Victims' Response to Trauma and Implications for Interventions: A Selected Review and Synthesis of the Literature

6. CONCLUSIONS AND RECOMMENDATIONS

In conclusion, it is apparent that victims undergo cognitive and emotional changes through the process of victimization. Research on treatment programs indicates that programs that focus on cognitive skills help victims reach a non-symptom status more quickly. However, other research shows that those who do not receive treatment may eventually catch up to treated groups. Thus, it is reasonable to assume that there are changes in cognitive elements and that the victim is faced with cognitive adjustment after victimization. Victims requiring services need to quickly access appropriate interventions to minimize the time they must cope with distress. However, clinicians must be mindful of the effects of crime victimization and take measures to respect victims and their wishes in a effort to minimize further distress. Matching clients to services could use severity as a guide, Critical Incident Stress Management may be useful initially and the Transtheoretical Model of Change may offer a way to direct victims to appropriate services. Unfortunately, much of this is conjecture as there is little research in the area. However, improvements in outcomes is a likely result if we better allocate resources to clients, matching service-deliverer, interventions and victims may help reduce the distress associated with victimization and intervention.

Despite the limitations of the literature in this area, certain recommendations can be made with relative confidence, especially if linked with a solid program evaluation element. Many of these interventions are cost-effective and could have profound impact on victim adjustment.

Recommendation 1: Improved research
As noted above, research initiative with victims need to move beyond simple relationships and examine the process of change associated with victimization. Through an examination of how victims change cognitively, emotionally, behaviourally and socially, researchers and clinicians will gain insight into how to develop more effective programming. This also means that an empirically solid research program needs to be supported by the system.
Recommendation 2: Treatment matching
Matching clients to services is a practical solution to restrictions in resources. Clients may graduate into and out of the system. The concern is that low-need clients are receiving too intensive an intervention, while high need clients are not receiving enough services. Research indicates that victims prefer and benefit from natural supports. Natural supports need to be seen as part of the continuum of treatment and that low need clients may benefit from minimal support and intervention, if they are taught to access these preferred support people. Similarly, high need clients would be able to access natural supports, while receiving more services to address their more severe symptoms and distress.
Recommendation 3: Development of a service continuum
As noted in Recommendation 2, client matching could be beneficial. This requires a system of service delivery that matches client needs. Thus, the system should range from minimal services (educational development, information sessions) to peer support/professional support to targeted interventions and therapy. The victim could then enter the system through any means and quickly receive the level of service he or she requires. They could then move out of the system, reducing dependency and returning to their normal daily life.
Recommendation 4: Support of practical treatments
Treatment initiatives should include practical, daily living elements to address victimization. These initiatives could focus on coping skills, emotions management, economic issues, practical planning, or other issues. Ideally, these treatments would be linked to supporting research and include a program evaluation component. However, the focus of any victim intervention must be to return the person to a state of reintegration as soon as possible. This is beneficial to the victim and cost-effective to the system.
Recommendation 5: Prevention of future victimization
Given the consistent research finding that past victimization predicts future victimization, treatment initiatives should include training in avoiding future victimization. These interventions will likely need to focus on cognitive problem-solving skills building and improving appraisal skills. However, the potential positive effect of preventing future victimization should not be underestimated.
Recommendation 6: Support for Service-Deliverers/Natural Support
Although beyond the scope of the current review, the issue of vicarious victimization and burnout was raised to illustrate that the victimization process also affects service-deliverers. It is likely that service-deliverers and natural supports experience cognitive, emotional, behavioural and social effects of dealing with victims. The system needs to work to support these people through education, provision of resources and effective supportive supervision/consultation. Through these efforts, the system should work better for victims and continue to improve.
Recommendation 7: Public Education and Policy Review
As a preventative measure for future victims and to help supports to current victims, it would be useful to direct education and policy efforts to understanding the psychological effects of crime. Although it is understandable that crime victims get entangled in the medical and legal systems, it is very likely that minimal education and policy initiatives could help victims and supports track important psychological changes. Such efforts will help all concerned parties to quickly identify appropriate services. Further, victims and supports will be able to evaluate when such services are needed. This will not only alleviate distress but also reduce the strain on the professional support system as victims will truly access services they feel they require.

In conclusion, the process of victimization can have profound psychological effects on the victim, his or her support network and society in general. These internal, cognitive and emotional changes need not be permanent to have a negative effect. Fortunately, there are many avenues that can be used to help understand victims and to use this understanding to develop responsive treatment and education initiatives. This review and synthesis should be viewed as an early step because of the sparse research in the area of cognitive changes and treatment matching for victims. However, the greater research areas reviewed give the author optimism that with some solid research, the area could be improved dramatically.