guidelines for CRISIS SUPPORT SERVICES FOR SURVIVORS (MAINSTREAM SERVICES)
Specialist sexual assault services providing crisis support have existed in New Zealand since the 1970s when a number of Rape Crisis collectives were established. Groups of women developed collectives to meet the needs of survivors of sexual violence as negative societal attitudes to survivors were not conducive to good treatment by services, communities or often even families. This was of particular concern given the high impacts of sexual violence and resulting vulnerability of many survivors thereafter. While societal attitudes have changed to a degree, a high incidence of sexual violence and high impacts on survivors have not changed. Quality of service responses has improved in line with changes in societal attitudes, but not sufficiently to ensure that survivors are not further harmed by contact with services.
In July 2007, in response to public pressure in the wake of what has come to be known as the Louise Nicholas trial (R v Rickards, Shipton and Schollum ) the New Zealand Government established The Taskforce for Action on Sexual Violence to lead and coordinate efforts to address sexual violence, and advise Government on future actions. This Taskforce was somewhat unique in that it was established as a partnership between Government and a sector body Te Ohaaki a Hine - National Network Ending Sexual Violence Together (TOAH-NNEST), a bi- cultural umbrella group for those working in the sector, particularly the specialist community service providers. This group aims to promote social, political and institutional change so that all people can live free of sexual violence and its effects.
One of the six priority areas for the Taskforce to address was early intervention and crisis response to acute and chronic sexual abuse and assault, looking to an outcome of impact of sexual violence is reduced and survivors are supported. The sector believed that our grass roots practice was effective, but we needed to be able to demonstrate the evidence base for this. Negotiations with the Ministry of Social Development led to funding for a project to develop a framework for best practice by mainstream services in responding to acute needs of survivors of sexual assault, which resulted in the first good practice guidelines - Mainstream Crisis Support Services Responding to Sexual Violence Perpetrated Against Adults. Round 1. (Evidence Section)
We were well placed to undertake this project at the time due a number of factors:
the development of Te Ohaaki a Hine National Network Ending Sexual Violence Together, a national organisation which includes both Nga Whiitiiki Whanau Ahuru Mowai o Aotearoa / The National Collective of Rape Crisis and Related Groups of Aotearoa Incorporated and other groups,
- the development of research and theory from the trauma field which was validating practices which were developed in this grass roots movement, such as, the importance of working at the client's pace,
- the importance of the relationship and the importance of honouring the adaptations a survivor made to living with experience of abuse
- the review Responding to Adult Survivors of Sexual Violence: A Review of Literature on Good Practice commissioned by the Ministry of Women's Affairs, and
- the 2009 stocktake and visioning process by specialist crisis support services which identified shared values in the work across the sector.
This all combined to provide us with a good opportunity to develop shared and multiply informed ideas about what best practice might be in the delivery of crisis support services.
DEVELOPING GUIDELINES FOR GOOD PRACTICE
The project set out to:
- Identify the knowledge that service providers held. Validity of the resulting principles and practices were confirmed by a consultation round with survivors and service providers, asking for their feedback. The context of this service provision is the tri-partite response to sexual violence, so representative police and medical teams practising in this area of work were also consulted.
- Link this knowledge with the research evidence about the effectiveness of various practices. The highest level of scientific validation from a positivist point of view would have required the use of experimentally designed research producing statistically significant results, along with these results being replicated by further research and/or by delivery in different contexts. However, in their comprehensive review, Decker and Naugle (2009) were not able to identify any research relating to immediate intervention following sexual assault which met these parameters. This was not surprising given the multiple difficulties in applying rigorous research design, primarily due to ethical constraints such as the lack of ethics in randomly allocating survivors to a no treatment research control group. Therefore, we needed to look more broadly for research which could provide support for practices consistent with what that research might tell us, for example, survivor feedback, evaluations of service, and research about physiological and psychological impacts of trauma.
While it had been fashionable for some time to seek the supremacy of best practice, a number of limitations were identified with this concept.
- Use of best forecloses room for challenge and improvement.
- Any determination of what best practice is will be temporary, as it will be always changing as knowledge develops, and as survivor need changes along with changes in societal responses to sexual violence.
- What is best for one victim/survivor might not be for another due to differences in need based on variables such as rural/urban, gender, culture, age, sexual orientation, abilities, and resilience.
Therefore, this project sought to promote the multiple possibilities of good practice (Mossman et al, 2009), rather than the supremacy of best practice.
The 2009 Good Practice project
[Project Background] Three stages were used to develop the Guidelines, this included:
- Interviews with specialist sexual assault services and key informants. The material from these interviews was considered alongside a number of other guidelines and practice documents from the field, and some initial guidelines were developed.
- Sector consultation, survivor voices, and the review of literature, including the stocktake of mainstream services. During that project, services were asked what they valued about the services that they provided. When these values were clustered, they came to constitute most of the core principles that are espoused here.
- Consultation with crisis support services and representative police and medical teams.
The resulting Guidelines were then presented in 3 parts:
- Good Practice Part 1 - Principles of Service Delivery (beginning with a 3 page summary of the principles)
- Good Practice Part 2 - Types of Service Delivery
- Good Practice Part 3 - Promising Practices
The Guidelines were intended to be used as a resource for the sector, to promote ongoing development of and reflection on good practice, including increasing access to research and identifying areas where research is needed; to bring to our relationships with others so that we can be accountable as we ask our partners to be; and to increase transparency in our relationships with our communities, at both local and national levels.
The guidelines were developed as a living project, in recognition of the changes which occur in practice and research over time. It had been intended to establish a vehicle for ongoing feedback into the guidelines, as well as regular review and updating of the research. This review and update is round two, in which we also expanded the guidelines to our work with survivors from diverse cultural and ethnic communities.