Violence in Families

Assessing Prevention and Treatment Programs

Rosemary Chalk and Patricia A. King, Editors

Committee on the Assessment of Family Violence Interventions

Board on Children, Youth, and Families

Commission on Behavioral and Social Sciences and Education

National Research Council and Institute of Medicine


NATIONAL ACADEMY PRESS
Washington, D.C.
1998



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--> Violence in Families Assessing Prevention and Treatment Programs Rosemary Chalk and Patricia A. King, Editors Committee on the Assessment of Family Violence Interventions Board on Children, Youth, and Families Commission on Behavioral and Social Sciences and Education National Research Council and Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C.1998

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by the Carnegie Corporation of New York under contract number B5936, the U.S. Department of Health and Human Services under contract number HPU 940003, and the U.S. Department of Justice under contract 95-1J-CX-0001. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Violence in families : assessing prevention and treatment programs / Rosemary Chalk and Patricia A. King, editors ; Committee on the Assessment of Family Violence Interventions, Board on Children, Youth, and Families, National Research Council and Institute of Medicine. p. cm. Includes bibliographical references (p. ) and index. ISBN 0-309-05496-6 (cloth) 1. Family violence—United States—Prevention—Evaluation. 2. Crisis intervention (Psychiatry)—United States—Evaluation. 3. Evaluation research (Social action programs)—United States. I. Chalk, Rosemary A. II. King, Patricia A., 1942- . III. Board on Children, Youth, and Families (U.S.). Committee on the Assessment of Family Violence Interventions. HV6626.2.V56 1998 362.82'927'0973—dc21 97-45375 This book is available for sale from theNational Academy Press, 2101 Constitution Avenue NW, Washington, DC 20418. Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). This report is also available on line at http://www.nap.edu Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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--> Committee On The Assessment Of Family Violence Interventions PATRICIA A. KING (Chair), Georgetown University Law Center JACQUELYN C. CAMPBELL, Johns Hopkins University School of Nursing DAVID S. CORDRAY, Vanderbilt Institute for Public Policy Studies DIANA J. ENGLISH, Office of Children's Administration Research, Department of Social and Health Services, State of Washington JEFFREY A. FAGAN, School of Public Health, Columbia University RICHARD J. GELLES, Family Violence Research Program, University of Rhode Island JOEL B. GREENHOUSE, Department of Statistics, Carnegie Mellon University THE HONORABLE SCOTT HARSHBARGER, Office of the Attorney General, Commonwealth of Massachusetts DARNELL F. HAWKINS, Departments of African-American Studies and Sociology, University of Illinois, Chicago THE HONORABLE CINDY LEDERMAN, Eleventh Judicial Circuit of Florida, Miami ELIZABETH McLOUGHLIN, San Francisco Injury Center, San Francisco General Hospital ELI NEWBERGER, Family Development Program, Children's Hospital, Boston JOY D. OSOFSKY, Department of Pediatrics and Psychiatry, Louisiana State University Medical Center HELEN RODRIGUEZ-TRIAS, Pediatrician/Consultant in Health Programming, Brookdale, California SUSAN SCHECHTER, School of Social Work, University of Iowa MICHAEL E. SMITH, School of Law, University of Wisconsin, Madison BILL WALSH, Investigations Unit, Youth and Family Crimes Bureau, Dallas Police Department CAROLE L. WARSHAW, Cook County Hospital, Chicago ROSALIE WOLF, Institute on Aging, The Medical Center of Central Massachusetts, Worcester JACK P. SHONKOFF (Liaison), Board on Children, Youth, and Families CATHY SPATZ WIDOM (Liaison), Committee on Law and Justice, Commission on Behavioral and Social Sciences and Education ROSEMARY CHALK, Study Director NANCY CROWELL, Staff Officer KATHERINE DARKE, Research Assistant SEBLE MENKIR, Research Assistant (through August 1995) CINDY PRINCE, Project Assistant NIANI SUTARDJO, Project Assistant (through August 1996)

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--> Board On Children, Youth, And Families JACK P. SHONKOFF (Chair),Heller Graduate School, Brandeis University DAVID V.B. BRITT,Children's Television Workshop, New York City LARRY BUMPASS,Center for Demography and Ecology, University of Wisconsin FERNANDO A. GUERRA,San Antonio Metropolitan Health District, Texas BERNARD GUYER,Department of Maternal and Child Health, The Johns Hopkins University ALETHA C. HUSTON,Department of Human Ecology, University of Texas at Austin RENEE JENKINS,Department of Pediatrics and Child Health, Howard University Hospital SARA McLANAHAN,Office of Population Research, Princeton University ROBERT MICHAEL,Harris Graduate School of Public Policy Studies, University of Chicago PAUL NEWACHECK,Institute of Health Policy Studies and Department of Pediatrics, University of California, San Francisco MARTHA PHILLIPS,The Concord Coalition, Washington, D.C. JULIUS B. RICHMOND,Department of Social Medicine, Harvard University Medical School TIMOTHY M. SANDOS,National Digital Television Center, Littleton, Colorado DEBORAH STIPEK,Graduate School of Education, University of California, Los Angeles DIANA TAYLOR,Women's Health Program, Department of Family Health Care Nursing, University of California, San Francisco GAIL WILENSKY,Project Hope, Bethesda, Maryland ELEANOR MACCOBY (Liaison),Commission on Behavioral and Social Sciences and Education RUTH T. GROSS (Liaison),Board on Health Promotion and Disease Prevention, Institute of Medicine DEBORAH A. PHILLIPS, Director ROSEMARY CHALK, Deputy Director ANNE BRIDGMAN, Program Officer for Communications DRUSILLA BARNES, Administrative Associate

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--> Contents     TABLES AND FIGURES   ix     PREFACE   xiii     EXECUTIVE SUMMARY   1 1   INTRODUCTION   11     Scope of the Problem   12     Fragmentation of the Field   13     Challenges to Effective Evaluations   14     Charge to the Committee   17     Study Approach   18     The Committee's Perspective   29 2   FAMILY VIOLENCE AND FAMILY VIOLENCE INTERVENTIONS   31     Definitional Issues   32     Measurement Issues   38     Risk Factors   41     Interventions   50 3   IMPROVING EVALUATION   59     Assessing the Limitations of Current Evaluations   60     Points of Collaboration Between Researchers and Service Providers   77

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-->     The Dynamics of Collaboration   85     Evaluating Comprehensive Community Initiatives   89     Conclusion   91 4   SOCIAL SERVICE INTERVENTIONS   93     Child Maltreatment Interventions   95     Domestic Violence Interventions   110     Elder Abuse Interventions   115     Conclusions   118 5   LEGAL INTERVENTIONS   158     Child Maltreatment Interventions   160     Domestic Violence Interventions   171     Elder Abuse Interventions   184     Conclusions   188 6   HEALTH CARE INTERVENTIONS   206     Child Maltreatment Interventions   211     Domestic Violence Interventions   223     Elder Abuse Interventions   231     Conclusions   233 7   COMPREHENSIVE AND COLLABORATIVE INTERVENTIONS   260     Types of Interventions   261     Examples of Comprehensive and Collaborative Interventions   264     Improving Evaluation   271     Conclusions   272 8   CROSS-CUTTING ISSUES   274     The Ecological Context of Family Violence   275     Approaches to Punishment and Rehabilitation   278     The Roles of Autonomy and Competence   281     Cultural Factors and Community Representation   283     Assessment of Dangerousness and Risk   285     Conclusions   287 9   CONCLUSIONS AND RECOMMENDATIONS   289     Conclusions   290     Recommendations for Current Policies and Practices   294     Recommendations for the Next Generation of Evaluations   304     Topics for Basic Research   312     Forging Partnerships Between Research and Practice   315

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-->  REFERENCES 319   APPENDICES A  Site Visit Resources 359 B  Biographical Sketches 367  INDEX 375

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--> Tables and Figures TABLES S-1   Total Number of Quasi-Experimental Evaluations of Family Violence Intervention by Service Sector, 1980-1996   4 1-1   Array of Interventions by Type of Family Violence and Institutional Setting   22 1-2   Total Number of Quasi-Experimental Evaluations of Family Violence Interventions by Service Sector, 1980-1996   28 2-1   Past Year Rates of Family Violence (per 1,000 persons)   34 2-2   Array of Services for Family Violence by Service Sector and Purpose   51 2-3   Federal Programs That Provide Services or Sponsor Research Relevant to Family Violence   53 2-4   Estimated Annual Costs of Family Violence   56 3-1   Interventions by Type of Strategy and Relevant Quasi-Experimental Evaluations, 1980-1996   69 3-2   Reviews of Multiple Studies and Evaluations   73 3-3   Outcome Measures Used in Evaluations of Family Violence Interventions   86

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--> 4-1   Expected Outcomes of Social Service Interventions for Child Maltreatment   96 4-2   Range of Family Support Interventions   98 4-3   Responses to Reports of Child Maltreatment by Child Protective Services   107 4-4   Expected Outcomes of Social Service Interventions for Domestic Violence   111 4A-1   Quasi-Experimental Evaluations of Parenting Practices and Family Support Services   122 4A-2   Quasi-Experimental Evaluations of School-Based Sexual Abuse Prevention   130 4A-4   Quasi-Experimental Evaluations of Intensive Family Preservation Services   138 4A-5   Quasi-Experimental Evaluations of Child Placement Services   146 4A-6   Quasi-Experimental Evaluations of Individualized Service Programs   148 4B-1   Quasi-Experimental Evaluation of Shelters for Battered Women   150 4B-3   Quasi-Experimental Evaluations of Advocacy Services for Battered Women   152 4B-4   Quasi-Experimental Evaluations of Domestic Violence Prevention Programs   154 4C-2   Quasi-Experimental Evaluation of Training for Caregivers   156 4C-3   Quasi-Experimental Evaluation of Advocacy Services to Prevent Elder Abuse   156 5A-3   Quasi-Experimental Evaluations of Court-Mandated Treatment for Child Abuse Offenders   190 5A-4   Quasi-Experimental Evaluations of Treatment for Sexual Abuse Offenders   192 5B-3   Quasi-Experimental Evaluations of Arrest Procedures   194 5B-4   Quasi-Experimental Evaluations of Court-Mandated Treatment for Domestic Violence Offenders   198 5B-5   Quasi-Experimental Evaluations of Criminal Prosecution   204 5B-7   Quasi-Experimental Evaluations of Systemic Approaches   204 6-1   Public Health Strategies for Preventing Violence and Its Consequences   209 6A-1   Quasi-Experimental Evaluations of Identification and Screening of Child Maltreatment   238 6A-2   Quasi-Experimental Evaluations of Mental Health Services for Child Victims of Physical Abuse and Neglect   240 6A-3   Quasi-Experimental Evaluations of Mental Health Services for Child Victims of Sexual Abuse   242

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--> 6A-4  Quasi-Experimental Evaluations of Mental Health Services for Children Who Witness Domestic Violence  246 6A-5  Quasi-Experimental Evaluation of Interventions of Mental Health Services for Adult Survivors of Child Abuse  246 6A-6  Quasi-Experimental Evaluations of Home Visitation and Family Support Programs  248 6B-1  Quasi-Experimental Evaluations of Domestic Violence Screening, Identification, and Medical Care Responses  252 6B-2  Quasi-Experimental Evaluations of Mental Health Services for Domestic Violence Victims  256 FIGURES 1-1  Family Violence Interventions by Type of Strategy  24 3-1  Hierarchy of Strength of Evidence in Research Evaluations  63 6-1  Public Health Scientific Method and Its Role in Family Violence Research  208 7-1  Examples of Service Integration Initiatives  263 8-1  Systems That Influence Family Violence and Interventions to Address Them  276

