social behavioral and cultural factors in public health

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

person’s 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, women’s 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

year’s 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.

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