Showing posts with label evaluation. Show all posts
Showing posts with label evaluation. Show all posts

Tuesday, March 27, 2018

Report Writing for Battering Intervention Classes

Administrative issues in domestic violence work are topics that are easily seen as dry, boring, and for some even unnecessary if they are doing direct service work. Cultures within agencies and programs are easily ingrained and accepted with little critical thought, sometimes because front line workers have little power to address them, and at other times because workers with very little experience are placed in roles where they do not fully understand the content, let alone the administrative structure. In addition, battering intervention work is easily downplayed in importance and need, with interns gaining responsibility, agencies investing few resources, or the program itself becoming sidelined due to other agency needs. These are all issues which need to be addressed to create an effective program, and report writing is a dynamic which can link to several of these challenges in this work.

When I conduct supervision, I consider administrative issues to be important ones. When discussing clinical challenges, I stress creating balance between process and content. You both need to understand the specific details of individuals in the group and curriculum/educational information (content), and the boundaries of group rules and how individuals make their way through the sessions of the class (process). I have written before that there is a need to know the difference between the model used for intervention (the process of the class, the structure of the rules, the beginning, middle and end experience of the individual participant) and the curriculum used for education (the lesson plans, activities, use of media, structured discussions). The article is going to be focused on methods of reporting on an individual participant in a battering intervention program.

Each program has intake paperwork that gathers background information on incoming participants. While this is not strictly reporting a battering intervention worker will do to outside sources, these documents help inform later reporting, and sometimes help to establish rapport and understanding og the individual participant. The format this takes is sometimes an individual interview, sometimes a group orientation, sometimes a group overview. State guidelines and standards often determine the content requirements, but some of the important aspects include:
  1. Danger/Risk/Lethality assessment: Specific questions on paperwork that give indications of potential lethality are important to include, along with understanding that such assessment is an ongoing process throughout an individual's time in the program, not just during paperwork. It is best to have these questions spread out, rather than in a block, as someone filling out intake paperwork may gloss over extreme questions if they are all together, particularly when they are "yes or no" answers. Most often, these questions come from Jaqueline Campbell's work on Domestic Violence Danger Assessment.
  2. Screening tools: These may vary by program, but I personally like to use the PHQ9, the Mood Disorders Questionnaire, and the Adverse Childhood Experiences (ACE). I think such items support participants in working toward self-care, and often provide words to experiences that make depression, mental illness, and childhood trauma difficult to talk about and seek help over. This paperwork serves a dual purpose: identifying potential problem areas for individuals, and providing humanization by specifically discussing how domestic violence classes are not just about harm toward others, but also harms toward self. It can demonstrate a layer of care over the individual that can be important in establishing rapport and motivating change.
  3. Description of harms: If done as an individual interview, this might engage a participant prior to group to discuss hurtful behavior. I personally think it is better, as an engagement strategy, to collect basic information without getting into detail unless the participant wants to provide it. I want to know charged crimes (if applicable), general patterns of harm, motives for hurtful behavior, a participant's perception of the situation, and I also consider general attitude as a part of collecting this information. Some programs collect police reports and collaborative information or require it for initial intake appointments. I think these can be useful secondary information and a way to ask specific questions, but can also become distracting toward motivating change and allowing an individual participant to see where they might need to make shifts in their behavior in relationships overall.
  4. Objective data collection: I like to do pre-post collection of information to show overall program efficacy and to determine usefulness of the program and potential for updates and feedback from participants. I use an adapted version of Emerge's Violent and Controlling Behavior Checklist, but I know some programs prefer to use versions of the Power and Control Wheels. I also have a survey that asks for goals, concerns, perceptions of how the class might be useful for the individual, and how a participant describes respect and harm in relationships. I find that comparing the survey and the checklist before entering class, and after finishing provide some insight that is useful for participants, and fascinating for reporting on the program overall.
  5. Intake letter: I avoid doing any assessing of participants until they have attended 6-8 class sessions. I will often say during intakes, "this is the first time I've met you, and I know when I meet someone for the first time, I don't tell them my entire life story. Especially not details of things I am not proud of, or don't want to talk about. I don't expect you to do that with me today, although I am going to collect some background information so I can start learning how I can help you the best I can." This is a part of working to use Motivational Interviewing engagement strategies in the program, and it is best to do so as early as possible. Some states require writing a letter informing the referral source that an individual has entered the program, general information about battering intervention groups, the date and time the individual agreed to start classes, and contact information for the program and group facilitators. I suggest such letters not provide details beyond a general statement that the person is accepted into the program due to admission of hurtful behavior.
I work to communicate that there is no such thing as a domestic violence evaluation. People request them all the time, and the general assumption is that such an evaluation will determine if someone NEEDS the program or not. Whenever I hear this request, it is from an individual who definitely believes they do not need the program, and therefore will be evaluated as such. The reason for this confusion, in my experience, is that mental health treatment and substance abuse counseling both involve an evaluation. These evaluations use psychological tools, drug testing, structured interviews, evaluative guidelines, and diagnostic determination for an individual. From all of these sources of information, a determination is made for the TYPE of treatment an individual will receive. This may include inpatient treatment, individual counseling 1-5 times weekly, group sessions, educational sessions, or a combination of things. The American Society of Addiction Medicine (ASAM) has a breakdown of axes which look at factors within an individual's life which may intersect with substance use, and help to determine what sort of treatment might work best. Battering Intervention does not have any such screening tools, any diagnostic components, guidance on setting criteria, or differentiation of classes necessary, save the state of Colorado (which has a process for domestic violence offenders, but I disagree with several of their foundational research studies they have used to justify separation of participants which are based on general criminal populations, not specific to domestic violence offenders. They also charge a fee for initial intake that is often comparable to a full self-pay mental health evaluation of anywhere from $600-$1500).  

