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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Treatment of Offenders The treatment, control, and punishment of offenders who engage in child abuse, intimate violence, or elder abuse have been fragmented across many different legal and social service systems in American society. Some forms of assault come within the scope of criminal law where victims may claim protection from law enforcement agencies. In many areas, however, the role of the law in addressing the offenders is very limited or uncertain. Responding to those who commit acts of violence against children is problematic because current institutional systems rely heavily on self-reports or reports by relatives, neighbors, school officials, or social services or health professionals who may see signs of physical evidence or hear accounts of the assault from the child. Yet law enforcement officials or judges may be reluctant to seek or impose penalties on the offender if physical evidence is not convincing or if a child's testimony is inconsistent. In addition, some forms of physical abuse may result from corporal punishment or lack of parental awareness of developmental abilities (especially in the area of feeding and toilet training). Effective treatment of such offenses may require therapeutic or educational interventions focused on changing parent or caretaker perceptions or expectations of child behavior. Distinguishing abusive behaviors that result from ignorance or inappropriate perceptions from those that are characterized by a desire to harm a child can be a challenging task for caseworkers and other public officials. In the field of intimate violence, the law enforcement system has played a more prominent role in dealing with offenders through a variety of instruments, including the use of restraining orders, anti-stalking legislation, increased sanctions, monitoring systems, and mandated treatment programs. However, there is uncertainty within the legal system regarding the extent to which those who commit violence against family members or intimate associates are capable of violence against others in the community. The traditional view of domestic violence cases as “family matters” has impeded the search for public safety measures that could deal effectively with the identification and control of offenders. There is also uncertainty regarding the effectiveness of alternate forms of batterers' treatment programs, which may be voluntary or mandatory as part of a judicial strategy in settling specific offenses.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP The evolution of offenders' treatment programs has occurred in a variety of settings, primarily in mental health services and law enforcement settings for batterers and sexual offenders and in social service agencies for physically abusive or neglectful parents. A range of conceptual models, including cognitive, psychoeducational, therapeutic, use of medications, lie detectors, deterrence, and other control/monitoring mechanisms has been used to identify and treat offenders. In the following presentations, service providers and researchers review a portion of offenders' treatment programs, focusing primarily on cognitive or psychoeducational approaches designed to reduce recidivism among incest offenders and men or parents who are reported for the physical abuse of women and children. In the field of elder abuse, the treatment of offenders has received only minimal attention and has not yet supported the development of specific intervention programs.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP ECOBEHAVIORAL MODELS FOR TREATMENT OF CHILD ABUSE PERPETRATORS John R. Lutzker After the recognition of child abuse syndrome in the early 1960s, treatment literature in the form of simple case studies and single-case experiments began to appear in the mid-1970s. The focus of these efforts revolved around either the teaching of parents in simple child behavior management techniques (Jeffery, 1976; Crozier and Katz, 1979) or in teaching parents anger control (Polakow and Peabody, 1975) or other stress reduction techniques (Sanford and Tustin, 1974). This work represented a promising beginning for treatment of the parental perpetrators of child abuse, but it was too simplistic when the many mitigating factors that correlate with risk of child abuse are considered. These factors include poverty, child-rearing and problem-solving deficits, lack of knowledge about child development, money management deficits, home safety and cleanliness (health) hazards, inadequate knowledge about maternal/child health and nutrition, inadequate or absent bonding or infant stimulation, poor adult relationships, and delayed basic skills of the child who has been abused. The ecobehavioral model (Lutzker, 1992) was developed in order to try to address several of these factors by providing in-home multifaceted assessment and services related to many of these factors. These services have included parent-child training, stress reduction, basic skill training of children, money management training, problem-solving skill training, health and safety training programs, pre- and postnatal maternal/child health training, behavioral pediatrics, and the development of bonding through planned activities training and infant stimulation. Since 1979, Project 12-Ways has offered these ecobehavioral services to families referred for child abuse and neglect in rural southern Illinois. A systematic replication of the Project 12-Ways model (Lutzker, 1984) has been ongoing in southern California since 1988 through Project Ecosystems (Lutzker et al., 1992). This is an in-home service to families whose children are at high risk for child abuse because of their severe behavioral excesses and deficits as a function of developmental disabilities. Also, recently funded by the California Wellness Foundation, Project SafeCare is another systematic replication attempting to provide parent training and health and safety training to families within a 15-week package. This treatment and research project is aimed at examining several issues of replicability of the ecobehavioral model. The average duration that a family is seen by Project 12-Ways is nine months. Thus, one question is whether this 15-week package can be as effective in a more succinct
