Reducing the incidence of domestic violence: An observational study of an equine‐assisted intervention

Abstract

This paper is presenting results from an observational study which has measured the impact of an equine‐assisted education (EAE) intervention on the future occurrence of domestic violence within the family over 1 year following completion of the intervention as part of the troubled families program. The data analyzed were collected by the local authority troubled family's team from the different agencies involved including crime, health, and social care data. The data were analyzed and compared across four groups, those families on the troubled families program who had a key worker with a member or members who had attended and completed the equine‐assisted intervention (n = 268); those families who were on the troubled families program but no support had been offered (n = 10,569), those families who were on the program and were being supported by a key worker only (n = 2119), and those families on the program who were being supported by a key worker and had received further support, not from the equine‐assisted intervention (N = 1119). Significant reductions in domestic violence and child in need status were found for those families who had a member or members attend and complete the equine‐assisted intervention under study. Those families referred to the equine‐assisted intervention also had significantly more complex needs than those in the other groups. Referrals to this intervention are normally for those families for whom talk‐based interventions such as parenting, or education‐based interventions are not working.

Full text

Family P rocess . 2022;61:549–570.
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549
wileyonlinel ibrary.com/journal/famp
Received: 23 Septembe r 2021
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Revis ed: 18 February 2022
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Acce pted: 19 Febr uary 2022
DOI: 10.1111/famp.12768
ORIGINAL ARTICLE
Reducing the incidence of domestic violence: An
observational study of an equine- assisted intervention
AnnHemingway | KeziaSullivan
This is an open acce ss art icle under the t erms of the Creative Commons Attribution- NonCommercia l License, which per mits
use, d istribution an d reprodu ction i n any med ium, prov ided the original work i s properl y cited a nd is not us ed for com mercial
purposes.
© 2022 The Aut hors. Family Process publish ed by Wil ey Perio dicals LLC on beh alf of Fam ily Pro cess Instit ute
Ann He ming way and Kez ia Sul livan c ontributed equ ally to t his work.
Depa rtme nt of Medic al Sci ence &
Public Health, Bournemouth Un iversit y,
Bourne mouth, UK
Correspondence
Ann He ming way, Depar tment of Medical
Scie nce & Pub lic Hea lth, Bournemouth
University, Bour nemouth G ateway Bu ildi ng,
Bournemouth, Dorset BH1 3LT, UK.
Emai l: aheming way@bournemouth.ac.uk
Abstract
This paper is presenting results from an observational
study which has measured the i mpact of an equine- assisted
education (EAE) intervention on the future occurrence of
domestic violence within the family over 1 year follow-
ing completion of the intervention as part of the troubled
families program. The data analyzed were collected by
the local authority troubled family's team from the differ-
ent agencies involved including crime, health, and social
care data. The data were analyzed and compared across
four groups, those families on the troubled families pro-
gram who had a key worker with a member or members
who had attended and completed the equine- assisted in-
tervention (n=268); those families who were on the trou-
bled families program but no support had been offered
(n=10,569), those families who were on the program and
were being supported by a key worker only (n = 2119),
and those families on the program who were being sup-
ported by a key worker and had received further sup-
port, not from the equine- assisted intervention (N=1119).
Significant reductions in domestic violence and child in
need status were found for those families who had a mem-
ber or members attend and complete the equine- assisted
intervention under study. Those families referred to the
equine- assisted intervention also had significantly more

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BACKGROUND TO THE TROUBLED FAMILIES PROGRAM
IN ENGLAND
This paper is presenting results from an observational study which has measured the impact of
an equine- assisted learning (EAE) intervention on the future occurrence of domestic violence
(DV) within the family over 1year following completion of the intervention as part of the trou-
bled families (TF) program.
The TF program was launched in England in 2012 and is now in its second iteration (2015–
2020 and 2021/2022) having been developed further following an initial evaluation (MHCLG,
2020).
The program focuses on supporting families with multiple problems. Each family must
include dependent children and/or expectant parents and have at least two of the following
problems. Crime and antisocial behavior, education, poor life chances, poor living standards,
domestic abuse, domestic violence, mental/physical health issues (and in the county under
study here at least one child in need, CiN). This program is run from the Ministry of Housing,
Communities and Local Government (MHCLG, 2002) and is managed by upper tier local
authorities in England. This EAE intervention is used as one possible intervention on the TF
program in a county in Southern England and is run by a charity which now has five centers
across Southern England. The intervention is an equine- assisted education (EAE) intervention
which is referred individuals and families who are experiencing mental health and behavioral
issues when talk- based options such as educational or parenting skills/talk- based therapy or
group therapy services are not being attended or having a positive impact. Individuals or fam-
ilies referred to the charity have often been referred to multiple services without impact prior
to attending the EAE intervention. This paper focuses on the charities work with families
referred to them by the local TF program specifically focusing on the impact of the charities
intervention on DV and Child in Need (CiN) status.
The second iteration (2020– 2021; MHCLG, 2020) of the TF program has the following aims:
For local services to transform the way that public services work with families with multiple
problems to take an integrated, ‘whole family approach’ and help reduce demand for reactive
services. To demonstrate that this way of working results in lower costs and to make work
an ambition for all troubled families, whole family working on the TF program is facilitated
by a keyworker who agrees a single plan with the family across local services. The intention
is to increase resilience by offering support with parenting, mental health issues, household
budgeting, and inter- parental relationships. Services or interventions offered to families are
organized around needs rather than around agency boundaries. This includes joint commis-
sioning, shared data systems and a common referrals procedure.
It is important to note that the TF program has been criticized due to its approach to la-
belling families and its focus on reducing worklessness in families rather than looking at the
context within which they live, including, for instance, local poverty, lack of opportunity, and
access to support services overall but particularly in relation to mental health and drug and al-
cohol issues (Hayden & Jenkins, 2014). This is an important and relevant critique of this policy
initiative, it is, however, not the focus of this paper.
complex needs than those in the other groups. Referrals to
this intervention are normally for those families for whom
talk- based interventions such as parenting, or education-
based interventions are not working.
KEYWOR DS
domestic violence, equine assisted, troubled fami ly's program

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HEMINGWAY ANd SULLIVAN
The Crime Survey for England and Wales (CSEW, 2 018) estimates of domestic violence/abuse
are based on a broad def inition covering male and female victims of par tner or family non- physical
and physical abuse, threats, force, sexual assault, or stalking. The statistics in 2018showed that:
7.5% of women and 4.4% of men were estimated to have experienced domestic abuse in 2016/2017,
equivalent to an estimated 1.2million female and 713,000male victims. Overall, 26% of women
and 15% of men aged 16– 59had experienced some form of domestic abuse since the age of 16.
These figures were equivalent to an estimated 4.3million female and 2.4million male victims.
However, following the first COVID- 19lockdown in March 2020, an increase in DV was
captured by the Office for National Statistics (ONS 2021; House of Commons Library, 2021).
In mid- May 2020, there was a 12% increase in DV cases referred to victim support services.
Between April and June 2020, there was a 65% increase in calls to the national DV helpline
in comparison with the first 3months of 2020. DV remains an important increasing crime in
England which can result in serious injury and murder and this situation has only worsened
during the COVID- 19 pandemic. The long- term impacts on whole families of DV are extensive
and enduring including mental health and emotional issues. These may include post- traumatic
stress, flashbacks, nightmares, anxiety, and depression and may impact on children's behavior
and educational/developmental trajectories (House of Commons Library, 2021). This high-
lights the importance of the TF program in England.
Background to equine- assisted services (EASs)
Equine- assisted services (EASs) are an umbrella term including programs with leisure (equine
activities), educational (Equine- Assisted Education, EAE), or therapeutic (Equine- Assisted
Therapy, EAT) goals. EASs are often offered by a multidisciplinary team depending on the
needs of the participants involved. This paper will focus on Equine- Assisted Education (EAE).
The UK EAE landscape has been growing rapidly over the past decade, gaining media cover-
age particularly in relation to young people's mental health during and recovering from the
COVID 19 pandemic (Strength & Learning Through Horses, 2020) and growing support from
councils (Equilore Equine Therapy & Learning, 2021; South Downs Equine Therapy, 2020)
alongside Equine Facilitated Therapy (EFT). There is currently no universally agreed industry
standard, and these terms are often conf lated. However, as a rule, EFT includes a qualified
therapist, whereas EAE can be facilitated by anyone and tends not to include riding (Horses
Teaching & Healing, 2021). This broad distribution of activities and qualifications which can
be considered relevant to EAE means that the gold standard for the industry is yet to be set.
The intervention under study here falls under EAE.
Qualitative research has captured the communication skills, calmness, and pride which
young people experienced through attending an EAE program (Dell et al., 2011). In addition,
an EAE program provided in a young offender's institution was studied by Hemingway et al.
(2015) who gathered both qualitative and quantitative data on the impacts of the program
which included enhanced feelings of calmness and a greater ability to engage with education.
Prison guards also reported improvements in behavior for the young men who attended the
program, while a qualitative study undertaken in Guatemala with an EAE program which
taught participants natural horsemanship skills with the aim of reducing violent behavior re-
corded positive reflections from participants in relation to enhanced calmness (Gibbons et al.,
2015 ).
A waiting list randomized controlled trial has been published (Pendry & Roeter, 2013) which
evaluated the effect of an EAE program teaching natural horsemanship skills to enhance chil-
dren's social competence. The findings show significant positive changes (moderate effect size)
in 5th to 8th grade children in the USA. In 2014, a study using a waiting list crossover design
(Hauge et al., 2014) was published which explored the effect of an EAE with adolescents aged

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FAMILY PROCESS
12– 15. The study found that the intervention group achieved a significant increase in their
perceived social support following the EAE program in comparison with the control group.
In 2015 (Boshoff et al.), an experimental study was published which had collected data on
the effect of an EAE on subjective well- being, problem- focused coping, and emotion- focused
coping. The results of this research showed signif icant positive changes in young men in a cus-
todial school in South Africa.
In 2019, a qualitative study was published (Watson, 2019) which explored the experiences
of children and parents attending the intervention under study here. The analysis generated
four overall themes emerging from their experiences; ‘change as a journey’, ‘seeing is believing;
‘a chance to shine’, and ‘making connections’. Quotes from the participants included in the
paper showed that parents felt they had tried all they could at home in relation to helping the
young people change their feelings and behavior. When these youngsters participated in this
intervention, however, and the parents were able to witness the changes in their children from
observing the intervention and the ref lective discussions; this really helped with the change
process for parents and children. In addition, as parents are normally present during the inter-
vention, they too had their own experience of what they had seen and what they had witnessed
their child do. Parents described a significance in seeing something that enabled belief in the
possibility of change for the family.
A recent systematic review suggested a need in future for studies to offer more precise de-
tails of the EAE interventions being researched and where appropriate to use validated mea-
surement tools in addition to in- depth qualitative evaluation (May et al., 2016).
Overall research to date therefore has found that the interaction between humans and
horses may have an impact on behavior, quality of life, and well- being; however, small sample
sizes and wide variations in approaches to equine- assisted interventions make the evidence
base limited. There are currently few studies focused on the theory of change in relation to
how these interventions may work and further randomized studies to test their effectiveness
are lacking from the literature.
Summary of published EAE literature relevant to DV
The extent to which EAEs have been investigated for reducing DV and CiN using controlled
randomized trials is limited, although there are some insights from previous studies which
used convenience samples. A study published in 2007 by Schultz et al., used a before and after
measurement of global assessment of functioning (GAF) in 63 children who had experienced
intra- family violence. The children were engaged with an EAE intervention for promoting
mental health and showed significant improvements in the short term.
In 2016, a meta- analysis of quantitative research focused on assessing the impact of domes-
tic violence interventions was published to determine the overall effectiveness of the programs
included in the analysis (Hackett et al.,). The 17 research papers that met the inclusion criteria
for the study yielded findings indicating that the DV interventions included had a large effect
size, which decreases to a medium effect size when compared to control groups. Interestingly,
in relation to the EAE intervention under study here, the areas of focus for the interventions
included advocacy, empowerment, parent– child relationships, play therapy, and cognitive be-
havioral approaches. No animal- assisted interventions were included.
Other published research on DV indicates that interventions to support victims do not
necessarily have a significant effect on reoccurrence of violence (DePrince et al., 2012;
Stover, 2005). Previous research on EAE interventions has highlighted that improvements
in anger management and violent behavior may be occurring, although the studies are not
methodologically robust and are exploratory in nature (Boshoff et al., 2015; Gibbons et al.,
2015; Hemingway et al., 2015). Improvements in relationships have also been reported in

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HEMINGWAY ANd SULLIVAN
exploratory studies on EAE interventions although not specifically relating to DV or CiN
issues (Hemingway et al., 2019).
A model by Sullivan (2018)describes domestic violence as strongly linked to resource loss—
whether interpersonal or economic. According to Hobfoll (20 01), changes to resources can be
viewed as spirals, in which one gain is likely to lead to another, whilst losses are often precur-
sors to other losses. This demonstrates an opportunity for interventions to create gains, for
example, by teaching skills around responsibility, communication, and assertiveness. Bybee
and Sullivan (2002)found that these strengths- based interventions for victims of DV prevented
further abuse.
CURRENT ST U DY
This study is a quantitative observational study which has statistically analyzed data from the
TF program in order to understand any possible association between family members attend-
ing the EAE under study here and reductions in DV in the family in the year after attendance.
This analysis has never been published before on TF data and as such offers unique initial
insights into a potential intervention to reduce DV.
Setting
The intervention under study here is offered by a charity which operates in the South of England
and is referred over 150 people every year by Schools & Pupil Referral Units, Children's
Services, National Health Service (NHS, UK), Mental Health Services (including Child &
Adolescent Mental Health CAMHS) UK, Troubled Families, Offender Services, and other
specialist agencies such as charities working with Domestic Violence or Drug and Alcohol
Services. Those referred are typically disengaged fromtalk- based support and engaged with
multiple local services.
The intervention uses the principles of Natural Horsemanship as its philosophical underpin-
ning and structure (PNH, 2019). This approach is based on learning calmness, co- operation, and
partnership development through developing horsemanship skills. At this introductory level, this
involves ‘playing’ with specially trained horses inviting them to respond to requests with the per-
son on the ground and the horse on a loose rope or at liberty. The ‘team’ involved in each session
comprises the equine, the participant, and the course facilitator. The facilitators are high level
accredited natural horsemanship practitioners and have all undertaken further training provided
by this charity focused on preparing them to facilitate this EAE intervention.
These games help to establish a simple, comprehensive communication system between
horses and humans. However, to be a ‘partner’ the human needs to use clear, phased assertive
communication and control their body language and energy in a non- aggressive way. The par-
ticipant is coached to success with the horses by a facilitator and the students are taught how
to play seven ‘games’ (PNH, 2019) with the horse. The course takes place in an indoor arena
with a soft sand floor over 10h in five 2- h sessions over the course of a week and costs £950
per participant. Each session is structured according to the needs of the participant, focused
on building their ability to communicate with the horse using their bodies, achieving success
through playing the seven games.
The games taught are as follows:
1. The Friendly game (creating relaxation through touch, grooming, hanging out).
2. The Porcupine game (moving the horse's feet through using steady pressure, touching the
horse).

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FAMILY PROCESS
3. The Driving game (moving the horse's feet through rhythmic pressure, not touching the
horse).
4. The Yo - yo game (moving the horse backwards and forwards).
5. The Circling game (asking the horse to travel around you on the circle).
6. The Sideways game (asking the horse to move sideways).
7. The Squeeze game (asking the horse to go through, under or over something), (PNH, 2019).
The charity tries to involve as many family members as possible in the experience of attending
the EAE intervention. Normally a parent attends to watch sessions and be involved in discus-
sions, feedback, and reflections on what has been learnt. This is normally the mother, the inclusive
model, however, means that fathers, grandparent's, and guardians are also invited to be involved.
Equine husbandry, selection, training and handling
All the horses who engage in these courses with young people are kept outside in a natural environ-
ment (hedges, trees, other horses) in friendship groups with access to shelter if they want it. The work-
load for each horse is logged and kept light in line with the charities welfare policy. All horse training,
handling, and husbandry use natural horsemanship methods and underpinning philosophies and is
informed by the charities welfare policy. The horses taking part in this intervention are trained using
natural horsemanship by course facilitators. In addition, rescue horses are retrained, take part in the
intervention, and are then rehomed as appropriate through their registered rescue charity.
Ethics
Ethical permission was gained from the researchers employing universities ethics panel (BU
REF, 15373) for this study. All data analyzed by the researchers were accessed through the
local authority via a data sharing agreement and were anonymized prior to being shared with
the researchers. All anonymized data were stored on a password protected university com-
puter in compliance with UK data management and storage Data Protection Law. The regis-
tered charity under study here undertakes risk assessments for all participants who are never
left unsupervised with the horses. This ethical review included consideration of the horse's
well- being and humane treatment during their involvement with the intervention under study
here. The horses are all observed for possible stress/distress throughout the course informed
by the ‘ethogram’ of horse behavior (Young et al., 2012) all activities would cease immediately
if any observations of this were made. In EAE interventions, it is important to also prioritize
the welfare of the horses involved. Horses are sensitive and susceptible to stress particularly
relating to physical and behavioral constraints placed upon them while with human beings.
METHOD
A quantitative observational study was undertaken, using statistical analysis to explore any
association between family members attending the EAE under study here and reductions in
DV and CiN status in the family in the year after attendance. Data were collected by the Local
Authority (LA) Troubled Families (TF) team from local services, including police crime data,
and health services and social worker data. The data for all the comparison group participants
were collected a year apart in 2017 and 2018, whereas due to practical restrictions on the num-
ber of participants who can take the EAE intervention in a year, data were collected immedi-
ately prior to, and 1 year after the course for participants undertaking the equine intervention
between 2016 and 2018.

