Developing and established programs always seek to satisfy the needs of specific
Running head: THE RESULTS: COMMUNICATION TO STAKEHOLDERS
The Results: Communication to Stakeholders
Dr. Holly Scott
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 1
The following analyzes data collected from 26 hypothetical clients participating in an
outpatient-based program geared toward rehabilitating female survivors of intimate partner
violence (IPV) suffering with PTSD and/or depression. This study evaluated the effectiveness of
trauma-focused cognitive behavioral therapy (TF-CBT) compared to treatment as usual (TAU).
The main program-evaluation question was identified as, Is TF-CBT more effective than TAU
(where TAU equals a person-centered approach) at decreasing the symptoms of PTSD and
depression (i.e., symptoms less severe, decrease in frequency of episodes, overall improvement of
functioning)? Two additional program-evaluation questions were also identified: 1) Is there a
statistically significant difference on change scores of outcome measurements by race (white or
non-white)? and 2) Is there a correlation between total change scores of outcome measurements
and the level of satisfaction with treatment?
Data from this study was collected from women over the age of 18 who were seeking
treatment following the experience of intimate partner violence. The intended number of women
to be treated in this study was 29, but the total number of participants who completed treatment
was 26 (nTFCBT = 13, nTAU =13).
The age range of participants was 19-64 years (M=34.96, SD = 13.307) (table 1; figure 1;
table 5). This sample consisted of 37% Caucasian, 29.6% Hispanic, 18.5 % Black, 3.7% Asian,
3.7% Native/Alaskan American, and 3.7% Pacific Islander. Of the participants, only 46.2% of
participants identified as being employed (table 2, figure 2). The religious beliefs of the
participants was sampled with 26.9% of participants identifying with Christianity, 7.7% with
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 2 Islam, 3.8% with Hinduism, 11.5% with Buddhism, 7.7% with Judaism, 11.5% with other,
11.5% with spirituality, and 19.2% identifying with no religious beliefs (table 3, figure 3). Of the
total number of participants who completed treatment (n=26), 50% of participants had been in
one IPV relationship prior to treatment, 26.9% of participants had been in two IPV relationships,
19.2% of participants had been in three IPV relationships, and 3.8% of participants had been in
four IPV relationships (M = 1.77, SD = .908) (table 4, figure 4, table 5).
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 3
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 4 Measures
Several variables were analyzed in this study including participant age, race, the number
of IPV relationships, treatment group, employment status, and religious beliefs, as reported
above. The Beck-Depression Inventory-II (BDI-II) and the Posttraumatic Diagnostic Scale
(PDS) were given to participants of both treatment groups before and after the intervention. A
satisfaction with treatment survey (1= very dissatisfied, 5 = very satisfied) was also given at the
end of treatment.
The main alternative hypothesis was that participants who completed the TF-CBT group
would demonstrate statistically significant differences on outcomes measures (dependent
variable) after the intervention (independent variable) when compared with pre-test scores as
compared to the TAU control group (H0= µTF-CBT – µTAU ≤ 0; H1= µTF-CBT – µTAU > 0).
A between-subjects repeated measures of analysis of variance (ANOVA) was conducted
on the pre-intervention scores of both the PDS, F (1, 24) = .119, p = .734 (tables 6a and 7), and
the BDI-II, F (1, 24) = .004, p = .948 (tables 6b and 8). Both analyses indicated that there was no
significant differences in the scores of the measures between the two groups prior to treatment.
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 5 Table 7 PDS pre-treatment scores between groups
Table 8 BDI-II pre-treatment scores between groups
A between-subjects repeated measures of analysis of variance (ANOVA) was conducted
on both the PDS and the BDI-II to assess the treatment effects between the groups (nTFCBT =
13, nTAU =13). A significant main effect of treatment type on the difference scores of the PDS,
F (1, 24) = 11.108, p = .003 was evident (see table 9, figure 9). A significant main effect of
treatment type on the difference scores of the BDI-II, F (1, 24) = 5.885, p = .023 was also
evident (see table 10).
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 6 Table 9 Pretreatment and Posttreatment Results for PDS Outcome Measure Between Groups
Figure 9 Mean Difference Scores for PDS Between Groups
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 7 Table 10 Pretreatment and Posttreatment Results for BDI-II Outcome Measure Between Groups
Figure 10 Mean Difference Scores for BDI-II Between Groups
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 8 A between-subjects repeated measures of analysis of variance (ANOVA) indicated a significant
main effect of the type of treatment on the reported level of satisfaction with the treatment, F (1,
24) = 12.522, p = .002 (see table 11, figure 11).
