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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Spousal Victim Services In a background paper prepared for the NRC Panel on Understanding the Control of Violent Behavior, Fagan and Browne (1994) observe that research on marital violence has spanned nearly three decades. Although the Pilgrims had adopted laws that prohibited beating female spouses and violence against husbands, and social reform measures were adopted in the latter half of the nineteenth century to stop wife beating and other forms of family violence, it was not until the late 1970s that feminist activists and clinical researchers created a concerted national effort to document and publicize this issue and engage legal, social, and health institutions in developing a broad range of intervention and prevention services. Schechter (1982) observes that women who were victims of spouse assault presented themselves to feminist grassroots organizations via rape hotlines as well as victim assistance agencies or rape crisis centers. The response of the grassroots organizations identified a wide range of services that were needed to address this problem, including shelters, transportation, counseling, legal assistance, and child care. They also played a key role in discovering the limitations of existing legal remedies to sanction offenders or offer protection to victims. Feminist organizations mobilized through state and national political organizations to eliminate requirements for divorce filing, to obtain an order of protection, and to simplify the prosecution of marital rape. The influence of these grassroots efforts resulted in a campaign that identified spousal violence as a multifaceted public policy issue whose solutions spanned the organizational boundaries of specific social or legal institutions. The range of programs directed toward adults who experience violence in intimate relationships, regardless of the marital status of the victim and offender, include battered women's shelter and hotline services, restraining and protection orders issued by the courts, and victim advocacy programs. In this section, the presenters describe different approaches to the complex dilemmas of protecting and empowering victims of spousal violence and address the more fundamental cultural norms that may influence the behavior of the victimizer.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP REFERENCES Fagan, J., and A. Browne 1994 Violence between spouses and intimates: Physical aggression between women and men in intimate relationships. Pp. 115-292 in A.J. Reiss, Jr., and J.A. Roth, eds., Understanding and Preventing Violence, Vol. 3. Committee on Law and Justice, Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, D.C.: National Academy Press. Schechter, S. 1982 Toward an analysis of violence against women in the family. Pp. 209-240 in Women and Male Violence. Boston, Mass.: South End Press.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP DOMESTIC VIOLENCE TRAINING PROJECT Anne H. Flitcraft In the physical sciences, an important principle has emerged that is called “The Heisenberg Principle,” named after the German physicist Werner Heisenberg. This principle states that the more one tries to measure the characteristics of physical nature, especially at the subatomic stage, the greater impact the scientist will have on the phenomenon to be studied. In applying this principle to the social sciences, the same assumptions may hold true. When we as scientists try to observe the basic elements that contribute to the effectiveness or success of a domestic violence intervention program, the intrusion of our measurement instruments, may in fact be altering the nature of that program. The Domestic Violence Training Project, based in New Haven, Connecticut, uses domestic violence to bring the study of the whole person back to medicine. The project addresses domestic violence using the framework of the public health model, offering programs in primary, secondary, and tertiary prevention. Primary prevention programs involve basic education. Training programs introduce health care providers to the issue of domestic violence and provide a means for them to discuss domestic violence with the women they examine in contexts such as prenatal programs, nutritional seminars, and diabetes classes. In the secondary prevention, or early intervention, programs, project staff help hospital emergency personnel to identify victims of domestic violence, provide for the victim's immediate safety, and refer the victim to community resources. The core issues in secondary prevention involve defining what a health care provider's response to domestic violence should be. Project staff believe that emergency room staff should be able to identify victims of domestic violence, comprehensively assess their safety, and, if the clients and their children are not safe, implement a crisis intervention with appropriate multidisciplinary teams. The hope is that the comprehensive safety assessment will become integrated into every physician's basic training program and that this skill will be updated regularly, much like basic cardiopulmonary resuscitation. Tertiary prevention involves complex case management. The training project's approach stems from the belief that effective responses to the problems that accompany domestic violence are beyond the capability of any single agency. Women who are battered and addicted to alcohol, for example, need both an alcohol treatment program and an intervention against domestic violence. The Domestic Violence Training Project is therefore working to build bridges between health services and treatment for
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP overlapping problems, such as addictions, high-risk pregnancies, HIV/AIDS, and mental health disorders. Measurements of effectiveness for these training programs are difficult to achieve. Anecdotal reports suggest that the medical faculty and students are increasingly receptive to the inclusion of domestic violence training components in the educational process of both young and senior physicians and other health personnel. Evaluation studies have not yet been prepared, however, to gauge which forms of education or training are particularly effective in this field.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP TRANSFORMING COMMUNITIES Donna Garske In 1992, Marin Abused Women's Services of Marin County, California, launched a new program called Transforming Communities (TC): Creating Safety and Justice for Women and Girls. The TC program has now developed four projects in varying stages of development, implementation, and testing. The assumptions that guide the TC program reflect a gender-based analysis that is distinct from the more prevalent gender-neutral analysis of family or domestic violence. The latter views the family, not society, as the key unit of analysis and believes that any member of the family can be violent or be victimized. The gender-specific approach is derived from the violence against women perspective, which assumes that violence is predominantly initiated by male partners and that all forms of male violence against women, both inside and outside the family, are connected. TC projects also reflect a belief that the effort to identify reliable risk factors has provided an inadequate basis for effective prevention efforts. Moreover, an approach that concentrates on individual factors will not be able to address underlying social issues or cultural beliefs that may condone or perpetuate male violence against women. Transforming Communities takes a firm position that men's violence against women stems from a perception of superiority that entitles them to use authority over women, family members, and other perceived subordinates and to exert control over them through any means, including violence. The TC program has conducted survey research that suggests that men typically do not sanction male batterers, but rather excuse a man's abusive behavior by attributing it to circumstances beyond his control. If communities are to change, they will need to actively eliminate such belief systems and practices and replace them with beliefs that benefit everyone and promote the right of women and girls to safety, equality, and justice. Such a community effort will be similar to those for the prevention of substance abuse, HIV/AIDS, and drunk driving. Transforming Communities works from the assumption that a critical mass is needed to achieve community change within a broader population. The programs are designed to build this movement through specific strategies such as the use of formal and informal sanctions that hold violent men responsible for their abuse, including emotional and verbal violence; building men's awareness of beliefs that support abusive and coercive behavior and holding them accountable for eliminating these beliefs; and helping men who have transformed their beliefs to encourage other men to do so as well.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP The TC program is currently undertaking a 5-year campaign to test these assumptions in a project in Novato, California, a city of about 50,000 people. Novato was selected as a test community following a review that examined 10 Marin Country communities according to 33 selected variables, including size of the community, the degree of need for services, and indicators of citizen and community readiness for an intimate violence prevention project. Novato showed the second greatest need in this analysis, based on the number of domestic violence-related calls to law enforcement agencies. Its moderate size makes it typical of other U.S. communities, which will facilitate eventual replication of the project's strategies. Moderate size also enables a strong sense of a unified community, while still allowing for diversity in terms of ethnicity, age, distribution and levels of income, education, and experience. The goal of the Novato project is to reduce the incidence of domestic violence against women and girls, to test the effectiveness of mobilizing community members to transform sociocultural norms that perpetuate domestic violence, and to test how effectively changing these norms contributes to changing behaviors. The project will be evaluated through a two-level approach that will combine the use of summary measures of outcomes with formative measures of open-systems processes. Survey measures will be used to determine community attitudes toward, understanding of, and willingness to intervene in domestic violence. A control community (San Rafael) has been selected as part of the evaluation for beginning and end measures. The approach of Transforming Communities is seen as an alternative to the tendency in the United States to approach all problems from an individual, therapeutic approach. By concentrating on social rather than individual change, the program seeks to use the problem of men 's violence against women as a catalyst for community and political action that would result in a socially just society for all.