Copy of Taking Back Control presentation

Rape Crisis Centres have been providing vital support for victim-survivors for forty years.

Funding issues led to a marked decline in Rape Crisis provision over the 1990s and into the early 2000s.

New funding and commissioning landscape - more important than ever before that effectiveness of interventions can be demonstrated.

Little academic research internationally, and none in the UK, that has looked at the outcomes over time.

Funded by Northern Rock Foundation to do this work.

• The final tool consisted of 15 items administered by counsellors on the first or second week, and again every 6 weeks as appropriate.

• Clients were asked to indicate their response on a scale of 1 - 5, with 1 representing 'strongly agree' and 5 representing 'strongly disagree'.

• Broad approach: a feminist, woman-centred, empowerment model in line with the ethos of the Rape Crisis movement.

• Two sets of results: responses at the first time point (sample size 260) and change in responses over time (sample size 87).

• Most identified as female, white British, and had experienced rape at least one year ago.

• Perceived control over one's own life is an important factor in psychological well-being.

• Perceived control over the recovery process reduces distress, and is even more helpful than the belief that future attacks are unlikely.

• A panic attack is a sudden increase in anxiety which can be so intense that the person feels that they are going to die.

• Panic attacks have frequently been documented amongst survivors of sexual violence

• Sexual abuse in childhood quadruples the risk of panic attacks in adulthood (Goodwin et al., 2005).

• Sexual violence is associated with the development of many different phobias, especially social phobia (intense anxiety in social situations) and agoraphobia (extreme fear of situations where escape could be difficult).

• Victim/survivors may fear and subsequently avoid cervical screening tests, which could have serious consequences for their physical health.

• Rape Crisis workers told us that clients had reported many different fears, including soap, the light, going to sleep, and certain sensations.

• Self blame is common amongst survivors of sexual abuse. The more a woman blames herself for the assault, the greater her likelihood of experiencing depression, PTSD and feelings of helplessness.

• Stigma surrounding sexual assault is common across society, and many women also fear blame from others.

• Women who feel responsible for what happened to them or fear that others will hold them responsible may be less likely to report the assault.

• Previous research has shown a strong link between sexual violence and self harm (Maniglio, 2011; Campbell et al., 2007).

• All our interviewees said that self harm was used by many of their clients.

NB There was disagreement amongst counsellors as to whether this measure should be included in our study, as some felt that women may not feel able to disclose illegal behaviour. We have subsequently made it an optional measure in the final version of the tool.

I do not feel responsible for what happened to me

Relevance of measure

• "They wonder what it was they did wrong. When you blame yourself it is impossible to seek justice." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

38% of women strongly/disagreed with the statement 'I do not feel responsible for what happened to me'.

First: 33% (disagree)

Last: 22%

Difference: 11%

I feel well enough to work or study

Relevance of measure

I have a fear or phobia that prevents me from doing everyday things

• The psychological benefits of returning to work following trauma have been well documented.

• Rape victim/survivors' day to day functioning can be impaired for up to eight months (Resick et al., 1981).

• Support is crucial - any delay in its provision can lead to chronic work-related impairments (Bursztajn, 2001).

Relevance of measure

• "We can help women overcome their feelings of self blame which in turn have an impact on their health and relationships and their study or work." (Rape Crisis worker)

• "We had a woman who was afraid of cream. This reminded her of the perpetrator’s semen." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

First point of data collection:

A third (33%) of respondents strongly/agreed they had a fear or phobia which stopped them from doing everyday things.

Changed responses:

First: 40%

Last: 29%

Difference: 11%

42% of women strongly/disagreed that they felt well enough to work or study.

First: 45% (disagree)

Last: 29%

Difference: 16%

I feel depressed

I over-eat, under-eat or use food as a means of control

Relevance of measure

• Studies suggest that around half of women who are sexually assaulted will develop depression (Machado et al., 2011).

• Recent cuts to mental health services mean that Rape Crisis services are even more important. Cognitive therapy can have more enduring effects than antidepressants (DeRubeis et al., 2008).

• Research has consistently documented a strong relationship between sexual violence and eating disorders.

• Carter et al. (2006) found that around half of female inpatients with anorexia had a history of child sexual abuse.

• Similarly, Faravelli et al. (2004) found that over half of the women who had been raped in the last four to nine months had developed an eating disorder.

• "Much of our work is with women who have depression and have been prescribed medication. Our therapy is an alternative to that." (Rape Crisis worker)

• "I suppose something that springs to mind initially is that I have quite a few clients who have responded to their trauma by developing an eating disorder. This obviously has a knock on effect for their health and well being." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

The majority of respondents (73%) strongly/agreed that they felt depressed.

The majority (56%) of women strongly/agreed with the statement.

First: 72%

Last: 56%

Difference: 16%

First: 57%

Last: 47%

Difference: 10%

I have thoughts about ending my life

Relevance of measure

• Victim/survivors of sexual abuse are at least four times more likely to attempt suicide than people who have not been abused (Chen et al., 2010).

• A study by Bebbington et al. (2009) suggested that, if sexual abuse were eliminated, the number of women attempting suicide would fall by 28%.

• "It’s quite common for women to feel suicidal. There is a danger that we don’t ask the things we should be asking. We shouldn’t be afraid to ask these questions, they are really relevant." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

41% of women strongly/agreed that they had thoughts about ending their life.

First: 39%

Last: 23%

Difference: 16%

I use self harm to help me cope with my feelings

Relevance of measure

• "We are seeing more and more cases of women using self harm as a coping mechanism. We know that workers within the NHS have little understanding and often their response is one of impatience." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

20% of women strongly/agreed that they used self harm to help them cope with their feelings.

First: 17%

Last: 7%

Difference: 10%

I have panic attacks

Relevance of measure

Results

• "It’s often different for each woman, they may be fearful of going out, or if it happened at home, afraid to stay in." (Rape Crisis worker)

I use non-prescribed drugs (such as heroin, cocaine, speed, cannabis) to help me cope.

Findings

First point of data collection:

Changed responses

Relevance of measure

64% of women strongly/agrede that they have panic attacks.

First: 68%

Last: 43%

Difference: 25%

• Sexual assault increases the likelihood that a woman will develop a substance misuse disorder.

• The health service response to a woman’s needs as a substance misuser is unlikely to see long term success unless her needs as a victim of sexual violence are also addressed - this has important implications in terms of funding.

I use alcohol to help me cope

• "Over time their issues can become more complex. It becomes so deep rooted that many women think it is just the way they are rather than the direct result of the abuse." (Rape Crisis worker)

Relevance of measure

Findings

First point of data collection:

• Sexual abuse increases the risk of alcohol problems.

• Kilpatrick et al. (1997) found that rape survivors were over 13 times more likely to become dependent on alcohol.

• Similarly, women who were sexually abused as children are between 4 and 7 times more likely to become addicted to alcohol.

• Rape victim/survivors also tend to be more severely impaired by their alcohol dependency than other people with the same condition.

Changed responses:

9% of women strongly/agreed that they used non-prescribed drugs to help them cope.

First: 6%

Last: 2%

Difference: 3%

• "To have been abused by someone you love and trust and who should be there to provide and care for you is, (pause), well, I don’t think women are aware of why they are drinking too much or why they are self harming." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

24% of women strongly/agreed that they use alcohol to help them cope.

First: 28%

Last: 11%

Difference: 16%

I have 'flashbacks' about what happened

Relevance of measure

• Flashbacks are very intense sensory and emotional experiences which often feel as though a trauma is being re-lived.

• They are extremely common amongst rape survivors.

• Survivors may experience flashbacks for years after the assault.

• "The image may be visual and can also be accompanied by the feelings, smells and sounds associated with the assault. It’s as if that person is right back in the experience, no matter how long ago it had taken place." (Rape Crisis worker)

Findings

I feel empowered and in control of my life

First point of data collection:

Relevance of measure

Changed responses

The majority (83%) strongly/agreed that they had flashbacks about what happened.

Administration of the Taking Back Control tool

First: 84%

Last: 57%

Difference: 26%

• "It’s about independence, choice, regaining self confidence and assessing whether they are taking control back over their life." (Rape Crisis worker)

Findings

First point of data collection:

Changed responses:

Over half (55%) of respondents strongly/disagreed that they felt empowered and in control of their life.

First: 61% (disagree)

Last: 31%

Difference: 30%

What next?

• All centres were able to give examples in which the tool was useful to them, such as in funding applications and training sessions.

• The changes which were suggested at the end of the pilot testing were used to create a final draft of the tool. This included simplifying the reporting of the results and scaling all measures in the same way.

• How you can use this research 1.
• Start using the tool within your organisation (its free and we can help you with this!)

Example -

• How you can use this research 2.
• Include the existing findings within your funding applications (its free and we can help you with this!)

Taking Back Control

Creation of the Taking Back Control tool

Interviews with Rape Crisis staff

Collation and review of existing tools and measures

International literature review

Collate all potential items and produce list of draft items

Interviews with funders and commissioners

Identify and review all relevant government policy

Meet with Rape Crisis staff teams to discuss draft items and implementation

Design electronic database

Finalise items and wording

The Taking Back Control tool

Aims of the research

1)

2)

3)

Develop and pilot an outcome measurement tool tailored to the work of Rape Crisis Centres.

Encourage the collection of data within Rape Crisis Centres.

Explore the impact of Rape Crisis counselling on women’s health, mental health and well-being.

Dr Nicole Westmarland

Durham Centre for Research into Violence and Abuse (CRiVA)

nicole.westmarland@

durham.ac.uk

Introduction