Unit 2: Working with Survivors

Learning Objectives

Chapter 1: Asking Questions and Listening

It's important to think about the person's safety (and their children's) before you even begin to engage with them. So...

If the contact is face-to-face:

Make every attempt to interview each and every person alone. Why is this critical?

• • You want the person to feel safe to talk freely. Having a friend or family member in the room might hinder conversation or even put the person at risk.

    • You can say that it is standard procedure, and ask anybody accompanying them to have a seat in the waiting room area for a few minutes. Alternatively, there might be a natural moment during which you are alone with the person. Once you are alone, you can ask about the nature of the relationship more specifically.

    • If the person you're speaking with has young children with them, it might not be possible to interview them alone. If there isn't a safe play space for the children to go during the conversation, be very aware of the questions you ask and the nature of what is shared. In other words, don't assume the children do not understand or are not paying attention to the conversation.

  • You want to reduce the chance that you'll make any false assumptions about the nature of the relationship. For example, you might assume the people are just friends because they are the same sex, when they may be in a relationship. Or, you might assume that you don't need to ask about domestic violence because they seem happy.

  • An exception to interviewing the person alone is when an interpreter is needed. In those cases, it is essential to identify a colleague or professional interpreter to assist with the conversation. Relying on the person's friends or family might not be safe. Relying on the person's children can be even worse, as it is potentially harmful for the children as well as the survivor. When working with an interpreter, it is important to first explain the context of your questions: Some interpreters might be uncomfortable or resistant to talking about domestic violence and, thus, not provide verbatim or even accurate translations.

If the contact is over the phone:

• • Start by asking if the person is safe to talk. If not, stick to questions that only require a yes or no answer, to assess what the survivor wants your next steps to be. For example:

• If it is safe to talk, make a plan for what to do if it becomes unsafe (see questions in the bullet above), including how he or she will convey to you that they are unsafe and what steps to take in the event of an abrupt hang up.

• Please note: Depending on agency protocol, you might be permitted to use texting or email in your work with survivors. If this is the case, be sure to develop a plan for what you can and cannot include in these communications. Remember that neither you nor the survivor may have control over who sees those messages, and electronic surveillance of survivors is a common abusive tactic.

Guidelines for asking questions and listening:

Below are general guidelines for questions that will help you get to know the person you are working with. These guidelines will explore their strengths and most pressing concerns or needs, regardless of whether they approach you with reservations - which they might depending on their situation and experiences with other service providers. These questions are designed to help you begin to build a relationship, not just gather information. And while this training and section are about working with people who have experienced violence, these guidelines reflect ideal practice when interacting with all people.

Please note: if you are a mandated reporter, you'll need to inform the client; however, the timing of that depends on

the situation. Please see Unit 5 for more information on mandated reporting and issues of provider privacy and confidentiality.

Consider what information you already have.

If you already have information from another staff person or the person's file, summarize to the survivor what you already know so that the survivor does not have to repeat it all over again, which may be re-traumatizing, and can correct any misinformation you may have. This also allows you to reflect on and reinforce all the things the survivor has done to get this far, including the difficult tradeoffs they may have had to make. Before asking a question, always ask yourself:

• • • What do I absolutely need to know to complete the next steps?

    • What does my organization require me to collect about this case and how might I get that information in the least intrusive manner?

Use questions that are not directly about domestic violence to surface information about the person's challenges and experiences with violence.

Doing so can surface information about the person's challenges and experiences with violence. Simply asking, "How are you?" can surface a tremendous amount of information. Sometimes approaching domestic violence head-on can result in immediate defenses, especially if your relationship with the person has not been fully developed yet and the person has not disclosed domestic violence. People often are more willing to share difficult information when you focus on their assets and strengths first.

Build rapport through focusing on assets and strengths:

Good rapport is essential to positive and productive interactions with the people you serve. The better the rapport, the more likely people will be to share their needs and concerns and the more likely you can be of help. Thus, establishing good rapport should be the primary purpose of any first encounter. Part of building rapport is demonstrating that you see the person as a whole person, meaning someone with multiple identities and strengths - not only as someone who has experienced trauma.