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP WOMEN'S CENTER AND SHELTER OF GREATER PITTSBURGH Martha Friday Founded in the early 1970s, the Women's Center and Shelter of Greater Pittsburgh (WC&S) is almost 25 years old and was one of the first 6 domestic violence programs in the country. A large, urban program rooted in the assumption that battered women are experts on domestic violence and that the program's role is to help them develop and expand their choices, the program has grown beyond shelter services and now sponsors several programs that promote self-sufficiency. Part of the program's basic mission is to work with other agencies and to use the domestic violence experience as a catalyst for the integration of other services. The WC&S was serving 1,179 women and children annually by 1987, excluding the hotline service, but they were turning away 1,200 others. Realizing that alternatives were needed to meet the practical limitations on shelter availability, the program staff decided to expand in new directions, to develop additional choices for services available to battered women, and to create efforts that go beyond basic shelter toward a self-sufficiency model. A triage model was developed within the 24-hour hotline service, assigning women in the most immediate danger to shelter. Highest risk includes violence and physical injury, threats with or use of weapons, threats to kill her or suicide threats, break-ins, or statements from the victim like “this time he looks different. He is going to kill me.” In 1994, WC&S sheltered 651 women and children for 11,400 nights of shelter. Women in intermediate danger are assigned to nonresidential counseling. Moderate risk includes emotional, financial, verbal, and some physical abuse, such as blocking, shoving, or stealing keys. This program has grown from 6 women in 1988 to 675 women in 1994. When the shelter is full, women in our hospital-based program can be placed at the hospital for up to 60 nights of short-term shelter or in free motel and hotel rooms through a motel/hotel partnership program. Expenses for services are low: shelter costs $42 per night and counseling costs $33 per hour. The options and choices developed by WC&S include direct services and efforts to meet housing, income, moving, medical, and legal needs. In 1994 the program served more than 7,000 women and provided telephone counseling to 13,500, but the turn-away rate remains very high (1,800 were turned away from shelter in 1993-1994.) Women can move from one category to another at any time as their circumstances change.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP The majority of those served by the WC&S are white (62.3 percent). African-Americans constitute the largest minority group (30.42 percent), with much smaller percentages of Hispanic (5.2 percent), Asian American (1.02 percent), and Native American clients (0.31 percent). The greatest challenge in developing intervention efforts involves the effects of the use of crack cocaine by shelter residents. The program does offer preliminary drug and alcohol counseling on-site, as well as referrals to drug and alcohol treatment centers. The crack addiction, however, often impedes the use of these resources to achieve safe and violence-free homes. WC &S is now planning a new partnership in collaboration with local substance abuse programs to search for new solutions. The programs focused on drug and alcohol treatment have acknowledged that domestic violence affects large numbers of their clients, and they are interested in seeking effective solutions to these difficult issues. After developing a nonresident counseling program, a separate legal advocacy department was created whose staff works directly with the justice system, serving 4,500 women in 1994 and representing an important alternative to shelter. WC&S established a fund to pay for legal costs that are not covered by Legal Aid, and a Pro Bono Mental Health Project has been developed that involves volunteer social workers, psychologists, and psychiatrists for at least one hour a week for a year. The mental health professionals provide long-and short-term counseling to children in six area shelters who have been affected by domestic violence. The goal of the counseling program is to help children cope with domestic violence by assisting them in understanding what is happening to them and to encourage mothers and children to talk together about the impact of domestic violence on their lives. Children thus have access to a private therapist model, which responds to the difficulties with obtaining access to local community health services. The WC&S program, along with the Pennsylvania Coalition Against Domestic Violence, has developed activities beyond direct services to focus on systems advocacy and broaden the options available for battered women. The Coalition staff have provided leadership in shaping state legislation for Protection From Abuse orders, Protection From Abuse amendments, stalking laws, and other relevant laws. The judicial system has been reformed in Pittsburgh to create specialized courts for domestic violence cases and a domestic violence task force has been created to help coordinate the separate elements of the justice system. In the health area, the Coalition is introducing domestic violence information into standard medical school and police training programs. WC&S has developed a prevention program for the schools which has curricula for grades 4-12, and a program is in development for younger children in kindergarten through grade 3. The fourth-grade program, Healthy Choices, has been publicized in other publications. As a result, WC&S now fills curriculum requests from other parts of the United States and other countries. These prevention programs all have an element of crisis intervention in response to disclosures of domestic violence in the home or with the student. The conceptual framework for this program emphasizes that the staff implementing the program should
