The Avalon Model: Empowering Individuals and Communities To Respond To Sexualized Violence

Avalon Sexual Assault Centre
The Avalon Model:

Empowering Individuals and Communities to Respond to Sexualized Violence
The Avalon Model:

Empowering Individuals and Communities to Respond to Sexualized Violence
Produced by Avalon Sexual Assault Centre 2012 For more information contact us: 1526 Dresden Row, 4th Floor Halifax, Nova Scotia B3J 3K3 Phone: (902) 422-4240 Fax: (902) 422-4628 Email: info@avaloncentre.ca
ACKNOWLEDGEMENTS
This model is dedicated to all those who have used Avalon Centres services over the past 29 years and whose input and feedback have helped to shape Avalon Centres programs and services. It is also dedicated to all staff, volunteers, Board Members, and community partners who have dedicated their passion, energy and wisdom to addressing sexualized violence in Halifax Regional Municipality and across Nova Scotia. Special thanks to the current staff for so graciously sharing your knowledge, verbal and written words of wisdom, and constructive criticism in the documentation of the Avalon Model. The staff wanted to acknowledge that this model is not static, but a living model that continues to grow and evolve as issues and new insights emerge. The Avalon Centre staff who contributed various sections of the model are: Irene Smith, Executive Director

I wish to acknowledge the research projects undertaken by Pam Rubin for Avalon Centre related to expansion of SANE programs (Rubin, 2007), the provincial sexual assault needs assessment (Rubin, 2008), and exploring service options for youth (Rubin, 2011). The research reports have been very helpful in documenting the model. In some sections, with Pams permission, we have adapted material from these reports. These have been acknowledged with reference to the End Notes and References. Thank you to the Nova Scotia Advisory Council on the Status of Women which has supported the need for a provincial strategy for delivery of sexual assault services in Nova Scotia and the documentation of the model. It has been a privilege and pleasure to work with Avalon Centre on the documentation of the Avalon Model. Peggy Mahon BA, MAdEd., Writer and Editor September 2012
Cindy Prepper, Office Manager Jackie Stevens, Coordinator, Community/Legal Education and Training Theresa Emberly, Legal Support/Advocate Glenda Haydon, Coordinator of Individual Counselling and Group Program, Elizabeth Fitzgerald, Counsellor Nancy Gray, Intake/Support Worker Susan Wilson, Coordinator, SANE Program Ann Lawton, Administrative Assistant, SANE Program Kaley Kennedy, Communications Officer
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TABLE OF CONTENTS
Acknowledgements ....................................................................... ii Table of Contents.......................................................................... iii The Avalon Model: A Message from the Executive Director....... 1 Introduction .................................................................................... 4
A Word About Language .......................................................................... 5
Avalon SANE Response Line ................................................................ 29 Specialized Services .............................................................................. 29 Training & Certification of Nurses .......................................................... 32 Recognition & Retention of Nurses ........................................................ 32 Community Involvement ......................................................................... 33
Support, Information & Referral .................................................. 34 Legal Support & Advocacy.......................................................... 35 Specialized Therapeutic Counselling Program .......................... 36
Populations Served and Location .......................................................... 36 Feminist Informed Sexual Assault/Abuse Counselling Principles .......... 37 Specialized Counselling Model .............................................................. 39 Individual Counselling Program ............................................................. 43 Group Counselling Programs ................................................................. 44
Avalon Model Overview ................................................................. 6 The Herstory of Avalon Sexual Assault Services ........................ 8 Why Document the Avalon Model? ............................................ 10
Demand for Services across Nova Scotia .............................................. 10 Prevalence of Sexualized Violence ........................................................ 10 Provincial Needs Assessment ................................................................ 11
Community Engagement for Social & System Change ............. 47

Awareness and Community Mobilization ............................................... 48 Research and Policy Change ................................................................. 49 Collaboration .......................................................................................... 50
Why a Community-based Feminist Model for Addressing Sexualized Violence?................................................................... 12 The Avalon Model of Care ........................................................... 13
The Focal Point: Individual & Community Empowerment & Safety ...... 13 Feminist Lens ......................................................................................... 14 Vision, Mission and Guiding Principles .................................................. 15 Awareness and Prevention Approach .................................................... 16 Avalon Approach to Care ....................................................................... 17 Populations Served ................................................................................ 19
Organization Supports................................................................. 52
Community-Based and Flexible ............................................................. 52 Community-Governed ............................................................................ 52 Accountability ......................................................................................... 53 Planning & Evaluation ............................................................................ 53 Multi-disciplinary Staff Team .................................................................. 54 Professional Development ..................................................................... 54 Policies and Protocols ............................................................................ 54 Financial Sustainability ........................................................................... 56
Continuum of Services ................................................................ 20 Community/Legal Education & Professional Training .............. 22

Populations Served and Location ........................................................... 22 Objectives, Approaches and Processes ................................................. 22 Public Awareness and Public Education ................................................ 23 Community and School-Based Education .............................................. 25 Legal Education ...................................................................................... 26 Professional Training .............................................................................. 26
Challenges to Achieving the Model ............................................ 57

Comprehensive Sexual Assault Services .............................................. 57 The Need for a Provincial Strategy to Address Sexualized Violence .... 57 The Need for Standards and Coordination to Ensure Quality, Consistent Services .................................................................................................. 58 The Need for Adequate Resources for Services ................................... 59 Moving Toward Comprehensive Services.............................................. 61
The SANE Program ...................................................................... 28

Why a Community-based Program? ...................................................... 28 Populations Served & Locations ............................................................. 28 SANEs .................................................................................................... 29
Glossary of Terms........................................................................ 62 References.................................................................................... 65 End Notes ..................................................................................... 66
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THE AVALON MODEL: A MESSAGE FROM THE EXECUTIVE DIRECTOR

I am proud to introduce you to the Avalon Model a model that has evolved over the 29 year life-span of the Avalon Sexual Assault Centre - and our focus on Empowering Individuals and Communities to Respond to Sexualized Violence. When first asked to document our model, we had a discussion about whether we should document the model as it currently exists or whether we should attempt to write up the ideal model - the model that we are working toward. We decided on the former because our model has a number of elements that are important to highlight. I will first focus on these elements and then outline some of our key challenges as we move forward toward our ideal - a comprehensive model of sexual assault services. The first component of our model, the Model of Care incorporates a feminist lens that involves having an understanding of the root causes of sexualized violence and a commitment to changing the social and political culture that condones, supports and permits it; then, applying that understanding and commitment in all planning, decision-making and actions. We believe this analysis is important to apply no matter who the audience of our service or program is, as it moves away from blaming the victim and makes it a community responsibility. This is very important for finding solutions to preventing sexualized violence and for preventing re-traumatization. The Model of Care promotes a holistic approach that integrates our approaches, principles and processes our Awareness and Prevention Approach, the feminist lens, and our vision, mission
and values with how we do our work or our best practices. This effectively integrates our delivery of services with our strategies for social and system change. The effect of this integration is that while, on the one hand, we are communicating to those using services that sexualized violence is a community responsibility; on the other hand, we are proactively engaging the community to take action to address sexualized violence our model not only talks the talk, but also walks the walk. An important element of the Avalon Model is the overarching goal of Individual & Community Empowerment & Safety, which is the focus of everything we do. This means we recognize that each individual and each community is unique; that each brings a valuable perspective; and that safety and empowerment are essential to making informed choices and decisions. Therefore, we work collaboratively with individuals and communities to enhance skills and knowledge in order to prevent sexualized violence and re-traumatization. Another important element is being community-based and flexible. As a community organization, all of our services are based in the community and governed by a community Board of Directors. For example, the Sexual Assault Nurse Examiner (SANE) Program is governed and administered by Avalon Centre and works successfully in partnership with several hospitals in Halifax Regional Municipality to deliver services. While not unique internationally, this community-governed model was unique in Canada when we first established the SANE program. In our program evaluation (Mahon, 2003), our partners in the health care and justice systems pointed to the strengths of SANE as a community-based service. Since then, a similar program has been established in northeastern Nova Scotia which is governed and administered by the Antigonish Womens Resource Centre and Sexual Assault Services Association. This program has two

partnerships (1) with the Guysborough Antigonish Strait Health Authority (GASHA) and St. Francis Xavier University, and (2) with the Pictou County Health Authority (PCHA). The report,Building a SANE Network in Nova Scotia (Rubin, 2007), noted the following: Of those responding to recent requests for input relevant to provincial SANE program implementation, Halifax justice system professionals, health care managers, and other community non-profits continue to express support for the community-based administrative model in the Avalon program. (p. 10) This same report made 26 recommendations and the following recommendation regarding the governance model: Community-based programs should be the standard governance model for SANE programs in Nova Scotia. The decision regarding which community organization will manage the program in each region should be part of the collaborative community development process of implementing a SANE program, and remain the choice of the local communities. (p. 64) Being community-based and flexible means our services and programs are responsive to community needs and build on community assets through innovative partnerships and collaboration. A big part of this is the ingenuity, creativity, passion, and commitment of our staff team, volunteers and partners. For example, the Community/Legal Education and Professional Training Program continues to expand and to design programs for specific audiences, the most recent being youth engagement. As a result, our services, our system and social change strategies, and our model are not static but continue to evolve over time. As a womens organization, we recognize the gendered nature of sexualized violence; therefore, an important focus of the Avalon Model has been to provide services and a supportive, safe environment for women who have experienced sexualized violence. To this end, Avalon Centre maintains an all-woman Board of Directors and staff. In recent years, while continuing to maintain our services for women, Avalon Centre has expanded the populations we serve. For example, the SANE program serves all ages and genders and the Community/ Legal Education and Training Program provides education and training for the general public, community organizations, government agencies, schools and universities. While working to be creative and responsive, our model has to work within the resources available to us. As a result, we face constraints in broadening services to other populations. For example, the Specialized Therapeutic Counselling Program has developed a counselling model that is recognized in the Atlantic region because it is specifically designed for women who experience sexualized violence. Due to lack of resources, we are not able to hire more counsellors to meet current requests by women for counselling; and, we have instituted wait lists and mandatory breaks in counselling services. This is not an ideal situation for the women or for our service. In addition, there are no resources available to develop services and training for specialized counsellors for other populations. Providing a continuum of services is critical to an effective model. Avalon Centres current services range from responding to immediate sexual assaults through the SANE program to providing specialized therapeutic counselling, information and referral services, community/legal education, and professional development. We wish to point out, however, that these services comprise only part of what is considered a comprehensive sexual

assault service model; and, throughout our history, we have had to reduce or restructure services due to lack of adequate funding and/or cuts to funding. While we have been innovative in diversifying our funds and using project funds, this also can create a precarious situation for our services. For example, in 2012 as this model was being drafted, the Law Foundation funding was significantly reduced and Avalon Centre made the difficult decision to cut this program. Avalon Centre decided to leave the program in the model description because it has been an important component to the Continuum of Services. The components of a comprehensive model and the key challenges we currently face in moving toward more comprehensive services are outlined in the last section of this model. Briefly, these challenges are: the lack a provincial strategy for the provision of sexual assault services in Nova Scotia; the need for standards and coordination to ensure quality, consistent services; and the need for adequate resources for services. Recommendations to address these challenges have been presented to the provincial government in two recent reports.i Avalon Centre is encouraged that an interdepartmental committee has been established by the Department of Health and Wellness. The documentation of the Avalon Model was identified as an important step to moving forward with a provincial strategy at a workshop with community-based womens groups and key government stakeholders, hosted by the Nova Scotia Advisory Council on the Status of Women in 2010. We hope that the Avalon Model, with its focus on empowering individuals and communities to respond to sexualized violence, will provide a template to assist the provincial government and communities to develop a strategy for comprehensive sexual assault services, thus assuring quality services accessible to all Nova Scotians. Irene Smith, Executive Director, Avalon Sexual Assault Centre
Being community-based and flexible means our services and programs are responsive to community needs and build on community assets through innovative partnerships and collaboration. A big part of this is the ingenuity, creativity, passion, and commitment of our staff team, our volunteers and our partners. As a result, our services, our system and social change strategies, and our model are not static but continue to evolve over time. We hope that the Avalon Model, with its focus on empowering individuals and communities to respond to sexualized violence, will provide a template to assist the provincial government and communities to develop a strategy for comprehensive sexual assault services, thus assuring quality services accessible to all Nova Scotians.
INTRODUCTION
INTRODUCTION
Founded in 1983, Avalon Sexual Assault Centre (Avalon Centre) located in Halifax, Nova Scotia, provides full-time specialized, professional sexual assault services. Because there have been few other specialized services in Nova Scotia for most of its history, Avalon Centre has been the cornerstone for sexual assault services for the province, providing support for sexual assault response throughout Nova Scotia including prevention and intervention. The purpose for documenting the Avalon Model grew out of a province-wide needs assessment of sexual assault services in Nova Scotia. The report, Suffering in Silence (Rubin, 2008), details the outcomes of the needs assessment and provides recommendations for preventing and addressing sexualized violence in Nova Scotia. The needs assessment (Rubin, 2008) found that Avalon Centres community-based model for delivery of sexual assault services is recognized and highly valued by persons who have experienced sexualized violence and by the many different agencies with whom they are connected. It found that Avalon Centres service standards and leadership are recognized nationally and internationally by other sexual assault services and by multi-agency organizations addressing sexual assault. Furthermore, the model and leadership is highly attractive to other Nova Scotia communities wanting sexual assault services. Many service providers participating in the research expressed their wish for their community to have an Avalon, or follow the Avalon model. (p. x). The needs assessment report concluded with an overall recommendation that Nova Scotia should create a comprehensive response to sexualized violence based on the Avalon Centre model. (p.
xiii).
Fundamental to Avalon Centres model is that it is based in the community, administered and governed by a community-based organization. Avalons leadership in developing a community-based model and practice for specialized therapeutic counselling is recognized across the Atlantic Region and the Sexual Assault Nurse Examiner (SANE) program is recognized provincially and nationally. The strength of this model is its flexibility and ability to listen and respond to meet individual and community needs and emerging issues. As a womens organization, Avalon Centre maintains an all-woman Board of Directors and staff and has a well-developed feminist model of practice that has evolved over the last 29 years. Avalon Centres vision is to eliminate sexual assault/abuse and to change the current socio-political culture that fosters sexism, social injustice and other forms of oppression. Central to Avalon Centres model is a feminist analysis of sexualized violence the feminist lens which informs Avalon Centres approach to education, services and community mobilization. Feminist analysis asserts that sexualized violence exists because of power imbalances rooted in patriarchy and gender inequality as well as other forms of oppression and systemic inequalities based on gender/sex, age, race/ethnicity, class, ability, and religion. Sexualized violence is generally regarded as gendered because, according to Statistics Canada General Social Survey (GSS), the majority of those victimized in Canada are female (over 70% 15 years and older in 2009) and the majority of offenders are male (87% in 2009) (Perreault and Brennan, 2009). However, the dynamic of dominance, control, and oppression is reflected in all acts of sexualized violence regardless of the sex of the offender or of the person who has experienced sexualized violence.
This model documents Avalon Centres approach to empowering individuals and communities to respond to sexualized violence which effectively combines a continuum of services with advocacy to address sexualized violence as a systemic social issue.
INTRODUCTION
The description of the Avalon Model begins with an overview of the four interdependent components as follows: Avalon Model of Care Continuum of Services Community Engagement for Social and System Change Organization Supports The model then provides the background or context Avalon Centres Herstory, why it is important to document the model, and why it is important to have a feminist community-based model. This is followed by a detailed description of each of the four components. The last section describes some of the challenges faced by Avalon Centre and other communities in Nova Scotia in provision of sexual assault services.
Avalon Sexual Assault Centre is a feminist organization working to eliminate sexual assault/abuse, and to change the current socio-political culture that fosters sexism, social injustice and other forms of oppression.
Avalon Centres Vision Statement
A WORD ABOUT LANGUAGE

A Glossary of Terms provides definitions of terms that are used in the model and this section provides an explanation of how some of these terms are used. This reveals the transitional nature of language and ongoing work to find the terms that best describe the issue and those impacted by the issue. The term sexualized violence is being used more often than the term sexual violence as an overarching term and has been primarily used in this model. The term sexual assault is also commonly used and is embedded in many of the formal and informal names that have been historically used for the centres services and programs; therefore, it continues to be used in this context throughout the model: for example, Avalon Sexual Assault Centre, Sexual Assault Nurse Examiner Program, and sexual assault services. The terms sexual assault, sexual harassment, sexual abuse, and childhood sexual abuse or historical sexual abuse are used to describe particular forms of sexualized violence.
Finding the right term for those who are at risk of or who have experienced sexualized violence is challenging. The terms victim and survivor are often used on their own and together. The term victim, on its own, is complex. On the one hand, it can be simply defined as someone who has been harmed; while on the other hand, it has the potential danger of overlaying another identity on the individual, which is not beneficial to their healing process and may lead to further harm or secondary wounding. The term survivor, is often considered a better term to use as it indicates that the individual is healing and beginning to cope with trauma. However, it can also have the result of labeling someone. The term victim/survivor is often used to connote that individuals have experienced trauma and are moving toward or in the process of healing and recovery. In this model, where possible, the term person/persons who has/ have experienced sexualized violence is used. However, the term victim/survivor is also used, particularly in the SANE program where the SANEs are responding to an immediate sexual assault. The term victim is used in the statistics section because this is the term used by Statistics Canada in their reports. Finally, the terms victim and sexual violence are embedded in Avalon Centres approved vision, mission and guiding principles; therefore, remain as such in the model.
THE AVALON MODEL: EMPOWERING INDIVIDUALS AND COMMUNITIES TO RESPOND TO SEXUALIZED VIOLENCE
AVALON MODEL OVERVIEW

The following is an overview of the four interdependent components of the Avalon Model which are also illustrated on the opposite page in a series of concentric circles. The Avalon Model of Care has, at its core the overarching goal of Individual & Community Empowerment & Safety. Essential to the model of care are: the feminist lens; the vision, mission, and guiding principles; the Awareness and Prevention Approach; and populations served. The Approach to Care is how Avalon Centre puts principles, processes, and approaches into practice or best practices. These elements underpin and guide all planning, decision-making, services, and advocacy. Avalon Centre serves a range of populations. Some services are available only for women 16 years and over. Some are provided for supportive partners of women using services and non-offending parents of children who have disclosed sexual abuse. Others serve all ages and genders. Still others are for community organizations, schools, universities, government agencies, and the general public. The Continuum of Services range from public awareness, community/legal education, support, information, referral, and advocacy to professional training, the SANE program, and specialized therapeutic counselling. Individuals and organizations access services through a variety of entry points appropriate to their situation and needs. There is a dynamic inter-relationship among services, where they intersect and inform each other. Community Engagement for Social and System Change describes three strategies that Avalon Centre employs to create change in how the general public, groups, service providers, systems and governments understand and respond to sexualized violence and to eliminate barriers to access.
Organization Supports describes how Avalon Centre is structured to support this model. Being community-based and community governed enables Avalon Centre to be close to the ground and responsive to community needs. It increases community ownership and community commitment to addressing sexualized violence.
The Avalon Model: Empowering Individuals & Communities to Respond to Sexualized Violence
The illustration of the Avalon Model on the right is a series of concentric circles. These circles represent Avalon Centres commitment to growth, to evolving services and social change initiatives in response to individual and community needs, as well as emerging issues related to sexualized violence. The arrows are intended to show that all components are inter-related and inform each other. This illustration was chosen because Avalon Centres logo is a tree and the concentric circles are like the cross section of the trunk of a tree or the tree rings.
The Stepping Stones, shown on the front cover, represent Avalon Centres overall approach to working with individuals and communities in a gradual progressive process to support individual and community empowerment and safety. This is at the heart of the model. They also represent Avalon Centres unique Stepping Stone Approach which was developed by Avalon Centre for the Specialized Therapeutic Counselling Program which is discussed further in the Specialized Therapeutic Counselling Program section of the model.
THE AVALON MODEL: EMPOWERING INDIVIDUALS AND COMMUNITIES TO RESPOND TO SEXUALIZED VIOLENCE
ORGANIZATION SUPPORTS
Figure 1: The Avalon Model: Empowering Individuals and Communities to Respond to Sexualized Violence
Community Based & Flexible
COMMUNITY ENGAGEMENT SOCIAL AND SYSTEM CHANGE
CONTINUUM OF SERVICES
Multidisciplinary Staff Team
Community Governed
Specialized Therapeutic Counselling
MODEL OF CARE
Feminist Lens Individual & Community Empowerment & Safety
Community/ Legal Education & Training Vision, Mission &Guiding Principles Research & Policy Change
Awareness & Community Mobilization
Approach to Care
Planning & Evaluation
Legal Support & Advocacy
Awareness & Prevention
Populations Served
Support, Information & Referral
Policies & Standards
Sexual Assault Nurse Examiner (SANE) Program
Collaboration Financial Sustainability Professional Development
THE HERSTORY OF AVALON SEXUAL ASSAULT SERVICES

