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This research framework, which competed successfully in the 2008 CIHR open operating grants competition, focuses on protocols to measure the impact of community-led interventions to reduce domestic violence in Aboriginal communities. The project develops and tests tools and procedures for a randomized controlled trial of prevention of family violence. Women’s shelters mainly deal with victims of domestic violence, and the framework also addresses other types of domestic violence (male and female children, elderly, and disabled). The partner shelters are in Aboriginal communities across Canada, on and off reserve, in most provinces and territories. The baseline study applies a questionnaire developed by the shelters. Testing the stepped wedge design in an Aboriginal context, shelters randomized themselves to two waves of intervention, half the shelters receiving the resources for the first wave. A repeat survey after two years will measure the difference between first wave and second wave, after which the resources will shift to the second wave. At least two Aboriginal researchers will complete their doctoral studies in the project. The steering committee of 12 shelter directors guides the project and ensures ethical standards related to their populations. Each participating community and the University of Ottawa reviewed and passed the proposal.
Family violence affects all ethnic, cultural, age, religious, social and economic groups (Bennett, 2005; Family Violence Initiative, 2002). Women who experience intimate partner violence are at an increased risk of injury and death (Eisenstat and Bancroft, 1999; Campbell, 2002) and exposure to violence as a child places women at higher risk of poor health outcomes (Cohen and Maclean, 2003). Pregnant women are at greater risk of physical harm (Mahajarine and D’Arcy, 1999; Cokkinides et al., 1999). The experience of family violence is likely to be a pivot in gendered choice disability — people who are unable to implement their prevention choices, which puts them at risk of unwanted pregnancy and sexually transmitted infections including HIV (Andersson, 2006).
There is little epidemiological research on domestic violence in Canada and virtually none involving Aboriginal families. A systematic review of interventions for violence against women revealed that evidence-based approaches for preventing intimate partner violence are seriously lacking (Wathen and MacMillan, 2003). Shea and colleagues confirm this in their systematic review in this special issue of Pimatisiwin (Shea et al., 2010).
First Nations, Inuit, and Métis report more domestic violence than the rest of Canada; both men and women can be victims. The overview article in this special issue catalogues the many studies that report domestic violence across the country (Andersson and Nahwegahbow, 2010). This level of occurrence has contributed to the idea that family violence is a normal and relatively accepted practice within Aboriginal communities. As Dion Stout puts it, for many Aboriginal children, domestic violence is a fact of life (Dion Stout, 1996; 1998).
Susceptibility to family violence may be exacerbated by a history that disrupted the traditional balance between Aboriginal men and women (LaRocque, 1996; MacMillan and Wathen, 2005). Many victims of intergenerational violence become perpetrators (Green, 2001; Monture, 1995). The result is family violence recycling in many homes; two out of every three victims of violent crime in Saskatchewan knew their assailant, and one in every four were abused by a family member (Saskatchewan Justice, 2006). In Aboriginal communities, 75% of sexual assault survivors are young women under 18 years of age; 50% are under 14 years of age and almost 25% are younger than 7 years of age (Metropolitan Action Committee on Violence against Women and Children [METRAC], 2001). Literature on Aboriginal peoples of New Zealand and Australia describe similar root causes of domestic violence and the associated impacts on women, children, and the community (Memmott et al., 2001; Dodson, 1991; Ministry of Social Development, 2002).
In general, Canada does not address violence against women adequately and it categorically fails to address racism and bias when violent crimes are committed against Aboriginal women (Canadian Feminist Alliance, 2003). To date there has been no controlled trial to reduce sexual violence in First Nations, Inuit, and Métis communities.