Table 11 Level of Satisfaction with Treatment Between Groups
Figure 11 Mean Level of Satisfaction with Treatment Between Groups
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 9 The second alternative hypothesis was that change scores on outcome measurements
(dependent variable) completed by participants would differ by race (independent variable) (H0:
µwhite = µnon-white ; H1: µwhite ≠ µnon-white). An independent-samples t-test was conducted to
evaluate whether race (white or non-white) significantly influenced change scores on outcome
measurements. The test revealed that non-white participants had significantly better change
scores on outcome measurements (M=16.88; SD = 10.118) than white participants (M=9.50; SD
= 3.598), t(24) = -2.205, p = .037 (see table 12).
Table 12 Change Scores on Outcome Measurements by Race (white or non-white)
The third alternative hypothesis was that there would be a positive correlation between
the change scores (independent variable) and the level of satisfaction with treatment (dependent
variable) (H0: r = 0 ; H1: 0 < r ≤ +1.0). Results of the Pearson correlation indicated that there
was a significant positive correlation between change scores and treatment satisfaction, r= .460,
n = 26, p = .018 (see table 13).
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 10 Table 13 Relationship between Total Change Scores and Treatment Satisfaction
Of the scaled variables analyzed (i.e., participant age, number of IPV relationships
experienced prior to treatment, difference scores of outcome measures, and the level of
satisfaction with treatment), all yielded asymmetry and kurtosis within acceptable ranges,
demonstrating normal univariate distribution. Based on this data set, there do not appear to be
any significant outliers affecting the distribution.
As expected, TF-CBT had a significant effect on the symptoms of PTSD and depression
of participants as assessed by pre-test and post-test scores of outcome measurements compared
to TAU (i.e., person centered approach). The TF-CBT model uses psychoeducation, stress
management, affect modulation, cognitive coping, trauma narratives, cognitive processing, and
behavior management to decrease symptoms related to trauma (MUSC, 2005). While a person-
centered approach is not typically utilized by clinicians who are exclusively treating trauma
(Joseph, 2004), this clinical approach to treatment is common for intimate partner violence
agencies in conjunction with an empowerment model as a way to meet the client where they are.
Future qualitative research that analyzes the experiences of the treatment interventions might
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 11 help clarify this further and might point to the appropriateness of the intervention for this specific
Communicating Results to Stakeholders
Developing and established programs always seek to satisfy the needs of specific
stakeholders, or individuals/agencies/organizations with vested interest in the service(s), being
offered (Royse, Thyer, & Padgett, 2016). The upstream stakeholders for this program (i.e., those
who had a hand in the development and/or implementation/management of the program) include
policy makers, funding organizations, and the program itself. Downstream stakeholders for this
program (i.e., those who are impacted either directly or indirectly by the program) include the
clients; their children; other local, state, and national domestic violence coalitions (which, in this
case, might also be considered an upstream stakeholder); and the community (Briere & Scott,
When presenting results to external stakeholders – which in this case would likely
include funding and accreditation organizations – it will be important to deliver the results in an
understandable, ethical, and transparent manner, even when the results are undesirable or
uncertain (Broughton, 1991; ACC, 2003; Longest & Rohrer, 2005; ACA, 2013; Han, 2013).
According to Broughton (1991), finding this balance can be confusing and can require the
evaluator to judge the target audience’s preferences before communicating the results.
Depending on who or what the intended target is, often overlooked aspects like language and
generalizations can significantly impact the future of the program. Guiffrida, Douthit, Lynch, and
Mackie (2011) suggest that a clear description of an existing knowledge gap should be included
in the report to demonstrate a need for continued research. Once the data has been analyzed, a
report should be drawn up to organize the information and conclusions effectively. Presenting
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 12 the results also poses a degree of difficulty. Some evaluators may find that it is necessary to
develop several presentations in order to appeal to the various audiences (Broughton, 1991). The
evaluator should be prepared to handle questions about bias, methodology, and data
interpretation. Since there is very little empirical evidence demonstrating the effectiveness of TF-
CBT with the adult population, there is likely to be several questions regarding the adaptability
of the intervention and its appropriateness for this population. Finally, the evaluator should
present the study’s limitations and implications for the future that do not overstate the data in
favor of the program or intervention being evaluated (Guiffrida et al., 2011).