Avalon Sexual Assault Centre was originally called Service for Sexual Assault Victims or SAAV. SAAV was formed in 1983 and incorporated in 1984 as a non-profit community-based charitable organization. A federal grant provided sufficient funds to hire an Executive Director and six Crisis Interveners from July 1983 to May 1984. The mandate was to establish a 24-hour crisis line, to recruit and train volunteers in crisis intervention, and to raise public awareness of sexual assault. In 1984, SAAV received funding from the Department of Social Services for an Executive Director and Program Coordinator to direct the Volunteer Services Program. At that time volunteers, called Crisis Interveners, carried pagers on 12 hour shifts and provided services 24 hours a day, seven days a week. Between 1985 and 1989, several other programs were initiated, such as the Personal Safety for Adolescents, Parent Support Program, and the Adult Survivors Program. By 1989, due to insufficient funds, these programs were either terminated or offered at a reduced level. In 1989, SAAV submitted a strategic planning proposal to various levels of government. As a result of a review by the provincial government, core funding was provided. This enabled SAAV to expand programs and ensured stability for the next four years, during which SAAV continued provide direct service to survivors, public education and advocacy. Fundraising became a priority. In 1994, a Strategic Long Range Plan Committee was struck to develop future plans. In that same year, Service for Sexual Assault Victims officially changed its name to Avalon Centre Society to reflect its philosophy and the changing needs of the community. This was changed again in 1995 to Avalon Sexual Assault Centre.
In 1996, with the development of Halifax Regional Municipality (HRM), the service delivery area for Avalon Centre increased to the entire HRM and put more strain on an already limited budget. An independent consultant conducted an internal program review which resulted in program restructuring. The outcome included many of the current programs: counselling programs; court support; community education; professional development; support, information and referral; and the after hours sexual assault response line. There was an increased focus on partnerships and consultations with agencies and womens groups. During this period, the counselling program changed from a lay/peer-led service to professional therapeutic counselling services, because the therapeutic needs of individuals who experience sexualized violence are unique and require a specialized response. Individual and group programs were developed based on the Stepping Stone Approach" to address earlier, mid and later stages in the healing process. The response line changed from all calls to services for immediates, hence the name Immediate Sexual Assault Response Line. Between 1996 and 2003 Avalon Centre continued to evolve current programs and develop new ones to address community needs. The community education program was revised to meet increased demand for professional training and began to develop customdesigned programs. The Sexual Assault Nurse Examiner (SANE) program began as a three-year demonstration project in 2000. It was unique in Canada because of its community-based approach to management and coordination. The IWK Grace Hospital, the QEII and the Dartmouth General were formal partners, as SANEs delivered emergency care through their emergency rooms. The SANE program was permanently funded in 2003-04 through the IWK. In 2009, this service was expanded to include the Cobequid Community Health Centre. 8

Legal Education began in 2001 as a result of project funding from the Law Foundation of Nova Scotia. In 2005, the Foundation approved core funding allowing Avalon Centre to establish legal education as a program with a permanent coordinator position. A budget increase in 2007 enabled a legal support and advocacy staff position. In 2012, as this model was being drafted, the Law Foundation funding was significantly reduced and Avalon Centre made the difficult decision to cut this program. . Avalon Centre has worked locally, provincially and nationally with organizations to provide public and professional education, as well as to conduct research and advocate for policy change to improve responses to sexualized violence. Partners have included: local community organizations; local, provincial and national womens organizations; universities; schools and the Halifax Regional School Board; provincial and federal Departments of Justice; Halifax Regional Police (HRP) and the RCMP; Department of Health; Capital Health; IWK Grace Health Centre; and the Department of Community Services. Since 1997, Avalon Centre strengthened fundraising efforts through innovative events and initiatives including: Athletes for Avalon Golf Tournament; Friends of Avalon Silent Auction and Benefit; The Vagina Monologues; Little Mysteries Book Store Freaky Fridays; Dalhousie Association of Women and the Law Dinner and Benefit. Many were organized by a third party, such as the Dalhousie Association of Women and the Law and Friends of Avalon, with funds raised being donated to the centre. The year, 2003-04 was a pivotal year for Avalon Centre. Core funding from the NS Department of Community Services had remained stagnant with no increase for 10 years. It was the first fiscal year that Avalon Centre was unable to meet all its operating expenditures. Two one-time grants totaling $30,000 were received from the NS Departments of Health and Justice. In 2005 a $25,000 increase in core funding for four years was received from the Department of Community Services. While this helped to address some of the long standing financial needs, Avalon made the difficult choice of shutting down the After Hours Sexual Assault Response Line due to funding shortages. The centre continued to face ongoing challenges with increased demand for service locally as well as across Nova Scotia. In 2011, after several presentations, the Department of Community Services granted a $70,000. increase in core funding. Avalon Centre has historically been a not-for-profit communitybased womens organization with a woman-centred focus. Recognizing the gendered nature of sexualized violence, an important goal has been to provide services, support and a safe place for women who have experienced sexualized violence. In recent years, while maintaining services for women, Avalon Centre has expanded the populations served. The SANE program serves all ages and genders, and the Community/ Legal Education and Training Program offers programs for the general public, community organizations, government agencies, schools, and universities. Today, Avalon Centre maintains an all-woman Board of Directors and staff and has a well-developed feminist model of practice. For their contribution to the community and commitment to social justice and anti-violence work, the women who have worked and volunteered at Avalon Centre have been recognized through various community awards. In 2013, Avalon Centre will celebrate 30 years of providing sexual assault services and working to create social, political, and cultural change in how individuals, systems, and governments understand and respond to sexualized violence.
WHY DOCUMENT THE AVALON MODEL
WHY DOCUMENT THE AVALON MODEL?

The interest in documenting the Avalon Model came out of a growing demand for sexual assault services to be established in communities throughout Nova Scotia, which is the result of the prevalence of sexualized violence and the recognition of Avalon Centre approach as a model for developing these services.
DEMAND FOR SERVICES ACROSS NOVA SCOTIA

Avalon Centre has experienced ongoing requests for assistance from service providers and organizations throughout Nova Scotia who are identifying the need to address sexualized violence. This includes requests for training, education, resources and consultation related to developing services. Organizations are also looking for policies, procedures, best practices, and assistance with community development and strategic planning. Although Avalon Centres Community/Legal Education and Professional Training Program has developed various resources for professional development, there is no documented model for community agencies to use to design services for their communities.
According to the Nova Scotia Advisory Council on the Status of Women (2010), in 2009, there were 20,931 sexual assault incidents reported to police in Canada which includes 17,719 (or 85%) female victims. In Nova Scotia, in 2009, a total of 701 sexual assault incidents were reported to the police which includes 595 (or 85%) female victims. This decreased by 2.7% between 2009 and 2010. In 2010, a total of 682 sexual assault victims reported the crime to the police in Nova Scotia. This includes 572 (or 84%) female victims. Results from GSS 2009 show that 88% or close to 9 in 10 sexual assaults were never reported to the police (Perreault and Brennan, 2010). Under-reporting of sexual assault incidents is an issue. In 2009, in Canada, police reported almost 55,000 children and youth victims (0-17 years) of a physical assault or sexual offence. Of these, 3 in 10 or close to 15,000 experienced sexual or physical abuse within the family. Of this 15,000, 33% suffered sexual offences. Parents committed more than half (59%) of all family-related physical assaults and sexual offences. The rate of sexual offences by family members that were reported to police was four times higher for girls than boys (113 versus 28 per 100,000 children and youth population). (Statistics Canada, 2011) In Nova Scotia in 2009-10, of 2654 cases referred to the IWK Health Centre for abuse issues, 14% of parents identify children have experienced sexual abuse. Of 706 youth who were referred and interviewed, 30% identify sexual abuse as happening sometimes or often. (Rubin, 2011, p. 10). In 2010-11, the Avalon SANE program, which provides medical forensic care for immediate assaults in HRM, had 18 clients under age 17 which comprised almost 20% of their total 92 clients in 2010-11. 10
PREVALENCE OF SEXUALIZED VIOLENCE

In 2009, according to Statistics Canadas General Social Survey (GSS), there were 677,000 self-reported sexual assault victims across Canada which translates to a rate of 24 per 1,000 population age 15 years and older. Rates of sexual assault are higher for female victims when compared to males. From the 2009 GSS, the rate for sexual assault victimization of females is twice the rate compared to males. Over 70% of all sexual assaults reported in Canada involved a female victim over the age of 15 and 87% of sexual assault incidents were committed by a male offender (Perreault and Brennan, 2009).
WHY DOCUMENT THE AVALON MODEL

Assessment and recommendations for preventing and addressing the harms of sexualized violence in Nova Scotia, based on the assets and gaps identified through the research. The recommendations were presented to the Minister Responsible for the Status of Women. Updates to the report were submitted in 2010. In 2010, the Nova Scotia Advisory Council on the Status of Women hosted a one-day workshop, Moving from Suffering in Silence to an Action Plan, with community-based womens groups and key government stakeholders. The purpose of the forum was to discuss the current situation of sexual assault services in Nova Scotia and to identify areas for action over the next four years. The key areas recommended for action were as follows: Models for Services and Standards Provincial Wide Prevention Programs Specialized Therapeutic Counselling Standards for SANE Services and Phasing in SANE Programs Barriers to Access and Cultural Competency. Workshop participants discussed: (1) working together to further enhance sexual assault services in Nova Scotia using a collaborative, integrated approach; (2) the need for a provincial model; and, (3) formalizing professional standards of practice, based on the Avalon model. The identified next steps included documenting the Avalon Model for service delivery and practice, and acquiring provincial ministerial support to move forward with key areas recommended for action.
PROVINCIAL NEEDS ASSESSMENT

In 2006, Avalon Centre brought together numerous provincial agencies to organize efforts to address the lack of sexual assault services in the province. Organizations and agencies comprising the planning group were the Avalon Sexual Assault Centre, Antigonish Womens Resource Centre and Sexual Assault Services Association, Colchester Sexual Assault Centre, Nova Scotia Advisory Council on the Status of Women, Cape Breton Interagency on Family Violence, the Transition House Association of Nova Scotia, and Womens Centres Connect. Over the course of 2006, the Planning Group uniformly identified concerns across all regions of the province. Two concerns were the ability of individuals and communities to access adequate services related to sexualized violence and the need to prevent and undo the harms associated with it. The group decided to conduct a needs assessment and, in 2007, accessed funding from the Nova Scotia Advisory Council on the Status of Women and the Law Foundation of Nova Scotia, in addition to in-kind contributions from all participating organizations. The objectives of the needs assessment were: To expand the information and understanding available with respect to whether and where survivors access the help they need; To determine how communities across the province are responding to the challenge of sexual violence; and, To identify what is needed to prevent and undo the harms of sexual violence in Nova Scotia. The report, Suffering in Silence, was released in 2008 (Rubin, 2008) detailing the outcomes of the Sexual Assault Needs
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AVALON MODEL OF CARE
WHY A COMMUNITY-BASED FEMINIST MODEL FOR ADDRESSING SEXUALIZED VIOLENCE?

In the Sexual Assault Needs Assessment report, Rubin (2008) discusses why community-based womens organizations are well suited to provide survivor-centred care. (p. 33-34) Her case is presented in this section with permission.ii Pioneering feminists and feminist organizations developed an understanding of sexual assault that saw such violence not as a problem of individuals alone, but as rooted in social phenomena connected to gender inequality, as well as subordination on the basis of race, class, ability and other characteristics. Research revealed (and continues to show) that those with the least status and power in society were those most likely to be sexually assaulted (Canadian Panel on Violence Against Women, 1992). Feminist analysis views sexualized violence as the predictable outcome of societal beliefs about power, the use of force, and gender roles, not as a biological imperative which manifests when provoked by persons who have experienced sexualized violence, nor as largely due to the psychopathology of a few individual deviants. Sexual assault is viewed, not as a sexual act, but rather one of humiliation and oppression that expresses privilege and dominance. This analysis, once radical, is now the most widely accepted approach to understanding and preventing sexualized violence in Canada as identified by the Ministers Responsible for the Status of Women: Much qualitative evidence and analysis indicates that violence is linked to inequalities and power imbalances in society. As a rule, womens experiences of violence will vary depending on the impacts of gender and other factors such as the womans race, her ability, her sexual orientation, her age, her cultural, educational and economic status, as well as her experiences of dislocation or colonization. Women who face discrimination on
various grounds are more vulnerable to violence and abuse and face greater barriers when seeking services. - Federal-ProvincialTerritorial Ministers Responsible for the Status of Women iii
Due to their relationships of trust with those who have experienced sexualized violence, as well as their expertise, structure and philosophies of service, feminist community-based organizations are well suited to provide survivor-centred care. They offer a shift from a diagnostic treatment model common in the medical field to a collaborative, non-pathologizing approach. Research with persons who have experienced sexualized violence indicates that, among all responders, such community organizations have been correlated most strongly with healing and least with hurting in post-sexual assault care. Survivors strongly rated their contact with community rape crisis centers as healing (75%) (Campbell et al., 2001). There were no significant associations between perceived secondary victimization and service delivery outcomes for rape crisis centers. In contrast, only 47% of survivors reported contact with the health care system as healing; and nearly a third considered it hurtful. Contact with the legal system was perceived as hurtful by 52% of responders. Nova Scotia research suggests that this perception is shared by Nova Scotians experiencing sexualized violence. Community organizations in Nova Scotia, including community mental health professionals, sexual assault centres, womens centres, transition houses, and organizations serving criminalized women have been identified as enjoying a level of trust by abused, sexually assaulted and marginalized women, that is not associated with either the conventional health or justice systems (Rubin, 2003). Avalon counsellors in the needs assessment research (Rubin, 2008) affirmed that clients continue to experience significant secondary wounding from the justice and other institutional systems. (p. 33).
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THE AVALON MODEL OF CARE

The Avalon Model of Care is at the centre of the Avalon Model and describes the important elements that inform the centres programs and services, as well as the strategies for social and system change. At its core is the overarching goal of Individual & Community Empowerment & Safety. Essential to the Model of Care are: the feminist lens; the vision, mission, and guiding principles; the Awareness and Prevention Approach; and populations served. The Approach to Care is how Avalon Centre puts principles, processes, and approaches into practice or best practices. This Model of Care integrates the work of Avalon Centre into a holistic approach. While, on the one hand, staff are communicating to those using services that sexualized violence is a community responsibility; on the other hand, they are proactively raising awareness and engaging the community to take action to reshape societal norms and to change systemic responses to sexualized violence. The opportunity to witness this action and the option to participate in creating change has a healing and empowering effect for those using Avalons services. Also, it is essential to reducing staff burnout, who can act to address the root causes, while working directly with those who have experienced sexualized violence.
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Figure 2: The Avalon Model of Care
MODEL OF CARE
Feminist Lens
Approach to Care
Individual & Community Empowerment & Safety
Vision, Mission &Guiding Principles
Awareness & Prevention
Populations Served
THE FOCAL POINT: INDIVIDUAL & COMMUNITY EMPOWERMENT & SAFETY

Avalon Centres programs involve building relationships with individuals, groups, and communities that respect social and cultural diversity, result in services to meet needs, and increase capacities, opportunities, and choices.
Avalon Centre recognizes that each persons needs and paths are unique. Individual and group programs are based on the assumption that each individual brings a valuable perspective of her/his life situation and must feel both safe and empowered in order to make informed choices and decisions. Building trust is an important component of supporting safety and empowerment. In this regard, Avalon Centre does not serve as a monitor for agencies; for example, Child Protection or Corrections. Similarly, each communitys needs and assets are unique whether identified by geography, gender, sexual identity, sexual orientation, age, race/ethnicity, class, ability, or religion. Avalon works with individuals and communities to enhance skills and knowledge as well as to mobilize community members to take collective action in order to prevent sexualized violence and re-traumatization. 13
AVALON MODEL OF CARE FEMINIST LENS

Looking outward from the centre, Avalon Centre uses a feminist lens which incorporates an understanding of the root causes of sexualized violence with the commitment to eradicating inequality and power imbalances as described in the statement that follows:v As a feminist organization, Avalon Centre is committed to changing the current socio-political culture that condones, supports and permits sexualized violence. Sexualized violence exists because of power imbalances that are rooted in patriarchy and gender inequality, as well as other forms of oppression and inequalities based on gender/sex, age, race/ethnicity, class, ability, and religion. Because of sexual assault myths and gender, racial and other stereotypes, sexualized violence is perpetuated and often condoned within our society. Often there is a perceived right to commit sexual assault as a result of entitlement, relationship to the victim, of war, and/or beliefs about the victim. Sexualized violence is regarded as gendered because the majority of those victimized are female and the majority of offenders are male. However, the dynamic of dominance, control and oppression is reflected in all acts of sexualized violence regardless of the sex of the offender or of the person who has experienced sexualized violence. The feminist lens informs all planning, decision-making, and actions. This includes all day-to-day work and interactions with those using services, the general public, other service providers, and community partners. The feminist lens shapes programs, services, and educational resources. It informs advocacy strategies to effect change in perceptions, attitudes, system response, public policy, and legislation.
The Feminist Lens

Having an understanding of the root causes of sexualized violence and a commitment to changing the social and political culture that condones, supports and permits it; then, applying that understanding and commitment in all planning, decision-making and actions. Will this decision, service, initiative and/or interaction
Recognize and raise awareness about embedded ideas of gender inequality, power imbalances and other forms of oppression and inequalities based on gender/sex, age, race/ethnicity, class, ability, and religion? Challenge gender, racial and other stereotypes and sexual assault myths, such as those related to sexual coercion and consent? Shift the focus from individualized victim responsibility to a focus on understanding and linking together the broader impacts and challenges related to societal sexism, racism, and other forms of oppression? Engage and mobilize individuals and communities to collectively take action to effect change in perceptions, attitudes, system response, public policy, and/or legislation? Hold offenders accountable for their harmful behaviour?
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AVALON MODEL OF CARE VISION, MISSION AND GUIDING PRINCIPLES

Avalon Centre is guided by the following vision, mission and guiding principles. Vision Statement The Avalon Sexual Assault Centre is a feminist organization working to eliminate sexual assault/abuse and to change the current socio-political culture that fosters sexism, social injustice and other forms of oppression. Mission Statement To provide services for those affected by sexual violence, with primary emphasis on immediate care, support, education, counselling and leadership/advocacy services for women. Guiding Principles As advocates, counsellors, educators, health practitioners and activists, we are committed to providing a leadership role in the community by developing our practice around the following guiding principles: We believe that sexual violence is caused and maintained by social and political imbalances of power. Therefore, we are committed to working with our colleagues, clients, and community using a feminist approach to invoke change and healing at both personal and societal levels. We believe in using a flexible, client-centred approach that supports the inherent right to self-determination. As such, we support clients by being non-judgmental, providing information about their options and affirming their decisions. We believe that healing is a process. Therefore, we offer a variety of program options that reflect different needs and layers of recovery work.

