564077

research-article2014

VAWXXX10.1177/1077801214564077Violence Against WomenWathen et al.

Article

What Counts? A Mixed-Methods Study to Inform Evaluation of Shelters for Abused Women

Violence Against Women 2015, Vol. 21(1) 125­–146 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801214564077 vaw.sagepub.com

C. Nadine Wathen1, Roma M. Harris1, Marilyn Ford-Gilboe1, and Michele Hansen2

Abstract Shelters for abused women have expanded from “safe havens” to providing a range of residential and outreach services, and face increasing pressure to demonstrate “value for money” by providing evaluation metrics that may or may not reflect what they actually do. We conducted interviews and surveys with 68 shelter directors in Ontario, Canada, and found that differences in service philosophy and how abuse is defined influence decisions about who receives services and the shelter’s role in the broader community; these in turn affect how the work of shelters is positioned. Implications for shelter service evaluation are discussed. Keywords evaluation, interviews, survey, women’s shelters

Introduction The primary focus of shelters for abused women has been, and remains, providing women a safe place to stay during a time of crisis. Over time, however, shelters have expanded their services to help women meet needs that extend beyond this initial period (Bennett, Riger, Schewe, Howard, & Wasco, 2004; Panzer, Philip, & Hayward, 2000; Tutty, 2006). Today, in addition to secure accommodation, shelters also

1Western 2Huron

University, London, Ontario, Canada Women’s Shelter, Goderich, Ontario, Canada

Corresponding Author: C. Nadine Wathen, Western University, 1151 Richmond St., NCB240, London, Ontario N6A 5B7, Canada. Email: [email protected]

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typically provide crisis telephone lines, short-term counseling, programs for children and parenting support, and follow-up programs for former residents; some provide transition housing services, outreach for abused women who do not stay at the shelter, and treatment groups for abused and abusive men (Goard & Tutty, 2003; Lyon, Lane, & Menard, 2008; Sullivan et al., 2008). However, the full range of services provided by shelters and the extent to which these services vary across shelters located in different contexts is only beginning to be understood (Lyon et al., 2008). Significantly, shelter leaders and staff members also advocate both for individual women to obtain services in the broader social service sector and for abused women as a collective, striving to educate communities and systems about ways to respond to and prevent violence against women (VAW) and children (Ontario Association of Interval and Transition Houses [OAITH], 1996; Tutty, 2006). The impetus to expand these services and roles—from a “safe bed” to an integrated set of services for women, children and men, both in shelter and in the community—has generally occurred from within the shelter sector, with leaders recognizing needs and finding ways to respond to them (OAITH, 1996; Tutty, 2006). Concurrent with ongoing discussions about what shelters do has been growing pressure for shelters to demonstrate their effectiveness, accountability (Sullivan et al., 2008), and “value for money,” (Harris, Wathen & Lynch, 2014) trends consistent with a new public management approach to public services (McLellan, 1997). However, formal shelter evaluations are few (Lyon et al., 2008; Sullivan et al., 2008; Tutty, 2006), with the majority of those published having methodological shortcomings, including small sample sizes, high attrition rates, noncomparative designs, and the use of inadequate measures to evaluate “effectiveness,”—a situation that parallels evaluation work across the range of potential interventions for abused women (Feder et al., 2009; Nelson, Nygren, McInerney, Klein, & The U.S. Preventive Services Task Force, 2004; Wathen & MacMillan, 2003). Because interventions for women leaving shelter have demonstrated benefits (Ramsay et al., 2009; Sullivan, Basta, Tan, & Davidson, 1992; Sullivan & Bybee, 1999; Sullivan, Campbell, Angelique, Eby, & Davidson, 1994), and as calls for service standardization and evaluation among shelters and the broader VAW service sector increase (e.g., Sullivan, 2011; Women’s Aid in Scotland, 2011), there is a pressing need to develop a more in-depth understanding about what shelters do, how they do it, and what difference this makes for women and their families, and for communities (Lyon et al., 2011), so as to design more appropriate and informative evaluation approaches for shelters.

Shelters in Canada and Ontario Canada’s first shelters for abused women were opened in 1973 (Tutty, 2006; Tutty & Rothery, 2002) and have since become available across the country’s 10 provinces and 3 territories, becoming a key resource in protecting women from abusive partners. Now numbering around 600, Canada’s shelters serve more than 100,000 women and children per year (Sauve & Burns, 2009). In Ontario, Canada’s most populous province, shelters are available in 122 communities, housing well over 1,000 women and their children at any given time.

