These findings suggest that participants have had limited experience with integrating IPV-related services for victims of abuse into their treatment programs. Participants consistently identified victimization from IPV as a problem for clients enrolled in their treatment programs. Furthermore, staff was receptive to providing services that addressed violence in their clients’ lives. The minority of staff from agencies who had access to an IPV specialist expressed confidence in having had sufficient training in addressing IPV with their clients (i.e. conducting screening for IPV, safety assessment, safety planning, and referral to appropriate IPV-related services), and in their agency’s ability to handle IPV.
Despite provider awareness of and receptivity towards addressing IPV, our focus groups indicated a need for additional training and integration of IPV-related practices. Although staff readily identified IPV as a frequent problem for clients and were willing to “ask about” IPV, few participants reported feeling that they had sufficient training. When asked about specific strategies or protocols they might employ in this area, few staff were able to articulate how to conduct adequately detailed assessments and safety planning generally accepted to be the standard of care. In addition, participants were familiar with only rudimentary counseling skills in the area of IPV. Despite the fact that counseling victims to leave partners is not accepted as best practice in preserving safety, in most focus groups, this was the main strategy that staff identified.
In addition to identifying their own limited skills in offering IPV-related services and counseling, participants identified system-level limitations to addressing violence-related issued among clients. Participants believed that they received mixed messages from administrative staff about their roles and responsibilities with regard to IPV, and felt confused about the depth expected from them. Uniformly, staff expressed that IPV referrals and shelter referrals were difficult to obtain, particularly for women actively using drugs.
Similar to prior investigations, this study found that staff training and education alone on IPV may be insufficient to help programs modify their services; rather, system-wide approaches may be necessary for successful change. (Feder, Ramsay & Zachary 2006
; Zachary et al. 2002
). We believe that participants’ enthusiasm for and awareness of addressing IPV victimization among clients reflects larger system- and societal-level awareness of IPV. Focus group participants had received basic training in IPV, reflecting these changes. The staff who participated in this study demonstrated readiness for change, but needed additional in-depth training, clear messages and expectations from leaders and a greater awareness of the limits and strengths of local resources. As previous demonstration projects show, successful and uniform integration of IPV-related services needs to address change at multiple levels: staff, organization and management, and system-wide capacity (Markoff et al. 2005
; O’Brien et. al. 2002
). Successful organizational change may require on-site expertise, cross-system collaboration and perhaps expansion of resources for drug-using women. (Lehman, Greener & Simpson 2002
; Simpson 2002
; D’Aunno, Vaughn & McElroy 1999
Our recruitment methodology may have biased in finding staff willing to address IPV in substance abuse treatment. We recruited staff participants by asking substance abuse treatment programs to send a staff member to a focus group on IPV. Thus, we expect that, in many cases, agency administrators sent participants who were already interested and willing to discuss IPV. This selection may explain why there was ready consensus among participants that IPV was a common problem among clients, and that substance abuse staff were generally willing to provide more services in this area. On the other hand, we believe that our conclusion that staff has basic, but not in-depth training on IPV is strengthened by this bias: if agencies sent their most well-trained or interested staff members, and they reported and demonstrated inadequate skills in this area, substance abuse treatment staff at large are likely to be at least as poorly informed. An additional limitation of this study is that we did not contrast counselor and administrator/supervisor comments, and so cannot comment on differences between these groups.
In conclusion, this focus group study of substance abuse treatment staff suggests their awareness of and receptiveness to addressing IPV among female clients. We believe our focus group participants’ willingness to address IPV is consistent with the changing culture of substance abuse treatment in response to national and local awareness of the relationship between substance abuse, recovery, and IPV. Yet, staff from many of the agencies that participated in this study felt inadequately trained, confused about their roles with regard to IPV counseling and services, and frustrated with their limited skills and access to resources. Clearer messages from leaders, in-depth training, and increased coordination with community-based services might promote effective delivery of IPV-related services in substance abuse treatment programs. Future studies are needed to extend these findings and to determine the content, effectiveness, and implementation of such change in a highly heterogeneous substance abuse treatment system.