What Works in Violence Prevention A Global Overview

Transcription

1 What Works in Violence Prevention A Global Overview Professor Mark A. Bellis OBE Centre for Public Health World Health Organization Collaborating Centre for Violence Prevention

2 Categories of Violence Interpersonal violence - between individuals. Divided into family and intimate partner violence (child maltreatment, intimate partner, elder abuse) and community violence (acquaintance, stranger, youth) Self-directed violence - self-abuse and suicide Collective violence violence by larger groups of individuals, subdivided into social, political and economic violence

3 Violence Prevention Basic Requirements Effective Criminal Justice system Functional, accessible Care system Functioning schools Research based evidence Monitoring and surveillance Political support for prevention Equity

4 Baseline Propensity for Violence Genetics, Epigenetics, Foetal Exposure Adaptation Adverse Childhood Experiences Hair Trigger Disengaged at school Triggers Circumstances (Ecology/Environmental) What are you looking at?

5 Risk Factors Aggression and involvement in violence Societal Community Relationship Individual Krug et al, 2002 Poverty Presence Being Parental male conflict of guns, drugs, gangs Media Living Substance Single-parent violence urban use household areas Economic Living Low Having intelligence a high inequality teenage crime mother areas Rapid Attention Having demographic delinquent problems friends change Ineffective Poor school parental criminal achievement monitoring justice system Cultural Delivery Childhood norms complications abuse supportive and neglect at of birth violence

6 A&E assault presentation rate/10,000/year A&E assault presentation rate/10,000/year Assault attendances Accident and Emergency Services across England Deprived males Affluent males Deprived females Affluent females Age By age 13, females from deprived communities exceed the peak level of female presentations in affluent 4 areas (aged 20 years) Age Age Age Bellis et al. BMC Public Health 2012, 12:746

7

8 Working with High Risk Youth Behaviour change counselling e.g. brief interventions Family therapy Helping parents and youths to cope and respond to family, school, relationship and community problems Programmes for offenders e.g. Cognitive behavioural therapy Gang prevention programmes e.g. Boston Ceasefire model, Pulling Levers strategy Youth inclusion programmes Activities and skills for high risk youth Mentoring Partnering high risk youth with positive role models Largely ineffective for violence prevention US - Multisystemic therapy lower recidivism than individual therapy 50% versus 81% - over 13 year follow up New Zealand - 32% committed violent crime in 2 years following release compared with 63% of comparison group US reduced gun homicides by one per month over project period UK - reduced frequency of arrest but not risk of arrest (Boredom Booze) Compared with controls those in mentoring programmes were less likely to be involved in carry a weapon, fighting, bullying Sethi et al, 2010

9 ACE Study Adverse Childhood Experiences (USA) Experiences before age 18 Abuse: Physical, sexual, emotional Neglect: Physical, emotional Household Dysfunction: Mother treated violently Household substance abuse Household mental illness Parental separation / divorce Incarcerated household member (n=17,000) Felitti et al, 1998; Anda et al, 2006

10 Childhood Violence and Adult Health Increased risk (adjusted odds ratio) of health behaviours and conditions in adulthood for individuals experiencing four or more ACEs Low mental wellbeing x 4.6 x 3.5 Severe obesity x 1.9 x 3.0 Current smoker x 1.8 x 4.0 Alcohol abuse x 7.2 x 3.7 Illicit drug use x 4.5 x 5.5 Perpetrating violence x 5.5 x 7.9 Felitti et al, 1998; Anda et al, 2006; Dietz et al, 1999; Bellis et al, in prep Had a teenage mother x 2.6 Unintended teen pregnancy x 4.5 Unintended first pregnancy x 1.5

11 Primary Prevention Risk factors for Violence Poor relationships with parents Child maltreatment Low academic achievement Low self esteem Key Prevention Strategies 1. Developing safe and stable relationships 2. Developing life and social skills Cultural tolerance of violence High community violence Easy access to weapons High levels of weapon ownership Easy access to alcohol Heavy alcohol use 3. Challenging cultural and social norms that support violence 4. Reducing access to lethal means 5. Reducing availability and harmful use of alcohol

