Violence in Families Assessing Prevention and Treatment Programs (1998) / Chapter Skim
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9 CONCLUSIONS AND RECOMMENDATIONS
9 CONCLUSIONS AND RECOMMENDATIONS
Pages 289-318
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They address different aspects of child maltreatment, domestic violence, and elder abuse.
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The committee then identifies a set of four topics for basic research that reflect current insights into the nature of family violence and trends in family violence interventions. A final section makes some suggestions to increase the effectiveness of collaborations between researchers and service providers.
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Major treatment and prevention interventions, such as child maltreatment reporting systems, casework, protective orders, and health care for victims of domestic violence, battered women's shelters, and elder abuse interventions of all types, have not been the subjects of rigorous evaluation studies. The programmatic and policy emphasis on single interventions as panaceas to the complex problems of family violence, and the lack of sufficient opportunity for learning more about the service interactions, client characteristics, and contextual factors that could affect the impact of different approaches, constitute formidable challenges to the improvement of the knowledge base and prevention and treatment interventions in this field.
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Research suggests that the risk and protective factors for child maltreatment, domestic violence, and elder abuse interact across multiple levels. The uncoordinated but interactive system of services requires further attention and consideration in future evaluation studies.
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Secondary preventive interventions, such as those serving children exposed to domestic violence, have the potential to reduce future incidents of family violence and to reduce the existing need for services in such areas as recovery from trauma, substance abuse, juvenile crime, mental health and health care. However, evaluation studies are not yet available to determine the value of preventive interventions for large populations in terms of reduction of the need for treatment or other support services over a client's lifetime.
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in which a rigorous set of studies offers important guidance to policy makers and service providers. In four other areas (reporting practices, batterer treatment programs, record keeping, and collaborative law enforcement approaches)
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Several states have opted for voluntary systems after conducting studies that considered the advantages and disadvantages of voluntary and mandatory reporting systems, on the grounds that mandatory reports do not achieve significant increases in the detection of elder abuse cases. In reviewing the research base associated with the relationship between reporting systems and the treatment and prevention of family violence, the committee has observed that no existing evaluation studies can demonstrate the value of mandatory reporting systems compared with voluntary reporting procedures in addressing child maltreatment or domestic violence.
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In the committee's view, mandatory reporting systems have some disadvantages in cases involving domestic violence, especially if the victim objects to such reports, if comprehensive community protections and services are not available, and if the victim is able to gain access to therapeutic treatment or support services in the absence of a reporting system. The dependent status of young children and some elders provides a stronger argument in favor of retaining mandatory reporting requirements where they do exist.
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From page 297... ...
who are the subjects of protective orders or treatment, and low rates of attendance, completion, and enforcement are persistent problems that affect both the evaluation of the interventions and efforts to reduce the violence. A few studies suggest that court oversight does appear to increase completion rates, which have been linked to enhanced victim safety in the area of domestic violence, but increased completion rates have not yet led to a discernible effect on recidivism rates in general.
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The documentation in health and social service records of abuse histories that are self-reported by victims and offenders can help service providers and researchers to determine if appropriate referrals and services have been made and the outcomes associated with their use. The exchange of case records among service providers is essential to the development of comprehensive treatment programs, continuity of care, and appropriate follow-up for individuals and families who appear in a variety of service settings.
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Collaborative Law Enforcement Strategies In the committee's view, collaborative law enforcement strategies that create a web of social control for offenders are an idea worth testing to determine if such efforts can achieve a significant deterrent effect in addressing domestic violence. Collaborative strategies include such efforts as victim support and offender tracking systems designed to increase the likelihood that domestic violence cases will be prosecuted when an arrest has been made, that sanctions and treatment services will be imposed when evidence exists to confirm the charges brought against the offender, and that penalties will be invoked for failure to comply with treat
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Further studies are needed to determine the extent to which improved collaboration among police officers, prosecutors, and judges will lead to improved coordination and stronger sanctions for offenders and a reduction in domestic violence. The absence of empirical research findings of the results of a collaborative law enforcement approach in addressing domestic violence makes it difficult to compare the costs and benefits of increased agency coordination with those achieved by a single law enforcement strategy (such as arrest)
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Such practices by themselves can neither be recommended nor rejected as effective measures in addressing domestic violence on the basis of existing research studies. Home Visitation and Family Support Services Home visitation and family support programs constitute one of the most promising areas of child maltreatment prevention.
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Recommendation 5: As part of a comprehensive prevention strategy for child maltreatment, the committee recommends that home visitation programs should be particularly encouraged for first-time parents living in social settings with high rates of child maltreatment reports. The positive impact of well-designed home visitation interventions has been demonstrated in several evaluation studies that focus on the role of mothers in child health, development, and discipline.
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Eight of ten evaluation studies of selected intensive family preservation service programs (including five randomized trials and five quasi-experimental studies) suggest that, although these services may delay child placement for families in the short term, they do not show an ability to resolve the underlying family dysfunction that precipitated the crisis or to improve child well-being or family functioning in most families.
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Future allocations of research investments may require agencies to reorganize or to develop new programmatic and research units that can inform the process of selecting interventions for future evaluation efforts, determine the scope of adequate funding levels, and identify areas in which program integration or diversity may contribute to a knowledge base that can inform policy, practice, and research. Such agencies may also consider how to sustain an ongoing dialogue among research sponsors, research scientists, and service providers to inform these selection efforts and to disseminate evaluation results once they are available.
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Training for Service Providers and Law Enforcement Officials Training in basic educational programs and continuing education on all as
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Universal Screening in Health Care Settings The significant role of health care and social service professionals in screening for victimization by all forms of family violence deserves critical analysis and rigorous evaluation. Early detection of child maltreatment, spousal violence, and elder abuse is believed to lead to an infusion of treatment and preventive services that can reduce exposure to harm, mitigate the negative consequences of abuse and neglect, improve health outcomes, and reduce the need for future health services.
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Evaluation studies of family violence screening efforts could build on the lessons derived from screening research in other health care areas (such as HIV detection, lead exposure, sickle cell, and others)
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have developed systemwide strategies to coordinate their law enforcement and other service responses to domestic violence. Comprehensive community-based interventions must confront difficult challenges, both in the design and implementation of such services, and in the selection of appropriate measures to assess their effectiveness.
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Third, the selection of an appropriate comparison or control group for community-wide interventions presents formidable problems in terms of matching social and structural characteristics and compensating for communityto-community variation in record keeping. These challenges require close attention to the emerging knowledge associated with the evaluation of comprehensive community-wide interventions in areas unrelated to family violence, so that important design, theory, and measurement insights can be applied to the special needs of programs focused on child maltreatment, domestic violence, and elder abuse.
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Evaluations need to consider the mix of components in comprehensive interventions that determine their effectiveness and successful implementation; the comparative strengths and limitations of inter- and intraagency interventions; community factors, such as political leadership, historical tensions, diversity of ethnic/cultural composition, and resource allocation strategies; and the impact of comprehensive interventions on the capacity of service agencies to provide traditional care and effective responses to reports of family violence. Shelter Programs and Other Domestic Violence Services Over time, most battered women's shelters have expanded their services to encompass far more than the provision of refuge.
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Key research issues include: the effect of review team actions on the protection of family members of children who have died as a result of child maltreatment; the impact of child fatality review reports on the prosecution of offenders; the influence of review team efforts on the routine investigation, treatment, and prevention activities of participating agencies; the impact of review teams on other community child protection and domestic violence prevention efforts; and the identification of early warning signals that emerge in child homicide investigations that represent opportunities for preventive interventions.
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Three major issues challenge effective interventions in this area: the degree of dependence between perpetrators and victims, restricted social services budgets, general public distrust of social welfare programs, and the relationship between judgments about competence and the application of the principles of self-determination and privacy to the problem of elder abuse. Evaluation studies should consider the different types and multiple dimensions of elder abuse in the development of effective interventions.
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This relatively young area of research has the potential to take the family as the unit of analysis and integrate the largely separate strands of research on child maltreatment, domestic violence, and elder abuse. For this reason, the committee strongly urges that this line of research be continued in a fashion that cuts across these areas of study.
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These economic and social indicators will become increasingly important with the enhanced use of performance measures by health care, public health, and social service agencies. Programmatic research is needed that can identify whether certain characteristics of selected family violence treatment and prevention interventions (such as the mixture, scope, and intensity of services; the philosophy and training of service providers; and levels of institutional support)
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From page 315... ...
In numerous family violence interventions, key social setting issues arise that warrant study because of their implications for the design of treatment, support, prevention, and law enforcement strategies. These issues include ways in which the mandatory or voluntary character of reporting and treatment systems influences service provider behavior and institutional practices; conditions and factors in the criminal justice system that foster deterrence, especially among individuals who have a history of violent behavior and who have little stake in social conformity; psychological, social, and institutional factors that facilitate or inhibit victim use of and perpetrator compliance with protective orders, treatment programs, mental health services, and other interventions in different community settings; classification of groups of offenders that can distinguish offenders who use violence only against certain family members from those who pose a general threat to others inside and outside their family; and behavioral or cognitive processes associated with "natural improvements" or "spontaneous change" (without intervention)
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Yet significant barriers inhibit the development of such partnerships, including disagreements about the nature and origins of family violence, broad variations in the conceptual frameworks that guide service delivery, differences over the relative merits of service and research, a lack of faith in the ability of research to inform and improve services, a lack of trust in the ability of service providers to inform the design of research experiments and the formation of theoretical frameworks, and concerns about fairness and safety in including victims and offenders in experimental treatment groups. These fundamental differences obscure identification of outcomes of interest in the development of evaluation studies, which are further complicated by limitations in study design and access to appropriate subjects that are necessary for the conduct of research.
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Evaluation research will help program sponsors and managers clarify program goals and experience and identify areas in need of attention because of the difficulties of implementation, the use of resources, and changes in the client base. Research and data-based analysis can guide ongoing program and policy efforts if evaluation studies are integrated into the design and development of interventions.
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Conversely, programs that offer only limited effectiveness may appear to be successful on the basis of evaluation studies that did not consider the significant points of vulnerability and limitations in the service design or offer a comparative analysis with the benefits to be derived from routine services. The establishment and documentation of a series of consensus conferences on relevant outcomes, and appropriate measurement tools, will strengthen and enhance evaluations of family violence interventions and lead to improvements in the design of programs, interventions, and strategies.
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