Well-Being of Latina Survivors of Intimate Partner Violence and Sexual Assault Receiving Trauma-Informed and Culturally-Specific Services

Abstract

The purpose of the current study was to examine the well-being of Latina survivors of intimate partner violence and sexual assault receiving services from community based, Latina-serving organizations. Despite the critical role that culturally-specific organizations play in supporting Latina survivors from healing, there is a gap in the academic literature base on the impact of these services on Latina survivors. Using a cross-sectional survey design, the current study attempts to fill this gap by exploring the influence of trauma-informed practices and culturally-specific work on outcomes for Latina survivors of intimate partner violence. Study participants included 175 Latinas from five Latina-serving organizations across the United States. Findings indicate that culturally-specific practice accounted for unique variation over and above trauma-informed practice in promoting well-being and trauma-informed outcomes among participants in this study. This study is an important contribution to bridging practice-based knowledge into the academic field by documenting the impact of trauma-informed and culturally-specific services on Latina survivors in the context of community based, Latina-serving organizations.

Latinas’ Experiences of Intimate Partner Violence and Other Trauma

According to the Centers for Disease Control and Prevention, Intimate Partner Violence (IPV) includes “physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner” (Breiding et al. 2015, p.11). The term Domestic Violence (DV) is used broadly by practitioners to refer to IPV, thus this paper refers to DV when describing service providers or organizations who work with survivors and IPV when referring to the construct. The latest national survey on IPV indicates that one in three (34.4%) LatinasFootnote 1 within the United States have experienced violence from a partner in their lifetime, including physical violence, sexual assault and stalking (Smith et al. 2017). A growing literature base indicates that Latinas may experience significant levels of polyvictimization and revictimization patterns throughout their lifetime. In a study of interpersonal victimization patterns among Latinas, researchers found that 63.1% (n = 594) of women who reported being victimized had experienced more than one incident of victimization in their lifetime. The total victimization counts for victimized women ranged from one to 10, with an average of 2.56 victimizations (Cuevas et al. 2012a, b). Another study analyzing the same data set showed that threat of IPV was the most common form of IPV in this sample, however physical, sexual, stalking and threat IPV were all endorsed as being experienced by Latinas in various configurations (Sabina et al. 2015a, b).

The growing literature base is increasing our understanding of the nuances of intersecting variables (e.g., race, ethnicity, country of origin, class, immigration status, sexual identification) that influence the experience of violence for Latinas. For example, researchers have found differences among ethnic groups of Latinas (e.g., women of Mexican ethnicity were more likely to experience violence than women of Cuban ethnicity; Sabina et al. 2015a, b), as well as differences based on immigration status and levels of acculturation (e.g., immigrant Latinas are less likely to report violence when compared to highly acculturated Latinas; Alvarez et al. 2018). For immigrant Latinas, studies have started to document the impact of pre-migration victimizations on their experiences of IPV. In a study exploring the impact of pre-migration trauma, researchers found that experiences of pre-migration predicted experiences of post-migration trauma and acculturative stress (Cho et al. 2014). Study findings underscore the importance of service provisions that consider the nuances of trauma experienced by Latina survivors including and beyond IPV and sexual assault.

In addition, there is emerging evidence that supports the need to examine unique cultural variables in providing effective services to Latinas. For example, certain cultural variables may buffer the impact that violence has on their mental health (Cuevas et al. 2012a, b) while others (immigration status) may reduce their help-seeking behavior (Zadnik et al. 2016). Nevertheless, the buffer that positive aspects of cultural identity may provide for Latinas cannot be overlooked. For example, endorsing a Latino orientation as measured using an acculturation scale (e.g., speaking Spanish, enjoying media in Spanish, etc.) and being an immigrant was associated with decreased odds of all forms of IPV (Sabina et al. 2015a, b). In another study of Latinas who had experienced IPV, researchers found that having a strong Latino orientation and aspects of religious belief were associated with lower victimization count (Sabina et al. 2013). Latinas draw on cultural strengths when looking for help; they are more likely to look to family, neighbors and friends for support than to turn to traditional formal services (Zarza and Adler 2008).