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HEMINGWAY ANd SULLIVAN
The anonymized data were analyzed and compared across four groups by two independent
researchers. The four groups are as follows: Those families on the troubled family's program
who had a key worker with a member or members who had attended and completed the EAE
intervention; those families who were on the troubled family's program but no support had
been offered; those families who were on the program and were being supported by a key
worker only and, those families on the program who were being supported by a key worker and
had received further support, not from the EAE intervention.
Participants
The domestic violence (DV) data relate to a young person or adult who has experienced, is
experiencing, or is at risk of DV. Flags (recorded on the data sets) are triggered by: Available
MARAC dates (Multi- Agency Risk Assessment Conference), DV crime/incidents from the po-
lice database, or disclosure to a lead professional. The score is refreshed every 3months; for the
purposes of this study, scores were extracted before the intervention and 1year after.
The CiN data relate to the child in need plan which is a peer- reviewed social worker deci-
sion. The score is refreshed every 3 months; scores for the purposes of this study were extracted
before the intervention and 1 year after. The overall number of DV and CiN flagged partici-
pants included in the data analysis are shown in Tab l e 1.
The inclusion criteria for the study were as follows:
All families who fell within the four groups outlined here for more than one full calendar
year.
All families where complete consistent data were available over the prescribed period.
The exclusion criteria for the study were as follows:
Incomplete data available.
Any inconsistencies in recorded data over the required period.
Families falling within the four groups outlined here for less than one full calendar year.
The participants comprised an opportunity sample of people engaged with the TF program.
Therefore, the study size was established according to the number of people involved in the
program with data available as outlined in the inclusion and exclusion criteria over the years
outlined here previously.
Materials
The capture of outcomes across agencies by the TF team at the local authority has enabled
this research study to use data collected by agencies other than the charity under study to
inform an observational study comparing outcomes for four groups through the use of a
data sharing agreement. The decision as to which families sit within each of these group's
rests with the social services and TF team in the LA who decide based on need which group
families fall within when they join the TF program. Please see Tabl e 2 for a description of
each group.
TABLE 1 Numbers of CiN and DV flagged participants included in data analysis
Criteria Participants
Number of
participants
Child in nee d Participants under the age of 18 8477
Domestic violence All participants 13,947

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The outcome of the interventions was determined using the DV and CiN flags. Reductions
in the numbers of DV or CiN flags of a group at one year's follow- up indicate a positive effect
with an increase indicating a negative effect.
The sample for the EAE intervention under study was made up of 268 individuals who were
from 62 family groups. Each family group had a minimum of one individual who attended
and completed the intervention. This sample comprised 119male participants and 149 female
participants, all of whom were aged between 0 and 63 prior to the intervention, with an average
age of 22.4years old. The average size of each family group was 4.32members. Across these
62 families, 84 participants actively took part in the intervention (as in learned to play with
the horse under the supervision of the facilitator) rather than watching or/and taking part in
reflective discussions or not attending the intervention at all. The overall distribution of at-
tendees at the intervention under study within families was in 43 families one member of the
family completed the intervention, in 17 families two members completed, in one family three
members completed, and in one family four participants completed. There were six families in
which only an adult attended, 13 families in which both adult(s) and child(ren) attended, and
43 families in which only children attended the EAE; therefore, adults officially attended in
30.6% of cases. For families with DV flags at pre- test, the proportion with official adult attend-
ees was higher at 47.4%.
The total number of TF comparison group individuals across all three comparison groups
who had no members attend the EAE intervention was N=13,805.
In the TF identified group (where no TF support was offered), 10,569 participants had been
identified by the TF program: 4928 of whom were male, 5542 of whom were female, and 97 of
whom were of unknown gender (gender not stated on data set). This group had a mean age of
20.0 years.
In the TF active group (having a key worker only=TF active), 2119 participants had been
identified and engaged with their key worker, including 989male participants, 1112 female
participants, and 18 participants of unknown gender. The TF active group had a mean age of
21.2yea rs.
In the TF Plus group, 1119 participants had been engaged with the TF program as well as
having funding allocated for other services (key worker plus other interventions, primarily
TABLE 2 Descr iption of each group
Group Descript ion
Total participants Children Adults
Number of
intervention attendees Number
of
families
All Male Fema le Unk nown All Male Fem ale Un known All Male Fe male Unknow n Children Adults
EAE Families who were within the TF program with
suppor t from their key worker and at le ast
one fam ily memb er who attende d the EAE
inter vention under s tudy
268 119 149 0145 67 78 0119 49 70 063 20 62
TF plus Famil ies who we re with in the TF progra m and in
receipt of key worke r suppor t and add itiona l
inter ventions such a s play therapy or
counselling
1119 525 586 8645 341 301 3470 18 2 283 5N/A N/A 263
TF active Famil ies who we re with in the TF progra m and in
receipt of key worke r suppor t only
2119 989 1112 18 1165 614 541 11 9 52 374 570 8N/A N/A N/A
TF identified Famil ies who we re with in the TF progra m but
not in re ceipt of a ny key worker support or
additional interventions
10,567 4928 5542 97 6519 3376 3079 66 4024 154 0 2451 33 N/A N/A N /A
Tot a l All participants 14,073 65 61 7389 123 8474 4398 3999 80 5565 2145 3374 46 N/A N/A N/A
Note: All data ta ken from Pre for each g roup as shou ld be mat ched pairs.

