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

Executive summary

This report presents the findings of an evaluation of Family Violence Initiative activities at the Public Health Agency of Canada. It is based on research conducted by Evaluation Services, Public Health Agency.

Evaluation purpose and methodology

Senior management requested this evaluation of Family Violence Initiative activities at the Public Health Agency to support program planning and decision making.

The purpose of the evaluation is to gain an understanding of how the Family Violence Initiative activities align with and add value to the roles and priorities of the Public Health Agency. The evaluation also examines the performance of various components of these activities between 2004 and 2011.

The evaluation focuses on the Public Health Agency and explores the intersection between public health roles and priorities. It does not take into consideration the activities of the other 14 departments that participate in the broader federal government Family Violence Initiative.

The evaluation analyzes information from a number of sources:

• a review of existing literature
• a study of key internal documents, including administrative records, correspondence, and communication
• interviews with key senior managers and program staff within the Public Health Agency, with senior managers from other government departments, and with one international expert.

The Family Violence Initiative

Family violence is broadly defined as violence inflicted by one family member against another. It is an abuse of power within relationships of trust or dependency; family violence always involves the use of power by one person to control another in a hurtful way. It can be violence between spouses, intimate partners, children, siblings, parents or extended family members. Family violence can take many forms, such as physical, psychological, sexual or economic abuse. Victims may suffer many effects from the abuse, including a host of physical and mental health consequences. Family violence takes place across all sectors of Canadian society.

In Canada, addressing family violence depends on collaboration among various levels of government and non-governmental organizations. All levels of government (federal, provincial/territorial and local) have a role to play. In general, the provinces and territories are responsible for the delivery of critical local services, including primary prevention and assistance for people who have experienced family violence, while the federal government plays a supportive role. The Public Health Agency's specific role is to support the coordination of activities across federal departments as well as provinces/territories to ensure a collaborative and cohesive approach.

For the past 30 years, the Public Health Agency (formerly as part of Health and Welfare Canada, then Health Canada) has led and coordinated the federal Family Violence Initiative on behalf of partner departments. This involves fostering and maintaining working relationships with international partners, provinces and territories, and non-governmental research and community partners to support and further implement a coordinated approach to addressing family violence in Canada.

The Family Violence Initiative at the Public Health Agency consists of three interrelated activities. It is responsible for: the leadership and coordination of the broader federal Family Violence Initiative; the management of the National Clearinghouse on Family Violence (a web-based resource centre for information on violence within the family); and the facilitation and development of policy and research related to health consequences of family violence.

The policy and research role has evolved over time. The Public Health Agency currently contributes to existing policy levers and advances current knowledge of links between violence and health, emphasising primary prevention and promotion of health. It does so by influencing policy and program development, leveraging stakeholder relationships, and highlighting the implementation of promising practices developed by stakeholders.

In 2010-11, the annual budget of the Family Violence Initiative activities at the Public Health Agency was approximately $1,899,000, which consisted of approximately $631,000 for salaries and benefits and approximately $1,268,000 for operations and maintenance (O&M).

Evaluation findings and recommendations

The synthesis and analysis of the information gathered for this evaluation resulted in findings about both relevance and performance, which in turn led to three recommendations for the senior management of the Public Health Agency. The findings confirm that there is a clear need for a federal public health response to family violence. The findings also offer lessons from past Public Health Agency activities that will enhance future approaches in its role to support federal action to address family violence in Canada.

Relevance: The need for a federal public health response to family violence

There is a need for family violence activities

Family violence continues to be a societal problem that affects the health and well-being of Canadians. Family violence occurs frequently and widely, although some groups in our society are disproportionately affected by family violence: Aboriginal peoples, persons with disabilities, gay men and lesbians, visible minorities and immigrant women^{[Link to footnote 1]}. Numerous and potentially serious health consequences associated with experiences of family violence include physical injuries, mental health effects, addictions, chronic diseases and infectious illness^{[Link to footnote 2]}.

Family violence is a public health issue

The2002 World Health Organization's World Report on Violence and Health confirms that a public health approach to addressing the issue of family violence is critical and appropriate. The report details the following elements of a public health approach:

• It uses a 'determinants of health' lens to understand that 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.
• It emphasizes primary prevention. A public health approach works on changing the circumstances and conditions that give rise to family violence by examining its root causes.
• It uses an evidence-based approach to work toward identifying and promoting innovative, promising and best practices in the prevention of family violence.
• It 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.

There is a federal public health role in family violence

The federal government acts as a leader on public health issues of national concern to protect, maintain and improve the health of Canadians. The World Health Organization (WHO) has clearly identified family violence as a major public health issue and has called for leadership of the ministers of health of its member states^{[Link to footnote 3]}, further confirming the need for a federal public health response to family violence. As part of its health promotion mandate, the Public Health Agency has a role to play in this response.

Performance: The Public Health Agency's past activities and future role in the prevention of family violence

Leadership of the Family Violence Initiative

One of the key roles of the Public Health Agency in the Family Violence Initiative is to provide leadership and coordination on behalf of the other 14 departments that participate in the initiative. This leadership role fits well with the multi-sectoral approach inherent in the Public Health Agency's federal public health role.

It is appropriate for the Public Health Agency to lead the Family Violence Initiative. Recently, the leadership of the initiative has improved. But this leadership role requires enhanced senior management engagement, strategic vision and communication, and increased accountability.

Challenges often noted in the management of a federal horizontal initiative (such as lack of senior management engagement, unclear roles and responsibilities, lack of collective strategic priorities, and need for more timely and open communication) are reflected in the experiences of the Public Health Agency over the past decade. While activities on a joint priority increased in 2010-11, the Public Health Agency has not met its broader leadership obligations under the Family Violence Initiative.

Moving forward, as the current lead for the federal Family Violence Initiative, the Public Health Agency must improve its approach to leadership and coordination. In consultation with the other 14 departments in the federal Family Violence Initiative, the Public Health Agency must take steps to address these challenges in the management of horizontal initiatives.

Management of the National Clearinghouse on Family Violence

Over the past 30 years, managed by the Public Health Agency (formerly as part of Health and Welfare Canada, then Health Canada) on behalf of the departments participating in the Family Violence Initiative, the National Clearinghouse on Family Violence has evolved to tackle Canadians' need for information on violence and abuse within the family. It collects and develops resources on prevention, protection and treatment. Resources are available online free of charge, in English and French, and in alternative formats upon request.

The continuation of a Canadian federal information portal on family violence may potentially have merit. This assertion is substantiated by the popularity of some of the resources of the National Clearinghouse on Family Violence, such as the E-Bulletins and certain publications. Further, a review of national family violence websites in selected countries shows that a number of developed countries have a national web portal for information on family violence, supported by the national government (see Appendix B).

However, as knowledge requirements and electronic platforms and tools for information dissemination continue to evolve in Canadian society, a number of challenges with the operation of the Clearinghouse must be addressed should it continue:

• The target audience for the information provided by the Clearinghouse is not clearly defined. Dissemination data suggests that the majority of users are health and social service providers.
• The website is difficult to search and navigate.
• Stakeholders have had limited input about the purpose of the Clearinghouse.
• Although several publications address gaps in information, much of this information is found elsewhere on the Internet where it is more locally relevant.
• Content from federal government departments (other than the Public Health Agency) is minimal.
• Client use of the Clearinghouse in its current format is declining.

Moving forward, as the current lead for the federal Family Violence Initiative, the Public Health Agency must build on work it has already initiated to better understand current and evolving national information and knowledge exchange requirements and opportunities in the field of family violence in Canada. In consultation with Family Violence Initiative partners and other stakeholders, opportunities exist to develop and implement an approach that is consistent with the federal leadership role in family violence issues. The Public Health Agency may want to consider its role in building public health system capacity, in particular by supporting the work of intermediaries (health and social service providers) in this effort.

Links with other Public Health Agency and Health Portfolio programs

Family violence is a complex issue. Its risk factors and consequences are linked to a long list of determinants of health and a wide variety of health outcomes.

The Public Health Agency 's Strategic Policy Research Assessment report[Link to footnote 4] highlights opportunities for new and continuing policy and research activities linking family violence and public health in Canada, on topics such as maternal and child health, injury prevention, migration health, Aboriginal health and global public health.

While a number of links and partnerships between family violence and existing Health Portfolio and Public Health Agency programming have been established (including with the Canadian Institutes on Health Research), the role of the Public Health Agency in supporting research on family violence and population health lends itself well to exploring opportunities to leverage further integration and partnerships across the Portfolio. Opportunities for collaboration could include, among other topics, children's programs, seniors' programs, mental health, surveillance, chronic disease risk factors (such as obesity), infectious diseases (such as hepatitis C and HIV/AIDS), Aboriginal health (including in the North), women's health and international affairs.