Taken together, these studies highlight the complexity of Latina realities and call for dynamic and complex responses that approach the issue from a nuanced cultural understanding that acknowledges that Latinas experience, respond to and seek services in different ways. Moreover, beyond simple understandings of cultural-specific work (e.g. language accessibility), this literature base calls for a nuanced understanding of various forms of trauma and cultural-identity variables like acculturation and ethnic group identity when providing interventions for Latina survivors. Fortunately, Latina-specific organizations have been at the forefront of providing such services to Latina survivors for decades. Unfortunately, there is a significant gap in the academic literature base on the impact of these services on Latina survivors. This study is an important contribution to bridging practice-based knowledge into the academic field by documenting the impact of organizations that center nuanced understandings of trauma and culturally-specific frameworks in their work with Latina survivors.

Interventions with Latina Survivors

A recent systematic review of intervention studies with Latina survivors of IPV identified only four published articles over an eleven-year span that increased positive outcomes for Latinas and highlighted the significant scarcity of effective interventions in this area (Alvarez et al. 2016). The studies included in the systematic review were diverse in terms of who they targeted (e.g., sexually active Latinas, mutually violent couples with children, Latina survivors, expectant and current mothers) and design (e.g., only two interventions were designed specifically to target IPV). Nevertheless, the studies reported positive outcomes (e.g., increase in safety behaviors and lowered experiences of violence), and indicated elements of care that were found to be effective for Latinas including community input in developing the intervention, group formats (e.g., peer support groups), improving relationship skills and providing information on IPV resources. These elements of intervention were also documented in a recent study with women from Peru who described through focus groups what they saw as important components for intervention (e.g., compassionate support, professional counseling, informational and practical resources; Cripe et al. 2015). What is known from this publication is that the academic literature base primarily includes information about interventions for Latinas that take place in health settings or in the context of health interventions (e.g., sexual risk behaviors). Only one study was conducted in a community based setting although still in the context of a HIV intervention (Alvarez et al. 2016) and none were identified as being culturally-specific, that is, none described being developed or originating in an organization whose mission or services are focused on centering the culture of a specific marginalized or minority community in their work (Serrata et al. 2016). These findings highlight the significant gap in research studying services for Latina survivors that are centered on their cultural realities which is extremely unfortunate given the tremendous practice-based knowledge that exists on serving Latinas and underscores the importance of his study (Serrata and Notario 2016).

Culturally-Specific Practice

For the purposes of this study, culturally-specific practice is defined as an individual program or intervention tailored for Latina survivors considering shared cultural practices (e.g., using “dichos” or culturally relevant metaphors to understand healing), experiences (e.g., sharing in Latino-specific holidays), identities and/or beliefs (e.g., familism, collectivism, religiosity, etc.; Serrata et al. 2016). Organizations that identify as culturally-specific are often (but not always) embedded within the communities they serve, provide an array of services including shelter, crisis intervention, advocacy services, support groups and counseling from a framework that prioritizes the ethnic cultural experiences of their clients (Serrata et al. 2015a, b). In reviewing the literature for interventions that were developed with this framework for work with Latina survivors revealed a small, albeit growing, literature base. Two articles documented an evaluation study that revealed the effectiveness of developing the self-empowerment of Latina survivors through a leadership program based on the promotora (health promotion) model, which trains lay-persons to provide resources about IPV and engage community members in holistic, culturally appropriate ways (Serrata et al. 2016; Serrata et al. 2015a, b). Two other publications presented evaluation results for a psycho-educational curriculum called, Si, Yo Puedo, and reported the curriculum’s effectiveness at increasing self-esteem and increasing knowledge of IPV (Fuchsel et al. 2016; Fuchsel and Hysjulien 2013). Another article documented the effectiveness of a culturally specific, HIV-risk reduction intervention in reducing IPV relationship mechanisms among Latina participants (McCabe et al. 2016). Taken together, these articles are the very start to building the knowledge base that documents the effectiveness of culturally-specific programming with Latina survivors. Moreover, this research provides evidence for culturally-specific practices (e.g., creating physical spaces where Latino culture is positively represented, ensuring that organizational staff are Latinos, allowing various expressions of Latino culture in healing, etc.) for serving this unique sub-population (Serrata and Notario 2016). Coupling this research with the findings above that cultural factors influence all dynamics of a survivors’ life (how they experience violence, their help-seeking behaviors and how they engage in services) highlights the significant need for further exploration of the influences of cultural-specific interventions on positive outcomes for Latinas.

