Domestic Violence and the Evidence Context

Nov 28, 2013, 05:02 PM

Clare Perkins, Director of PHE's North West Knowledge & Intelligence Team, explains the evidence base for domestic violence: what it is, who it affects, how we prevent it. Transcript INTIMATE PARTNER VIOLENCE (sometimes referred to as Domestic Violence) is a serious, but preventable public health problem.

In 2011/12, 7.3% of women and 5% of men reported having experienced domestic abuse in the last year according to the Crime Survey for England & Wales. This is equivalent to an estimated 1.2 million female victims and 800,000 male victims.

INTIMATE PARTNER VIOLENCE is defined as any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. There are four main types (Saltzman et al. 2002):

• Physical violence • Sexual violence and • Threats of physical or sexual violence and Psychological/emotional violence – this can include humiliating the victim, controlling what the victim can and cannot do, withholding information, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, and denying the victim access to money or other basic resources. In addition, stalking is often included among the types. The most common forms of INTIMATE PARTNER VIOLENCE are non-physica,l including emotional and financial abuse. INTIMATE PARTNER VIOLENCE can vary in frequency and severity. It occurs on a continuum, ranging from one episode to chronic, severe abuse and violence. Not everyone is equally at risk of Intimate Partner Violence. Victims are more likely to be:

• Female • At a Younger age • From a Low household income • Being single, co-habiting, separated or divorced • & Living in areas of high physical disorder

They are more likely to

• Consume alcohol (victim and perpetrators) • Have a controlling and jealous partner • Be a perpetrator or victim of childhood abuse • Live in communities where there is gender inequality and where • Cultural norms are tolerant of violence

The health and social effects of intimate partner violence can be severe and wide-ranging and can have lasting harmful effects on individuals, families, and communities. The consequences can include physical injuries and chronic conditions; anxiety, depression and post traumatic stress disorder. In addition, experience of INTIMATE PARTNER VIOLENCE is linked to risky behaviours such as tobacco, alcohol and drug misuse, often as a way of coping.

INTIMATE PARTNER VIOLENCE is not just a problem for the men and women who experience it but also for children who observe it. Much like infections, violence in contagious. For instance, exposure to violence as a child makes an individual more likely to be involved in violence in later life. We need to break this vicious cycle.

The costs of INTIMATE PARTNER VIOLENCE can be substantial. In 2004, the cost of domestic violence in England and Wales was estimated to be £23 billion per year.

The goal for public health is to recognize and prevent INTIMATE PARTNER VIOLENCE and it can be prevented.

In the United Kingdom and elsewhere, there are a range of programmes and interventions available that can be used to address the risk factors for INTIMATE PARTNER VIOLENCE, and promote protective factors across the life course to help prevent INTIMATE PARTNER VIOLENCE or to reduce subsequent victimization.

The primary prevention of intimate violence (and by primary prevention I mean reducing the number of new instances of violence) is likely to save lives and money.

The importance of primary prevention is often overshadowed by the importance of the large number of programmes that, understandably, seek to deal with the immediate and numerous consequences of violence.

However, investment to stop intimate partner violence before it occurs is crucial as this will protect and promote the well-being and development of individuals, families, communities and societies.

At present, evidence on the effectiveness of primary prevention strategies for intimate partner is limited, with the overwhelming majority of data primarily from the United States.

A Review of evidence for prevention of intimate partner violence from the UK focal point for violence and injury prevention was published in September 2010. The World Health Organization also published a report in the same year entitled Preventing IP and Sexual Violence against Women- Taking Action and generating evidence.

These reports conclude that

• School-based education programmes that promote gender equality and healthy relationships have been successful in reducing violence towards current dating partners. For example, the ‘Safe Dates’ programme in the US that targets 12-18 year olds. An evaluation of the scheme reported less sexual, physical and psychological violence perpetrated against current dating partners one month after the programme ended and 4 years later compared to controls.

And also

• Among offenders, treatment for substance misuse has been successful in reducing future INTIMATE PARTNER VIOLENCE.

• At a community level, lowering levels of drinking in the population through regulating alcohol sales (e.g. through controlling the price of alcohol) has been associated with a reduction in INTIMATE PARTNER VIOLENCE. Alcohol is a common feature of sexual assault. Over a third of offenders and a quarter of victims of serious sexual assault are thought to have consumed alcohol prior to the incident. In Canada, minimum unit prices have been used for several years. In British Columbia, a study estimated that a 10% increase in MUP of alcoholic drinks reduced their consumption by 3.4%.

There is also good evidence that

• Routinely enquiring about intimate partner violence (INTIMATE PARTNER VIOLENCE) in health care settings and training health professionals to deal with cases of INTIMATE PARTNER VIOLENCE can be effective in increasing disclosure and identification. However, less is known about their ability to protect against future violence by partners. • The use of protection orders (e.g. an order to stop abuse or contact with the victim) can be effective in reducing re-victimisation. Additionally, use of specialist domestic violence courts has been associated with increased levels of arrests and prosecutions of perpetrators. There is also some evidence that advocacy services (that offer help and support to victims) can reduce some forms of physical abuse in the medium term.

Pioneering approaches in the US have shown that University based bystander programmes have been effective in reducing IPV. The ‘Get Savi’ programme in Scotland encourages youngsters to take a stand against harassment, abuse and violence by being an ‘active bystander’ and teaches them safe ways to intervene. This approach not only works as a secondary prevention technique to minimize harm but also works as a primary prevention, changing social norms.

There is emerging evidence of the effectiveness of interventions for children and adolescents exposed to INTIMATE PARTNER VIOLENCE, and also evidence for changing social and cultural norms through media awareness campaigns and working with men and boys, but further research is needed. Little is known about the effects that public information campaigns can have on experiences of INTIMATE PARTNER VIOLENCE, nevertheless they have a valuable role to play in creating public discussion and debate about INTIMATE PARTNER VIOLENCE and signposting those affected to local and national support services.

The National Institute for Health and Care Excellence has produced draft guidance on identifying and preventing domestic violence and expects to issue final guidance in February 2014.

In summary INTIMATE PARTNER VIOLENCE is a serious public health problem but one that is preventable. We still have a lot to learn about how to prevent INTIMATE PARTNER VIOLENCE but there is a growing evidence base of the effectiveness of strategies. Tackling violence effectively requires action on a multiagency basis. The Department of Health in its report ‘Protecting people, Promoting health, published in October 2012 sets out why we need this public health approach to violence prevention and how it can be achieved. Recent changes to the NHS and public health system, with public health integrated into local government structures allows stronger connections to be made between Directors of Public Health and key services including children’s services, adult social care, education services, community safety and alcohol licensing. Connections must be made with and between these services to ensure that they recognize connections between early life experiences and propensity for INTIMATE PARTNER VIOLENCE late in life; exploit all opportunities to prevent INTIMATE PARTNER VIOLENCE violence and understand the benefits such prevention brings for educational achievement, employment prospects and long-term health and well-being. Local authorities and other commissioners (including clinical commissioning groups), working with service providers and through strategic partnerships and health and wellbeing boards have the ability to create multi-agency plans for INTIMATE PARTNER VIOLENCE prevention. Such plans should use the strong evidence base behind public health approaches to violence prevention to ensure public health, private sector and community assets all contribute to violence prevention and benefit from less IP violence. #domesticviolence, #publichealth #healthdata