Appendix C: Evaluation of Family Violence Initiative Activities at the Public Health Agency

Some of the most recent national data on family violence indicate the following^{[Link to footnote 37]}:

• Of the 19 million Canadians who had a current or former spouse in 2009, six per cent reported being physically or sexually victimized by their partner or spouse in the preceding five years.
• Nearly 55,000 children and youth were the victims of a sexual offence or physical assault in 2009, about three in 10 of which were perpetrated by a family member.
• In 2009, police reported over 2,400 senior victims of violent crime by a family member, representing about one-third of all violent incidents committed against older adults.

Like all violent crime in Canada, rates of family violence appear to have fallen in the last decade and have now levelled off. For example, the reported rate of spousal violence in 2009 was the same as in 2004^{[Link to footnote 38]}.

However, the incidence of family violence is generally under-reported. In 2009, victims of spousal violence were less likely to report an incident to police than in 2004. Just under one-quarter (22 per cent) of spousal victims of violence stated that the incident came to the attention of police. Many victims of spousal violence are victimized multiple times before they turn to the police. In the 2009 General Social Survey, almost two-thirds of spousal violence victims (63 per cent) said they had been victimized more than once before contacting the police. Nearly three in 10 (28 per cent) stated that they had been victimized more than 10 times before they contacted the police^{[Link to footnote 39]}.

Linked to social and economic factors that can marginalize individuals and communities, the data also suggest that some groups in our society are disproportionately affected by family violence.

Aboriginal people and northern residents:

• The 2009 General Social Survey found that 10 per cent of Aboriginal peoples have experienced physical or sexual spousal violence as compared to 6 per cent of non-Aboriginal peoples^{[Link to footnote 40]}.
• The results of the 2009 General Social Survey indicated that of the Aboriginal women who experienced violence, 48 per cent reported the most severe forms of violence^{[Link to footnote 41]}. Results also showed that Aboriginal people were almost twice as likely as non-Aboriginal people not to report being the victim of spousal violence^{[Link to footnote 42]}.
• The 2004 General Social Survey found that approximately 12 per cent of northern residents reported being the victim of spousal violence^{[Link to footnote 43]}.

Persons with disabilities:

• Persons with disabilities are 50 to 100 per cent more likely than those without disabilities to have experienced spousal violence, and the violence they experience tends to be of a more severe form^{[Link to footnote 44]}.

Gay males or lesbians:

• The 2009 General Social Survey indicated that people who identified themselves as either a gay male or a lesbian were more than twice as likely as heterosexuals to experience spousal violence^{[Link to footnote 45]}.

Visible minority or immigrant:

• The 2004 General Social Survey reported that visible minority and immigrant women reported lower rates of spousal violence than other women (4 and 5 per cent respectively). In addition, rates of spousal violence for immigrant women declined slightly from 1999 (5 per cent versus 6 per cent). However, the General Social Survey is administered only in English and French, and therefore may under-represent the actual rates of spousal violence in these populations^{[Link to footnote 46]}.
• Consistent with these findings, the 2009 General Social Survey found that immigrants were less likely to report being a victim of spousal violence than non-immigrants^{[Link to footnote 47]}.

There are numerous, and potentially serious, health consequences associated with experiences of family violence^{[Link to footnote 48]}, including:

• physical injuries (e.g. broken bones, fractures, bruises, cuts, burns, disfigurement and even death)
• mental health effects (e.g. eating and sleep disorders, post-traumatic stress disorder, depression and suicidal behaviour)
• addictions, including alcohol and drug abuse
• chronic illness (e.g. poor self-esteem may lead to risk of obesity which in turn leads to diabetes and cardiovascular diseases; sustained stress may lead to risk of gastrointestinal syndromes; repeated injuries may lead to chronic pain syndromes)
• infectious illness (e.g. sexually transmitted infections, such as hepatitis C and HIV/AIDS).

