THE EXPECT RESPECT CALENDAR PROJECT A PILOT PROJECT TO ADDRESS DEPRESSION AND FAMILY VIOLENCE IN SCHOOL STUDENTS IN SOUTH ASUTRALIA Introduction According to the World Health Organisation (WHO, 2012) over 350 million people worldwide are affected by depression. Depression often starts in youth and can impact on persons wellbeing for the rest of their life (WHO, 2012). Current research shows that young women experience a high rate of depression, and that depression can be related to many factors such as genetics, family circumstances and particularly if living with violence (Rees, Steel, et.al. 2014; Artz, Jackson, et.al, 2014; Buzi, Smith, et.al, 2015). Domestic violence can be prevented (Graffunder, Noonan, et al., 2004). This report will examine the relationship between the prevalence of depression in relation to family violence for young people and offer a school-based public health intervention to address this issue. A socio-environmental framework will be used, and gender will be examined using a participatory model (Baum, 2008). Strong community partnerships will be built and developed during the planning and delivery of this project. It is hoped that such partnerships will also build trust and cooperation in the community (Baum, 2008). The Expect Resect Calendar Project for Year 6 students A Pilot Program The Ottawa Charter for Health Promotion (WHO, 1986) notes that health promoting skills often already exist within communities, and this expertise can be called upon to advance systems and thus enhance health. The WHO (2014), also state that intersectoral action has been successful in enacting changes in perceptions of mental health. The proposed intervention will engage many sectors of the community in order to address depression. Depression in young women can develop as a result of living in a domestic violence situation (Sternberg, Lamb, et. al., 1993). Furthermore, many young people experience intimate partner violence in their early relationships. Many young people do not seek assistance for mental health issues due to stigma (Wilson, 2007; Pinfold, Toumlin, et al., 2003). Providing information to young people, in particular to girls, regarding how to stay safe and avoid such potentially violent relationships can ensure their safety and thus reduce the onset of depression (Pinfold, Toumlin, et al, 2003). Using a socio-environmental model (Baum, 2008), a public health intervention is proposed. School teachers are offered a package of information and training which will equip them to deliver a block of lessons to year six school students. Providing interactive information has been shown to be successful with this age group (Graffunder, Noonan et al., 2004). The training will include information provided by other agencies such as SA Police, local youth workers and mental health workers. The students will learn about respectful behaviour and will translate this learning into positive statements regarding respectful behaviour. In addition, they will design posters that will include their drawings and declarations about respectful behaviour. Twelve of their pictures will be used to produce a calendar for the following year that will be launched on White Ribbon Day (see http://www.whiteribbon.org.au/). Funds for this project will be provided by local service groups (Rotary, Zonta International, and the Girl Guides Association) who may also be involved in classroom work (i.e. as guest speakers). The launch will include the school students and class teachers along with local youth workers, representatives from SA Police, local TAFE colleges, Local Government staff, General Practitioners and local media. Men attending the event will be encouraged to state the White Ribbon oath (I swear never to commit, excuse or remain silent about violence against women. This is my oath. http://www.whiteribbon.org.au/ accessed online 8 March 2015). This program will be evaluated and may be enhanced and further developed for the following year. In addition, the program could be developed in other schools across that state. Framework for the Expect Respect Calendar Project Frameworks and approaches to public health interventions are varied, and some have been shown to have more success than others (Baum, 2008). Evaluations have highlighted that interventions that draw on the strength and capabilities of the local community achieve better health outcomes. Community groups in many communities drive health action (Baum, 2008, p. 508). Traditionally groups such as social clubs, womens action groups and youth clubs offer support, funding and ideas for community ventures. Following this notion, the Expect Respect project will be guided by a participation model (Baum, 2008, p 489). In addition, a strength-based approach as described by Baum (2008) and Lin (2007) will also inform the processes. The drive and passion often seen within service clubs (for example Zonta International, 2015) serves to highlight that volunteer organisation can effect change, thus highlighting a participatory manner of working (Baum, 2008). In addition to this participation, a socio-environmental approach is utilised in this intervention. A socio-environmental approach has been described as the interrelationship between social systems or setting and human health (Lee, and Stewart, 2013, p. 795). In the Expect Respect project the social systems are observed by the action of the teachers in the classroom who will engage the young people to consider respectful behaviour in their own lives and the lives of others. Moreover, the young people will consider health in relation to disrespectful behaviour and the impact such conduct can have on a young person. Ideas of mental health and illness will then be considered. Finally, the potential harm from family violence will be examined. This will then be translated into the pictures and statements (sketched and drafted by the students) to be included in the calendar. The students will see their work in print. Funds raised from the sale of the calendars could be allocated to the next years calendars or donated to the White Ribbon Campaign. Gender, Depression and