Trauma-Informed Practice

Trauma-Informed Practice (TIP) is not new in the practice field of IPV and sexual assault. Due to the very nature of their work, IPV and sexual assault organizations have been at the forefront of understanding the complexities of trauma and service delivery (Serrata and Notario 2016; Wilson et al. 2015), however, this knowledge similar to that of the culturally-specific services has largely been missing from the published academic literature base (Wilson et al. 2015). Originating in the field of substance abuse and mental health, the trauma informed framework was conceptualized to centralize the understanding of the effects of trauma in all human services delivery systems (Harris and Fallot 2001a, b). A small literature base has begun to capture important knowledge regarding TIP with survivors of IPV and sexual assault. Wilson et al.’s (2015) analysis of approaches within the IPV field found that TIP within the context of IPV includes key organizational elements unique to a TIP, such as the promotion of emotional safety, restoring choice and control, facilitating connection, supporting coping and responding to identity and context. Moreover, Anyikwa (2016) and Serrata and Notario’s (2016) articles translate Substance Abuse and Mental Health Services Administration’s (SAMHSA) trauma-informed principles and values to the field of IPV highlighting essential elements to trauma-informed care with survivors, including the need for practitioners to understand, recognize and respond to the pervasiveness of trauma in all of its forms (and its consequences) in the lives of survivors and their families. These documents in addition to the development of a TIP scale measure (Goodman et al. 2016), which identified six domains of TIP ([a] environment of agency and mutual respect, [b] access to information on trauma, [c] opportunities for connection, [d] emphasis on strengths, [e] cultural responsiveness and inclusivity, and [f] support for parenting) have laid the groundwork for researchers and practitioners to begin to explore more systematically the impact that TIP has for survivors within IPV and sexual assault programs. In fact, a study conducted by Sullivan et al. (2017) that was developed to fill this gap in the literature found that TIP among IPV survivors in a shelter setting resulted in increased self-efficacy, higher safety-related empowerment, and decreased depressive symptoms. This was the first published study of its kind to document the impact of TIP since the essential conceptual groundwork was done by Wilson and colleagues (Wilson et al. 2015). Although the study did not focus on Latinas specifically, it serves to mark the beginning of the empirical knowledge base of this work in the field of IPV.

The current empirical study is meant to continue to add to the literature base about TIP for survivors of IPV and sexual assault and bridge the knowledge base with culturally-specific practice given the importance of culturally-specific service provision for Latina survivors. Importantly it expands previous work by exploring whether culturally-specific and TIP contributed differently to impacting Latina survivors’ well-being. Specifically, the authors hypothesized that survivors reporting more favorable TIP would report higher positive well-being and trauma informed outcomes. In addition, authors hypothesized that adding culturally-specific practice to TIP would further increase survivors’ well-being and that culturally-specific practice would contribute uniquely (above and beyond TIP) to positive well-being for Latina survivors given the research evidence that points to the particular influence that cultural factors have on Latina survivors’ experiences of violence, help-seeking behaviors, and engagement with services.

Method

Participants

The current study utilized a community-research partnership model to survey a convenience sample of IPV survivors (N = 186) who were at the time of this study receiving services from community-based DV organizations across the U.S. Participants were eligible for the study if they (a) were 18 years or older, (b) self-identified as Latina, and (c) were receiving services for IPV from a partner organization. A total of 186 Latina/o survivors, from ages 18–65, who were seeking services at community-based DV organizations, participated in the current study. Although the survey was open to both male and female survivors, 95% of the sample was female, thus this study only includes the female sample (N = 175). The majority of Latina participants were born in Mexico (66%) and over half (58%) were between 31 and 44 years old. Latinas in this study were predominantly low-income earning less than 15 thousand dollars per year and slightly over half had a high school level education or higher. Women had participated in their programs for a wide range of times, from less than one month to 24 months (M = 14.83, SD = 20.63). Additional demographic information is provided in Table 1.

Table 1 Demographic characteristics of Latina participants

Procedures

Five partner organization sites were selected to participate in this study based on their history of partnership with the National Latin@ Network for Healthy Families and Communities (a national DV technical assistance organization) and their interest in building the evidence around culturally-specific practices. All partner organizations provided IPV services to predominately Latina survivors and were located in the Southwest, Southeast, and Midwest of the U.S. Partner organizations provided a variety of program services; all provided case management, general advocacy, and peer support groups or therapy, and two organizations provided shelter services. Each partner organization collected survey data from between 20 to 60 of their program participants. Partner organizations were involved in both the development and data collection for this study. Organizations elected for either National Latin@ Network researchers (n = 2) or program staff to administer informed consent and collect survey data (n = 3). All program staff involved in this study received training on the protection of human subjects, study protocols, and procedures. Each partner organization was mailed all study supplies, including procedures, consent forms, surveys, $20 gift cards, envelopes, and return postage.