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP be part of a community-based domestic violence program, and not a separate training institute serving multiple counties. The WC&S Community Education Department trains other professionals, including clergy and medical, mental health, and drug and alcohol abuse treatment professionals, so that they can intervene in domestic violence situations. The program also has staff helping to train hospital personnel in a collaborative demonstration program for identifying and assisting battered women. Through this program, 214 battered women were identified in the period July 1994 through January 1995, compared to 36 during the entire previous year. Project staff also participate in the Family Intervention Program at Children's Hospital, which aims to reduce placements to foster care. They also are experimenting with a program involving couples counseling. The last major program component to be developed was the follow-up program, designed to provide support to former shelter residents and assist with the evaluation of the shelter services. Twenty-seven percent of shelter residents enter the follow-up program. WC&S has established a basic goal of reducing immediate and long-term domestic violence. The primary outcome expected from the resident (shelter) and nonresident services is that 50-70 percent of the clients will live in violence-free homes for at least one year after intervention. It is expected that a large percentage will live in violence-free homes for a longer period, but the program does not have the capacity to track clients beyond 12 months. Resident and nonresident clients are expected to receive at least 3 of 20 specialized service options available to them, such as medical, housing and legal advocacy services, children's program, translators, referrals, and so forth. Assessments of the level of violence are done in a variety of ways, including the follow-up program with former shelter residents, contacts through the Home Find program or volunteer efforts, and informal “check-ins ” with nonresident clients through weekly support groups or a monthly coffee house. One of the most difficult components of the program to evaluate include the school prevention programs. The pre/post-test scores show increased knowledge of domestic violence dynamics and resources, and school officials continue to request more programs and call for domestic violence crisis interventions. However, WC&S has not been able to conduct a longitudinal study to measure long-term prevention effectiveness. The program is planning a comprehensive prevention/intervention program which will include an evaluation component. This approach involves the selection of a community for a comprehensive service intervention, including K-12 school programs plus intensive training of community police, magistrates, hospital, and other community officials. At present, the most promising opportunities for intervention services include treatment for drug and alcohol addiction and its effect on achieving violence-free lives; targeting a smaller community for a new model of comprehensive intervention; experimenting with new partners, such as real estate agents in a subsidized “Home Find” service; and replicating successful programs in other communities.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP CHICAGO ABUSED WOMEN COALITION Vickii Coffey The Chicago Abused Women Coalition (CAWC) is a direct-service organization that opened Chicago's first 24-hour hotline in 1977 and the first domestic violence shelter in 1979. In 1990, the Coalition began to plan how the program could expand these services beyond serving more than 700 women and children annually and to address the needs of thousands of others. CAWC now sponsors an emergency transitional shelter service, a hospital crisis intervention project, and a Domestic Violence Reduction Program. The program is also planning a long-term housing project for women in transition. In 1992 the Chicago Police Department approached CAWC to discuss the increasing reports of domestic violence in the community. Of the 929 homicides in Chicago that year, 101 were related to domestic violence. In addition, police were receiving over 90,000 calls a year in one district that were coded as domestic violence calls. Some of the families were calling 10 times or more. Other calls often not coded as domestic violence involved vandalism and other property crimes not normally associated with domestic violence. When the police investigated, however, they found that many calls were actually the result of harassments and stalkings. After studying the demographic data provided by Chicago Police Department, the CAWC found that calls and homicides related to domestic violence were concentrated in seven communities. One of these districts was selected as a demonstration project site for the Domestic Violence Reduction Program, which primarily serves African Americans, the largest ethnic group within the project site community. The program goal is to reduce homicides, injuries, and incidents related to domestic violence by following up emergency 911 calls within 24 to 72 hours within the targeted area. An information system has been created to track families, and a training program has been developed for the Domestic Violence Reduction Unit, composed of crisis teams of police officers and counselor/advocates from CAWC and another service agency who visit homes together in response to 911 calls. The role of these teams is to provide intervention for victims, including direct service, crisis intervention counseling, safe refuge, and referral to shelter services; and some intervention and referral for abusers. Counselors have learned a great deal from their work responding to 911 calls with the police. After making many such visits, counselors have considered the circumstances under which a strong response may increase the battered woman's risk.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP In studying this problem, counselors found that interventions that occur more than 48 to 72 hours following an incident of domestic violence may increase the risk to the woman. Teams arriving after that time may find the couple reconciling; in such circumstances, women may deny that they ever called the hotline, possibly to protect themselves from an immediate resurgence of the violence. Counselors now hesitate to intervene later than 72 hours after receiving the call. They have had some success in these cases, however, when they have sent letters and brochures to the home. The Domestic Violence Reduction Program does not yet have a formal evaluation component. The program relies on interim measures of effects, and project staff have noted that the number of calls to the unit have increased, as have the number of orders of protection, reports, and complaints filed, since the demonstration project began. At the same time, families who do not want to accept shelter services have demonstrated a high rate of recidivism and resistance. However, after two or three interventions, many of these families file complaints and orders of protection. Difficulties have emerged in collaborating with other social services because of different conceptual frameworks and administrative procedures, including cash flow. The experience of collaboration has also produced attention to common concerns, however, such as the need to deal with the safety risks for both victims and service providers in going into homes where there may be violence without being apprised of the situation in advance.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP AYUDA, INC. Suzanne Jackson and Yvonne Martinez Vega Ayuda is a service program in Washington, D.C., that has worked with immigrants for 25 years. For many years, Ayuda (which means “help ” in Spanish) provided legal services to immigrant clients, the majority of whom were men. Staff eventually realized that domestic violence was a key factor that inhibited women from requesting legal assistance services. In 1986, Ayuda established a comprehensive program to serve battered immigrant women, and in 1994 Ayuda's legal clinic, which is staffed by three attorneys, provided services to 390 women in a variety of cases involving restraining orders, child custody decisions, and immigration services. Ayuda's program offers direct legal services and community education, a video for high school students, and educational services for court officials. Social isolation, which is often associated with abuse, is particularly strong among immigrant women. Many fear that if they come forward, they may be reported to immigration authorities, and many immigrant women are not aware of opportunities to remain legally in the United States. Women who are servants of diplomats have special concerns because their employers often hold their passports. Immigrant women also have cultural and religious issues that need to be addressed in intervention efforts. Many women have had limited education, and many are illiterate in both English and Spanish. About 90 percent of the immigrants in Washington, D.C., are from El Salvador. When immigrant women come to Ayuda for counseling, they often are eager to turn their lives over to the counselors, who resist this transference. While helping the clients understand their individual situations, the counselors try to empower the women to make their own decisions. This can be difficult, especially for legal advocates who have no formal training in counseling. The program educates the women about domestic violence. In discussions of how community values support violence and how these values are perpetuated, there is much attention to differences in child-rearing practices for young girls and boys and differences between customs and expectations in Central America and the United States. The clients may realize that they are not helping their children by staying in abusive relationships, because domestic violence damages children at every level of development. Discussions of these cultural issues can initially seem to be a double-edged sword for those women who prefer to be with a Latino man. However, Ayuda's preliminary research has found that Latina women who are married to U.S. citizens are
