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In 1995, domestic violence was recognized as one of the foremost public health concerns in the U.S. by Congress. Since 1997, violence committed by adolescents has also received significant attention due, in part, to a number of high profile school shootings (Office of Juvenile Justice and Delinquency Prevention, 1999). Teen dating violence, however, has received comparably little attention, despite its prevalence and the severity of its impact. Recognizing that this gap exists, researchers and practitioners have gradually begun to focus on adolescent males who perpetrate dating and family violence. As a result, juvenile batterer intervention programs have been developed in several jurisdictions across the United States. These programs attempt to hold young men who batter accountable for their violence and rehabilitate them whenever possible. No evaluations of these programs have been published, or to our knowledge conducted. Moreover, few efforts have been made to collect, summarize, evaluate and disseminate existing program methods or protocol.

This article offers an overview of the nascent juvenile batterer intervention programs. It identifies risk factors for teen dating violence perpetration as described by the literature and considers the utility of these findings, describes efforts to prevent re-offenses by juvenile perpetrators of domestic violence, discusses several shortcomings inherent in post-crisis intervention, and outlines current challenges within the field. In addition, the authors draw upon research from related fields to posit possible future directions for research and intervention efforts.

Prevalence

A growing body of research indicates that dating and family violence is a leading cause of injury for women and girls. Lifetime prevalence of teen dating violence victimization among girls in the U.S. is estimated to be between 9 and 41% (Avery-Leaf, Cascardi, O'Leary & Cano, 1997; Silverman, Hathaway, Freedner, Aynalem & Tavares, 1999; Sugarman & Hotaling, 1986). Although research in the area of adolescent-to-parent violence is limited, several studies suggest that approximately 10% of adolescents aggress toward their parents each year (Cornell & Gelles, 1982; Peek, Fischer & Kidwell, 1985; Straus, Gelles & Steinmetz, 1980). Adolescent male violence against female family members is a concern of many practitioners, and is reported by battered women as frequently coinciding with violence from adult partners (Bancroft & Silverman, in press). Many (e.g. Carlson, 1990; Hotaling & Sugarman, 1986) theorize that men who abuse family members provide a powerful model for family violence to adolescent males.         

Who are the boys most at risk for abusing and assaulting their dating partners? What can be done to prevent these adolescent batterers from becoming adult domestic violence offenders? While scientific inquiry into these topics is in its infancy, and intervention programs designed to address teen dating violence have yet to be established in most states, initial investigation and program development have taken place in select areas.

Who are adolescent male perpetrators of dating violence?

The profile of the adolescent male perpetrator of dating violence suggested by the literature is similar to the profile of other juvenile offenders. In short, teen boys who abuse their dating partners are more likely to have experienced child abuse or neglect (McCloskey, Figueredo & Koss, 1995; Wekerle & Wolfe, 1998; Wolfe, Werkele, Reitzel-Jaffe & Lefebvre, 1998), witnessed domestic violence (Hotaling & Sugarman, 1986), and to use alcohol or drugs (Cate, Henton, Koval, Christopher & Lloyd, 1982) than their non-abusive counterparts. In addition, several studies have established that adolescent males who abuse their dating partners are more likely to have sexist attitudes that support male domination over females (Follingstad, Rutledge, McNeil-Harlings & Polek, 1992; Henton, Cate, Koval, Lloyd & Christopher, 1983; Himelein, 1995; Koss & Dinero, 1989, Koss, Leonard, Beezley & Oros, 1985; Malamuth, Heavey, Barnes & Acker, 1995; Tontodonato & Crew, 1992) and are more likely to associate with peers that support these attitudes (Lavoie, Robitaille & Hebert, 2000; Roscoe & Callahan, 1985).

It is important to note that most research conducted on juvenile perpetrators of domestic violence to date is based on non-representative samples; no studies have utilized samples that would enable generalization to all juvenile perpetrators of dating violence. Therefore, the studies reflect only the profile of those adolescents who come to the attention of researchers—i.e., boys who come into contact with the criminal justice system or who readily admit to perpetrating violence during interviews or surveys. It is possible that there are many adolescent males who perpetrate violence and abuse that don’t fit the established profile and will remain undetected by research. Moreover, it is critical to bear in mind that no study has established that any of the risk factors listed above (such as witnessing domestic violence) actually cause youth to perpetrate violence. Risk factors only reveal which characteristics or life experiences juvenile perpetrators are likely to share in common. They don’t provide us with answers to the question: “What is it that causes the boys to be violent?”

Therefore, developing “profiles” or “prediction tools” based upon existing research is premature and could unfairly label adolescents. Practitioners who attempt to predict which adolescents are most dangerous based on available information run the risk of overestimating dangerousness for certain individuals and failing to identify those who are in fact dangerous. Investigation of resiliency or protective factors, in addition to research on the level of risk of individual offenders, may provide practitioners, survivors and policy-makers with more useful information (E. Gondolf, personal communication, June, 2000).

Keeping in mind the limitations of “risk factor” research, we offer the following review of what is known about adolescent males who are violent towards dating partners, female family members and others.

Parent-to-Child Violence: Maltreatment of children by parents is a consistent predictor of young males’ physically, sexually and verbally abusive behaviors (Wekerle & Wolfe, 1998; Wolfe et al., 1998; McCloskey et al., 1995) and later criminal behavior (Viemeroe, 1996). This evidence notwithstanding, it is also recognized that children who are maltreated by parents are not guaranteed to become adolescent or adult offenders; a significant proportion of children from abusive families are non-abusive to intimate partners (Widom, 1989). Adolescent males who are referred to programs for domestic violence perpetration should be screened for parent-to-child maltreatment and provided with services as needed.

Witnessing Inter-parental Abuse: Many studies support the contention that young males who witness parental domestic violence are at increased risk for becoming abusive themselves in adult intimate relationships. Through a comprehensive review of family violence literature, Hotaling and Sugarman (1986) found that 88% of studies with adequate comparison groups revealed that witnessing parental violence was a significant predictor of adult violence against a female partner. Childhood observation of inter-parental abuse may also predict the development of attitudes that support violence against women (Silverman & Williamson, 1997; Stith & Farley, 1993). Practitioners are cautioned against approaching all adolescent males who witness family violence as potential offenders. Similarly, the literature does not support an assumption that all adolescent males who perpetrate domestic violence have witnessed inter-parental abuse. Rather, all adolescent males who witness domestic violence must receive appropriate support services and education regarding healthy relationships. All identified juvenile perpetrators of domestic violence should be screened for witnessing inter-parental abuse.

Substance Use: Several studies have found that the perpetration of family and dating violence by adolescent males is strongly associated with alcohol consumption (Cate et al., 1982; Foo & Margolin, 1995; Makepeace, 1987; Malik, Sorenson & Aneshensel, 1997; O'Keefe, 1997; Symons, Lin & Gordon, 1998). No research has been conducted that establishes the effect of substance abuse intervention on teen dating violence perpetration rates. Many advocates predict that treating a juvenile perpetrator of domestic violence for substance abuse problems alone will not produce significant change in the perpetration of abusive behavior. Substance use and violence perpetration are often viewed as related, yet distinct, health problems that each require specialized intervention (Bennett, 1997).

Sexist Attitudes: Several studies have found that adolescent males who possess attitudes legitimizing violence against female partners are more likely to report being physically violent toward dating partners (DeKeseredy & Kelly, 1993; Riggs & O'Leary, 1996; Silverman & Williamson, 1997; Smith, 1990; Stithe & Farley, 1993). Thus, intervention programs that fail to address perpetrators’ sexist attitudes may have a minimal effect. To date, there have been no evaluations of adolescent intervention programs that do or do not address sexism, nonetheless, advocates encourage practitioners to include education about sex-role stereotyping, and concepts of masculinity and femininity, in intervention programs on the basis of available research on adolescent attitudes.

Peer Attitudes: At least three studies have found that having peers who support violence against women predicts one’s own dating violence behavior (DeKeseredy & Kelly, 1993; DeKeseredy & Schwartz, 1993; Silverman & Williamson, 1997). Based on this knowledge, some practitioners believe that encouraging juvenile perpetrators to form new peer relationships with non-violent and non-sexist males may reduce abuse perpetration.

Current Methods Of Intervention

Juvenile batterer intervention programs have emerged in the U.S. over the last decade. Most have developed in relative isolation from one another, despite the fact they often share similar philosophies. They have been developed by courts, survivor advocacy agencies, batterer intervention programs and community-based agencies that serve youth. As a result, the programs differ with regard to structure and methodology. As alternatives or complements to incarceration, such programs offer possible methods to re-educate young men about their relationships and their use of violence. Most juvenile batterer intervention programs utilize a psycho-educational group format and meet weekly for 1-2 hours. Intervention group activities may include discussions of healthy and unhealthy relationships, sex-role stereotyping, coping with anger or rejection, and the effect of alcohol or drug use on one’s behavior, among other topics. The atmosphere of groups is neither intimidating nor social; trained staff works to maintain a safe, encouraging, yet serious tone. Group cycles last from 12-52 weeks. Parents receive orientation information regarding the program and, in some communities, are involved in the intervention on an on-going basis. Intervention participants who re-offend may be expelled from the group or asked to re-start it, depending upon the program. In some communities, those who are expelled may face more severe penalties from a probation department or court.

Table 1: Features of Some Juvenile Batterer Intervention Programs

 

Location

Number of Youth

Served

Per year

Ages

Intervention

Component

Program Duration (in weeks)

Referring Entity

Expect Respect

Austin, TX

School Based

60

6-12 grade

School groups. Individual & Family Available onsite

24

Middle and High Schools

MOVE Youth Program

SF, CA

Agency based

30

 

12-21

Individual

Group

Family

Siblings

52 minimum

Juvenile Courts

Mass DPH

10 Programs

Mixed

 

150

13-17

Group

12

Juvenile Courts,

Schools &

DYS

STEPUP

Seattle, WA

Comm. Centers

30-40

 

Individual

Group

Family

24 minimum

Juvenile

Courts,

CBO’s

Juvenile Batterer Intervention Programs: Challenges and Dilemmas

Programs for adolescents who batter currently face a number of challenges and dilemmas, as do all new interventions. These challenges include public recognition of teen domestic violence as a phenomenon distinct from generalized violence; a dearth of culturally appropriate interventions and research; and partnering with a juvenile justice system perceived by many to suffer from pervasive racial and class biases.

Recognizing teen batterers: Between 1997-1999, seven incidents of teen-perpetrated domestic violence received national attention in the U.S.—perhaps the most widely-publicized of these events being the shooting in Jonesboro, AK. In the wake of these tragedies, media posed questions about the cause of “youth violence” or “school violence,” but failed to emphasize that in all cases the shooters were male and the intended victims female (Sousa, 1999). In fact, the incidents might have been more appropriately and specifically classified as “violence against women or girls.” An inability to perceive violence perpetrated by adolescent males as similar to domestic violence perpetrated by adults may limit our capacity to alter their behavior.

For many, it may be difficult to acknowledge that boys as young as eight or nine years old participate in “dating” relationships. As a result, in some cases abusive behavior may be dismissed or handled as though it were acceptable rough-housing. (For example, girls and boys may be told that if someone kicks or insults them, it is a sign of affection.) In order to offer victims of abuse consistent and comprehensive protection, and in order to provide young perpetrators with the services and intervention that they need, adults may be required to alter their own definitions of “dating.” Similarly, any incidents involving violence between adolescents should be assessed to determine if, and to what extent, dating or sexism was a motivational factor.

Culturally appropriate intervention and research: Although men of color are over-represented in batterer intervention programs, there are few culturally specific intervention strategies and insufficient research on violence in communities of color (Richie, 1998; Williams, 1997). While research does not demonstrate conclusively that culturally specific programs have improved outcomes for adult batterers (Gondolf, 2000), some resarchers have found that men of color have higher completion rates when working with staff of similar ethnic backgrounds (O. Williams, personal communication, September, 2000). It is possible that these results would hold true for adolescent offenders in culturally-specific intervention programs as well. Despite the fact that very few outcome studies of culturally specific batterer intervention programs have been conducted, practitioners have expressed a need for the development, implementation and evaluation of culturally specific models (Carillo & Tello, 1998; Williams, 1997).

Partnering with the juvenile justice system: The juvenile justice system has an important role to play in securing safety for victims and holding juvenile batterers accountable. In a number of jurisdictions, law enforcement agencies, probation departments and juvenile courts work with juvenile batterer intervention programs to monitor program compliance, enhance victim safety and to hold juvenile batterers accountable. Much work is still needed across the nation to establish a consistent juvenile justice response to teen dating violence.

There are, however, considerable drawbacks to relying on the juvenile justice system as the primary agency of response to teen dating violence. By nature, the juvenile justice system provides a response only once violence has occurred. Other than the deterrent effect of holding batterers accountable for their violence after the fact, it does not seek to prevent dating violence. There are also significant risks associated with youth involvement in the juvenile justice system. According to Amnesty International, "use of incarceration in the United States Juvenile Justice System is a matter of grave concern because of its inherent risks to the physical and mental integrity of children, and its potential for negative influence rather than rehabilitation." (Amnesty International, 1998). In addition, recent research demonstrates that the juvenile justice system continues to suffer from pervasive racial bias (National Council on Crime and Delinquency, 2000). Efforts to respond to teen dating violence in communities of color will be hindered by the perception that the domestic violence movement relies uncritically on what is perceived as a racially biased system.

Juvenile Batterer Intervention Programs: New Directions

As the field of teen dating and family violence intervention becomes more sophisticated, stakeholders are increasingly exploring new strategies, identifying needs and attempting to build on lessons learned in related fields. Examples of these new developments include partnering with schools, drawing on the strengths of ecological approaches to violence, and promoting efforts that attempt to link post-crisis intervention with primary prevention.

Partnering with school administrators and educators: While intervention with individual perpetrators of dating or family violence is essential, it as just as critical that social norms that support violence change. Educators have an enormous potential to affect the social environments in their classrooms and in their school-communities. School administrators have the power to design, promote and implement policies and curricular approaches that can significantly affect students’ attitudes and behavior. It is important that school personnel receive training on the topic of gender-based violence and are supported when they link existing literature or social studies themes to social norms regarding violence and gender (B. Rosenbluth, personal communication, November, 2000).

Research: Creating policy or awarding funding to intervention programs in the absence of evaluation research potentially places victims at continued risk for abuse and may waste resources. It is imperative that long-term follow-up evaluation studies of juvenile intervention programs are conducted and that the results be widely disseminated. Moreover, those who develop programs should base the design of curricula and intervention components on data collected from program participants; optimal interventions will be created if the service population is more fully understood.

Learning from related research: The last two decades have seen a proliferation in research and evaluation on violence prevention and intervention. While the bulk of the literature focuses specifically on youth violence, findings may be applied to dating and domestic violence intervention and prevention. In 1999, the Center for the Study and Prevention of Violence evaluated several violence prevention and intervention initiatives. Those that utilize ecological approaches were shown to have high success rates with violent juvenile offenders (Center for Prevention and Study of Violence, 2000). The factors associated with the success of ecological approaches are potentially instructive for the nascent efforts to rehabilitate and hold accountable young men who batter.

Ecological approaches recognize that individuals often reflect the values of their families, communities, and societies, and that “effecting sustained change requires addressing the multiple problems of youth wherever they arise; in the family, the community, the health care and school systems" (Currie, 1998, p.105). Ecological approaches also recognize that treating offenders in isolation of their social environment is a "prescription for failure” (Currie, 1998, p.105). The evidence in favor of ecological approaches is supported by other studies that have found that involvement of the family seems necessary to effect sustained change (Henggeler, Melton, Smith, Hanley & Hutchinson, 1993; Tolan, Gorman-Smith, Huesmann & Zelli, 1997), and that community based efforts are more effective than institutional efforts (Tolan et al., 1997).

Ecological Approaches: Some adult and youth batterer intervention programs have attempted to integrate ecological principles into batterer intervention programs. Common to some of these approaches is the recognition that each participant serves as an important point of access to the family, community members, including peers, and institutions such as the faith community, schools, other community based agencies, the juvenile and family courts and to youth employment agencies. This access makes it possible to enlist family, community members and institutions in holding perpetrators accountable and ensuring victim safety. In some cases, however, it is acknowledged that involving family members is not always appropriate—the safety of the young men who batter may be jeopardized if abusive parents are included in the approach. Unlike many intervention strategies that work to affect behavior change by focusing on perceived deficits, ecological approaches emphasize individual and community strengths and build on emerging understandings of individual resiliency and community assets.

In Atlanta, the Men Stopping Violence (MSV) program attempts to affect the social ecology of adult program participants by involving their friends, and on occasions their sons, and by advocating for change across the broad range of institutions with which participants interact (S. Nuriddin, personal communication, April, 2000). Similarly, some juvenile batterer intervention programs have developed models that involve a wide range of stakeholders including city agencies, community based organizations and community members themselves. For instance, the MOVE Youth Program, a juvenile batterer intervention program based in San Francisco, CA, is implementing a model that involves family and community members in teen dating violence prevention (A. Silva, personal communication, May, 2000). In this way, ecological approaches such as those used by MSV and MOVE also serve as important opportunities for engaging in prevention, and in this way connect intervention and prevention efforts.

The Case for Prevention: Studies indicate that "punitive, legalistic approaches" are unlikely to have much effect on youth violence unless they are integrated into policies that focus funding and efforts on prevention (Tolan, 2000). Domestic violence prevention campaigns have been pursued in health care settings, in schools and through the media, and show promise in changing attitudes towards the use of violence (Edleson, 2000). Important lessons can be drawn from related fields that have been effective in changing adolescent behaviors and attitudes, for example regarding teen pregnancy prevention and child abuse awareness (Daro & Cohn Donnelly, 2000). Prevention efforts may be enhanced through collaboration with related fields, such as child welfare and youth violence, and by developing connections with a range of agencies that serve youth. These partnerships could include linkages with mentoring programs, employment training sites, arts and recreation programs, rites of passage programs, and literacy and media literacy projects (National Advisory Council on Violence Against Women, 1999).

Since lower education, lower-status jobs, and under-employment are all identified as probable risk factors for the perpetration of violence, effective prevention plans will need to address each of these, and the relationship between these potential risk factors and domestic violence should be further clarified by continuing research (Edleson, 2000; Kaufman Kantor & Jasinski, 1998). Prevention activities should also address peer behaviors and attitudes since these have been shown to affect boys’ choices about whether to use violence (Heise, 1998). Given the contemporary predisposition in favor of intervention and incapacitation, committing resources to prevention will require a shift in policy priorities (Tolan, 2000). Nevertheless, the returns on rigorously designed and well-implemented prevention may be significant in terms of money saved and lives enhanced.

Conclusion

The paper presented here offers a brief overview of the emerging field of working with adolescent perpetrators of domestic violence. The fact that there exists such a field, embryonic as it may be, is evidence of the increasing attention being paid to the devastating impact that intimate partner and family violence have on the lives of children and youth. While significant challenges remain, work being done to detect, deter and rehabilitate adolescent perpetrators represents an important step towards interrupting intergenerational cycles of violence and enhancing safety for victims.

Working with Men to Prevent Violence Against Women: An Overview (Part One)


Alan D. Berkowitz

With contributions from David Mathews 

There is a growing awareness that men, in partnership with women, can play a significant role in ending violence against women.   This has led to an increase in programs and activities that focus on men's roles in violence prevention.   Men should take responsibility for preventing violence against women because of the untold harm it causes to women in men's lives and the ways in which it directly hurts men.   Violence against women hurts men when it results in women being afraid of or suspicious of men due to fear of potential victimization and when it perpetuates negative stereotypes of men based on the actions of a few.   The behaviors and attitudes that cause violence against women may also be a cause of men being violent towards other men.   These same behaviors and attitudes may also keep men from having close and meaningful relationships with each other.   Finally, while only a minority of men are violent, all men can have an influence on the culture and environment that allows other men to be perpetrators.   For example, men can refuse to be bystanders to other men's violent behavior.

For all of these reasons men have a stake in ending violence against women.   To do this, men must accept and examine their own potential for violence and take a stand against the violence of other men.   In recent years, a number of authors have argued persuasively that men need to take responsibility for preventing men's violence against women, both in the United States (Berkowitz, 2002a; Funk, 1993; Katz, 1995; Kilmartin, 2001; Kivel, 1992), and internationally (Brienes, Connell, & Eide, 2000; Flood, 2001, 2003; INSTRAW, 2002; Kaufman, 2001).

This paper provides a brief overview of what is known about effective strategies for involving men in violence prevention efforts from the perspective of men who are recipients of anti-violence programs as well as from the men who provide them.   It defines the term "prevention" for men's violence against women, reviews best practices for involving men and for tailoring programs (for men in general and for particular groups of men) and, in Part Two, offers examples of prevention program formats and pedagogy.   These examples are provided to illustrate best practices rather than to describe specific programs, as this review is not intended to be exhaustive or comprehensive of all violence prevention efforts involving men.   Finally, in order to be useful to practitioners and educators the paper provides references to websites containing information about men's anti-violence organizations and programs.   While the conclusions and trends noted here are applicable to the prevention of all forms of men's violence against women, the preponderance of literature cited is from the rape prevention field where there has been more research conducted on this subject.

Defining Men's Roles in Prevention

Men can prevent violence against women by not personally engaging in violence, by intervening against the violence of other men, and by addressing the root causes of violence.   This broad definition provides roles for all men in preventing violence against women.   Men's involvement can take the form of primary or universal prevention (directed at all men, including those who do not appear to be at risk of committing violence and those who may be at risk for continuing a pattern of violence), through secondary or selective prevention (directed at men who are at-risk for committing violence), and/or through more intensive tertiary or indicated prevention (with men who have already been violent).  

For violence prevention these distinctions may be somewhat artificial because it can be argued that all men are at risk for perpetration by virtue of their socialization as men (Hong, 2000; Kaufman, 1985), because men can commit violence without defining it as such, and because men who have been violent can successfully participate in programs to prevent other men's violence.   "Prevention" is defined here as any program or activity that reduces or prevents future violence against women by men.   Programs for men who already have a documented history of violence against women, such as batterer's or perpetrator treatment programs, will not be discussed here.

Prevention programs can take the form of one session, a series of sessions or ongoing interactive educational workshops, leadership training, social marketing and social norms media campaigns (defined in Part Two of this paper), or through participation in one-time or ongoing public events.   These may focus directly on the issue of violence or on its specific forms (for example, sexual assault, domestic violence, dating violence and/or harassment, and stalking), or indirectly through men's involvement in consciousness raising, fatherhood and/or skill-building programs that foster attitudes and behaviors that may protect against violence, or by providing healthy resocialization experiences about what it means to be a healthy, nonviolent man.   In its broadest definition, violence prevention for men includes any activity that addresses the root causes of men's violence including social and structural causes as well as men's gender role socialization and men's sexism.

Among men's violence prevention programs those for school-aged boys have tended to focus on issues of sexual harassment and dating violence, those for college age men have tended to focus on sexual assault, and those for men not in college or older have tended to focus on domestic violence in longer-term partnerships.   In actuality it is important for all men to be involved in the prevention of all forms of violence against women, even when it may be developmentally or strategically appropriate to foster this involvement by focusing initially on one form of men's violence.

What Works in Men's Violence Prevention?

Due to evaluation literature that is limited in scope, it is difficult to assess the effectiveness of violence prevention programs for men.   For example, most prevention program assessments measure changes in attitudes that are associated with a proclivity to be violent rather than actual violent behavior.   Reviews of the literature suggest that sexual assault prevention programs for college men can be effective in improving attitudes that may put men at-risk for committing violence against women, although these attitudinal changes are often limited to periods of a few months (Brecklin & Forde, 2001; Breitenbecher, 2000; Lonsway, 1996; Schewe, 2002). In contrast, programs that focus only on providing information have not been found to be effective (Schewe, 2002). Among pre-college aged males, dating violence and harassment prevention programs offered to mixed gender groups in school settings can result in both attitude and behavior change for a few months or longer (Avery-Leaf & Cascardi, 2002).  

Despite the limited research, there is an emerging consensus regarding what constitutes effective violence prevention for men.   Violence prevention programs that have been found effective in evaluation studies tend to share one or more of the assumptions listed below.   Practitioners who work with men to prevent violence have also concluded that effective violence prevention programs for men share some or all of these assumptions:

•  Men must assume responsibility for preventing men's violence against women.

