Although the world is full of suffering, it is also full of the overcoming of it.

Helen Keller

This project was supported by Grant No. 95-MU-GX-K003 awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The Assistant Attorney General, Office of Justice Programs, coordinates the activities of the following program offices and bureaus: Bureau of Justice Statistics, National Institute of Justice, Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

"There is nothing more isolating than the pain of violation. It forces victims to question themselves and their world because it destroys two essential beliefs: (1) their sense of trust and (2) their sense of control over their lives. After the crime is over, victims begin to struggle with their reactions...they are often overcome with fear, anger, guilt and shame. They may feel contaminated and unworthy of help. Their relationships with family and friends can be seriously disrupted, and if they become involved with the police and the courts, they may come to believe that no one understands or cares about what has happened to them." (The Crime Victim's Book, Bard and Sangrey, 1986)

A victim of a serious personal crime as well as significant others, family members and friends, go through a difficult adjustment period, often experiencing the impact of the crime in varying degrees for the remainder of their lives.

This curriculum and participant's resource manual were produced with a grant from the Office for Victims of Crime. The resource manual contains a collection of articles and information written from either a mental health or a victim services perspective. Because these perspectives are not always in agreement, there may be conflicting points of view which participants can use as discussion starters.

Individuals with diverse backgrounds, expertise and experience in victim services and mental health served as an advisory panel and assisted the Pennsylvania Coalition Against Rape with the development of this curriculum. The panel members of Victim Empowerment: Bridging the Systems - Mental Health and Victim Services Providers saw the project as essential and vital to the provision of quality support services and treatment for victims of crime and their significant others. They also saw this project as an opportunity to develop a collaborative systems approach to victim services between mental health and victim services providers.

The Pennsylvania Coalition Against Rape wishes to thank the advisory panel members for their time and expertise in the development of the curriculum outline.

Advisory Panel Members

Dr. Ida Marie Gentzler, Assistant Professor of Sociology and Community Psychology, Penn State Harrisburg, Middletown, PA

Training Development Coordinator:

Donna Johnson, Consultant, Norristown, PA

Author, Thinking Beyond the Office:

Mary Margaret Hart, Licensed Psychologist, Bellefonte, PA

Project Manager and Editor:

B. J. Horn, Training Coordinator, Pennsylvania Coalition Against Rape, Harrisburg, PA

Additional Panel Members:

Beverly Andrews, Counseling Supervisor, The Sexual Assault Resource & Counseling Center of Lebanon County, Lebanon, PA

Rosalie Danchanko, PA State Director, Neighbors Who Care, and President, Coalition of Pennsylvania Crime Victims Organizations, Johnstown, PA

Susan Jensen, Child Therapist, Bethel Park, PA

Bernadine P. Lasher, Director, Council on Domestic Violence and Sexual Assault, Midland, MI

Grace S. Mattern, Director, New Hampshire Coalition Against Domestic & Sexual Violence, Concord, NH

Dawn McKee, Project Coordinator, Pennsylvania Commission on Crime and Delinquency, Pleasant Gap, PA

Beth Resko, Women's Program Therapist, The Meadows Psychiatric Center, Centre Hall, PA

Judith Rex, Coordinator, Vermont Network Against Domestic Violence and Sexual Assault, Montpelier, VT

Jamie Snyder, Director, Center for Sexual Assault & Domestic Violence Survivors, Columbus, NE

Advisory Panel Recommendations

• The training curriculum will be provided to individuals only as part of a training program.
• A 'train the trainers' program will be conducted to ensure that the manual and its information are used consistently.
• Trained teams, representative of victim services and mental health professionals, will be sought.
• Trainees or participants will be selected with the advice and input of local community leaders.
• Trainees are to be representative of the victim services and mental health fields.
• Trainees are to be motivated individuals who are committed to change and willing to promote change in their respective communities.
• Funding and resources should be available to address the recommendations as stated.

