Chapter 4: Service Delivery Models
A service delivery model refers broadly to how a clinic operates, including connecting to clients, interfaces with other kinds of support services, client case lifecycles, the types of services the clinic offers, and how technology consultants communicate with clients. A service delivery model encompasses both literal means of connection (in-person/remote, scheduled/drop-ins), but also includes other aspects of care, such as the length of care and types of services offered.
Our own service delivery models have undergone many iterations. Some changes emerged due to uncontrollable circumstances (e.g. the remote-only demands of the COVID-19 pandemic), while others evolved in response to changing capacities or client needs. We share service models used in existing clinics to ground this discussion in examples. However, we recognize that there is no single 'best' service delivery model, and the models used in existing clinics are likely to see future improvements.
In the following, we start by discussing how clinics should decide on a care model and scope their services, which inform the rest of the service model. Then we discuss other aspects of service delivery.
In this chapter:
Care Models
Clinics may want to consider how they handle requests for multiple appointments or long-term care. If the clinic would like to provide continuity of care between appointments by, e.g., pairing the client with the same consultant or building off of information stored in past appointments, it will need to also consider what information to store about past appointments and how to store it safely (see Clinic IT and Data Infrastructure). Example care models include:
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Drop-in appointments: Technology consultants work with a client in some time-bounded appointment (minutes to hours); all client-consultant interactions occur within this appointment.
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Short-term cases: Technology consultants meet with a client multiple times over the course of a relatively short period of time (days to a month).
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Long-term cases: Clients are helped over a longer period (weeks to months) by the clinic, either via the same consultant assigned to the client or a collection of consultants.
Different approaches have different trade-offs. Supporting longer term care may increase the amount of work for each consultant per client, and this may reduce client capacity of the clinic overall. Moreover, long-term care necessitates more infrastructure to manage personally identifiable information, case notes, and more. On the other hand, drop-in care may be insufficient for some complex client problems.
From the Clinics: In our experience, a lot can be done for clients via drop-in appointments, and it may be the best starting point for new clinics as it is the least complicated to set up. CETA started with drop-in care, and subsequently expanded to include short- and long-term care approaches. The TECC Clinic remains a drop-in care service. Hybrid models in which drop-in or short-term care services are the standard but more complex cases are escalated to a reserved team for longer care have not yet been explored, but may offer a balance.
Scope of Services
Technology abuse can take many forms, and possible interventions to mitigate different types of abuse may require drastically different involvement by technology consultants. It is important for technology consultants to know beforehand what services they are expected to render and how to communicate service limitations to clients, who may ask for services that consultants are unable to provide.
As an example, a narrow service model might limit service to checking the configuration settings for accounts and devices. Even this narrow model can cover a daunting number of accounts: email, social media, iCloud and other cloud storage, phones, laptops, tablets, financial accounts, WiFi routers and modems, and Internet of Things (IoT) all fall under the category of accounts and devices, and may run different operating systems (Windows, Android, MacOS, iOS, Linux). Further scoping of this model may pre-define which devices and accounts the clinic is able to handle.
Other service models might require technology consultants to guide clients through issuing take-down requests for publicly posted information or online harassment, requests for forensics and analyzing user data, physically searching for tracking/audio devices, or digitally scanning devices for unwanted software. The scope of these services would likely be incompatible with all but long-term care models.It’s also important to consider setting boundaries on what clinics can help with.
From the Clinics: As a hard rule, neither CETA nor the TECC Clinic do home visits or vehicle scans, although we may provide instructions or advice on how clients can do this for themselves. The clinics primarily check account and device configurations, and this is typically what what clients request. However, clients can share any technology-related issue, and technology consultants will do their best to provide assistance, if possible.
Certain issues such as harassment, non-consensual intimate imagery (NCII or 'revenge porn'), and forensics are beyond our (and as far as we know, any technologists') ability to meaningfully help with, so technology consultants are instructed to set expectations with clients asking for help with these issues, and then direct them to whichever relevant resources of which we are aware.
Referrals
A crucial consideration for any clinic is thinking through the mechanisms by which potential clients can request service. In an advocate-driven approach, an advocate at an IPV agency is the first point of contact for the survivor. The advocate conducts an intake with the client for their agency. As part of this intake, they might determine whether a referral to the technology abuse clinic is warranted and, if so, follow instructions mutually agreed upon by the agency and the clinic to refer the survivor to the clinic (see Intake, Screening, and Triage below). This approach ensures that all clients seen by the technology abuse clinic are already supported by a professional IPV advocate who is trained in topics such as how to conduct risk assessment and safety planning.
In an advocate-driven approach, the technology clinic needs to decide which IPV agencies can make referrals. In areas where there are many different anti-violence service providers, technology abuse clinics might consider exclusively partnering with a single agency or, if one exists, a coalition representing a collection of existing agencies, with all other agencies going through this partner agency for referrals. This has the advantage of having one organization act as a central clearinghouse for referrals, which can streamline the intake process for the clinic, but might be frustrating for service providers who do not have a direct line for services.
Alternatively, a self-referral model allows survivors to contact the clinic directly and request services. This has the potential advantage of reaching more survivors and lowering the barrier for access, particularly in communities where there is a waitlist for advocacy services. However, the self-referral model can introduce other challenges. A self-referral model requires dedicated resources and staffing to field incoming requests and will require a robust intake/screening process (see Intake, Screening, and Triage below). Additionally, survivors might attend the clinic without having already engaged in individualized safety-planning conversations with an advocate, and might leave the clinic without sufficient advocacy support needed for follow up conversations — including additional safety planning related to the technology issues uncovered during the clinic session. The self-referral model may also require a more public advertising scheme, which again may reduce barriers to access, but might also result in people seeking services who do not fit the clinic’s criteria (e.g., people with a technology question who are not IPV survivors or even abusers seeking to misuse the clinics services).
From the Clinics: CETA only accepts referrals from partner agencies within the New York City Metropolitan area. Its major partner is the Family Justice Centers run by the NYC Mayor's Office; the FJCs act as a central clearing house that streamlines referrals for the many domestic violence agencies operating in New York. As of 2022, CETA also accepts referrals directly from the Anti-Violence Project, an LGBTQ+ and HIV-affected serving agency in New York.
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From the Clinics: As of 2022, the TECC Clinic utilizes a self-referral model on a first-come, first-served basis. In previous iterations, the clinic experienced a high no-show rate that staff attributed to the delays between survivors completing an intake, being referred to the clinic by their advocate, and receiving an appointment time. The self-referral model has reduced the number of scheduling calls that the survivor receives, and the TECC Clinic is now experiencing a lower no-show rate. In practice, most clients are working with an advocate before attending the clinic, which is how they learn about the service, but the client initiates contact with the clinic directly. Future screening may harden the requirement that clients have an advocate before attending the clinic.
Intake, Screening, and Triage
Regardless of the model by which clients request services, clinics will need to internally review incoming requests to collect basic information about the client and their needs, and to ensure that the survivor is requesting services that are appropriate for the clinic's expertise. There are different methods for gathering this information. For example, clinics may use an online form (powered by, e.g., Google Forms or Qualtrics) that the client and/or their case worker fill out that triggers a request for service, or intakes may occur over the phone between the survivor and a contact person at the technology abuse clinic.
The information included on an intake form may vary depending on specific aspects of the service model. For example, if technology consultants contact clients directly for scheduling, the intake form will need the client’s name (or a pseudonym) and contact information.
In addition, depending on the volume of requests and clinic capacity, there may also be a need to triage requests for services, rather than following a first-come, first-serve model. If the request is urgent or time-sensitive (e.g. the client is moving into a shelter or has an upcoming court date), the clinic may consider prioritizing those clients for services and include such variables on the intake form.
We encourage all technology clinics to carefully design their intake forms to ensure that they follow the principles of data minimization (i.e., only request information that is necessary for providing service), plain language, and inclusivity. Examples of some intake forms used by existing clinics are included in the Appendix.
From the Clinics: CETA maintains an intake form created in Qualtrics. The intake form may be filled out by the client directly, by a caseworker on behalf of the client, or by both together. CETA's intake does not gather information about the abuser. Most fields are optional (including the clients name, pronouns, and any demographic information) but it does require contact information for the caseworker and safe methods (call, text, voicemail, email) and times to contact the client.
From the Clinics: At TECCC, the Clinic Coordinator completes the intake directly with the survivor. In addition to gathering information about the survivor’s current technology concerns the intake also explores potential conflicts of interest, including whether the abuser is employed in the technology industry. Because the Seattle region is a hub for technology companies and many of the clinic’s technology consultants are employed in the technology industry, the intake process specifically aims to ensure that the survivor is not paired with a technology consultant who may be a colleague of the abuser.
Scheduling
Scheduling practices determine how to arrange a time for clients to meet with technology consultants. Regardless of the order clients are seen in (prioritized, first-come first-served), there is a need to pair them with a technology consultant. Potential models include:
Scheduled clinic hours: The clinic advertises open hours during specific days and times, and clients are informed of those hours. During that time, any client seeking service contacts the clinic and is connected to an available technology consultant.
Appointment slots: Similar to drop-in services, the clinic advertises a list of available appointment slots to advocates or clients. Then clients or their advocates reserve an available appointment slot.
Client-driven scheduling: The clinic or technology consultant contacts the client directly (e.g., via phone or email) to arrange a mutually convenient time to conduct an appointment.
Our experiences at existing clinics have yielded two consistent insights. First, scheduling affects no-show rates, and no-show rates can sometimes be large (e.g., 50%). In any model, and especially in IPV contexts, clients will sometimes not show up for an appointment. Scheduling practices may elect to take this into account by, for example, offering to take drop-in clients if a client with an appointment does not show up. Additionally, scheduling can be burdensome for clients, technology consultants, and advocates. Small changes to scheduling models can have outsized impact on how much work is needed to schedule an appointment and by whom that work is done.
From the Clinics: The TECC Clinic is held on the first and third Monday of each month during a two-hour block in the evenings over Zoom. This offers consistency for the technology consultants who sign up for shifts upwards of two months in advance. The TECC Clinic Coordinator connects with clients the day of the appointment to complete the intake. The short time between intake, scheduling and the appointment has assisted in reducing ‘no shows’. If there are more referrals than available appointments, the TECC Clinic Coordinator also schedules waitlist appointments, where a client waits in the Zoom waiting room and if a survivor with a scheduled appointment does not show, the survivor in the waiting room receives the appointment.
From the Clinics: Scheduling at CETA has gone through several iterations; during the in-person only (pre-Covid) era of CETA, the clinic offered 4-5 slots on a single day each month per location, and advocates booked clients into those slots. If clients did not show up, then walk-ins were able to take their spot. In its current iteration that requires a remote appointment first, CETA consultants schedule the appointment directly with the client via the contact information provided in the intake; we experience a no-show rate of about 20-30% using this approach.
Medium of Appointments
Most service delivery models include scheduled appointments with a client. These appointments can be in-person or remote. Below, we explore benefits and challenges of each medium.
In-person appointments: In an in-person session, the technology consultant and client meet in a safe, physical location. This is usually provided by the partner agency.
Benefits of in-person session:
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technology consultants see the client's device which helps with navigating unfamiliar settings or devices
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enables physical scans of devices or other complex tasks
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depending on the location of the clinic, on-site advocates may also be available for immediate follow-up support
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may be easier to build rapport or read non-verbal cues
Challenges of in-person sessions:
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difficulties in arranging transportation, child care, or other difficulties may contribute to higher no-show rates
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higher time commitments for technology consultants which may contribute to difficulty staffing sessions
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finding a safe space to utilize, especially if client is concerned about location-tracking
Remote or virtual session: In remote or virtual appointments, the technology consultant and client communicate without meeting in person. Remote assistance can occur through synchronous meetings such as speaking over the phone or through teleconferencing software with potential for video and/or screen sharing, or asynchronously, such as providing assistance over email or text message, either directly to the client or through an intermediary, such as a caseworker.
Benefits of remote/virtual sessions:
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Increased accessibility and flexibility for both clients and technology consultants
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Fewer safety concerns when client is concerned about or at-risk of location tracking
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Clients may experience a great sense of agency and empowerment by learning to navigate their devices and accounts in real-time, rather than being tempted to hand over their devices.
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More flexible for volunteer consultants who can schedule or participate in appointments, leading to potential greater availability.
Challenges of remote sessions:
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Clients may only have one device, and struggle to use it both to access the session while following instructions.
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Concerns about the safety of the device or security of the connection.
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Client may go to e.g. the partner agency or a friend/family member's house and participate remotely with a loaned device.
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Sessions may take longer, especially if technology consultants cannot see the clients device.
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No on-site support from advocates without prior coordination.
A hybrid model offers the opportunity for both or either virtual and in-person meetings, with the type of appointment defined by other aspects of the service model and the client's needs. In either type of session, technology consultants can maintain communication with their fellow consultants to collaboratively problem-solve during individual sessions over an instant messaging or email platform, but this may be easier during remote appointments.
From the Clinics: Both the TECC Clinic and CETA started by offering exclusively in-person services, meeting with clients at the physical location of their partner agencies. During the COVID-19 pandemic, both clinics then moved to entirely remote services.
At the time of writing, CETA offers a hybrid model in which appointments are remote by default, but clients may request an in-person meeting. Remote appointments are conducted using either a VoIP service (RingCentral) or Zoom with dial-out capabilities (see Clinic IT and Data Infrastructure for more details). We are also able to provide asynchronous, remote assistance via email and text, directly to clients or through caseworkers.
By contrast, the TECC Clinic remains fully virtual, with clients and technology consultants meeting on Zoom. Zoom was chosen because it became the go-to platform during the COVID-19 pandemic for advocacy agencies in the region to provide services to survivors and for survivors to access the court system for Protection Order hearings. In other words, the platform was familiar to many survivors and could be accessed without a separate download or new account.