Violence Prevention: the evidence Alessandra C. Guedes, MA, MSc Regional Advisor, Intra-family Violence Pan American Health Organization 2 nd Special Meeting.

Violence Prevention: the evidence

Alessandra C. Guedes, MA, MScRegional Advisor, Intra-family Violence

Pan American Health Organization

2nd Special Meeting on Criminal Gangs

OAS – March 2, 2010

Structure of this presentation

1. Public health model for prevention

2. Socio ecological model for understanding violence

3. 7 strategies for violence prevention with a sound evidence base

4. Conclusions

3

1. SurveillanceDefining and understanding the problem

2. Research

Identifying causes and risk factors

3. Monitoring and evaluation

4. Implementation

Innovative and effective strategies

Achieving results and sharing findings

The public health model for prevention

Socio-ecological model for understanding violence

Choice of 7 strategies for which there is substantial evidence

1. Developing safe, stable & nurturing relationships between children & their parents / caregivers

2. Developing life skills in children and adolescents

3. Reducing availability and harmful use of alcohol

4. Reducing access to guns and knives: the means of lethal violence

5. Promoting gender equality to prevent violence against women

6. Changing cultural and social norms that support violence

7. Victim identification, care and support programmes

Nucleo de Estudos da Violencia (NEV), Brazil• Home visitation programs by health care professionals•Low-income first time adolescent mothers

• Parenting skills• Emotional bonding• Health behaviours• Personal development

•Parenting programmes

• Information & support for parents

•Parent & child programmes

•Preschool education, family support, child/health services etc.

•Social support groups• e.g. peer support for

parents

•Media interventions•e.g. raise awareness &

knowledge of child maltreatment

Developing safe, stable & nurturing relationships between children & their

parents & caregiversEarly, primary prevention to avoid the development of violence such as child abuse and childhood aggression

1

Some strong evidence that

parenting programmes and parent and child programmes can

reduce child maltreatment and problem/aggressiv

e behaviours in youth

•Preschool enrichment•Child skills, parent

programmes

•Social development training

•Empathy, relationships, conflict resolution, anger management..

•Academic enrichment•Study & recreation out of

school

•Educational incentives •E.g. finance for completing

school

•Vocational Training•Providing skills to find work

¡Preparados, Listos, Ya!A synthesis of effective interventions for the prevention of violence amongst youth and adolescents – PAHO, 2008

Developing life skills in children and adolescents

Cognitive, emotional, interpersonal & social skills to enable youth to deal with the challenges of everyday life

2

Some strong evidence that

preschool enrichment and

social development

programmes can reduce aggression and improve social skills, particularly in at-risk youth

Reduced alcohol hours

• Diadema, Brazil

• Sales banned after 11pm

• Municipal law

• Information campaign

• Strict enforcement

• Three year impacts

• Reduced homicides

Reducing availability and harmful use of alcohol

Addressing the strong links between alcohol and violence

3

Evidence promising,

suggesting that alcohol-focused

interventions can reduce violence.

However, barriers to

intervening and few available

studies

•Regulating alcohol availability

•Sales times, outlet density

•Raising alcohol prices•E.g taxation, minimum price

•Reducing alcohol use in problem drinkers

•E.g. brief interventions, treatment for alcohol dependence;

• Improving drinking environments

•Community partnerships, responsible retailing, strict enforcement, physical design…

Studies in Colombia and El Salvador indicate that enforced bans on carrying firearms in public may reduce homicide rates

Reducing access to lethal means

Reducing access to guns, knives; the means of lethal violence

4

Some evidence of success, mainly for firearms

legislation. Elsewhere

evidence base poorly

developed. More research needed,

particularly in developing countries

•Legislative measures•E.g. bans and licensing

schemes

• Increased enforcement

•E.g. test purchasing, stop and search

•Weapons amnesties

“Program H” / PROMUNDO (Bolivia, Brazil, Colombia,

Jamaica, Mexico, Peru)•Works with boys and young men;•Interactive group education;•Creates alternative non-violence peer groups;•Puts young men in contact with non-violent role-models;•Makes it ‘cool’ to be non-violent by tapping into popular youth culture.•Promotes male-friendly health services

Promoting gender equality to prevent violence against women5

Challenging ideas that one sex has more power and control over another; a reason for violence against women

Good evidence for school-based

programmes. Some evidence for community-

based interventions,

although further research is

needed

•School-based interventions

•Addressing gender norms and attitudes, e.g. safer dating

•Community interventions

•Microfinance programmes, combined with gender equity training

•Life skills programmes •educate about gender-based

violence and develop relationship skills

Puntos de Encuentro, Nicaragua

• Edutainment:• Soap opera (Sexto Sentido), radio, information booklets• Addressed social issues, including IPV

•Longitudinal cohort study with 4,000 youth showed that:

•Sexto Sentido significantly changed views on gender, stigma, sexuality and violence

Changing cultural and social norms that support violence

Challenging rules or expectations of behaviour within a social or cultural group that tolerate violent behaviour

6

Limited evidence for mass media

campaigns, including

edutainment initiatives.

However, further rigorous

evaluations are needed.

•Campaigns for dating and sexual violence

•Challenges harmful beliefs about dating and encourages healthy relationships

•Campaigns for youth violence

•Challenges violence as a method of resolving conflict and promotes non-violent conflict resolution

• Laws and policies• Implementing laws that make

violent behaviour an offence.

Brief support & counselling

• Targeted at IPV victims in US

•Safety plan•Details of local

support services •Nurse-led discussion

offering support, guidance and referrals

• Following intervention:•Reductions in

violence•Better behavioural

functioning of victim’s children

victim identification, care and support programmes

Providing effective care and support to victims of violence to protect against further violence and minimise harm

7

Good evidence for the use of

advocacy support

programmes. Promising

evidence for screening and

referral, psychosocial interventions

and protection orders

•Screening and referral• Identifying and supporting

victims of violence

•Advocacy support •Support and guidance to

victims, e.g. counselling, education, legal aid.

•Psychosocial interventions

•Treat emotional & behavioural problems linked to victimisation.

•Protection orders•Prohibit perpetrators from

further abusing their victims

Conclusions• Sufficient evidence to take action now and implement

interventions• Intensify and expand violence prevention awareness

– among decision makers in low-income and middle-income countries – leaders of high-income countries and international donor agencies

• Enhance investment in research on violence and violence prevention– especially in low-income and middle-income countries– expanding the number of outcome evaluation studies

• Increase the flow to low-income and middle- income countries of – financial resources– technical support for violence prevention.

• Strengthen evidence-based, prevention-oriented collaborative work between public health and criminal justice agencies

Thank you, gracias, obrigada, merci…

Alessandra Guedes

[email protected]

Violence prevention: the evidence

is available at: www.who.int