According to the2002 World Health Organization's World Report on Violence and Health, the public health approach to any problem is interdisciplinary and science-based, which has allowed the field of public health to respond to a range of health conditions around the world.^{[Link to footnote 49]} This report details the following elements of a public health approach.

• Uses a 'determinants of health' lens. Health is determined by the interactions among genetics, social and economic factors, the physical environment and individual behaviours. A public health approach to the prevention of family violence is concerned with the health of the entire population, while paying particular attention to the special needs and specific risks of various sub-populations.
• Emphasizes primary prevention. Primary prevention approaches aim to prevent violence before it occurs. "Public Health is above all characterized by its emphasis on prevention. Rather than simply accepting or reacting to violence, its starting point is the strong conviction that violent behaviour and its consequences can be prevented."^{[Link to footnote 50]} A public health approach works on changing the circumstances and conditions that give rise to family violence by examining its root causes.
• Uses an evidence-based approach. Public health practice works toward identifying and promoting innovative and promising and best practices in the prevention of family violence. The public health approach is based on the rigorous requirements of the scientific method which moves from problem to solution by:
  • uncovering as much basic knowledge as possible about all aspects of family violence
  • investigating why family violence occurs
  • exploring ways to prevent family violence and
  • implementing, in a range of settings, interventions that appear promising, widely disseminating information and determining the cost-effectiveness of programs.
• Involves multi-disciplinary and multi-sectoral partners. The public health approach to any problem is interdisciplinary, and therefore requires a flexible and holistic response to deal with the multifaceted nature of family violence. The public health approach to family violence prevention emphasizes collective action, drawing upon the knowledge of many disciplines (justice, housing, health, social services, etc.) and representing federal government departments and agencies, and other jurisdictions (provincial/territorial and local).

Senior management: engagement and strategic vision

Mechanisms for senior management support for preventing family violence are lacking:

• no meetings between 2004 and 2010 of the only senior management committee in place - the longstanding Family Violence Initiative Director General Steering Committee
• little senior management engagement for setting a vision, making decisions- or championing the issue
• no assistant deputy minister level committee
• no ministerial or senior federal/provincial/territorial forum for decision-making, discussion or communication.

Working level: engagement and communication

Between 2004 and 2009, a moderate level of engagement with working-level groups occurred, including approximately one to three meetings per year of the Interdepartmental Working Group and two to four meetings per year of the Federal/Provincial/Territorial Working Group. These meetings were largely characterized by information-sharing, not strategic planning or priority setting. Program records indicate that the Interdepartmental Evaluation Working Group met once in 2007 and has not met since then (see Figure 1). A review of the records of decision for these meetings suggests that, beginning in 2009-10, the level of engagement at the working level increased in both frequency and substance.

• The Interdepartmental Working Group met five times, and dialogue on a common priority of violence against Aboriginal women in the North led to the establishment in 2010 of a sub-working group on this issue.
• A Director General Steering Committee meeting was held in January 2011.
• The Federal/Provincial/Territorial Working Group continued to meet regularly and refocused its discussions on joint policy priorities.
• Since 2004, the Family Violence Prevention Unit has been involved actively at the international level in the World Health Organization's Violence Prevention Alliance (the Public Health Agency was a founding member). In the past year, the Family Violence Prevention Unit has assumed an enhanced role as a member of the Executive Steering Committee.

In 2010 activities were initiated to establish and move forward on an interdepartmental priority. Challenges with strategic planning and communication still remain. For example, regular dialogue been used to revisit strategic priorities at the senior management level. There is no overarching joint framework to drive collective action on priorities.

Accountability

There is no evidence of substantial action on ongoing performance measurement for, or periodic evaluation of, the Family Violence Initiative over the past six years.

The requirements for accountability in the foundational documents of the Family Violence Initiative indicated that the lead department was to provide annual reports and periodic formal interdepartmental evaluations to the Treasury Board of Canada Secretariat (TBS). The Public Health Agency did not submit a formal evaluation to TBS between 1995 and 2011 (16 years). As mentioned previously, the Family Violence Initiative Interdepartmental Evaluation Working Group has not been active since 2007.