Organizations used multiple recruitment techniques to advertise the study to program participants, including flyers, announcements, approaching clients in waiting areas, and during regularly scheduled phone calls. Those interested in participating were read a brief description of the study purpose and procedures. Interested participants were then administered consent procedures. In order to prioritize survivors’ comfort and agency, researchers offered participants the option to complete the survey one-on-one or with other survivors in a group format where the survey would be read aloud while participants followed along. However, some women selected to self-administer the survey as evidenced by their completing the survey before the researcher had read all the questions. Once complete, participants returned surveys directly to program staff in a sealed envelope. Survivors received a gift card worth $20 U.S. to a retail store upon completion of the survey. Additionally, program partners were compensated $150 for collecting at least 25 surveys or $300 for collecting 50 or more surveys. No identifying information was collected from survivors and surveys were kept at the program site in a locked cabinet until the study period ended after which the surveys were mailed to the National Latin@ Network researchers for analysis. Data collection was conducted over the span of four months from October 2016 to January 2017. Surveys and consent forms were provided in English and Spanish. All study materials and procedures received Institutional Review Board approval.

Measures

Demographic Information

Participants were asked to report general demographic information including age, marital status, education, income level, country of birth, number of years in the U.S. (if foreign born) and number of children. These data are included as descriptive information.

Subjective Well-Being

The Subjective Well-Being (SWB) scale was used to measure survivors’ satisfaction with their quality of life and was developed to capture indicators of positive change as opposed to measures focused on the absence of mental health symptomology of survivors (e.g., “I take a positive attitude toward myself” and “I have a lot to be proud of”; Hamby et al. 2016). Survivors’ rated 13 items on a 4-point Likert-type scale (0 = not true about me to 3 = mostly true about me). The original SWB scale (4 = mostly true about me to 1 = not at all true about me) was reversed to enhance clarity and better fit the sample population. Mean scores were computed if at least 11 out of 13 (85%) items were answered with higher means indicating higher SWB. Total mean scores ranged from .69 to 3.00, (M = 2.25, SD = .59). Cronbach’s alpha indicated excellent internal reliability (α = .93).

Trauma-Informed Practices

The extent to which programs used TIP, from the survivors’ perspective, was measured using the Trauma-Informed Practices Scale (TIPS; Goodman et al. 2016). The TIPS includes 33 items assessing (a) general trauma-informed practices (e.g., “I can trust staff” and “I am learning more about how to handle unexpected reminders of the abuse and difficulties I have endured”), (b) cultural responsiveness and inclusivity (e.g., “People’s cultural backgrounds are respected in this program” and “This program treats people physical or mental health challenges with compassion”), and (c) support for parenting (e.g., “I am learning more about how my own experience of abuse can influence my relationships with my children”). Respondents rated each item on a 4-point Likert scale (0 = not at all true to 3 = very true). Part B and Part C also have an option for respondents to indicate “I don’t know” and Part C is only applicable to parents. Only two participants in the total sample did not have children and skipped the parenting subscale. Although, Goodman and colleagues’ (Goodman et al. 2016) study identified six domains, the authors created a mean score of all items representing general TIP, (i.e. domains 1–4), to reduce multicollinearity and in accordance with previous research using this scale (Sullivan et al. 2017). Participants scores for general TIP ranged from 1.60 to 3.00, with an average score of 2.82 (SD = .28). Scores on the cultural responsiveness and inclusivity subscale ranged from 1.63 to 3.00, (M = 2.90, SD = .22). Scores on the support for parenting subscale ranged from 0 to 3, (M = 2.87, SD = .32). All three measures, general TIP, cultural responsiveness and inclusivity, and support for parenting, indicated excellent internal reliability (α = .89, α = .78, α = .86), respectively.

Culturally-Specific Practices

A measure to determine the extent to which participants perceived programs as using cultural-specific practices for Latinos, was developed for the current study. This measure, Cultural Specific Practices (CSP) consisted of 10 items, of which six were adapted from the Iowa Cultural Understanding Assessment-Client Form (White et al. 2009) to better represent service provision within the context of domestic violence services. The remainder was developed by the research team (e.g., “Staff here understands that Latinas/Latinos/Hispanics are not all alike” and “Most of the staff are Latinas/Latinos/Hispanics”). Participants rated each item on a 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree). Total mean scores ranged from 1.40 to 5.00, (M = 4.41, SD = .57). Cronbach’s alpha indicated good internal reliability (α = .87).

Trauma Informed Outcome Measures

Lyon, Phillips, and Kaewken (TIOM; 2016) developed the TIOM to assess changes in survivors’ lives as a result of receiving trauma-informed services including three sections that measure (a) how survivors see their children’s feelings and experiences have changed, (b) change in the survivors relationships with their children, and (c) changes survivors have seen regarding their own thoughts, feelings, and experiences as a result of having received services. The TIOM uses a 5-point Likert-scale ranging from 1 = strongly disagree to 5 = strongly agree including “I don’t know” as an additional response option for respondents.

For the purpose of this study we utilized the 24-TIOM, which solely focuses on changes survivors have seen in their lives. One of the three possible subscales included emotional well-being (8 items), that includes items such as “I am better able to handle the anger that I feel.” The second subscale is self-confidence (10-items) that includes items such as “I feel more comfortable exploring my own interest.” The third subscale focuses on relational self (6 items) and asks questions such as “I am better able to recognize when other people may have been affected by abuse and violence.” Due to some items being highly correlated in Lyons and colleagues’ original sample of self-identified Latina/os (144 Latina/os from over 14 sites in New Mexico and Idaho), nine items were removed in consultation with the original developer of the measure who at the time of our study was running preliminary analysis on this measure. Thus, a total of 15 items on a 5-point Likert-type scale were used (4 items from relational self, 4 items from emotional well-being and 7 items from the self-confidence subscale). Cronbach’s alpha indicated good internal reliability (α = .96). Total mean scores ranged from 1.13 to 5 (M = 4.41, SD = .68).

Analytic Strategy

In order to understand the relationship between culturally specific and trauma-informed practices on participant outcomes we conducted separate linear regressions for each outcome. First, we examined the hypothesis that higher scores of well-being would be predicted by higher scores of TIP in a linear regression. We examined the second hypothesis using a hierarchical regression to understand whether culturally-specific practices further increased participant positive well-being and trauma informed outcomes. Thus, the second regression model added culturally specific practices in the last step of the regression comparing the variance (i.e. ∆R2) explained by a model with only covariates and TIP to one that added culturally specific practices. Categorical dummy variables were added into the first step of each model to control for significant covariates. We included a dummy variable to control for clustering by program site. While a multi-level model could control for the clustering of individuals in different programs, the fixed effects approach is preferable when samples have less than 10 groups (Snijders and Bosker 1999), as in this study.

Results

Preliminary Analyses

All variables were visually inspected for potential outliers and erroneous values, and all values fell within the expected values for each scale. Responses of “I don’t know” were treated as missing data. Data were checked for missingness at the item level, and no item was missing more than 8.5% (n = 11) of responses. Average scores were computed for each scale if participants answered at minimum 80% of the scale items. At the scale level, less than 1% of the SWB scores were missing, and no data were missing from either general TIPS or the CSP scales. However, 8.5% and 5% of TIPS B and TIPS C scale scores were missing, respectively, given that these two scales included “I don’t know” response options. Data were inspected for multivariate normality by examining univariate distributions of all continuous indicator variables. All continuous variables had adequate normal distributions with skew and kurtosis falling within acceptable ranges (Tabachnick and Fidell 2007). Number of years in the United States, age, yearly income, marital status and education were examined as potential covariates of SWB and TIOM scores. No significant relationship between number of years in the United States and SWB (r = .14, p = .09) or TIOM scores (r = .14, p = .09) were found. Results from a series of ANOVAs found no significant effects between SWB scores and age, F(3, 168) = 1.04, p = .38, yearly income, F(5, 155) = 1.56, p = 0.17, or marital status, F(5, 158) = .63, p = 0.68. Participants’ education level was significantly related to SWB, F(3, 162) = 3.55, p < 0.05. No significant effects were found between TIOM scores and yearly income, F(5, 157) = 1.03, p = 0.40, or marital status, F(5, 160) = .91, p = 0.48. However, there were significant differences on TIOM scores based on age, F(3, 170) = 3.64, p < 0.05, and level of education, F(3, 164) = 4.87, p < 0.01. Thus, education was entered as a covariate for both models and age was entered into the model for TIOM. Means, standard deviations, and correlations of the major study variables are presented in Table 2. Overall, the three TIPS domains were moderately and positively correlated with one another and with our outcome measures.

