inspire: seven strategies for ending violence against children
TRANSCRIPT
INSPIRE: Seven strategies for ending violence against children
INSPIRE: seven strategies for ending violence against children
• Implementation and enforcement of laws• Norms and values • Safe environments• Parent and caregiver support• Income and economic strengthening• Response services• Education and life skills
The INSPIRE technical package
INSPIRE and SDG prevention targets• Ending violence against
children– 4a safe schools– 5.2 violence against
women and girls – 16.1 all forms of violence
and related deaths– 16.2 all forms of VAC
• Other targets– communicable disease– mental health– substance abuse– gender equity– education– Etc.
Types of violence against children
Prevalence of violence against children
• 36% psychological abuse• 23% physical abuse• 18% girls sexual abuse• 8% boys sexual abuse• 16% neglectStoltentborgh et al, multiple papers, various years.
• Base case analysis, for physical, sexual and emotional maltreatment, and bullying and fighting experienced in the past year– up to one billion children or every second child
Hillis S, Mercy J, Amobi A, et al. Global Prevalence of Past-year Violence Against children: A Systematic Review and Minimum Estimates. Pediatrics. 2016; 137 (3): e20154079
Chronic LungDisease
Fractures
PregnancyComplications
Cancer
Burns
Unintendedand Adolescent
Pregnancy
FetalDeath
Internal Injury
Diabetes
Heart Disease
HIV
STDs
Violence
AlcoholAnd Drugs Unsafe
Sexual Practices
Maternal andChild Health
Injury Non-Communicable Disease
Communicable Diseaseand Risk Behaviors
Stroke
Alcohol
Smoking
Obesity
PhysicalInactivity
Multiple Partners
Head Injury
Mental HealthProblems
Suicide
Depression and Anxiety
PTSD
Assault
Direct effect Indirect effect due to adoption of high-risk behaviour
Health consequences of violence against children
INSPIRE components• Seven strategies that provide an overarching
approach for ending violence against children– specific interventions including programmes, practices
and policies to implement the strategies – evidence supporting these strategies and interventions – Links to related SDG targets
• Two crosscutting components– Multisectoral actions– Monitoring and evaluation
• Implementation considerations
INSPIRE evidence: implementation and enforcement of laws
0
5
10
15
20
25
30
35
40
2001 2002 2003 2004 2005
Hom
icid
es p
er 1
00 0
00 p
opul
atio
nReduction in homicide rate across 5 South African cities
from 2001-2005 following Firearm Control Act
Firearm homicide
Non-firearm homicide
Matzopoulos RG, Thompson ML, Myers JE. Firearm and non-firearm homicide in 5 South African cities: a retrospective population-based study. American Journal of Public Health. 2014;104(3):455–60
4500 lives saved over 5 years, many of them adolescents
INSPIRE evidence: norms and values
-64%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
SASA!
Perc
enta
ge d
ecre
ase
in w
itnes
sing
IPV
Reduction in children witnessing intimate partner violence due to SASA! community mobilization programme
Kyegombe N, Abramsky T, Devries K, et al.(2015). What is the potential for interventions designed to prevent violence against women to reduce children's exposure to violence? Findings from the SASA! Study, Kampala, Uganda. Child Abuse & Neglect, Volume: 50, Page(s): 128-140]
INSPIRE evidence: safe environments
-42% -32%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
Hospital admissions Police-recorded woundings
Perc
enta
ge d
ecre
ase
in v
iole
nce-
rela
ted
inju
ries
Reduction in violence-related injuries following implementation of Cardiff approach to hotspot intervention
Source: Florence C, Shepherd J, Brennan I, Simon T. Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis.British Medical Jounral, 2011; 342: d3313
INSPIRE evidence: parental and caregiver support
-48%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
Nurse-Family Partnership
Perc
enta
ge d
ecre
ase
in m
altr
eatm
ent
Reduction in child maltreatment due to Nurse-Family Partnership programme at 15-year follow up
Source: Olds D, Henderson CR Jr, Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L, Sidora K, Morris P, Powers J. Long-term effects of nurse home visitation on children's criminal and antisocial behaviour: 15-year follow-up of a randomized controlled trial. JAMA. 1998 Oct 14;280(14):1238-44.
INSPIRE evidence: income and economic strengthening
-50%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
IMAGE programme
Perc
enta
ge d
ecre
ase
in in
timat
e pa
rtne
r vi
olen
ceReduction in intimate partner violence among 430
women receiving the Intervention with Microfinance and Gender Equity (IMAGE) programme
Source: Julia C. Kim, Charlotte H. Watts, James R. Hargreaves, Luceth X. Ndhlovu, Godfrey Phetla, Linda A. Morison, Joanna Busza, John D.H. Porter, and Paul Pronyk. Understanding the Impact of a Microfinance-Based Intervention on Women’s Empowerment and the Reduction of Intimate Partner Violence in South Africa American Journal of Public Health October 2007, Vol. 97, No. 10 : pp. 1794-1802.
INSPIRE: response services
-37% -56%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
Individual therapy Group therapy
Perc
enta
ge d
ecre
ase
in sy
mpt
oms
and
impa
irmen
t
Reductions in trauma symptoms and functional impairment across 11 trauma-informed cognitive behavioural therapy trials
Source: Wethington HR et al, The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review. American Journal of Preventive Medicine Volume 35, Issue 3, September 2008, Pages 287–313
INSPIRE evidence: education and life skills
-25% -33%
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
Programmes for all students Programmes for selected students
Perc
enta
ge d
ecre
ase
in a
ggre
ssiv
e an
d di
srup
tive
beha
viou
rReductions in aggressive and disruptive behaviour in school settings across 249 life skills and socio-emotional training
programmes
Source: Wilson SJ, Lipsey MW. School-Based Interventions for Aggressive and Disruptive Behavior: Update of a Meta-Analysis. American Journal of Preventive Medicine, Volume 33, Issue 2, Supplement, August 2007, Pages S130–S143
There are major challenges!
• While 56% of 155 countries provide some support for implementing INSPIRE interventions
• Just 25% consider this support sufficient to reach all who need them
Drastic action on scale up is needed
Societal responses to COVID-19 demandnew delivery channels
• COVID-19 responses have increased the prevalence of violence
• Most programme designs and evidence for effectiveness predate the COVID-19 pandemic
• Efforts to deliver INSPIRE interventions through virtual channels and their evaluation must be prioritized
Thank you!
For more information:
www.who.int/violence_injury_prevention/violence/inspire-package/en/