Prevention Form
Instructions:
Please fill out this form for
EACH
prevention strategy used by your agency
Prevention Strategy Code
Staff
Choose One
Staff Member A
Staff Member B
Staff Member C
Staff Member D
Staff Member E
Strategy Start Date
Strategy End Date
Program
Choose One
ACTS*Turning Points
Abuse Alternatives
Alexandria Domestic Violence Program
Amherst County Commission Against Domestic Violence
Arlington County Violence Intervention
Artemis House (Shelter House INC)
Artemis House - VDSS Grant
Avalon: A Center for Women and Children
BV Outreach
Bedford Domestic Violence Services
Bethany House for Battered Spouses
Boat People SOS
Center for Earth-based Healing
Central VA Task Force on Domestic Violence Later in Life
Chesterfield Co. Domestic Violence Resource Center
Christian Relief Services
Citizens Against Family Violence
Clinch Valley Community Action, Inc.
Collins Center
Council on Domestic Violence Page County
Crisis Center
Domestic Violence Emergency Services
Doorways for Women and Families
Eastern Shore Coalition Against Domestic Violence
Empowerhouse
Ethiopian Community Development Council
Fairfax Co. Office for Women & Domestic and Sexual Violence Services
Family Crisis Support Services
Family Resource Center
Family Violence and Sexual Assault Unit
Fauquier Co. Dept. of Social Services
Fauquier Domestic Violence Services
Fauquier Faith Partners
First Step
Franklin County Family Resource Center
Ft. Lee Community Svc. Family Advocacy Program
Genieve Shelter
Goochland Family Services
Hampton Roads Community Action Program
Hanover Safe Place
Harmony Place
Haven in Richmond County
Haven of Dan River Region
Hearts of Hope
Help and Emergency Response
Hope House of Scott County
James House Intervention/Prevention Services
Jewish Coalition Against Domestic Violence
Korean Community Service Center of Greater Washington
LGBT Life Center
LGBTQ Helpline
Laurel Shelter
Loudoun Citizens for Social Justice/LAWS
New Directions
PREA Hotline
Partners In Hope
Pearl's Center of Hope
People, Inc. Domestic Violence Program
Phoenix Project
Powhatan Department of Social Services
Powhatan/Goochland Domestic Violence Program
Project Empower
Project Hope of Quin Rivers
Project Horizon
ProjectLGBTQ Helpline
ProjectPREA Hotline
ProjectVSDVAA
Rappahannock Council Against Sexual Assault
Response Woodstock
Response:Sexual Assault Support Services
Sacred Heart Center
Safe Harbor
Safehome Systems
Samaritan House
Services to Abused Families
Sexual Assault Resource Agency
Sexual Assault Response & Awareness Blue Ridge Community
Sexual Assault Response Program of the YWCA of Central Virginia
Sexual Assault Responses and Awareness
Sexual Assault Victim's Advocacy Service
Sexual Assault Victims Volunteer Intervention
Shelter for Help in Emergency
Side by Side
Southside Center for Violence Prevention
Spousal Abuse Friend and Educator Program
State Agency
Test Agency
The Center for Sexual Assault Survivors
The Laurel Center
Total Action for Progress - Domestic Violence Services
Transitions Family Violence Services
Tri-County Community Action
Turning Point (The Salvation Army)
UVA Gender Violence & Social Change
VCU Sexual Assault Program
Virginia Anti-Violence Project
Virginia Family Violence and Sexual Assault Hotline
Virginia Sexual and Domestic Violence Action Alliance
Virginians Aligned Against Sexual Assault
Women's Resource Center of the New River Valley
YWCA Domestic Violence Prevention Center
YWCA Women in Crisis Program
YWCA Women's Advocacy Program
1. In which locality/localities did this strategy take place?
Choose One
- Out of State
- Unknown
Albemarle Co.
Alexandria
Bath Co.
Danville
Goochland Co.
Greensville Co.
Halifax
Lunenburg Co.
Mecklenburg Co.
Nottoway Co.
Petersburg
Powhatan Reception and Classification Center
South Boston
Town of Bedford
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
If multisession educational program was selected, please enter the number of sessions provided
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If multisession educational program was selected, please select the curriculum used
Action Alliance’s Teen Dating Violence Prevention Facilitator’s Guide
Ask.Listen.Respect Consent Campaign
Bringing in the Bystander
Care for Kids
Coaching Boys into Men
DO YOU
Expect Respect
Family Life and Sexual Health (FLASH)
Fourth R
Green Dot
Nurturing Parenting Program
Our Whole Lives
Peaceline
Red Flag Campaign
Rights, Respect, Responsibility (3Rs)
Safe Church
Safe Dates
Safer Choices
Second Step
Shifting Boundaries
Teen Health Project
Too Good for Violence
Other
If training professionals and stakeholders was selected, please enter the number of sessions presented.
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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