the Expect Respect Project As noted by Sen and Ostlin (2008, p. viii.), taking action to improve gender equity in health is one of the most direct and potent ways to reduce health inequities . This view of gender resonates with that of Baum (2008), who notes that although women in industrialised countries tend to live longer than men, they have poorer health overall. In addition, women also experience more violence in their lives. However, data to capture this information is lacking (Baum, 2008). The analysis of the different levels of power within relationships is useful when examining the health of women (WHO n.d.). Gender analysis can show how norms in society inform the individual how to behave as female or male. The Expect Respect project will assist in the development of appropriate skills for both boys and girls. The young people will learn about respectful and safe behaviour in society, and this will lead to improved safety for girls and boys. In turn, if society is safer for young people then there will be less prevalence of depression. Depression Current evidence based theory influences Current theory in public health has developed rapidly in recent years. The dominant contemporary approaches to health are medical, behavioural and socioeconomic (Baum, 2008). According to Labonte (in Baum, 2008), a medical approach to health treats people who are already unwell, a secondary approach to health addresses peoples behaviour in the hope of changing their actions. Settings and organisational structures are examined in the socioeconomic approach (Baum, 2008). The Expect Respect project is built upon the premise of both behavioural and socioeconomic models. The project aims to develop behavioural changes to raise awareness of respectful behaviour and also challenges the predominant gender frames. Moreover, the project examines family violence and its relationship with depression and mental health. It also highlights a socio-environmental methodology by inspiring the community to participate in action (Baum, 2008). A goal of the socio-environmental approach to public health is for communities to experience fewer inequities between population groups (Baum, 2008, p. 445). In the Expect Respect project, it is hoped that the experience of learning about respectful behaviour, along with community participation will result in fewer inequities and improved mental health outcomes particularly for young women. Primary prevention, in tandem with a corresponding whole of community response, has had some extensive successes in the United States (Graffunder, Noonan et al., 2004). The Expect Respect Project hopes to mirror these achievements, and continue to work with the community as the project develops further. Conclusion Symptoms of depression can start early in life and affect the whole lifespan. Young women often experience elevated rates of depression (Rees, Steel et.al, 2014), and this can be related to factors that include family violence. The Expect Respect project is proposed to address depression in students in school which draws on the skills within the community. Community partnerships will be established and enhanced throughout this project. Funding will be sought from local service clubs (Rotary, Zonta International) and a class teacher will deliver lessons regarding respectful and safe behaviour that will highlight appropriate conduct and also highlight how poor behaviour and family violence can lead to depression. A socio-environmental framework has been utilised along with considerations of gender roles. Depression in young people, especially among young women, must be addressed adequately. The Expect Respect Project will prove to be a starting point for the community to address depression in girls and, following evaluation, it can be rolled out throughout the state. References Artz, S., Jackson, M. A., Rossiter, K. R., Nijdam-Jones, A., Gczy, I., & Porteous, S. (2014). A Comprehensive Review of the literature on the impact of exposure to partner violence for children and youth. International Journal of Child, Youth and Family Studies, 5(4), 493-587. Baum, F. (2008). The new public health, (3rd ed.). South Melbourne, VIC: Oxford University Press. Buzi, R. S., Smith, P. B., Kozinetz, C. A., Peskin, M. F., & Wiemann, C. M. (2015). A Socioecological Framework to Assessing Depression Among Pregnant Teens. Maternal and child health journal, 1-8. Graffunder, C. M., Noonan, R. K., Cox, P., & Wheaton, J. (2004). Through a public health lens. Preventing violence against women: An update from the US Centers for Disease Control and Prevention. Journal of Womens Health, 13(1), 5-16. Lee, P. C., & Stewart, D. E. (2013). Does a SocioEcological School Model Promote Resilience in Primary Schools? Journal of School Health, 83(11), 795-804. Lin, V., Smith, K., Fawkes, S. (2007). Public Health Practice in Australia: The organised effort. Allen & Unwin, NSW Australia. Marcus, M., Yasamy, M. T., Van Ommeren, M., Chisholm, D., & Saxena, S. (2012). Depression: A global public health concern. WHO, 2012 accessed on line 8 March 2015. 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When and how do young people seek professional help for mental health problems? The Medical Journal of Australia, 187(Supplement), S35-S39. White Ribbon Campaign. http://www.whiteribbon.org.au/ accessed online 8 March 2015. WHO. (1986). Ottawa Charter for Health Promotion. Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ on 14 February 2015. WHO. (2003). Social determinants of health: The solid facts (2nd ed.). Retrieved from the Torrens University Australia Library databases. WHO. (1986). Ottawa Charter for Health Promotion. Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ on 14 February 2015. WHO (n. d.). Gender and womens mental health. Retrieved from http://www.who.int./mental_health/prevention/genderwomen/en/ WHO and Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. Geneva, World Health Organization. Zonta International (2015). http://www.zonta.org/ accessed online 8 March 2015.
According to the World Health Organisation
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