Preventing Violence Against Women and Children Workshop Summary (2011) / Chapter Skim
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6 Papers on Research in Preventing Violence Against Women and Children
6 Papers on Research in Preventing Violence Against Women and Children
Pages 49-116
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From page 49... ...
They also explored potential intervention points that were illuminated by this discussion. The first paper is a reprint from the World Health Organization publication Preventing Intimate Partner and Sexual Violence Against Women (WHO and LSHTM, 2010b)
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From page 50... ...
PREVENTING INTIMATE PARTNER AND SEXUAL VIOLENCE AGAINST WOMEN: PRIMARY PREVENTION STRATEGIES1 Intimate partner and sexual violence are not inevitable -- their levels vary over time and between places because of a variety of social, cultural, economic, and other factors. This can result in substantial differences between and within countries in the prevalence of intimate partner and sexual violence (WHO and LSHTM, 2010a)
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From page 51... ...
Creating a Climate of Non-Tolerance Addressing risk factors at the societal level may increase the likelihood of successful and sustainable reductions of intimate partner and sexual violence. For example, when the law allows husbands to physically discipline wives, implementing a program to prevent intimate partner violence may have little impact.
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From page 52... ...
These systems should aim to help prevent further violence, facilitate recovery, and ensure access to justice -- for example, through the provision of specialized police units, restraining orders, and multi-agency sexual assault response teams. Potentially, legal protection against intimate partner and sexual violence helps to reinforce non-violent social norms by sending the message that such acts will not be tolerated.
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From page 53... ...
ASSESSING THE EVIDENCE FOR DIFFERENT PREVENTION APPROACHES From the perspective of public health, a fundamental question is, "Do intimate partner and sexual violence prevention programs work? " That is to say, are there certain programs or strategies that are effective in preventing or reducing intimate partner and sexual violence?
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From page 54... ...
The limited evidence base for intimate partner and sexual violence prevention has three important implications for this paper. First, the paper extrapolates, when relevant, from the stronger evidence base for child maltreatment and youth violence prevention but clearly signals that these extrapolations remain speculative.
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From page 55... ...
SUMMARY TABLES OF PRIMARY PREVENTION STRATEGIES AND PROGRAMS Table 6-1 summarizes the strength of evidence for the effectiveness of those strategies to prevent intimate partner violence and sexual violence for which some evidence is available. Strategies are grouped according to life stage.
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From page 56... ...
At present, there are no correspondingly evaluated effective programs against sexual violence. TABLE 6-1 Primary Prevention Strategies for Intimate Partner Violence and Sexual Violence for Which Some Evidence Is Available Strategy Intimate Partner Violence Sexual Violence During Infancy, Childhood, and Early Adolescence Interventions for children and adolescents 2 3 subjected to child maltreatment and/or exposed to intimate partner violence School-based training to help children 3 2 recognize and avoid potentially sexually abusive situations During Adolescence and Early Adulthood School-based programs to prevent dating 1 N/A violence Sexual violence prevention programs for N/A 3 school and college populations
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From page 57... ...
Home-visitation programs with an intimate 3 3 partner violence component All Life Stages Reduce access to and harmful use of alcohol 2 3 Change social and cultural gender norms 3 2 through the use of social norms theory Change social and cultural gender norms 2 3 through media awareness campaigns Change social and cultural gender norms 2 3 through working with men and boys 1 -- Effective: strategies that include one or more programs demonstrated to be effective; effective refers to being supported by multiple well-designed studies showing prevention of perpetration and/or experiencing of intimate partner and/or sexual violence; 2 -- Emerging evidence of effectiveness: strategies that include one or more programs for which evidence of effectiveness is emerging; emerging evidence refers to being supported by one welldesigned study showing prevention of perpetration and/or experiencing of intimate partner and/or sexual violence or studies showing positive changes in knowledge, attitudes, and beliefs related to intimate partner violence and/or sexual violence; 3 -- Effectiveness unclear: strategies that include one or more programs of unclear effectiveness due to insufficient or mixed evidence; 4 -- Emerging evidence of ineffectiveness: strategies that include one or more programs for which evidence of ineffectiveness is emerging; emerging evidence refers to being supported by one well-designed study showing lack of prevention of perpetration and/or experience of intimate partner and/or sexual violence or studies showing an absence of changes in knowledge, attitudes, and beliefs related to intimate partner violence and/or sexual violence; 5 -- Ineffective: strategies that include one or more programs shown to be ineffective; ineffective refers to being supported by multiple well-designed studies showing lack of prevention of perpetration and/or experiencing of intimate partner and/or sexual violence; 6 -- Probably harmful: strategies that include at least one well-designed study showing an increase in perpetration and/or experience of intimate partner and/or sexual violence or negative changes in knowledge, attitudes, and beliefs related to intimate partner and/or sexual violence; N/A -- Not applicable.
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From page 58... ...
Strategies relevant to all life stages are described last. Because of the way programs are organized, intimate partner violence is considered here to include instances of sexual violence that occur within an intimate partnership, while sexual violence is used here to refer to sexual violence occurring outside intimate partnerships (i.e., perpetrated by friends, acquaintances, or strangers)
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From page 59... ...
It is therefore reasonable to assume that preventing child maltreatment has the potential to reduce subsequent intimate partner and sexual violence (Foshee et al., 2009)
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From page 60... ...
Interventions for Children and Adolescents Subjected to Child Maltreatment and/or Exposed to Intimate Partner Violence Because children or adolescents who have been subjected to child maltreatment or exposed to parental violence are at increased risk of becoming the perpetrators and victims of intimate partner and sexual violence, interventions in this area are particularly important. One meta-analysis examined 21 programs involving psychological interventions targeted at children and adolescents who had experienced child maltreatment (Skowron and Reinemann, 2005)
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From page 61... ...
. Nonetheless, they appear to have potential in preventing subsequent intimate partner violence and sexual violence.
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From page 62... ...
Some sexual violence prevention programs in the United States include bullying prevention components for elementary- and middle-schoolage children (Basile et al., 2009)
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From page 63... ...
. Accordingly, the prevention of dating violence can be assumed to be preventive of intimate partner and sexual violence in later life (Foshee et al., 2009)
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Given that the risk factors for youth violence and intimate partner and sexual violence are to some extent shared, such programs would appear to have some
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From page 65... ...
Sexual Violence Prevention Programs for School and College Populations In the United States, the majority of programs for the primary prevention of sexual violence by strangers, acquaintances, and non-intimate dating partners have focused on college students -- though they have also increasingly been delivered to high school and middle school pupils. In settings where few go into higher education this approach has obvious limitations.
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From page 66... ...
These include providing universal rape prevention education and parent education in sexual violence prevention throughout schools and workplaces, educating teachers and coaches about sexual violence and its prevention, and changing organizational practices to include activities such as mandatory training in the prevention of violence against women. During Adulthood Empowerment and Participatory Approaches to Reduce Gender Inequality Empowerment is an approach that helps individuals and communities to identify their own problems and to develop, through participatory methods, the resources, skills, and confidence needed to address them.
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From page 67... ...
. Two examples of empowerment approaches for preventing intimate partner violence are the use of microfinance with gender-equality training and the Stepping Stones training package.
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From page 68... ...
A randomized controlled trial found that two years after completing the pro gram, participants reported experiencing 55 percent fewer acts of violence by their intimate partners in the previous 12 months than did members of a control group. In addition, participants were more likely to disagree with statements that condone physical and sexual violence toward an intimate partner (52 percent of participants versus 36 percent of the control group)
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From page 69... ...
Family programs to promote positive communication and healthy relationships and prevent family violence might also be effective in preventing both intimate partner and sexual violence, given the importance of family factors in their development. In Ecuador one intimate partner violence prevention program that was implemented (but not evaluated)
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From page 70... ...
The primary aims are to develop a model for an inhome intimate partner violence prevention program for enrolled mothers at risk of such violence, to test the feasibility and acceptability of the program, and in a randomized controlled study to compare the effectiveness of the approach to that of the Nurse Family Partnership alone. An evaluation of the Hawaii Healthy Start Program -- an early childhood home visitation program -- found that when compared with a control group, the participation of mothers was associated with reduced perpetration and experiencing of intimate partner violence.
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From page 71... ...
However, the relationship between harmful use of alcohol and violence is complex -- not everyone who drinks is at equally increased risk of committing violence, and intimate partner and sexual violence can occur at high rates in cultures where alcohol use is taboo. Furthermore, there is disagreement among experts on whether or not alcohol can be considered to be a "cause" of intimate partner and sexual violence or whether it is better viewed as a moderating or contributory factor.
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From page 72... ...
. Intimate partner and sexual violence may also be reduced through primary prevention programs to reduce the more general harms caused by alcohol (Anderson et al., 2009)
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From page 73... ...
In such settings it may instead be beneficial to develop the role of primary health care workers or general practitioners in identifying and alleviating the harmful use of alcohol. Although evidence for the effectiveness of measures to reduce access to and harmful use of alcohol is only beginning to emerge and high-quality studies showing their impact on intimate partner and sexual violence are still largely lacking, alcohol-related programs for the prevention of intimate partner violence and sexual violence appear promising.
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From page 74... ...
. Efforts to change social norms that support intimate partner and sexual violence are therefore a key element in the primary prevention of these BOX 6-3 Examples of Social and Cultural Norms That Support Violence Against Women • A man has a right to assert power over a woman and is considered socially superior.
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From page 75... ...
. Currently the three main approaches for changing social and cultural norms that support intimate partner and sexual violence are social norms theory (i.e., correcting misperceptions that the use of such violence is a highly prevalent normative behavior among peers)
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From page 76... ...
; providing accurate information; dispelling myths and stereotypes about intimate partner violence and sexual violence; and changing public opinion. Such campaigns have the potential to reach large numbers of people.
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From page 77... ...
Because of these efforts, the reported frequency of intimate partner violence and sexual violence against women has increased dramatically. The more advocacy and awareness, the more likely women will report violence against them.
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From page 78... ...
Although programs to alter cultural and social norms are among the most visible and ubiquitous of all strategies for preventing intimate partner and sexual violence, they remain one of the least evaluated. Even where evaluations have been undertaken, these have typically measured changes in attitudes and beliefs rather than in the occurrence of the violent behaviors themselves, making it difficult to draw firm conclusions on their effectiveness in actually preventing intimate partner and sexual violence.
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From page 79... ...
• Currently, there are no strategies of demonstrated effectiveness for preventing sexual violence outside intimate partner or dating rela tionships. Only one strategy has been demonstrated to be effective in preventing intimate partner violence, namely school-based pro grams for adolescents to prevent violence within dating relation ships -- and this still needs to be assessed for use in resource-poor settings.
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From page 80... ...
Topics in the questionnaire included gender-based violence, health and health-related practices, household division of labor, men's participation in care-giving and as fathers, men's and women's attitudes about gender and genderrelated policies, transactional sex, men's reports of criminal behavior, and quality of life. This report focuses on the initial, comparative analysis of results from the men's questionnaires across the six countries, with women's reports on key variables.
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From page 81... ...
• All research sites followed standard World Health Organization (WHO) practices for carrying out research on intimate partner violence in terms of offering referrals and information for services and special training of interviewers.
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From page 82... ...
; victimization of violence by partner (using WHO protocol) ; men's use of sexual violence against non-partners; men's self-reported purchasing of sex or paying for sex, including with underage individuals.
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From page 83... ...
Between 34 percent and 88 percent of men in the survey sites reported feeling stress or depression because of not having enough income or enough work. Men who experienced work-related stress were more likely to report depression, suicide ideation, previous arrests, and use of violence against intimate partners.
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From page 84... ...
In all the countries except India, men who reported more gender-equitable attitudes were more likely to report being sexually satisfied with their current female partner. In India, Brazil, and Croatia, women who reported that their male partner plays an equal or greater role in one or more domestic duties also reported higher levels of overall relationship and sexual satisfaction.
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From page 85... ...
Men's reports of perpetration of sexual violence against women and girls ranged from 6 percent to 29 percent; in India and Mexico the majority of sexual violence took place against a current or former partner. Relatively high percentages of men reported ever having participated in criminal or delinquent acts; between 6 percent and 29 percent of men reported ever having been arrested.
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From page 86... ...
Women who reported that their partners participate in daily care work report higher levels of relationship and sexual satisfaction. Findings suggest that most men in most of the survey sites accept gender equality in the abstract even if they are not yet living it in their daily practices.
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From page 87... ...
For example, children who experience child abuse and are exposed to domestic violence are at an elevated risk for perpetrating dating violence and domestic violence. Essentially, there is a continuity in their relationships such that problems with violence are evident in different ways at different times.
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From page 88... ...
. Furthermore, the risk for experiencing intimate partner violence as an adult (as a victim or perpetrator)
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From page 89... ...
The ACE Study has documented the additive detrimental effects of experiences such as exposure to woman abuse, a parent with substance abuse or mental health problems, and incarceration of a parent. Low socioeconomic status can further compound difficulties for children who are experiencing child abuse.
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From page 90... ...
Although attachment is most often discussed in the context of parent– infant relationships, it continues to play an important role throughout a youth's development. Recent longitudinal research demonstrated that youth dually exposed to direct and indirect violence (i.e., child abuse and exposure to domestic violence)
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From page 91... ...
The detachment from emotion and compassion that allows a person to survive chronic abuse is the same detachment that facilitates perpetration of severe violence without apparent remorse. Even in less extreme cases of trauma, the dysregulation of anger and arousal that develop create potent risk factors for the intergenerational transmission of violence.
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From page 92... ...
What Programs Are Effective or Promising? In efforts to prevent child abuse and exposure to domestic violence, there are a number of points for possible intervention.