The assessment for battering intervention is simply: is the individual appropriate for the class or not? This means that a report that determines appropriateness needs to be based on factors that make the classes useful for an individual. Complications arise when an individual participant is referred due to non-intimate partner violence, which may count as "domestic violence" but dynamics with parents, children, siblings, roommates, or extended family are much different than intimate partner relationships and are best treated differently.

Some criteria I use to assess appropriateness include:
  • The participant admits to hurtful behavior in a relationship toward an intimate partner
  • The description of hurtful behavior includes patterns and history in the relationship
  • The participant speaks both about the incident leading to referral and dynamics of harm throughout the relationship (which may include answering "why did things go downhill?")
In general, if someone is referred for a violent, abusive, or coercive controlling incident in an intimate partner relationship they will be appropriate for the class. The assessment looks at willingness to admit to hurtful behavior, and a certain degree of acknowledging patterns of harm. For those who are not referred for intimate partner violence, some additional pieces I consider have to do with the ability of the individual to speak defensively of their intimate partner, admit to hurtful behavior within "normal limits" with an intimate partner (which would include speaking about arguments, selfish and/or controlling behavior that does not stray into abuse or violence), the context of the incident itself, and the interest for the individual in joining the class in general.

For example, one man I saw for an assessment had a fight with his adult daughter over her moving out of the house because she had not followed through with an agreement to stay in treatment. He and his wife agreed with this decision (per his report), and when he spoke about his wife he did so with care and admitted to raising his voice during arguments on occasion, and lying to her about where he was going (specifically related to him coming to the class, because he said she was very stressed about his court involvement). He was assessed as inappropriate because while his incident was perhaps domestic violence related (this point could be argued), his report about his relationship with his wife over the course of 40 years seemed based in overall health and respect, and his contributions to class discussions over six class sessions consistently demonstrated this attitude about her.

Another individual was referred for brandishing a knife toward his adult siblings when they were arguing during him making dinner. He was not in a relationship at the time. While discussing the incident, he admitted to his threatening behavior toward them. He then spoke to a history in his relationships that included direct violence with a former partner, and dismissive neglectful patterns in a more recent relationship. During his sixth class session when doing a long check-in, he said directly that he needed to be in the class as he had learned about ways he had been violent that he never had considered before. The incident bringing him to the class may not have been intimate partner related, but this history and his willingness to look at his patterns made him appropriate. Now in his case, if he had not spoken to a history in his relationships, without collaborative information, it may have been difficult to assess him as appropriate due to the lack of intimate partner relationship history - but such things demonstrate why intake paperwork can be an important part of this process.

