Essay Grade

The Petrakis Family
Helen Petrakis is a 52-year-old heterosexual married female of Greek descent who says that she
feels overwhelmed and “blue.” She came to our agency at the suggestion of a close friend who
thought Helen would benefit from having a person who could listen. Although she is
uncomfortable talking about her life with a stranger, Helen said that she decided to come for
therapy because she worries about burdening friends with her troubles. Helen and I have met
four times, twice per month, for individual therapy in 50-minute sessions.
Helen consistently appears well-groomed. She speaks clearly and in moderate tones and seems to
have linear thought progression; her memory seems intact. She claims no history of drug or
alcohol abuse, and she does not identify a history of trauma. Helen says that other than chronic
back pain from an old injury, which she manages with acetaminophen as needed, she is in good
health.
Helen has worked full time at a hospital in the billing department since graduating from high
school. Her husband, John (60), works full time managing a grocery store and earns the larger
portion of the family income. She and John live with their three adult children in a 4-bedroom
house. Helen voices a great deal of pride in the children. Alec, 27, is currently unemployed,
which Helen attributes to the poor economy. Dmitra, 23, whom Helen describes as smart,
beautiful, and hardworking, works as a sales consultant for a local department store. Athina, 18,
is an honors student at a local college and earns spending money as a hostess in a family friend’s
restaurant; Helen describes her as adorable and reliable.
In our first session, I explained to Helen that I was an advanced year intern completing my
second field placement at the agency. I told her I worked closely with my field supervisor to
provide the best care possible. She said that was fine, congratulated me on advancing my career,
and then began talking. I listened for the reasons Helen came to speak with me.
I asked Helen about her community, which, she explained, centered on the activities of the Greek
Orthodox Church. She and John were married in that church and attend services weekly. She
expects that her children will also eventually wed there. Her children, she explained, are
religious but do not regularly go to church because they are very busy. She believes that the
children are too busy to be expected to help around the house. Helen shops, cooks, and cleans for
the family, and John sees to yard care and maintains the family’s cars. When I asked whether the
children contributed to the finances of the home, Helen looked shocked and said that John would
find it deeply insulting to take money from his children. As Helen described her life, I surmised
that the Petrakis family holds strong family bonds within a large and supportive community.
Helen is responsible for the care of John’s 81-year-old widowed mother, Magda, who lives in an
apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family
dinners and driving herself shopping and to church. But 6 months ago, she fell and broke her hip
and was also recently diagnosed with early signs of dementia. Through their church, Helen and
John hired a reliable and trusted woman to check in on Magda a couple of days each week.
Helen goes to see Magda on the other days, sometimes twice in one day, depending on Magda’s
needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications.
Helen says she would like to have the helper come in more often, but she cannot afford it. The
money to pay for help is coming out of the couple’s vacations savings. Caring for Magda makes
Helen feel as if she is failing as a wife and mother because she no longer has time to spend with
her husband and children.
Helen sounded angry as she described the amount of time she gave toward Magda’s care. She
has stopped going shopping and out to eat with friends because she can no longer find the time.
Lately, John has expressed displeasure with meals at home, as Helen has been cooking less often
and brings home takeout. She sounded defeated when she described an incident in which her son,
Alec, expressed disappointment in her because she could not provide him with clean laundry.
When she cried in response, he offered to help care for his grandmother. Alec proposed moving
in with Magda.
Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John
and Alec had been arguing lately, and Alec and his grandmother had always been very fond of
each other. Helen thought she could offer Alec the money she gave Magda’s helper.
I responded that I thought Helen and Alec were using creative problem solving and utilizing their
resources well in crafting a plan. I said that Helen seemed to find good solutions within her
family and culture. Helen appeared concerned as I said this, and I surmised that she was reluctant
to impose on her son because she and her husband seemed to value providing for their children’s
needs rather than expecting them to contribute resources. Helen ended the session agreeing to
consider the solution we discussed to ease the stress of caring for Magda.
