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The Cooktown-Ten is 5 years old and just hit a milestone…

This month, the Cooktown-Ten (C-10) turns 5, and has been downloaded over 5,000 times all over the world. This coincides with two significant developments in Australian policy to end violence against women and family violence. The launching of Change the Story #2 and The Draft National Plan to End Violence against Women and Children 2022-2032 (the National Plan). Can the C-10 contribute to both of these important frameworks?

What is the C-10?

The C‐10 is a model for use in primary care to encourage the prevention of violence for use by workers in the health and personal service sectors. It was named after the town where it was established as a practice tool in a place with a history of peaceful negotiation that extends tens of thousands of years.

The C-10 revolves around the interactions of 10 factors, six contributing factors of violence and four conditions necessary for a happy and healthy life. The C-10 presents pathways, choices and options, and gives clients the language tools to alter their trajectory to prevent violence before it occurs.

It works by bringing awareness of the intersection of prejudices (sexism, racism etc), frustrations, desperation, place, triggers and isolation. Contrary to popular belief, violence is rarely a one-off-. People don’t just ‘crack’ or ‘lose it’ in the heat of a moment. To commit an act of violence requires overcoming significant barriers in one’s mind. Sets of circumstances have to meet threshold levels before threatening or violent acts can occur. With guidance from the C-10, people can clearly identify their power, and make plans and positive choices for non‐violent actions. It helps people make sense of and explain repetitive cycles of violence and the effects of interpersonal violence and self‐directed harm.

The violence we all hope to prevent includes self‐harm, workplace bullying and harassment, domestic coercive control, intimate partner violence and suicide. The C-10 is used with families, or people at risk of perpetrating violence- we call this anticipatory prevention, proactive counselling that address physical, emotional, psychological and developmental changes germane to all interactions people have with their health and healing workers. It is also an educative framework for whole-of-community primary violence prevention. We’re now on a mission to share the C-10 with health and healing workers, because if these people can have conversations about violence prevention, we have a better chance of saturating the whole population with prevention messaging.

How is it aligned to Change the Story?

Change the Story, produced by Our Watch, is now in its second edition and will continue to underpin Australia’s national policy approach to the prevention of violence against women. The framework’s contribution to the theory of violence prevention is the articulation of the drivers and contributing factors of violence, with gender inequality and misogyny as a key condition for persistently high rates of violence against women in this country. As they state in the second edition:

“There are distinct gendered dynamics to violence in Australia, including differences in prevalence and in the ways in which men and women perpetrate and experience violence.”

And that effective prevention depends on changing the underlying social conditions that produce and drive violence against women, and that excuse, justify or even promote it.

The C-10 reinforces our awareness of the gendered drivers of violence against women, and the contributing factors that coalesce and enable violence to happen. We agree that the prevalence of gendered violence is utterly unacceptable. Taken from Change the Story, some alarming Australian statistics show that:

  • Women were sexually assaulted at a rate seven times higher than men in 2018.

  • In 2012, 95% of men and 94% of women who experienced violence did so at the hands of a male perpetrator.

  • Women are more likely than men to report fearing for their lives at the hands of a partner.

  • 1 in 4 women has experienced violence by an intimate partner, compared to 1 in 13 men.

  • Men are more likely to perpetrate extreme forms of violence that result in serious injury or death.

  • In 2017–2018, men committed homicides at five times the rate of women.

  • Women are more likely to be injured so severely by a male partner that they require hospitalisation.

Effective prevention needs whole populations to be engaged and this is why Violence Prevention Australia has a special focus on health and healing workers. But what is meant by this? Put simply, the combined working populations of the health care and personal services sectors.

The health care, social assistance and personal services industries in Australia employ a vast number of people, across a range of occupations and reaching into diverse settings where prevention work can and should be undertaken.

Think hairdressers, for example, nail technicians, natural therapists, and anyone who spends time with another person and their focus is on one’s health and wellbeing. Why can’t everyone of these people spread the message of prevention by having the C-10 basic principles at the tips of their tongues?

The World Health Organisation and leading advocates for the prevention of violence against women have for years recommended that the health care sector, its entire workforce and multiple sites and settings, be included wholistically in prevention work. Yet, too often the health sector is seen to come in at the end of the road. The emergency department or perpetrator counselling. The health sector is crucial in both the ‘prevention of and response to violence against women and children, particularly to eliminate stigmatising attitudes among health-care providers.[1]

Our Watch states that:

“A national approach requires the active involvement of many other stakeholders … of those who can work effectively with different age groups, as well as those who can work in and with the wide range of population groups and communities who make up the Australian population.”

