Concurrent session Wednesday 11th November.

1. Preventing Family
Violence – it’s all
our business!
Karen Field, CEO
Reima Pryor, Director R&E
FRSA Conference, Brisbane 2015

2. Today’s Workshop
1. National policy context
2. FV Prevention Evidence-base
3. Overview of 2 FaRS FV Prevention Projects
4. FaRS’ role in FV Prevention

3. National policy context
The National Plan to Reduce Violence against Women
and their Children 2010-2022
• Targets domestic and family violence and sexual assault
– DV = intimate partner violence
– FV= broader term (inc. Aboriginal kinship relationships)
– Physical, sexual, emotional, psychological harm
• Acknowledges its gendered/unequal nature
• Links with other COAG reforms (Indigenous women, Child
Protection, Homelessness, Health and Hospitals, Social
Inclusion)

4. Family and Relationship Services
• As a sub-activity of the Families and Children Activity of the
Families and Communities Programme of DSS
• aim to strengthen family relationships, prevent breakdown
and ensure the wellbeing and safety of children
• broad-based counselling and education to families of different
forms and sizes
• primarily early intervention and prevention
• targeted to critical family transition points including
formation, extension, and separation.

5. Family Violence=
• All types (physical, sexual, emotional,
psychological, social, financial, spiritual)
• Intimate partner violence
• Child maltreatment (abuse and neglect)
• By children/young people in families
• By extended family members

6. What is prevention?
• Primary prevention (aiming to
prevent violence before it occurs);
• Secondary prevention (immediate
responses once violence has
occurred);
• Tertiary prevention (efforts to
reduce the impacts of the
violence).
Dahlberg & Krug (2002) in WHO (2010a)

7. Spectrum of interventions
Spectrum of Interventions for Mental Health Promotion
(Mrazek & Haggerty, 1994; cited in CDHAC,2000)

8. Spectrum of interventions
• efforts are needed across the spectrum of
interventions to address the health risk issue
within a population
• Universal - the general population
• Selective - subgroups identified to be at risk
• Indicated- those with detectable signs and
symptoms (ie Early Intervention)

9. The FV Prevention Evidence-Base
• WHO (2010 a)- Preventing intimate partner
and sexual violence against women
• A public health approach
• Risk and protective factors for IPV and SV
• The ‘Ecological’ model
• A life-course perspective

10. A public health approach (WHO)
• Population-based data and outcomes
• Science/research driven
• Interdisciplinary/inter-sectoral
• describes the problem, its impact, and the
associated risk and protective factors
• derives directions for intervention, evaluation,
and eventually, implementation

11. The Ecological Model
• organises evidence-based risk and
protective factors into 4 levels of a nested
hierarchy
– Individual
– relationship/family
– community; and
– societal
Dahlberg, L.L. and Krug E.G. (2002)

12. Ecological model
• emphasis on multiple and dynamic
interactions among risk factors and between
levels/domains
• promotion of the importance of cross-sectoral
prevention policies and programs

13. Risk and Protective Factors
for IPV and SV
See handouts 2, 3
Which relate to your
programs
and are amenable to
change?

14. Protective factors
Less researched but include:
• Higher education of women and men
• Healthy parenting as a child
• Own supportive family
• Living with extended family
• Belonging to an association
• Women’s ability to recognise risk

15. Relationships between risk factors
• Risk factors often occur in constellations
• It is the number and not the type that predicts
long-term outcomes
• Relationships between risk factors are
complex and our knowledge incomplete
• Bromfield et al. (2010) – the impacts of FV, mental illness and
substance abuse on parenting and child development and
wellbeing/child maltreatment, with implications for practice

16. Domains of Risk and Protective Factors
Protective
Factors
Individual Factors
Family Factors
School Context
Life
Events/Situations
Community and
Cultural Factors
Risk factors
Individual Factors
Family Factors
School Context
Life
Events/Situations
Community and
Cultural Factors
Risk
factors
Protective
Factors
The Challenge:
Effective programs that are able to
focus on multiple risk and
protective factors at the same time

17. Life-course perspective
• Influences early in life can act as risk factors for health-related
behaviours or health problems at later stages (Smith, 2000; cited in
WHO, 2010 a) – cumulative risk or protection
• Therefore target risk/protective factors as early as possible
• WHO (2010 a) organised their review of programs by life-
course stages
1. Infancy (0-4 yrs)
2. Childhood and early adolescence (5-14yrs)
3. Adolescence and young adulthood (15-25 yrs)
4. Adulthood (26+ yrs)
5. All ages

18. Developmental Prevention
• Australia’s National Crime Prevention
initiative (1999)
• Sees the series of transitions or points
of change across the life course as being
points of:
– increased stress
– a fork in the pathway with more than one
possible outcome
– increased malleability with associated
opportunity for effective intervention

19. FV prevention strategies- the
evidence-base
Rigorous reviews by:
• WHO (2010) Preventing Intimate Partner and Sexual Violence
against women (IPV and SV)
• WHO (2010) Violence prevention: the evidence (interpersonal
and self-directed violence, incl.:
child maltreatment, IPV, SV, youth violence, elder abuse,
suicide and other forms of self-directed violence)
• Organised by strategy – see handouts 1,4,5

20. Effective programs
Which life-course stage does
your program target?
Do your programs look similar
to any of these?
Or is yours a new strategy?

21. FV Prevention evidence-base
• Evidence still very limited, with most derived
from high income countries, esp. USA
• The generation of evidence
via incorporation of
well-designed outcome
evaluations is critical to
progress the field(WHO, 2010)

22. Evaluation considerations
• Changes in knowledge, attitudes and beliefs do not
necessarily lead to behaviour change outcomes
• The need for behaviour-specific qns
• Operational definitions and tools available
• However given our the focus on prevention and early
intervention, and the difficulty of longitudinal
research, measuring outcomes related to risk and
protective factors is more realistic and appropriate
(WHO, 2010)

23. Three principal areas for evaluation
1. Process evaluation (What’s being delivered? What’s
working/not?
2. Outcome evaluation
• ideally reductions in violence perpetration/victimisation
• more realistically -changes to risk factors based on theory
• ruling out alternative explanations for changes
• Time-series design (pre, post, f/up)
• Quasi/Experimental design (control/comparison groups)
• Controlled trial (RCT)
3. Economic evaluation (efficiency of resources)

24. FaRS
So what role can our FaRS sector play in
FVprevention?
-Service development and delivery
-Program evaluation & research
-What about early intervention?

25. • Upstream prevention and early intervention
needs to take place outside FV tertiary level
services (Nat.MH Plan, 2000)
• FaRS as a a quasi universal service sector
• The opportunity for a public health approach
targeting family as setting, and vulnerable life
course transitions and vulnerable groups
(proportionate universalism)
• Placing a FV lens over our organisations and
programs

26. 2 FaRS FV Prevention Projects
1) Just Families- multi-risk prevention
and early intervention targeting the
transition to parenthood
2) Indian Australian FV Project

27. Just Families
• Targets those transitioning to parenthood
• Pregnant and new parents (including men!)
• For prevention and early intervention
• Across multi-risks
• Mental Illness
• Family Violence
• Substance Abuse
• Child Abuse and Neglect
(Copyright - Drummond Street Services)
•

28. Just Families- what we did
• Initially funded for 4 years by William Buckland (2007-11)
• Involved research, service development & delivery, and evaluation
• Partnered with local universal Perinatal and first-to-know services to
– Re-orient services and build capacity for prevention and pathways to early interventions
– Prevention intervention seminars
– Early Intervention Screening Tool
• Research identified 10 early (as distinct from tertiary level) risk factors
• 10 FV prevention and early intervention practice principles
• Developed and evaluated FaRS Early Interventions for families ‘at risk’
– 1:1 Parent Support Sessions
– Hands on Parenting Education and Support (HOPE)- for the most vulnerable
– Family Counselling (and Guide)

29. Promotion Prevention
strengthen family wellbeing
Early Intervention
identify & respond to risks early
Treatment
evidenced based treatment
Recovery
support families to recover
Level Of
Intensity
Of Services
Increases
As
Vulnerability
Increases
Families
Self-select
More Intensive
Service Based
On A
Perceived
Higher Level
Of Risks
And Needs
Universal

30. Table 1: 10 Early Risk Factors For Family Health & Wellbeing
1 Relationship Conflict (including Attachment styles)
2 Transition-related issues – Parenting and issues to do with the child
3 Mental health vulnerability- Adults and Infant
4 Anger and violence (or Withdrawal)
5 Problematic alcohol and other drug use
6 Lack of support /isolation
7 Conflicts in relation to extended family /culture
8 Past experience of past abuse/trauma
9 Financial Pressures
10 Problematic gender role attitudes

31. Pre existing
vulnerability
Early Indicators /
Mediating Factors
Positive
Wellbeing
Outcomes
Poor
wellbeing
outcomes
Including couple
relationship and other
individual
vulnerabilities which
may relate to family
of origin
Which come to the
fore during perinatal
period.
The 10 early
intervention risk
factors. e.g. relationship
breakdown, family
violence, poor mental
health, alcohol and
other drug abuse,
child abuse and
neglect
Pre - Pregnancy
Commencement
of Perinatal
Period
Adjustment to
transition/ Access to
Prevention & Early
Interventions
Long-term adult
& infant outcomes
Pathways to Family Heath and Wellbeing:
Early Intervention in the Transition to
Parenthood.

32. Client Outcomes-
Early Intervention Family Counselling
• Deakin University Psychology Department for
measure selection and data analsis
• Pre and Post counselling surveys
– family functioning- cohesion and conflict
– couple relationship functioning
– mental health symptoms
All showed significant improvements post
counselling
Mental health symptoms reduced from a clinical
to non-clinical level
Maternal and paternal attachment measures
piloted

33. Risk and Strength
• This transition is inherently stressful
• Hold risk -assessment and -management
practices in balance with strengths-based
practice
• Target both risk and
protective factors

34. Language and Focus
• Normalising stressors arising
• Supportive- encouraging, re-assuring, strengths-based
• Solution-focussed -optimistic and empowering
• Psycho-educative and skills focus
• Encourage self-identification of vulnerability, self-
management where possible, or self-initiated early help-
seeking where indicated, now and for future transitions
• Warm/active linking with early supports
• Child-centred, family focussed, father-inclusive

35. 10 Early Intervention Practice Principles
1.The responsibility for violence behaviours and for change continues to
reside with the perpetrator of violent behaviour, recognising that in most
cases extreme abuse is perpetrated by males against females within
intimate partner violence
2.Risk factors for tertiary level violence are not the same as early risk
factors for family violence, which occur further upstream and are are seen
as mediating factors which may predate pregnancy and birth, but which
come to the fore or escalate at this transition to parenthood, and which
may interfere with successful adjustment to this transition stage
3.Gender-based power use is only one of 10 identified early intervention
risk factors which come to the fore at this time, which, if addressed early
may prevent deterioration of the relationship, and other poor health and
wellbeing outcomes including gender-based violence onset

36. 4.Assessment of risk must be held in strict balance with a
strengths-based approach during prevention and early
intervention work, with engagement and parenting and
relationships confidence-building as key aims
5.Relationship skills enhancement activities are effective in
preventing and early intervening with family violence, as well as
other health risks such as mental illness
6.Awareness-raising and normalising in relation to risk issues
that come to the fore at this transition to parenthood are
important
7.Practical non-blaming strategies to promote healthy equal
relationships and sharing of parenting and household
responsibilities are valuable

37. 10 Early Intervention Practice Principles
8.Promoting early self-identification by mothers and fathers
about when and where to go for help when difficulties arise
during the transition to parenthood is important
9.Ante- and post-natal universal services provide settings for
prevention and early intervention with family violence, via a
focus on engaging men in their roles as fathers, promoting
equal relationships, early identifying couple relationships at
risk, and providing pathways for early intervention couples
counselling
10.Family relationship services provide a public health
opportunity to early intervene with couples at risk during
transition to parenthood

42. Tipsheets
• Bonding with your Baby
• How partners can bond with babies in
the early days
• Adjusting to your baby
• Coping strategies when you have a new
baby
• What sort of parent do I want to be?
• Routines
• Adjusting to the new role of mum or
dad
• Supporting your partner
• Gender roles
• Healthy relationships
• Coping skills

43. Tipsheets
• Healthy vs. unhealthy coping
• More on power and control within a
relationship
• Dealing with anger – what is healthy
• Alcohol/dugs and raising kids
• Tips for grandparents – this tip sheet
can be given to grandparents
• Community connection and kids/
Importance of connection
• Dealing with intrusive in-laws
• How to read signs that past
experiences are affecting a loved one
• Being money wise
• Money Worries
• Healthy sleep for adults

46. Indian Australian FV Project
Partnered with
• Australia India Society of Victoria (AISV) and their
Taskforce Against DV in Indian and Ethic
Communities (ethnic community partner)
• Melbourne University’s Centre for International
Mental Health (now Global and Cultural Mental
Heath Unit) (academic partner)
• Third Way Theatre (arts-based partner)

47. Aims
• Explore the nature of FV in our Indian Australian
community
• Explore cultural barriers to FV help-seeking
• Utilise a Forum Theatre process to engage, build
understanding and awareness, and empower
change
• Ensure the safety of community members

48. Outputs and outcomes
• Built understanding of the nature of FV in our Indian
Australian community and barriers to help-seeking
• Ideas regarding FV interventions across the spectrum
• Positive individual level outcomes- raised awareness
• Positive community level outcomes- built cultural
knowledge-base, leader attitude changes, group
momentum for change
• Dissemination via publications

49. Reflection on FaRS
• What existing skillsets and processes (points of
engagement, assessment, interventions) can be
utilised and optimised?
• What partnerships and coordination is needed?
• What re-orientation of our services need to occur?
• What vulnerable groups are not being serviced?
• What workforce development is needed?
• Pathways from prevention to early intervention?

51. For further
information:
Karen Field
Karen.field@ds.org.au
Reima Pryor
reima.pryor@ds.org.au
www.ds.org.au