We are committed to a practice approach that promotes victim empowerment and acknowledges that the person who commits the violence is responsible for his behaviour. We are committed to reducing barriers to accessing Avalon Centres confidential services within our existing mandate and resources. We are committed to providing a leadership role in eliminating barriers for access to justice. We are committed to working with grass roots and womens organizations and other community partners on a local, provincial and national level to improve social policy and promote social action. We are committed to fostering an environment that supports self-care and provides professional growth and learning opportunities for staff, students and volunteers. We are committed to being flexible and accountable by developing policies, procedures and programs that are in keeping with our mission statement, principles and resources. We are committed to a women only staff and Board of Directors.
We acknowledge that sexual violence profoundly affects individuals, families and our community. We ask every member of our community to support us in assisting sexual assault/abuse survivors/victims, their partners and non-offending parents to heal from the effects of sexual violence. We challenge all people to commit to a culture free from sexual violence and abuse.
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AVALON MODEL OF CARE AWARENESS AND PREVENTION APPROACH

Avalon Centre has developed a distinctive Awareness and Prevention Approach that combines a gendered sociological education model with a public health model that has three dimensions primary, secondary and tertiary prevention. This approach is integrated through all of Avalon Centres services and programs. The purpose of the Awareness and Prevention Approach is to prevent future sexual assaults, secondary wounding and retraumatization by:
been using these practical approaches to safety, yet sexualized violence continues to occur. While some of these measures may minimize individuals risk of sexual assault, they do not prevent sexual assault from occurring because these campaigns do not address the actions and behaviours of offenders. The public health related component focuses on harm reduction, where prevention is articulated as primary, secondary or tertiary prevention. The following are definitions related to sexual assault: (a) Primary Prevention focuses on activities that take place before sexualized violence occurs. These tend to be public awareness and community education initiatives. (b) Secondary Prevention focuses on immediate responses after sexualized violence has occurred that enables the person who has experienced sexualized violence to deal with immediate and short term effects and to prevent further trauma. An example of this is the SANE Response line, the SANE program, and court preparation and accompaniment. (c) Tertiary Prevention focuses on long term responses after sexualized violence has occurred that enables the person who has experienced sexualized violence to deal with ongoing impacts, including lasting trauma effects. The therapeutic counselling service is an example of tertiary prevention. The audiences for prevention range from the entire population, regardless of exposure, to particular audiences. The three types of audiences are universal, selective and indicated. To illustrate how this works, Table 1 defines the different audiences, provides an example and the type of prevention.
Addressing embedded ideas of gender inequality, patriarchy, sexual coercion, and consent by challenging sexual assault myths and stereotypes that permit, condone, and perpetuate sexualized violence; Shifting the focus from individualized victim responsibility to mobilizing the community to take collective action against sexualized violence, to reshape societal norms, to challenge the responses of the government and its agencies; Holding offenders accountable for their harmful behaviour.
The gendered sociological educational model challenges the traditional prevention messages and emphasizes that the message has to change from dont get raped to dont rape. Many mainstream sexual assault prevention messages emphasize ways that potential victims can make themselves less vulnerable to sexual victimization. For example, the media and police often advise women to protect themselves or change their behaviours in order to avoid sexualized violence. These messages focus responsibility for preventing rape on potential victims and treat it as an isolated incident. They imply that sexualized violence is most often perpetuated by strangers who can be avoided if women follow conventional protection measures. For centuries society has
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AVALON MODEL OF CARE Table 1: Audiences and Type of Prevention AVALON APPROACH TO CARE
Target Audience
Universal
Definition
Directed towards entire population regardless of exposure to sexualized violence Targets individuals that are at risk of sexualized violence, offender, bystander i.e. youth/young adults
Example
Avalon Centre Teal Ribbon Campaign Avalon Centre Poster Campaign
Type of Prevention
Primary Prevention
The Avalon Approach to Care has nine components that describe how Avalon Centre puts the principles, processes and approaches into practice or best practices. As part of the Model of Care, the Approach to Care has at its core, the overarching goal of individual and community empowerment and safety and the feminist lens which guides all planning, decision-making, programs, initiatives, and interactions. Community-Based and Flexible
Selective
University Campus Sexual Assault Awareness Campaign Sexual Assault Legal Information Series for New Canadians Court preparation and accompaniment for women who have experienced sexualized violence Specialized Therapeutic Counselling
Primary Prevention
As a community-based organization, Avalon Centre is able to be flexible and responsive to individual and community needs and priorities. This independence enables coordination and issues to be addressed quickly and effectively. Reducing Barriers to Access
Indicated
Directed at persons who have experienced sexualized violence, offenders, or bystanders
Secondary Prevention
Avalon Centre works to remove barriers to access through provision of services free of charge in a supportive environment that is safe, non-judgmental and confidential. Part of reducing barriers to access is striving for cultural competence which involves strengthening knowledge, skills, behaviours, policies and programs to better meet the needs of diverse populations; for example, adolescents, elderly people, sex trade workers, immigrant and migrant peoples, lesbian, gay, bisexual, trans, queer, and intersex. Staff also builds and maintains relationships with government and community organizations in order to support those who have experienced sexualized violence to access information, support and services.
Tertiary Prevention
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Continuum of Services Avalon Centre offers a continuum of services that include education, support, information, referral, medical/forensic exams individual/case advocacy, individual counselling, group programs, and professional training. Interventions and educational strategies are flexible and varied and may involve linkages to other services and programs within Avalon Centre or through referral to other service providers or agencies which supports access to services and avoids individuals having to shuffle from agency to agency. Individuals may access services through a variety of avenues and entry points as appropriate to their particular situation and needs. Every effort is made to ensure that persons who have experienced sexualized violence receive the most appropriate service, provided by the most appropriate service provider, in the most appropriate location. Multi-disciplinary Team A multi-disciplinary team of women providers provide services and supports. These include counsellors, health practitioners, educators, advocates, and activists. Each provider works according to their professional code of ethics, operational policies and procedures, as well as Avalons Model of Care. Open and Transparent Processes Safety and trust building are vital to the resolution and healing of relational trauma. Therefore, all programs incorporate open and transparent processes where full information with respect to both intention and process is provided. Building Relationships and Collaboration Avalon Centre is committed to building collaborative relationships at the individual, community and system levels.
Building Relationships & Collaboration
At the individual level, the emphasis is on building relationships and trust with each person and honoring their wisdom, perspectives, values and choices. At the community and system levels Avalon Centre works locally, provincially, and nationally with a range of community organizations and government agencies to improve responses to sexualized violence, develop innovative programs, improve service response and coordination, and effect change in public policy.
Figure 3: Avalon Centres Approach to Care

Community-Based & Flexible
Monitoring & Evaluation

Feminist Lens
Reducing Barriers to Access

Continuum of Services
Research & Policy Change
Individual & Community Empowerment & Safety
Multi-disciplinary Team Open & Transparent Processes
Awareness & Community Mobilization
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Awareness and Community Mobilization Avalon Centre actively works to change the socio-political culture that fosters sexualized violence through raising awareness and mobilizing communities to take collective action to address sexualized violence. Solutions may include public awareness, development of services, community protocols, and policy change. It may also involve building knowledge and skills through education and training, as well as supporting organizational change through consultation, strategic planning and provision of resources and tools. Research and Policy Advocacy Avalon Centre works to identify and research critical emerging issues and brings together key stakeholders to develop innovative policy recommendations which are responsive to the needs and concerns of persons who have experienced sexualized violence. Monitoring and Evaluation Avalon Centre recognizes the importance of ongoing monitoring and evaluation to identify trends and inform evidence-based decision-making. The centre implements several monitoring and data collection systems and reports these statistics annually through the annual report. The centre also has developed systems for feedback and evaluation. Womens services All programs are available to women over 16 years. Specialized Therapeutic Counselling and Legal Support and Advocacy are provided only for women over 16 years. Services for supportive partners and non-offending parents Programs are available for supportive partners of women accessing services and non-offending parents of children who have disclosed sexual abuse. Services for all genders and ages The Sexual Assault Nurse Examiner (SANE) program provides services to all gender identities and all ages. Services for service providers, community groups, government agencies, and communities; as well as the general public, persons at risk of or who have experienced sexualized violence, offenders, and bystanders Supportive information, referral, and resources are provided over the phone to service providers, the general public, and persons who are at risk of or who have experienced sexualized violence. Community education, legal education, and school-based programs are provided on request to schools, universities, community organizations, church groups, and the general public. Professional training is provided for a wide range of service providers who deal with sexualized violence; for example, police, victims services, and womens organizations. Public awareness and public education focus on a wide range of audiences including the general public, persons who are at risk of or who have experienced sexualized violence, offenders, and bystanders.
POPULATIONS SERVED
As identified in the Mission Statement, Avalon Centre provides services for those at risk of or who have experienced sexualized violence, with primary emphasis on support, education, counselling and leadership/advocacy services for women. As shown next, Avalon Centre serves women and a broader population.
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Avalon Centre provides the following services which are described in this section:
Community/Legal Education and Professional Training which includes: Public Awareness and Public Education Legal Education Community and School-based Education Professional Training and Consultation Information, Support and Referral Sexual Assault Nurse Examiner (SANE) Program which includes: 24 hour Response Line Specialized Services Legal Advocacy and Support Specialized Therapeutic Counseling which includes: Individual Counselling Group Programs
programs and by the administrative support staff, who are often the first point of contact by phone or for those coming to the centre. Another example is Community/Legal Education and Professional Training. While the Coordinator delivers many of these programs, she also works with the staff of the SANE, Specialized Therapeutic Counselling, and Legal Advocacy and Support program staff who also provide community education and professional training. While there are intersections, there are also specialized services such as the Specialized Therapeutic Counselling Program and the SANE Program which are provided by staff with specialized training. Avalon Centre makes every effort to ensure that those using services receive the most appropriate service, provided by the most appropriate service provider, in the most appropriate location and in a supportive environment. To support access to services for different populations, Avalon Centre has created particular spaces for service delivery. Recognizing the importance of the need for a safe, supportive place for women who have experienced sexualized violence, women only services such as the counselling and the legal support and advocacy program are offered at Avalon Centre. The SANE program is delivered in a designated, confidential space within several hospitals throughout HRM. The community/legal education and professional training programs are generally taken to those organizations and groups who request them and, therefore, are offered in various locations throughout HRM and across the province. Services for the most part are free of charge. A fee for service is charged for professional training and there is a small fee for group participation which is used for refreshments.
All of Avalons Centres services are grounded in the Model of Care. Within the Model of Care, the Approach to Care describes services as a continuum of services, and Figure 4: Avalon Centres Continuum of Services Responding to Sexualized Violence, illustrates this continuum. As shown in Figure 4, individuals and organizations may access services through a variety of avenues and entry points as appropriate to their particular situation and needs. There is a dynamic relationship among services, as shown by the arrows, where the services inform each other and there are overlaps and intersections. For example, while support, information and referral is described as a distinct service, it is provided through all
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Figure 4: Avalon Centres Continuum of Services Responding to Sexualized Violence
Engage groups, communities, and audiences * to prevent sexualized violence from occurring.
Work with government agencies and community organizations to improve responses to sexualized violence and prevent secondary wounding
Assist women 16 years and over to heal from relational trauma. Support supportive partners of women accessing services and non-offending parents of children who have disclosed sexual abuse.
Public Awareness and Public Education Respond to community organizations, schools and universities looking for information and education. Immediate response to all ages and genders when sexual assault occurs
Professional Training and Consultation
Legal Education, Community and Schoolbased Education SANE Program 24 hr Response Line and Specialized Services
Specialized Therapeutic Counselling - Individual and Group Programs
Legal Support and Advocacy
Support, Information & Referral
Support women 16 yrs and older and non-offending parents to access the justice system and other services
Respond to organizations and individuals requesting options, information, and referrals.
**Communities are broadly defined by geography, gender/sex, age, race/ethnicity, class, ability, or religion. Audiences can vary from the general public (universal) to selective (specific audiences such as youth) or indicated(victims/survivors, offenders or bystanders).
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CONTINUUM OF SERVICES COMMUNITY/LEGAL EDUCATION AND PROFESSIONAL TRAINING
COMMUNITY/LEGAL EDUCATION & PROFESSIONAL TRAINING

The Community/Legal Education and Professional Training Program includes four types of education programs as follows: Public Awareness and Public Education, Community and School Based Education, Legal Education, and Professional Training. This section describes the broad objectives, approaches and strategies used followed by a description of each type of program. There is a strong relationship among the education programs. For example, a public awareness campaign or resource display may result in a request for a community or school-based education presentation, which may lead to a series of educational modules, professional training for staff of an organization, and partnering in a larger health promotion initiative.
continuing to increase its focus on youth and has just completed a feasibility study, Exploring Service Options for Youth Victim/Survivors in Halifax Regional Municipality (Rubin, 2011). Professional training provides training for service providers in agencies who are dealing with persons who have experienced sexualized violence. This can range from police to health care providers and womens organizations. Legal Education is offered through all programs to service providers, schools/universities and community organizations. Programs are generally taken to the group or community making the request. Public awareness and public education uses various media, both traditional and new media, to reach intended audiences.
OBJECTIVES, APPROACHES AND PROCESSES

The main objectives of this program are: To improve public awareness about Avalon Centre and its programs and services; To increase understanding of root causes and effects of sexualized violence; To change societal, professional, and systemic perceptions of and responses to persons who have experienced sexualized violence; and To mobilize people and communities to take action on sexualized violence. This program focuses on both primary and secondary prevention as outlined in the Awareness and Prevention Approach in Section 3. Primary prevention concentrates on activities that take place before sexualized violence occurs. Secondary prevention concentrates on 22
POPULATIONS SERVED AND LOCATION

Public Awareness and Public Education, as their name implies, are focused on the general public and those audiences can vary from the general public (universal) to selective (specific audiences such as youth) or indicated (victims/survivors, offenders or bystanders). Community, legal and school-based programs serve a range of audiences from community organizations to youth in schools and universities and communities. As already noted in the Continuum of Services diagram on the previous page, communities are broadly defined by geography, gender/sex, age, race/ethnicity, class, ability, or religion. It is worthy of note that Avalon Centre is

immediate responses after sexualized violence has occurred that enables the person who has experienced sexualized violence to deal with immediate and short term effects and to prevent further trauma. Much of the public awareness, community/legal and school-based education are primary prevention. Professional training is more oriented to secondary prevention, focusing on how professionals dealing with sexual assault can prevent further trauma and secondary wounding. Capacity building and community development are important aspects of this program. Avalon Centre staff work with organizations to build and strengthen their capacity to respond to sexualized violence through professional training with staff and through consultation, strategic planning and provision of resources and tools. Community development involves working with communities to support them to mobilize and take collective action in order to address sexualized violence and enhance the quality of life as a long term focus. Community development encourages participation, community control over development processes, and the development of leadership for planning and action. It promotes a set of principles or values as the basis for practice as follows:vi Promote active and representative citizen participation, so that community members can meaningfully influence decisions that affect their lives; Engage community members in learning about and understanding community issues, and the economic, social, environmental, political, psychological, and other impacts associated with alternative courses of action; Incorporate the diverse interests and cultures of the community in the community development process; and disengage from support of any effort that is likely to adversely affect the disadvantaged members of the community; Work actively to enhance the leadership capacity of community members, leaders, and groups within the community; and Be open to using the full range of action strategies to work toward the long term sustainability and well being within the community. This program uses a combination of the above approaches depending on the purpose and who is involved.
PUBLIC AWARENESS AND PUBLIC EDUCATION

The primary objectives of public awareness and public education are to raise awareness of sexualized violence as a systemic societal issue and to mobilize people and communities to take action. Strategies include public awareness campaigns, development and distribution of educational materials, and broader health promotion initiatives. These are not offered in isolation, but build on each other with the intent of achieving the objectives. The following provides more detailed description of each and some examples. (a) Public Awareness Campaigns Public awareness campaigns focus on a general or more specific audience, can be ongoing or planned for a specific timeframe, may involve community partners, and can involve events and opportunities for community engagement. One example is a poster campaign funded by the Law Foundation. Its purpose was to educate youth, young adults and the general public about sexual consent and to create public awareness about the programs and services provided by Avalon Centre. Another example is the Teal Ribbon Campaign. This is a public awareness campaign that encourages the general public to wear the teal lapel pin signifying sexual assault awareness. These are distributed on an ongoing basis and in association with other events and awareness 23

campaigns, such Sexual Assault Awareness Month (SAAM). The audience for SAAM is also the general public; however, this campaign focuses on a particular time of year, involves community partners, and has a number of events to generate interest and support as described in the box below. (b) Educational Tools and Materials To promote public awareness, Avalon Centre develops a range of educational tools and materials which provide information about Avalon Centre services and programs, about sexualized violence and to support improved access to services. To reach new audiences and youth, Avalon Centre continues to explore alternative ways to raise awareness and mobilize communities using social networking and the spoken word. Some examples are: Avalon Centre brochure, website, Facebook page and Twitter; Sexual assault zines (magazines); A Media Guide to Reporting Sexual Assault developed in 2007. This resource is intended to provide media with statistical and educational information about sexual assault issues. It also addresses sexual assault myths, stereotypes, and sensationalism often portrayed in the media; Information pamphlets for particular audiences, such as Navigating the Child Protection System produced in 1998 and funded by the Department of Health and A Womens Guide to the Medical System After Sexual Assault produced in 1998. Tool Kits such as the Stop It ASAP (Awareness of Sexual Assault Project) Tool Kit (2011). (c) Health Promotion and Community Mobilization Initiatives Public awareness can involve into broader health promotion and community mobilization initiatives. This may start as a short term campaign or one event. Then, based on response, Avalon Centre creates tools or guides for partner groups to run their own campaigns or events. ASK for sexual consent campaign was launched in partnership with the Nova Scotia Advisory Council on the Status of Women in 2010. This campaign used a poem to 24
Sexual Assault Awareness Month

The Sexual Assault Awareness Month (SAAM) in Nova Scotia was first announced in 2009 and declared by the Premier in 2010. SAAM provides an opportunity to host public events and distribute educational material over a one month period on an annual basis. During SAAM 2010, the Nova Scotia Advisory Council on the Status of Women and Avalon Centre partnered to host a public event in Province House. SAAM awareness packages were sent to various community partners, the Halifax Regional School Board, Youth Health Centres, and the media. Avalon Centre created a SAAM page on the website to further promote SAAM and make SAAM educational materials widely available to the general public. Each year can have a specific theme. In 2010, the theme was Together we can STOP! Sexual Assault.

engage people in discussion about consent. It emphasized that consent must never be assumed or chemically induced. Based on the response, the initiative was developed further into a health promotion initiative as described in the box below, Ask Initiative.
COMMUNITY AND SCHOOL-BASED EDUCATION

The objectives of community and school-based education programs are to enhance understanding of sexualized violence, raise awareness of Avalon Centre and its programs, and increase knowledge of supports available. They are delivered when requested by community organizations, schools, and universities. Activities can involve an information table, resource displays, public forums, presentations, participation in health fairs, and hosting or partnering in delivering workshops and conferences. Specialized educational programs address sexual assault trends and issues. They are custom designed for the specific needs, interests, and abilities of the groups; for example, age appropriate, gender specific, and facilitated through language or sign language interpreters. They may be formal presentations, informal question and answer sessions, or interactive, participant-driven workshops. Two examples are Elder Sexual Abuse and Sexual Assault Definitions and Laws: What New Canadians Need to Know. Much of this work involves working with youth and young adults through schools, universities, youth organizations, or youthfocused programs. Programs are custom-designed to reflect the age, learning styles, and needs of participants. Sessions are usually co-educational and interactive focusing on topics such as: Sexual assault awareness and prevention including definitions, statistics, myths and stereotypes, age of consent, and sexual assault and the law; Healthy and unhealthy relationships and acquaintance sexualized violence; The concept of sexual consent; Alcohol and drug facilitated sexualized violence; and Campus sexual assault. 25
ASK Initiative
The ASK campaign was developed into an awareness and prevention initiative to address alcohol and drug facilitated sexual assault and to promote the concept of sexual consent. ASK cards, stickers, hand stamps, and T-shirts were distributed to youth organizations, universities, Youth Health Centres, and other community organizations. Avalon Centre created an information guide and workshop for people who wanted to organize their own ASK campaigns. An ASK promotion page was created on the website. ASK promotions were provided during the Evolve Music Festival in Antigonish, at Femm Fest, and during orientation week at various universities in Nova Scotia. ASK presentations were given to participants of the YWCA-Halifaxs Finding Leadership in Young Women program and with their Power Camp (summer day camp) groups. Avalon Centre has provided three information sessions for community partners.

Through their work with youth and youth service providers, Avalon Centre has adapted programs to reflect the reality of how youth experience sexualized violence and the ways in which they prefer to learn about, explore, and address these issues. For example, in 1999, the Youth Dating Violence Peer Education Program was developed by a young adult mentor who had been a youth peer educator. She worked with groups of peer educators/leaders and with other youth to create teaching tools, agendas, and group activities. Avalon Centre provided support and training for adult supporters working with peer educators. Similarly, in 2011, Avalon Centre partnered with the YWCA Halifaxs Finding Leadership in Young Women (FLY-W) Program and the Girls Action Group at Citadel High to develop Stop It ASAP (Awareness of Sexual Assault Project). More information on this project is included in the Community Engagement for System and Social Change section. who have experienced sexualized violence. The project, Sexual Assault Legal Education Training: Improving the Service Providers Response to Survivors of Sexual Violence, was funded by the Law Foundation of Nova Scotia in response to requests for information from professionals, the general public, and women who have experienced sexualized violence.
PROFESSIONAL TRAINING
Avalon Centre has created professional training curriculums and materials that are custom designed and can be easily adapted so that they are sustainable. To meet the needs of different agencies that may be at different stages of learning, programs are multilayered they are designed to be ongoing, delivered in stages, and for progressive learning from introductory to more in-depth content. The following criteria are followed by Avalon Centre for design of these programs: That they are proactive, not reactive; That they are delivered by trained and knowledgeable facilitators, who are experienced in sexual assault work and who are able to foresee potential controversies and strategically create learning opportunities; That, they focus on building cultural competency and eliminate barriers to access; That, when possible, they be coordinated provincially according to standards, curriculum, and resources; That they be tailored to address particular needs of a group or community; and That they be part of a continuum of ongoing sexual assault services and programs offered either by Avalon Centre or by the community. 26
LEGAL EDUCATION
Because sexualized violence is a criminal offence, legal education is an important component of all Avalon Centres educational program. Legal information sessions are offered through all education programs - community and school-based programs, professional training and public education. Avalon Centre has also prepared Legal Educational materials for professionals; for example, the How Can I Help? and What Do I Do Now? Professionals are sometimes unsure of how to respond to a victim of sexual violence or are unaware of available services. They may have concerns about their professional liability or legal responsibility and how this is impacted upon by sexual assault laws. Avalon Centre has instituted a project to improve the overall legal knowledge of a variety of professional groups who in order to reduce barriers to access to the criminal justice system for women

Avalon Centre has learned that brief, one-time presentations are not helpful in effectively providing sexual assault education and addressing social change. Facilitators have had more success with programs that are delivered over a period of time, conducted with participants who are committed and interested in the issue, and where there has been a previous and/or ongoing dialogue within the group pertaining to sexual assault. Also, it is important to have a sense of safety and rapport within the group, between the group and the organizer, or between the organizer/group and the Avalon facilitator. Custom designed training programs focus on sexual assault awareness, response, support, investigation, and advocacy. Which aspects of this training that participants receive depends on their profession, knowledge, experience, and skill level, and the nature of the training workshop. Training may provide a broader understanding of the issues pertaining to sexualized violence and a feminist analysis of sexualized violence as a social issue. It may be skills-based, providing participants with the knowledge, skills, and techniques to respond to and support persons who have experienced sexualized violence within the context of their day-today work. Participants are not trained to be therapeutic counsellors but rather to prevent/minimize secondary wounding, provide first response to disclosures, provide basic emotional support, inform persons who have experienced sexualized violence of options, have a broader analysis of sexualized violence as a social issue. Examples of programs and materials are: Sexual Assault Awareness, Response, and Support Training for Service Providers; Secondary Wounding Education series for professionals; Legal Information sessions.
Being able to get staff training and resources on sexual violence that is based inprovince is a gift for everyone in NS who works in the area of sexual violence, hosting important forums for legal and community professionals, (and) being an articulate media voice on sexual violence, are just some of the examples of the important leadership role Avalon has taken on.
Agency participating in Professional Education
Avalon Centre also organizes conferences as professional development opportunities for service providers on current topics such as legal education, child sexual abuse, coordinated efforts to respond to sexualized violence, and youth sexual assault issues. Training programs may be followed by requests by organizations for Avalon Centre staff to provide follow-up consultation to support organizational change or community development activities. This may involve further training, strategic planning and/or provision of resources and tools.
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CONTINUUM OF SERVICES THE SANE PROGRAM
THE SANE PROGRAM

The Sexual Assault Nurse Examiner (SANE) program provides emergency response 24 hours a day, seven days a week to persons who have experienced a sexual assault that has occurred within the previous three days (72 hours). Services include the SANE Response Line and Specialized Services. With the individuals consent, specialized services include the following options: immediate care; follow-up services; storage of forensic evidence for up to for six months, giving the individual time to make decisions regarding legal action; and expert testimony in a court of law should the case proceed to court.
(1) community-based; (2) professional management; (3) credibility, knowledge, and experience working with/on sexual assault issues; and, (4) dedication and commitment to improving services and policies for sexual assault victims/survivors. In addition, independence from large institutions and flexibility enables effective coordination and issues to be addressed quickly and effectively. (p. 86-87)
POPULATIONS SERVED & LOCATIONS

Services are provided for all genders and all ages to four health centres within Halifax Regional Municipality: the QEII Health Sciences Centre, Dartmouth General Hospital, the Cobequid Community Health Centre, and the IWK Health Centre for Women, Children, and Families. Initially, the SANE program responded to both males and females, age 13 and over, at the QEII Health Sciences Centre, Dartmouth General Hospital, and IWK Health Centre. By 2007, the program was well established and had proven itself to be a very valuable, specialized service; not only for those who have experienced sexualized violence, but for community partners and the healthcare professionals working within the institutions where services are provided. In 2007, the program changed its mandate to respond to all ages and genders in response to healthcare (specifically IWK pediatricians) and community demand for our specialized team to provide care within a broader community. This also resulted in a slightly different response to the prepubescent population with one SANE and a pediatrician providing care, combining the SANEs unique expertise in sexualized violence and forensic science with the pediatricians expertise in caring for children. In 2008, the program expanded to the Cobequid Community Health Centre to better meet the needs of Bedford/Sackville and surrounding 28
WHY A COMMUNITY-BASED PROGRAM?

Mahon (2003, p. 1) noted that the SANE program grew out of the Metro Sexual Assault Initiative, a collaboration of agencies including police, hospitals, universities, government, and community-based agencies with a vested interest in improved services for sexual assault victims/survivors. The group had identified a number of critical inadequacies in services for sexual assault victims/survivors, essential services needed to address these inadequacies, and a vision for the new program. A communitybased SANE program model was selected because the committee felt that this model would ensure seamless treatment from the emergency room setting to community follow-up. The SANE Program Evaluation (Mahon, 2003) conducted focus group and interviews with ER managers and educators, police, and Crown Prosecutors. The evaluation found the community-based model, using a client/woman-centred approach, was an excellent and effective model that strongly supports the delivery of SANE services. The evaluation report concluded that, overall, the management and administration by Avalon Centre was found to be effective. Particular strengths of Avalon Centre coordination were:

catchment areas, in direct response to concerns voiced by youth to provide access for their population. These expansions came following analysis of the need, numbers potentially served and budget considerations. The SANEs continue to provide telephone information, support and referral to healthcare workers, support persons, police and first responders beyond 72 hours following the assault. They continue to strive for excellence in cultural competence by strengthening their knowledge of unique issues and challenges within specialized populations; for example, adolescents, elderly, males, sex trade workers, immigrants, and LGBTQI (lesbian, gay, bi-sexual, transgender, queer, intersex). forensic evidence. This line is available 24 hours a day and two SANEs are on-call 24/7.
SPECIALIZED SERVICES
The SANE program provides the following specialized services which are described in this section: Immediate care with the individuals consent. This may include physical assessment for injuries, treatment, support, and information/referral to available resources. A forensic examination with the individuals consent. This may include evidence collection, careful written and photo documentation, and evaluation of injuries. Supportive follow-up with the victim/survivor; Expert testimony if the case proceeds to a court of law; and Storage of forensic evidence for six months. (a) Immediate Care - Emergency Response 24/7 When the victim/survivor goes to the emergency room at the hospitals and tells the medical personnel that s/he has been sexually assaulted a SANE is called. Two SANEs attend each call at the hospital. The individual is directed by the emergency room nurse on duty to a designated private room to wait for the SANE to arrive. At the IWK, the IWK Child Protection Team or ER pediatrician may also be involved. Prior to meeting with the person who has experienced sexualized violence, the SANE converses with them about a plan of action. The comprehensive care the SANE provides to the victim/survivor includes: Support and crisis intervention in a non-judgmental, confidential environment; Discussion of medical, legal and follow-up options; A physical assessment, STI evaluation and preventive care, pregnancy risk evaluation and prevention,
SANES
A Sexual Assault Nurse Examiner (SANE) is a registered nurse with advanced training and education in sexual assault examination of treatment, including medical and forensic examination of persons who have experienced sexualized violence. The Avalon SANE Program employs a full time SANE Coordinator and a part time SANE Administrative Assistant. Twelve to fifteen (12-15) oncall SANEs are contracted to deliver the SANE Program. Funding for the SANE program is provided by the Department of Health and Wellness through the IWK Health Centre.
AVALON SANE RESPONSE LINE

Avalon provides the Avalon SANE Response Line for individuals who have experienced a sexual assault within the past three days (72 hours). This line provides the victim/survivor with information about their options after an immediate sexual assault, and is a connection with Avalon SANEs who can meet the victim/survivor at the hospital to provide medical care and/or the collection of
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A forensic exam if the individual chooses; Information and appropriate links with community supports and resources; and Discussion of medical follow-up.
gives a medical clearance and will order any medications or treatments that are necessary. The SANE discusses medical follow-up and offers the option of a follow-up call, usually within 48 to 72 hours. At the IWK, the IWK Child Protection Team may also follow up. When the individual leaves the hospital, she/he is given a pamphlet, Treatment and Follow-up Care. This outlines the details of the procedures, tests, and any treatments given by the SANE, including detailed recommendations for medical followup. The pamphlet also provides community follow-up counselling resources that are available with phone numbers. (b) Follow-up Services
The medical exam involves: (1) taking a medical history; (2) documenting details of the assault/abuse to help identify potential infections, injuries, or treatments required; and (3) taking blood and urine samples to test for pregnancy and/or infections. A speculum exam may be performed. The SANE ensures the child abuse forms are completed when necessary. At the IWK, the Child Protection Team will follow up with the youth who has experienced sexualized violence. If the individual chooses to have a forensic examination (evidence collection using the forensic kit), the SANE will conduct the examination. The forensic exam takes approximately three hours to complete. Only the SANE nurse and other emergency personnel need to be present during this exam. The forensic exam includes the steps listed for a medical exam and may also include the following: Collection of clothing for evidence; A head to toe visual exam looking for injuries, blood stains, seminal stains, evidence, etc.; Fingernail scrapings/swabs; Photographs of injuries; and Oral, rectal, vaginal and body swabs to examine for semen or infections. The victim/survivor may wish a support person, such as a friend or relative. During working hours, the hospital social worker provides support as able while waiting for the SANEs to arrive. At the IWK, the After Hours Crisis Team may provide this support. After the medical examination, the emergency physician
Follow-up services are provided by the SANE program. A phone call to the person who has experienced sexualized violence is made by the SANE within approximately 48 to 72 hours of the assault. The purpose of this call is a general check in, focusing on medical, forensic, and emotional concerns. The SANE may inquire about any prescribed medications that have been taken and whether they have been tolerated well, inquire about any adverse effects, other symptoms or medical concerns, and ensure that the individual has a good understanding of the follow up care with a physician. Any newly developed forensic concerns, information about counseling, other resources, and other concerns are also discussed as required. After this call, the SANE no longer has contact with the individual. Any further follow up initiated by the individual is directed to the SANE Coordinator. (c) Expert Testimony in a Court of Law If a case goes to court, the SANE may be called by the Crown Prosecutor to testify about the findings of the medical/forensic examination. Proper collection and storage of forensic evidence 30

and continuity of evidence are crucial components of the SANEs responsibilities. Therefore, professional training in the proper collection and handling of evidence and related documentation made during the exam is essential. It is important that the SANE ensure the consistent assessment and documentation of findings so that they can be used as evidence, should the victim/survivor decide to report either at the time of the exam or at a later date. SANEs may also be asked to testify about observations made during the exam, such as condition of hair, clothing or demeanour of the victim/survivor (if the case proceeds to court). It is very important that the SANEs maintain objectivity with respect to the evidence; therefore, their contact with the victim/survivor is limited to the consultation and examination and one mandatory follow-up phone call regarding medical condition. (d) Storage of Forensic Evidence for up to Six Months If the victim/survivor decides to have a forensic examination through the SANE program, s/he has the option to have the forensic evidence frozen and stored for six months. This enables the individual to have a choice about immediately reporting the assault to the police. The SANE brochurevii outlines this process as follows: The time following a sexual assault can be very traumatic for individuals. The victim/survivor may or may not want to report the sexual assault to the police, or s/he may be undecided. This is understandable given what has just happened. The SANE program allows people to make decisions about reporting the sexual assault to the police. If the victim/survivor decides to immediately report the assault to the police, the police will be notified. Forensic evidence will be handed over to them at that time. The victim/survivor may decide that s/he does not want to involve the police at this time. If the victim/survivor decides not to file a report with police at this time, s/he may still want to have a forensic examination. Through the SANE program, victims/survivors have the options of having the forensic evidence collected, frozen and stored for six months. During the six month period if the victim/survivor decides to report the sexual assault to police, the SANE Coordinator will provide the forensic evidence to police at that time. They will then proceed with the investigation.
One woman talks about her experience with being given options by the SANEs It was all professional, all about a process and going through steps. I like to be told why someone is doing something, what it will achieve and the nurses are very good at explaining everything and why they are doing things and what I could expect from things, so it was the professionalism that put me at ease. They wanted to know if I even wanted them to collect the evidence and they told me I could say just say I dont want to do that. I wasnt feeling concerned about what they were doing. It was not intimidating to me. They did everything they were supposed to The only thing that took a long time was the pregnancy test and we waited for the results from that. The doctor gave me the once over. It was very painless.
Victim/Survivor Interview, SANE Program Evaluation 2003
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CONTINUUM OF SERVICES THE SANE PROGRAM TRAINING & CERTIFICATION OF NURSES

The SANE training is based on the framework of the National Protocol for Sexual Assault Medical Forensic Examinations as well as the National Training Standards for Sexual Assault Medical Forensic Examiners. The model includes a 48 hour classroom training program, developed and facilitated by the SANE Coordinator and involving a variety of guest speakers from the multidisciplinary team. The purpose of the training is to prepare the SANE to provide consistent quality standard of care to persons who have experienced sexualized violence of sexual assault. The training has four stages as follows: Stage 1: A 48 hour didactic component facilitated by professionals with expertise in the field and includes a detailed training manual. Stage 2: A minimum of 10 speculum examinations supervised by a physician or nurse practitioner experienced in female genital exams to gain proficiency in speculum exam procedures. Stage 3: Completion of simulated patient training on males and females to gain beginning experience in medical/forensic examinations. This is completed in partnership through the Dalhousie University Faculty of Medicine Learning Resource Centre. Stage 4: Supervision and evaluation by a SANE and demonstrated competency for the forensic examination whereby the nurse assumes the primary caregiver role for a minimum of 3 sexual assault patients. Ongoing professional development is actively encouraged (See Organization Supports Professional Development). 32
RECOGNITION & RETENTION OF NURSES

Recognition and retention of nurses is an important aspect of the SANE program. Earlier experiences with the roster of physicians viii and the first attempt at SANE as a hospital-based program ix revealed that both burn-out and scheduling were major issues. Supports for SANES and a collaborative and cooperative working environment were built in at the very beginning of the program. To this end, there are opportunities for ongoing education, teambuilding, sharing of information and debriefing. Monthly meetingsx include an educational component in addition to program updates. As part of the debriefing process after each case, the SANE contacts the Coordinator as an opportunity to debrief, along with a report of the case completed. The SANEs are a resource and support for each other during and after cases. SANEs are involved with program development, for example developing policies and protocols, maintenance of forensic carts at each hospital, and providing education sessions to peers. Recognition is given to a SANE annually in the form of a peer nominated award. This award is in honor of Arthene Dawe, a dear friend of Avalon Centre and dedicated SANE who demonstrated excellence in nursing practice, an ongoing commitment to continuing education, and was naturally devoted to sharing her knowledge and expertise with others. The award is presented to a dedicated SANE who exemplifies Arthenes exceptional qualities and who is committed to providing outstanding and compassionate care to persons who experienced sexualized violence and to the dedication to life long learning.

In the SANE Program Evaluation (2003), a representative from the RCMP forensics lab reported that the evidence collected by the SANEs is consistent and of good quality. He also noted that well trained individuals can maximize information from the person who has experienced sexualized violence, which can also support the recovery of biological evidence and minimize the chances of problems or missing evidence. His comments are included in the box to the right, Well-trained SANEs can maximize information, support recover of evidence and minimize problems.
Well Trained SANEs can maximize information, support recovery of evidence and minimize problems.
Weve noticed a very uniform, consistent, well thought out series of cases over the past three years, where we can tell the difference in an area where there is standardized program and well trained as opposed to certain areas where there are samples missing. The SANEs took it upon themselves to take all the samples they could. Well-trained individuals can instil confidence in the complainant to maximize the information. The more often they gather the evidence, the better chance the lab has of maximizing the recovery of biological evidence. Because of doing it (the forensics kit) over and over again, they know how to do it. The more you do it, the more you know what to look for. By having one component constant, the SANEs, you are minimizing the chances of problems or missing evidence. Keeping things consistent, well organized, well ordered, well itemized has definite advantages. Having a nucleus of people who are well trained, know what to look for, have done it repeatedly and get feedback from us when we lecture to them maximizes return and, minimizes losses.
Representative of the RCMP Forensics Lab, SANE Evaluation Report, 2003
COMMUNITY INVOLVEMENT
The SANE Program provides educational sessions to medical groups, hospital staff, police and community groups. The program also responds to requests for information and assistance from outside HRM regarding immediate care of persons who have experienced sexualized violence, assistance with completion of sexual assault evidence kits, and guidance for implementation of SANE Programs in other areas within and outside the province. The SANE Coordinator is involved with various committees to provide collaboration, support, and education; for example, the IWK Multidisciplinary Child Protection Rounds, Atlantic Partners in Sexual Assault Response Committee, Halifax Sexual Assault Response Team (HSART), and the Forensic Nurses Society of Canada.
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CONTINUUM OF SERVICES: SUPPORT, INFORMATION & REFERRAL
SUPPORT, INFORMATION & REFERRAL

Support, information and referral are important components of all of Avalon Centres services. This service is also provided through what Avalon Centre calls general office contacts. General office contacts are defined as phone calls, emails, and walk-ins that do not result in direct service delivery from one of the other programs. While, they may not result in providing services, they are relevant to ongoing service delivery, support and advocacy provided by staff. The majority of these contacts are made by other service providers. They are looking for information and resources in order to refer clients to Avalon Centre. They are looking for consultation regarding issues pertaining to sexual assault and the law and/or regarding how to support their clients. Service providers are also looking for counselling referrals for males and for youth under age 16 who have experienced sexualized violence. Avalon Centre receives inquiries for how to partner with other service professional to address specific issues pertaining to sexualized violence. The next largest group of general office contacts comes from women who identify as persons who have experienced sexualized violence and non-offending parents, partners, friends, and supporters. They are looking for general sexual assault information, educational resources, and options after sexual assault, legal education, and referrals for other relevant services and supports. Other general office contacts may include: people seeking student placements, volunteer, or employment opportunities; students doing projects or research on sexual assault; researchers; and the media. 34 Avalon has been a refuge in my healing process, a place that has nurtured my courage and resilience, and a place where the shame and secrets could evolve into insight and healing. Avalon helped me find a voice for my experience with sexual abuse, to give it words and to broaden my perspective on what it means to address these things in my community. For survivors of sexual violence. Avalon may be the only place where they can speak their truth without fear of repercussion, and liberate themselves from secrecy and shame for the first time.
Participant in Avalon Centre Services
Other than immediate sexual assaults, which are addressed through the SANE program, Avalon Centre provides referrals for males who have experienced sexualized violence who call looking for services. The centre also receive inquiries about sexual assault issues from members of the general public looking to get more informed about or involved in addressing sexualized violence.
CONTINUUM OF SERVICES LEGAL SUPPORT AND ADVOCACY
LEGAL SUPPORT & ADVOCACY

The Legal Support and Advocacy Program is designed women who have experienced sexualized violence aged 16 years and older, non-offending parents, and survivors of historical sexual abuse. While parts of this program were offered through the years with volunteer support and project funding, in 2007 Avalon Centre received core funding from the Law Foundation of Nova Scotia and was able to create a program with a permanent staff position. Unfortunately, in 2012 as this model was being drafted, the Law Foundation funding was significantly reduced and Avalon Centre made the difficult decision to cut this program. Avalon Centre decided to leave this program in the model description because it has been an important component to the Continuum of Services. This program provides the following services: justice system navigation; information, individual advocacy and support; education; court watch; and liaison with the justice system and community agencies. Referrals are accepted at any stage before or during the criminal justice process. The following elaborates on these services. (a) Navigation Navigation assists with navigation through the criminal justice system. The Legal Support and Advocacy Worker presents options and provides information so that persons who have experienced sexualized violence can make informed decisions. (b) Individual Support and Advocacy Individual support and advocacy provides support related to reporting to police, court preparation and accompaniment, follow-
Thanks for everything and for keeping me updated. Who said there werent angels? (what ever the outcome!)
Participant in Legal Support and Advocacy Program
up, as well as individual advocacy for persons who have experienced sexualized violence as needed. (c) Education Education assists individuals, the general public, professionals and other service providers to improve their knowledge of the legal system and access to it. (d) Court Watch Court watch monitors and tracks sexual assault court cases. This maintains current knowledge of sexual assault cases, issues and trends, so that Avalon Centre is able to identify areas where improvement/change is needed. (e) Community Liaison and Collaboration Community liaison and collaboration focuses on liaising with police, Crown, Provincial Victims Services and community agencies. The purpose is to increase awareness of the program and to support collaboration among service providers to improve the systems response to persons who have experienced sexualized violence. For example, one initiative has been to consult with the Nova Scotia Barristers Society regarding a handbook for sexual assault victims regarding sexual assault myths and stereotypes. The Legal Support/Advocate is a member of the Halifax Sexual Assault Response Team (H-SART) and has been assisting with the formal H-SART protocols. 35
CONTINUUM OF SERVICES: SPECIALIZED THERAPEUTIC COUNSELLING
SPECIALIZED THERAPEUTIC COUNSELLING PROGRAM

The Specialized Therapeutic Counselling Program includes both individual and group counselling services which are based on feminist informed sexual assault/sexual abuse principles and a specialized counselling model. The sexual assault needs assessment (Rubin, 2008) identified the importance of a holistic, survivorcentred therapy provided by a community-based organization as follows: The wide-ranging and intensely harmful effects of sexual violence can seldom be overcome without specialized therapy. The therapeutic needs of sexual violence survivors are unique and require a specialized expert response. The current mental health services delivery model is ill-matched to the needs of sexual assault survivors. Best outcomes are achieved through delivery of specialized, holistic, survivor-centred therapy by communitybased agencies. The Avalon Centre model of this care is associated with positive outcomes for survivors, has received provincial and national recognition, and provides guidance as to best practices. (p. v)
sexualized dominance by males towards girls and women and that womens needs are unique and different from male or child survivors. The program offers a feminist lens in connecting sexism practices and attitudes, along with traditional gender socialization, in exploring with women the frequent occurrence and continuation of sexualized violence. The program recognizes a historical pattern of those being marginalized on the basis of gender, race, sexual orientation, age and ability, experiencing higher rates of oppression and violence, including sexual abuse/assault. It is the ongoing, day to day marginalization ingrained within the social fabric that serves as the underpinning for the most extreme expressions of dominance and violence. Over the years, Avalon Centre has continued to develop the specific knowledge and expertise required to deliver this feministbased counselling model which has been effective for women who have experienced sexualized violence. It has received provincial and national recognition, and provides guidance as to best practices. Counselling services are offered at Avalon Centre. The provision of a safe and empowering place for women is central in countering social isolation and stigmatization following sexual assault/abuse. This supports women reclaiming space, voice and dignity. Womens wisdom, skills and knowledge join together creating profound ripple effects of empowerment and healing. Most individuals who access the program live within the Halifax Regional Municipality or surrounding area. A small number travel a significant distance due to a lack of specialized counseling services for sexual assault/abuse in their communities. Counsellors provide phone support, information and referral to callers from other areas of the province.
POPULATIONS SERVED AND LOCATION

The counselling program is available to women, 16 and older, who have experienced sexual assault, childhood sexual abuse or sexual harassment. Individual counselling support sessions and group programs are offered to the non-offending parents of children who have disclosed sexual abuse. Information sessions are available for supportive partners of women accessing services. The specialized counseling program has been developed for women in recognition of the societal prevalence of gendered
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CONTINUUM OF SERVICES: SPECIALIZED THERAPEUTIC COUNSELLING FEMINIST INFORMED SEXUAL ASSAULT/ABUSE COUNSELLING PRINCIPLES
The following sexual assault/abuse counselling principles guide the Specialized Therapeutic Counselling Program and are described in detail in this section: (a) Social/Political Causal Explanation of Sexualized Violence (b) Strength/Resourced Based View of Those Seeking Assistance (c) Collaborative Relational Counselling Approach (d) Progressive Stepping-Stone Counselling Frame (e) Addressing Secondary Wounding (a) Social/Political Causal Explanation of Sexualized Violence Childhood sexual abuse and adult sexual assault are often defined as caused by patriarchal power imbalances that condone one group to dominate another on the basis of gender/sex, age, race/ethnicity, class, ability and religion. Often there is a perceived right to commit sexual assault by the offender as a result of entitlement and ownership. In addition, the victim/survivor can experience marginalization and/or depersonalization. This dynamic of dominance, control and oppression is reflected in all acts of sexualized violence regardless of the sex of the offender or the person who has experienced sexualized violence. Sexual assault is regarded as a gendered crime as the majority of offenders are male and the majority of those victimized are female. Feminist-informed scholars and therapists challenge explanations that reduce sexual assault to being an individual offence committed by those who are deviant, mentally ill, have a sex addiction. An individual pathology explanation fails to acknowledge the magnitude of sexual assault/abuse and its highly gendered nature. This causal explanation also fails to recognize socially condoned sexist stereotypes that fuel sexualized violence and common sexual assault myths that blame persons who experience sexualized violence and diminish the harm that has been caused. A genetic explanation fails to acknowledge that sexual assault/abuse is foremost an act of power and control and not a sex act. Explanations involving offenders being childhood victims are inadequate as they fail to account for the large number of offenders who were not child victims, nor the fact that the majority of child victims do not commit sexualized violence as adults.
(b) Strength/Resourced-based View of Those Seeking
Assistance Feminist therapists are careful to not create an individual pathology identity in the client through clearly naming sexualized violence as a social problem, along with not viewing the effects of the trauma as a sign of pathology or giving mental health labels/diagnosis. The various trauma impacts, including the survival methods developed in a best attempt to regulate an overactive nervous system, are seen as adaptive solutions that have worked to some extent but which carry difficult and sometimes dangerous side effects. An emphasis is placed on highlighting an individuals strengths, resources, skills, knowledge and abilities while fully validating the serious injuries caused by sexual abuse/assault experience(s) and the pain and grief that they are carrying. An emphasis is also placed on identifying important relational values and ethics that were dishonoured. The pain and grief are seen as a strong testament to the preciousness of these relational values and the losses created on both individual and societal level when they are not honored.
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(c) Collaborative, Relational Counselling Approach A collaborative counselling relationship is supported by the counsellor reducing the power differential in the therapeutic relationship as much as is possible. This is established by the counsellor providing transparency regarding her role including the limitations of this role and the organization, along with the counselling approach and principles followed. The client is given control in naming concerns she would like to focus on each counselling session and the therapist walks alongside providing validation, witnessing and helping to counter internalized shame or blame. The counsellor takes an active role in checking in when safety issues arise, the client moves into a trauma memory or survival state or when they may be at risk of sharing too much or moving too quickly and flooding. A relational approach is followed with a gradual building of safety and trust in the therapeutic relationship. This focus is seen as critical in providing a reparative experience to the significant trust betrayal central to the sexual abuse/assault. Issues that arise within the therapeutic relationship, including trust triggers with the therapist, are acknowledged and processed. (d) Progressive, Stepping-Stone Counselling Frame A stepping-stone approach to the healing journey supports the building of a safe container both within the counselling relationship and within the individual prior to uncovering or un-layering of the trauma effects and held emotion so that the process is manageable and workable. A focus is placed on addressing presentlife effects and integration of the trauma. Women are supported to maintain a solid connection with their adult resources when processing memories of childhood or early life sexual abuse/assault
In a collaborative, relational counselling approach, the counsellor reduces the power differential in the therapeutic relationship as much as possible. The client is given control in naming concerns she would like to focus on each counselling session and the therapist walks alongside providing validation, witnessing and helping to counter internalized shame or blame.
to prevent a reliving of the overwhelming powerless or helpless feelings. This approach does not place a focus on memory regression work. This counselling frame provides the essential conditions of adequate time, space and anchors to the present, which are essential for the incremental integration of the past trauma. This protects clients from the common experience of the counselling becoming too triggering, causing flooding and retraumatization. (e) Addressing Secondary Wounding Secondary wounding experiences also become a focus of the therapy. This includes failed responses by individuals and /or community providers or institutions, who directly or indirectly disregarded, disbelieved, minimized, discounted or diminished womans experience or implied blame or culpability in some way. Secondary wounding also includes stigmatizing the individual for the trauma effects they have developed or viewing them as permanently damaged or deficient or seeking unwarranted attention. A link is made between common attitudes that contribute to secondary wounding and the underlying cause of societal sexism and patriarchal oppression of groups that are marginalized. The counsellor protects from contributing to secondary wounding by placing a clear spotlight on the behaviors, attitudes and 38

strategies of the offenders, along with societal attitudes and institutional failures that foster these attitudes and allow them to persist rather than on questioning the womens behaviors. This makes it clear that there is no justification for sexual assault or no indirect implication that she was somehow responsible by the way she dressed, how much she drank, where she went, who she went with. The focus for sexual assault prevention is placed on stopping men from committing sexual assault rather putting the onus on women having to protect themselves. Because sexual assault is so prevalent, women need to be aware of common strategies and patterns used by those who assault. This is not intended to make women feel responsible for sexual assault and cannot guarantee that women are protected, as offenders are usually someone they know or who has befriended them, rather than a stranger. The same dilemma applies in the case of child sexual abuse. Parents need to be fully informed to help protect their children from offenders; however, most are known to the child and many are in positions of trust, including relatives and family members. Ultimately, it is named that everyone should have the right to live in a society free from fear and reality of sexualized violence to women, children and all individuals. Room is given for women's and parent's voices and anger that sexualized abuse/assault occurs and is so rampant, and for the many ripple effects, including secondary wounding experiences. This empowered outrage helps to counter any internalized blame or shame/guilt that was put onto those victimized by the offender, along with those conveying secondary wounding attitudes.
SPECIALIZED COUNSELLING MODEL

The specialized counselling model has four components as follows: (a) Areas of Healing (b) Stepping Stone Approach (c) Integrated Therapeutic Approach (d) Cautions in Relational Trauma Work (a) Areas of Healing This includes addressing the effects or impacts of sexual abuse/assault in all areas of ones life experience as follows: Relationship with oneself and ones body and sexuality, including self-beliefs and identity conclusions that are deficit or shame-based; Relationships with others around themes of safety, trust, control and intimacy; Physiological effects of an over-active arousal system, which increases sensitivity to triggers and a roller coaster of flight/flight, freeze/comply and attach survival reactions; Held grief related to significant losses in ones life due to early abuse/neglect and abandonment; and Spiritual despair and disillusionment about the world we live in and difficulty maintaining a sense of hope and connection.
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(b) The Stepping-Stone Approach The Stepping Stone Approach involves working with a gradual, progressive process to ensure safety. The three elements are described next. Foundations of Safety Focus involves: - Building a container of trust and control within the counselling relationship; - Learning about ones ability to remain present when trauma triggers/memories surface and exploring grounding practices and skills; - Addressing any safety issues within the persons present life relationships and circumstances, including any protection concerns following a recent assault; - Seeking appropriate outside assistance to first address any current severe safety concerns related to; mental/emotional health, addiction, or current abusive relationships, prior to beginning this specialized healing focus; - Extending ones support system and identifying sources of secondary wounding; - Beginning to counter misdirected blame and stigmatizing messages from others that create shame-based identity conclusions; and - Acknowledging demonstrations of protest, resilience despite injury, aspects of empowered identity, and islands of safety already rooted within the person and their lives. Relational Healing & Grieving Focus involves:
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Further countering layers of misplaced shame and an internalization of responsibility for the sexual abuse/assault experiences; Connecting with a building of protective anger in externalizing responsibility to the offenders, along with society for maintaining sexist and oppressive attitudes and practices, which are the root cause of sexualized violence; Continuing to identify triggered memory states using mindfulness awareness and expanding practices and skills in soothing/protection of vulnerable feeling states; Building a container of accompaniment, both within the person and within the counselling relationship for grief work and the gradual un-thawing and processing of pain and sorrow; Bearing witness to the full acknowledgement of the profound personal and social losses stemming from childhood sexual abuse and adult sexual assault; Processing existential despair regarding the state of the world; Deepening self-compassion and worthiness/dignity through the grieving process; Discovering ones strong voice and deep truth along this path and claiming the territory of ones life and ones body, more and more; and Defining multiple meanings for ones life now and in the remaining years and chosen relational ethics and practices that enrich our world.
Living Fully in the Present Focus involves:

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Deepening an exploration of effects within the selfrelationship and relationships with others, along with broader life view and spiritual effects.
Discovering more of oneself and ones preferences, likes, dislikes, dreams, passions and purposes; Coming further into presence and the experience of deepening our connection within;
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Expanding ones ability to remain more present in relationships with others and not loose oneself through moving into trauma memory states; Defining the boundary between self and others and challenging gender-based expectations for women to please or over-accommodate; Defining ones preferred experience of emotional and sexual intimacy; Expanding enjoyment of ones body and sexuality on ones own terms; and Bringing ones healing into relationships with others and the broader community and world.
The unique Avalon Centre Stepping Stone Approach has three elements:
Foundations of Safety Focus
Relational Healing & Grieving Focus

Living Fully in the Present Focus
(c) An Integrated Therapeutic Approach
The five aspects of this approach are feminist informed, relational approach, narrative response approach, mindful awareness, and body-centred as follows: Feminist Informed involves: A clear understanding of the causes of sexualized violence linked with societal sexism, along with other forms of oppression; Awareness of power dynamics within the counselling relationship and intention of reducing this imbalance through being transparent in how counsellors work; Striving to give the person control over the counselling and healing process, so long as they are able to access their adult capacities to attend to attend safety concerns when they arise; Seeking to assist people in re-accessing their present adult capacities when moving into triggered unsafe feeling states.
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Relational Approach The primary experience of healing comes from the reparative container offered through the therapeutic relationship. As the nature of the crime was relational, the repair must also be relational. Individuals come to experience who they are through the mirrors of their relationships. The mirroring provided by the abuser(s) was highly distorted and largely devoid of any true reflections of the person they abused. The emotional presence of the therapist serves to repair injuries to self-identity and trust. Counsellors reflect their presence through witnessing and mirroring back, offering acceptance and validation, being a real person in exploring challenges and triggers in the counselling relationship. This supports a process of coming to know and trust oneself and ones truth while restoring dignity and self-worth. Narrative Response Approach In keeping with the feminist informed analysis, a narrative response approach recognizes dominant sociocultural attitudes and judgments that devalue and oppress groups of people who are considered to be subordinate by gender, race, class, age, sexual orientation, ability etc. The impact of these dominant attitudes becomes internalized as disempowering identity conclusions by individuals in positions of less power and authority, which creates a ripple effect of stigmatization and a storying of self as inadequate and incompetent. A narrative response approach deconstructs and counters these false dominant stories and recognizes aspects of chosen identity that persisted through the trauma, along with ways people were able to resist the full control of the offender(s) over their minds, bodies and lives.
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Through my own experience, journey and evolution, I feel quite inspired, stirred and grounded all wrapped into one. Inspired to follow my own belief system, my own internal map and to do my best to love myself instead of blame myself.
Participant in the Specialized Counselling Program
Mindfulness Awareness involves:

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Working with triggered trauma survival states through building in mindfulness awareness skills; Increasing knowledge and recognition of present life associations that tend to lead to trigger trauma memory states; Gaining skills in remaining present and bringing oneself down from a panic reaction using self-talk and grounding to calm the mind and body; and Maintaining a connection to the mindfulness resources of the left-brain (problem-solving, reflective ability, self-soothing, regulating impulses) to calm the right-brain survival center when triggers occur.
Body-Centered involves:
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Integrating body-calming practices and self-nurturing activities into daily life to lower the threshold of an overactive physiological arousal response; Teaching people to sense when their energy is becoming hyper-aroused along with awareness of gradual levels of unwinding and coming down a notch or two; Teaching people to become more aware of hypo-aroused energy states and an awareness of a gradual coming back into the body and a feeling of connection with oneself and the environment; and 42

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Working to incrementally reoccupy the territory of the body including the feeling body, the sensate body and the sexual body, without this triggering strong trauma memories or a sense of shame
INDIVIDUAL COUNSELLING PROGRAM