Use a tone of support and interest:

Questions are only effective when communicated in a way that establishes emotional safety for the survivors. Survivors may be traumatized and feel mistrustful of systems due to previous experiences such as feeling judged. Supportive communication that reflects curiosity - combined with a non-judgmental attitude - might help lower defenses and lead people to be more open to questions and conversation. This also includes paying attention to your body language (e.g., try to avoid crossing your arms in front of your chest) and letting the interaction "breathe" (i.e., giving time for people to feel their emotions, recover composure, take breaks).

Use follow-up questions and a natural conversation pattern:

It can be tempting, when presented with a list of questions (such as on an intake form) to run through them like a checklist. However, doing so can jeopardize the relationship you have with the person you're working with and distract from genuine conversation. Questions are doorways to mini-conversations, so use follow up questions or prompts to gather more information and facilitate dialogue. One strategy is to memorize forms ahead of time or at least keep in mind the questions you are seeking answers to. This way, as the conversation progresses, you know the questions you have covered without having to stick to the form. Similarly, it allows you to look the person in the face when you're speaking with them and pay attention to their body language and important nonverbal cues.

For example, you may ask, "Who would you call if your car breaks down?" and she says her mother. A follow up request might be, "can you tell me about your mom?" to gain insight into her social connections.

"When we were talking about your family earlier, you said you have a difficult relationship with your children's father, can you tell me more about that?"

Listening is just as important, if not more important, than the questions you ask:

Paying attention to all aspects of people's lives can help you gain a fuller picture of the person you're working with, beyond just the violence they've experienced. This means that you will be better able to support them in minimizing the tradeoffs that hinder positive change (e.g., the person you're working with might decline a domestic violence shelter if it means her children will have to move to a new school).

Listen for:

• What the person says is the most important to them and what they are holding onto or unwilling to give up. You may not always agree or understand their motivations, but this information gives you critical clues into the person's priorities and the resources that they won't or can't give up because the tradeoff isn't worth it.

• The sophisticated strategies that survivors have already been using, and recognize the value of these strategies, even if they're not the strategies you would use or encourage. You don't need to agree, but you do need to listen non-judgmentally.

[Back to top]

Chapter 2: Understanding and Assessing Protective and Risk Factors

In this section, we provide an overview of protective factors, risk factors, and guidelines for how to assess for both. Please remember, however, that the extent to which you assess someone's protective factors and risk factors will depend on the person's situation and your role.

What do we mean by "protective factors"?

A protective factor is anything that helps a person manage, minimize, or prevent a stressful, threatening, or dangerous situation. One way to think about protective factors is to think about resiliency, which is the extent to which individuals (and communities) can succeed in the midst of ongoing adversity and "bounce back" from difficult or traumatic events. Having adequate assets in each of the Five Domains of Wellbeing - social connectedness, stability, safety, mastery, and meaningful access to relevant resources - are all key protective factors.

Individual factors may include:

• Survivors' past strategies to protect self and loved ones

• The strength and diversity of their relationships and connections to others

• Employment not only of the survivor, but also of the person using abusive behaviors

• Meaningful access to formal and informal resources (e.g., money, transportation, housing, help with childcare, ability to navigate social service organizations)

Family and community factors may include:

• Familial ties and supports

• Availability and accessibility of services or informal supports

• Connections among community members

• Cultural and community norms

  • For example, a community that has declared "zero tolerance" for domestic violence may rally around and support survivors in positive, protective ways

What do we mean by "risk factors"?

As with protective factors, risk factors can be present at many levels. A useful framework for thinking about risks is to group them as either those generated by the person using abusive behaviors (i.e., "batterer-generated risks") or those generated by other people, situations, and oppressive systems (i.e., "life-generated risks") (Davies & Lyons, 2014). According to Davies and Lyons (2014), life-generated risks are those that can be experienced by anyone, not just survivors of domestic violence, but exacerbate the negative consequences of domestic violence and affect resiliency. These factors can be used to further reinforce power and control in the intimate relationship. Below are examples of risks; however, this list does not include every possible risk nor does it reflect how risks can affect certain survivors disproportionately and cause more severe tradeoffs. For a more extensive list, please see Davies and Lyon's (2014) book, Domestic violence advocacy: Complex lives/difficult choices.

