4
Social Service Interventions

State and municipal governments and nongovernmental entities provide a broad range of social services designed to prevent or treat family violence. These services include counseling and advocacy for victims of abuse; family and caregiver support programs; alternative living arrangements, including out-of-home placement for children, protective guardianship for abused elders, and shelters for battered women; educational programs for those at risk of abusing or being abused; intensive service programs to maintain families at risk of losing their child; and individual service programs in both family and placement settings.

Social service interventions may consist of casework as well as therapeutic services designed to provide parenting education, child and family counseling, and family support. Social service interventions also may include concrete services such as income support or material aid, institutional placement, mental health services, in-home health services, supervision, education, transportation, housing, medical services, legal services, in-home assistance, socialization, nutrition, and child and respite care. The scope and intensity of casework, therapeutic services, and concrete assistance to children and adults in family violence interventions are often not well documented, and they may vary within and between intervention programs. As a result, similar interventions (such as parenting practice and family support services) may offer very different kinds of services depending on the resources available in the community and the extent to which the clients can gain access to available services.

Some social service interventions (such as child protective services) are directly administered by state agencies; some services (such as parenting education and family support programs) are funded by government agencies but are



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--> 4 Social Service Interventions State and municipal governments and nongovernmental entities provide a broad range of social services designed to prevent or treat family violence. These services include counseling and advocacy for victims of abuse; family and caregiver support programs; alternative living arrangements, including out-of-home placement for children, protective guardianship for abused elders, and shelters for battered women; educational programs for those at risk of abusing or being abused; intensive service programs to maintain families at risk of losing their child; and individual service programs in both family and placement settings. Social service interventions may consist of casework as well as therapeutic services designed to provide parenting education, child and family counseling, and family support. Social service interventions also may include concrete services such as income support or material aid, institutional placement, mental health services, in-home health services, supervision, education, transportation, housing, medical services, legal services, in-home assistance, socialization, nutrition, and child and respite care. The scope and intensity of casework, therapeutic services, and concrete assistance to children and adults in family violence interventions are often not well documented, and they may vary within and between intervention programs. As a result, similar interventions (such as parenting practice and family support services) may offer very different kinds of services depending on the resources available in the community and the extent to which the clients can gain access to available services. Some social service interventions (such as child protective services) are directly administered by state agencies; some services (such as parenting education and family support programs) are funded by government agencies but are

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--> provided by public or private services; other services (such as advocacy services for battered women) rely on grass roots support or local voluntary agencies. All of these interventions are designed to address the social support and safety needs of individuals and families, but they often have different focal points in meeting the needs of their clients. Their goals include the protection of children and vulnerable adults; the enhancement of parents' ability to support and care for their children; the preservation of families; and the development of resources and networks to enhance family functioning, the safety of women, and the care of children and the elderly. Although treatment and prevention interventions for child maltreatment, domestic violence, and elder abuse have drawn on a series of theoretical frameworks over the past three decades, the connections between interventions and research are often uncertain and ambiguous. Their development has involved trial-and-error experiments in which ideas gain prominence for a short time, only to fade when disappointing results are documented (Wolf, 1994). The interventions have focused on different levels—the individual, the family, the neighborhood, and the social culture—each providing a different set of outcomes of interest, complicating the tasks of designing interventions and evaluating their effects. In addition to shifts in theoretical frameworks and relevant outcomes, evaluations of social service interventions have been complicated by two other significant factors: (1) variations in programs that are viewed as a single intervention and (2) differences in the population of children or adults who receive the social services. Conflicting results in evaluation research studies thus may reflect these program differences (such as the intensity or scope of services or the training of service personnel) or variations in the personal histories or types of problems experienced by the clients served. This chapter reviews social service interventions and the available evaluations of them, using the selection criteria discussed in Chapter 1, first for child maltreatment, then for domestic violence, and finally for elder abuse. Although this discussion of social service approaches to addressing family violence identifies specific interventions, these are far from distinct strategies. There is substantial overlap in the specific services provided by each intervention—which raises the critical cross-cutting question of which elements in this set of interventions are most effective in preventing and treating family violence. Nevertheless, the specific interventions discussed in this chapter have been identified by the field, and the evaluation literature has evolved from these services as they are identified. For this reason, the committee has retained these somewhat arbitrary distinctions. Although the interventions are described in discrete categories, the individual interventions are part of a continuum of services available to victims and their families. The interventions discussed in one section may therefore be relevant in other sections of the chapter and to interventions discussed in the chapters on legal and health care interventions.

