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Abstract

This study used simulation-based research (SBR) to gain a better understanding of how intimate partner violence (IPV) service providers engage in trauma-informed practice in a simulated session with a standardized patient. Our qualitative study recruited 18 IPV service providers from Canada and the United States. Each participant engaged in a virtual 30-minute case-based simulated session with an actor portraying a survivor of IPV experiencing vulnerabilities related to violence and immigration status. Following each simulation, IPV service providers participated in a 30- to 45-minute reflective dialogue. The data were analyzed using reflexive thematic analysis. Identified themes included: (a) simulation builds trauma-informed responses that recognize intersecting identities (e.g., race, immigration status, culture) and (b) simulation helps train service providers in responding to IPV. Implications for social work research and practice, including the benefits of using simulation for training IPV service providers, will be discussed.

Keywords

intimate partner violence (IPV)trauma simulation service providers

Introduction and Background

Intimate partner violence (IPV) service providers work in complex practice settings supporting survivors of IPV during some of the most challenging periods in their lives. IPV service provision is complex, nuanced, multifaceted, and requires service providers to attend to multiple aspects of violence, trauma, identity, culture, and service need. IPV service providers are required to use a variety of skills and models of intervention to best support the needs of survivors of IPV. In particular, students and new service providers may feel overwhelmed or unprepared to work with survivors of IPV who have experienced trauma (Tarshis & Baird, 2019). Service providers who are newer to trauma-informed approaches and working with survivors of IPV who are recent immigrants who may have experienced multiple forms of marginalization, might feel they lack skills or knowledge for complex practice. Additional training and practice experience can be beneficial and help build confidence, but there are often few opportunities for this type of learning. Simulation has been recommended as one way to help fill this gap (Bogo et al., 2017; Kourgiantakis et al., 2020).

The following article outlines our study which investigated the use of simulation-based learning in trauma and IPV practice.

IPV Scope and Severity

IPV is a pervasive, widespread, global health concern impacting nearly one in three women and one in four men in their lifetime (Centers for Disease Control and Prevention [CDC], 2022; García-Moreno et al., 2013). According to the World Health Organization (WHO, 2021) “Intimate partner violence refers to behavior within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors. This definition covers violence by both current and former spouses and partners” (p. 1). In the United States, between 36.6% and 57.2% of women have been survivors of psychological abuse from an intimate partner during their lifetime (Smith et al., 2017). An intimate partnership is defined as a close and personal relationship involving regular contact that supports a partner’s emotional connectedness, including – but not limited to – ongoing sexual and physical contact, and an awareness and understanding of each other that contributes to the formation of an identity as a couple (Breiding et al., 2015).

IPV has severe consequences on survivors’ mental health and physical well-being and has repeatedly been referred to as a public health crisis (CDC, 2022; García-Moreno et al., 2013; Heise et al., 2019; WHO, 2021). Survivors of IPV can suffer from significant health consequences including physical injuries, mental health issues, sexually transmitted infections, and substance use (Willie & Kershaw, 2019). Previous studies have suggested that survivors of IPV are at higher risk of developing chronic conditions, including those affecting the digestive, reproductive, cardiovascular, and nervous systems, as well as the bones and muscles (CDC, 2017). Furthermore, depression and posttraumatic stress disorder (PTSD) are common among survivors of IPV (Stein & Kennedy, 2001). Consequently, IPV has devastating economic consequences on society (Voth Schrag et al., 2019). Costs range from loss of employment, health care expenses, to involvement with the justice system (Postmus et al., 2020). In the United States, nearly $5.8 billion per year is allocated toward mental and physical health services for survivors of IPV (Willie & Kershaw, 2019).

Approximately 13.5% of the general population in the United States are immigrants (Masferrer et al., 2018). An immigrant refers to someone born outside the country where they currently reside and include refugees, asylees, legal nonimmigrants, and naturalized citizens, among other categories (Njie-Carr et al., 2021). For many refugees or asylees, their decision to leave their home countries represents an accumulation of multiple factors including violence and persecution, social-economic and political instability, and religious, cultural, political, or racial membership (United Nations, Office of the High Commissioner for Human Rights, 2022). As they flee their home country and settle in a foreign country, refugees and asylees may be without legal immigration status, which may contribute to challenges such as limited financial resources, limited access to health and social services, and lack of social support (Njie-Carr et al., 2021).