Ethical and Cultural Considerations
The American Counseling Association’s (ACA) Code of Ethics (2014) contains an entire
section devoted to evaluation, assessment, and interpretation (Whiston, 2012). Section E of the
ACA Code of Ethics is comprised of various sub-and sub-sub-sections that provide several
competencies and professional standards for counseling practitioners to refer to during the
evaluation process including: client welfare, limits of competence, appropriate use, informed
consent, release of data, diagnosis, cultural sensitivity, instrument selection, referral information,
conditions of assessment, multicultural issues, scoring and interpretation, security, and forensic
evaluation (ACA, 2014). The American Evaluation Association (AEA) provides more
evaluation-specific guidelines for evaluators. These guidelines are comprised of five principles:
A) systematic inquiry; B) competence; C) integrity/honesty; D) respect for people; and E)
common good and equity (AEA, 2018). While working with the IPV survivor population, there
are several ethical and legal issues that can arise during the evaluation process; specifically,
confidentiality and informed consent. Unfortunately, confidentiality can be limited based on
reports of child abuse and intent to harm (self or others) – potentially damaging the established
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 13 rapport between client and counselor (if the counselor is also the evaluator). Respecting both the
evaluation guidelines and the client-evaluator relationship will likely increase cooperation from
the client and, subsequently, the significance of the measured data.
When conducting an evaluation, it is imperative that it demonstrate cultural sensitivity so
as to not exclude (either intentionally or unintentionally) any particular individual or group
(AEA, 2018; ACA, 2014). This requires that the evaluating body be knowledgeable about
cultural norms (Royse et al., 2016). With this particular program, there are many challenges
related to cultural sensitivity. First and foremost, the IPV culture (i.e., victims, perpetrators, other
innocent bystanders) has a very unique culture that is, to some degree, based on maintenance
and/or survival. Often times, one will see that the communication style, gender roles, and family
structure of this culture share certain characteristics despite cultural or ethnic differences that
unite this population; making it a culture all its own. Secondly, while some commonalities might
be expressed throughout the population, there are differences in age, gender, socioeconomic
status, culture, ethnicity, and language that require an evaluator to consider the risk of
generalizing the evaluation process. These two considerations pose significant issues for the
program. Cultural barriers such as language or religious beliefs may very well deter or hinder a
potential client from participating in the services offered by the program. And while it is a great
idea to employ staff who speak other languages or have difference cultural
influence/experience/knowledge, this isn’t always a realistic option for employers. As far as
needy but unserved clients go, this population is notorious being inadequately served, either
because of limited resources of community agencies or individual unwillingness/inability to
participate. Attrition rate is also very high and can occur at any time of treatment. However, this
is likely to be a result of IPV risk (i.e., risk for assault, continued assault, severe assault, frequent
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 14 assault, assault after intervention, treatment attrition, domestic homicide) than unmet cultural
needs (Sartin, Hansen, & Huss, 2006).
When communicating results, it is important to clearly identify the population and
demographics relevant to the study. Historically, treatment interventions have been developed
with a primarily white, English speaking sample base (Royse et al., 2016). However, if validity
cannot be established because the intervention is not cross-culturally adaptable, it is unlikely to
be funded or supported as appropriate intervention for general counseling. In this particular
study, the sample consisted of 37% Caucasian, 29.6% Hispanic, 18.5 % Black, 3.7% Asian,
3.7% Native/Alaskan American, and 3.7% Pacific Islander. TF-CBT has demonstrated
considerable cultural adaptability, and the assessment measures (PSD and BDI-II) have
demonstrated reliability and validity measures that suggest considerable cross-cultural relevance.
These factors suggest that this study can be considered culturally sensitive. Furthermore, the
Association for Assessment in Counseling (2003) maintains that communicating results in a way
that can be understood by a variety of people is crucial to the helping others understand the
implications of the results. This absolutely includes cultural considerations that should be
occurring at every stage before, during, and after the evaluation (Section E.5.b, E.8, and E.9.a)
Using Results to Improve the Program
Based on the quantitative data, it appears as though TF-CBT is highly effective at
reducing symptoms associated with both posttraumatic stress and depression. Compared to TAU,
TF-CBT was significantly more effective at reducing symptoms of posttraumatic stress and
moderately more effective at reducing symptoms of depression. In order to improve the
effectiveness of the program, it is recommended that further research be conducted that compares
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 15 other treatment interventions (such as CBT). In the interim, it might also be beneficial for all
counselors to be thoroughly trained on TF-CBT. A third recommendation based on these
preliminary results would be to replicate this study with a semi-structured interview at the
conclusion of treatment to expand on the treatment experience to help evaluate the
appropriateness of the TF-CBT intervention with the intimate partner violence survivor
population. Collecting qualitative data that can speak to the effect of race on change scores
would also support the development of a cross-culturally appropriate program.
Using Results to Advance the Counseling Field
Innovative research has the ability to generate new intervention models and techniques
that can stimulate an improvement in mental health and general wellness (Longest & Rohrer,
2005; Guiffrida et al., 2011). TF-CBT has been proven to address symptoms of trauma, including
PTSD and depression with statistical significance (Bradley, Greene, Russ, Dutra, & Westen,
2005; Seidler & Wagner, 2006; Bisson, Ehlers, Matthews, Pilling, Richards, & Turner, 2007;
Shearing et al., 2011; Watts, Schnurr, Mayo, Young-Xu, Weeks, & Friedman; 2013). During the
literature review segment of this evaluation, it became evident that because TF-CBT was
originally designed as a means to reduce trauma-related symptoms in children, significant data
for the success of this model for the adult population would be extremely limited (d’Ardenne,
Farmer, Ruaro, & Priebe, 2007; Shearing, Lee, & Clohessy, 2011; Ehring, Welboren, Morina,
Wicherts, Freitag, & Emmelkamp, 2014). However, the author maintains that, with some
modifications, this approach would be highly applicable for the adult population as well. The
results from this study indicated that TF-CBT was, in fact, effective at reducing symptoms of
posttraumatic stress and depression for the adult population. Continued exploration of this
therapy model with this population will help to bridge the knowledge gap that exists for this
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 16 intervention. If effectiveness can be established, it may encourage other counseling agencies to
integrate TF-CBT not just with domestic violence survivors, but with an array of clients
experiencing trauma-related symptoms. Successful integration of TF-CBT could possibly reduce
counseling duration, eliminate the necessity of pharmacological dependence, and improve
overall wellness to a greater degree than TAU alone.
The purpose of this study was to determine if TF-CBT was more effective than TAU in
treating posttraumatic stress disorder and depression in women over the age of 18 receiving
treatment at an outpatient-based program geared toward rehabilitating female survivors of
intimate partner violence. Analysis revealed that symptoms of PTSD and depression in
participants in this sample did, in fact, decrease significantly after the TF-CBT treatment
intervention was applied as compared to TAU. Additionally, on average, participants rated their
level of satisfaction with the TF-CBT treatment higher than TAU. Further analysis of data
yielded that race significantly influenced change scores on outcome measurements and that the
level of treatment satisfaction was positively correlated with change scores.
As a result of this study, three recommendations were provided for stakeholders: 1)
conduct additional research that tested the effectiveness of TF-CBT against other treatment
modalities; 2) provide thorough TF-CBT training for employees; and 3) replicate this study with
a mixed methods design to expand the data with qualitative information.
THE RESULTS: COMMUNICATION TO STAKEHOLDERS 17
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Association for Assessment in Counseling. (2003). Responsibilities of users of standardized tests
(RUST) (3rd ed.). Retrieved from
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Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multi-dimensional meta-
analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162 (2), 214-
Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation,
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Journal of Health Promotion, 6 (2), 138-143.
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accountability-oriented program evaluation: An evaluation of the adventure scouts
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THE RESULTS: COMMUNICATION TO STAKEHOLDERS 18 d’Ardenne, P., Farmer, E., Ruaro, L., & Priebe, S. (2007). Not lost in translation: Protocols for
interpreting trauma-focused CBT. Behavioural and Cognitive Psychotherapy, 35, 303-
Ehring, T., Welboren, R., Morina, N., Wicherts, J.M., Freitag, J., & Emmelkamp, P.M.G. (2014).
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Guiffrida, D.A., Douthit, K.Z., Lynch, M.F., & Mackie, K.L. (2011). Publishing action research
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Han, P.K.J. (2013). Conceptual, methodological, and ethi
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