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Women working in violence intervention and outreach: providing space for emotional vulnerability and empathy
  1. Grace Keegan1,
  2. LaCrisha Jones2,
  3. Collette Sholi3,
  4. Paige-Ashley Campbell4,
  5. Tanya L Zakrison5,
  6. Lea E Hoefer5
  1. 1Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
  2. 2Chicago CRED, Chicago, Illinois, USA
  3. 3Eastern Virginia Medical School, Norfolk, Virginia, USA
  4. 4University of California San Francisco, San Francisco, California, USA
  5. 5Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
  1. Correspondence to Ms Grace Keegan; gkeegan{at}uchicago.edu

Abstract

Introduction There is a growing presence of violence intervention workers who identify as women, yet their unique strengths and challenges have not been described previously. The purpose of this study was to characterize the intersections of gender and violence intervention work.

Methods We conducted a qualitative study of women working in violence intervention via focus groups. Perceived strengths and risks were explored using a semistructured interviewing technique. Focus groups were transcribed and coded by two separate evaluators. Grounded theory methodology was used for thematic analysis.

Results 17 violence intervention and outreach specialists who identify as women were included in three focus groups. Common challenges include a sense of powerlessness when faced with inequitable structural limitations and vicarious trauma. When discussing the role of their gender identity in the work, the women reported that men seem more willing to be emotionally vulnerable with women, including disclosures of a history of sexual abuse. Women also experience a lack of respect personally and professionally in their role related to gender. The women revealed a need for leadership opportunities to leverage their strengths and for enhanced training, especially for male colleagues who may benefit from the insights of colleagues who are women.

Conclusions Women bring unique strengths to roles as violence intervention specialists to deal with trauma and prevent future violence. These findings suggest a need for specific curricula to support women working in violence intervention and further studies that explore the intersectional role of race as well as gender in violence intervention work.

Level of Evidence 6

  • Community Health Services
  • violence

Data availability statement

No data are available.

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WHAT IS ALREADY KNOWN ON THIS TOPIC

  • There is a growing presence of violence intervention workers who identify as women.

WHAT THIS STUDY ADDS

  • Our study is the first to describe the unique strengths and challenges of women working in violence intervention and recovery.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • Our findings suggest the need for leveraging the strengths of women working in violence intervention and recovery programs, both in the community and within hospital-based programs, to improve the effectiveness of these violence intervention and prevention in the future.

Introduction

The community-based approach to violence intervention has been shown to be an effective strategy for injury prevention by reducing urban violence.1 Gun violence has continued—and in some cities increased—throughout the COVID-19 pandemic, maintaining the need for violence interruption and outreach work.2 Violence interrupters and outreach workers provide counseling and ongoing support to people previously involved in incidents of interpersonal violence, most often men, and connect them to resources or lead mentorship programs to deter imminent or future interpersonal violence.3 By nature of this work, these community-based workers are vulnerable to vicarious trauma which can compromise their health and ability to effectively serve their role.4

Violence intervention specialists identifying as women (VISW) comprise a group of violence interrupters and outreach workers who identify as women. VISW make up a small proportion of violence intervention professionals; however, they have a growing presence. Original estimates from Ceasefire Chicago, one of the oldest and most well-known violence intervention programs, described the program’s early hiring strategy as focusing on men with only 8% of their workers identifying as women; however, more recent estimates by community violence intervention non-profits in Chicago suggest this percentage is up to 20%.5 While these women bring a different perspective to violence recovery and intervention, the value they add to trauma intervention teams has not been formally described in the literature previously.

We hypothesized that women working in this field experience unique challenges, but also bring unique strengths to violence recovery and injury prevention work related to their experiences and identities as women in society. The purpose of this study was to identify the unique strengths these women bring to violence recovery and intervention, recognize the challenges they face related to their identities as females working in the field, and determine support needs for VISW which can be implemented in trauma intervention programs on a broader scale.

Methods

Design

This investigation was a qualitative study of violence outreach and recovery workers who identify as women working with community members affected by interpersonal violence in a single major metropolitan area. The study was conducted via focus groups either on Zoom or at the site where the VISW worked. The goal of these groups was to learn directly from the perspectives of VISW.

Participants

VISW were recruited by a snowballing sampling method. Participants recruited that agreed to participate in the study were separated into three in-person focus groups of 5–8 women each. Participants were recruited via word of mouth, email, and text message through coordination with managers of violence intervention specialists (VIS). Inclusion criteria included age of 18 and over, able to communicate in English, identifying as a female, and working as a VISW (defined as any social worker, mentor, or program coordinator for violence recovery programs within the hospital and at any city-wide non-profit organization with a violence recovery mission). Participants did not have a previous relationship with researchers but were informed of the background of the researchers and purpose of the study, including the researchers’ interest in the topic of gender and trauma work. For the purpose of clarity and brevity, people who identified as female were described as ‘women’ or ‘females’ in this study, though we recognize that sex assigned at birth and gender identification are not equal.