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From page 93... ...
Additional approaches may improve protective factors or reduce risk factors, but these three are the only ones that have been shown to prevent the occurrence or recurrence of abuse. Home Visitation Home visitation is the most effective child maltreatment prevention program to date (Macmillan et al., 2009)
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From page 94... ...
A parenting program may increase parents' satisfaction with parenting, improve their social connections, and even lead to more positive attitudes and skills, and yet it may not reduce direct child abuse or exposure to domestic violence. If a program is being espoused as a child abuse prevention program, then the research must look at child abuse outcomes and not rely on proxies or interpret the promotion of positive parenting attitudes and skills as synonymous with the prevention of abuse.
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From page 95... ...
Third, at this point there is little available evidence concerning programs that are effective for preventing emotional abuse. Finally, there have not been any trials on programs to reduce exposure to domestic violence.
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From page 96... ...
Some work has been done in this area of child sexual abuse, but very little has been carried out that looks at father–child relationship restoration after domestic violence. There is a significant need to develop and evaluate protocols for deciding when it is safe to restore parent–child relationships post-violence and how this can be achieved with minimal risk to children.
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From page 97... ...
Any comprehensive approach to preventing violence against children requires specialized responses that can be activated in the most high-risk cases. With the advent of domestic violence homicide review committees, a clearer picture of the risk factors for lethality to women and their children is emerging (Jaffe et al., 2003; Campbell, 2005; Jaffe and Juodis, 2006)
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From page 98... ...
Trauma-informed care is important for a number of reasons: • Trauma and, in particular, violent victimization are pervasive. • The impact of trauma is broad, extending well beyond the post traumatic stress disorders frequently perceived to be the most com mon outcome.
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From page 99... ...
. Consumers surveyed about their experiences in behavioral health care settings report violence and the fear of violence (including physical restraint and seclusion)
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From page 100... ...
In putting these ideas into practice, we address six domains of organizational culture in human service settings; three are service-level domains, and three are at the systems-level (Fallot and Harris, 2009) : Services-level changes in a culture of trauma-informed care: 1.
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From page 101... ...
For example, one residential substance abuse setting had a large sign that read "Denial stops here" over the entrance to the residential areas of its building. Deciding that this sign did not create a hospitable or emotionally safe first impression of their setting, they replaced it with a "Welcome" sign that was much more inviting.
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From page 102... ...
Ford, Ph.D. University of Connecticut School of Medicine The health care and social service professions tend to approach the question of how to assist women and children who are victims of violence by doing research on, and developing practice guidelines for, the treatment of posttraumatic stress disorder (PTSD)
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From page 103... ...
. As a result of this paradigm shift, in the past decade an impressive array of psychological empowerment interventions has been developed for children and adults who have experienced violence and related forms of complex trauma (Courtois et al., 2009; Ford and Cloitre, 2009)
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From page 104... ...
104 PREVENTING VIOLENCE AGAINST WOMEN AND CHILDREN by Courtois and colleagues, psychological empowerment interventions are built upon the following two central philosophical foundations: 1. Recognizing the uniqueness of the individual.
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From page 105... ...
Skills Training for Emotion and Interpersonal Regulation (STAIR) has shown promise in reducing PTSD and depression symptoms and in enhancing emotion regulation with women survivors of violence (Cloitre et al., 2010)
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From page 106... ...
, then traumatic stress disorders such as PTSD and its more complex variants are simply extreme versions of the out-of-balance emotional states that everyone experiences. Therefore, if recovery from the aftereffects of violence involves regaining or restoring
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From page 107... ...
2010. Reducing maternal intimate partner violence after the birth of a child: A randomized controlled trial of the Hawaii Healthy Start home visitation program.
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From page 108... ...
2009. Intimate partner violence and sexual violence victimization assessment instruments for use in healthcare settings: Version 1.
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From page 109... ...
2000. Preventing child abuse and neglect with a pro gram of nurse home visitation: The limiting effects of domestic violence.
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From page 110... ...
2008. Traumatic victimization, post traumatic stress disorder, suicidal ideation, and substance abuse risk among juvenile justice-involved youths.
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From page 111... ...
2007. In their own voices: A qualitative study of women's risk for intimate partner violence and HIV in South Africa.
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From page 112... ...
2008. Women's perceptions and experiences of sexual violence in marital relationships and its effect on reproductive health.
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From page 113... ...
2008. A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.
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From page 114... ...
2005. Sexual violence and youth in South Africa: The need for community based prevention interventions.
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From page 115... ...
2007b. A network model for providing culturally competent services for intimate partner violence and sexual violence.
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From page 116... ...
In Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva, Switzerland: World Health Organization.
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