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP format. Also, families served by Project 12-Ways, Project Ecosystems, and replications in Florida and Mexico all employ highly trained graduate students as the service providers. Although these developing professionals provided competent services, another question is whether or not these services can also be provided successfully by caseworkers and nurses, and perhaps more indirectly through video formats. Thus, another experimental question being addressed by Project SafeCare is whether or not these other formats can be effective. There are five methods to evaluate the ecobehavioral model, or any similar model in providing family services. First, “clinical” data should be collected. That is, data are collected whether or not they will be used within experimental designs and whether or not they are necessarily reliable. These include data collected directly by counselors or self-report data collected by the client. For example, a parent might be asked to count the number of criticisms directed at her child during the week. These data, although of little scientific merit, are of great value. First, they can be used to show a parent progress, or lack thereof, in treatment. Another use for these data is for counselor supervision. The counselor can present the data to a supervisor in order to embellish supervision and for the supervisor to have a more complete image of treatment experience with the family. Finally, the data can have a helpful reactive effect. For example, the parent who begins to count and record the frequency of criticisms may actually reduce the frequency as a function of awareness through self-recording. Case studies represent the next level of evaluation. These are reports that are published in the literature, though lacking the usual scientific criteria for publication. The data often lack reliability or robust research designs, but there are detailed descriptions of dramatic change in highly resistant behavior. For example, Lutzker et al. (1984) described significant household cleanliness and children' s hygiene in a family referred for neglect in which the parents displayed developmental delays. The value of these case studies is that they provide researchers and service providers with published accounts of novel treatment techniques that can be replicated and tested for their generality. A more sophisticated level of evaluation is the use of single-case experiments. These are published studies in which a single individual or family is the subject of the research. If the data are reliable, single-case design allows for confidence that there is internal validity, showing definitively that the treatment is responsible for changes in behavior. For example, Campbell et al. (1983), through a withdrawal research design, showed that stress reduction techniques were responsible for a dramatic reduction in migraine headaches in a mother who was at high risk for child abuse. In addition, a multiple baseline design across responses showed that parent training techniques produced significant change in maternal use of behavior management procedures and instruction-following by the child. Single-case experiments lack external generality; however, like case studies, they allow for possible replication and thus subsequent demonstrations of external generality. Research using single-case designs with more than one family or group (statistical) research designs represent the next level of evaluation. This kind of
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP research extends the generality of treatment procedures reported. For example, Barone et al. (1986) used a slide-tape program to reduce household hazards accessible to children whose parents had been referred for abuse or neglect. A multiple baseline design across families clearly showed that the slide-tape program was responsible for the dramatic improvements. Finally, program evaluation represents the most comprehensive level of evaluation. This can take several forms such as measuring recidivism and comparing it in families treated in one model to another. For example, Lutzker and Rice (1987) showed that there was a lower risk of repeated incidence of abuse among families treated by Project 12-Ways than families in a comparison group who were matched demographically, lived in the same region, but received other services provided by the child protective agency. Other possible program evaluation data can include placement and social validation. Social validation involves questionnaires sent to consumers asking about the quality of the goals, process, and outcome of treatment. O'Brien et al. (1993) explored these issues with consumers who received services from Project Ecosystems. They also asked these questions of agency personnel who referred families to the project. Social validation and other program evaluation allows an examination of the larger questions associated with services aimed at the treatment and prevention of child abuse and neglect. Ideally, all five forms of evaluation outlined here should be included in examining treatment services. The ecobehavioral model shares some similarities with, but also differences from, other large-scale in-home wrap-around services for families. The primary differences are in the direct observation of behavior and collection of data. For example, in looking at parent-child interactions, independent observers record several operationally defined parent and child responses. Research designs as described above are used to evaluate the effectiveness of each new treatment. In addition, there is a focus on criteria-based performance in teaching staff each ecobehavioral treatment strategy. Several challenges face all treatment providers in child abuse. Parent compliance to recommended treatment regimens remains one of the biggest of these challenges. Parents who are court-mandated seem to cooperate better than those who are not. Behavioral contracts between the service provider and the family are helpful in assuring compliance. Good humanistic counseling skills of the counselors add to the likelihood of compliance to the otherwise invasive strategies offered within the ecobehavioral model. Some families may comply as a function of negative reinforcement. That is, they do so because they are aware that their compliance will ultimately cause the service provider to go away! Although we would always like to think of ourselves as positive, this reason for compliance may not be problematic as long as change seen in the family is durable. Finally, it must be noted that every treatment provider faces failures, and that often noncompliance cannot be solved. Although the ecobehavioral model in treating perpetrators of child abuse appears to be effective, several areas deserve future research. More empirical work is needed on the effects of treatment on child victims. Strategies can be explored for teaching children to be aware of cues that might lead to abusive incidents and they can be taught