"Batterer-generated risks" may include:

• Threats of physical violence, particularly involving a firearm, directed at the survivor or her loved ones (e.g., children, family, friends, pets, or other animals in his/her care)

• Physical violence directed at the survivor or her loved ones (e.g., children, family, friends, pets, or other animals in his/her care)

• Sexual violence

• Psychological aggression that erodes a survivor's mastery, autonomy, and self-worth

• Controlling and jealous behaviors that limit a survivor's

  • Access to money, medications and medical care, and other relevant resources

  • Social connections and connectedness

• Behaviors that disrupt a survivor's stability, including creating an environment that causes hypervigilance

"Life-generated risks" may include:

• Limited or inadequate access to relevant resources such as money, transportation, and housing

• Family or community culture or norms that minimize the experience of domestic violence or engage in active victim blaming

• Physical or developmental disabilities and other health problems

• Mental health and behavioral health problems (e.g., use of substances to cope)

• Limited or inadequate access to services and supports

• Involvement in gangs or illegal activities (e.g., sex work)

• Identification with groups that experience systematic discrimination, oppression and marginalization; influenced by race, ethnicity, gender, sexual orientation, class, immigration or citizenship status, and more

Assessing protective and risk factors

Now that you have a sense of some common protective and risk factors, let’s move on to ways to ask about these factors. First, listen carefully to the person’s own assessment of their safety. Most survivors are acutely aware of and tuned into the dangers of the person who is abusing them. Remember that everyone’s situation is unique, so what might look very dangerous or unsafe to one person, may not feel or be as much of a threat to another. Conversely, situations that might look less dangerous may hold significant threat. For example, a survivor you are working with may tell you every time he receives flowers from his partner, it signals impending violence. For another survivor, however, flowers may signal remorse.

Assessing a survivor’s protective and risk factors requires a meaningful conversation about all of the people, places and strategies that increase or threaten safety. Based on what you hear about their situation, it’s okay and important to express concern. For example, you could state: "I'm worried about your safety. You told me ____________. This makes me concerned because_________________."

Below is a table with practical information intended to assist you in assessing protective and risk factors. Keeping in mind that every situation is different, we provide examples of questions you might want to ask in the left hand column. In the right hand column, we explain why these questions are important, as well as factors to consider while asking the question.

Prior to asking any of these questions, it’s important to be transparent about why you’re asking them. You might say something along the lines of:

"I have a few questions that I'd like to ask. These questions are intended to better understand the factors in your

life that might pose a threat to your safety, and the factors that are helping you stay safer. Most of these questions come

from what we know about factors that increase risk for future harm and even death. Not all of the questions will be relevant

to you, and you don't have to answer anything that makes you uncomfortable. And I'm not here to judge you; it's just that

the more information I have, the more helpful I can be."

Regardless of how you introduce the questions, the point is to do so in a way that explains that you’re asking these questions to be helpful, not to be intrusive. Finally, when asking questions, please keep in mind guidelines from Chapter 1, “Asking Questions and Listening.” For example, don’t treat the questions like a checklist, but rather as a framework to guide the conversation and inform safety planning.

Formal Danger and Lethality Assessment

Assessing lethality risk is complicated, and in most cases you should consult with someone who has formal training in lethality assessment. One of the most commonly used tools to assess lethality risk for female survivors in heterosexual relationships is the Danger Assessment Scale developed by Dr. Jacqueline Campbell. It is available in four languages. A revised version for women who are in abusive same-sex relationships is also available at that site. Assuming you have not been trained to score it, you and the person you’re working with can still use it to better understand risk-indicators for lethal violence (some of which were mentioned in the table preceding this section).

Final Consideration: What if you suspect domestic violence but the person does not disclose?

