8
Cross-Cutting Issues

A vast share of the research literature on family violence interventions is organized in the context of the dominant institutional settings that characterize the field: social services, health care, criminal justice, and community-based programs. This organization facilitates a review of the ways in which service settings influence the development of interventions for the different types of family violence, but it discourages an analysis of the ways in which policies and practices in one institutional setting can affect interventions in the other institutional settings.

As communities move toward the integration and coordination of existing services and the development of community-wide interventions, stronger interest has emerged in the research, service, and policy sectors about the interactions between family violence interventions in different service settings. This discussion of cross-cutting concerns is intended to highlight these kinds of interactions. Focusing on these interactions may enable us to identify trends that are often overlooked in research syntheses that concentrate on a single service system or setting.

For example, the emerging integration of health and social service interventions for child maltreatment raises important questions about the threshold of risk or endangerment that should prompt treatment and prevention interventions. These service integration efforts also call attention to the interaction of concerns about privacy and confidentiality with the disclosure and documentation of child maltreatment. The role of the law enforcement and social service systems in identifying and meeting the needs of child witnesses to domestic violence is another example of service interactions that may shape the ways in which child



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--> 8 Cross-Cutting Issues A vast share of the research literature on family violence interventions is organized in the context of the dominant institutional settings that characterize the field: social services, health care, criminal justice, and community-based programs. This organization facilitates a review of the ways in which service settings influence the development of interventions for the different types of family violence, but it discourages an analysis of the ways in which policies and practices in one institutional setting can affect interventions in the other institutional settings. As communities move toward the integration and coordination of existing services and the development of community-wide interventions, stronger interest has emerged in the research, service, and policy sectors about the interactions between family violence interventions in different service settings. This discussion of cross-cutting concerns is intended to highlight these kinds of interactions. Focusing on these interactions may enable us to identify trends that are often overlooked in research syntheses that concentrate on a single service system or setting. For example, the emerging integration of health and social service interventions for child maltreatment raises important questions about the threshold of risk or endangerment that should prompt treatment and prevention interventions. These service integration efforts also call attention to the interaction of concerns about privacy and confidentiality with the disclosure and documentation of child maltreatment. The role of the law enforcement and social service systems in identifying and meeting the needs of child witnesses to domestic violence is another example of service interactions that may shape the ways in which child

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--> protection, victim safety, mental health services, and family support interventions are developed in a particular community. As agencies and communities develop comprehensive and collaborative interventions, fundamental tensions can arise from the goals, traditions, and cultures of the different institutional settings. These tensions may require particular attention to the effects of different service strategies (such as deterrence or treatment) in formulating a comprehensive approach to the problem of family violence. This chapter supplements the committee's research reviews with an analysis of five key issues that arise repeatedly in the different service settings and in efforts to evaluate interventions based in these settings: The ecological context of family violence, Approaches to punishment and rehabilitation, The roles of autonomy and competence, Cultural factors and community representation, and Assessment of dangerousness and risk. Some of these issues are unique to the field of family violence; others are more generally associated with violence research, criminal justice research, and community-based programs. Although the committee did not attempt to pursue these issues in great depth, the following discussion clarifies these issues, describes the relevant research, and examines their implications for the design of interventions and evaluations. The Ecological Context Of Family Violence Many theoretical frameworks seek to explain the causes of child maltreatment, domestic violence, and elder abuse. Evolving in different historical periods, these frameworks assign different levels of responsibility to individuals (including the parent, spouse, and child), the family, the community, and society in general (see Figure 8-1). Although no single theoretical framework dominates the field, both researchers and service providers are increasingly focused on the interactions that occur across multiple levels. In the area of child maltreatment, early interventions focused on the individual characteristics of offenders and sought to explain maltreatment in terms of individual pathology (National Research Council, 1993a). However, only a very small percentage of child abuse and neglect cases involve parental psychosis (Pelton, 1989); the extent of less severe mental disorders is unknown. More recent studies have yielded important distinctions between abusive and nonabusive parents in terms of expectations for their children, the extent to which parents view their children's behavior as stressful, and their view of themselves as inadequate or incompetent parents (Wolfe, 1991; National Research Council,

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--> FIGURE 8-1 Systems that influence family violence and interventions to address them. SOURCE: Committee on the Assessment of Family Violence Interventions, National Research Council and Institute of Medicine, 1998. 1993a). What is not certain is how perceptions about adequate or competent parenting interact with the social ecology of the family, especially under conditions of poverty and economic distress. Many cases of child abuse and neglect involve disruptions of childrearing that coexist with other serious problems, such as poverty, substance abuse, transiency, and antisocial behavior (National Research Council, 1993a). Researchers and service providers have focused attention on the interactions between parenting behaviors and broader family or community factors that may contribute to the abuse or neglect. The social ecology approach in child maltreatment interventions has stimulated interest in the need for concrete and supportive interventions for families (as opposed to educative and counseling interventions) to provide child care, housing assistance, job training, and employment referrals in addition to parenting education.

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--> These services are designed to improve the safety and protection of children, to enhance family interactions, and to strengthen community supports for families; they are increasingly offered in neighborhood-based settings as well as at traditional agency sites. In a similar manner, studies of domestic violence and violence against women have shifted away from single-risk-factor approaches in favor of models that examine the interactions of factors across individual, social, and cultural domains (National Research Council, 1996). Domestic violence interventions in the criminal justice system initially encouraged a search for batterer profiles, based on psychopathology or individual personality traits, similar to that sought for child maltreatment in the 1970s. In more recent years, greater reliance has been placed on a series of multifactor models, testing new hypotheses regarding the relationship between domestic violence and other forms of violent behavior among adults (National Research Council, 1996). Some of these models conceptualize all forms of violence against women together (rape, incest, wife battering), rather than emphasizing the nature of family or intimate relationships as the pathway to violence (Counts et al., 1992; Levinson, 1989; Dobash and Dobash, 1979). Accordingly, domestic violence prevention advocates have emphasized the need to reform cultural attitudes toward gender in general and male attitudes toward women in particular as part of the social intervention process. Domestic violence interventions have also begun to stress the importance of addressing the material and financial needs of victims to help them to lead violence-free lives. Although social ecology models have been used extensively in the development of interventions in the health care and social services domains, until recently they have had limited utility in law enforcement. Legal interventions such as investigative, arrest, and prosecution policies and practices have traditionally focused on individual motivation, standards of evidence, and the determination of criminal intent and behavior. With the development of drug courts, victim advocacy, and community policing programs, however, law enforcement agencies now pay more attention to the social context and settings in which violence occurs, prompting attention to family and community factors that accompany incidents and patterns of violence. This broader framework has encouraged the development of legal interventions that seek to enhance victim safety by improving the capacity of communities to care for their vulnerable members during times of distress and emergency need. In the area of domestic violence, the criminal justice system has been used extensively as an instrument of social change, designed not only to hold batterers accountable for their actions but also to serve as a referral source to enhance victim safety. In the area of elder abuse, limited attention has been given to the ecological context of family violence. Rather, this field remains dominated by risk assessment models that focus on single risk and protective factors in the design of interventions. The ecological framework, although still in an early stage of development,

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--> suggests that some forms of family violence may share risk factors and common origins and thus warrant common approaches—for example, training child welfare and law enforcement officials to recognize the relationships between domestic violence and child maltreatment. Other forms of family violence result from interactions among particular risk factors—for example, mental disorders and substance abuse—that can aggravate aggressive and injurious behavior. The presence of multiple risk factors in a household may require targeted interventions and risk assessment approaches to identify warning signals and dangerous settings from which the child or offending adult should be quickly removed in the interest of safety. Achieving the right balance between comprehensive and targeted approaches requires knowledge of the strength of interactive relationships among the antecedents of family violence, particularly those that present extreme risks to the victim. Such knowledge can contribute to the development of community-based interventions as a form of primary prevention, an approach that can strengthen protective factors and reduce risk factors before cases or patterns of behavior require more intensive treatment. The interactive ecological models of family violence may have great potential for the development of theory to guide intervention efforts, but to date the research base has not developed the capacity to explain the multiple pathways involved. This process of locating the level at which an intervention is focused has acquired new importance with the use of performance standards and outcome assessments in the management of human services agencies. Standards focused on reducing child deaths and injuries from abuse and neglect, for example, need to move beyond case report measures to take account of interim indicators, such as the availability and use of services and other interactions that may accompany or precede changes in child death and intentional injury trends. This approach emphasizes the importance of the availability and use of parent support services, the density and quality of community services and resources for low-income families, and the consistency of messages and norms in a social setting or community that encourage child safety and well-being and discourage the use of violence to resolve conflicts between spouses or in parent-child interactions. Evaluations of the impact of family support interventions, for example, could consider whether the presence and use of support services are associated with the patterns and level of violence in a community beyond their impact on specific clients or families. Approaches To Punishment And Rehabilitation The development of family violence interventions has evolved in a social context that stresses the importance of both punishment and rehabilitation. Punishment is generally associated with law enforcement interventions, and it may include actions that are designed to deter as well as incapacitate offenders in the

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--> expectation that such efforts will foster individual and community safety. Punishment may also include acts of retribution that reflect society's belief that offenders must pay for serious acts of violence that violate basic principles of social conduct. Components of incapacitation, retribution, and deterrence theories are reflected in various proposals to address family violence, including mandatory sentencing procedures, increased prosecution and arrest practices, and attaching special conditions to protective orders (such as restrictions on access to firearms or a driver's license). The criminalization of child maltreatment, domestic violence, and elder abuse classifies as criminal certain acts of family violence in the federal and state criminal and civil codes, fosters the creation of distinct categories of victims and perpetrators in the justice system, requires evidence of wrongdoing, and establishes a process to remove an offender or victim from the home environment without unreasonable delay. The criminal justice system has traditionally been reluctant to impose fines, sentences, and other punitive sanctions on individuals charged with child maltreatment, domestic violence, or elder abuse. Such cases are generally regarded as difficult to substantiate and to prosecute. Supporting evidence is often difficult to obtain, sometimes because witnesses are not willing to present evidence against those with whom they share a family or intimate relationship. In contrast, the rehabilitation, or therapeutic, perspective is built around different assumptions that have guided the development of service interventions in social and health settings. This perspective often focuses on the multiple social problems that characterize the relationships and settings in which family violence occurs, such as substance abuse, unemployment, homelessness, and community crime. The rehabilitation approach further assumes that reducing the sources of stress or conflict in a family or intimate relationship will lead to more enduring reductions in violent behavior, although such efforts may involve extensive time and may require a temporary removal of the offender or victim. Rehabilitation interventions generally focus on changing perceptions and beliefs, such as inappropriate expectations about children's behavior or socialized belief systems that reflect male use of power and control over women. These multiple dysfunctions are seen as stressors that threaten healthy family functioning, disturb the development of parent-child and intimate partner relationships, and contribute to the use of violence in response to stressful situations. The rehabilitation approach recognizes that, even when acts of violence occur in a family or intimate relationship, the ongoing nature of the relationships may provide many benefits as well as potential risks. The affected parties may want the violence to cease, but may also want the relationships to continue. These dual interests can foster ambivalence and uncertainty that may discourage some victims from seeking assistance from police or the courts because of their association with punitive interventions. These two perspectives, which emphasize different ways of addressing the

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--> problem of family violence, can lead to very different types of interventions. Punitive interventions in law enforcement settings have generally been reserved for more severe cases of family violence. The rehabilitation and support services associated with social and health care settings are associated with the larger number of cases that involve child neglect or occasional or even chronic, but minor, incidents of violence. The shift in attention to the social settings and interactive nature of family violence, however, has stimulated a broad rethinking of the roles of law enforcement, social services, and health care, resulting in innovative approaches that seek to blend the deterrent capabilities of the law with the treatment and support resources of health and social service providers. This approach includes consideration of contextual and community factors, as well as client history, in the disposition of individual cases. For example, punitive interventions, such as arrests and protective orders for domestic violence, can be important gateways to therapeutic treatment services for both offenders and victims, either as a complement or as an alternative to fines or incarceration. In this way, punitive interventions can take on aspects of respite services, providing opportunities for education, counseling, and concrete support services during the temporary removal of the offender. The use of mandatory reporting and investigative systems that are designed to integrate social services and law enforcement interventions are regarded as another effort to blend punitive and support services, enabling appropriate authority to take action against the offender if necessary and to provide appropriate services for the victim. However, the threshold for intervention by the legal system is often higher than that for social and health interventions, requiring evidence of, rather than risk for, harm. Service providers in various institutional settings must often determine which types of family violence cases and circumstances are appropriate for punishment (which includes deterrence, incapacitation, and compulsory treatment) or for therapeutic services (which include voluntary treatment and support programs). In making these distinctions, a host of ethical, legal, and economic issues arise that reflect competing goals and values. These issues often emerge acutely in risk assessment decisions and safety planning strategies, especially when the violence is severe, when the likelihood that it will recur is uncertain, and when the victim is particularly vulnerable or believed not to be competent to make decisions about his or her own well-being. One area in which law and social service interventions seek to balance concerns about punishment and rehabilitation is court oversight of batterer treatment programs. Some research indicates that it does increase rates of completion (Dutton, 1995a), and completion has been linked to reductions in violent behavior, but the extent to which court oversight increases an individual offender's readiness to change remains elusive. Increasing the penalties for failure to comply with a treatment protocol is thought to ensure greater compliance and cooperation with the services system, although deterrence theory recognizes that there

