Preventing Violence Against Women and Children Workshop Summary (2011) / Chapter Skim
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8 Papers on Preventive Interventions
8 Papers on Preventive Interventions
Pages 144-184
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From page 144... ...
The result was a successful multisectoral response that resulted in reduction of a number of adverse outcomes, including violence and HIV transmission. The second paper describes the success of two programs to address intimate partner violence and child maltreatment in Hong Kong.
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The final paper looks at the "systems change model" of Kaiser Permanente, an integrated health care system that incorporates all levels and aspects of health care delivery. Using this pre-existing structure, Kaiser Permanente has implemented a family violence prevention program meant to identify potential violence as victims and perpetrators access the health care system.
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Evaluated as a cluster randomized trial in eight villages in rural Limpopo, the program assessed the impacts on poverty, women's empowerment, and risk of intimate partner violence (IPV)
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There are a number of lessons that have been learned from the IMAGE program. The program presents encouraging evidence that it is possible to reduce IPV and to challenge gender norms and violence even when they appear to be "culturally entrenched" and resistant to change.
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In this paper two interventions are presented: the Positive Fathering Program, which was designed as a primary prevention strategy; and the Empowerment Intervention, which aims to interrupt the cycle of violence against pregnant women and their unborn infants. The Positive Fathering Program The Positive Fathering Program aims to engage expectant fathers in prenatal education in order to prepare them for transition to fatherhood while working in tandem with their intimate partners.
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From page 149... ...
. The Positive Fathering Program has been developed to address the gap in the engagement of men in prenatal education.
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Finally, couples are encouraged to talk through various strategies they can use to accommodate the involvement of in-laws in infant care and traditional postpartum practices. The Positive Fathering Program was implemented, in combination with standard prenatal education, in a large public hospital in Hong Kong from August 2009 to February 2011.
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≤ 50% of the participants are couples 100% couple attendance Content is based on well-established Content is based on identified needs prenatal education Teacher-centered, didactic teaching, Couple-centered, two-way, interactive one-way transmission of content discussion and hands-on practice Passive learning Active learning Minimal couple partnership in learning Couple partnership in learning is the main theme of the program the woman needed to be less than 20 weeks into her pregnancy at the time of recruitment, and the couple had to agree to attend all three sessions together. Participation was voluntary, and recruitment took place in prenatal clinics.
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From page 152... ...
To summarize, the Positive Fathering Program demonstrated acceptability and efficacy for 166 Chinese expectant couples using public prenatal care in Hong Kong. In the next stage of development, the program will be modified based on a hospital–community partnership model, which will combine the use of professional and non-professional caregivers over the pre- and postnatal period.
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From page 153... ...
What she needs is an opportunity to express her feelings to a nonjudgmental and empathic person and to be allowed to make her own decisions. Methods The modified Empowerment Intervention was tested on 110 abused Chinese pregnant women in a prenatal setting in Hong Kong in 2002 and 2003 using a randomized controlled trial (Tiwari et al., 2005)
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The original intervention was modified for use among abused Chinese pregnant women in Hong Kong in order to ensure that it was consistent with the subscribed norms of Chinese women living in a "shame-oriented" culture (Tiwari et al., 2005)
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In particular, participants are informed that the most dangerous time occurs when a woman leaves the relationship or makes it clear to the abuser that she is leaving for good. As social disharmony is often a taboo subject in Chinese society, and partner violence is frequently treated as a family affair not to be shared with outsiders, many abused Chinese women may not recognize the signs of increased danger; hence, time should be spent to ensure that she understands the warning signs.
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The Empowerment Intervention has now been further modified for use in a community setting and tested in a randomized controlled trial (Ramsay et al., 2009; Tiwari et al., 2010)
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Wolfe, Ph.D. Centre for Addiction and Mental Health, Centre for Prevention Science and University of Toronto Best Practices in School-Based Violence Prevention This paper focuses on the prevention of adolescent dating violence, a significant and commonly occurring form of violence and aggression among this age group.
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From page 158... ...
Best-practice principles based on bullying and peer violence prevention have considerable significance for dating violence initiatives. Reports suggest that successful programs are comprehensive in nature, focus on skills, pick appropriate targets for change, use peers, include parents, and attempt to change the larger environment (Blueprints Violence Prevention Initiative, www.colorado.edu/cspv/blueprints; Office of the Surgeon General, 2001)
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. Safe Dates is a school-based program based on the premise that changes in norms regarding partner violence and gender roles coupled with improvement in pro-social skills lead to primary prevention of dating violence.
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. How Universal Programs Prevent Violence Against Women and Children Effective violence prevention programs empower young people to be involved in the work, which then becomes rewarding through the promotion of
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Such connections require a commitment to building capacity in each community to be inclusive of all youths and to perceiving each adolescent as a person rather than a potential problem. The ultimate act of inclusion is to empower youths to identify the critical issues they face and the solutions that are most meaningful to the reality of their lives and circumstances.3 In addition to providing improved skills and reducing dating violence, universal programs such as the Fourth R may serve to buffer the effects of poor relationship models that adolescents experienced while growing up (an important factor in reducing the cycle of violence)
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From page 162... ...
Beyond looking at a deficit-based model that identifies certain racial or ethnic groups as being at higher risk for dating violence, we need to look at ways that cultural strengths can be accessed as protective factors in interventions. An implementation study of Canadian schools that have adopted the Fourth R revealed that a critical factor in administrators choosing this violence-prevention curriculum was the research base of the Fourth R and the perception of the program's potential to have a positive impact on students (Crooks et al., 2008)
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Four U.S. evaluation sites are currently using the program as part of the Robert Wood Johnson Start Strong teen dating violence prevention initiative: Bronx, New York; Providence, Rhode Island; Wichita, Kansas; and Boise, Idaho.
