In this CVR podcast series, we talk with those doing research and serving victims and learn about the work they've done together.

Tell Us About It, Episode 16: Connecting the Dots Between Multiple Forms of Violence

A convo with Natalie WilkinsJun 21Time: 21:36

This episode of Tell Us About It features a talk with Natalie Wilkins, a behavioral scientist the Centers for Disease Control and Prevention (CDC). Natalie joins us to discuss the creation of the Connecting the Dots tool, an online training tool that is a part of the CDC’s VetoViolence resource. The Connecting the Dots tool offers training that highlights the shared risk and protective factors that research shows are linked to multiple forms of violence perpetration. VetoViolence is a comprehensive resource for violence prevention, offering online training, tips, and tools.

Natalie Wilkins is a behavioral scientist with the National Center for Injury Prevention and Control at the CDC. Prior to this role, she was a Senior Fellow at the CDC Foundation and a Public Health Analyst at the CDC. She holds a PhD in Community Psychology and Public Health from Georgia State University.

Related links:

• Check out the Connecting the Dots training tool:
https://vetoviolence.cdc.gov/apps/connecting-the-dots/

• Read the original Connecting the Dots publication:
https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf

• Learn more about the VetoViolence resource on their website:
https://vetoviolence.cdc.gov/

• Learn more about the National Center for Injury Prevention and Control on their website:
https://www.cdc.gov/injury/index.html

Transcript:

Susan Howley Welcome to Tell Us About It: Victim Research Convos, a podcast from the Center for Victim Research with support from the Office for Victims of Crime. On each episode of Tell Us About It, we talk to researchers and practitioners about their work, the tools being built for use in the field, and how we can work together to build an evidence base for victim services. Today we’re talking with Natalie Wilkins, a behavioral scientist with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. Natalie, welcome and can you give us an overview of your role at the CDC?

Natalie Wilkins Hi, thank you for having me here with you today. As you mentioned, my name is Natalie Wilkins and I am a community psychologist by training, currently working as a behavioral scientists here at CDC. In terms of my role here at CDC, I’ve worked in the National Center for Injury Prevention and Control since 2008 and have had the opportunity over the course of the last ten years to collaborate with a wide range of partners at the national, state, and local levels around Injury and Violence Prevention, particularly exploring ways that we can bridge the gap between research and practice in injury and violence prevention. I think, one of the most important and exciting things about public health to me is that it’s a field that’s grounded in data and scientific inquiry, but also explicitly committed to practical action in the real world to improve the health and safety of the public. And I think that this dual focus is really critical for ensuring that we are addressing injury and violence in ways that the best available data and science and research indicate are likely to be effective. But at the same time, continuing to learn, innovate, and improve based on the experiences and discoveries of those working in applied settings. One of the challenges I find in my role here at CDC is that while this is a really exciting approach to the work – looking at that praxis between research and practice – coordinating and helping to negotiate that bi-directional flow of information between research and practice settings can really be an exciting challenge. And that’s really been where a lot of my professional interest and work has been focused. I’d say, in particular, over the past five years or so, I’ve been working on better understanding the linkages between different forms of injury and violence, understanding that these linkages – or understanding these linkages really requires integrating the best available evidence from the research literature on those connections, and also incorporating experiential evidence from those working in injury and violence prevention practice settings to really get a full picture of how these different forms of injury and violence are really connected.

Susan Howley Natalie I’m a fan girl for the VetoViolence work at the CDC, which I know is part of the work of the National Center for Injury Prevention and Control. And it really has a lot of that bridging the gap work that you have just been talking about, including incorporating practice-based evidence with research-based evidence. But for those of our listeners who are not familiar with the VetoViolence work, can you tell us a bit about that effort?