Previous research has suggested that women who are new immigrants may be at higher risk of IPV; studies in the United States indicate that between 20% and 70% of immigrant women report abuse (Goncalves & Matos, 2016; Y. S. Lee & Hadeed, 2009). Immigrants who initially experienced violence in their country of origin may also be at increased risk of IPV in their new host country (Mose & Gillum, 2016). Some immigrant families face sociocultural challenges and stressors related to their adjustment to the new environment, which has been reported to affect family dynamics and may also lead to increased violence (Kalunta-Crumpton, 2013). In addition, changes related to gender roles, threats to the changing structure of the family, and more responsibilities may increase the risk of violence among immigrant families (Akinsulure-Smith et al., 2013). An additional risk can occur if immigration status is tied to the status of an abusive partner (Sabri et al., 2018). In this situation, an abusive partner may threaten immigration status in order to maintain power and control in the relationship (Kim, 2019). Furthermore, this situation may make it especially difficult to leave an abusive relationship due to fears related to deportation and separation from children (Kim, 2019). Additional challenges faced by women experiencing IPV as new immigrants include: isolation in a new country due to a lack of a robust support system and distance from family and friends, language barriers, cultural differences, lack of resources about available services, financial dependence, fear of retaliation from abusive partners, and shame. In many circumstances, these constitute fundamental barriers related to accessing help and leaving an abusive relationship (Nije-Carr, 2021; Ting, 2009). Therefore, service providers should have the necessary skills to respond to the complex needs of this population.

Trauma-Informed Practice and IPV

More than half of survivors of IPV experience trauma as a negative outcome of violence (Jones et al., 2001; Smyth et al., 2017), resulting in a greater likelihood of posttraumatic stress than depression or anxiety (Dekel et al., 2020). Posttraumatic stress or PTSD, referring to overwhelming or intrusive responses to a negative or complex situation, can make it difficult for survivors of IPV to heal from violence (Carlson & Dalenberg, 2000; Herman & van der Kolk, 2020). Service providers supporting survivors of IPV require specific skills in understanding and responding to trauma.

Trauma-informed practice or a trauma-informed approach has been defined by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) as a response that “realizes the widespread impact of trauma and understands potential paths for recovery. It recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system” (p. 9). Trauma-informed practice has emerged out of trauma theory, which includes a broad area of research and literature aiming to understand the scope of trauma, how it impacts individuals, communities, and societies, and how they cope in response (Briere & Scott, 2013; Knight, 2015; Reeves, 2015). Trauma-informed practice recognizes that the impact of trauma can range from neurological, biological, and psychological, to social, while also impacting a person’s strengths and potential for resilience, and it seeks to build services in response to these potential impacts (Fallot & Harris, 2001).

Given the complexity of experiences of IPV for survivors who are immigrants, and the potential for intersecting experiences of trauma as well as resilience, a trauma-informed response is particularly important (Tarshis et al., 2022). In particular, IPV researchers and service providers have called for increased intersectional service delivery models that integrate trauma-informed approaches (Kulkarni, 2019). Intersectional theory is credited to Black feminist scholars (Crenshaw, 1989;1991; Hill Collins, 2000) and underscores the importance of recognizing individuals’ unique identities and experiences of marginalization. Intersectionality highlights how identities (e.g., race, class, gender, sexuality, ability, and immigration status) interact and influence experiences of violence, and how multiple levels of oppression such as racism, sexism, employment discrimination, xenophobia, and others, create violence but are not always addressed in service delivery models. Trauma-informed service delivery models that are rooted in intersectionality are survivor-centered and attend to the multiple identities of survivors of IPV (Kulkarni, 2019). They are intended to center identity and the source of trauma as structural forms of oppression while responding to the specific and individual needs of each person, ranging from housing and shelter, immigration and legal, emotional and physical, and employment and finances. As articulated by Quiros et al. (2020), trauma-informed approaches have often not centered race or identity or recognized racism as trauma, which should be at the core of any trauma-informed response.