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP strategies that could aid in their protection. Empirical approaches need to be improved in teaching parents to have more appropriate child development expectations. Also, there should be explorations into very intensive treatment services, such as, perhaps, a 3-week, 24-hour camp-like experience in which families are provided constant feedback on their parenting and problem-solving practices. Finally, evaluation and assessment procedures should continue to be emphasized. REFERENCES Barone, V.J., B.F. Greene, and J.R. Lutzker 1986 Home safety for parents being treated for child abuse and neglect . Behavior Modification 10:93-114. Campbell, R.V., S. O'Brien, A. Bickett, and J.R. Lutzker 1983 In-home parent training, treatment of migraine headaches, and marital counseling as an ecobehavioral approach to prevent child abuse. Journal of Behavior Therapy and Experimental Psychiatry 14:147-154 . Crozier, J., and R.C. Katz 1979 Social learning treatment of child abuse.Journal of Behavior Therapy and Experimental Psychiatry 10:213-220 . Jeffery, M. 1976 Practical ways to change parent-child interaction in families of children at risk. In R.E. Helfer and C.H. Kempe, eds., Helping the Battered Child and His Family. Philadelphia, Penn.: JB Lippincott. Lutzker, J.R. 1984 Project 12-Ways: Treating child abuse and neglect from an ecobehavioral perspective. Pp. 260-291 in R.F. Dangel and R.A. Polster, eds., Parent Training: Foundations of Research and Practice. New York: Guilford Press. 1992 Developmental disabilities and child abuse and neglect: The ecobehavioural imperative. Behaviour Change 9:149-156. Lutzker, J.R., and J.M. Rice 1987 Using recidivism data to evaluate Project 12-Ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect . Journal of Family Violence 2:283-290. Lutzker, J.R., R.V. Campbell, and M. Watson-Perczel 1984 Utility of the case study method in the treatment of several problems of a neglectful family.Education and Treatment of Children 7:315-333. Lutzker, J.R., R.V. Campbell, M. Harrold, and K. Huynen 1992 Project Ecosystems: An ecobehavioral approach to families with children with developmental disabilities. Journal of Developmental and Physical Disabilities 4:17-35. O'Brien, M., J.R. Lutzker, and R.V. Campbell
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP 1993 Consumer evaluation of an ecobehavioral program for families with children with developmental disabilities. Journal of Mental Health Administration 20(3): 278-284 . Polakow, R.L., and D.L. Peabody 1975 Behavioral treatment of child abuse. International Journal of Offender Therapy and Comparative Criminology 19: 100-103 . Sanford, D.A., and R.D. Tustin 1974 Behavioural treatment of parental assault on a child. New Zealand Psychologist 2: 76-82 .
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP EVALUATION OF BATTERERS' TREATMENT PROGRAMS Richard Tolman Despite the growing use of the criminal justice and social service interventions designed to help change the behavior of perpetrators, the efficacy of such interventions has not yet clearly been established. Although the number of arrests has increased, efforts to assess their effectiveness as a deterrent or as an intervention have shown mixed results. A 1990 research review of group treatment for batterers (Tolman and Bennett, 1990) revealed one consistent finding: in a range of programs, using various methods of interventions, a large proportion of men report that they stop their abusive behavior following involvement in the programs. These outcomes deserve further analysis, however, because of variation in the range of success reported for different treatment programs (from 53 percent to 85 percent) and because “success” is often defined simply as an absence of physical abuse. Various explanatory factors should be considered in this analysis, as well as methodological shortcomings of the studies. For example, lower percentages of success tended to occur in programs with longer-term follow-up and in programs that rely on reports of the women victims rather than self-report measures. More importantly, many treatment programs experience high levels of offender attrition, which dilutes the overall effectiveness of the studies. The scarcity of experimental studies in the field of batterers' treatment programs is a major shortcoming because it is not clear whether the intervention programs for batterers are responsible for changing men's abusive behavior. Some studies that compare treatment drop-outs with men who have completed treatment demonstrate only modest gains for those who have completed intervention programs. Additional research is needed that views interventions for batterers in a broader context, including their interactions with the criminal justice system as well as with their partners. For example, the availability of services for battered women is related to an increase in the use of orders of protection as well as in arrest and successful prosecution of batterers. The effects of services for battered women must be considered in evaluations of batterers programs because changes in batterers' behavior may be mistakenly attributed to the interventions for batterers, when, in fact, the changes may be the result of the empowerment of battered women. In order to improve the evaluations of treatment programs, researchers should look beyond the measurement of the cessation of physical abuse to other indicators of success. Further research is needed to develop measures of sexual and psychological maltreatment, especially since some studies suggest that psychological abuse may
