Prevention Form

Instructions: Please fill out this form for EACH prevention strategy used by your agency

Prevention Strategy Code Staff
Strategy Start Date Strategy End Date
Program




1. In which locality/localities did this strategy take place? Show All

To choose multiple localities hold CTRL while selecting


2. What is the prevention strategy that you are implementing? (Must select only one)
Individual/Relationship
Multisession Educational Program
Public Awareness
Single Session Educational Presentation
Training Professionals and Stakeholders
Community/Societal
Changes to Physical Environment
Coalition Building and Community Mobilization
Media Campaign
Policy Change
Social Norms Change
 
3. Where did this strategy take place?
Church/Religious Institution(s)
Community-Based Agency (Boys and Girls Club, recreation center, etc.)
Governmental Agency
Local/State Business, Organization, or System
Neighborhood/Geographically Defined Area (county, city, zip code, etc.)
Other
School-Based: Elementary
School-Based: Middle
School-Based: High
School Based: Community College, College, University

4. How many people participated in/were reached by this strategy?

5. Who is the target population you intend to reach with this strategy? (select all that apply)
Allied Professionals
Child/Youth (under the age of 18)
College/University Students
Faith Community
Geographically Isolated/Rural
Immigrants/Refugees
Incarcerated/Formerly Incarcerated Persons
Internal Agency Members/Volunteers
Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ)
Limited English Proficiency
Military (active duty, retired, discharged)
Other
Parents and/or Caregivers
Persons 60 Years of Age and Older
Persons Underserved due to Race/Ethnicity
Persons with Mental Health/Intellectual Disabilities
Persons with Physical Disabilities

6. Please identify characteristics of the participants for this strategy (select all that apply)
Allied Professionals
Child/Youth (under the age of 18)
College/University Students
Faith Community
Geographically Isolated/Rural
Immigrants/Refugees
Incarcerated/Formerly Incarcerated Persons
Internal Agency Members/Volunteers
Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ)
Limited English Proficiency
Military (active duty, retired, discharged)
Other
Parents and/or Caregivers
Persons 60 Years of Age and Older
Persons Underserved due to Race/Ethnicity
Persons with Mental Health/Intellectual Disabilities
Persons with Physical Disabilities

7. Which protective factors does this strategy seek to address? (select all that apply)
Individual Level:
A personal belief in gender equality, and attitudes and behaviors consistent with that belief.
Personal belief in the positive value of, and commitment to, caring, equality, and social justice.
Presence of skills to experience healthy sexuality and engage in healthy relationships.
Willingness and ability to be active participants in a thriving community in which healthy sexuality and healthy relationships are core values.

Community Level
Communities engage diverse people in activities promoting healthy relationships and healthy sexuality.
The presence of just/fair boundaries and expectations about healthy relationships and healthy sexuality are applied consistently across community entities.
The principles and skills of healthy relationships and healthy sexuality are demonstrated across various institutions.
Relationship Level
Families and/or other important figures provide a caring, open, and encouraging environment that actively promotes positive development, and fosters skills to lay the foundations for healthy relationships and healthy sexuality.
Parents, adult authority figures, and peers of diverse backgrounds model and teach positive interpersonal relationship skills.
Peers, families, and intimate partners effectively identify and respond to behaviors that are potential precursors to violence

Societal Level
Culture equitably values and relies on experiences and leadership from all members of society, including persons of any gender, race, ethnicity, class, sexual orientation, age, ability, religion, or belonging to any other historically oppressed group that has experienced restrictions on their rights.
Developing and maintaining healthy relationships and healthy sexuality is a highly valued social norm.
Shared responsibility across social institutions for developing and maintaining thriving communities in which healthy sexuality and healthy relationships are core values.

I don't know
Protective factor is not listed

 

8. Which risk factors does this strategy seek to address? (select all that apply)
Individual Level:
Belief in rigid, stereotyped gender roles
Experience that violence and coercion are accepted and effective “means to an end”.
Internalized belief that certain groups of people have rights and benefits over other groups of people.
Lack of empathy for intimate/sexual partners.
Lack of social development.

Community Level
Community norms that support the protection of family / peer group “privacy,” regardless of harm being perpetrated by or within these groups
Decision-making institutions within communities support an adversarial approach to relationships and sexuality
Institutions that entitle groups to maintain greater social status over others.
Weak and/or inconsistent community sanctions for perpetration of intimate partner violence or sexual violence.
Relationship Level
Absence of role models who promote healthy relationships and healthy sexuality
Peer/family support for adversarial approaches to relationships and sexuality. That is, promoting “the battle of the sexes” as the normal way that boys/girls and men/women should relate to one another.
Reinforcement/pressure from family and friends to exercise entitlement.
Reluctance to hold others accountable when relationship is perceived as “private,” often stemming from social norms that frame violence as “private” or “family issues,” and prohibit persons outside of the family or “private” group from intervening.

Societal Level
Power differences between groups of people are interwoven in culture. These differences might take the form of sexism, racism, classism, and heterosexism. They create the opportunity for abuse of power, including perpetration of intimate partner and sexual violence.
Rigid gender roles stifle individuality while artificially promoting men as society’s leaders and subjugating women to passive or supporting roles. Social norms governing “acceptable sexual behavior” correspond to these rigid gender roles, and create a sexually adversarial climate in which sexual violence and intimate partner violence can thrive.
Society devalues peaceful problem solving while honoring or promoting violence and coercion as an acceptable means to an end.
There are many policies and practices in our society that promote individual rights/accountability at the expense of collective rights/accountability.

I don't know
Risk factor is not listed
 
Funding Source of Prevention Strategy
BHFF VDH VDSS Other Source - 1 Other Source - 2 Other Source - 3

Status Of This Form In-Progress Complete