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Victim Advocacy Self-Care

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    Victim Advocacy Self-Care Victim Advocacy Self-Care Document Transcript

    • Title: A multiple case study of rape victim advocates' self-care routines: the influence of organizational context Date: 2002 Author: Sharon M. Wasco, Rebecca Campbell, Marcia R. Clark Publication: American Journal of Community Psychology. Volume: 30. Issue: 5 INTRODUCTION The rape victimology literature has documented many of rape's direct effects on victims. Over 30 years of solid empirical evidence suggests that up to one in five American women will be raped in her lifetime (see Koss, 1993), that after the assault she is likely to suffer psychological distress (Hanson, 1990; Neville & Heppner, 1999) and physical health problems (Golding, 1996; Koss & Heslet, 1992), and that she may employ several types of coping to deal with these experiences (see Burt & Katz, 1988). Additionally, research indicates that although a sizable number of rape victims are likely to stay silent about their experiences, other victims may turn to family, friends, or service providers for help and support (George, Winfield, & Blazer, 1992; Kimmerling & Calhoun, 1994; Ullman, 1996). As victims share their experiences of sexual assault, the number of individuals exposed to, and impacted by, negative effects of rape increases exponentially. A fairly recent trend in the victimology literature explores the vicarious effects of sexual assault on family members or therapists of rape victims (see McCann & Pearlman, 1990). Empirical research suggests that those who are in close contact with rape survivors can experience quite a bit of distress, with female significant others usually being more affected than males (e.g., Davis, Taylor, & Bench, 1995). Despite potential negative outcomes, some women do choose careers that involve daily exposure to rape. The current work explores the assumption that rape crisis work requires employees to engage in various types of self-care (Stamm, 1995) in order to perform their job duties effectively and responsibly. Trauma researchers offer the notion of self-care to distinguish strategies and routines employed by those who work with trauma victims from more traditional models of coping. A key tenet of self-care theory is that organizations can be instrumental in facilitating workers' use of such strategies (see Rosen bloom, Pratt, & Pearlman, 1995). To gain a better understanding of the strategies women use to deal with a heightened awareness of rape, as well as the ways organizational context influences such processes, this exploratory study employed qualitative and quantitative methodologies to describe the subjective experiences of a small number of rape victim advocates working in diverse settings. The Ripple Effect of Rape
    • Empirical studies have shown that secondary traumatization, or secondary traumatic stress, is prevalent among family members and significant others of violent crime victims in general (Amick-McMullan, Kilpatrick, & Veronen, 1989; Riggs & Kilpatrick, 1990), and rape survivors in particular (Barkus, 1997; Davis et al., 1995; Holmstrom & Burgess, 1979; Remer & Ferguson, 1995). "Secondary traumatization" refers most frequently to indirect effects of trauma, such as experiencing recurring disturbing images, on victims' family members and significant others. Relatedly, "vicarious traumatization" (McCann & Pearlman, 1990) and "compassion fatigue" (Figley, 1995) are theories predicting that, over time, service providers who assist victims may experience indirect psychological effects of trauma, which can significantly alter the way victim-helpers perceive the world and have lasting impacts on their feelings, relationships, and lives (McCann & Pearlman, 1990; Saakvitne & Pearlman, 1996). Astin (1990) reported that her work with rape victims resulted in nightmares, extreme tension, and feelings of irritability, lending support to models of indirect traumatization. Empirical studies have also documented similar experiences among mental health service providers. Female counselors who work with sexual assault survivors experience symptoms of distress (e.g., intrusive thoughts or memories, increased arousal, numbness) similar to those experienced by victims themselves (Pearlman & MacIan, 1995; Schauben & Frazier, 1995). Trauma counselors also experience shattering of their basic beliefs about safety, trust in oneself, and trust in the goodness of others by the traumatic nature of the stories they hear from clients everyday (Johnson & Hunter, 1997; Pearlman & MacIan, 1995). Victim advocates who do outreach work with rape survivors seeking help from community systems report feeling anger and fear in response to helping victims access medical and legal services (Wasco, 1999; Wasco & Campbell, 2002). This line of research suggests that as survivors turn to service providers for help, the repeated exposure to the devastation of rape impacts providers' lives. Coping With Exposure to Rape In response to vicarious, secondary, or even direct stress, service providers who work with rape victims are likely to employ various coping methods. Schauben and Frazier (1995) were among the first to explore the coping strategies utilized by rape victim counselors. These researchers surveyed 148 counselors who worked with rape victims, at least some of the time, about the strategies used to cope with job-related stresses. Four common types of common strategies emerged from the open-ended responses. Over 35% of the sample reported engaging in (1) activities that promoted physical health, (2) spiritually oriented activities, (3) leisure activities, and (4) seeking both emotional and instrumental support. Other strategies included changing work conditions, cognitive restructuring, and engaging in political action (Schauben & Frazier, 1995). In a later study of 73 counselors, Johnson and Hunter (1997) found that sexual assault counselors were more likely than other types of counselors to use escape/avoidance st rategies of coping. Recently, Iliffe and Steed (2000) interviewed 13 female and 5 male counselors who
    • worked with domestic violence victims and/or perpetrators. Although participants in this study were aware of the negative effects that domestic violence counseling had on their lives (e.g., burnout, changes in views about the world), they were able to utilize a wide range of strategies to deal with these issues. Debriefing and peer support were identified by all the participants in this study as the most important resources for dealing with the difficult nature of their work (Iliffe & Steed, 2000). Also, socializing and physical activity, such as exercise or gardening, reading, and participating in recreational activities, were commonly cited as strategies to reduce negative effects of counseling sessions. Counselors also reported thinking about positive things, such as identifying clients' resilience and strength, and discussed channeling their anger, feelings of powerlessness, and other energy into sociopolitical activism as h elpful coping strategies (Iliffe & Steed, 2000). From Coping to Self-Care As research uncovers the risks inherent in supporting traumatized individuals, some researchers have begun to emphasize the importance of selfcare among counselors who work with victimized populations (see Stamm, 1995). Self-care refers to proactive strategies, or routines, that professionals use to offset the negative aspects of working with trauma victims and promote their own well-being. This wording represents a conceptual shift away from traditional stress and coping paradigms, which often frame coping as reactive behaviors or mechanisms that may or may not be chosen consciously. The notion of self-care is predicated on the assumption that working with trauma victims can be emotionally strenuous for service providers (Figley, 1983,1995; Neumann & Gamble, 1995; Saakvitne & Pearlman, 1996; Stamm, 1995). In this paper, then, self-care routines will refer to those strategies employed by professional caregivers to proactively manage their exposure to sexual violence. Concepts of self-care are relevant to the study of community psychology in part because of an explicit focus on competence, rather than risk, in understanding community workers' behavior. Furthermore, because this study targets rape victim advocates, whose roles cross boundaries of community organizing, service provision, and activism, this inquiry explores not only the experiences of practitioners who work with trauma victims (as framed in previous research), but also the experiences of frontline social change agents. In this sense, rape victim advocates' self-care routines can inform community psychology's understanding of how relatively disadvantaged persons manage a type of harm that is distributed unequally across gender and privilege. Literature on traditional coping suggests that rape victim advocates might call upon a variety of personal resources while engaging in self-care routines. Hammer and colleagues differentiate five basic types of resources for coping: emotional, cognitive, social, spiritual/philosophical, and physical (Hammer and Marting, 1985; Zeidner & Hammer, 1990). The researchers define the various coping resources as the extent to which individuals can access strengths that will allow effective responses to potentially stressful events (Zeidner & Hammer, 1990). Individuals' coping resources (e.g., expression of affect, positive outlooks on self and others, being imbedded in social
