connecngthedots:understanding and(addressing(the(links ... ·...

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Connec5ng the Dots: Understanding and Addressing the Links between Mul5ple Forms of Violence

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Call iLinc Technical Support at 800.799.4510. PreventConnect is a national project of the California Coalition Against Sexual Assault sponsored by U.S. Centers for Disease Control and Prevention. The views and information provided in this web conferences do not necessarily represent the official views of the U.S. government, CDC or CALCASA. 3

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PreventConnect

•  DomesFc violence/inFmate partner violence •  Sexual violence •  Violence across the lifespan •  Prevent before violence starts •  Connect to other forms of violence & oppression

•  Connect to other prevenFon pracFFoners

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CONNECTING THE DOTS: AN OVERVIEW OF THE LINKS AMONG MULTIPLE FORMS OF VIOLENCE

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ObjecFves •  Describe what the latest research says about shared risk and

protecFve factors across different forms of violence •  Describe how experiencing one form of violence affects

people’s risk for experiencing other forms of violence •  Describe how to consider peoples’ risk and protecFon from

mulFple forms of violence within the context of their communiFes

•  Give examples of ways state health departments can address mulFple forms of violence through shared risk and protecFve factors

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The findings and conclusions in this presenta3on do not necessarily represent the official posi3on of the Centers for Disease Control and

Preven3on

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Presenters

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Annie Lyles PrevenFon InsFtute

Natalie Wilkins, PhD Centers for Disease

Control and PrevenFon

Tomei Kuehl, MPA Colorado Department of Public

Health and Environment

Marci Hertz, MSCenters for Disease

Control and PrevenFon

Not Too Many

www.streetpoetsinc.com

Taylor Code Maxie Jr.

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Linkages

What linkages do you see between different forms of

violence?

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“It’s all connected.” “Gang violence is connected to bullying is connected to school violence is connected to in3mate partner violence is connected to child abuse is connected to elder abuse. It’s all connected.”

Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connec5ng the Dots: An Overview of the Links Among Mul5ple Forms of Violence. Atlanta, GA: NaFonal Center for Injury PrevenFon and Control, Centers for Disease Control and PrevenFon Oakland, CA: PrevenFon InsFtute.

-‐Dr. Deborah Prothrow-‐S3th, Adjunct Professor, Harvard School of Public Health

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Background: “Connec5ng the Dots” Brief

•  What it is: Brief document that translates research about the connecFons between different forms of violence (e.g. shared risk and protecFve factors)

•  Audience: Public health and violence prevenFon pracFFoners and their partners

•  Purpose: Help violence prevenFon pracFFoners and their partners

1) Beher understand and make the case for the connecFons between mulFple forms of violence, 2) Think strategically and crea5vely about ways to prevent all types of violence from occurring in the first place

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Have you read…?

Have you read the report “Connec5ng

the Dots”?

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Answer on the lel

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Insert Ques5on …

Photo by Kai Schreiber

Linkages

Sesameworkshop.org

§  MulFple forms of violence are §  Experienced together §  Share common underlying factors §  Result in common outcomes

§  Exposure to one form of violence increases risk of further vicFmizaFon and engagement in violent behavior

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Insert Ques5on …


Linkages

Sesameworkshop.org

MulFple forms of violence are someFmes experienced together

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Different Forms of Violence

CHILDHOOD ADOLESCENCE ADULTHOOD

Suicidal Behavior

Child Maltreatment: physical, sexual, emoFonal, neglect

Teen Da5ng Violence

Sexual Violence

In5mate Partner Violence

Source: Centers for Disease Control and PrevenFon, Division of Violence PrevenFon

Elder Abuse

Peer Violence: youth violence, bullying, gang-‐related violence, fights

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Insert Ques5on …


Sesameworkshop.org

NaFonal Survey of Children’s Exposure to Violence

Up to 1 in 10 children in the US either witness or are vicFmized by co-‐occurring forms of violence

Children Exposed to Mul5ple Forms of Violence

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Children Exposed to Mul5ple Forms of Violence

•  High risk of suffering chronic and severe symptoms of traumaFc stress, including long-‐term psychiatric problems and lifelong limitaFons on health, well-‐being, relaFonships, and personal success.

•  These risks are especially high when exposure to violence involves a fundamental loss of trust and security

Sesameworkshop.org

Source: NaFonal Task Force on Children Exposed to Violence 17

Insert Ques5on …


Linkages

Sesameworkshop.org

MulFple forms of violence share common underlying factors

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Defining Shared Risk and ProtecFve Factors

•  Research on risk and protecFve factors for violence is conFnuously evolving

•  In the tables on the following slides: – Risk and protecFve factors are collapsed into general categories, but may have been measured differently across different violence areas/different studies*

– “X’s” indicate the existence of at least one study published in a peer reviewed journal demonstraFng an associaFon between the risk or protecFve factor and that type of violence.

*For more informaFon on how each factor was measured, please refer to the “ConnecFng the Dots: An Overview of the Links between MulFple Forms of Violence” brief where references for each study can be found.

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Societal Risk Factors

CM TDV IPV SV YV Bullying Suicide Elder Abuse

Norms suppor5ng aggression*

X X X X X X

Media Violence X X X X

Societal income inequality

X X X X

Weak health, educa5onal, economic, and social policies/laws

X X X X

Harmful gender norms*

X X X X X X

*Norms are generally measured at the individual level


NOTE: CM (Child Maltreatment), TDV (Teen DaFng Violence), IPV (InFmate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

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Youth Development

NaFonal Indian Child Welfare AssociaFon

Todd County, SD

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The Halls

Boston Public Health Commission

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The Halls

Boston Public Health Commission

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Neighborhood Risk Factors


Neighborhood poverty

X X X X X

High alcohol outlet density

X X X X

Community Violence

X X X X

Lack of economic opportuni5es

X X X X X

Low Neighborhood Support/ Cohesion*

X X X X X



*Neighborhood support/cohesion typically measured at the individual level

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Alcohol Policy Reduces Violence

Richmond, VA

CDC-‐funded Academic Center of Excellence in Youth Violence PrevenFon (ACE) at Virginia Commonwealth University partnered with community stakeholders to invesFgate the link between alcohol and youth violence in Richmond’s neighborhoods

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Neighborhood Protec5ve Factors


Coordina5on of services among community agencies

X X X X

Access to mental health and substance abuse services

X X

Community support and connectedness*

X X X X X X



*Community support and connectedness typically measured at the individual level

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School-‐Based Clinics

Minneapolis

Mbasics.facebook.com 27

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Courtesy of Debra Seltzer 28

What are you doing?

What ac5vi5es are you doing to

address the linkages between different types of violence?

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RelaFonship Level Risk Factors


Social isola5on X X X X X X X

Poor parent-‐child rela5onships

X X X X X X X

Family conflict X X X X X X

Economic stress X X X X X

Associa5on w/ delinquent peers

X X X X X

Gang involvement X X X X



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EssenFals for ParenFng Toddlers and Preschoolers

Essen3als for Paren3ng Toddlers and Preschoolers is a free, online resource developed

by the Centers for Disease Control and PrevenFon (CDC).

www.cdc.gov/parents/essenFals/

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Wakanheza Project

§  Create family-‐friendly spaces, train museum staff to support parents

§  Improve customer service and prevent family violence

Ramsey County, MN

Minnesota Children’s Museum

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RelaFonship/Individual Level ProtecFve Factors


Family support/ connectedness

X X X X X X

Connec5on to a caring adult

X X X

Associa5on w/ prosocial peers

X X X

Connec5on/ commitment to school

X X X X X

Skills solving problems non-‐violently

X X X X



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Rethink

New Orleans

Kids Rethink New Orleans Schools

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Individual Level Risk Factors


Low educa5on X X X X X X

Lack of non-‐violent problem solving skills

X X X X X X X X

Poor behavior/ impulse control

X X X X X X

Violent vic5miza5on X X X X X X X X

Witnessing violence X X X X X X X

Mental Health Problems

X X X X X X

Substance use X X X X X X X X NOTE: CM (Child Maltreatment), TDV (Teen DaFng Violence), IPV (InFmate Partner Violence), SV (Sexual Violence), YV (Youth Violence)


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Social EmoFonal Learning Standards

Portland, ME Division of Public Health

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Photo credit: Grand Forks Air Force Base

Grand Forks County, ND

PrevenFon Curriculum

§  Reaches nearly every student in the county

§  Addresses risk and resilience factors

§  Accounts for age and context

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Why Focus on Shared Risk and ProtecFve Factors?

•  Prevent mulFple forms of violence simultaneously

•  IdenFfy strategies that address “real world” contexts of shared risk/protecFon

•  Develop new partnerships

•  Leverage resources/funding streams

•  Consider a larger pool of strategies


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Insert Ques5on …


Linkages

Sesameworkshop.org

Exposure to one form of violence increases risk of further vicFmizaFon and engagement in violent

behavior

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Survivors of one form of violence are more likely* to be vicFms of other forms of violence

–  Girls who are sexually abused are more likely to: •  suffer physical violence and sexual re-‐vicFmizaFon •  engage in self-‐harming behavior •  be a vicFm of inFmate partner violence later in life

–  Youth who have been physically abused by a da5ng partner are also more likely to have:

•  suffered abuse as a child •  been a vicFm of sexual assault •  witnessed violence in their family

–  Women and girls involved in gangs: •  olen experience physical, emoFonal and sexual abuse by other gang members

•  are more likely to have been physically or sexually abused as children

*Likelihood refers to the probability of re-‐vic5miza5on as compared to non-‐vic5ms. It never means always.


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…(Cont.) Survivors of one form of violence are more likely* to be vicFms of other forms of violence

•  Youth who report ahempFng suicide: –  are approximately five Fmes more likely to have been in a physical fight in the

last year

•  Children who have been bullied: –  are at greater odds for becoming involved

in physical violence (e.g. weapon carrying, physical fighFng)


*Likelihood refers to the probability of re-‐vic5miza5on as compared to non-‐vic5ms. It never means always.

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Although most vicFms of violence do not behave violently, they are at higher risk for behaving violently

•  Children who experience physical abuse or neglect early in their lives are at greater risk for commiing: –  violence against peers (parFcularly for boys) –  bullying –  teen daFng violence –  child abuse, elder abuse, inFmate partner violence, and sexual violence later in life

•  Youth who have witnessed parental violence are more likely to: –  bully others


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People who behave violently are more likely to commit other forms of violence

•  Adults who are violent toward their partners are at higher risk of also abusing their children.

•  Youth who bully are more likely to: –  carry weapons and be physically

violent. –  sexually harass peers –  commit violence against partners

as teens –  commit violence against partners as adults


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Insert Ques5on …


Linkages

Sesameworkshop.org

MulFple forms of violence result in common outcomes

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Survivors of Violence are at Risk for Other NegaFve Health Behaviors/Outcomes

Adverse Childhood Experiences (ACEs) As ACEs “score” goes up, so does risk for…

–  Risky Behaviors •  Physical InacFvity, Smoking, Drug/Alcohol Abuse, Early Sexual AcFvity

–  Chronic Disease •  Obesity, COPD, Asthma, Diabetes, Liver Disease, Heart Disease

–  Other Health Outcomes •  Teen Pregnancy, STDs, Miscarriage, Depression, Suicide Ahempts, Early Death, Job Problems/Lost Time from Work, Rape vicFmizaFon, PerpetraFon of IPV

Source: Centers for Disease Control and PrevenFon, Adverse Childhood Experiences Study. Available at: hhp://www.cdc.gov/violenceprevenFon/acestudy/

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How Do ACEs Affect Our Lives?

Source: CDC, Adverse Childhood Experiences Study. Available at: hhp://www.cdc.gov/violenceprevenFon/acestudy/

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How will you use this informa5on in your preven5on

efforts?

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Younger

Older

Ahachment EmoFonal RegulaFon

CogniFve Development Memory Storage & Processing

Social Withdrawal InhibiFon of Aggression

Moral Development Friendship FormaFon & Acceptance

AhribuFonal Biases Academic Performance

Self-‐Esteem Pessimism Social Competence

AnFsocial Behavior

Impact of Violence: Developmental Aspects

Adapted from a presentaFon by David Finkelhor 48

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What is Trauma?

•  Experiences or situaFons that are emoFonally painful

•  Chronic adversity (discriminaFon, racism, sexism, poverty, oppression)

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PTSD

Persistent

TraumaFc

Stress

Disorder

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Root Causes Shape…

q Systems

q Neighborhoods

q School

q Families

q Peers

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Building Community Resilience

§  RestoraFve JusFce

§  Healing Circles

§  Reclaim and Improve Public Spaces

§  Shil Community Social Norms

§  Enhance Social ConnecFons and Networks

§  Build IntergeneraFonal ConnecFons and Networks

§  Organize and Promote Regular PosiFve Community AcFvity

§  Providing more of a voice and element of power for community folks around shiling and changing environmental factors as well as the structural factors

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Examples of PotenFal Strategies for Addressing MulFple Forms of Violence

•  Community/Societal level –  Norms change strategies –  Strategies/acFviFes that enhance community support & connectedness –  Coordinated services

•  RelaFonship level –  Strategies that support families under stress –  Strategies that connect youth with supporFve adults, pro-‐social peers, and their schools

•  Individual level –  Strategies that build youth and families’ skills in solving problems non-‐violently

–  Substance abuse prevenFon strategies

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Integrated Approach

§  underesFmaFng true scope of vicFmizaFon; §  limitaFons in idenFfying children who are poly-‐vicFms; §  unnecessary compeFFon for scarce resources; §  reduced policy influence; §  reinforcing arbitrary disFncFons and §  ignoring the perspecFve of the child and community

Adapted from a presentaFon by David Finkelhor

Honoring the linkages between mulFple forms of violence reduces potenFal shortcomings associated with addressing different forms of violence independently, including:

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Insert Ques5on …


Linkages

Sesameworkshop.org

§  MulFple forms of violence are §  Experienced together §  Share common underlying factors §  Result in common outcomes

§  Exposure to one form of violence increases risk of further vicFmizaFon and engagement in violent behavior

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Child Trauma Training Academy

Los Angeles

www.childrensinsFtute.org

Violence Connected. DomesFc Violence, Gangs and ParenFng:

A Dialogue about Learned Violence.

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Source://cospl.coalliance.org/fedora/repository/co:1583

Addresses shared risk and protecFve factors for: §  Child maltreatment §  Youth suicide §  School violence §  Bullying §  Community violence §  Sexual violence §  Teen daFng violence

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Sesame Workshop

Sesameworkshop.org

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TOMEI KUEHL, MPA

Colorado’s Shared Risk and Protective Factor Strategy

Colorado Dept. of Public Health & Environment

•  Violence and Injury Prevention – Mental Health Promotion Branch (VIP-MHP)

•  Who is VIP-MHP? •  Suicide Prevention •  Essentials for Childhood (Child Maltreatment

Prevention) •  Prescription Drug Overdose Prevention •  Youth Marijuana Prevention – campaign •  Child Fatality Prevention •  Older Adult Falls Prevention •  Motor Vehicle Prevention •  Sexual Violence Prevention

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Enhancing and Making programs and outcomes work to end rape (empower)

PHASE I – Piloting a shared risk and protective factor approach

•  Teen Dating Violence •  Intimate Partner

Violence •  Sexual Violence/

Domestic Violence with LGBTQ Community

Phase II – Youth Development Programs

•  Partnership with state youth violence prevention program (TGYS)

•  Funded the following: – Mentoring Program – Early Childhood

Program

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Risk factors for perpetration of sexual violence

ProtecFve factors against sexual violence

Title Text MORE TITLE TEXT.

Content about this page goes here.

PHASE III – Youth Suicide Prevention

•  Suicide Prevention Program

•  Child Fatality Prevention •  Youth Violence

Prevention (Tony Grampsas Youth Services)

•  Sexual Violence Prevention

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Success •  Who we currently fund:

–  2 Dual Agencies •  (DV/SV – plus prevention programming)

– 1 Domestic Violence Agency

– 1 LGBTQ specific Prevention and Intervention Agency

– 5 Youth Development Organizations •  (Positive youth development –mentoring,

afterschool programming, etc.)

•  Future: – 7 Youth Suicide Prevention school sites

(upon CDC approval)

What about marijuana?

In case you didn’t know, Colorado legalized marijuana….

•  Questions? •  Tomei Kuehl, MPA

–  Sexual Violence Prevention Unit Supervisor – [email protected] –  303-692-2049

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Why Now?

What is happening right now in our field that helps make the shim

possible?

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Why Now?

§  The difficult financial environment is a great opportunity to leverage experFse and resources across mulFple experFse/organizaFons.

§  CollecFve impact and community collaboraFon §  ACEs study provides the data tools to convince why we all

need to partner §  What else?

What is happening right now in our field that helps make the shil possible? What trends do we have to use

as tools to build credibility?

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For More Informa5on ConnecFng the Dots: An Overview of the Links Between MulFple Forms of Violencewww.cdc.gov/violenceprevenFon/pub/connecFng_dots.html Centers for Disease Control and PrevenFon

–  Natalie Wilkins [email protected] –  Marci Hertz [email protected] –  Joanne Klevens [email protected]

Colorado Department of Public Health and Environment –  Tomei Kuehl, MPA, Sexual Violence PrevenFon Unit Supervisor

[email protected] 303-‐692-‐2049

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Annie Lyles 510-‐‑444-‐‑7738 annie@ prevention institute.org

Sign up for our media alerts at www.preventioninstitute.org/alerts

www.preventioninstitute.org

Connect with us on

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PreventConnect 1215 K Street Suite 1850 Sacramento CA 95814

Website: preventconnect.org

Email: [email protected]

Email Group:

preventconnect.org/email-‐group

eLearning: learn.preventconnect.org

Wiki: wiki.preventconnect.org

preventconnect.org/Facebook

preventconnect.org/TwiSer

preventconnect.org/Flickr

preventconnect.org/YouTube

preventconnect.org/LinkedIn

preventconnect.org/Pinterest 74

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