The Petrakis Family
Magda Petrakis: mother of John Petrakis, 81
John Petrakis: father, 60
Helen Petrakis: mother, 52
Alec Petrakis: son, 27
Dmitra Petrakis: daughter, 23
Athina Petrakis: daughter, 18
In our second session, Helen said that her son again mentioned that he saw how overwhelmed
she was and wanted to help care for Magda. While Helen was not sure this was the best idea, she
saw how it might be helpful for a short time. Nonetheless, her instincts were still telling her that
this could be a bad plan. Helen worried about changing the arrangements as they were and
seemed reluctant to step away from her integral role in Magda’s care, despite the pain it was
causing her. In this session, I helped Helen begin to explore her feelings and assumptions about
her role as a caretaker in the family. Helen did not seem able to identify her expectations of
herself as a caretaker. She did, however, resolve her ambivalence about Alec’s offer to care for
Magda. By the end of the session, Helen agreed to have Alec live with his grandmother.
In our third session, Helen briskly walked into the room and announced that Alec had moved in
with Magda and it was a disaster. Since the move, Helen had had to be at the apartment at least
once daily to intervene with emergencies. Magda called Helen at work the day after Alec moved
in to ask Helen to pick up a refill of her medications at the pharmacy. Helen asked to speak to
Alec, and Magda said he had gone out with two friends the night before and had not come home
yet. Helen left work immediately and drove to Magda’s home. Helen angrily told me that she
assumed that Magda misplaced the medications, but then she began to cry and said that the
medications were not misplaced, they were really gone. When she searched the apartment, Helen
noticed that the cash box was empty and that Magda’s checkbook was missing two checks.
Helen determined that Magda was robbed, but because she did not want to frighten her, she
decided not to report the crime. Instead, Helen phoned the pharmacy and explained that her
mother-in-law, suffering from dementia, had accidently destroyed her medication and would
need refills. She called Magda’s bank and learned that the checks had been cashed. Helen cooked
lunch for her mother-in-law and ate it with her. When a tired and disheveled Alec arrived back in
the apartment, Helen quietly told her son about the robbery and reinforced the importance of
remaining in the building with Magda at night.
Helen said that the events in Magda’s apartment were repeated 2 days later. By this time in the
session Helen was furious. With her face red with rage and her hands shaking, she told me that
all this was my fault for suggesting that Alec’s presence in the apartment would benefit the
family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec
would never be in this trouble if I had not told Helen he should be permitted to live with his
grandmother. Helen said she should know better than to talk to a stranger about private matters.
Helen cried, and as I sat and listened to her sobs, I was not sure whether to let her cry, give her a
tissue, or interrupt her. As the session was nearing the end, Helen quickly told me that Alec has
struggled with maintaining sobriety since he was a teen. He is currently on 2 years’ probation for
possession and had recently completed a rehabilitation program. Helen said she now realized
Alec was stealing from his grandmother to support his drug habit. She could not possibly tell her
husband because he would hurt and humiliate Alec, and she would not consider telling the
police. Helen’s solution was to remove the valuables and medications from the apartment and to
visit twice a day to bring supplies and medicine and check on Alec and Magda.
After this session, it was unclear how to proceed with Helen. I asked my field instructor for help.
I explained that I had offered support for a possible solution to Helen’s difficulties and stress. In
rereading the progress notes in Helen’s chart, I realized I had misinterpreted Helen’s reluctance
to ask Alec to move in with his grandmother. I felt terrible about pushing Helen into acting
outside of her own instincts.
My field instructor reminded me that I had not forced Helen to act as she had and that no one
was responsible for the actions of another person. She told me that beginning social workers do
make mistakes and that my errors were part of a learning process and were not irreparable. I was
reminded that advising Helen, or any client, is ill-advised. My field instructor expressed concern
about my ethical and legal obligations to protect Magda. She suggested that I call the county
office on aging and adult services to research my duty to report, and to speak to the agency
director about my ethical and legal obligations in this case.
In our fourth session, Helen apologized for missing a previous appointment with me. She said
she awoke the morning of the appointment with tightness in her chest and a feeling that her heart
was racing. John drove Helen to the emergency room at the hospital in which she works. By the
time Helen got to the hospital, she could not catch her breath and thought she might pass out.
The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms.
I asked Helen how she felt now. She said that since her visit to the hospital, she continues to
experience shortness of breath, usually in the morning when she is getting ready to begin her
day. She said she has trouble staying asleep, waking two to four times each night, and she feels
tired during the day. Working is hard because she is more forgetful than she has ever been. Her
back is giving her trouble, too. Helen said that she feels like her body is one big tired knot.