When writing an assessment report, I suggest that facilitators take notes when an individual talks about hurtful patterns of behavior. I use the Emerge model of intervention, which means I believe in doing a long check-in at session 6-8 of the program. I ask questions about most recent harms, what the individual considers to be the "worst" hurtful behavior, what the incident was that resulted in referral (if not otherwise disclosed), the history of the relationship currently, prior history of relationships, and specific questions about other physical assaults, sexual harms, affairs, and threats. I also tend to ask "why did your relationship go downhill" as it tends to give a lot of information about the context of the relationship overall. All of these answers given by the individual I capture quotes and detail for use in reporting. The structure of the report includes:

  1. Information on payment and attendance: this includes any financial issues, tardiness, missing classes, and overall administrative compliance with the program. This may mean I include information on an individual's inconsistency, or alternately their ability and willingness to communicate problems they might experience while attending the class. 
  2. Participation: detailing how an individual uses the classes, this can be anywhere from minimal participation noted, excessive or inappropriate participation, or details on how an individual contributes or uses the class appropriately. 
  3. Report of hurtful behavior: I start here by listing information on the referral incident. The challenge in this section is never adding in secondary information a participant might give which places responsibility onto others, justifies hurtful behavior, or exposes other people's personal issues. It is important to think about the reports through the lens of how a victim/survivor might read the report, and how a defense or prosecuting attorney might read the report. If a victim/survivor could read the report and say "those are lies about me," or if a prosecutor or a defense attorney reads the report and thinks "we need to charge the victim/survivor," or "if that is how it happened, we need to dismiss the case," then the report needs to be rewritten. The goal of reports are never to try a case, but rather to provide information on how a participant views themselves and their patterns of harm. If an individual blames, then it is possible to write "Mr. Jones justifies his behavior by focusing on Ms. Jones' behavior" or to simply not include such information at all and focus exclusively on hurtful behavior the participant admits to. This section will also detail patterns and history, and may include other dates and times of harm. It is important to either specifically name times (years and months when available), or if speaking of general patterns to identify a timeframe (in a prior relationship X years ago). Generally speaking about behavior without a time reference could again be used for or against someone in legal negotiations, and is important to differentiate for clarity. I often also include details of cheating, other physical harms, and threats in this section.
  4. Concerns: It is important to note concerns for each individual participant. Sometimes concerns are related to administrative compliance issues, sometimes for behavior issues in the class, sometimes for specific nature of harms in a relationship, sometimes for current behavior in a relationship, sometimes with self-care issues and/or overlaps with mental health or substance abuse issues. Occasionally, I have noted the very real possibility that an individual is feeding me information to coach a report but there may be additional information left out. Noting concerns can be helpful to discuss with a co-facilitator or supervisor.
  5. Recommendations: The most common recommendation is to complete the program, however, if there are secondary issues to be addressed such as parenting, mental health, or substance abuse related needs, then I will note that the individual may benefit from specific care in other areas. As this is not an evaluation report, recommendations are best as suggestions and if needs are apparent, these suggestions are best made for the individual to be evaluated for services by someone else.
There may be state guidelines that outline needs for reports on a monthly, quarterly, or even weekly basis. Often this can be determined by the needs of the referral sources.
  • Weekly reports: I currently do weekly reports on participants via email. These reports are basic attendance and compliance issues, and occasionally I will write a note that summarizes a problem. If weekly reporting is needed, it is best done in a list style. This can create confidentiality issues, and have several logistical challenges as a result. Most of my referrals are from a specific probation department, so I do a list of every class participant, but those not referred by them I use initials instead of names. The challenge with this method of reporting is it tends to lack detail, and problems are not flagged until they are bigger issues.
  • Monthly reports: Overall, I think this is the best method of ongoing reports. It does become cumbersome for facilitators to write reports on every participant, but it structures an individual's process through the program which is useful when behavior builds over time, and can often be protective of program staff's decisions about individual participants. I like to use a section with check-off boxes to simplify the process, and a section with notes to add in information on how a participant is in the classes. Most commonly, the notes section contains a statement such as "Mr. Jones participated appropriately during class sessions," but it allows facilitators an opportunity to communicate information on individual activities, challenges, ongoing issues inside or outside the class, or details on behavior problems.
  • Status updates: These are simple reports, often just listing attendance and payment details. I often do these per request, and they are not specifically scheduled.
  • Letters/information to partner/victim/survivors: State requirements may indicate a need to conduct partner contacts, and occasionally may require a letter to be sent to a participant's partner and/or ex-partner. If this is a practice, it is important to detail the limitations of the group, information on how to get support or advocacy, and contact information for the program specifically. It can be good to provide a pamphlet outlining the program goals, and basic information on domestic violence. 
For completion reports, I mirror the format of the assessment report, including all the sections as listed above. If someone is completing, I will insert additional information on "report of abuse" if additional information came forward during an individual activity, and also tend to expand on participation information to detail how the individual used the groups overall. Concerns may shift based on how facilitators have experienced the individual, and recommendations often include a line such as "if Mr. Jones were to be abusive or violent, he may return to the program," in addition to any overall needs that may have been identified during the course of the program.