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP increase as physical abuse decreases. It is possible that if success is described as the absence of threats, intimidation, and other forms of psychological abuse, as well as the absence of physical abuse, then the modest successes in batterers' programs may drop even more. Measures of separation abuse, such as work and telephone harassment and misuse of child visitation privileges, often are missed in evaluation studies of batterers' treatment programs. Measures are also needed for assessing positive, caring behaviors in egalitarian relationships, not simply measuring the negative skills in relationships. Finally, there is a need for outcome observational measures that can be reported by battered women themselves who may have important perceptions of their partners' behavior or well-being. The well-being of the woman, especially in areas such as safety, stress, self-esteem, and fear, can be an important indicator of effectiveness of a selected treatment program. One area that has received little attention in the evaluation of batterers' treatment programs is the assessment of relationships between offenders and the children of battered women. If an intervention program is fully effective, improvements may be seen in the aggressive behavior and developmental adjustments of children who often witness scenes of intimate violence. When regarded in this way, treatment programs for batterers could be conceptualized as programs that prevent the use of violence by the children of batterers. Another area that may serve as a good target for early intervention is the pattern of relationships that emerges in high school dating. Some studies suggest that a high incidence of intimate violence occurs in these relationships, but we have little knowledge about what forms of intervention programs are most effective for adolescents who may be experimenting with violence early in their dating relationships. In conclusion, much effort is needed to improve the variation in the models of treatment that are available for different categories of batterers. Such variation is needed to respond to the needs and impulses of different categories and types of offenders that has emerged from earlier research studies. Studies by Levesque (1995) and others, for example, suggest that batterers at different stages of motivation may respond differently to selected treatment programs. Experimental studies that examine the comparative effects of mandatory versus voluntary programs, the effects of sanctions associated with participation in batterers' treatment programs, and the enhanced use of surveillance and monitoring efforts would help improve the quality of the knowledge base that could guide programmatic efforts in this field. REFERENCES Levesque, D. 1995 Battering Men and Women: Applying the Transtheoretical Model to Resistance and Change. Unpublished manuscript, University of Rhode Island Family Violence Research Program.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Tolman, R., and L.W. Bennett 1990 A review of research on men who batter. Journal of Interpersonal Violence 5(1): 87-118 .
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP TREATMENT OF SEXUAL OFFENDERS Robert A. Prentky Research suggests that exclusive intrafamilial sexual offenders have the best treatment prognosis and the lowest recidivism rate of all child molesters. Even incest offenders, however, fall into different categories and vary substantially in amenability for treatment and the risk for offending again. Indeed, incest offenders are differentiable on most of the dimensions that are important for nonincestuous child molesters (e.g., level of social competence, degree of sexual preoccupation with children, and lifestyle impulsivity). By and large, incest offenders are not differentiable along the dimensions of amount of contact with children and degree of physical injury. Treatment programs for sex offenders should include protocols for baseline assessment, progress evaluation, risk assessment, and discharge. On the basis of data obtained from these protocols, informed judgments can be made about differential prognosis, especially in the area of risk assessment. TREATMENT OR REHABILITATION OF INCEST OFFENDERS Incest offenders are most successfully treated in group with a cognitive behavioral orientation, often based on a model of relapse prevention. Treatment regimens often include victim empathy training and cognitive restructuring, as well as psychoeducational classes that augment the work in group. Psychoeducational classes provide the cognitive preparation for the affective work that takes place in group. A key to maximizing long-term treatment effectiveness appears to be the affective component of treatment (i.e., awakening genuine feelings of sadness, remorse, guilt, shame, etc.). When these feelings are internalized (e.g., feelings of sadness or shame about one's own victimization, feelings of sadness, or remorse about one's victimization of others) they will provide a powerful defense against re-offending. The potential utility of medication, particularly the SSRI antidepressants (selective serotonin re-uptake inhibitor, such as Prozac), should be considered, as appropriate.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP The plan was written by the participants after a thorough examination of other national models. Certain components that were selected as critical to the model were identified, integrated, and coordinated prior to implementation. Final components of the plan or enhanced components were added following implementation in the criminal misdemeanor and the civil injunction courts. These are described below. Criminal Misdemeanor Court Domestic violence criminal cases are filed with one of four judges in the Domestic Violence Division of the court, and these domestic violence judges preside over domestic violence hearings. The court is staffed by public defenders with knowledge of the dynamics of domestic violence. Domestic violence arraignment occurs within 21 days. The State Attorney's Domestic Crimes Unit consists of specialized prosecutors, paralegal staff, and victim witness counselors. The Domestic Crimes Unit