I suggested that her symptoms could indicate anxiety and she might want to consider seeing a
psychiatrist for an evaluation. I told Helen it would make sense, given the pressures in her life,
that she felt anxiety. I said that she and I could develop a treatment plan to help her address the
anxiety. Helen’s therapy goals include removing Alec from Magda’s apartment and speaking to
John about a safe and supported living arrangement for Magda.
(Plummer 20-22)
Plummer, Sara-Beth, Sara Makris, Sally Brocksen. Sessions: Case Histories. Laureate
Publishing, 02/2014. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.
Administration in Social Work, 33:439–449, 2009
Copyright © Taylor & Francis Group, LLC
ISSN: 0364-3107 print/1544-4376 online
DOI: 10.1080/03643100903173040
Standardizing Practice at a Victim
Services Organization: A Case Analysis
Illustrating the Role of Evaluation
1544-4376
0364-3107
WASW
Administration
in Social Work,
Work Vol. 33, No. 4, Jul 2009: pp. 0–0
Standardizing
M.
Larsen et al.Practice at a Victim Services Organization
MANDI LARSEN
Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Germany
COREY TAX and SHELLY BOTUCK
Safe Horizon, New York, New York, USA
This paper provides an example of how an internal evaluation
department at a midsize victim services organization led key
activities in achieving strategic organizational goals around
unifying service delivery and standardizing practice. Using the
methods of logic model development and naturalistic observation
of services, evaluation staff guided the clarification of program
expertise and outcomes, and assessed the necessary resources for
standardizing practice.
KEYWORDS program evaluation, standardized practice, victim
services, logic models, observation
There is little question that there is a growing demand for program evaluation data at nonprofit organizations, stemming from government, foundations, and other funding sources that want to know the impact of the
programs they are supporting and that require demonstrations of effectiveness (Botcheva, White, & Huffman, 2002; Carman, 2007; Newcomer, Hatry, &
Wholey, 2004). This focus on accountability to funders is also an opportunity
for organizations to learn what services work best through evidence collection for outcome measurement (Botcheva et al., 2002; Buckmaster, 1999).
An organization’s ability to use this evidence and make strategic management decisions that are evidenced-based or informed is essential in an
Address correspondence to Shelly Botuck, Safe Horizon, 2 Lafayette Street, 3rd Floor,
New York, NY 10007, USA. E-mail: sbotuck@safehorizon.org
439
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increasingly competitive environment for funding (Menefee, 1997; Neuman,
2003; Proehl, 2001).
Despite the increased focus on evaluation from funders, limited
resources make it difficult for nonprofit organizations to carry out evaluation (Hoefer, 2000). A study by Carman (2007) found that very few organizations have the discretionary funds necessary to employ internal evaluation
staff members. This is in part because demands for evaluation can often
seem like detractions from the service provision, especially when funding
for services is limited (Kopczynski & Pritchard, 2004; Neuman, 2003). Poorly
developed information systems and high staff turnover at many social
service organizations also present barriers to implementing evaluation that
demonstrates program improvement over time, both in terms of data collection and institutional memory (Kopczynski & Pritchard, 2004). As a result,
organizations focus on counting products or services provided through the
activities of the organization (e.g., number of counseling sessions, number
of trainings conducted) in an attempt to meet funder demands (Carman,
2007). This emphasis on outputs can shift the focus from achieving the
mission of the organization to counting services, and may take attention
away from case documentation that could be used to monitor practice and
assess client outcomes. Despite all of these barriers, evaluation is still the
key to understanding the effects of programs and services. Thus, the
challenge lays in making evaluation useful to organizations, because
without an appreciation of its value and worth, program evaluation will not
be efficacious (Chelimsky, 1994).
Using Safe Horizon’s community and criminal justice programs (CCJP)
as an example,1 this paper provides a case analysis illustrating the role of
evaluation in furthering the implementation of our organization’s strategic
plan. It focuses on two key activities, logic modeling and assessing program
practice, and highlights the ways that these activities assisted Safe Horizon
in standardizing service delivery.