Resilience is the means by which people choose to use individual and community strengths to protect themselves and to build their future. In prevention research, we see resilience as more than just traits or behaviour that protects against domestic violence. It is a complex interplay of social, cultural, and behavioural factors that operate at individual, family, and community levels (Dion Stout and Kipling, 2003; Anthony, 1987). We understand resilience to combine spirituality, family strength, elders, ceremonial rituals, oral traditions, identity, and support networks (HeavyRunner and Marshall, 2003) — beyond the negative tone implicit in “the capability of individuals and systems to cope and flourish successfully in the face of significant adversity or risk”(Reid et al., 1996). It is necessary to prepare the ground to gather hard scientific evidence about how resilience can be built upon to reduce domestic violence.
Randomized controlled trials (RCTs) are considered the high water mark of contemporary health research. Because of their ability to attribute an impact to a specific intervention, and to unpack cause and effect in a way that is largely free of bias and confounding, RCTs tend to have more impact on national resource allocation than, for example, a cross-sectional study or participatory action research. To date, RCTs have been the almost exclusive preserve of non-Aboriginal researchers. This project will lead to a large scale RCT on one of the most pressing issues faced by Aboriginal communities — an issue not usually subjected to formal intervention studies. In addition, it will be run by Aboriginal researchers.
With appropriate resources, many Aboriginal communities have the resilience to develop and implement their own effective solutions to domestic violence. A key resource is culturally appropriate scientific method to test the impact of community-led interventions. This grant will develop the scientific basis to measure the impact of evidence-based interventions to reduce domestic violence in Aboriginal communities across Canada. It will develop and test tools and procedures for future randomized controlled trials (RCTs) of domestic violence prevention.
Building on their cultural and spiritual resilience, how can Aboriginal communities best reduce domestic violence? What does it take to measure this?
In 2003, through the Ottawa ACADRE, the five national Aboriginal organizations approved seed funds to develop research into Aboriginal family violence. Consultations with women’s shelters across the country showed broad support for this research. The Native Women’s Association of Canada (NWAC), for whom domestic violence is a priority, convened a national steering committee to oversee development of a research framework that could lead to serious research in the area. Committee membership includes Aboriginal faculty at the universities of Ottawa and Saskatchewan, several community-based Aboriginal organizations involved with domestic violence, the RCMP, and elders.
Most health research is not geared to Aboriginal paradigms and Aboriginal groups are increasingly critical of research that views them as objects (Reading and Nowgesic, 2000). By focusing on resilience and protective behaviours, communities can develop interventions that reduce domestic violence. A resilience focus counters a dominant research trend of “what is wrong” in Aboriginal communities; it ensures research is framed in a positive manner and results in practical benefit for Aboriginal peoples. This shift has several effects: it increases relevance and acceptability of the research to Aboriginal peoples, and it increases immediacy of solutions. Resilience offers a pathway by which disadvantaged populations can learn about domestic violence, take responsibility to reduce risks, engage with Aboriginal and Canadian social services and health care systems, and share experience (Jessica, 2004).
For too many people, home is not a safe haven but a site of family violence (Blackstock et al., 2004; Klein, 1998). Men are also at an increased risk of emotional and physical abuse (O’Leary, 2000; Schmiedel, 2006). This project will enable Aboriginal communities as a whole to build on their resilience, and not just target high-risk subgroups. For many Aboriginal people, improving resiliency at the individual, family, or community level is itself an important outcome. This could have reduce delinquency, alcohol and substance abuse.
Apart from the direct positive effect of less domestic violence (less physical and mental trauma), reduced domestic violence will probably mean an increase in the proportion of “decision enabled.” These are people who can choose their sexual and reproductive risks, rather than having these imposed in a violent way. This has implications for unwanted pregnancies, sexually transmitted infections, and blood-borne viruses.
A final product of this project will be a research proposal for a national RCT to test multiple interventions developed by Aboriginal communities to reduce domestic violence. Successful randomization by the communities themselves contributes to a new clarity on randomization methods in an Aboriginal context. Additional advances could include community engagement strategies and methods of dealing with unsympathetic community leadership, individual questionnaire design and administration protocols, support and counselling, action planning and implementation processes, confidentiality, data security, and a range of issues relating to analysis and reporting.
The five years cover three phases, corresponding to the three main objectives.
Phase 1 (years 1–2): Build partnerships with communities to develop and test culturally appropriate methods to identify resilience factors that protect against domestic violence among Aboriginal people, with a view to using these in unbiased prevention trials;
Phase 2 (years 2–3): Develop and test culturally appropriate protocols to formulate evidence-based community-led interventions that increase resilience of Aboriginal populations in regard to domestic violence
The main activity to achieve this objective is in-depth analysis and socialization of evidence generated by Phase 1. The epidemiological analysis of data collected in Phase 1 will include:
Phase 3 (years 3–5): Implementation and assessment of pilot interventions.
Implementation involves three sets of stakeholders. The first deals with social services, represented in this project by the 12 shelter directors. The second set includes the community-based organizations involved in domestic violence risk education, represented in this project by the 12 community working groups and their respective elders. Third is the public health initiative recommended to the Canadian government, represented in this project by the Native Women’s Association of Canada supported by the project steering committee and elders. The central activity of Phase 3 is to promote implementation of the intervention(s) to increase resilience of Aboriginal people to domestic violence.
The team will explore ways to transfer the findings to government and nongovernment organizations, promoting culturally appropriate interventions and policies. Guided by the communities in the appropriate format (talking circle, Band council, elders, or community meetings), a dissemination strategy throughout the research process will be directed to a range of knowledge users (Table 2), evolving as community requirements are articulated more clearly.
The follow-up survey in year 4 will be appropriately comparable to the baseline: in the same communities although not linked to the same individuals. As in the baseline, as many members as possible of each of the 12 communities will be asked to complete the follow-up survey. It will be administered under exactly the same conditions and will assess uptake and acceptability of the pilot intervention. Outcomes of interest will depend on actual interventions, but could include resilience, knowledge, attitudes/perceptions, behavioural intention, discussion/socialization around the issue of domestic violence, reported behaviour, availability of care and other services, utilization of services, and incidence of domestic violence each year over the three years intervening years.
The research team includes the Native Women’s Association of Canada (NWAC), CIET at the University of Ottawa, an Aboriginal Steering Committee, two elders, and 12 Aboriginal communities.
NWAC has links with Aboriginal communities across Canada and advocates for equity oriented community-based participatory research involving Aboriginal communities. CIET has experience in community-based research in Aboriginal populations in Canada and conducts large scale epidemiological studies, training, and policy development related to sexual violence. The team brings in collaborators from the Universities of Ottawa, Toronto, and Saskatchewan.
The Steering Committee will be involved in all aspects of the project (design, data collection, analyses, interpretation, dissemination, etc.), to ensure meaningful involvement of the communities. The advisory committee prior to submission had academic, shelter, youth, and elder representatives from universities, RCMP, several Aboriginal women’s shelters and friendship centres. The steering committee taking the project into its implementation phase comprised the directors of 12 participating shelters. It is anticipated that the Committee would meet once a year face to face, and by teleconference as required. Comparisons will identify best-practice solutions and learning about resilience of Aboriginal people. The budget allows a national meeting each year, coinciding with relevant national conferences. Annual meetings will allow team learning and transfer of successful models between provinces.
The project pays for staff to support the work in each shelter; the part time prevention convener/CBR will answer to the shelter director. Exchanges of trainees and community-based researchers will promote a national network of emerging Aboriginal researchers.
Two First Nations Elders guide the technical support team. Their participation in the project preparation and implementation provided mental, spiritual and emotional insights. They emphasized the importance of children and youth participating in all stages of the project, so that that intergenerational transmission of values and traditions can be continued. They are a vital link to traditional wisdom and will participate in the project for its duration.
The training and involvement of Aboriginal trainee researchers is integral to this research process. The project funds two First Nations PhD candidates. Capacity building also entails community involvement in discussions about the research problem and, importantly, in the development and implementation of intervention strategies. The evidence-based interaction among community service organizations will increase awareness of the social resources that can protect families.
Since 1995, CIET has built capacities in Aboriginal communities to enable them to design and carry out their own research. CIET works with all 5 national Aboriginal organizations and has trained CBRs in 250 Bands across the country: tobacco abuse among Native Canadian youth (Winnipeg, 1995); problems of urban Aboriginal youth (Victoria, 1996); substance abuse among youth of the James Bay Cree (8 communities, 19968 communities, 1997); First Nations national youth inquiry into tobacco use (97 communities, 1996–7), First Nations youth resilience to HIV/AIDS (4 communities, 1998); AFN evaluation of the Canada Prenatal Nutrition Program (80 communities, 2001–3); Aboriginal Community Youth Resilience Network (ACYRN) (12 eastern Mi’kmaw and 8 western Métis communities, 2005–9); and Aboriginal youth resilience to STIs and blood borne viruses (23 Treaty 8 and 4 urban communities). CIET also runs the Ottawa ACADRE, training Aboriginal researchers through Masters and PhD levels, and emphasizing scientific methods attuned to Aboriginal paradigms.
CIET’s experience in Canada is not limited to Aboriginal communities. From 1998–2000, CIET led a Health Canada pilot project in the Atlantic provinces. The aim was to increase local capacity to plan strategically, access existing data, obtain local evidence, and put it to work for better health. Health regions focused on perinatal care and caring, youth risk and resiliency, breastfeeding, and heart health. Public health nurses received additional training; four of them pursued Master’s degrees in epidemiology through the CIET capacity building program.
CIET’s international work includes several projects on domestic violence.
We submitted the proposal for ethical review to the University of Ottawa REB. Permission to work in the community, usually from the Band council, will be obtained through the shelter before beginning training and preparations for fieldwork. Community discussions will involve social services personnel, councillors, and elders. These are well positioned to identify shortfalls of support mechanisms, and they will be the beneficiaries of the research results.
The researchers will discuss objectives with CBRs in participating communities to ensure clear goals and research that flows from community beliefs and traditions. Prior to starting the facilitated self-administered questionnaire, CBRs will read the consent form to each participant, explain the instrument, that participation is strictly voluntary, that any question which proves uncomfortable can be skipped, and that they may stop at any time. For minors below legal age, parental consent will be required. Several shelters are concerned they may be blocked from hearing the voice of abused minors by parents who deny consent. The guidance from the elders on this project is that each community will need to choose an appropriate format for consent in these (hopefully few) cases. Once that is decided at community level, we will submit the solution to the REB for consideration. Where parental consent has been given but a minor declines to participate, the child’s wish will prevail.
The research will be administered in a way that guarantees confidentiality and anonymity as part of the inducement to disclose. Participants will be informed that their responses are confidential. No identifying marks or names will appear on the completed form. Focus groups and talking circles will not register any identities and participants will be asked to respect privacy and confidentiality.
The project identifies community and home factors that protect communities from domestic violence. The personal nature of these issues can make responding to questionnaires uncomfortable. At the individual level, questions about violence could be injurious to the respondent. Harm to the community could result from research findings stated negatively, or if individual responses became inappropriately public. Before and after completing the questionnaire, respondents will be reminded of the availability of a counsellor at the shelter, and encouraged to make use of these services as appropriate.
Since we will be working with and from the shelters in each community, we will have detailed information about any risks to interviewers. Fieldwork will proceed only with support and recognition from the Band councils, where these exist. We anticipate that CBRs will work together in each others communities, providing support and momentum for the community survey. Typically CBRs work within sight of each other, not entering the homes of people they interview.
All data gathered in this project will the property of the communities from which they came. However, the potential for breach of confidentiality increases with local data sets. We deal with this by accessing the data set on behalf of the community, answering their queries with anonymized tables with no fewer than five individuals in any cell. Paper records from which the data were derived (kept for a minimum of five years in case any of the results are challenged) are stored in accordance with a set of CIET guidelines for security, storage, and eventual destruction of paper records.
A data sharing agreement with each participating community will specify community ownership of data with data stewardship. This will allows access to results by the communities, while protecting the individual rights of people who participate. The project will also have to clarify and complement the usual interpretation of OCAP for application in this gender and victim sensitive context, where individuals who represent local decision taking may also be the perpetrators of domestic violence. A sample of this agreement follows.
BETWEEN: CIETcanada, as represented by its Executive Director
AND: <Community name>
It is acknowledged and respected that the right to self-determination of the First Nations, Métis and Inuit includes the jurisdiction to make decisions about research in their communities. The benefits to the communities, to each region and to the national effort should be strengthened by the research. Research should facilitate these communities to take control and manage their own community information and to assist is the promotion of healthy lifestyles, practices and effective program planning.
This agreement formalizes an arrangement between CIET and <Community name> regarding the research process, protocols and products, including the data collected as part of the to the CIHR-funded project: Community-led Reduction of Domestic Violence in Aboriginal Communities: Rebuilding from Resilience. The project will identify and help to initiate community-led interventions that reduce domestic violence.
Domestic violence is a well known problem in many communities, and Aboriginal communities are not exempt from this risk. This research project focuses on protocols assist communities in the design of their own interventions, and to measure the impact of these interventions in the reduction of domestic violence. The project will develop and test tools and procedures, develop proposals for and generate community buy-in to, further studies at prevention of domestic violence in Aboriginal communities.
The parties therefore agree that the Rebuilding from Resilience project will take place as follows:
The data from this project will only be used to meet the goals and objectives of the Rebuilding from Resilience project. The goals and objectives of the Rebuilding from Resilience are:
Enable the participating Aboriginal communities to examine domestic violence, using scientific yet culturally appropriate methods to identify community-led interventions that reduce violent behaviours.
As custodians of this data, <community name> and CIET agree to safeguard the privacy and security of all information containing personal and/or community identifiers. Permission from survey participants will be obtained prior to collecting personal information. Survey questions of a personal nature will remain completely anonymous.
<community name> and CIET will not release the information collected for any purpose unless agreed to by the parties.
Amendments to this agreement may only be made in writing and agreed upon by both parties.
IN WITNESS WHEREOF THE PARTIES HAVE SIGNED THEIR NAMES effective
The __________ day of __________, 2009.
(Position of signer)
Madeleine Dion Stout
Anita Olsen Harper
Participating Organizations and Executive Directors:
Caroline Anawak, ED, Agviik Society, Iqaluit, NU
Susanne Point, ED, Xolhemet Society, Chilliwack, BC
Emma Johnson, ED, Nuxalk Nation Transition House, Bella Coola, BC
Darrell Royal, Family Wellness Coordinator, Siksika Nation Prevention of Family Violence, Siksika, AB
Mary Simpson, ED, Paspew House, Fort Chipewyan, AB
Donna Brooks, ED, YWCA of Prince Albert, Prince Albert, SK
Sharon Mason, Program Administrator, First Nations Healing Centre, Koostatak, MB
Cynthia Francois, ED, Mamawehetowin Crisis Centre, Pukatawagan, MB
Dorothy McKay, ED, Kitchenuhmaykoosib Equaygamik, Big Trout Lake, ON
Catherine Lelievre, Program Manager, Akwesasne Family Violence Program, Cornwall, ON
Louann Stacey, ED, Native Women’s Shelter of Montreal, Montreal, QC
Debbie Boyd-Crawford, Program Supervisor, Mi’kmaq Family Healing Centre, Whycocomagh, NS
Sheila Swasson, Listuguj First Nation in Quebec.
Elders: Dan Smoke, Mary Lou Smoke
And in memory of Judy Ford, ED, Nain Safe House, Nain, LB
1Acknowledgements: This proposal was funded under the CIHR operating grant 84489: Rebuilding from Resilience — research framework for a randomized controlled trial of community-led interventions to prevent domestic violence in Aboriginal communities.