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Violence in Families: Assessing Prevention and Treatment Programs (1998)

Chapter: 4 SOCIAL SERVICE INTERVENTIONS

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Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
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4
Social Service Interventions

State and municipal governments and nongovernmental entities provide a broad range of social services designed to prevent or treat family violence. These services include counseling and advocacy for victims of abuse; family and caregiver support programs; alternative living arrangements, including out-of-home placement for children, protective guardianship for abused elders, and shelters for battered women; educational programs for those at risk of abusing or being abused; intensive service programs to maintain families at risk of losing their child; and individual service programs in both family and placement settings.

Social service interventions may consist of casework as well as therapeutic services designed to provide parenting education, child and family counseling, and family support. Social service interventions also may include concrete services such as income support or material aid, institutional placement, mental health services, in-home health services, supervision, education, transportation, housing, medical services, legal services, in-home assistance, socialization, nutrition, and child and respite care. The scope and intensity of casework, therapeutic services, and concrete assistance to children and adults in family violence interventions are often not well documented, and they may vary within and between intervention programs. As a result, similar interventions (such as parenting practice and family support services) may offer very different kinds of services depending on the resources available in the community and the extent to which the clients can gain access to available services.

Some social service interventions (such as child protective services) are directly administered by state agencies; some services (such as parenting education and family support programs) are funded by government agencies but are

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

provided by public or private services; other services (such as advocacy services for battered women) rely on grass roots support or local voluntary agencies. All of these interventions are designed to address the social support and safety needs of individuals and families, but they often have different focal points in meeting the needs of their clients. Their goals include the protection of children and vulnerable adults; the enhancement of parents' ability to support and care for their children; the preservation of families; and the development of resources and networks to enhance family functioning, the safety of women, and the care of children and the elderly.

Although treatment and prevention interventions for child maltreatment, domestic violence, and elder abuse have drawn on a series of theoretical frameworks over the past three decades, the connections between interventions and research are often uncertain and ambiguous. Their development has involved trial-and-error experiments in which ideas gain prominence for a short time, only to fade when disappointing results are documented (Wolf, 1994). The interventions have focused on different levels—the individual, the family, the neighborhood, and the social culture—each providing a different set of outcomes of interest, complicating the tasks of designing interventions and evaluating their effects.

In addition to shifts in theoretical frameworks and relevant outcomes, evaluations of social service interventions have been complicated by two other significant factors: (1) variations in programs that are viewed as a single intervention and (2) differences in the population of children or adults who receive the social services. Conflicting results in evaluation research studies thus may reflect these program differences (such as the intensity or scope of services or the training of service personnel) or variations in the personal histories or types of problems experienced by the clients served.

This chapter reviews social service interventions and the available evaluations of them, using the selection criteria discussed in Chapter 1, first for child maltreatment, then for domestic violence, and finally for elder abuse.

Although this discussion of social service approaches to addressing family violence identifies specific interventions, these are far from distinct strategies. There is substantial overlap in the specific services provided by each intervention—which raises the critical cross-cutting question of which elements in this set of interventions are most effective in preventing and treating family violence. Nevertheless, the specific interventions discussed in this chapter have been identified by the field, and the evaluation literature has evolved from these services as they are identified. For this reason, the committee has retained these somewhat arbitrary distinctions. Although the interventions are described in discrete categories, the individual interventions are part of a continuum of services available to victims and their families. The interventions discussed in one section may therefore be relevant in other sections of the chapter and to interventions discussed in the chapters on legal and health care interventions.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Child Maltreatment Interventions

Research points to the interaction of multiple factors in the maltreatment of children; the interaction of these factors has been described in a variety of theoretical models that have evolved over the past decade (National Research Council, 1993a,b). Current models include (a) the ecological models of Belsky and Garbarino, based on the original conceptions of Ure Bronfenbrenner (Belsky, 1980; Garbarino, 1977); (b) the transitional model, which regards child maltreatment and maladaptive parenting as extreme ends of a continuum of interactions among social and cultural forces, parenting roles, and individual behavior (Wolfe, 1991, 1994); and (c) the transactional model of Cicchetti (Cicchetti and Carlson, 1989), based on Sameroff and Chandler's (1975) formulations, which focus on interactions among risk and protective factors in the social environment of the family. All three approaches share underlying assumptions that individual characteristics of the child or parent are insufficient to explain the nature and emergence of child maltreatment; each group of models uses a different set of assumptions to examine the interactive processes, perceptions, stresses, and social supports in the family environment.

Theorists have considered specific factors that appear to play a significant role in the different models: social isolation (DePanfilis, 1996; Kennedy, 1991; Ammerman, 1989), stress (Fanshel et al., 1992; Kennedy, 1991), mental health disorders (McCord, 1983), lack of knowledge about child development and rearing (Wolfe, 1987), contributing child behavior (including the lack of knowledge of self-protective behaviors) (Fanshel et al., 1992), and social and individual characteristics such as poverty and substance abuse. Three decades of research and practice have shifted the focus of treatment and prevention interventions away from models based solely on individual pathology toward broader social ecological models, with a new emphasis on the social context of parent-child relationships (Wolfe, 1994).

Although the focus of concern is the child victim, interventions in this area often target the parent (usually the mother), under the assumption that behavior change in the parent will protect the child. Such activities include parent support groups, parent education, home visiting, mental health, and other concrete social support and therapeutic services. Programs targeting children include skill-building around resistance to maltreatment, conflict management skills, and therapeutic interventions. Table 4-1 lists some major outcomes expected from social service interventions, many of which lack reliable measures. Most treatment and prevention interventions do not include data related to child maltreatment as an outcome measure, and those that do usually rely on reports of child abuse and neglect rather than observations of parent-child interactions.

Many of the outcomes highlighted in the table are interrelated; any single intervention may have several intended outcomes for parents, for children, or for both. The relationships among outcomes, such as changes in mental health,

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4-1 Expected Outcomes of Social Service Interventions for Child Maltreatment

Child Outcomes

Parent Outcomes

Enhanced child development and well-being

Improved parenting skills, knowledge of child development, and more realistic expectations for child behavior

Fewer child hospitalizations and fewer emergency room visits

More stimulating home environment

Lower injury and death rates and reduced child accident rate

Reduced use of corporal punishment

Amelioration of symptoms of maltreatment

Increased use of community services and enhanced social support

Ability to recognize dangerous and potentially dangerous situations

Fewer and more widely spaced pregnancies (for young parents)

Knowledge of and appropriate use of self-protective behaviors

Reduced stress

Reduction in reports of child abuse and neglect

Reduction in out-of-home placements

 

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

parenting skills, use of community and other support services, child development, child maltreatment reports, and injury and death rates, are still poorly understood. Changes in cognitive or social skills may or may not be accompanied by behavioral changes (such as use of community resources); both are thought to be highly influenced by social context and cultural forces. For example, individuals are unlikely to seek out formal or informal services that have consistently been unavailable or unreliable in their family networks or neighborhoods.

Six social service interventions for child maltreatment are reviewed in the sections that follow: (1) parenting practices and family support services, (2) school-based sexual abuse prevention, (3) child protective services investigation and casework, (4) intensive family preservation services, (5) child placement services, and (6) individualized service programs. The sections are keyed to the appendix tables that appear at the end of the chapter.

4A-1: Parenting Practices and Family Support Services

Child neglect is the most common form of child maltreatment reported to

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

child protective service agencies (National Center on Child Abuse and Neglect, 1996b). Researchers have suggested that families who are socially isolated and lack social support may be more prone to neglect than matched comparison samples (Belsky, 1980, 1993; Belsky and Vondra, 1989; Bronfenbrenner 1979; Cicchetti, 1989; Rizley and Cicchetti, 1981; Thompson, 1994, 1995; Wolfe, 1987, 1991). A number of strategies for intervention have been described and evaluated in the research literature, including (1) individual social support interventions, such as lay counseling, in-home education and parent aide programs, and parent education support group interventions; (2) multiservice interventions that match services to the specific needs of families; (3) risk assessment interventions that assess the strength of the family social support systems; (4) social skills training that seeks to improve a family's ability to gain access to appropriate resources and services (see Table 4-2); and (5) intensive family preservation services, which provide family support counseling and referrals during periods of crisis. These interventions are discussed below in terms of what is known about the outcomes associated with different strategies. Another strategy for preventive intervention, the home visitation program, is usually administered by public health departments and is discussed in Chapter 6 in our review of health care interventions.

Variations in the selection of relevant outcomes as well as differences in the service and evaluation designs make it difficult to compare the results of social service interventions in the area of child maltreatment. There is a lack of consensus about the definition of neglect (Dubowitz et al., 1993; Hegar and Youngman, 1989; Zuravin, 1991), the goal of the intervention, key constructs that should be assessed in evaluating outcomes (Cameron, 1990; Gottlieb, 1980), the tools that can accurately measure the presence or absence of neglectful behavior, and the meaning of social support. Most of the evaluations in this area use relatively limited sample sizes, and few have control group comparisons (DePanfilis, 1996).

The variety of outcomes measured includes maltreatment and placement rates, client motivation to change neglecting conditions, childrearing practices, parents' personal care, and child outcomes in domains such as cognitive, language, verbal, and social skills (DePanfilis, 1996). Although reducing child maltreatment is the ultimate goal for most interventions, proxy outcomes, such as measures of improved child health and emotional and social adjustment, are often used to measure an intervention's effectiveness. Official reports of child abuse and neglect are often viewed as unreliable indicators, because incidents may not be reported to authorities, or may be falsely reported, or because surveillance bias may affect reports in treatment families who are in close contact with social services programs.

In addition, variations in the components, duration, and intensity of treatment services and the length of follow-up periods confound efforts to identify particularly promising interventions. Controlled designs of multiservice interventions

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4-2 Range of Family Support Interventions

Strategy

Description

Social network models

Used to evaluate the quantity and quality of a family's linkages with formal and informal supportive resources outside the family system. Each model is structured somewhat differently, but all seek to identify intervention targets for strengthening the social network of families.

Examples include:

The Eco Map (Hartman, 1978)

The Social Network Map (Tracy, 1991; Tracy and Whittaker, 1990)

Index of Social Network Strength (Gaudin, 1979)

Pattison Psychosocial Inventory (Hurd et al., 1981)

Social Network Form (Wellman, 1981; Wolf, 1983)

Individual social support

Operates from a family empowerment philosophy and includes multiple types of social support mixed with professional interventions. Services may include casework services, support groups, parent training, support by lay therapists or parent aides, memberships in recreational centers, transportation, and homemaker services. Individually planned service mixes seek to match services to the specific needs of families.

Parent education and support groups

Offer information and role modeling as well as social support to impoverished families. Parent groups provide information on basic child care skills, problem solving, home management, and social interaction skills.

Social skills training

Seeks to increase the effectiveness of other interventions geared to serve specific social support functions. Researchers have suggested that neglectful parents are often handicapped by a lack of social skills that might enable them to utilize community support services.

 

SOURCE: Modified from DePanfilis (1996).

have not been used to clearly document which program components are effective for which specific presenting problems.

Quasi-Experimental Evidence

Table 4A-1 lists 15 evaluations on increasing social support that meet the committee's criteria for inclusion. The table includes studies that examine parenting education and social support interventions for families that experience

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

different types of stress, as well clinical interventions that focus more explicitly on providing mental health services for parents involved in known cases of child maltreatment.

Reduced reported maltreatment. Three quasi-experimental evaluations with reports of child maltreatment as an outcome measure indicate no statistically significant difference in the rate of reports of abuse and neglect for experimental versus comparison groups following treatment (Barth et al., 1988; Barth, 1991; Wesch and Lutzker, 1991). A fourth study initially indicated fewer reports of abuse/neglect in the treatment program than a comparison group (Lutzker et al., 1984), but this result was not maintained in the follow-up study (Wesch and Lutzker, 1991).

Some evaluators have used the standardized Child Abuse Potential Inventory (CAPI) as a proxy outcome to assess the likelihood that parents will abuse their children again. Two evaluations of the Child Parent Enrichment Project, for example, found that treatment-group parents had significantly lower CAPI scores post-treatment, relative to pretreatment and relative to control parents (Barth et al., 1988; Barth, 1991).

Parental competence and skills. Another outcome thought to enhance child well-being is improved parental competence. Seven of nine studies testing gains in parenting competence indicate positive effects of interventions to reduce child neglect (Burch and Mohr, 1980; Egan, 1983; Gaudin et al., 1991; Hornick and Clarke, 1986; Larson, 1980; National Center on Child Abuse and Neglect, 1983a; Schinke et al., 1986). One study did not find enhanced parenting skills in treatment groups relative to comparison groups (Resnick, 1985). A second study of parenting skills at home and in laboratory observation of parent-child interactions, which was the only study to explicitly include fathers, also found no reliable change pre- to postintervention. The authors noted that aversive behavior scores for fathers in the treatment group did not differ significantly from scores of the nondistressed fathers in the no-treatment control group (Reid et al., 1981). Methodological factors, such as the use of observed effects versus self-report data and reliance on project-developed instruments rather than standardized assessment tools, discourage the comparison of these results with other studies.

An evaluation was conducted of an intervention designed to change parental perceptions and expectations, to teach relaxation procedures to mediate stress and anger, and to train parents in problem-solving skills (Whiteman et al., 1987). The results indicate that all three individual intervention strategies improved parents' scores on affection, discipline, and empathy indexes relative to no-treatment control parents. A composite intervention, which combined all three strategies, produced the largest change in index scores.

Findings from less rigorous studies, which did not meet the committee's selection criteria, examined the effect of teaching social skills to parents at risk of

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

neglect. Three studies report that parent support groups that offer social skills and problem-solving training are more successful with neglectful parents than programs offering more general content on child development (Daro, 1988; Gaudin et al., 1991, 1993). In a study of the Homebuilders program, the behavioral intervention to teach social skills was identified as an essential component (Kinney et al., 1991).

Parental mental health. New theoretical models that emphasize the interactions among social context, mental health, and family functioning have emerged in interventions for child maltreatment, focusing on the need to improve parental self-esteem, stress management, and the regulation of impulsive behaviors in order to enhance parental (usually the mother's) abilities to manage children through everyday care and discipline (Wolfe, 1994). Since parental apathy and impulsivity are commonly associated with caregiver behaviors in cases of child neglect (Polansky, 1981), a number of studies hypothesize that improving parents' mental health will result in reduced child neglect. The relevant outcome in this approach is the intervention's ability to produce beneficial changes in the parents' mental health relative to comparison groups, including reduction of depression and negative effects of life stress and enhanced self-esteem. Six studies report at least short-term improvements in scores on standardized measures for treatment parents in these areas (Barth et al., 1988; Barth, 1991; Brunk et al., 1987; Egan, 1983; Resnick, 1985; Schinke et al., 1986). However, the only study that included long-term follow-up reported that treatment gains were not maintained after a one-year interval, and the hypothesized connection between short-term competence enhancement and long-term prevention of maltreating behaviors lacked empirical support (Resnick, 1985).

Social support. Social support has been described as the social relationships that provide (or can potentially provide) material and interpersonal resources that are of value to the recipient (Thompson, 1994). The absence or presence of social support and involvement in social networks has been identified as an important risk factor for abusive families, especially in cases of neglect. Social support can provide a variety of services that help reduce stress in family life, including individual and family counseling, advice on parenting practices, child and respite care, financial and housing assistance, sharing of tasks and responsibilities, skill acquisition, and access to information and services.

A number of evaluations use social network assessment tools to determine if interventions can reduce social isolation for neglectful families, thereby decreasing propensity for neglectful behavior (Barth et al., 1988; Barth, 1991; Gaudin et al., 1991, 1993; Resnick, 1985; Schinke et al., 1986). Two found no beneficial results in social support (Barth et al., 1988; Barth, 1991); two others found improved social support for families receiving treatment (Gaudin et al., 1991;

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Schinke et al., 1986). A sixth study found initial improvement in social support that deteriorated over time (Resnick, 1985).

These results have not yet been able to suggest that network assessments will lead to more effective interventions or improved treatment outcomes (DePanfilis, 1996). However, one less rigorous recent study suggests that collecting data on perceived social support, the reported frequency of use, and satisfaction with different types of support may provide better indicators of social support than structural features alone (Tracy and Abell, 1994).

Some research has focused on the role of ''natural helpers"—individuals who supplement the efforts of formal social service agents and who have connections to the values and norms of the community in the social environment of distressed families (Collins and Pancoast, 1976; Thompson, 1994, 1995). The efficacy of natural helpers in counteracting the multiple stresses of disadvantaged communities is not well understood; some research has suggested that creating a web of social support for families at risk of abuse or neglect may require connections with self-help groups (such as Parents Anonymous) or family support centers that are especially knowledgeable about the problems of child maltreatment and can provide counseling and advice outside the context of everyday social relationships (Thompson, 1994).

Home environments. One evaluation looked at improvements in home environments as a proxy for decreased likelihood of child neglect with mixed results (Larson, 1980). Larson found improvements in treatment group families.

Implications

Social service interventions designed to improve parenting practices and provide family support have not yet demonstrated that they have the capacity to reduce or prevent abusive or neglectful behaviors significantly over time for the majority of families who have been reported for child maltreatment. Although parental behavior can be modified in terms of stress, empathy, anger control, and child discipline, confidence in these and other proxy outcomes (such as improved parental skills and altered perceptions of child behavior) requires greater understanding of the key attributes of parental competence that relate to child maltreatment. Several interventions have demonstrated an ability to improve parental competence in the short term, but whether these gains can be maintained over long periods under stressful conditions and across different periods of the child's development is not certain. The intensity of the parenting and social support services required may be greater than initially estimated in order to address the fundamental sources of conflict, stress, and violence that occur repeatedly over time in the family environment, especially in disadvantaged communities. Focusing as they do on single incidents and short periods of support, the interventions

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

in this area may be inadequate to deal with problems that are pervasive, multiple, and chronic.

The use of social networks to build and sustain parental competence is a separate area that requires further analysis. Although a parent's use of social networks to support family functioning can be influenced through interventions, there is not enough evidence to indicate whether changes in social networks can create changes in parenting practices that endure over time and result in reduced child maltreatment. The evidence, although intriguing, does not yet provide clear indications as to which types of families are most likely to benefit from parental education and family support services as opposed to mental health services designed to address depression, lack of empathy, and impulsive behavior in both parents and children. Neither does the research base yet clarify whether enriching the supply of community resources will lead to expanded use of support services by families at risk of child maltreatment. Consistent dialogues between researchers and practitioners could facilitate greater awareness of the need to match families with individualized interventions.

4A-2: School-Based Sexual Abuse Prevention

Sexual abuse prevention programs are organized around the theory that children can be taught to avoid abuse or to protect themselves from further abuse by reporting threatening or abusive situations and employing other learned self-protective behaviors (Daro and McCurdy, 1994). Most child sexual abuse prevention education is classroom-based, brief in duration, and includes training on concepts of body ownership, types of touching, and skills to avoid or escape sexually abusive situations. Children are encouraged "to tell." Curricula may also include assertiveness training for older youths (Barth and Derezotes, 1990). Some programs include a parental component, although such efforts are rarely evaluated (Reppucci and Haugaard, 1988). Formats include skits, puppet shows, songs, films, videos, and story and coloring books.

Table 4A-2 lists 14 evaluations in this area that meet the committee's criteria for inclusion. In general, these evaluations lack long-term follow-up data and rely on proxy outcomes, such as an increase in children's knowledge and skills (Carroll et al., 1992). The evaluations indicate that, although most programs can provide positive changes in cognitive skills and program-specific prevention behavior, especially when they draw on age-appropriate materials and special teacher training, the size and duration of this effect for children at different developmental stages remain generally unknown. Two programs that included 1-to 6-month follow-up found that children retained "flight" responses to situational lures (Harvey et al., 1988; Kolko et al., 1989). However, the evaluations have not included long-term follow-up studies that could demonstrate that these changes constitute a sexual abuse prevention effect for the general population of children, reduce the risk of sexual abuse to the vulnerable children who receive

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

the training, or mitigate the consequences of sexual abuse when it occurs by encouraging reports to an adult. The studies demonstrate that children can retain prevention information, but retention may be influenced by age at exposure, length of training, and inclusion of review sessions. Moreover, there is some question about children's ability to translate knowledge into actual behavior and whether increased knowledge or learned self-protective behaviors do protect children from sexual abuse by family members.

4A-3: Child Protective Services Investigation and Casework

The primary duty of state- or county-administered child protective services (CPS) agencies is to investigate and either substantiate or dismiss reports of child maltreatment; these casework management services (as opposed to treatment and prevention services) account for the large majority of the CPS budget in most communities. In the course of an investigation, social workers are charged with a dual responsibility: protecting the safety of the child and maintaining the family if that course is consistent with child protection. Short-term interventions in this area include provision of casework services, concrete and therapeutic interventions, referral to community-based services, and short-term placements during the investigation phase. Services provided after investigation include concrete services, education, referral to community-based agencies, crisis intervention, treatment, and temporary or permanent placement in substitute care if necessary (National Center on Child Abuse and Neglect, 1996a).

There is wide variation in the duration, timing, and kinds of CPS interventions offered to maltreated children and their families, from no services to support, counseling, and placement services (Meddin and Hansen, 1985). Some reviews of the effectiveness of social casework intervention with troubled families in general (not just child protective services) have indicated limited evidence of the effectiveness of casework intervention (Lindsey, 1994), noting that the caseworker often has little ability to change the structural and institutional barriers (such as unemployment, dangerous neighborhoods, poor housing) that confront many of their clients, limiting the scope of the intervention to smaller-scale problems.

There are no evaluations of child protective services that meet the committee's criteria for inclusion. Thus, several decades of experience with different types of CPS interventions remain relatively unexamined in the research literature, and the impacts of case identification and investigation procedures and practices are unknown. In the absence of a research base, policy makers rely on anecdotes and media accounts to formulate guidelines for casework interventions. The available studies analyze how type of abuse and degree of risk influence rates of case investigation, substantiation, and child placement as a result of investigation (Barth et al., 1994; English and Aubin, 1991; Murphy et al., 1991). At present, child sexual abuse is the most likely type of abuse to be investigated;

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

neglect is the least likely to be investigated and substantiated, although the large majority of reported cases involve allegations of neglect.

4A-4: Intensive Family Preservation Services

Once child maltreatment has been substantiated, assuming resources are available, caseworkers design a service plan. Many localities have adopted an array of services referred to as intensive family preservation services, which are designed to avert child placement in substitute care and, if possible, keep the family intact through the provision of therapeutic and concrete services, such as home appliance repairs and temporary rent subsidies.