Table 2 Correlations and descriptive statistics of major study variables

Trauma-Informed Practices and Positive Outcomes

Linear regressions were conducted to test our first hypothesis that higher ratings of TIP would predict positive outcomes for survivors as measured by subjective well-being and trauma-informed outcomes. For the first analysis the subjective well-being mean score was entered as the outcome variable and dummy coded variables, education and program site, were entered in step one followed by the three TIPS domain (TIPS A, B, and C) mean scores in step two of the regression model. The final regression model predicting subjective well-being from TIPS controlling for participants education level and program was significant, F(10, 135) = 3.95, p < .001, however, only the TIPS domain A, general TIP, significantly contributed to the model positively predicting subjective well-being scores, t (135) = 2.15, p < .05 (Table 3). The covariates, program site and participant education level, were not significant predictors of subjective well-being scores and were thus removed from further consideration in subsequent analysis.

Table 3 Regression predicting subjective well-being from trauma informed practices

For the second analysis, the TIOM mean score was entered as the outcome and the dummy coded control variables, education, age, and program site, were entered in step one followed by the three TIPS domains (TIPS A, B, and C) mean scores in step two of the regression model. The final regression model predicting trauma-informed outcomes while controlling for participant education, age, and program was significant, F(12, 134) = 5.427, p < .001, and accounted for 33% of the variance in trauma-informed outcomes (Table 4). In step two, program site and age continued to be significant covariates, however, only one of the three TIP subscales, domain B assessing culturally responsive and inclusive TIP significantly contributed to the model predicting trauma-informed outcomes, t (134) = 2.03, p = .04.

Table 4 Regression predicting trauma informed outcomes from trauma informed practices

Unique Addition of Culturally-Specific Practice

To test our second hypothesis, that culturally-specific practices would predict an increase of positive outcomes above and beyond TIP, we conducted two hierarchical regression analyses for each outcome, subjective well-being and trauma-informed outcomes. Only significant predictor variables from the previous regression models were entered in the following hierarchical analyses. For the first hierarchical regression on subjective well-being, the TIP domain A, assessing general TIP was entered into step one and the CSP scale was entered in step two of the regression model. Results from the overall model indicated that general TIP continued to significantly predict higher well-being in this sample, Step 1: R2 = .26, F(1, 171) = 61.43, p < .001, (Table 5), however, the addition of cultural-specific practices accounted for significantly, albeit a small, increase in variance in survivors well-being, Step 2: R2 = .28, F(2, 170) = 33.54, p < .001; ∆R2 = .02, p < .05.

Table 5 Hierarchical regression predicting subjective well-being from trauma-informed and culturally specific practices

The second hierarchical linear regression analysis tested the addition of cultural-specific practices to TIP on trauma-informed outcomes while controlling for significant covariates age and program site. Covariates were added to the model in step one, followed by TIPS domain B, culturally and responsive TIP in step two and the cultural-specific practice scale in the final step. As before, the TIPS domain B, cultural responsive and inclusive practices, significantly predicted higher reported trauma-informed outcomes while controlling for age and program site, R2 = .24, F(7, 151) = 6.98, p < .001, however, the addition of cultural-specific practices accounted for significantly more variance in survivors’ trauma-informed outcomes, R2 = .50, F(8, 150) = 18.48, p < .001; ∆R2 = .22, p < .001, (Table 6).

Table 6 Hierarchical regression predicting trauma-informed outcomes from trauma-informed and culturally specific practices

Discussion

The purpose of the current study was to examine the well-being of Latina survivors of IPV and sexual assault receiving services from community-based, Latina-serving organizations. Despite the critical role that culturally-specific organizations play in supporting Latina survivors in healing from trauma (Serrata et al. 2017), there is a gap in the academic literature base on the impact of cultural-specific and TIP on Latina survivors (Alvarez et al. 2016). The current empirical study serves to address this knowledge gap in the academic literature base and is an important contribution to bridging practice-based knowledge into the academic field, something that practitioners and researchers have desperately been calling for (Serrata et al. 2017; Kulkarni 2018).