    • networks, values, and health-promoting behaviors) influence the various coping strategies utilized during times of stress (Zeidner & Hammer, 1990). This work offers a framework of multiple individual-level resources, which informs the current investigation of self-care routines. Organizational Context Ecological theorists have suggested that complex human behaviors, such as self-care routines, can best be understood as interactions between individuals and their environments (Bronfenbrenner, 1979; Kelly, 1966, 1968, 1971). In addition to examining individuals' resources involved in self-care practices, this inquiry also focuses on extra individual resources available to participants in their environments. Because vicarious traumatization, emotional exhaustion, or compassion fatigue occurs in the workplace, the organizational setting is highlighted in this study. Advocates' self-care routines are viewed as interactive processes between persons and the systems in which they are embedded; the strategies draw upon individual resources and are enacted in the context of organizational supports and structures. The field of community psychology has often aimed to understand how organizations can be supportive of their members (see Bond, 1999). As the previous literature review has demonstrated, rape crisis centers are distinctive, although certainly not unique, in that the nature of their business places employees at risk for emotional exhaustion, compassion fatigue, and/or vicarious traumatization. Some trauma researchers have theorized these risks as occupational hazards that can be addressed, and even prevented, by organizational practices (Neumann & Gamble, 1995; Rosenbloom et al., 1995). An organization can create a supportive environment for trauma workers by, first and foremost, acknowledging the difficult nature of providing supportive services to victims. Towards those ends, supervisors can schedule regular meetings with their employees to address ongoing reactions to their work. In addition to individual supervision, workplace settings such as rape crisis centers can hold structured case conferences, group case consultations, or peer process groups to provide a safe and respectful forum for workers to process their experiences together as a group (Neumann & Gamble, 1995; Rosenbloom et al., 1995). Pickett, Brennan, Greenberg, Licht, and Wornell (1994) have validated the importance of the group forum for processing experiences. They reported on the structured debriefing techniques used with their research team while conducting interviews with victims of residential fires. In this study, the sharing of individual experiences and feelings was related to decreased perceptions of isolation as interviewers realized common themes exist across interviews. The authors concluded that structured debriefing techniques may be instrumental in preventing compassion fatigue in research teams dealing with graphic, violent, or other sensitive and disturbing subjects (Pickett et al., 1994). Other important ways that organizations can support workers include the provision of adequate financial remuneration, private office space, and/or some control over one's caseload (Neumann & Gamble, 1995). It is also critical that organizations respond to
    • mistakes made by workers in a nonshaming manner, provide flexible leave and funding for work-related professional conferences, overtly recognize and value hard work, and pay attention to dynamics such as secrets in the organization, power struggles, and issues of exclusion and inclusion, which may interfere with worker's development (Neumann & Gamble, 1995). On the basis of the limited literature about the role of organizational support in alleviating the stress of working with rape victims, it is reasonable to assume that the culture and structure of an organization, as well as organizational-level responses to employees, may differentiate experiences of sexual assault service providers in disparate settings. This Study The current work is part of a project documenting the subjective experiences of rape victim advocates in several community-based organizations. The approach is exploratory, as scarce published research documents the experiences of rape victim advocates. The specific goals of this study are (1) to provide descriptive information about the types of self-care strategies that advocates employ and the organizational settings they work in and (2) to examine the relationship between organizational support and use of self-care strategies by rape victim advocates. It is expected that advocates will employ strategies that draw upon various individual resources (e.g., cognitive, social, spiritual). This study conceptualizes rape victim advocates' experiences to be grounded within organizational contexts. As such, differences in the nature of self-care strategies employed by advocates working in more or less supportive settings are also expected. METHOD Design Given the exploratory nature of the research questions, a multiple case study design using qualitative methods of data collection was employed. A multiple case study investigates a number of cases jointly to inquire into a general condition, phenomenon, or population (Stake, 1994). Conclusions are supported through replication over multiple cases (Yin, 1994). In this study, qualitative techniques were used to collect interview data from (N = 8) experienced staff members at sexual assault service delivery programs to gain an understanding of the subjective experience of providing advocacy services to rape victims. Case Selection Strategy A purposive sampling design was used to select cases for study. Cases were selected at the level of the program to ensure diversity in organizational resources. The population of potential cases was 24 direct service delivery programs involved in the Sexual Assault and Rape Prevention (SARP) Evaluation Project (Campbell & Davidson, 1996). (3) Previously collected data from the SARP Evaluation Project were used to assess appropriateness of sites for this study (4) and to stratify cases by organizational support, a key variable of interest in this study. To assess organizational support for case selection
    • purposes, two proxy measures were used: (1) sexual assault staff resources (number of full time employees) and (2) the percentage of organizational budget devoted to sexual assault service delivery. (5) A combination of the two proxy measures was used to rank potential cases in order of increasing level of organizational support. A median split divided the ranked list into two equal groups: six were classified "low support," and six were classified "high support." Cases were randomly selected from each group, (n = 4) high support and (n = 4) low support, for inclusion in this study. Procedure Recruitment The first author contacted the executive director of each selected program and recruited her participation in the study. After each executive director agreed to participate, she identified the person at her agency that had the most experience providing advocacy services to rape survivors. This method of selecting an expert informant is adapted from Campbell (1998) and targets advocates with the longest tenure, ensuring a diverse pool of experiences upon which a participant can draw. Without exception, each advocate contacted met additional eligibility criteria (2 years experience and contact with a rape survivor within the last 6 months) and agreed to participate in the study. Interview Interviews were arranged at the convenience of the participant, took place where the participant worked, and were approximately 2 hours in duration. Participants responded to open-ended questions on a wide range of topics including (a) description of their advocacy program, the organization in which they worked, and the community they served; (b) self-care routines; (c) emotional reactions to their work; and (d) perceived roles of advocates and factors influencing their decision to stay involved in this work. The interviews were tape-recorded in their entirety and transcribed verbatim. Participants On average, the respondents had been assisting rape survivors for about 5 years (SD = 33.6 months), ranging from 24 to 125 months. Over her career, each participant had worked with a mean of 220 victims of sexual assault (SD = 120), ranging from 25 (this respondent reported that she had previously advocated for 250 domestic violence survivors) to 350. At the time of the interview, respondents had provided direct services to a rape survivor a mean of 2.7 days ago (SD = 2.2), ranging from 1 to 7 days ago. These results suggest that all informants had both extensive and recent experience providing advocacy services to sexual assault survivors. The majority of participants in this study were European American, except one Native American woman and one African American woman. Average age of the respondents was 37.4 years (SD = 9.4) and ranged from 27 to 52 years. All informants were currently, or had been, committed to a romantic partner. All respondents had earned an undergraduate college degree, and over half had completed some graduate training or a graduate degree. Half of the respondents (n = 4)
    • answered yes to the written question: Are you a survivor of sexual assault? Qualitative Data Analyses The first stage of analysis utilized an inductive process known as a grounded theory approach (Strauss & Corbin, 1990) and iterative coding procedures to extract relevant text from the transcribed interviews and assign meaning to those data. Two researchers independently open-coded the transcripts, labeling all text referring to the constructs of interest: organizational support and self-care routines. The coders met regularly throughout the coding process to compare codes. Where there was disagreement in coding, a consensus method was used to determine the final code. The data analyzed for this study consisted of the text that was coded as organizational support or as self-care strategies. Additional analyses further refined these data by identifying factors that participants perceived to be supportive characteristics of the organizations they worked in, as well as the various self-care resources they utilized and the functions the routines served. Organizational Support Although proxy measures were used to classify agencies as "high" or "low" on organizational support (i.e., resources), these measures did not assess the amount of support that participants themselves perceived within their settings. To better understand the role that organizational support plays in advocates' self-described experiences, the coded transcripts were reviewed, and each example of a supportive characteristic mentioned by the informants was noted. In this way, a list of supportive characteristics (e.g., volunteer base, weekly supervision sessions, high retention rate) was generated. Items on the list that seemed to describe the same organizational element were collapsed into one item so that the list contained no redundant characteristics. This process resulted in the identification of 27 different characteristics, which was used as a supportive characteristics checklist for organizations. Using the checklist, the content of each transcript was again reviewed to identify all mentions of the 27 char acteristics. For each case, if the respondent specifically mentioned the presence of an item, it was noted on the checklist. If the respondent described the absence of the characteristic as being problematic, that was also noted. Visual examination of the graphical display of checklist results (see Table I) revealed interesting similarities and differences among cases. Self-Care Routines A two-step axial-coding process was used to analyze the self-care routines that had been identified through open-coding procedures. Iterative reviews of the data suggested that participants' self-care strategies accomplished two functions: (1) they regulated the amount of rape-related pain that advocates allowed into their lives, or (2) they strengthened the advocates' ability to accommodate rape-related pain. The first step of axial coding, then, was to assign one of two codes that specified the function of each self-care strategy. Text was coded cathartic if the informant described the strategy as a means to screen, reduce, purge, release, or vent rape-related stress. For example, if the
    • advocate reported debriefing with a coworker or supervisor after a particularly difficult session to vent her frustration through conversation, the strategy would be coded cathartic. Text was coded integrative if the strategy was described by the respondent as a skill, strength, or support that she included in her life to m ake on-the-job experiences and repeated exposure to rape more tolerable. For example, if an advocate reported taking self-defense classes because those skills provided comfort as she incorporated a heightened awareness of rape (and her own vulnerability) into her life, that strategy would be coded integrative. The second step of coding each self-care routine was to specify the resource that each strategy utilized. Five additional codes that specified the resource that each strategy drew upon were defined as follows: spiritual, physical, social, cognitive, and verbal. Table II presents these five codes, the definitions used to code each strategy, and examples of cathartic and integrative self-care strategies drawing upon each of the five resources. To assess the reliability of this coding scheme, a second coder used the coding criteria described above to assign axial codes to one half of the cases (n = 4). Agreement between the two coders was recorded, and a kappa coefficient for nominal scales (Cohen, 1960) was calculated. A kappa coefficient of .62, which reflects the percentage agreement between two or more coders after correcting for chance agreement, indicated good reliability of the coding procedure. (6) Thus, the two-step axial-coding process generated reliable data about the resources utilized and the functions achieved by 218 self-care routines used by rape victim advocates. Quantitative Data Analyses In the second stage of analysis, quantitative identifiers were assigned to the coded data, measures of the constructs of interest were developed, and categorical statistical techniques were used to describe relationships among quantitative representations of organizational support and self-care strategies. The reader should note that the strength of quantitative data, collected from within a predominantly qualitative interview methodology, is relatively limited. Therefore, care was taken to select quantitative methods suited to exploratory work with small sample sizes. The main purpose of these analyses is to marshal additional evidence of a possible relationship between organizational support and self-care first suggested by the results of qualitative analytic methods (see Wasco, 1999). The quantitative analyses presented here highlight the complementary nature of qualitative and quantitative paradigms, in which the rich nature of qualitative data can be used to not only build theory, but inform construct co nceptualization and measurement development. Developing Measures of Organizational Support To understand differences in organizational support between the agencies (N = 8), the 27 items from the supportive characteristics checklist were used to create an index that assessed the amount of organizational support perceived by the respondent in each setting. For each item, the presence of each item was coded (presence = 1), and no mention of the item at all or mention of the absence of the characteristic was coded
    • (absence = 0). Items were summed to create the Organizational Support Index. (7) After confirming that the scale had discriminant validity in regards to organizational resources, additional analyses were run to create a variable distinguishing "types" of settings by the amount of perceived organizational support. The distribution of scores on the index were examined, looking for natural breaks in the scores. In fact, there seemed to be three different types of organizational settings that the advocates in this study worked in: those that were "high support" (n = 1, index score = 23), those th at were "moderate support" (n = 4, range of index scores 9-14), and those that were "low support" (n = 3, range of index scores 3-6). (8) Thus, a second variable representing organizational support was created: support type. In this three-level ordinal variable, organizational support types were coded such that high support = 3, moderate support = 2, and low support = 1. Modeling Relationships Between Organizational Support and Self-Care Using this measure of organizational support, additional analyses were conducted to explore possible relationships between organizational support and patterns of self-care strategies reported by the participants. Each self-care strategy (N = 218) was represented by several categorical variables: (a) the support type of the setting (high, moderate, low), (b) the function of the strategy (cathartic, integrative), and (c) self-care resource utilized (cognitive, physical, social, spiritual, verbal). Logit modeling (9) was used to test hypothesized main effects of organizational support and self-care resources on the function of self-care strategies reported by rape victim advocates in this study. RESULTS Types of Organizational Support: High, Moderate, and Low Multiple analytic methods converged to suggest that organizational support can have an important influence on the subjective experiences of rape victim advocates. Table III displays quantitative and qualitative data that were used to classify three distinct types of settings by the level of organizational resources (proxy measures of support) and perceived supportive characteristics in the organization. One agency in this sample (Case A) was, by far, the most supportive organization in the study. Case A was, in many ways, an exemplar among sexual assault service delivery programs. For example, Case A has successfully developed a sexual assault nurse examiner (SANE) program to treat rape victims in a safe, comfortable setting outside of the emergency room (see Ahrens et al., 2000, for additional information on the SANE model). This innovative program is the product of an extremely coordinated community response to sexual assault and is run by highly trained nurse examiners and a dedicated volunteer base. There are considerable resources, both financial and human, at this setting, and the entire staff takes great pride in their sexual assault program. This case, qualitatively and quantitatively different than all other cases, represents the single case in the high support type. The majority of the cases (n = 4) were characterized as moderate support type. In the remaining three cases that were high support by proxy, Cases B through D, informants described the organizational support that they received as instrumental in their ability to
    • continue providing supportive services to sexual assault survivors. Participants described a number of supportive characteristics that contributed to their general satisfaction with the amount of organizational support they perceived, and did not mention the absence of any supportive characteristics. Although Case E had low organizational resources, the index score and qualitative data about perceived support landed this case in the moderate type as well. At this setting, sexual assault services often ranked below domestic violence in organizational priority and fewer resources were allocated to helping rape victims; but recognition and respect for the sexual assault program was quite high. Additionally, there were a number of other supportive charact eristics in the larger organization that added a supportive feel to the participant's workplace. Although participants in Cases F through H did, in fact, report that they received varying degrees of support from their organizations, they also described organizational barriers to their provision of advocacy services to sexual assault survivors. It should be noted that informants did not always mention the barriers when asked about perceived support. Rather, these issues emerged from discussion about the priority placed on sexual assault work within their agency, or changes that would help them to cope with the difficult nature of their jobs. The advocate in Case F felt that she, as an individual, and her work in the sexual assault program was supported by others in her agency, but that as one person working half-time on the "rape grant," she was a bit overwhelmed with her task. In Cases G and H, the advocates felt, indeed, that support at work wasn't always what they "would hope that it would be." These three types of organizational support were expected to impact the pattern of self-care strategies that participants employed to deal with repeated exposure to rape and the stress of their jobs, such that strategies in the high type of organizational support would be different than those in the low type. Distinguishing Patterns of Reported Self-Care Strategies On the basis of exploratory log linear analyses, it was predicted that strategies employed in high support agencies, which drew upon spiritual, cognitive, or social resources, were more likely to be integrative than cathartic in function. The predictive value of two main effects, organizational support and self-care resource, on strategy function was tested using logit modeling techniques. The overall model was nonsignificant, LR [chi square](8, N = 218) = 5.61, p = .69, indicating no difference between the proposed model and the observed data. A main effect for self-care resource was supported, such that strategies using the following self-care resources were more likely to be integrative than cathartic in function: social (76.5% of all social self-care strategies served integrative function), cognitive (74%), and spiritual (76%). Strategies relying on physical (39%) and verbal (12.5%) sell-care resources were significantly less likely to serve integrative functions. The test for a main effect of organizatio nal support type contrasted high-support-type settings with moderate-support-type settings and low-support-type settings. As predicted, self-care strategies utilized in high support settings were more likely to be integrative (71.4%) than strategies used by advocates in moderate(58.3%) or low-support-type (48.7%) settings. Please see Table IV for relevant statistics including odds ratios.
    • What's the Relationship Between Organizational Support and Self-Care Routines? Qualitative data from multiple cases in this study are presented to illustrate the effect of organizational support on participants' use of self-care routines. Previous literature has suggested that organizational support can be key to helping employees vent, process, or debrief traumatic material (Neumann & Gamble, 1995; Pickett et al., 1994). In this study, participants reported varying access to forums for group processing. For example, an advocate from a moderately supportive setting talked about forming a support group to discuss work-related issues: We've--when things get pressured here--we've tried to workout something, actually there were a few of us that formed a group--we do it according to need. There were a few of us that would meet after work and give each other support in the process. And it was a weekly thing, so it didn't build up. So we do it on our own...Yeah, yeah, yeah as needed. As needed. (E, 60-61) In this example, although members of the support group were coworkers of the respondent, she was quite clear that creating the informal group was something they decided to do to fulfill a need unmet by organizational structures. Likewise, another advocate in a less supportive setting also describes creating a "clinical support group" among counselors who, although they were coworkers, were not necessarily rape victim advocates themselves: That's probably the biggest thing, is that you need to vent it somewhere...and so finding somebody that--and not just anybody, you know, there's other people that I work with that have dealt with rape victims in the past, either they were already seeing them in counseling and a sexual assault had occurred and they continued to see them and they experienced some of the similar things so it's kind of our little clinical support group of each other. (F, 86) These examples illustrate how some advocates spent time and energy to seek opportunities for processing their experiences with colleagues. In these instances, the organization did not provide regularly scheduled opportunities for debriefing during the workweek, but participants were still able to draw upon organizational resources (i.e., other staff members) to meet their needs. In the following example, one advocate at a low-supportive setting describes a more difficult search to find ways to appropriately vent her experiences: Respondent: I'm on the board for the coalition...and I think my involvement in the [local task force name's deleted] in some ways...is really rewarding to be able to meet with advocates, from all around the state, working with children--domestic violence, sexual assault, whatever--but to be able to meet with them and just--that's kind of a source of support. We only meet every, every two months...But now that I'm the facilitator of that group, I talk with people regularly, and to just be able to use them as a sounding board, or to see that what I may feel like is my frustration alone, is not. That there are other people
    • experiencing it--that's been helpful...When I first started out here, my only real experience was my volunteer experience...for awhile I was sitting there going "What am I going to do?" "What am I supposed to be doing here?" And then luckily I did go to a [local task force name's deleted] meeting and I met some other contacts...but it was difficult starting this job because it didn't seem like there was adequate preparation. Interviewer: So now do you have anyone to do clinical supervision with? Or do you go over cases-- Respondent: It's supposed to be my director, and she has a really hard time keeping those appointments and doing that. But I have someone that I'm involved with--a board member, actually--that I use as my supervisor because of being in the social work career...and so I have her as a contact supervisor person or someone that I check in with, Interviewer: And is that something you set up for yourself? Or built-in for yourself? Respondent: Yeah. (H, 110-111) This participant searches outside the confines of her organization to find a single person to talk to about work: She has no access to a group forum at all. As illustrated above, although she successfully engages in a similar type of self-care routine as the others, she still feels relatively isolated from others like herself. Group processing forums are important organizational structures because they can facilitate two types of self-care routines: verbal cathartic and social integrative. For example, in the last quote, the participant mentions the cathartic function of being able to "talk to people regularly" and use them as "sounding boards," but also how realizing that what she feels "is my frustration alone, is not" serve as "a source of support"--an integrative function. These data suggest that talking in a semistructured setting may be an integral part of dealing with rape crisis work. Rape victim advocates in this study mentioned being bound to silence outside of work settings, either by legal confidentiality mandates or by social pressures not to bring up the topic of rape. Therefore, a key way that organizations can support workers, perhaps, is by providing opportunities for advocates to verbalize the rape-related pain and be in the company of supportive listeners, which may be difficult for them to arrange in other areas of their lives. Similarly, organizational settings with high and moderate support were often able to provide opportunities for advocates to exercise self-care routines that served integrative functions. For example, one participant draws upon her individual self-care resources (social) as well as organizational resources (organized prevention activities) to counter feelings of helplessness, a negative reaction to work with victims: One of the things that I do for [organization's name deleted], is that I do prevention activities also. And I think that that's the thing that helps me. Because I think if you're just constantly answering the crisis calls, and doing intervention, then you feel like--I think you start to feel a little helpless, and hopeless ... and I think that's done a lot of good for
    • me because I feel like then I'm doing something to maybe prevent crisis, you know. And I really like working with the boys ... I was the only girl in my family, so I think I have always kind of, you know, had a thing for the guys, and hanging out with the guys, and that type of thing and that's kind of how I approach the guys in the classes. And I think that's helped me a lot with being able to cope. (C, 73) All advocates described their use of cognitive self-care strategies, regardless of how much support was available from their organizations. However, the cognitive strategies aimed at "rethinking" different aspects of their jobs depended on whether they worked at an organization with higher or lower levels of support. This first example is from an advocate at a low-support organization, who finds interagency conflicts to be a barrier in performing her job duties: There have been ways that I have had to think about it [my job]. For example, I think just to really say, I don't have to be friends with everyone I work with, and when I'm here, I want to be civil, I want to be nice, but my goal is to come in and do my job ... So I think in some way-just to be able to try and say, "OK, I've tried. [to solve some inter-agency staff concerns regarding lack of supportive environment] I've done this. Now I'm going to have to try and let go of it, and focus on what I'm doing [helping rape survivors]." (G, 96) This advocate relied on cognitive resources, that is, rethinking the role of coworkers and her own behavior in the work setting, to be able to focus on her work. A respondent at a high-support agency also reports using cognitive strategies to focus herself. However, because this advocate felt quite supported by her coworkers, superiors, and organizational structure, she used available cognitive resources to focus herself on not becoming consumed by work: That it is work, you know? And work is not everything. It's one part of my life, not my entire life, so...and also that I'm here to do what I can, but I can't fix everything. And nor is it my responsibility to fix everything, you know, kind of trying to stay focused, and not get overwhelmed. (A, 66) Similar to advocates from high-support organizations, it is likely that advocates from low-support organizations also have to cognitively restructure the stressful nature of their daily job functions by reminding themselves "that it is work." However, these data suggest that advocates with low levels of organizational support will also draw upon those resources to cognitively restructure the way they regard relationships with other people at work, or the fact that they get less support than they desire from their organizations. Up to this point, the data have suggested that organizational-level factors might be directly related to self-care routines by facilitating or impeding opportunities to use certain strategies. Another comparative set of data offers a second explanation-a possible indirect relationship-for the observed association between organizational support and self-care routines. Here, words of study participants suggest that organizational support
    • might lead to positive or negative work-related experiences, which in turn might influence the type of self-care routines utilized by advocates. For example, women at different organizations describe their involvement in local "Take Back the Night" marches, which have become a powerful awareness-raising event for antirape activists. First, the experience of an advocate working at a low-support organization: It seems like-unfortunately I'm going to come right out and say this now-but sometimes my own director, at the agency, has made me angry because of unwillingness to really take a stand on any issue... there's a real middle-of-the-road kind of thing-that we don't want to sound too liberal, or we don't want to sound too feminist, or we don't want to sound too this or too that. So I feel like in a lot of cases we've been pushed almost not to take a stand and so like there's things where I find myself-like if I'm participating in "Take Back the Night" and I'm doing all this stuff-sometimes I have to say "well I'm doing this just as [advocate's name deleted], this isn't as a part of [organization's name deleted]," because I don't want to upset her. (Case G, 51) These words convey a different experience than the description of the same event from the advocate working in the high-support organization: Like we had a Take Back the Night event every year and staff would get right in there--all staff, you know? The entire building, even health/fitness or something, they'll get right in there and help us with volunteering or being a part of, of doing whatever we're trying to do, being interested in it. So, I think that's good. (Case A, 15) These two cases illustrate how the culture of an organization, including responses from influential figureheads such as the executive director, can feel either stifling or supportive to advocates. Participants in this study described how the nature of their job, which includes responding to rape victims at hospitals or police stations in the middle of the night, can be quite stressful. However, they also described various policies that their organizations have implemented to decrease the distress. By policy, at the high-support organization, everyone meets at the building where the SANE program is housed. This organizational procedure ensures that the advocate is not alone and that she (and the rape victim) is in a relatively comfortable setting: But also ... fear with coming downtown--this isn't the safest area--at night ... And it's not that I feel real fearful, but I think it's a presence, you know, it's a state of mind. It's dark, and it's isolated ... the way we've worked on those things is having other people here to meet you and that sort of thing. Also, the good part of that is, it's [organization's name deleted]--so it's my building--so I know how to get in here and I know what's in here when I get in here ... (Case A, 53-55) Similarly, one of the moderately supportive organizations sends advocates out in teams, so that they are not alone on outreach calls:
    • Respondent: [The local] hospital would call us, and they know us, for the most part. And when they have somebody in there that they've, you know, that comes in there and says, they've been raped, and we get a call, and we show up. Two of us would go out-- Interviewer: Oh--two people go out? Respondent: Right. Interviewer: Is that the, is that standard? Respondent: That's standard. (Case C, 24) In another organization with moderate support, training procedures are put into place to help advocates become more familiar with the settings they will work in And most of the training, part of the training for my volunteers is that they go to the hospital before they even start taking calls and they meet the nurses that are there and they meet the head nurse; they know the building; they know you know where to park. I mean the parking lot is right there. I mean, you park and there you are at the ER. Because it's a small area. The same with the other hospitals. So, they're familiar with where they're going. (B, 58) These data provide concrete examples of how organizational policy and procedures might potentially impact the stressful nature of advocates' crisis intervention work. One interpretation of these data is that organizational support, or the lack thereof, may indirectly influence the types of situations that might necessitate advocates' self-care routines. Overall, qualitative findings suggest two possible mechanisms by which organizational support may influence self-care routines. First, organizational support might directly facilitate or impede opportunities for particular self-care routines (e.g., group meetings); second, organizational support may be indirectly related to self-care routines by influencing the types of experiences, both positive and negative, to which advocates are exposed. DISCUSSION Summary of Major Findings The current research was conducted with an understudied population--rape victim advocates--using exploratory analytic techniques to compare experiences of advocates in different organizational settings. Results discussed here are intended to be considered descriptive results of case study design, particularly well suited to build theory and/or generate hypotheses for future research. Qualitative analyses reveal that advocates working in settings of varying organizational support reported the use of both cathartic and integrative self-care routines, which drew upon various individual-level resources. Two functions served by the practice of proactive self-care are documented: regulating the amount of work-related or rape-related stress that rape victim advocates experience
    • (cathartic strategies) and developing skills, strengths, and support to compensate for the daily exposure to traumatic experiences (integrative strategies). Additionally, all of the experienced advocates in this study reported the use of five self-care resources in dealing with their work: changing how they think about things (cognitive), using body and senses (physical), relying on their religious beliefs or spirituality (spiritual), using friends, family, or creative recreational activities as outlets (social/recreational), and putting into words the painful details and intense feelings that they experience (verbal). Findings of categorical statistical analyses suggest that strategies employed by advocates in settings with higher levels of organizational support might more frequently be integrative in function than strategies used by advocates in organizations with less support. Importantly, all advocates in this study needed to regulate the amount of rape-related pain in their lives through cathartic self-care routines. However, those rape victim advocates who worked in organizations with more resources and more characteristics perceived as supportive appeared to describe more integrative self-care strategies than advocates working in settings with less support. Contributions to the Literature The current findings are relevant to several bodies of literature. Results of this study describe, in detail, rape victim advocates' use of self-care routines, which are consistent with previous research on coping among rape counselors that has used both open-ended qualitative data (Schauben & Frazier, 1995) and traditional coping paradigms (Johnson & Hunter, 1997), and provide empirical support for models of self-care (Pearlman, 1995). Also, these findings might relate to a new "tend-and-befriend" stress paradigm being developed by stress and coping theorists Shelley Taylor and colleagues (see Azar, 2000). This work proposes that in contrast to the fight-or-flight paradigm, females respond to stressful situations and protect themselves and their young by nurturing behaviors and forming alliances with a larger social group (Azar, 2000). Although the tend-and-befriend model has yet to be empirically tested, the strategies described by women in this study to protect themselves from the indirect effects of gende r-based sexual violence might fit within this new coping paradigm. Results of this study also provide description of organizational support provided by sexual assault service delivery programs and the larger organizations in which these programs are housed. Rape crisis workers identified over 25 characteristics of organizations that lend to an overall perception of support in the workplace. This statistical work done here with these measures could inform future research with a variety of organizational settings, and is nicely suited to continued measurement development. Lastly, this study proposes a relationship, supported by theory that human behavior is the product of person--environment interactions, which links organizational support to the pattern of self-care strategies used by advocates. Qualitative analyses suggest two possible mechanisms by which workplace settings might influence individuals' behavior. The first is a direct relationship, where specific organizational culture or procedures potentially facilitate or bar opportunities for certain self-care routines. T he second is an indirect relationship in which organizational culture or policies might create situations
    • that necessitate or eliminate the use of particular types of self-care routines. These theoretical underpinnings, which now require empirical testing, might contribute to research topics exploring individuals, organizations, and communities. Limitations of the Current Work This study is not without limitations. Multiple case study design is best suited for generalizing to theory about a particular phenomenon, in this case rape victim advocates' self-care routines, and not a larger population, in this case all rape victim advocates (Stake, 1978). The reader should note that relationships found here were generated by analysis of a small number of cases, and that these findings will not likely generalize to the experiences of all, or even most, rape victim advocates. For example, because only the advocates with the longest tenure at their agency were included in this study, it is quite likely that their experiences differ substantially from newer advocates. Additional research, designed to test hypotheses, emphasize external validity, and use larger sample sizes, is needed to test the effects on a larger population of rape victim advocates. Related to that point, this study used a primary approach to data collection and analysis, qualitative methods, and complemented that approach with a secondary methodology, quantitative techniques, adapted for categorical data. Because this study was designed from a qualitative paradigm, the authors suggest that readers interpret the quantitative findings with caution. Specifically, it should be noted that when the qualitative data (text representing self-care routines) were assigned quantitative identifiers, the resulting 218 data points were not completely independent of one another. In the context of an exploratory study, aimed at generating theory, the authors risked violating a common assumption of quantitative statistical procedures to test an effect that had emerged from previous qualitative analyses (see Wasco, 1999). A more rigorous test of the resulting relationship between organizational support and self-care routines might be achieved using deductive logic, confirmatory methods, and independent da ta. Implications for Future Research and Action The current work raises questions to be examined in future research. For example, the personal and sociocultural characteristics of advocates seem likely to impact the types of self-care resources most comfortably accessed and/or the cultural manifestation of self-care routines. Although the purposive sampling design emphasized similarities among participants, important details about the age, ability status, religiosity, class background, ethnicity, and victimization history emerged in participants' description of their selfcare experiences (see Table I for evidence of these trends). These factors deserve explicit attention in future work using sample sizes large enough to accommodate such analyses. Secondly, although participants in this study reported organizational characteristics that were the opposite of supportive, these data were not completely analyzed. Community psychologists interested in understanding how settings influence behavior should examine not only the influence of supportive characteristic s present in a setting, but the influence of the absence of those supportive characteristics, as well as the presence of other, nonsupportive characteristics.
    • At a more general level, this work encourages a broader conceptualization of the ways that gender-based violence harms all women, to greater and lesser degrees, and not just rape victims (in preparation). This study suggests that rape has indirect effects on the lives of rape victim advocates who, indeed, employ self-care strategies to accommodate constant exposure to rape. In practice, organizations that work extensively with rape survivors and other victimized populations might emphasize to their employees, especially new advocates, the importance of engaging in self-care routines that draw upon multiple individual-level resources (e.g., verbal, social, physical). However, although individualized self-care routines are essential, current findings suggest that it might be equally important for organizations to develop and maintain agency-wide policies and procedures to promote advocates' self-care. Table I Supportive Characteristic Checklist Results Organizational setting/case Supportive characteristic A B Volunteers involved in SA service * * delivery Paging system/relationships with * * community systems well established Specific names of supportive people * * in agency mentioned Advocate on duty encouraged to call * * backup Director specifically mentioned as * * supportive Flexible hours * Training, conferences, workshops * * Sexual assault is main priority * Weekly case staffing meetings * Individual clinical supervision * * Work across programs/DV & SA * * overlap Sexual assault coalition in * * community Supervisor/program coordinator * * supportive Diversity of staff or community * members Clerical support, materials, * resources Compensated well * * SA team connected to rest of * organisation
