Aims and objectives
The aim of the study was to develop a comprehensive, national profile of VSS specialist services for victim-survivors in England, giving voice to service users’ experiences, and using a comparative analysis of the range, scope and funding of services, victim-survivors’ service experiences, service models and approaches, service linkages and commissioning arrangements, in order to make policy and practice recommendations that will strengthen the overall service response to victim-survivors.
The objectives were to:
- explore victim-survivors’ experiences of accessing and using VSS services, identifying what needs are being met for which groups of victim-survivors and what encourages victim-survivors to take up services
- analyse the range, scope and funding of VSS services and how demand is managed
- explore the usefulness of different approaches to service delivery (including peer support and delivery by volunteers) and different therapy models
- explore how different principles underlying service provision influence service delivery, including feminist and trauma-informed principles of care
- investigate referral patterns and pathways, and how VSS services fit with each other and link to the wider network of services for victim-survivors
- explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved over the last 3–5 years, and how they have impacted on VSS service provision
- develop a taxonomy of the VSS services/service models being commissioned and provided
- make recommendations for the commissioning and provision of VSS services at practice and policy levels, in order to strengthen overall service provision for victim-survivors of SV.
With the aim and objectives in mind, in March 2020, the team agreed the study title of PROSPER (Sexual Violence: The Supporting Role of Specialist Services). The naming of the study proved invaluable in providing a unique identifier that gave it prominence in the field of SV research in England.
Patient and public involvement and engagement and the co-research study design
Co-production was built into the PROSPER study from its inception; initially through the development of the research proposal with the two patient and public involvement and engagement (PPIE) co-applicants (one of whom is a survivor of SV), and latterly through their continued involvement, plus the addition of five co-researchers working on the study. Details of the PPIE activities are expanded upon later in the report. Moreover, an entire section (see Chapter 6) is dedicated to explaining and reflecting on the PROSPER co-research design (authorship of that chapter has been led by the co-researchers). As an overview, the PROSPER team has comprised not only an academic team with associated partners (e.g. practitioners, commissioners, academic advisors), but also the five experts-by-experience co-researchers. The co-researchers have worked alongside and with the academic team on numerous activities as detailed in the following chapters. This highly participatory methodology was embedded in order to:
- amplify the voices of victim-survivors
- enhance the collection of highly meaningful data
- empower victim-survivors who were participating in the research
- promote learning and development of new skills among the co-researchers.
Overall study design
The PROSPER study was divided into the following WPs:
- WP1: exploratory interviews with commissioners and providers and focus groups with victim-survivors.
- WP2: national survey of service providers and commissioners.
- WP3: case study analysis.
- WP4: co-research with victim-survivors.
- WP5: data integration.
An overview of each WP is provided later in this section and discussed in-depth in subsequent chapters of the report. WPs 1–4 are subsumed within a broader, multimethod framework as shown in Figure 1. In the original proposal, we had described the research design as an explanatory sequential mixed-methods study following the work of Creswell and Plano-Clark.67 In this form of mixed-methods design, the intention is to utilise a qualitative phase to help explain the results from a previous quantitative phase. We envisaged that the case study work (WP3) would help explain the results from the national survey (WP2). While this is the case, the study design evolved into something far more complex than a linear quant–qual mixed-methods design. Originally, the interviews that took place at the beginning of the study were not intended to provide a form of data in their own right. The purpose had been to provide insights into commissioning and VSS services that would inform the development of the national survey (WP2). However, the methodology and insights were sufficiently robust and complete to form a distinct strand of PROSPER (now WP1). In addition, the co-research component provided far greater depth and rich insights than we had envisaged originally. To that end, the co-researcher work, particularly the analysis of data from victim-survivors, forms a significant part of the overall PROSPER findings that warrant inclusion and embeddedness. For these reasons and to capture the complexity of the design, as shown in Figure 1, we refer to the design as a multimethod design, allowing for all the component parts to be integrated (into WP5).