As expected, the use of trauma-informed and culturally-specific practices at Latina- serving community-based organizations contributed to survivors’ experiences of subjective well-being and trauma-informed outcomes (e.g., relational self, emotional well-being, and self-confidence). This finding supports the few studies within the IPV field that have shown that the essential elements particular to TIP are important for positively impacting survivor’s self-efficacy, empowerment and mental health (Sullivan et al. 2017; Wilson et al. 2015). It also aligns with other TIP studies investigating individuals who perpetrate IPV and who received trauma-informed treatment to reduce further IPV perpetrations (Creech et al. 2017; Taft et al. 2016; Levenson and Grady 2016). Moreover, the current study aligns with the larger TIP literature base in other fields that indicate and hypothesize that TIP positively influences those seeking services across various sectors, including substance abuse treatment (Cruz-Feliciano et al. 2017), mental health services (Richmond et al. 2013), homeless families (Williams 2016), and university counseling centers (Yoshimura and Campbell 2016).

The finding that TIP positively influences Latina survivors is, alone, an important contribution to the academic literature, however researchers took this study a step further by providing empirical research related to effective culturally-specific practices in combination with and distinctly from TIP. This finding fits with other scholarly research that promote culturally-specific interventions for Latina survivors (Fuchsel and Hysjulien 2013; Fuchsel et al. 2016; McCabe et al. 2016; Serrata et al. 2016; Serrata et al. 2015a, b). This study confirms the important role of cultural-specific aspects of services for Latina survivors even (and especially) in the context of trauma-informed care. For Latina survivors, it is important for organizations to understand the cultural nuances of the Latina population. Taken further, it is key for organizations to understand the potential of cultural variables to influence survivors’ outcomes and to incorporate them into care. Findings from the current study substantiate the importance of implementing organizational practices that are culturally affirming (e.g., staff promoting cultural traditions and having Latina/o identifying staff).

The complexities of intersecting cultural identities have shown to be influential to the experiences of trauma among Latinas and are important considerations when working with underserved communities (Kulkarni 2018). By including and independently examining cultural-specific practices, researchers were able to gain a more nuanced picture that adding cultural-specific practices within TIP showed higher levels of well-being and outcomes for Latina survivors above and beyond only utilizing TIP. This is tremendously important because although TIP frameworks discuss culturally-affirming practices, study findings show that for Latina survivors, culturally-specific practices contribute uniquely to their well-being. This finding is important as practice-based knowledge has the potential to inform the academic literature base and encourage the field of IPV to learn from culturally-specific organizations at the forefront of providing services to survivors that center culture and nuanced understandings of trauma.

Limitations

Although the results are a unique contribution to the literature and add to the understanding of the impact of trauma-informed and culturally-specific services for Latina survivors of IPV, there are limitations to examine. One limitation is the nature of the cross-sectional study as we cannot make causal inferences with the variables as temporal limitations do not allow us to see the relationship of the variables over time. More studies, over longer periods of time, would allow researchers the opportunity to get closer to supporting causation and further strengthen, academically, the work of culturally-specific organizations. Furthermore, we self-selected sites to participate in the current study. Thus, the sample is limited to recruitment of survivors from partnered organizations rather than random selection. This introduces the potential for biased findings that may not reflect the experiences of participants from culturally-specific organizations more generally. Participants comprised of a majority of Latinas born in Mexico paralleling the demographic population of Latinos in the U.S. Thus, findings may be less generalizable to other Latina survivors (e.g., Guatemalan, Peruvian, Salvadorian) but may be reflective of Latinos of Mexican ethnicity. An additional limitation is that studying the impact of services through a cross-sectional study does not provide us with determining the survivors’ long-term well-being. Moreover, we did not gather information about documentation status of survivors, which could be helpful to understand how well-being is impacted by documentation status. Specifically, examining immigration status highlights the importance of acculturation level of survivors who are advancing their lives post-trauma (Kim et al. 2017). Future research should attempt to utilize methodologies that could allow for more advanced statistical analysis to understand the impact of TIP across sub-populations of Latinas (e.g., immigration status, country of origin, etc.) and across the lifespan. Additionally, threats to construct validity include the use of measures that are new and/or created for the purposes of this study. As these measures are utilized more in the field, we will be able to learn more about their validity in different contexts, however, given that these measures were either in development stages or just created when we used them, there is a possibility that they are not fully capturing the constructs as we have hypothesized them to.

