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1University of North Carolina at Chapel Hill2Carolinas Rehabilitation, Charlotte, NC3Ridgeview Institute, Atlanta, GA

Corresponding Author:Rebecca J. Macy, School of Social Work, Tate-Turner-Kuralt Building, 301 Pittsboro Street,

CB #3550, Chapel Hill, NC 27599

Email: [email protected]

Domestic Violence

and Sexual Assault

Service Goal Priorities

Rebecca J. Macy, PhD, MSW,1

Natalie Johns, BS,2 Cynthia F. Rizo, MSW,1

Sandra L. Martin, PhD,1 and Mary Giattina, MSW3

Abstract

We investigated agency directors perspectives about how service goals should

be prioritized for domestic violence and sexual assault service subtypes, includ-

ing crisis, legal advocacy, medical advocacy, counseling, support group, and

shelter services. A sample of 97 (94% response rate) North Carolina domestic

violence and/or sexual assault agency directors completed a survey askingparticipants to rank the importance of service goals. Overall, participants con-sidered emotional support provision to be a critical service goal priority acrossall service types. Social support and self-care service strategies were deemedless important. However, prioritization of other service goals varied depending

on the service type. Statistically significant differences on service goal prioritiza-

tion based on key agency characteristics were also examined, and agency char-acteristics were found to relate to differences in service goal prioritization.

Keywords

domestic violence, partner violence, sexual assault, sexual violence, services

Article

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3362 Journal of Interpersonal Violence26(16)

Many partner and sexual violence survivors seek help from community-based

domestic violence and sexual assault agencies (Hutchison & Hirschel, 1998;

Ingram, 2007; Macy, Nurius, Kernic, & Holt, 2005) because survivors needs

are often not met by health, human, and legal services (Campbell, 2006; Hazen

et al., 2007; Kunins, Gilbert, Whyte-Etere, Meissner, & Zachary, 2007; McKie,

2003; Plichta, 2007; Tower, McMurray, Rowe, & Wallis, 2006). Thus, domestic

violence and sexual assault agencies offer an important and unique human

service. Regrettably, there is limited empirical evidence about the effective-

ness of these services (Abel, 2000; Mears, 2003; Wathen & MacMillian, 2003;

Whitaker, Baker & Arias, 2007). The lack of evidence-based domestic vio-

lence and sexual assault services is a worrisome knowledge gap that causes

problems for practice, policy, and funding advancements (MacMillan et al.,2009; Moracco & Cole, 2009).

Evidence-Based Practices

and Services for Violence Survivors

There is a growing consensus about the necessary steps for evidence-based

practice development among intervention researchers (Carroll & Nuro, 2002;

Fraser, Richman, Galinsky, & Day, 2009; Muser & Drake, 2005). Briefly,they include: (a) conceptualizing an intervention and designing a treatment

manual, (b) conducting pilot and feasibility trials, (c) conducting randomized

efficacy and then effectiveness trials, and (d) adapting the intervention for

dissemination across diverse settings and communities. Even though there is

widespread acceptance of this intervention research paradigm, few social and

behavioral interventions could be considered a gold standard evidence-based

practice.

Although domestic violence and sexual assault services are already wellestablished and regularly delivered in communities throughout the United

States, few of these programs have been rigorously documented or tested,

though notable exceptions exist (e.g., Sullivan & Bybee, 1999). Work has

been done to document recommended practices (for a comprehensive review

of this literature, see Macy, Giattina, Sangster, Crosby, & Montijo, 2009),

and preliminary, quasi-experimental evaluations have been conducted on

domestic violence and sexual assault services (e.g., Edleson & Frick, 1997;

Riger et al., 2002; Wasco et al., 2004). In light of the research paradigm

described above, the state of knowledge about domestic violence and sexual

assault services could be considered preliminary.

Unfortunately, for those wanting to conduct efficacy and effectiveness

studies on domestic violence and sexual assault services, there are serious gaps

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Macy et al. 3363

in the work on conceptualizing domestic violence and sexual assault services

(e.g., What are the theories of change that underlie these services? What are

the services goals and delivery strategies?), as well as in the work to document

these services into manuals. More specifically, there is little research about

how these services should be delivered (Abel, 2000; Macy et al., 2009). Thus,

the knowledge required for the first step in the development of an evidence-

based practice (i.e., conceptualizing an intervention and designing treatment

manual) is incomplete.

Even with literature describing how these services are best delivered, the

current state of service delivery has been described as a black box because

the inner workings of these services remain largely unknown. Furthermore,

within the broad framework of domestic violence and sexual assault services,many service types are often (but not always) offered by providers. These

service types, which include crisis, legal advocacy, medical advocacy, counsel-

ing, support groups, and shelter, are often delivered in different ways by different

providers, including volunteers, advocates, and counselors. Furthermore, these

servicesboth the services overall, as well as the various service typesdiffer

across communities because of their grassroots beginnings (Koss & Harvey,

1991; Pfouts & Renz, 1981).

