Creating a Digital Trauma Informed Space: Chat and Text Advocacy for Survivors of Violence

Rapport Building in Written Crisis Services: Qualitative Content Analysis

BACKGROUND

Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations.

OBJECTIVE

This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers.

METHODS

The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations.

RESULTS

Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation.

CONCLUSIONS

Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

Pranks, Obscene Chatters, and Ambiguous Content: Exploring the Identification and Navigation of Inappropriate Messages to a Web-Based Sexual Assault Hotline

Sexual assault crisis hotlines provide crucial support for survivors. Though some hotline users engage in inappropriate conduct (e.g. prank or obscene calls), few studies explore these interactions. To address the lack of literature exploring inappropriate hotline interactions, we conducted a secondary data analysis of chat transcripts (n = 233) shared with the research team as part of the formative evaluation of a university-based sexual assault program's web-based crisis hotline. From those transcripts, we analyzed potentially inappropriate interactions (n = 38), most of which (n = 28) hotline responders flagged as inappropriate in post-chat log forms. We used codebook thematic analysis to explore how hotline responders identified and navigated these interactions. Our analysis generated three themes describing the processes through which responders seemed to identify potentially inappropriate chats - detecting implausibly graphic and abusive content, identifying patterns of presumably inauthentic chat topics, and interpreting ambiguous content. Hotline responders seemed to navigate ambiguous and less egregious boundary violations by gently redirecting conversations, and addressed clearer violations by setting firm, direct boundaries. Chatters responded to boundary setting by desisting and disconnecting or attempting to reengage responders. Findings highlight ambiguities and challenges web-based sexual assault hotline responders face and suggest a need for additional responder support, training, and debriefing options.

EHealth for Sexual Assault: A Systematic Scoping Review

Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.

"So many extra safety layers:" Virtual service provision and implementing social distancing in interpersonal violence service agencies during COVID-19

The coronavirus pandemic necessitated rapid shifts in approach for service providers working with survivors of interpersonal violence. To reduce the spread of the virus, providers and agencies implemented a rapid and unplanned expansion of virtual services while also developing new protocols to support safe and socially distant in-person services. To understand how these shifts have impacted victim service professionals and the survivors they serve, to provide guidance for on-going efforts, and to inform planning for future public health emergencies, this study asks the question: What approaches did the interpersonal violence workforce use to address social distancing needs during COVID-19? Semi-structured interviews were conducted from July to December 2020 with 33 interpersonal violence service providers from across the United States, and data were analyzed via conventional content analysis with additional steps for data credibility. Findings fall within two primary categories: 1) Technology and Virtual Service Provision; and 2) Social Distancing for In-person Services. Within each category, a number of themes emerged illustrating strengths and challenges of each approach, and the complex web of technological, safety, and public health considerations being balanced in interpersonal violence service agencies. These results provide guidance for the implementation of virtual services in an on-going manner, as well as underscoring the importance of future planning to facilitate effective in-person but physically distant services. There is also a clear need for agencies to support the interpersonal violence workforce to reduce occupational stress and enhance skills and capacities with new forms of services.