Procedures

Participants provided verbal consent to participate in this study. The semistructured group interview approach addressed questions related to the following categories: daily roles and responsibilities, training received for these roles, motivations for pursuing work in violence outreach and recovery, workplace highs and lows, gender identity and race, and perceived needs related to their job roles. Question themes were derived from discussions held at Chicago CRED, a city-wide non-profit with a mission to reduce gun violence. Interviewers included a first-year medical student (BS), surgical resident (MD), and attending trauma surgeon (MD) (authors GK, LEH, and TLZ) with previous training in qualitative research methods. The researchers all identified as women and have experience in trauma research. Focus groups ranged from 50 minutes to 75 minutes in length. No one else was present besides the participants and researchers. These sessions were audio-recorded and transcribed to maintain the accuracy of representation and quotation. Gift cards were given to participants as compensation for their time. Informal debriefing sessions were held after the interview for participants who wanted to discuss among their colleagues their feelings after sharing this information.

Analysis

Qualitative interview transcriptions were inductively coded using grounded theory methodology to generate themes from the data. Grounded theory methodology uses a structured but flexible approach that seeks to extract themes, gain meaning, and develop explanatory theories from a set of collected data, in this study focus group interviews. Each of the three focus groups was read and coded by two separate coders; a total of three coders analyzed the interviews as a whole. Codes were harmonized, and themes were generated from all groups by a team of four authors. Thematic saturation was determined as when no new themes were added when analyzing further content. Transcripts were also returned to two participants (one from a hospital-based violence intervention program (HVIP) and one from the community) who provided feedback on the findings.

Results

The focus groups were conducted between January and October 2022. We had 17 participants ranging age from early 20s to late 40s. No one who responded to the study inquiry was removed or dropped out. All but one participant (94%) identified as women of color. Participants included women from two organizations with distinct practice patterns, one HVIP and one community-based program. Both programs serve adults and teenagers on the south and west sides of Chicago. Two focus groups involved women who worked with clients in a community-based organization (12 participants total in community-based programs), and the third focus group was composed of women working in an HVIP (five participants total in HVIPs). Information from hiring leadership suggests that most participants were from the discipline of social work, including all of the participants from HVIPs and many from the community work, with very few from the background of community activism. Thematic saturation was achieved.

Motivations

When discussing motivations for working in violence intervention and outreach, a major theme that emerged was a firsthand experience with interpersonal violence. Many women shared that they had been drawn to the work after experiencing the death, injury, or incarceration of a friend or family member due to interpersonal violence. For them, these events were a catalyst that led to their desire to prevent what they had experienced from happening to others in their community. As one participant explained:

Unfortunately, it landed on my front door…for me, it was no longer just on the news. It was, literally, in my house…I was determined to get into a field that I could try to do something, even if it was a small amount to give back, to help somebody, a young man.

Interestingly, this shared perspective seems not to be understood by many of their clients, with one participant describing

…that the different [clients] that I see, they don’t always expect me to maybe have had similar stories with them or similar experiences as them because I am a female…They’re usually really shocked about just the similarities and upbringing, the similarities and experiences. And I do believe that it’s because I’m a female sometimes.

However, for women who had this personal connection to instances of interpersonal violence, their work with their clients in violence intervention and outreach was an opportunity for them to change the outcome for others and to disrupt the transgenerational cycles of trauma in their community.

Challenges

Despite their strong motivations for working in violence intervention, participants also cited several challenges they face in their daily work. These fell under three main subthemes: a sense of powerlessness in the face of wider systems-based issues and constraints outside of their control, the psychological effects of working in a field with frequent exposure to trauma, and difficulty maintaining work-life balance.

One of the significant challenges discussed by VISW was the frustration felt when they found themselves in a situation where despite their best efforts, factors outside their control prevented them from becoming successful. This might be the inability to connect a client to needed resources such as housing or job training due to lack of availability of services, or having a client who has been achieving many of their goals then become reinjured or even killed suddenly. One participant described this, stating, ‘There are certain times when we’re able to provide a safety plan for alternative options, but a lot of other times they end up going back to the same community, the exact same place where they got injured in the first place.’ VISW felt a sense of helplessness in the face of a system that often does not respond to the needs of their clients. These feelings were reported by community workers and participants in HVIPs, with no major distinctions along the lines of this work.