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--> The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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--> Preface In May 1993, a group of 35 research scholars, state and federal officials, and representatives from law enforcement, social services, and health care systems met at the Wingspread Conference Center in Racine, Wisconsin. The purpose of this meeting was to examine whether it would be feasible to synthesize the body of research knowledge that had emerged in the past few decades regarding the development, implementation, and effectiveness of interventions designed to treat and prevent family violence. The participants agreed that efforts are needed to bridge the gap that now exists between research resources and policy needs in addressing the problem of family violence, and that one way to address this gap is to synthesize the rigorous evaluations of public-sector programs designed to treat or reduce incidents of child and spousal abuse and abuse of the elderly. They emphasized that, although no single strategy for prevention or treatment has yet proven to be effective in the research literature, the existing evaluations of relevant program interventions should be identified and analyzed to disseminate important lessons learned from past efforts to reduce family violence. In response to the guidance of the Wingspread meeting participants, the Board on Children, Youth, and Families of the Commission on Behavioral and Social Sciences and Education (CBASSE) of the National Research Council (NRC) and the Institute of Medicine (IOM) established a Committee on the Assessment of Family Violence Interventions in August 1994. Funding was provided by several agencies within the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Justice (DOJ). The sponsoring agencies within DHHS include the Centers for Disease Control and Prevention, the Administration for Children and Families, the Office of Maternal and Child

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--> Health, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration. The National Institute of Justice was the DOJ sponsor. Funding was also provided by the Carnegie Corporation of New York. The Office of Health Promotion and Disease Prevention within DHHS served a valuable administrative role in coordinating the DHHS agency contributions for this project. This study is the latest in a series of reports by the NRC that examine the emerging social science research base on violence and families. It builds on five earlier NRC publications related to this topic. Understanding and Preventing Violence—Volume 1 (National Academy Press, 1993). This report is a comprehensive review of America's experience of violence, taking an interdisciplinary approach to examining the causes and consequences of interpersonal violence. The report includes a chapter on violence in families that describes the array of family violence interventions, research findings about police interventions and battered women's shelters, and the difficulties of evaluating and comparing interventions in this area. Understanding and Preventing Violence—Volume 3: Social Influences (National Academy Press, 1994). This volume includes four background papers that review research on violent victimization; violence between spouses and intimates; gender and interpersonal violence; and the role of alcohol and psychoactive drugs in violent events. The paper on spousal and intimate violence by Jeffrey Fagan and Angela Browne examines the state of empirical and theoretical knowledge on violence between adult partners and presents a social epidemiology of intimate violence, characteristics of victims and assailants, and an assessment of risk markers for marital violence. Understanding Child Abuse and Neglect (National Academy Press, 1993). This report presents a research agenda for studies of child maltreatment. It reviews the state of research on different forms of child maltreatment, including physical and sexual abuse, emotional maltreatment, and neglect. The research agenda emphasizes the importance of studies that address the nature and scope of child maltreatment, its causes and consequences, the assessment of prevention and treatment interventions, and the need for a science policy to guide the development of research in this field. Violence and the American Family (National Academy Press, 1994). This workshop report presents a summary of the Wingspread meeting that called for the development of an in-depth analysis of the state of knowledge regarding family violence interventions. Understanding Violence Against Women (National Academy Press, 1996). The result of a study requested by Congress in the 1994 Omnibus Crime Prevention Act, this report presents an agenda for research on intimate partner violence and sexual assault. The study identifies gaps in the knowledge base in this area and recommends a strategy for building comprehensive and interdisciplinary