Simulation-Based Learning and Research

Simulation has a long-standing history of being used in medical schools to help train students as they learn to diagnose, treat, and assess patients (Abdool et al., 2017; Halamek, 2013; Lavoie et al., 2018). While research in simulation-based learning has been well established in a broad range of health care settings (Hodges, 2006; Keskitalo et al., 2014; McGaghie et al., 2011) and nursing (Sittner et al., 2015), there has been a recent uptick in research examining the use of simulation-based learning to help teach and assess social work practice skills (Kourgiantakis et al., 2019; E. Lee et al., 2019; Logie et al., 2013). In social work, simulation refers to a situation where a social work student or service provider engages in session with a simulated client who is a trained actor (Sewell et al., 2023). Increasingly used to teach practice-based skills by offering live practice opportunities without harming real clients (Bogo et al., 2014; Kourgiantakis et al., 2019), simulation prepares social workers for practice by assessing knowledge and decision making processes (Kourgiantakis et al., 2019). It also provides an opportunity for the invaluable exercise of actively reflecting on one’s work (Gursansky et al., 2010).

Simulation may be especially beneficial for those seeking training in responding to IPV and trauma and in preparing for future practice in this area. Furthermore, simulation-based learning provides a practical and ethical experience for students or new service providers seeking to practice skills in a low-risk environment (e.g., actors vs. clients) without the risk of harming or retraumatizing survivors of IPV. Despite its growth in social work, there have only been two known studies examining the use of simulation to train service providers in responding to IPV (Choi et al., 2023; Forgey et al., 2013).

As service providers, educators, and researchers, the authors were interested in the use of simulation as a method for training current and future service providers in responding to IPV and trauma. We decided to use simulation-based research (SBR) as a methodology to gain insight into how service providers conceptualize complex clinical practice (Asakura et al., 2021; Todd et al., 2021). This study seeks to better understand how IPV service providers conceptualize trauma-informed practice and how simulation might be used to help train those interested in IPV and trauma work. The research question guiding this study is: How can the use of simulation support the professional training of IPV service providers in trauma-informed approaches with survivors of IPV?

Methods

Using SBR as a methodology, this qualitative study recruited 18 IPV service providers to gain insight into how they engage in trauma-informed practice with a live actor in a simulated session and how this method might be useful for training service providers new to the profession. The study was based at the School of Social Work at Carleton University and took place virtually between April 2022 and July 2022. Each participant engaged in a virtual 30-minute case-based simulated “first session” with a live standardized patient—“Taraji”—who portrayed a survivor of IPV describing specific experiences related to immigration status, race, and trauma. Taraji was portrayed as a 36-year-old Muslim woman with three children (ages 1, 6, and 8) who had moved from East Africa three years ago to join her husband in a large North American city. Currently living in a domestic violence shelter, Taraji described how she was seeking support to cope with trauma after experiencing physical, sexual, and emotional abuse.

Following the simulation, all participants engaged in a 30 to 45 minute semistructured reflective interview with a member of the research team to review a segment of the video-recorded sessions and reflect on the simulated session and how they applied trauma-informed practice. Several key interview questions included: “What does trauma-informed practice mean to you?” “How is a trauma-informed approach most helpful in your work?”; “How do those theories inform your practice?”; and “Reflecting on the session with Tariji, how do you see yourself incorporating trauma-informed practice here?” During this interview, participants were also asked to identify one or two segments from the simulation that they felt were relevant to their understanding of trauma-informed approaches. The reflective interview process aimed to provide insight into how service providers viewed their practice and learning through engagement in the simulated session. Participants selected a particular segment that they found interesting or challenging and watched the video clip with the researcher. The aim of this reflective experience is to prompt further reflection into practice skills and approaches as participants engage in a reflective dialogue with the researcher. This format is based on other simulation-based research studies (Asakura et al., 2023; Occhiuto et al., 2024; Todd et al., 2021).