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HEMINGWAY ANd SULLIVAN
parenting support or play therapy=TF plus). These participants comprised 525males, 586
females, and 8 participants of unknown gender. There were 263 families included from the
TF Plus group, with an average size of 4.26members. The TF plus group had a mean age of
20.2years.
Within this study, there are included, therefore, four comparison groups one of which re-
ceived no support but was known to the TF program classified in the paper as TF identified. In
the second group, all participants were receiving support from the TF key worker only, in the
third group TF plus the participants may have received parenting support which by definition
will engage with the adults in that group. The number of ‘active participants’ for the equine-
assisted intervention is included above.
Procedure
For the DV and CiN data, a mixed- measures ANCOVA analysis was undertaken to identify
differing effects of intervention group, time, and gender, as well as covariance with age.
Each dependent variable was initially investigated separately; therefore, separate mixed-
measures ANCOVAs were run for both DV and CiN. As such, group and gender were included
as independent variables, whilst age was included as a covariate.
RESU LTS
Domestic violence
A mixed- measures ANCOVA was carried out, with presence of DV included as a dependent
variable, time as a within- subject independent variable, group and gender as between par-
ticipant's independent variables, and age as a covariate. The dependent variable was a binary
measure of DV at pre- and post- test and of CiN status at pre- and post- intervention. Box's test
of equality of covariance was significant. Please see Tab le 3.
TABLE 2 Descr iption of each group
Group Descript ion
Total participants Children Adults
Number of
intervention attendees Number
of
families
All Male Fema le Unk nown All Male Fem ale Un known All Male Fe male Unknow n Children Adults
EAE Families who were within the TF program with
suppor t from their key worker and at le ast
one fam ily memb er who attende d the EAE
inter vention under s tudy
268 119 149 0145 67 78 0119 49 70 063 20 62
TF plus Famil ies who we re with in the TF progra m and in
receipt of key worke r suppor t and add itiona l
inter ventions such a s play therapy or
counselling
1119 525 586 8645 341 301 3470 18 2 283 5N/A N/A 263
TF active Famil ies who we re with in the TF progra m and in
receipt of key worke r suppor t only
2119 989 1112 18 1165 614 541 11 9 52 374 570 8N/A N/A N/A
TF identified Famil ies who we re with in the TF progra m but
not in re ceipt of a ny key worker support or
additional interventions
10,567 4928 5542 97 6519 3376 3079 66 4024 154 0 2451 33 N/A N/A N /A
Tot a l All participants 14,073 65 61 7389 123 8474 4398 3999 80 5565 2145 3374 46 N/A N/A N/A
Note: All data ta ken from Pre for each g roup as shou ld be mat ched pairs.

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FAMILY PROCESS
TABLE 3 A NC OVA re su l t s
Source
Type III sum of
squares df
Mean
square F p
η2
p
Noncent.
parameter
Observed
powera
Withi n participants effects on domestic violence flags
Time 1.545 11.5 45 35.2 64 0.000 0.003 35.264 1.000
Time × Age 16.162 116 .162 3 68 .911 0.000 0.026 36 8.911 1.000
Time × Gender 0.138 20.069 1.572 0.208 0.000 3.144 0.335
Time × Group 0.731 30.244 5.564 0.0 01 0.0 01 16.693 0.944
Time × Gender × Group 0.347 50.069 1.582 0.161 0.0 01 7.910 0.559
Error (time) 0.619 14,0 61 0.04 4
Betwe en participants effects on domestic violence flags
Intercept 5.757 15.757 48.19 3 0.000 0.003 48.19 3 1.000
Age 9.013 19.013 75.447 0.000 0.005 75.447 1.000
Gender 0.7 33 20.367 3.068 0.046 0.000 6.136 0.594
Group 0.623 30.208 1.738 0.156 0.000 5.214 0.457
Gender × Group 1.361 50.272 2.279 0.0 44 0.001 11. 39 6 0.743
Error 167 9.82 9 14, 061 0.119
Withi n participants effects on child in need f lags
Time 0.289 10.289 3.315 0.069 0.000 3.315 0.445
Time × Age 0.450 10.450 5.166 0.023 0.001 5.166 0.623
Time × Gender 0.548 20. 274 3.146 0.0 43 0.0 01 6. 291 0.606
Time × Group 1.167 30.389 4.464 0.004 0.002 13.392 0.8 81
Time × Gender × Group 2.039 50.408 4.678 0.000 0.003 23.391 0.978
Error(Time) 737.6 84 8462 0.087
Betwe en participants effects on child in need f lags
Intercept 32.72 4 132 .72 4 215.3 03 0.000 0.025 215.303 1.000
Age 0.841 10. 841 5.530 0.019 0.001 5.530 0.652
Gender 0.349 20 .174 1.14 8 0.317 0.000 2.295 0.254

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HEMINGWAY ANd SULLIVAN
Source
Type III sum of
squares df
Mean
square F p
η2
p
Noncent.
parameter
Observed
powera
Group 40.6 42 313.547 89.132 0.000 0.0 31 267.396 1.000
Gender × Group 1.216 50.243 1.600 0.156 0.0 01 8.002 0.564
Error 12 86 .162 8462 0.152
aComputed using alpha=0.05.
TABLE 3 (C ont inue d)

560
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FAMILY PROCESS
Interaction between group and time
The overall interaction among time, group, and gender was not significant, F(5, 14,061) = 1.58,
p = 0.161, although there was a significant main effect of time, F(1, 14,061) = 35.26, p < 0.001.
The interaction between group and time is shown in Figure 1 and was significant as F(3, 14,0 61)
= 5.56, p = 0.001. The interaction between gender and time was not found to be significant,
F(2, 14,061) = 1.57, p = 0.208, although there was a significant impact of age as a covariate, F(1,
14,061) = 368.91, p < 0.001.
Interaction between gender and group
There was found to be a significant main effect of gender, F(2, 14,061) = 3.07, p = 0.047. There
was no significant main effect of group, F(3, 14,061) = 1.74, p=0.156, though there was a sig-
nificant interaction between gender and group, F(5, 14,061) = 2.28, p = 0.044, demonstrated in
Figures 2 – 5.
Higher risk of DV flags
Post- hoc analyses were carried out with a Bonferroni correction applied. These showed that
female participants were not significantly ( p = 0.056) more likely to have DV f lags (M = 0.134)
than male participants (M = 0.117) or participants of unknown gender ( p = 0.061), and that
male participants were not significantly ( p = 0.061) more likely to have DV flags than partici-
pants of unknown gender (M = 0.067).
Post- hoc comparisons to compare groups also found that there was no significant difference
between any groups ( p > 0.05) except for between the EAE intervention and TF identified,
where the intervention was found to have participants at significantly higher risk of DV flags
(M = 0.134) than TF identified (M = 0.079) across the time periods (p = 0.007). DFM Plus (M
= 0.115) and TF Active (M = 0.119) also had lower likelihoods of DV flags than intervention
participants, although these differences were not found to be significant.
FIGUR E 1 Interaction b etween time and group for DV flags. Covar iates appearing in the model are evaluated
at the following values: Age=20.2845. Error bars: 95% CI

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561
HEMINGWAY ANd SULLIVAN
Gender and time
Time alone was also not found to have a significant effect, as the difference between pre- test
(M = 0.122) and post- test (M = 0.098) was not significant (p = 0.057).
Child in need
A mixed- measures ANCOVA was carried out, with the presence of Child in Need (CiN)
flags included as a dependent variable, time as a within- subject independent variable (see
Figure 6), group and gender as between participants independent variables, and age as a
covariate.
Group gender and time
As demonstrated in Figures 6– 9 (for Figures 7– 9), a significant overall interaction among time,
group, and gender was found, F(5, 8462) = 4.68, p = 0.000, although the main effect of time was
not significant, F(1, 8462) = 3.32, p = 0.069. The interaction between group and time is shown in
Figure 10 and was found to be significant, F(3, 8462) = 4.46, p = 0.004. The interaction between
gender and time was also found to be significant, F(2, 8462) = 3.15, p = 0.043, as was the impact
of age as a covariate, F(1, 8462) = 5.12, p = 0.023.
No significant main effect of gender was found, F(2, 8462) = 1.15, p = 0.317, although there
was a significant main effect of age, F(1, 8462) = 5.53, p = 0.019.
Post- hoc analyses with a Bonferroni correction applied found that male participants (M =
0.320) are significantly more likely to have CiN f lags than participants of unknown gender (M
= 0.155, p = 0.025) as are female participants (M = 0.330, p = 0.015), although male and female
participants showed no significant differences ( p = 1.0). Please see Tabl e 4 for details of this
post- hoc analysis.
FIGUR E 2 Interaction b etween gender a nd time for EAE group pa rtic ipants. Covariates appearing in the
model are evaluated at the following values: Age=20.2845. Non- estimable means are not plotted

562
|
FAMILY PROCESS
Higher risk of CiN
It was also found that EAE intervention participants (M = 0.592) are significantly more likely
to have CiN flags than participants in any of the other groups ( p < 0.001 for all). TF Plus (M
= 0.245) was not significantly more likely to have CiN flags than participants who were in the
TF Identified group (M = 0.107, p = 0.070), or less likely to have CiN f lags than those in the TF
Active group ( p = 1.0). However, TF Active (M = 0.275) were significantly more likely to have
CiN flags than those in the TF Identified group ( p < 0.001). Time 1 vs time 2 were not found
to be significantly different in terms of the number of CiN f lags across all groups ( p = 0.142).
Please see Tabl e 5 for post hoc comparison.
FIGUR E 3 Interaction b etween gender a nd time for TF plus par ticipants. Cova riates appearing i n the model
are evaluated at t he followi ng values: Age=20.2845. Error bars: 95% CI
FIGUR E 4 Interaction b etween gender a nd time for TF active participants. Covariates appeari ng in the model
are evaluated at t he followi ng values: Age=20.2845. Error bars: 95% CI

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HEMINGWAY ANd SULLIVAN
DISCUSSION
Skills covered by this intervention include developing calmness, assertiveness, and commu-
nication (Hemingway, 2019), which helps participants to learn how to manage their feelings.
A study by Katz and Windecker- Nelson (2006)found that coaching, particularly around fear
and anger, may help families affected by DV. Therefore, the skills covered by this intervention,
which includes learning how to be calm in a practical setting (Bybee & Sullivan, 2002) could
help to improve participant's abilities to cope in potentially challenging domestic situations.
(Evans,2014) suggest in their paper on prevention of violence abuse and neglect in early child-
hood that interventions need to utilize each person's optimal ways to engage in learning and
be skills oriented. Can the use of practical skills based EAE interventions help enable young
people and families to learn different ways of ‘being’ together?
FIGUR E 5 Interaction b etween gender a nd time for TF identified participants. Covariates app earing in the
model are evaluated at the following values: Age=20.2845. Error bars: 95% CI
FIGUR E 6 Interaction b etween gender a nd time for EAE group pa rtic ipants. Covariates appearing in the
model are evaluated at the following values: Age=9.6990. Non- e stimable means are not plotted