Individual counselling is grounded in the Feminist-Informed Sexual Abuse/Assault Counselling Program Principles and Specialized Counselling Model developed by Avalon Centre. This specialized individual counselling supports women in addressing current life impacts stemming from sexual assault/abuse trauma in such areas as safety, trust, control, self-identity, intimacy and sexuality. It also supports women in understanding and linking together the broader impacts and challenges related to societal sexism and other forms of oppression. Due to underfunding and limited staff resources, the counselling program has wait lists and has instituted mandatory breaks. This creates significant challenges for the women who have experienced sexualized violence as well as the counsellors and would not be considered acceptable in an ideal model. These challenges are further outlined in the section Challenges to the Ideal Model, under Wait Lists and Mandatory Breaks in the Specialized Therapeutic Counselling Program. Waiting periods for counselling varies according to demand and the length of current wait lists. Due to wait lists, Avalon Centre offers counselling support over time-limited frameworks. Women are able to re-access further counselling sessions following a sixmonth or longer break. Many women reconnect in seeking these sessions to expand upon and deepen their processes of healing. All counselling services are self-referral and begin with a telephone request. This can be followed by an initial consultation session, foundational safety sessions and relational trauma healing sessions.
(d) Cautions in Relational Trauma Therapy Work Two cautions in relational trauma therapy work include avoiding flooding and re-traumatization as well as reducing the therapy and therapist triggering survival states as follows: Avoiding Flooding and Re-traumatization by:
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Protecting women from feeling overexposed or lost in trauma memory states following initial sessions through revealing too much too quickly and not building in enough safety through containment and grounding strategies; Being careful in not encouraging people to get in touch with trauma memories or feelings of buried grief when this has a disorganizing, dissociative effect; and Learning about the persons ability to remain present when emotions surface.
Reducing the Therapy and Therapist Triggering Survival States

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Taking great care in building initial trust and transparency to increase the persons ability to feel in control and in their adult self; Working to ensure that counsellors are being clear and consistent regarding boundaries around their availability and limits, and not contributing to creating expectations that they cannot fulfill; Not getting into power struggles with protector stage (fight or flight) but rather working to align with and validate concerns as much as possible, while emphasizing the mandate of counsellors to ensure safety.
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(a) Initial Consultation Session An initial consultation session provides support while mutually exploring the fit of specialized counselling for each individual's most important current needs. These consultation sessions are offered to each person within two to four weeks following the initial call. Those who identify a serious present life safety concern including: a harmful addictive pattern, a mental health difficulty or ongoing violence by a partner, continue to be referred to appropriate specialized services in the community and may re-access Avalon services at a time of greater safety. Women who have identified as having experienced a recent sexual assault (within the past month) are prioritized to receive quicker access to a consultation session (within one to two weeks of their request call). (b) Foundational Safety Focus The program offers short-term foundational safety building counselling sessions (from 1-10) to women and non-offending parents who are currently experiencing a heightened time of crisis following a recent sexual assault or discovering that their child has been sexually abused. These quicker to access shortterm sessions are also offered to women who are currently experiencing overwhelming flashbacks related to past sexualized abuse/assault. (c) Relational Trauma Healing Focus The program offers relational healing-focused counselling sessions (from 1-20) to support women who have established sufficient emotional safety to name, acknowledge and have witnessed the many impacts and losses surrounding past childhood sexual abuse and/or adult sexual assault experiences. A focus is placed on countering the disempowering effects of sexualized violence and societal sexism to support reclaiming and healing. This relational trauma healing focus is supported through creating much safety within the counselling approach. (d) Follow-up Sessions Follow-up sessions are available for those who have completed Foundations of Safety or Relational Healing Focus sessions and no longer require ongoing contact. These sessions provide women with the opportunity to practice skills they have learned, while having the reassurance of follow-up contact if they begin to experience a resurgence of trauma effects. They are offered on a case by case basis according to need.
GROUP COUNSELLING PROGRAMS

Group programs include a variety of theme-focused groups and workshops for women who have experienced childhood sexual abuse and/or adult sexual assault, as well as, information sessions for supportive partners and parents. Group programs can expand and deepen healing begun in individual counselling through providing a connection to a community of mutual support, validation, inspiration and vision. The counsellors have developed a Stepping Stone Model for Group Preparation as follows: Counsellors recommend an individual counselling focus to begin prior to suggesting group work. Individual counsellors raise group work as a possibility to those who show readiness indicators as the counselling process moves along. Pre-group meetings provide each person with the opportunity to meet with the group facilitators to further explore the fit of a particular group focus with the persons healing process.
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The following indicators have been developed for group work readiness: The person holds the ability to maintain a connection with an adult grounded presence when experiencing strong emotions and trauma memories surface. (Does not become fully flooded and shift completely into dissociative survival states; fight/flight, freeze/comply, attach). They are able to maintain self-awareness and access self-calming/soothing to avoid becoming overwhelmed. The person is not at a crisis point and has been experiencing a time of stability over a consistent period. The person holds the ability to feel empathy for others, to relate with others and to listen and focus on others. The person has the life space to commit to regular group attendance at this time. Following the Stepping Stone Model, the Group Model SteppingStones are: (a) Foundations of Safety Focus (b) Relational Healing Focus (c) Living Fully in the Present Focus It is important to note that programs evolve and change over time as needs change. The following are examples of current programs within each Stepping Stone. (a) Foundations of Safety Focus Examples of programs are the Grounding Practice Series, Information Session for Parents and Information Session for Partners.
It made the healing process seem easier than to do it on your own. Avalon gave me my life back and made me realize that its okay to connect with your feelings and acknowledge them. I feel alive again.
Grounding Practice Series is a beginning series of four sessions offered to women who have experienced any form of past sexual violation. The series is intended for women who would like to learn and share foundational grounding practices, which help in working with anxiety and trauma reactions. This focus includes: developing an understanding of the bodys protective response to trauma memories or flashbacks; countering social stigmatization surrounding trauma reactions; exploring grounding and calming practices; and, relating grounding to mindfulness awareness as an important aspect of healing. Information Sessions for Parents are available to the supportive parents of young women seeking services when this is requested. These sessions are intended to help parents understand and respond to the aftermath following disclosure including: validating parents feelings and needs for support, naming possible impacts and trauma responses for both themselves and their child and supporting the healing journey. These are offered when there is sufficient interest. Information Sessions for Partners provides education and support to partners of women coming to Avalon Centre and focus on the effects of sexual assault/abuse trauma, secondary impacts for partners, and possibilities for supporting healing and recovery. This session is offered when there is sufficient interest. 45

(b) Relational Healing Focus The following are examples of programs that are offered: Weaving Our Wisdom Workshop, Honoring Our Chosen Identities, and Recognized Losses, Spoken Grief. Weaving Our Wisdom Workshop is a day and a half workshop for women who have experienced adult sexual assault. This program is designed for women who are beyond the immediate crisis of the assault and have been moving through a process of addressing impacts in individual counselling. The workshop themes are empowerment focused challenging and countering sexual assault myths and stereotypes, and defining respect and mutual consent in relationships. Honoring Our Chosen Identities is an 8-session group for women who have experienced sexual abuse or assault in earlier years. The group is offered to women who have been on a healing journey and are interested in coming together to share perspectives and offer witnessing and inspiration to one another. Healing and empowerment themes are offered for the group to explore. A significant focus is in countering messages that marginalize women and stigmatize those who have experienced sexual abuse/assault. Women work together in deconstructing negative identity stories and beliefs connected to sexualized violations and sexism. They support one another in connecting with chosen identities, values and relational practices. Recognized Losses, Spoken Grief is a 12-session group for women who have experienced sexual abuse/assault in childhood/teen years. The group is offered to women who are at a place in their healing where they are moving through a process of making personal losses visible connected with earlier life abuse and abandonment experiences. The group explores and names unique aspects of traumatic grief stemming from the relational I have been in workshops with women who have had the courage to speak the truth. These women have supported and encouraged me to go on at times when I was afraid and discouraged.
betrayals that occur with sexual abuse/assault. The group serves as a witness in voicing and acknowledging significant losses and hurts that often remain hidden and minimized in society. Through this process, a clarity and conviction of vital and chosen practices and ethics in relationships evolves, as well as deepening of self-trust and worthiness. It is important that participants have set the groundwork for this deep focus and that the group represents a natural next step. A guided format supports a process of safely moving stages and layers of a grieving process. (c) Living Fully in the Present Focus Celebrating Intimacy is a current program in the Intimacy and Sexuality Workshop Series. It offers three sessions for women who have moved through a significant process of healing past sexual abuse/assault experiences and who feel ready for a significant present life claiming focus around the themes of intimacy and sexuality. This begins with deepening self-intimacy and experiencing a fully embodied connection through embracing sexuality. Group members work together in separating sexuality and intimacy from sexualized violence and oppression. From a cornerstone of self-intimacy and embodied presence, the group then explores their chosen experience of intimate relating and closeness with others. 46
COMMUNITY ENGAGEMENT FOR SOCIAL & SYSTEM CHANGE

In addition to the delivery of services, Avalon Centre has a commitment to address broader social and systemic inequalities and injustices, as well as mobilizing the community to take collective action to reshape societal norms and change systemic responses to sexualized violence. When working with persons who have experienced sexualized violence and supporting them to access the health, criminal justice or other systems, care providers invariably identify barriers to accessing services as well as lack of or gaps in services. This results in recognizing the need to advocate for system change, either change in public policies or improvements to services and programs. It is important to note that this individual or case advocacy always informs system or policy advocacy. This section describes three broad advocacy strategies that focus on community engagement for social and system change: Awareness and Community Mobilization, Research and Policy Change and Collaboration. The purpose of each strategy is as follows:
findings; and (3) to persuade key decision-makers to change policy or improve services.
Collaboration: The objectives of this strategy is to build teams and partnerships among community groups, womens organizations, universities, schools, and government agencies to deliver innovative services, improve services, improve system coordination, and develop/improve policies and protocols
While these strategies are described separately in this section, they are often used together to strengthen the advocacy effort. For example, awareness and community mobilization may use collaboration strategies. Similarly, research and policy change may use both awareness and community mobilization and collaboration strategies. Community engagement means engaging a variety of audiences depending on the purpose of the initiative. Community can be universal (the general public), selective (targeted to those at risk) or indicated (targeted to persons who have experienced sexualized violence, offenders, or bystanders) as defined by the Awareness and Prevention Approach (Section 3). It also includes engaging and working with community organizations, womens organizations, universities, schools and government agencies. As defined earlier in the model, advocacy for system change or system advocacy can be broadly defined as an action directed at changing laws, policies, practices, programs and attitudes of any type of institution. More specifically, policy advocacy also focuses on system change but more specifically targets changes to policies and legislation. Policy advocacy initiatives seek to establish new policies, improve existing policies or challenge the development of policies that diminish resources and opportunities for vulnerable groups of people. Policy advocacy usually seeks to 47
Awareness and Community Mobilization. The objectives of this strategy are: (1) to raise public awareness and mobilize people and communities to take action to address myths and stereotypes about sexualized violence; (2) to support persons who have experienced sexualized violence; and (3) to hold offenders accountable for their harmful behaviour. Research and Policy Change: The objectives of this strategy are: (1) to provide key decision-makers with information, analysis and policy or service alternatives as a result of a research initiative; (2) to provide education related to research

engage various sectors of the government which includes public servants, political appointees, elected officials, and legislators.
AWARENESS AND COMMUNITY MOBILIZATION

The primary focus of awareness and community mobilization is to address sexualized violence as a systemic societal issue. This strategy uses the Avalon Awareness and Prevention Approach which focuses on persons who have experienced sexualized violence and offenders of sexualized violence, as well as engaging bystanders members of the general public. The objectives are as follows: To mobilize the general public to take action to address myths and stereotypes that perpetuate sexualized violence; To support persons who have experienced sexualized violence; and To hold sexual offenders accountable for their harmful behaviour. This strategy is used effectively by Avalon Centre when staff are engaged in community/legal education and professional training programs such as public awareness campaigns, community/legal and school-based education, and professional training. One example of this strategy is the Stop It ASAP! Initiative which grew out of a partnership between Avalon Centre and the Halifax YWCA. Participants in the YWCA FLY-W programs requested a presentation from Avalon Centre. Following this, Avalon Centre, in partnership with the YWCA, received a grant from the Canadian Womens Foundation to implement the Sexual Assault Awareness and Empowerment Project for Girls/Young Women undertaken in 2010-11. Renamed, Stop it ASAP!, the story of this awareness and community mobilization strategy is described further in the box to the right.
Stop it ASAP! started with a presentation to the Halifax YWCA FLY-Y groups because many of the young women who participate in the FLY-Y groups are vulnerable to sexual victimization, gang violence, drugs, and/or sex trade work and wanted to learn more. The Girls Action Group at Citadel High School also requested sexual assault education and peer education training and they were invited to participate in Stop It ASAP! The Coordinator worked with six Fly-W groups (girls age 1115) and the Girls Action Group to provide training and support activities. Avalon Centre provided first responder training to FLY-W staff and peer leaders. The Coordinator conducted interactive participatory sessions about sexual assault awareness/ prevention and empowerment. Each group created their own empowerment activity/tool which included T-shirts and cookies with awareness and empowerment messages, spoken word, posters, a radical cheer, and a video based on the ASK campaign. The next step is to develop promotional and educational tools relevant to youth, based on ideas and outcomes from Stop it ASAP! This will include a facilitators guide and workbook for youth to support running similar programs. Due to the projects popularity and requests for participation from other groups, Avalon Centre and the YWCA applied for and received funding to coordinate a Sexual Assault Youth Outreach Education project.
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COMMUNITY ENGAGEMENT FOR SOCIAL & SYSTEM CHANGE RESEARCH AND POLICY CHANGE
Research and Policy Change provides key decision-makers with information, analysis, and policy alternatives; and then focuses on persuading them to make the policy or program changes. This can be done through participation on government task forces and working groups, presentations to government departments, media releases, public statements, and press conferences to cite a few examples. Because decision-makers are more likely to be persuaded by factual information, research is often used to gather factual information in order to advocate for change. Avalon Centre uses many forms of research. Court watch or observation is one research method that Avalon Centre uses. Court watch maintains current knowledge of sexual assault cases, issues and trends, so that Avalon Centre is able to identify areas where improvement/change is needed. Media watch is another research activity through which Avalon Centre can track how the media is dealing with sexual assault cases. This has led to Avalon Centre speaking out and advocating for change in the way the police, court and media handled various sexual assault and dangerous offender cases. Avalon Centre has also conducted or been involved in a number of formal research studies that have made recommendations that include policy alternatives or improvements to services. Sometimes collaboration is used as a strategy to strengthen the research and to provide a collective voice for change. Once the research is complete, the focus turns to educating government stakeholders on the findings of the research and persuading them to take action on the recommendations. Various activities are used such as media releases, meetings with government departments, joint working groups, etc. The following are some of the recent research initiatives: Metro Response to Sexual Assault: Policies, Protocols and Procedures of the Halifax Regional Police and the Public Prosecution Service is a research project, aimed at improving the response to sexual assault by identifying areas in which policy and protocol for the Halifax Regional police and the Public Prosecution Service could be developed or changed. This was funded by Status of Women Canada. Restorative Justice in Nova Scotia: Womens Experiences and Recommendations and Implementation for Positive Policy Development, was a participatory research project funded by Status of Women Canada. Partners were Avalon Centre, Transition House Association of Nova Scotia (THANS), National Association of Women and the Law, Womens Centres Connect and the Elizabeth Fry Society. The report made recommendations for policy development and implementation. The next step involved a joint working group with representatives of the Department of Justice, police, Crown, and the Restorative Justice Womens Coalition to study the findings and the future of Restorative Justice in Nova Scotia. The Womens' Innovative Justice Initiative (WIJI) was phase II of the Restorative Justice research project. Its focus was to assess the current status of innovative alternative justice planning and programming in Nova Scotia. LINKs is an example of advocacy at the federal level. LINKS was a national research study conducted by the Canadian Association of Sexual Assault Centres (CASAC). The report, Canadas Promises To Keep: The Charter and Violence Against Women, was released in 2003. In May 2004, with the goal of increasing judicial awareness, Avalon Centre presented to the Federal and Provincial Courts Community Liaison Committee challenging those present to
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consider whether womens Charter of Rights are being violated in the Criminal Justice System. conference with focused on continuing coordinated efforts to respond to sexual assault in Nova Scotia. By 2011, the Halifax Sexual Assault Response Team (HSART) formalized the HSART protocols for responding to, investigating, and prosecuting sexual assaults in HRM and supporting a coordinated response to sexualized violence. HSART is comprised of Avalon Sexual Assault Centre, The Halifax Regional Police/RCMP Halifax Integrated Sex Crimes Unit, The IWK Women and Childrens Hospital Child Protection Team, Nova Scotia Department of Justice Victim Services, The Provincial Sexual Offender Treatment Program, and the Public Prosecution Service Halifax/Dartmouth. Joint Initiatives with the Halifax Regional Police. As a result of numerous complaints from persons who have experienced sexualized violence, their families, and other service providers about the way that police were dealing with persons who have experienced sexualized violence, Avalon requested a meeting with the Halifax Regional Police (HRP). A similar meeting was also held between HRP and other community agencies in the HRM. This meeting marked the beginning of a number of joint initiatives between Avalon and HRP. Avalon Centre and HRP developed a police-training curriculum for patrol officers, Major Crime investigators and cadets. HRP consulted Avalon Centre and the SANE program when revising their standard Operating Procedures for Responding to Sexual Assault. Avalon Centre and the SANE Program are asked to assist the RCMP Halifax Detachment in the interviewing process for their Sexual Assault Investigation Team. (b) Partnerships to Deliver Awareness and Community Mobilization Programs Avalon Centre partners with a number of organizations on an ongoing basis to deliver programs that raise awareness about sexual 50
COLLABORATION
Collaboration is another strategy that has been used effectively by Avalon Centre to advocate for change and to improve the quality of services for those most profoundly and directly affected by sexualized violence. It demonstrates how communities can work together to speak out and to find solutions to address sexualized violence, and to support persons who have experienced sexualized violence. Avalon Centres collaborative efforts are important to improving services, delivering innovative services, system coordination, and changing policy. Relationships have been formed at the local, provincial and national levels. (a) Collaboration to Improve Services and System Coordination The following are examples of the way collaboration improves system coordination and the way services respond to persons who have experienced sexualized violence. Making A Difference (MAD) and Halifax Sexual Assault Response Team (HSART). A joint team comprised of members from the Halifax and Antigonish Sexual Assault Community Response Teams participated as one of the eight teams from across Canada to participate in the Making A Difference (MAD) Conference in Ottawa in 2004. MAD Canada is an initiative to improve the collaborative responses of community sexual assault response teams (SARTs). Two years later, Avalon Centre, Halifax Regional Police and RCMP jointly hosted a national Making a Difference

assault. These organizations include universities, schools, Youth Health Centres, and the Halifax Sexual Health Centre. Avalon Centre partners with a number of organizations to deliver specific projects. For example, Avalon Centre partnered with the Youth Health Centres and the YWCA to carry out the Sexual Assault and Empowerment Project. They also partnered with the Nova Scotia Barristers Society to develop a victims' rights booklet called, Sexual Assault Myths and Stereotypes. (c) Collaboration to Deliver Innovative Direct Services and Remove Barriers to Access These relationships are essential to ensuring effective service delivery. For example, the SANE program partners with four health care facilities throughout HRM to enable better access to services. The Legal Support and Advocacy Worker liaises with the Halifax Regional Police, RCMP, Nova Scotia Public Prosecution Service, and Department of Justice to support persons who have experienced sexualized violence, to navigate the criminal justice system, and to facilitate access to services. (d) Cooperation and Professional Education Avalon Centre has developed partnerships with agencies and groups to deliver sexual assault awareness training modules. These include Halifax Regional Police, the Nova Scotia Association of Womens Centres (Connect), Immigrant Settlement and Integration Services, NS Guidance Counsel Association, Halifax Community Justice Society, and the Transition House Association of Nova Scotia (THANS). Avalon Centre partners with organizations organize and deliver educational conferences for service providers with the goal of The whole thing has become a partnership that developed. We have common goals in the partnership which are recovery of the victim, quality care, (the victim) should not have to be revictimized, and providing a better experience for the victim. It took several years to build up trust. We also opened up our doors to them (Avalon Centre) with respect to our investigation policies. They worked with us and participated in drafting of policies related to sexual assault. We also do joint training ventures and give the SANE program access to data and trends that we are seeing related to investigations.
Halifax Regional Police, SANE Program Evaluation, 2003
improving services for persons who have experienced sexualized violence. One example is the Atlantic Partners in Sexual Assault Response which has organized a number of conferences. The partners are: Halifax Regional Police Sex Crimes Unit, the IWK Child Protection Team, Department of Community Services Child Protection Team, and others. Avalon Centre collaborates with a number of agencies to provide professional consultation and strategic planning related to sexual assault services. These include the following: Antigonish Sexual Assault Response Team, Cape Breton Interagency on Family Violence, IWK Child Protection Team, the Department of National Defense Investigation Services, Acadia University, Saint Marys University, and Dalhousie Medical, Law and Nursing Schools.
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CHALLENGES TO ACHIEVING THE IDEAL COMPREHENSIVE MODEL
ORGANIZATION SUPPORTS
This section describes the organization supports for the model which are: community-governed; accountability; strategic planning; staff team; professional development; policies and procedures; and financial stability and sustainability. This section outlines these supports. Being a community-based organization and grounded in the community, Avalon Centre is flexible to be both responsive and proactive to address sexualized violence. This feature is a critical component of the Avalon Model and shapes the organization supports. Therefore, this section starts with a further elaboration on what is meant by community-based and flexible. Avalon Centres community-based model is an excellent and effective model that strongly supports the delivery of the services. In addition, program partners indicated that independence and flexibility enables issues to be addressed more quickly and effectively than within larger institutions.
Sane Program Evaluation (2003)
COMMUNITY-BASED AND FLEXIBLE

The Avalon Sexual Assault Centre is a registered, not-for-profit, community-based organization. Being community-based is an important feature of the model for a number of reasons. First, it enables Avalon Centre to be close to the ground and responsive to community needs. Secondly, the means that the community has a strong voice in how services are delivered. Thirdly, the centre is governed by a community Board of Directors who bring their community perspective to overall policy and planning processes. Finally, the centre is directly accountable to the community through its registration as a non-profit organization and its by-laws which require the organization to report annually to the community at an annual meeting. With benefits of being community-based, Avalon Centre has developed professional, specialized services for persons who have experienced sexualized violence that are provincially and
nationally recognized. The SANE program evaluation (Mahon, 2003) which included interviews and focus groups with a wide range of program partners, found that Avalons community-based model is an effective model that strongly supports the delivery of the services. In addition, program partners indicated that independence and flexibility enables issues to be addressed more quickly and effectively than within larger institutions. It also increases community ownership of sexualized violence and, hence, community commitment to finding solutions.
COMMUNITY-GOVERNED
Avalon Centre is governed by a volunteer Board of Directors. Board members carry out their role and responsibilities through Board meetings, standing and ad-hoc committees and their relationship with the Executive Director and staff. Only women can serve as Board members. The Board makes every effort to reflect the diversity of the community through nominations to the Board and to maintain a pro-woman, feminist perspective. Governance has a dual role. On the one hand, it has a goal of protection of the public interest through the various Board functions which include responsibilities for selecting the Executive 52

Director and assessing her performance; reviewing and authorizing policies and strategic plans; ensuring continuance of the organization through compliance with financial, legal requirements and Board nominations; evaluating the organization's work; and public relations. On the other hand, the Board plays a support role through fundraising, sharing knowledge and skills with the organization, and a working relationship with staff. yearly statistical reports. These track program demand, comparisons overtime, key trends, and program issues. Community Education and Training This program gathers information on types of requests and who is making requests for programs and resource materials. This is compared year to year to determine any increase or decrease in demand and to identify patterns from year to year. A review and analysis of trends or themes is used to assess strengths and gaps in programs and resource materials. Participant evaluations are conducted for education and training sessions. These are collated and reviewed to revise existing programs, create new services, and resource materials required. An annual internal review of programs and services determines the priorities and time line for the coming year. Similarly, an annual audit and inventory of resource materials identifies quantity distributed, requirements for the coming year including and revisions required. Sources for this process include resource and presentation request forms; input (phone, email, verbal, written) from service providers, Avalon Centre staff, students, general public and program participants; reports (monthly, interim and year end); order invoices; and office call statistics. SANE The program undergoes ongoing review of statistics and trends documented in monthly, quarterly and annual reports. Evaluation of client care is done through client satisfaction surveys distributed to all clients following their care in the Emergency Room. Evaluation of SANEs and the care provided is undertaken, both formally and informally, through reviews of all charts by SANE staff, random peer chart reviews, and case reviews. SANEs also provide peer feedback. This is done formally with new SANEs and informally on a regular basis with all SANEs. Any issues, trends, 53
ACCOUNTABILITY
The Board of Directors is accountable to the community through its registration as a non-profit organization and its by-laws. As required through their by-laws, Avalon Centre holds an annual general meeting and reports to the community on its activities. The centre is also accountable to various funding agencies for management of the funds received from those sources.
PLANNING & EVALUATION

One function of the Board of Directors is to provide overall direction through strategic planning. This includes a Vision, Mission, Guiding Principles, Key Result Areas (KRAs), and Goals. Because Avalon Centre is a community-based organization, Avalon Centre staff can be responsive to community needs and trends when designing programs and activities. As noted in the Model of Care (Section 3), Avalon Centre implements several monitoring and data collection systems and reports these statistics annually through the annual report. The centre also has developed systems for feedback and evaluation. The following outlines how various programs are evaluated. Specialized Therapeutic Counseling and Group Programs This program gathers statistical information which includes the daily client direct service logs and the monthly, quarterly and

themes, or gaps in the program are continually assessed and addressed, with adjustments made as required. A number of staff belong to professional associations which require ongoing training to maintain standing. Two counsellors are members with the Canadian Counselling and Psychotherapy Association, which has very specific professional development requirements for trainings and courses approved. The SANE Coordinator is a member of (International Association of Forensic Nurses (IAFN) and the Forensic Nurses Society of Canada (FNSC). In addition to education sessions, several of the SANEs have specific certification. Four SANEs hold a SANE-A (Adult/Adolescent) Certification and the SANE Coordinator also holds a SANE-P (Pediatric) Certification. One SANE has pursued additional baccalaureate level education in forensic nursing. The SANE Coordinator holds a Certificate in Forensic Nursing and is pursuing graduate studies in forensic nursing. One of the counsellors in the Therapeutic Counselling Service is supported by external specialized supervision from a physician who works out of the Boston Trauma Centre for difficult complex trauma cases. This specialized supervision enables counsellors to be more effective in extreme cases.
MULTI-DISCIPLINARY STAFF TEAM

The multi-disciplinary staff team works collaboratively to deliver the continuum of services. The team includes core staff, contract staff, project and casual staff. These include counsellors, health practitioners, educators, advocates, and activists. The permanent staff are as follows: Executive Director Office Manager Coordinator of Individual Counselling and Group Program Services Counsellor Legal Support and Advocacy Worker Intake/Support Worker Coordinator, Community/Legal Education and Training Coordinator, SANE Program Administrative Assistant, SANE Program Contract staff includes the self employed SANEs who are contracted by Avalon Centre to work for the SANE program. Project and casual staff are hired to carry out specific projects and initiatives when funded.
POLICIES AND PROTOCOLS

Avalon Centre has adopted policies which guide Board decisionmaking as well as operational policies for various programs. In addition, joint policies and protocols have been developed with various agencies to support improved responses to persons who have experienced sexualized violence.
PROFESSIONAL DEVELOPMENT
Avalon Centre has a commitment to providing professional development opportunities for staff. These include educational sessions and conferences which provides an opportunity for staff to share their knowledge and experiences and to incorporate evidence-based strategies into their practice.
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Board Policy Manual The Board of Directors has a board policy manual and binder which is distributed to all board members and guides Board decision-making. Specialized Therapeutic Counselling Policies The Specialized Therapeutic Counselling Program has a number of policies and forms for their program as follows: Right to Refuse Services Policy Right to Refuse Service-Group Policy Conflict of Interest-Dual Relationships Policy Confidentiality of Counselling Files Policy Individual Counselling Contract-Foundations of Safety Focused Sessions Individual Counselling Contract-Relational Healing Focused Sessions Counselling Records Release Form Release of Information Consent Form; and Client Interpreter Confidentiality Agreement SANE Program Policies The SANE program has both operational and administrative guidelines as well as Sexual Assault Nurse Examiner guidelines. The latter, Guidelines and Protocols for the Sexual Assault Nurse Examiner, Metro Halifax Sexual Assault Response Program, were adapted from the Ontario Sexual Assault Program and incorporated guidelines related to: (1) the SANE qualifications and job description; (2) education, certification, and program planning; (3) administering various medical tests and treatments; and (4) referral to a physician. These guidelines are included in the Sexual Assault Nurse Examiner Training Manual for Metro Halifax. Because SANE services are delivered through the hospital emergency rooms, the SANEs follow the hospital policies for medications and treatments, consent to treatment, confidentiality, and all other applicable policies according to the formal agreement with the facilities. The CDHA and IWK Sexual Assault policies have been revised in consultation with the SANE Coordinator and include response protocols by hospital personnel as well as SANEs. Policies for collection of forensic evidence and storage (freezing) were developed by the SANE program, were vetted through the policy and procedure process within each health care facility, and have been adopted by each health care facility. SANE response flowcharts were developed showing the various roles and relationships of the SANE, the emergency room nurses, physicians and social workers, and with other teams within the QEII and the Dartmouth General, and with the IWK Child Protection Team. The response flowchart is different for the IWK because of the age of the person who has experienced sexualized violence, the collaboration with the IWK Child Protection Team or After Hours Crisis Team, and the requirement for Child Welfare to be called. The response to prepubescent children is also different with only one SANE responding and providing the medical exam. Although there is a collaborative exam and evaluation, the ER physician is ultimately responsible for the medical evaluation of the children in these cases. Each hospital has a binder related to SANE in the emergency department, which contains the flowcharts and monthly on-call schedules. Each hospital has a private designated area for the SANE examination.
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HSART Protocols The Halifax Sexual Assault Response Team (HSART) formalized in writing the HSART protocols for responding to, investigating, and prosecuting sexual assaults in HRM and supporting a coordinated response to sexualized violence. Joint Policies with the Halifax Regional Police (HRP) The Halifax Regional Police and Avalon Centre worked together to jointly develop policies and protocols in response to persons who have experienced sexualized violence. sufficient counsellors to eliminate wait times for individual therapeutic counselling; and (2) additional services such as a sexual assault crisis line, justice system accompaniment and on-call community-based advocates. This is further outlined in the next section, Challenges to Achieving the Model.
FINANCIAL SUSTAINABILITY
Financial Stability and Sustainability is one of Key Result Areas identified by the Board of Directors. Priorities include fundraising, diversifying funding sources and relationships with funders. The agencies providing core funding include: the NS Department of Community Services, NS Department of Health and Wellness through the IWK Health Centre, and The Law Foundation of Nova Scotia. Avalon Centre has received project funding from the NS Advisory Council on the Status of Women, the NS Department of Justice, Status of Women Canada, the Canadian Womens Foundation, Department of Justice Canada, Victim Fund, Youth Secretariat and the NS Public Interest Research Group (NSPIRG). As noted earlier in the model, the centres core funding had remained stagnant for over 10 years which resulted in reduction or elimination of some services. At the same time, the demand for services has increased. In 2011, after several presentations, the Department of Community Services granted a $70,000. increase in core funding. This increase was greatly appreciated; however, to fully achieve a comprehensive sexual assault service delivery model, Avalon Centre requires the following: (1) increased resources to strengthen services to meet demand, such as adding 56
CHALLENGES TO ACHIEVING THE MODEL

Avalon Centre staff and Board members felt it was important to identify some of the current challenges they face in sustaining the Avalon Model as well as challenges in moving toward a full range of services or a comprehensive model as described in the recent provincial needs assessment for sexual assault services. This section puts forward some of these challenges and starts with clarifying what is meant by a comprehensive model.
THE NEED FOR A PROVINCIAL STRATEGY TO ADDRESS SEXUALIZED VIOLENCE.

The needs assessment report (Rubin, 2008) pointed out that, because Nova Scotia does not have a planned strategy to address sexual assault, the province lacks nearly all the components that typically comprise a comprehensive response in other jurisdictions. This has resulted in communities struggling in isolation to address this issue and an ad hoc patchwork of attempts to meet Nova Scotians needs without adequate resources. The following summarizes the findings related to services available in Nova Scotia outlined in the report.xi A review of services by county revealed that only the provision of general information is uniformly present at an adequate level across the province. A provincial 24 hour crisis line response, on-call community-based advocates, justice system accompaniment, and specialized services for men and transgendered individuals are virtually absent in the province. Some services are only available in some areas of the province. For example, Avalon Centre is the only centre to offer specialized therapeutic counselling for women and this program is severely underfunded. Based on the population of Nova Scotia and the General Social Survey (GSS) victimization rates for NS in 2004 (with an estimated 30,000+ survivors), there should be approximately 37.5 counselling positions in Nova Scotia. With only 3 positions serving the entire province through Avalon Centre, the specialized therapy needed for recovery from sexual assault is inaccessible to most Nova Scotians. Similarly, Avalon Centre is the only centre that has funding for public education, community/legal education, and school-based programs, although a good portion of this work is undertaken with special project funding rather than core funding. 57
COMPREHENSIVE SEXUAL ASSAULT SERVICES

The provincial Sexual Assault Needs Assessment (Rubin, 2008) reported that the best response to sexualized violence is a comprehensive one based on the uniform provision of services that encompass personal healing, education, prevention, advocacy, and working synergistically in communities to address root causes and harms of sexualized violence. The report put forward thirty-eight (38) implementation recommendations for a comprehensive response to sexualized violence in Nova Scotia. The needs assessment identified eight core services for a comprehensive model as follows: Specialized Therapeutic Counselling Basic Survivor Support (information and referral) Crisis Lines On-Call Community-Based Advocates Justice System Accompaniment Sexual Assault Nurse Examiners (SANES); Services for Men, and Professional Education.

There are only two SANE programs in Nova Scotia. One is offered through Avalon Centre for Halifax Regional Municipality (Capital Health and IWK Health Centre). The second is offered through the Antigonish Womens Resource Centre and Sexual Assault Services Association in partnership with the Pictou County Strait Health Authority (PCHA) and in partnership with the Guysborough, Antigonish, Strait Health Authority (GASHA) and St. Francis Xavier University. Avalon Centre, Colchester Sexual Assault Centre, and to a lesser extent, Antigonish Womens Resource Centre and Sexual Assault Services Association have delivered specialized training to professionals to prevent secondary wounding. Any service in Nova Scotia must commit to reducing barriers to access. The needs assessment indicated the need for cultural competency, access to transportation, access for persons with disabilities, and addressing challenges for rural communities. Finally, there is a need for local service structure to be created and strengthened in key areas of Nova Scotia and to develop coordinated approaches in order for sexual assault services to be delivered effectively and efficiently throughout the province. expanding SANE services across the province (Rubin, 2007). This included establishing community-based SANE programs modeled on Avalon Centre SANE program across the province; and, a provincial coordination mechanism to ensure efficient start-ups, training, community collaboration, and standardized practices and philosophy of service. The Sexual Assault Needs Assessment was occurring in a similar timeframe, with the report completed in 2008. As follow-up to the needs assessment and as mentioned earlier in the model, the Nova Scotia Advisory Council on the Status of Women hosted a one-day workshop with community-based womens groups and key government stakeholders to discuss the current situation of sexual assault services in Nova Scotia and the following Areas of Action as follows: Models for Services and Standards Provincial Wide Prevention Programs Specialized Therapeutic Counselling Standards for SANE Services and Phasing in SANE Programs Barriers to Access and Cultural Competency. Within these action areas, some specific activities discussed to phase-in sexual assault services were: - Develop standards for delivery of sexual assault services for Nova Scotia; - Develop an implementation plan to phase in comprehensive services for preventing and addressing the harms of sexualized violence in Nova Scotia; - Develop a plan to implement standards, models and training programs to enable cultural competency; - Effect Provincial Standards for community based SANE Programs; 58
THE NEED FOR STANDARDS AND COORDINATION TO ENSURE QUALITY, CONSISTENT SERVICES
Avalon Centre has recognized the need for expansion of services across the province, for standards and coordination to ensure quality, consistent services, and to address barriers to access. In 2006, Avalon Centre was approached by the Department of Health to make recommendations concerning the provincial development of SANE programs because of their experience in delivering their highly successful community-based SANE program. Avalon Centre submitted a report with twenty-six recommendations for

Develop an implementation plan to phase in SANE Programs across the province; and Develop a province-wide prevention program based on effective, evidence-based prevention models. funding shortages, Avalon made the difficult choice of shutting down the After Hours Sexual Assault Response Line. The Avalon SANE program has only been able to partially fill this gap with the Avalon SANE Response Line by responding to calls from persons who have experienced an immediate sexual assault. Another example is the Specialized Therapeutic Counselling Service which saw a reduction in the number of counsellors from 3.7 positions in 2008 to 2 positions in 2010-11 due to financial pressures. In 2011, with a funding increase, the number has increased to three counsellors. This program is severely underfunded. Earlier, it was pointed out that, with an estimated 30,000+ survivors in Nova Scotia, there should be 37.5 counselling positions in Nova Scotia. At this time, there are only three positions for all of Nova Scotia. Through innovative community partnerships and proposals for project funds, Avalon Centre has been able to innovate and add programs and services over the years. For example, the SANE Program began as a pilot project and received core funding from the Department of Health and Wellness through the IWK Health Centre in 2004. Similarly, legal education began as project funding and for several years has been funded from year to year by the Law Foundation of Nova Scotia. In 2007, a permanent staff position was created to support the Legal Support and Advocacy Program. In 2012, Avalon Centre learned that this funding would be significantly reduced due to the current global economic situation impacting on interest rates for the Law Foundation and made the difficult decision to cut the program. While project funding can be helpful to initiate a program, it is difficult to sustain those programs beyond project funding without adequate staff and funds. The challenge with services being funded this way is the potential lack of consistency if funding is eliminated. This impacts on the ability for those who have experienced sexualized violence to access 59
The next step, before moving forward, was to document the Avalon Model.
THE NEED FOR ADEQUATE RESOURCES FOR SERVICES

Avalon Centre has been able to gradually evolve the Avalon Model, based on twenty-five years of community engagement and being responsive to emerging needs. Financial constraints, however, have been a major determinant in which services to offer and to what extent. Some of the challenges that Avalon Centre faces with its current services are as follows: Ability to consistently offer services and sustain programs; Ability to respond to requests for education and training; Wait lists and mandatory breaks in the specialized therapeutic counselling program; Access to services and programs; and Gaps in specialized counselling services for men, transgendered individuals and youth. (a) Ability to Consistently Offer Services & Sustain Programs The ability to consistently offer services and sustain programs is an ongoing challenge with limited core funding supplemented with project funding. One difficulty has been having no choice but to eliminate or reduce services and staff due to insufficient core funding, in spite of increased demand for services. For example, in 2005, due to

consistent, quality services and for Avalon Centre to continue to provide innovative prevention programs for particular populations, such as youth. (b) Wait Lists and Mandatory Breaks in the Specialized Therapeutic Counselling Program. Due to underfunding and limited staff resources, the counselling program has wait lists and has instituted mandatory breaks. This would not be considered acceptable in an ideal model, because it creates significant challenges for the women who have experienced sexualized violence and for the counsellors. With wait lists, counsellors prioritize access for women who have experienced a very recent assault; however, many who call due to past sexual assault/abuse are in high levels of crisis and distress. Being on a wait list, following an initial consultation, can result in losing those whose courage to come in lessens with each passing day. Women who do wait report significant experiences of posttrauma related distress while they are waiting. The mandatory breaks are imposed following participation in up to 20 counselling sessions and women are able to re-access counselling following a six-month or longer break. This causes great difficulties, particularly for women who have experienced the most extensive trauma often involving multiple sexual abuse/ assault experiences and abusers beginning in childhood. For these women, the mandatory breaks damage the fragile trust that has been established gradually over time and often trigger profound abandonment feelings leading to a rupture in the counseling relationship. This tends to set off a significant crisis response resulting in a set-back and lost ground that was hard won. Counsellors faced with the need to impose wait lists and mandatory breaks with those experiencing high levels of suffering and isolation experience moral distress, which contributes most significantly to a build- up of vicarious trauma. Counsellors may attempt to compensate by taking on too many clients and overworking. This not only harms the physical and emotional health of counselors, but can also impact their ability to remain fully emotionally present in difficult sessions or with those experiencing ongoing crisis. Other impacts can include increased sick time or the loss of staff as they become more and more depleted. These outcomes have a very negative impact on the clients that have established significant trust with them. (c) Ability to Respond to Requests for Education and Training For the Community/Legal Education and Professional Training Program, limited resources restrict the ability to respond to requests for education and training or to travel to participate in initiatives outside HRM. Furthermore, is difficult to address more than one issue at a time. For example, while focusing on youth programs, other populations and issues are not being fully addressed. Requests for one program often lead to other requests from the same organization. For this program area, the challenge is finding a balance between responding to requests and being proactive to work with priority populations and continue with the ongoing social change strategies. (d) Access to Services and Programs Avalon Centre is committed to reducing barriers to access. The SANE Program and the Specialized Therapeutic Counselling Program have identified outreach services as important to reach populations such as African Nova Scotians, First Nations and immigrant communities who may be less likely to access services in downtown Halifax or at the four healthcare institutions. The counselling program has also identified a need for services for women with intellectual disabilities and those with a hearing 60

impairment. To improve access, the SANE program would like to establish satellite units or a mobile SANE unit in select locations outside the four healthcare institutions. Satellite locations could also be an opportunity for offering counselling in these communities. In addition, the counselling program would like to be able to build a more diverse counselling team. Avalon Centre produces educational tools and resource materials on various topics that are distributed throughout Nova Scotia to be made available to the general public and /or for specific campaigns. They would like to be able to continue to produce these materials; however, without adequate funding, it is challenging to continually update and distribute this resource material. Resistance, fear and lack of understanding of sexualized violence can present barriers to accessing the Community/Legal Education and Professional Training Program. For example, some administrators, service providers, and legal/law professionals are reluctant to initiate or participate in sexual assault related endeavours because they fear that addressing the issue implies their organization has a sexual assault problem. Similarly, some parents, service providers, administrators are uncomfortable talking about sexualized violence with youth or want to protect youth from the issue, so they avoid engaging youth in sexual assault education. Also, some participants are not open to examining their beliefs regarding sexual assault myths, gender stereotypes, and victim blaming. (e) Gaps in Counselling Services for Men, Transgendered Individuals, Youth and Children Another challenge is the lack of specialized counselling services for men, transgendered individuals, youth and children. Avalon Centre has actively advocated for these services to be offered in the community. Avalon Centre has not developed these services for 61 two reasons. The first is that their current resources cannot meet the current demand for womens counselling services. Secondly, the development of services to fill these gaps would require significant resources for program development, additional facilities to provide safe, supportive environments for service delivery, and the specific expertise and training required to appropriately meet specific needs of children, youth, men and transgendered individuals.
MOVING TOWARD COMPREHENSIVE SERVICES

There is no doubt that Avalon Centre is underfunded and that Halifax Regional Municipality is underserved with respect to sexual assault services. Similarly, communities across Nova Scotia are underserved with little or no services in most areas. There is no doubt that a provincial strategy will begin this process of transitioning to a comprehensive approach to providing quality, consistent services throughout the province. Avalon Centre remains committed to continuing to advocate for improved services in the HRM area and for standards and coordination to ensure quality, consistent services throughout Nova Scotia. Avalon Centre is encouraged that an interdepartmental committee has been established by the Department of Health and Wellness. The documentation of the Avalon Model is an important step to move forward with a comprehensive strategy assuring quality services accessible to all Nova Scotians.
GLOSSARY OF TERMS
GLOSSARY OF TERMS
The following are definitions of terms used in the Avalon Model. Victim A victim is defined as someone who has experienced some form of trauma, be it emotional, sexual, psychological or physical. A victim is immobilized or prevented from living a life similar to his/her life prior to the trauma. This person is in a victimized state. Survivor A victim is someone who has been victimized but is healing and beginning to cope with the trauma and is working towards getting beyond the traumatic event. Thriver While no one can completely get over or forget a traumatic event, a thriver is someone who has gone through the various stages of healing to get beyond trauma and is able to function and participate in life in a meaningful way. Healing Healing is the process of getting beyond trauma. There are levels or stages of healing that people experience. People heal or overcome trauma in different ways and at different speeds. Sexualized Violence Sexualized violence is an overarching term that includes a physical or psychological violence and harassment. Language can sometimes operate to obscure the deliberate acts of violence and use of power and control tactics by offenders who rely on sexist cultural norms to shift culpability to victims and reformulate rape and other sexualized assaults as some sexual activity. Avalon Centre takes a clear position that sexualized assaults are acts of unilateral violence and dominance and the language needs to
highlight the deliberate tactics of offenders as well as the many ways that women resist. Sexual Violence Sexual violence is an umbrella term for sexual assault, abuse and harassment, etc.. It is used to indicate the vastness and all encompassing impact unwanted sexual acts can have on the individual and on a society. Sexual Assault Sexual Assault is a crime of brutality and/or intimidation. Sexual assault is ANY act that invades an individuals sexual privacy. Sexual assault may range from verbal obscenities to rape. It is an act of power and control over the victim. Sexual assault is a crime of violence because the victim is subjected to the aggression of the assailant. It is NOT a crime of sex. The feelings associated with sexual assault are disgust, shame, humiliation and powerlessness. It not only violates someone physically but may also affect a persons sense of safety and ability to control his/her own life. Sexual Abuse Sexual Abuse is used to describe a pattern of sexual violations which often occurs over a period of time. Secondary Wounding The reactions of those in formal or informal support roles to individuals disclosures of recent or past sexual abuse/assault experiences have a direct impact on how the person will continue on the journey of recovery. The messages that are directly or indirectly implied can have a damaging impact upon the persons identity beliefs and sense of personal competence and worth, along with their basic trust and safety with others, community institutions and world-view. Secondary wounding experiences are common for victims of crime and violence. Many victims report that their secondary wounding 62
GLOSSARY OF TERMS
experiences were more painful and devastating than the original traumatic event because the shock of the original betrayal was further coupled by a subsequent betrayal from those who were regarded as sources of support. The most important factor, which helps to determine the extent of long-term post trauma effects for an individual, is the level of support she/he receives following a traumatic event. A growing body of research is indicating that those victimized by sexual assault are often denied help by their communities, and what help they do receive often leaves them feeling blamed, doubted and re-victimized. Client-Centred, now Collaborative, Relational Approach Avalon Centre is not actively using the term client-centred however, the term is still included in the Guiding Principles, therefore the definition is included. A client-centred model which Avalon is now calling a Collaborative Relationship Approach, recognizes that each persons needs and paths are unique; and s/he must feel empowered to make informed decisions about her/his situation. Programs are based on the assumption that the person using services brings a valuable perspective of her/his life situation. Staff work collaboratively with clients and honor the wisdom, perspectives, values and choices of each person. Cultural Safety Cultural Safety is an action that enables safe services to be defined by those who receive the service which is achieved through relationship building that focuses on increasing the capacities, opportunities, and choices of individuals, groups, and communities accessing care. Cultural Competency Cultural competence refers to the attitudes, knowledge, skills, behaviours and policies required to better meet the needs of all people served. Culture refers to a group or community that share common experiences that shape the way its members understand the world. It is multi-layered, evolving and includes groups that individuals are born into or become such as; national origin, levels of ability, gender, sexual orientation and identity, race/ethnicity, socioeconomic class or religion. People have multiple cultures. Cultural competence can work to reduce disparities in services, address barriers to services, and respectfully respond to the diversity of Nova Scotians which encompasses race, ethnicity, language, sex, sexual orientation, gender identity, (dis)ability, spirituality, age, geography, literacy, education and income, etc. (NS Department of Health and Wellness, 2008, p. 1). Advocacy There are different types of advocacy and many definitions. The Avalon Model focuses on three types of advocacy: self advocacy, individual or case advocacy; system and policy advocacy which focus on system change. The definitions are provided below:
Self Advocacy refers to an individuals ability to effectively communicate, convey, negotiate or assert his or her own interests, desires, needs, and rights. It involves making informed decisions and taking responsibility for those decisions. Individual or Case Advocacy seeks to uphold the rights and interests of individuals on a one-to-one basis to solve problems and/or secure needed services. It promotes social inclusion and social justice. Advocates work in partnership with an individual on either a short-term or issue-specific basis to support them and 63
GLOSSARY OF TERMS
take their side. An advocate (1) listens and works with an individual requiring one-to- advocacy support; (2) creates a safe environment; (3) develops a plan of action (sometimes called an individual advocacy plan) in partnership with the individual that maps out clearly defined goals; (4) educates individuals about their rights; and (5) assists them to navigate the system (legal, medical, community services, etc). xii

Tertiary Prevention focuses on long-term responses after sexualized violence has occurred that enables the person who has experienced sexualized violence to deal with ongoing impacts, including lasting trauma effects.
System Advocacy or Advocacy for System Change refers to an action directed at changing the laws, policies, practices, programs and attitudes of any institution. Policy Advocacy refers to advocacy tactics, strategies and initiatives which specifically target changes to policies and legislation. Policy advocacy seeks to establish new policies, improve existing policies or challenge the development of policies that diminish resources and opportunities for vulnerable groups of people. Policy generally refers to 'social' policy. Policy advocacy usually seeks to engage various sectors of the government which includes: public servants, bureaucrats, political appointees, elected officials and legislators. All policy advocacy should be generated by case advocacy.xiii
Patriarchy Patriarchy can be broadly defined as social organization that structures the dominance of men over women; control by men of a disproportionately large share of power; and a society or institution organized according to the principles or practices of patriarchy
Prevention Avalon Centres Awareness and Prevention Approach utilizes the public health model that focuses on harm reduction, where prevention is articulated as primary, secondary or tertiary prevention. The following are definitions related to sexual assault:
Primary Prevention focuses on activities that take place before sexualized violence occurs. Secondary Prevention focuses on immediate responses after sexualized violence has occurred that enables the person who has experienced sexualized violence to deal with immediate and short term effects and to prevent further trauma. 64
REFERENCES
REFERENCES
Atkinson, B. (1999). The emotional imperative: Psychotherapists cannot afford to ignore the primacy of the limbic brain. Family Therapy Networker, 23(4), 22-33. Brennan, S. and Taylor-Butts, A. (2008). Sexual Assault in Canada 2004 and 2007 (Catalogue No. 85F0033M No. 19). Ottawa, ON: Canadian Centre for Justice Statistics. Campbell, R., Wasco, S. M., Ahrens, C. E., Sefl, T., & Barnes, H. E. (2001). Preventing the second rape: Rape survivors experiences with community service providers. Journal of Interpersonal Violence, 16, 12391259. Canadian Panel on Violence Against Women, Marshall, P.F., & Vaillancourt, M.A. (1992). A progress report Ottawa, ON: Author. Chu, J. (1998). Riding the therapeutic roller coaster: Stage-oriented treatment for survivors of childhood abuse. In J.A. Chu, Rebuilding shattered lives: The responsible treatment of complex post traumatic and dissociative disorders. New York: Wiley & Sons. Mahon, P. (2003). Sexual assault nurse examiner (SANE) program evaluation report Halifax, NS: Avalon Sexual Assault Centre. NS Advisory Council on the Status of Women, 2011. Fact Sheet on Sexual Violence December 2011[On-line] women.gov.ns.ca/factsheets.html Halifax, NS: Author. NS Department of Health and Wellness. (2008). Cultural competence guidelines for the delivery of primary health care in Nova Scotia, Updated 2011. http://www.novascotia.ca/DHW Halifax, NS: Author. Perreault, S and Brennan, S. (2010). Criminal victimization in Canada, 2009 (Catalogue No. 85002X, Vol. 30, no. 2). [On-line]
http://www.statcan.gc.ca Ottawa, ON: Canadian Centre for Justice Statistics. Rubin, P. (2003). Restorative justice in Nova Scotia: Womens experience and recommendations for positive policy development and implementation Halifax, NS: Womens Innovative Justice Initiative. Rubin, P. (2007). Building a coordinated sane network for Nova Scotia: A Community-based, victim/survivor-centred model. recommendations of the Avalon Sexual Assault Centre Halifax, NS: Avalon Sexual Assault Centre. Rubin, P. (2008). Suffering in silence: An assessment of the need for a comprehensive response to sexual assault in Nova Scotia Halifax, NS: Avalon Sexual Assault Centre. Rubin, P. (2011). Exploring service options for youth victim/ survivors in Halifax Regional Municipality Halifax, NS: Avalon Sexual Assault Centre. Statistics Canada. (2004). 2004 General social survey, Housing, Family and Social Statistics Division, Ottawa, ON: Author. Statistics Canada. (2011). Family violence in Canada: A statistical profile (Catalogue no. 85-224-X). [On-line] http://www.statcan.gc.ca Ottawa: ON: Author Thomas, P. (2005). Dissociation and internal models of protection: Psychotherapy with child abuse survivors. Psychotherapy: Theory, Research, Practice, Training, 42(1). Trippany, Helm, Simpson, (2006) Trauma reenactment: Rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counselling, 28, 95 110.
65
END NOTES
END NOTES
i
Two reports with recommendations related to implementation of sexual assault services for Nova Scotia are: Suffering in silence: An assessment of the need for a comprehensive response to sexual assault in Nova Scotia (Rubin, 2008) and Building a coordinated SANE network for Nova Scotia: A communitybased, victim/survivor-centred model (Rubin, 2007). ii This section has been adapted with permission from the report: Rubin, P. (2008). Suffering in silence: An assessment of the need for a comprehensive response to sexual assault in Nova Scotia. Halifax, NS: Avalon Sexual Assault Centre, pp. 33-34.
iii
Assessing violence against women [electronic resource]: a statistical profile. Issued also in French under title: valuation de la violence contre les femmes, un profil statistique. Status of Women Canada. (2002). The Avalon Model of Care has been adapted from the Winnipeg Womens Health Clinic Model of Care. Adapted from Avalon Centres Analysis of Approach. Community Development Society http://www.comm-dev.org/ Taken from the pamphlet, Avalon Sexual Assault Centre, The Sexual Assault Nurse Examiner Program and What Happens at the Hospital, Compassionate Care for Victims of Sexual Assault. The Sexual Assault Assessment Service ran out of the Infirmary Hospital from 1986-97. .
iv
v vi
vii
viii
ix x xi
The first SANE program was set up in 1998. The exception to this was the summer months due to holiday schedules. Adapted with permission from Rubin, P. (2008). Suffering in silence: An assessment of the need for a comprehensive response to sexual assault in Nova Scotia. Guy, A. (2004). Case Advocacy and Active Citizenship BCASW Summer Newsletter [On-line] http://www.vcn.bc.ca/seatosky/advocacy.pdf. http://provincialadvocate.on.ca/main/en/what/types_advocacy.cfm
xii
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66

The Avalon Model: Empowering Individuals and Communities To Respond To Sexualized Violence

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The Avalon Model: Empowering Individuals and Communities To Respond To Sexualized Violence

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Avalon Sexual Assault Centre

The Avalon Model:

The Avalon Model:

Community Engagement for Social & System Change ............. 47

Continuum of Services ................................................................ 20 Community/Legal Education & Professional Training .............. 22

Challenges to Achieving the Model ............................................ 57

The SANE Program ...................................................................... 28

Glossary of Terms........................................................................ 62 References.................................................................................... 65 End Notes ..................................................................................... 66

THE AVALON MODEL: A MESSAGE FROM THE EXECUTIVE DIRECTOR

THE AVALON MODEL: A MESSAGE FROM THE EXECUTIVE DIRECTOR

THE AVALON MODEL: A MESSAGE FROM THE EXECUTIVE DIRECTOR

THE AVALON MODEL: A MESSAGE FROM THE EXECUTIVE DIRECTOR

A WORD ABOUT LANGUAGE

AVALON MODEL OVERVIEW

Community Based & Flexible

COMMUNITY ENGAGEMENT SOCIAL AND SYSTEM CHANGE

Multidisciplinary Staff Team

Specialized Therapeutic Counselling

Awareness & Community Mobilization

Planning & Evaluation

Legal Support & Advocacy

Awareness & Prevention

Support, Information & Referral

Policies & Standards

Sexual Assault Nurse Examiner (SANE) Program

Collaboration Financial Sustainability Professional Development

THE HERSTORY OF AVALON SEXUAL ASSAULT SERVICES

THE HERSTORY OF AVALON SEXUAL ASSAULT SERVICES

THE HERSTORY OF AVALON SEXUAL ASSAULT SERVICES

WHY DOCUMENT THE AVALON MODEL

WHY DOCUMENT THE AVALON MODEL?

DEMAND FOR SERVICES ACROSS NOVA SCOTIA

PREVALENCE OF SEXUALIZED VIOLENCE

WHY DOCUMENT THE AVALON MODEL

PROVINCIAL NEEDS ASSESSMENT

AVALON MODEL OF CARE

WHY A COMMUNITY-BASED FEMINIST MODEL FOR ADDRESSING SEXUALIZED VIOLENCE?

AVALON MODEL OF CARE

THE AVALON MODEL OF CARE

Figure 2: The Avalon Model of Care

Individual & Community Empowerment & Safety

Vision, Mission &Guiding Principles

Awareness & Prevention

THE FOCAL POINT: INDIVIDUAL & COMMUNITY EMPOWERMENT & SAFETY

AVALON MODEL OF CARE FEMINIST LENS

The Feminist Lens

AVALON MODEL OF CARE VISION, MISSION AND GUIDING PRINCIPLES

AVALON MODEL OF CARE AWARENESS AND PREVENTION APPROACH

Directed at persons who have experienced sexualized violence, offenders, or bystanders

AVALON MODEL OF CARE

Figure 3: Avalon Centres Approach to Care

Monitoring & Evaluation

Reducing Barriers to Access

Research & Policy Change

Individual & Community Empowerment & Safety

Multi-disciplinary Team Open & Transparent Processes

Awareness & Community Mobilization

AVALON MODEL OF CARE

Professional Training and Consultation

Specialized Therapeutic Counselling - Individual and Group Programs

Legal Support and Advocacy