Participants

There were a total of 18 IPV service providers who engaged in the simulation-based session and postreflection. All participants identified as using trauma-informed approaches in their practice. Participants were located in Canada (n = 9) and the United States (n = 9). We used purposive sampling (Douglas, 2022) to intentionally recruit participants who could provide the relevant data to answer the research question. Through the research team’s professional networks, listservs, and through social media sites, we invited social workers, psychologists, and mental health counselors in Canada and the United Statets who engage in IPV and trauma work (n = 18).

Participants were given a $50 gift card as compensation for their time. All research materials were reviewed and approved by the Board of Ethics at Carleton University. The average age of participants was 43 years old. All participants identified as women. Participants’ average years of IPV practice experience was a mean of 8.8 years with a range of 2 years to 22 years of IPV practice experience. Participants held a master’s degree (n = 14: MSW = 9; other [MFT, Master of Counseling degree] = 5), PhD (n = 2), or bachelor’s degree (n = 2). The sample was racially diverse, participants identified as white (n = 9), Latinx (n = 3), Black (n = 3), South Asian (n = 1), Middle Eastern (n = 1), and mixed race (n = 1). Participants had worked in a variety of settings including IPV organizations and shelters, immigration organizations, human trafficking organizations, private practice, outpatient and community adult mental health, children’s mental health, and hospital settings. Many learned about IPV and trauma work through on the job training (in-house workshops, supervision), graduate training (internship training, coursework), continuing education, postgraduate certificate, or conferences and webinars.

Data and Analysis

The semistructured interviews were digitally recorded, transcribed verbatim, and used as qualitative data. We followed Braun and Clarke’s (2022) six-step reflexive thematic analysis (RTA) process: (a) reading and familiarizing ourselves with the data; (b) coding the interviews: (c) reviewing the codes to create themes; (d) reviewing the themes together; (e) adjusting and defining themes, and; f) writing up research findings. The first four authors all independently coded the data, meeting weekly to discuss understandings and develop themes together by consensus. Individually, the authors all reflected on their own experiences, identities, and interpretations of the data before again reflecting together as a team during weekly discussions. Trustworthiness measures included credibility through prolonged engagement with the data and extensive IPV research and practice experience and confirmability through the use of direct quotations and reflexive discussions (Drisko, 1997; Gilgun, 2015).

Results

Two themes were identified to better understand how IPV service providers use trauma-informed approaches in a simulated session and how simulation may be beneficial for training. Identified themes included: (a) simulation builds trauma-informed responses that recognize intersecting identities (e.g., gender, religion, immigration status, culture) and (b) simulation helps train new service providers in responding to IPV.

Simulation Builds Trauma-Informed Responses that Recognize Intersecting Identities

This theme illustrates how, when engaging in practice with Taraji, participants demonstrated and then reflected on how the use of an intersectional lens was an essential component of their trauma-informed approach. This participant described the link between being trauma-informed and intersectionality: “There [is] this trauma lens, in terms of understanding, intersectionality, and the trauma that people experience” (Participant 08). Another participant described how trauma and identity are interwoven:

There are times when, and especially working with the marginalized population, whose identity is defined by trauma, forced migration, you’re defined by trauma, it’s really hard for anybody to undo that narrative, right? It’s really hard to not have a trauma informed lens. (Participant 01)

In conceptualizing and building their own trauma-informed responses, participants identified and responded to various aspects of Taraji’s identity including her gender, religion, immigration status, and culture. Participants described how they think about religion, gender, immigration status and IPV in their work, and how to have discussions about religion with clients. For example, one participant considered the role of faith in their engagement with Taraji. They engaged in a conversation about the role of religion and how Taraji’s faith was both a strength but also a source of internal conflict, as she worried about not being a “good wife” for leaving her husband who was abusive.

Understanding that faith is very powerful . . . it was important to hear that she felt like God wasn’t pleased with her. Because she might [feel]that God may not be pleased with her because she’s not a good wife. And she’s not a good wife because [she believes] culturally and spiritually she’s supposed to listen to her husband, she’s supposed to obey. (Participant 12)

Some participants reflected on their own identities during their simulated session with Taraji. This participant considered their own identity as a white woman.

