Section 3: Evaluation of Family Violence Initiative Activities at the Public Health Agency – Findings

3. Findings

This section provides a summary of the findings organized under two broad headings:

  • The need for a federal public health response to family violence (section 3.1)
  • The Public Health Agency's past activities and future roles in the prevention of family violence (section 3.2).

This summary is based on an analysis of the descriptive information provided in available documents and on the themes that emerged from interviews with key informants.

3.1 The need for a federal public health response to family violence

For more than 30 years, the Government of Canada has supported the collection of information about family violence in Canada. This research, and numerous other sources of data, has demonstrated that the issue of family violence in Canada continues to be a societal problem with health consequences.

Finding #1: Family violence continues to be a problem that affects the health and well-being of Canadians.

Some of the most recent national data on family violence indicate the following[Link to footnote 8]:

  • 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 9]. 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 10].

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 six per cent of non-Aboriginal peoples[Link to footnote 11].
  • 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 12]. Results also showed that Aboriginal people were almost twice as likely as non-Aboriginal people to not report being the victim of spousal violence[Link to footnote 13].
  • The 2004 General Social Survey found that approximately 12 per cent of northern residents reported being a victim of spousal violence[Link to footnote 14].

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 15].

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 16].

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 17].
  • 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 18].

There are numerous, and potentially serious, health consequences associated with experiences of family violence[Link to footnote 19], 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).

In summary, family violence occurs frequently and widely in Canada, causes serious health consequences, and some groups are more at risk than others. Family violence continues to be a problem affecting the health and well-being of Canadians.

Finding #2: Family violence is a public health issue and a public health approach to addressing the issue is appropriate.

The World Health Organization identified violence in the family as a major public health issue. According to the2002 World Health Organization's World Report on Violence and Health, the public health approach to any problem, including violence in the family, 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 20]

This World Health Organization report highlights four elements of a public health approach: uses a determinants of health lens; emphasizes primary prevention; uses an evidence-based approach; and involves multi-disciplinary and multi-sectoral partners. Provided below, for each of these four elements, are short descriptions and examples of the value of applying a public health approach to family violence prevention.

  • 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 21] 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 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
    • implementing, in a range of settings, interventions that appear promising, disseminating information widely 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).

Finding #3: As part of its health promotion mandate, the Public Health Agency has a role to play in the prevention of family violence.

In 2002, the World Health Organization called for leadership of the ministers of health of its member states (see Appendix A) to take action on family violence.[Link to footnote 22] Many developed countries (for example: United States, Australia, and New Zealand, among others) have established broad-based national strategies to address family violence (see Appendix B).

The federal government has consistently and clearly indicated that it is committed to protecting all Canadians from violent crime like family violence. For example, the June 2011 Speech from the Throne indicates that:

Our Government will continue to protect the most vulnerable in society and work to prevent crime. It will propose tougher sentences for those who abuse seniors and will help at-risk youth avoid gangs and criminal activity. It will address the problem of violence against women and girls.

The federal government has a legitimate leadership and coordination role in identifying emerging societal issues, devising national strategies and assessing and encouraging innovative ways of responding to these issues. In Canada, federal leadership on family violence as a public health issue takes place within the context of the shared responsibility for public health in Canada.

  • All levels of the public health system (federal, provincial/territorial and local) have a role to play. In general, the provinces and territories are responsible for the delivery of health care and social services. Primary prevention services and assistance for victims of family violence are delivered at the local level, for example through front-line public health professionals.
  • Public health practice also relies heavily on collaboration among government and non-governmental organizations, such as professional associations.

Notably, because of the multi-disciplinary and multi-sectoral (justice, housing, health, social services, etc.) nature of the responses required to address family violence, the Public Health Agency has a unique role. The Public Health Agency can provide national leadership to facilitate public education, research and information exchange across jurisdictions and sectors, and provide national coordination to support partnerships with other jurisdictions and sectors to develop innovative solutions. As highlighted in the Public Health Agency of Canada - Strategic Plan (2007-2012):

Public health has a key role to play in mobilizing efforts across sectors in order to address [the] determinants of health. With this in mind, the Agency will continue to place a high priority on action on health disparities, in collaboration with other governments, sectors and partners.