In summary, there is a literature describing how domestic violence and sexualassault services are best delivered, but there is little research about whether

these recommended practices are used in community-based settings. To further

complicate matters, there is considerable variability in how these services are

delivered in practice because of differences in service types, providers, com-

munities, as well as the grassroots nature of these services. In addition, little is

known about what providers consider best practice strategies for each of the

specific service types. Given that these services are grassroots and community-

based and that the best practices literature has been largely developed by educa-tors and researchers, evidence from providers about how these services should

be delivered to best help survivors is critically important.

The Current Study

We investigated domestic violence and sexual assault agency directors opinions

of how service delivery goals should be prioritized to ensure that survivors

needs are met. Given their leadership positions in their agencies, directors are

important informants concerning the service delivery strategies that work well

for the survivors in their communities. However, there is little research about

service delivery practices from directors points of view. We investigated

directors opinions of how service delivery goals should be prioritized for the



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six service types that are often discussed in the domestic violence and sexual

assault services literature (Macy et al., 2009). These six service types are as

follows: (a) crisis services, (b) legal advocacy, (c) medical advocacy, (d) support

group, (e) individual counseling, and (f) shelter. We wanted to better understand

the extent to which service delivery goal priorities were similar and/or distinct

across these six service types.

We also investigated the extent to which directors opinions about service

delivery goals differed based on key agency characteristics, specifically: (a) the

rural/suburban/urban location of their agencies and (b) the agency service focus

(i.e., domestic violence, sexual assault, or both). Agencies may vary in their

service delivery practices because of their service foci, their community-based

nature, and their grassroots beginnings. Consequently, we posed this researchquestion: To the extent that there are significant differences in how directors

prioritize service delivery goals, does this variability relate to these differences

in agency characteristics?

Agency characteristics. On the basis of the existing literature, we hypothesized

that agency characteristics would relate to differences in service goal priorities.

Research shows that survivors have different needs based on the types of com-

munities in which they live. Vinton and colleagues (Vinton et al., 2007) identified

19 factors distinguishing rural survivors from their nonrural counterparts, suchas geographic and social isolation, higher gun ownership, and lack of trained

providers. Thus, providers from diverse agency locations (i.e., rural, suburban,

urban) may prioritize service goals differently based on the needs of survivors

in their locales.

We also posited that the focus of agency services (i.e., domestic violence

only, sexual assault only, combined domestic violence and sexual assault)

may relate to differences in directors perceptions for service goal priorities.

Domestic violence and sexual assault services are often conceived of anddescribed as distinct sets of services that are tailored to meet the needs of

survivors who experienced either domestic violence or sexual assault. More-

over, questions are found in the literature regarding how combined agencies

deliver services to survivors compared with single-focused agencies (Byington,

Martin, DiNitto, & Maxwell, 1991; OSullivan & Carlton, 2001). Nevertheless,

most sexual assault and domestic violence agencies in the United States and

in North Carolina (where the study was conducted) provide both of these

services and thus can be considered combined agencies (Bergen, 1996; Edmond,

2005). Consequently, we investigated differences in service goal priorities

based on whether an agency delivered sexual assault services only, domestic

violence services only, or delivered both of these services.



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Macy et al. 3365

Method

Participants and Procedures

We developed our sampling frame by relying on the websites of the following

organizations: (a) the North Carolina Council for Women/Domestic Violence

Commission (NCCWDVC), (b) the North Carolina Coalition Against Sexual

Assault (NCCASA), and (c) the North Carolina Coalition Against Domestic

Violence (NCCADV). Using these sources, we created a database of all North

Carolina domestic violence and sexual assault agencies and their executive

directors. We used the list of directors (n= 103) as our sampling frame.

We conducted the survey over a 10-week period. Before survey administra-

tion, the study protocols were approved by the Institutional Review Board atour university. A paper version and an electronic version of the survey were

made available. Typically, the agency executive director was the best person

to respond to the survey. In some cases, however, associate directors or other

staff members are in charge of overseeing agency services. Therefore, the

cover letter accompanying the survey invited the directors to either complete

the survey themselves or designate a staff member with the most knowledge

of the agencys services. To encourage survey participation, potential partici-

pants received multiple survey invitations via mail, e-mail, and telephone.Instructions for opting out of the study were also provided. There was a 94%

(n= 97) response rate to the survey.