•  Men need to be approached as partners in solving the problem rather than as perpetrators.

•  Workshops and other activities are more effective when conducted by peers in small, all-male groups because of the immense influence that men have on each other and because of the safety all-male groups can provide.

•  Discussions should be interactive and encourage honest sharing of feelings, ideas, and beliefs.

•  Opportunities should be created to discuss and critique prevailing understandings of masculinity and men's discomfort with them, as well as men's misperceptions of other men's attitudes and behavior.

•  Positive anti-violence values and healthy aspects of men's experience should be strengthened, including teaching men to intervene in other men's behavior.

•  Work with men must be in collaboration with and accountable to women working as advocates, educators, and prevention specialists.

What is the Logic of these Assumptions?   First, research and experience have shown that putting men on the defensive or using blame is not effective and can even result in negative outcomes.   Thus, in Lonsway's review of the literature she stated:   "although educational programs challenging rape culture do require confrontation of established ideologies, such interventions do not necessitate a style of personal confrontation "   (Italics added, 1996, p. 250).   Thus, men should take responsibility for acting as perpetrators and bystanders of violence and the best way to accomplish this is to encourage men to be partners in solving the problem rather than by criticizing or blaming men (Berkowitz, 2002a; Men Can Stop Rape, 2000; Schewe, 2002).   Most men are not coercive or opportunistic, do not want to victimize others, and are willing to be part of the solution to ending sexual assault.   (In contrast, while men who are predatory or who have a history of perpetration may benefit from exposure to some education and prevention programs, more intensive treatment is likely required for these men to change previous patterns of perpetration).

The majority of men may already hold attitudes that can be strengthened to prevent and reduce violence and encourage men to intervene with other men.   For example, research has demonstrated that most men are uncomfortable with how they have been taught to be men, including how to be in relationship with women, homophobia, heterosexism, and emotional expression, and that they are uncomfortable with the sexism and inappropriate behavior of other men (Berkowitz, 2003; 2004).   Because many men already feel blamed and are on the defensive about the issue of men's violence (even when this defensiveness is misplaced), effective approaches create a learning environment that can surface the positive attitudes and behaviors that allow men to be part of the solution.   This can be accomplished in the context of a safe, nonjudgmental atmosphere for open discussion and dialogue in which men can discuss feelings about relationships, sexuality, aggression, etc. and share discomfort about the behavior of other men.

What Types of Discussions are Effective?   Literature reviews have suggested that the quality and interactive nature of the discussion may be more important than the format in which it is presented (Breitenbecher, 2000; Lonsway, 1996), a dimension that Davis (2000) has called "program process."   Because men are influenced by other men and by what men think is true about other men, this influence can be positively channeled in all-male groups.   Thus, effective violence prevention for men acknowledges the important influence that male peer groups have on men's actions (Schwartz & DeKeseredy, 1997), corrects misperceptions that men have about each other's attitudes and behavior (Berkowitz, 2002a), and channels this influence towards positive change.

The common element in successful prevention programs for men is the opportunity to participate in an experience where men are encouraged to honestly share real feelings and concerns about issues of masculinity and men's violence.   The opportunity for men to hear the attitudes and views of other men is powerful, especially because it empowers men who want to help and provides them with visible allies.   This strategy encourages the majority of men to take the necessary steps to avoid perpetrating and to confront the inappropriate behavior of male peers.  

Are All Male or Mixed Gender Programs More Effective?   Research suggests that these goals can be accomplished most effectively with male facilitators in all-male groups.   For example, Brecklin and Forde (2001) conducted a comprehensive meta-analysis of forty-three college rape prevention program evaluations and concluded that both men and women experienced more beneficial change in single-gender groups than in mixed-gender groups.   This was also the conclusion reached in five other literature reviews of rape prevention programs that all recommended that rape prevention programs be conducted in separate-gender groups when possible (Breitenbecher, 2000; Gidycz, Dowall & Marioni, 2002; Lonsway, 1996; Schewe, 2002; Yeater & Donohue, 1999).

While there are advantages to programs facilitated by men, skilled female facilitators can also work very effectively with men.   Women working with men need to be aware that men may view their leadership as reinforcing the assumption that violence prevention is a "women's issue" not relevant to men and must also find ways to prevent participants from attributing honest dialogue simply to the presence of a female.   It is also beneficial for men to see women and men co-facilitating in a respectful partnership.   Examples of programs for men that have been developed and led by women include those by Hong (2000) and Mahlstedt (1999).  

One of the main arguments for separate gender workshops is that the goals for violence prevention are different for men and women (Gidycz, Dowdall, & Marioni, 2002; Schewe, 2002).   Despite this being true in some settings, it may be necessary or more appropriate to offer violence prevention in mixed groups. Trainers must still take into account the gender differences that make such separation desirable, avoid the polarization that can occur in mixed-gender groups, avoid potential victim-blaming, not give information about victim-risk that could be useful to perpetrators, and avoid approaches that are blaming of men (Schewe, 2002).   While mixed gender workshops have been evaluated as successful with boys in school settings, these programs have not been compared with similar programs offered in all-male settings (see Avery-Leaf & Cascardi, 2002 for an excellent review of this literature

Partnerships with Women and Accountability to Women.   Attention to men's roles in preventing violence against women is only possible because of the decades of tireless work and sacrifice by female victim advocates, social activists, researchers, academicians, survivors, and leaders.   These courageous women have successfully challenged society to take notice of this problem and to begin to fund efforts to solve it.   Men's work to end violence against women must include recognition of this leadership and must never be in competition with or at the expense of women's efforts.   Thus, prevention programs for men should be developed to exist alongside of victim advocacy, legal and policy initiatives, academic research, rape crisis and domestic violence services, and educational programs for women.   Male anti-violence educators must recognize that we are accountable to the women who are the victims of the violence we hope to end, and must work to create effective collaborative partnerships and alliances that provide a role for women in men's programs (Flood, 2003).   To do this requires an understanding and exploration of men's privilege, sexism, and other biases, and an openness to learning from women and to working with them as allies.

Challenges to Men's Involvement.   Finally, it is important to acknowledge that there are many challenges and barriers for men who do this work.   Men who work to end violence against women are challenging the dominant culture and the understandings of masculinity that maintain it.   Thus, male activists are often met with suspicion, homophobia and other questions about their "masculinity." Men and women who feel threatened by this work often discredit male activists efforts and persons (Flood, 2003; Stillerman, 1998).   At the same time many men are grateful for the example set by male activists and for modeling a different way of being male.   Men who do this work are also frequently and unfairly given more credit for their efforts than women who do similar work (Flood, 2001).   Men engaged in violence prevention need to personally recognize these challenges and take responsibility to change these dynamics both personally and professionally.

Cultural Issues and Masculinities

While men in North America may share some common socialization experiences and definitions of what it means to be male, there are also important differences in terms of race, ethnicity, social class, sexual orientation, religion, and other identities that must be addressed in violence prevention efforts.   In addition, there are cultural differences regarding the appropriate context for prevention including how violence should be addressed.   Currently there is extensive literature documenting the need for culturally relevant and tailored programs in medical, psychological, and public health literatures, along with evidence for the ineffectiveness of approaches derived from dominant groups or paradigms.   Providing culturally competent programming should not be considered optional, but is a necessity for effectiveness.  

"Relevance" is a critical component of program success. It has been determined to be an important component of effective prevention programs and is discussed further in Part Two of this paper.   Because men from different identities have different experiences, relevant programming must address these differences, including experiences of racism among men of color, of homophobia for gay, bisexual and/or transgender men, the effects of economic inequalities for working class and poor men, and the cultural context for violence prevention within different communities.   As with every other issue, there is a danger of imposing definitions and understandings from more established violence prevention efforts (which, like the larger culture, is predominantly white and middle class) upon other cultures and communities.

An example of the importance of culturally relevant programs comes from research on the differential impact of programs on men from different racial backgrounds.   In one study, a generic race-neutral program was effective for European heritage men but not men of color, while a modified program with a co-presenter of color and relevant information (including statistics on violence in ethnic communities and dispelling of ethnically based rape myths) were effective for both groups (Heppner, Neville, Smith, Kivlighan, & Gershuny, 1999).   In other research conducted on perpetrators from different ethnic backgrounds, differences were found in personality characteristics and motivations for perpetration that may have important implications for designing culturally sensitive prevention programs for men (Hall, Sue, Narang, & Lilly, 2000; Kim & Zane, 2004).

Violence prevention efforts need to acknowledge these kinds of differences and also correct stereotypes and myths about the prevalence of violence among different groups of men.   Finally, men from different cultural groups have different experiences with the educational and criminal justice systems that may influence receptivity to violence prevention.   Violence prevention efforts that are community based, sensitive to ethnic and class issues, and accountable to the larger community have been developed in many communities and show promise. All of the above strongly suggest the critical importance of developing programs that are either tailored to the needs of a particular group, or conducted in a way that is inclusive and welcoming of all backgrounds.   A critical oversight is the lack of research examining the needs of gay, bisexual and transgendered men with respect to violence prevention programming.  

Summary

In recent years there has been expanded interest in developing programs and strategies that focus on men's responsibility for ending violence against women.   These programs create a safe environment for men to discuss and challenge each other with respect to information and attitudes about men's violence.   The literature suggests that these programs can produce short-term change in men's attitudes that are associated with a proclivity for violence, encourage men to intervene against the behavior of other men, and in some cases reduce men's future violence.   As these programs become more popular and as more men take leadership on this issue we are hopeful that the epidemic of men's violence against women will be significantly reduced and that all of our relationships will come closer to embodying ideals of respect, mutual empowerment, growth, and co-creation.

Working with Men to Prevent Violence Against Women: Program Modalities and Formats (Part Two)

In Part One of this paper an overview was provided of men's role in prevention along with effective strategies for ending men's violence against women, and the importance of creating culturally relevant programs that address all of men's identities was presented.   The discussion is continued in this document by providing an overview of best practices in prevention, the content and format of men's prevention programs, and an overview of different program philosophies or pedagogies.

It is a challenge to classify and summarize the many different types of violence prevention efforts that have been developed for men in recent years.   One-way to conceptually organize and describe them is in terms of:   1) program content; 2) program format (how the information is provided and delivered), and; 3) program philosophy or pedagogy.   In addition, extensive research within the prevention field regarding program effectiveness has identified best practices that can be applied to programs on all three of these dimensions.   These topics are reviewed below, beginning with best practices.

Best Practices in Prevention

The prevention literature suggests that effective prevention programs have a number of characteristics that are independent of particular issues or topical areas.   In particular, effective prevention programs are comprehensive, intensive, relevant to the audience, and deliver positive messages.   (For a more detailed discussion of these areas with respect to rape prevention see Berkowitz, 2001.)

Comprehensiveness.   Comprehensiveness addresses who participates in the intervention.   In a comprehensive program all relevant community members or systems are involved and have clearly defined roles and responsibilities.   Linking activities that are normally separate and disconnected can create positive synergy and result in activities that are more effective in combination than alone.   A comprehensive program views the target population as the whole community and emphasizes creating meaningful connections with colleagues.   This can foster awareness of what others are doing, develop a common prevention framework, and provide information and messages that are mutually reinforcing, integrated and synergistic. Within the domestic violence prevention movement, comprehensiveness has been encouraged through the development of coordinated community responses to men's violence and its prevention (Pence, 1999).  

Intensiveness.   Intensiveness is a function of what happens within a program activity.   Programs should offer learning opportunities that are interactive and sustained over time with active rather than passive participation.   In general, interactive interventions are more effective than those that require only passive participation (Lonsway, 1996; Schewe, 2002).   Interactive programs that are sustained over time and which have multiple points of contact with reinforcing messages are stronger than programs that occur at one point in time only.   As noted earlier, providing meaningful interactions between men that foster change is a critical element of successful violence prevention programs.

Relevance .   Relevant programs are tailored to the age, community, culture, and socioeconomic status of the recipients and take into consideration an individual's peer group experience.   Creating relevant programs requires acknowledging the special needs and concerns of different communities and affinity groups.   These programs are stronger when group-specific information is used in place of generic statistics (Schewe, 2002).   Relevance can be accomplished by designing programs for general audiences that are inclusive and acknowledge participant differences, or by designing special programs for particular audiences.   Relevant programs pay attention to the culture of the problem, the culture of the service or message delivery system, and the culture of the target population (Berkowitz, 2003).   Differences in these three cultures must be addressed in the design of programs.   Carillo and Tello (1998) provide an excellent example of the issues involved in designing culturally relevant programs for men of color from a variety of ethnic backgrounds.   Part One of this paper contains an extensive discussion of relevance from the perspective of developing culturally inclusive programs for men.

Positive messages should build on men's values and predisposition to act in a positive manner.   Men are more receptive to positive messages outlining what can be done than to negative messages that promote fear or blame.  

To design a program that incorporates these elements may seem like a daunting task.   It is important, therefore, to focus on quality and process rather than quantity.   A few interventions that are carefully linked, sequenced, and integrated with other activities will be more powerful than many program efforts that are discrete, isolated, and unrelated.

Program Content

As noted earlier, programs focusing on men's responsibility for preventing violence against women can address men's violence in general or focus on specific forms of violence, such as sexual assault and rape prevention, domestic violence prevention, dating violence prevention, stalking prevention, and sexual harassment prevention.   Other programs may address the issue of violence indirectly by teaching men relationship, parenting and fathering skills, how to manage aggression and anger, how men are socialized, and by providing positive re-socialization and bonding experiences for men.   There is some controversy in the field regarding whether these latter programs can be considered bona-fide violence prevention for men, with the answer depending on the content of the individual program and the degree to which links to men's violence are made explicit (for an excellent discussion of this issue go to www.endabuse.org/bpi/ in the Online Discussion Series).   Because they devote considerable attention to addressing socialization and cultural issues that underlie men's violence they certainly have a place in the larger task of redefining masculinity and male culture of which violence prevention is a part.   They may also be more appropriate with men who do not have a history of violence and when safety issues are not a concern.  

Program Format

Violence prevention programs that focus on changing individual men's behaviors can be offered as one-time only events, such as educational programs or workshops, or as multiple linked events over time.   These types of workshops have been traditional in the violence prevention field.   Recently, there have been attempts to also address the larger culture of violence and target the general population through the use of media in the form of social marketing campaigns that provide positive messages about men, social norms marketing campaigns that provide data about healthy anti-violence norms, and through activist events such as the White Ribbon Campaign and appropriate participation in Take Back the Night.   There is very little research on these larger efforts, although preliminary research suggests that social norms marketing campaigns can change relevant attitudes and in some cases behaviors (Berkowitz, 2003; Bruce, 2002; Hillenbrand-Gunn et. al, 2004; White, Williams & Cho, 2003).   It may be even more powerful to combine both types of interventions in a synergistic fashion so that men participating in individual workshops are also exposed to supportive media campaigns outside the workshop setting.

Program Philosophy

Violence prevention programs for men may differ in terms of their pedagogy, i.e., their philosophy regarding how to help men change.   Programs may focus on building empathy towards victims, the development of personal skills, learning to intervene in other men's behavior, re-socialization of male culture and behavior, or media efforts to change the larger environment.   While there has been debate about whether men's violence prevention efforts should be pro-feminist, it is this author's contention that violence prevention for men is pro-feminist by definition because it is about changing men in ways that support the feminist agenda of creating of a society in which women and men are treated equally and equitably (see Capraro, 1994 and Corcoran, 1992 for a discussion of the feminist underpinnings of men's anti-violence efforts).   These program philosophies are briefly summarized below.

Fostering empathy for victims .   It is undeniable that men need to understand and be empathic to the experiences of victims and that development of such empathy may discourage men from harming women.   Presenting stories of victims in person, by video, or through interactive theater, can help create such understanding and empathy.   For victim stories to have an impact it is important that men's defensiveness first be reduced.   Victim empathy programs are useful when men are not sufficiently aware of the problem of men's violence.   However, they fall short of asking men to make changes in our own and other men's behavior and run the risk of appealing to a male-helper mentality.   In addition, they are not appropriate for coercive and/or opportunistic men with impaired empathy.   The literature on empathy induction programs has been reviewed by Berkowitz (2002a), Lonsway (1996) and Schewe (2002).

Individual change .   Learning skills such as managing anger, understanding gender based privilege, relationship skills (including communication, partnership, and parenting skills), or how to ensure that intimate relationships are consenting can all help to reduce men's violence.   Research has established that deficiency in these skills is associated with violence and that teaching men these skills may decrease the likelihood of future violence when the acquisition and maintenance of these skills is encouraged in a supportive environment (Low, Monarch, Hartman, & Markman, 2002).   However, while focusing on personal skill development moves beyond empathy development by asking men to change behavior and take responsibility for actions and intentions in relation to others, it still does not address the larger cultural context that supports and maintains men's violent behaviors.  

Bystander interventions .   Programs attempting to reduce bystander behavior teach men how to intervene in the behavior of other men (see for example, Berkowitz, 2002; Katz, 1995).   Men who are likely to commit violence are men who over-identify with traditional masculine values and roles and who are especially sensitive to what other men think.   The focus of bystander intervention programs is to provide the majority of men who are uncomfortable with these men's behavior with the permission and skills to confront them.   Bystander interventions move beyond empathy and individual change to make men responsible for changing the larger environment of how men relate to each other and to women.   This can change the peer culture that fosters and tolerates men's violence.

Re-socialization experiences .   Socialization focused programs explore the cultural and societal expectations of men that influence how men are taught to think and act in relation to women.   A socialization-oriented discussion inevitably focuses on men's homophobia, heterosexism, and sexism.

Social marketing and social norms marketing .   In recent years there has been an effort to augment and reinforce small group interventions through the use of media campaigns that portray men in positive, non-violent roles or through social norms marketing campaigns that provide data about the true norms for men's behavior (see Bruce, 2002; Hillenbrand-Gunn et al, 2004; Men Can Stop Rape, 2000; White, Williams, & Cho, 2003).   The social norms approach relies on the assumption that men commonly misperceive the attitudes and behaviors of other men that are relevant to violence.   For example, men think that other men are more sexually active than themselves, are more comfortable behaving in stereotypically masculine ways, are less uncomfortable with objectification of women and violence, are more homophobic and heterosexist, and are more likely to endorse rape myths (Berkowitz, 2003, 2004).   Because of the powerful influence that men have on each other, correcting these misperceptions can free men to act in ways that are healthier and more aligned with personal values.   In one study, for example, it was found that the strongest influence on whether men were willing to intervene to prevent violence against women was the perception of other men's willingness to intervene (Fabiano, Perkins, Berkowitz, Linkenbach, & Stark, 2004).   Thus, correcting misperceptions among men about violence-related attitudes is an emerging and important prevention strategy that can be implemented in media campaigns or in small group interventions.  

All of these approaches are interdependent and overlap in practice.   Considering these four approaches is helpful in adapting a program to the needs and characteristics of a specific audience.   They can be thought of as occurring in a developmental sequence starting with creating an awareness of the problem of violence against women, to fostering personal change, and ending with a commitment to impact the behavior of other men, all within a context that is consistent with the goals and practices of feminist thinking.

Summary

Effective prevention programs for men must be developed that are consistent with the prevention literature - i.e., they must be comprehensive, intensive, and relevant.   These programs can focus on a variety of issues relevant to men's violence, including specific forms of violence and the larger cultural context that makes men's violence possible.   Such programs may attempt to foster empathy in men, change individual men's attitudes and behaviors, encourage men to intervene against other men's behavior, and provide men with positive re-socialization experiences.   Programs may also be developed utilizing social marketing and social norms marketing techniques to present images of men in new and different roles and by providing alternative perspectives on men's behavior. All of the programs share common assumptions and philosophies for working with men that were reviewed in Part One of this paper.


 

Update of the 'Battered Woman Syndrome' Critique

 

 

 

 

Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization

Problem/Condition: Sexual violence, stalking, and intimate partner violence are public health problems known to have a negative impact on millions of persons in the United States each year, not only by way of immediate harm but also through negative long-term health impacts. Before implementation of the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, the most recent detailed national data on the public health burden from these forms of violence were obtained from the National

Violence against Women Survey conducted during 1995–1996.


This report examines sexual violence, stalking, and intimate partner violence victimization using data from 2011. The report describes the overall prevalence of sexual violence, stalking, and intimate partner violence victimization; racial/ethnic variation in prevalence; how types of perpetrators vary by violence type; and the age at which victimization typically begins. For intimate partner violence, the report also examines a range of negative impacts experienced as a result of victimization, including the need for services.


Reporting Period: January–December, 2011.


Description of System: NISVS is a national random-digit–dial telephone survey of the noninstitutionalized English- and Spanish-speaking U.S. population aged ≥18 years. NISVS gathers data on experiences of sexual violence, stalking, and intimate partner violence among adult women and men in the United States by using a dual-frame sampling strategy that includes both landline and cellular telephones. The survey was conducted in 50 states and the District of Columbia; in 2011, the second year of NISVS data collection, 12,727 interviews were completed, and 1,428 interviews were partially completed.


Results: In the United States, an estimated 19.3% of women and 1.7% of men have been raped during their lifetimes; an estimated 1.6% of women reported that they were raped in the 12 months preceding the survey. The case count for men reporting rape in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. An estimated 43.9% of women and 23.4% of men experienced other forms of sexual violence during their lifetimes, including being made to penetrate, sexual coercion, unwanted sexual contact, and noncontact unwanted sexual experiences. The percentages of women and men who experienced these other forms of sexual violence victimization in the 12 months preceding the survey were an estimated 5.5% and 5.1%, respectively.


An estimated 15.2% of women and 5.7% of men have been a victim of stalking during their lifetimes. An estimated 4.2% of women and 2.1% of men were stalked in the 12 months preceding the survey.
With respect to sexual violence and stalking, female victims reported predominantly male perpetrators, whereas for male victims, the sex of the perpetrator varied by the specific form of violence examined. Male rape victims predominantly had male perpetrators, but other forms of sexual violence experienced by men were either perpetrated predominantly by women (i.e., being made to penetrate and sexual coercion) or split more evenly among male and female perpetrators (i.e., unwanted sexual contact and noncontact unwanted sexual experiences). In addition, male stalking victims also reported a more even mix of males and females who had perpetrated stalking against them.


The lifetime and 12-month prevalences of rape by an intimate partner for women were an estimated 8.8% and 0.8%, respectively; an estimated 0.5% of men experienced rape by an intimate partner during their lifetimes, although the case count for men reporting rape by an intimate partner in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. An estimated 15.8% of women and 9.5% of men experienced other forms of sexual violence by an intimate partner during their lifetimes, whereas an estimated 2.1% of both men and women experienced these forms of sexual violence by a partner in the 12 months before taking the survey. Severe physical violence by an intimate partner (including acts such as being hit with something hard, being kicked or beaten, or being burned on purpose) was experienced by an estimated 22.3% of women and 14.0% of men during their lifetimes and by an estimated 2.3% of women and 2.1% of men in the 12 months before taking the survey. Finally, the lifetime and 12-month prevalence of stalking by an intimate partner for women was an estimated 9.2% and 2.4%, respectively, while the lifetime and 12-month prevalence for men was an estimated 2.5% and 0.8%, respectively.


Many victims of sexual violence, stalking, and intimate partner violence were first victimized at a young age. Among female victims of completed rape, an estimated 78.7% were first raped before age 25 years (40.4% before age 18 years). Among male victims who were made to penetrate a perpetrator, an estimated 71.0% were victimized before age 25 years (21.3% before age 18 years). In addition, an estimated 53.8% of female stalking victims and 47.7% of male stalking victims were first stalked before age 25 years (16.3% of female victims and 20.5% of male victims before age 18 years). Finally, among victims of contact sexual violence, physical violence, or stalking by an intimate partner, an estimated 71.1% of women and 58.2% of men first experienced these or other forms of intimate partner violence before age 25 years (23.2% of female victims and 14.1% of male victims before age 18 years).


Interpretation: A substantial proportion of U.S. female and male adults have experienced some form of sexual violence, stalking, or intimate partner violence at least once during their lifetimes, and the sex of perpetrators varied by the specific form of violence examined. In addition, a substantial number of U.S. adults experienced sexual violence, stalking, or intimate partner violence during the 12 months preceding the 2011 survey. Consistent with previous studies, the overall pattern of results suggest that women, in particular, are heavily impacted over their lifetime. However, the results also indicate that many men experience sexual violence, stalking, and, in particular, physical violence by an intimate partner. Because of the broad range of short- and long-term consequences known to be associated with these forms of violence, the public health burden of sexual violence, stalking, and intimate partner violence is substantial. Results suggest that these forms of violence frequently are experienced at an early age because a majority of victims experienced their first victimization before age 25 years, with a substantial proportion experiencing victimization in childhood or adolescence.