Four performance reports were completed in the last 14 years:

1. 1999 - Family Violence Initiative Annual Report 1997-1998
2. 2002 - Five Year Report Family Violence Initiative 2002
3. 2005 - Performance Report Family Violence Initiative 2002-2004
4. 2010 - Family Violence Initiative Performance Report for 2004-2008^{[Link to footnote 53]}.

A number of interviewees suggested that the limited scope of the activities regarding accountability over the past 16 years reflects, in part, the minimal guidance from TBS on the management of horizontal initiatives, including expectations for accountability.

A final contextual note highlights the shift in the organizational model for evaluation at the Public Health Agency. In January 2010, the Public Health Agency moved from a decentralized model (where program areas were responsible for initiating and completing evaluation projects) to a centralized model (where corporate Evaluation Services took over this role). Some interviewees suggested that the transition to this new model may have contributed to a more recent lag in the completion of an evaluation for the Family Violence Initiative.

Opportunities for enhanced leadership and coordination

Based on key informant interviews, and a review of a selection of documents on the management of horizontal initiatives within the Canadian federal government[Link to footnote 54], the following themes emerged with respect to approaches required to enhance the effectiveness of the Public Health Agency's leadership and coordination role in the Family Violence Initiative.

Senior management leadership

Full (regular and meaningful) senior management engagement is required for decision-making, including senior-level governance committees at the associate deputy minister level or higher. This approach might also include engagement at the political level with the respective ministers responsible.

Strong departmental leadership is also required, by providing adequate human and financial resources to meet the efforts required for effective horizontal leadership and coordination.

Well understood and accepted roles and priorities

Robust horizontal initiatives, at their outset, put in place mechanisms to ensure a clear understanding of expectations, roles and responsibilities of all participating departments. Once agreed upon, this understanding is often formalized in writing. This approach supports an appreciation among all partners of why they are at the table – of course respecting that all participating departments may not need to be equally engaged.

Regular dialogue about expectations and priorities promotes a clear understanding of and agreement on the strategic priorities the group will collectively accomplish, and a clear understanding of the requirements for accountability and reporting (with Treasury Board Secretariat and among the participating departments). Adjustments made as required.

An appropriate and consistent level of communication is required. The lead department listens to, and is able to facilitate negotiation among, participating departments. This effort involves taking the time required for negotiation so that all participating departments are engaged and any challenges are well understood by everyone.

Insights from previous hard copy distribution data

Clearinghouse client profile

More than half of the requests for print documents came from health and social service providers (52 per cent), followed by the general public (17 per cent) and academics (13 per cent). This client pattern has been consistent since the establishment of the Public Health Agency in 2004 (see Figure 2).

Modes for accessing the resources

Print documents in the Clearinghouse were requested through a variety of channels, including:

• 41 per cent - web orders for publications
• 36 per cent - toll-free line
• 18 per cent – emails
• 5 per cent – other (local telephone line, letter, fax, visit, interview, etc).

Various groups of individuals requesting print documents have requested them in different ways. Service providers tended to make web-based orders as a means of requesting publications, while the general public was more likely to use the toll-free line or emails for their requests (see Figure 3).

Trends in documents distributed

The Clearinghouse distributed more than 70,000 print publications during 2010-11. The "top 10" most requested titles accounted for almost half (34,615 copies) of all print publications distributed. Compared to other available Public Health Agency print publications not distributed through the National Clearinghouse on Family Violence, there was a relatively moderate level of demand for Clearinghouse publications.

Interestingly, there was variation in the type of document and audience between hard copy and electronic copy requests. Requests for print publications included mostly shorter guides and pamphlets designed for the general public. These documents were most often requested by health and social service providers. Publications most requested electronically were reports and overview papers (best practices) informing academic research and service providers about the development of interventions.

The current National Clearinghouse on Family Violence website

Overall, the purpose and target audience of the Clearinghouse website is difficult to ascertain. A number of different components serve a variety of audiences, from the general public to social service professionals. The 2006 needs assessment indicated that a significant proportion of practitioners in the field of family violence in Canada are not familiar with the work of the Clearinghouse. No recent consultations have taken place to determine the needs of any target audience.