Other Public Health Agency activities have a critical role to play in enhancing primary prevention programs that tackle the root causes of family violence. Using an evidence-based approach, the Public Health Agency leads a number of activities that provide leadership and support in promoting health and reducing health inequalities among Canadians. The Public Health Agency aims to support Canadians in making healthy choices during all life stages through initiatives focussed, for example, on child development, families, lifestyles and aging[Link to footnote 23].

3.2 The Public Health Agency's past activities and future roles in the prevention of family violence

Analyzing past objectives and accomplishments, the evaluators reviewed the various Family Violence Initiative activities of the Family Violence Prevention Unit between 2004 and 2011. Lessons learned from past challenges can lead to future opportunities for targeted and integrated action to support the federal response to family violence in Canada.

Finding #4: The Public Health Agency's leadership of the Family Violence Initiative needs enhanced senior management engagement, strategic vision, communication and accountability.

The Public Health Agency's leadership and coordination role of the Family Violence Initiative consists of:

  • leading coordination among departments to ensure a multi-disciplinary response, and to ensure that resources are used effectively and efficiently for sharing information, promoting collaborative activities and preventing duplication
  • coordinating an overall review of activities by monitoring progress through collecting and reporting on key indicators
  • providing annual reports and periodic formal interdepartmental evaluations to the Treasury Board of Canada Secretariat.
Broad challenges in management

As evidenced below, the Public Health Agency's management of the Family Violence Initiative has been more proactive starting in 2010 than it had been between 2004 and 2010. The Public Health Agency's leadership and coordination approach of the Family Violence Initiative still has some challenges.

Senior management: engagement and strategic vision

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

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

As part of the leadership and coordination role for the Family Violence Initiative, the Public Health Agency is responsible for the secretariat function of several long-established working-level committees:

  • Family Violence Initiative Interdepartmental Working Group (IWG)
  • Family Violence Initiative Sub-Working Group on Aboriginal Family Violence (new 2010)
  • Family Violence Initiative Interdepartmental Evaluation Working Group (IEWG)
  • Family Violence Prevention Federal/Provincial/Territorial Working Group.

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).

Figure 1: Frequency of Family Violence Initiative committee meetings

Figure 1: Frequency of Family Violence Initiative committee meetings
Text Equivalent - Figure 1

Figure 1 is a bar graph that illustrates the frequency of Family Violence Initiative committee meetings held from 2004-05 to 2010-11. During that time, the following types of meetings were held: federal, provincial and territorial working group meetings; interdepartmental working group meetings; Aboriginal sub-working group meetings and Director General steering committee meetings. There were relatively few committee meetings held in the years 2004-06 and 2007-09, with an average of four federal, provincial and territorial and interdepartmental working group meetings combined. In 2006-07 there was an increase in the number of committee meetings, due mostly to the six federal, provincial and territorial working group meetings held that fiscal year. In 2009-10, there was a higher than average amount of federal, provincial and territorial working group meetings and interdepartmental working group meetings (four and five respectively). While, 2010-11 had the largest amount of committee meetings; not only were there five federal, provincial and territorial working group meetings and four interdepartmental working group meetings. But, for the first time during the 2004-11 time period, there were five Aboriginal sub working group meetings and one Director General steering committee meeting.

Enlarge Picture - 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, the Public Health Agency initiated activities with interdepartmental partners on an interdepartmental priority. However, challenges with strategic planning and communication remain. Even though there has been some regular dialogue at the senior management level on one priority, there is no overarching framework for the Family Violence Initiative to drive collective action.

Accountability

There is no evidence of systematic initiative-wide performance measurement for the Family Violence Initiative over the past six years. There has not been an evaluation of the broader Family Violence Initiative since 1996.

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). No formal evaluation was submitted to TBS between 1995 and 2011. 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 1997-2002
  3. 2005 - Performance Report Family Violence Initiative 2002-2004
  4. 2010 - Family Violence Initiative Performance Report for 2004-2008[Link to footnote 24]

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

Opportunities for enhanced leadership and coordination

Based on key informant interviews, and a review of a selection of documents on the management of initiatives within the Canadian federal government[Link to footnote 25], it was noted that the challenges that the Public Health Agency has experienced in its leadership and coordination of the Family Violence Initiative have also been identified in assessments of the leadership and coordination of other federal horizontal initiatives. The "Best Practices Highlights" box below lists best practice approaches for the leadership and coordination of federal horizontal initiatives in general that may be applied to the Public Health Agency's leadership and coordination role in the Family Violence Initiative.