Termination reports are also mirrored, but often list information on last attended session, outstanding balance due, content on the reason for termination, and concerns tend to highlight those reasons. Administrative discharges (participant moved, changed programs, is released due to medical issues, is suspending program participation for an agreed upon allowance, etc) need to detail out the reasons for closure, methods of reentry, and also follow the same format overall.

Sometimes, when an individual never attends a class, or drops out before completing an assessment (most common terminations in my experience) I will write a shorter letter outlining the issues leading to termination. I may also draw from intake paperwork to detail some information if it seems necessary to use the entire termination report format.

The most common issue I have seen with program reporting is including impersonal check-off report styles with little to no context, or providing a "certificate" at the end of the program. Often I find that battering intervention workers may not understand how dangerous such practices can be for victims/survivors. Lack of detail in reports can be used against victims/survivors by saying things such as "hey, I finished my program and they loved me there - said I could teach the class - and she hasn't done anything." This is an easy set up, and may lead to court systems making decisions in favor of someone who is abusive, and uses the certificate to further manipulation and control. Check-off style reports without individual details can sometimes contain things such as "good progress/poor progress" which seems to indicate that the facilitators know definite risk and how a participant is using the program. However, a primary characteristic of domestic violence offenders are that they are excellent radars, and great at using those radars to manipulate others. I can never guarantee that even the seemingly most enlightened participant has changed behavior without doing a partner/victim contact and having knowledge of behavior outside of the class. Judging absorption of material is not the place facilitators need to focus - let the individual's behavior speak for itself through quotes, and detail of attitude in the class. After all, participation in class is a mirror into behavior in intimate partner relationships.

Other problems involve facilitators not understanding why report writing is an important part of accountability. Yes, it is sometimes an administrative headache, but when the safety of victims/survivors is at risk it is both necessary and ethical to make sure reports are neutral or worse about participants, and that assessment or discharge reports always contain information that describes the participant's hurtful, abusive, violent, and controlling behavior. Some programs, who may have an integrated community coordinated response that involves extensive contact with referral sources in an authentic and working relationship may minimize paperwork due to this. That doesn't mean reporting doesn't happen - it just means the reporting is directed through interpersonal connections, not by paperwork. I prefer the paper trail, regardless, because it CAN potentially be used against an abuser who might evidence increased risk or danger.

For this reason, reports for BIP should be neutral or worse. Remember that "positive" reports might overlook manipulations an individual abuser has worked to use against facilitators. The thinking error of "feeding the change agent what the change agent wants to hear" is particularly challenging in BIP classes, and often can lead facilitators to miss how an individual participant avoids responsibility and accountability in classes, and might be using the class to look good and further harm others.

What are your experiences? Have you worked in agencies with excellent or poor reporting systems, and how did you navigate those spaces? What is your philosophy behind report writing and administrative details of this work?