Ontario Coalition of Rape Crisis Centres Using Technology to Better Support Survivors: Literature Review
Learning Network Brief 33
Nicole Pietsch is a Coordinator of the Ontario Coalition of Rape Crisis Centres. The Coalition’s membership includes 29 community-based sexual assault centres from across Ontario.
Since 1998, Nicole has assisted women and youth living with violence, including immigrant and refugee women and survivors of sexual violence. In recent years, Nicole has worked with youth and adult survivors of violence who are incarcerated, those living in an institutional setting, and Deaf youth. Nicole has a particular interest in the ways in which social constructs of sex, gender, age and race inform Canadian social policy, including law.
Nicole’s written work has appeared in York University’s Journal of the Association for Research on Mothering, the University of Toronto’s Women’s Health and Urban Life, and Canadian Woman Studies/les cahiers de la femme.
Pietsch, N. (April 2018). Using Technology to Better Support Survivors: Literature Review. Learning Network Brief (33). London, Ontario: Learning Network, Centre for Research and Education on Violence Against Women and Children. http://www.vawlearningnetwork.ca
The Ontario Coalition of Rape Crisis Centres (OCRCC) works toward the prevention and eradication of sexual assault. OCRCC’s membership includes community-based sexual assault centres from across of Ontario, offering counselling, information and support services to survivors of sexual violence.
The use of technology for communication, maintaining social connections, and day to day organization is a reality for young, adult, and older women today. In recent years, technological tools like text-messaging, Skype, online correspondence and social media have overtaken traditional tools (i.e. voice calling, mail) in both popular usage and accessibility. Anecdotally, we know that some of these technologies have greatly increased access to health, language interpretation, or mental health supports in under-serviced regions of Ontario by creating remote or virtual service access in Northern, rural and isolated regions. In response, many social service agencies are utilizing e-counselling, texting and other technologies in their frontline work to connect with and check-in with support-seekers.
Of particular interest to sexual violence survivor advocates, technology has also made access to crisis, counselling and other supports easier and cost-effective for specific isolated and under-resourced populations of survivors of sexual violence in Ontario. As survivor advocates, we are aware that some survivor populations may wish to seek support, yet face financial, geographical, physical, or social barriers to accessing it in person. This can include women living with disabilities and Deaf women, youth, women living in poverty, working women, rural women in regions where no public transit exists, women with limited phone access, transient and trafficked women, and survivors with high confidentiality concerns. Sexual Assault Centre staff teams agree that some populations of survivors only have access to text or cellular-based data, present unique confidentiality or time limitations, or face other access barriers that inhibit their ability to use traditional in-person or telephone-based crisis and counselling options.
BARRIERS TO IMPLEMENTATION OF INNOVATIVE TECHNOLOGY
- Financial constraints
- Concerns about maintaining support-seeker confidentiality
- A commitment to mitigating the creation of unnecessary or incidental support-seeker records
- A lack of policies and best practices on technology use in frontline settings
Despite this, inconsistent access to and understanding of these new technologies is a reality amongst service providers working with sexual violence survivors in Ontario.
An increased understanding of technological tools that could be used in frontline outreach, crisis and counselling settings – and the capacity to implement these with confidence – presents an important innovation to the Sexual Assault Centre sector in Ontario communities.
With this in mind, OCRCC undertook the Using Technology to Better Support Survivors: Innovation in Frontline Settings Project. Its developmental phases include an environmental scan of existing technologies that can offer increased access to outreach, crisis and counselling supports for survivors of sexual violence, as well as a consultative process with OCRCC’s member Sexual Assault Centres. A literature review was also a part of the Project’s development.
Some of the literature in this review was identified by key informants who participated in the consultative process. This included sexual assault centre teams, centre managers and volunteers as well as non-centre organizations in Ontario that offer frontline services to women, youth or survivors of violence. The Project team also conducted searches for relevant publications through:
- Organizations that offer or oversee frontline service provision to populations of women, youth or survivors of violence, and have conducted evaluative or informational research on technological tools and frontline service provision, based on this service provision;
- Other organizations that have conducted prior research on technological tools and related positive impacts or challenges to the public (though not necessarily frontline service provision);
- Community research created by sexual assault centres
- A search in multiple academic databases, using the key words: texting +violence against women; texting + sexual violence survivor; sexual violence survivor + video counselling; text + crisis support; online + crisis support.
Our findings of this literature review are summarized below.
I. What’s out there?: A high-level review of existing technologies that can offer increased access to outreach, crisis and counselling supports
Already, many social service agencies are utilizing some form of technology in their frontline work today. An increasing array of service access options and the literature available point to the fact that “technology is changing communication between doctors and patients”, “between physicians and other healthcare providers”, and between support service providers and support-seekers -- including those working in organizations that support survivors of sexual violence.
