Final Observations

The participants in the Workshop on Family Violence Interventions shared a wide range of experience and concerns with the members of the committee. In addition to providing information on selected programs, the speakers offered practice-based perspectives on intervention, outcomes research, and program evaluation efforts in the field of family violence interventions.

In reflecting on the day's presentations, the committee identified a set of key issues that emerged from the presentations and discussions that followed each panel. These issues are highlighted here as a basis for further reflection and attention over the course of the study.

KEY ISSUES

The relationship between responses to child abuse and spouse abuse deserves particular consideration in the design of intervention programs.

Many participants expressed the belief that issues of child protection and domestic violence are intrinsically connected because child abuse and spouse abuse often coexist and may affect both the child's safety and the disposition of child custody cases. Tensions, and even direct conflicts, can arise between advocates for different affected groups who represent differing philosophies (such as child welfare advocates and battered women's advocates). The financial, physical, or emotional dependence of a victim on an abuser also deserves special consideration in establishing effective intervention strategies.

Opportunities for early identification of family violence need to be examined in terms of the organizational settings in which other family services are provided.

The growing involvement of health care providers in assessment and interventions for family violence, for example, raises many questions about opportunities for early identification, referral, and prevention of family violence.



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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Final Observations The participants in the Workshop on Family Violence Interventions shared a wide range of experience and concerns with the members of the committee. In addition to providing information on selected programs, the speakers offered practice-based perspectives on intervention, outcomes research, and program evaluation efforts in the field of family violence interventions. In reflecting on the day's presentations, the committee identified a set of key issues that emerged from the presentations and discussions that followed each panel. These issues are highlighted here as a basis for further reflection and attention over the course of the study. KEY ISSUES The relationship between responses to child abuse and spouse abuse deserves particular consideration in the design of intervention programs. Many participants expressed the belief that issues of child protection and domestic violence are intrinsically connected because child abuse and spouse abuse often coexist and may affect both the child's safety and the disposition of child custody cases. Tensions, and even direct conflicts, can arise between advocates for different affected groups who represent differing philosophies (such as child welfare advocates and battered women's advocates). The financial, physical, or emotional dependence of a victim on an abuser also deserves special consideration in establishing effective intervention strategies. Opportunities for early identification of family violence need to be examined in terms of the organizational settings in which other family services are provided. The growing involvement of health care providers in assessment and interventions for family violence, for example, raises many questions about opportunities for early identification, referral, and prevention of family violence.

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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Health providers in public settings have access to fewer resources and generally must handle more difficult cases. They often have limited ability to determine who receives treatment and they often receive only limited feedback on the disposition of cases that may be referred to social services or law enforcement agencies for further attention. Monitoring and responding to complex cases is a labor-intensive effort. Health care providers are sometimes brought into the circle of those providing assessment and intervention services on the assumption that such individuals can make risk and safety assessments quickly and inexpensively. However, for complex situations, referral or follow-up services can be very labor intensive, and most service providers do not have compensatory categories for such efforts. The philosophy or ideology of family violence that underlies an intervention can make a difference in the form and characteristics of the intervention. One of the major conceptual tensions that is affecting the design of family violence interventions is a discussion over gender-neutral and gender-specific approaches to treatment and prevention programs. Terms such as “spouse abuse” and “domestic violence” are general neutral; many program advocates now prefer terms such as “wife abuse” or “violence against women” to describe the perspectives that should be considered in the design and implementation of services. Ideology can play a powerful role in shaping the direction and design of an intervention, but it should not restrict the scope of inquiry on program effects. Standards of evidence, guided by research theory and reliable instrumentation, can provide a valuable framework for independently assessing the relative effectiveness of a specific program apart from the claims of success of the program advocates. Those who work in law enforcement agencies must often consider the threat posed by the offender to other potential victims, even if the current victim is “made safe” and does not wish to press charges. Several workshop participants noted that their philosophical view of family violence as a gender-linked expression of family dynamics had a profound influence on the conceptual framework that formed the basis for their intervention services. This view is held most strongly in the area of batterers' treatment programs for intimate violence. Poverty and the lack of financial and material resources can affect the natural course of family violence. Questions in the discussions emerged about intersections between poverty and family violence. The lack of financial and material resources can deeply affect family life, restrict access to services, and inhibit individual abilities or motivation to seek social and professional assistance.