12 Primary Prevention Developing safe & stable relationships e.g. Nurse Family Partnership (Olds et al 1997; Eckenrode et al 2010) Developing life and social skills e.g. Seattle Social Development Program (Hawkins et al 1999, 2008) Challenging social and cultural norms e.g. Olweus Bullying Prevention Program (Olweus et al, 2010) Reducing access to lethal means e.g. Austrian gun reforms (Kapusta et al, 2007) Nurse home visits for low income first time mothers from pregnancy to 2 years Reduced child abuse, maternal crime and serious criminal behaviour in adolescence (girls) Cost benefit per $ invested Student social & emotional skill development, teacher and parent training Less adolescent violence, substance use and pregnancy; better education/economic outcomes Cost benefit - $3.14 per $ invested Whole school approach Clear school rules; classroom curriculum; teacher training; parent awareness; improvements to physical school environment Reductions in bullying and victimisation Minimum purchase age of 21; background checks & psychological testing; safe storage regulations Reduced firearm suicides 4.7% per year Reduced firearm homicides 2.3% per year

13 School-based social and emotional learning programmes to prevent conduct problems in childhood Cumulative payoffs per child ( s) (Knapp et al, 2011) Year 1 Year 5 Year 10 NHS ,148 Social Services Education Criminal Justice 14 1,139 1,849 Voluntary Sector Victim costs (crime) 30 3,164 4,912 Other crime costs 12 1,295 2,038 Total payoffs 125 6,501 10,164 Cost of intervention Net cost/pay offs - 7 6,369 10,032

14 Dakowicz

15 Bushman & Cooper, 1990; Sripada et al Links between Alcohol and Violence Warning signs for confrontation missed Worse self-control & information processing (In vino veritas) Individual/societal beliefs alcohol causes aggression Poorly managed drinking venues, packed, sexual competition

16 Get Drunk Safely Measures Improving Management Inspection, Licensing, Award schemes, Staff training Managers, Sensible Server, Door supervisors Safety and security outside Lighting, CCTV, Targeted Policing Late night transport Environmental Measures Additional provision, Security at transport points

17 Locational and Residential Intelligence on Nightlife Assaults Assault Location Number Area of residence Number >10 Emergency Department Assault Attendances Hospital Emergency Department (Trauma and Injury Intelligence Group 2008) Proximal alcohol and environmental management Distal current and childhood circumstances

18

19 Student Experiences of Non-Consensual Sex when Intoxicated >1000 University students (UK) (aged years) 30.7% - alcohol-related nonconsensual oral, vaginal or anal sex since age 14. Victims Drinking more extreme prior to act Drinks over shorter time periods (3-4 hours) 2/3 participants disclosed their experience Most frequently a friend (n=184); few (n=9) to the police Gunby et al 2012

20 Alcohol and Violence - Options Policing and Environmental Management Early Life Support Pre-school enrichment, Life skills training Limiting Alcohol Sales Times Australia, closing time 5am 3am Assaults at night 1/3 Density On & off license density linked to violence Increasing Prices Minimum price 50p/standard alcohol unit Dakowicz Reduce violence 2.1% (10,300 /yr) (Kypri et al 2011, Livingston et al, 2008, Meier et al, 2008)

21 INTERVENTION CM IPV SV YV EA S 1 Developing safe, stable and nurturing relationships between children and parents and caregivers Parent training, including nurse home visitation Parent-child programmes 2 Developing life skills in children and adolescents Preschool enrichment programmes Social development programmes 3 Reducing the availability and harmful use of alcohol Regulating sales of alcohol Raising alcohol prices Interventions for problem drinkers Improving drinking environments 4 Reducing access to guns, knives and pesticides Restrictive firearm licensing and purchase policies Enforced bans on carrying firearms in public Policies to restrict or ban toxic substances 5 Changing cultural and social norms that support violence Social marketing to modify social norms School-based programmes to address gender norms and attitudes Life skills interventions Microfinance combined with gender equity training Well supported by evidence (multiple RCTs with different populations) Emerging evidence CM, child maltreatment; IPV, intimate partner violence; SV, sexual violence; YV, youth violence, EA, elder abuse; S, suicide

22 Youth violence n=141 Youth violence Number of articles by violence type Child abuse Self-directed violence 2007 to 2011 Total = 237 articles Sexual violence Intimate partner violence Elder abuse n=1 Elder abuse

23

24 Geographical Spread of Evidence Americas n = 161 (USA 144) Europe n = 46 E Mediterranean n = 3 SE Asia n = 2 Africa n = 5 Western Pacific n = 21 All studies

25 Preschool education Social development programmes Bullying prevention Relationship skills Nurse home Parenting visiting programmes Life skills Primary School Birth Secondary School Multisystemic therapy Family therapy Positive parenting Employment Further education

26