Public Health Action: Because a substantial proportion of sexual violence, stalking, and intimate partner violence is experienced at a young age, primary prevention of these forms of violence must begin early. Prevention efforts should take into consideration that female sexual violence and stalking victimization is perpetrated predominately by men and that a substantial proportion of male sexual violence and stalking victimization (including rape, unwanted sexual contact, noncontact unwanted sexual experiences, and stalking) also is perpetrated by men. CDC seeks to prevent these forms of violence with strategies that address known risk factors for perpetration and by changing social norms and behaviors by using bystander and other prevention strategies. In addition, primary prevention of intimate partner violence is focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop these positive behaviors before their first relationships. The early promotion of healthy relationships while behaviors are still relatively modifiable makes it more likely that young persons can avoid violence in their relationships.


Introduction


Sexual violence, stalking, and intimate partner violence are important public health problems that affect the lives of millions of persons in the United States. These forms of violence can lead to serious short- and long-term consequences including physical injury, poor mental health, and chronic physical health problems (1,2). For some persons, violence victimization results in hospitalization, disability, or death. Furthermore, previous research indicates that victimization as a child or adolescent increases the likelihood that victimization will reoccur in adulthood (3,4).


Before implementation of the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, the most recent data on the national public health burden of sexual violence, stalking and intimate partner violence victimization came from the National Violence Against Women Survey, which was administered one time during 1995–1996 (3). This report examines these three forms of violence from the second year of NISVS data collection. The report describes overall prevalence of sexual violence, stalking, and intimate partner violence victimization by sex; racial/ethnic variation in prevalence; how the type of perpetrator varies by violence type; and the age at which victimization typically begins for each violence type. For intimate partner violence, this report also examines a range of negative impacts experienced as a result of victimization, including the need for various community and health services. The purpose of this report is to describe the most recent data on the public health burden of sexual violence, stalking, and intimate partner violence victimization and the characteristics of victimization. Researchers, advocates, and policymakers can use the findings in this report to inform efforts to prevent and address these forms of violence.


Methods


NISVS is an ongoing nationally representative random-digit–dial telephone survey of the noninstitutionalized English- and Spanish-speaking U.S. population aged ≥18 years. NISVS uses a dual-frame sampling strategy that includes both landline and cellular telephones and is conducted in 50 states and the District of Columbia.


In 2011, a total of 14,155 interviews were conducted (7,758 women and 6,397 men). A total of 12,727 interviews were completed, and 1,428 interviews were partially completed. A total of 6,879 women and 5,848 men completed the survey. The estimates presented in this report are based on completed interviews. An interview is defined as having been completed if the respondent completed the demographic and general health questions as well as all of the violence victimization questions. Approximately 40.0% of completed interviews were conducted by landline telephone, and 60.0% of completed interviews were conducted by using a respondent's cellular telephone.


The American Association for Public Opinion Research (AAPOR) response rate RR4 was computed by using weighted case counts (5). The overall weighted response rate for the 2011 NISVS survey was 33.1%. The weighted cooperation rate, which reflects the proportion of persons contacted who agreed to participate in the interview and who were determined to be eligible, was 83.5%.
The questionnaire included behaviorally specific questions that assessed being a victim of sexual violence, stalking, and intimate partner violence over the respondent's lifetime and during the 12 months before interview.


The specific types of sexual violence assessed included rape (completed or attempted forced penetration or alcohol- or drug-facilitated penetration) and sexual violence other than rape, including being made to penetrate a perpetrator, sexual coercion (nonphysically pressured unwanted penetration), unwanted sexual contact (e.g., kissing or fondling), and noncontact unwanted sexual experiences (e.g., being flashed or forced to view sexually explicit media).


Respondents were classified as stalking victims if 1) they experienced multiple stalking tactics or a single stalking tactic multiple times by the same perpetrator and 2) they felt very fearful or believed that they or someone close to them would be harmed or killed as a result of a perpetrator's stalking behaviors. Examples of stalking tactics measured by NISVS included receiving unwanted e-mail messages, instant messages, or messages through social media; being watched or followed; and having someone approach or show up in the victim's home, workplace, or school when unwanted.


This report examines the four subtypes of intimate partner violence that comprise CDC's definition of being a victim of intimate partner violence: sexual violence, physical violence, stalking, and psychological aggression (6). Intimate partner violence can be perpetrated by current or former spouses (including married spouses, common-law spouses, civil union spouses, and domestic partners),boyfriends/girlfriends, dating partners, and ongoing sexual partners. Questions concerning physical violence victimization included items regarding the experience of being slapped, pushed, or shoved, as well as items categorized as severe physical violence in the literature (7). These include being hurt by pulling hair, being hit with something hard, being kicked, being slammed against something, attempts to hurt by choking or suffocating, being beaten, being burned on purpose, and having a partner use a knife or gun against the victim. Psychological aggression includes expressive aggression (e.g., name calling, or insulting or humiliating an intimate partner) and coercive control, which includes behaviors that are intended to monitor, control, or threaten an intimate partner.


Intimate partner violence-related impact was measured by using a set of questions that assessed a range of direct impacts that might be experienced by victims of intimate partner violence. Intimate partner violence–related impacts include fear, concern for safety, having experienced at least one post-traumatic stress disorder (PTSD) symptom, injury, having contacted a crisis hotline, needing health care, needing housing services, needing victim's advocate services, needing legal services, and having missed at least 1 day of work or school. For those who reported being raped, it also includes contracting a sexually transmitted infection or, for women only, becoming pregnant. This information not only serves as an indicator of the range in severity of victimization experiences but also documents the need for particular preventive services and responses. Intimate partner violence–related impact was assessed in relation to specific perpetrators, without regard to when the impact occurred. It also was asked in relation to all forms of intimate partner violence experienced in that relationship. The prevalence of intimate partner violence–related impact was calculated among those who experienced contact sexual violence, physical violence, or stalking by an intimate partner. Contact sexual violence includes not only rape but also being made to penetrate a perpetrator, sexual coercion, and unwanted sexual contact.


Analyses were stratified by the respondent's sex. Prevalence by race and ethnicity also were estimated. No formal statistical comparisons of the prevalence estimates between demographic subgroups were made. Statistical inference for prevalence and population estimates were made on the basis of weighted analyses, in which complex sample design features (including stratified sampling, weighting for unequal sample selection probabilities, and nonresponse adjustments) were taken into account to produce nationally representative estimates. The estimated number of victims affected by a particular form of violence is based on U.S. population estimates from the census projections by state, sex, age, and race/ethnicity (8–10).


The relative standard error (RSE) is a measure of an estimate's reliability and was calculated for all estimates in this report. If the RSE was >30%, the estimate was deemed unreliable and is not reported. Consideration was also given to the case count. If the estimate was based on a numerator that was ≤20, the estimate also is not reported.

Several of the sexual violence and stalking questions were modified between the 2010 and 2011 survey. Specifically, questions from 2010 regarding rape and being made to penetrate a perpetrator that combined several behaviors were split into separate questions in 2011. Also, the wording of a question measuring public sexual harassment was changed from "harassed" to "verbally harassed." In addition, a question from 2010 asking about a perpetrator having fondled or grabbed the respondent's sexual body parts was modified to ask about a perpetrator having fondled, groped, grabbed, or touched the respondent in a way that made the respondent feel unsafe. One of the stalking items asked in 2010 was split into two items for 2011, and the order of the administration of stalking questions was changed between the 2010 and 2011 surveys so that questions about more severe stalking behaviors were asked first. This change in the ordering of items was made to set a better context for the stalking behaviors that might be perceived by respondents as less severe (e.g., unwanted calls and e-mail messages). These items were placed after the more severe stalking items to minimize reporting of these behaviors when they occurred outside of a stalking situation (e.g., harassment). Finally, intimate partner violence–related impact was calculated differently in 2011 than in 2010. In 2010, intimate partner violence–related impact was calculated among those who experienced rape, physical violence, or stalking whereas in 2011, intimate partner violence–related impact was calculated among those who experienced contact sexual violence, physical violence, or stalking. The NISVS survey protocol received approval from the Institutional Review Board of RTI International.


Results
Sexual Violence Victimization
Prevalence of Sexual Violence Victimization


In the United States, an estimated 19.3% of women (or >23 million women) have been raped during their lifetimes. Completed forced penetration was experienced by an estimated 11.5% of women. Nationally, an estimated 1.6% of women (or approximately 1.9 million women) were raped in the 12 months before taking the survey.


An estimated 1.7% of men (or almost 2.0 million men) were raped during their lifetimes; 0.7% of men experienced completed forced penetration. The case count for men reporting rape in the preceding 12 months was too small to produce a statistically reliable prevalence estimate.


An estimated 43.9% of women experienced sexual violence other than rape during their lifetimes, and an estimated 5.5% of women were victims of sexual violence other than rape in the 12 months preceding the survey. For men, an estimated 23.4% experienced sexual violence other than rape during their lifetimes, and 5.1% experienced sexual violence other than rape in the 12 months before completing the survey.
An estimated 0.6% of women (>700,000 women) were made to penetrate a perpetrator during their lifetimes. The case count for women reporting being made to penetrate a perpetrator in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. For men, the lifetime prevalence of being made to penetrate a perpetrator was an estimated 6.7% (>7.6 million men), while an estimated 1.7% of men were made to penetrate a perpetrator in the 12 months preceding the survey. An estimated 12.5% of women experienced sexual coercion during their lifetimes. Sexual coercion was experienced by an estimated 2.0% of women in the 12 months before taking the survey. An estimated 5.8% of men experienced sexual coercion during their lifetimes while an estimated 1.3% of men experienced sexual coercion in the 12 months before taking the survey.


Approximately one in four women (27.3%) is estimated to have experienced some form of unwanted sexual contact during their lifetimes. In the 12 months preceding the survey, an estimated 2.2% of women experienced unwanted sexual contact. An estimated 10.8% of men experienced unwanted sexual contact during their lifetimes, with an estimated 1.6% of men having experienced unwanted sexual contact in the 12 months before taking the survey.


Approximately one in three women (32.1%) is estimated to have experienced some type of noncontact unwanted sexual experience during their lifetimes, and an estimated 3.4% of women experienced this in the 12 months before taking the survey. An estimated 13.3% of men experienced noncontact unwanted sexual experiences during their lifetimes, and an estimated 2.5% of men experienced this type of victimization in the previous 12 months.


Prevalence of Sexual Violence Victimization by Race/Ethnicity
In the United States, an estimated 32.3% of multiracial women, 27.5% of American Indian/Alaska Native women, 21.2% of non-Hispanic black women, 20.5% of non-Hispanic white women, and 13.6% of Hispanic women were raped during their lifetimes. The case counts of other racial/ethnic categories of women were too small to report statistically reliable estimates. Lifetime estimates of rape for men by race/ethnicity were also not statistically reliable for reporting because of a small case count, with one exception: an estimated 1.6% of non-Hispanic white men were raped during their lifetimes.


An estimated 64.1% of multiracial women, 55.0% of American Indian/Alaska Native women, 46.9% of non-Hispanic white women, and 38.2% of non-Hispanic black women experienced sexual violence other than rape during their lifetimes. In addition, an estimated 35.6% of Hispanic women and 31.9% of Asian or Pacific Islander women experienced sexual violence other than rape during their lifetimes.
Among men, an estimated 39.5% of multiracial men experienced sexual violence other than rape during their lifetimes. In addition, 26.6% of Hispanic men, 24.5% of American Indian/Alaska Native men, 24.4% of non-Hispanic black men, and 22.2% of non-Hispanic white men experienced sexual violence other than rape during their lifetimes, and an estimated 15.8% of Asian or Pacific Islander men experienced this type of sexual violence during their lifetimes.


Characteristics of Sexual Violence Perpetrators


For female rape victims, an estimated 99.0% had only male perpetrators. In addition, an estimated 94.7% of female victims of sexual violence other than rape had only male perpetrators. For male victims, the sex of the perpetrator varied by the type of sexual violence experienced. The majority of male rape victims (an estimated 79.3%) had only male perpetrators. For three of the other forms of sexual violence, a majority of male victims had only female perpetrators: being made to penetrate (an estimated 82.6%), sexual coercion (an estimated 80.0%), and unwanted sexual contact (an estimated 54.7%). For noncontact unwanted sexual experiences, nearly half of male victims (an estimated 46.0%) had only male perpetrators and an estimated 43.6% had only female perpetrators.


The majority of victims of all types of sexual violence knew their perpetrators. Almost half of female victims of rape (an estimated 46.7%) had at least one perpetrator who was an acquaintance, and an estimated 45.4% of female rape victims had at least one perpetrator who was an intimate partner . More than half (an estimated 58.4%) of women who experienced alcohol/drug facilitated penetration were victimized by an acquaintance. An estimated 44.9% of male victims of rape were raped by an acquaintance, and an estimated 29.0% of male victims of rape were raped by an intimate partner. The estimates for male victims raped by other types of perpetrators are not reported because the case counts were too small to calculate a reliable estimate.


For sexual violence other than rape of both women and men, the type of perpetrator varied by the form of sexual violence experienced. The majority of female victims of sexual coercion (an estimated 74.1%) had an intimate partner as a perpetrator, and nearly half of female victims of unwanted sexual contact (an estimated 47.2%) had an acquaintance as a perpetrator. About half of the female victims of noncontact unwanted sexual experiences had a stranger as a perpetrator (an estimated 49.3%).


Among men who were made to penetrate a perpetrator, an estimated 54.5% were made to penetrate an intimate partner and an estimated 43.0% were made to penetrate an acquaintance. The majority of male victims of sexual coercion (an estimated 69.5%) had an intimate partner as a perpetrator. Among male victims of unwanted sexual contact, about half (an estimated 51.8%) had an acquaintance as a perpetrator. Finally, among male victims of noncontact unwanted sexual violence, an estimated 39.2% had an acquaintance as a perpetrator, followed by an intimate partner (an estimated 30.9%), or a stranger (an estimated 30.9%).


Stalking Victimization


Prevalence of Stalking Victimization


In the United States, an estimated 15.2% of women (18.3 million women) have experienced stalking during their lifetimes that made them feel very fearful or made them believe that they or someone close to them would be harmed or killed. In addition, an estimated 4.2% of women (approximately 5.1 million women) were stalked in the 12 months before taking the survey.


Nationally, an estimated 5.7% of men (or nearly 6.5 million) have experienced stalking victimization during their lifetimes, while an estimated 2.1% of men (or 2.4 million) were stalked in the 12 months before taking the survey.


Prevalence of Stalking Victimization by Race/Ethnicity


An estimated 24.5% of American Indian/Alaska Native women experienced stalking during their lifetimes, and an estimated 22.4% of multiracial women were stalked during their lifetimes. An estimated 15.9% of non-Hispanic white women experienced stalking during their lifetimes, and the prevalence of stalking for Hispanic and non-Hispanic black women was an estimated 14.2% and 13.9%, respectively. The estimate for Asian or Pacific Islander women was not reported because the case count was too small to produce a reliable estimate.


An estimated 9.3% of multiracial men experienced stalking during their lifetimes, as did an estimated 9.1% of non-Hispanic black men, 8.2% of Hispanic men, and 4.7% of non-Hispanic white men. The estimates for the other racial/ethnic groups of men are not reported because case counts were too small to produce a reliable estimate.


Frequency of Stalking Acts Among Stalking Victims


A variety of tactics were used to stalk victims during their lifetimes. An estimated 61.7% of female stalking victims were approached, such as at their home or work; over half (an estimated 55.3%) received unwanted messages, such as text and voice messages; an estimated 54.5% received unwanted telephone calls, including hang-ups. In addition, nearly half (an estimated 49.7%) of female stalking victims were watched, followed, or spied on with a listening device, camera, or global positioning system (GPS) device.


An estimated 58.2% of male stalking victims received unwanted telephone calls, and an estimated 56.7% received unwanted messages. An estimated 47.7% of male stalking victims were approached by their perpetrator, and an estimated 32.2% were watched, followed, or spied on with a listening or other device.


Characteristics of Stalking Perpetrators


Among persons who were victims of stalking during their lifetimes, the sex of the perpetrator varied somewhat by the sex of the victim. Among female stalking victims, an estimated 88.3% were stalked by only male perpetrators; an estimated 7.1% had only female perpetrators. Among male stalking victims, almost half (an estimated 48.0%) were stalked by only male perpetrators while a similar proportion (an estimated 44.6%) were stalked by only female perpetrators.


Both female and male victims often identified their stalkers as persons whom they knew or with whom they had an intimate relationship. Among female stalking victims, an estimated 60.8% were stalked by a current or former intimate partner, nearly one-quarter (an estimated 24.9%) were stalked by an acquaintance, an estimated 16.2% were stalked by a stranger, and an estimated 6.2% were stalked by a family member . Among male stalking victims, an estimated 43.5% were stalked by an intimate partner, an estimated 31.9% by an acquaintance, an estimated 20.0% by a stranger, and an estimated 9.9% by a family member.


Intimate Partner Violence Victimization


Prevalence of Intimate Partner Violence Victimization


The lifetime and 12-month prevalence of rape by an intimate partner for women was an estimated 8.8% and 0.8%, respectively. Nationally, an estimated 15.8% of women experienced other forms of sexual violence by an intimate partner during their lifetimes, while an estimated 2.1% of women experienced other forms of sexual violence by a partner in the 12 months before taking the survey. The lifetime prevalence of physical violence by an intimate partner was an estimated 31.5% among women and in the 12 months before taking the survey, an estimated 4.0% of women experienced some form of physical violence by an intimate partner. An estimated 22.3% of women experienced at least one act of severe physical violence by an intimate partner during their lifetimes. With respect to individual severe physical violence behaviors, being slammed against something was experienced by an estimated 15.4% of women, and being hit with a fist or something hard was experienced by 13.2% of women. In the 12 months before taking the survey, an estimated 2.3% of women experienced at least one form of severe physical violence by an intimate partner. The lifetime and 12-month prevalence of stalking by an intimate partner for women was an estimated 9.2% and 2.4%, respectively. Finally, an estimated 47.1% of women experienced at least one act of psychological aggression by an intimate partner during their lifetimes; an estimated 14.2% of women experienced some form of psychological aggression in the 12 months preceding the survey.


Nationally, an estimated 0.5% of men experienced rape by an intimate partner during their lifetimes. However, the case count for men reporting rape by an intimate partner in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. An estimated 9.5% of men experienced other forms of sexual violence by an intimate partner during their lifetimes, while an estimated 2.1% of men experienced other forms of sexual violence by an intimate partner in the 12 months before taking the survey. The lifetime prevalence of physical violence by an intimate partner was an estimated 27.5% for men, and in the 12 months before taking the survey, an estimated 4.8% of men experienced some form of physical violence by an intimate partner. An estimated 14.0% of men experienced at least one act of severe physical violence by an intimate partner during their lifetimes. With respect to individual severe physical violence behaviors, being hit with a fist or something hard was experienced by an estimated 10.1% of men, and 4.6% of men have been kicked by an intimate partner. In the 12 months before taking the survey, an estimated 2.1% of men experienced at least one form of severe physical violence by an intimate partner. The lifetime and 12-month prevalence of stalking by an intimate partner for men was an estimated 2.5% and 0.8%, respectively. Finally, an estimated 46.5% of men experienced at least one act of psychological aggression by an intimate partner during their lifetimes; an estimated 18.0% of men experienced some form of psychological aggression in the 12 months preceding the survey.


Prevalence of Intimate Partner Violence Victimization by Race/Ethnicity


Nationally, an estimated 11.4% of multiracial women, 9.6% of non-Hispanic white women, 8.8% of non-Hispanic black women, and 6.2% of Hispanic women were raped by an intimate partner during their lifetimes. The case counts for men reporting rape by an intimate partner during their lifetimes were too small to produce statistically reliable prevalence estimates by race/ethnicity.


An estimated 26.8% of multiracial women, 17.4% of non-Hispanic black women, 17.1% of non-Hispanic white women, and 9.9% of Hispanic women experienced sexual violence other than rape by an intimate partner during their lifetimes. The case counts of other female racial/ethnic groups (Asian or Pacific Islander and American Indian/Alaska Native) were too small to report statistically reliable estimates. In addition, an estimated 18.2% of multiracial men, 14.8% of non-Hispanic black men, 13.5% of Hispanic men, and 7.6% of non-Hispanic white men experienced sexual violence other than rape by an intimate partner at some point during their lifetimes. The case counts of other male racial/ethnic groups (Asian or Pacific Islander and American Indian/Alaska Native) were too small to report statistically reliable estimates.


An estimated 51.7% of American Indian/Alaska Native women, 51.3% of multiracial women, 41.2% of non-Hispanic black women, 30.5% of non-Hispanic white women, 29.7% of Hispanic women, and 15.3% of Asian or Pacific Islander women experienced physical violence by an intimate partner during their lifetimes. An estimated 43.0% of American Indian/Alaska Native men, 39.3% of multiracial men, 36.3% of non-Hispanic black men, 27.1% of Hispanic men, 26.6% of non-Hispanic white men, and 11.5% of Asian or Pacific Islander men experienced physical violence by an intimate partner during their lifetime.


An estimated 13.3% of multiracial women, 9.9% of non-Hispanic white women, 9.5% of non-Hispanic black women, and 6.8% of Hispanic women were stalked by an intimate partner during their lifetimes. The case counts of other female racial/ethnic groups (Asian or Pacific Islander and American Indian/Alaska Native) were too small to report statistically reliable estimates.


In addition, an estimated 1.7% of non-Hispanic white men were stalked by an intimate partner during their lifetimes. The case counts of all other male racial/ethnic groups were too small to report statistically reliable estimates.


Prevalence of Intimate Partner Violence–Related Impact


An estimated 27.3% of women have experienced contact sexual violence (rape, being made to penetrate, sexual coercion, or unwanted sexual contact), physical violence, or stalking by an intimate partner during their lifetimes and have experienced at least one measured negative impact related to these or other forms of violence (noncontact unwanted sexual experiences, psychological aggression, or control of reproductive or sexual health) experienced in that relationship . More specifically, an estimated 23.7% of women were fearful, 20.7% were concerned for their safety, 20.0% experienced one or more PTSD symptoms, 13.4% were physically injured, 6.9% needed medical care, 3.6% needed housing services, 3.3% needed victim advocate services, 8.8% needed legal services, 2.8% contacted a crisis hotline, 9.1% missed at least 1 day of work or school, 1.3% contracted a sexually transmitted infection, and 1.7% became pregnant as a result of the violence experienced by an intimate partner.


Nationally, an estimated 11.5% of men have experienced contact sexual violence, physical violence, or stalking by an intimate partner during their lifetimes and have experienced at least one measured negative impact related to these or other forms of violence experienced in that relationship. More specifically, an estimated 6.9% of men were fearful, 5.2% were concerned for their safety, 5.2% experienced one or more PTSD symptoms, 3.5% were physically injured, 1.6% needed medical care, 1.0% needed housing services, 4.0% needed legal services, and 4.8% missed at least 1 day of work or school. The case counts for men needing victim advocacy services, having contacted a crisis hotline, or contracting a sexually transmitted infection as a result of these types of violence were too small to produce statistically reliable estimates.


Age of First Victimization
Completed Rape


Among female victims of completed rape (completed forced penetration and completed alcohol- or drug-facilitated penetration), this form of sexual violence was first experienced by an estimated 78.7% before age 25 years, by an estimated 40.4% before age 18 years (28.3% at ages 11–17 years and 12.1% at age ≤10 years), and by an estimated 38.3% at age 18–24 years . In addition, among female victims of completed rape, an estimated 15.2% first experienced this at age 25–34 years, an estimated 4.6% at age 35–44 years, and an estimated 1.5% at age ≥45 years. The case counts for men reporting lifetime completed rape were too small to produce statistically reliable estimates for all age categories.

