The work of Phoenix House is to prevent and ameliorate the impact of interpersonal trauma. The Phoenix House (2003) mission statement outlines its commitment to ‘the provision of a safe, supportive service which assists those members of our community who have been harmed, are at risk of harm, and/or are willing to address their own harmful behaviours, using a public health approach to the prevention of sexual violence’. Phoenix House provides a whole of community integrated response towards the prevention of sexual violence; as such, it utilises a number of primary, secondary and tertiary prevention programs across a spectrum of prevention (Cohen & Swift, 1999).
Since the mid-1990s, the staff at Phoenix House realised that in order to impact the incidence of sexual violence within society they had to move beyond providing the ‘ambulance at the bottom of the cliff’ response. In 2002, a strategic plan was developed to work towards implementing an integrated approach to the prevention of sexual violence, whilst still maintaining a gendered analysis. This has resulted in some excellent outcomes for individuals, organisations and communities who access Phoenix House services. Phoenix House has a strong commitment to social justice and human rights; it is committed to addressing inequalities in society based on gender, ethnicity, culture, age, ability, religion, sexuality, socioeconomic status or geographic location, which perpetuate sexual violence. As part of this commitment it strives to provide inclusive services which the community in particular has identified as a priority, using community-based participatory approaches, rather than the oft practiced ‘top down’ approach of providing the services which professionals, organisations and governments believe a community ‘needs’.
Phoenix House staff use research in their everyday practice. The word ‘research’ is often considered to belong to the world of academia, but it is simply another term for ‘finding out’ so that informed decisions are made. Therefore, staff use practice experience to inform research and evaluate programs, as well as employing evidence-based interventions. Research findings are used to improve practice, policy and service delivery, and ultimately to achieve the best possible outcomes for the children, young people and adults who access the organisation. However, over-stretched and under-resourced community organisations often struggle to find the time and capital required for their own qualitative and quantitative research projects, despite it being such an integral part of achieving good outcomes.
In 2004, two CQUniversity researchers (Drs Signal and Taylor) entered into a research partnership with Phoenix House. Truly successful, engaged research needs to ensure that outcomes are mutually and collectively beneficial. Early conversations between the Director of Phoenix House (and other staff) and Drs Signal and Taylor were open, frank and forthright, with all concerned outlining and documenting what they needed and wanted from the project(s). The needs of vulnerable and/or at risk clients had to be a primary concern. This necessitated innovative problem solving, particularly in regards to methodology, in order to meet the competing need for rigorous evaluation without making clients ‘subject’ to the research process. The staff at Phoenix House are immersed within the local community and this wealth of experience and knowledge proved invaluable in all stages of design, recruitment and dissemination of findings - all of the projects outlined below are truly collaborative and collective efforts, and this has been acknowledged in all outputs with inclusion of principal staff from Phoenix House in the author list.
We have chosen to outline three specific projects/research activities as exemplars for this chapter - we have collaborated together on a number of other grant/funding applications, conference presentations and interventions but these are by far the most successful within both the academic and community spheres.
Design and evaluation of a novel Animal Assisted Therapy program in conjunction with RSPCA,
Queensland (Qld) for children who have been sexually and/or physically abused
This was our first collaborative project. The success of this (in achieving funding of over AUD$8o,ooo, developing links with RSPCA Qld and successful therapeutic gains for the children involved) was exceptional, although there does need to be an acknowledgement of the significant investment in time made by all involved which may seem an over-investment by some. However, the flow-on effects, in terms of further projects, networking and profile-raising, were well worth the investment. This project did take a significant amount of time to develop. This was largely due to the vulnerability of the children involved (and potentially the animals as many of the children were reported to be engaging in animal harm behaviour) and a desire to ensure that everything went smoothly.
One aspect of engaged community research that is often overlooked are the many ‘extra’ institutional permissions/regulations that need to be addressed prior to any research occurring. For this project there was a need to get permission from the then Queensland Department of Family Services, as well as CQUniversity (Human and Animal ethics committees) and these processes took approximately 18 months to complete. However, this lengthy process had unforeseen benefits as it resulted in opportunities to present the project to Department of Community Services (DoCS) staff. The project was subsequently included in a DoCS ‘Research Roadshow, increasing the profile of Phoenix House and the research team.
The main aim of this project was to assess the utility and efficacy of Animal Assisted Therapy (AAT) and Humane Education (HE) with children who had suffered some form of sexual and/or physical abuse or neglect. The project involved children, recruited through Phoenix House, experiencing an AAT and HE program for ten weeks (in total). Early discussions resulted in very clearly defined roles and responsibilities so that there was no confusion regarding who was doing what - something that proved essential given the project took such a long time to reach fruition. The academic researchers took the lead on securing funding (from Institute for Sustainable Regional Development [CQU] and RSPCA Qld) and coordinated the input of RSPCA Qld educators and shelter staff. Social workers from Phoenix House assisted with design of the intervention and lessons, designed the research assessment tools and undertook the final analysis and write up. The Director of Phoenix House took the lead in writing the therapeutic group session plans, on recruiting families to the project, ensuring data collection followed established protocols, supporting staff at Phoenix House delivering the ‘in-house’ segment of the intervention and getting de-identified data to us for analysis.
Each ‘wave’ of the program lasted for ten weeks and involved three weeks of AAT and seven weeks of therapeutic group sessions, all undertaken with either RSPCA humane educators (on the grounds of the Bundaberg RSPCA shelter) and/or Phoenix House social workers as appropriate. The children were tested at intake into the Phoenix House service, pre-program and post-program. Testing involved an array of psychometric measures designed to assess: a) clinical and behavioural symptoms resulting from abuse/neglect; b) attitudes towards, and treatment of, animals; and c) age-appropriate human-directed empathy. Caregivers, social workers and the children themselves were also asked to give feedback about the project and their experience of it. A total of 19 children successfully completed the ten- week program and in most cases clinically significant improvements in behaviour and trauma symptomology were seen. For example, boys’ attitudes and behaviours towards animals (as measured by the Children’s Treatment of Animals Questionnaire) significantly improved over the course of the program while girls’ Post-Traumatic Stress Disorder-related symptomology significantly decreased. Caregiver feedback regarding the usefulness of the program for their child was overwhelmingly positive. This research has resulted in a number of presentations (Signal, Taylor, & Prentice, 2009; Taylor & Signal, 2006), a student summer scholarship (paper in preparation) and one publication in a high profile international journal to date (Taylor, Fraser, Signal, & Prentice, in press). The individual benefits are reflected in the following vignette related to one of the participants of the program.
Nick (pseudonym) was a nine-year-old boy who lived on a rural property near Bundaberg. He had been sexually abused by several much older male cousins. They had also forced Nick to witness cruelty towards some of the farm animals. Nick was referred to Phoenix House to originally assist him to resolve the trauma related to the sexual abuse he experienced. Nick was exhibiting a number of negative effects following the sexual abuse, including being very reactive, having lost his capacity to apply his cognitive ‘brakes’. At school it was reported he was bullying much smaller children. He was also very aggressive at home towards the farm collie, often kicking it in the genitals. Nick attended the AAT group as part of the therapeutic process.
Nick’s parents reported a shift in his behaviour towards the family dog after the second group session. This was in small ways to begin with; for example, he started to top up the collie’s water and stopped shouting at him. After group session seven, Nick’s mother phoned the next day and said Nick had been in tears after the group. ‘Nick said he didn’t know that Bob [the collie] had feelings! He went outside and said sorry to Bob!’ During that particular session the children had chosen a dog puppet and a person puppet. They sat in a circle and used the puppets to talk in the ‘first person’ about a situation, their body sensation and the feeling that went with this, first using a dog puppet, then a person puppet. Nick continued to make progress. His parents and teachers reported that Nick was starting to talk about his feelings and ask for help when he felt angry. He was being kind to Bob, and at follow-up some time later this was continuing. He had also ceased his bullying at school, and was sometimes seen holding younger children’s hands and walking around the playground with them.
Evaluation of existing programs to enhance delivery and meet statutory requirements for continued fUnding (Therapeutic Preschool - Bumblebees)
In 2009, we conducted an evaluation of the Bumblebees Therapeutic Preschool (BTPS) program being provided by Phoenix House. This program is an early intervention and prevention therapeutic preschool which provides assessment, therapy and education to children aged 3-6 years who have been harmed, or at risk of harm. The BTPS also provides counselling and support for the parents/caregivers and families of these children. This program receives Federal funding and as such must be formally evaluated and efficacy established for funding to continue. The evaluation of the efficacy of the BTPS was based on the completed data collection sheets of 72 children; data collection spanned from 11 November 2002 to 12 December 2008 and a large amount of data had been recorded for every child. Most of the children attending BTPS had witnessed family violence (80%), more than 40 per cent had been sexually abused and approximately 28 per cent were under a Care and Protection order at the time they attended BTPS. The majority of the primary caregivers of the children attending had a secondary school level education and were currently unemployed, and 52 per cent were single parents/caregivers. Lower educational levels, single parent families and unemployment (as related to lower income levels) are all acknowledged risk factors for increased parental/ caregiver stress and lower levels of resiliency (Campbell-Sills, Forde, & Stein, 2009). This indicates that BTPS was meeting its remit to provide services, and support, to a segment of the Bundaberg community where there is a higher, a priori, risk for further parenting related stresses and problems.