The psychological ramifications for providers working in a field with constant secondary exposure to trauma were felt by both those working at the community organization and in the HVIP. One participant described this stating:

Just constantly hearing what happened to a patient and then the circumstances in which they got injured, it can become—it can make you look paranoid. I don’t even like going to get gas anymore because I’m always hearing, oh, it happened at the gas station…it definitely takes something away from you, a level of freedom that I used to have. I don’t have it anymore.

Other participants related that they often struggled to process their client’s experiences and would turn to detachment as a coping mechanism. Many were reluctant to share or discuss their work experiences with others in their lives for fear of burdening them with the distress of the events they had indirectly borne witness to. Lastly, participants related that it was often difficult to create adequate separation from their home and work life.

The role of gender and identity

When discussing how they thought gender and other identity roles impacted their work, participants discussed that they felt their clients often opened up to them in a way they did not with their male coworkers. Participants hypothesized this may be due to a perceived sense of increased safety or nurturing with female staff compared with male staff, stating:

Men who have been involved in, you know, you know, gun violence and, you know, so they might not…they might come from a way where life is just tough love. And you know, our participants don't need tough love all the time, you know, sometimes it works, sometimes it doesn't. And I think honestly, we as you know, women, we know when it works, when it doesn't. So we are able to navigate that a little bit better.

Participants described that this sometimes led to their male coworkers bringing clients to them or other women in the office when they were concerned they were not able to open up fully.

In addition, participants felt this unique relationship between female staff and their male clients allowed clients to develop healthy relationship models for relationships with the other women in their lives, challenging models of toxic masculinity. One participant stated:

I think that as females, whatever we allow clients to learn how to gain healthy relationships, learn how to build healthy attachments to someone to have how to have healthy communication and with other women in their lives….And basically just bringing like a—like we highlighted before, like, you know that that feminine, soft spirit to the mortar really allows them to kind of open up in a way that is different….

The closeness and trust that develops between male clients and female staff even led, in one case, to disclosure of histories of trauma, including sexual violence in childhood. ‘I wanna say that many of the young men I’ve spoken to have opened up about a history of molestation when they were kids.’ This unique relationship may also help young men seek support for histories of trauma, another mechanism of learning how to develop healthier relationships.

Despite the unique strength that women bring to their roles because of this, many of the participants in our study felt like they received less respect than their male colleagues. This manifested both in less perceived respect from their clients, as well as feeling that women were not given as many opportunities for leadership in their organizations, with one woman stating:

And I wasn’t in the room where decisions were being made. And so I felt limited in my role on how I wanted to help people. And because I did the work for so long as a case manager, I saw the changes that needed to be made. Couldn’t get in the room, though.

Participants felt that receiving less respect from their clients may be in part due to the perception that the women did not share or understand their experiences. One woman described an event at work that made this apparent to her:

They just don’t give us the street…I guess…respect or credit that they would give to a guy. We played this game one time where we all had to say something about ourselves, and then we pull it out and we try to say it. And then they have to go around the room and try to guess who said it. So everything that came out that appeared to be male-dominant, they went to a male. But the funny thing is a lot of it was women, and they couldn’t believe it. They were like, ‘Really?’

Overall, gender plays a significant role in the interactions that VISW have with their clients, both positively by promoting trust and relationship building and negatively as male clients often view VISW as unrelatable.

Future needs

Participants noted a need for ensuring adequate time for physical and psychological self-care. They discussed that dealing with the stress and vicarious trauma of their role should be considered a regular part of their job, not something extra they had to be responsible for in their free time. One participant expressed:

I, personally, don’t even think that this is like a 40-hour-a-week job. I feel like in order for people to function at a capacity where they're able to help others, even the scheduling should—I don’t know. It should not be like an 8-hour shift every day. It could be like alternative days. It could be maybe one week you work for 10-hour shifts and then the other week you work on case management from home.

The VISW explained there are currently no trainings to address vicarious trauma in their work, despite all participants stating being affected by it. Participants also expressed a desire for peer support and debriefing opportunities, and for more opportunities for career development and leadership for women in their field.

Additionally, one woman pointed out that the strengths they had identified related to their gender could also be leveraged to improve the effectiveness of men working in violence outreach and intervention, suggesting

trainings… not really for us, but more training for like the other stuff that basically teaches them how to work in a…I need the right word for it…more therapeutic… to have these conversations where like they don’t have to be this like father or this hard exterior towards the guys or whatever, but teaching staff on how to be more client centered, client focused, you know, basically just a different approach overall.

The participants noted an interest in participating in these trainings and serving as peer educators.