Best Practices Highlights

The following themes emerged with respect to approaches required to enhance the effectiveness of horizontal initiatives in general.

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 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 are 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.

Finding #5: The continuation of a federal information portal on family violence may potentially have merit. However, the rationale of the National Clearinghouse on Family Violence is not clear and its functionality is limited.

Established initially in the early 1980s, the purpose of the National Clearinghouse on Family Violence was to provide resources for Canadians seeking information about and solutions to violence in the family. For many years, the Clearinghouse has collected, developed and disseminated resources on the prevention of family violence, protection and treatment.

Recent changes to the distribution of Clearinghouse resources

In 2009, as part of a Public Health Agency review and a government-wide effort to establish greater ease of access to government services, telephone access to Clearinghouse services moved to Service Canada.

  • Pre-2009: The Clearinghouse was accessible by a toll-free 1-800 telephone line answered by trained Public Health Agency personnel.
  • April 2009: The line was transferred to Service Canada's Tier 2 service (1-800-O-Canada). A specialized unit answered calls on behalf of the National Clearinghouse on Family Violence and provided information and referrals.
  • June 2011: The 1-800-O-Canada line provides a general Tier 1 level of service. Agents answer calls on behalf of the Government of Canada, give out general information about the program, and direct clients to the Clearinghouse website. 1-800-O-Canada is presently equipped to refer callers in distress to a local service.

Adapting to recent trends toward more electronic resource dissemination, the Clearinghouse suspended distribution of hard copy documents as of June 30, 2011. Today the Clearinghouse uses the Internet as its main vehicle to make resources available. The electronic Clearinghouse, located on the Public Health Agency's website[Link to footnote 26], contains electronic documents organized in an online inventory, as well as other products such as electronic newsletters, a link to a best practice portal for service providers and a list of sources of referral information.

As well, in 2011 the Clearinghouse reduced the number of publications available on its website. The majority of publications from 2005 and earlier were removed, as was the Clearinghouse shopping cart, which allowed visitors to order print copies of publications online.

Finally, in 2010-11, the Public Health Agency suspended its library collection of catalogued printed documents and its bibliographic reference service. With the ease of electronic access to documents, and the establishment of university research centres specifically on violence against women and family violence[Link to footnote 27], this library collection was deemed less relevant today than it was 10 to 25 years ago. Anecdotally, it appears this collection has been accessed rarely in recent years.

Insights from previous hard copy distribution data

Detailed statistics are not available from the limited data on the dissemination of electronic documents. As stated in the previous section, the print publication dissemination service of the Clearinghouse has been suspended. However, data available about requests for print publications between 2004-05 and 2010-11 leads to some important insights. The following sections describe these trends, including: Clearinghouse client profile, modes for accessing resources, and documents distributed.

As a note, a printed document or "publication" can range from a folded pamphlet(e.g. What's Wrong with Spanking),to a 15-page booklet (e.g. When Boys Have Been Sexually Abused - A Guide For Young Boys), to a 40-page research summary (e.g. Little Eyes, Little Ears: How Violence Against A Mother Shapes Children As They Grow), to a 70-page directory of community services (Transition Houses and Shelters for Abused Women in Canada).

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).

Figure 2: Clearinghouse client groups (by sector) over time

Figure 2: Clearinghouse client groups (by sector) over time
Text Equivalent - Figure 2

Figure 2 is a bar graph that captures the various Clearinghouse client groups over the 2004-05 to 2010-11 time period. The client groups are described by the following sectors: academia, the public, service providers and others. The proportion for each client group has remained steady over the 2004-2011 timeframe. Service providers make up the largest client group, with a high of approximately 57 per cent in 2004-05 and a low of approximately 46 per cent in 2010-11. Together academia, the public and others make up a relatively small proportion of the client groups, with an average of 12 per cent, 13 per cent and 17 per cent respectively.