At Intake more than 70 per cent of those attending BTPS had serious, problematic behaviour that required intervention and treatment as measured by the Child Behavior Checklist (CBCL) scores. At Exit nearly 70 per cent (n = 46) had CBCL Total T scores well within the ‘normal’ range for children this age. One particularly important finding was that those attending BTPS of Indigenous descent showed the greatest overall improvement in behaviour (as measured by the CBCL). This suggests that the BTPS program was particularly effective in addressing clinical levels of maladaptive behaviour for children of Indigenous descent. This success has been noted at a Federal level with the academic paper written from the evaluation (Prentice, Signal, & Taylor, 2012) now freely available on the Australian Institute of Family Studies Aboriginal and Torres Strait Islander Promising Practice Profile (see apps.aifs.gov.au/ipppregister/ projects/list). Inclusion on this register is particularly rewarding for Phoenix House reflecting a national recognition and strong endorsement of their practices and approach. The utility and benefit of engaged community-based research like this is clear.
On a practical level the evaluation successfully met the funding bodies’ requirements and funding for BTPS was continued. As noted above, part of the evaluation was subsequently written up and published in a peer-reviewed journal. This publication has been positively received within service circles (further raising Phoenix House’s profile) including coverage by NEARI (http://nearipress.org/), an international web-hub which provides ‘resources for highly at-risk children and youth and the professionals who work with them’. The following vignette provides an example of a more personal benefit.
Caleb (pseudonym) and his family were referred to Phoenix House due to past sexual abuse of several of the children and the sexualised behaviours of the oldest child. Caleb, aged four years, had experienced domestic violence. He was displaying challenging behaviours towards his peers and had been excluded from his preschool. His mother, Annie (pseudonym), was struggling to cope with all her children as a single parent and to manage their behaviours. Caleb attended the BTPS for nine months and Annie also accessed the home visiting and parent education program. Whilst the family identified as Aboriginal, Annie said they were not active members of the local Aboriginal community. She was keen to discover her Aboriginal history and for her children to be aware of their rich culture.
Caleb responded well to the BTPS environment and changes in his behaviour were soon noticed both at the BTPS and in the home environment. These included his boundary setting and awareness of personal space, his communication and overall social skills development. Home visits involved working with Annie about her interactions with all her children; Annie made significant changes to her parenting style and accepted that her behaviour was contributing to family chaos (screaming, yelling and smacking). At the time of referral, Annie would not take the children out of the house due to their behaviours. After six months, the family were going on regular outings, and Annie reported that these were fun rather than stressful.
Caleb progressed through the BTPS and it was recommended that he attend a main-stream preschool from the following term; following a transitional period Caleb went on to thrive within his new preschool environment. Annie also immersed herself in the local Aboriginal community and was enjoying learning about her family’s heritage with her children.
Advice and subsequent evaluation of an Equine Assisted Therapy program for women and children who have experienced abuse
This project is currently ongoing with an aim to further expand the collaboration between Phoenix House and CQUniversity. Following the success of the canine AAT project, Phoenix House has been running an Equine Assisted Therapy (EAT) program utilising the same protocol (single subject, quasi-experimental design) as designed and outlined above. Following extensive international training in EAT approaches, one of the senior counsellors (Helena Botros) joined the Phoenix House- CQUniversity research team and we discussed appropriate measures (for assessing efficacy of treatment) for use with survivors of childhood sexual abuse of differing ages and therapy sessions began. Input from the academic side was fairly minimal while therapy sessions took place with Phoenix House taking the lead on participant recruitment and data collection. Email and phone discussions occurred sporadically until, early in 2012, an incredibly rich (de-identified) data set collected from the children, adolescents and adults who have been through the EAT program to that point arrived at CQUniversity. Approval to analyse and report on the (now archival) data set was received from CQUniversity Human Ethics Committee and analysis began. As is apparent below, the richness of the data set resulting from this collaborative project led to a number of ‘extra’ outcomes - from successful summer scholarship applications to fourth-year Psychology theses and PhD projects.
Child sexual abuse (CSA) is a health and societal concern in Australia and worldwide, and while prevalence rates are hard to estimate due to underreporting (Richards, 2011), the long-term psychosocial and mental health outcomes for victims of CSA are well documented. Therapies that are traditionally based on verbalisations between the therapist and client, such as Cognitive Behaviour Therapy, are not always appropriate for young people particularly when age-appropriate behavioural, cognitive and emotional abilities are off-set by negative CSA sequelea, such as hyper-arousal, non-trusting of adults and dissociation from trauma.
Further, many therapies that are mono-culturally biased and conducted in a clinical environment may be unsuited to some cultures, particularly to Indigenous clients. Westerman (2010) claims that cultural differences in regards to gender, engaging with a ‘stranger’ about family matters and the requirement to talk about feelings and emotions make it difficult to engage Indigenous clients in therapy and leads to high attrition. It is within this milieu that Phoenix House sought to develop, and rigorously evaluate, the efficacy of EAT as a secondary prevention program with a strong culturally and community appropriate approach.
Age-appropriate measures of psychological (including distress, depression, PTSD) and interpersonal (e.g., empathy) functioning were collected from children (ages 8 to 11 years), adolescents (ages 12 to 17 years) and adults (aged 18 years and over) across three points in time (Intake into service, prior to EAT and at the conclusion of the ten-week EAT program). In order to minimise impost on Phoenix House clients and the staff working within the intervention, standard intake assessment tools/measures were used where possible and the number of new scales/measures added was deliberately kept to a minimum.
Across ages, genders and ethnicities the EAT program resulted in significant improvements on all measures of psychological and relationship functioning. Several findings are worthy of pulling out here for specific mention, partly due to the level of academic and practitioner interest received following publication (Kemp, Signal, Botros, Taylor, & Prentice, 2014; Signal, Taylor, Botros, Prentice, & Lazarus, 2013) but also as examples of the utility of research evaluations for a service like Phoenix House.
For example, when examining the efficacy of EAT we were able to benchmark the treatment effect of the ‘standard therapy’ provided by Phoenix House (trauma-focused CBT - seen as changes in measures between Time 1 and Time 2) and demonstrate that this was at, or exceeding, that reported in international studies. Given the remit of Phoenix House to provide a range of primary and secondary abuse prevention strategies, there was significant interest in examining the effect of EAT on known risk factors for re-victimisation across the life-span. Problematic sexualised behaviours, particularly for adolescents, are one such variable with researchers suggesting these may be particularly treatment resistant and persist across time (Lanktree & Briere, 1995). Changes in sexualised concern scores between Time 2 and Time 3 (i.e., the effect of the EAT) for the adolescent cohort indicated a significantly larger (i.e., more efficacious) reduction in problematic sexualised behaviours than previously seen in the literature; indeed more than twice as effective - a very important and potentially game-changing result. Added to this was the fact, unlike standard therapeutic approaches, these benefits were seen across genders and, significantly, ethnicity. As noted above, standard, CBT-based, therapeutic approaches appear to be less effective for Indigenous survivors of CSA for a number of reasons (Westerman, 2010). Given the focus for Phoenix House on providing culturally appropriate services, the finding that children, adolescents and adults identifying as Indigenous Australians showed significant improvements in psychological functioning similar to those of non-Indigenous descent was exciting and particularly important for Phoenix House. The following vignette illustrates a more personal benefit.
May (pseudonym) was referred by another agency to Phoenix House for EAT. She had a history of complex trauma: childhood sexual abuse; physical abuse; and neglect. May also had a history of not engaging with any counselling services, general mistrust towards anybody or any assistance offered. Despite this May agreed to give EAT a go, because she was ‘not locked in a counselling room and talked at’. May attended EAT sessions on a weekly basis over a ten-week period. Of these ten scheduled sessions, May missed only one due to sickness.
Activities during EAT sessions were designed to: build trust; improve communication skills; awareness; self-regulation; impulse control; mindfulness; awareness of own attitude; boundaries; and taking responsibility for own actions. This involved groundwork in foundational horsemanship and at liberty activities with the horses on the ground. Participants needed to observe their body language and respond appropriately. They undertook mindfulness exercises such as breathing in sync with the horse, standing with the horse without touching it, or feeling the horse’s heart beat and bringing their own heart rate down through conscious breathing.
Although May did not have any previous experiences with horses, she engaged enthusiastically with them from the beginning. Soon May was able to name her feelings and emotions during certain activities. She was able to observe things that others may have missed, and gradually became aware of her own affect, agitation, rising anger, frustration; acknowledging them rather than masking them, and stepping back and sitting with these emotions for a while - recognising them as her own, or as emotions reflected from others. Most significantly, the unconditional acceptance
May experienced with the horses broke through an invisible barrier which had isolated her from positive experiences and possibilities.
May successfully completed the EAT program. She has since returned to two other EAT groups, in the last one in the role of a mentor. She also stayed off the streets, with some safe family care givers and resumed school attendance. May’s ambition is now to become a youth worker; she remains in contact with her EAT peers.
The engaged research outlined in this chapter has resulted in tangible benefits. This has undoubtedly been related to negotiating the context and the processes in place, but also significantly related to the individual characteristics of the collaborators. Phoenix House was fortunate to find researchers who demonstrated interpersonal skills which have enhanced and strengthened this relationship; those of patience, honesty and reliability, unselfishness, emotional intelligence, open mindedness and being change oriented. Such attributes have been recognised as being some of the most important ingredients for a truly collaborative partnership, and indeed are the very foundations upon which community resilience is built.