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--> Child Maltreatment Interventions Research points to the interaction of multiple factors in the maltreatment of children; the interaction of these factors has been described in a variety of theoretical models that have evolved over the past decade (National Research Council, 1993a,b). Current models include (a) the ecological models of Belsky and Garbarino, based on the original conceptions of Ure Bronfenbrenner (Belsky, 1980; Garbarino, 1977); (b) the transitional model, which regards child maltreatment and maladaptive parenting as extreme ends of a continuum of interactions among social and cultural forces, parenting roles, and individual behavior (Wolfe, 1991, 1994); and (c) the transactional model of Cicchetti (Cicchetti and Carlson, 1989), based on Sameroff and Chandler's (1975) formulations, which focus on interactions among risk and protective factors in the social environment of the family. All three approaches share underlying assumptions that individual characteristics of the child or parent are insufficient to explain the nature and emergence of child maltreatment; each group of models uses a different set of assumptions to examine the interactive processes, perceptions, stresses, and social supports in the family environment. Theorists have considered specific factors that appear to play a significant role in the different models: social isolation (DePanfilis, 1996; Kennedy, 1991; Ammerman, 1989), stress (Fanshel et al., 1992; Kennedy, 1991), mental health disorders (McCord, 1983), lack of knowledge about child development and rearing (Wolfe, 1987), contributing child behavior (including the lack of knowledge of self-protective behaviors) (Fanshel et al., 1992), and social and individual characteristics such as poverty and substance abuse. Three decades of research and practice have shifted the focus of treatment and prevention interventions away from models based solely on individual pathology toward broader social ecological models, with a new emphasis on the social context of parent-child relationships (Wolfe, 1994). Although the focus of concern is the child victim, interventions in this area often target the parent (usually the mother), under the assumption that behavior change in the parent will protect the child. Such activities include parent support groups, parent education, home visiting, mental health, and other concrete social support and therapeutic services. Programs targeting children include skill-building around resistance to maltreatment, conflict management skills, and therapeutic interventions. Table 4-1 lists some major outcomes expected from social service interventions, many of which lack reliable measures. Most treatment and prevention interventions do not include data related to child maltreatment as an outcome measure, and those that do usually rely on reports of child abuse and neglect rather than observations of parent-child interactions. Many of the outcomes highlighted in the table are interrelated; any single intervention may have several intended outcomes for parents, for children, or for both. The relationships among outcomes, such as changes in mental health,

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--> TABLE 4-1 Expected Outcomes of Social Service Interventions for Child Maltreatment Child Outcomes Parent Outcomes Enhanced child development and well-being Improved parenting skills, knowledge of child development, and more realistic expectations for child behavior Fewer child hospitalizations and fewer emergency room visits More stimulating home environment Lower injury and death rates and reduced child accident rate Reduced use of corporal punishment Amelioration of symptoms of maltreatment Increased use of community services and enhanced social support Ability to recognize dangerous and potentially dangerous situations Fewer and more widely spaced pregnancies (for young parents) Knowledge of and appropriate use of self-protective behaviors Reduced stress Reduction in reports of child abuse and neglect Reduction in out-of-home placements     SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998. parenting skills, use of community and other support services, child development, child maltreatment reports, and injury and death rates, are still poorly understood. Changes in cognitive or social skills may or may not be accompanied by behavioral changes (such as use of community resources); both are thought to be highly influenced by social context and cultural forces. For example, individuals are unlikely to seek out formal or informal services that have consistently been unavailable or unreliable in their family networks or neighborhoods. Six social service interventions for child maltreatment are reviewed in the sections that follow: (1) parenting practices and family support services, (2) school-based sexual abuse prevention, (3) child protective services investigation and casework, (4) intensive family preservation services, (5) child placement services, and (6) individualized service programs. The sections are keyed to the appendix tables that appear at the end of the chapter. 4A-1: Parenting Practices and Family Support Services Child neglect is the most common form of child maltreatment reported to

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--> child protective service agencies (National Center on Child Abuse and Neglect, 1996b). Researchers have suggested that families who are socially isolated and lack social support may be more prone to neglect than matched comparison samples (Belsky, 1980, 1993; Belsky and Vondra, 1989; Bronfenbrenner 1979; Cicchetti, 1989; Rizley and Cicchetti, 1981; Thompson, 1994, 1995; Wolfe, 1987, 1991). A number of strategies for intervention have been described and evaluated in the research literature, including (1) individual social support interventions, such as lay counseling, in-home education and parent aide programs, and parent education support group interventions; (2) multiservice interventions that match services to the specific needs of families; (3) risk assessment interventions that assess the strength of the family social support systems; (4) social skills training that seeks to improve a family's ability to gain access to appropriate resources and services (see Table 4-2); and (5) intensive family preservation services, which provide family support counseling and referrals during periods of crisis. These interventions are discussed below in terms of what is known about the outcomes associated with different strategies. Another strategy for preventive intervention, the home visitation program, is usually administered by public health departments and is discussed in Chapter 6 in our review of health care interventions. Variations in the selection of relevant outcomes as well as differences in the service and evaluation designs make it difficult to compare the results of social service interventions in the area of child maltreatment. There is a lack of consensus about the definition of neglect (Dubowitz et al., 1993; Hegar and Youngman, 1989; Zuravin, 1991), the goal of the intervention, key constructs that should be assessed in evaluating outcomes (Cameron, 1990; Gottlieb, 1980), the tools that can accurately measure the presence or absence of neglectful behavior, and the meaning of social support. Most of the evaluations in this area use relatively limited sample sizes, and few have control group comparisons (DePanfilis, 1996). The variety of outcomes measured includes maltreatment and placement rates, client motivation to change neglecting conditions, childrearing practices, parents' personal care, and child outcomes in domains such as cognitive, language, verbal, and social skills (DePanfilis, 1996). Although reducing child maltreatment is the ultimate goal for most interventions, proxy outcomes, such as measures of improved child health and emotional and social adjustment, are often used to measure an intervention's effectiveness. Official reports of child abuse and neglect are often viewed as unreliable indicators, because incidents may not be reported to authorities, or may be falsely reported, or because surveillance bias may affect reports in treatment families who are in close contact with social services programs. In addition, variations in the components, duration, and intensity of treatment services and the length of follow-up periods confound efforts to identify particularly promising interventions. Controlled designs of multiservice interventions

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--> TABLE 4-2 Range of Family Support Interventions Strategy Description Social network models Used to evaluate the quantity and quality of a family's linkages with formal and informal supportive resources outside the family system. Each model is structured somewhat differently, but all seek to identify intervention targets for strengthening the social network of families. Examples include: The Eco Map (Hartman, 1978) The Social Network Map (Tracy, 1991; Tracy and Whittaker, 1990) Index of Social Network Strength (Gaudin, 1979) Pattison Psychosocial Inventory (Hurd et al., 1981) Social Network Form (Wellman, 1981; Wolf, 1983) Individual social support Operates from a family empowerment philosophy and includes multiple types of social support mixed with professional interventions. Services may include casework services, support groups, parent training, support by lay therapists or parent aides, memberships in recreational centers, transportation, and homemaker services. Individually planned service mixes seek to match services to the specific needs of families. Parent education and support groups Offer information and role modeling as well as social support to impoverished families. Parent groups provide information on basic child care skills, problem solving, home management, and social interaction skills. Social skills training Seeks to increase the effectiveness of other interventions geared to serve specific social support functions. Researchers have suggested that neglectful parents are often handicapped by a lack of social skills that might enable them to utilize community support services.   SOURCE: Modified from DePanfilis (1996). have not been used to clearly document which program components are effective for which specific presenting problems. Quasi-Experimental Evidence Table 4A-1 lists 15 evaluations on increasing social support that meet the committee's criteria for inclusion. The table includes studies that examine parenting education and social support interventions for families that experience

