Promising Practice Programs

Northern Sydney Sexual Assault Service
Building 30, Royal North Shore Hospital
Pacific Highway, St Leonards, NSW, 2065

Jane Davidson, Project Manager and Researcher
Phone: 02 9926 7580
Fax: 02 9906 5495
Email: jdavidso@nsccahs.health.nsw.gov.au

NSW Health, Northern Sydney Health, Dee Why RSL

1997

The program is running approximately one group per year.

Since the start of the Jacaranda Project, there have been approximately 20 groups for adult survivors of childhood sexual abuse.

The Project still runs a limited number of groups for adult women survivors of childhood sexual abuse, for which there is a constant demand. The resumption of the community capacity building aspects of the Project is dependant upon securing adequate funding.

There were two facets to the Jacaranda Project. One was to provide effective, therapeutic group work for adult survivors of childhood sexual abuse. Single-gender groups of no more than 10 members ran for 10 weekly sessions of hours. Core topics included secrecy and disclosure, myths and facts about sexual abuse, perpetrator tactics, legacies of childhood sexual abuse, self-care, and moving on. Further topics included sexual expression, self-harming behaviours, parenting, relationships, body image, and strategies for dealing with traumatic effects.

The second aim was to enhance the capacity of non-specialist workers to assist adult survivors of childhood sexual abuse, by teaming up an experienced specialist sexual assault counsellor in a mentoring capacity with a generalist worker, who may be experienced in counselling or group work but not specifically in working with this client group. The facilitators receive core training in working with adult survivors of childhood sexual abuse, and are mentored by the specialist co-facilitator. The facilitation team also receives specialist clinical supervision during the course of the group.

During the period from 2002-2004, six groups (5 for women, one for men), involving 51 participants, were completed. Nineteen workers received training and 6 co-facilitated group work programs.

• Service delivery and therapeutic responses to victims/survivors
• Service provider professional development and training/Training for community groups/organizations

• Region - inner metropolitan

• Adult survivors of child sexual abuse
• Service providers

What need in the community does the program meet?
There is a long-standing paucity of specialist counseling services in New South Wales for adult survivors of childhood sexual abuse. Statewide Health Department Sexual Assault Services, which generally have the expertise to work therapeutically with survivors, have a small number of staff to provide services to a large client base. Policy guidelines stipulate that adult survivors of childhood sexual abuse are a 'low priority' client group (with recent victim/survivors given higher priority). The Jacaranda Project program meets a need for therapeutic services while enhancing the capacity of the broader service sector to provide this service.

How did the program originate?
The program started in 1997, when the Northern Sydney Health Sexual Assault Service recognized the lack of services for adult survivors of childhood sexual abuse. The demands of the project require dedicated resources and workers. Since the initial groups were run, the project has only gone ahead when funding has been available, which has been intermittent.

The program is based on an extensive review of the research literature on working with adult survivors of childhood sexual abuse. The full review is available in the report Looking to a Future. Some of the key literature informing the project included:

Studies of the potential long-term impacts of childhood sexual abuse, including:

Studies on effective interventions with the client group, including:

The Northern Sydney Sexual Assault Service has conducted two evaluations of the program. The first was in 2001 (McMaugh, 2001), and the second phase of the Project (2002 - 2004) was altered to meet the recommendations of that evaluation report.

The program was developed by the service, based on collective clinical experience, research literature on working with adult survivors of childhood sexual abuse, and broader literature addressing trauma and group work.

Has the program been designed with a specific community in mind?
The specific target group is adult survivors of childhood sexual abuse.

What strategies have been attempted or have been successful in making the program accessible to this group?
Although not a specific strategy as such, the Project receives a significant number of referrals through mental health services, due to the promotion of the Project in these services. The Project has built up a sound reputation over a number of years amongst workers in these agencies.

If the program is for a non-specified general population, have there been specific strategies used to make it accessible to marginalised groups? If so, please describe these strategies.
A unique aspect of the group work project is the policy of including those who have a current psychiatric diagnosis (subject to a case by case assessment of the suitability of the group).

The project faces similar issues to other service providers in regards to accessibility for CALD and Indigenous communities. For example, about 5% of people referred for the group program were from CALD backgrounds, which is an under-representation of the population in the region.

Does the program engage with other agencies/services/individual that respond to sexual assault? If so, how are they involved?
A core component of the Jacaranda Project is the focus on collaboration with non-specialist service providers to enhance their capacity to work with adult survivors of childhood sexual abuse. Clinicians from within Northern Sydney Health who did not have prior expertise in working with adult survivors of childhood sexual abuse were invited to participate in specialised training, and a number of these were then selected to co-facilitate groups with an experienced sexual assault worker. Clinicians from the fields of sexual health, alcohol and other drugs, family support services, generalist counselling and mental health were selected to co-facilitate groups.

Has the program been evaluated?
The program (from 2002-2004) has been comprehensively evaluated, including qualitative and quantitative components. The research report, Looking to a Future: A research report on the Jacaranda Project (Davidson, 2007), is available from Northern Sydney Sexual Assault Service. The findings regarding the two overall aims of the project are summarized below.

a - Community capacity building and practitioner development
The research highlights the importance of attending to inter-facilitator dynamics and the crucial role of organisational support and effective supervision. As the group facilitators are recruited from their 'host' organisations, the commitment and support of their own managers is vital.

b - The group participants
Of course, the ultimate measure of the project is the service it delivers to group participants. As well as a qualitative component, the research team for Looking to a Future also included a rigorous quantitative study, utilising standardised psychological tests, repeat administrations, and a non-randomised treatment and wait-list control group. Psychological tests were administered at several points before, during and after the group work program, measuring such constructs as shame and self-esteem, and symptoms of depression, anxiety, PTSD and general psychological symptomatology. Analysis of these data demonstrated a marked improvement in a range of 'symptoms' of group participants, and that these changes were generally sustained or improved at the 3-month follow-up. Comparison with the small control group (5 'controls' completed all the measures, compared to 39 of the group participants) suggested that the improvements for the participants were due to the group intervention. The small size of the control group was due to ethical and practical reasons (e.g. the ethical impossibility of placing potential clients on a no-treatment waiting list).

The qualitative component of the research with group participants highlighted a number of benefits, such as their newfound knowledge and confidence in social, family, and occupational contexts. In some cases this led participants to active involvement in community education about child sexual abuse. Generally, the participants spoke about enjoying their lives more and feeling more connected.

If the program has been designed for a particular group or community, could it be replicated or useful for other groups or communities in responding to sexual assault? Briefly explain how.
Other sexual assault service providers could adopt the program. Their involvement would be pivotal in leading the Project with the expertise on working with this client group. While the development group manual is planned (pending funding), its use would require practitioners who are experienced with this client group, to assess the appropriateness of the activities for he specific group. The basis of the group work program is client safety, based on a sound understanding of the long-term traumatic impacts of childhood sexual abuse.

The group work program is based on a substantial body of research evidence regarding the potential mid-to-long term impacts of childhood sexual abuse, and the effectiveness of group work interventions with this client group. An understanding of trauma and its potential long-term impacts is central to the therapeutic work. While not every adult survivor of childhood sexual abuse will experience such debilitating impacts, many do experience problems in their psychological and social functioning, physical health, and interpersonal relationships.

The success of the group work is based upon the following principles:

• attention to safety from beginning to end - in the structure, content and process of the groups, and in the stringent requirements for facilitators;
• assessment and selection of group members;
• availability of one-to-one counselling for group members who were finding it heavy going; and
• the inclusion of perpetrator tactics ("the grooming process") as a discussion topic.

This necessitates the involvement of experienced practitioners in each group, so that while a less experienced worker (with this client group) can learn the skills and develop the necessary confidence, this in no way threatens the integrity of the group or the safety of the group participants. In this sense, the safety of new group facilitators is also assured, through their co-facilitator, the group supervisor, and the organisational support from their own service manager.

Publications

Is the program available for others to use?
A group manual is planned pending funding.