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP more likely to be victims of domestic violence than those married to Latino immigrants. Some clients eventually change from victims of domestic violence to community activists working against it.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP DISCUSSION HIGHLIGHTS In the discussion, the participants observed that cultural beliefs that fail to discourage domestic violence often inhibit broader support by major social institutions for reformist efforts. Religious beliefs that prohibit divorce, for example, may encourage male dominance. Some religious leaders may even encourage women not to prosecute violent and abusive husbands. Similarly, panelists noted that although some police departments have made efforts to support domestic violence victims, individual officers on the street may not be as helpful. Many police officers may not recognize domestic violence incidents as part of an ongoing pattern of behavior. Some officers do not separate couples before interviewing them, or law enforcement officials will ask if a woman wishes to remain with her partner while he is present. In Chicago, the city has developed a special project for dealing with domestic violence perpetrated by police officers because this form of abuse was seen as a factor that inhibited active police responses to other domestic violence cases. Training programs can sometimes influence such behaviors and offer general remedies to the failures of large institutional systems. For example, the creation of a domestic court and special training programs for the police, magistrates, and prosecutors in some jurisdictions can increase the use of probable-cause arrests in domestic violence cases and can improve the deterrent capability of the law enforcement system. However, most judicial and law enforcement training programs have not been evaluated, and the outcomes associated with such efforts remain uncertain. What is not known at present is whether, or how often, contact that occurs between the victims of domestic violence and the criminal justice or law enforcement system leads to the effective use of other social services. Some forms of contact, such as a request for a restraining order, represent important opportunities to direct victims to services that do not involve law enforcement personnel (such as shelter programs, child care services, job training, or income support programs). The need for flexible responses at many different levels of separate systems was recognized as an important feature of victim services. Yet it can be difficult to measure the effectiveness of informal referral services, especially when the client does not pursue prosecution or draw upon other law enforcement resources. The importance of capturing key lessons
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP from the direct experiences of abused women was stressed repeatedly as a major theme in the discussion. One panelist spoke of the difficulty of introducing expert testimony in court and the need for additional training programs for judicial officers, similar to those that exist in the field of poverty law and legal services seminars. Injury epidemiology databases were also identified as an important resource that, if properly coded, could reflect the extent of domestic violence. At present, however, these databases have no injury code for domestic violence. Many domestic violence training and service programs rely on categorical funding, comparable to drug and alcohol treatment centers. This arrangement was seen as a major administrative challenge, because it is difficult for such programs to offer comprehensive services that many professionals believe are necessary. Participants also noted that the special needs of domestic violence victims from different ethnic and social class backgrounds deserve recognition. An approach that might be appropriate for women with independent financial resources may have limited relevance to a woman with no economic or social resources, language difficulties, or limited educational background. Strategies that are effective for urban women may not be useful for rural populations. Reports of violence in teen dating have prompted some communities to develop early intervention programs for adolescents as a prevention measure for domestic abuse. The use of risk factors to predict the likelihood of abusive relationships is a controversial topic, especially approaches that focus on the “victim” profile and suggest that the victim is to blame in part for the violence that may occur. Service providers are also concerned that some forms of preventive interventions (such as job training efforts) may encourage independent activities by the victim and cause her to act in a way that increases the potential for violence in a relationship. Such efforts may require additional attention to safety planning if the client remains in an abusive relationship but is preparing to leave. The participants noted that formal scientific evaluations are often not available to determine the effectiveness of intervention programs in the field of domestic violence. Limited measures in this field have created tensions between research and practice, and the urgency of the problem and the need for services often foster a desire to implement promising programs and approaches, even though such efforts may lack empirical evidence of effectiveness. What is particularly needed at this time are more detailed descriptions of intervention goals, the strategies used to achieve specific goals, institutional barriers to case recognition and service implementation, and hypothesized outcomes that could serve as a basis for further research and improvements in service efforts. This research would be particularly useful in the development of training efforts for service providers.
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Representative terms from entire chapter: