Practitioner Perceptions of Evidenced-Based Treatments and Barriers to Implementation in Rape Crisis Centers

Background: Practitioners in Rape Crisis Centers (RCCs) provide crucial services to survivors of sexual violence, often serving as the primary resource for addressing their needs.  While the consequences of sexual violence are well documented, comparatively little is known about the service sector tasked with addressing these consequences. As empirical support growths for the demonstrated effectiveness of trauma treatments for survivors, it would be useful to know 1) how these interventions are perceived by RCC practitioners, 2) how interested they might be in receiving training in these models, and 3) what barriers to implementation might exist.

Methods: The data to be reported is from a sequential mixed methods quantitative-qualitative design with two primary elements: a web-based survey and focus groups. Only the qualitative focus group data will be presented. A semi-structured interview guide for the focus groups was developed after the web-based survey had been analyzed so that the quantitative data informed the qualitative questions, to explore the key topics of interest in more depth. RCC staff members who provide individual or group counseling to survivors from three regions of a southwestern state were invited to participate in one of three focus groups held in three different cities. The focus groups included a total of 24 participants from 15 different RCCs. All focus groups were digitally recorded, transcribed, and coded utilizing NVivo 10.

Results: Most practitioners endorsed using an empowerment model with clients, which was operationalized mainly in terms of providing survivors with choices/options, and being strengths-based. They were familiar with and interested in receiving training in several evidence based treatments, particularly EMDR, CBT, CPT, Prolonged Exposure and Mindfulness. However, several significant barriers were identified that inhibit access to training and subsequent utilization of these evidence based treatments. Most notably was cost. Most of the trainings for these EBTs are seen as prohibitively expensive.

They are however highly motivated to continue to grow professionally and seek out affordable alternatives. Many practitioners described reading books, attending conferences, webinars, local trainings, workshops, supervision, and consultation. University interns were also seen as a useful resource for professional development. Most of these educational endeavors left them wanting, the information provided felt too basic; they want more advanced “higher level” training to better meet the needs of their clients. Several practitioners discussed the need for stronger collaborations with academic partners to provide relevant and accessible trainings at a reasonable cost.

Another important barrier described was the organizational environment. Several reported that training is not seen as a priority. Some colleagues are seen as resistant to adopting new models and being the only person trying something new made it more challenging to initiate or sustain practice changes. There are also philosophical differences between clinicians and administrators and between clinicians with advanced degrees and advocates without degrees.

Implications: RCC practitioners want and need access to affordable evidence based trainings. Partnerships with researchers at universities could support their interest in implementation of EBTs.