FIGURE 1 Multimethod design with WPs linked to study aim and objectives. Reproduced with permission from Bradbury-Jones et al.72 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) licence, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The figure includes minor additions and formatting changes to the original text. (Figure not reproduced here; see the original article.)
Work package 1: exploratory interviews with service providers and commissioners and focus groups with victim-survivors
Overview of work package 1
Work package 1 was an exploratory qualitative study carried out with victim-survivors, VSS service practitioners and commissioners of services for victim-survivors. It was based on extensive preparatory work and relationship building across the SV sector. The aims of WP1 were:
- To develop understanding of the principal issues shaping the delivery, funding and commissioning of VSS services and the unique features of these organisations
- To use the findings to inform the development of three national surveys that will map the provision, funding and commissioning of specialist SV services.
Two experienced, female qualitative researchers (Isham PhD and Gunby PhD) carried out interviews with: (1) senior practitioners of VSS services (n = 13), (2) commissioners of SV services (n = 8) and (3) providers (n = 2) from the statutory sector who worked in the area of SV. We also carried out two focus groups with (1) female victim-survivors (n = 9) and (2) male victim-survivors (n = 5) and one telephone interview with a female victim-survivor. Interviews and focus groups were recorded and transcribed verbatim by a professional transcription company.
Topics explored (in the interview and focus groups)
- The strengths and limitations of VSS services.
- The relationships, pathways and comparative differences between voluntary and statutory sector services.
- Details of current funding and commissioning arrangements, identifying areas where there has been change and continuity.
- Victim-survivors’ experiences of accessing voluntary and statutory sector services, their reflections on differences between services and their suggestions for improvements.
Transcription and analysis
The audio recording of the interview and focus groups were transcribed verbatim and then checked and anonymised by the researchers. The transcripts were analysed thematically, drawing on Billis and Glennerster’s theory of the comparative advantages of the voluntary sector (see section on ‘theoretical framework’ for more detail). The findings informed the design and development of the national surveys (WP2) and case study analysis (WP3).
Work package 2: national survey of service providers and commissioners
Work package 2 involved the development and administration of a national survey of provider and commissioners’ views about the design and delivery of VSS services for victim-survivors of SV. Initially, there were to be two online surveys; however, during survey development, it became apparent that separate surveys would be required for the VSS services and SARCs due to differences in their operation and configuration. As a result, we designed and administered three separate online surveys for:
- Commissioners of services for victim-survivors
- VSS service providers
- SARCs.
The surveys were designed to enable comparisons between the three participant groups on a number of key themes (e.g. views of funding and commissioning, the strengths of specialist services, under-representation of victim-survivor groups). The surveys were available for completion electronically between January and June 2021. Once data collection was complete, two members of the co-researcher team were involved with the analysis process.
Work package 3: case study analysis
Work package 3 involved an in-depth investigation of four areas in England using a case study approach. We explored the role of VSS services, their links with other local services and the funding and commissioning arrangements that underpin them. We also explored victim-survivors’ views and experiences of (not) accessing services across their life course. Interviews were carried out with providers of VSS services, commissioner/funders and victim-survivors.
Case studies are well established as an appropriate method for studying contemporary complex phenomena in a holistic way in their real-life contexts, particularly when the boundaries between the phenomenon and context are not clear.68 They benefit from the prior development of theoretical propositions to guide design, data collection and analysis, and so rely on multiple sources of evidence which need to converge and triangulate in order to provide plausible explanations of observed phenomena. They also help to build theory, providing rich descriptions, which lead to a holistic understanding of the case.69 This research is largely based on Stake’s approach, where multiple perspectives on the case need to be gathered, with a flexible design allowing data collection to adapt in response to experiences in the field, and an inductive analysis of data.70,71 This WP involved detailed analysis at four distinct geographical areas of England, each selected on the basis of various features, including their different models of VSS service configuration, delivery and funding (see Chapter 5 for details).