interviews the victim prior to arraignment. Diversion (for first offenders) or a plea is offered to the defendant at arraignment. Both diversion and plea offers mandate treatment (including substance abuse treatment where appropriate) as a condition of diversion or probation. Those defendants who wish to plea not guilty are set for trial. Defendants deferred or adjudicated guilty are referred to assessment within the domestic violence unit of the probation department and then are assigned to a treatment group. Defendants are assigned according to their geographic location and financial ability to pay for cost of treatment. Indigent and low-income clients are treated by a county-run program or the probation department. Nonindigent clients are referred to private providers on sliding scale. Compliance is tightly monitored by the probation department and the court. The probation department monitors the progress of the defendant in treatment. Judges review treatment progress on a judicial review calendar, similar to those utilized for drug courts. Probation violations are heard on a separate calendar. Civil Injunction Court The Domestic Violence Intake Unit (DVIU) of the court conducts an interview of every individual who wishes to petition for an injunction for protection against domestic violence. This unit, part of the Court Administrator's Office, is assisted by personal from the Clerk 's office. The petitioner is assisted with the actual filing for the injunction and emergency social service referrals. Emergency ex-parte injunctions may be obtained through this unit 7 days a week and an emergency hotline number can access an emergency judge 24 hours a day. The hotline number is shared with the local women's shelter. Petitions and ex-parte temporary orders, if they are issued, are served by the sheriff's department at no cost to the petitioner. Permanent injunction
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP hearings are set within 15 days before a judge in the Domestic Violence Division. Whenever necessary, judges are assisted by staff court coordinators, members of the Florida Bar, who assist litigants with minor children develop both visitation schedules and child support recommendations based on statutory guidelines. If the court enters a permanent injunction and the respondent is ordered to treatment, the respondent is also ordered to report to the probation department for assessment and monitoring as described in the criminal description above. As in the criminal model, the court provides judicial review. Violations of the court's order may be enforced by either criminal or civil contempt as well as the filing of a new charge. Criminal violations or new charges are prosecuted by the State Attorney's Office. OUTCOME MEASUREMENTS AND EVALUATION CRITERIA In September, 1993, one year after the implementation of the Dade County Domestic Violence Plan, John S. Goldkamp from the Crime and Justice Research Institute in Philadelphia, Pennsylvania, received a grant from the National Institute of Justice (NIJ) to study Dade County's domestic violence court process and the outcome of treatment in selected cases. In addition, the State Justice Institute (SJI) awarded a grant to Dade County's court system to develop a dual-diagnostic treatment model for domestic violence offenders who are also substance abusers. Dr. Goldkamp was again chosen to evaluate this second project within the overall NIJ study. The results of these studies should be ready for publication by Dr. Goldkamp in late 1995. In addition to this research, the Dade County Grand Jury, Spring Term, 1994 examined domestic homicides, attempted homicides, and stalking cases from the year 1991 (one year prior to the implementation of the domestic violence plan) and 1993 (one year after its adoption) (Final Report of the Dade County Grand Jury, Spring Term A.D. 1994, Circuit Court of the Eleventh Judicial Circuit of Florida In and For Dade County). These data indicate that domestic violence homicides decreased slightly, though overall nondomestic homicides increased. In 1993, 73 percent of the arrestees had a prior criminal arrest for general crimes at the time of arrest as compared to 60 percent of the arrestees in 1991. However, the number of prior arrests for domestic violence offenses among those arrested in 1993 was lower than those arrested in 1991. With regard to other felonies (not homicides or attempted homicides), overall domestic violence felonies increased from 13 to 16 percent. It is not known whether this reflects an actual increase or increased reporting. In the area of stalking, 73 percent of arrestees had a prior criminal record and 35 percent had been arrested for crimes of domestic violence against their victim.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP FINAL OBSERVATIONS The development of model court programs in coordination and cooperation with other affected justice system agencies, treatment providers, and community advocacy group represents a promising opportunity for intervention services in the field of domestic violence. Coordinated efforts have several positive results: the same offenders and victims may stop re-entering the system for repeated violence; scarce resources may be utilized in an effective manner without wasteful overlap; increasing numbers of defendants may modify their behavior in response to systemwide accountability; victims of violence and their children may escape the cycle of violence; and the community at large may be educated to the dynamics of domestic violence. Some of the most challenging difficulties in developing intervention efforts in the field of family violence reside in achieving coordination among the various components. If coordinated systems prove to be an effective means of combating domestic violence, then the initial challenges include the need to identify the necessary system pieces and to convince leaders in the hierarchy of government, the court, and the other identified governmental and community system components to work as a team. Once this is achieved, domestic violence task forces or councils can be empaneled collectively to develop and implement coordinated systems and to develop standard protocols and procedures for each system component. After implementation, interagency boards or