Sounds like the health sector would be included here, but insert the words we omitted and the full quotation reads:

“A national approach requires the active involvement of many other stakeholders – those who can lead prevention work in schools, workplaces, unions, businesses, leisure venues, sports clubs and the media, and those who can work effectively with different age groups, as well as those who can work in and with the wide range of population groups and communities who make up the Australian population.”

Given the enormity of the health sector in Australia, we would expect that the sector be named in Change the Story. But it is not. Is it assumed that its inclusion lies within the wording ‘workplaces’? We contest that it is not, as Change the Story along with the National Plan fail to see what’s possible when we make a concerted effort to include, prioritise and even go so far as to mandate training for health and healing workers.

Back in 2015, in a series of papers published in the Lancet on violence against women and girls the authors stated that the health sector has barely begun to recognise its potential role and responsibility in responding to violence against women.[2] We’d add that if describing the health sectors’ willingness to engage in prevention work is part of stepping up to that responsibility and role, then in 2022, we have still barely begun. However, we also note the call for health workers to be part of a ‘coordinated prevention strategy’ and, it is not the health sector’s responsibility alone to make this happen. Some ardent voices from within general practice, for example, are frustrated by the ongoing and deliberate exclusion of GPs in prevention work, despite their positioning for effective universal program delivery.

“… health-sector leadership needs to be increased. Health-care practitioners and systems can strengthen the integration of primary prevention in policies and protocols against violence against women and girls, including intersections with other public health concerns…”[3]

The serious inclusion of health and healing workers in Australia may also go some way towards ameliorating the ‘off the charts’ levels of violence perpetrated within doctor’s medical training. Surveys of Australian women medical trainees report endemic cultures of workplace bullying, harassment and institutional tolerance of sexual assault perpetrated by their senior colleagues, bosses, mentors and power-brokers over their careers.

“Bullying, discrimination and sexual harassment are common in the medical workplace, with between one-quarter to three-quarters of medical students and junior doctors experiencing harassment. Sexual harassment is more frequent in medical education than in other university faculties or schools, and experienced disproportionately by female students.” [4]

We contest then, that the omission of the health sector and recognition of its participants and the roles they can and do play in the prevention, is ideological rather than a position derived from evidence. Indeed, what evidence is there to suggest that targeting health and healing workers in violence prevention should not be undertaken?

How can it contribute to the National Policy?

Which brings us to the Draft National Plan to End Violence against Women and Children 2022-2032 a 10-year blueprint that sets out the priorities and targets to end violence against women and children in Australia. Pillar one of the National Plan is dedicated to prevention. The National Plan reflects conventional thinking about prevention as Change the Story.

We have the same concerns expressed above with the language of exclusion of the health and personal services sectors. The National Plan states which settings are suitable for prevention work and we note that there may be some cross-over.

“Firmly embed prevention approaches in all settings including in homes, educational settings, workplaces, law enforcement, media, online, the justice system, sport, the arts and community organisations.”

Further to this, the draft National Plan goes so far as to call out some particular sectors over others for their potential role and influence. “Recognise and champion the critical role of the corporate sector” but NOT the primary preventative role of the health care or personal service sectors? Not even primary health care centres?

Why does this matter? Because given the size, distribution and wide number of people who maintain the health and wellbeing of just about all of us, this omission limits the full potential effectiveness of prevention work. Many of whom do not work in the response-end of a violent incident, yet are in the right location to share prevention messaging regardless of whether a man, woman or young person is or is not deemed ‘at risk’ of violent offending or becoming a victim of violence. Further, the educational pathways are well established, so inserting training materials and supports is a matter of commitment by leaders, and not due to an absence of knowledge and resources.

We see hope and opportunity, and a need for the ongoing development and use of the C-10 with health and healing workers, driven by their hunger to do more as much as our passion to help Our Watch and others bring an end to family and community violence.

[1] García-Moreno, C., Zimmerman, C., Morris-Gehring, A., Heise, L., Amin, A., & Abrahams, N. & Watts, C.(2014). Addressing violence against women: a call to action. The Lancet, 385(9978), 16851695. [2] García-Moreno et al, p.1691 [3] Michau, L., Horn, J., Bank, A., Dutt, M., & Zimmerman, C. (2015). Prevention of violence against women and girls: lessons from practice. The Lancet, 385(9978), 1672-1684. [4] Stone et al., 2019 -Sexual assault and harassment of doctors by doctors: A qualitative study. Medical Education

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