A Comprehensive Model for Underserved Victims of Violent Crime: Trauma Recovery Centers

Introduction

Violent crime victimization can result in a variety of psychological symptoms and related mental health needs.^[1] Individuals often experience anxiety, depression, and post-traumatic stress disorder after a violent victimization. While some victims are able to process and cope without formal support services, others experience severe trauma symptoms that greatly impact their lives and are in need of support services.

For some victims, debilitating symptoms emerge and persist for years, impacting their overall functioning and quality of life.^[2] Trauma symptoms, such as a fear of leaving one’s home, may cause financial burden or emotional distress that impacts long-term safety and stability.^[3] Furthermore, support systems may respond insensitively or stigmatize the victim, particularly those in traditionally underserved groups, such as second language learners, people of color, young males, and victims with an undocumented immigration status. Understanding how context and service delivery impact help-seeking is particularly important in addressing the needs of these underserved groups. The present article first discusses research on factors that negatively impact victim help-seeking, followed by a review of an evidence-based, comprehensive model that reduces barriers for traditionally underserved victims of crime.

Barriers to Help-Seeking

Victims may not seek services for a variety of reasons. Some may not seek help because they are unsure of how to access services. Reasons victims have identified for not seeking help include being unaware that programs exist, an assumption that they do not qualify for services, or a concern that service providers would be insensitive to their disability or cultural beliefs.^[4] One of the main avenues that individuals become aware of services is through reporting the crime to law enforcement; however, many victims do not report their crimes to the police.^[5] Even when they do report the crime, negative experiences interacting with formal systems, such as the criminal justice system, can deter victims from seeking further services.

Cultural beliefs also influence help-seeking behaviors. Members of particular racial or ethnic minority groups may prefer to seek help from their informal support networks, such as family members, friends, and partners, rather than formal support systems of law enforcement, victim service providers, and healthcare professionals.^[6] Stigmatized views of formal support services, particularly mental health services, also may be an issue. Furthermore, the absence of diversity among service providers and a lack of culturally sensitive services creates another barrier to accessing help.

Harmful responses from informal support providers, such as family and friends, can reduce victim use of support services,^[7] as can fear or uncertainty of how others will respond. Past experiences of receiving negative reactions following disclosure, such as victim-blaming and infantilizing responses, or the lack of emotional support and validation that the crime occurred, may dissuade victims from future reporting and help-seeking.^[8] Shame and embarrassment or a belief that victims services cannot help are additional reasons victims may not seek services.^[9] Risk-taking and the desire for independence are common features of adolescence and young adulthood, and young persons who are victimized while exercising greater independence may self-blame or fear being blamed.

Stereotypes and social norms also may impact and inform victims’ decisions to seek help. Individuals may experience victim-blaming responses due to individual characteristics such as disability, gender, legal status, race and ethnicity, sexual identity, or social class.^[10] Stereotypes about victims and victimization may inform these harmful responses. Males and younger individuals are less likely to seek formal mental health services than women and older victims,^[11] and this difference may be partly informed by societal expectations such as norms of masculinity that suggest men should be able to protect themselves.^[12]

Barriers appear even as victims do seek services. In order to meet multifaceted needs resulting from the crime, victims are often directed to different providers and systems. These systems are often fragmented and may have a variety of requirements that victims need to meet in order to receive services. For individuals who are both traumatized and disadvantaged due to victimization, economic strain, or structural inequalities, navigating such systems without assistance may be particularly challenging. Research has shown that disadvantage and trauma impact an individual’s “bandwidth” or mental ability to engage in day-to-day activities, much less manage multiple systems and requirements.^[13]

Services providing a single point of access may be particularly important for engaging victims with multifaceted and complex needs, specifically for underserved victims. Service delivery models should strategically deliver services in ways that facilitate knowledge of services in non-traditional settings, such as hospitals, medical clinics, schools, and community centers, and address trauma symptomology and quality of life needs following victimization in culturally sensitive and accessible ways. Comprehensive models that facilitate access to a variety of resources and allow for tailored services based on individual needs have been shown to improve victim outcomes and well-being.^[14]

Trauma Recovery Centers

Trauma recovery centers (TRCs) offer a promising program model to address both the psychological and tangible needs of violent crime victims, particularly those in underserved groups. TRCs are designed to address the needs of crime victims who typically do not access services due to individual and cultural barriers to seeking help. This program uses early and assertive outreach and coordinated, clinical case management to provide services to victims whose trauma needs for both services and outreach require a greater level of engagement than traditional service models.^[15] In this model, clinicians provide both clinical intervention and case management to actively engage with victims to work toward client-defined priorities, provide mental health interventions and advocacy services in tandem, and simultaneously address the multifaceted social and tangible needs of survivors. The model acknowledges that survivors will have different needs at different times and survivor concerns guide the care and referrals provided.