committees need to be in place to ensure the effective participation of each component. Funding sources need to be in place so that every community can develop and implement coordinated plans. Local communities would also benefit from the creation of national databases so that innovative programs can be shared with other jurisdictions. The development of standard evaluation criteria would assist each jurisdiction in the assessment of their own programs. Research on systemic approaches to the problem of domestic violence as well as new and better treatment modalities for offenders, victims, and their children would help to improve the operations of local systems. Many jurisdictions have developed one or more domestic violence court programs, such as specialized police or prosecutor units, dynamic treatment methods, victims advocacy groups, legal clinics, and specialty courts. However, few jurisdictions have integrated systems combining all the components for reducing domestic violence.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP REFERENCE Merryman, M. 1995 Specialized Domestic Violence Courts: A New Means to Address an Age Old Problem. Prepared for the Pennsylvania Coalition Against Domestic Violence. Reading, Penn.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP MANALIVE TRAINING PROGRAMS FOR MEN Hamish Sinclair Manalive Training Programs for Men has provided innovative batterer re-education programs to communities in the San Francisco Bay Area in California and consultations on male violence intervention programs, nationally and internationally, for over 14 years. The Manalive system of batterer interventions was developed in 1980 for the Marin Abused Women's Services (MAWS) in San Rafael, California, in response to women's experience of violence and their urgent need for it to stop. Since 1985 Manalive has been an independent organization that provides technical assistance and training for individuals and community agencies providing direct services to batterers. Recently we established the Manalive Education and Research Institute to support local programs, research and evaluate intervention methods, provide training services, and educate the public on men's violence. There are over 20 Manalive community-based programs in the San Francisco Bay Area--several in San Francisco (one Spanish monolingual), including the San Francisco City Sheriff's Department, one at the California State Prison at San Quentin, and programs in Napa, Nevada, and Placer counties. Since 1986, Manalive classes for batterers have been offered 4 nights a week, for 50 weeks each year. Over 1,000 men participate in classes in the Bay Area, and the hotline responded to over 1,800 calls in 1994. The Manalive programs seek to end men's violence to women by engaging men in changing the beliefs that result in violence to women and in fostering nonauthoritarian relationships of equality and intimacy with women. Manalive programs are based on a six-stage re-education process in a peer setting, utilizing an “each-one-teach-one” methodology under the supervision of a trained facilitator. In the first-, second-, and third-stage classes, each of which meet once a week for 3 hours for 16 weeks, men agree that they are emotionally, verbally, and physically violent to their intimates and agree to stop their violence. They also create a mutually supportive environment in which to change their own beliefs and behaviors and challenge community attitudes that sustain men's violence. Since a principle of the program is that men must be accountable for their violence, they are required to pay, on a sliding scale, for these classes. Both the classes and the 24-hour hotline are operated by volunteer graduates of the program under the supervision of Manalive staff. As men progress through their own re-education process they assume more responsibility for presenting material, facilitating exercises, and
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP coordinating logistical support. Men who complete the first year of classes and remain violence-free may participate in an ongoing training program for volunteers. More than 140 men have become volunteers since 1980, and 35 men serve as facilitators, program advocates, and hotline volunteers as of June 1995. THEORY OF INTERVENTIONS The system of interventions developed in Manalive programs explicitly relies on a gender analysis of control and coercion. In this model, men's violence is seen as the socially approved enforcement of the cultural belief that men have authority over women and children. Four basic principles inform this model. First, batterers' abusive behavior is an effort to control through a broad continuum of coercive behavior, not limited to physical actions. Second, beliefs and attitudes support abusive behavior. Third, men require education to learn how to change these beliefs and attitudes in order to stop their violence. Fourth, once men are violence-free, they need to learn to express intimacy effectively. This model generates the following assumptions for program design: The intervention focus must be on men because men are the primary perpetrators of domestic violence. The intervention focus must be on men's belief system because current social values support and teach male-role domination and the subjugation and subordination of women by men. Changing men's loyalty from the male-role belief in their superiority over women to one of equality with women would render violence unnecessary. The California Alliance Against Domestic Violence has adopted the gender-based intervention theory and has used the Manalive model to establish standards for court-ordered batterer intervention programs mandated in the 1993 California Assembly Bill No. 226. This legislation requires that batterer intervention programs include the examination of “gender roles, socialization, the nature of violence, (and) the dynamics of power and control (Chapter 221, Section 1000.93). OUTCOMES The goal of Manalive is attitudinal and behavioral change that will lead to the cessation of violence by men against women. The program seeks to measure its effectiveness by questions such as: Has the man's emotional, verbal, and physical violence stopped? Does the man take responsibility for his violence and for his efforts to stop it?