ORGANIZATIONAL CONTEXT
Founded in 1978, Safe Horizon’s mission is to provide support, prevent
violence, and promote justice for victims of crime and abuse, their families,
and communities. Safe Horizon is New York City’s leading victim assistance
organization delivering services to victims of domestic violence, sexual
assault, child abuse, stalking, human trafficking, and other crimes through
programs in the family and criminal courts, police precincts, child advocacy
centers, schools, and other locations. Safe Horizon also operates domestic
violence shelters; New York City’s 24-hour domestic violence, rape, and
sexual assault hotlines; drop-in centers and emergency shelters for homeless and street-involved youth; case management services; and specialized
Standardizing Practice at a Victim Services Organization
441
mental health programs. Victims’ program involvement may last minutes or
years. Safe Horizon’s primary service obligation is to provide victims of
crime and abuse with the resources and tools needed to maximize their
personal safety and reduce their risk of further harm, whatever the presenting
victimization or service setting.
Safe Horizon’s leadership has long recognized the importance of internal research and evaluation. As Whyte (1989) noted, when knowledgeable
stakeholders conduct research, they can report on practices without the
distortion caused by the presence of an outside observer. However, external
funds obtained to answer macro social science and criminal justice questions dictated most of Safe Horizon’s research and evaluation activities. As a
result, these activities rarely informed day-to-day direct practice or service
delivery. Additionally, it was difficult to agree on measurable outcomes for
victims of violence. This was due in part to the context of traditional victim
services programs, which are often designed to prevent a negative event
from occurring (reabuse), and where the approach often holds that “the
survivor is not responsible for preventing, and is indeed often unable to
prevent, this negative event from occurring regardless of her actions”
(Sullivan & Alexy, 2001, p. 1).
Thus, as a first step in establishing evaluation that would directly
inform practice, while acknowledging the challenges of establishing
outcomes, program evaluation focused on victim satisfaction surveys. This
was helpful in improving practice and began collaboration between evaluation and program staff. This also built a foundation for trust and understanding that would become important in engaging with programs in thinking
about outcomes beyond victim satisfaction.
Over the course of three decades, Safe Horizon grew into a midsize
organization with the capacity to serve a wide range of victims in disperse
settings, and each program determined its own method for assessing victim
needs. As a result, the organization’s service delivery and documentation
practices were decentralized and varied. In 2003, this was addressed in the
organization’s strategic plan with the goal of unifying service delivery to
ensure coordinated and high-quality services.
Standardized practice is the creation of uniformity in the definitions,
training, staff role, and procedures for common practices within a discipline
or organization, which is “intended to promote the effectiveness of practice,
reduce variability in implementing best practice, [and] increase the predictability of practice behaviors” (Rosen & Proctor, 2003, p. 1). Using our safety
assessment and risk management policy (Safe Horizon, 2007) to standardize
practice, Safe Horizon began its first steps towards unifying service delivery
and creating a continuum of care across programs. This policy places a
“victim’s needs, wishes, resources, and capacities at the center of client
work,” and thereby sets a “standard for a dynamic and collaborative process
to address the complex challenges that victims of crime or abuse face” (Tax,
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Vigeant, & Botuck, 2008, pg. 6). The policy provides a framework that
acknowledges change in a victim’s risk over time, while also integrating
both the staff’s knowledge and the victim’s perspective into the safety planning process. Its implementation requires attention around standardization
because the policy emphasizes “a standard of care that will be upheld
across the organization,” while still recognizing that “specific aspects of
implementation will depend on the program and the services offered by
that program” (Safe Horizon, 2007, p. 2).
To prepare to implement the policy in a way that would unify service
delivery across programs, evaluation staff engaged CCJP in a number of key
activities, the first of which was the development of logic models. These
were intended as blueprints defining the expertise, activities, and goals of
each program, clarifying how programs work together, and setting up a
framework for monitoring program practice. To identify the necessary
resources for implementing standardized practice, evaluation staff assessed
program practice to determine to what extent the skills and practices
outlined in the policy were already taking place.