Being Made to Penetrate a Perpetrator


Among males who were made to penetrate a perpetrator, this was experienced first by an estimated 71.0% before age 25 years, with an estimated 21.3% having first experienced this before age 18 years (18.6% at age 11–17 years) and an estimated 49.7% at age 18–24 years. In addition, among male victims who were made to penetrate a perpetrator, this was experienced first by an estimated 15.3% at age 25–34 years and by an estimated 7.9% at age 35–44 years. The case count for men reporting first being made to penetrate a perpetrator at age ≥45 years was too small to produce a statistically reliable estimate. In addition, the case counts for women reporting being made to penetrate a perpetrator during their lifetimes were too small to produce statistically reliable estimates for all age categories.


Stalking


Among female victims of stalking, an estimated 53.8% were first stalked before age 25 years, with an estimated 16.3% first experiencing this before age 18 years (13.5% at ages 11–17 years) and an estimated 37.5% at ages 18–24 years . In addition, among female victims of stalking, this was experienced first by an estimated 28.8% at ages 25–34 years, by an estimated 11.5% at ages 35–44 years, and by an estimated 5.9% at age ≥45 years.


Among male victims of stalking, an estimated 47.7% were first stalked before age 25 years, with an estimated 20.5% having first experienced stalking before age 18 years (16.2% at ages 11–17 years) and an estimated 27.2% having first experienced this at age 18–24 years . In addition, among male victims of stalking, this was experienced first by an estimated 21.3% at age 25–34 years, by an estimated 17.9% at age 35–44 years, and by an estimated 13.1% at age ≥45 years.


Intimate Partner Violence


Among female victims of contact sexual violence, physical violence, or stalking by an intimate partner, an estimated 71.1% first experienced these or other forms of intimate partner violence before age 25 years, with an estimated 23.2% having first experienced this before age 18 years (23.1% at age 11–17 years) and an estimated 47.9% at age 18–24 years . In addition, among female victims of contact sexual violence, physical violence, or stalking by an intimate partner, these or other forms of intimate partner violence were experienced first by an estimated 20.7% at age 25–34 years, by an estimated 5.9% at age 35–44 years, and by an estimated 2.3% at age ≥45 years.


Among male victims of contact sexual violence, physical violence, or stalking by an intimate partner, an estimated 58.2% first experienced these or other forms of intimate partner violence before age 25 years, with an estimated 14.1% having first experienced this before age 18 years (14.0% at age 11–17 years) and an estimated 44.1% at age 18–24 years . In addition, among male victims of contact sexual violence, physical violence, or stalking by an intimate partner, these or other forms of intimate partner violence were first experienced by an estimated 26.7% at age 25–34 years, by an estimated 10.4% at age 35–44 years, and by an estimated 4.7% at age ≥45 years.


Discussion


The results presented in this report indicate that a significant number and proportion of female and male U.S. adults have experienced sexual violence, stalking, or intimate partner violence during their lifetimes or in the 12 months preceding the 2011 survey. Because of the broad range of short- and long-term consequences associated with these forms of violence, the public health burden of sexual violence, stalking, and intimate partner violence is substantial.


The results provided in this report indicate that the burden of sexual violence, stalking, and intimate partner violence is not distributed evenly in the U.S. population. Consistent with previous studies, the results suggest that women, in particular, are impacted heavily during their lifetimes (11,12). However, the results indicate that many men also experience sexual violence, stalking and, in particular, physical violence by an intimate partner. Although there are relatively smaller differences in the overall prevalence of physical violence by an intimate partner when comparing women and men, there is greater differentiation between women and men in terms of the prevalence of negative intimate partner violence–related impact. This suggests the need to look beyond the overall prevalence estimates when comparing the total burden of men's and women's intimate partner violence victimization. Previous research indicates that characteristics (e.g., frequency, severity, and impact) of men's and women's intimate partner violence victimization differ in ways that might not be reflected in overall prevalence estimates (12). However, any focus on differences between men and women should not obscure the fact that nearly 16 million men have experienced some form of severe physical violence by an intimate partner during their lifetimes and >13 million men have experienced intimate partner violence during their lifetimes that resulted in a negative impact.


The results also suggest that certain racial/ethnic groups experience a comparatively higher burden. Although statistical testing was not undertaken, an examination of the pattern of lifetime prevalence estimates suggests that multiracial and American Indian/Alaska Native women experience elevated levels for most of the types of violence examined in this report. These findings are consistent with previous reports indicating that multiracial and American Indian/Alaska Native women are at greater risk for rape, stalking, and intimate partner violence (3,13). These findings underscore the importance of prevention efforts and services that address the needs of multiracial and American Indian/Alaska Native women. Although previous research has suggested explanations for elevated rates of violence among American Indian/Alaska Native women (e.g., elevated poverty, social and geographic isolation, and a higher likelihood of alcohol use by the perpetrator) (14), little is known about why multiracial women are at greater risk for these forms of violence. Research is needed to identify risk and protective factors for violence victimization among multiracial persons.


By definition, all victims of intimate partner violence knew their perpetrator; however, the majority of sexual violence and stalking victims also knew their perpetrators. Despite frequent depictions in the media of sexual violence and stalking perpetrated by strangers (15,16), strangers were reported as the perpetrator by less than one fourth of stalking victims and by less than one fourth of victims of each form of sexual violence except noncontact unwanted sexual experiences. For stalking and for all forms of sexual violence except noncontact unwanted sexual experiences, two frequently reported perpetrators were intimate partners and acquaintances. This pattern suggests that prevention efforts for sexual violence and stalking need to focus on preventing violent interactions between persons who are intimate or are known to each other in another capacity.


Female victims of sexual violence and stalking reported predominantly male perpetrators, whereas for male victims, the sex of the perpetrator varied by the specific form of violence examined. Male rape victims predominantly had male perpetrators, but other forms of sexual violence experienced by men either were perpetrated predominantly by women (i.e., being made to penetrate a perpetrator or sexual coercion) or were split more evenly among male and female perpetrators (i.e., unwanted sexual contact and noncontact unwanted sexual experiences). In addition, male stalking victims also had a more even mix of males and females who had perpetrated stalking against them. Prevention efforts should take into consideration that female sexual violence and stalking victimization is predominately perpetrated by men and that a substantial proportion of male sexual violence and stalking victimization (rape, unwanted sexual contact, noncontact unwanted sexual experiences, and stalking) also is perpetrated by men.


For each of the violence types assessed, ≥53.8% of all female victims and ≥47.7% of all male victims experienced their first victimizations before age 25 years, with many first experiencing victimization in childhood and adolescence. These findings suggest that primary prevention of sexual violence, stalking, and intimate partner violence should take place at an early age. CDC's approach to the primary prevention of violence is in keeping with this finding. Specifically, CDC supports the development of safe, stable, and nurturing relationships and environments for children as a precursor to healthy parent-child relationships; healthy peer relationships among adolescents; healthy dating relationships among adolescents before their first experience with dating and the engagement of bystanders to intervene before violence occurs. CDC also supports the development, evaluation, and widespread adoption of empirically supported teen dating violence prevention programs. For example, the school-based Safe Dates program, which focuses on enhancing conflict management skills and changing norms about dating violence, has been shown to prevent perpetration of physical and sexual violence as well as psychological aggression in teen dating relationships (17). When parental, peer, and dating relationships are influenced early in life, healthy relationship behaviors and patterns and healthy social environments can be promoted while these behaviors are relatively modifiable. In so doing, adolescents can be equipped with healthier behaviors to use in place of violence within adult relationships.

In addition to primary prevention efforts, secondary prevention is also important. The results suggest that a substantial number of women and men also have experienced a range of negative impacts as a result of the intimate partner violence they have experienced. Most notably, nearly 13.4% of women and 3.5% of men have been injured physically, and 9.1% of women and 4.8% of men have missed at least 1 day of work or school because of experiencing intimate partner violence. Previous research has established that in addition to these near-term impacts, those who experience intimate partner violence are at greater risk for a range of long-term health consequences (1,2). For the negative effects of intimate partner violence, sexual violence, and stalking to be mitigated, it is important to ensure that relevant services are available to victims. The findings in this report suggest that many adults are in need of these types of services as a result of intimate partner violence victimization. During their lifetimes 6.9% of women and 1.6% of men needed medical services, 8.8% of women and 4.0% of men needed legal services, and 3.6% of women and 1.0% of men needed housing services (e.g., shelters). Analyses of 2010 NISVS data suggest that nearly half of female victims and approximately two thirds of male victims who indicated a need for services did not receive any of the services needed as a result of intimate partner violence experienced during their lifetimes (12). Research is needed to examine the degree to which needed services are not being received and to determine whether any existing gap is attributable to services being unavailable, inaccessible, or inadequate, or to victims choosing not to use available services.


Limitations


The findings of this report are subject to at least five limitations. First, the overall response rate for the 2011 NISVS survey was relatively low (33.1%). However, the cooperation rate was high (83.5%), and multiple efforts were made to reduce the likelihood of nonresponse and noncoverage bias. These included a nonresponse follow-up in which randomly selected nonresponders were contacted again and offered an increased incentive for participation as well as the inclusion of a cellular telephone sample. Second, although NISVS captures a broad range of self-reported victimization experiences, it is likely that the estimates presented underestimate the prevalence of sexual violence, stalking, and intimate partner violence (18). Victims who are involved in violent relationships or who have recently experienced severe forms of violence might be less likely to participate in surveys or might not be willing to disclose their experiences because of unresolved emotional trauma or concern for their safety, among other reasons. Third, a telephone survey might be less likely to capture some populations that could be at higher risk for victimization (e.g., persons living in nursing homes, military bases, prisons, or shelters, or those who are homeless). Fourth, self-reported data are vulnerable to recall bias because respondents might believe that events occurred closer in time than they did in actuality (i.e., telescoping), and this type of bias might particularly affect 12-month prevalence estimates. Finally, follow-up questions were designed to reflect the victim's experience with each perpetrator across the victim's lifetime and there were limitations associated with how these questions were asked. Respondents were asked about the impact from any of the violence inflicted by each perpetrator. Therefore, the impact of specific intimate partner violence behaviors cannot be assessed. Also, because victims' reports of the age and relationship at the time any violence began with each perpetrator were used, it was not always possible to assess the age or relationship at the time specific types of intimate partner violence occurred.


Conclusion


Although progress has been made in efforts to prevent sexual violence, stalking, and intimate partner violence, these forms of violence continue to exact a substantial toll upon U.S. adults. Further, it is clear that many of these forms of violence are first experienced by many in adolescence and young adulthood. This suggests the critical need for primary prevention to focus on promoting healthy relational behaviors and patterns that can be carried forward into adulthood. Continued surveillance of sexual violence, stalking, and intimate partner violence is needed to understand these public health problems better and to serve as a measuring stick by which the success of prevention efforts can be gauged.

 


TABLE 1. Lifetime and 12-month prevalence of sexual violence victimization, by sex of victim — National Intimate Partner and Sexual Violence Survey, United States, 2011

 Prevalence

Women

Men

%*

(95% CI)

Estimated no. of victims†

%*

(95% CI)

Estimated no. of victims†

Lifetime

Rape

19.3

(17.9–20.8)

23,305,000

1.7

(1.3–2.2)

1,971,000

Completed forced penetration

11.5

(10.3–12.7)

13,826,000

0.7

(0.5–1.1)

834,000

Attempted forced penetration

6.4

(5.6–7.4)

7,732,000

—§

Completed alcohol- or drug-facilitated penetration

9.3

(8.3–10.5)

11,276,000

1.1

(0.8–1.6)

1,308,000

Other sexual violence

43.9

(42.1–45.6)

52,958,000

23.4

(21.8–25.0)

26,590,000

Made to penetrate

0.6

(0.4–0.8)

703,000

6.7

(5.7–7.8)

7,610,000

Sexual coercion

12.5

(11.3–13.7)

15,045,000

5.8

(4.9–6.7)

6,558,000

Unwanted sexual contact

27.3

(25.8–28.9)

33,016,000

10.8

(9.6–12.0)

12,238,000

Noncontact unwanted sexual experiences

32.1

(30.5–33.8)

38,813,000

13.3

(12.1–14.7)

15,150,000

12-month

Rape

1.6

(1.1–2.2)

1,929,000

Completed forced penetration

Attempted forced penetration

Completed alcohol- or drug-facilitated penetration

1.0

(0.7–1.5)

1,213,000

Other sexual violence

5.5

(4.7–6.5)

6,687,000

5.1

(4.3–6.0)

5,797,000

Made to penetrate

1.7

(1.3–2.3)

1,921,000

Sexual coercion

2.0

(1.5–2.6)

2,389,000

1.3

(1.0–1.8)

1,495,000

Unwanted sexual contact

2.2

(1.7–2.9)

2,687,000

1.6

(1.2–2.1)

1,777,000

Noncontact unwanted sexual experiences

3.4

(2.7–4.1)

4,046,000

2.5

(2.0–3.1)

2,829,000

Abbreviation: CI = confidence interval.
* Percentages are weighted.
† Rounded to the nearest thousand.
§ Estimate is not reported; relative standard error >30% or cell size ≤20.

TABLE 2. Lifetime prevalence of sexual violence victimization, by sex and race/ethnicity* of victim — National Intimate Partner and Sexual Violence Survey, United States, 2011

Women

Men

%†

(95% CI)

Estimated no. of victims§

%†

(95% CI)

Estimated no. of victims§

White, non-Hispanic

Rape

20.5

(18.8– 22.3)

16,475,000

1.6

(1.2–2.2)

1,232,000

Other sexual violence¶

46.9

(44.9–48.9)

37,661,000

22.2

(20.5–24.1)

16,846,000

Black, non-Hispanic

Rape

21.2

(17.2–25.9)

3,084,000

—**

Other sexual violence¶

38.2

(33.3–43.3)

5,555,000

24.4

(19.4–30.2)

3,094,000

Hispanic

Rape

13.6

(10.1–18.1)

2,204,000

Other sexual violence¶

35.6

(30.3–41.3)

5,771,000

26.6

(21.6–32.3)

4,348,000

American Indian/Alaska Native

Rape

27.5

(16.1–42.7)

Other sexual violence¶

55.0

(41.5–67.9)

452,000

24.5

(13.5–40.3)

Asian or Pacific Islander

Rape

Other sexual violence¶

31.9

(22.6–43.0)

1,924,000

15.8

(10.0–24.3)

842,000

Multiracial

 

Rape

32.3

(22.9– 43.3)

663,000

Other sexual violence¶

64.1

(52.5–74.2)

1,316,000

39.5

(30.2–49.5)

817,000

Abbreviation: CI = confidence interval.
* Race/ethnicity was self-identified. The American Indian or Alaska Native designation does not indicate being enrolled or affiliated with a tribe. Persons of Hispanic ethnicity can be of any race or combination of races.
† Percentages are weighted.
§ Rounded to the nearest thousand.
¶ Includes being made to penetrate a perpetrator, sexual coercion, unwanted sexual contact, and noncontact unwanted sexual experiences.
** Estimate is not reported; relative standard error >30% or cell size ≤20.

Abbreviation: CI = confidence interval.
* Relationship is based on victims' reports of their relationship at the time the perpetrator first committed any violence against them. Because of the possibility of multiple perpetrators, combined row percentages might exceed 100%.
† Includes immediate and extended family members.
§ Includes, for example, boss, supervisor, superior in command, teacher, professor, coach, clergy, doctor, therapist, and caregiver.
¶ Includes friends, neighbors, family friends, first date, someone briefly known, and persons not known well.
** Percentages are weighted.
†† Rounded to the nearest thousand.
§§ Estimate is not reported; relative standard error >30% or cell size ≤20.

TABLE 3. Prevalence of stalking victimization, by sex and race/ethnicity* of victim — National Intimate Partner and Sexual Violence Survey, United States, 2011

Women

Men

%†

(95% CI)

Estimated no. of victims§

%†

(95% CI)

Estimated no. of victims§

All races/ethnicities (lifetime)

15.2

(13.9–16.6)

18,330,000

5.7

(4.7–6.8)

6,487,000

White, non-Hispanic

15.9

(14.4–17.5)

12,749,000

4.7

(3.9–5.8)

3,581,000

Black, non-Hispanic

13.9

(10.7–17.9)

2,020,000

9.1

(5.3–15.4)

1,159,000

Hispanic

14.2

(10.6–18.7)

2,295,000

8.2

(4.9–13.3)

1,342,000

American Indian/Alaska Native

24.5

(14.2–38.8)

—¶

Asian or Pacific Islander

Multiracial

22.4

(15.0–32.1)

461,000

9.3

(5.3–15.7)

192,000

All races/ethnicities (12-month)

4.2

(3.5–5.1)

5,094,000

2.1

(1.6–2.8)

2,435,000

Abbreviation: CI = confidence interval.
* Race/ethnicity was self-identified. The American Indian/Alaska Native designation does not indicate being enrolled or affiliated with a tribe. Persons of Hispanic ethnicity can be of any race or combination of races.
† Percentages are weighted.
§ Rounded to the nearest thousand.
¶ Estimate is not reported; relative standard error >30% or cell size ≤20.


* Relationship is based on victims' reports of their relationship at the time the perpetrator first committed any violence against them. Due to the possibility of multiple perpetrators, the combined percentages exceed 100%.
† Includes friends, neighbors, family friends, first date, someone briefly known, and persons not known well.
§ Includes immediate and extended family members.
Alternate Text: The figure shows lifetime reports of stalking among female and male victims by type of perpetrator, using data from the National Intimate Partner and Sexual Violence Survey conducted in the United States in 2011. Four types of perpetrators are shown in order of prevalence: intimate partner, acquaintance (which includes friends, neighbors, family friends, first date, someone briefly known, and persons not known well), stranger, and family member (which includes immediate and extended family members).

Women

Men

Lifetime

12-month

Lifetime

12-month

%*

(95% CI)

Estimated no. of victims†

%*

(95% CI)

Estimated no. of victims†

%*

(95% CI)

Estimated no. of victims†

%*

(95% CI)

Estimated no. of victims†

8.8

(7.8–9.8)

10,574,000

0.8

(0.5–1.2)

922,000

0.5

(0.3–0.8)

572,000

—§

5.6

(4.8–6.5)

6,770,000

2.8

(2.2–3.5)

3,368,000

3.8

(3.1–4.5)

4,558,000

0.5

(0.3–0.8)

618,000

15.8

(14.6–17.1)

19,082,000

2.1

(1.6–2.6)

2,476,000

9.5

(8.4–10.8)

10,828,000

2.1

(1.7–2.7)

2,442,000

0.3

(0.2–0.5)

374,000

3.6

(2.9–4.5)

4,151,000

0.8

(0.6–1.2)

962,000

9.2

(8.3–10.3)

11,156,000

1.5

(1.1–1.9)

1,752,000

4.0

(3.3–4.8)

4,554,000

0.9

(0.7–1.3)

1,044,000

6.4

(5.6–7.3)

7,711,000

0.6

(0.4–1.0)

776,000

2.4

(1.9–3.1)

2,771,000

8.5

(7.6–9.6)

10,311,000

0.9

(0.6–1.2)

1,043,000

4.1

(3.4–5.0)

4,686,000

0.8

(0.5–1.3)

929,000

31.5

(29.9–33.2)

38,028,000

4.0

(3.2–4.8)

4,774,000

27.5

(25.8–29.3)

31,331,000

4.8

(4.0–5.8)

5,452,000

29.7

(28.1–31.4)

35,872,000

3.7

(3.0–4.5)

4,447,000

25.5

(23.8–27.2)

28,992,000

4.4

(3.6–5.3)

4,983,000

18.9

(17.6–20.4)

22,864,000

1.7

(1.2–2.3)

2,056,000

19.5

(18.0–21.1)

22,216,000

2.7

(2.1–3.5)

3,072,000

27.3

(25.7–28.9)

32,955,000

3.1

(2.5–3.9)

3,736,000

18.3

(16.9–19.9)

20,849,000

3.2

(2.6–4.0)

3,641,000

22.3

(20.8–23.9)

26,928,000

2.3

(1.8–2.9)

2,752,000

14.0

(12.7–15.5)

15,985,000

2.1

(1.6–2.7)

2,374,000

9.4

(8.4–10.6)

11,397,000

0.9

(0.6–1.3)

1,088,000

2.6

(2.1–3.3)

3,014,000

13.2

(12.0–14.4)

15,881,000

1.2

(0.8–1.8)

1,471,000

10.1

(9.0–11.4)

11,506,000

1.5

(1.1–2.1)

1,695,000

6.7

(5.8–7.6)

8,033,000

0.4

(0.2–0.7)

494,000

4.6

(3.8–5.4)

5,190,000

0.5

(0.3–0.8)

555,000

15.4

(14.2–16.8)

18,638,000

1.3

(1.0–1.8)

1,614,000

2.5

(2.0–3.1)

2,836,000

0.4

(0.2–0.7)

455,000

9.2

(8.2–10.3)

11,120,000

0.7

(0.5–1.2)

896,000

0.7

(0.5–1.1)

814,000

10.5

(9.5–11.7)

12,719,000

0.7

(0.4–1.0)

795,000

2.3

(1.8–3.0)

2,654,000

1.2

(0.8–1.7)

1,423,000

0.3

(0.2–0.6)

384,000

4.2

(3.5–5.0)

5,101,000

2.3

(1.8–3.0)

2,661,000

9.2

(8.2–10.3)

11,149,000

2.4

(1.9–3.0)

2,883,000

2.5

(1.9–3.3)

2,822,000

0.8

(0.6–1.2)

940,000

47.1

(45.3–48.8)

56,807,000

14.2

(12.9–15.5)

17,091,000

46.5

(44.6–48.4)

52,937,000

18.0

(16.5–19.6)

20,471,000

39.0

(37.3–40.8)

47,118,000

9.7

(8.6–10.8)

11,677,000

31.0

(29.3–32.8)

35,330,000

9.1

(8.1–10.2)

10,314,000

39.9

(38.2–41.6)

48,140,000

10.4

(9.3–11.6)

12,552,000

40.4

(38.5–42.3)

45,964,000

15.4

(14.0–17.0)

17,571,000

27.3

(25.8–28.9)

32,996,000

NA

NA

NA

11.5

(10.3–12.8)

13,080,000

NA

NA

NA

Abbreviations: CI = confidence interval; NA = not assessed.
* Percentages are weighted.
† Rounded to the nearest thousand.
§ Estimate not reported; relative standard error >30% or cell size ≤20.
¶ Psychological aggression includes expressive aggression (such as name calling, or insulting or humiliating an intimate partner) and coercive control, which includes behaviors that are intended to monitor, control, or threaten an intimate partner.
** Contact sexual violence by an intimate partner includes rape, being made to penetrate a perpetrator, sexual coercion, and unwanted sexual contact perpetrated by an intimate partner.
†† Includes experiencing any of the following: being fearful, concerned for safety, any post-traumatic stress disorder symptoms, injury, need for medical care, need for housing services, need for victim advocate services, need for legal services, missed at least 1 day of work or school, and contacting a crisis hotline. For those who reported being raped, it also includes having contracted a sexually transmitted infection or having become pregnant. Intimate partner violence–related impact questions were assessed in relation to specific perpetrators, without regard to the time period in which they occurred, and asked in relation to any form of intimate partner violence experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. By definition, all stalking incidents result in impact because the definition of stalking requires the experience of fear or concern for safety.

TABLE5. Lifetime prevalence of intimate partner violence, by race/ethnicity* and sex of victim — National Intimate Partner and Sexual Violence Survey, United States, 2011

Hispanic

Black, non-Hispanic

White, non-Hispanic

Asian or Pacific Islander

American Indian/Alaska Native

Multiracial

Women

Rape

Weighted % (95% CI)

6.2 (4.2–9.2)

8.8 (6.3–12.2)

9.6 (8.4–10.9)

—†

11.4 (6.9–18.2)

Estimated no. of victims§

1,011,000

1,286,000

7,730,000

234,000

Other sexual violence

Weighted % (95% CI)

9.9 (7.2–13.4)

17.4 (13.8–21.8)

17.1 (15.6–18.7)

26.8 (17.8–38.1)

Estimated no. of victims§

1,603,000

2,536,000

13,710,000

550,000

Physical violence

Weighted % (95% CI)

29.7 (24.9–35.1)

41.2 (36.1–46.6)

30.5 (28.6–32.4)

15.3 (8.9–24.9)

51.7 (38.1–65.0)

51.3 (40.2–62.3)

Estimated no. of victims§

4,819,000

5,996,000

24,469,000

921,000

424,000

1,055,000

Stalking

Weighted % (95% CI)

6.8 (4.7–9.9)

9.5 (6.9–13.0)

9.9 (8.6–11.3)

13.3 (7.7–21.8)

Estimated no. of victims§

1,105,000

1,386,000

7,935,000

272,000

Psychological aggression

Weighted % (95% CI)

43.9 (38.3–49.6)

53.8 (48.5–59.0)

47.2 (45.2–49.2)

29.8 (20.5–41.1)

63.8 (50.4–75.3)

61.1 (49.7–71.5)

Estimated no. of victims§

7,115,000

7,819,000

37,888,000

1,797,000

523,000

1,256,000

Contact sexual violence,¶ physical violence, or stalking with intimate partner violence-related impact**

Weighted % (95% CI)

24.2 (19.7–29.3)

31.8 (26.9–37.2)

28.0 (26.1–29.8)

42.4 (29.4–56.5)

43.1 (32.4–54.6)

Estimated no. of victims§

3,918,000

4,627,000

22,444,000

348,000

886,000

Men

Rape

Weighted % (95% CI)

Estimated no. of victims§

Other sexual violence

Weighted % (95% CI)

13.5 (9.8–18.2)

14.8 (10.8–19.9)

7.6 (6.5–8.9)

18.2 (11.7–27.2)

Estimated no. of victims§

2,204,000

1,878,000

5,777,000

377,000

Physical violence

Weighted % (95% CI)

27.1 (22.0–32.8)

36.3 (30.0–43.1)

26.6 (24.8–28.6)

11.5 (6.8–19.0)

43.0 (27.4–60.1)

39.3 (30.4–49.0)

Estimated no. of victims§

4,428,000

4,603,000

20,190,000

612,000

335,000

814,000

Stalking

Weighted % (95% CI)

1.7 (1.3–2.3)

Estimated no. of victims§

1,279,000

Psychological aggression

Weighted % (95% CI)

50.9 (44.8–57.1)

56.1 (49.5–62.4)

44.8 (42.7–46.9)

26.6 (18.9–36.2)

47.2 (31.1–64.0)

64.2 (53.6–73.5)

Estimated no. of victims§

8,333,000

7,110,000

33,959,000

1,415,000

368,000

1,329,000

Contact sexual violence,¶ physical violence, or stalking with intimate partner violence-related impact**

Weighted % (95% CI)

11.2 (8.1–15.3)

16.8 (11.9–23.2)

10.7 (9.4–12.1)

22.2 (15.1–31.2)

Estimated no. of victims§

1,835,000

2,128,000

8,074,000

459,000

Abbreviation: CI = confidence interval.
* Race/ethnicity was self-identified. The American Indian/Alaska Native designation does not indicate being enrolled or affiliated with a tribe. Persons of Hispanic ethnicity can be of any race or combination of races.
† Estimate is not reported; relative standard error >30% or cell size ≤20.
§ Rounded to the nearest thousand.
¶ Contact sexual violence by an intimate partner includes rape, being made to penetrate a perpetrator, sexual coercion, and unwanted sexual contact perpetrated by an intimate partner.
** Includes experiencing any of the following: being fearful, concerned for safety, any post-traumatic stress disorder symptoms, injury, need for medical care, need for housing services, need for victim advocate services, need for legal services, missed at least 1 day of work or school, and contacting a crisis hotline. For those who reported being raped, it also includes having contracted a sexually transmitted infection or having become pregnant. Intimate partner violence–related impact questions were assessed in relation to specific perpetrators, without regard to the time period in which they occurred, and asked in relation to any form of intimate partner violence experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship. By definition, all stalking incidents result in impact because the definition of stalking requires the experience of fear or concern for safety.


Abbreviations: IPV = intimate partner violence; NA = not applicable; PTSD = post-traumatic stress disorder.
* Includes rape, being made to penetrate a perpetrator, sexual coercion, and unwanted sexual contact perpetrated by an intimate partner.
† Includes experiencing any of the following: being fearful, concerned for safety, any PTSD symptoms, injury, need for medical care, need for housing services, need for victim advocate services, need for legal services, missed at least 1 day of work or school, and contacting a crisis hotline. For those who reported being raped, it also includes having contracted a sexually transmitted infection or having become pregnant. IPV-related impact questions were assessed in relation to specific perpetrators, without regard to the time period in which they occurred, and asked in relation to any form of intimate partner violence experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship; 12-month prevalence of IPV-related impact was not assessed. By definition, all stalking incidents result in impact because the definition of stalking requires the experience of fear or concern for safety.
§ Includes had nightmares; tried not to think about or avoided being reminded of; felt constantly on guard, watchful, or easily startled; and felt numb or detached. Asked only of victims who reported being fearful or concerned for their safety in relation to violence experienced by an individual perpetrator.
¶ Estimate not reported; relative standard error >30% or cell size ≤20.
** Asked only of women who reported rape by an intimate partner.
Alternate Text: The figure shows lifetime prevalence of contact sexual violence, physical violence, or stalking by an intimate partner with intimate partner violence-related impact by sex, using data from the National Intimate Partner and Sexual Violence Survey conducted in the United States during 2011. Sexual violence includes rape, being made to penetrate a perpetrator, sexual coercion, and unwanted sexual contact perpetrated by an intimate partner. Any reported intimate partner violence-related impact includes experiencing any of the following: being fearful, concerned for safety, any post-traumatic stress disorder symptoms, injury, need for medical care, need for housing services, need for victim advocate services, need for legal services, missed at least 1 day of work or school, and contacting a crisis hotline. For those who reported being raped, it also includes having contracted a sexually transmitted infection or having become pregnant. Intimate partner violence -related impact questions were assessed in relation to specific perpetrators, without regard to the time period in which they occurred, and asked in relation to any form of intimate partner violence experienced (sexual violence, physical violence, stalking, expressive aggression, coercive control, and control of reproductive or sexual health) in that relationship; 12-month prevalence of intimate partner violence-related impact was not assessed. By definition, all stalking incidents result in impact because the definition of stalking requires the experience of fear or concern for safety. Any post-traumatic stress disorder symptoms includes had nightmares; tried not to think about or avoided being reminded of; felt constantly on guard, watchful, or easily startled; and felt numb or detached. This question was asked only of victims who reported being fearful or concerned for their safety in relation to violence experienced by an individual perpetrator.
* Includes completed forced penetration and completed alcohol/drug-facilitated penetration but not attempted forced penetration.
† Represents the age at time of first experience of intimate partner violence among women who experienced contact sexual violence, physical violence, or stalking by an intimate partner. Includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health. Contact sexual violence by an intimate partner includes rape, being made to penetrate a perpetrator, sexual coercion, or unwanted sexual contact perpetrated by an intimate partner.
Alternate Text: The figure shows the age at the time of first victimization among female victims by type of victimization, using data from the National Intimate Partner and Sexual Violence Survey conducted in the United States during 2011. Three types of victimization are reported: completed rape (which includes completed forced penetration and completed alcohol/drug-facilitated penetration but not attempted forced penetration), stalking, and intimate partner violence (which includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health).
* Estimate not reported; relative standard error >30% or cell size ≤20.
† Represents the age at time of first experience of intimate partner violence among men who experienced contact sexual violence, physical violence, or stalking by an intimate partner. Includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health. Contact sexual violence by an intimate partner includes rape, being made to penetrate a perpetrator, sexual coercion, or unwanted sexual contact perpetrated by an intimate partner.
Alternate Text: The figure shows the age at the time of first victimization among male victims by type of victimization, using data from the National Intimate Partner and Sexual Violence Survey conducted in the United States during 2011. Three types of victimization are reported: made to penetrate, stalking, and intimate partner violence (which includes physical violence, all forms of sexual violence, stalking, psychological aggression, and control of reproductive or sexual health).

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Training Professionals in the Primary Prevention of Sexual and Intimate
Partner Violence: A Planning Guide
 
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide is a publication of the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Executive Summary

Sexual violence and intimate partner violence are complex, multifaceted issues that affect all sectors of our communities. Preventing sexual violence and/or intimate partner violence requires a comprehensive approach involving many individuals, organizations, and sectors. We know from our experience with other public health issues that primary prevention strategies that take place before violence occurs can work (CDC, 2004).


An effective, comprehensive program to prevent sexual violence and/or intimate partner violence takes a multitude of approaches, one of which is training professionals to engage in sexual violence prevention and/or intimate partner prevention. This Guide describes how to develop, implement, and evaluate a training process, taking into account your available level of resources. Additionally, this training process emphasizes turning awareness and knowledge into mastered skills and practices to prevent sexual violence and/or intimate partner violence by:

1.      Teaching based on organizational context.    
2.      Providing opportunities for skill development through participatory learning.
3.      Following up to assess progress and determine level of mastery.
The Guide is intended for use by state-level entities providing training to community based organizations (CBOs) or to other state-level entities as well as for CBOs providing training within their own organizations or to other professionals in their communities. The Guide can help plan, deliver, and evaluate trainings whether you initiate the trainings yourself or are asked by others to provide trainings.

Highlights of the Planning Guide’s Content

The Guide’s content is divided into three stages:
•       Start a Training Plan: The Basic Elements
•       Refine and Tailor Your Training Plans
•       Prepare for Evaluation and Follow-up

When you start developing your training plan, the first step is to state clearly why you want or need to do training in the first place and then develop and tailor trainings in partnership with the professionals you plan to train to address the identified needs or problems. The issues, needs, or problems you wish to address will shape the goals and desired outcomes of your training plan. Your goals and outcomes will describe the changes you expect to see in the professionals being trained as you try to increase both knowledge and skills in order to prevent sexual violence and/or intimate partner violence.

Ideally, everyone has a role in preventing sexual and/or intimate partner violence, but training takes a significant investment of time and resources. The best use of your resources will be to start by training those who seem ready or with whom you already have relationships. You may also strategically want to train those you believe can be change agents or who show existing organizational support for your primary prevention efforts.

Once you have decided whom you want to train, invite some of those professionals to help you shape the content and delivery of your trainings. This early involvement by a small group can help ensure your plans are relevant for all your participants. Invite professionals from different cultures, organizations, and communities, as well as from different generations, when appropriate. Participants can help you develop and deliver trainings that are culturally competent.

To make trainings relevant, you will need to consider both the organizational context in which professionals work as well as their individual readiness and level of knowledge. Understanding organizational context will help you address ways professionals can better apply their new skills. Factoring in their readiness helps address learning needs, beliefs about challenges and barriers related to sexual violence and/or intimate partner violence, and professionals’ reasons for participating in trainings. Regardless of individual and organizational issues, your trainings will be grounded in the same core content, which will include understanding what constitutes sexual and intimate partner violence, strategies and skills that support preventing sexual and intimate partner violence from occurring in the first place (primary prevention), and what increases risk and protects against perpetration and victimization. It is also important to include in your trainings how to respond to disclosures of abuse.
Tailoring trainings to the needs of your professionals also means being realistic about kinds of resources you have available to develop and deliver the trainings as well as publicize and market them. Whether you select trainers from inside or outside your organization, you need individuals who understand the issues at hand and reflect the diversity of your participants in experience, profession, position, and cultural backgrounds. You will also need resources to conduct some level of evaluation of your trainings to ensure your effectiveness as well as follow-up to provide ongoing support for those you train.

As you move into refining and tailoring your training plans before actually delivering them, use what you have learned about different groups of professionals to tailor the core content to match their unique needs. You can use what you know about different groups of professionals and their constituencies to help tailor trainings in culturally relevant ways. This validates and uses the expertise of the participants while helping them see how they can apply what they know in ways that are meaningful for their clients.

To increase the effectiveness of your trainings, you will need to first understand how adults learn best and incorporate some of these strategies into your work. Adults have special needs and requirements as learners that differ from those of children and teens (Lieb, 1991). Adults retain more when they can learn through a combination of seeing, hearing, saying, and doing. They need to feel autonomous and self-directed in learning situations, preferring educational environments that deliver practical, goal-oriented knowledge that seems immediately relevant to their experience (Knowles, 1998).

To be effective and relevant to diverse groups of participants, training design, content, and delivery all need to be done with cultural competency. This is different than talking to groups about cultural competency. This Guide describes an approach to help you move beyond simply trying to increase awareness of cultural issues; rather, you want demonstrate your organization’s full engagement and integration of diverse perspectives. Working with cultural competence involves changing your behavior and is an ongoing, daily, evolving process. Training with cultural competence assumes you will actively engage participants in learning how to change their behavior as well.

Once you have completed your plans and prepare to deliver your trainings, you want to:


•       Review and finalize the training curriculum in consultation with the workgroup of professionals you invited to advise you.
•       Verify the availability of projected resources and that they will be sufficient to implement your training plans.
•       Finalize your logic model if you are using one.
•       Prepare and package curriculum and materials, including a training agenda with adequate breaks, PowerPoint® presentations, and printed handouts collated into binders.
•       Schedule trainings.
•       Book and prepare training locations.
•       Communicate information to participants
Once the trainings have been delivered, you can prepare for evaluation and follow-up. This involves trying to determine, as your resources will allow, whether your training efforts are making a difference as well as following up with participants to help them keep their efforts going.

Conduct both a process evaluation to determine the delivery quality of your trainings and an outcome evaluation to measure the impact of your training including whether there have been actual changes in behaviors. Overall, you will want to measure changes in the following key areas:

•       Knowledge: how well participants understand the concepts presented.
•       Attitude: how participants think or feel or what they believe.
•       Skills: participants’ ability to behave in certain ways.
•       Organizational change: how the original context assessed earlier on in this process has changed to pave the way for needed changes in the workplace.


As professionals go back to their workplaces and start to implement the new skills you taught them, they will inevitably encounter barriers and distractions. Research has shown that follow-up activities or “boosters” are important for increasing the likelihood that new knowledge and skills will be put into practice.

Although there is no formula for follow-up activities, we recommend you develop follow-up plans, as resources allow, that do the following:
•       Provide technical assistance after training
•       Assess and support organizational integration
•       Consider mentoring, coaching, trainer “on call,” and/or practicum
•       Use ongoing training for incremental learning and to reinforce material
•       Encourage participants to go back and share the impact of the training on their work
•       Use follow-up to inform training evaluation

Incorporating follow-up activities appropriate for the groups being trained will help you continue to guide professionals toward more meaningful sexual and/or intimate partner violence prevention work as well as allow you to maintain important relationships within the community to help strengthen your work. Finally, thinking about ways to sustain your prevention work and the work of your community partners early on in your training plan development will help you wisely use the resources you have now and develop ways of supporting your training plans in the future.

What is in the Guide

The Planning Guide describes important concepts and strategies for developing, implementing, and evaluating your prevention training efforts. The Guide’s content is designed to help you quickly assess what you may need to tailor individual trainings to different groups of professionals. It provides definitions of sexual violence and intimate partner violence on which the Guide’s contents are based. The Guide also includes a fictional case study as well as real-life examples to illustrate theory put into practice.

In addition to providing step-by-step guidance on all the tasks necessary to your work, the Guide includes:
•       Tip sheets: Ideas and additional information to expand your knowledge.
•       Worksheets: Blank worksheets to help you build the details of your plans. Filled-in samples of some worksheets using the case study are also provided to illustrate the work.
•       Checklists: A few simple checklists to help you stay on top of recommended tasks.
•       Resources: Where to find additional, useful resources to learn more about topics.
Unless otherwise noted throughout the guide, the tools and resources listed above are gathered together in an Appendix that can be found at the end of the Guide.

 
Introduction: Why Train?
 
Sexual violence and intimate partner violence are complex, multifaceted issues that affect all sectors of our communities. Preventing sexual violence and/or intimate partner violence requires a broad-based, multi-system, comprehensive approach involving a wide array of individuals, groups, and agencies representing many disciplines and areas of expertise (Centers for Disease Control and Prevention [CDC], 2004).

Primary prevention efforts are approaches that take place before violence occurs to prevent initial perpetration or victimization. We know from our experience with other public health issues that primary prevention strategies work (CDC, 2004).

An effective, comprehensive program to prevent sexual violence and/or intimate partner violence takes a multitude of approaches including mobilizing communities around sexual violence and/ or intimate partner violence prevention and building and/or joining well-organized, broad-based coalitions that can more effectively create change in communities. Other essential activities are implementing strategies that promote positive social norms among youth, families, adults, and community institutions, and developing and implementing public and organizational policies aimed at preventing sexual violence or intimate partner violence.

Another key approach is training professionals to engage in sexual violence prevention and/or intimate partner prevention. Practitioners doing sexual violence prevention or intimate partner violence prevention work do not have enough resources, time, or avenues to reach everyone. However, professionals in other fields can influence risk and protective factors for sexual violence and/ or intimate partner violence within their own spheres of influence. Training those professionals to incorporate intimate partner violence and/or sexual violence prevention into their existing work can dramatically increase the breadth of your impact.

Training may also provide opportunities to help expand community efforts and collective responsibility for preventing sexual violence and/or intimate partner violence. Training also allows you and the professionals with whom you will work ways to identify methods and opportunities for integrating and institutionalizing sexual violence and/or intimate partner violence prevention as organizational priorities.

There are numerous examples throughout this guide of how incorporating sexual violence and intimate partner violence prevention into the existing work of a wide range of professionals in your community can help increase your collective impact.

Definitions of sexual violence and intimate partner violence
For this training guide, the concise definitions of sexual violence and intimate partner violence are as follows:

Sexual violence (SV) includes nonconsensual completed or attempted penetration, nonconsensual non-penetrative sexual contact, or non-contact acts such as verbal sexual harassment, by any perpetrator. This definition includes incidents when the victim is unable to consent (e.g., due to age or illness) or unable to refuse (e.g. due to physical violence or threats) (Basile & Saltman, 2002).

Intimate partner violence (IPV) is abuse that occurs between two people in a close relationship. The term “intimate partner” includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering. IPV includes four types of behavior:

•       Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking, burning, or other physical force
•       Sexual violence is forcing a partner to take part in a sex act when the partner does not consent
•       Threats of physical or sexual violence include the use of words, gestures, weapons, or other means to communicate the intent to cause harm
•       Emotional abuse is threatening a partner or his or her possessions or loved ones, or harming a partner’s sense of self-worth. Examples are stalking, name-calling, intimidation, or not letting a partner see friends and family (Saltman, Fanslow, McMahon and Shelly, 2002). 

What training means
We define training as a process for turning awareness and knowledge into mastered skills and practices to prevent sexual violence and/or intimate partner violence by:
1. Teaching based on organizational context.
2. Providing opportunities for skill development through participatory learning.
3. Following up to assess progress and determine level of mastery.
Training involves more than simply imparting knowledge. It should also help practitioners develop skills and shift the way they work. To develop useful training, you must first understand adult learning principles and learning styles. We believe teaching based on organizational context is key because it provides the support necessary to help people more easily and effectively put to use what they learn from you. By understanding the daily contexts in which your trainees work, you can then demonstrate how professionals can practically implement the skills and strategies you teach. Follow-up activities after the training is completed will also help your trainees sustain what they have learned and will increase the likelihood your training will strengthen community-wide sexual violence prevention efforts. We think that the training you provide, coupled with organizational support as well as follow up from you once the training is completed, will all combine to increase the chances your trainings will successfully strengthen community-wide intimate partner violence and/or sexual violence prevention efforts.

Who should use the Guide
The intended audiences for this Guide are:
•       State-level entities (e.g. state domestic violence and sexual assault coalitions, state health departments) providing training to community based organizations (CBOs) or to other state-level entities.
•       Community Based Organizations or CBOs (e.g. rape crisis centers, domestic violence programs) providing training within their own organizations or to other professionals in their communities.

This document can help you plan, deliver, and evaluate trainings whether you initiate the trainings yourself or are asked by others to provide trainings. We recommend your trainings link to your organization’s prevention goals and/or state and local prevention plans. You may also want to look for logical ways to link your training efforts to other comprehensive prevention efforts in your community.

We are not asking you to develop an entire community-based plan, nor do you need to have a training activity for every goal in your prevention plan if you have one. We encourage you to look for a few key, logical links between your prevention and training plans. Integrate training into your ongoing work, rather than viewing training as an “add-on” to everything else you are trying to do.

 

What is in the Guide

This Planning Guide describes important concepts and strategies for developing, implementing, and evaluating your prevention training efforts. It also provides tip sheets, worksheets, and checklists to help you quickly assess what you may need to tailor individual trainings to different groups of professionals. Most of these materials are found in the Appendix (starting on page 51). All resources may be copied as needed as you tailor individual trainings.

Within the instructive sections of the guide, we have included real-life examples, as well as a fictional case study, to illustrate theory put into practice. You will also find tips on where to find additional, useful resources if you want to learn more about various topics.

We designed this Guide to be as comprehensive as is practical. We recognie, however, that some organizations lack the resources or capacity to carry out all of the steps recommended. Avoid taking an “all or nothing” approach; rather, do as many steps as possible. Read through the Guide to realistically determine what you can and cannot do, then develop your training plans accordingly. Keep in mind that once you identify certain fundamental aspects of your plans, such as core content, they will inform everything you do no matter who you train. Except for periodic fine-tuning, once you have developed those parts of your plan, you will not need to address them again.
Learn more: We did not intend this guide to be a primer on sexual violence, intimate partner violence, public health, or the primary prevention of violence against women. Take a look at the following resources if you need more information:

•       Centers for Disease Control and Prevention, National Center for Injury Prevention and Control—www.cdc.gov/ncipc
•       National Online Resource Center on Violence Against Women–www.vawnet.org
•       National Sexual Violence Resource Center—www.nsvrc.org
•       Prevention Institute—www.preventioninstitute.org
•       Violence Against Women Prevention Partnership—www.preventconnect.org

Fictional Case Study: The Center for Community Peace
To illustrate how the instructions and suggestions in this guide might be implemented, we have created a fictional case study of the Center for Community Peace. Throughout the Guide, we use the center’s story to illustrate examples of how an organization moves through the steps of planning, delivering, and evaluating its training plan.

 

While the center is fictional—as are all persons, businesses, and agencies named—we believe it is representative of the myriad agencies and organizations working to better their communities. Before moving forward, take a few minutes to get to know the center, its staff, its values, and the people it serves. Perhaps you will see some similarities with your own organization.

The Center

The Center for Community Peace is a community center in a suburb of a metropolitan area in the United States. The center receives a variety of funding to cover its operating expenses, including federal, state, and local grants, as well as private and in-kind donations.

Mission

The center offers programs and services that empower and inspire all generations and institutions in the community to work together to promote and practice peace.
It facilitates positive changes in individuals, families, and communities by providing:
•       Comprehensive education
•       Counseling services for social, emergency, and financial problems
•       Referrals to agency partners when appropriate
Key values
The center:
•       Values client diversity by delivering expert, innovative approaches to life’s challenges within the context of each client’s cultural experience.
•       Ensures no one is refused services because of financial hardship or inability to pay.
Staff and services
The center has nine paid staff members:
•       Reynaldo Torres, PhD—Executive Director and CEO
•       Lorinda Hobart—Vice President, Human Resources, Finance, and Administration
•       Lois Philips, MD—Vice President, Clinical and Health Services
•       Bobby Ming, LCSW—Director, Youth Programs
•       Odette Harrison, RN—Senior Clinical Advisor and Practitioner
•       Hani Littlefoot, LCSW—Certified Sexual Assault Counselor and Mental Health Services Practitioner
•       Vivian Bosley, BSW, LPC—Community Outreach and Volunteer Coordinator
•       Shivany Singh, MS—Head Start and Early Childhood Coordinator
•       Audrey McMaster, BA—Development Manager and Office Assistant
•       Josiah Stevens, PhD—Director of Program Evaluation and Improvement
The center provides community services and educational programs through a variety of local youth-serving organizations (e.g., Big Brothers Big Sisters), as part of existing programs (e.g., after-school tutoring and sports, alcohol-free teen nights, and related parties), and through partner programs. Such services include:
•       Emergency shelter and low-income housing
•       Parenting and nutrition classes
•       Food assistance
•       Meals on Wheels
•       Drug abuse counseling
•       GED preparation
•       Job training
•       Credit counseling, financial literacy, and budget training
•       Sexual assault crisis counseling
•       Pregnancy counseling
•       Child sexual abuse, sexual assault, and dating violence prevention

Key Demographics
The center is located in a suburban area of a major metropolitan region with the following demographics:
•       Sex: males 46.5%, females 53.5%
•       Median age: 30 (local), 33.4 (state)
•       Estimated median household income: $37,300 (local), $45,604 (state)
•       Racial composite statistics:
o       Black 38.2% 
o       White, non-Hispanic 28.8% 
o       Hispanic 14.6%
o       Two or more races 7.4%
o       Asian Indian 4.5%
o       Other Asian 2.7% 
o       American Indian 2.3%
o       Other race 1.5%
Community partnerships
In addition to its regular service offerings, the center participates in a local positive youth development coalition. Members of the coalition include:
•       Youth from middle and high school teen center governing boards
•       Center staff
•       Dachel Coleman, Executive Director, The Urban League
•       Stephanie Pearson, MA, PCC, Program Director, ARTScape
•       Herman Witherspoon, Outreach Director, YMCA
•       Linda Smithers, MD, CEO, YWCA
•       Salvatore Sandroni, PC, Director, County Court-Appointed Special Advocates (CASA)
•       Aisha Taylor, Director, Families First
•       Lorinda Hernandes, RN, LCSW, Regional Director, Planned Parenthood
•       Amy adek, Coordinator, Volunteers in Service to America (VISTA)
•       Reverend Jane Evans, President of community interfaith coalition
•       Law-enforcement officials:
o       Detective Anna Warren, Special Victims Unit
o       Officer Curtis Wilson, Drug Abuse Resistance Education (DARE) officer
•       Local parents and guardians:
o       Arlena and Alvin Foster 
o       Maybelle Young
o       Jorge Chave
•       Mark Karakas, Board Member, Chamber of Commerce
•       Maria Rui, staff writer, Daily Reporter
 
 
Start a Training Plan: The Basic Elements

The planning steps in this document should look a lot like other planning processes with which you are already familiar. Taking time to develop the basic elements of a training plan will increase the likelihood of success in helping people learn new skills, change the way they work, and, ultimately, institutionalie practice changes. It will also help you prioritie where you want to focus your resources, including staff, money, and time.
In the next section of the Guide, we will go over the basic elements we think are important to consider as you start your training plan, including:

•       Clearly identifying the needs or problems you want to address to help focus your efforts
•       Using that focus to shape training goals and outcomes
•       Deciding whom to train
•       Involving participants in developing your training and how to do so meaningfully
•       Understanding the core topics that should form the foundation of your training
•       How to consider important organizational contexts in shaping your content
•       Recogniing individual readiness and levels of knowledge before you train
•       Determining the resources you need to support your trainings
•       How to select the right trainers

Upcoming sections of the Guide will help you further refine and deliver your trainings once you have developed some of these details.

Identify the needs or problems to be addressed

The first step in developing your training plan is to state clearly why you want or need to do training in the first place. Are there issues, problems, observations, or data that tell you training is necessary? How did you determine that training is the best way to address a need or problem? Perhaps other kinds of approaches (e.g. a policy change) would be more appropriate to address identified needs.

Important reasons for training may include opportunities to:
•       Saturate community efforts by expanding the responsibility and expertise needed to prevent sexual violence and/or intimate partner violence
•       Implement or reinforce prevention messages with populations you do not currently work with (e.g. training Latino health workers to promote healthy relationships in their work with Latino families)
•       Identify methods and opportunities for integrating and institutionaliing sexual and/or intimate partner violence prevention as organizational priorities

Another reason for training is the occurrence of an incident that suddenly increases public awareness of sexual violence. Such an event may require both an immediate response and longer-term training efforts. The Boston Area Rape Crisis Center (BARCC), for instance, dealt with such a situation when a popular teacher was accused of sexually assaulting several students. The event traumatied school staff and students.

BARCC staff realied that students, parents, and school staff needed a variety of supports to cope with the situation and resulting emotional issues, especially for individuals who had suffered past abuse. After defining more specifically the needs of the school and community, BARCC staff decided to offer trainings to educate staff and students about sexual violence. It was believed training would help teachers respond to questions from parents and empower both teachers and students to strengthen future prevention efforts.


It will be important to ensure you are not duplicating efforts. Determine what others in your area are already doing about sexual violence and/or intimate partner violence prevention training, perhaps by doing a short resource assessment to find out. For example, YWCA’s often offer a variety of sexual violence and/or domestic violence education and prevention trainings for professionals and the public. Knowing what other groups are doing will save your time and resources as well as reveal potential training partners.


Case study: The Center for Community Peace identifies the problems to address


In addition to its regular program offerings, the center participates in a local positive youth-development coalition. As an outgrowth of the coalition’s effort, the center discovers that students at the local alternative high school have been experiencing high rates of sexualied bullying and sexual assault. Members of the local positive youth-development coalition would like to work with the center to develop a plan for preventing sexualied bullying and assault in their community.
 
Develop goals and outcomes

The issues, needs, or problems you wish to address will shape the goals and desired outcomes of your training plan.
Goals reflect ambitious change that you believe you can actually accomplish. An example of a strong, change-based goal statement would be “to increase bystander intervention behavior among high school males in response to sexist comments made by peers.” Avoid simply describing a program or activity, a common mistake when writing goal statements.

Outcomes—sometimes called objectives—are specific, measurable statements that let you know when you have reached your goals. Outcome statements describe the specific changes in knowledge, attitudes, skills, and behaviors you expect to occur as a result of your actions.

Remember, we are defining training as the process of turning awareness and knowledge into mastered skills and practices to prevent sexual and/or intimate partner violence. Your goals and outcomes will describe these changes and ideally will reflect your aim to increase both knowledge and skills. But, depending on where you start with a particular group, your goals and outcomes could be different, reflecting the need to change knowledge or skills.

The following examples show the difference in goals for knowledge vs. skills training for youth workers in a youth diversion program.


If you are training to increase knowledge, your training goals could be to:
•       Increase knowledge about sexual violence and dating violence perpetration and victimiation
•       Increase knowledge of the overlapping risk factors for sexual and dating violence perpetration and youth violence
•       Identify appropriate opportunities to address issues related to sexual violence and dating violence in current program efforts


If you are training to increase knowledge and also skills, your training goals could include all those shown above as well as to:
•       Increase skills to interrupt language and behaviors that objectify and demean women and to promote respectful language and dating behavior


Good outcome statements are specific, measurable, and realistic. Think carefully about what you can realistically accomplish in your trainings given the groups you want to reach and the scope of your resources.
Develop short, intermediate, and long-term outcomes as follows:

•     Short-term outcomes should describe what you want to happen within a relatively brief period (e.g., during the course of one or several trainings, depending on how many sessions you conduct). Focus your short-term outcomes on what you want people to learn. An example of a short-term outcome would be that coaches learn about the risk and protective factors for sexual violence and/or intimate partner violence.

Intermediate outcomes describe what you want to happen after your trainings are completed. Focus your intermediate outcomes on what you want people to do when they go back to their workplaces and apply what they have learned. An example of an intermediate outcome would be that coaches demonstrate interrupting sexual harassment and teaching respect.
 
•       Long-term?outcomes describe the impact you hope to have on the primary prevention of sexual violence and/or intimate partner violence after the trainings are completed, but farther out into the future. Describe what you hope will change as a result of your trainings. An example of a long-term outcome would be that incidents of sexual harassment decrease in schools.

Well-written and complete outcome statements will usually define the following five elements (Fisher, Imm, Chinman & Wandersman, 2006) as you describe:
•       Who will change—the professionals you are training.
•       What will change—the knowledge, attitudes, and skills you expect to change.
•       By how much—how much change you think you can realistically achieve.
•       By when—the timeframe within which you hope to see change.
•       How the change will be measured—the surveys, tests, interviews, or other methods you will use to measure the different changes specified.

A useful way to remember these elements is the ABCDE Method of Writing Outcome Statements (Atkinson, Deaton, Travis & Wessel, 1999):
A—Audience (who will change?)
B—Behavior (what will change?)
C—Condition (by when?)
D—Degree (by how much?)
E—Evidence (how will the change be measured?)

Address as many of the five elements as possible when you are writing outcome statements, but keep in mind that you may not be able to address them all. Such gaps may indicate areas where you need to gather more information to complete your outcome statement.

Remember to link your training goals back to your organization’s plan for sexual violence and/or intimate partner violence prevention goals or state and local plans when it makes sense. However, you need not have a training goal for every goal in your prevention plan.

As you move ahead, you may find it helpful to summarie your plans in a logic model. We have provided a blank Logic Model Template for you to use starting on page 71 in the Appendix. We have also provided a filled-in example of the logic model on page 72 based on the case study as an illustration.

A detailed table titled Whom to Train starting on page 52 in the Appendix summaries the different kinds of organizations you should consider training. Included in the table are example outcomes for those organizations.

Case study: The Center for Community Peace identifies training goals and outcomes

To help prepare for the trainings, center staff discuss and identify key goals for the training, which include those they consider generally important based on their knowledge in the subject area, as well as those they anticipate will be specifically important to the issues and problems that need to be addressed in the school. Goals for training are:

•       Increasing knowledge of the importance of primary prevention
•       Increasing knowledge of how youth display sexualied bullying and harassing behaviors
•       Increasing knowledge about factors that put students at risk for sexual violence and those that reduce students’ chances of experiencing or perpetrating sexual violence
•       Increasing skills among students, faculty, and staff to address sexualied bullying and harassment through policies, practices, conduct, and positive school climate
The center drafted the following outcomes:
•       In the short-term, all participants will be able to—
o       Compare and contrast the differences between primary  prevention and other strategies such as intervention (i.e., providing services after an incident has occurred) and explain how primary prevention complements intervention strategies and activities
o       List the behaviors considered sexualied bullying or  sexually harassing
o       Compare and contrast the differences between healthy  (i.e., positive relationships) and unhealthy (i.e., sexually violent) behavior
o       List and describe risk and protective factors 
•       In the intermediate term, participants will be able to—
o       List and describe effective practices for stopping existing  sexualied bullying and harassing behaviors as well as preventing sexual assault
o       Describe and display, through role plays and other  methods, how to model healthy and respectful behaviors
o       Review existing school policies and codes of conduct  to identify existing rules that can be used to promote a culture that does not tolerate sexual violence
Identify, where needed, new school policies and codes of conduct that promote a positive school climate emphasiing positive social behaviors and healthy relationships.
•       In the long term, participants will be able to:
o       Report measurable progress in emphasiing the use of  existing rules to promote respect
o       Report measurable progress in putting new policies and  codes of conduct into place both to promote respect and to increase positive school climate
o       Demonstrate a decrease in incidents of sexualied  bullying and harassment within the school
o       Demonstrate an increase in safety, equality, and respect 

As part of its training plans, the center will soon involve participants from the school to help further define and tailor the goals and outcomes using the ABCDE method.


Decide whom to train
Ideally, everyone has a role in preventing sexual and/or intimate partner violence, but it is not realistic or feasible for prevention practitioners to train all the professionals in their communities. Training takes a significant investment of time and resources. The best use of your resources will be to start by training those whom you believe exhibit readiness. What we mean by readiness in this context includes groups (Biech, 2008):
•       Already connected to your prevention goals
•       Already motivated to learn and develop new skills
•       Who have support and resources within their organizations to apply what they learn
For example, if one of the activities associated with your state prevention plan is to partner with your state’s Safe and Drug Free Schools program, then you might consider developing ongoing prevention training for school administrators associated with such efforts.

You have probably already assessed readiness when you have worked with community partners on first responses to sexual and/or intimate partner violence. You identified gaps and other issues in the system’s responses to victims. You identified who in the system needed training and worked with them on developing organizational supports and developing and implementing new policies and procedures. For example, when training police in responding to sexual violence, you typically thought “up the chain” about whom you needed buy-in from before training responding officers. Apply this same strategic thinking to planning primary prevention training.


Note: The prompt to consider readiness at this stage is meant to be from a high-level view of the professionals you hope to train. Later in this guide, we will discuss more about organizational and individual readiness to help you develop content tailored to the needs of your trainees.


To help you begin your choices about whom to train, consider these questions:


With whom do you already have relationships? It makes the most sense to start with professionals or organizations that are already aligned with the mission of your organization or have identified violence prevention as a part of their mission.

Consider training exchanges with other programs or organizations as an efficient way to use your resources and build relationships. For example, you could offer training on sexual and/or intimate partner violence prevention to a community network that could, in turn, train your organization on youth development.

Tip: Remember to consider starting with staff, volunteers, and board of directors in your own agency or organization.

One successful example of this approach comes out of the merger of two different coalitions in Virginia in 2004, resulting in the Virginia Sexual and Domestic Violence Action Alliance. The need to prevention while also emphasiing intervention and, at the same time, bridging domestic and sexual violence, called for cross-training of staff to be done with care. Leadership decided to leverage the successful approaches from each area, including the prevention focus of sexual violence and work in domestic or intimate partner violence with advocates and other professionals, into a series of trainings that included:

•       An initial training for internal staff on primary prevention
•       Additional explanations of basic prevention principles such as public health approaches, defining elements of primary prevention and the social-ecological model provided during three hours of regularly-scheduled bi-monthly staff meetings
•       Later in the first year, another four hours was spent with staff viewing the film Kinsey and discussing some of the basic tenets of healthy sexuality
•       A year after the merger, leadership encouraged all coalition staff to attend a 1 ½ day-long training on “Promoting Protective Factors to Prevent Sexual and Domestic Violence: Applying the Search Institute’s Developmental Assets Framework.” This training not only provided valuable content, but also helped professionals meet their annual development requirements.
•       The coalition has also developed its own Guidelines for the Prevention of Sexual Violence and Intimate Partner Violence to assist Virginia sexual and domestic intimate partner violence agencies in developing effective primary prevention initiatives.

The coalition also holds an annual 2 ½ day-long training retreat at a local women’s college open to staff and volunteers from any local member program. The retreat involves coalition staff and plays a crucial role in sustaining and refreshing learning on primary prevention.


With whom do you have natural alliances? Groups that naturally share your concerns and constituencies are more likely to be ready and open to incorporating sexual violence and/or intimate partner violence prevention into their practices. Think about the following groups:


•       Youth-serving organizations
•       Childcare and daycare workers 
•       Faith-based organizations
•       Organizations working with men and boys
•       Violence prevention organizations and coalitions
•       School and higher-education personnel
•       Health care providers

A good example of tapping a natural alliance comes from the South Bay 0-5 Coalition in Chula Vista, California. As part of its work with the coalition, the staff of South Bay Community Services routinely offers the Incredible Years training to its coalition partners. The Incredible Years curriculum is aimed at teaching children 0-5 and their parents a variety of social skills and competencies that may help reduce the likelihood of intimate partner violence perpetration or victimiation later in life. South Bay Community Services decided to offer the training to local preschool and childcare providers to expand its prevention outreach as well. It was hoped that the training would boost the capacity of more providers who have direct contact with children to help reduce intimate partner violence.

A detailed table titled Whom to Train, starting on page 52 in the Appendix, summaries the different kinds of organizations you should consider training. The table also includes information on the rationale for training each group as well as suggested content and example outcomes.
 
What other health or social issues overlap with sexual and/or intimate partner violence? Sexual and/or intimate partner violence share many risk and protective factors with other health and social issues and are themselves considered risk factors for adverse health behaviors. For example, sexual violence victimization increases risk for substance abuse and impacts academic achievement. Schools that are invested in lowering youth substance abuse and improving academic success may be open to sexual violence prevention as one avenue to achieve this goal.

Who can be levers for change or impact? Certain individuals, groups of professionals, or entire organizations can be catalysts for broader change in your community. Youth workers, for example, have powerful opportunities to model positive relationships and promote healthy youth development. Training a diverse group of youth workers from a variety of organizations has the potential for wide-ranging influence. Training managers or the board of directors of a key organization could influence organizational practices and promote a culture of respect. In rural and frontier areas professionals often wear multiple hats and therefore may have wide ranging impact.
Another tactic to try is piggybacking your training with others who are already training professionals, such as medical schools. You could also encourage policy makers and others who set guidelines and professional standards not only to participate in trainings, but also to change policies and procedures to support sexual violence and/or intimate partner violence prevention.

The Migrant Clinician Network, for example, an organization that serves as a “force for justice in health care for the mobile poor” often trains peer health educators called “promoters” who already successfully address health issues with migrant workers to also deliver a five-session healthy relationship curriculum with male migrant workers.

Where is there organizational support for individual practice change? In some cases, training must include those with the power to make changes in plans, policies, and procedures. You may know of individuals such as teachers or youth workers who support your work, but you also want to know how much their agencies and organizations support your work. You may not be as effective in training a group of teachers, for example, to implement a primary prevention curriculum in their classrooms if the school administration does not fully support the teachers in doing so.

Some dimensions of organizational support include (Johnson, Fisher, Wandersman, Collins & White, in press):
Awareness. How aware are organizations of efforts to prevent sexual and/or intimate partner violence?

Skills. If organizations are aware and supportive, do they have the necessary skills needed to implement primary prevention?
Commitment. If awareness and skills are present, is there also a level of commitment to the important tasks necessary to prevent sexual and/or intimate partner violence? How likely is the organization to commit its own resources to engage in prevention-related activities?

From your experience, you may be able to come to some conclusions very quickly about which organizations have the basic levels of awareness, skills, and commitment needed to serve as a good springboard for effective training. Answering these questions for other organizations may require time, staff, and resources.

What to do with a group that is only willing to let you do a single training when you know multiple training sessions are necessary for skills mastery? You may need to say no to organizations with such limitations so you can focus your finite resources on organizations that will have better payoffs for your prevention plans. On the other hand, if you have been trying to get a foot in the door with a particular organization for a long time, delivering a single training could help further your efforts. Take time to discuss your stance on this issue.

One key to your success will be to continually invite people to partner and collaborate with you. You might have to really pursue a group you think is important to engage. Or, you might find that because of your expertise, you have groups pursuing you for training. Deciding whom to train and how much time you spend on assessing readiness, engaging organizations, or helping to build organizational support are all important parts of your planning.

Case study: The Center for Community Peace decides whom to train


After talking with other members of the positive youth development coalition and interviewing administrators of the alternative high school, the center decides to provide training for administrators and faculty at the school so they can learn how to address and prevent harmful sexualied bullying behaviors and assault among students. Based on student focus groups, the center also realies that other school personnel such as bus drivers and cafeteria workers also play a role in influencing school climate. Given this information, the center decides to include all school personnel in training but administrators want to discuss if all personnel need the same content and dosage.

 Involve participants in training development


Once you have decided whom you want to train, invite several of those professionals to help you shape the content and delivery of your trainings. This early involvement by a small work group is the best way to ensure your plans are relevant for your participants.
Inclusion of training participants can be helpful in developing almost every area of your training plans, including:
•       Understanding the context and practices of their home organizations
•       Selecting trainers
•       Assisting with organizational and individual readiness assessments ahead of time to understand levels of motivation and engagement
•       Understanding the constituents your professionals work with
•       Understanding the community context
•       Helping develop training agendas and to help shape training content with an emphasis on preparing participants for learning and change (Biech, 2008)
•       Determining training activities and the resources needed to implement them
•       Improving the cultural competence of your trainings
•       Determining appropriate follow-up to support training application
•       Determining appropriate ways to assess effectiveness

Involving participants up front will take time and effort, but it is worth it. Here are some ways to involve participants in planning:


Involve a diverse group of participants. Invite professionals from different cultures, organizations, and communities, as well as from different generations, when appropriate. Participants can help you develop and deliver trainings that are culturally competent. For instance, they can offer guidance on how to address the different ways professional communities think and talk about sexual and/or intimate partner violence, rather than simply translating materials into a different language.

Make it easy for people to participate. Plan meetings at times and in places that are convenient for participants. Would providing a light meal increase participation? While you may not be able to use federal dollars to provide food, you may be able to get local business to donate these resources as in-kind, tax-deductible contributions. Consider going to the participants’ organizations.

Gather the information you need in a variety of ways. Convene some small groups first to help you map out what your plans need to look like. Gather some information through telephone interviews. Do a short paper survey at some of your professionals’ regularly scheduled meetings or ask participants to complete a short, web-based survey.

Learn more: Free or low-cost web-based survey software can help you design short, easy-to-use surveys participants can complete online


•       Survey Monkey (free)—www.surveymonkey.com
•       oomerang (basic package is free—www.oomerang.com
In the case of the Boston Area Rape Crisis Center (BARCC) cited earlier, staff sought input from the school district’s superintendent, principals, and school nurses from two middle schools and one high school to determine who should be included in educational trainings following the accusation of sexual assault by a beloved teacher. The decision was made to train the entire staff and student body at the affected school. By including youth and adults, BARCC was better able to empower these two groups to work together to build a positive, healthy, and safe school environment. Educators and parents eventually reported being better able to identify risky situations and possible perpetrators; teachers and staff reported being able to respond more knowledgably to parents.

Case study: The Center for Community Peace involves participants in training development
Two coalition members, Jorge Chave, a parent, and Anna Warren, a detective from the Special Victims Unit of the local police department, agree to facilitate a discussion with school administrators. Their goal is to determine how receptive school officials are about helping to address and correct the problem.

During their meetings with school personnel, center staff hears from teachers and guidance counselors about their perceptions of sexually harmful behavior at the school. Several school employees disagree about what constitutes sexually harmful behavior and the roles they play in addressing and preventing these problems.

Nonetheless, they discover some critical information and find several key advocates:


•       Rita Lincoln, a guidance counselor, is particularly articulate. She shares with the group that several students had asked her for help regarding sexualied bullying and assault. Lincoln feels the problem is growing rapidly and agrees to lead the effort to further explore and address this issue at the school.
•       Buck Frost, a physical education teacher and sports coach, states that sexualied bullying seems to be an erroneous “rite of passage” for some participants on his teams. He stresses the need for strong male mentors and agrees to work on solving the problem.
•       Lou Ventura, the technology coordinator at the school, mentions that he has seen an increase in sexually explicit instant messages and e-mails from some students over the school’s network. He agrees to help in any way he can.

As the center develops its training plans, staff invites these individuals to help shape the trainings. Lincoln, Frost, and Ventura are especially helpful in reviewing training plans and materials. Center staff uses their feedback to refine the training goals and outcomes, which helps increase the training’s relevance. These advocates are also enlisted to help build consensus with other school staff members and to help deliver training sessions.

Center staff members Bobby Ming and Hani Littlefoot also identify two young people in the course of their conversations at the alternative school whom they want to include. They believe these students can provide valuable, real-world experience and help boost credibility for the trainings. After clearing the idea with the school, the center, and families of the young people, the youth are invited to become part of the training team.
Identify core topics for trainings

The more meaningful the information you teach, the more likely people will take what they learn back to their workplaces and use it in their everyday practice. At this early planning stage, consider the core topics you want to cover. Although training sessions will be tailored to specific participants’ needs as you gather more information during the planning process, these topics will form the foundation of any training you do.

We suggest including the following core topics in all of your trainings:


Understanding what constitutes sexual and intimate partner violence. Sexual violence and sexual health are not commonly discussed in our society, and many children, adolescents, and adults do not know what constitutes sexually harmful behavior. Cordelia Anderson (2002) developed a helpful Sexual Behavior Continuum that may be a useful teaching tool. It describes a continuum of sexual behaviors from positive (healthy/helpful, appropriate, respectful, safe) to playful (teasing and flirting) to mutually inappropriate to harmful (sexual bullying) to harassment and violence.

Likewise, intimate partner violence is also not commonly discussed, but is commonly experienced in homes and communities, leaving professionals with their own opinions and biases about why it happens. Providing context about the occurrence of intimate partner violence, from a single episode to ongoing battering, and an understanding of the four types of behaviors that constitute intimate partner violence -- physical violence, sexual violence, threats, and emotional abuse -- will help professionals start to see their role in prevention.

Understanding primary prevention. Obviously, if you are training other professionals to implement strategies or policies to prevent sexual and/or intimate partner violence from occurring in the first place, they need to both understand and promote primary prevention. Core topics to explore include:

•       What is included in primary prevention such as working with men and boys to promote positive social norms; building bystander skills; and promoting healthy respectful relationships.
•       What is not included in primary prevention such as just raising awareness of sexual violence and/or intimate partner violence; knowing what services are available to survivors; learning how to help a friend who has been abused
Note: While raising awareness can be one important task when working to prevent sexual violence and/or intimate partner violence, remember that raising awareness by itself is insufficient to prevent sexual violence and/or intimate partner violence.
•       How primary prevention complements intervention such as being part of an overall response to sexual and/or intimate partner violence
•       Skills the professionals you are training need to have in order to be successful in their prevention activities (e.g. using non-violent language)
You should also discuss the characteristics of effective prevention programs (Nation et al., 2003). Such programs are appropriately timed, comprehensive, theory-based, and socio-culturally relevant. Well-trained staff conducts the programs, varying the teaching methods, and presenting information in sufficient dosage. Such programs also build positive relationships.
Learn more: We have included a tip sheet in the Appendix on page 62 that summaries the characteristics of effective prevention programs.

Understanding what increases risk and protects against sexual and/or intimate partner violence perpetration and victimiation. Individual, relationship, community, and societal factors can increase risk for or protect against sexual and intimate partner violence perpetration and victimiation. It is important for the professionals you are training to understand those factors and to identify their role in modifying them among the individuals, families, and communities with whom they work. Training materials should include information about risk and protective factors, state or local data about the incidence and prevalence of sexual or intimate partner violence, along with the social and political issues that can foster or inhibit change.

Responding to disclosures of abuse. When training professionals about sexual and intimate partner violence prevention, you should also consider including some skill building for responding to disclosures of abuse. While this is not an activity of primary prevention, invariably, as the professionals you are training begin implementing what they have learned (e.g., talking with youth about healthy relationships, interrupting sexually harassing behaviors), they will have survivors of sexual violence and/or intimate partner violence disclose their experiences. These professionals need to know how to respond appropriately and supportively, what the mandatory reporting requirements are, if any, and what resources exist in the community to help survivors.

Consider organizational context


Training does not occur in a vacuum. You are asking professionals to learn new skills, then take those skills back to their workplaces to use them. Worksites, professional requirements, and practice norms all need to support application of these new skills to help achieve sexual and intimate partner violence prevention. You may have to do some research and preparation before the actual training to make it easier for training participants to apply what they learn when back in their work environment.

For example, before training teachers and coaches how to recognie and interrupt sexual harassment or other abusive behaviors, you may need to better understand existing administrative policies and how the skills you will teach fit with those policies. You may discover that supportive policies do not exist or current policies need to be modified to enable effective school climate change. Trainings will need to address how trainees can meet these challenges.

The organizational assessment need not be an enormous job, but it is important to look at potential barriers that could hinder the incorporation of new skills and to identify facilitators that may help promote new practices. Chances are you already know a lot about the organizations from the work you are already doing and can easily summarie what you know as you proceed with your plans. If you have already involved potential participants in your planning process, they can also be an excellent source of information on these issues.

Consider the following:

•       Who the organization serves. It may be useful for you to know about the organization itself and who is served to help tailor training content in meaningful ways. For example, if training will be provided to the staff of a inpatient, substance abuse treatment center that serves women with children under 16 living with them, knowing more about the families being served could reveal important points to address. Are there incidents of prior victimization? What are the risk and protective factors present among the organization’s clients? Seeking this kind of information also reinforces the engagement of your potential training participants as experts on their own constituencies.

•       Professional requirements. Do the professionals you plan to train need to meet any continuing education, regulatory, or other requirements? By incorporating these elements into your curriculum, you increase the relevancy and accessibility of the training.

For example, many states require that social workers obtain a certain number of continuing education credits each year. State licensing boards and organizations such as the National Association of Social Workers have standards for providers of continuing professional education (CPE). If you want your training on sexual violence and/or intimate partner violence prevention to be useful for continuing education, you’ll need to consult with relevant organizations to be sure coursework and activities qualify for CPE credits.

•       Workplace policies and practices. Familiarize yourself with relevant policies, procedures, and goals of trainees’ agencies and organizations. Talk with potential trainees about their practice community and work environmental norms to glean important information about existing practices you can highlight in your training sessions. In doing so, you may also learn what training styles will work best and what kinds of information groups have already received.

•       Organizational and leadership priorities. The more you know about existing priorities and concerns, the more you can connect your trainings to them. Many schools, for example, are very concerned about bullying. Offering training on sexualized bullying or teen dating violence could appeal to schools, especially those with concerns but limited resources to address the issues. Providing trainings that are logically linked in this way could also help establish or strengthen partnerships.

•       Community context.  Examine and understand community norms (i.e., local politics, economics, and social contexts) and how they can influence trainees’ implementation of newly acquired prevention skills for sexual violence and/or intimate partner violence. For example, you might train youth diversion workers in two adjoining counties, one of which is more conservative. The more conservative county may have to implement strategies to promote healthy sexuality or teen dating violence strategies differently than the less-conservative county. While these two groups have the same job descriptions and work with similar populations, you will need to help them tailor their approaches to the unique needs of their communities.
Note: Later in this guide, we will discuss how organizational context may also influence whom you choose as a trainer.

Consider individual readiness and knowledge

Biech (2008) describes two important ways to help training participants learn. One is to energize their motivations to learn and two is to take advantage of whatever existing motivations they already have. Taking some time up front to determine the motivations as well as knowledge and skill levels of your trainees will help you tailor your trainings to build on existing knowledge and skills, fill in gaps, and use or build readiness as needed. You do not want to waste time going over issues and skills they already understand, nor do you want to cover topics for which they lack requisite background knowledge or are unmotivated to learn.

Assessing individual readiness may reveal the need to conduct a simple, basic training to ease participants’ concerns and make them feel comfortable talking about sexual violence and/or intimate partner violence prevention issues. Follow-up with groups of this type could include more advanced, skill-building trainings. Conversely, your assessment may lead you to develop more advanced, comprehensive training to meet the needs of professionals such as those called to immediate action because of an agency or community imperative to prevent sexual violence and/or intimate partner violence.
Gathering information about individual readiness can also become an important part of your evaluations later on. Short, pretest surveys, for example, determine participant knowledge about specific topics before your training. After the training, the same survey, given as a posttest, will reveal if participants learned what you intended.

Questions aimed at assessing individual readiness will be highly dependent on exactly what you plan to cover in specific trainings and should be specific, rather than overly broad. Ask individuals to identify:

•       Learning needs and preferred training approaches?(e.g. I understand information best when it is presented in lecture, visual, and auditory formats)
•       Current knowledge about the planned training topics
•       Beliefs?about challenges or barriers related to sexual violence and/or intimate partner violence prevention

•       Their reason or goal for training,?(e.g., I value the information because it will benefit me in my work) which may help reveal how motivated they are to learn new knowledge and/or skills


The professionals you invited to help you develop your trainings—or even a key individual from among them—can provide useful information about the group you are training. Information might include background on education, experience, and skill level within the group as well as details about an organization’s history, work, and relationships in the community.

What if you find variance in levels of knowledge and/or motivation among individuals within a group? You and those helping develop your trainings can incorporate activities to engage all the participants so they will want to learn including compelling stories, skill building that directly addresses what individuals say they want to learn, and asking learners to make plans for how they will apply what they learn (Biech, 2008).


Note: We talk more about how to build and tailor your training content in the next section of the Guide starting on page 33.

Case study: The Center for Community Peace examines organizational context and prepares to explore individual readiness
In a series of meetings with school administrators, personnel, and student groups, center staff learns how different groups perceive the problem of sexual violence. This information provides a gauge of both the school climate and level of support for change. Center staff also discovers what the school has done to address the problem—and what they have not done—and determines if there are any relevant policies in place to help address the issue of sexual bullying and harassment. School administrators in particular show a great deal of support. They pledge to attend the training and take an active role in addressing and preventing sexualied bullying and assault.


The center receives permission to do small focus groups and a limited, school-climate survey with teachers, guidance counselors, and students involved in school clubs to further determine individual readiness. The center particularly wants to know what challenges the school faces in making students, educators, and staff aware of what constitutes sexual assault and why it should not be tolerated.

Determine resource needs

You will need a variety of resources to support and deliver trainings including supplies, money, space, and marketing materials, as well as other human and technical resources. As you develop your training plans, you will obviously have to make decisions about how much you can do based on the resources you have. Some important areas to consider:


•       Human resources. Do you have the staff capacity needed to plan, deliver, and follow up on all the trainings you plan to offer? You will need to either prepare your own staff or find the right trainers to conduct the trainings.
Note: We provide guidance on how to select trainers in the next section of the guide.
•       Technical resources. You may need computers and software to produce training materials and to coordinate schedules and track your progress, including your evaluations. You may also need a laptop and audio/visual equipment to deliver the trainings. Do not forget the staff needed to manage these resources, too.
•       Fiscal resources. You will need to ensure your existing funding can cover staff time devoted to your training plans, pay trainers (if hired from outside your staff), buy food, and rent facilities or seek new sources of funding. You may be able to get some of these items covered through matching or in-kind donations from other participating organizations.
One other resource area to consider is how you plan to publicie and market the availability of your trainings. Do you have a website that can be used or will you need to create one? Do you need mailers, newsletters, or other materials designed, printed, and sent out?

Just as training needs among professionals will probably differ between urban and rural areas, available resources—and needs—will probably vary as well. North Dakota DELTA/EMPOWER state coordinators found, for example, that several local urban and rural coalitions focused on different ways to engage participants in prevention. Rural coalitions worked with community leaders; urban coalitions decided to expand existing prevention partnerships. Available resources to accomplish these tasks varied. While the urban coalitions often had more people or could combine some existing funds to move their work forward, rural communities often found creative new ways of pulling teams together from those working in existing efforts.


As you talk with policy makers, funders, and other potential partners to gather support and resources to improve your training efforts, be sure to describe your training goals and outcomes and your progress so far. If you have not been able to achieve goals and outcomes because of a lack of resources, give policy makers and funders clear ideas about the resources needed to institutionalie and successfully implement effective sexual violence and/or intimate partner violence prevention efforts.

Select trainers

Communications research shows that the messenger can be more important than the message in getting the attention and buy-in of an audience. Whether you use trainers from within your own organization, or work with trainers outside your organization, select people who demonstrate:


•       Firm grounding in primary prevention
•       Knowledge of, experience in, and commitment to the specific content to be presented
•       Credibility with the professionals you are training, which includes experience, profession, position, and language similar to your participants
•       Experience delivering content with cultural competence
•       Experience dealing with possible disclosures of abuse from training participants

Develop a solid training team of people in your agency or community from which you can select individuals to do specific trainings. Ask the professionals who are helping you develop your trainings for input about the make-up of the team and the selection criteria for building the team.
Consider these ideas as you start building your training team:

•       Match trainers with participants. When it makes sense, match trainers with learners by experience, profession, position, and cultural backgrounds. For example, training religious leaders to promote healthy, equitable relationships would be perceived as more credible and relevant when delivered by a leader from the same or a similar denomination. Diverse groups of learners will also benefit from seeing people from their own community on the training team.

•       Develop a diverse training team. A multidisciplinary team approach can be very effective in bringing a broader complement of skills and expertise to your training. Combining different professions such as public health nurses teamed with advocate trainers can also model cross-discipline collaboration for your learners. A multicultural and/or multigenerational training team also models cooperation and sharing among cultures. Consider pairing young people with adults or including trusted leaders from a particular community or cultural group as part of your team.

•       Find other training resources. If your organization does not have the internal staff resources for training, consider hiring consultants. You may also be able to find trainers you can partner with in local colleges or business training centers.

Note: This Guide can be used to help prepare trainers for the tasks described, whether you are using someone within your organization or a professional trainer or consultant. You may need to take some additional time to work more closely with an outside trainer or consultant to develop the content and materials you plan to deliver.

In the Appendix, refer to the worksheet Criteria for Selecting Trainers on page 63 to help you choose trainers who will be a good fit for each of the groups or organizations you train.
 
Summarize what you have learned so far


Now is a good time to start summarizing the information and ideas you have developed thus far. To help you, we have provided the following resources and worksheets in the Appendix to use as needed:
•       •       A completed sample background worksheet on page 66 using the Center for Community Peace case study
•       Worksheet: Use a Logic Model to Map Plan Details on page 70.
•       A completed sample logic model on page 72 using the Center for Community Peace case study

 
Refine and Tailor Your Training Plans

Now that you know who you want to train, who will do the training, what resources you have to work with, and what you hope to achieve, it is time to plan for exactly what you will teach and how you will do that. In this next section, we will cover how to:
•       Tailor or enhance core training content to meet the specific needs of the professionals you will train
•       Determine sufficient dosage for your trainings
•       Determine the best training approaches for your selected groups
•       Train with cultural competence
Note: If you are using the logic model, by the time you reach the end of this section of the Guide, you will be able to fill in many of the remaining sections of it.

Tailor training content for your audience

Earlier in the Guide, we discussed core topics to consider for inclusion in your trainings (i.e., elements of primary prevention, risk and protective factors, definition of sexual violence and/or intimate partner violence, response to disclosures of abuse). Use what you have learned about different groups of professionals to tailor the core content to match their unique needs. Doing so will ensure that everyone you train is exposed to the core topics while also addressing what they need to know to do their jobs.


You can use what you learn from different groups of professionals about what they describe and understand about their organizations and their constituencies to help tailor trainings in culturally relevant ways. This validates and uses the expertise of the participants while helping them see how they can apply what they know in ways that are meaningful for their clients. For example, different racial or ethnic groups may have different norms or language to describe healthy relationships. Professionals who work with these populations may be more knowledgeable about such norms and language and can bring that knowledge to the table. You can help them figure out how to apply their new training skills in ways that best fit with these communities.

In addition to providing the professionals you are training with these important core topics, you also want to teach them the knowledge, skills, and practices they will need to conduct primary prevention of sexual and/or intimate partner violence in their jobs. Although the exact content will depend on whom you are training and what your goals are for those groups, you will want to consider these basic elements:


•       Roles professionals play in preventing sexual violence and/ or intimate partner violence
•       Specific skills and competencies needed to implement prevention strategies for sexual and/or intimate partner violence, including teen dating violence (e.g., helping youth workers model empathy and respect)
•       How to identify teachable moments in professional practice and everyday life
•       Modeling and teaching concepts that influence behavior changes (e.g., interrupting sexist attitudes and behaviors or promoting positive youth development practices into everyday work)

Find logical ways to link the content of your training with what people already do. For example, a youth-serving agency that regularly addresses teen drinking could use newly acquired skill in articulating risk and protective factors to explain the strong association between alcohol use and perpetration, particularly as staff frame the concepts of consent and coercion and use specific examples in their mentoring sessions.

How you present and sequence activities within the training may help make it easier for participants to learn, retain, and ultimately use new knowledge and skills. As mentioned earlier, Biech (2008) notes that participants are more likely to attend trainings and use new skills if they feel their time will be well spent developing abilities that have obvious benefit to then. Among Biech’s suggestions for developing more motivational trainings:


•       Develop up-front learning activities that intrigue, excite and captivate participants’ attention before launching into detailed skill development
•       Instead of just listing objectives and expected outcomes, look for opportunities to develop compelling stories to convey content; testimonials from previous participants could be used to help boost motivation for example
Assist participants in thinking through whether learning new skills will be worth the effort and then help them devise a plan for making the changes they will need to make to put those skills into practice
Note: Later on in the Guide, we will talk about using training follow-up to help move learning into practice.  As you work to tailor content for specific groups, look again at the Whom to Train table starting on page 52 in the Appendix, and consider the information about suggested training content and example outcomes.

Case study: The Center for Community Peace tailors training content


Center staff members are familiar with many of the alternative high school’s students because about 40% of them participate in various programs at the center. Bobby Ming, director of youth programs, and Hani Littlefoot, a certified sexual assault counselor, have talked informally with several students about their experiences with sexualied bullying and assault.


Given these discussions, Ming and Littlefoot research the problem further by conducting focus groups with other students, including those who have not yet come forward to discuss this problem. They obtain a wider student perspective about the sources of the problem. They also gather ideas about how the center could help motivate school personnel to address—and prevent—sexualied bullying and assault.

Some of the topics the center decides to include in the training:
•       Discussions about sexual violence stories as reported in the news compared with what youth report is happening in their communities
•       Discussions about the special needs of some students in the alternative high school context, including what may put them at potentially greater risk for any type of violence
•       Role-play and modeling activities to demonstrate positive, respectful behavior
•       Creation of a plan by youth and adults to make the school safer

Sprinkling vs. saturation

One-time trainings are not sufficient to change behavior. Multiple training sessions are more effective not only for changing behavior, but also for gaining better buy-in and working toward sustainability of those changed behaviors.

How do you determine sufficient dosage? Consider the value of sprinkling vs. saturation. Rather than spreading yourself thin doing six, three-hour trainings to six different groups (i.e., sprinkling), your trainings might be more effective if you deliver two, day-long trainings to two different groups and offer six months of follow-up technical assistance (i.e., saturation). While the second option takes more effort for the trainer, and requires a greater degree of commitment from the professionals you are training, the likelihood of practice change is greater.

One frame of reference to consider -- Many volunteer advocate or crisis line trainings require at least 40 hours before participants can answer the hotline or do first response advocacy. We are not suggesting all of your professional trainings have to be 40 hours long, but you will need to provide more than just a few hours of training if you want to achieve skill changes in the workplace.

Keeping your training goals in mind can help you decide what sufficient dosage means. If you are trying to increase knowledge, you can probably do that effectively with fewer training sessions. Changing behavior—your ultimate goal—will require more time.
You must also consider your own resources when determining appropriate dosage. What level of staff time will be needed to develop, market, and deliver your planned trainings? What sorts of resources will you need to deliver multiple trainings to multiple groups? Does your organization have those resources? If not, you may need to hold less training or look elsewhere for partners who could assist and support your efforts.


You may find some groups want you to train them, but only once. The group making the request may be one that you have been trying to develop a relationship with for a long time or one to which you would like to be more closely connected. While you are trying to avoid short, single-session trainings, such an event may be necessary to nurture a future relationship.
Although single events may help you get your feet in some important doors, once you have accomplished more of your training goals, you will want to be clear about how to make best use of your limited resources and concentrate on saturation. Depending on your community and some of the political considerations you face, you might need to say no to some groups. That is okay. You probably want to spend some time discussing how to negotiate these situations as you develop your training plans.


Identify the best training approaches and methods

The educational strategies used to deliver the content are often as important as the content itself and the person who delivers it. The more your trainings include strategies that reinforce the way your participants naturally learn, retain, and use information, the more effective your trainings will be.


Adults have special needs and requirements as learners that differ from those of children and teens. To increase the effectiveness of your trainings, you will need to first understand how adults learn best and incorporate some of these strategies into your work (Lieb, 1991).


Adults retain more when they can learn through a combination of seeing, hearing, saying, and doing. They need to feel autonomous and self-directed in learning situations, preferring educational environments that deliver practical, goal-oriented knowledge that seems immediately relevant to their experience (Knowles, 1998).

The following table highlights principles of adult learning, along with their implications for training.

Adult education principle   

  
Implications for training plans


Adults learn best when they perceive learning as relevant to their needs. 

  •       Identify learners’ needs and what is important to them.
•       Provide real-life situations and emphasie the application of learning to real problems.
Adults learn by doing and by being actively involved in the learning process.       •        Provide activities that require active participation of learners.
•       Provide activities that involve the learners as whole people: their ideas, attitudes, feelings, and physical being.
Adult learners are unique. Each learns in a different way, at a different rate, and from different experiences. •       Establish an atmosphere of respect and understanding.
•       Use a variety of training techniques.
Participants bring relevant and important knowledge and experiences to the training setting.         •       Provide opportunities for sharing information.
•       Discuss and analye participants’ experiences.
•       Use participants as a resource and encourage them to participate and share their experiences.
Used with permission from the Guide to Participatory Training for Trainers of Primary Health Care Workers, Reproductive Health Response in Conflict Consortium. (2007).
 
Taking time to assess and match the best learning strategies to the training group improves your chances of accomplishing what you set out to do. There is more information available about adult learning than we can realistically cover within the scope of these guidelines. However, the tip sheet Overview of Training Approaches and Methods on page 73 in the Appendix summaries information on adult learning styles as well as training approaches and methods.

Just as prevention strategies cannot have a one-size-fits-all approach, neither can training. Trainers must be aware of the many issues that could influence the learning environment. To be effective and relevant to diverse groups of participants, training design, content, and delivery all need to be done with cultural competency. This is different than talking to groups about cultural competency. We recommend moving beyond simply trying to increase awareness of cultural issues; rather, demonstrate your organization’s full engagement and integration of diverse perspectives. Working with cultural competence involves changing your behavior and is an ongoing, daily, evolving process. Training with cultural competence assumes you will actively engage participants in learning how to change their behavior as well.


Cultural competence is a topic of special interest and study to many. Here, we offer highlights from a variety of sources to help you get started in shaping your trainings. We believe the information provided on cultural competence will be useful in all aspects of your trainings including selecting trainers, tailoring content for specific groups to be trained, and determining appropriate training approaches as you assess the readiness of individuals within those groups.

Note: The professionals you selected earlier in this process to help you develop your training plans will be important resources for also helping you shape the cultural competence of your work.
What training with cultural competence means

Training with cultural competence means trainings are conducted within the context of the unique aspects of various populations and communities.


The Trainer’s Guide for Cancer Education (National Cancer Institute, 2007) notes that culture influences people’s values, attitudes, beliefs, and behavior. Those factors, in turn, influence how they learn, communicate, make decisions, and interact in groups. But culture does not just mean race or ethnicity. Thinking broadly, culture can also include:
•       Gender
•       Sexual orientation
•       Age
•       Physical abilities
•       Language
•       Extent of acculturation
•       Regional differences
•       Level of education
•       Profession or job
•       Spiritual beliefs and practices

In The Spirit of Culture: Applying Cultural Competency to Strength-based Youth Development (Guajardo Lucero, 2000), cultural competency is described as a change process that occurs personally and professionally as people are exposed to various cultural strengths and traditions, learning to do things differently as a result. This change process embraces diversity, using an inclusive process that involves, reaches, and empowers all members and segments of a community.

Paying attention to everyone’s cultural strengths and traditions moves participants from cultural awareness, sensitivity, and valuing, to incorporating this newly appreciated information into one’s individual, family, and community experiences, actions, and philosophies. “It acknowledges, not ignores, our differences,” writes Guajardo Lucero (2000, p. 10). “It goes beyond celebrating culture, which is often short-term and time limited, to promoting a new way of thinking that fully embraces diversity. Embracing means getting to know someone, developing a relationship with them, and engaging in a process of sharing with them.”

Mary Ann Dutton

With contributions from Sue Osthoff and Melissa Dichter

Battering and the effects of battering are complex phenomena, which often are not well understood by the lay public. In addition to physical injury, individuals who have experienced battering often confront an array of psychological issues that differ in both type and intensity. The effects of domestic violence vary according to the social and cultural contexts of individuals' lives and include differences in the pattern, onset, duration, and severity of abuse. Importantly, this context is also determined by institutional and social responses to the abuser and to the survivor of abuse and many other factors characteristic of both persons in an abusive relationship: level of social support, economic and other tangible resources, critical life experiences (e.g., prior trauma, violence history, developmental history), and cultural and ethnic factors (Dutton, 1996; Dutton, Kaltman, Goodman, Weinfurt, & Vankos, 2005; Heise, 1998).

Although individual women experience and respond to battering differently, a number of reactions are common among those who have been exposed to these traumatic events. “Battered woman syndrome” (BWS), a construct introduced in the 1970s by psychologist Lenore Walker, is sometimes used in an attempt to explain common experiences and behaviors of women who have been battered by their intimate partners (Walker, 1989; Walker, 2006) . However, through more than three decades of accumulated empirical research, we have come to recognize major limitations in both the original and revised conceptualizations of BWS, as well as with the term itself (Osthoff & Maguigan, 2005). The use of BWS to describe the experience of women who have been victimized by intimate partner violence or to explain their response to such violence and abuse is both misleading and potentially harmful. As currently defined, the construct of BWS has several important limitations: (1) BWS is often not relevant to the central issues before the court in a specific case, (2) BWS lacks a standard and validated definition, (3) BWS does not reflect current research findings necessary to adequately explain either the experience of individuals who have been battered or their behavior in response to battering, and (4) BWS can be unnecessarily stigmatizing (Biggers, 2005; Ferraro, 2003). This paper reviews the definition, evolution, and utilization of BWS in the courts, and offers a critique of its framework and its use.

What is Battered Woman Syndrome?

BWS is a term typically used to refer to women's experiences that result from being battered. It has evolved from a term used to describe a broad range the victim's (e.g., learned helplessness) and abuser's (e.g., cycle of violence) behaviors to a mental health disorder describing symptoms experienced by an individual following traumatic exposure (e.g., Posttraumatic Stress Disorder, PTSD).