It is common – and sometimes necessary – for survivors to avoid talking about their experiences of abuse, or even say that they are not being abused. In those cases, consider the following:

• Be on the lookout for:

  • Unexplainable injuries and accidents, especially during pregnancy

  • Expressed fear of their partner or other significant person in their life. This can range from a general sense of unease or anxiety to terror

  • Difficulty or inability talking to you alone because a partner or other significant person insists on being present

  • Partner-initiated constraints on the person's freedom to act and make choices (e.g., not being allowed to see friends or buy necessities for themselves and their children)

  • Intense anxiety about things that typically do not cause anxiety (e.g., getting a call from a wrong number)

  • An unusually high number of visits to health care providers

  • High number of sexually transmitted infections, vaginal and urinary tract infections, miscarriages, and/or abortions

• Provide a range of referrals to relevant services (e.g., domestic violence counseling) with the explanation that it is standard practice with all clients (see Unit 6 for resources)

[Back to top]

Chapter 3: Safety Planning

Safety planning is an ongoing process that is done with a survivor, and it is based on the person’s individual needs, circumstances, and choices. It is informed by an understanding of the survivor's strengths, including what s/he has done in the past to survive and increase safety, as well as a current assessment of risk and of how protective factors can be supported.

It is essential to remember that relationships and life situations are fluid and evolving. For example, it is rare for someone to be either “in” or “out” of an abusive relationship, and rarely can someone’s situation be labeled as either “staying” or “leaving.” Most people’s reality is much more complex. For example, someone may no longer be living with an abusive partner but is still in frequent contact with that person because they have children in common. Someone else may be going through the motions of being in their relationship but mentally and emotionally disengaged to the point of no longer considering that person a partner.

Because relationships are fluid and it can be difficult to completely separate from an abusive partner, safety planning must be responsive to the ever-changing dynamics of each individual survivor’s situation.

The link below from the Massuchusetts Office for Victim Assistance (MOVA) provides a template for basic things to consider when safety planning. We draw attention to a few key strategies that are particularly important for survivors, especially in the context of lethality risk: knowing the quickest and safest way to get out of the home (including avoiding rooms where there are weapons or sharp surfaces, such as bathrooms), frequently changing the route to work, and being aware of ways in which technology can put the survivor at risk (e.g., computer use, GPS tracking devices put on a car or phone). Other important factors to consider that are not mentioned in this plan: discuss what to do if there is unexpected contact and, for survivors who are in hiding, discuss what to do if the abusive partner discovers his/her location.

http://www.mass.gov/mova/docs/safety-plan/safety-plan-english.pdf

Another helpful resource can be found at the link below. This document provides an in-depth look at safety planning with survivors who are in close or frequent contact with an abusive partner. Of particular importance is the recognition that safety planning is person-specific and must include discussion of safety tradeoffs.

http://www.futureswithoutviolence.org/userfiles/file/Children_and_Families/Advocates%20Guide(1).pdf

[Back to top]

Chapter 4: Using Trauma-Informed Practice and a

Wellbeing-Oriented Approach with Survivors

At the very beginning of this training, you read about the following principles: the Five Domains of Wellbeing, asset-based, intersectionality, and trauma-informed practice (see Introduction Unit). Together these form the framework that guides the entirety of this training. Here, we return to two of those principles, trauma-informed practice and the Five Domains of Wellbeing, to provide a brief overview of how you might apply them in your ongoing work with survivors directly and at your workplace generally.

Regardless of your role, it is important to learn about trauma and being trauma-informed because 1) many DV survivors have experienced multiple kinds of trauma in their lifetime; 2) understanding trauma can help you make sense of survivors’ experiences and responses; and 3) many social services are adopting a trauma-informed approach and trauma-informed practices.

First, what do we mean by trauma?

• • "Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being" (SAMHSA, 2014, pg. 7)

  • Trauma, in addition to other life experiences, affects the way that survivors weigh and prioritize tradeoffs in their lives, and how they experience the Five Domains of Wellbeing

Second, what is a Trauma-Informed Approach?