Mission: Facilitate healing for survivors of trauma, violence, and loss through an innovative, clinically-proven model of comprehensive care, advocacy, and outreach; eliminate barriers to healing; and inspire survivors to embrace hope.

Goals: Decrease psychological distress, minimize long-term disability, improve quality of life, reduce future risk, and promote post-traumatic growth.

Clients: TRCs serve survivors of violent of crime who are typically unable to access traditional services. Client populations who may benefit from comprehensive TRC services include:

• Individual who are homeless.
• Individuals who are chronically mentally ill.
• Immigrants and refugees.
• Individuals who are disabled.
• Individuals with severe trauma-related symptoms.
• Individuals of diverse ethnicities/origins.

TRCs serve victims of battery/physical assault, domestic violence, human trafficking, persons exposed to community violence, including gun violence, sexual assault, and vehicular assaults. Also served are surviving loved ones of homicide victims. No person is excluded from services as a result of emotional or behavioral issues resulting from trauma, such as low motivation, substance use, or anxiety.

Staff: TRC staff are comprised of multidisciplinary teams of trauma clinicians. Staff include psychiatrists, psychologists, and social workers. Administrators must be mindful of vicarious trauma of staff and build in supports for staff members to engage in self-care.

Services: TRCs provide 16 service sessions to victims where they are in their homes and communities, outside of a hospital. Clinicians provide coordinated psychotherapy and case management utilizing evidence-informed services and practices to address the needs of victims of crime.

• Assertive case management includes:

  • Accompanying the client to court, medical appointments, and community appointments, as needed.
  • Support with filing police reports.
  • Assistance applying for crime victim compensation.
  • Access to safe housing, financial entitlements.
  • A liaison to other agencies when coordinated care is needed.

• Evidence-informed mental health and support services include:

  • Crisis intervention.
  • Individual and group therapy.
  • Medication evaluation and management.
  • Substance use treatment.
  • Clinical case management.
  • Assertive outreach.

• Evidence-informed practices include:

  • Motivational interviewing.
  • Seeking safety.
  • Cognitive-behavioral therapy.
  • Dialectical behavior therapy.
  • Cognitive processing therapy.
  • Skills Training in Affect and Interpersonal Regulation (STAIR).

The first trauma recovery center was established in San Francisco, California, in 2001 as a four-year demonstration project to address barriers to accessing support services and explore how funding might be used to better reach underserved, urban populations. ^[16] Through a randomized control trial, researchers explored how access to comprehensive care from the TRC impacted use of victim compensation, state monies for crime victims and their families to reduce the financial burden on victims of violent crime. The researchers found victims who participated in the comprehensive TRC model were more likely to apply for crime victim compensation than victims receiving usual care (i.e., information about victim compensation and support services). This resulted in a greater number of younger, less educated, or homeless individuals applying for compensation, thus reducing victim compensation application disparities (Figure 1):^[17]

Figure 1

Percentage of victim compensation applications field comparing usual care and TRC clients

Data Source: Alvidrez, Shumway, Boccellari, Green, Kelly, & Merrill, 2008

Other research around the use of active outreach and engagement within TRCs suggests that such practices, specifically when carried out in settings beyond victim service agencies where victims may be treated for injuries such as hospitals, are particularly effective to identify and assist victims of violent crime who traditionally do not seek services.^[18] Through comprehensive services spanning from outreach to clinical mental health care, the TRC model holds promise to engage underserved victims of crime.

Conclusion

Victims who are underserved or marginalized face unique individual, societal, and cultural hurdles that impact help-seeking. Models of service delivery that provide a single point of contact and comprehensive, evidence-based services hold promise to serve victims whose needs extend beyond traditional services. Comprehensive trauma recovery center models have been shown to lead to positive survivor outcomes. TRC model expansion should be explored to assess how they might complement existing services and reach underserved individuals and groups.