The Cooktown Ten: a problem structuring model for violence prevention: addressing violence through primary care

Abstract

This piece of writing is to provide background and description of our thinking behind The Cooktown-Ten (C-10). The C-10 is a model for use in primary care to encourage the prevention of violence. Understood as a pathogenesis, it can be used by health professionals in primary care settings. The violence that has the potential to be prevented in primary care settings is violence that occurs on a personal scale. This includes a range of significant harms to individuals and groups including self-harm, workplace, domestic, intimate partner, family and community violence, and suicide. The subject of significant attention in Australia, the elimination of violence against women and their children, such as gender-based sexual assault, harassment and domestic violence, is a national priority. In our opinion a significant gap in the suite of prevention efforts is the capacity to work with all people at risk of using violence prior to any event. Yet most practitioners work with those affected after the act. The pathogenesis of violence presented in this paper is based on many years of clinical practice and brings together literature from divergent fields. The C-10 is a problem structuring tool for counselling opportunities to understand, explain and ameliorate all types of violence including physical, psychological, social, and self-directed harms, and to identify and make an effective plan to support people to make positive choices for non-violent action. It has been developed and used in time and resource poor settings with and for General Practitioners (GPs), nurses, allied and other health sector workers. Any such model should be useful to practitioners and be just complex and robust enough to enable an exploration of the variety of nuances within a persons' situation. Our model can be used to explain repetitive cycles and effects of interpersonal violence and self-directed harm. The C-10 can be used with individuals, groups, families and communities. It is intended as a free resource for clinical use. Currently clinical applications are based on Level 5 evidence. It is hoped that ongoing research will build on this evidence base. At a minimum, this model provides a conversation template and a take-home framework to allow individuals to reflect, anticipate and modify their responses to problems—to make deliberate choices to avoid violence in their actions.