Instrument

Our research team developed the survey questions based on an extensive

review of the literature and qualitative findings from in-depth interviews with

North Carolina domestic violence and sexual assault agency directors abouttheir services delivery practices (Macy et al., 2009; Macy, Giattina, Montijo,

& Ermentrout, 2010; Macy, Giattina, Parish, & Crosby, 2010). Directors who

participated in the interviews were also invited to participate in the survey,

though a year passed between the interviews and the survey administration.

After developing a draft survey instrument, two staff members at NCCADV,

NCCASA, and the NCCWDVC, along with four persons who had previously

delivered domestic violence and sexual assault services, piloted the survey

(n= 10). No one who piloted the survey was a member of the survey sampling

frame though all the pilot testers had experience delivering domestic vio-

lence and/or sexual assault services. The survey was finalized using pilot

feedback.



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Measures. Participants were asked their opinions about specific service deliv-

ery goals (e.g., emotional support, safety planning, help with social support,

and community referrals) for six subtypes of domestic violence and sexual

assault services: (a) crisis services, (b) legal advocacy, (c) medical advocacy,

(d) support group, (e) individual counseling, and (f) shelter. For each of the

service subtypes, participants were asked to rank the importance of specific

service goals. Participants were asked to give the ranking of 1 to the item

they felt was the most importantfor a survivor to receive from that service, 2

for thesecondmost important, 3 for the thirdmost important, and so on.

For each of the six service subtypes (crisis services, legal advocacy, medical

advocacy, etc.), the survey included two-item types. First, the survey included

goals that are common to all six service subtypes (e.g., emotional support, safetyplanning). Examples of these survey ranking items are as follows: (a) Client

received emotional support, such as kindness, caring, and empathy for the

emotional supportitem and (b) Client received help with planning for safety,

such as vary routine, plan for what to do if perpetrator becomes violent again,

memorize emergency numbers for the safety planningitem. Such ranking

items were listed with all six service subtypes.

Second, the survey included goals that are unique to service subtypes. For

example, the service goal of legal accompaniment is only relevant to legaladvocacy. Thus, to capture information about unique service goals, each set of

survey ranking items for the six service subtypes (crisis services, legal advocacy,

counseling, etc.) listed goals specific to that service. Examples of these survey

ranking items are as follows: (a) Client was accompanied to court, trials, and

legal meetings for the legal accompanimentitem listed with legal advocacy;

(b) Client received information about medical options, as appropriate to advo-

cacy role and not in conflict with advice of medical professionals for the

medical information ranking item listed with medical advocacy; and (c) Clientreceived a safe place to live free from violence for the safe shelterranking

item listed with shelter services. Furthermore, instructions asked participants

to answer questions only if their agencies provided that specific service. Some

agencies, such as those that provide only sexual assault services, do not offer

shelter services. Thus, the number of items ranked by each participant varied

depending on the number of services their agency provided. The survey also

included questions about agency and participant characteristics.

Analysis

First, frequencies and percentages were conducted on participant and agency

characteristics. Then, to address the first aim, descriptive analyses were used

to identify directors opinions about service goal priorities with medians and



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Macy et al. 3367

ranges. These finding are presented in Table 1. Table 2 shows the rankings of

each service goal priority for the various service subtypes. Each service goal

priority is ranked first (highest priority) to last (lowest priority) based on the

overall medians in Table 1. Table 2 also shows the similarities and differences

in service delivery priorities across the service subtypes for the overall sample.

The second aim was to investigate to what extent service goal priorities dif-

fered based on specific agency characteristics. We used the KruskalWallis

test for these analyses because it is a nonparametric method for assessing the

equality of population medians among groups. That is, the KruskalWallis test

uses the sum of the ranks for each group to calculate the test statistic. We tested

for significant differences in rankings based on two agency characteristic

groupings. Participants were grouped by (a) agency location: rural, urban/suburban, and both rural and urban/suburban and (b) agency service focus:

domestic violence only, sexual assault only, and both domestic violence and

sexual assault. Statistical analyses were then conducted in SPSS 18.0. All

statistically significant findings are presented in Tables 3 and 4.

Results and Discussion

Participant and Agency Characteristics

Most participants described themselves as a director (n= 80; 82.47%), with

the remaining participants describing themselves as an advocate or other.