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--> studies that can examine the causes and consequences, nature and scope, and prevention and intervention for violence against women. These NRC reports provide important insights into what is known about interventions in the field of family violence. But their assessment of rigorous evaluation studies of treatment and prevention programs is limited. In this study, our committee sought to extract knowledge from research concerning the evaluations of family violence interventions as well as insights reported in other assessments of selected interventions. The committee met six times over a 24-month period to identify major conceptual themes and to review the relevant knowledge base in formulating its conclusions and recommendations. This synthesis of research and program evaluation knowledge was augmented by expert opinion through two workshops, commissioned papers, consultant reports, and five site visits designed to draw on the experiences and insights of service providers in the health, social service, and legal communities. The study also included a review of the methodological issues associated with research in areas characterized by weak conceptual clarity and immature measurement (Institute of Medicine, 1994). The committee benefited from an inter-agency working group organized to help guide the early stages of development and the dissemination of this study and to share agency research resources. Program officers from the sponsoring agencies also participated in the committee workshops. We are grateful to each of these officials for their thoughtful contributions over the course of the study: Bernard Auchter and Christy Visher from the National Institute of Justice; Ashley Files, Matthew Guidry, and James Harrell from the Office of Health Promotion and Disease Prevention; Lynn Short from the Centers for Disease Control and Prevention; Frank Sullivan from the Substance Abuse and Mental Health Services Administration; Audrey Yowell from the Office of Maternal and Child Health; Malcolm Gordon from the National Institute of Mental Health; William Riley from the Administration for Children and Families; and Michael Levine from the Carnegie Corporation of New York. The committee's study identification and data collection effort required an extensive staff effort; these studies appeared in dozens of journals and had not been previously assembled into a research database. Study director Rosemary Chalk and research assistants Katherine Darke and Seble Menkir, in consultation with committee member David Cordray, identified search strategies and citation indexes to gather the appropriate studies. The results of their effort are presented in Tables 3-1 and 3-2. Katherine Darke provided an important contribution in the preparation of the individual research review tables that are included in Chapters 4 through 6. The committee held two workshops in Washington, D.C. to inform its deliberations. The first workshop was designed to elicit expertise and perspective from service providers associated with treatment and prevention interventions in child maltreatment, domestic violence, and elder abuse. Background papers

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--> prepared by the workshop participants were published in an interim report by the committee (Service Provider Perspectives on Family Violence Interventions, 1995). The participants observed that much of the information regarding family violence programs does not appear in the research literature, and that reforms in community-based interventions have not been studied in a systematic manner. The second workshop focused on evaluation methods and research designs associated with the assessment of family violence interventions. The participants included researchers who had studied selected interventions in health care, social services, and law enforcement settings. They reviewed specific methodological challenges and creative strategies that have been used in the selection and retention of research subjects, the ethical and legal concerns associated with research in this field, and the quality of data that is associated with administrative records in public agencies. The site visits were coordinated by Katherine Darke, who contacted local organizations and developed comprehensive itineraries for committee members and staff in each of the five cities that served as the subjects of these meetings (Boston, Dallas, New York City, Miami, and Seattle). A detailed listing of these organizations is included in Appendix A. Several consultants provided background information that was very helpful to the committee's work. Jodi Short and Joseph Youngblood contributed materials on the nature and scope of family violence and federal intervention programs (Chapter 2). Anne Flitcraft, Patti Culross, Patricia Mrazek, and Michelle Forcier prepared background materials on health care interventions for domestic violence (Chapter 6). Terry Fulmer and Georgia Anetzberger prepared a research review on elder abuse interventions that informed several chapters. The material in Chapter 3 that pertains to client referrals, screening, and baseline assessment benefited from a publication prepared by Georgine Pion and David Cordray (Cordray and Pion, 1993). Chapter 5 benefited from contributions by Diane Juliar and Juliana Blome and a research paper on legal interventions for family violence developed by Alissa Pollitz Worden. The committee is grateful to all these contributors. The committee also benefited from the tremendous support of the staff of the Board on Children, Youth, and Families and the Institute of Medicine: Cynthia Abel, Nancy Crowell, Katherine Darke, Seble Menkir, Faith Mitchell, Deborah Phillips, and Michael Stoto contributed careful readings, draft chapters, and literature searches that identified relevant materials throughout the development of the project. Lauren R. Meader, Julie Walko, and Susan M. Fourt of the National Research Council Library provided invaluable assistance in identifying and collecting research materials. Special thanks are due to senior project assistants Niani Sutardjo and Cindy Prince who provided administrative support during the study, including the organization of meetings, workshops, and the preparation of several drafts of the report. Project assistants Karen Autrey and Roger Butts helped to prepare the final draft for publication. Communications director Anne

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--> Bridgman was particularly helpful in the final stages of preparing the report and planning its dissemination. We also thank our editors Rona Briere and Christine McShane, whose efforts contributed significantly to the organization and presentation of the panel's views. Most of all, thanks and acknowledgment of extraordinary effort are due to the members of the committee and our study director Rosemary Chalk. Patricia A. King, Chair Committee on the Assessment of Family Violence Interventions

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Violence in Families: Assessing Prevention and Treatment Programs

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