    • Two advocates go together if/when necessary Males involved in SA service * * delivery Agency recognized for making impact * on community Use person-centered planning * Advocate training involves visiting * * local ER Ideas are vlidated, supported, * enacted Monthly staff meetings * Staff from other programs support * SA events High retention rate * Important organization for people * of color Organizational setting/case Supportive characteristic C D E Volunteers involved in SA service * * * delivery Paging system/relationships with * * community systems well established Specific names of supportive people * * * in agency mentioned Advocate on duty encouraged to call * * backup Director specifically mentioned as * * supportive Flexible hours * * Training, conferences, workshops Sexual assault is main priority * # Weekly case staffing meetings * Individual clinical supervision * Work across programs/DV & SA * overlap Sexual assault coalition in * community Supervisor/program coordinator * supportive Diversity of staff or community members Clerical support, materials, * * resources Compensated well SA team connected to rest of
    • organisation Two advocates go together if/when * * necessary Males involved in SA service * delivery Agency recognized for making impact * on community Use person-centered planning * Advocate training involves visiting local ER Ideas are vlidated, supported, enacted Monthly staff meetings Staff from other programs support SA events High retention rate Important organization for people of color Organizational setting/case Supportive characteristic F G H Volunteers involved in SA service # * # delivery Paging system/relationships with # # # community systems well established Specific names of supportive people * in agency mentioned Advocate on duty encouraged to call * * backup Director specifically mentioned as * # supportive Flexible hours * * Training, conferences, workshops * * * Sexual assault is main priority # # Weekly case staffing meetings * * Individual clinical supervision Work across programs/DV & SA # overlap Sexual assault coalition in # community Supervisor/program coordinator # supportive Diversity of staff or community * members Clerical support, materials, * resources Compensated well #
    • SA team connected to rest of # # organisation Two advocates go together if/when necessary Males involved in SA service delivery Agency recognized for making impact on community Use person-centered planning Advocate training involves visiting local ER Ideas are vlidated, supported, # enacted Monthly staff meetings # Staff from other programs support # SA events High retention rate Important organization for people of color Note. * denotes the presence of a supportive response from an organizational setting, and # denotes the presence of a nonsupportive response from the organizational setting. Table II Coping Resources: Code Definitions and Examples Domain code Code definition Cognitive Mental activities that effect perception of events. Includes intellectual or practical belief systems (but not spiritual or philosophical beliefs), attitudes, ruminations/self-talk, internal "cheers" Physical Activities using the physical body and the five sensory functions (seeing, smelling, hearing, touching, tasting). Includes music, exercise, relaxation, driving, and altering one's physical environment (e.g., taking a vacation) Social/recreational All forms of creative expression or recreational diversion and interacting with other people socially to gain love, acceptance, and companionship. Includes
    • spending time with friends or colleagues, creation or appreciation of arts (widely difined), craft activities, hobbies, volunteer activities, shopping, travel, working with kids, use of all types of media including books, TV, movies Spiritual/philosophical Faith or value systems that provide an outlook on life, or guidance/ rules for living life. Includes the use of religious customs, practices, activities, gatherings, as well as ethical or philosophical beliefs, and/or worldviews regarding destiny, fate, justice Verbal The use of language to identify and express feelings and/or stress. Includes talking out loud to self, or others (including personal therapist), writing, keeping a journal, naming the problem or the feeling Domain code Example of cathartic Cognitive Sometimes I have wonderful revenge fantasies that I should never utter out loud, because they are completely illegal....sometimes I really do spend a lot of energy doing revenge fantasies. They're fun. I work it through. I've even had dreams where I work revenge fantasies in...And that's all it needs to be, you know? I just need to somehow emotionally fight my way out of it Physical Yeah, I, physical activity, exercise, I do that. The really hard ones, I cry. And sometimes I drive around and cry... Social/recreational And I'm very protective of my outside time. I don't want to watch movies that have anything to do with violent themes; I don't want to deal with, you know, I can tell
    • when there's a lot of stress in my life, when I really don't want to deal with any serious televised topic Spiritual/philosophical "I pray a lot. That seems to be a way for me mentally to get rid of a lot of what I'm feeling..." Verbal And that happens to me sometimes if--I notice especially if it's a real brutal situation, you know, you go through--it's secondary victimization, you kind of go through some of the same emotions. And so we try ... very hard to talk to each other about what it is that we saw, what it is that we smelled, what it is that we heard while we're on the call, and try to work through some of those things and do the debriefing after the call Domain code Example of integrative Cognitive I think recognizing that, you know, that I am, recognizing that I am not the be-all and end-all of someone's support system. I think sometimes I've made a really big difference and many times, I probably haven't made that much of impact, and that's OK Physical I put myself in a position where I had to teach self-defense so I had to learn it. And I'm constantly looking for new strategies to deal with the situations. But I think that's how I compensated for it, because that was borne out of fear. I was, I lived alone when I first started this job. I'm a woman with a disability...a fairly obvious one to most people and I knew that I was in a pretty high- risk category there. So I really actively went out and made myself stronger, physically and emotionally
    • Social/recreational I surround myself with positive people that have positive interests I like to play around on the computer; I find things that are are completely unrelated to the work here Spiritual/philosophical I have a deep faith in--I'm Native American and I do a lot of praying to the spirits. I have animal totems and spirit guides that I turn to a lot. That's just you know part of my own spirituality. I also have a Catholic faith that I would [inaudible] turn to--I kind of walk both worlds... But I take the best out of both, and I really feel empowered by that Verbal One of the big things is you have to be able to talk to other people about what's happening,... and I'm one of those kind that "you're going to listen to me, whether yo want to or no!" But they've got big ears, and they listen to me, and I try to with them Table III Quantitative and Qualitative Data Suggesting Differences in Organizational Support by Case Organizational Case support variables Qualitative data (a) A Proxy: High Interviewer: What has it been like Index: 23 for you to work here at Type: High [organization's name deleted]? Respondent: For me, it's really been exciting and challenging because no day is ever the same; and because I get to grow and to stretch into different areas. Like I said, when I want to learn about something, I have that chance to learn about something. You have a lot of different--it's a huge organization, but it's an intimate organization. So that's really nice...even though it's huge
    • there's not a lot of bureaucracy and that sort of thing. But it's huge enough to have the resources that you need, and also the diversity--you learn so much from different people around you, and the styles that they have and their background, sharing information. And, like I said, I really like it. B Proxy: High Interviewer: Um, and so what is Index: 14 that like for you in terms of, Type: Moderate what is it like to work in an organization that you feel gives you a lot of support in this work? Respondent: Feels...I would say good, but I don't let my group members get away with good, so I will give you a better word--Makes me feel like I want to keep coming back every day. I don't think you can do this work, if you don't get support from your agency, I think it would be, the burnout rate would just be ungodly awful...I can't imagine, I just can't imagine. C Proxy: High Interviewer: Um, and so for you, I Index: 10 don't know what your other Type: Moderate experience has been like, but what has it been like for you to work in an agency that gives pretty substantial support to you in doing this work? In your efforts to do sexual assault advocacy? Respondent: Well, I definitely [laughter] it helps a lot because there's nothing worse than feeling like you're alone if you're doing crisis intervention because...one of the big things is you have to be able to talk other people about what's happening, you have to be able to debrief, because if you can't, you're not going to be much of a crisis responder and an advocate.
