Assessing Receptivity to Empirically Supported Treatments in Rape Crisis Centers

  • Tonya Elaine Edmond Washington University in St. Louis
  • Rachel Voth Schrag University of Texas at Arlington
Keywords: Trauma, evidence-based practice, PTSD, rape, rape crisis centers


Survivors of sexual violence are at risk for PTSD, depression, and anxiety. There are several empirically supported treatments (EST) that are effective for addressing these trauma symptoms; however, uptake of these ESTs among Rape Crisis Center (RCC) counselors is low. This research project sought to determine counselors’ attitudes toward evidence-based practices (EBPs); their perceptions of the intervention characteristics of three specific ESTs: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing Therapy; and differences in attitudes and perceptions based on agency setting (urban/rural) and counselor education. The Consolidated Framework for Advancing Implementation Science (CFIR) was used to construct a web-based survey to send to all RCCs in Texas (n=83) resulting in an overall agency response rate of 72% (n=60) and responses from 76 counselors. Counselors’ attitudes towards EBP and perspectives on specific ESTs suggest that dissemination and implementation efforts are needed within the RCC service sector to advance the uptake of CPT, EMDR and PE.

Author Biographies

Tonya Elaine Edmond, Washington University in St. Louis
Social Work, Associate Professor
Rachel Voth Schrag, University of Texas at Arlington
Social Work Doctoral Candidate


Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61-74. doi:
Aarons, G., Glisson, C., Hoagwood, K., Kelleher, K., Landsverk, J., Cafri, G., & The Research Network on Youth Mental Health. (2010). Psychometric properties and United States National Norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychological Assessments, 22(2), 356-365. doi:
Aarons, G., Glisson, C., Green, P., Hoagwood, K., Kelleher, K., Landsverk, J., & the Research Network on Youth Mental Health. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study. Implementation Science, 7(56), 1-15.
Allen, B., Gharagozloo, L., & Johnson, J. C. (2011). Clinician knowledge and utilization of empirically supported treatments for maltreated children. Child Maltreatment, 17(1), 11-21. doi:
Barnett, M., Brookman-Frazee, L., Regan, J., Saifan, D., Stadnick, N., & Lau, A. (2017). How intervention and implementation characteristics relate to community therapists’ attitudes toward evidence-based practices: A mixed-methods study. Administration and Policy in Mental Health and Mental Health Services Research, online first, 1-14. doi:
Bass, J. K., Annan, J., McIvor Murray, S., Kaysen, D., Griffiths, S., Cetinoglu, T., . . . Bolton, P. A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine, 368(23), 2182-2191. doi:
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660-665. doi:
Bisson, J., & Andrew, M. (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 3(CD003388 ). doi:
Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T.,… Stevens, M. R. (2011). The national intimate partner and sexual violence survey (NISVS): 2010 Summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
Bohn, D. K., & Holz, K. A. (1996). Sequelae of abuse: Health effects of childhood sexual abuse, domestic battering, and rape. Journal of Nurse-Midwifery, 41(6), 442-456. doi:
Borntrager, C., Chorpita, B., Hilga-McMilan, C., & Weisz, J. (2009). Provider attitudes toward evidence-based practices: Are the concerns with the evidence or with the manuals? Psychiatric Services, 60(5), 677-681. doi:
Campbell, R., Dworkin, E., & Cabral, G. (2009). An ecological model of the impact of sexual assault on women’s mental health. Trauma, Violence, & Abuse, 10(6), 225-246. doi:
Campbell, R., & Martin, P. Y. (2001). Services for sexual assault survivors: The role of rape crisis centers. In C.M. Renzetti, J. L. Edelson, & R. K. Bergen (Eds.), Sourcebook on violence against women (pg. 227-241). Thousand Oaks, CA: Sage.
Chen, Y., & Ullman, S. (2010). Women’s reporting of sexual and physical assaults to police in the National Violence Against Women Survey. Violence Against Women, 16(3), 262-279. doi:
Chilcoat, H. D., & Breslau, N. (1998). Posttraumatic stress disorder and drug disorders: testing causal pathways. Archives of General Psychiatry, 55(10), 913-917. doi:
Classen, C., Palesh, O., & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence, & Abuse, 6(2), 103-129. doi:
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J., A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50-65. doi:
Dorsey, S., Pullmann, M. D., Kerns, S. E., Jungbluth, N., Meza, R., Thompson, K., & Berliner, L. (2017). The juggling act of supervision in community mental health: Implications for supporting evidence-based treatment. Administration and Policy in Mental Health and Mental Health Services Research, online first, 1-15. doi:
Edmond, T. (2004, September). Theoretical and intervention preferences of service providers addressing violence against women: A national survey. Paper presented at the 9th International Conference on Family Violence, San Diego, CA.
Edmond, T., Lawrence, K., & Voth Schrag, R. (2016). Perceptions and use of EMDR therapy in rape crisis centers. Journal of EMDR Practice & Research, 10(1), 23-32. doi:
Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress studies (2nd ed.). NY: Guilford Press.
Golding, J., Siegel, J., Sorenson, S., Burnam, M., & Stein, J. (1989). Social support sources following sexual assault. Journal of Community Psychology, 17, 92-107. doi:<92::AID-JCOP2290170110>3.0.CO;2-E
Herschell, A. D., McNeil, C. B., & McNeil, D. W. (2004). Clinical child psychology’s progress in disseminating empirically supported treatments. Clinical Psychology: Science and Practice, 11, 267-288. doi:
Jarero, I., Amaya, C., Givaudan, M., & Miranda, A. (2013). EMDR individual protocol for paraprofessional use: A randomized controlled trial with first responders. Journal of EMDR Practice and Research, 7(2), 55-64. doi:
Jordan, C. E., Campbell, R., & Follingstad, D. (2010). Violence and women's mental health: The impact of physical, sexual, and psychological aggression. Annual Review of Clinical Psychology, 6, 607-628. doi:
Kaukinen, C., & Demaris, A. (2005). Age at first sexual assault and current substance use and depression. Journal of Interpersonal Violence, 20, 1244-1270. doi:
Kessler, R. C., Crum, R. M., Warner, L. A., Nelson, C. B., Schulenberg, J., & Anthony, J. C. (1997). Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national comorbidity survey. Archives of General Psychiatry, 54(4), 313-321. doi:
Kilpatrick, D., Resnick, H. S., Ruggiero, K., Conoscenti, M., & McCauley, J. (2007). Drug-facilitated, incapacitated, and forcible rape: A national study. Washington D.C.: Department of Justice. Retrieved from
Lalor, K., & McElvaney, R. (2010). Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma, Violence, & Abuse, 11(4), 159-177. doi:
Macy, R. J. (2007). A coping theory framework toward preventing sexual revictimization. Aggression and Violent Behavior, 12(2), 177-192. doi:
Macy, R. J., Rizo, C. F., Johns, N. B., & Ermentrout, D. M. (2013). Directors’ opinions about domestic violence and sexual assault service strategies that help survivors. Journal of Interpersonal Violence, 28(5), 1040-1066. doi:
McFarlane, J., Malecha, A., Gist, J., Watson, K., Batten, E., Hall, I., & Smith, S. (2005). Intimate partner sexual assault against women and associated victim substance use, suicidality, and risk factors for femicide. Issues in Mental Health and Nursing, 26, 953-967. doi:
NREPP (2017). National registry of evidence-based programs and practices. Retrieved from
Palinkas, L., Schoenwald, S., Hoagwood, K., Landsverk, J., Chorpita, B., & Weisz, J. (2008). An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. Psychiatric Services, 59, 738-746. doi:
Patterson, D., Greeson, M., & Campbell, R. (2009). Understanding rape survivors' decisions not to seek help from formal social systems. Health & Social Work, 34(2), 127-136. doi:
Pigott, T. D. (2001). A review of methods for missing data. Educational Research and Evaluation, 7(4), 353-383. doi:
Plouffe, K. A. (2007). Paraprofessional intervention using a cognitive processing protocol. Clinical Case Studies, 6(4), 348-361. doi:
Raghavan, R. (2012). The role of economic evaluation in dissemination and implementation research. In R. Brownson, G. Colditz, & E. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (pp. 94-113). New York: Oxford University Press. doi:
Rape, Abuse, and Incest National Network [RAINN]. (2017). Rape, Abuse, and Incest National Network: Sexual Assault Service Providers. Retrieved from
Reding, M., Chorpita, B., Lau, A., & Innes-Gomberg, D. (2014). Providers’ attitudes toward evidence-based practices: Is it just about providers, or do practices matter too? Administration and Policy in Mental Health, 41(6), 767-776. doi:
Regehr, C., Alaggia, R., Dennis, J., Pitts, A., & Saini, M. (2013). Interventions to reduce distress in adult victims of rape and sexual violence: A systematic review. Research on Social Work Practice, 23(3), 257-265. doi:
Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD victims. Journal of Traumatic Stress, 18, 607-616. doi:
Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal, 312(1), 71-72. doi:
Schaaf, K., & McCanne, T. (1998). Relationship of childhood sexual, physical, and combined sexual and physical abuse to adult victimization and posttraumatic stress disorder. Child Abuse and Neglect, 22(11), 1119-1133. doi:
Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing: Information processing in the treatment of trauma. Journal of Clinical Psychology, 58, 933-946. doi:
Steel, J., & Herlitz, C. (2005). The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: A random sample of the general population of Sweden. Child Abuse & Neglect, 29(10), 1141-1153. doi:
Walsh, K., Galea, S., & Koenen, K. C. (2012). Mechanisms underlying sexual violence exposure and psychosocial sequelae: A theoretical and empirical review. Clinical Psychology: Science & Practice, 19(3), 260-275. doi:
Department of Veterans Affairs (2017). The Management of Posttraumatic Stress Disorder and Acute Stress Disorder. Washington D.C: Department of Veterans Affairs. Retrieved from
Voth Schrag, R., & Edmond. T. (2015, January). Frequently reported treatment goals and issues assessed among clinicians in rape crisis centers. Society for Social Work and Research Annual Meeting, New Orleans, LA.
Zinzow, H., Grubaugh, A., Frueh, B., & Magruder, K. (2008). Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: A multi-site study. Psychiatry Research, 159(1-2), 226-236. doi: