Various disciplines have contributed to the development of research on violence against women, including psychology, psychiatry, medicine, nursing, public health, social work, statistics, epidemiology, sociology, ethnography, anthropology, social history, criminology, and law. Each discipline brings different theoretical models, databases, instrumentation, and problem definitions to its work. As a result, it is often extremely difficult to generalize from clusters of studies or to build on earlier work.
With the passage of the Violence Against Women Act of 1994 (Title IV of P.L. 103-322), the federal government initiated a broad set of programs focused on violence against women, many of which will be administered by law enforcement, prosecution, and victim services organizations. Hotline services, victim advocate programs, and shelter resources represent important community-based programs that can respond to the immediate needs of women in crisis as a result of violence. However, these same programs are often not equipped to deal effectively with research knowledge in the development of their services, and, conversely, their collec-
tive experiences in dealing with women affected or threatened by violence are often not accessible or used by the researchers.
Training Researchers And Practitioners
The community of researchers whose work focuses on understanding, controlling, or preventing violence against women is extremely small. Although this community has developed some networks in communicating research findings of common interest across disciplines, it lacks the resources or opportunities to integrate this research into other fields of study and practice. Furthermore, this field of research is characterized by the absence of clear conceptual models, large-scale data bases, longitudinal research, and reliable instrumentation. Investigators have difficulty obtaining funding because their research proposals often compete against those from more established fields that can build on an infrastructure developed through decades of prior research activity. Investigators may also lack opportunities to learn from relevant research in areas that can enrich the development of research on violence, such as deterrence theory in criminal behavior, the study of community-based organizational behavior, the effectiveness of formal and informal controls in governing individual and group behavior, research on the use of community services, adolescent health, the cultural context of coercion and power, and program evaluation, particularly models of community responses that have been developed in such fields as substance abuse prevention (see, e.g., Kaftarian and Hansen, 1994).
At the same time, there is increasing need for researchers who understand violence against women and can put that understanding to work with practitioners to improve program design and evaluation. In these days of budget cutbacks, programs will increasingly be called on to show evidence of their effectiveness through systematic evaluation. Program evaluation studies of treatment and prevention services in this
field will require improved efforts to design outcome studies that target violence reduction as a specific measure of the effectiveness of the program under review. Such studies will require careful design and attention to a range of concerns that are often associated with other community-based program evaluation studies, including the theoretical strength of the selected program, fidelity of implementation of the particular activity that is under review, the length of follow-up, the availability of a matched control group, and the size of the sample. Such studies will require researchers and practitioners who are able and willing to work together to achieve better evaluation studies that can inform and improve interventions.
There are also training needs among related professionals who are in positions to identify women victims of violence. For example, a broad set of initiatives has been developed to improve the diagnostic skills of emergency room health personnel, obstetric-gynecologist physicians, and primary care practitioners in detecting and responding effectively to battered women and to sexually assaulted women. However, many mental health and health care professionals who are responsible for the treatment of women for substance abuse, mental health disorders, or sexually transmitted diseases have not received the same type of educational effort designed to highlight the importance of identifying the role of violent trauma in the course of complex health behaviors. Other neglected health care fields are the areas of pediatrics, adolescent medicine, sports medicine, and the military and veterans' health care systems, which often have very broad access to young men but which virtually ignore any attempt to identify risk factors for violent behavior in the course of primary care treatment. All too often, the result in health care is a ''field" that sees fragmented aspects of physical and mental health problems that share common risk factors and common origins but lacks a means of connecting them and the presenting symptoms to a recommended course of treatment. The effort to integrate research on violence against women into
the training and certification requirements for a wide community of health professionals thus confronts a tremendous challenge that requires constructive approaches in the decade ahead. One promising proposal is for the inclusion of information on many forms of violence, including battering and sexual assault, in training, continuing education, and certification requirements for a variety of professions, such as law, law enforcement, nursing, social work, and education (Minnesota Higher Education Center Against Violence and Abuse, 1995).
A topic that is often missing in the training of both researchers and practitioners is information on diverse population groups—at the same time that both researchers and practitioners are frequently exhorted to be sensitive to cultural differences and to be culturally competent. These concepts were well described by the Institute of Medicine's Committee on Reducing Mental Disorders (Mrazek and Haggerty, 1994:391-392):
Cultural sensitivity is the awareness of a body of important information relevant to the population(s) of interest, which should inform the entire research process, from defining the sampling frame, through negotiating access, to actual intervention and dissemination of results. Such sensitivity can be, and typically is, learned through formal, didactic means and by familiarity with the rapidly growing literatures. It is a necessary but insufficient condition for cultural competence. Cultural competence is achieved through personal experience, either closely supervised practice or actual immersion in the field, which leads to acquisition and mastery of the skills needed to fit interventions to context.
There is little information characterizing the experience of violence among racial and ethnic minority women or among women who are homeless, poor, substance abusers, recent immigrants, migrants, disabled, or lesbian. It is in these areas, where violence is often thought to be more prevalent because of the nature of the dependency of women and
their social isolation, that researchers are most poorly equipped to understand the forms, nature, or scope of gender-specific violent behavior. Services targeted for these populations are also often lacking.
Training is needed to prepare researchers and practitioners to meet the challenges of culturally competent research and interventions, by exposing them to the relevant literature, teaching qualitative research techniques as well as quantitative ones, and providing opportunities to interact with the communities they are studying or serving. Training more minority researchers and service providers may also be beneficial in broadening research and intervention contexts to include underserved and understudied populations.
As in other fields for which resources are insufficient to meet demand for services, practitioners may see researchers as competitors for scarce funds. Research is also seen by some practitioners as irrelevant to providing services. Researchers, for their part, may ignore the experiential knowledge base of those who have worked with battered women or rape victims or fail to make their findings accessible to the practitioner community. Although many individual researchers have established contacts and collaborations with practitioners, this is a time-intensive task that is not necessarily supported by current research infrastructure and funding mechanisms. Practitioners who want input from researchers or technical assistance in planning and evaluating programs have to spend scarce time and resources locating researchers to help them.
The issue of violence against women has received increased attention at the federal level in recent years, accompanied by targeted funding for programs and research. Research funding is based primarily in three agencies: the National Institute of Justice (NIJ) of the U.S. Department of Justice, and the Centers for Disease Control and Prevention
(CDC) and the National Institutes of Health (NIH) of the U.S. Department of Health and Human Services (HHS). A variety of other federal agencies have also supported individual studies on violence against women, including HHS's Administration for Children and Families (ACF), the U.S. Department of Labor, and the U.S. Department of Education.
Despite some efforts in the past 2 years to coordinate activities relating to violence, however, the funding remains fragmentary, and no single agency is responsible for determining the overall level of funding for research (or programs). As a consequence, it is extremely difficult to determine how much money the federal government is currently investing in violence against women research. It is even difficult to locate information on funded projects or the results of funded research. Without such information, it is difficult to evaluate the scope and emphasis of the federal effort, to improve dissemination of research findings, and to identify research gaps. The panel did not have the resources within its 1-year study to identify or comprehensively review all federal research; rather, it could only catalog some of the larger areas of research activity.
In fiscal 1994, $7.3 million was appropriated to the CDC to undertake a program to prevent violence against women (Centers for Disease Control and Prevention, 1995). Activities have been developed to meet five broad goals: describing and tracking the problem, increasing knowledge of causes and consequences, demonstrating and evaluating ways to prevent violence against women, supporting a national communications effort, and fostering a nationwide network of prevention and support services. The CDC's National Center for Injury Prevention and Control is overseeing this effort and is currently spending about $1.8 million a year in extramural research efforts.
Over the past 4 years, NIJ has awarded more than $1 million annually to research and evaluation projects on family violence (National Institute of Justice, 1995), which includes child abuse, battering, and elder abuse. NIJ has indicated that
it plans to allocate a percentage of its program funds under the Violence Against Women Act for evaluation research, but the nature of this activity has not yet been defined.
In 1993 the Administration for Children and Families awarded funding to establish the national Domestic Violence Resource Network, composed of the National Resource Center on Domestic Violence, the Battered Women's Justice Project, the Health Resource Center on Domestic Violence, and the Resource Center on Child Protection and Custody. The members of the Resource Network collect information and support services for battered women and their children. The resource centers provide important distribution points for program-related information, but their efforts do not have a primary focus on research studies or on tracking what may be relevant findings from studies in this field.
Other federal agencies have also provided funding for research on violence against women, particularly two NIH institutes. In fiscal 1994, the National Institute of Mental Health (NIMH) spent about $2.5 million on physical and sexual violence studies and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) spent about $314,000 on studies dealing with sexual assault and alcohol and battering and alcohol.
At present there are no state research centers focused primarily on violence against women. However, individual training projects in the area of prosecution and law enforcement provide important regional and national resources that reveal key characteristics of law enforcement and judicial policy and process that may impede or contribute to the reduction of violence against women.
No private foundations have established violence against women as a primary area of programmatic emphasis, but several foundations are developing research programs in various aspects of family and community violence that have implications for the field. The Family Violence Prevention Fund, for example, which is funded by the California Wellness Foundation and other private foundations, has established a major
initiative designed to foster reform in health care practices in the treatment and prevention of violence against women. The Conrad N. Hilton Foundation has recently made domestic violence one of its four funding areas.
A number of private foundations and corporations have supported services for victimized women. For example, the Domestic Violence Prevention Project in New York City received initial funding from the Robert Sterling Clark Foundation, the New York Community Trust, the Norman Foundation, and the Conrad N. Hilton Foundation, and the Ford Foundation supported evaluation of the project. Other foundations are beginning to explore the issue of violence against women within the context of improving women's health. The Commonwealth Fund, for example, is sponsoring the Women's Health Initiative, which organized a symposium on violence against women, held in New York City in September 1995, to examine the implications of violent behavior for the health outcomes of women.
Conclusions And Recommendations
Research on violence against women will be strengthened by a research infrastructure that supports interdisciplinary efforts and helps to integrate those efforts into service programs and institutional policies, especially in the area of preventive intervention. Key areas for improving research infrastructure are coordination and leadership at the federal level and improving research capacity and strengthening ties between researchers and practitioners.
Government Coordination and Leadership
At the national level, three major agencies provide most of the research funding for violence against women—the Centers for Disease Control and Prevention, the National Institute of Justice, and the National Institutes of Health—with some funding from other agencies. In addition, many other
agencies, including the National Science Foundation and the Department of Education, have programs that could contribute to the development of research on violence against women. Special efforts are needed to strengthen the role of these agencies in a collaborative effort at the national level. A mechanism for information sharing, interdisciplinary research development, research collaboration, and collaborative dissemination across agencies is needed. The panel has taken note of on-going collaborative efforts and applauds the agencies for them. Added efforts are needed to ensure the continuation of these collaborations and bring in agencies that are not yet part of the collaboration.
Providing effective leadership requires not only collaboration among agencies, but also a coordination of effort. Coordination might best be achieved through the designation of a lead agency on violence against women. Current government efforts have centered around criminal justice interventions, such as the establishment of the Office on Violence Against Women at the U.S. Department of Justice and NIJ's decision to set aside a proportion of its Violence Against Women Act funds for research in this field. These steps should help ensure a strong criminal justice system involvement in violence against women programs and research. However, the focus of research efforts must go beyond criminal justice.
The panel believes that in order to significantly reduce the amount of violence against women in the United States the focus must be on prevention. This suggests that an agency with more interdisciplinary, prevention-oriented experience than NIJ coordinate the federal research effort on violence against women. The panel recognizes that prevention is a long-term strategy—that research must continue on criminal justice interventions with individual perpetrators of violence against women and on social service, health, and mental health interventions for victims—but it should guide the overall effort in this field.
Recommendation: The panel recommends that government agencies develop a coordinated strategy to strengthen the creation of a research base that is focused on prevention of violence against women and interventions for offenders and victims.
One way to achieve this goal would be the formation of a federal Task Force on Research on Violence Against Women with representation from all relevant agencies and a chair that rotates between the U.S. Department of Justice and the U.S. Department of Health and Human Services. Coordination of government-supported research in the field of violence against women could be further improved through the designation of a lead agency to track all federal research and expenditures on violence against women and identify research gaps. Should a lead agency be designated, the panel believes that agency should be the Centers for Disease Control and Prevention because of CDC's record of experience with interdisciplinary and prevention research.
Improving Research Capacity and Strengthening Research-Provider Collaboration
In many fields, research centers have been successful in developing innovative, interdisciplinary research. Examples of such efforts include the CDC-funded Injury Control Research Centers, the NIMH-funded Minority Mental Health Research Centers, the Children's Safety Network funded by the Maternal and Child Health Bureau, and the NIMH-funded Preventive Intervention Research Centers (PIRC). Research centers are usually funded for extended periods of time, allowing for the development of excellent in-depth theoretical, methodological, and applied research focused on a specific topic. The PIRC model may be particularly applicable to issues related to violence against women: its funding mechanism allows for a combination of basic, intervention, and methodological studies that can inform each other. This com-
bination led to an integration of careful scientific theory and process into all phases of design, testing, and dissemination of preventive interventions (Koretz, 1991). Research emanating from the PIRCs has been at the forefront of efforts to move preventive intervention research away from simple outcome assessments of a theoretical intervention strategies toward experimental tests of population-based, theoretically derived models. This development has led to a greater understanding of causal mechanisms and processes of the various conditions that are the focus of individual PIRCs and to innovative methodologies for overcoming the many challenges of doing field experimentation.
Research centers can also serve as a potent mechanism for research and practitioner collaboration and for training. The flexibility inherent in the funding for many research centers allows for the creation and evaluation of demonstration service delivery projects that require the talents and skills of both practitioners and researchers and also provide opportunities for training young researchers and practitioners. Research centers that include a technical assistance component can serve as a resource for service delivery programs in surrounding communities, helping them to incorporate research findings into their programs and helping them design and carry out program evaluations. The history of past research endeavors leads the panel to question whether topics relating to women's experiences of violence would receive adequate attention without resources earmarked specifically for them.
Recommendation: The panel recommends that a minimum of three to four research centers be established within academic or other appropriate settings to support the development of studies and training programs focused on violence against women, to provide mechanisms for collaboration between researchers and practitioners and technical assistance for integrating research into service provision.
The panel believes that research centers specifically devoted to violence against women are important to expanding and improving the knowledge base. The centers could be organized as regional centers or each could have a particular focus. The experience of PIRCs and the Injury Control Research Centers with focused centers leads the panel to prefer that model over a regional model. The centers could be organized around research areas such as the epidemiology and measurement of violence against women, causes and risk factors for violence against women, and preventive and treatment intervention evaluation research. Or centers could be organized around such topics as violence against women in minority and underserved populations, alcohol and drug abuse in violence against women, violence against women in the media, and violence against rural women.
The purpose of the technical assistance aspect of the centers is to encourage state agencies and community-based and other service providers to use theoretical models and research tools and instruments in the design of their service interventions and program evaluation. Service providers are increasingly being called on by funders to evaluate their programs. Providers also have contact with large numbers of victims and offenders and offer unique opportunities for collecting data to better understand violence against women. Yet most service providers lack the technical expertise to plan and carry out research. The technical assistance function of the centers would provide a source of information to improve service providers' ability to collect data and evaluate program effectiveness. Furthermore, dissemination is an inherent part of research, yet all too often research findings never reach the service providers. Technical assistance from the centers would also help to make research findings accessible to service providers; could support technical training programs for service provider agency personnel; and could possibly provide seed money for service providers to conduct small-scale case studies or descriptive reviews of selected program interventions.1
The research centers would contribute to the field by incorporating interdisciplinary areas of knowledge; fostering exchanges between and among sciences and the humanities in the development of theory, measurement, social constructs, and policy recommendations; and assisting service providers to develop and carry out well-designed program evaluations. More specifically, the role of the Violence Against Women Research Centers would include the following:
- to foster a dialogue among the disciplines about the nature of violence against women and its relationship to other forms of violence and injury and to develop a conceptual framework that could assess the development of this field;
- to stimulate creative approaches in encouraging service providers' collaboration with researchers on the design and evaluation of program interventions;
- to foster collaborative research efforts among researchers from different disciplines and institutions and between research institutions and service providers;
- to develop training programs for young investigators and to provide curriculum materials to other training institutions;
- to encourage the training of minority researchers;
- to provide a national focus for public forums designed to disseminate research knowledge about violence against women; and
- to provide technical assistance to service providers.
The problem of violence against women in the United States will not be solved in the short term or without concentrated attention. Well-organized research will be critical to and will contribute to the long-term goal of preventing and ameliorating the effects of violence against women.