Enlarge Picture - Figure 2

*Note: "Service providers" include social service, health service and non-governmental organizations; "Academic" includes schools, students, universities and colleges; "Others" include media, criminal justice, library, clergy, federal provincial or municipal government, Member of Parliament or Senate, corporate, professional, community centre, Aboriginal organization, women's organization, home care centre and other.

Modes for accessing the resources

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

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

Different 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)[Link to footnote 28].

Figure 3: Mode of print publication requests by client group in 2010-11Figure 3 Note *

Figure 3: Mode of print publication requests by client group in 2010-11
Text Equivalent - Figure 3

Figure 3 is a bar graph that captures the various modes of print publication requests to the Clearinghouse by client group in 2010-11. The three modes include: toll-free line, web orders and e-mails. The client groups are described by the following sectors: academia, the public, service providers and others. Service providers tended to make more web-based requests. The general public was more likely to use email or the toll-free line for their requests.

Enlarge Picture - Figure 3

*Note: "Service providers" include social service, health service and non-governmental organizations; "Academic" includes schools, students, universities and colleges; "Others" include media, criminal justice, library, clergy, federal provincial or municipal government, Member of Parliament or Senate, corporate, professional, community centre, Aboriginal organization, women's organization, home care centre and other.

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:

  • One publication - What's Wrong with Spanking? - comprised the majority of those requests with 19,873 copies distributed. However, this pamphlet was sent out in much larger quantities than other resources – up to 500 copies per request.
  • The next most requested publication was a 40-page research summary titled Little Eyes, Little Ears: How Violence Against A Mother Shapes Children As They Grow, with 3,388 copies distributed.
  • Distribution of the other eight publications, the majority of which were support guides written for individuals, averaged a modest distribution rate of fewer than 1,700 copies each[Link to footnote 29].

In addition, in 2010-11 the Clearinghouse proactively targeted distribution of print copies of several publications, including the following:

  • More than 900 copies of the Canadian Incidence Study on Reported Child Abuse and Neglect, a surveillance report produced by the Public Health Agency, were distributed after its launch in October 2010.
  • 1,850 copies of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse, a product of extensive consultations with survivors of childhood sexual abuse and health care practitioners across Canada, were disseminated in 2010-11.

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. Examples of these include guides produced by the Vancouver Incest and Sexual Abuse Centre (VISAC) such as Sexual Abuse - What Happens When You Tell - A Guide For Children, or Sexual Abuse Counseling - A Guide For Children And Parents.
  • Publications most requested electronically were reports and overview papers (best practices) informing academic research and service providers about the development of interventions. Examples of these publications include Woman Abuse - Overview Paper, Financial Abuse of Older Adults and Adult Survivors of Child Sexual Abuse - Overview Paper.
The current National Clearinghouse on Family Violence website

As of July 2011, the Clearinghouse website consists of four key components:

  1. resources
  2. best practices
  3. "find support" referrals
  4. E-Bulletins.

This section provides an overview of findings on the performance of each of these components. Some of the findings highlighted here were previously noted in a National Clearinghouse on Family Violence needs assessment study conducted in 2006.

a. Resources
Publication description

Through the resource section of its website, the Clearinghouse disseminates original information (reports, overview papers, handbooks, pamphlets, etc.) produced by the Public Health Agency. 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.

Some interviewees indicated that 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. Information about general topics is widely available. Information on some specific topics for specific audiences is less available elsewhere, e.g. a paper on Distinguishing between poor/dysfunctional parenting and child emotional maltreatment.

Trends in electronic distribution

Website traffic statistics provide the only means of tracking the demand for electronic resources.

The number of "pageviews" refers to each time a web page was accessed and does not include the number of times a PDF document was downloaded. For example, the pageviews number represents the number of times a page is viewed, and counts as a separate view if someone opens the page multiple times. The pageview numbers exclude all internal Public Health Agency and Health Canada employee traffic, as well as non-human traffic such as robots and spiders that search engines (e.g. Google) use to index websites (software applications that run simple automated tasks to collect and analyse information - such as checking links to other websites).

In total, there were approximately 265,865 pageviews of the Clearinghouse website between June 1, 2010 and May 31, 2011 (not including PDF downloads).