Interventions in this area are short term and crisis oriented. Prior to referral for services, a child must be assessed as at imminent risk of removal from the family. Although specific components of these services vary, there are some common features (Fraser et al., 1991; Wells and Biegel, 1992). Generally, they are brief (4-6 weeks), intense, home-based, therapeutic, and concrete; the caseloads tend to be small. In keeping with the 1980 Adoption Assistance and Child Welfare Act (Public Law 96-272), the programs are shaped by the philosophy that, as long as their safety can be reasonably ensured, the best place for children to live is in their own homes. Family preservation strategies are also guided by the theory that families are more responsive to change during periods of crisis and are more likely to engage in services at such times (Heneghan et al., 1996; Kinney et al., 1977; Edna McConnell Clark Foundation, 1985).

The outcome measures used in evaluations of intensive family preservation services are (1) prevention of child removal and (2) reduction in the length of stay in placement outside the home. Some studies count any type or length of placement in measuring outcome (Feldman, 1991), whereas other studies do not consider placement with a relative or other temporary placement (Pecora et al., 1992). The use of administrative data on placements excludes other indices of success, such as a reduction in the number of runaway episodes (Bath and Haapala, 1993). And, although placement is a primary outcome measure, it is not always indicative of service failure (Nelson 1988; Tracy, 1991; Wells and Biegel, 1992).

Quasi-Experimental Evidence

Table 4A-4 lists 14 evaluations in this area that meet the committee's criteria for inclusion (the use of a comparison or control group in the conduct of the study). Some investigators found small or temporary effects on families (Feldman, 1991; Schwartz et al., 1991; Dennis-Small and Washburn, 1986; Pecora et al., 1992). Others reported that the majority of families who receive services improved significantly and maintained improvements for 6 months to a year

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

(Bergquist et al., 1993; Halper and Jones, 1981; Walton et al., 1993; Walton, 1994; Wood et al., 1988). Still others found no difference in the number of episodes of out-of-home placements for families who received services over comparison families, but they do report shorter placement episodes (AuClaire and Schwartz, 1986; Schwartz et al., 1991).

In a methodological assessment of an identified field of 46 evaluation, 36 were excluded from further consideration because they used no comparison groups (Heneghan et al., 1996). Four of the remaining group of 10 studies were also found to be methodologically unacceptable because of poorly defined assessment of risk, inadequate descriptions of the interventions provided, and nonblinded determination of the outcomes. The methodological review of 10 evaluation studies by Heneghan et al. (1996) concluded that rates of out-of-home placements were 21 to 59 percent among families who received intensive family preservation services and 20 to 59 percent among comparison families. The relative risk of placement was significantly reduced by services in only two studies; one of these sites had the highest rate of placement for both treatment and comparison groups.

Implications

Although intensive family preservation services may delay placement for many families in the short term (Schwartz et al., 1991; Pecora et al., 1992), there is little evidence to date that the services resolve the underlying family dysfunction that precipitated the crisis or improve the child's well-being or the family's functioning. The use of placement rates as a primary outcome is problematic, since it is a "program-based" measure that may not fully capture the range of positive effects of the intervention (Heneghan et al., 1996). Attention to other child and family outcomes, such as child development, maternal-child interactions, episodes of maltreatment, and injury rates, might demonstrate more conclusively that these services provide better child and family outcomes than foster care, but these effects have not been tested in the evaluation literature.

At best, a 30-day intervention can be expected only to stabilize the immediate crisis that places the child at imminent risk. Dramatic results cannot be expected in this area given the number and magnitude of the problems faced by many families and the variability in the services that are provided to them (Schuerman et al., 1994). The results suggest that longer-term interventions may be required to sustain changes initiated by the intensive family preservation services and that the differential effects for different types of families need more attention.

Evaluations in this area are confounded by differences in the types of abuse and characteristics of families and children referred for services. Targeting services to families who are most likely to benefit from them is an important goal. However, it is uncertain whether improved targeting will significantly reduce

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

child placement rates, because those families who are most likely to benefit may not be the same as those who are most at risk for child removal.

Several major issues require consideration in assessing the effectiveness of these interventions. First is the issue of targeting: Do the programs actually serve children at imminent risk of placement? Many studies do not define what is meant by imminent risk and programs vary regarding the concept of "placement" (Feldman, 1991; Tracy, 1991; Wheeler et al., 1992; Schuerman et al., 1994; Fraser et al., 1991; Yuan et al., 1990; Schwartz et al., 1991). As a result, it has been difficult to establish valid comparisons of results across studies. Furthermore, the decision about what constitutes imminent risk is usually based on the subjective judgment of the caseworker (Rossi, 1992; Tracy, 1991; McCroskey and Meezan, 1993).

Several studies question the utility of imminent risk as an eligibility criterion for the programs (Ensign, 1991; Rossi, 1992; Schuerman et al., 1994; Yuan et al., 1990). They also do not account for the spontaneous remission of symptoms, as families reestablish their equilibrium after the abatement of the crisis that triggered the intervention (Jones, 1991; Rossi, 1992). Until standardized definitions and objective assessment tools are adopted to measure services, placement, and risk, tests of the efficacy of an intervention strategy using this criterion will remain difficult.

4A-5: Child Placement Services

In some cases, removal of the child from the home becomes unavoidable. Placement settings include foster care, therapeutic foster care, residential group care, and psychiatric hospitalization. Recently kinship care, or placement with a relative, has been included in this array of services. For teenagers who have remained in alternative care to adulthood, interventions have been designed to foster safety and self-sufficiency in the transition from foster care to independent living.

The number of children taken from their homes as a result of investigations is not clear (Table 4-3). One study of 169 investigations indicated that 59.7 percent of the substantiated cases were offered no services, that placement (13 percent) and counseling (11 percent) were the most frequently offered services for cases that did receive attention, and that for those children placed, services prior to placement were considered by social workers only one-third of the time (Meddin and Hansen, 1985). A more recent study found that 56 percent of all indicated cases were closed the same day they were officially substantiated (Salovitz and Keys, 1988). Estimates of the number of out-of-home placements as a result of maltreatment range from 1 to 15 percent for substantiated cases (American Humane Association, 1979; Runyan et al., 1981; National Center on Child Abuse and Neglect, 1996c; English, 1994).

An increased focus on the nature and effectiveness of placement services for

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4-3 Responses to Reports of Child Maltreatment by Child Protective Services

Citation

Substantiated Cases Offered Services (%)

Substantiated Cases Resulting in Out-of-Home Placement/Dependency Proceedings (%)

Meddin and Hansen, 1985

60

13

Salovitz and Keys, 1988

44

 

National Committee to Prevent Child Abuse, 1991

78

 

Tjaden and Thoennes, 1992

75

21

McCurdy and Daro, 1994

19 state reports vary from 29-100; average 60

 

English, 1994

 

15

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

maltreated children has emerged in the past 10 years. Although out-of-home placements represent a small percentage of all services for children reported and substantiated for maltreatment, recent data from the U.S. General Accounting Office (1993) indicate a 55 percent increase in placement from 1985 to 1991. Adolescents ages 12 to 18 were the largest group in placement in 1986; by 1995, children under age 5 are the largest group in placement (Goerge et al., 1994b). Rapid growth in the numbers of children who are placed outside the home is evident in urban centers associated with the onset of the drug epidemic, although the rate of placement relative to numbers of cases handled by the child welfare system has remained relatively stable. The entry and length of stay fluctuates over time and between population subgroups, the number of infants entering foster care has increased dramatically, and infants have longer lengths of stay than children who enter at older ages (Goerge et al., 1994b).

Quasi-Experimental Evidence

Table 4A-5 lists the four evaluations in this area that meet the committee's criteria for inclusion. Effectiveness of foster care has generally been measured in two ways: (1) whether or not the placement is permanent and (2) the level of the child's or adult's ability to function upon leaving foster care. Two studies reviewing long-term outcomes indicate that children who are removed from their

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

homes fare no worse on proxy variables for development and social adjustment than their maltreated peers who are left at home (Runyan and Gould, 1985; Wald et al., 1988). A study of infants in residential treatment showed short-term improvements in height and weight and interaction skills, a decline in psychomotor development pre- to postintervention, and a decline in interaction skills 5 months later (Elmer, 1986). A fourth study reported that foster parent retention and satisfaction with their foster children's behavior can be enhanced by providing training, support, and increased stipends (Chamberlain et al., 1992), but it is uncertain whether such changes lead to improvements in the children's functioning as well.

Research on foster care outcomes generally consists of follow-up studies of youth in foster care with little comparison group analysis, weak retrospective designs, and small sample sizes, with significant attrition rates of subjects across studies (Royse and Wiehe, 1989). A review of 27 less rigorous evaluations of foster care found a variety of poor outcomes (including failure to complete high school, public assistance, homelessness, and frequent use of alcohol and drugs) for adults who grew up in foster care (McDonald et al., 1993). However, there was significant variation in the methodology and results of the studies included in the review. Many of these studies compared foster care children to those who lived with their biological families without considering the issue of maltreatment. Longitudinal studies of children in foster care (Fanshel and Shinn, 1978; Fanshel, 1992; Runyan and Gould, 1985; Widom, 1991) found generally favorable outcomes for children; the authors found no evidence that foster care alone was responsible for a significant portion of social adjustment problems, including crime and delinquency, encountered by child victims of maltreatment. Other studies have found less positive long-term outcomes for adults who were children in foster care: their educational attainment is below average (Palmer, 1976; Zimmerman, 1982; Festinger, 1983; Jones and Moses, 1984); their unemployment is higher than in the general population (Festinger, 1983; Barth, 1990; Jones and Moses, 1984; Zimmerman, 1982); and housing for many is marginal or unstable (Russell, 1984; Harari, 1980; Jones and Moses, 1984; Susser et al., 1987; Sosin et al., 1991).

Since those studies were completed, the Independent Living program has been initiated in many states, specifically targeting youth ages 16 to 18 leaving foster care. The purpose of this program is to help prepare foster children for the transition to independence, including specific training in employment, education, and other basic living skills. Studies conducted on youth leaving foster care in the 1990s may reveal different results.

Implications

A key question for foster care research studies is whether out-of-home placement for children who have experienced abuse or neglect creates a separate

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

source of additional harm or benefit for their development. The evaluation research base is not sufficient to provide clear answers, but longitudinal studies suggest many children who reside in foster care fare neither better nor worse than those who remain in homes in which maltreatment has occurred. However, the changing character of children in foster care over the last decade, with the trend toward increased placement of children under age 5, requires new studies to examine whether the age, length, or stability of placement is correlated with beneficial or adverse outcomes, especially when children in placement are compared with young children who have been maltreated but remain with their families. Prior research has shown that the younger the child is at placement, the less likely the child will return home.

Comparing family foster care to residential services (a group home or center-based form of placement) suggests that children in foster care are better able to function in less restrictive post-discharge environments and are more often discharged to family or relative care. Foster care appears to offer significant cost advantages compared with residential treatment (Hawkins et al., 1985, 1989; Rubenstein et al., 1978). But there is some question as to whether children in foster care and residential treatment are comparable in terms of their mental health and experience with trauma (Barth et al., 1994). Interpretation of the data on whether placement in foster care is permanent is made difficult by the need to average across all children in placement (Shyne and Shroeder, 1978; Wiltse, 1985).

Although residential services are widely used as an intervention for older and more disturbed youth who cannot live with their families, they have not been assessed to determine their effectiveness. There is little empirical evidence available to identify which characteristics of an after-care intervention are effective, although such services are widely acknowledged as important (Whittaker and Pfieffer, 1994; Jenson et al., 1986).

4A-6: Individualized Service Programs

Out-of-home placements may not necessarily signal the end of service provision to the child victim; in some cases, intensive programs are designed to prevent the need for other, more costly, or perhaps stigmatizing interventions. Individualized service programs have been developed to identify flexible and intensive intervention plans that meet children's needs and provide services in the least restrictive environment, either with their biological families or not. These programs emphasize consideration of the total environment in which the maladjusted behavior occurs rather than focusing solely on the child's behavior.

The majority of the research in this area is descriptive or focuses on implementation issues (Burchard et al., 1993; Burchard and Clarke, 1989; Duchnowski et al., 1993; Van Den Berg, 1993; Dollard et al., 1994). Most evaluations are anecdotal, drawing on nonstandardized measures and data-gathering procedures

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

and small, nonrandom samples; they lack control or comparison groups and clear specification of program components and procedures (Bates et al., 1995).

Table 4A-6 lists the three evaluations in this area that meet the committee's criteria for inclusion. Two studies that measured the comparative success of individualized service interventions against subsequent reports of child maltreatment and removal of the child did not show positive results (Hotaling et al., undated; Jones, 1985). Both found that children receiving individualized services were just as likely to live out of the home and their families were just as likely to be the subject of maltreatment reports as comparison families receiving routine community services.

One of the most rigorous studies of individualized service interventions compared 109 children in foster care who received individualized services to children who did not (Clark et al., 1994). Both groups had significantly improved scores on measures of emotional and behavioral adjustment, but children who received individualized services had significantly improved scores on certain dimensions (such as withdrawal of attention). The treatment group had significantly fewer days of incarceration and fewer felony convictions than the comparison group.

The very nature of individualized service interventions makes them difficult to evaluate, and the evaluations difficult to compare. Because each family in the treatment group is theoretically receiving the mix of services designed to address its particular needs, repeated iterations would be required to identify the "best" or "most effective" mix of services for a particular kind of family. Trying to generalize from one study population to another with different characteristics and problems would require increasingly complex methodology. The most effective approach may be to design methodologically sound evaluations of each individual service plan, and then design evaluations to test varying service packages.

Domestic Violence Interventions

Today, there are approximately 1,800 programs in the United States for victims of violence by spouses and intimate partners; approximately 1,200 of these programs are shelters (Plichta, 1995). Shelter programs emerged in the 1970s in response to grass roots concerns about the need to provide places of safety and emotional support for battered women and their children. The shelter movement has evolved to include a broad array of related social services, including 24-hour hotlines, counseling, job training, medical and legal assistance, referrals to drug and alcohol treatment, and housing assistance. This combination of crisis intervention and social support has emerged in a variety of settings, including religious organizations, women's organizations, hospitals, and community development programs. Individual social workers, psychologists, and clinics also provide services to victims of domestic violence.

This section describes social service interventions designed for battered

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

women and evaluations of such interventions. Mental health programs for battered women and children who witness domestic violence are discussed in the chapter on health interventions. Programs for male perpetrators of domestic violence are discussed in the chapter on legal interventions, since the client referrals to these programs are largely administered through the courts.

As in the field of child abuse, variation in the outcomes identified complicates the task of designing and implementing evaluations of services for battered women. Although the ultimate goal is to foster violence-free lives, it is often unrealistic to expect a brief intervention focused on the victim to create a situation in which a batterer is no longer violent. Interim outcomes are therefore often used to judge the effectiveness of interventions—such as greater empowerment and increased options for victims, improved life skills (including improved communication and self-assertive skills), and more effective use of available community services. Even these proxies, however, are difficult to quantify in a standardized way (Table 4-4). Given the difficulty of precisely defining desired outcomes of interventions for domestic violence and the even greater difficulty of quantifying them, only a small number of quasi-experimental evaluations of such interventions exist. Some evaluations that did not meet the committee's criteria for inclusion nonetheless are discussed below because they are valuable in their attempt to clarify issues in outcome measurement and program implementation.

TABLE 4-4 Expected Outcomes of Social Service Interventions for Domestic Violence

Outcome

Data Source

Absence of violence

Interviews with survivors, former perpetrators

End of relationship with perpetrator

Police reports

Medical/hospital records

Empowerment

Interviews with survivors

Discrete actions (e.g., adopting safety plan)

Improved measure of self-sufficiency, self-reliance

Improved mental health

Effective use of community services

Caseworker records

Self-sufficiency

Interviews with victims

Discrete actions accomplished (e.g., obtaining a job, pursuing education, finding housing)

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Four interventions are described in the sections that follow: (1) shelters for battered women, (2) peer support groups for battered women, (3) advocacy services for battered women, and (4) domestic violence prevention programs. The sections are keyed to the appendix tables that appear at the end of the chapter.

4B-1: Shelters for Battered Women

No national data exist on the number or the characteristics of clients who are served by various shelter programs. Individual state data on waiting lists and turn-away rates indicate that the resources are inadequate to meet the needs of victims of domestic violence (National Research Council, 1996).

Women who go to shelters tend to be from lower socioeconomic groups. Women with more economic resources may not appear in shelter samples because they are able to pay for temporary shelter or rely on housing provided by friends or relatives; they may seek other services through private means. The racial makeup of shelter users seems to reflect the regional location of the shelters. It may be that women who use shelter services are experiencing the most serious violence at home and therefore do not represent other women who are victimized (Berk et al., 1986).

Most studies of shelters and the outcomes of shelter stays are descriptive. The committee found no evaluations that compared outcomes for women using shelters with outcomes for battered women not using shelters. Several studies do compare women's pre- and post-shelter experiences or compare groups of shelter residents based on services provided either during or after the shelter stay. Recruiting samples of battered women to study can be difficult. Some researchers advertise for subjects, creating a sample that is subject to self-selection bias. Most studies have drawn samples from women who seek help at a shelter or elsewhere (for example, the courts). The use of such samples makes it impossible to have a control group of women who have not sought services, so that a quasi-experimental evaluation is not possible.

One potentially important outcome measure for programs is the victim's progression through stages of change. Housing, education or job training and acquisition, economic self-sufficiency, child care, safety, and other issues need to be resolved before a woman can completely separate from an abusive partner on whom she has been emotionally or financially dependent. Work is currently under way on a tool for the measurement of one conceptualization of the stages of change women experience on their way to leaving a violent relationship (Brown, 1997). This may prove to be an important instrument for assessing programs for victims of violence. Should such an instrument be developed, it will be critical to evaluate whether it is a valid and meaningful measure for all women or only certain groups.

Table 4B-1 lists the only evaluation in this area that meets the committee's criteria for inclusion. It found that, for some women, shelters appeared to limit

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

new incidents of violence in the 6 weeks following shelter stays (Berk et al., 1986). Another larger but not controlled study found that shelters play a pivotal role in helping women seek appropriate support services (Gondolf and Fisher, 1988).

Beyond traditional shelters, transitional housing programs, which provide not only shelter but also continued advocacy and counseling services to residents, allow women to gradually make the transition from violent home, to emergency shelter, to marshaling the skills and resources necessary to eventually live independently. These transitional programs have not yet been rigorously evaluated; anecdotal information from service providers and victims indicates that the opportunity for an extended period of safe, low-cost housing, support services including child care and health services, and opportunities for generating an independent source of income are critical to the goal of violence-free, independent living.

4B-2: Peer Support Groups for Battered Women

The most common auxiliary service offered to battered women in the social service context is peer or support group counseling. These programs may be offered through a shelter, social service agency, religious group, or other community organization. The groups are facilitated by professional therapists, paraprofessionals, or victim advocates and generally focus on identification of feelings about being victimized, education about domestic violence, and skill-building and self-protective behaviors (Walker, 1979; Dutton, 1992). Few such services have been evaluated (Taylor, 1995), and none meets the committee's criteria for inclusion.

4B-3: Advocacy Services for Battered Women

Advocacy services are typically provided to battered women by shelter staff or trained lay persons in the community, who include self-identified survivors of domestic violence themselves. The role of the advocate is to inform the client of her legal, medical, and financial options, to validate her feelings of being victimized, to facilitate her access to community resources, to assist her in goal setting and making choices, and to provide emotional support. Advocacy services may be provided in-person either in a shelter, in a community agency, or by telephone hotline. Advocacy services are frequently offered by communities in conjunction with emergency shelter and more formal individual counseling or support groups.

Table 4B-3 lists two evaluations in this area that meet the committee's criteria for inclusion. The outcome measures used include standardized mental health instruments and nonstandardized measures of social support and access to community resources. Neither study found a connection between the use of advocacy services and the cessation of violence. Tan et al. (1995) conclude that short-term

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

advocacy may not be sufficient given the severe life difficulties that battered women face.

An emerging intervention for battered women extends traditional advocacy services into weeks and months beyond the crisis period during which services are commonly available. One less rigorous study found that women significantly improved their scores for appraisal support (finding someone to talk to about one's problem); there was also some evidence of an increase in self-esteem by the end of the program (Tutty, 1995). Although this evaluation does not meet the criteria for a quasi-experimental evaluation, it is the first to use qualitative and quantitative methods to review follow-up services.

The evaluations reviewed do not indicate that short-term advocacy services for battered women reduce the risk of future violence to the victims. However, advocacy programs do appear to improve other outcome measures, such as increased social support for the victim and enhanced self-esteem and feelings of empowerment. Future research should focus on how these outcomes are associated with long-term safety for battered women. More research and experimentation with longer-term advocacy models are needed.

4B-4: Domestic Violence Prevention Programs

Domestic violence prevention efforts generally consist of school-based programs on dating and on domestic violence in intimate relationships. Such programs focus on gender roles, expectations, and personal safety as well as legal statutes regarding relationship violence. Community-wide efforts have begun recently in some areas to build this movement through specific strategies to educate men and women about domestic violence and to create a community norm that reduces social tolerance of and provides sanctions for violent behavior (including restrictions on gun ownership).

Table 4B-4 lists four evaluations in this area that meet the committee's criteria for inclusion. These evaluations test students' knowledge about and attitudes on relationship violence before and after the prevention program, as well as personal experience with dating violence (Jones, 1991; Jaffe et al., 1992; Krajewski et al., 1996; Lavoie et al., 1995).

These studies found generally positive changes associated with prevention programs. Two found increased levels of knowledge in participants relative to no-training controls (Jones, 1991; Krajewski et al., 1996). A third found that all students improved their knowledge of and attitudes about dating violence (Lavoie et al., 1995). Although Krajewski et al. and Lavoie et al. found more definitive attitude effects than Jones, all three studies identified differential effects on boys and girls, with girls showing more positive attitudinal and knowledge effects.

No longitudinal studies exist to document whether these programs, which may change knowledge or attitudes about violence between intimates, have any long-term impact on domestic violence. As with school-based programs to prevent

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

child sexual abuse, future research will need to test the relationship between knowledge gain, attitudinal change, and behaviors that can reduce or prevent violence.

Elder Abuse Interventions

Elder abuse has recently emerged as an area of interest to researchers and service providers. A wide range of preventive approaches is suggested by theory and risk factors, including programs that promote good mental health (reducing depression), independence, and social contact; buffer stressful life events; and resolve conflict without violence. Support groups and training that emphasize elder rights and advocacy, outreach efforts to inform minority communities, financial management programs, and instructional sessions in behavior management for caregivers of Alzheimer's patients have been proposed as ways to reduce the potential for abuse or neglect. Most programs have been conducted on a small scale without specification of outcome measures and without the procedures or resources necessary for good evaluation.

Interventions in elder abuse mirror the experience with child maltreatment and domestic violence. Social service programs designed to prevent maltreatment of elders include adult protective services agencies, casework and provision of concrete and therapeutic services, individualized service programs, training for caregivers, advocacy services, family counseling, and out-of-home placement services.

Three interventions are described in the sections that follow: (1) adult protective services, (2) training for caregivers, and (3) advocacy services to prevent elder abuse. There are few evaluations in this area that meet the committee's criteria for inclusion. Therefore, some of the information presented in the sections below is derived from descriptive information of existing programs. The sections are keyed to the appendix tables that appear at the end of the chapter.

4C-1: Adult Protective Services

All 50 states have some form of adult protective service program to investigate referrals of cases of abuse or neglect of the elderly, although such programs are comparatively recent interventions in some regions (Byers et al., 1993; Quinn, 1985; Tatara, 1995). If a vulnerable adult appears to lack the capacity to consent to service, agencies are frequently empowered to initiate guardianship proceedings. These agencies are designed to provide short-term, crisis-oriented interventions, usually lasting no more than 90 days (Fredriksen, 1989).

In addition to investigation and case management, many state agencies can provide concrete services, such as income support or material aid, institutional placement, mental health services, in-home health services, supervision, education, transportation, housing, medical services, legal services, in-home assistance,

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

socialization, nutrition, respite care, and casework. These services may be offered both to the victim and to the abuser if the caseworker feels that such support may lessen the risk for future abuse (Quinn et al., 1993; Illinois Department on Aging, 1990).

Most state protective services agencies have the legal authority to intervene in emergency situations to remove the victim or abuser from the home, to institutionalize the victim, or to appoint a guardian to manage the victim's affairs. The decision to take any of these actions rests on the agency's determination that the victim is mentally or physically incapable of protecting herself without this intervention.

There are no evaluations of adult protective services interventions that meet the committee's criteria for inclusion. One less rigorous study found that the intervention most likely to result in reduced risk for the victim was the placing of a cognitively impaired victim into long-term care (Quinn et al., 1993). Unimpaired victims of physical abuse, emotional abuse, or exploitation tend to remain in the community and to remain at high risk for future abuse.

A survey of types of social service interventions available in 335 area agencies on aging is illustrative (Blakely and Dolon, 1991). Almost half of the sample (181 agencies) offered information and referrals on elder abuse, reported cases of suspected elder abuse to adult protective services agencies, and worked to increase public awareness of the problem. A similar number (182 agencies) report serving as advocate for victims of elder abuse, and 178 provide educational programs to elder clients and to relevant professional groups and lawmakers to enhance awareness of the problem. Slightly fewer agencies reported such activities as direct services to clients, receiving referrals of elder abuse cases from adult protective services, case management services, participation in state or community task forces focused on elder abuse, demonstration projects, and sponsoring or conducting research. Agencies reported their most successful activities as public education, legal assistance and ombudsman services, respite and other caregiver services, and influencing legislation.

4C-2: Training for Caregivers

It has been suggested that lack of understanding of the needs and care of the elderly by caregivers may contribute to mistreatment (Kinderknecht, 1986). As with new parent training offered to families at risk for child abuse and neglect, education for caregivers for the elderly can reduce the risk of violence stemming from unmet expectations or misunderstanding of physical and behavioral changes that may be attributed to meanness or ''acting-up" (Kinderknecht, 1986). Like new parents, caregivers may require extensive information about hygiene, nutrition, medication, and routine needs of elderly family members in order to care for them properly (Ansello et al., 1986).

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Table 4C-2 lists the only evaluation in this area that meets the committee's criteria for inclusion. This evaluation of a training program for caregivers of elderly family members showed relatively little change over time for any group on the participants' self-esteem or level of anger. Training was associated with a slight reduction in the reported costs of providing care at a rate that approached statistical significance. Both the control and the delayed training group showed increased symptoms of distress over time, and the training group reported a definite decrease in symptoms (Scogin et al., 1989).

4C-3: Advocacy Services to Prevent Elder Abuse

Advocacy services to identified abused elders include companionship, legal, financial, health care advice, and referral to community services. The goal may be referrals to available community services, or efforts may be made to elicit joint responses from the health, social services, and legal fields.

Table 4C-3 lists the only evaluation in this area that meets the committee's criteria for inclusion. The Elderly Abuse Support Project of Rhode Island's Department of Elderly Affairs provides assistance, support, and advocacy to elderly victims of abuse in the utilization of the criminal justice system. Trained volunteers spent an average of two hours a week with the victims, providing information and encouragement in pressing charges, obtaining restraining orders, providing transportation and/or accompaniment to police stations or to the court, and assisting with completion of reports and forms (Filinson, 1993). Several major limitations in the study prevent a conclusive statement about the intervention, including the small sample size, a possible mismatch between the control and treatment groups (particularly with reference to substance abuse by the perpetrators), and systematic bias in the completion of the forms. The results did suggest that the volunteer program, in comparison with the conventional system, could lead to more ambitious goal-setting, greater achievement of goals, and more extensive monitoring of cases. However, with regard to facilitating utilization of the criminal justice system, the primary goal of the project, there was no difference between the intervention or control cases.

Victim Services, Inc., in cooperation with the New York City Police Department, is currently conducting an evaluation of a joint community policing and social service response to elder abuse. In the evaluation, completed in September 1997, 400 complainants who reported elder abuse incidents in public housing to the New York City Police Department were randomly assigned to one of four treatment conditions (Davis and Taylor, 1995): home visits from a joint police and social service team after the complaint; a letter sent to complainants describing elder abuse services available in the community; a public education campaign targeting specific public housing units; and a no-treatment control condition.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Conclusions

The most extensive area of study in evaluations of social service interventions for family violence is the field of child maltreatment research. A knowledge base has developed that focuses primarily on parenting practices and family support services, school-based sexual abuse prevention programs, intensive family preservation interventions, and individualized service programs for children in the child welfare system. In contrast, widely used social services such as child protective services, kinship care, and other out-of-home placement services provided through the child welfare system have not been the focus of evaluation studies that could provide significant insights into the benefits or harms associated with these interventions.

Areas that have received extensive study focus on program-specific outcomes, such as reports of child maltreatment or out-of-home placement rates. In general, important outcomes in other domains, such as those related to child health and development and level of family functioning, are unexamined, although they are increasingly the focus of studies of interventions related to parenting practices and family support. The research base in this area, which has had the longest period of development in the area of family violence, has not yet achieved consensus on the key measures of child or family well-being or parenting practices that would allow separate studies to compare their results over time.

The research reviewed in this chapter suggests the following:

  • Social service interventions designed to improve parenting practices and provide family support have not yet demonstrated that they have the capacity to reduce or prevent abusive or neglectful behaviors significantly over time for the majority of families who have been reported for child maltreatment.
  • The intensity of the parenting, mental health, and social support services required may be greater than initially estimated in order to address the fundamental sources of instability, conflict, stress, and violence that occur repeatedly over time in the family environment, especially in disadvantaged communities. Focusing as they do on single incidents and short periods of support, the interventions in this area may be inadequate to deal with problems that are pervasive, multiple, and chronic.
  • Although a parent's use of social networks to support family functioning can be influenced through interventions, there is not enough evidence to indicate whether changes in social networks can create changes in parenting practices that endure over time and result in reduced child maltreatment rates. The evidence, although intriguing, does not yet provide clear indications as to which types of families are most likely to benefit from parental education and family support services as opposed to mental health services designed to address depression, lack of empathy, and impulsive behavior in both parents and children.
  • Evaluations of child sexual abuse prevention interventions show some
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
  • evidence that school-based programs can provide positive changes in knowledge and attitudes related to prevention behavior. However, the size and duration of this effect for children at different developmental stages remain generally unknown, and there is no evidence tracing these outcomes either to reductions in sexual abuse involving family members or to mitigated effects of such abuse.
  • Intensive family preservation services for families that have experienced child maltreatment may delay child placement for many families in the short term, but there is little evidence to date that the services resolve the underlying family dysfunction that precipitated the crisis or improve the child's well-being or the family's functioning. Although it is possible that intensive family preservation services may provide better child and family outcomes for some children and families than foster care, these effects have not been tested in the evaluation literature. Service providers do not have an effective screening method to determine which children or families who have been reported for maltreatment would benefit from intensive services designed to prevent child placement.
  • Longitudinal studies suggest that many children who reside in foster care fare neither better nor worse than those who remain in homes in which maltreatment has occurred. However, the changing character of children in foster care over the last decade, with the trend toward increased placement of children under age 5, requires new studies to examine whether the age, length, or stability of placement is correlated with beneficial or adverse outcomes, especially when children in placement are compared with young children who have been maltreated but remain with their families.
  • Child maltreatment prevention programs focused on improvements in parenting practices, family support resource centers, and informal social support systems show promise of influencing cognitive and problem-solving skills and child discipline behavior. However, it is not certain if such gains can be established for families who experience multiple sources of stress (such as domestic violence, substance abuse, unemployment, and violent neighborhoods) or whether such gains can be sustained over time once the intervention has ended. The emerging research base suggests that interventions designed to strengthen parenting practices and family functioning require serious attention to the crises and unpredictable nature of problems that occur in the homes of families in disadvantaged neighborhoods to counteract pressures that encourage the use of violence in resolving family disputes and parent-child relationships.

In the area of domestic violence, evaluation studies have focused on the role of shelters and advocacy services for battered women, and domestic violence prevention programs. Little is known about the role of informal or formal support services for victims of domestic violence who choose not to rely on shelters, crisis intervention programs, or advocacy services in seeking to reduce or prevent the use of violence in their intimate relationships. The only study of battered women's shelters that met the committee's criteria for inclusion indicates that

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

shelters can have an immediate effect on limiting incidents of violence—probably a result of reducing exposure and access between the victim and batterer. Longer-term outcomes pertaining to violence, relationship issues, and independent living await documentation. The research base is not yet strong enough to indicate whether other types of support programs, including transitional housing, peer group support, and advocacy services are effective in improving the health, safety, and well-being of the clients who use them.

For elder abuse, there is no research base to inform decisions about how best to address social service interventions. The two studies of elder abuse interventions reviewed by the committee, focused on training for caregivers and on advocacy services to prevent elder abuse, suggest that caregiver training had mixed results and that advocacy services did not succeed in facilitating utilization of the criminal justice system.

Despite the proliferation of services available, evaluations of social service interventions have lacked the rigor and specificity needed to identify which services, or combinations of services, are most effective with which types of victims and offenders. Resources that can contribute to the future development of rigorous service evaluations include

  • improved characterization of the services provided in an intervention, including description of the intensity, frequency, length, and scope of the program as well as the training of service personnel;
  • the development of consensus about the relevant outcomes and the use of consistent measures of client, family, and community characteristics that can facilitate comparative analyses across studies;
  • the identification of subgroups that may benefit from, or be resistant to, certain types of interventions and the identification of cohorts within study samples;
  • the inclusion of comparison groups in evaluation studies that can indicate when support programs can make a difference in child, adult, or family outcomes among groups that experience common, different, and multiple stressors in their social environments; and
  • the clarification of the theoretical frameworks that guide service interventions.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Appendix Tables Begin On Next Page

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4A-1 Quasi-Experimental Evaluations of Parenting Practices and Family Support Services

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Child Parent Enrichment Project (CPEP), Contra Costa, California. Clients received pre- and postpartum services from parenting consultants for 2 hours per week for 6 months.

Barth et al., 1988

N(X) = 24/10

N(O) = 26/7

Child Abuse Potential Inventory, Depression Scale, State-Trait Anxiety Inventory, Pearlin Mastery Scale, Social Support Scale, use of prenatal care, birth outcome, infant temperament

CPEP participants showed advantages in prenatal care, birth outcomes, better reports of child temperament, and better indicators of child welfare. CPEP mothers tended to report better well-being. No significant differences demonstrated in levels of support. Reports of child abuse were similar for both groups.

Randomly assigned comparison group received standard community services; 6 months

Two and 5-year follow-up evaluations of CPEP, Contra Costa, California.

Barth, 1991

N(X) = 97

N(O) = 94

Same as above

No advantages for self-report measures measured at 1-year posttest. Reports of child abuse similar for both groups. Some indication of greater success with families with less severe problems.

6 month and 2- and 5-year follow-up

Parent training (PT), multisystemic therapy (MT) provided to 43 families, in which one parent had been investigated for child abuse or neglect but not child sexual abuse. Therapy sessions lasted 1.5 hours per week for 8 weeks.

Brunk et al., 1987

N(PT) = 22/17

N(MT) = 21/16

Symptom-90 Checklist, Child Behavior Checklist, Family Environment Scales, Family Inventory of Life Events and Changes, treatment outcome questionnaire developed for the project, parent-child interaction system rated by evaluator

Parent training was more effective than multisystemic therapy at reducing identified social problems. Families who received either treatment showed decreased parental psychiatric symptomology, reduced overall stress, and a reduction in severity of identified problems.

8 weeks

Positive Parenting, a weekly group educational developmental treatment program for abusing parents.

Burch and Mohr, 1980

N(X) = 45/21

N(O) = 41/10

Written test based on the program

Abusing parents who became part of an educational developmental treatment program showed significant and positive changes in potential stress factors, isolation factors, knowledge of child development, attitudes, and values compared with the control group.

4 months

Instruction in a combination of stress management or cognitive restructuring skills and child management instruction focused on the acquisition of cognitive and behavioral skills. Offered by the Panel for Family Living in Tacoma, Washington.

Egan, 1983

N(stress management) = 11

N(child management) = 11; N(combination) = 9

N(O) = 10

State-Trait Anxiety Inventory, Recent Events Survey, Family Environment Scale, role play interview, parent-child observation

Improvements in positive affect between parent and child were noted for stress management parents. Stress management parents also reported less negative affect associated with negative life events. Parents who received the child management component were more likely to talk to their child during a role-playing disciplinary situation, were less likely to verbally attack their child, and were more likely to reinforce their child's good behavior.

6 weeks

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

The Social Network Intervention Project (SNIP) was designed to provide support network intervention services to neglectful families, including personal networking, mutual aid.

Gaudin et al., 1991

N(X) = 28/34

N(O) = 21/17

Childhood Level of Living Scale, Child Neglect Severity Scale, Indicators of Caretaking Environment Scale, Social Network Assessment Guide, Adult Adolescent Parenting Inventory

SNIP families reported improvement on all measures compared with the control families. Reincidence of one type of maltreatment occurred during the period of the intervention for 27 (79.4%) of SNIP families and two types of maltreatment for the other 7 (20.6%) SNIP families. This compares unfavorably with the untreated families.

Comparison group received traditional agency services

2-23 months, median 10

Supportive home helpers, spending an average of 17.5 hours per month with each client in person (12.3 hours) or on the phone for families with high-risk or abusing mothers.

Hornick and Clarke, 1986

N = 55

Cattell's 16 Personality Factor Test, Coopersmith's Self-Opinion Form, Nurturance and Parent Observation Scales, Parent Attitude/Belief Scales, Parent Behavior Rating Scales, Client Satisfaction Questionnaire

Results showed a trend toward improvement on outcomes measures for both treatment groups. The group receiving lay therapy improved only slightly more than the group receiving standard treatment; however, there was significantly less attrition in the lay therapy group. Lay therapy involved more direct client contact than standard treatment and was significantly more costly.

A matched comparison group received routine services

12 months

Project 12-Ways, a multiple setting behavioral management program including parent-child interaction training, health maintenance and nutrition assistance, home safety training, counseling, job finding counseling, and referral for treatment of substance abuse.

Lutzker et al., 1984

N(X) = 51

N(O) = 46

Reports of child abuse and neglect

The 1-year follow-up on recidivism showed a 21% rate of child abuse and neglect for the treatment group and a 31% rate for the comparison group.

1 year

Perinatal Positive Parenting provided parent training and information on child care and development, community support groups for new parents, home visits by trained volunteers, and a "warm line" to call for support and information in Royal Oak, Michigan for firs-time mothers.

National Center on Child Abuse and Neglect, 1983a

139 treatment mothers and 27 control mothers completed the BNPI; 97 treatment and 58 control mothers completed the A/API

Bavolek Adult/Adolescent Parenting Inventory (A/API), Broussard Neonatal Perception Inventory (BNPI)

No significant differences between treatment and control groups on the BNPI and A/API.

Pride in Parenthood, a program for first-time parents including biweekly support group meetings for young parents in urban Norfolk, Virginia.

National Center on Child Abuse and Neglect, 1983b

N(X) = 27/15

N(O) = 26/15

BNPI, A/API

Treatment parents improved their scores on outcome measures from pre- to posttest, control families did not.

2 years

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Social learning theory counseling, child management training offered to parents of distressed families by the Oregon Social Learning Center.

Reid et al., 1981

N(X) = 27 distressed/abusive families

In-home observations of family interaction

Treatment data suggest that intensive training in parenting skills can be highly effective in reducing the level of parent-child conflict in abusive homes.

N(O) = 27 nondistressed families

4 weeks 12-month follow-up

Comparison of two programs for single mothers living on government assistance in Ontario, Canada. Both programs offered 14 weeks of weekly, 2.5 hours of service. Opportunity for Advancement (OFA) is an esteem-building and socially supportive group treatment. New Directions for Mothers (NDM) provides life skills training and parenting skills training.

Resnick, 1985

N(OFA) = 18/10 N

(NDM) = 18/10

N(O) = 18/13

Parental Attitudes Research Instrument, The Way I See It, social network analysis, videotaped observations of parent-child interaction, report of utilization of treatment facilities, CES Depression Scale, Child Behavior Checklist

No evidence for a connection between short-term competency enhancement and long-term prevention of disorder.

14 weeks

Twelve 1-hour weekly sessions on stress reduction/management offered to 70 adolescent mothers in a public school continuation program.

Schinke et al., 1986

N(X) = 33

N(O) = 37

Rosenberg Self-Esteem Scale, Beck Depression Inventory, Generating Options Test, Self-Reinforcement Attitudes Questionnaire, Social Support Inventory, Personal Support Scale, Parenting Sense of Competence Scale, Good Care Scale, Pearlin Mastery Scale, behavioral role play

Study findings noted posttest and 3-month follow-up improvements among preventive intervention subjects relative to test-only control subjects on measures of personal and social support, cognitive problem solving, self-reinforcement, parenting competence and care, and interpersonal performance.

12 weeks 3-month follow-up

Project 12-Ways, a multiple setting behavioral management program including parent-child interaction training, health maintenance and nutrition assistance, counseling for home safety training, job finding, and referral for treatment of substance abuse.

Wesch and Lutzker, 1991

N = 232

Subsequent child abuse and neglect charges, rate and severity of recidivism, out-of-home placement

Both treatment and standard service groups experienced decreases in child abuse and neglect.

A subset of study participants received only routine agency services

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Cognitive restructuring intervention to change the perceptions, expectations, and appraisals of the parent regarding the child as well as the stresses encountered by the parent; relaxation procedures to alleviate stress and anger; problem-solving skills to reduce hostile response of parents; a "package" of interventions that includes the first three modalities.

Whiteman et al., 1987

N(cognitive restructuring) = 8

Affection Scale, Discipline Scale, Empathy Scale

Results indicated a reduction in anger measures among subjects exposed to the experimental interventions. The composite treatment resulted in the strongest degree of anger alleviation.

N(relaxation) = 12

N(problem solving) = 11

N(package) = 11

N(O) = 13

6 sessions

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4A-2 Quasi-Experimental Evaluations of School-Based Sexual Abuse Prevention

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Sexual abuse prevention training offered to children aged 4-5 and 6-10 at a day care center in a suburb of Chicago, covering good and bad touching and reinforcing assertive behavior.

Conte et al., 1985

N = 50/40

Interview to test knowledge of sex abuse

Children in the prevention training group significantly increased their knowledge of prevention concepts whereas children in the control group did not. Older children learned more than younger children. Both younger and older children had greater difficulty learning prevention concepts of an abstract nature than concepts of a specific nature.

3 hours

Sexual abuse training program offered to 1st and 2nd grade children in a Denver, Colorado, elementary school.

Fryer et al., 1987

N(X) = 24/23

N(O) = 24/21

Simulation of abduction scenario to test children's reaction

The effectiveness of a primary prevention program based on age-appropriate, experiential, and interactive instruction was empirically documented.

20 minutes per day for 8 days

Good Touch, Bad Touch, a sexual assault prevention curriculum offered to kindergarten children from four schools in rural Georgia.

Harvey et al., 1988

N = 90/71

Test focused on differentiation between good and sexually abusive touches in pictures and vignette

Relative to the control group, at both 3-week posttest and 7-week follow-up, children participating in the prevention program demonstrated more knowledge about preventing abuse and performed better on simulated scenes involving sexual abuse. The results indicated that children as young as kindergarten age can be taught skills to prevent sexual abuse.

A subset of study participants were part of a no-training control group.

3.5-hour sessions for 3 days

7-week follow-up

Feeling Yes, Feeling No, a sexual abuse prevention curriculum offered to students in 21 elementary schools in a southeastern suburb. Comparison of teacher and child training, child-only training, and teacher-only training.

Hazzard et al., 1991

N(teacher and child training) = 6 classrooms

N(child training) = 13 classrooms

N(teacher training) = 13 classrooms

N(O) = 8 classrooms

State-Trait Anxiety Inventory for Children, video taped vignette test, parent questionnaire, What I Know About Touching Questionnaire

Treatment children exhibited significantly greater knowledge and better ability to discriminate safe from unsafe situations on the video measure than control children at posttesting. These gains were maintained at the 6-week follow-up. Children's knowledge gains and prevention skills on the video measure were maintained at the 1-year follow-up. A 1-session ''booster shot" program further enhanced children's safety discrimination skills on the video measure.

N = 399 students

3 sessions

6-week and 1-year follow-up

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Teacher training workshop on child sexual abuse.

Kleemeier et al., 1988

N(X) = 26

N(O) = 19

Teacher Knowledge Scale, Teacher Opinion Scale, Teacher Vignettes Measure, Teacher Prevention Behavior Measure, teacher rates of reporting sexual abuse of their students

Relative to controls, trained teachers demonstrated significant increases from pre-to posttesting in knowledge about child sexual abuse and pro-prevention opinions. On a post-test-only vignettes measure, trained teachers were better able than control teachers to identify indicators of abuse and suggest appropriate interventions. Over a 6-week follow-up period, trained teachers read more about child abuse than control teachers but did not differ on other behavioral dimensions such as reporting suspected abuse cases.

6 hours

6-week follow-up

Red Flag, Green Flag, a sexual abuse prevention curriculum for 3rd grade students that offers teachers, children, and parents personal safety lessons and personal safety strategies in Washington County, Pennsylvania.

