Because victims of trauma and violence are often women, support to victims tends to apply a gender perspective. However, this perspective disregards the fact that there are other important categories that shape the experience of violence, such as ethnic/racial belonging, sexual orientation, socioeconomic level, and cultural context. To provide adequate care, professionals must consider the context and conditions of people’s lives and the consequences of their experiences of victimisation. According to the model proposed by the United States Substance Abuse and Mental Health Services Administration, an institution that works with persons exposed to trauma and violence must develop a set of knowledge, attitudes, and practices that make it possible to identify the effects of violence on the physical, mental, and relational health of the victim, promoting recovery and guaranteeing that professionals treat the victim fairly and respectfully. These practices are called trauma-informed care and all institutions that support victims should adopt it. Trauma-informed care benefits victims, namely in reducing of the effects of the violence experienced, but also professionals, in promoting their job satisfaction. Working daily with victims of trauma and violence is highly demanding for professionals and can lower professionals’ well-being (e.g., from exhaustion or a lack of commitment to their job), but it can also result in positive feelings related to compassion satisfaction, when the professionals feel grateful for the opportunity to have a positive impact on victims’ lives. This study aimed to describe the challenges that professionals who work in institutions that provide victim support in Portugal face, as well as describe their competencies and quality of life. 

The sample of this study was composed of 503 professionals, mostly women (91%), with a mean age of 42.69 (SD = 9.55) years. The professional area was mostly psychosocial (56%), followed by health (33%), justice (4%), and other (7%). The participants had worked in victim support for an average of 14.81 (SD = 9.73) years. Data collection consisted of an online questionnaire about the needs and challenges, competencies, and quality of life of professionals who work to support victims of trauma and violence in Portugal.

Professionals that provide support to victims in Portugal work with a variety of forms of violence such as domestic violence, sexual abuse, sexual harassment, mobbing (or labour harassment), female genital mutilation, and human trafficking. The largest portion of participants reported providing support to victims of domestic violence (76%) followed by sexual abuse (38%). Participants supported a mean of 2.33 (SD = 1.59, min = 1; max = 7) types of violence victims, with 43% reporting to support one type of violence victims and 35% reporting to work with, at least, three types of violence victims.

Also, participants worked with victims from different age groups, although adults were the most frequent (68% of the participants), with most participants reporting that they worked with more than one age group (72%). Twenty-three percent of participants reported working with all four identified age groups (children, adolescents, adults, and older adults). Most participants supported victims that were migrants (56%) and/or from minority ethnic groups (55%).

​​​

Participants identified greater than average difficulty in working with victims who were from minority groups according to gender identity (e.g., transgender), gender (e.g., non-binary), sexual orientation (e.g., homosexual), ethnicity (e.g., Roma), nationality (e.g., migrant), and/or religion (e.g., religious minority). A considerable portion also reported greater difficulty working with male victims of domestic violence, probably because of stereotypes about masculinity and who can be a victim. In addition, age and socioeconomic level, especially older people (53%) and people from lower socioeconomic levels (35%), were considered more demanding by a considerable portion of participants, probably because such victims had other needs beyond their situation of victimisation.

​​​

Professionals were asked to identify difficulties in their communication with victims and the institutional obstacles in their daily professional life, such as institutional conditions that hindered the successful performance of their work. The obstacles reported by the largest proportions of participants were difficulties of accessing translation services (44%) and the lack of supervision in their work (39%), that is, institutional support in improving their practice and enhancing their professional well-being. When working with victims from different cultural and ethnic contexts, the difficulties reported by the largest share of participants were linguistic barriers (67%), the unpredictability of the situations (49%) and the challenges in establishing trusting relationships (45%). The percentages in the figure below allow us to conclude that each participant faced, from their point of view, more than one difficulty and/or obstacle in their work.

​​​

Participants answered the Cultural Competence Questionnaire for Help Professionals, which uses a scale from 1 (totally disagree) to 6 (totally agree). The professionals positively evaluated their cultural competence in two domains: cultural awareness (i.e., they agreed that they could appreciate and understand other cultures and recognise their prejudices against other cultures) and cultural competence (i.e., they agreed that they had the competencies needed to adjust professional practice to meet the needs of multicultural populations). However, their evaluation was lower in the other two domains: cultural knowledge (i.e., familiarity with the characteristics, values, beliefs, history, and behaviours of other cultures) and organisational support (i.e., institutional conditions to develop cultural competencies, namely training, support in different languages, and the availability of written materials in different languages).

​​​

Trauma-informed care involves showing respect for service users and establishing trusting relationships with them. To gauge the state of trauma-informed care at Portuguese institutions, participants responded to the Trauma-Informed Care Questionnaire, which has a four-point scale from 1 (totally disagree) to 4 (totally agree) and makes it possible to determine the nature and strength of trauma-informed care (insufficient, fair/needs improvement, good, excellent). Fifty percent of participants assessed trauma-informed care at their institution as insufficient and 38% assessed it as fair or needing improvement. Only 12% of participants evaluated these practices as good or excellent at their institutions. 

​​​

Working with victims of trauma and violence can result in negative consequences for professionals, such as secondary traumatic stress (trauma symptoms that develop from exposure to others’ trauma) and burnout (feelings of exhaustion or decreased energy, increased mental distance from work, and/or feelings of work-related negativity that result in reduced professional effectiveness). In contrast, work with victims can also have positive effects on professionals, such as compassion satisfaction, which is defined as the sense of reward and meaning resulting from helping people who have had traumatic experiences.

To assess these three aspects, participants took the Professional Quality of Life Questionnaire, which has a scale from 1 (never) to 5 (very often). Just under half of participants had low levels of secondary traumatic stress (48%) and burnout (44%), while just over half had moderate secondary traumatic stress (52%) and burnout (56%).  No participants had high secondary traumatic stress or burnout. Participants experienced moderate (64%) to high (36%) levels of compassion satisfaction. No participants had low compassion satisfaction.

​​​

This study gives visibility to the challenges and skills of professionals working in institutions that support victims in Portugal. Considerable proportions of participants reported that the work was more complicated when victims were from cultural minorities (e.g., human trafficking, female genital mutilation). In addition, participants recognised greater difficulty in working with victims that challenge assumed gender patterns of violence and with those who come from one or more demographic minority. Gender is, undoubtedly, an important issue when working with victims. However, professionals must attend to other vulnerability factors that interact with it (e.g., sexual orientation, socioeconomic level, age, religious beliefs, and others), in an intersectional approach. 

Participants also recognised that language and cultural barriers compound with other difficulties identified. Congruently, although they had a positive perception of their ability to appreciate different cultures, assess their own cultural bias, and recognise some competencies for culturally competent work, they negatively evaluated the organisational support that their institutions provide to help them develop these skills. This insufficiency in the institutions was also evident at the level of trauma-informed care, which seems to be at a precarious level in Portugal. Research has shown that trauma-informed care and practices provide conditions of greater well-being for both victims and professionals. 

The results of this study make it possible to draw conclusions at the level of professional practice, the promotion of equality and the fight against violence, operationalised at both national and international levels. In terms of professional practices, it will be necessary to ensure that professionals are able to meet, support and respond to the needs of victims in a culturally competent way that responds to the consequences of their traumatic experiences. The achievement of this goal will only be possible through the promotion of cultural competencies and trauma-informed care, through organisational policies and specialised training actions for professionals.

Gonçalves, M., & Matos, M. (2016). ). Cultural competence in intervention with immigrants: A comparative analysis between health professionals, social workers and police officers. Acta Médica Portuguesa, 29(10), 629-638.

Hales, T., Nochajski, T., Green, S., Hitzel, H., & Woike-Ganga, E. (2017). An association between implementing trauma-informed care and staff satisfaction. Advances in Social Work, 18(1), 300-312.

Salloum, A., Choi, M., & Stover, C. (2019). Exploratory study on the role of trauma-informed self-care on child welfare workers’ mental health. Children and Youth Services Review, 101, 299–306. 

Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, Substance Abuse and Mental Health Services Administration.

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances, 24, 319–333. doi: 10.1192/bja.2018.29