Section 4: Evaluation of Family Violence Initiative Activities at the Public Health Agency – Summary

4. Summary and recommendations

In terms of the relevance of the Family Violence Initiative activities at the Public Health Agency, this evaluation suggests that the Agency has a role to play in preventing family violence in Canada.

• Family violence is a public health issue. Family violence occurs frequently and widely, causing serious health consequences, with some groups disproportionately affected. All populations require access to appropriate and cost-effective interventions, including health promotion.
• A public health approach to addressing family violence is appropriate. This approach: uses a 'determinants of health' lens; emphasizes primary prevention; uses an evidence-based approach; and involves multi-disciplinary and multi-sectoral partners.
• The World Health Organization identified family violence as a major public health issue and called for leadership of the Ministers of Health in its member states. (World Report on Violence and Health, 2002)

In terms of the performance of the Family Violence Initiative activities at the Public Health Agency, there is room for improvement of the Agency's leadership and coordination of the broader federal Family Violence Initiative as well as its collaboration within the Health Portfolio. The three recommendations listed below highlight three areas for improvement.

4.1 Leadership of the Family Violence Initiative

One of the key expectations 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 to the Public Health Agency's federal public health role.

Challenges often noted in the management of a federal horizontal initiative are reflected in the experiences of the Public Health Agency:

• no effective mechanism for the engagement of senior management
• consistent performance reporting but little collective action to support reporting, and no evaluation submitted to the Treasury Board of Canada Secretariat in 16 years.

The focus of activities has been largely information-sharing, with little collective strategic priority setting or action. The Public Health Agency has not met its broader leadership obligations for the Family Violence Initiative.

In the future, as the current lead for the federal Family Violence Initiative, the Public Health Agency must intensify its leadership. The Public Health Agency, in consultation with the other 14 departments that participate in the federal Family Violence Initiative, must take steps to address these management challenges.

4.2 Management of the National Clearinghouse on Family Violence

Since it was established in the early 1980s, and as the current lead for the federal Family Violence Initiative, the Public Health Agency manages the National Clearinghouse on Family Violence. The Clearinghouse has evolved in its continuing response to the information needs of Canadians. It has collected, developed and disseminated a wide variety of resources about the prevention of family violence, protection and treatment. The current Clearinghouse is web-based and contains an online inventory of publications, electronic newsletters, a link to a best practice portal, and a list of sources of referral information.

The continuation of a federal information portal on family violence may potentially have merit. Other developed countries have established national web-based repositories of resources on the prevention and effects of family violence. There is a moderate demand for some of the resources of the National Clearinghouse on Family Violence, such as the E-Bulletins and select publications.

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.

• Purpose: The target audience for the information is not clearly defined or communicated on the website. The website is difficult to search and navigate by audience or purpose. Stakeholders (including interdepartmental partners) have not had input on the purpose and function of the Clearinghouse.
• Content: 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.
• Usage: 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.

The Public Health Agency has initiated work to better understand the evolving information dissemination requirements and opportunities in the field of family violence prevention in Canada. The Public Health Agency should consult with Family Violence Initiative partners and other stakeholders, then develop and implement an approach that is consistent with the federal leadership role in the prevention of family violence. In particular, the Public Health Agency should 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.

4.3 Links with other Public Health Agency and Health Portfolio programs

Family violence is a complex issue. The 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 of Canada's Strategic Policy Research Assessment (April 2010) identified several research gaps and priorities in the area of family violence and public health, including:

• family violence in different immigrant communities
• cross-cultural aspects of domestic violence and cultural norms
• social determinants of Aboriginal health, including family violence
• factors that could exacerbate violence, such as drug and alcohol abuse and child maltreatment.

While a number of links among the Family Violence Initiative activities at the Public Health Agency and other Public Health Agency programs have been established, the role of the Public Health Agency to support research on family violence and population health lends itself well to exploring opportunities to leverage further integration across the Portfolio.

Opportunities to engage in other areas within the Public Health Agency include children's and 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.