LOGIC MODEL DEVELOPMENT
McLaughlin and Jordan (2004) have described logic models as “the basis for
a convincing story of the program’s expected performance, telling stakeholders and others the problem the program focuses on and how it is
uniquely identified to address it” (p. 8) through a visual representation of a
program’s resources, activities, outputs, and a range of outcomes. “A logic
model provides a blueprint that delineates all the elements of the program
that need to be documented in order to fully understand the program”
(Conrad, Randolph, Kirby, & Bebout, 1999, p. 20) and represents how a
specific set of resources and activities will bring about intended outcomes.
Logic models are useful tools in pinpointing inconsistencies or redundancies, as well as determining whether activities are still relevant to program
goals. Conrad et al. (1999) also noted the usefulness of logic models for
bringing the perspectives of various program stakeholders to consensus,
which can serve to establish clear and measurable expectations for a
program and a common understanding of staff roles and function across an
organization (McLaughlin & Jordan, 2004).
In order to integrate the service delivery model into the organizational
culture and everyday decision making, the logic model development
process aimed to ensure buy-in at all levels. Evaluation staff (namely, the
authors) met with all levels of program management. Prior to these
meetings with CCJP leaders and site supervisors, evaluation staff reviewed
current funding reports and objectives and investigated reporting and
documentation mechanisms in order to gain an initial understanding of
Standardizing Practice at a Victim Services Organization
443
resources and program activities. This served as preparation for building an
overall logic model with CCJP leaders to define the vision for this cluster of
programs.
Initial meetings with CCJP leaders included discussions about resources
(e.g., funding, staff expertise, external partners, documentation systems)
and activities, but primarily centered upon the expectations and vision for
this cluster of programs. This focus on vision was only possible given the
mutual trust and understanding previously built between evaluation and
program staff. Due to previous negative experiences in tying program
success to the actions of outside systems or the actions of the offender (e.g.,
receiving an order of protection, successful prosecution of the offender,
placement in a domestic violence shelter, desistance of violent behavior),
CCJP leaders voiced a general reluctance to define victim outcomes. Given
this reluctance and the challenges inherent in establishing and operationalizing outcomes at social service organizations (Neuman, 2003), extra time
was devoted to discussing meaningful program outcomes that accurately
assess whether the program is having its intended effect. Over the course of
these discussions, consensus on appropriate outcomes was achieved
through continual grounding in the policy, which was centered upon the
organization’s guiding principles and the commitment to “support and
promote our client’s self-determination, dignity, and empowerment in a
compassionate, non-judgmental environment” (Tax et al., 2008, p. 14). With
this grounding, evaluation staff and CCJP leaders developed victim
outcomes that were not dependent upon outside actors, but measured program success through individual victim change. These outcomes, along with
quality assurance of standardized practices, have the potential to inform
program practice by their measurement.
After developing a draft based on these discussions, evaluation staff led
CCJP leaders through the refinement and vetting of the CCJP logic model
during a daylong off-site work retreat. In this focused setting, the group
walked step-by-step through the logic model, critiquing and offering
suggestions for revision. The end result was an overall logic model of CCJP
resources and services with victim outcomes that CCJP leaders expected
would result from a victim’s involvement with the CCJP cluster.
The next task in creating a blueprint for unified service delivery was
the development of a logic model for each of the four main programs in this
cluster to clarify each program’s expertise and to define the roles the programs should play in a unified service delivery model. Separate discussions
were held with site supervisors from each of the programs (these programs
have five sites, one in each borough of New York City), walking through
the overall CCJP logic model and breaking down the aspects specific to
their program. Document review and discussions with site supervisors
revealed that programs performed similar activities, but that these activities
were conducted slightly differently in each program. For example, information
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provided in a police program focused on police processes, while information provided in a criminal court program focused on court processes. The
expected outcome of information provision (that the victim will be able to
strategize and make informed decisions about their situation) remained the
same across the CCJP, but the differences in program expertise were clear.
Evaluation staff incorporated these commonalities and differences into the
initial logic model drafts for each of the programs, totaling four logic models
altogether.