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--> different types of stress, as well clinical interventions that focus more explicitly on providing mental health services for parents involved in known cases of child maltreatment. Reduced reported maltreatment. Three quasi-experimental evaluations with reports of child maltreatment as an outcome measure indicate no statistically significant difference in the rate of reports of abuse and neglect for experimental versus comparison groups following treatment (Barth et al., 1988; Barth, 1991; Wesch and Lutzker, 1991). A fourth study initially indicated fewer reports of abuse/neglect in the treatment program than a comparison group (Lutzker et al., 1984), but this result was not maintained in the follow-up study (Wesch and Lutzker, 1991). Some evaluators have used the standardized Child Abuse Potential Inventory (CAPI) as a proxy outcome to assess the likelihood that parents will abuse their children again. Two evaluations of the Child Parent Enrichment Project, for example, found that treatment-group parents had significantly lower CAPI scores post-treatment, relative to pretreatment and relative to control parents (Barth et al., 1988; Barth, 1991). Parental competence and skills. Another outcome thought to enhance child well-being is improved parental competence. Seven of nine studies testing gains in parenting competence indicate positive effects of interventions to reduce child neglect (Burch and Mohr, 1980; Egan, 1983; Gaudin et al., 1991; Hornick and Clarke, 1986; Larson, 1980; National Center on Child Abuse and Neglect, 1983a; Schinke et al., 1986). One study did not find enhanced parenting skills in treatment groups relative to comparison groups (Resnick, 1985). A second study of parenting skills at home and in laboratory observation of parent-child interactions, which was the only study to explicitly include fathers, also found no reliable change pre- to postintervention. The authors noted that aversive behavior scores for fathers in the treatment group did not differ significantly from scores of the nondistressed fathers in the no-treatment control group (Reid et al., 1981). Methodological factors, such as the use of observed effects versus self-report data and reliance on project-developed instruments rather than standardized assessment tools, discourage the comparison of these results with other studies. An evaluation was conducted of an intervention designed to change parental perceptions and expectations, to teach relaxation procedures to mediate stress and anger, and to train parents in problem-solving skills (Whiteman et al., 1987). The results indicate that all three individual intervention strategies improved parents' scores on affection, discipline, and empathy indexes relative to no-treatment control parents. A composite intervention, which combined all three strategies, produced the largest change in index scores. Findings from less rigorous studies, which did not meet the committee's selection criteria, examined the effect of teaching social skills to parents at risk of

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--> neglect. Three studies report that parent support groups that offer social skills and problem-solving training are more successful with neglectful parents than programs offering more general content on child development (Daro, 1988; Gaudin et al., 1991, 1993). In a study of the Homebuilders program, the behavioral intervention to teach social skills was identified as an essential component (Kinney et al., 1991). Parental mental health. New theoretical models that emphasize the interactions among social context, mental health, and family functioning have emerged in interventions for child maltreatment, focusing on the need to improve parental self-esteem, stress management, and the regulation of impulsive behaviors in order to enhance parental (usually the mother's) abilities to manage children through everyday care and discipline (Wolfe, 1994). Since parental apathy and impulsivity are commonly associated with caregiver behaviors in cases of child neglect (Polansky, 1981), a number of studies hypothesize that improving parents' mental health will result in reduced child neglect. The relevant outcome in this approach is the intervention's ability to produce beneficial changes in the parents' mental health relative to comparison groups, including reduction of depression and negative effects of life stress and enhanced self-esteem. Six studies report at least short-term improvements in scores on standardized measures for treatment parents in these areas (Barth et al., 1988; Barth, 1991; Brunk et al., 1987; Egan, 1983; Resnick, 1985; Schinke et al., 1986). However, the only study that included long-term follow-up reported that treatment gains were not maintained after a one-year interval, and the hypothesized connection between short-term competence enhancement and long-term prevention of maltreating behaviors lacked empirical support (Resnick, 1985). Social support. Social support has been described as the social relationships that provide (or can potentially provide) material and interpersonal resources that are of value to the recipient (Thompson, 1994). The absence or presence of social support and involvement in social networks has been identified as an important risk factor for abusive families, especially in cases of neglect. Social support can provide a variety of services that help reduce stress in family life, including individual and family counseling, advice on parenting practices, child and respite care, financial and housing assistance, sharing of tasks and responsibilities, skill acquisition, and access to information and services. A number of evaluations use social network assessment tools to determine if interventions can reduce social isolation for neglectful families, thereby decreasing propensity for neglectful behavior (Barth et al., 1988; Barth, 1991; Gaudin et al., 1991, 1993; Resnick, 1985; Schinke et al., 1986). Two found no beneficial results in social support (Barth et al., 1988; Barth, 1991); two others found improved social support for families receiving treatment (Gaudin et al., 1991;