Kolko et al., 1989

N(X) = 296/191

N(O) = 41/30

Child self-report, parent self-report, teacher self-report

Results indicated greater gains in general knowledge and prevention skills at posttraining and 6- month follow-up for trained compared with control children. Some improvements were made by trained teachers and parents of trained children.

2 sessions over 2 weeks

2-week and 6-month follow-up

Training workshop for elementary school teachers on preventing child sexual abuse in Ottawa, Canada.

McGrath et al., 1987

N(X) = 38

N(O) = 95

Written instruments based on teacher's knowledge of child abuse

The workshop had a strong effect on the teachers' knowledge about child abuse, school practices, and the existence of policy.

2 days

2-month follow-up

Red Flag, Green Flag, a sexual abuse prevention program. Study compared the results of the program taught to children at home by parents who received instruction with a control no-instruction parent group in a midwestern metropolitan area.

Miltenberger and Thiesse-Duffy, 1988

N(X) = 24

Discrimination between good and bad touches in pictures and vignettes

Results of this study demonstrated that the program, when used by parents to teach children aged 4-7, did not produce changes in personal safety knowledge or skills. A behavioral skills training program did produce the desired acquisition of knowledge and skills. Maintenance of the gains was seen only in the group aged 6-7 at the 2-month follow-up.

35 minutes

2-month follow-up

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

WHO preschool program to teach children to recognize potentially victimizing situations. Includes a program for children and training for teachers.

Peraino, 1990

N(X) = 23/10

N(O) = 23/9

Interview questionnaire with puppet scenarios

Results showed that preschoolers who received the program scored significantly higher at posttest than did the control group. Follow-up testing demonstrated retention of learned concepts.

3 weekly 15-minute sessions

1-hour training for teachers

6.5-week follow-up

Extra training for teachers before using a child abuse awareness curriculum with their classes.

Randolph and Gold, 1994

N(X) = 21

N(O) = 21

Teacher Knowledge Scale, Teacher Opinion Scale, Teacher Vignette Measure, Teacher Behavior Prevention Measure

A 3-month follow-up survey indicated that trained teachers were more likely to have engaged in certain behaviors related to the training (e.g., talking with children and reporting suspected cases of abuse).

3 2-hour sessions

3-month follow-up

"Touch," a film designed to teach children self-protection skills, followed by a class discussion with children from kindergarten, 1st, 5th, and 6th grades.

Saslawsky and Wurtele, 1986

N(X) = 33

N(O) = 34

Paper and pencil questionnaire, child interviews

Children who viewed the film had significantly greater knowledge about sexual abuse and enhanced personal safety skills compared with controls; older children achieved higher scores on both assessments compared with younger children. These gains were maintained at the 3-month follow-up assessment.

50 minutes

3-month follow-up

Two 5-minute skits written and rehearsed by medical students about child sexual abuse prevention offered to children in grades 4 and 5 in three public schools in a southeastern city.

Wolfe et al., 1986

N(X) = 145

N(O) = 145

Evaluation questionnaire

Relative to controls, children who received the program showed an overall increase in knowledge of correct actions to take in the event of potential or actual abuse.

5 minutes plus discussion

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

"Touch," a film designed to teach children self-protection skills, followed by a class discussion; a behavioral skills training program (BST) to teach safety skills, and a third treatment that combined the first two provided to children in elementary grades attending a public school in a small rural town in eastern Washington.

Wurtele et al., 1986

N("Touch") = 19/17 N(BST) = 15/14 N(combination) = 19/18

Personal safety questionnaire, "What If'' situations test

In comparison with the control presentation, the BST program, alone or in combination with the film, was more effective than the film alone in enhancing knowledge about sexual abuse. Posttreatment group comparisons suggested the superiority of the BST program for enhancing personal safety skills. Older children performed significantly better than did younger children. The knowledge and skill gains made directly after treatment were maintained for the 3 months between posttest and follow-up assessments.

50 minutes

3-month follow-up

Token Time, a personal safety curriculum for preschoolers taught by parents to their children in a YMCA preschool in a Colorado community.

Wurtele et al., 1991

N = 52

"What If" situations test, personal safety questionnaire, parent perception questionnaire

The results suggest that parents can teach their preschoolers personal safety skills, and that the program can be implemented in the home.

A subset of subjects was randomly assigned to a delayed-training control group.

1 hour, 48 minutes

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4A-4 Quasi-Experimental Evaluations of Intensive Family Preservation Services

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Four weeks in-home service, two families per caseworker, intensive caseworker involvement, structural family therapy approach focus on alternatives to out-of-home placement. Families served for an average of 5 weeks with 14 hours of face-to-face contact offered to families with adolescents aged 12-17 approved for placement by Hennepin County, Minnesota, child protective services managers.

Au Claire and Schwartz, 1986; Schwartz et al., 1991

N(X) = 55/22

N(O) = 58

Out-of-home placement history, postservice placement tracking, client treatment record, social worker perceptions

An overall comparison of placement episodes for home-based service and comparison group clients showed no differences in the number of placement episodes (of any length of stay). However, the two groups differed significantly on all other placement activity measures. Home-based service clients spent 1,500 fewer days in placement and had shorter average lengths of stay than did comparison group clients.

4 weeks

12- to 16-month follow-up

Families First, a family systems therapy provided for 4-6 weeks with therapists on call 24 hours per day. Therapists provided advocacy and support in meeting basic needs and coordinating other services, and they provided parenting skills, mood management, communication skills training, and individual and family counseling to families of children in three California counties referred to child protective services for abuse or neglect.

Barton, 1994

N(X) = 75

N(O) = 75

Family Adaptability and Cohesion Scales (FACES II), Family Inventory of Life Events and Changes (FILE), cost of services, rate of out-of-home placement

Both experimental and comparison groups showed reduction in stress over time. The experimental group showed greater improvement in communication skills than the comparison group. Costs of in-home therapy were significantly lower than the costs of out-of-home foster care.

Comparison group received traditional county services.

4-6 weeks

1-year follow-up

Families First Program provided 4-6 weeks of intensive services such as parenting skills training, financial management, transportation, and job skills training to families with children at risk of imminent placement in Michigan.

Bergquist et al., 1993

N(X) = 225

N(O) = 225

Placement rates in foster care

When compared with similar families who did not receive services, children were consistently placed out-of-home at a much lower rate at 3-, 6-, and 12-months postintervention.

4-6 weeks

1-year follow-up

Home-based family services intervention provided by the DePelchin Children's Center, designed to solve family problems and reduce recurrence of abuse and neglect, offered to families with a child at risk for removal but not in immediate danger. Intervention compared with a group of families receiving standard community services from the Texas Department of Human Services (DHS).

Dennis-Small and Washburn, 1986

N(X) = 87

N(O) = 85

Frequency of removals, rate of recidivism, costs of services to families

Children were removed from their homes in 6 (14.6%) of the 41 families served by the intensive intervention and in 9 (9.6%) of the 46 families served by the DePelchin Children's Center. Twenty-one (24.7%) children receiving standard services were removed from the home. Standard services were less expensive than the two experimental interventions.

Treatment group received services from the state DHS or a private contracted agency. Control group received standard protective services.

3-14 months

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Homebuilders programs offered to families referred to Family Preservation Service (FPS) in five New Jersey counties.

Feldman, 1991

N(X) = 117

N(O) = 97

Family Environment Scale, Life Event Scale, Interpersonal Support Evaluation List, Goal Attainment Scaling, Child Well-Being Scales, Parent Outcome Interview, Work Environment Scale, placement data, measures of agency effort

By the end of the 1-year follow-up, 42.7% (50) of the 177 FPS families had at least one of their children who was a target of the FPS intervention enter placement. In the control group, 56.7% (55) of the 97 families receiving traditional services had a child enter placement. There was no statistically significant difference between the groups in the number of placements experienced or cumulative time in placement.

Comparison group received traditional services

4-6 weeks

1-year follow-up

Counseling, homemakers' services, day care, medical, legal, and other family support services provided to families with children at risk of placement.

Halper and Jones, 1981

N(X) = 60

N(O) = 60

Placement rates, reports of abuse and neglect, interviews with 27 subjects, Polansky's Childhood Level of Living Scale

Nine of the experimental families (15%) were reported to the Central Registry for abuse or neglect after they were referred to the project. Eight control families (15%) were reported.

2-25 months

1-2 year follow-up

Comparison group received one-third in-person services as treatment group

Homebuilders program, providing 36 hours of in-person and telephone contact in 4-8 weeks for families in Utah and Washington with one or more child at risk of imminent placement.

Pecora et al., 1992

N(X) = 581

N(O) = 26

Placement rates, Child Welfare League of America Family Risk Scales, FACES II

The treatment success rates of the Homebuilders program matched or exceeded those of other Intensive Family Preservation Services or family-centered programs using comparable intake criteria. Twelve-month follow-up data indicate treatment success rates decline over time.

4-8 weeks, 36 hours

1-year follow-up

Families First Program, providing short-term in-home services to families referred for child abuse or neglect. Services include both therapeutic and concrete services.

Schuerman et al., 1994

N(X) = 995

N(O) = 569

Achievement rating by case workers, placement rates, subsequent reports of maltreatment, family and child functioning

Results offer little evidence that Family First resulted in lower placement rates. Experimental group experienced placement of children at a rate slightly higher than the control families. Results also find no evidence that Family First decreased risk of subsequent harm to children or improved case-closing rates when compared with standard services.

Comparison group received routine community services

Varied for all clients

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Social learning program including training in parenting skills, parent sensitization to child needs, and coping skills training offered to client families of the Cascade County, Oregon, Social Services Child Protective Service Unit. Included families with children aged 3-12 who were considered at risk for placement because of abuse.

Szykula and Fleischman, 1985

N(X) = 24

N(O) = 24

Rate of out-of-home placement

The results indicate that this intervention reduced out-of-home placements for approximately 50% of typical child protective services caseloads.

Not discussed

In-home family-based services provided for at least 90 days, with three visits per week per family by caseworker, oriented toward the provision of concrete services and focused on skills training.

Walton et al., 1993

N(X) = 57

N(O) = 53

Total number of days the child spent in the home during the treatment and follow-up periods.

After a 90-day service period, 93% of 57 families assigned to receive intensive intervention were reunited, compared with 28% of the 53 control families. Impacts endured for upward of 12 months following the cessation of direct intervention services.

Comparison group received routine reunification services

90 days

1-year follow-up

Intensive family support services over a 30-day period provided to families referred to child protective services in Lucas County, Ohio, judged to be at least a moderate risk for placement.

Walton, 1994

N(X) = 74/69

N(O) = 74/65

Six-month follow-up survey developed for project, interview with participants, Index of Parental Attitudes, Children's Restrictiveness of Living Environments Instrument, review of case histories, Caseworker Survey, Daily Service Activity Record

When compared 6 months after case determination, families in the experimental group had fewer cases opened. The cases that were opened more often opened to the child's own home and were opened for shorter periods of time. Caregivers from the experimental group seemed more likely to use the array of services available, viewed the agency as more responsive and supportive, appeared more willing to express their needs, and utilized services more often than comparison families.

30 days

6-month follow-up

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Families First Program in Davis, California, provided home-based, intensive services to families in which at least one abused or neglected child was at risk for placement.

Wood et al., 1988

N(X) = 26 families/34 children

N(O) = 24 families/32 children

Cost of placements, rate of placement, family functioning as measured by FACES II

One-year follow-up data indicate in-home treatment was successful at reducing out-of-home placement and lowering placement costs compared with comparison group.

Comparison group received routine community services

4-6 weeks

1-year follow-up

Homebuilders model family therapy, life skills training, concrete services.

Yuan et al., 1990

N(X) = 143

N(O) = 150

Placement costs, family functioning, service use

No significant differences in placement rates between the project group and the comparison group. 75% of the project families and 82% of their children were not placed; 80% of the comparison group and 83% of their children were not placed. Approximately 23% of the families in each group had an investigation of abuse/neglect subsequent to their referral to the study.

Service for varying periods

6-month follow up

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4A-5 Quasi-Experimental Evaluations of Child Placement Services

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Enhanced stipends, training, and support provided to foster parents of 72 children in three Oregon counties.

Chamberlain et al., 1992

N(enhanced support, stipend, and training [ES&T]) = 31 N(enhanced stipend [IPO]) = 14 N(O) = 27

Parent daily report, dropout/retention rates of foster parents, staff impressions measure of foster parents' skills and discipline

During the 2-year project, 12 of the 72 participating families (16.6%) (9.6% of ES&T group, 14.3% of the IPO group) discontinued providing foster care compared with the state average dropout rate of 40%. Parents in ES&T group reported significantly fewer problem behaviors in their foster children over time.

Residential treatment for abused and high-risk infants.

Elmer, 1986

N(X) = 31

N(high-risk comparison group) = 31

N(O) = 31

Bayley Scales Infant Development, Barnard Feeding and Teaching Scales, anthropometric development measures, reunification with families

At Time Two (end of Center residence), experimental children had gained more height for age, scored lower on the psychomotor scale, and stayed relatively equal to the comparison children on the motor scale. By Time Three, physical measurements were the same for the groups, the experimental group maintained its standing with the Bayley scales, scored lower on the interactions scale, but surpassed the comparison children.

3-month follow-up at 5-month posttreatment

Foster care.

Runyan and Gould, 1985

N(X) = 114

N(O) = 106

Rate of subsequent juvenile delinquency

Foster children committed 0.050 crimes per person per year after age 11 years, cohort comparison children committed 0.059. Foster children were more likely than their comparison cohort to have committed a criminal assault.

Comparison group of victims of child maltreatment who were left in the family home

Foster care of children in San Mateo, California, removed from home because of abuse and or neglect.

Wald et al., 1988

N(X) = 76

N(O) = 76

Pre- and postintervention physical exams of children; interviews with caretakers, children, social workers; Wechsler Primary Scale of Intelligence; Wechsler Intelligence Scale for Children; school records of academic performance; teacher ratings of children; Child Behavioral Scale developed for project; Social Competence Instrument developed for project; reports of abuse and neglect; foster placement rates

Foster children received somewhat better physical care and missed less school than children left at home. The foster children demonstrated higher scores in overall socioemotional well-being.

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4A-6 Quasi-Experimental Evaluations of Individualized Service Programs

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Fostering Individualized Assistance Program (FIAP) provides assessments, planning, case management, and support services to children in foster care because of abuse and neglect. FIAP compared with standard practice.

Clark et al., 1994

N(X) = 47

N(O) = 62

Child Behavior Checklist, Youth Self-Report, days in out-of-home placement, juvenile crime court records

Both FIAP and standard practice subjects improved in emotional and behavioral adjustment measures. There was a significant improvement in the behavioral adjustment of the FIAP children in permanency placements in contrast to the standard practice group. The FIAP group had less runaways than the standard practice group. The FIAP youth spent less time in incarceration than the standard practice group.

Randomly assigned comparison group received standard foster care system services

18 months

Weekly visits by trained home visitors and nurse or social worker, child care, day camp, respite care, goods and services, referrals to other community services provided to families with young children who were reported as abused or neglected by school personnel. Cases were resolved as unfounded by protective services.

Hotaling et al., undated

N(X) = 39

N(O) = 39

Subsequent child abuse and neglect reports, number of families' unmet needs, improved social support, improved parent-child interaction, reduction in parental stress

Fifty-six percent of treatment families compared with 64% of control families were reported for child maltreatment over the 2-year study period. The experimental group did report fewer family problems and lower stress but did not report greater social support. Overall, the treatment group did not show improvements in parent-child relations compared with control groups.

Comparison group received baseline services

Weekly, for 2 years

Intensive services including individual, group, or family counseling; financial services; medical services; help with housing; psychological evaluation and treatment; education in home management and nutrition; tutoring and remedial education; vocational counseling; homemaker services; and day care offered to families served by a New York City program with at least one at-risk child under 14 who was not an active case under child protective services.

Jones, 1985

N(X) = 175/80

N(O) = 68

Child Welfare Information Services foster care history data, State Central Registrar of substantiated complaints of child maltreatment, Special Services for Children information on clients served, agency case records, in-person interviews

Forty-six percent of the control children and 34% of the experimental children entered foster care during the study. Control children entered foster care sooner than experimental children.

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4B-1 Quasi-Experimental Evaluations of Shelters for Battered Women

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Battered women's shelter.

Berk et al., 1986

N = 155

Reports of violence, shelter stays

Shelters can reduce the risk of new violence for a woman who is taking control of her life in other ways. Otherwise, shelters may have no impact or may even trigger retaliation from abusive spouses.

Some survey participants chose to use shelter services, some did not

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4B-3 Quasi-Experimental Evaluations of Advocacy Services for Battered Women

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Service of trained advocates for 10 weeks after shelter exit, 4-6 hours per week provided to residents of a domestic violence shelter in a midwestern city.

Sullivan and Davidson, 1991

N = 41

Subject interviews, Conflict Tactics Scales, Effectiveness of Obtaining Resources Scale designed for program

Four women reported experiencing further abuse within 10 weeks after leaving shelter. This was not related to either experimental condition. Women in the experimental condition reported being more successful in accessing resources.

A subset of participants was randomly assigned to a no-treatment control condition

Service of trained advocates for 10 weeks after shelter exit, 4-6 hours per week provided to residents of a domestic violence shelter in a midwestern city.

Tan et al., 1995

N(X) = 71

N(0) = 75

Social Support Scale, Conflict Tactics Scales, Index of Psychological Abuse, Quality of Life Measure, Depression Scale CES-D, Effectiveness of Obtaining Resources Scale

The experimental intervention expanded the social network of women; women in the treatment group felt more effective in obtaining resources than the women who did not have advocates.

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4B-4 Quasi-Experimental Evaluations of Domestic Violence Prevention Programs

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

A high school program to prevent wife assault and dating violence.

Jaffe et al., 1992

N = 737

London Family Court Clinic Questionnaire on Violence in Intimate Relationships

Twenty-two of 48 test items showed statistically significant changes immediately after the intervention. Females had more positive significant changes than males; males showed some undesired direction changes. Positive changes decreased by half at 6-week posttest.

Delayed posttest for some participants at 6 weeks

Minnesota School Curriculum Project is a domestic violence awareness curriculum taught at the junior high school level, including teacher training.

Jones, 1991

N = 560

True/false knowledge questions about domestic violence

Relative to control students, treatment students improved scores on the posttest over three points. There was little change for their group on the attitude test posttreatment. Girls had higher attitude improvement scores than boys.

A subset of the study participants was assigned to a matched no-treatment control group

"Skills for Violence Free Relationships," a prevention curriculum about women abuse presented to 7th grade health education students.

Krajewski et al., 1996

N = 239

Inventory to test knowledge and attitudes about woman abuse

Significant differences were found between experimental and control groups from pretest to posttest on both knowledge and attitude inventories. This impact did not remain stable at posttest. Females showed greater change in attitude over time.

A subset of the study participants was assigned to a no-treatment control group

Comparison of short and long forms of a dating violence prevention curriculum for 10th graders. Short form was two classroom sessions (120-150 minutes). The long form added a film on dating violence and a letter-writing exercise to a fictional victim and a fictional aggressor.

Lavoie et al., 1995

N(L) = 238

N(S) = 279

Paper and pencil test

Positive pre- and posttests and experimental versus control group gain in knowledge and attitude scores indicate that a short program modified attitudes and knowledge about dating violence.

1-month follow-up

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×

TABLE 4C-2 Quasi-Experimental Evaluations of Training for Caregivers

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

A combination of didactic presentations, group discussions, role playing, education about the aging process, problem solving, stress management, utilization of community resources, anger management, and guided practice for caretakers of elderly relatives who were at risk for abusing the elderly relative in their care.

Scogin et al., 1989

N(X) = 56

N(delayed treatment comparison) = 16

N(O) = 23

Brief Symptom Inventory (BSI), Anger Inventory (AI), Rosenberg Self-Esteem Scale (RSPS), cost of care index

Results indicated little change over time for either group on the AI or RSPS inventories. Training was associated with a slight reduction in the cost of providing care. The training group reported a significant decrease in symptoms over time on the BSI, whereas the comparison groups reported an increase in distress over time.

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

TABLE 4C-3 Quasi-Experimental Evaluations of Advocacy Services to Prevent Elder Abuse

Intervention

Citation

Initial/Final Sample Size Duration of Intervention Follow-up

Data Collection

Results

Volunteer advocates provided assistance and support to victims of elder abuse in the utilization of the criminal justice system to clients of the Elder Abuse Unit of the Department of Elderly Affairs in Rhode Island.

Filinson, 1993

N(X) = 42

N(O) = 42

Improving self-esteem, seeking legal action, relocating victim or perpetrator, increasing social supports, access services

The findings indicate that the volunteer advocate program, in comparison with the conventional system, can lead to more ambitious goal setting, greater achievement of goals, and more extensive monitoring of cases.

 

SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.

Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
Complete table on previous page.
Suggested Citation:"4 SOCIAL SERVICE INTERVENTIONS." Institute of Medicine and National Research Council. 1998. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: The National Academies Press. doi: 10.17226/5285.
×
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Reports of mistreated children, domestic violence, and abuse of elderly persons continue to strain the capacity of police, courts, social services agencies, and medical centers. At the same time, myriad treatment and prevention programs are providing services to victims and offenders. Although limited research knowledge exists regarding the effectiveness of these programs, such information is often scattered, inaccessible, and difficult to obtain.

Violence in Families takes the first hard look at the successes and failures of family violence interventions. It offers recommendations to guide services, programs, policy, and research on victim support and assistance, treatments and penalties for offenders, and law enforcement. Included is an analysis of more than 100 evaluation studies on the outcomes of different kinds of programs and services.

Violence in Families provides the most comprehensive review on the topic to date. It explores the scope and complexity of family violence, including identification of the multiple types of victims and offenders, who require different approaches to intervention. The book outlines new strategies that offer promising approaches for service providers and researchers and for improving the evaluation of prevention and treatment services. Violence in Families discusses issues that underlie all types of family violence, such as the tension between family support and the protection of children, risk factors that contribute to violent behavior in families, and the balance between family privacy and community interventions.

The core of the book is a research-based review of interventions used in three institutional sectors--social services, health, and law enforcement settings--and how to measure their effectiveness in combating maltreatment of children, domestic violence, and abuse of the elderly. Among the questions explored by the committee: Does the child protective services system work? Does the threat of arrest deter batterers? The volume discusses the strength of the evidence and highlights emerging links among interventions in different institutional settings.

Thorough, readable, and well organized, Violence in Families synthesizes what is known and outlines what needs to be discovered. This volume will be of great interest to policymakers, social services providers, health care professionals, police and court officials, victim advocates, researchers, and concerned individuals.

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