Given the “pervasiveness and convenience” of tech devices and related services (i.e. internet access, wireless internet, communication software), it makes sense that social service providers consider the tools available, as well as how they might fit the service needs of populations in their local communities. Reviewed literature offered information about the most popular and practical technological tools that can be used in frontline outreach, crisis and counselling settings. These included:
- Online Chat
- Video Counselling
- Support and communications via Text Message
- Self-Guided Web-based Resources: for example, tips on how to cope with a panic attack or with flashbacks
- Social Media
II. Benefits associated with the use of technology in outreach, crisis and counselling supports
There are numerous advantages to using technological tools in outreach, crisis and counselling services identified by the literature.
Advantages to using technological tools to support survivors:
- Increasing Accessibility
- Privacy & Confidentiality
- Content (Problem of Situation Topic)
The literature shows that technology-based services can also increase access to support for support-seekers who are already using services, or waiting for services. In addition to survivor populations generally, the literature identifies that technological tools can increase service access to specific populations, including historically under-served or hard to reach populations.
Kids Help Phone, for example, shares that “19% of online chatters who participated in the [service’s] 2014 evaluation were seeing a counsellor or therapist, and…13% of online chatters were on a waiting list for mental health supports.”
Technological tools that are designed for brief interactions can support a continuity of care, be it crisis, check-in or ongoing support.
“I w0d luv 2 cal u guys but im deaf”
“Can i just txt because i have a speech inpediment.”
“I cnt talk wen I cry”
“Mobile phone calls don’t work here”
“My fone don’t work 4 calls”
“I’m at boarding school. We aren’t allowed to talk after lights out.”
This aligns with a feminist and community-based sexual assault centre framework, in which centres aim to offer a continuum of care to survivors in their local communities, and as identified by the survivor herself. This continuum includes crisis and emotional support (counselling); but can also include practical support such as referrals to other local organizations, accompaniment to relevant appointments, support to survivors who may check-in as-needed, and education and information.
In addition to survivor populations generally, the literature identifies that technological tools can increase service access to specific populations. Notably, Youthline NZ found that in one year alone, “20% of received text messages [from those seeking support] were asking that the service be provided by text and frequently would provide reasons for not wanting to, or not being able to, take up other options.” Others noted other practical barriers to voice service access. Youthline NZ (Haxell) shares the following access considerations, as self-identified by youth’s texts seen on the left.
While this selection is from a youth population sample, the access barriers identified here are also applicable to adults and older adults.
Privacy and Confidentiality
The prospect of using technology with survivors commonly raises service-provider apprehensions concerning confidentiality. Understandably, sexual assault centres supporting survivors place a high value on support-seeker confidentiality, and take leadership in prioritizing survivor privacy.
The literature identified important facets of this subject. Largely, many of these fall under benefits to using technology, as opposed to challenges. Overall, much of the literature identified ways in which tech platforms can offer emotionally (and sometimes physically) safer options for some survivors seeking confidential support.
Support-seeker experiences identified in the literature shared the following positive iterations of privacy and confidentiality:
- “The advantage to texting is the ability to maintain privacy by limiting the chance that someone could overhear”
- Support-seekers “preferred a text-based line specifically because they would not be identifiable by voice cues and no one could overhear their conversations” 
- One student noted that “such confidentiality might encourage youth to disclose more details about their problems”
- “In the text messages [from support-seekers] reviewed, a preference to text is most commonly related to concerns for privacy, of not wanting others to hear what is private and potentially embarrassing”
Content (Problem or Situation Topic)
The literature review revealed that text, chat and web-based support services tend to see more support-seeker contacts disclosing serious content or serious problems. These included mental/emotional health (25% of online chatters in one study), suicide/suicide-related (15% of online chatters in one study), and sexual violence disclosures.
Kids Help Phone’s review of online chatters found this key distinction between online and phone (voice) contacts: “youth experiencing serious mental health or suicide-related concerns are 22% more likely to reach out for counselling via Live Chat than by phone. As a result, when a counsellor responds to a chat, it is almost three times more likely to be about mental health or suicide than when they respond to a phone call”.
More, the same study found that sexual violence disclosures rated at 0.9% for callers and 2% for chatters -- both small percentages, but still an increase in chatters versus callers.
In this, we can see the impact that different frontline service mediums – in this case, online/text support, versus voice only -- can have in increasing crisis options to support-seekers.