As of September 19, 2011, the "View Resources" section of the website included 56 publication titles across the following themes: abuse of older adults, child abuse and neglect, child sexual abuse, intimate partner abuse against women, intimate partner abuse against men, and family violence. Searching available resources on the Clearinghouse website is difficult because the resources section is categorized by topic, but the topics are not searchable by intended audience or by title of the publication. The publication collection is relatively current. Most (96 per cent) of the Clearinghouse resources available were produced within the last 10 years. Two-thirds (66 per cent) were published in the last five years and none were published more than 10 years ago.

An internet scan of family violence-related information currently available on Canadian websites suggests that the most accessed Clearinghouse publications are either available on other websites, or the same information is available in other documents on other websites. In 2010 and 2011, the number of pageviews of all electronic publications) decreased. It is not clear why the volume of pageviews and website visits for resources available electronically on the website has declined. Limited resources are available from the other 14 departments that participate in the Family Violence Initiative, and some federal departments have their own family violence resource website pages.

There was a modest amount of website traffic to this page. The Clearinghouse's English page on the Canadian Best Practices Portal received 1,869 pageviews between June 2010 and May 2011. The French page received 512 pageviews. There was a moderate amount of website traffic (2,475 pageviews in English and 789 pageviews in French) to the "Find support referrals" section of the website from June 2010 to May 2011.

E-Bulletins

Twenty-seven E-Bulletins were published between September 2006 and July 2011. Online traffic to the E-Bulletins consisted of approximately 27,224 pageviews between June 1, 2010 and May 31, 2011. This amount represents approximately 10 per cent of the total traffic to the Clearinghouse website, ranking the E-Bulletins second in terms of overall popularity after the resources/publications section of the Clearinghouse website.

Promotion of E-Bulletins has increased the subscription rate from 451 initial subscribers to more than 4,000 in the last five years. The vast majority of this increase took place between 2006 and 2009, when the subscription rate grew 400 per cent within the first year and almost doubled again in the next two years. The subscription increase rate has slowed to 6 per cent (from 2009 to 2010).

In collaboration with the Division of Aging and Seniors within the Public Health Agency, the Clearinghouse published a series of four E-Bulletins focusing on elder abuse, which were disseminated to a different list of 450 subscribers from October 2009 to June 2011.

While no formal review or evaluation has taken place, anecdotal evidence from program staff indicates that these E-Bulletins are helpful to stakeholders and are distributed more widely than the original stakeholder list.

International context

A review of national family violence websites in selected countries shows that other developed countries have a national web portal for information on family violence, supported by the national government (see Appendix B).

The Public Health Agency counterpart in the United States, the Centers for Disease Control and Prevention (Department of Health and Human Services) has a website for family violence information on behalf of the United States federal government, but federal health departments in other countries do not necessarily lead or manage an electronic resource website.

• In Australia, the Centre for Gender-related Violence Studies, School of Social Sciences and International Studies, University of New South Wales operates the Clearinghouse. It is funded by Women's Safety Agenda through the Office for Women, Department of Families, Housing, Community Services and Indigenous Affairs.
• In New Zealand, the University of Auckland manages a family violence Clearinghouse funded through the Families Commission, an autonomous Crown Agency.

Regardless of who leads this process, websites in other countries appear to serve intermediary or support organizations rather than individual citizens. The purpose of New Zealand's website is to provide information and resources for people working towards the elimination of family violence, including those working as health professionals, police officers or social workers. While intermediary organizations are the primary target audience, those looking for immediate help are also directed to the appropriate sites.

Other websites also have a searchable function to find resources easily. The Australian Domestic and Family Violence Clearinghouse allows publication searches by author, title or subject, and it has a link to its Facebook page. The National Clearinghouse on Family Violence website does not provide functionality for easy searches for publications nor does it make use of any social media.