Core Beliefs and Concepts

The material in this manual has been selected based on these core beliefs:

• We need a violence-free culture
• Victims should be the focus of the system(s)
• The victim empowerment as the model includes:

Victims

Having the right to be believed and owning their stories

Being in control of the healing process

Service Providers

Acknowledging the rights and responsibilities of victims

Respecting the choices of victims

Providing victims with options for choices

Avoiding inappropriate labeling of victims

Working collaboratively with other systems to support victims

• Victims are not to blame for their victimization
• People are responsible for the effects of their behavior
• The trauma of victimization is not mental illness but victimization is trauma and needs to be addressed
• Confidentiality is important

Why Build a Bridge?

A mental health professional who has not received any training on the unique emotional and psychological issues of trauma may not be able to appropriately respond to a crime victim or even make a suitable referral. For example, to someone not trained in victimization issues, a burglary might be seen as a minor loss of possessions, something to be dealt with quickly by the police and insurance company, with perhaps the added security of new locks. However, to burglary victims, there has been a violation of an extension of themselves. For many, the loss or damage to money and/or possessions are not nearly as harmful as the intrusion into the privacy of the home, the place where people are supposed to feel safe.

Historically, mental health counselors, psychologists, and psychiatrists have not received extensive training in victimization issues. In a recent survey by the Mental Health Association of more that 175 mental health professionals in Berks County, Pennsylvania:

• Less than one-third of the 130 respondents were willing to and/or had experience in working with victims of violent crime
• Only a handful indicated they had more than limited experience
• There were very few mental health professionals who indicated knowledge of sexual assault issues

At the Erie County Rape Crisis Center in Pennsylvania:

• Approximately 25% of its clients, who were victims of sexual assault/abuse or victims of other crimes, were also receiving services at one or more mental health service providers

It is important to note that not all crime victims require treatment by a mental health professional. If a victim is regarded as having functioned adequately or "normally" prior to the victimization, then the crime is seen as a crisis or a disruption to the life of the victim. While a victim's response may not "look" normal to those who do not have an understanding of trauma issues, it could be a normal response to an abnormal event.

Victim service providers use crisis intervention techniques, including empowerment counseling, to restore the victims to their previous level of functioning. They address issues unique to the victimization such as:

- Safety

- Body boundaries

- Self-esteem

- Regaining power and control

- Re-establishing trusting relationships

Studies such as Rape in America (NVC, 1992) show that many victims do not successfully regain control over their lives after their victimization. Although many crime victim programs provide victims with long term counseling, including support groups, numerous individuals are concurrently and appropriately seen by mental health professionals. For those programs that are limited to crisis services and for those clients who should be referred for further treatment for mental health issues, victim services providers must learn when and where to refer clients:

• Victim services counselors must learn the warning signals to make referrals, such as those offered by the American Psychiatric Association, which include:

- Prolonged depression or apathy

- Suicidal ideations

- Substance abuse

- Inability to cope with daily activities after an appropriate period of time

• Victim programs must develop referral lists of mental health providers who understand trauma and victimization issues, are willing to accept clients who do not have insurance coverage or funds and are available without prolonged waiting periods.
• Through coordinated appropriate releases with mental health practitioners, victim services staff can continue to address the victimization needs such as court accompaniment, and specific victimization counseling.

Ten years ago, the American Psychological Association Task Force on the Victims of Crime and Violence, chaired by Morton Bard, Ph.D., made the following recommendations:

• Psychologists involved in service delivery should acquire specific, identifiable skills in direct intervention with victims.
• More psychologists should acquire specialized consultative skills to increase the capacity of indigenous workers to help victims.
• More psychologists should become involved in initiating and evaluating changes in the criminal justice system to ameliorate the problems victims experience in that system.
• More psychologists who are prepared to do so should actually provide service directly to victims, to indigenous helping systems, and in the criminal justice system.
• Psychologists should be more involved in gaining knowledge about the victim experience and about helpful intervention for victims.
• There should be greater public awareness about the mental health needs of victims and the roles psychologists can serve in helping victims.
• The APA should endorse laws and legal arrangements that facilitate the realization of victims' interests and encourage the formal evaluation of these arrangements.

Dr. Bard made recommendations for the mental health community in The Crime Victim's Book, which include:

• Establishing training programs that enable practitioners to treat crime victims and their families
• Establishing and maintaining direct liaisons with victim services agencies

These comments were echoed by Shelly Neiderbaum, one of the founders of the International Association of Trauma Counselors, Inc., at the National Organization for Victim Assistance 1995 Conference.