The resources (publications) pages were by far the most popular section of the Clearinghouse website, accounting for 32 per cent of the total traffic.

In 2009, the three most viewed publications (in English) were:

  • The Effects of Media Violence on Children 12,725 pageviews
  • Adult Survivors of Child Sexual Abuse - Overview Paper 7,850 pageviews
  • What is Emotional Abuse? 7,505 pageviews

In 2010 and 2011, the number of pageviews for these three publications (and for all electronic publications) decreased.

From June 1, 2010 to May 31, 2011, the three most viewed publications (in English) were:

  • Woman Abuse - Overview Paper 5,082 pageviews
  • Financial Abuse of Older Adults 4,577 pageviews
  • Adult Survivors of Child Sexual Abuse - Overview Paper 3,487 pageviews

It is not clear why the volume of pageviews and website visits for resources available electronically on the website has declined, but it warrants a review of the relevance of the documentation and performance of the functionality of the Clearinghouse website.

Online inventory of family violence resources

In addition to providing electronic copies of documents produced for and made available by the Clearinghouse, a new inventory introduced in 2010-11 lists resources published by or available from other organizations:

  • The inventory is geared toward family violence prevention stakeholders, including health and social service providers, educators, researchers, policy makers and non-governmental organizations.
  • The resources listed by the inventory have been developed by other organizations, including Family Violence Initiative partner departments, provincial and territorial governments, research organizations and family violence prevention stakeholders across Canada.
  • Resources include information sheets, research reports, discussion papers, toolkits and other similar resources.

The original purpose of the Clearinghouse was premised on the value of a central repository of federal government documentation. However, it is not clear if this continues to be a key purpose of the Clearinghouse. 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.

b. Best practices

The Clearinghouse also links to the Canadian Best Practices Portal – a wider Public Health Agency initiative. The Canadian Best Practices Portal is a collection of effective community interventions related to chronic disease prevention and health promotion, including family violence. The goal of this section of the website is to share successful provincial and territorial or community-level interventions that address family violence. Over the past two years, the Family Violence Prevention Unit added 38 violence prevention interventions.

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.

c. "Find support" referrals

The support section of the Clearinghouse website identifies where and how to get help in case of abuse. The Clearinghouse provides links to websites of partners (both non-governmental and government departments) that provide up-to-date and searchable features for local sources of support.

There was a moderate amount of website traffic (2,475 pageviews in English and 789 pageviews in French) to this section of the website from June 2010 to May 2011.

d. E-Bulletins

The Family Violence Prevention E-Bulletin is a quarterly newsletter compiled by Family Violence Prevention Unit staff and published on the Clearinghouse website. It is also distributed to subscribers by email. Each Clearinghouse E-Bulletin addresses a specific family violence issue, such as intimate partner abuse against men or child maltreatment in Canada.

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 E-Bulletins second in terms of overall popularity after the resources/publications section of the Clearinghouse website.

Document review data indicates that the E-Bulletin subscription rate increased 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 the E-Bulletins are helpful to stakeholders and are distributed more widely than the original stakeholder list.

The international context: other clearinghouses on family violence

A review of the national family violence website in three other developed 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's 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 the three other countries reviewed 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.

The other websites that were reviewed 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. Canada's National Clearinghouse on Family Violence website does not provide functionality for easy searches for publications, nor does it make use of any social media.

Summary of Clearinghouse findings (Finding #5)

Based on the review of national family violence websites in three other developed countries, the continuation of a Canadian federal information portal on family violence may potentially have merit. This assertion is also substantiated by the moderate popularity of some resources of the National Clearinghouse on Family Violence, such as the E-Bulletins and select publications. However, there is room for improvement.

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 website is difficult to search and navigate by purpose or audience. No recent consultations have taken place to determine the needs of any target audience. Stakeholders (including interdepartmental partners) have not had recent input on the purpose and function of the Clearinghouse.

Several publications address gaps in available information, but much of the information is found elsewhere on the Internet where it is more locally relevant. The Clearinghouse does not function as a repository for information produced by the Family Violence Initiative. There is little content from other government departments and provincial and territorial partners.

Over the past two years, the subscription rate of the E-Bulletin and requests for information have increased only minimally. The volume of website visits for all website resources has declined. A 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.