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--> Schinke et al., 1986). A sixth study found initial improvement in social support that deteriorated over time (Resnick, 1985). These results have not yet been able to suggest that network assessments will lead to more effective interventions or improved treatment outcomes (DePanfilis, 1996). However, one less rigorous recent study suggests that collecting data on perceived social support, the reported frequency of use, and satisfaction with different types of support may provide better indicators of social support than structural features alone (Tracy and Abell, 1994). Some research has focused on the role of ''natural helpers"—individuals who supplement the efforts of formal social service agents and who have connections to the values and norms of the community in the social environment of distressed families (Collins and Pancoast, 1976; Thompson, 1994, 1995). The efficacy of natural helpers in counteracting the multiple stresses of disadvantaged communities is not well understood; some research has suggested that creating a web of social support for families at risk of abuse or neglect may require connections with self-help groups (such as Parents Anonymous) or family support centers that are especially knowledgeable about the problems of child maltreatment and can provide counseling and advice outside the context of everyday social relationships (Thompson, 1994). Home environments. One evaluation looked at improvements in home environments as a proxy for decreased likelihood of child neglect with mixed results (Larson, 1980). Larson found improvements in treatment group families. Implications Social service interventions designed to improve parenting practices and provide family support have not yet demonstrated that they have the capacity to reduce or prevent abusive or neglectful behaviors significantly over time for the majority of families who have been reported for child maltreatment. Although parental behavior can be modified in terms of stress, empathy, anger control, and child discipline, confidence in these and other proxy outcomes (such as improved parental skills and altered perceptions of child behavior) requires greater understanding of the key attributes of parental competence that relate to child maltreatment. Several interventions have demonstrated an ability to improve parental competence in the short term, but whether these gains can be maintained over long periods under stressful conditions and across different periods of the child's development is not certain. The intensity of the parenting and social support services required may be greater than initially estimated in order to address the fundamental sources of conflict, stress, and violence that occur repeatedly over time in the family environment, especially in disadvantaged communities. Focusing as they do on single incidents and short periods of support, the interventions

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--> in this area may be inadequate to deal with problems that are pervasive, multiple, and chronic. The use of social networks to build and sustain parental competence is a separate area that requires further analysis. Although a parent's use of social networks to support family functioning can be influenced through interventions, there is not enough evidence to indicate whether changes in social networks can create changes in parenting practices that endure over time and result in reduced child maltreatment. The evidence, although intriguing, does not yet provide clear indications as to which types of families are most likely to benefit from parental education and family support services as opposed to mental health services designed to address depression, lack of empathy, and impulsive behavior in both parents and children. Neither does the research base yet clarify whether enriching the supply of community resources will lead to expanded use of support services by families at risk of child maltreatment. Consistent dialogues between researchers and practitioners could facilitate greater awareness of the need to match families with individualized interventions. 4A-2: School-Based Sexual Abuse Prevention Sexual abuse prevention programs are organized around the theory that children can be taught to avoid abuse or to protect themselves from further abuse by reporting threatening or abusive situations and employing other learned self-protective behaviors (Daro and McCurdy, 1994). Most child sexual abuse prevention education is classroom-based, brief in duration, and includes training on concepts of body ownership, types of touching, and skills to avoid or escape sexually abusive situations. Children are encouraged "to tell." Curricula may also include assertiveness training for older youths (Barth and Derezotes, 1990). Some programs include a parental component, although such efforts are rarely evaluated (Reppucci and Haugaard, 1988). Formats include skits, puppet shows, songs, films, videos, and story and coloring books. Table 4A-2 lists 14 evaluations in this area that meet the committee's criteria for inclusion. In general, these evaluations lack long-term follow-up data and rely on proxy outcomes, such as an increase in children's knowledge and skills (Carroll et al., 1992). The evaluations indicate that, although most programs can provide positive changes in cognitive skills and program-specific prevention behavior, especially when they draw on age-appropriate materials and special teacher training, the size and duration of this effect for children at different developmental stages remain generally unknown. Two programs that included 1-to 6-month follow-up found that children retained "flight" responses to situational lures (Harvey et al., 1988; Kolko et al., 1989). However, the evaluations have not included long-term follow-up studies that could demonstrate that these changes constitute a sexual abuse prevention effect for the general population of children, reduce the risk of sexual abuse to the vulnerable children who receive

