INSPIRE: Seven strategies for ending violence against children

INSPIRE: seven strategies for ending violence against children

• Implementation and enforcement of laws• Norms and values • Safe environments• Parent and caregiver support• Income and economic strengthening• Response services• Education and life skills

The INSPIRE technical package

INSPIRE and SDG prevention targets• Ending violence against

children– 4a safe schools– 5.2 violence against

women and girls – 16.1 all forms of violence

and related deaths– 16.2 all forms of VAC

• Other targets– communicable disease– mental health– substance abuse– gender equity– education– Etc.

Types of violence against children

Prevalence of violence against children

• 36% psychological abuse• 23% physical abuse• 18% girls sexual abuse• 8% boys sexual abuse• 16% neglectStoltentborgh et al, multiple papers, various years.

• Base case analysis, for physical, sexual and emotional maltreatment, and bullying and fighting experienced in the past year– up to one billion children or every second child

Hillis S, Mercy J, Amobi A, et al. Global Prevalence of Past-year Violence Against children: A Systematic Review and Minimum Estimates. Pediatrics. 2016; 137 (3): e20154079

Chronic LungDisease

Fractures

PregnancyComplications

Cancer

Burns

Unintendedand Adolescent

Pregnancy

FetalDeath

Internal Injury

Diabetes

Heart Disease

HIV

STDs

Violence

AlcoholAnd Drugs Unsafe

Sexual Practices

Maternal andChild Health

Injury Non-Communicable Disease

Communicable Diseaseand Risk Behaviors

Stroke

Alcohol

Smoking

Obesity

PhysicalInactivity

Multiple Partners

Head Injury

Mental HealthProblems

Suicide

Depression and Anxiety

PTSD

Assault

Direct effect Indirect effect due to adoption of high-risk behaviour

Health consequences of violence against children

INSPIRE components• Seven strategies that provide an overarching

approach for ending violence against children– specific interventions including programmes, practices

and policies to implement the strategies – evidence supporting these strategies and interventions – Links to related SDG targets

• Two crosscutting components– Multisectoral actions– Monitoring and evaluation

• Implementation considerations

INSPIRE evidence: implementation and enforcement of laws

0

5

10

15

20

25

30

35

40

2001 2002 2003 2004 2005

Hom

icid

es p

er 1

00 0

00 p

opul

atio

nReduction in homicide rate across 5 South African cities

from 2001-2005 following Firearm Control Act

Firearm homicide

Non-firearm homicide

Matzopoulos RG, Thompson ML, Myers JE. Firearm and non-firearm homicide in 5 South African cities: a retrospective population-based study. American Journal of Public Health. 2014;104(3):455–60

4500 lives saved over 5 years, many of them adolescents

INSPIRE evidence: norms and values

-64%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

SASA!

Perc

enta

ge d

ecre

ase

in w

itnes

sing

IPV

Reduction in children witnessing intimate partner violence due to SASA! community mobilization programme

Kyegombe N, Abramsky T, Devries K, et al.(2015). What is the potential for interventions designed to prevent violence against women to reduce children's exposure to violence? Findings from the SASA! Study, Kampala, Uganda. Child Abuse & Neglect, Volume: 50, Page(s): 128-140]

INSPIRE evidence: safe environments

-42% -32%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

Hospital admissions Police-recorded woundings

Perc

enta

ge d

ecre

ase

in v

iole

nce-

rela

ted

inju

ries

Reduction in violence-related injuries following implementation of Cardiff approach to hotspot intervention

Source: Florence C, Shepherd J, Brennan I, Simon T. Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis.British Medical Jounral, 2011; 342: d3313

INSPIRE evidence: parental and caregiver support

-48%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

Nurse-Family Partnership

Perc

enta

ge d

ecre

ase

in m

altr

eatm

ent

Reduction in child maltreatment due to Nurse-Family Partnership programme at 15-year follow up

Source: Olds D, Henderson CR Jr, Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L, Sidora K, Morris P, Powers J. Long-term effects of nurse home visitation on children's criminal and antisocial behaviour: 15-year follow-up of a randomized controlled trial. JAMA. 1998 Oct 14;280(14):1238-44.

INSPIRE evidence: income and economic strengthening

-50%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

IMAGE programme

Perc

enta

ge d

ecre

ase

in in

timat

e pa

rtne

r vi

olen

ceReduction in intimate partner violence among 430

women receiving the Intervention with Microfinance and Gender Equity (IMAGE) programme

Source: Julia C. Kim, Charlotte H. Watts, James R. Hargreaves, Luceth X. Ndhlovu, Godfrey Phetla, Linda A. Morison, Joanna Busza, John D.H. Porter, and Paul Pronyk. Understanding the Impact of a Microfinance-Based Intervention on Women’s Empowerment and the Reduction of Intimate Partner Violence in South Africa American Journal of Public Health October 2007, Vol. 97, No. 10 : pp. 1794-1802.

INSPIRE: response services

-37% -56%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

Individual therapy Group therapy

Perc

enta

ge d

ecre

ase

in sy

mpt

oms

and

impa

irmen

t

Reductions in trauma symptoms and functional impairment across 11 trauma-informed cognitive behavioural therapy trials

Source: Wethington HR et al, The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review. American Journal of Preventive Medicine Volume 35, Issue 3, September 2008, Pages 287–313

INSPIRE evidence: education and life skills

-25% -33%

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

Programmes for all students Programmes for selected students

Perc

enta

ge d

ecre

ase

in a

ggre

ssiv

e an

d di

srup

tive

beha

viou

rReductions in aggressive and disruptive behaviour in school settings across 249 life skills and socio-emotional training

programmes

Source: Wilson SJ, Lipsey MW. School-Based Interventions for Aggressive and Disruptive Behavior: Update of a Meta-Analysis. American Journal of Preventive Medicine, Volume 33, Issue 2, Supplement, August 2007, Pages S130–S143

There are major challenges!

• While 56% of 155 countries provide some support for implementing INSPIRE interventions

• Just 25% consider this support sufficient to reach all who need them

Drastic action on scale up is needed

Societal responses to COVID-19 demandnew delivery channels

• COVID-19 responses have increased the prevalence of violence

• Most programme designs and evidence for effectiveness predate the COVID-19 pandemic

• Efforts to deliver INSPIRE interventions through virtual channels and their evaluation must be prioritized

Thank you!

For more information:

www.who.int/violence_injury_prevention/violence/inspire-package/en/