564
|
FAMILY PROCESS
As already discussed in this paper, the EAE intervention under study here tries to involve as
many family members as possible in the experience of attending the equine intervention. The
charities model is based on empowerment, assertiveness, and calmness building this for the
attendee and those other family members who are involved. A qualitative study has been un-
dertaken with participants on this intervention which is mentioned here in the literature review
(Wat son , 2019). Parents attending the intervention described a significance in seeing some-
thing that enabled belief in the possibility of change for the family. While another qualitative
study undertaken on this intervention when it was initially developed within a young offender's
institute found that inmates described an increased sense of calmness and ability to see anoth-
er's point of view which reduced recorded incidents in prison (Hemingway et al., 2015).
Although this is a convenience sample of participants from the TF cohort in this area, the
numbers are large enough to see significant differences in two areas DV and CiN across the
FIGUR E 7 Interaction b etween gender a nd time for TF plus par ticipants. Cova riates appearing i n the model
are evaluated at t he followi ng values: Age=9.6990. Error bars: 95% CI
FIGUR E 8 Interaction b etween gender a nd time for TF active participants. Covariates appeari ng in the model
are evaluated at t he followi ng values: Age=9.6990. Error bars: 95% CI

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565
HEMINGWAY ANd SULLIVAN
groups studied. Those families with at least one member who attended the intervention under
study here had significantly higher levels of both DV and CiN on referral than other groups
in this study. This highlights the impact of the intervention on this vulnerable group of indi-
viduals and families over time. This intervention is generally referred individuals and families
when other options such as talking therapies and educational/parenting, or counselling oppor-
tunities are not working or have not been attended. The TF referral cohort makes up around a
third of the referrals to the EAE intervention overall each year.
Age was found to be a significant covariant across the groups with increases in age suggest-
ing increased likelihood of flags for DV and CiN. However, the effect of age was not specifi-
cally considered as a factor in this study but may have implications for further research.
FIGUR E 9 Interaction b etween gender a nd time for TF identified participants. Covariates app earing in the
model are evaluated at the following values: Age=9.6990. Error bars: 95% CI
FIGU RE 10 Interaction between t ime and group for CiN f lags. Covariates appearing in the model are
evaluated at the following va lues: Age=9.6990. Error bars: 95% CI

566
|
FAMILY PROCESS
Over the last 5years, 94% of those individuals who commence the EAE intervention com-
pleted the course (Hemingway, 2019) which suggests that the experience as a whole is a positive
and engaging one. Previous studies have shown that the practical, hands- on nature of being
with the horses helps people to engage and enjoy building a connection with another ‘being’
during the course (Watson, 2019). During the intervention under study here participants are
responded to in the same way as horses by the facilitator, in response to their body language
primarily rather than the spoken word. Participants learn to understand the point of view
of the horse as a prey animal to be effective when communicating with them through their
bodies. These qualities of learning to see another's point of view were highlighted by (Prior
& Mason 2010) when considering the evidence so far on what works to engage young people.
The generalizability of this study may be limited due to the lack of randomization of this
sample and because this intervention is being used in conjunction with the TF initiative
which is not always implemented consistently across counties/regions and is an English policy
TABLE 4 ANCOVA results: Post- hoc pairw ise comparisons
Measure: Domestic violence flags
Mean
difference
(I– J) Std. error p.c,d
95% conf idence interval for
differencec
Lower Bound Upper Bound
Gender
Male Fem ale −0 .017 0.009 0.056 −0.034 0.000
Unknown 0. 051a0.036 0.162 −0.020 0.122
Female Male 0.017 0.009 0.056 0.000 0.034
Unknown 0.068a0.036 0.061 −0.003 0.13 8
Unknown Male − 0.051b0.036 0.162 −0.122 0.020
Female −0.068b0.036 0. 061 − 0.13 8 0.003
Inter vention group
EAE TF plus 0.020a0.033 0.544 −0.044 0.084
TF active 0.015a0.025 0.54 −0.033 0.063
TF identified 0.056a,*0.017 0.0 01 0.022 0.089
TF plus THC −0.020c0.033 0.544 −0.084 0.044
TF active −0.005 0.035 0.89 −0.074 0.0 64
TF identified 0.036 0.030 0.24 −0.024 0.095
TF active THC −0 .015c0.025 0.54 −0.063 0.033
TF plus 0.005 0.035 0.89 −0.064 0.074
TF identified 0.0 41 0.0 21 0.057 −0.0 01 0.082
TF identified THC −0 .056*,c 0.017 0 .001 −0.089 −0.022
TF plus −0.036 0.030 0.24 −0.095 0.024
TF active −0.041 0.021 0.057 −0.082 0.001
Time
1 2 0.024a0.012 0.057 −0.001 0.048
2 1 −0.024a0.012 0.057 −0.048 0.001
Note: Bas ed on est imate d marg inal means a: A n esti mate of th e modif ied populat ion marg inal mean (J); b: A n esti mate of
the mod ified population ma rgin al mean (I); c: Computed usi ng alpha=0.05; d: Adjustme nt for multip le compa risons: Least
Signific ant Dif ference (equivalent to no adjust ments).

