often themselves trauma-inducing (Substance Abuse and Mental Health Services Administration, 2014). For instance, compassionate inquiry into a victim’s history can seem similar to the interest shown by a perpetrator many years before. Also, direct confrontation by counselors about behaviors related to abuse can be seen as provocation building up to assault (Kolis & Houston-Kolnik, 2018; Substance Abuse and Mental Health Services Administration, 2014). Thus, it is crucial that service providers and law enforcement officers incorporate trauma-informed care (TIC) into their practice to prevent re-traumatization of victims seeking services (Han H-R et al., 2021).


SAMHSA’s Concept of Trauma-Informed Care


Trauma-informed care creates a safe environment where individuals do not experience further trauma or harm in the process of receiving services and support (Purkey, Patel, & Phillips, 2018). In addition, TIC aims to decrease the impact of emotional and psychological trauma on all participants within a system of care (Weiss et al., 2017). Likewise, the U.S. Department of Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma-informed care as a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and victims, and that creates opportunities for victims to rebuild a sense of control and empowerment (Kolis & Houston-Kolnik, 2018). SAMHSA’s model of TIC incorporates four key elements: realizing the significant impact of trauma and understands potential paths for recovery; recognizing how trauma may affect children, families, staff, and others involved with the system; respond by applying TIC knowledge into practice; and resist re-traumatization (Hornor, Davis, Sherfield, & Wilkinson, 2019; Substance Abuse and Mental Health Services Administration, 2014).


SAMHSA’s model of TIC involves the incorporation of six broad principles: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice, and choice, and cultural, historical, and gender issues (Substance Abuse and Mental Health Services Administration, 2014).


Safety is paramount. Victims and their families who have experienced trauma may have feelings of danger and insecurity. They may be in a constant state of hyperarousal, feeling insecure or unsafe. A conscious effort must be made to ensure that all victims, their families, and staff are physically and emotionally safe (Hornor et al., 2019). The second principle of TIC is that of trustworthiness and transparency, both of which are fundamentally embedded in professional practice. Organizations and individual practitioners must approach decisions with transparency, which engages the trust of victims and their families. DV service providers should be honest with victims and their families throughout every service encounter. This is essential because many trauma survivors have experienced secrecy, betrayal and/or power-over relationships (Sweeney, Filson, Kennedy, Collinson, & Gillard, 2018). Peer support is important for victims and their families who have encountered traumatic events. It is vital that they understand they are not alone in experiencing trauma and that there are others with similar lived experiences. Additionally, maintaining adequate social support within an organization will help prevent isolation and depression in clients and staff (Kolis & Houston-Kolnik, 2018).


The fourth fundamental concept involves collaboration and mutuality. Collaboration and mutuality involve partnering and the leveling of power differences between staff and clients. The organization recognizes that everyone has an important role to play in the recovery process (Sweeney et al., 2018). Empowerment, voice, and choice, the fifth principle of TIC, must be incorporated into every trauma-informed practices. Developing plans of care for victims of trauma require patient-centered approaches that empower children and families (Oral et al., 2016). Finally, TIC embraces cultural, historical, and gender issues.

Trauma-informed practices incorporate processes that are sensitive to a patient’s culture, ethnicity, and personal and social identity. The organization demonstrates cultural competency. By doing this, the organization actively resists biases and cultural stereotypes. The organization understands the healing value of traditional cultural connections, offers gender-responsive services, and recognizes and addresses the existence of historical trauma in both children and adults (Kolis & Houston-Kolnik, 2018; Purkey et al., 2018).


Incorporating these elements and principles to trauma-informed practices, SAMHSA’s model of trauma-informed care seek to help acknowledge individuals’ histories of trauma, understand their responses to trauma, and recognize the pathways victims take in navigating safety and recovery (Kolis & Houston-Kolnik, 2018).


Concluding thoughts


Traumatic experiences and exposure to violence can leave a lifelong impact on an individual, especially when left untreated. To reduce harm and better serve victims, service organizations can implement a trauma-informed approach that is beneficial to the clients, staff members, and to the success of an entire organization.

By adopting a trauma-informed care approach across various levels, organizations can foster a safe environment that empowers both clients and staff (Kolis & Houston-Kolnik, 2018). Continuous research is needed to understand the traumatic effects of violence on survivors and service providers and the importance of trauma informed care.


References


Goodson, A., Garza, A. D., Franklin, C. A., Updegrove, A. H., & Bouffard, L. A. (2020). Perceptions of Victim Advocates and Predictors of Service Referral Among Law Enforcement Personnel. Feminist Criminology, 15(5), 611–633. https://doi.org/10.1177/1557085120939658
Han H-R, Miller HN, Nkimbeng M, Budhathoki C, Mikhael T, Rivers E, et al. (2021) Trauma informed interventions: A systematic review. PLoS ONE, 16(6): e0252747. https://doi.org/10.1371/journal.pone.0252747
Hornor, G., Davis, C., Sherfield, J., & Wilkinson, K. (2019). Trauma-Informed Care: Essential Elements for Pediatric Health Care. Journal of pediatric health care, 33(2), 214–221. https://doi.org/10.1016/j.pedhc.2018.09.009
Kolis, K., & Houston-Kolnik, J.D. (2018, April 10). Trauma Types and Promising Approaches to Assist Survivors. U.S. Department of Justice. https://icjia.illinois.gov/researchhub/articles/trauma-types-and-promising-approaches-to-assist-survivors
Kulkarni, S. (2019). Intersectional Trauma-Informed Intimate Partner Violence (IPV) Services: Narrowing the Gap between IPV Service Delivery and Survivor Needs. J Fam Viol, 34, 55–64. https://doi.org/10.1007/s10896-018-0001-5
Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric research, 79(1-2), 227–233. https://doi.org/10.1038/pr.2015.197
Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed care: Better care for everyone. Canadian family physician, 64(3), 170–172.
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4816.pdf
Sullivan, C.M. (2018). Understanding How Domestic Violence Support Services Promote Survivor Well-being: A Conceptual Model. J Fam Viol, 33, 123–131. https://doi.org/10.1007/s10896-017-9931-6
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych advances, 24(5), 319–333. https://doi.org/10.1192/bja.2018.29
The International Association of Chiefs of Police. (2019, November 1). The Importance of Law Enforcement-Based Victim Services in the United States. https://www.theiacp.org/resources/resolution/the-importance-of-law-enforcement-based-victim-services-in-the-united-states
U.S. Department of Justice. (2019, June). Establishing or Enhancing Law Enforcement-Based Victim Services – What are the key considerations? https://ovc.ojp.gov/library/publications/establishing-or-enhancing-law-enforcement-based-victim-services-what-are-key
Weiss, D., Kassam-Adams, N., Murray, C., Kohser, K. L., Fein, J. A., Winston, F. K., & Marsac, M. L. (2017). Application of a Framework to Implement Trauma-Informed Care Throughout a Pediatric Health Care Network. The Journal of continuing education in the health professions, 37(1), 55–60. https://doi.org/10.1097/CEH.0000000000000140

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