The PEACH Study: What Makes for Effective Prevention in Domestic Abuse for Children and Young People?
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Nick Stanley, Jane Ellis, Nicola Farrelly, Soo Downe, Sue Bailey and Sandra Hollinghurst
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The PEACH Study: What Makes for Effective Prevention in Domestic Abuse for Children and Young People?
- 1. The PEACH Study: What Makes for Effective Prevention in Domestic Abuse for Children and Young People? Jane Ellis, Nicola Farrelly, Soo Downe, Sue Bailey, Sandra Hollinghurst and Nicky Stanley
- 2. Effectiveness Questions of effectiveness linked to: • aims or intended outcomes of programmes • underpinning theory • evaluation methodology • time frame
- 3. Systematic review: flow chart
- 4. Programme aims and intended outcomes • Few explicitly seek behaviour change • Most seek to 'raise awareness' – increase knowledge and understanding – implicit assumption K and U will change attitudes – support for victims through help-seeking information
- 5. Peer reviewed literature: programme outcomes • 9 controlled trials and 14 cohort studies • 8 had evidence of medium (5-12 months) and long-term (over 12 months) outcomes • 3 reported behavioural change (all RCTs) • 2 reported changes in awareness, knowledge and help seeking only (pre- and post) • 1 reported no change (control group) • 2 adverse effects (one RCT and one control)
- 6. Audiences • Small groups of students at higher risk at baseline might have skewed data • Boys increasingly identified as a key target for change • ‘Fourth R’ programme that found gender to have a direct relationship on outcomes • Little attention paid to addressing complexities for marginalised children and young people; lack of attention to LBGT young people repeatedly emphasised • No controlled studies with children aged under 10
- 7. UK grey literature • Reviewed evaluations of 28 programmes • Pre/post and process evaluations • Those who received interventions generally enjoyed them and found them valuable • Criticisms focused on a need for longer programmes • Difficulties in engaging some boys who thought programmes were anti-men
- 8. Theoretical underpinning • Theories about causation and change • Explicit statements of theory found in more recent studies in published and grey literature • Social norms and feminist theory widely used • An interpretation of behavioural change theory hypothesised • Five programmes had theory of change models • Philosophical mis-alignment is more problematic than lack of programme fidelity
- 9. Context • National policy: framing delivery of preventive interventions as a statutory requirement = wider and more consistent implementation • Also provides a strong message from Government that contributes to shifting social norms • Transferring across cultures and populations difficult • Boys to Men - greater resources required • Safe Dates - attention to language and cultural context of abuse
- 10. Local contexts • Readiness of setting/school was seen to be important • Support across all aspects of a school’s work, parents, local community and relevant local agencies (whole school approach) • Advantages in involving young people in design and delivery • Issues re referral on after disclosure
- 11. Disclosure and access to support services Qualitative literature reviewed and the young people’s consultation group argued for interventions to be linked to appropriate services for those who disclosed experiences of abuse in their own or their parents’ relationships ‘it makes people aware but then they need the help afterwards’ (Young People’s Consultation Group 1)
- 12. UK Media Campaign ‘This is Abuse’ • Target audience: • 13 -18 year old boys and girls with a slight C2DE bias • parents/carers (adults 35+) • partner agencies • latterly shift to focus on boys conduct • Aims to challenge attitudes, mobilise communities and signpost help • Multi platform: website, TV, ads in range of locations inc online and mobile, materials for partner organisations • TV and online – greatest reach
- 13. Campaign outcomes • Longer term outcomes from the campaign not captured, such measures are difficult to obtain • Data from two waves in 2011 and 2012 • Increased help-seeking from partner agencies and use of ‘Need Help’ section on website • 540,000 visits to website during 2011/12 with 2,500 comments made on discussion forums • High proportion of comments (48% on rape prevention campaign) from victims of abuse • Comments show adverts helped young people to understand what abusive behaviours were and that they had been raped
- 14. this website is so good and helpful! I never spoke to anyone about my experience because i was worried no one would understand but on here people who actually know what you have been through can reply to you, it’s helped me so much and now i am seeking the right help to get my life back to normal and to deal with my feelings. I'm so relieved i found this website, I'm now having councilling but i could have never done it without getting advice from this website, i hope everyone else on this website who has been hurt can now feel more confident and now feel as though they aren't alone :) xxx (Comment on campaign website’s discussion forum)
- 15. Media campaigns and schools work • Increasingly important in shaping the climate within which school based interventions are received • Function as a source for materials used in the delivery of schools programmes