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567
HEMINGWAY ANd SULLIVAN
initiative. Previous studies on this intervention have identified that calmness and assertiveness
are outcomes of being involved as a participant (Hemingway, 2019); however, further inves-
tigation of the impact on parents of attending to observe and be included in discussions and
reflections with participants is needed.
This study has only offered insights into reported DV (to the police or a health or social care
professional) and this is an important limitation of the findings, as much DV does go unre-
ported (ONS, 2021). In addition, the families under study here are part of a particular govern-
ment policy program (TF) once again this may inf luence the findings of the study. However,
as an observational study, some associations between the EAE intervention and a reduction
in DV have been detected through the data analysis which need further exploration through a
randomized study to explore any causative link.
Two pilot studies have suggested what the physiological mechanism of action of EAE
interventions may be with a particular focus on cortisol levels and fMRI scanning to help
to identify which parts of the brain are used during interaction with horses. One pilot study
TABLE 5 ANCOVA results: post- hoc pair wis e comparisons
Measure: child in need f lags
Mean
difference
(I– J) Std. error p.cd
95% Conf idence interval for
differencec
Lower bound Upper bound
Gender
Male Fem ale −0.010 0.013 0.439 −0.037 0 .016
Unknown 0.165*,b 0.062 0.008 0.042 0.287
Female Male 0.010 0.013 0.439 −0. 016 0.037
Unknown 0 .175*,b 0.062 0.005 0.053 0.297
Unknown Male − 0.165*,c 0.062 0.008 −0.287 −0.042
Female − 0.175*,c 0.062 0.005 −0.297 −0.053
Inter vention group
EAE TF plus 0.347*,b 0.058 0.000 0.233 0.461
TF active 0. 317*,b 0.038 0.000 0.244 0.391
TF identified 0.485*,b 0.026 0.000 0.435 0.536
TF plus THC −0.347*,c 0.058 0.000 −0.461 −0. 233
TF active −0.029 0.012 0.631 −0.149 0.0 91
TF identified 0.138* 0.055 0.000 0.031 0.246
TF active THC − 0.317 *,c 0.038 0.000 −0.391 −0.244
TF plus 0.029 0 .061 0.6 31 −0.091 0 .149
TF identified 0.168* 0.032 0.000 0.105 0.230
TF identified THC −0.485*,c 0.026 0.000 −0.536 −0.435
TF plus −0.138* 0.055 0.012 −0.246 − 0. 031
TF active −0.168 * 0.032 0.000 −0.230 −0 .105
Time
1 2 0.039a0.027 0 .142 − 0.013 0.091
2 1 −0.039a0.027 0.142 −0. 091 0.013
Note: Bas ed on est imate d marg inal means a: A n esti mate of th e modif ied populat ion marg inal mean (J); b: A n esti mate of
the mod ified population ma rgin al mean (I); c: Computed usi ng alpha=0.05; d: Adjustme nt for multip le compa risons: Least
Signific ant Dif ference (equivalent to no adjust ments).

568
|
FAMILY PROCESS
was undertaken looking at the effects of EAE interventions on resting brain state func-
tion in attention- deficit/hyperactivity disorder (Yoo et al., 2016). This study found that
the intervention was associated with short- range functional connectivity in the regions of
the brain related to the behavioral inhibition system, which are associated with symptom
improvement. In addition, a recent pilot study (Nuber et al., 2019) also reported on heart
rate, heart rate variability, and salivary cortisol measurements in both humans and horses
and reported reductions in cortisol for human participant's post- intervention. Both these
findings would suggest that increased calmness may occur through these interventions ei-
ther through reducing stress or activating parts of the brain related to behavior inhibition,
although the evidence base on this area is minimal and these are both small pilot studies.
Indeed, this intervention would benefit from further research to explore more specifically
why significant reductions in DV and CiN may be occurring. Overall, this observational
study has provided some interesting findings; however, it has substantial limitations which
will be covered in the next section of this paper.
Limitations
This study used a convenience sample from data routinely collected by the LA in the area
in which the TF program refers to the EAE intervention under study here. A data sharing
agreement was required to put together the data from different agencies, crime, health, and
social care. No manipulation of the sample groups including randomization of participants
was undertaken in the allocation into different groups and no attempt was made to match the
characteristics of the comparison groups. The groups studied here were defined by the local
TF program criteria as presented earlier.
The four groups compared here are all part of the TF program in relation to the TF identi-
fied and the TF active groups and no information was available in relation to family size and
membership. This information was only available for the TF plus and EAE intervention groups
(as presented in Tabl e 2 earlier). In addition, the interventions offered to the TF plus group
were parenting support through education courses or play- based interventions. In the EAE
intervention group, the equine intervention was successfully completed by at least one family
member. Both the TF plus and EAE intervention groups were also benefitting in all families
from TF case worker support, which may have inf luenced the outcomes of the analysis.
This study has only allowed analysis of DV which has been reported through the police,
health services, or social services, as we know that much DV remains unreported (HMIC,
2015 ) this is a substantial limitation of this study. Therefore, the study findings are only rele-
vant in relation to reported DV.
The generalizability of this study may be limited due to the lack of randomization of this
sample and because this intervention is being used in conjunction with the TF initiative
which is not always implemented consistently across counties/regions and is an English
policy initiative.
CONCLUSION
In conclusion, the ability to analyze across cohorts in relation to this intervention has
yielded interesting results suggesting that there may be an effect of a family member at-
tending the intervention under study relating to reductions in future DV and the removal
of CiN status in the families under study, although randomized studies are still needed to
further explore the issue of causality. Of further interest is that this charity is normally re-
ferred those for whom other talk- based or education- based options are not working or are

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HEMINGWAY ANd SULLIVAN
not being attended. This study would suggest, however, that even in this group the interven-
tion under study may be having a positive impact in comparison with other types of support
offered through the TF program.
ACKNOWLEDGEMENTS
The authors would like to thank all those involved with the Charity especially the horses and
the local authority staff who helped with data extraction and sharing across agencies.
CONFLICTS OF INTEREST
The authors declare that they have no conf licts of interest. No funding was received for this
research.
ORCI D
Ann Hemingway https://orcid.org/0000-0002-0920-3897
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