Extensive exploratory work was carried out establishing relationships with key stakeholders in each of the site areas before recruitment of participants began. Recruitment began in the autumn of 2021, and 70 participants across three main participant groups – commissioner/funders, practitioners and victim-survivors – were interviewed by the end of April 2022. Approximately half of the victim-survivor interviews were co-facilitated by a co-researcher and a member of the academic team.
Work package 4: co-research with victim-survivors
In February 2021, a team of five co-researchers (initially six, but one co-researcher withdrew after several weeks due to personal circumstances) w recruited to join the core study team. The co-researchers have considerable personal and professional expertise (both in practice and research settings) working with victim-survivors and other ‘vulnerable’ groups. Prior to the case study phase starting, the co-researchers received training in key research skills and methods; this was complemented by one-to-one support from an assigned mentor (a member of the PROSPER core team) and reflective team sessions. Throughout the study, the co-researchers have participated in wider research team meetings, the survey design and analysis, the case study stage and particularly the victim-survivor interviews, data analysis and integration. The co-researchers have contributed to the writing of this report and have led on the development of the chapter that reports on the co-research aspect of the PROSPER study.
Work package 5: data integration
Triangulation is an accepted method for integrating multiple data sets which have first been analysed individually. In the PROSPER study, this involved:
- methodological triangulation, comparing data collected using different methods, for example, comparing victim-survivors’ experiences using data from focus groups and interviews
- data triangulation, comparing quantitative with qualitative data, for example, comparing quantitative results about service provision and commissioning from the quantitative surveys with the qualitative case study interviews
- investigator triangulation, comparing the analysis of the same data by different team members, including different interpretations from individual academics and co-researchers.
In terms of data triangulation, we integrated data at different stages of the research, in line with the multimethod design. For example, qualitative data from initial focus groups with providers and commissioners (WP1) informed the development of the provider and commissioner surveys (WP2). Quantitative data from the surveys then informed the selection of case study sites (WP3) (although not to the degree that we had originally intended). Case study data were analysed separately for each site and then synthesised across sites. Each data set from each source was analysed separately initially, by different members of the team with at least two people analysing each data set and comparing and amending results. The purpose was to avoid bias in relation to the quantitative data and improve trustworthiness of the qualitative analysis. The final stage of data integration at the end of the project was crucial for ensuring the research aims and objectives were answered appropriately and to ensure a resonance and direct linkage to the underpinning theoretical framework.
Theoretical framework
As laid out in the introductory chapter, the study was informed by Billis and Glennerster’s50 theory of the comparative advantages and unique features of the voluntary sector when providing human services, particularly to ‘vulnerable’, marginalised and racialised groups. This is a theory that has longevity and has been applied in many contexts, but as far as we know, to date, the theory has not been applied in the context of SV service provision. The unique features of voluntary sector services that Billis and Glennerster identify are:
- flatter organisational structures with less distance and distinction between senior or decision-making staff and those on the front line
- closeness to communities
- being mission-led and driven by core values and purpose
In the context of PROSPER, our rationale for drawing on this particular theory was its potential to help us understand and explain the prominence and distinctiveness of the voluntary sector in providing support to victim-survivors of SV and identify the unique features (and perceived limitations) that shape their response to victim-survivors. During the study, we revisited this theoretical framework frequently, reflecting on how it was shaping and informing our methodologies and subsequent analyses. This ensured that the processes we employed were grounded throughout, not solely in the study objectives, but also in the study’s theoretical underpinnings. To bring the theory to the fore, we used it as the guiding framework for integration as described later in this chapter and in chapter 7. This flexible and reflexive use of theory is advocated by Bradbury-Jones et al.73
As shown in Figure 1, we had planned for WP1 to feed into WP2 by way of an exploratory sequential design, whereby the purpose of the qualitative phase was primarily to inform the survey development. WP2 was designed to sequentially inform WP3, but due to factors discussed elsewhere in the report, we did not achieve this fully. However, in its own right, WP2 addressed the objectives as indicated. There was a considerable degree of interaction between WPs 3 and 4, with the co-researchers being appointed to work primarily on this part of the PROSPER study. Data integration followed the first four WPS and from these, objectives 7 and 8 were met.