Violence Prevention Education: Problem Structuring for Systemic Empowerment in Health Settings

Applying a system lens and systemic approach is valuable for exploring problem situations and difficulties. A systems understanding allows deep exploration of complexity and diversity with respect and invites multiple approaches and perspectives. Importantly, and sensitively, issues of power, dynamics, and change in perspective and opportunity can be brought into clearer understandings. Solutions that value creativity and imagination can be revealed. Preventing family and community violence before it happens is a challenge. Many targeted campaigns focus on bystander actions, victim protection, and support, or on the perpetrator from counselling support to lengthy jail convictions, after an event or series of violent acts has occurred. Community campaigns encourage victims of violence to get help, leave, or change shared attitudes, but despite concerted effort, the rate of domestic, community, and family violence have not changed in Australia. Every act of violence is another lived example of the failure of prevention effort. In Australia, on average, one woman a week is killed by her intimate partner from preventable violence. This has prompted us to consider the problem of intimate partner violence (IPV) from the perspective of primary care and especially that of the family physician. There are significant resources devoted to the clinical response for family physicians whose patients reveal that they have experienced violence from someone with whom they have had a previous relationship (see, for example, the RACGP’s White Book, Safer Families (2014). The source of frustration for us as practitioners is that while family medicine physicians are expert in disease prevention and primary prevention, to date few resources have been devoted to the recognition and active prevention of violence in relationships before the initial act, at developmentally appropriate opportunities. With a review of the sociology and neurobiology of violence and conflict analysis, we developed a problem-structuring model containing ten elements including six necessary factors that must coalesce for an act of violence to take place. Our systems application reveals these factors, and their implications and strategies for change can be explored by family physicians, counsellors, and health workers who are able to use this model as a tool to talk through matters with individuals, families, and communities. We call this the Cooktown Ten (C-10). Coupled with mindful self-calming strategies, and our own “Gentle Hands” technique, the approach supports practitioners and clients to effectively diffuse and de-escalate tension, prejudice and isolation, and over time, change behaviors. Self-control and self-soothing have long been an interest to systems researchers. As self-aware writers/practitioners/researchers/activists, we acknowledge that with almost every concept we have designed from we build on the work of others; we can because they have. This chapter discusses the C-10 as a practical application of systemic thinking for individual and community education. Systemic thinking is a necessary tool in our repertoires of practice to deal with the almost universal problem of interpersonal harm. We will explore the paradigmatic framework that can justify clinical endeavor without waiting for a bureaucratic directive or guideline to follow. Primary healthcare has an important role to play in dealing with violence prevention particularly where early identification can allow timely interventions.