Discussion

In this study, we found that women working in the violence recovery and intervention field experience unique challenges, but also bring unique strengths to violence recovery and injury prevention work related to their experiences and identities as women in society. Systems-based factors and events occurring outside of individual control are sources of frustration in their work, and the psychological toll of frequent exposure to trauma and difficulty creating work-life separation leads to additional job stress. Women are motivated to work in this field from a sense of altruism and desire to help, and in many cases because of personal or family experiences with interpersonal violence that mirror that of their clients and drive them to prevent similar events from happening to others. Participants noted that their male clients seemed to be more open and vulnerable in their disclosures with them as compared with men working in similar job roles. They felt this created an opportunity for them to model healthy relationships and is a potential area for skill development for their male coworkers. Lastly, women working in violence intervention and outreach expressed a desire for more support and time for self-care and more opportunities for leadership for women in their field.

Despite the unique strengths discussed by our all-female focus groups, the role of women in violence intervention and outreach has historically been one that has been relegated to the sidelines. Beyond the Ceasefire Chicago report, which describes instances where a female candidate’s ability to do the outreach job and effectively reach male clientele was questioned based on her gender, previous studies both in Chicago and elsewhere on violence intervention and outreach programs do not delve into the topic of gender or mention it only in passing.5–8

Our results suggest that examining the role of gender in violence outreach and intervention may provide important clues to improve its effectiveness. Our participants’ discussion suggested that women are able to effectively reach male clientele when working in a violence outreach and intervention setting, and they in fact have strengths that make them uniquely situated to the role. Additionally, the perception either by organizations during hiring or by clientele that women working in these jobs do not share the experiences of their clients is often not true, as was described by our study participants who frequently came to their jobs after experiencing interpersonal violence in their own lives. This is something that can be taken into account when thinking about how to strengthen community-based organizations and as trauma programs across the country continue to build and strengthen their HVIPs which often serve patients experiencing intimate partner violence or sexual violence (IPSV).9

The unique role that VISW play as a trusted resource for discussing vulnerable topics is even more meaningful in the context of IPSV. Internal communications from Chicago CRED indicates that up to 40% of clients affected by violent trauma have experienced sexual abuse in their childhood. While the rate of IPSV among male and female trauma patients is nearly equal, men affected by IPSV are more likely to be victims of penetrating trauma.10 As penetrating trauma represents the vast majority of cases of community-related violence faced by VISW, this association implicates a role for VISW specifically in promoting healing in men affected by IPSV because they may be the first person to whom this history is disclosed. The trust that VISW may build in this process may help interrupt patterns of toxic masculinity that follow IPSV, further contributing potentially to a broader reduction in community-level violence.11

Recognizing the strengths of women working in violence outreach and intervention can mean supporting them in multiple ways. Providing paid time off for self-care, therapy, or other outside-of-work wellness activities is a strategy that has been implanted by organizations in the past and could be expanded.6 Strikingly, as one of our participants astutely noted, the increased willingness of male clients to disclose and open up to women working in violence outreach and intervention roles should not turn into increased emotional labor for women. Finding ways to harness and teach the communication skills these women are displaying in these encounters and breaking down the barriers that prevent male clients from feeling that they can be open with male staff can help reduce the workload placed on women and increase the effectiveness of all working in these roles.

There are a few limitations to our study. First, our study population is small in part due to the small number of women who work in the field we were investigating. Our study is also limited to a single urban metropolitan area, limiting our ability to generalize to other locations. Additional studies in other areas with potentially different models of violence intervention and outreach are needed. We acknowledge that the discussion of gender in this article is largely centered around a binary view of gender and that there is room to explore this topic from a more gender-expansive lens going forward. And finally, our study is restricted to the perspective of females, and future studies should explore the perspectives of VIS who identify as other genders on the topic of identity and strengths in this work.

In summary, women working in violence outreach and intervention are often seen by their clients as a safe space to be emotionally vulnerable and disclose in a way they often do not with male staff. The shared experiences of female staff with their clients are often not perceived by others, and women often feel they receive less respect and leadership opportunities in their field. Opportunities exist to better support both women and men working in violence outreach and intervention, and future studies should endeavor to consider how gender plays into the interpersonal dynamics which are key to this work.

Data availability statement

No data are available.

Ethics statements

Patient consent for publication

Ethics approval

This study involves human participants and was approved by University of Chicago's Biological Sciences Division Institutional Review Board (IRB21-1928). Participants gave informed consent to participate in the study before taking part.

References

Footnotes

  • Contributors GK, LEH, LJ and TLZ were involved in the concept and study design, conducting of research and analysis of data. GK, LEH, and CS were involved in the original drafting of the article. GK, LEH, LJ, and TLZ were involved in the final revisions of the article. GK and LEH accept full resposibility for the work and are the guarantors of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.