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--> the training, or mitigate the consequences of sexual abuse when it occurs by encouraging reports to an adult. The studies demonstrate that children can retain prevention information, but retention may be influenced by age at exposure, length of training, and inclusion of review sessions. Moreover, there is some question about children's ability to translate knowledge into actual behavior and whether increased knowledge or learned self-protective behaviors do protect children from sexual abuse by family members. 4A-3: Child Protective Services Investigation and Casework The primary duty of state- or county-administered child protective services (CPS) agencies is to investigate and either substantiate or dismiss reports of child maltreatment; these casework management services (as opposed to treatment and prevention services) account for the large majority of the CPS budget in most communities. In the course of an investigation, social workers are charged with a dual responsibility: protecting the safety of the child and maintaining the family if that course is consistent with child protection. Short-term interventions in this area include provision of casework services, concrete and therapeutic interventions, referral to community-based services, and short-term placements during the investigation phase. Services provided after investigation include concrete services, education, referral to community-based agencies, crisis intervention, treatment, and temporary or permanent placement in substitute care if necessary (National Center on Child Abuse and Neglect, 1996a). There is wide variation in the duration, timing, and kinds of CPS interventions offered to maltreated children and their families, from no services to support, counseling, and placement services (Meddin and Hansen, 1985). Some reviews of the effectiveness of social casework intervention with troubled families in general (not just child protective services) have indicated limited evidence of the effectiveness of casework intervention (Lindsey, 1994), noting that the caseworker often has little ability to change the structural and institutional barriers (such as unemployment, dangerous neighborhoods, poor housing) that confront many of their clients, limiting the scope of the intervention to smaller-scale problems. There are no evaluations of child protective services that meet the committee's criteria for inclusion. Thus, several decades of experience with different types of CPS interventions remain relatively unexamined in the research literature, and the impacts of case identification and investigation procedures and practices are unknown. In the absence of a research base, policy makers rely on anecdotes and media accounts to formulate guidelines for casework interventions. The available studies analyze how type of abuse and degree of risk influence rates of case investigation, substantiation, and child placement as a result of investigation (Barth et al., 1994; English and Aubin, 1991; Murphy et al., 1991). At present, child sexual abuse is the most likely type of abuse to be investigated;

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Complete table on previous page.

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--> TABLE 4A-6 Quasi-Experimental Evaluations of Individualized Service Programs Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results Fostering Individualized Assistance Program (FIAP) provides assessments, planning, case management, and support services to children in foster care because of abuse and neglect. FIAP compared with standard practice. Clark et al., 1994 N(X) = 47 N(O) = 62 Child Behavior Checklist, Youth Self-Report, days in out-of-home placement, juvenile crime court records Both FIAP and standard practice subjects improved in emotional and behavioral adjustment measures. There was a significant improvement in the behavioral adjustment of the FIAP children in permanency placements in contrast to the standard practice group. The FIAP group had less runaways than the standard practice group. The FIAP youth spent less time in incarceration than the standard practice group. Randomly assigned comparison group received standard foster care system services 18 months Weekly visits by trained home visitors and nurse or social worker, child care, day camp, respite care, goods and services, referrals to other community services provided to families with young children who were reported as abused or neglected by school personnel. Cases were resolved as unfounded by protective services. Hotaling et al., undated N(X) = 39 N(O) = 39 Subsequent child abuse and neglect reports, number of families' unmet needs, improved social support, improved parent-child interaction, reduction in parental stress Fifty-six percent of treatment families compared with 64% of control families were reported for child maltreatment over the 2-year study period. The experimental group did report fewer family problems and lower stress but did not report greater social support. Overall, the treatment group did not show improvements in parent-child relations compared with control groups. Comparison group received baseline services Weekly, for 2 years Intensive services including individual, group, or family counseling; financial services; medical services; help with housing; psychological evaluation and treatment; education in home management and nutrition; tutoring and remedial education; vocational counseling; homemaker services; and day care offered to families served by a New York City program with at least one at-risk child under 14 who was not an active case under child protective services. Jones, 1985 N(X) = 175/80 N(O) = 68 Child Welfare Information Services foster care history data, State Central Registrar of substantiated complaints of child maltreatment, Special Services for Children information on clients served, agency case records, in-person interviews Forty-six percent of the control children and 34% of the experimental children entered foster care during the study. Control children entered foster care sooner than experimental children.   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

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Complete table on previous page.

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--> TABLE 4B-1 Quasi-Experimental Evaluations of Shelters for Battered Women Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results Battered women's shelter. Berk et al., 1986 N = 155 Reports of violence, shelter stays Shelters can reduce the risk of new violence for a woman who is taking control of her life in other ways. Otherwise, shelters may have no impact or may even trigger retaliation from abusive spouses. Some survey participants chose to use shelter services, some did not   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

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Complete table on previous page.