    • D Proxy: High Respondent: So from within the Index: 9 agency there's lot of support...As Type: Moderate individuals, yeah, most of us have been here long enough or doing similar work that we understand the need for some kind of support. You just need to blow it off; you need to vent. You need somebody to sit there and just nod their head and say, "yup, been there." [laughter] Not necessarily fix the problem, but just kind of listen, you know? Interviewer: So, what is it like for you to work in an organization that is sounds like you get moderate to substantial to support in your efforts here, as compared to maybe working for an agency that wasn't as, I guess, focused? Respondent: I've been able to be here for ten years. [laughter] I thing that's it--I worked with DHS for--I had two different jobs for two years each, and I couldn't handle it. E Proxy: Low Interviewer: OK. And I'm, I'm Index: 9 interested a little bit, too, in Type: Moderate how working within the structure of your agency here, how that effects your experiences as a staff member. How much support do you feel that your organization provides to you in, in your work supporting sexual assault survivors? Respondent: Quite a bit. Interviewer: And how high of a priority, in your opinion, is sexual assault here at the agency --in comparison to other focuses that you might have? Respondent: It's increasing. It came after domestic violence ... Awareness is definitely increasing. The main focus was on
    • domestic violence, but there is an increased interest and understanding with sexual assault. It is not up to par with the domestic violence yet, but it is increasing. It depends, yeah, it really depends. It does get down to funding. F Proxy: Low Respondent: I feel very supported Index: 6 doing the work that I'm doing. Type: Low Interviewer: OK, how high of a priority is sexual assault within your organization? It sounds like you work with a lot of different things there ... how big of an issue--or a priority--is it [sexual assault services], do you think, in your agency? Respondent: As an agency I feel like we have a large mission and because we have so many different components ... I think those separate components have their own missions. I think as an agency we are looking to provide a multitude of services to women and their children and their families and we do ... There's lots and lots of different things that we do; so within the realm of that, sexual assault may seem kind of small ... it does have it's priority but you have to look at where it's coming from: It's a real big agency, getting bigger and bigger and bigger and bigger, especially for the community that we're in. [Later in the interview] Interviewer: OK, um Are there any things that you can think of that would make your job easier to cope with, things that would help you deal with the difficulties of the job better? Respondent: It would also be nice to have more of a counterpart here
    • to split the job with, you know, right now, I'm--you know, we have a rape grant, I think it's 24 hours a week, um, to cover five counties--to do really everything, and you know the frustration of thinking where I would like to see the sexual assault program in our agency go you know, if I do my dreaming, and my brain-stroming of my vision where this would be, it's pretty limiting because I think, "Well, you know, in order to really get the message out, you know, we have to do a lot more presentations in schools which is real time-consuming ... and to do the kind of networking with the law enforcement officers, that I'd like to have, takes time, and to get the netwoking with the hotpital staff, so that they just automatically call us ... A lot of networking that I'd like to do you know, that I, and, I just don't have the time because I you know, it's only half-time [inaudible] sexual assault ... you know, we've got seven therapists here and they're all doing different things, and it's just, you know, they're not invested in how do I make an interesting presentation on sexual assault for middle school kids. And, and I'm it. It's not like there's somebody else that could go if I'm busy and it doesn't work into my schedule ... that would be a real ideal, to have somebody else that could be here half time and we could say, "Oh, OK this is a project we could work on together." That's be great. G Proxy: Low Interviewer: How much support do Index: 4 you feel overall that your
    • Type: Low organization gives to you in your work to support rape survivors? Respondent: That's interesting ... well, we have a bit of a conflict in our agency, but I think certain staff people have been very supportive and it's kind of one of those things were we don't really have anyone at our agency who is designated as a person--I think that there almost needs to be someone that, like, just gives staff support ... does staff check- ins, or, you know, progress or things like that ... we're starting to be one of the few programs in the state that doesn't have any type of an assistant director or anything. So I think sometimes support from work isn't always what I would hope that it would be. Interviewer: For you, what has it been like as an employee to work in an organization like this where it sounds like sometimes--like you said--the support isn't exactly what you want it, wanted it to be? Respondent: At times that has been frustrating because I would like to work somewhere where there's like a real team approach ... But it's also been, you know what I mean, there's been times when--I'm kind of back and forth ... You know, times when it's frustrating that everybody has their different ideas about what they're going to do, or can't be there, or doesn't seem to have the same commitment, or however that is; but then there's other people that make you see, "OK, this is worth it; this is great I get to work with someone like this," and so, kind of both sides [laughter].
    • H Proxy: Low Interviewer: OK. What is it like Index: 3 for you to work for in an Type: Low organization that gives, it sounds like, moderate support to what you're doing? I guess if you could just talk a little bit in general about what that's been like working here. Respondent: It's very frustrating at times. Um, because, you know, I know at least in this department and the people that have been hired even in positions before us have a really strong desire to take that taboo away from sexual abuse or sexual assault and to really concentrate on the dynamics like power and control. And those issues seem so similar to domestic violence from what we can see ... So it's been frustrating here where you expect more support, or you expect counselors to understand the dynamics to be very similar to what they're doing ... [later in the interviewer] Interviewer: My question was what would help coping-- Respondent: I think more staff support would make it easier ... my assistant and I are kind of on our own. We have about 23 people that work here. There's 21 people that work here that work on DV and prevention, education, one works with batterers, so we're the only two that do it [sexual assault work], so we feel isolated sometimes. (a) In this section of the interview, respondents were first asked, "how much support do you feel your organization gives you in your work to support rape victims?" followed by "What is it like to work in an agency that gives (fill in respondents word choice here) support to your efforts?" and then "How much priority does your organization give to providing services to rape survivors?" Table IV
    • Logistic Regression Analysis Predicting Integrative Function of Self-Care Strategy Variable B SE z value Odds ratio Organizational support High vs. moderate 0.76 0.57 1.32 -- High vs. low 1.08 0.61 1.78 * 2.94 Self-care resource Social vs. physical 1.73 0.43 3.98 * 5.64 Social vs. cognitive 0.10 0.46 0.22 -- Social vs. verbal 3.06 0.63 4.85 * 21.35 Social vs. spiritual 0.08 0.58 0.14 -- * p < 0.05. (1.) The authors thank Robin Lin Miller and James G. Kelly for their helpful suggestions and support throughout the collection and analyses of these data. We otter sincere gratitude to the rape victim advocates that were interviewed as a part of this project, not only for their diligence in working on behalf of rape survivors, but for their willingness to share their experiences with us. (3.) All rape crisis centers throughout the state of Michigan who received funds from the federal Violence Against Women Act of 1994 are participating in a multiyear collaborative effort to enhance program evaluation skills: the SARP Evaluation Project. Prior to initiating this study, entry into these diverse agencies had already been established, and a background interview was completed with each site. These preliminary data indicated that the agencies in this study were organizationally, geographically, and programatically diverse enough to provide considerable variability for comparison and contrast. (4.) Of the 24 direct service delivery programs, 7 advocacy programs did not distinguish between rape and domestic violence and were not considered for the case study. At the onset of this study, four agencies were still in the process of developing advocacy programs, and these programs were also dropped from consideration. (5.) One additional site was dropped from consideration at this stage, as information regarding priority of sexual assault within the agency was not available. (6.) According to Fleiss (1971), kappas of .40-.60 are fair, .60-.75 are good, and values greater than .75 are excellent (as cited in Pett, 1997). (7.) Using nonparametric statistics, the predictive ability of this index was tested to determine whether the index scores could distinguish between high-support cases and low-support cases (as classified by the organizational resources proxy measures used during case selection). The results of the Mann--Whitney test (z = -2.18, one-tailed p < .05), a nonparametric alternative to the independent t test, indicated that high-support settings had significantly more supportive characteristics (M = 14, SD = 6.38) than did low support settings (M = 5.5, SD = 2.65). (8.) A Kruskal-Wallis test, the nonparametric alternative to one-way ANOVA, indicated
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    • (2.) To whom correspondence should be addressed at Department of Psychology, University of Illinois at Chicago, 1007 West Harrison, Chicago, Illinois 60607-7137; e-mail: swasco@uic.edu. ------------------------------------------------------------------------ Questia Media America, Inc. www.questia.com Publication Information: Article Title: A multiple case study of rape victim advocates' self-care routines: the influence of organizational context. Contributors: Rebecca Campbell - author, Marcia R. Clark - author, Sharon M. Wasco - author. Journal Title: American Journal of Community Psychology. Volume: 30. Issue: 5. Publication Year: 2002. Page Number: 731+. COPYRIGHT 2002 Plenum Publishing Corporation; COPYRIGHT 2002 Gale Group