Natalie Wilkins Absolutely. So VetoViolence was originally developed in 2009 by CDC and in particular by the wonderful health communication staff and contractors we have here working in the Injury Center. And it’s a comprehensive resource that’s really designed to educate and empower communities on how to prevent violence before it happens. And the website that folks can go to if they want to check it out is VetoViolence.CDC.gov. And there are really three main governing principles that guide VetoViolence. It’s really focused on promoting a public health approach to prevent violence that is evidence-based and solutions-oriented. It also is really grounded in a focus on stopping violence in all of its forms before it starts and reducing its consequences as well, so both a primary prevention focus and then also looking at reducing the consequences of violence. And then the third really sort of grounding principle is that it’s really focused on promoting and understanding that violence involves risk and protective factors across what we call the social ecology or at the individual relationship, family, community, and societal levels. And I’d say that over the years here at CDC, we’ve really continued to share research trends and best practices gathered from all over the country from our partners at state and local levels, and the website has really expanded into a home really for diverse and accredited trainings, tools, and resources that we really have tried to make as engaging and interactive as possible with lots of rich imagery, video, and animation. And VetoViolence really has grown in its use and recognition also over the past few years as one of the leading digital toolkits for violence prevention as recognized by public health professionals and organizations.

Susan Howley Well I just love your materials and in fact the Center for Victim Research links to a number of them. But your Center recently released a new tool called Connecting the Dots. Before we get into a discussion about that tool, can you tell us more about the Connecting the Dots initiative? You’ve alluded to this already, but how did this effort get started?

Natalie Wilkins So the original Connecting the Dots publication – folks can access that online, it’s available for download and PDF. It’s got sort of a long web link, but if you Google search Connecting the Dots in CDC, it should take you to the right address. But the original Connecting the Dots publication really provides an overview of the shared risk and protective factors or root causes that research shows are linked to multiple forms of violence perpetration. In other words, it provides sort of insight as to what puts individuals, families, and communities at higher risk for experiencing multiple forms of violence, and also what can help build resilience or protection for people and communities from multiple forms of violence. And the original idea really behind the Connecting the Dots publication came out of a partnership with the Prevention Institute, which is one of our national partners that engages heavily with coalitions in cities across the country around preventing youth violence in particular, as well as a number of other health-related outcomes. And one of the big messages that we were hearing from these local violence prevention coalitions is that communities experience multiple forms of violence simultaneously, yet most prevention efforts are really siloed and focus only on one particular form of violence at a time. And so what we were really hearing from folks in these communities and cities was that they really needed more information on how different forms of violence were connected and whether there were any common or shared root causes that place people at risk or protect them from multiple forms of violence. And we were hearing from folks that this kind of information really would help communities to better coordinate and prioritize their violence prevention efforts and potentially enable them to prevent multiple forms of violence at once.

Susan Howley How did you assemble the research base for this work?

Natalie Wilkins So I worked in partnership with my colleagues here at CDC, Marci Hertz and Joanne Kevins, both scientists in the Injury Center, and we worked with the Prevention Institute to do a deeper dive into the research literature on risk and protective factors linked to multiple forms of violence. And so the way that we went about doing this is we first developed a preliminary list of risk and protective factors for each form of violence and that was based on existing CDC resources. And these different forms of violence that we were looking at included child abuse and neglect, teen dating violence, intimate partner violence, sexual violence, youth violence, bullying, suicide, and elder maltreatment. And then, once we had our sort of preliminary list of risk and protective factors that were linked to each of these different forms of violence, we then reached out to subject matter experts here at CDC who specialize in each of these different forms of violence or the prevention of each of these different forms of violence. And we asked them if they had recommendations for some of the latest scientific articles and review papers that they thought really provided the most up-to-date research evidence on risk and protective factors linked to each of those forms of violence. And then from there, using the information that we gathered through those two processes, we really created a preliminary table that listed all of the shared risk and protective factors that we had found so far, and then it also indicated which forms of violence each of those risk and protective factors had been linked to in the research literature.

Susan Howley Natalie, VetoViolence really works to integrate the practitioner perspective in identifying evidence. How did you integrate the practitioner perspective in the Connecting the Dots efforts?

Natalie Wilkins So as I mentioned before, after we worked with the existing research evidence that CDC had already developed and with our subject matter experts, we then used the information gathered through those two processes to create a preliminary table that listed all of the shared risk and protective factors that we had found so far, and also indicated which forms of violence each of those risk and protective factors had been linked to in the research literature. And at that point, we really wanted to make sure that we were also integrating the experiential evidence and perspective of those working in communities into our process of reviewing the research. So we shared this preliminary table with violence prevention practitioners to review and provide additional feedback, particularly around any of the connections between risk and protective factors in each form of violence that they felt were missing based on their experience in the field. And then based on that feedback, we conducted more focused reviews of the research literature for those areas identified as gaps by our practice partners to determine if there was, in fact, some research evidence that supported these connections that practitioners were seeing in the field. So it’s really in that way that we were able to use a more sort of iterative process that leveraged both the research evidence and the expertise and guidance of practitioners in the field, as well to identify shared risk and protective factors that were really grounded in what folks on the ground were seeing, but also empirically linked through the research evidence to multiple forms of violence.

Susan Howley That’s great. So it sounds like you really produced a much more rich integration of all of the research in this area or all of the collective understanding of this area, rather than just trying to use the researcher perspective standing alone.

Natalie Wilkins Yes, that was really our goal.

Susan Howley That’s really a model for the rest of us. Now if I were coming at the Connecting the Dots initiative for the first time, where should I start? I know you have mentioned the overview and then we have the new tool – where should someone start?

Natalie Wilkins That’s a great question. So for folks who are new to the idea of shared risk and protective factors, a nice place to start might be to either read the original Connecting the Dots publication or if you go to the VetoViolence tool, there’s an interactive training that might be the nicest place for folks to start. So just thinking about the VetoViolence resource overall – again it can be found it VetoViolence.CDC.gov – and if you go to that home page and then click on the Trainings tab, you can scroll down to Connecting the Dots and reach the VetoViolence Connecting the Dots page that way. And the VetoViolence resource really consists of three main parts. The first is that online training that I just mentioned, which provides really an introduction to the links between multiple forms of violence. And then the second section is our Notes From the Field section, which showcases the work of states and communities who are already using a shared risk and protective factor approach to prevent violence. And then the third part of the tool is the Connection Selector and this is the newest addition to the online platform.

Susan Howley Can you tell us why you decided to make this new interactive tool?

Natalie Wilkins So after the publication of the original Connecting the Dots brief, we talked a lot to our state and local partners and traveled to a number of different conferences and meetings to share what we had found from the research evidence about shared root causes that are linked to multiple forms of violence. And during these conversations, we asked violence prevention practitioners what additional tools and resources they needed to help them to take this information and put it into practice to strengthen coordination of violence prevention efforts in their states and communities. And we received lots of really helpful feedback and ideas, and that’s really where the idea for the VetoViolence tools came from. So for example, one of the things that we heard was that folks really needed a way to be able to communicate with their partners about shared risk and protective factors, and so what the connections selector tool does is it allows users to explore risk and protective factors in a more hands-on way. So for example, a user can select two or more forms of violence and see which risk and protective factors are shared across those forms of violence. So if I’m a prevention practitioner working to prevent youth violence in my community, but I’m also concerned about a rise in suicide attempts among youth that I work with, I could select “youth violence” and “suicide” in the connection selector tool and it would help me to identify some of the risk and protective factors that are linked to both of these violence-related outcomes. And then those results might then help me to start thinking about how my community might address some of these shared root causes that are linked to both youth violence and suicide, and potentially have the ability to increase the resilience of youth in my community more holistically.

Susan Howley Great. So it’s a conversation starter and it can start the creative thinking about how to work across these different areas.

Natalie Wilkins Yeah absolutely.

Susan Howley Now Connecting the Dots is really centered on prevention. How can this intersect with work that’s focusing on the response to victimization?

Natalie Wilkins That’s a great question. You know, I’ve talked a lot about how different forms of violence are connected by shared root causes but some forms of violence – particularly those that occur early on in life, such as child abuse and neglect, bullying, and witnessing intimate partner violence – all of these violence experiences increase individuals’ risk for experiencing other forms of violence later on in life. So work focusing on response to victimization, for example services for women who are survivors of domestic violence, can still offer opportunities for prevention for children who are no longer at risk for witnessing violence in their families through those services. Another important way that intervention and response services play a role in addressing shared risk and protective factors is through trauma-informed services and care. We know that even when youth, families, and communities have experienced trauma and violence, increasing protective factors like the coordination of resources and services within communities, and strengthening family and community support, increasing connectedness, these things can all help to buffer the effects of trauma and reduce the likelihood that multiple forms of violence may occur later on.