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--> TABLE 4B-3 Quasi-Experimental Evaluations of Advocacy Services for Battered Women Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results Service of trained advocates for 10 weeks after shelter exit, 4-6 hours per week provided to residents of a domestic violence shelter in a midwestern city. Sullivan and Davidson, 1991 N = 41 Subject interviews, Conflict Tactics Scales, Effectiveness of Obtaining Resources Scale designed for program Four women reported experiencing further abuse within 10 weeks after leaving shelter. This was not related to either experimental condition. Women in the experimental condition reported being more successful in accessing resources. A subset of participants was randomly assigned to a no-treatment control condition Service of trained advocates for 10 weeks after shelter exit, 4-6 hours per week provided to residents of a domestic violence shelter in a midwestern city. Tan et al., 1995 N(X) = 71 N(0) = 75 Social Support Scale, Conflict Tactics Scales, Index of Psychological Abuse, Quality of Life Measure, Depression Scale CES-D, Effectiveness of Obtaining Resources Scale The experimental intervention expanded the social network of women; women in the treatment group felt more effective in obtaining resources than the women who did not have advocates.   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

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Complete table on previous page.

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--> TABLE 4B-4 Quasi-Experimental Evaluations of Domestic Violence Prevention Programs Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results A high school program to prevent wife assault and dating violence. Jaffe et al., 1992 N = 737 London Family Court Clinic Questionnaire on Violence in Intimate Relationships Twenty-two of 48 test items showed statistically significant changes immediately after the intervention. Females had more positive significant changes than males; males showed some undesired direction changes. Positive changes decreased by half at 6-week posttest. Delayed posttest for some participants at 6 weeks Minnesota School Curriculum Project is a domestic violence awareness curriculum taught at the junior high school level, including teacher training. Jones, 1991 N = 560 True/false knowledge questions about domestic violence Relative to control students, treatment students improved scores on the posttest over three points. There was little change for their group on the attitude test posttreatment. Girls had higher attitude improvement scores than boys. A subset of the study participants was assigned to a matched no-treatment control group "Skills for Violence Free Relationships," a prevention curriculum about women abuse presented to 7th grade health education students. Krajewski et al., 1996 N = 239 Inventory to test knowledge and attitudes about woman abuse Significant differences were found between experimental and control groups from pretest to posttest on both knowledge and attitude inventories. This impact did not remain stable at posttest. Females showed greater change in attitude over time. A subset of the study participants was assigned to a no-treatment control group Comparison of short and long forms of a dating violence prevention curriculum for 10th graders. Short form was two classroom sessions (120-150 minutes). The long form added a film on dating violence and a letter-writing exercise to a fictional victim and a fictional aggressor. Lavoie et al., 1995 N(L) = 238 N(S) = 279 Paper and pencil test Positive pre- and posttests and experimental versus control group gain in knowledge and attitude scores indicate that a short program modified attitudes and knowledge about dating violence. 1-month follow-up   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

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Complete table on previous page.

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--> TABLE 4C-2 Quasi-Experimental Evaluations of Training for Caregivers Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results A combination of didactic presentations, group discussions, role playing, education about the aging process, problem solving, stress management, utilization of community resources, anger management, and guided practice for caretakers of elderly relatives who were at risk for abusing the elderly relative in their care. Scogin et al., 1989 N(X) = 56 N(delayed treatment comparison) = 16 N(O) = 23 Brief Symptom Inventory (BSI), Anger Inventory (AI), Rosenberg Self-Esteem Scale (RSPS), cost of care index Results indicated little change over time for either group on the AI or RSPS inventories. Training was associated with a slight reduction in the cost of providing care. The training group reported a significant decrease in symptoms over time on the BSI, whereas the comparison groups reported an increase in distress over time.   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998. TABLE 4C-3 Quasi-Experimental Evaluations of Advocacy Services to Prevent Elder Abuse Intervention Citation Initial/Final Sample Size Duration of Intervention Follow-up Data Collection Results Volunteer advocates provided assistance and support to victims of elder abuse in the utilization of the criminal justice system to clients of the Elder Abuse Unit of the Department of Elderly Affairs in Rhode Island. Filinson, 1993 N(X) = 42 N(O) = 42 Improving self-esteem, seeking legal action, relocating victim or perpetrator, increasing social supports, access services The findings indicate that the volunteer advocate program, in comparison with the conventional system, can lead to more ambitious goal setting, greater achievement of goals, and more extensive monitoring of cases.   SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

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