I’m a white woman who grew up in [large urban city]. So I have a completely different understanding of systems . . . there’s a lot of things that are really different and I can feel that the clients really feel that when they talk with me. And so trying to be as aware and as explicit about my positionality as possible. (Participant 06)

A participant who was also an immigrant reflected on the unique experience of being an immigrant, highlighting the strength and resilience stemming from their own healing process, and considering unique ways of healing based on the individual.

Because of my own immigrant experience and also because of the people I work with—because they don’t fit those lenses [of being an immigrant]—and you know I think we could all learn from each person’s culture; they have their own ways of healing. (Participant 07)

Most participants discussed Taraji’s immigration status, their concerns around deportation, and the need for immigration legal support. Their reactions within the vignette prompted them to reflect on the key role that immigration status plays in improving mental health, and how seeking legal support should be a primary goal for treatment.

As I’m talking to her, (immigration is) coming into mind, I’m like, “Oh. OK. Let me find out what’s your status?” Right away. And then she said, “Oh, I’m undocumented.” I said, “Oh. OK. Then I have to reel that back to say, “Maybe we need to start by giving a referral to the lawyers to help you as a survivor of IPV.” (Participant 04)

This participant spoke to the experience of many survivors of IPV who are both unsure about their legal status and also aware that their abusive partner holds “immigration status” as a means of coercion and control.

It’s a not [an] uncommon experience of specifically women in this situation—where they might not even know what their immigration status is, if they came with a husband who was holding power. And so being able to use hopefully good lawyers and all those things, (which are) often really hard to come by, and also [focus on] the lack of workforce authorization. (Participant 06)

Simulation Helps Train Service Providers in Responding to IPV

Participants found simulation to be a valuable learning experience that provided an opportunity to practice skills in a realistic setting that creates demands similar to actual therapeutic interactions. In particular, the experience provided a training opportunity to not only test their current skills, but to further reflect on areas to improve and how to refine these skills. As one participant stated,

I thought it was surprisingly realistic. . . more realistic than I expected it to be. I thought she [Taraji] was wonderful. It was hard, but it felt very real. It felt like what I deal with at the hospital or when I worked at the sexual violence clinic, it felt very real. And it was a good test to my skill set to figure out what are we trying to cover here (in session), (and simultaneously) trying to pay attention to my own urges not to rescue and save her from her own feelings. Yeah, it was good. It was hard but good. (Participant 11)

As illustrated in the previous quotation, nearly all participants spoke to the quality of the actor playing the simulated patient Taraji that made the experience realistic. These participants voiced that an authentic actor created a realistic setting. One stated: “The person who was Taraji was just terrific. I felt that I was sitting across from 12 years worth of women survivors. I could put so many patients there all at once” (Participant 15). Another participant shared:

I think the thing I’m still really boggled by was how real it felt. And I am born and bred in [large U.S. city], I am skeptical about everything, So I think that’s something I want to highlight and how we talk about simulation. I think as we talk about simulation, talking about it very separately from roleplay, and be it this is very different and I think part of that’s also because of the level of professionalism that Taraji had. And the value of having somebody who was very well trained. . . she was very, very good. (Participant 01)

This participant spoke to the benefits to new students of engaging in this low-risk situation with an actor, since there is no harm done to a real client.

The fact that this is something with actors, so it’s lower risk. So if you were a new student this is where you can make the mistakes . . . where we can use this as a stepping stone especially with incoming MSWs. They’re so excited, they want to do work in trauma and domestic violence because they’re women and they’re feminist, but they have no experience. And they jump in and they start doing this work and they’re so green and then they get traumatized and secondary trauma, so there’s not a lot of prep with them. (Participant 08)

Participants spoke to the potential for learning about intersectionality through the use of the simulated session, how this simulation brought up overlapping concerns in the lives of the undocumented. This participant found the simulation method to be a promising tool for teaching social work students about the complexity of practice.