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Does the man demonstrate an understanding that attitudes and behaviors to maintain dominance are unacceptable in an intimate relationship? Has the man learned that physical, verbal, and emotional abuse represent a male-role belief system that is based on men's domination of women? Does the man demonstrate that he has learned intimacy skills to replace his violence? Does the man genuinely care for himself and for those who care for him? Positive responses to these questions are the expected behavioral outcomes of the belief-system change advocated by the program. However, the ultimate success of a program is based on women's reports that the violence has stopped. The practice of monthly partner feedback provides ongoing evaluation of program effectiveness. Not all women participate, either because of fear or unwillingness to continue the relationship. Those who do participate report the cessation of violence as well as marked changes in deep-seated attitudes within the relationships. Nevertheless, negative outcomes can also be associated with any program. Through partner feedback it is sometimes reported that a man has learned to manipulate or oppress his partner. Attrition rates are also a source of concern. The last analysis indicated that 37 percent of the clients did not finish the entire 32 weeks of the program. This is a significant attrition rate, especially because the men who come to the program represent only a small percentage of the men who actually are violent and who would benefit from the program. EVALUATIONS No research team has conducted an evaluation of this program to date. The long-term outcomes of Manalive have not been measured in a systematic way, although one statistical analysis based on the class registration logs and violence-reporting instruments was done in 1988 by Harder and Kibbe, a community-service assessment consulting firm. Since the program focuses on the development of a community of nonviolent men, there is subsequent contact, and thus there is much anecdotal evidence of its success. Following participation in the program, men talk to each other more openly about their history of violence and their ongoing struggle to stop it. The former participants are the program's best advocates when they declare how fundamentally the program has improved their lives. In fact, a number of men enter the program on the recommendation of men who have participated in the program rather than through the court system. Referrals also come from therapists and counselors who have been through the program and from the extensive 12-step network in the community. Finally, many men who enter Manalive as batterers become volunteers in the program, sustaining and expanding it, and often becoming advocates to end other men's violence to women in their communities.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP OPPORTUNITIES The increased national interest and attention on the issue of men 's violence to women, and the violence of men and boys, has generated promising opportunities for intervention services focused on intimate violence. High-profile events such as the O.J. Simpson trial come at the culmination of an almost 20-year effort by the battered women 's shelter movement to place the issue of domestic violence at the center of national attention. This public awareness also provides the opportunity to increase individual attention and community interest in prevention programs focused on men. Manalive has already experienced a significant increase in referrals to the Bay Area programs, as well as requests for information and training services from other programs in the United States and other countries. The Manalive Education and Research Institute is facilitating the development of neighborhood batterer intervention programs in the San Francisco Bay Area as a model project for the nation. The diverse multicultural population of the Bay Area offers unique challenges in designing culturally sensitive programs, which could provide a rich source of further knowledge about the sources of men's violence and the methods that will end it. The willingness of program graduates to set up, facilitate, and maintain programs represents an opportunity to bring together a community of men dedicated to ending the current tragedy of men's violence in the home, and, in addition, campaigning to change the contemporary cultural standards that condone male violence. CHALLENGES The process of evolving from a direct intervention model to a community prevention model includes a number of distinct challenges. These include: Educating men to give priority to the safety of women who choose to leave controlling, coercive relationships, and allocating significant resources to provide services for women who break the batterer's cycle of control. Establishing batterer intervention program standards, for example, length of program, aims, content, and quality control methods. These standards would help programs that now exist to operate with greater effectiveness and accountability, and new programs would be based on the experience of the shelter-related intervention community. Moving from an intervention strategy that engages men who have been referred to a batterer's program in changing their beliefs and behaviors to a prevention approach that engages all men in preventing male-controlling and coercive behavior. Networking with the medical, judicial, probation, and law enforcement agencies to provide technical assistance to improve and integrate effective community responses that hold men accountable for their violent behavior in local cases of domestic violence.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP Building a community of men dedicated to an alternative belief system of cooperation rather than competition and identifying and studying viable models that support this effort in order to reach the “critical mass” required to change sociocultural norms. Exploring the role of formerly violent men as advocates to other violent men and as activist/educators in their communities. Exploring additional strategies for holding men accountable for their violence, including legal and nonlegal social sanctions. Creating an awareness of the essential role that men can play in identifying and preventing men's violence and developing strategies to educate men in regard to the full spectrum of abusive and violent behavior. The high toll of male violence on the health and well-being of the families and the nation is increasingly a matter of public concern. Approaches need to be developed to reach the men who do the violence and who have it in their power to stop it. One strategy that deserves greater consideration is an examination of the social sources of men's violence and the methods that encourage men to account for and change their violent behavior.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP DISCUSSION HIGHLIGHTS In the workshop discussion that followed these presentations, the participants noted that major attention in treatment services for offenders in the area of child abuse has been given to mothers, rather than fathers, often because service providers have more opportunities for access to mothers in health care and home visitation programs. More thought needs to be given to the role of fathers as caretakers, and opportunities for intervention could be developed in the workplace, health care settings that treat young men, recreational centers, or other settings. The caretaker or partner's perception of behavior, and attribution of hostile intent or other negative attributes, may be important topics for the development of future intervention programs, both in the field of child abuse and intimate violence. Aspects of coercion and control, rather than just physical violence, deserve attention in developing the frame of reference of treatment programs. The use of power and anxiety in intimate relationships, rather than simple impulse control, are important indicators of behavioral change that have received little attention in offender treatment research. Service providers also need to improve the offenders' skills in dealing with acute confrontations as well as fostering changes in attitudes and beliefs that support abusive behavior. The impact of batterers' treatment program on child-rearing practices is an additional area that deserves particular attention in future treatment studies. The time-frame for most evaluation studies is 6 to 12 months, which offers little opportunity for observing significant changes in relationships or parent-child dynamics. Domestic violence programs need to focus on children as well as women, which requires coordination and integration of comprehensive programs such as criminal justice and social work. Panelists agreed that the issue of child abuse as a precursor of later abusive behavior is extremely complex. To understand the impact of abuse on a child in both the near term and later in adolescence, several factors require consideration: the age of onset and duration of the abuse, its invasiveness, and the relationship of the perpetrator to the victim. The notion that the vast majority of sex offenders were themselves abused and are simply doing what was done to them has come into question. While it is true that many sex offenders were abused sexually and otherwise, a large proportion were not.
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SERVICE PROVIDER PERSPECTIVES ON FAMILY VIOLENCE INTERVENTIONS: PROCEEDINGS OF A WORKSHOP In the area of domestic violence, one of the emerging challenges of perpetrator services is matching offenders with appropriate interventions. In the absence of demonstrated effectiveness for a particular approach, batterers need to be matched with different forms of treatment, including individual therapy, group counseling, or social change approaches. The high rates of attrition and noncompliance require consideration in the evaluation of perpetrator interventions, which often seem to require higher standards of success than other interventions. The low success rate for treatment programs may reflect not just the efficacy of treatment but the fact that many batterers drop out or never begin. One participant suggested an analogy to the use of insulin in treating diabetes: the fact that some diabetics refuse insulin does not suggest that insulin treatment does not work; similarly, getting batterers into treatment should be viewed as a separate issue from the effectiveness of the treatment. Yet the issue of motivation and the range of variation among human personalities are crucial in understanding the rates of attrition in voluntary and mandated treatment programs. The factors that influence compliance with treatment are an especially important research topic because the consequence of low compliance is often harm to others. Research on the reasons and circumstances that clarify why potential clients refuse to participate or drop out in the midst of a treatment programs can provide important insights in this area. The potential for treatment programs to provide surveillance opportunities for future abuse incidents should also be recognized. Additional empirical evidence is needed in assessing different forms of batterers' treatment programs to determine factors that contribute to or weaken their effectiveness. Finally, it is important to determine the client's degree of participation in a treatment program in assessing the effectiveness of a selected intervention. To be effective, treatment requires a certain level of exposure to key concepts and appropriate feedback on behavioral reports. The efficacy of a program may be weakened if the client is chronically absent, late, or participates in a limited manner. Service providers may require more autonomy or authority in determining whether a client's participation is adequate to justify continuing treatment services in cases where the courts have resorted to this type of intervention as an alternative to punitive sanctions.
Representative terms from entire chapter: