Alexandra Restrepo Director PREVIVA Program Professor, School of public Health University of Antioquia Medellin, Colombia

PREVIVA PROGRAM EXPERIENCE

-L IFE RISK BEHAVIORS PREVENTION PROGRAM-

MEDELLIN, COLOMBIA.

1. PREVIVA DESCRIPTION

PREVIVA PROGRAM AIM

-Prevention of violence and other risky behaviors associated with it, by means of the participation of municipal governments and communities, so that social processes are generated to guarantee their effectiveness in the long run.

-Program was funded by Luis F Duque

PREVIVA MODEL

SUCCESFUL PUBLIC

POLICY

Empowerementmunicipal authorities

and communityrelationships

Concrete programsAction oriented

information

system

J Richmond model adapted by Luis F Duque

HOMICIDE RATE. MEDELLIN, ANTIOQUIA

AND COLOMBIA 1980-2012

0

50

100

150

200

250

300

350

400

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Medellín Antioquia Colombia

In Colombia, 10% homicides---relation with political and community violence

RESEARCH AND

INTERVENTION LINES Lines Description

Design, implementation and evaluation of surveillance system

-Population survey - Surveillance fatal and non-fatal injuries

Study of risk and protective factors -Family violence -Child abuse -Interpersonal aggression -Youth resilience

Design and evaluation of interventions -Early child development program (Zero to five years) -Program to prevent aggression with pre-school and school children -Intimate partner violence -others

Design and evaluation of public policies -22 municipalities of Antioquia, Colombia. - Interdisciplinary approach

2. DESIGN AND EVALUATION OF PUBLIC

POLICIES TO PREVENT VIOLENCE

-Actors mapping -Interventions

inventory -Problem

discussion and consensus

-Empowerment

-Surveillance system

-Surveys -Income and

outcome matrix

Coexistence and

security committee

s

- Actors mapping - Interventions inventory - Problem discussion and consensus

-Empowerment

- Surveillance system - Population

survey: magnitude, Odd Ratio and Attributable Risk factors

- Evidence review

Coexistence and security committees

DESIGN OF PUBLIC POLICIES TO PREVENT

VIOLENCE AND PROMOTE COEXISTENCE

Applied in 22 municipalities of Antioquia, Colombia.

68.8

40.1

30.8

3.2 4.6

3.4

7.7

0.2

3

41.3

11.7

33.1

10.4 9

0.2 0.1 0.5 0.3 0 0.3

0

10

20

30

40

50

60

70

Verbal orpsychological

aggression

Phisycalaggression

threat

Unarmedphysical

aggression

Severe threat Armedrobbery

Sexualaggression

Aggressionwith weapon

Kidnapping Murder

Witness Victim Agressor

V ICTIMS, AGGRESSORS AND WITNESSES, VIOLENCE.

MEDELLIN METROPOLITAN AREA, 2007. % AND CI 95%).

37

8.4

2.1

42.7

8.5 2

41.7

9.6

2.5

42.1

11.3

3.2

0

10

20

30

40

50

60

70

80

90

100

Agresión verbal o sicológica Agresión física Agresión física con lesión Agresión verbal o sicológica Agresión física Agresión física con lesión

Hombre Mujer

VÍCTIMA AGRESOR

Resourse: Second survey of violence. Medellin. 2007

Factors Armed threat

Physical

aggression with a

weapon

Physical

aggression

without a weapon

Robbery without

a weapon

OR %PAR OR %PAR OR %PAR OR %PAR

Mother´s

watching 0,1 -92,5 0,2 -79,5 0,3 -50,7 0,5 -96,1

Social cohesion 0,5 -100,0 0,3 -48,5

Attitude of

cooperation with

local authorities 0,5 -85,2

1 point increase

Socioeconomic

level 0,8 -25,0

Protective factors against interpersonal violence.

Medellin metropolitan area, 2007

Risk factors for interpersonal violence. Medellin metropolitan area, 2007

Factors

Threat with a

weapon

Physical

aggression with a

weapon

Physical

aggression without

a weapon

Robbery

without a

weapon

OR %PAR OR %PAR OR %PAR OR %PAR

Anomy 7,2 86,1 7,52 86,7 14 92,9

Neighborhood violence 7,1 85,9 6,84 85,4 4,6 78,1 4,7 78,7

Social solidarity expectations

frustration 4,7 78,8

Victim of physical child abuse 4,37 77,1

Legitimating violence as a

mechanism for conflict

resolution 3,0 66,9

Legitimating violence as an

education method 3,2 69,0

Social control in the

neighborhood 2,9 65,6

Distrust of others 2,1 51,9 Unemployment in the past

year 2,0 50,5 1,4 29,1

Factors Threat with a weapon

Physical

aggression with a

weapon

Physical

aggression

without a weapon

Robbery without a

weapon

OR %PAR OR %PAR OR %PAR OR %PAR

Chauvinist attitudes

(machismo) 2,7 63,4 2,5 59,8 7,4 86,5

Physically abused

by mother in

childhood 2,8 63,9 2,2 55,2 3,1 67,3 2,1 51,2

Lifetime

unemployment 3,0 66,4

Approval of murder

use for community

defence 1,5 31,9

Higher education

and professional

activity frustrations 1,9 47,1

Legitimating

violence for family

and as a defense

from society

1,9 45,9 3,2 69,1

Risk factors for interpersonal violenc. Medellin metropolitan area, 2007

CONSTRUCTS PROTECTIVE AND RISK FACTORS

Family as source of attitudes,

values, and practices with

respect to violence and

coexistence

Communication and affection between children and parents;

vigilant mother and father

Legitimacy of violence, especially as educational method

Machismo

Childrearing practices for early prevention of aggressive, risky, and criminal behaviors

Unequal and exclusive society

Frustration over access to quality higher education (e.g., technical, university)

Frustration over professional or career opportunities

Lack of communication and

trust amongst citizens and

between them and authorities

Distrust amongst citizens and between citizens and local authorities

Collective efficacy: social cohesion and taking care of the neighborhood

Lack of civic culture for

coexistence and security

Acceptance of violation of norms

Lack of social responsibility and high individual efficacy

GROUPS OF RISK AND PROTECTIVE FACTORS.

METROPOLITAN AREA OF MEDELLLIN POLICY. 2007-

2015

PUBLIC POLICY STATEMENTS PROGRAMS ADOPTED IN PUBLIC POLICY APROVAL DECREE

Development of family coexistence

Early prevention of aggression. From prenatal up to 3 years of age

Promotion of civic awareness and early prevention of violence (4 to 11 years of

age)

Gender oriented early prevention of intimate partner violence

Re-socialization of severe domestic aggressors

Improvement of inclusion and equity

Increasing access to high quality higher education

Strengthening already existing mechanisms of coordination among public and

private universities and the private sector

Stimulation of the development of micro enterprises and productive chains

among low SES population

Resilience promotion among children and adolescents

Strengthening communication and

interaction among citizens and

between them and local authorities

Strengthening relationships between the Police and local communities

Strengthening effectiveness, efficiency, and transparency of municipal institutions

Strengthening social cohesion and collective efficacy

Development of a culture of

acceptance of formal and social

norms for civic coexistence and

security

Municipal social pacts for the culture of legality

Re-socialization of young gang members

PUBLIC POLICY STATEMENTS:

METROPOLITAN AREA OF MEDELLIN POLICY.

2007-2015.

SCIENTIFIC EVIDENCE

Scale and distribution (victimization, offender,

witness)

Factors associated with each type of aggression - GROUP

• Risk and protective factors • Identification of strategies

Follow-up and evaluation

Problem definition

2004

Goals definition

2007 2013

EVALUATION OF PUBLIC

POLICY

3. DESIGN AND EVALUATION OF

VIOLENCE PREVENTION PROGRAMS

P ILAS!. MEJORES ADULTOS, MEJORES

NIÑOS

¿What is Pilas! program?

Program to promote the personal skills and prevent violence in preschool and school health.

Aim: To reduce violence and other risky behaviors (Use drugs and alcohol use, unsafe sex, school failure) in preschool and school.

To increase social skills and citizenship skills in children / as preschool and school age.

To reduce the beliefs that legitimize violence

With

Pre-school and school teachers

Parents and caregivers

Activities with teachers and parents

EVALUACIÓN DE IMPACTO

PILAS! Mejores adultos, Mejores niños

Components

12 activities with teachers

6 activities with parents an caregivers

2 hours

P ILAS!. MEJORES ADULTOS, MEJORES

NIÑOS

EVALUATION

• Program reduce: • Direct aggression report by parents and

children • Child abuse (moderate and severe) report by

parents and children.

• Program increase:

• Relationship and supervision with caregiver • Affect and communication with caregiver • Discussion of daily activities with children • Regulation of peers relationships. • Communicative skills

P ILAS!. MEJORES ADULTOS, MEJORES

NIÑOS

PROMESA.

DE UN FUTURO MEJOR

Early child development program and prevent the child abuse

Integrate health services, nutritional services and social services.

Previva design to psychosocial component base on evidence- improve parenting practices and prevent child abuse

Training to health care provider implement the program.

Evaluation with a RCT

Children 0–5 year

Health care institutions

Institutions

n=10

Institutions

n=10

Children and

caregivers

n=2.000

Children and

caregivers

n=2.000

Follow up 1.5

years Follow up 1.5

years

With intervention Control group

20 health care institutions

Ramdomization

Ramdomization

Ramdomization

1. Prevention of intimate partner abuse in families of former members of illegal armed groups (guerrilla and paramilitaries)

2. Prevention of domestic violence in general population

3. Promotion of the rule of law acceptance in communities

4. Adopting public policy on human security and violence prevention in municipalities

5. Pactos por la legalidad

Identified

Risk protective

factors

What works?

Design Validatio

n Evaluatio

n

PREVIVA http://previva.udea.edu.co/ Alexandra Restrepo cheres80@gmail.com

Thanks!