Susan Howley Now what changes are you seeing as you’ve rolled out Connecting the Dots? Is that what we would find in those case examples or case studies you mentioned earlier?

Natalie Wilkins Yes. So we work primarily with state health departments, so most of our perspective on the impact of Connecting the Dots is centered around their work. There may be other examples of impact outside of that sphere, but one example of where we’ve really started to see a shift is through the core State Violence and Injury Prevention Program. This is a program that provides CDC funding to 23 state health departments across the country to address multiple forms of violence, as well as preventing multiple forms of unintentional injury as well, such as motor vehicle injuries and traumatic brain injury. These state health departments have a broad scope of work and are measuring the impact of their prevention efforts, not only on these injury and violence outcomes, but also on shared risk and protective factors that are linked to those outcomes. And I’d say that one of the biggest shifts that we’ve started to see through this program is the restructuring of state strategic injury and violence prevention plans to focus on shared risk and protective factors. And usually with state health departments, they’re tasked with developing plans for addressing a wide range of injury and violence outcomes, including multiple forms of violence, motor vehicle injury, opioid overdose prevention, traumatic brain injury, older adult falls. And increasingly what we’re seeing is that states are moving toward a more integrated strategic plan approach that really prioritizes activities and strategies that address shared risk and protective factors at the state level, versus separate plans for each of those different forms of injury and violence. And one example of this – that is featured on the Notes From the Field page on VetoViolence that you mentioned ­– is in Colorado, where the state health department has restructured its statewide Injury and Violence Prevention Plan to focus on some priority shared protective factors for their state. And that includes connectedness, increasing behavioral healthcare access, and economic stability. And they’ve also developed a comprehensive data dashboard that is helping to measure the impact of their work on these protective factors in counties across the state. And then another example would be in Utah, where their state health department is in the process of developing a new state Injury and Violence Prevention Plan, and they’ve been working really collaboratively with other state agencies and local health departments to identify shared risk and protective factors that will be prioritized across the state in order to improve multiple injury and violence outcomes there.  We’ve also heard examples from other states that are working toward changing organizational structures and cultures to facilitate a shift towards addressing shared risk and protective factors versus each of these injuries and violence outcomes in those siloed approaches. For example, some states are starting to train leaders within their health departments on the importance of focusing and working on shared risk and protective factors among violence types, and making the case for how this can really help to coordinate prevention work, both within and outside the health department with other partners, such as behavioral health and juvenile justice.

Susan Howley Well that must be really gratifying for you and your colleagues to be able to look at these state plans and other things to see that the work that you all have been doing is really resonating on the ground with people. It shows that this need was really there and that your efforts were well-placed here. Natalie, what is next for this type of intersectional work? Looking forward, do you see different iterations of this tool in the future, or where do you think this sort of researcher-practitioner work is heading?

Natalie Wilkins That’s a great question. I think there’s a number of ways that we are working right now toward expanding and building upon this work, both from sort of the research side as well as on the practice side. I’d say from a research perspective, right now we’re really currently working on conducting a comprehensive review of the research literature on shared risk and protective factors linked to multiple forms of unintentional injury, including motor vehicle injury, traumatic brain injury, and opioid overdoses. And then on the practice side, we’re really continuing to learn from our state and local partners about what it takes to apply a shared risk and protective factor approach to violence prevention in practice. And as more and more states begin to really make this shift towards a shared and coordinated approach to violence prevention and addressing shared risk and protective factors, we’re really committed to showcasing and sharing their successes and the lessons that they’re learning, as well as some of the innovations that are really coming up through their work with others so that we can really do our best to continue to support the field in putting this kind of an approach into place. And really making sure that there’s a more sort of coordinated and holistic approach to injury and violence prevention in states and communities.

Susan Howley Well, we will all be watching your progress eagerly. Natalie, I want to thank you for your time today. We’re so glad that someone is helping all of us connect the dots and make our efforts more effective across victimization and injury types. Thank you so much for sharing your work with us today.

 

Natalie Wilkins Thanks so much for having me.