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Jennifer L Matjasko, Ph.D. Behavioral Scientist

Centers for Disease Control and Prevention

OPRE Webinar October 29th, 2014

The Role of Economic Factors and Economic Support in Preventing and Escaping From

Intimate Partner Violence (IPV)

Disclaimer, disclosure, acknowledgements

q  The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention

q  The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose q  Many thanks to my CDC colleagues at the Division of

Violence Prevention: Phyllis Holditch Niolon and Linda Anne Valle*

Matjasko, J. L., Niolon, P. H., & Valle, L. A. (2013). The role of economic factors and economic support in preventing and escaping from intimate partner violence. Journal of Policy Analysis and Management, 32, 122-128.

Overview

q  IPV Typologies q  Risk and protective factors for IPV by Typology

(highlighting role of economic factors) q  Evidence base for IPV prevention programs and

policies q  The role of economic support in IPV prevention q  CDC’s Economic Development Initiative q  Lingering questions

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IPV Typologies: The Dynamics of Intimate Partner Violence

Power and Control Distinguishes Between Different Types of IPV

q  Intimate Terrorism §  High levels of relationship violence §  Patterns of power and control by one partner §  Mostly perpetrated by men

q  Situational Couple Violence §  Violence typically does not characterize the relationship §  Neither partner is using coercive or controlling relationship

tactics §  Usually stems from an escalation in a specific conflict

Johnson (2008; 2011).

Economic Factors and IPV Typologies: Intimate Terrorism

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Economic Factors and IPV Typologies: Situational Couple Violence

Financial Stress and Conflict Escalation: Family Stress Model

Conger & Conger (2008).

Other Risk Factors

q  Intimate Terrorism

q  Situational Couple Violence

à Implication: Both typologies carry serious risks for injury and require a public health approach to address all forms of IPV

PUBLIC HEALTH APPROACH TO ADDRESS IPV

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A Public Health Approach to IPV

q  Focus is on prevention

q  Comprehensive §  Focused on reducing risk, strengthening protective factors §  Multisector approach

q  Prevention strategies based on strong evidence

q  Apply science to reduce IPV-related injury and mortality

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THE STATE OF THE EVIDENCE FOR IPV PREVENTION

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The State of the Evidence for IPV Programs and Policies

q  Dyadic Interventions §  E.g., PREP

q  IPV Screening §  E.g., screening in healthcare settings

q  Coordinated Community Response (CCR)

q  Mandated programs for male batterers §  E.g., Domestic Abuse Intervention Project (i.e., Duluth Model)

The Potential Role for Economic Support in IPV Prevention

Frieden (2010).

State of the Evidence: Economic Support and IPV Prevention

q  Economic Programs and Policies and IPV Research §  TANF Sanctions and Time Limits §  Unemployment Benefits, etc.

q  LIMITED Evidence

q  Microfinance Programs: Rigorous evidence of effectiveness §  Example: Grameen Bank, created in Bangladesh in 1976 by

Nobel Peace Prize Winner Muhammad Yunus

§  The practice of providing financial resources to individuals in order to build capital (e.g., small loans for entrepreneurship activities, individual development accounts, microcredit)

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Microfinance and Health

Sherman et al, 2006

Odek et al, 2009 Dunbar et al, 2010

Rosenberg et al 2011

Sherman et al, 2010

Pronyk et al, 2008

Schuler et al, 1997 Ashburn et

al, 2008

CDC Efforts in Addressing Economic Factors

q  Economic Development Initiative (EDI), a cross-cutting, cross-Division collaboration §  Division of Violence Prevention §  Division of HIV/AIDS Prevention §  Division of STD Prevention §  Division of Diabetes Translation

Key Intervention Development Activities

–  Four groups informed several components of the intervention development process:

•  Core Study Group (Seven experts in MF research and intervention development, IPV research, HIV research, community expert)

•  National Consultation Meeting (A larger body of national experts)

•  Local Advisory Groups (based in 3 geographically diverse urban areas with relatively high HIV/STD rates: Oakland, CA; New Orleans, LA; Washington, DC)

•  Literature Reviews (Extensive reviews)

–  Key products that will be informed by all four groups:

•  Theory of Change/Logic Model Development •  Intervention Manual

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Key Themes from Experts and Community Stakeholders

1)  Addressing social determinants of health is critical

and needed 2)  Requires a needed collaboration between the health

and financial sectors •  There are existing organizations that are ready to implement

the MF Intervention (e.g., health clinic in DC)

3)  The need to address racism within the intervention 4)  Build in safety planning/resources for those who may

be experiencing IT or SCV 5)  Foster community trust

Figure  1:  Theory  of  Change  

 

 

 

 

Short-­‐term  Outcomes Intermediate  Outcomes Long-­‐term  Outcomes

Education,  Training  and  Skill  Building

Individual  Components

Tools  and  Resources

Knowledge  and  Skills Financial  Status Individual  Impact Overall  Impact

Financial  Education  &  Skill  Building   *  There  is  specific  content  about  racism  and  

discrimination  in  this  component

Access  to  Business  

Development  and  Financial  

Tools

Intro  Training  on  Business  Development

Case  Management  and  Support  Services

Personal  Effectiveness  Skill  Building

Financial  Stability  and  Well-­‐being

Maintenance  of  Healthy  Peer,  

Intimate,  and  Family  Relationships

HIV/STD  Risk  Reduction

Increased  Income  and  Net  Assets

Financial  Control

Basic  Business  Education • Knowledge  of  skills  

required  for  business  development  

• Ability  to  assess  self-­‐employment  and  business  options  

Financial  Capability  Skills • Ability  to  construct  and  

follow  a  household  budget  • Ability  to  track  spending  • Planning  ahead  and  saving  

for  the  future  • Understanding  and  

using/managing  financial/banking  products  

• Gaining  and  exercising  financial  knowledge    

Personal  Effectiveness  Skills

• Better  time  management  • Expansion  of  networks  • Improved  relationships  • Solving  problems  and  

thinking  critically  • Short  and  long-­‐term  

planning  • Making  decisions  about  the  

future  • Communicating  effectively  • Knowledge  of  stress  

management  techniques  

Structural  Outcomes:    Collaboration  and  integration  across  health  and  economic  sectors

Growth  and/or  Survival

Initiated/Increased  Savings

Built,  Improved,  and/or  Repaired  

Credit

Social  Support  for  Financial  Control

Healthier  Communication  

Behaviors

Decrease  in  Material  Hardship

Financial  Self-­‐Efficacy

Future  Orientation  and  Hopefulness  or  

Optimism

Locus  of  Control

Relationship  Power

Challenging  Gender  Norms  decreased

Cultural  Pride  and  Civic  Engagement

Increased  Skills  in  Intimacy  Negotiation

Gender  Equity  /  Partner  

Relationship  Quality  

Decreased  Risky  Sexual  Behaviors

Intimate  Partner  Violence  Risk  Reduction

Peer  Norms  for  Financial  Well-­‐being

Increased  Mental  Health

Indicates  outcomes  that  are  hypothesized  to  overlap  with  and  reinforce  HIV/IPV  health  behavior  change  mediators.

12  to  18  months       12  to  24  months         24  to  60  months

Positive  coping  strategies

Decreased  material  

hardship  and  economic  stress

Figure  1:  Theory  of  Change  

 

 

 

 

Short-­‐term  Outcomes Intermediate  Outcomes Long-­‐term  Outcomes

Education,  Training  and  Skill  Building

Individual  Components

Tools  and  Resources

Knowledge  and  Skills Financial  Status Individual  Impact Overall  Impact

Financial  Education  &  Skill  Building   *  There  is  specific  content  about  racism  and  

discrimination  in  this  component

Access  to  Business  

Development  and  Financial  

Tools

Intro  Training  on  Business  Development

Case  Management  and  Support  Services

Personal  Effectiveness  Skill  Building

Financial  Stability  and  Well-­‐being

Maintenance  of  Healthy  Peer,  

Intimate,  and  Family  Relationships

HIV/STD  Risk  Reduction

Increased  Income  and  Net  Assets

Financial  Control

Basic  Business  Education • Knowledge  of  skills  

required  for  business  development  

• Ability  to  assess  self-­‐employment  and  business  options  

Financial  Capability  Skills • Ability  to  construct  and  

follow  a  household  budget  • Ability  to  track  spending  • Planning  ahead  and  saving  

for  the  future  • Understanding  and  

using/managing  financial/banking  products  

• Gaining  and  exercising  financial  knowledge    

Personal  Effectiveness  Skills

• Better  time  management  • Expansion  of  networks  • Improved  relationships  • Solving  problems  and  

thinking  critically  • Short  and  long-­‐term  

planning  • Making  decisions  about  the  

future  • Communicating  effectively  • Knowledge  of  stress  

management  techniques  

Structural  Outcomes:    Collaboration  and  integration  across  health  and  economic  sectors

Growth  and/or  Survival

Initiated/Increased  Savings

Built,  Improved,  and/or  Repaired  

Credit

Social  Support  for  Financial  Control

Healthier  Communication  

Behaviors

Decrease  in  Material  Hardship

Financial  Self-­‐Efficacy

Future  Orientation  and  Hopefulness  or  

Optimism

Locus  of  Control

Relationship  Power

Challenging  Gender  Norms  decreased

Cultural  Pride  and  Civic  Engagement

Increased  Skills  in  Intimacy  Negotiation

Gender  Equity  /  Partner  

Relationship  Quality  

Decreased  Risky  Sexual  Behaviors

Intimate  Partner  Violence  Risk  Reduction

Peer  Norms  for  Financial  Well-­‐being

Increased  Mental  Health

Indicates  outcomes  that  are  hypothesized  to  overlap  with  and  reinforce  HIV/IPV  health  behavior  change  mediators.

12  to  18  months       12  to  24  months         24  to  60  months

Positive  coping  strategies

Decreased  material  

hardship  and  economic  stress

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CDC’s Microfinance Intervention (Beta Version)

Future Directions: CDC’s Economic Development Initiative

•  Continue to build and strengthen

partnerships inside and outside of the CDC

•  Refine curriculum/components testing

•  Individual-level implementation and randomized evaluation of the MF intervention

•  Community-level evaluation of the MF intervention

Future Directions: CDC’s Economic Development Initiative

•  Continue to build and strengthen

partnerships inside and outside of the CDC

•  Refine curriculum/components testing

•  Individual-level implementation and randomized evaluation of the MF intervention

•  Community-level evaluation of the MF intervention

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Lingering questions for the field…

q  Replicate/confirm IPV Typologies

q  The evidence for economic support and IPV prevention is promising but needs to be tested

q  Build and understand the evidence base for IPV prevention accounting for typologies

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov

Thank you! Questions?

jmatjasko@cdc.gov