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Key Issues

The opening statements of the participants demonstrated the complex dimensions of the problem of family violence. The issues identified by the participants as fundamental in developing responses to family violence can be grouped in three categories: dimensions of the problem; existing interventions; and policies, programs, and research directions.

DIMENSIONS OF THE PROBLEM

  • Evaluations of child abuse prevention programs have demonstrated that families who are in greatest need often do not have access to therapeutic intervention services. At-risk families are often marginalized by existing social service and health care systems until an incident of severe abuse or other form of violence occurs.

  • Publicly subsidized family counselling and support services are often available only after an incident of family violence has been reported and investigated. Such services are usually provided as part of a mandatory referral program, often within a punitive or coercive context (suggesting, for example, that “if you don't change your behavior, your kids will be taken from your home”).

  • An early detection process for identifying families at risk of child abuse or neglect or other forms of family violence does not exist. The research base regarding risk factors for family violence does not provide reliable indicators for an effective screening process with sufficient speci-



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Violence and the American Family: Report of a Workshop Key Issues The opening statements of the participants demonstrated the complex dimensions of the problem of family violence. The issues identified by the participants as fundamental in developing responses to family violence can be grouped in three categories: dimensions of the problem; existing interventions; and policies, programs, and research directions. DIMENSIONS OF THE PROBLEM Evaluations of child abuse prevention programs have demonstrated that families who are in greatest need often do not have access to therapeutic intervention services. At-risk families are often marginalized by existing social service and health care systems until an incident of severe abuse or other form of violence occurs. Publicly subsidized family counselling and support services are often available only after an incident of family violence has been reported and investigated. Such services are usually provided as part of a mandatory referral program, often within a punitive or coercive context (suggesting, for example, that “if you don't change your behavior, your kids will be taken from your home”). An early detection process for identifying families at risk of child abuse or neglect or other forms of family violence does not exist. The research base regarding risk factors for family violence does not provide reliable indicators for an effective screening process with sufficient speci-

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Violence and the American Family: Report of a Workshop ficity to avoid large numbers of false positives (that is, falsely identifying families at risk). The number of very young, severely battered or neglected children appears to be increasing. The exposure of these children to different types of program interventions (such as battered women's shelters) is also increasing, but the effects of such experiences on children and their families have not been well studied. Attention and explanation of documented differences in the cycle of intergenerational transmission of violence are needed. The manner in which certain institutions and communities respond to incidents of violence directed towards young children may differ, depending on the child's race, gender, ethnic origin, and social class. These differences can result in a wide range of disparities and inconsistencies in access to services, as well as in the evaluation of outcomes of interventions. The demands of handling different forms of family violence on the court system are enormous and costly. Family violence cases—especially ones involving spousal abuse—are commonly viewed as high-volume, low-significance events in judicial and law enforcement centers. The apparent failure of many police and court interventions in family violence cases (especially spousal abuse cases) has stimulated examinations of the broader dimensions of the problem to identify points of intervention, outside the criminal justice system, that present opportunities for prevention and behavioral change. Economic, ethnic, and cultural factors that affect the changing family structure of many American homes need consideration in identifying sources of family violence and methods of intervention. In the absence of parental and community figures who foster the development of social values and behavior, schools are playing an increasingly important role in teaching children social values and behavior important to conflict resolution—especially self-esteem, self-control, and respect for authority. Since poverty and unemployment are commonly associated with family violence, the significant decrease in real income of families with young children over the past decade needs special consideration in designing service and policy interventions. In particular, the role of government in supporting families during periods of personal, economic, and social stress requires greater attention in considering the range of preventive measures for family violence. Although child and spousal abuse have received increasing attention in family violence research, almost nothing is known about the dimensions, scope, causes, or effects of elder abuse. The characteristics of individuals and families that are associated with abuse of the elderly need consideration, as do the features of interventions designed for other forms of family

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Violence and the American Family: Report of a Workshop violence that might be adapted to this problem. The relationships between different forms of family violence have not been examined. The importance of neighborhood factors has only recently received recognition in considering structural, ethnic, economic, and social characteristics of families who experience violent behavior. Certain neighborhoods appear to pose greater risks for these families. The diversity of poor neighborhoods has not been considered in the design of service interventions. The unique characteristics of child sexual abuse need special consideration in analyses of family violence. This form of abuse does not appear to have the same risk factors as other forms of violent behavior, especially in considering the role of poverty and social isolation. American culture currently fosters a perception that violence and fear-induced compliance are effective in achieving short-term objectives in controlling the behavior of others. Violence within the family is reinforced by reports and images in the media, in entertainment programming, and in sports that implicitly condone or promote the use of violence. Religious and parental experiences with corporal punishment and child discipline also need to be considered in examining attitudes towards the use of violence against family members in American culture. EXISTING INTERVENTIONS The experience with existing services suggests that there are no “quick fixes” to problems of family violence. A comprehensive set of family support programs or a continuum of services to families at different stages of child development does not exist. Although some promising interventions have been developed, the range of existing programs does not offer services that enable parents to deal with stress and violence at all stages of a child's life—from pregnancy and infancy through toddlerhood, early childhood, the preteen years, and adolescence. Rigorous evaluations have not been developed for social service interventions that respond to different dimensions of family violence. Such interventions include home visits, family support and family preservation services, day care support, foster care, mandatory reporting for child abuse, and other health, legal, and social services programs. Although many service providers believe that some interventions for family violence seem to work with certain forms of violence or abuse, information about the universality of the effectiveness of such interventions is weak and uncertain. Information is also lacking about the circumstances under which selected interventions appear to work for certain population groups. Home visitors' programs (interventions that provide a public health nurse or trained paraprofessional to visit homes and to provide services and

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Violence and the American Family: Report of a Workshop resources designed to improve the quality of parent-child interactions following the birth of a child) represent one promising development that deserves careful evaluation. The existing variation in home visitation programs requires a comprehensive evaluation to identify factors that contribute to the success or limitations of these programs in preventing family violence, especially violence directed at newborns or very young children. In particular, information is needed on what types of special populations (rural, inner city, immigrant, migrant, etc.) are best or poorly served by what types of programs. The role of family preservation programs has not been well studied. In particular, more knowledge is needed about the effects of family preservation efforts on parents and children to determine whether intensive family assistance programs can promote the healthy development of children. Furthermore, the role of family preservation in families characterized by multiple forms of abusive behaviors needs to be examined. Experimental programs of mandatory arrest for spousal abuse suggest that these programs may be beneficial in some circumstances but that they may cause additional harm in others. Particular attention needs to be given to program features that provide victims with an opportunity to receive an apology and sense of restitution from the offender. The response of the courts to spousal abuse needs to deal with two significant obstacles in developing an effective system: victim ambivalence and offender control. Some courts have established innovative efforts focused on these issues that deserve broader evaluation and attention. The time-consuming and expensive processing issues associated with handling child and spousal abuse cases have generated a search for solutions outside the legal system. Reform efforts have focused on fostering cooperation among the courts, police programs, and health and social services to design collaborative interventions that can be offered prior to an arrest for or a report of family violence. POLICIES, PROGRAMS, AND RESEARCH DIRECTIONS The role of prevention needs greater emphasis in considering public-sector responses to family violence, although difficulties remain in identifying families at risk for potential violence. Rather than waiting for incidents of violence to trigger the availability of support and assistance, counseling and education services need to build on an integration of existing interventions and to design proactive approaches that are responsive to community needs and feasible with community resources. Integrated, coordinated, community-based programs need to combine the successful features of existing categorical services. The concept of “community response” needs to be reconceptualized for family violence.

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Violence and the American Family: Report of a Workshop Programs that move away from fragmented and piecemeal efforts and develop a broader service system based on child and family needs in a neighborhood context need to be encouraged. Greater attention needs to be given to the training of physicians and other health professionals in identifying, treating, and preventing family violence. Hospital-based programs are needed to improve the quality of health professional education regarding methods of responding to suspected family violence. Alternative forms of reimbursement for the time and expenses associated with diagnostic tests and involvement in social service or legal proceedings need to be developed for both physical and mental health professionals and educators following a report of suspected abuse. The strong association in the research literature between the use of corporal punishment and child abuse suggests that greater attention needs to be given to the prevention of “spanking” and other forms of physical discipline. In particular, health professionals need to be informed about alternative forms of child discipline to guide parental behaviors. More knowledge is needed about the sources of motivation for behavioral change, especially violent behavior. Although characteristics of certain program interventions may improve the quality of spousal relationships and parent-child behaviors, a key ingredient for the success of such programs may be the ability of individuals to identify a problem and be willing to change. Basic and applied research on the processes of change for a variety of behaviors (such as alcoholism, smoking, teenage pregnancy) need to be linked to the study of family violence to foster effective program development. In developing new programs, caution must be exercised to ensure that new interventions do not replace older, but effective, forms of service and care. Small-scale effective service programs need to be protected when innovative but untested approaches in service delivery are being tested and implemented. Public attention to the issue of family violence is just beginning to emerge. A broad constituency and resource base needs to be organized that can support an effective public campaign and highlight key issues related to family violence (such as the proliferation of handguns) that are amenable to change. The experience of the public health sector in influencing other areas of personal behavior (such as smoking and drunk driving) suggests that a broad-based publicity campaign is necessary to foster change in individual behaviors linked to family violence. Concerned professionals from a range of fields need collaborative forums and resources to create a public constituency that recognizes the magnitude and significance of the problem of family violence and will support a public health approach as a tool for social reform.

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Violence and the American Family: Report of a Workshop The knowledge base of program evaluations in the area of family violence is fragmentary and lacks integration. However, research in related fields can help identify factors that need to be considered in transferring promising research or experimental programs to a broad-based implementation effort in social services. Useful databases about the scope, severity, and characteristics of different forms of family violence are needed to inform program and policy efforts. Particularly lacking is detailed information about children who abuse their siblings or parents, the nature of elder abuse, and the relationship between different forms of family experiences and family violence.