Finding #6: In collaboration with other federal partners and stakeholders, the Public Health Agency undertakes research related to the health consequences of family violence, but there are gaps in the research.

As part of its mandate to undertake research related to the health consequences of family violence, the Public Health Agency has supported numerous collaborative efforts over the past six years to influence research agendas and contribute to research from a policy perspective.

Examples of some recent activities include:

  • participation as part of the Canadian Institutes of Health Research, Institute on Gender and Health's grant review team on violence and health
  • participation as a member of PreVAiL (Preventing Violence Across the Lifespan) research network to help inform future research directions
  • organization of a meeting with Family Violence Initiative departments and the Alliance of Canadian Research Centres on Violence to discuss research priorities
  • partnering with other departments in the Family Violence Initiative in shared research and policy priorities on the following topics: culturally diverse communities, victimization of Aboriginal women and intervention services.
Public Health Agency, Strategic Policy Research Assessment 2010

The Public Health Agency's Strategic Policy Research Assessment report[Link to footnote 30] highlights opportunities for new and continuing policy and research activities linking family violence and public health in Canada. While it is not intended to be an exhaustive list of gaps, it does signal that further research on the intersection between family violence and public health is strongly warranted. Family violence prevention is addressed with respect to the following public health gaps and priorities.

Child health

In its report, What's rights for some: 18 @ 18: A portrait of Canada's first generation growing up under the UN Convention on the Rights of the Child, the United Nations Children's Fund (UNICEF) has found Canada to be falling behind in its obligations to children – including reducing the incidence of violence and abuse[Link to footnote 31]. The report notes that groups such as immigrant and refugee children, Aboriginal children, and children with disabilities are under-represented in the research.

Injury prevention

Intentional injury results from interpersonal violence, which is the "intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation."[Link to footnote 32] Research is needed on the factors that lead to child maltreatment by distinguishing the specific types of maltreatment and the mechanisms that can be used to prevent and reduce maltreatment, while keeping in mind cross-cultural factors.

Migration health

The Public Health Agency is concerned with the health issues of: those coming to Canada to live permanently, long-term visitors, students and temporary workers who remain in Canada for a period of six months or more. There is a lack of information on the key factors and/or interventions that can prevent family violence within this population. Research is needed about the factors that can exacerbate family violence, as well as interventions that can be successful in preventing family violence. Research is also needed about family violence in different immigrant communities and about issues such as honour killings.

Aboriginal health

Canada's Aboriginal population continues to grow at a faster rate than non-Aboriginal people (between 1996 and 2006, the population growth for Aboriginal people was 45 per cent, compared to 8 per cent for non-Aboriginal people)[Link to footnote 33]. Improvements in Aboriginal health have been made, but many still experience poorer health outcomes when compared to the general population. While a significant amount of research has been conducted on Aboriginal health in different research communities, gaps remain. Research is needed on the social determinants of Aboriginal health, including family violence. Aboriginal mental health is also an area where more research is needed.

Global public health

Global health issues are best addressed by cooperative actions and solutions. The Public Health Agency can continue to play an important role in promoting health beyond Canada's borders by working with other countries and multilateral organizations such as the World Health Organization. For example, the global agenda should include research that focuses on the relationship between the various social determinants of health. More research is needed about how the health of marginalized groups, such as indigenous peoples, can be improved at the global level.

Finding #7: The Family Violence Prevention Unit has collaborated with other areas within the Public Health Agency to link family violence to other determinants of health and primary prevention efforts, but there are opportunities for more substantial collaboration.

Links made

Over the last few years, the Family Violence Prevention Unit has initiated dialogue to share information and collaborate with a number of other areas within the Health Promotion and Chronic Disease Prevention Branch on related work.

Examples of engagement include the following activities:

  • Discussions are beginning within the Centre for Health Promotion on the value of taking a broader health promotion approach to preventing family violence with various stakeholders.
  • Information about research on child maltreatment and mental health as well as injury prevention has been shared internally with staff in the Centre for Health Promotion program in both the Division of Childhood and Adolescence and the Healthy Communities Division.
  • As mentioned in a previous section, collaboration took place with staff from the Division of Aging and Seniors within the Centre for Health Promotion, through the completion and dissemination of a series of four E-Bulletins on elder abuse between October 2009 and June 2011.
  • Staff from the Centre for Chronic Disease Prevention and Control have collaborated on the addition of 38 violence prevention programs to the Public Health Agency-led Canadian Best Practices Portal.
Additional opportunities

A number of key informants suggested additional opportunities to engage other program areas within the Public Health Agency to enhance links between public health priorities and the prevention of family violence. It was suggested that enhanced linkages could leverage shared knowledge and funding partnerships among program areas, leading to more efficient and effective delivery of program and research activities. Public Health Agency program areas include those inside the Health Promotion and Chronic Disease Prevention Branch, such as the Strategic Initiatives and Innovations Directorate, as well as within other branches including the Infectious Disease Prevention and Control Branch and Emergency Management and Corporate Affairs. Health Portfolio enhanced links include Health Canada and the Canadian Institutes of Health Research.

While not intended as an exhaustive list, new or enhanced partnerships with programs within the following areas may lead to further opportunities to leverage/support shared priorities.

Centre for Health Promotion
  • Given the significant impact of early childhood development, a number of Public Health Agency programs address primary prevention through child health and healthy families. The following grants and contributions programs are housed within the Centre for Health Promotion, Division of Childhood and Adolescence: Community Action Program for Children, Canadian Prenatal Nutrition Program, and Aboriginal Head Start in Urban and Northern Communities.
  • In 2003, 13,906 Canadians died as a result of injuries[Link to footnote 34], unintentional and intentional. Intentional injuries occur as a result of interpersonal violence (family and intimate partner violence) and self-inflicted harm (suicide). In addition, unintentional injury is the leading cause of death, morbidity and disability among Canadian children and youth.[Link to footnote 35] There is opportunity for continued liaison with staff from the Injury Prevention Unit within the Centre for Health Promotion.
  • Although upstream interventions regarding child health are important, Canada's population continues to age. An aging population brings with it serious concerns with regard to the disproportionate vulnerability of this group. Key informants within the Family Violence Prevention Unit suggested that previous collaboration between the Family Violence Prevention Unit and the Division of Aging and Seniors within the Centre for Health Promotion were valuable.
  • Preserving and promoting mental health among Canadians contributes to healthy families, productive workplaces and nurturing communities. The damaging mental health effects of exposure to family violence are well established. The World Health Organization's World report on violence and health states that "women who are abused by their partners suffer more depression, anxiety and phobias than non-abused women[Link to footnote 36]." Therefore, further links with the Mental Health Promotion Unit within the Centre for Health Promotion seem logical.
Centre for Chronic Disease Prevention and Control & Centre for Communicable Diseases and Infection Control
  • Effective and timely surveillance is critical to the ability of all orders of government to accurately track, plan for and respond to public health issues. Key informants suggested opportunities for enhanced surveillance on various aspects of family violence. This work falls within the Centre for Chronic Disease Prevention and Control's Health Surveillance and Epidemiology Division (particularly its child maltreatment section).
  • The health consequences of family violence include increased risk for both chronic and infectious diseases. To date the Family Violence Prevention Unit has not systematically liaised with both the Centre for Chronic Disease Prevention and Control (Health Promotion and Chronic Disease Prevention Branch) and the Centre for Communicable Diseases and Infection Control (Infectious Disease Prevention and Control Branch).
Strategic Policy and International Affairs Directorate
  • As mentioned previously, the Family Violence Prevention Unit has a long-standing relationship of international collaboration with the World Health Organization's Violence Prevention Alliance. Although currently under development, there has not been much liaison with the International Public Health Division of the Strategic Policy and International Affairs Directorate to ensure that international family violence prevention activities support the Public Health Agency's strategy for approaching international issues.
Health Canada
  • Aboriginal Canadians experience significant health disparities from the general population. The Public Health Agency has initiated collaboration with the First Nations and Inuit Health Branch at Health Canada, in particular regarding violence against Aboriginal women in the North. Key informants indicated that another area of potential shared interest that the Public Health Agency could further explore is with the activities of the Gender and Health Unit within the Regions and Programs Branch at Health Canada.
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