III. Sector (agency and worker) challenges, concerns and barriers to the productive use of technology in outreach, crisis and counselling supports
Those working with survivors of sexual violence, stalking or intimate partner violence are well aware of the potential dangers that technologies -- such as social media, smartphones and digital pictures -- can cause to women, youth, and marginalized populations. In addition to these realities, an incredible amount of research, criminal justice, public opinion and traditional media energy has gone towards identifying technology, particularly social media, as a ready medium for youth and women’s exploitation (Public Safety Canada, Urban Institute, CyberTip). For this reason, many of us supporting survivor populations are understandably cautious about implementing technology in our work.
Given these contexts, it is important to point to positive and reputable literature that shares safe, healthy ways in which technology can be used (see Public Safety Canada, MediaSmarts, Women’s Support Network of York Region, Haxell, Law et al). As well, we note many current campaigns and literature that deconstruct the popular patriarchal narrative which too-often confounds technology with feminized and victim-blaming notions of vulnerability, prevention and risk. These campaigns (see Draw the Line, Women’s Support Network of York Region, Haxell) support a more nuanced understanding of technology: benefits, challenges and safety strategies. We also note that using technology as a medium to foster support, of course, differs vastly from technology used by abusers to cause harm.
Overall, we know that concerns about technological tools and their safe and effective use with survivors of sexual violence has inhibited our sector’s capacity to successfully implement these innovative tools. Comparable concerns were identified in the literature reviewed. Challenges include privacy and security (of support-seekers), as well as concern that miscommunication or losing the meaning over tech-based communications could occur.
Privacy and security of support-seeker information is often constructed as inherently precarious in the context of technology, many of which tools are designed by and operated by third (that is, tech) parties. However, as the field of tech tools and platforms have improved over the last ten years, research identifies that “there are a number of enterprise solutions that can provide encryption, including many patient [support-seeker] portals”; for example, iCarol crisis online chat/texting portal.
We also heard that service-providers using traditional (voice and face-to-face) service models often fear that worker-to-service user correspondence may fail, miscommunicate or weaken over text or chat-based support mediums. However, with appropriate training and supervisor support to frontline workers, much literature showed that, in fact, “the necessary and sufficient conditions of the therapeutic relationship, of being accessible, friendly and relevant in working with [service users] are shown to translate within a texting medium” and others, such as online chat.
SOME RECOMMENDATIONS FROM THE LITERATURE REVIEW
- Suggestions from relevant agency policies
- Identifiable best practices in using tech tools in frontline service provision
- Specific recommendations towards sexual assault support worker training content
 Canadian Medical Protective Association. Using electronic communications, protecting privacy. Published October 2013; Revised January 2016: 1.
 Many of the articles reviewed in the literature review (Canadian Medical Protective Association, Birnbaum, Reamer, Burrows, Haxell) identify social media as a popular technological tool, however caution its use in crisis and counselling support models, due to its inherent privacy limitations. Social media does remain a useful platform for program and agency outreach.
 Law, Jaclyn with Dilys Haner, Alisa Simon, and Sharon Wood (Kids Help Phone). 2015. Proof Positive: Evaluation of Kids Help Phone’s Phone and Live Chat Counselling Services: 7.
 Evans, W., Laura Davidson and Lorie Sicafuse. May 2013. Someone To Listen: Increasing Youth Help‐Seeking Behavior, Through A Text‐Based Crisis Line For Youth. Journal Of Community Psychology. May 2013, Volume41(Issue4): 478
 Ibid: 479.
 Ibid: 479.
 Law, Jaclyn with Dilys Haner, Alisa Simon, and Sharon Wood (Kids Help Phone). 2015. Proof Positive: Evaluation of Kids Help Phone’s Phone and Live Chat Counselling Services: 21, 29.
- Women’s Support Network of York Region (2015). Are you? Online & Okay…Online: https://sexualassaultsupport.ca/wp-content/uploads/2018/08/Online-Survivors-PagebyPage.pdf
- Public Safety Canada. Child Sexual Exploitation on the Internet. Online: www.publicsafety.gc.ca/cnt/cntrng-crm/chld-sxl-xplttn-ntrnt/index-eng.aspx;
- Media Smarts, 2014. Young Canadians in a Wired World, Phase III: Sexuality and Romantic Relationships in the Digital Age report. Online: http://mediasmarts.ca/sites/mediasmarts/files/pdfs/publication-report/full/YCWWIII_Sexuality_Romantic_Relationships_Digital_Age_FullReport_0.pdf;
- Haxell, Ailsa Janet. January 2015. On becoming textually active at Youthline, New Zealand. In British Journal of Guidance & Counselling. Volume 43(Issue1): 144-155;
- Law, Jaclyn with Dilys Haner, Alisa Simon, and Sharon Wood (Kids Help Phone). 2015.
Proof Positive: Evaluation of Kids Help Phone’s Phone and Live Chat Counselling Services.
 Canadian Medical Protective Association. Using electronic communications, protecting privacy. Published October 2013; Revised January 2016: 1-2.