Victim Advocacy Self-Care

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
Supportive characteristic C D E
Volunteers involved in SA service * * *
delivery
Paging system/relationships with * *
Specific names of supportive people * * *
in agency mentioned
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
Supportive characteristic F G H
Volunteers involved in SA service # * #
delivery
Paging system/relationships with # # #
Specific names of supportive people *
in agency mentioned
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

that the number of supportive characteristics across the three groups (high, moderate, and
low) were significantly different ([[chi square].sub.K-W] = 5.90, p < .05).

(9.) Prior to logit modeling, hierarchical, backwards-elimination log linear modeling was
used to examine the relationships between organizational support type, strategy resource,
and strategy function. A nonsaturated model was obtained that adequately explained the
data: Likelihood ratio (LR) [chi square](18, N = 218) = 19.57, p = .36. A significant
two-way interaction between resource and function of self-care strategy emerged in this
model, LR [chi square](4, N = 218) = 53.93, p < .001. The interaction between resource
and function was such that strategies that drew upon verbal and physical resources were
more often cathartic in function, whereas strategies that drew upon social, spiritual, and
cognitive resources more frequently served an integrative function. Furthermore, a main
effect for organizational type was supported, LR [chi square](2, N = 218) = 77.06, p <
.001, such that strategies employed in high-support organizations were more likely to be
integrative in function than the strategies employed in low-sup port organizations.

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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

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