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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP The concept of community needs greater clarification in addressing the issue of community involvement and responsibility. The need to involve communities in recognizing and responding to family violence issues is widely discussed as a major social policy goal. Community programs are increasingly encouraged to develop approaches that are responsive to needs and resources of their members. However, there is extensive variation in the use of the word “community” which could refer to a geographic area, such as a city or neighborhood, or to a group of people who share common values, such as a religion or similar ethnic background. The rights of an adult to autonomy and self-determination need to be balanced against the community's responsibility to provide safety and to protect potential victims. Similarly, the child's right to safety and protection needs to be considered in the context of preserving family strengths and unity. The issues of autonomy, safety, self-determination, and “best interests of the child” are value-laden concepts in our society. Service providers in a variety of settings are often frustrated by their efforts to resolve conflicts in responding to the needs of elderly victims who may have varying degrees of competency; in providing services for a woman who chooses to remain with a violent man despite apparent avenues for escape; and in dealing with adolescents who do not wish to remain in abusive home environments. The determination of cultural competence in service interventions requires further consideration to determine which components are most effective in improving the quality of programs and practitioners. The workshop participants agreed on the importance of developing culturally competent interventions, but observed that there is an absence of shared definitions, objective standards, or measures of cultural competence. The paucity of research in this area inhibits the evaluation of programs that are designed for special populations as well as the evaluation of programs that may fail to meet the needs of ethnic minorities. Ecological or sociocultural frameworks that support “social change” approaches to family violence need to be compared with approaches that treat family violence as a reflection of individual pathology or risk factors that require treatment. The factors that contribute to family violence cut across many sectors, including individual characteristics and experience, the family context, the neighborhood setting, and the culture of society. A major challenge for service providers is to select models that are most effective in addressing different forms of family violence and to find

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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP ways to match interventions to characteristics of the people and communities that request them. In assessing family interventions it is particularly difficult to identify and assess the impact of the interventions as the dynamics of relationships within the family. The consensus in the field is that there are multiple levels for intervention and multiple opportunities for treatment and prevention, yet program providers who focus on individual risk factors, or who may focus on cultural components of family violence, lack the opportunities to work in a coordinated manner so that their efforts may enhance each other's work. Interdisciplinary and comprehensive responses require greater attention to the coordination process, the management of costs and cash flow, and evaluation procedures. Several participants noted that, while interdisciplinary efforts may have the greatest potential for effectiveness, they are complex, requiring the presence of staff members whose sole function is to facilitate successful interdisciplinary interaction. The costs associated with managing coordinated responses across multiple agency settings have not been carefully detailed, and the evaluation procedures that should be applied to efforts that combine different approaches require further examination to develop flexible responses that address key concerns. Evaluation frameworks and methods require critical examination to determine the best strategies for evaluating family violence interventions. Service providers in the workshop often expressed reservations about the utility of scientific evaluation methods in capturing the significant effects of a good intervention program. Recognizing that certain types of offenders or victims may respond differently to one form or approach, the research community needs to examine the best methods for identifying which components of an intervention strategy are most likely to succeed with different types of clients, victims, or offenders. Incomplete data sets, high rates of attrition, the absence of baseline data, lack of control groups, and poor behavioral measurement are only a few of the methodological difficulties that discourage the development of rigorous evaluation studies in this field. Furthermore, the urgency of the need for services often prevents the ability to set aside financial resources or personnel that are necessary for evaluation studies. GAPS IN THE KNOWLEDGE BASE Few speakers in the workshop offered data on the outcomes or effectiveness of their programs. In some cases, such data were not available, either because the program was in early stages of implementation or because the program did not make systematic efforts to collect such data. Empirical evidence regarding some

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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP interventions is available, however, and the committee will review the scientific literature to determine which evaluation studies have been published in the professional literature, and additional steps will be taken to locate unpublished studies as well. Many service providers work hard under difficult and challenging conditions to provide treatment or prevention programs whose success may not be obvious. This situation creates a climate in which efforts to measure impact or to assess relative effectiveness are often viewed with suspicion. The lack of resources for both basic services and research in the field of family violence interventions generates competitive and political climates that detract from collaborative efforts to foster the development of data collection and documentation that can provide the basis for analysis of both the strengths and limitations of favored projects. Child violence against other children, which some researchers have identified as the most frequent form of violence within families, was not addressed at all in the workshop. In addition, the speakers did not address the problems presented by children who witness scenes of family violence in their homes, involving a parent, sibling, or other relative. Intervention programs for these child witnesses are very new and have not yet been carefully examined. Committee members noted that specific interventions for various types of child abuse--physical, emotional, sexual--received little attention in the discussion, and that the perspective of child welfare agencies--who represent the most common intervenors in child abuse cases--was not directly represented. While ethnic and cultural issues and their impact on family violence interventions were discussed by workshop participants, the complexity of these issues remains imperfectly understood and seems to require greater attention. Despite this extensive coverage of spousal abuse interventions, significant gaps exist in the workshop review of intervention services in this area. Nearly all the speakers approached the subject from a similar perspective, that is, from the perspective that spousal abuse can be best understood as gender-related (male violence toward women) rather than as part of a system of interactions within the family, possibly linked to other forms of family violence. The latter perspective may not be associated with many intervention approaches, but it may provide some useful insights in the assessment of policies and programs.