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BCFIV Perspectives
A Case for Prevention

Imagine you are on a picnic on a pleasant spring day with a group of friends. You set out your favourite foods. You are sitting by the bank of a river, and as you are about to bite into a sandwich a cry is heard from the river. "Help, help!" the screamer yells. Putting down your sandwich, you tear off your shoes and coat, dive in to rescue the drowning victim, apply artificial respiration, and then prepare to turn to your picnic. Suddenly two people call out "help, help!" You dive in again and pull them out, one on each arm. As you return three or four others call for help. Again you return, but this time, tired and overwhelmed by several people at once, a few slip away. Again, now in larger numbers, people call for help, but you cannot handle very many. You are only one person and you don't even swim very well yourself. Your friends don't swim at all, but as they watch you one has a bright idea. "Why not go upstream and find out who is pushing these people in?" (As retold by Julian Rappaport, 1977.)

What do we really mean when we speak of prevention of family violence and other forms of abuse?

The basic idea underlying prevention programs in the area of family violence is that efforts are most worthwhile when they take place before abuse or neglect ensues. From a historical perspective, the development of child guidance clinics, and late the community mental health clinic movement, parallel an increased understanding of the importance of early intervention in the provision of services. The number of different service providers beyond that of traditional professional groups has also helped to extend the idea that it is worthwhile to be involved with "at risk" and "in need" populations, in addition to those in acute or crisis situations.

Prevention has commonly been broken down into primary, secondary and tertiary prevention (Caplan, 1964). Primary prevention involves intervening before the abuse has occurred. Primary prevention programs that many of our readers are involved with include prenatal education programs for expectant parents, programs to enhance child self-esteem, and general educational programs for the public dealing with human relationships and non-violent conflict resolution.

Secondary prevention involves intervening so as to minimize the effects of abuse or so that an abusive situation can be avoided. Examples of secondary prevention programs include programs to identify high-risk families, well-baby check up programs, drop-in centres, or taking the child out of the home when a parent is indicating concern about their ability to cope with stress or to deal calmly and nonabusively with the children.

Tertiary prevention has to do with intervention after the abuse has occurred. Examples of such programs include therapy and counselling for victims or offenders.

The above descriptions of the stages of prevention typically corresponds to the populations targeted by public health programs such as medical or dental care: for example, for the total population (fluoridation of public water supply), milestone (fluoride treatments at regular dental appointments), and high-risk (special fluoride treatments for individuals with many cavities).

Our province has a wide and varied array of programs in the primary, secondary and tertiary areas targeting these different population groups. Many of these programs are generating important results. With the establishment of the new Ministry for Children and Families, many service providers are concerned about how decisions to fund or close programs will be made. Each of our locations on the program continuum impacts on our perspective about the best method and the most effective time to intervene, not to mention impacting on the perspective one has on the problem itself. Overriding these issues is the simple fact that the problems and issues our services address are almost always multi-determined and embedded in complex situations, rather than due to a single and easily identifiable cause.

Many of the organizations working in prevention programs and with agencies for children have been brought together under First Call, a province-wide agency devoted to advocating that children are given "first call". The BC Institute on Family Violence is a member of the First Call Task Group on Prevention, a task group currently struggling with defining priorities in terms of prevention and how to best have an impact on policy-makers.

Prevention needs good intentions and much more. In the words of Luciano L'Abate (1990): "This conviction needs to be supported by workable plans and programs relevant to the goal, that is, to increase personal, partnership, and parental competence in all of us." It also needs a broad and well-informed view of the whole picture and a long-term plan to address its various components. Let us hope that the new Ministry for Children and Families approaches its noble goals with wisdom, let us wish them the best, and let us keep our voices raised loud and clear from the banks of the river.

Andrea Kowaz, Ph.D., R. Psychologist
BC Institute on Family Violence