Learned Helplessness

Initially, BWS was conceptualized as “learned helplessness” (Walker, 1977), a condition originally conceptualized by Seligman and his colleagues (Miller & Seligman, 1975) to describe the failure of dogs to escape a punitive environment, even when given the opportunity to do so. The theory was later used to explain depression in humans (Abramson, Seligman, & Teasdale, 1978). Walker (1977) applied the theory of learned helplessness to describe women's seeming lack of effort to leave or escape an abusive relationship or their failure or inability to take action to protect themselves and their children.  

Seligman and colleagues (Peterson, Maier, & Seligman, 1993) have clearly refuted Walker's use of learned helplessness by stating that

In sum, we think the passivity observed among victims/survivors of domestic violence is a middling example of learned helplessness. Passivity is present, but it may well be instrumental. Cognitions of helplessness are present, as is a history of uncontrollability. But there may also be a history of explicit reinforcement for passivity. Taken together, these results do not constitute the best possible support for concluding that these women show learned helplessness (p. 239).

Seligman and colleagues further argue that passivity may be instrumental behavior that functions to minimize the risk of violence, instead of reflecting “learned helplessness” as it was originally conceptualized. Some women who have been battered may appear helpless or intentionally use “passive” behavior (e.g., giving in to demands) to stay safe. Indeed, research with low-income African-American women who have experienced domestic violence showed that, as violence toward women increased, they increased their use of both passive (placating) and active (resistance) strategies for dealing with the violence (Goodman, Dutton, Weinfurt, & Cook, 2003). Further, as Seligman suggested, women sometimes use strategies that may seem passive or tantamount to “doing nothing,” but these may actually be active efforts to reduce the risk of violence and abuse to themselves and their children. Indeed, the intended and actual function of a particular strategy is understood only in the context of the lives of the individual woman and her partner, as well as their relationship together.

Cycle of violence

Another early definition of BWS referred to the “cycle of violence” (Walker, 1984), a theory that describes the dynamics of the abuser's behavior, which is characterized in three stages: tension building, acute battering, and contrite loving. The theory suggests that the abuser keeps the survivor within his control largely by the contrite loving behaviors that follow even severe violence. There is little empirical evidence testing the cycle of violence theory. Walker's own early research showed that only some of the women interviewed in her study reported patterns of abuse consistent with this theory, with 65% of all cases reporting evidence of a tension-bulding phase and 58% of all cases reporting evidence of loving contrition afterward (Walker, 1984). Further, a recent study (Copel, 2006) of the patterns of abuse in a small sample of women with physical disabilities did not find a contrite loving phase in the aftermath of abuse.

Posttraumatic stress disorder

In an attempt to standardize criteria for BWS, Walker (1992) revised the definition to be synonymous with posttraumatic stress disorder (PTSD), a psychological condition which results from exposure to a traumatic event. Indeed, PTSD is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). Many single instances of domestic violence, and certainly the cumulative pattern of violence and abuse over time, easily meet the DMS-IV-TR criteria of a traumatic stressor. These criteria are (1) events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or other and (2) intense fear, helplessness, or horror. The symptoms that defined PTSD include (1) intrusive symptoms (images, thoughts, perceptions, nightmares; distress at exposure to cues that symbolize or remind one of the traumatic event; physiological reactivity to exposure to internal or external cues that resemble the traumatic event), (2) emotional numbing1 (feeling detached or estranged, inability to recall important aspects of the trauma) and behavioral avoidance (efforts to avoid thoughts, feelings, conversations associated with the trauma and activities, places and people that arouse recollections of the trauma), and (3) hyperarousal (difficulty sleeping, anger and irritability, difficulty concentrating, hypervigilance, exaggerated startle response) (American Psychiatric Association, 2000). The psychometric validity of PTSD symptoms has been recently validated with women exposed to intimate partner violence (Krause, Kaltman, Goodman, & Dutton, 2007).

Walker again revised the definition of BWS in 2006 to include not only the three symptom clusters of PTSD (re-experiencing, numbing of responsiveness, hyperarousal), but also three additional criteria (disrupted interpersonal relationships, difficulties with body image/somatic concerns, and sexual and intimacy problems) (Walker, 2006). Many “associated features” (e.g., impaired ability to regulate emotion, dissociative symptoms, shame, feeling permanently damaged, hostility, social withdrawal, feeling constantly threatened, impaired relationships with others) often accompany PTSD, but these are not included in the criteria for its diagnosis. Walker has not provided a rationale for selecting a particular subset of these associated features and for including them as criteria for BWS.

During the 1980s, BWS was included in educational programs and materials of many domestic violence advocates, in trainings for lawyers and judges and was used by some therapists and counselors to describe the experiences of women exposed to domestic violence. Having a scientific-sounding term like BWS to describe what they learned from talking and working with women who had experienced domestic violence proved useful in some cases; it increased credibility with other professionals and the general public. However, as the field developed, more and more practitioners grew to understand the problems and limitations of using BWS; most stopped using the term. During the past 15 years, numerous articles and books have been published discussing the limitation of BWS (Ferraro, 2003; Ferraro, 2006; McMahon, 1999; Schuller, Wells, Rzepa, & Klippenstine, 2004; Stark, 2007; USDOJ/DHHS, 1996). Instead, today many practitioners use the term “battering and its effects” to describe the experiences of women exposed to domestic violence (Osthoff & Maguigan, 2005). Even so, it is important to note that some experts and attorneys continue to utilize the term BWS in their work.  

Use of BWS in Expert Testimony

Expert testimony about battering and its effects has been introduced in a wide range of criminal and civil cases. Most typically, it has been introduced by the defense in cases involving women who are criminally charged, especially women who have killed their abusers. It can also be offered by the prosecution in criminal cases, usually to explain why the survivor of a crime has recanted or is unwilling to participate in the prosecution, or to explain other behaviors that might be difficult for jurors to understand without the aid of expert testimony (e.g., why don't the survivors leave, why would a survivor return to an abuser, why did the survivor act emotionally unaffected right after a shooting). Expert testimony about battering and its effects has also been introduced in civil matters, such as child custody cases, marital dissolution, tort, or personal injury cases. Here we will focus more heavily on the use of the testimony in criminal cases, and more specifically in self-defense cases, although many of the issues described here are also applicable to other uses of expert testimony.

It is in the legal (rather than clinical) arena that BWS continues to be most firmly embedded and to receive the most attention. Indeed, the term BWS appears in some state statutes, as well as in numerous legal decisions. Even today, it is not uncommon to hear about cases that involve expert testimony on BWS. Notwithstanding widespread misconception, BWS is not a legal defense. Regrettably, even to this day, many myths persist about a specialized legal defense using the BWS. Osthoff and Maguigan (2005) outline five basic misconceptions related to the legal defense of women exposed to domestic violence. The most central misconception is that defendants who have been battered invoke a separate “battered syndrome defense.” There is no special “battered women's defense” or “battered woman syndrome defense” (Maguigin, 1991; USDOJ/DHHS, 1996). Other important misconceptions are that expert testimony is only about BWS and that it is based on an analysis of the victimization dynamic only, excluding information about women's strengths, including responsibility (e.g., taking care of her children, providing economic resources to her family), agency (e.g., making decisions intended to protect herself and her children from violence and abuse), and capacity (e.g., competence to act independently and endurance to continue functioning in the face of great adversity).    

Both expert and lay testimony about battering and the effects of battering may be useful in support of (but not to replace) already existing legal defenses, such as self-defense or duress when the defendant in a criminal case is a women who has experienced domestic violence. Also, it may be offered to explain the defendant's behavior to support a different criminal defense or defense theory other than self-defense or duress and/or to negate the specific intent element of a crime.  

In criminal cases involving a woman who has experienced domestic violence as the defendant, it is necessary for jurors to understand why the defendant did what she did. The context of her behaviors – including her motivation – is essential for determining the ultimate issues in a criminal case. For example, a homicide can be ruled as murder if judged to be premeditated “cold-blooded” intent to kill, or it can be ruled as justifiable if understood as an act of self-defense from a “reasonable” perception of danger. When the defendant is a woman who has been battered, what she did (and in some cases, did not do) is not always understandable to the lay individuals on the jury. Judges and jurors can hold myths and misconceptions, which may result from their limited experiences with women who have been battered, and bring these misunderstandings and biases to the bench or jury box. Without information to better understand the defendant's experiences and behaviors, judges and jurors often inaccurately evaluate and unfairly judge the defendant. For example, they may not understand why the defendant did not “simply” leave the batterer, assuming that leaving would have made the woman safe. As a result, they may blame the woman for the abuse she experiences. They may believe that unless the defendant had previously reported the abuse, she is not to be believed when she later asserts self-defense against an abusive partner. It is essential that judges and jurors have the information necessary to fairly understand a defendant's situation, especially when jurors are asked to put themselves “in the defendant's shoes.”  

Thus, expert testimony can be useful to aid the factfinder in determining the “ultimate issue” (e.g., in a self-defense case, reasonable perception of immediate danger), as well as to educate the factfinder about common myths and misconceptions (Maguigin, 1991) . Expert testimony may cover a wide range of topics, such as domestic violence and abuse, characteristics of abusers, the emotional and physical effects of violence and abuse on women and children exposed to domestic violence, women's efforts to protection herself and her children, women's use of strategies to cope with domestic violence, including the use and responsiveness of community resources, the impact of domestic violence on economic stability, employment, and social and family relationships and the influence of contextual factors (e.g., race and ethnicity, economic status, prior trauma history, alcohol and substance abuse, physical and mental health status) on battering and the effects of battering.  

What is Wrong with Battered Woman Syndrome?

Even though expert witness testimony can be useful in cases involving domestic violence, there are serious limitations of using BWS as the framework for this work. Where expert testimony is used to explain an individual's state of mind or behavior, to support a particular defense, or to bolster credibility (when allowed) in situations that might otherwise seem unreasonable or unlikely (Parish, 1996) , a packaged “syndrome” can be convenient and have the perceived legitimacy of a “diagnosis” (Schuller & Hastings, 1996). A number of factors, however, make this package particularly problematic. The most fundamental of these concerns is the lack of relevance of BWS to the issues before the court. A second concern is the lack of a standard and validated definition of BWS with which to guide experts' use in evaluation and testimony. Third, BWS does not adequately incorporate the vast scientific literature on victims' response to battering. Finally, BWS suggests a pathology that can stigmatize the defendant unnecessarily and inaccurately.  

BWS may not be relevant to the issues before the criminal court.

An initial limitation of BWS testimony is that it may not be relevant to the specific issues before the court in a particular case; that is, PTSD (whether referred to as BWS or not) simply may not be relevant for those issues which require explanation by the expert witness.

For example, BWS may not be helpful for explaining why a woman returns to an abuser after separating or fails to call police. She may be reluctant to tell others about the abuse. Expert witness testimony may be needed to challenge mischaracterizations when a woman is well-educated, has access to economic resources, or has specialized training (e.g., police officer) since a judge or jury often does not understand how such a woman could not simply leave or protect herself against an abusive partner. BWS is not particularly relevant for these issues. A woman who appears unemotional right after or right before shooting her abusive husband may be thought merely to have killed in “cold blood.” PTSD may be relevant here, but dissociation as a part of acute stress disorder may be even more accurate. Certain experiences that an abused woman may have had (e.g., substance abuse history, prostitution, criminal history) can easily lend themselves to victim blaming. Expert witness testimony may be required to understand how these experiences do not necessarily negate the reality that the woman may have been abused by her partner, or that she perceived her partner's behavior as an imminent threat to her safety. These particular experiences may make it even more difficult for a woman who is being abused to seek help and effectively protect herself and her children from abuse. Typically, BWS is not adequate or perhaps even relevant to these issues.

According to Federal Rule 702, "If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise" (Federal Rule of Evidence, 2009). There is a great deal of scientific literature that can be brought to bear and is potentially helpful to understand the evidence and to determine facts in issue in domestic violence cases. However, BWS is simply insufficient to this task.

First and foremost, an expert witness needs to know the relevant questions for which expert testimony is needed. Too often an attorney will begin with one question: “Does she have BWS?” without considering the particular relevance of this question to the defense theory or considering how the defendant's particular abusive history is specifically relevant to her conduct. The goal of the expert testimony in most cases is not to “prove” that the defendant has been battered. Rather an expert can help the jury understand better the defendant's experience of abuse and why those experiences are legally relevant. For example, in self-defense cases, perhaps the most relevant question is, "What factors would inform the court to better evaluate the defendant's assertion that she was in immediate danger?" When the expert focuses his or her evaluation on this question, the result is an analysis of those factors that support or fail to support the reasonableness of the defendant's perception of immediate danger, given the circumstances.

Since the expert cannot testify to the ultimate issue, the expert offers to the court an analysis that allows the trier of fact to make a more informed decision about these “ultimate” issues. BWS is neither necessary nor sufficient to explain the defendants' perception of immediate danger. Relying on BWS as the primary explanation for the defendant's perception of danger offers the untenable formulation that only when the defendant has a clinical diagnosis of PTSD is her perception of danger reasonable. BWS is simply not a sufficient explanation for this central question or most other questions typically posed to the expert witness in criminal cases involving a woman who has experienced domestic violence

BWS lacks a standard definition and evidence of scientific validity.

BWS – even as currently conceptualized – lacks both a standard definition and evidence of scientific validity for many of the purposes for which it is used. As stated, BWS is not recognized in the DSM-IV-TR. Although the International Classification of Diseases, 10th Version (ICD-10; World Health Organization, 1993), classifies “battered spouse syndrome” and “effects of abuse of an adult” as maltreatment syndromes, these do little to clarify the definition for use in legal matters. Although numerous articles have been written about BWS, few include validation through empirical research. The term BWS does appear in several state laws, but its definition is not consistent from state to state when a definition is actually included in the language of the statute, which often it is not.

If it is argued that BWS is really just PTSD, then BWS is entirely redundant and there is no need for a separate term. Clear and well-validated criteria for a PTSD diagnosis exist. Expert testimony relying primarily on PTSD can – and is – used by expert witnesses in court. However, it is only appropriate to do so when PTSD is relevant for explaining a particular issue before the court that might not otherwise be well understood by the jury or judge. PTSD might well explain important issues before the court in some cases. An example is when a woman's perception of danger is explained by an intrusive recollection or subjective experience of “reliving” prior domestic violence that may be “triggered” by events leading to the criminal act (e.g., shooting). In this example, the focus is on the woman's internal psychological state (e.g., PTSD), not on external events to explain the perception of threat posed by the abuser's behavior. While this explanation “fits” some battered women who might – due to PTSD – experience objectively nonthreatening events as threatening and might respond in self-defense, it fails to account for many women's accurate understanding of unique danger cues learned over repeated incidents of violence and abuse from their abusive partners.

Indeed, there is a large scientific literature pertaining to PTSD, including empirical research, theoretical and conceptual articles, and clinical case studies. And, a significant portion of this research includes victims of domestic violence and sexual assault, as well as other types of traumatic events, such as child abuse, vehicle accidents, terrorism, and combat. At this point in time, the scientific community does not distinguish PTSD arising from one type of trauma vs. another. When the diagnostic criteria are met, a PTSD diagnosis is appropriate regardless of trauma type. However, clear scientific evidence for PTSD does not translate to support of the construct of BWS. There is no “type” of PTSD called BWS.  

The inclusion of associated features in Walker's 2006 revised definition of BWS further contributes to the lack of standardization in its definition. The reliability of several of the measurement scales used in Walker's study (2006) to “operationalize” BWS using these additional indicators of BWS is unacceptably low. Further, no threshold level of these additional criteria for defining BWS was described. For example, how much or what kind of body image distortion is required to meet criterion for BWS? Does sexual dissatisfaction refer to an abusive partner or someone else and how much dissatisfaction is required to be considered BWS? Again, how much loss of the perception of power and control is necessary? Regrettably, Walker's newer definition has clouded the criteria for assessing BWS even more than had previously been the case. Perhaps more importantly, these issues really have little relevance for many issues raised in criminal cases?

Without standard and validated criteria, we do not have a way to determine with reliability who meets criteria for BWS and who does not. This is a problem in the legal context because, without a scientifically accepted definition or standard criteria, the use of BWS can fail to meet basic standards of scientific reliability and, therefore, may be inadmissible as expert testimony in court under the scientific reliability prong according to Daubert v. Merrl Dow Pharmaceuticals (1993). In sum, because it is not clear what is meant when we say BWS and because we do not have a clear way of measuring the condition, BWS is not even a good shorthand term for explaining the experience of women who have been abused by their intimate partners. Thus, the lack of a clear definition of BWS makes it difficult for jurors and judges, attorneys, parties to a legal case and the lay public, to understand even what is being referred to when the term BWS is used.

BWS does not adequately incorporate current research.

The state of knowledge concerning battering and its effects has increased dramatically in the past three decades since BWS was first introduced. Simply, scientific knowledge continues to expand on an ongoing basis as new research is completed. A qualified expert witness is compelled to rely on the most rigorous available scientific evidence that is pertinent to an evaluation of a defendant and providing expert testimony.

When an expert witness is called to testify in a legal matter involving battering and its effects, he or she is required to have command of the current scientific literature as the foundation for sound theoretically- and empirically-based testimony. It is clear from the current scientific literature what advocates have known, which is that no single profile adequately characterizes women's experiences following domestic violence. BWS is often used to describe victims as if they all experience similar effects from having been exposed to battering and all respond in the same way. For example, we know that patterns of violence and abuse vary across women, as does their desire to remain in relationships, the extent to which they stay or leave (Bell, Goodman, & Dutton, 2007) , and the extent of traumatic effects (Dutton et al., 2005) . BWS is often used as if it were a standard against which to determine whether a particular woman is justified in her actions against an abusive partner, is credible as a woman claiming to have experienced domestic violence, or deserves consideration in some other way. While we know that there is a range of common reactions to being battered by an intimate partner (Dutton, Hohnecker, Halle, & Burghardt, 1994) , how an individual woman experiences or reacts to being battered will vary depending on her psychological, social, cognitive and practical circumstances. Given this reality, it is not appropriate to describe “the profile of a battered woman” or to describe the effects of battering as a “syndrome.”

The expert witness must rely on the continually expanding body of existing scientific literature to develop a formulation in each case about factors that address pertinent questions posed to the expert. This body of scientific knowledge, which provides relevant information for the issues before the court, is extensive. A few of these research areas include primary stress appraisal (“How do victims evaluate the seriousness of actual and threatened violence and abuse?”), secondary stress appraisal (“What options do abused victims perceive that they have to deal with violence and abuse?”), coping (“What do victims actually do to deal with violence and abuse?”, “Why don't victims leave or do other things that some others might expect?”), traumatic stress reactions (“What are the traumatic and related mental health effects of being exposed to violence and abuse?”), and social and cultural context (“How does having children, poverty, gender, racism, immigration status, heterosexism, and other social and cultural factors influence a victim's experience of violence?” “How do these factors influence the way in which she responds to it?”). Notably, there is very little empirical research on BWS per se.

A full discussion of alternatives to BWS as a framework for expert testimony in cases involving battering is beyond the scope of this paper. Briefly, these include expert testimony referred to as “social agency” (Schuller et al., 2004; Schuller & Hastings, 1996) or social framework (Monahan & Walker, 1988) testimony, both of which are available generally to criminal defendants and are not specific to the defense of victims of domestic violence. Another option is simply referring to the testimony as about “battering and its effects” (Osthoff & Maguigan, 2005; USDOJ/DHHS, 1996). These three approaches all refer to the idea that the issues presented to the expert can be explained in terms of the context in which victims experience violence and abuse – relying on the available scientific literature and the expert's experience to inform that testimony.  

BWS can be stigmatizing.

For whom is BWS intended to explain experience and behavior? The answer is not clear. BWS is sometimes used as if to describe the experiences of all women who have experienced domestic violence. At other times, it is used to describe a stereotypic image of the so-called “good” or “sympathetic battered woman.” The “image” of a woman who has experienced domestic violence is often clouded by stereotypes based on race, culture, ethnicity, social and economic class, and sexual orientation.  

BWS often evokes the image of a woman who ends up “snapping” and killing her abusive partner. BWS often creates a stigmatizing image of pathology, which may affect the decision-making of judge, jury, clinician, and/or researcher (Schuller et al., 2004). Interestingly, some research using simulated jurors found that testimony utilizing BWS and PTSD in combination was associated with jurors' opinions focusing on the women's deficits, a pathological view of the hypothetical defendant, even more than BWS alone (Terrance & Matheson, 2003) . Although BWS is intended to explain the experience of women who have been abused, the use of “syndrome” language defined essentially as a mental disorder (PTSD) helps to create an image of pathology. Ironically, a woman with PTSD may also reasonably perceive immediate danger, but not because of PTSD. Nevertheless, the image of PTSD or BWS runs counter to the self-defense argument that the defendant's perception of immediate danger was reasonable for someone in her circumstances and therefore that her actions were justifiable under the law. It is difficult to argue that a defendant who is viewed as “flawed,” “damaged,” “disordered” or “abnormal” by virtue of a mental health diagnosis (PTSD) should be justified in her actions based on the reasonableness of her perceptions. Her perceptions – and even her actions – may be understandable, given her history of domestic violence and its impact on her (e.g., PTSD). However, this argument is likely to be insufficient for a straightforward self-defense claim.

Expert testimony to explain a victim's experience and behavior must also rely on information about non-psychological effects of battering, including disruption of a woman's economic stability and employment, impairment in physical health, and alterations in her view of the world and others in such a way as to influence her trust of others and sense of safety in day-to-day life. Women can feel trapped in an abusive relationship because of the very real threat of further violence, lack of economic resources, and lack of institutional and social support (Anderson et al., 2003; Fleury, Sullivan, & Bybee, 2000) . In most cases, a woman's behavior is best characterized as logical within the context of her abuser's behavior and functional in its attempt to stop the violence and abuse, not the product of a mental health problem. Although emotional dependence and feelings of hopelessness may keep a woman in a relationship with an abusive partner (Short, McMahon, Chervin, Lezin, Sloop, & Dawkins, 2000), these emotions are not defined as a mental disorder. Even when mental health problems, such as PTSD and depression, result from battering, and influence a woman's decisions or her behavior, they are usually only a part of it. Empirical evidence has found that predictions of risk of future assault by women who have experienced domestic violence are often correct (Bell, Cattaneo, Goodman, & Dutton, 2008; Cattaneo, Bell, Goodman, & Dutton, 2007; Heckert & Gondolf, 2004; Weisz, Tolman, & Saunders, 2000).

If a women's behavior is not understood in the full context of their lives, important decisions in a legal case can be incorrectly influenced by stereotypes or assumptions about how or why women who are battered behave the way that they do. In sum, the concept of BWS does a poor job of describing for the court the range of experiences or behaviors of women exposed to domestic violence. Thus, in the courtroom, the use of BWS by those with scientific knowledge and specialized experience with domestic violence fails to serve those who demand, and deserve, the very best: jurors and judges and, ultimately, women who have endured domestic violence.

Conclusion            

The conceptualization of BWS helped the field focus on the fact that battering has adverse effects on those who have been exposed to it. Over three decades later and an accumulation of a wealth of scientific knowledge, BWS is now recognized as a flawed model (Rothenberg, 2002, 2003), even as a shorthand reference. Its use persists, in part, because it conveniently packages in a single phrase a far more complex issue. Indeed, we need to understand the unique experiences of each defendant informed by the large and continually growing body of scientific literature that is pertinent for understanding an individual's experience and reaction to having been exposed to domestic violence. This information can be invaluable in support of expert testimony for explaining the state of mind and behavior of a woman who has experienced domestic violence and who has been charged with criminal conduct that was influenced by her history of violence and abuse.

Author of this document:

Mary Ann Dutton, Ph.D.
Professor and Associate Director
Center for Trauma and the Community
Department of Psychiatry
Georgetown University Medical Center

Consultants:

Sue Osthoff and Melissa Dichter
National Clearinghouse for the Defense of Battered Women
Philadelphia, PA

Endnotes

1 Emotional numbing and behavioral avoidance symptoms are combined in a single symptom cluster in the DSM-IV-TR diagnostic criteria.

2 In some states, this situation may give rise to an “imperfect self-defense,” but this option varies across jurisdictions.

 

Citation: Dutton, M. A. (2009, August). Update of the "Battered Woman Syndrome" Critique. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved month/day/year, from: http://www.vawnet.org

 

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