Over half of the sample reported being employed in their current position for

no more than 5 years (n= 52; 54.7%). However, 22 participants (23.2%)

reported 6 to 10 years in their current position; 5 participants (5.3%) reported

11 to 15 years; and 16 participants (16.8%) reported 16 or more years. Most

participants had completed either graduate degrees (n= 40; 41.2%) or 4-yearcollege degrees (n= 32; 32.9%). Fourteen (14.4%) had completed community

college or associate degrees, and 11 (11.3%) had completed high school and/

or some college. On average, agencies had eight full-time employees and five

part-time employees. However, staff numbers ranged from 1 to 100 full-time

employees and from 0 to 20 part-time employees. Forty-three (44.3%) agen-

cies had five or fewer staff members; 38 (39.2%) agencies had 6 to 10 staff

members; 16 (16.5%) agencies had 11 or more staff members. Most participants

came from combined agencies that provided both domestic violence and sexual

assault services (n= 67; 69.8%), with 18 participants (18.8%) from agencies

that provided domestic violence services only and 11 (11.5%) from agencies

that provided sexual assault services only. Most participants came from agen-

cies that provided their services to survivors only in rural communities (n=

66; 68.0%); 13 (13.4%) provided their services only in urban/suburban



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3368

Table1.Rank-OrderDescriptiveStatisticsforServiceGoalsAcrossServiceTypes(1=M

ostImportant;1

0=L

eastImportant;

n=8

7to64a)

Crisis

Legal

advocacy

Medical

advocacy

Support

group

Individual

counseling

Shelter

Median

(ran

ge)

Median

(range)

Median

(range)

Median

(range)

Median

(range)

Median

(range)

Commongoals

Communityreferrals

5.00

(1-7)

7.00(2-9)

6.00(2-9)

7.00(3-9)

5.00(2-8)

5

.00(2-10)

Emotionalsupport

1.00

(1-7)

2.00(1-9)

1.00(1-9)

1.00(1-9)

1.00(1-8)

2

.00(1-10)

Safetyplan

ning

2.00

(1-7)

4.00(1-9)

4.00(1-9)

5.00(1-9)

2.00(1-8)

3

.00(1-10)

Self-carestrategies

6.00

(1-7)

9.00(1-9)

8.00(1-9)

5.00(1-9)

6.00(1-8)

8

.00(2-10)

Socialsupport

5.00

(2-7)

8.00(1-9)

7.00(3-9)

7.00(1-9)

6.00(1-8)

8

.00(2-10)

Violenceinformation

4.00

(1-7)

6.00(1-9)

6.00(2-9)

4.00(1-9)

3.00(1-8)

5

.00(2-10)

Uniquegoals

Agencyinformation

4.00

(1-7)

Relationshipswithothers

5.00(1-9)

7

.00(1-10)

Helpwith

lifeproblems

6.00(1-9)

6.00(1-8)

6

.00(2-10)

Accompan

iment

4.00(1-9)

2.00(1-9)

Legal/medicalin

formation

2.50(1-9)

3.00(1-8)

Self-esteem

4.00(1-9)

4.00(1-8)

7

.00(2-10)

Victimsco

mpensation

3.00(1-9)

5.00(1-9)

Safeshelte

r

1

.00(1-10)

Note:Rangesreflectthenumberofgoalitem

sforeachservicetype,from1

to7,1to8,1to9and1to10.

a.Samplerangenonresponsebecauseparticipantswereinstructedtoskipsurveyquestionsforservicesth

eiragenciesdidnotprovide.



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3369

Table2.Ser

viceGoals:PrioritizingWhatSurvivorsShouldReceive

FromServices,Highest(1)toLowest(10)BasedonSurvey

ParticipantsMedianRankings(1=M

ost

Important;10=L

eastImportant;n=8

7to64a)b

Ranking

Crisis

Legaladvocacy

Medical

advocacy

Supportgroup

Counseling

Shelter

1

E

motional

support

Emotional

support

Emotional

support

Emotional

support

Emotional

support

Safeshelter

2

S

afety

planning

Legal/medical

information

Legal/medical

accompaniment

Self-esteem

Safety

planning

Emotion

al

support

3

V

iolence

information

Victims

compensation

Legal/medical

information

Violence

information

Violence

information

Safetyplanning

4

A

gency

information

Legal/medical

accompan

iment

Safetyplanning

Safetyplanning

Self-esteem

Violence

informa

tion

5

C

ommunity

referrals

Safetyplan

ning

Victims

compensation

Relationshipswith

othersurvivors

Community

referrals

Community

referrals

6

S

ocial

support

Violence

information

Violence

information

Self-care

strategies

Helpwithlife

problems

Helpwithlife

problem

s

7

S

elf-care

strategies

Communit

y

referrals

Community

referrals

Helpwithlife

problems

Social

support

Self-esteem

8

Socialsupp

ort

Socialsupport

Community

referrals

Self-care

strategies

Relationshipswith

othersurvivors

9

Self-care

strategies

Self-care

strategies

Socialsupport

Self-care

strategies

10

Socialsu

pport

a.Samplerangenonresponsebecauseparticipantswereinstructedtoskipsurveyquestionsforservicesth

eiragenciesdidnotprovide.

b.Tobreaktie

s,weanalyzedthefrequencies

aboveandincludingthemedia

nforeachgoal.Wechosethe

goalwiththehigherfrequencyofrating

thegivengoalasmoreimportant.



11/23


communities; and 16 (16.5%) provided their services in both rural and urban/

suburban communities. We also conducted a chi-square analysis on the

relationship between service foci and service geography. We determined that

there was a significant relationship between these two agency characteristics

(2= 18.73, df= 4,p .001), with combined agencies being most often serving

rural communities.Next, we discuss the service goal results from the research. We present our

results along with a discussion of the results due to the complex nature of the

findings. We discuss the ways that each study finding is consistent with, or is

not consistent with, the literature and research on domestic violence and sexual

assault service delivery goals priorities.

Overall Service Delivery Goal Priorities

Common service goals. The first aim of this study was to identify directors

overall opinions about service delivery goals among the various domestic vio-

lence and sexual assault service subtypes. Tables 1 and 2 show that on the

whole, the directors in this sample highly ranked the provision of emotional

support as an important goal across the different service subtypes. This finding

Table 3. Mean Ranks and KruskalWallis Test for Crisis Service, Medical Advocacy,Support Group, and Counseling Goals by Agency Location

Rural only

Urban/suburban

only

Rural andurban/

suburbanKruskalWallis

Mean rank Mean rank Mean rank 2 (df)

Crisis goals

Safety planning 42.29 29.64 54.35 6.64 (2)**

Community referrals 47.81 28.18 34.04 8.60 (2)**

Medical advocacy goals

Safety planning 33.78 19.00 42.30 6.25 (2)**

Support group goals

Self-esteem 41.71 48.15 27.46 5.90 (2)*

Self-care strategies 41.35 49.06 26.11 6.99 (2)**

Counseling goals

Emotional support 39.60 53.50 35.79 5.70 (2)*

Note: Chi-squares are KruskalWalliss approximation of chi-squares. Survey responses wereranked so that lower numbers reflect higher importance.

*p< .06. **p< .05. ***p< .01. ****p< .001.



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resources; and (d) securing independent housing, as a few examples (Lindhorst,

Nurius, & Macy, 2005; Roberts & Roberts, 2002). Consequently, our finding

helps to substantiate safety planning as best practice recommendation consistent

with the literature.

Remarkably, the provision of violence information as a service goal priority

was only ranked as moderately important in this study, which is not consistent

with the service literature. Rather, the literature recommends offering survivors

a greater understanding of the effects of violence and trauma because providing

information is an expression of the empowerment philosophy that is the

foundation of domestic violence and sexual assault movements (Gilbert, 1994;

McDermott & Garofalo, 2004; Roberts & Roberts, 2002; Tutty & Rothery,

2002; White Krees, Trippany, & Nolan, 2003). We speculate that the provisionof information may not be considered an unimportant service strategy among

these participants given its overall ranking as moderately important across service

subtypes. Instead, this finding may reflect that the provision of information may

not be as important as other service strategies, such as safety planning.

The study findings show that several goals were ranked consistently lower

priorities across service subtypes, including the provision of community refer-

rals, helping survivors with self-care strategies, and helping survivors with

building social supports. Our findings regarding community referrals are notablebecause experimental research on domestic violence advocacy has determined

greater access to community resources to be important (Bybee & Sullivan,

2002; Sullivan & Bybee, 1999). Also, the finding that self-care strategies were

ranked as a lower service priority relative to other service goals was notable

because this service strategy has been found to be a best practice in other

research (Gorde, Helfrich, & Finlayson, 2004).

Our finding that directors rank social support strategies as less important

relative to other service goals was also unexpected because social support hasbeen identified as a factor associated with partner violence survivors resilience

(Carlson, McNutt, Choi, & Rose, 2002). However, other research is mixed

about the usefulness of social support for sexual assault survivors because of

negative social reactions from friends, family, and providers (Ullman, 1996).

Thus, this finding may reflect the uncertain nature of social reactions to violent

victimization.

Unique service goals. This studys findings about the differences in the rank-

ings for the goals of legal and medical accompaniment, legal and medical

information, and victims compensation shed light on the differences between

the delivery of legal and medical advocacy in community-based practice among

this sample of directors (see Tables 1 and 2). For medical advocacy, our find-

ings show that medical accompaniment is the service strategy priority followed



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Macy et al. 3373

by the provision of medical information. For legal advocacy, the study find-

ings show that the provision of legal information and help with victims com-

pensation are clear priorities, though legal accompaniment is the next priority.

Although the service strategy of helping survivors to improve their self-esteem

is a recommended best practice in the domestic violence and sexual assault

literature (Macy et al., 2009), it was only ranked as a moderate to low priority

for support group, counseling, and shelter services in this study. Likewise,

helping survivors with other life problems as needed was ranked a low priority

by participants in our sample, even though a recommendation in the domestic

violence literature is for providers to help survivors with safety by attending

to their needs in holistic and individualized ways (Lindhorst et al., 2005).

Service Delivery Goal Priority Differences

Agency location differences. In this study, agencies that serve rural, urban/

suburban, and both rural and urban/suburban locales were found to have statisti-

cally significant differences in prioritizing goals for crisis, medical advocacy,

counseling, and support group services (see Table 3). In the context of crisis

services, the findings show that the participants from agencies serving urban/

suburban communities more highly prioritized the provisions of communityreferrals and safety planning, as well as safety planning in the context of medi-

cal advocacy, relative to participants from agencies that served rural locales in

a dedicated way or as part of their service geography overall. We speculate that

the emphasis on community referrals for urban/suburban providers in this study

may reflect the reality that there are more services to which to refer in these

communities relative to rural ones. The reasons why urban/suburban participants

in this study placed a priority on safety planning is less apparent. However,

these study findings may suggest a potentially important service provision dif-ference for urban/suburban communities that future research should investigate

to eliminate the possibility of a finding by chance. Likewise, our findings that

urban/suburban directors prioritized the provision of emotional support in the

context of counseling as less of a priority relative to other participants also

requires additional research. One interpretation of these study findings is that

participants in agencies serving rural/urban/suburban communities more highly

prioritized self-esteem and self-care strategies for support groups to reflect a

general service approach, which works well across all communities.

Agency services focus differences. We found in this study that agencies that

are dedicated to domestic violence, dedicated to sexual assault, or provide

both domestic violence and sexual assault services have significant differences

in prioritizing crisis, medical advocacy, counseling, and support group service



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goals (see Table 4). In the context of crisis services, the participants from

agencies dedicated to sexual assault services prioritized the provision of emo-

tional and social support strategies more highly and the provision of safety

planning less highly than participants from agencies that provide domestic

violence services in either a dedicated or combined fashion. Though this find-

ing was only marginally significant, it may reflect the importance of emotional

support for sexual assault survivors in the immediate aftermath of violence.

Given the mixed findings in the sexual assault literature regarding the useful-

ness of friends and family for social support (Ullman, 1996), it is notable that

social support strategies were ranked in this study as more important in the

context of crisis services among participants at agencies that focus on sexual

assault. However, we speculate that our study findings suggest that planningfor safety is considered a more important crisis service goal for participants

from domestic violence agencies because many partner violence survivors

needing crisis services may be still involved in dangerous situations.

Similarly for support group services, the participants from agencies dedi-

cated to sexual assault services prioritized the provision of self-esteem, self-

care, and the development of relationships with other survivors more highly

than participants from agencies that provide domestic violence services. These

study findings are consistent with the sexual assault services literature, whichemphasizes the import of support groups for fostering self-esteem, promoting

the development of relationships with others who survived similar experiences,

and increasing self-care strategies (Koss & Harvey, 1991). Conversely, our

findings showed that the participants from sexual assault agencies did not

prioritize the provision of violence information as highly as the participants

from agencies that provide domestic violence services. Thus, our study find-

ings show that the provision of violence information may be a more important

service goal for partner violence survivors relative to sexual assault survivorsin the context of support group services.

Also in this study, participants from agencies with a combined focus tended

to rank safety planning as a higher priority for medical advocacy than partici-

pants from agencies that provide a dedicated service, either domestic violence

or sexual assault. In light of these findings, we posit that this service goal

priority for directors from combined agencies may reflect a generic approach

to medical advocacy for both survivors of partner violence and sexual assault.

Alternatively, this finding may reflect the fact that directors of combined

agencies know from experience that many violence survivors have experienced

both domestic violence and sexual assault and that providing safety planning

is especially helpful to survivors of multiple violent traumas in the context of

medical advocacy. Future research should focus on how to tailor medical



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Macy et al. 3375

advocacy services to survivors of (a) partner violence, (b) sexual assault, and

(c) both partner violence and sexual assault. Study participants from combined

agencies also tended to rank social support strategies for counseling as a lower

priority than participants from agencies that provide a dedicated service, either

domestic violence or sexual assault. Given the mixed findings about social

support in this study as well as the other literature cited earlier, we echo our

recommendation that future research carefully investigate the utility of this

practice for survivors of both partner violence and sexual assault.

Conclusions

Domestic violence and sexual assault agencies offer important and unique servicesfor violence survivors. Unfortunately, limited evidence about service effectiveness

poses a considerable barrier for practice, policy, and funding advancements.

A key challenge to the development of an evidence-based practice research

agenda for domestic violence and sexual assault services is the dearth of empirical

information about the inner workings of these services. Though there is grow-

ing attention to domestic violence and sexual assault service evaluation and

though there are articles, books, and manuals describing best practices, these

streams of research have not been well integrated. Moreover, evidence about theways that community-based providers deliver services in their everyday practice

is needed, including how practices may vary because of agency differences.

With findings from a statewide survey of agency directors, this study pro-

vides information to help address these knowledge needs. More specifically,

the study presents findings about service delivery goals for crisis, legal advo-

cacy, medical advocacy, support group, individual counseling, and shelter. The

literature concerned with the development of evidence-based practice manuals

recommends the documentation and empirical verification of theories ofchange, service strategies, service formats, and service goals (Carroll & Nuro,

2002; Fraser et al., 2009; Saunders, Berliner, & Hanson, 2004). By helping

to determine how those delivering these services think they are best delivered

in their community-based settings, the findings from this research may be

helpful in developing evidence-supported service manuals.

Some of the findings are consistent with the service recommendations found

in the best practices literature (e.g., the importance of emotional support).

However, the relatively low ranking of some service goals, such as the provi-

sion of community referrals, is not consistent with the literature. Such con-

tradictory findings suggest the need for researchers to investigate effective

service strategies while considering the realities of community-based practice.

In addition, the different findings about the importance of social support service



17/23


strategies point to the import of investigating the complex nature of social

support for violence survivors.

This study also presents information about how service goal priorities differ

based on agency characteristics. The findings regarding the differences in crisis

and support group service goal priorities point to ways that these services

may need to be differentiated between sexual violence and partner violence

survivors, as well as tailored for delivery in urban/suburban areas. The findings

regarding differences in combined services and services delivered by agencies

that serve rural/urban/suburban areas may point to a general service strategy

that is offered by these agencies. Such a general service strategy should be

evaluated in future research efforts, including its helpfulness relative to tailored,

specialized services.Nonetheless, we note the relationship between the agency characteristics of

service foci and geography. In light of this relationship, some of the common

significant findings may be due to either or both of these characteristics. Unfor-

tunately with this study, we are not able to determine which characteristic (or

both) made the difference in some of the significant findings. Though it is not

surprising that agencies in rural areas where there are fewer resources would

provide both domestic violence and sexual assault services, future research

should use larger, national samples to further investigate these agency char-acteristics and their relationships to service delivery practices.

We also note how few significant differences were determined based on the

type of service provided either by agency or by the agency service locale. For

example, it is striking that we did not find any significant differences in service

goal priorities for legal advocacy among participants at dedicated domestic

violence and sexual assault agencies or any significant differences for shelter

services among participants at rural and urban/suburban agencies. Although

there are statistically significant differences and these are worthy of consider-ation, we encourage readers to be mindful of our nonsignificant findings too.

Domestic violence and sexual assault services are often described as distinct

sets of services, and the practices of rural and urban agencies have been posited

to be markedly different. However, our research findings suggest more service

commonalities than differences on these agency characteristics.

Limitations

We also encourage readers to be mindful that a low priority ranking for a

service goal does not imply that a goal is unimportant. Such findings only

suggest that the service goal may be less important in a certain service context



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Macy et al. 3377

relative to other goals. The sample only included directors from North Carolina

agencies, thereby limiting the generalizability of the results. However, the

comprehensiveness of the sampling frame and high response rate (94%) provide

assurance that the findings are representative of the state. We investigated

directors opinions of how service delivery goals should be prioritized for the

six service types that appear most often in the domestic violence and sexual

assault services literature. However, there are other important domestic violence

and sexual assault services (e.g., lethality risk assessment) that are worthy of

investigation.

Another limitation is that these findings are based on directors opinions

about service goal priorities. Thus, we recommend empirical testing of these

service goal priorities especially in light of the dearth of evidence-based prac-tices for domestic violence and sexual assault services. Given that the findings

from this study help address the first step in the development of evidence-based

domestic violence and sexual assault practices (i.e., conceptualizing an inter-

vention and designing treatment manual), we encourage future research to

investigate the efficacy and effectiveness of these services.

We also recommend an investigation of other agency staff members perspec-

tives about helpful domestic violence and/or sexual assault services for survivors.

Frontline staff members perspectives about services may vary in importantways from directors. An additional next step should include an investigation

of what service strategies survivors find most helpful in securing safety and

recovering from the trauma of violence. Such research should also investigate

what service strategies survivors from diverse backgrounds deem as most help-

ful. Unfortunately, violence services have been largely developed and evaluated

in culturally neutral ways (Bent-Goodley, 2005, p. 196), including this study.

Thus, work is urgently needed to determine how domestic violence and sexual

assault services are best delivered to diverse survivors from nonmajoritycultures and groups.

Acknowledgments

We wish to acknowledge Lydian Altman-Sauer, Barry Bryant, Pam Dickens, Margaret

Henderson, Carol Nobles, Leslie Starsoneck, Gordon Whitaker, the staff of the North

Carolina Council for Women/Domestic Violence Commission, the staff of the North

Carolina Coalition Against Domestic Violence, and the staff of the North Carolina

Coalition Against Sexual Assault for their help with developing the survey instrument.

We also wish to acknowledge Tamara Sangster for her contributions to this research,

as well as Susan White and Diane Wyant for their comments on earlier drafts of this

manuscript.



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Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the authorship

and/or publication of this article.

Funding

This project was supported by Award No. 180-1-05-4VC-AW-463 awarded by the U.S.

Department of Justice, through the North Carolina Department of Crime Control &

Public Safety/Governors Crime Commission.

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Bios

Rebecca J. Macy, ACSW, LCSW, PhD, is an associate professor at the School of SocialWork at the University of North Carolina at Chapel Hill where she teaches courses in

social work practice, family violence, and statistics. She joined the faculty in 2002, after

receiving her doctoral degree in social welfare from the University of Washington in

Seattle. In 1993, she received her MSW from Tulane University in New Orleans. She

is a licensed social worker with practice experience in community mental health where

she worked with violence survivors. The aim of her program of research is to develop

and test interventions that promote violence survivors health and well-being, as well

as prevent their revictimization. She has also written about cognitive therapy techniques.Her research activities also focus on the health consequences of violent victimization,

repeated victimizations across the life span, coping with traumatic events, and the use

of advanced statistical methods to investigate violent victimization.

Natalie Johns received an MSW and an MPH from the University of North Carolina

at Chapel Hill in 2009. Currently, she is the director of Project STAR at Carolinas

Rehabilitation in Charlotte, North Carolina where she works to provide information

and services to individuals with traumatic brain injury, their families, and professionals

in the community. Prior to joining the Project STAR team, she was involved in research

focused on identifying and evaluating interventions for women and children involved

in family violence. Her professional interests include injury prevention, substance use

after brain injury, family violence, sex trafficking, and community program develop-

ment. She is also a member of the Brain Injury Association of North Carolina.



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Cynthia F. Rizo is a doctoral student at the School of Social Work at the University

of North Carolina at Chapel Hill. Currently, She works as a member of a research team

evaluating a parenting intervention for legally involved women and children who have

experienced domestic violence. In 2005, she received her MSW from Florida International

University. During completion of her postgraduate degree, she was a research assistant

on a project funded by the National Institute on Alcohol Abuse and Alcoholism that

examined the effectiveness of group treatment along with the dynamics of groups

targeting adolescents with substance abuse problems. After her graduation, she was

a health educator with the Community-Based Intervention Research Group at Florida

International University, conducting motivational interviewing with adolescents at risk

for developing substance abuse problems. Cynthia has experience providing services

to survivors of domestic violence and their children. Her research focus consists of

developing and evaluating interventions for Hispanic violence survivors.

Sandra L. Martin, PhD, is an epidemiologist who currently serves as the associate

dean for research in the Gillings School of Global Public Health and as a professor and

associate chair for research within the Department of Maternal and Child Health at

the University of North Carolina at Chapel Hill. Her research, teaching, and public

health service focus on the health of women and children, with particular attention

paid to the role that physical and sexual violence plays in their lives. Much of herresearch has examined violence during pregnancy and the postpartum period, with

investigations concerning the extent of such violence, risky health behaviors (such as

substance use) associated with this violence, and screening for violence within health

care settings. In addition, she has been involved in a variety of other studies concerning

violence in the lives of women, such as adolescent dating violence, violence in military

families, and the development of assessment and evaluation instruments that may be

used in domestic violence and sexual assault agencies. Her research projects have been

set both within the United States and abroad.

Mary Giattina, LMSW, is a case manager at Ridgeview Institute, a psychiatric hospital

outside of Atlanta. She provides group, individual, and family therapy to adolescents

struggling with addiction and mental illness. She has been at Ridgeview Institute since

2008, and prior to this position, she served as a victim advocate at Gwinnett Sexual

Assault and Childrens Advocacy Center. She received her masters in social work from

the University of North Carolina at Chapel Hill in 2007.

3361.fulldomestic violence and sexual assault service goal priorities

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