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help survivors of domestic violence protect themselves and their children from further violence and (2) actively advocate for women by generating and mobilizing community resources they report needing.
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Through role playing, coaching, and discussions, the advocate ensures the woman can effectively advocate on her own behalf with resistant or hostile community providers after the intervention ends. Although the five phases of advocacy intervention have been described here as distinct stages for clarification purposes, in reality advocates engage in various phases simultaneously.
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Women in the advocacy condition reported being more effective in reaching their goals than women in the control condition. The short-term impact of the advocacy intervention on the major outcome variables -- experience of further physical violence, psychological abuse, depression, social support, and quality of life -- was tested through multivariate analysis of covariance (MANCOVA)
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Although the project originated in a mid-sized city close to a university campus, it can be modified for larger cities as well as for more rural communities. Similarly, although the original studies focused on women who had used domestic violence shelter programs, CAP is equally applicable for women using non-residential support services or who are not receiving any community services at all (e.g., women exiting jails or prisons)
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Another advantage of using volunteers is that they may come from more diverse backgrounds than typical university students. Domestic violence service programs might consider aligning with church groups, community organizations, or other volunteer programs to obtain a paraprofessional advocacy workforce conducive to their individual needs.
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USING A SYSTEMS-MODEL APPROACH TO IMPROVING IPV SERVICES IN A LARGE HEALTH-CARE ORGANIZATION Brigid McCaw, M.D., M.S., M.P.H., FACP Family Violence Prevention Program, Kaiser Permanente Intimate partner violence (IPV) is a common and costly health problem associated with substantial medical and mental-health issues for victims and their children.
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In a report titled Confronting Chronic Neglect: The Education and Training of Health Care Professionals on Family Violence, the IOM called attention to a 1998 pilot program, implemented by Kaiser Permanente Northern California, which had been associated with a significant increase in rates of screening, identification, and referral to mental-health clinicians and had been well accepted by clinicians. The IOM report noted that Kaiser Permanente had achieved these results by implementing a "systems-change model" in which clinician training was just one component of a larger intervention designed to make use of the entire health care environment -- not just the doctor office visit -- to address intimate partner violence.
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It also lists the interventions used for each component. FIGURE 8-1 Systems model for intimate partner violence prevention.
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Disseminating the Approach to Other Kaiser Permanente Medical Centers in Northern California Over the next two years, the model was transferred to six more Kaiser Permanente medical facilities in Northern California through the guidance of a physician champion and a multidisciplinary team in each facility. This success led to identification of an "executive sponsor" and funding for a part-time medical director and project manager to facilitate rapid and efficient implementation across all 49 medical facilities in the Northern California region.
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2009. Intimate partner violence.
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In 2002 Kaiser Permanente Northern California selected Improving IPV Prevention to demonstrate implementation of a behavioral health prevention guideline that shows coordination between primary care and mental health to meet an NCQA standard.5 The quality measures used to track progress toward Improving IPV Prevention are similar to those used for other health conditions, such as asthma, diabetes, hypertension, and depression. These measures provide data to monitor performance over time, between medical centers and departments, and to help teams focus their training and other improvement efforts.
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For example, clinicians can draw on tools embedded in the FIGURE 8-2 Members diagnosed with intimate partner violence, 2000-2010.
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Advice nurses, trained in how to inquire about IPV and equipped with IPV-related scripts and protocols, can respond immediately to members who contact the health care system by phone, directing them to the appropriate Kaiser Permanente venue of care as well as to community resource information. Engaging the Kaiser Permanente Workforce The demographics of most health care workforces (made up in large part by women of childbearing age)
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that are more appropriately provided outside the health care setting and that require the expertise of community advocates, law enforcement, and criminal justice. Thus, the development of strong partnerships between health care and community resources is a key element of the systems-model approach.
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Dissemination to Other Kaiser Permanente Regions: Scaling-Up and Sustainability Over the past five years, the remaining eight Kaiser Permanente regions have embarked on implementing the systems-model approach. This scaling-up of the program was inspired by its successful adoption in the Kaiser Permanente medical facilities in Northern California and also by the compelling data showing improvement in IPV identification and referral.
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To the extent that IPV prevention can be aligned with these larger goals, executive decision makers will come to see the program as an imperative and a positive investment. This top-level support is evident in comments made at a 2007 CEO Roundtable by Robert Pearl, M.D., executive director and chief executive officer of the Permanente Medical Group: "IPV prevention is part of a strategic approach to quality, service, and affordability.
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From page 180... ...
• Establish clinician-researcher partnerships to ensure a robust design for both the program and its evaluation, and to ensure that evalua tion will yield credible findings that are clinically and operationally meaningful. Summary Over the next decade, health care organizations will be called upon to assume an increasingly important role in society's response to intimate partner violence and other forms of family violence -- through primary prevention, early identification, and effective interventions.
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2009. Main, mediating, and moderating effects of social support on the well-being of survivors of intimate partner violence across 2 years.
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2005. Assessing the effects of the dating violence prevention program "Safe Dates" using ran dom coefficient regression modeling.
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2011. Systems-model for intimate partner violence prevention.
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2010. Ef fect of an advocacy intervention on mental health in Chinese women survivors of intimate partner violence: A randomized controlled trial.
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