Importance of Findings and Theoretical and Practical Implications

Our findings contribute to an emerging academic literature on TIP among IPV survivors and contributes to the small, albeit growing, empirical literature on culturally-specific practice. These findings are important as they provide support for both frameworks of practice when working with Latina survivors of IPV and sexual assault highlighting the need of nuanced understandings of trauma and culture when serving Latinas. Moreover, the finding that culturally-specific practice contributes uniquely to the well-being of Latinas beyond that of TIP lends evidence to Kulkarni’s (2018) theoretical proposal that TIP be intersectional and embedded in anti-oppressive frameworks. As this study shows, culturally-specific practice is important for Latina survivors.

For over thirty years, Latina-specific, community-based organizations have been on the ground providing services alongside Latina/o communities and have contributed to the understanding of providing services for IPV and sexual assault survivors across the field broadly, however, academic understanding has been significantly lacking. With the large push to implement “evidence-based” practice, culturally-specific organizations are limited in being able to provide empirical evidence for their work (Serrata et al. 2017). An important aspect of this study is that it makes a significant contribution in bridging practice-based understanding to the academic evidence base.

Practically, given that this research was spearheaded by a research team embedded within a national technical assistance provider of Latino-specific IPV services, this research study has numerous implications for informing the evaluation field. Researchers developed the survey instrument based on their longstanding partnerships with practitioners from community-based organizations drawing from years of conceptual work to understand the constructs of trauma-informed and culturally-specific work as it pertains to Latinas. This study serves as the beginning of survey tools that might be useful to other practitioners and evaluators looking to evaluate programming with Latina survivors.

Future Research

This study serves to provide promising empirical evidence for trauma-informed and culturally-specific practices with Latina survivors of IPV and sexual assault. Among numerous future avenues for exploration, one major path for subsequent research will be to conduct more robust evaluation of services for Latina survivors and publish the findings in academic outlets. The field of IPV and sexual assault is in dire need of more academic literature documenting its programming, especially for historically marginalized communities. Thus, funding to expansively evaluate programming for Latinas (including both process and outcome evaluation with various methodologies) and support to publish research, in partnership with practitioners, is critical. This study serves to model the importance of researchers to partner with community-based organizations and practitioners to uplift effective service provision for survivors of IPV. Future research should replicate this model where researchers partner with, learn from and build the capacity of community-based organizations to conduct their own evaluation and research. It is through multiple facets of research that researchers and practitioners alike will build the evidence base. There is still more to examine in moving to empirically understand culturally-specific and TIP for Latina survivors. For example, does the importance of culturally-specific practices change over time? Are culturally-specific practices more important for particular groups of Latinas? What other culturally-specific and TIP are important to evaluate? What other outcomes are important to measure for Latina survivors? We encourage future researchers to employ an array of methodologies to answer these questions, including needs assessments, community-based participatory methodologies, and participatory and empowerment evaluation methods. The researchers in this study have just begun to scratch at the surface of empirically understanding culturally-specific and trauma-informed work and the critical role that culturally-specific organizations play in improving the well-being of Latina survivors.

Notes

  1. 1.

    Latina is used to describe women who self-identified as Latina and whose country of origin may include South or Central America, Mexico, Puerto Rico, Cuba or the Dominican Republic.

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Acknowledgements

The research team would like to acknowledge the practitioners who were critical in implementing this research study, as well as Lisa Goodman at Boston College for her support in providing funding for the startup of the project. Other funding came from grant number 90EV413.04-01 from the Administration on Children, Youth and Families, Family and Youth Services Bureau, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services. We would also like to dedicate this article to our mentor and friend, the late Dr. Julia Perilla.

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Serrata, J.V., Rodriguez, R., Castro, J.E. et al. Well-Being of Latina Survivors of Intimate Partner Violence and Sexual Assault Receiving Trauma-Informed and Culturally-Specific Services. J Fam Viol 35, 169–180 (2020). https://doi.org/10.1007/s10896-019-00049-z

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Keywords

  • Latinas
  • Latina survivors
  • Domestic violence
  • Intimate partner violence
  • Sexual violence
  • Culturally –specific services
  • Trauma-informed practice