• "A program, organization, or system that is trauma-informed: realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization" (SAMHSA, 2014, pg. 9). Trauma-informed approach is also known as "trauma-informed care" and "trauma-informed practice/s"

It is also very important to recognize that people are more than the trauma they've experienced. Every person, regardless of trauma history and experience with violence, has a range of assets, strengths, informal resources and challenges that inform what they need and how best to support them through program services. Being trauma-informed and paying attention to supporting survivors' overall wellbeing are both critically important in helping survivors heal and thrive.

Trauma-Informed and Wellbeing Practice in Domestic Violence

Programs and settings that take a trauma-informed approach and pay attention to survivor’s wellbeing appear to share similar practices. Below we highlight two projects – both rooted in real-world practice – that have identified and synthesized some of these practices.

The first is a qualitative analysis of trauma-informed practices (TIP) relevant to domestic violence, from which five broad TIP principles emerged (Wilson, Fauci, & Goodman, 2015). With their permission, we describe these principles in the chart below, along with examples of how they might be used in practice in an organization or program.

The second resource is from the Full Frame Initiative (FFI), which has documented common practices in social service organizations – including domestic violence providers – that support overall wellbeing and help minimize the tradeoffs that create barriers to change. Though designed for philanthropy, FFI’s toolkit “Shift: From Short-Term Change To Lasting Wellbeing Through The Full Frame Approach” provides concrete examples on what a wellbeing orientation looks like in a program: Shift Toolkit.

Programs that support overall wellbeing share common characteristics. For example, they:

• Pay explicit attention to the Five Domains of Wellbeing, the essentials every person needs to thrive, and intentionally help minimize the tradeoffs that come with making change in the Domains

• Focus on people's wellbeing rather than just identifying and addressing their problems and challenges

• Consider the full context of people's lives, including their nuances and complexities of their environment, relationships and social networks

• Recognize that people are fundamentally more alike than different, and that people share common needs and strategies for achieving wellbeing

• Leverage the assets, strengths and informal resources that every person has

In practice, this wellbeing orientation means:

1. Having eligibility criteria designed to screen in, not out. Program eligibility is designed to be welcoming and accepting of people facing complex, multiple challenges, and for people who have found more restrictive programs inaccessible or ineffective.

2. Supporting each person as an individual. The duration and level of support is completely individualized based on each participant's unique needs and wants; this is not a "one-size-fits-all" approach to support or services.

3. Defining advocacy and staff roles broadly. Advocacy and the roles of staff are broadly defined instead of limited to professional titles or credentials or narrowly determined responsibilities. Staff responded to all participants' needs with the mentality "How can we help you be everything you want and are capable of?" instead of "that's not my job" or "that's not what we do here."

4. Leveraging informal supports and resources. Staff work hard to leverage participants' existing social networks and community resources to support overall wellbeing, rather than just providing direct services aimed at responding to crises or addressing problems.

5. Building a program community. The program works intentionally to build an internal community, where everyone including people participating in services has a role and something of value to contribute. This means participants can contribute in ways that are meaningful to them.

6. Defining success based on wellbeing and the Five Domains of Wellbeing. Program outcomes and success are based on participant wellbeing and how well the program supports people making progress in, and minimizing tradeoffs among, the Five Domains of Wellbeing.

Measuring Trauma-Informed Practice

At this point in the training, you might find that you’d like a way to measure whether your workplace and co-workers are trauma-informed. One way to do that is to utilize the Trauma-Informed Practice (TIP) Scales – a set of valid and reliable scales that measure the degree to which DV agencies are using trauma-informed practices from the perspective of survivors (Goodman et al., 2016). In the words of the authors, “We hope that DV programs will use the Scales to ensure that their very good intentions translate into practices that promote health and healing for survivors who deserve our very best” (Goodman et al., 2016). For more about the TIP Scales, please see www.dvevidenceproject.org/evaluation-tools

*Goodman, L., Sullivan, C. M., Serrata, J., Perilla, J., Wilson, J., Fauchi, J., & DiGiovanni, C. (2016). Development and Validation of the Trauma Informed Practice Scales. Journal of Community Practice.

[Back to top]

[Back to top]