- 16. Gaps identified to date • Effectiveness in terms of outcomes (rather than process measures or intervening variables) • Effectiveness for populations and specific sub- groups • Agreed tool(s) for analysis of process and outcomes • Literature on costs and cost effectiveness • Evaluation of media campaigns
- 17. Conclusions • North American evidence shows programmes can change behaviour as well as knowledge and attitudes • Need for home-grown programmes in UK • Use whole population interventions to identify those at risk with need for other services • Interventions need to take account of power differentials particularly in relation to gender • Messages should be positively framed avoiding a blaming approach that could provoke resistance from some boys
- 18. This project was funded by the National Institute for Health Research Public Health Research Programme The views and opinions expressed are those of the authors and do not necessarily reflect those of the Public Health Research Programme, NIHR, NHS or the Department of Health PEACH Project report coming soon…
Notes de l'éditeur
- 3. Comparison between programmes in terms of specific outcome measures/tools used not attempted, due to the heterogeneity of tools and instruments across the programmes. CTS only one used in more than one study but adapted for use in different contexts, making comparison difficult 2. & 3. programme outcomes are framed as one or more of knowledge, attitudes, behaviours, and incidence of victimization or perpetration; knowledge or awareness is key to changing behaviour and that behaviour only changes over time 3. already victimised or if become victim
- Grouped into 23 programmes, all but one school-based 6 qualitative papers – x qual studies and x quat papers with qual data Broadened knowledge base from 3 previous reviews reported in this area – add names and dates
- Based on realist principles so inc qual and quant data 31 papers = 23 programmes The included RCTs were better quality and less likely to report statistically significant results than the case control and cohort studies in general the results reinforce those of the prior reviews in terms of a lack of evidence of significant programme efficacy In general, programme outcomes are framed as one or more of knowledge, attitudes, behaviours, and incidence of victimization or perpetration. Even where statistically significant findings are reported, the effect sizes are generally very low or, at best, moderate. Larger effect sizes are seen in measures of knowledge, though the differences in these tend to decrease over time. The only relatively large and statistically significant finding in a well-designed study in terms of incidence of perpetration or victimisation, is in perpetration of physical dating violence in the previous year by Wolfe et al’s (2009)(54) evaluation of the Fourth R programme. However the main effect was only in boys and there were counter-intuitive findings for girls that suggest the population in which this study was undertaken was atypical.
- indications in a number of the included studies of a strong influence from small groups of students who were at higher risk at baseline. This is evident in the distinct skew in the data in a number of the studies 3. Wolfe et al 2009 - this evaluation does lend support to this argument 4. Through race/ethnicity, class, sexuality or disability. 5. Given the lack of even a moderate effect on most outcomes except short term knowledge achieved by most of the programmes included in this review, it might be assumed that values, attitudes and behaviours are firmly established via family and community and early socialization by the time children are 10 years old or more. Interventions undertaken with younger children might yield better results. UK work with primary other methods in review provided evidence on the other process and outcome measures e.g. programme components, timings, staffing and underlying philosophies
- intention being to change knowledge and or attitudes towards specific social norms (usually, but not always, gender norms) with the assumption that this would change behavioural intention, and, eventually, actual behaviour, with a resulting effect on the incidence of perpetration and/or victimisation. Reasoned action, social learning, emancipatory, social ecological
- excessive fidelity to a programme can also be a limitation when the context that the programme was originally designed for is very different to that it is being rolled out to as is evidenced in the two studies undertaken. Dynamic sensitivity to local context is much more likely to trigger mechanisms of change based on that specific context than strict allegiance to the original programme design
- Robust evidence from Nam Complex interventions in which context, theory, audience, delivery and content all contribute to outcomes. Suggest that a whole-population approach can function as a screening tool to identify those young people who are at greater risk of either perpetrating or becoming victims and who might then benefit from more in-depth support. Such a scheme depends heavily on an easy referral process to available and effective services once individuals identified, and on the identification process being non- stigmatizing. The review highlighted the importance of distinguishing which messages are effective for which audiences; in particular, these preventive interventions need to take account of power differentials between perpetrator and victim and gender inequalities. This review has identified key questions to be addressed in the design and implementation of preventive programmes in domestic abuse for children and young people which are relevant for policy and practice in health and education as well as future research.