Yeah, I think it was very rich, in terms of potential learning, right? And I don’t think I had anything like this when I was in school. In university. . . I think that there’s often this disconnect between social work education and then practice, and I think so much in social work education is focused on, you know, understanding intersecting forms of oppression and intersectionality, and how that works. But then, regardless of all of that learning . . . . you have to find a way to navigate that, and I think these simulations can be helpful in that, right? in terms of, like how do I keep all my learning in mind? How do I create a safe environment that’s accepting and welcoming, but also being, very aware of [the] power differential. (Participant 09)

Some participants highlighted the personal and professional challenges of IPV practice—for both students and seasoned professionals — and the ways in which simulation provided an opportunity for reflective practice. For some, despite being well-trained and well-experienced, the work is still difficult. This participant continued:

It’s still trauma, right? Working with folks who have experienced domestic violence or intimate partner violence or any kind of violence in their relationships. But because it is so incredibly triggering, naturally as human beings, I don’t care how experienced we are, it’s very triggering . . . sadly a lot of the people who are doing these jobs, as we know, are interns or just beginning in their careers. So they really get the short end of the stick, more guidance in the field is really important. (Participant 08)

Several providers found the method to be an impetus to reflect on their own practice and try different approaches:

How useful it would have been, if I had this at the onset of my training and in a rather continuous fashion. Because sometimes you want to test out your hypothesis as a clinician. . . [If] you have the safety of doing it with an actor, is actually it’s a gift . . . (Participant 15)

Participants also highlighted the ways that simulation is helpful for providing feedback for students and as a tool for supervision.

Simulations are very important, especially in [the] social work field, because that puts the student, and their peers, in a space where one person becomes a supervisor, or one person becomes a provider, a clinician, one person becomes the patient. And that’s a very good learning tool, especially with the pandemic, a lot of them couldn’t get to do placements. (Participant 04)

Some IPV service providers discussed the value of rewatching themselves in action, learning from their struggles, and being able to return to particularly difficult segments. While several reported feeling anxious while reviewing their work, on video and with a colleague (in this case the researcher), they saw the value. One disclosed, “I can tell you this was anxiety provoking” (Participant 13), and another stated, “As panic inducing as [this was], it really helps” (Participant 08). Another participant summed up this theme by putting it this way:

I can’t say enough about the value of watching yourself again and self-appraisal. For self-growth, first of all, because you go through all the inner critic[s] and then you have to move through it because otherwise you’ll never do this job again. (Participant 18)

In analyzing and reflecting on the participants’ simulation experiences, an unexpected finding was identified, seen almost unanimously across participants. Over and over, respondents voiced their realization through this training experience that work with survivors of IPV who are immigrants is both meaningful and hard. As one participant voiced: “I was so focused in the moment, I didn’t realize. When I’m looking [at the recording now], I’m like, wow. I was riveted. I was present, and the story was powerful, and it was difficult to hear” (Participant 12).

Discussion and Implications for Research and Practice

Our qualitative study invited participants who were service providers currently practicing in the field, or beginning their first jobs in IPV, to conduct a simulated session from a trauma-informed approach. Although simulation has been shown to be a valuable training tool in higher education, including in medicine and social work (Abdool et al., 2017; Kourgiantakis et al., 2019); it has not yet been examined as a potential training method for service providers and students interested in working with survivors of IPV who are immigrants. This study attempted to address that gap by examining ways in which simulation-based learning can support professional training in IPV and trauma. Despite varying years of practice experience, all participants reported that the simulation was not only useful for their own learning but also for training others in responding to IPV. Our findings suggest that simulation can support IPV practice by offering providers opportunities to practice a trauma-informed approach and skills through realistic interactions, all while navigating the complexities and value of an intersectional perspective. This type of training is at the core of trauma-informed practice—building capacity around engaging in discussions on culture and religion, and increasing reflective practice (Bogo et al., 2014; Kourgiantakis, et al., 2019; E. Lee et al., 2022).

Corroborating previous research (Bogo et al., 2014; Kourgiantakis, et al., 2019; E. Lee et al., 2019), participants nearly unanimously agreed that this experience felt both real and meaningful, and so similar to their practice experiences that many repeatedly needed to remind themselves that the client was an actor. Participants also commented that this modality felt real enough to simulate the pressures one might feel engaging in an actual therapeutic encounter, but alleviated the fear so prevalent in novice service providers that that their therapeutic assays and inevitable missteps might unintentionally cause harm or disrupt the course of treatment (Craig et al., 2017; Kourgiantakis, et al., 2019). Knowing the client was an actor permitted some participants to take risks they might otherwise have not taken—trying out new phrasings or practicing implementing skills and strategies previously learned only through theory or in didactic settings. These findings show that through providing an experience-based activity on IPV and trauma, service providers can demonstrate their knowledge base and understanding of evidence-based skills and strategies (E. Lee et al., 2019). Choi and colleagues’ (2023) study used simulation as a training method for building the capacity of Korean American faith leaders to support IPV prevention and demonstrated increases in knowledge-base and confidence around IPV prevention and healthy relationships. Our study builds on this new area of research by focusing on what is needed to help prepare IPV service providers to translate knowledge into practice. Our hope is to expand on the utility of simulation to help enhance the development of IPV training.

Several participants talked about learning in academic or agency-wide training settings, but then finding themselves in professional situations lacking guided supervision as well as protected time to engage in reflective practice around implementing newly learned skills. This finding signals the need for more supervision and opportunities to engage in reflective practice—a theme that has been raised in previous literature (Bogo et al., 2011; Gursansky et al., 2010; Kourgiantakis et al., 2019). Participants in our study described finding value not only in engaging with the actor, but also having the opportunity to process the interaction by reflecting on video footage of their engagement, as well as their word choice, emotional attunement, and strategies used to navigate the therapeutic encounter scaffolded by the structured questions posed by our research team. Indeed, simulation is useful to help service providers engage in reflective practice where they can process their work, return to a video segment, and debrief with supervisors and peers on new strategies (Occhiuto et al., 2024).

Participants also appreciated that simulation allowed them to work on a case vignette that called on them to employ an intersectional, trauma-informed approach in a therapeutic encounter which makes an important contribution to the current models of training and education. Intersectionality reflects how identity is not a fixed state or construct, that each of us occupies different identities, over time and in different contexts, and that those identities interact with each other to create individual, formative experiences (Collins & Bilge, 2020; Crenshaw, 1989). An intersectional lens is an essential component of a trauma-informed approach with survivors of IPV (Kulkarni, 2019) because it recognizes the role of power and agency in people’s lives and encourages the discussion of how trauma impacts different aspects of a client’s life (Fallot & Harris, 2001; Tarshis & Baird, 2021).

With this in mind, the first four authors of this study drew from their shared experience with survivors of IPV who are immigrants to embed threads of different identities in the simulated case. Taraji gave voice to the impact of IPV on her identities as a mother, as a daughter, as a wife choosing to separate from her husband, as a member of a faith community, and as an undocumented immigrant. She verbalized the challenges she felt interpersonally, within her community, and in interacting with policies and systems that either provided or withheld needed care. In doing so, participants were pushed to confront, engage with, and learn from the overlapping identities and experiences that surfaced in the simulated session. This study’s authors adopted the view of McQueeney (2016) that incorporating intersectionality into education and training targeting IPV accounts for the breadth of survivors’ lived experiences, helps both emerging and experienced service providers to think about larger scale systemic concerns and challenges (McQueeney, 2016). As this study’s authors’ practice experiences are particularly strong in trauma, immigration, the migration process of African immigrants, and economic empowerment, our simulated case was able to promote discussion of those forces in Taraji’s life. The fifth author contributed conceptually with their vast expertise in simulation-based research which guided the direction of the study and encouraged us to move forward with this work.

Our study’s participants found this aspect of the simulation model to hold immense promise. Future iterations of this research could see different communities, training programs, and agencies tailoring simulation training cases to reflect both research-based and experience-based knowledge that has emerged from their specific communities of practice. Simulation vignettes could be developed to reflect interactions that might occur within non-mental health settings—such as nursing, midwifery, dentistry, police and emergency services, immigration law, and within faith communities for training on responding to the experiences of survivors of IPV who are immigrants. Furthermore, some scholars have called for further investigation into the utility of artificial intelligence (AI) for potential training opportunities. It has been suggested that AI could be beneficial for students early in their program (e.g., beginner-level students) (Asakura et al., 2020) which would be useful for students interested in IPV practice. This is an underdeveloped area of research and there are potential limitations to consider, such as a current need to determine how to adapt technologies to facilitate advanced learning (e.g., to be able to ask more than one question at a time, to be able to picking up nuances of complex practice). More research on its utility is warranted.

