Assessing Receptivity to Evidence-Based Treatments in Rape Crisis Centers

Background: Rape crisis centers (RCCs) are primary service providers to survivors of sexual violence who present with significant mental health consequences, which frequently include PTSD. Untreated PTSD increases risks of revictimization. There is strong evidence of the effectiveness of interventions for treating PTSD in rape/sexual assault survivors.  Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and EMDR have the strongest evidence of effectiveness. Meta-analyses comparing these treatments have found all to be effective with none demonstrating superiority. Despite the availability of evidence based treatments (EBT) there is low utilization of them in RCCs. This project sought to answer the following questions: (1) What are RCC counselors’ attitudes toward evidence based practice (EBP)?  (2) What are their perceptions of three specific EBTs: PE, CPT and EMDR? (3) Are there differences in EBP attitudes and perceptions based on agency setting (urban/rural) or counselor education?

Methods: The Consolidated Framework for Advancing Implementation Science (CFIR) was used in the construction of a web-based survey sent to all RCCs in Texas (N=83). The agency response rate was 72% (n=60), which included questionnaires for directors and counselors. For this presentation, only data from the counselors (n=76) is used. Sample: 95% female; 40 years old; predominately white (66%), 22% Latino, 5% African American; 54% have master’s/PhD degrees, 22% bachelor’s and 24% < bachelor’s. Setting: urban (59%), rural (40%). Measures: Subscales from the Evidence Based Practice Attitude Scale (Aarons, 2012) were used to compare RCC responses with those normed through a larger sample of practitioners. Perceptions of each EBT was assessed from a 10 item scale developed by the presenters using the CFIR intervention characteristics domain, which includes constructs shown to impact implementation of EBTs. The reliability for each scale is high: CPT= .91; PE = .87; & EMDR = .87. Data Analysis: Descriptive statistics, t-tests, and ANOVAs.

Results: There were significant differences between RCC counselors and practitioners reported by Aarons (2012) on the total EBPAS (2.57 vs 2.73; p=.01), and five subscales: requirements (2.78 vs 2.41; p=.004); divergence (.99 vs 1.25; p=.005); organizational support (2.54 vs 3.07; p=.001); fit (2.46 vs 2.9; p=.0001) and limitations (.65 vs 1.28; p=.0001). There were significant differences by educational level with counselors with advanced degrees being more likely to adopt an appealing EBP (p=.042); view EBPs as fitting their values (p=.000); and as having fewer limitations (p=.047). There were no significant differences in attitudes toward EBP by agency setting. CPT was most highly endorsed among the EBTs, viewed as having stronger evidence base, greater advantages, being most adaptable, acceptable, appropriate and feasible. There were no significant differences in these perceptions by education level or agency setting.

Implications: RCC counselors have predominately positive attitudes about EBPs in general and about CPT in particular. Those with advanced degrees are more likely to adopt an EBP and to see them as having fewer limitations. No differences were found between urban and rural settings. These findings suggest that implementation efforts should be made with this service sector to advance the uptake of CPT.