Violence in Families Assessing Prevention and Treatment Programs (1998) / Chapter Skim
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4 SOCIAL SERVICE INTERVENTIONS
4 SOCIAL SERVICE INTERVENTIONS
Pages 93-157
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From page 93... ...
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.
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From page 94... ...
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.
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From page 95... ...
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)
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From page 96... ...
Six social service interventions for child maltreatment are reviewed in the sections that follow: (1) parenting practices and family support services, (2)
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From page 97... ...
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)
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From page 98... ...
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.
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From page 99... ...
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)
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From page 100... ...
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)
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From page 101... ...
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)
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From page 102... ...
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.
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From page 103... ...
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)
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From page 104... ...
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.
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From page 105... ...
(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.
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From page 106... ...
. 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)
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From page 107... ...
Meddin and Hansen, 1985 60 13 Salovitz and Keys, 1988 44 National Committee to 78 Prevent Child Abuse, 1991 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.
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From page 108... ...
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)
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From page 109... ...
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.
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From page 110... ...
Individual social workers, psychologists, and clinics also provide services to victims of domestic violence. This section describes social service interventions designed for battered
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From page 111... ...
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)
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From page 112... ...
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)
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From page 113... ...
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.
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From page 114... ...
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.
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From page 115... ...
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.
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From page 116... ...
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)
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From page 117... ...
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.
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From page 118... ...
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.
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From page 119... ...
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.
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From page 120... ...
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.
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From page 122... ...
provided to 43 families, in N(MT) = 21/16 which one parent had been investigated for child abuse or neglect but not child 8 weeks sexual abuse.
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From page 123... ...
No significant differences demonstrated in levels of support. Reports of child abuse were similar for both groups.
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From page 124... ...
Perinatal Positive Parenting provided National Center on 139 treatment parent training and information on child Child Abuse and mothers and 27 care and development, community support Neglect, 1983a control mothers groups for new parents, home visits by completed the BNPI; trained volunteers, and a "warm line" to 97 treatment and call for support and information in Royal 58 control mothers Oak, Michigan for first-time mothers. completed the A/API Pride in Parenthood, a program for first-time National Center on N(X)
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From page 125... ...
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. Bavolek Adult/Adolescent Parenting No significant differences between treatment Inventory (A/API)
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From page 126... ...
New Directions for Mothers (NDM) provides life skills training and parenting skills training.
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From page 127... ...
interaction, report of utilization of treatment facilities, CES Depression Scale, Child Behavior Checklist Rosenberg Self-Esteem Scale, Beck Study findings noted posttest and 3-month Depression Inventory, Generating Options follow-up improvements among preventive Test, Self-Reinforcement Attitudes intervention subjects relative to test-only Questionnaire, Social Support Inventory, control subjects on measures of personal Personal Support Scale, Parenting Sense of and social support, cognitive problem Competence Scale, Good Care Scale, Pearlin solving, self-reinforcement, parenting Mastery Scale, behavioral role play competence and care, and interpersonal performance. Subsequent child abuse and neglect charges, Both treatment and standard service groups rate and severity of recidivism, out-of-home experienced decreases in child abuse and placement neglect.
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From page 128... ...
= 11 N(O) = 13 6 sessions SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.
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From page 129... ...
SOCIAL SERVICE INTERVENTIONS 129 Data Collection Results Affection Scale, Discipline Scale, Results indicated a reduction in anger Empathy Scale measures among subjects exposed to the experimental interventions. The composite treatment resulted in the strongest degree of anger alleviation.
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From page 130... ...
3.5-hour sessions for 3 days 7-week follow-up Feeling Yes, Feeling No, a sexual Hazzard et al., 1991 N(teacher and child abuse prevention curriculum offered to training) = 6 students in 21 elementary schools in a classrooms; southeastern suburb.
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From page 131... ...
Test focused on differentiation between Relative to the control group, at both 3-week good and sexually abusive touches in posttest and 7-week follow-up, children pictures and vignette 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.
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From page 132... ...
2-week and 6-month follow-up Training workshop for elementary school McGrath et al., N(X) = 38 teachers on preventing child sexual abuse 1987 N(O)
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From page 133... ...
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. Child self-report, parent self-report, teacher Results indicated greater gains in general self-report knowledge and prevention skills at posttraining and 6- month follow-up for trained compared with control children.
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From page 134... ...
50 minutes 3-month follow-up Two 5-minute skits written and rehearsed by Wolfe et al., 1986 N(X) = 145 medical students about child sexual abuse N(O)
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From page 135... ...
. Paper and pencil questionnaire, Children who viewed the film had child interviews 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.
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From page 136... ...
= 19/17 self-protection skills, followed by a class N(BST) = 15/14 discussion; a behavioral skills training N(combination)
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From page 137... ...
"What If" situations test, personal safety The results suggest that parents can teach questionnaire, parent perception questionnaire their preschoolers personal safety skills, and that the program can be implemented in the home.
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From page 138... ...
management, communication skills training, and individual and family counseling to 4-6 weeks families of children in three California counties referred to child protective services 1-year follow-up for abuse or neglect. Families First Program provided 4-6 weeks Bergquist et al., 1993 N(X)
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From page 139... ...
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. Frequency of removals, rate of recidivism, Children were removed from their homes in costs of services to families 6 (14.6%)
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From page 140... ...
= 569 child abuse or neglect. Services include both therapeutic and concrete services.
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From page 141... ...
were reported. Placement rates, Child Welfare League of The treatment success rates of the America Family Risk Scales, FACES II Homebuilders program matched or exceeded those of other Intensive Family Preservation Services or family-centered programs using comparable intake criteria.
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From page 142... ...
= 24 parenting skills, parent sensitization to child Fleischman, 1985 N(O) = 24 needs, and coping skills training offered to client families of the Cascade County, Not discussed Oregon, Social Services Child Protective Service Unit.
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From page 143... ...
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.
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From page 144... ...
32 children Comparison group received routine community services 4-6 weeks 1-year follow-up Homebuilders model family therapy, Yuan et al., 1990 N(X) = 143 life skills training, concrete services.
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From page 145... ...
SOCIAL SERVICE INTERVENTIONS 145 Data Collection Results Cost of placements, rate of placement, One-year follow-up data indicate in-home family functioning as measured by FACES II treatment was successful at reducing out-of home placement and lowering placement costs compared with comparison group. Placement costs, family functioning, No significant differences in placement rates service use between the project group and the comparison group.
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From page 146... ...
= 114 1985 N(O) = 106 Comparison group of victims of child maltreatment who were left in the family home Foster care of children in San Mateo, Wald et al., 1988 N(X)
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From page 147... ...
The foster children Intelligence; Wechsler Intelligence Scale for demonstrated higher scores in overall Children; school records of academic socioemotional well-being. 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
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From page 148... ...
= 68 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. SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998.
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From page 149... ...
Subsequent child abuse and neglect reports, Fifty-six percent of treatment families number of families' unmet needs, improved compared with 64% of control families were social support, improved parent-child reported for child maltreatment over the 2interaction, reduction in parental stress year study period. The experimental group did report fewer family problems and lower stress but did not report greater social support.
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From page 150... ...
150 VIOLENCE IN FAMILIES TABLE 4B-1 Quasi-Experimental Evaluations of Shelters for Battered Women Initial/Final Sample Size Duration of Intervention Intervention Citation Follow-up Battered women's shelter. Berk et al., 1986 N = 155 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.
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From page 151... ...
SOCIAL SERVICE INTERVENTIONS 151 Data Collection Results 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.
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From page 152... ...
= 71 after shelter exit, 4-6 hours per week N(0) = 75 provided to residents of a domestic violence shelter in a midwestern city.
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From page 153... ...
Women in the experimental condition reported being more successful in accessing resources. Social Support Scale, Conflict Tactics Scales, The experimental intervention expanded the Index of Psychological Abuse, Quality of Life social network of women; women in the Measure, Depression Scale CES-D, treatment group felt more effective in Effectiveness of Obtaining Resources Scale obtaining resources than the women who did not have advocates.
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From page 154... ...
= 238 dating violence prevention curriculum for N(S) = 279 10th graders.
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From page 155... ...
Positive changes decreased by half at 6-week posttest. True/false knowledge questions about Relative to control students, treatment domestic violence students improved scores on the posttest over three points.
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From page 156... ...
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 Initial/Final Sample Size Duration of Intervention Intervention Citation Follow-up Volunteer advocates provided assistance Filinson, 1993 N(X)
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From page 157... ...
Data Collection Results Improving self-esteem, seeking legal action, The findings indicate that the volunteer relocating victim or perpetrator, increasing advocate program, in comparison with the social supports, access services conventional system, can lead to more ambitious goal setting, greater achievement of goals, and more extensive monitoring of cases.
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