Limitations

Results from this qualitative study build on the small body of research on the use of simulation for training IPV service providers (Choi et al., 2023; Forgey et al., 2013). One of the unique strengths of this study is its emphasis on the voices of IPV service providers working in different settings in two countries (the United States and Canada), including authors whose expertise in this subject matter has developed over years of collective practice. However, there are a few limitations to note in the study, including a relatively small sample size and the use of purposive sampling methods. The results provide an in-depth understanding of participants’ engagement in one simulated client session, but a longer follow-up study might look at two or three IPV scenarios with different backgrounds and experiences. The actor was trained to play the same case scenario repeatedly without much deviance from the case. For example, the actor did not make it easier or harder depending on the IPV service provider’s level of practice (e.g., years of IPV practice experience), which would be an interesting iteration for future studies with student participants. The study also focused on participants’ approaches to applying trauma-informed practice. The study was not designed to assess or provide an objective measure of the participants’ skills, but rather their style and perceptions of practice and how they integrated trauma-informed approaches within their practice. Another important consideration is the emotional experiences of the actor. While a simulated session is considered low risk since it is not a session with a real client, there can still be emotional distress experienced by the actor which needs to be considered (Sewell et al., 2023). Simulation can also be costly and resource intensive. Educators and service providers need to consider if simulation is the most appropriate tool for training given these restraints (Asakura et al., 2023). Finally, the usefulness of simulation could be examined in a larger study that includes a training component for students in graduate school (e.g., MSW, psychology and counseling students), and other professional disciplines who interface with survivors of IPV (e.g., immigration attorneys, nurse practitioners).

Conclusion

In this simulated-based research study, 18 IPV service providers participated in a realistic clinical encounter with an actor portraying a survivor of IPV who is a recent immigrant. Research participants then engaged in a postsession reflective interview to share their insights on the simulated session. Participants applied a trauma-informed and intersectional approach in the simulated session with “Taraji” to explore her experiences, which included challenges related to immigration status (e.g., deportation threats), culture (e.g., use of religion to justify violence), and other traumatic experiences. This study offers a methodological innovation well-suited to attend to the complex nature of IPV practice through the real-time observation of simulated practice, while addressing ethical concerns that might arise from involving clients from vulnerable populations in research. Simulation-based learning provides a practical and ethical experience for new and experiencied service providers to practice skills in a low-risk environment (e.g., actors vs. clients), without the risk of harming or retraumatizing survivors of IPV (Sewell et al., 2023). This approach may be especially beneficial for social work students or new service providers who are interested in IPV and trauma and are seeking an opportunity to practice their skills. This study also highlights that a trauma-informed approach is essential for both clients and service providers and reminds us of the challenges of IPV service provision, the realities of vicarious trauma, and the potential for burnout of service providers. Ongoing training, supervision, and opportunities for reflection and feedback on practice are some strategies that can help support both emerging and experienced service providers alike.

Footnotes

Special issue co-editors: Megan R. Holmes,Richard P. Barth,& Samuel R. Aymer

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: The first author is grateful for funding support from the Carleton University Faculty of Public Affairs (FPA) Post-Doctoral Fellowship.

ORCID iDs

Sarah Tarshis

Stephanie L. Baird

Kenta Asakura

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Using Simulation to Train Service Providers in Responding to Intimate Partner Violence (IPV) and Trauma

Abstract

Keywords

Introduction and Background

IPV Scope and Severity

Trauma-Informed Practice and IPV

Simulation-Based Learning and Research

Methods

Participants

Data and Analysis

Results

Simulation Builds Trauma-Informed Responses that Recognize Intersecting Identities

Simulation Helps Train Service Providers in Responding to IPV

Discussion and Implications for Research and Practice

Limitations

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iDs

References