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The funding base for shelters in Ontario comes primarily from the Provincial Ministry of Community and Social Services (MCSS), with capital funding contributions from the Canada Mortgage and Housing Corporation (Goard & Tutty, 2003), and generally has not kept pace with the addition of services. A recent report (MCSS, 2009) indicates that while shelter operating costs increased by 13.1% from 2004/2005 to 2006/2007 (from $78.5M to $88.8M), MCSS funding only increased by 9.5% (from $66.5M to $72.8M over those 3 fiscal years). The shortfall (of $16M in 2006/2007) was covered by shelters through a variety of strategies, mainly local fundraising, increased use of volunteers, and increased community food and other donations to provide basic in-shelter services (MCSS, 2009). These patterns in funding constraints across the public sector, and specific to VAW services, are not unique to Canada (Global Network of Women’s Shelters, 2011). Given the growing pressure on shelters’ resources, a key area requiring exploration is how shelter leaders and workers, and external stakeholders, actually define the mandate of shelters and how this translates into the services they provide. For example, the definition of the “core services” of Ontario’s shelters, from review of relevant reports and policies (MCSS, 2009; Ontario Ministry of Citizenship and Immigration, 2004), appears to differ somewhat from the ways in which those within the shelter sector describe their work (Goard & Tutty, 2003; Tutty, 2006; YWCA Canada, 2009). Narrow definitions limit “core service” to providing a safe place for a woman who is currently experiencing abuse (and her children) to stay for a specified amount of time. Indeed, this definition was used by a Conservative Ontario government in the mid-1990s to substantially cut funding from shelters, deeming anything not directly related to a shortterm crisis-initiated stay to fall outside the mandate of shelters (OAITH, 1996; Ricciutelli, Larkin, & O’Neill, 1998). In contrast, in most shelters, an initial period of respite and safety is regarded as only the first step in service, which includes a range of in-house and community-based services, as described above (Goard & Tutty, 2003; Tutty, 2006; YWCA Canada, 2009). Successive Liberal governments since the 1990s have moved toward a broader definition of shelters’ core services, which acknowledges the role of shelters in helping to shape local practices and policies to enhance service integration and coordination and improve the awareness and responsiveness of, in particular, the criminal justice and child welfare sectors to the needs of abused women and their children (Ontario Ministry of Citizenship and Immigration, 2004, 2007). However, a number of factors point to a mismatch between what shelters view as their mandate, and what others view, and fund, as core shelter services. These include a survey conducted by the primary government funder (MCSS, 2009) to evaluate shelters, as well as consultations conducted with shelter leaders and workers, and the broader VAW service sector in Ontario during the planning stage of the present study. This mismatch has an immediate practical impact on how shelters conduct their daily work in terms of what funding is provided and how it is directed, that is, how many and which women can be helped (Grossman & Lundy, 2011), and where and how this happens. It also has implications, however, for how the shelters themselves can and should be evaluated, including regarding the delivery of specific types of services for women and men, and outcomes linked to these services. Historically, the

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evaluation of shelter services in the Province of Ontario has been ad hoc, with occasional self-report style surveys sent to shelters focusing mainly on the number of women served, service costs, and whether specific mandated services are provided (such as accessible rooms and phone lines for the hearing impaired to comply with legislation regarding access for people with disabilities; MCSS, 2009). More recently, the MCSS has developed a set of evaluation metrics for the VAW service sector that are much more detailed, requiring shelters to report on approximately 30 “service data elements” and “key metrics,” ranging from how many clients have safety plans to the “cost per interaction” with a client (MCSS, 2012). In this article, we report findings from a shelter-led research initiative designed to describe, using a comprehensive and representative multi-perspective approach, shelter services in Ontario, Canada, with the ultimate goal of developing an appropriate evaluation framework for the work of shelters. The primary research question guiding this analysis is as follows: Research Question 1: What do shelters say they do, and how does this fit with what funders expect, and fund, them to do?

Method A mixed methods approach was used to describe shelter service provision in Ontario, Canada.1 Specifically, we report here on a survey and interviews conducted with shelter executive directors (EDs) to assess the overall profile of services provided across shelters and to identify key themes related to how these leaders describe their shelters’ mandates, including whom they serve and how they help individual women, as well as the shelters’ roles in the broader community. The themes emerging from the ED data are interpreted in light of prevailing policy and funding contexts, and their implications are considered in terms of the development of a more sector-relevant and appropriate approach to evaluation of shelter services than currently exists.

Sample and Recruitment All shelters providing services to women in Ontario, Canada, were invited to take part in this study. A complete list of Anglophone2 shelters across Ontario (N = 112) was obtained from a publicly available listing of women’s shelters in Canada. This list was reviewed and updated by the project team and Advisory Committee. To account for any regional variation in services, shelters were stratified into four regional administrative boundary areas: Northern (n = 17), Eastern (n = 18), Western (n = 23), and Central Ontario (n = 27), as well as a designated stratum for shelters that serve primarily Aboriginal peoples (n = 27). A personalized introductory email from one of the four shelter EDs on the project team was distributed to each ED, inviting them to participate. In addition, a brief summary of the study was distributed at relevant shelter sector meetings attended by the project team, and a study website was developed to facilitate recruitment and to share study results. Repeated follow-up reminders, both

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by telephone and by email, were sent to EDs until interviews were arranged with a minimum of 7 EDs from each of the five strata. EDs received a detailed letter of information and consent and an outline of the interview questions in advance of the interview.

Procedures Data were collected between February and July 2010 by a trained interviewer with extensive experience in the VAW sector in a 60- to 90-min session. A detailed guide, comprising both forced-choice and open-ended questions and designed to capture the range of services and system linkage/navigation functions provided by shelters to their clients, was used for all interviews (see Table 1). This interview guide was developed in consultation with the project Advisory Committee based on feedback from our a priori consultations with the shelter sector. Both the questions and format were refined through pilot testing with 5 EDs. While there was agreement from all pilot respondents that the survey instrument was comprehensive and adequately addressed all relevant areas of service provision, benefits of services, and priority service issues for shelters, they indicated that the completion time was too long. To retain the breadth of the interview but reduce respondent burden, we elected to ask all respondents a common, core set of questions designed to elicit general information about the services provided and organizational characteristics (e.g., shelter mandate, staff profile and size), along with more detailed questions about the specific services they provided in 2 of 11 categories of service (Table 1). The two sections completed in each interview were drawn from those categories of service that each ED identified their shelter providing routinely or often, with selections made by the interviewer to ensure balance in the completion of each section across the four regions, and Aboriginal shelters (i.e., minimum of two completed sections per region). The interview guide was mounted in a secure online survey environment and the interviewer entered the participants’ responses to close-ended questions directly into the online instrument. In addition, the interviews were audio-recorded and transcribed to capture (often lengthy) responses to the open-ended questions. Due to technical difficulties, only 45 of the 56 interviews were audio-recorded. EDs who were unable to be reached by phone to schedule an interview were asked to complete a condensed online version of the survey at their convenience; this version contained all core questions except those specific to providing services for men (see Table 1). Written consent was obtained from all participants prior to data collection. The study was approved by Western University’s Non-Medical Research Ethics Board (#16375S).

Data Analysis All quantitative analyses were completed using SAS version 9.2. Responses to closeended questions from telephone interviews and online surveys were combined. Response distributions were summarized using the mean and standard deviation, or median and interquartile range, as appropriate. When the proportion responding was 100%, the Laplace method [p = (x + 1) / (n + 2)] was used to reflect the uncertainty of

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Table 1.  Interview Guide Structure. Section CORE: General Services and Organizational Structure

Specific focus

Question stems

Response options

Questions about your shelter

How many beds does your shelter have?a How many full-time equivalent staff do you employ?a Approximately how many volunteers does your shelter have at any given time? What do they do?a Approximately how many Board and committee volunteers does your shelter have at any given time?a Do you provide service to women not residing in the shelter? Do you provide second-stage housing?a Are there any important differences in how services are provided to women in shelter, in second-stage housing, or in the community?a Does your shelter have (accessibility services)?a Based on your primary mandate who SHOULD your shelter serve?a In addition to (above) who else does your agency serve?a Do you also provide services and/or referrals for abused men? Do you provide any services or referrals for abusive men/fathers? How do these services for abused and/or abusive men help these men, their partners and children, and the community? Does your shelter offer . . . (crisis line, counseling, etc.)a Do you support women in getting . . . (housing, legal help, etc.)a

Specify number (+ openended, as appropriate)

What organizations or agencies do you most commonly network with to provide these services?a How does this networking usually happen?a What are the most common bar-riers to providing these services?a Do you participate in community and public policy advocacy?a Do you participate in research/evaluation of services?a Are there any other supports or services provided for women, children, or men at or through your shelter?a What are the three most important things your shelter does?a What are the three most important benefits of your services for women?a What are the three most important benefits of your services for families? a What are the three most important benefits of your services for the community?a If you were able to expand the services you offer, what would your top three priorities be?a

Open-ended

How, where, and for whom services provided

Mandate

Summary of core services Summary: other support services/system navigation Detail: other support services/system navigation

Advocacy and research

Key benefits of services

Yes/no (+ open-ended, as appropriate) List of 5, Yes/No

6 items (yes/no) “Other” please specify Yes/no plus open-ended

10 items (yes/no) 10 items, 4-point Likerttype scale (routinely to never)

Yes/no plus probes and open-ended for advocacy processes and outcomes List 3, plus open-ended

(continued)

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Wathen et al. Table 1. (continued) Section OPTIONAL: Details of SectorSpecific Services Provided (each ED provided detailed responses to twob sections)

Specific focus

Question stems

Short-term counseling (n = 15) Housing (n = 22) Financial support (n = 15) Family law (n = 16) Criminal law (n = 12) Immigration law (n = 10) Health care (n = 10) Child welfare (n = 15) Child health (n = 7) Child education/ rec (n = 11) Culture and language (n = 11)

Detailed lists of service support and system navigation tasks specific to each sector, with questions probing: Which of the following services do you provide or help make arrangements for? How is this usually done? Do you network with other organizations or agencies? How does the support, related to education and recreational services, you provide help women and children? What are the barriers to providing this support?

Response options Lists, yes/no Open-ended Yes/no, specify (openended) Open-ended

Note. ED = executive director. aThese questions were included in the brief, self-completed online survey (all CORE questions except services to men). bEDs were asked to discuss two sections in which they had indicated in a previous question that they “routinely” or “often” provided service support; balance in sectors across the regions, including Aboriginal shelters, was also maintained.

the estimate. A finite population correction factor (fpc) was used to define the standard error for confidence intervals. Regional differences were examined using the Wilcoxon Rank Sum test or the likelihood ratio chi-square test for categorical data. Forty-two of the 45 recorded interviews were transcribed (3 recordings were not transcribed because of poor sound quality), producing more than 1,500 pages of text. Transcripts were analyzed to identify themes using a process of open coding at the level of sentences or phrases (Berg, 1995) by one of the academic research team members with expertise in qualitative data analysis. This process was relatively straightforward as the questions posed to the respondents were standardized across all the interviews. To check the reliability of the thematic categories, a second academic research team member reviewed a subset of the interview transcripts and reported findings consistent with those of the first coder.

Results A total of 56 EDs, of the total population of 112 (50%), took part and completed telephone interviews, which exceeded the a priori plan to achieve a minimum of 7 ED interviews from each of the five regional strata. Two EDs refused and the study period ended before interviews could be arranged with the remaining 54. Twelve of the 54

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EDs who did not complete the telephone survey completed an online version of the survey, increasing the response rate to 61% for the more quantitatively oriented set of questions. Shelters were relatively equally distributed across the province: 12 from the Central region, 11 from the Eastern region, 12 from the Northern region, 20 from the Western region, and 12 shelters that serve primarily Aboriginal women. Of the 12 Aboriginal shelters, 4 were in the Northern region, 3 were in the Western region, 2 were in the Central region and 1 was in the Eastern region. To assess whether the EDs who chose to participate in the study represented shelters that were systematically different from those not included, we compared our sample, using the 2009 MCSS report, to provincial averages on two key characteristics: shelter size (number of beds) and geographic location. The distribution of shelter size in our sample was consistent with that reported in the MCSS report: The province-wide average number of beds was 21 with a low of 10 beds in the Northern region and a high of 32 beds in the Central region, mirroring our own data. Similarly, there were no significant differences in the geographic distribution of responding versus non-responding shelters in terms of larger or smaller population centers (data available on request).

How Do Shelters Operate? A profile of services and organizational structure is provided in Table 2. On average, there were 17 beds per shelter. However, comments made by respondents to this question indicate that the number of “funded” beds does not always represent the level of service provided. For example, “Actually we have 27 beds with funding for 15—donations and fundraising pay for the rest” [W03].3 Another replied, “We always work with more than 100% occupancy for funded beds.” The EDs pointed out that in their shelters, considerable effort is made to be flexible in meeting women’s needs: If we need shelter beds, we sometimes have longer term residents at shelter move into a vacant apartment for a few nights. Second stage is beside the shelter. We also allow women in second stage to spend a few nights in shelter, if going through a bad time, e.g., at Christmas. [N01]

EDs reported having a median of 12 full-time and 9 part-time staff members. Notably, most shelters rely heavily on volunteer staff with a median of 17 volunteers providing direct service to clients, as well as 10 volunteer board and committee members; however, the number of volunteers between shelters ranged widely with some maintaining pools of as many as 300 (especially those in rural areas where a large number of drivers is needed to transport women to shelter and other services). Volunteers are responsible for a range of services, including fundraising, managing donations, operating food banks and second-hand stores, helping with general shelter operations such as answering phones, security, yard work, maintenance, and cleaning. Some volunteers are also involved in direct client/family contact and shift support, including child care and recreational activities, outings with shelter residents, driving women to appointments, helping women complete applications and resumes, finding

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Wathen et al. Table 2.  Shelter Characteristics, Mandates, and Services.

Shelter information   Number of beds   Number of full-time staff   Number of part-time staff   Number of volunteers   Number of board members  

n

M

Range

56 63 53 50 55

17 12 9 17 10

0-67 0.4-40.1 1.73-23 0-300 0-36

n

Accessibility   Accessible entrance, washrooms, bathrooms, and so on   Teletype or other line for the deaf   Staff trained in working with disabilities   Materials in alternative formats   Materials in multiple languages Where do you provide service   Women residing in shelter   Service to women not residing in shelter   Second-stage housing Primary mandate   Abused women only   Abused women and children   Abused and homeless women and children   Abused women and other vulnerable people Who else do you serve  Homeless   Children of homeless   Abused men   Mental health respite  Other Core services and programs offered   Short-term counseling   24-hr crisis line   Food and clothing   2-hr legal aid certificates   Recreational programs   Child care/respite   Furniture and household goods   Life skills program   Sexual assault program   Health care services

Percent yes

68 68 68 68 68

83.8% 69.1% 66.2% 48.5% 70.6%

63 63 66

100.0% 96.8% 36.4%

64 64 64 64

1.6% 71.9% 6.3% 20.3%

68 68 68 68 68

52.9% 0.0% 14.7% 8.8% 33.8%

56 68 68 68 68 68 68 68 56 68

98.2% 94.1% 79.4% 79.4% 69.1% 67.6% 66.2% 64.7% 42.9% 35.3%

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and evaluating housing, facilitating groups, and supervising student counseling placements. Other volunteers, especially those who serve on shelter Boards, help build public awareness through public presentations and by supporting special events.

Whom Do Shelters Serve? In addition to providing service to women in shelter, 97% of shelters offered service to women in the community (i.e., those not residing in the shelter) and 36% offered second-stage housing (see Table 2). EDs reported that there were no important differences in how services were provided to women in shelter, in second-stage housing, or in the community. However, there were differences in clients’ needs across these settings. For example, women living in shelters are in crisis and, therefore, in-shelter services are provided 24 hours a day, with a focus on security, short-term counseling, interim custody orders, and meeting basic needs for food and shelter (and sometimes clothing) for women (and often their children as well). Women living in second-stage housing have more access to other community services and therefore shelter-provided counseling is arranged by appointment rather than on a 24-hour as-needed basis, and support is geared toward life skills, parenting, budgeting, accessing services, and the like, and is tailored to specific needs, such as understanding court processes. Women who access shelters’ community counseling or outreach programs may be more settled, established, or even living with their partner, and for these women, shelters’ services are more heavily focused on group support, longer term advocacy work, and legal advocacy. The primary mandate (framed in the question as “who should the shelter serve”) reported by 72% of shelters is to provide service to abused women and their children; 6.3% included homeless women within this scope, while others included vulnerable women of any kind. In addition to their primary mandate, shelters also reported extending service to homeless women (53%) and their children (41%), and abused men (15%). One third (33.8%) of EDs reported serving other populations, including women who have experienced any form of violence, from landlord or employer abuse, to sexually abused teens, sex trade workers, women with addictions, immigrant women who have experienced trauma, and young women (and boys) at risk.

Defining “Abuse” A key factor that determines which people receive shelter services is how the shelter leaders in a community, including the ED, staff, and board members, define the concept of “abuse.” The EDs’ comments during the open-ended portions of the interviews revealed a range of interpretations about what constitutes abuse and who “counts” as “abused,” with some shelters enforcing a more narrow definition of who is entitled to receive services, while others have a more inclusive approach. At the more specific end of the spectrum, some shelters excluded from service women with current substance use issues, those with acute mental illness, and/or women who are homeless, as we see, for instance, in the following exchange:

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Interviewer [I]: Do you serve anyone else? Like homeless women sometimes? Respondent [R]: No. We will bring a woman in. We’ll assess the situation for 24 hours. She may be deemed to be there as a result of homelessness not abuse. At which point we will transfer her to a homeless shelter. [C09] On the other hand, the accounts of many of the EDs reflect a more inclusive interpretation of their mandate, beginning with the definition of abuse, which is often situated within a particular service philosophy. As one ED explained, We’re fully funded . . . to provide service to abused women and their children . . . our experience tells us that most women who are homeless are also violence survivors, and so, you know, we seek to kind of shelter the vast majority of women who have experiences of violence . . . to me, that’s homeless women, it’s women in the sex trades, it’s women who are abused by their . . . by their employers, . . . it’s that whole gamut of women. [C13]

Another said, We do serve women who experience violence and that extends beyond an intimate partner. We have a broader definition. It could be a landlord or it could be a member of an extended family, so we have a broader definition but it is within the framework of violence. [C24]

Others said, “We serve homeless women because if they’re homeless then they will be in danger of being abused” [E03]; “We always say, ‘We’ve never met a homeless woman yet who hasn’t experienced abuse’” [N10]; and “We’re not mandated to provide services to homeless women or if there are callers, however we always find that thread of underlying abuse” [C04]. However, the ability to accommodate these women was tempered by the reality of constrained resources, as summarized by this ED: “Homelessness is a systemic issue related to woman abuse. Our ability to take in homeless women and children, if abuse is not obvious, depends on our occupancy level at the time” [W23]. Thus, if a woman is homeless and there is confirmation (or an assumption) that she has experienced violence (though not necessarily in a current relationship), if space is available, some shelters will use it to help these women. Given the general lack of additional space and over-crowding in many shelters, these decisions have significant implications, and reflect the lack of a broader social safety net in many areas, especially in terms of safe and affordable housing.

“Where Else Are They Going to Go? We’re It” The primary reason cited by EDs for adopting a more inclusive approach about those who should be covered by their shelter’s mandate was a concern that there may be no other help available to a woman. For example,

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I: Based on your primary mandate, who should your agency serve? R: Women and their children who are fleeing abuse. . . . We serve women who have housing issues. So if they’ve been evicted . . . Because it seems to me, because we have the transitional and housing support program which is to help women find and maintain housing, it seems appropriate that we’re serving those women because . . . in our community we don’t have a homeless shelter. We are it. . . . And the next women’s shelter, the next closest one, is an hour and three quarters away. So we’re it for a huge geography. So, yes, we serve women who are, have been evicted. We have served women who have been discharged from psychiatric facilities. We have served women who have been discharged from the hospital and don’t have anywhere to go until they find some housing. We have served transient women. [N03] Similarly, I: Do you provide service to women not residing in the shelter? R: Officially? No . . . [but] anyone that calls, we’ll help. [C23] and, We’re not gonna turn any woman away who’s in need of help, and we’re not gonna tell them to sit on an eight-week waiting list. [E01]

Explaining why her shelter takes homeless women, another ED said simply, “Nobody wants them” [ABN04]. As the following passage makes clear, some EDs regard this more inclusive approach to the shelter’s mandate as an ethical obligation to assist women who are vulnerable and, hence, unsafe and in need of the shelter’s service and protection: Sometimes we stretch our mandate. We have this sort of thing about women that we’ve served in the past that we feel we have a pretty big investment in—some very, very vulnerable and very, very needy women, especially some young women, who are coming back to us time and time again. Sometimes they are not coming directly out of an abusive relationship, but we know that they have had them and they are at great risk. So, you know, we try and stretch our mandate for those individuals. We have been told historically by the Ministry that we may not take homeless people, homeless women, and in fact we don’t do that per se, but we do ask a lot of questions, and if you ask the right questions, you generally . . . and it is all about the definition of homeless as well. [In this community] we don’t have women sitting on the street corners or whatever, but they are couch surfers and they are doing all kinds of things to keep themselves. Some of those things are not safe at all. [W22]

In general, the shelter EDs who participated in this study tended to apply a responsive and flexible interpretation of their service mandates to meet the needs of abused women, though this was not universal. Permeating our findings was the sense that EDs

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must balance the needs of individual women, their (broadly or narrowly defined) exposures to violence, and their immediate and longer term needs, with resource constraints. This “balancing act,” and how it played out, was related to several factors. For instance, for some but not all EDs, the historical context and mission of shelters as feminist organizations, and a related very broad definition of “abuse,” was evident. Similarly, there was significant concern among the majority of respondents that women may not be able to access support elsewhere and, therefore, the shelter has a key role in filling gaps in the service landscape, often for women whose complex needs do not fit easily within the mandates of other agencies. For Aboriginal shelters, the concept of healing is situated in the family, necessitating a mandate that includes abusers. Some EDs described a condition of chronic under-funding in the number of beds available in their shelters vis-à-vis the demand and explained how they may use “work-arounds” to get women into a bed, such as taking up informal or “unfunded” beds (e.g., empty beds in second-stage housing units). Here it is clear that mandate “responsiveness” is balanced against the availability of resources. As noted earlier, many shelters attempt to extend their resources to achieve their mandate by soliciting donations and other forms of community support, as well as relying on the unpaid labor of volunteers (and staff members).

What About Men? The majority of the EDs surveyed in the study reported that their shelters focus services primarily on abused women and their children. If they do provide assistance to men (whether they are abusers or men who are abused themselves), it normally involves referring them to other community services or services offered by the shelter at a different site. However, some of the EDs from shelters that serve primarily Aboriginal communities had a different view of this issue. As we see in the following accounts, this may involve integrating men more directly into the services provided by the shelter: Our mandate talks about individuals. It doesn’t specify women or men because we are very holistic so our mandate specifies individuals. . . . Individuals experiencing family violence. [ABW23] In the Aboriginal culture and spirituality . . . with the holistic viewpoint and all that, the connection to the environment and to the family . . . it’s not a woman’s problem and it’s not a women’s and children’s problem, it is a family issue. So in order to heal the issue, you need to heal the family . . . in terms of our approach and our mandate and the way that we offer programs we certainly put safety and security of women and children first; however, we do heal the family and that is something that is unique to the Aboriginal population. . . . For example, the shelter on reserve houses men and women simultaneously. So they help the woman partner who’s being abused but also the abuser. Not in the same room mind you, but they do offer services to both. [ABW20]

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Meeting Needs Across Time The EDs’ accounts also reveal that mandate definition is connected to appreciating how women come to terms with violence and recognizing that change and growth differ from woman to woman and cannot be rigidly scheduled. This idea is captured in the following passage: We have women [in second stage] and all of a sudden they have a nightmare, they’re sweating, they’re scared. We let them go back over to the shelter for the rest of the evening. . . . Nobody makes steps forward in one fell swoop. People progress one step forward or two steps forward, one step backwards. That’s the way people progress, just normal and natural. And so we don’t think it’s natural to expect a woman who has suffered years of abuse to all of a sudden be able to deal with living alone in second stage . . . and, all of our timelines are extremely flexible. And I really, I just cringe every time I hear front line workers say six weeks in shelter, one year in second stage, I cringe. Nobody heals like that. Nobody. You cannot put a time line on it. [N01]

Service responsiveness, therefore, was not only related to what services were provided to whom but also when and for how long. Many respondents commented that women recover from crisis and begin to heal at very different rates which often means that shelters end up supporting women for a longer time than they are “officially” mandated (or funded) to do, either because there are no other services available (for instance, when there are long waiting lists for affordable or appropriate housing or for legal support services) or because women come back to the shelter for occasional “boosts” of emotional support and advice. Seeing these “boosts” as a natural part of the healing process, rather than as some form of “relapse,” is an important change in thinking about the longer term role of the shelter, and its staff, in the lives of abused women.

Discussion Shelters for abused women over the past several decades have expanded from a “safe haven” to providers of a range of residential and outreach services. However, funding models have generally not kept pace with the addition of services, and this is also reflected in limitations in what “counts” (and gets counted) when shelters are evaluated. Our interviews with shelter directors in Ontario, Canada, have brought to light a more nuanced understanding of how shelter mandates are interpreted, with implications for service delivery and evaluation. Key findings are that differences in service philosophy and how abuse is defined affect decisions about who receives services as well as the shelters’ roles in the broader community. Coupled with generally inadequate funding, reliance on uncertain resources (e.g., donations), and wide variability in other services and supports in the broader community, shelters are left with a difficult “balancing act” in deciding what services to provide, and to whom, a situation further exacerbated by evaluation metrics that perpetuate this limited view of the role of shelters.

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Specifically, our findings elucidate several aspects of shelter service provision, as described by shelter leaders, which are rarely, if ever, accounted for in existing evaluations (e.g., MCSS, 2009). These include the notion that healing from trauma is an evolving process that often, if not always, leaves women with an ongoing need for various kinds of services across time. In addition, most EDs in our sample discussed the need for a flexible mandate to include vulnerable women who may not currently be in abusive situations, but have a lifetime history of various kinds of abuse and trauma. Expanding on this, Aboriginal shelter leaders discussed their approach to care as including the “whole family” and even the community; the impact of historical and cultural trauma is difficult to represent in commonly used evaluation metrics. Third, while current government-led evaluations attempt to quantify numbers of volunteers involved in shelter service delivery, they rarely include the full nature, scope and value of this volunteer labor, nor of shelters’ necessary “work-arounds” to deal with chronic over-capacity. While the newly evolved “data standards” being implemented by MCSS are seemingly more broad in their attempt to capture a wider range of things that shelters do, including a list of 13 service types provided by shelters, from “temporary safe and secure shelter residence” to “advocacy on behalf of the woman and her children” (MCSS, 2012), these elements do not capture the factors described above. Our findings are consistent with those of a recent analysis of a large sample of domestic violence service seekers in a U.S. county, which revealed that in the context of resource scarcity, shelters make selective decisions about who will be admitted (Grossman & Lundy, 2011). The criteria for these decisions tend to be based on the perceived vulnerability of the abused woman, including type and severity of abuse, relationship status, and personal financial and other resources, such as education. These kinds of decisions take on an explicitly ethical dimension in shelters, many of which have their origins as grassroots feminist organizations. In the face of scarce resources, “triaging” women according to need, while concurrently doing everything possible to extend resources to as many as possible, seems to be the most common response by the shelters in our sample and in other assessments led by non-government researchers (Goard & Tutty, 2003; Grossman & Lundy, 2011; Tutty, 2006; Tutty & Rothery, 2002). However, this is not always the case, with our data showing that some shelters respond to these constraints by applying more rigid policies regarding service recipients and what “counts” as “abuse.” In other cases, shelters clearly try to enhance their services and their mandate by extensive use of volunteer labor and resources; this can be seen as a way of extending/stretching their existing core funding to maximize the benefit they can provide to women and their children, and the broader community. As neo-liberal ideologies and discourses of accountability become increasingly embedded in government policies in Canada, the United States, and elsewhere, the themes identified in this study resonate both with regard to the provision and sustainability of VAW services generally, and more broadly in whether and how social programs and services are delivered. Critical theorists in this area provide persuasive arguments that a “pathologizing” discourse (McDonald, 2005) has come to dominate how VAW clients are framed and, therefore, how VAW services are evaluated. This

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approach roots the problem of violence at the individual/family level, rather than at the collective social/structural level and simultaneously “clinicalizes” and “depoliticizes” the phenomenon. As described by McDonald (2005), [The pathologising] approach adopts a therapeutic model to enable survivors to cope with their situation. Thus, upon entering refuges, women are assessed for treatment. . . . Case management is used to identify the client’s needs and then coordinate services to meet those needs. . . . Success is measured in terms of achievement of the individual clinical goals of the client. (p. 278)

Indeed, this model of practice is directly reflected in how the respondents in our study describe how shelters help women in the context of a system funded within these structures and expectations. Perhaps one form of “resistance” (Morrow, Hankivsky, & Varcoe, 2004) reflected in the comments of many of our respondents is their ability to “stretch” their mandates to help as many women as possible, despite official constraints. Framed slightly differently, what EDs in our sample express as their “balancing act” may be a new form of “border tension” in the shelter movement more generally. Initially articulated by Haaken and Yragui (2003) as related to the “problematic question of how to draw physical and social boundaries between safe houses and the wider community” (p. 50), the concept of “border tensions” was later extended to include “the continuing struggle over the legitimacy of safe houses for women escaping male violence” (p. 50), which is tied explicitly to competition for “scarce resources in a weak and increasingly compromised social welfare system (in the United States)” (p. 50). These border tensions, when coupled with the emergence of neo-liberal discourses of accountability in public services generally, and VAW services specifically (Morrow et al., 2004), present a significant challenge for shelters, that is, how to maintain their woman-centered, feminist service orientation, not only in the face of resource scarcity but also in response to a growing demand to demonstrate “value for money” (Harris et al., 2014). This latter point is reflected in the increasing emphasis in the VAW academic literature on providing the sector with tools to explain to society the costs of violence, not only on individual and community-level outcomes, but increasingly on economic ones (e.g., Chan & Cho, 2010; Jones et al., 2006; Varcoe et al., 2011). However, like the advocacy work of shelters, these analyses may also be seen as a form of resistance—an effort to highlight in a public way the social costs of failing to address the root causes of genderbased violence and the need for social change to ameliorate gender-based inequities. It should also be noted that social and geographic contexts have a significant impact on how shelters interpret and enact their mandates. Specifically, Aboriginal women in Canada are two to four times more likely to experience violence by a male partner (Brownridge, 2008; Perreault, 2011), and report more severe forms of violence (Brennan, 2011). However, the dynamics of violence in Aboriginal communities have been partially attributed to the unique experiences of colonization, including ongoing racism and discrimination (Brownridge, 2003, 2008). EDs from Aboriginal shelters discussed a different philosophical orientation to service, one focused on the impact of historical trauma on all of their people, and therefore an approach that was family- and

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community-focused, including services for abused and abusive men. We are unaware of these kinds of alternate service philosophies being included in shelter evaluations. Moreover, shelters serving rural and/or remote areas were most strongly affected by the lack of available or accessible social services in sparsely populated regions. Here, volunteers play a particularly critical role in providing transportation that enables women to connect with services. In these shelters, EDs were especially likely to explain their shelters’ broad interpretation of their mandates with the phrase, “Who else is there?” Again, existing evaluations may identify “rural” and “urban” as categories of shelter type, but rarely do they allow for contextualization of these aspects of shelter location in terms of service outcomes.

Limitations The study’s response rate of 61% (including those who completed the condensed online version of the survey) precludes providing exact quantitative estimates of the service context in all of Ontario’s non-Francophone shelters. However, the regionally distributed nature of the sample, which exceeded the a priori minimum target of seven shelters per identified region, means that it likely provides reliable representation of the situation across this large Canadian province. Likewise, saturation of themes was achieved in the qualitative data derived from the EDs’ comments during the interviews, increasing trustworthiness of the findings. In addition, our findings are consistent with other examinations of shelter services in North America and beyond (Goard & Tutty, 2003; Grossman & Lundy, 2011; Tutty, 2006; Tutty & Rothery, 2002; Women’s Aid in Scotland, 2011). To further enhance interpretation of our results and as a form of member-checking, they were presented for discussion at a meeting of the Project Advisory Committee (comprising eight EDs from a cross-section of Ontario shelters, along with the four EDs on the project team, and eight service provider leaders from the broader VAW services sector), and at subsequent meetings with a broader group of shelter EDs. Key points arising from these discussions were the importance of “responsiveness” and “flexibility” in both defining exposure to abuse (e.g., of different types and across the life span, rather than only current partner violence) and making service decisions. This flexibility allows them to respond on a case-by-case basis and see beyond the immediate risk situation to clients’ mid-term and longer term needs. In many cases, this “stretching” of shelters’ mandates is a response to the lack of other services for women, especially in rural and remote areas. However, there was an awareness and concern that, as one ED stated: “too much [flexibility] results in exhaustion.”

Implications Our findings have several implications for policy and practice. First, as articulated by ED respondents and especially among those in the project advisory group, is the need for those who set policy for and fund shelters to better understand both what shelters actually do (i.e., beyond proscribed “core services”), and why they do it. This includes

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a more nuanced, perhaps less “pathologized” understanding of violence and abuse, crisis work, and women’s longer term healing, including the fact that returning to the shelter for help is not a “relapse” or negative outcome but a potentially important step in moving forward. This is consistent with research which characterizes leaving abuse as a complex, highly individualized, and often long-term process (Anderson & Saunders, 2003; Wuest & Merritt-Gray, 1999) in which women face ongoing interference from their ex-partners and structural barriers to needed resources, but proactively seek support to rebuild their lives (Ford-Gilboe, Wuest, & Merritt-Gray, 2005). Allowing shelters the flexibility to interpret their mandates to be responsive to the needs of women in the context of their communities was a common refrain. Respondents also noted that putting the woman first was not always in the shelter’s own best interests, nor that of the woman herself; as one ED said, “our kindness doesn’t pressure other services to deliver,” which means that women often do not get the specialized, coordinated services they need. To address this issue, many of the EDs described the considerable efforts they (and some of their staff members) make to work with other community agencies, both to advocate on behalf of individual women to obtain the services they need, but also to raise awareness more generally about the needs of abused women and their children. This type of work is generally unrecognized by funders, nor included in existing evaluation metrics, and, as a result, places yet another call on shelters’ scarce resources. Additional research is required to understand, from the perspectives of women, frontline staff, and service providers in the broader VAW social services sector, how these issues are perceived to influence what shelters do, and how this “works,” or does not work. Evaluation approaches and tools that include assessment of context and process, as well as specific service targets and outcome metrics, would provide a more nuanced and appropriate accounting of shelters’ contributions to abused women, their children, and their communities.

Conclusion While it is unlikely that budgets for any publicly funded service will increase in the nearterm, recognition that bureaucratic constraints may impede cost-effective delivery of services “on the ground” is perhaps the most important implication of our findings regarding how shelters articulate and negotiate their mandates, and how a more complete understanding of these mandates and their implementation can inform more effective evaluation of shelter services. Allowing for flexibility, and using policy and funding models and metrics to encourage, rather than limit, the ability of shelters to respond to the needs of their clients, could facilitate more effective and efficient service delivery. Authors’ Note Members of the Ontario Shelter Research Project Team, in addition to the named authors, are Linda Ense, executive director of the Native Women’s Centre in Hamilton, Ontario; Clare Freeman, executive director of Interval House of Hamilton (Ontario); Kate Wiggins, executive director of Women’s Community House in London, Ontario; and Barb MacQuarrie, community

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director at The Centre for Research and Education on Violence Against Women and Children, Western University, London, Ontario. We thank Arlene Timmins and Jennifer Macnab for their contributions to data collection.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Nadine Wathen was supported by a Canadian Institutes of Health Research New Investigator Award in Women’s Health. This study was funded by the Ontario Trillium Foundation, an agency of the Government of Ontario that funds projects in the not-for-profit sector.

Notes 1. The overall project consisted of four stages: surveys and interviews with shelter executive directors (EDs), frontline workers, women who accessed services, and service providers from a variety of agencies to which women are often referred. The study and funding proposal were designed with support from the Ontario Association of Transition and Interval Houses (OAITH), following a series of focus groups with shelters across Ontario. The project team included four shelter EDs (as content and context experts), three universitybased researchers, and the community director of a university-based violence research center with strong community partnerships. An Advisory Committee consisting of eight EDs from a cross-section of Ontario shelters and eight service provider leaders in the broader Violence Against Women services sector also guided the research process. See http://www. ontarioshelterresearchproject.com/for additional detail. 2. In consultation with the professional organization, Action Ontarienne, which represents Ontario’s French-language shelters, and due to lack of resources to translate and conduct the research in French, Ontario’s 10 Francophone shelters opted out of the research. 3. Participant IDs indicate the region (N = Northern, C = Central, W = Western, E = Eastern; AB = Aboriginal, plus region, for example, ABN = Aboriginal shelter in the Northern region) and interview number.

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Author Biographies C. Nadine Wathen, PhD, is associate professor and faculty scholar in the Faculty of Information and Media Studies at Western University in London, Ontario. Her research in the area of violence against women and children focuses on development and evaluation of interventions, and knowledge translation and exchange for practice and policy. She is co-principal investigator of the Preventing Violence Across the Lifespan Research Network (www.PreVAiLResearch.ca). She is a member of the advisory board of the Centre for Research and Education on Violence Against Women and Children in London, Ontario. Roma M. Harris, PhD, is professor in the Faculty of Information and Media Studies at Western University in London, Ontario. She is the author (with P. Dewdney) of Barriers to Information: How Formal Help Systems Fail Battered Women. She was a founding board member of the London Second Stage Housing project, London’s Battered Women’s Advocacy Clinic, and the Centre for Research and Education on Violence Against Women and Children. She was chair of the Board of Family Services London, and secretary to the Board of the Sexual Assault Centre of London. Marilyn Ford-Gilboe, RN, PhD, is professor and Women’s Health Research Chair in Rural Health in the School of Nursing at Western University in London, Ontario. Her research focuses on understanding the strengths and challenges of vulnerable populations, particularly women and children who have experienced abuse. She has led a number of interdisciplinary research projects including studies of the health and economic costs of violence after women leave an abusive partner, the efficacy of a health advocacy intervention on women’s health and quality of life, a trauma-informed primary health care intervention, and an online safety decision aid for abused women. Michele Hansen, BA (team leader), is the executive director of Women’s Shelter, Second Stage Housing and Counselling Services of Huron County in Southwestern Ontario and has been working since 1988 to end violence against women, first as a frontline crisis counselor, then as a children’s advocate, and, for the past 15+ years, in her current position. She has been an activist, community leader, and innovator, founding many committees dedicated to improving services for women, including, in 1992, co-founding the first Domestic Assault Review Team in Canada.

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What counts? A mixed-methods study to inform evaluation of shelters for abused women.

Shelters for abused women have expanded from "safe havens" to providing a range of residential and outreach services, and face increasing pressure to ...
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