Breaking the uncomfortable silence

Solutions through education and training

Mobilizing partner abuse research to support practice

For Nadine Wathen, solutions are hardest when you cannot even define the scope of the problem.

“Every time you think you have a solution pinned down, the nature of the problem changes,” explained the Western researcher.

“You’re not only chasing solutions, you're also chasing the problem. Everything is so interconnected. This is a 'wicked' problem.”

As national co-lead of the Violence, Evidence, Guidance, Action (VEGA) project at Western, Wathen is focused on examining the inter-related problems of intimate partner violence, child maltreatment, and children's exposure to violence in the home, while creating evidence-based educational tools long-missing for professionals expected to provide help for women and families. “It’s an Emperor's New Clothes phenomenon,” she said. “We expect the system to be able to help, but we don't provide these individuals any training or tools to do their work.”

Supported by a $4.5 million grant from the Public Health Agency of  Canada, and co-situated at McMaster University, VEGA’s work will result in a universal curriculum that arms health and social service providers with tools to help adults and children experiencing family violence.

There are 22 national organizations united in VEGA, including leading nursing, physician, and dental bodies, as well as those representing allied health and social services.

Such logical ideas. Create a co-ordinated, multi-disciplinary plan to help victims of family violence. Give frontline workers the tools to identify and respond safely to those affected. Provide appropriate help at the best time. Integrate principles of trauma- and violence-informed care, cultural safety and humility.

VEGA is ongoing. But big changes are coming as the program begins to roll out this summer and through next year. It was the first project funded under the Government of Canada’s 10-year, $100 million plan to support victims of violence.

Wathen has been researching family violence and seeking solutions to it for more than 20 years. Much of her work has been done at Western. VEGA is the latest project in a professional life dedicated to finding solutions to end violence against women and children.

“It is near and dear to my heart.”

Nadine Wathen

Wathen was initially trained in psychology and has two degrees in the subject. That flows through her work. She is a feminist researcher, committed and unflinching in reporting findings, even when “what we have uncovered does not align with what people want to hear.”

“From a policy perspective, we were wandering in the wilderness. Nobody cared,” said the Information and Media Studies and Nursing professor of her earliest days researching domestic violence and trying to mobilize knowledge for policy and practice. “I got into this realizing we didn’t know very much.”

As national co-ordinator of the Canadian Task Force on Preventive Health Care in the 1990s and early 2000s, her work revealed that, while one in three Canadians are either currently being or have been at one time abused in their lifetime, effective approaches to care were few and far between. That fact angers her.

“It resonated with me. I grew up in a home with a lot of conflict, an abusive stepfather who drank too much. You know, there was a lot in my early work that helped me unpack some of my own experiences. I just saw it as a fundamental social justice issue.”

Her passion is evident when talking about those she wants to help. The connection she makes between her work and her sense of purpose also shows up her role as a professor. She uses what she call the “irritation method” to inspire PhD and Master’s students to get “irritated” enough about issues to inspire their research, “if it doesn’t bother you, why bother?”, she says.

She has described her research as collaborative and multi-disciplinary, a path she sees as the best one to tackling the complex issues around abuse, especially involving prevention. More than once, she referred to the breadth of the research at Western and the fact it’s done by interconnected teams. She feels privileged to work with scholars like Western Nursing Professor Marilyn Ford-Gilboe, a key collaborator on the VEGA Project, in developing and testing interventions for abused women, and CREVAWC’s Barb MacQuarrie in examining the impacts of domestic violence on workers and workplaces.

It is a strategy that addresses different parts of what she called “the whole, complex ecosystem of understanding different prevention points in family violence. Prevent it before and if you can’t, prevent it from happening again.”

VEGA opened Pandora’s Box.

Many family physicians are time-squeezed, with just a few minutes allotted per patient. What if the doctor asks and someone then reveals abuse? These are not easy, or quick, conversations, especially when the doctor might not know what to do next; sometimes it's easier to not raise the issue.

“Many doctors would just rather not go there. That, to me, was a fundamental gap in the system. There's an expectation that helping professions should be helping.”

It’s a point she made in an interview with the The New York Times  January 2018 about research conducted in 2009 on the lack of effectiveness of domestic violence questionnaires being given to women before they saw medical staff.

... “The assumption that telling the story will automatically be healing is optimistic,” said Nadine Wathen, a researcher at the University of Western Ontario’s Center for Research and Education on Violence Against Women and Children. “All women have different experiences of abuse; all people dealing with trauma do.”

In a 2009 study, a research team including Dr. Wathen tested the impact of giving women who visit emergency rooms and other health clinics a domestic violence questionnaire - a brief, confidential checklist. Providers got the results of the questionnaire before seeing the women, and advised them based on the added information; the study tracked them over 18 months.

The questionnaires made no difference: the women who got them fared no better or worse than women in a comparison group who did not.

“The underlying dynamic of so much abuse is coercive control, so pushing people to disclose can replicate those patterns of coercion” and backfire, Dr. Wathen said.

More Than 150 Women Described Sexual Abuse by Lawrence Nassar.
Will Their Testimony Help Them Heal?

New York Times
Jan. 26, 2018

VEGA’s approach centres on establishing standard curricula for teaching health and social service providers to recognize and respond to family violence, not only to be alert to signs and symptoms of abuse, but to know when is the appropriate and safest time to have a conversation with a patient or client, and exactly how to go about it. To help, they’ll get advice, including scripts, to follow with patients, along with “practice-ready tools” for recognizing and responding safely.

VEGA is also developing game-based learning with the Games Institute at the University of Waterloo. The interactive game creates scenarios around abuse situations as they present in various care settings. The learner tries out different approaches to get to the best methods for care. It’s a teaching system that helps learning stick and provides a way to learn skills safely.

“Our innovative, but also practical, approaches to learning, as well as our partnerships with the key professional organizations responsible for educating providers, are the core of VEGA. This will be a game changer."

Linda Barnard

Written by Linda Barnard