Evaluation staff presented these drafts back to CCJP leaders for vetting,
walking step-by-step through each program logic model and considering
the following questions: Were there gaps in services that needed to be
addressed in order to better fit the vision of providing a continuum of care
to victims through integrated expert programs? Which services currently
offered should change? For example, while all site supervisors indicated
performing some type of community outreach, CCJP leaders did not feel
that this activity was within the appropriate scope of activities for the court
programs. They agreed that community outreach seemed beyond the goals
of court programs, whose aim is to serve those already involved in the court
systems and who do not receive any funding for outreach activities. CCJP
leaders felt that community outreach should be concentrated in the police
and community-based programs, which play an important role in ensuring
community members are aware of the services offered at Safe Horizon.
Another round of revisions resulted in four individual program logic
models that represented the vision for service delivery for the CCJP cluster.
To continue fostering a sense of ownership of these logic models, CCJP
leadership presented the models to site supervisors. This allowed for the
gathering of feedback and also allowed them to be on hand to answer
questions about strategic decisions made about standardizing services. By
the end of the logic-model development process, clear and measurable
expectations for programs were established, as was a common understanding
of staff roles and function across the CCJP.
ASSESSING PROGRAM PRACTICE
To assess the extent to which the skills outlined in the new policy were
already occurring in day-to-day program practice, observation of service
delivery and its documentation across Safe Horizon’s point-of-entry
(gateway) programs was conducted over a two-month period. In the
absence of documentation that would clearly reflect current practice,
prudent use of naturalistic observation—where behavior is observed in its
natural environment and is recorded in a manner that is as unobtrusive as
possible (Angrosino, 2007)—can provide a representative sample of service
delivery.
Standardizing Practice at a Victim Services Organization
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Based on designated performance indicators of the new risk and safety
policy, an observation tool (see Appendix for a detailed explanation) was
developed by evaluation staff that would collect information that could: (a)
describe current practice, (b) identify differences in practice across programs,
(c) examine how practice(s) apply to different types of victim interactions,
and (d) inform decision making about future staff training.
Over a three-week period, four observers, which included evaluation staff
and interns, were trained by one of the authors to assess client interactions
according to a standard and to match to his observations for all sections of the
tool. This necessarily included a common understanding and definition of
service delivery (e.g., referral, linkage, supportive counseling, crisis intervention, etc.), as well as how to be unobtrusive during observations and how to
keep appropriate boundaries with victims and staff. A 90% level of inter-rater
agreement was established between each of the four observers and the trainer.
All of the observations were scheduled in advance. Every effort was
made to ensure that the service delivery was representative of typical
sessions and workloads and did not underestimate the frequency or intensity of service delivery. Observers refrained from inferring anything about
service delivery and gathered information from only directly observed staff
comments, actions, or responses to a victim. Observations were always
conducted by one observer at a time. Upon arrival at the site, the site supervisor would introduce the observer to the staff and explain what he or she
would be doing. To gain the consent of the clients before observing a case
management interaction or counseling session, the case manager would
introduce the observer to the client and explain the process, emphasizing
that the observer was there to observe service provision only.
The data from the observations were entered into an SPSS database,
and frequencies were calculated. Twenty program sites were observed for
approximately 208 hours, totaling 213 victim interactions (162 telephone
and 51 face-to-face interactions).
The analysis of these observations revealed that expected practices
were not occurring at the frequency anticipated. Victim safety concerns
were documented, and observers noted that the need for assistance was
complex and ongoing (Vigeant, Tax, Larsen, & Botuck, 2008). Additionally,
even within the same program at different delivery sites, service provision
often had wide variability in both practice and documentation. As a result,
clients with identical presenting needs might be offered different services
depending on which program site they happened to walk into.
DISCUSSION
Evaluation activities, which included the development of logic models and
the assessment of current practice, identified gaps between the organization’s
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vision for unified service delivery as identified in its strategic goals and
current practice. This pointed to additional resource needs that were not
anticipated in the original planning. The findings also revealed practice realities that included considerable variability in service delivery and documentation, lower than expected frequency of specific activities, and complex
client need. These findings pointed to a need for changes in existing implementation plans.
The development of logic models served to bring staff with a range of
education, experience, and expertise closer to consensus around program
practices, services offered, and victim outcomes. Walking through the
models with CCJP leaders and site supervisors necessarily focused the discussion around variation in program practice. It was not unusual for there
to be a variety of perspectives on program functioning, a lack of shared
information across sites, and a variety of documentation systems. This process
brought to the forefront the current resources, expertise, and