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--> are limits to the influence over individual and group behavior of sanctions and controls—at some point, the perceived costs of compliance with a coercive treatment program may outweigh the benefits to be gained. Deterrence theory also suggests that law enforcement systems can be powerful instruments of social change if they hold batterers accountable for their behavior, protect victims, and foster deterrence throughout society. However, if law enforcement officials are not prepared to respond swiftly, or if resources are not available to support appropriate treatment services for less severe cases, the deterrent effects of the criminal justice response to family violence can be weakened. Many uncertainties remain regarding the effectiveness of voluntary and coercive treatment programs in addressing different forms of family violence. These uncertainties are likely to continue until new knowledge or compelling theories can explain the probable outcomes associated with different types of treatment protocols. Experimental studies are needed that can compare the participation and completion rates, behavioral changes, and long-term effects of voluntary and coercive programs. The quality of the knowledge base will also be improved by studies that examine whether the use of sanctions enhances participation in batterers treatment programs, and whether treatment programs influence victim safety through the surveillance and monitoring of offenders. In the interim, the lack of clear research guidance in this area will foster an environment characterized by competing interests involving family integrity, community and victim safety, individual privacy, accountability, and the protection of vulnerable individuals. The Roles Of Autonomy And Competence Issues of autonomy and competence in family violence interventions arise in many settings and involve individuals who are engaged in family violence interventions, who are at risk of family violence, and who are involved in research evaluation studies. These issues involve the abilities of individuals across the life span to determine what is in their own interest or to determine the best interests of children or elders whose caregivers cannot fulfill their obligations. The compromised autonomy of elders and the functional incompetence of children are often cited as specific examples of these issues, although questions of autonomy and competence arise for mature adults as well. The experience of the law enforcement system with battered women who decline to press charges or who will not testify against their batterers, for example, has stimulated interventions designed to allow police and prosecutors to proceed with legal action even if the assault victim or witness does not cooperate. Women who have experienced continued violence in their family and intimate relationships may be extremely fearful for their safety or that of their children. They may not perceive themselves as victims and may be unwilling to request or support interventions from outside agencies. Shifting societal norms regarding the nature of violence between intimate

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--> partners have raised many questions regarding the extent to which law enforcement systems can or should intervene in cases in which victims refuse to hold their partners accountable for violent actions. In evaluations of family violence interventions, two important issues have emerged: the problems of coercion and of the loss of privacy, both intentional and unintentional. Government regulations and professional standards that guide research on human subjects emphasize the principle of informed consent, based on the premise that subjects should be informed about the purpose and nature of research in which they will be asked to participate and that they should have an opportunity to consent to—or to refuse—such participation. Informed consent includes the principle that research subjects (or, in research involving children and minors, their parents or other custodial adults) should authorize the release of personal data and records regarding their own behavior or health status. Many individuals who are the subjects of family violence interventions are either victims or perpetrators of child maltreatment, domestic violence, or elder abuse. These individuals may volunteer for treatment or support services, but in many cases they are referred for services without their consent. Individuals may also be arrested, removed from their home, or lose their rights as custodial parents as a result of court interventions. Research on family violence interventions therefore involves interactions with people who are in a highly vulnerable status, who may not be able to clearly discern distinctions between research and services, and who may not understand or wish to cooperate with the objectives of a research project. Individuals who are incarcerated, under court supervision, or dependent on public services may have a limited understanding of the ways in which they can exercise rights over the use of their personal records, or of the ways in which information disclosed in research interviews may be shared with others. This observation is particularly true when the research or evaluation studies are being conducted by public agencies or organizations that are involved in the delivery of the services. The report from a series of meetings on ethical issues in violence research conducted by the National Institute of Mental Health from 1991 to 1993 observed that researchers who conduct violence studies must guard against unintentionally pressuring people to participate (National Institute of Mental Health, 1993). Participants who are clients in treatment programs, therapeutic day care centers, probation and corrections offices, and the courts may believe that negative consequences will result if they choose not to participate in or withdraw from a study on family violence. For example, participants recruited from a no-cost treatment program may believe they will be dropped from the program or asked to pay for services if they do not agree to participate in a research study. Although the issue of confidentiality of research and the use of personal and public records has been examined in previous studies (National Research Council, 1985, 1993c), unique sensitivities arise in the context of family violence. Concerns involving stigma, bias, and labeling require special consideration in

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--> structuring group interviews, providing guidance and referrals for victims who have not been reported prior to their participation in a study, and assessing medical, child welfare, employment and police records. Furthermore, the safety of research subjects should be of paramount concern to the investigator. Individuals who are asked to participate in research studies should not be placed at greater risk as a result of their agreement—or refusal—to serve as a research subject. Cultural Factors And Community Representation Cultural factors and community representation are important issues in discussions of individual interventions and evaluations. Research in this area is based primarily on descriptive studies, and findings are preliminary in the absence of sound empirical data. The ways in which cultural practices, social class, and economic opportunities interact with intimate, parenting, and caregiving practices are only beginning to emerge in the research literature and scant attention has been given to them in the dynamics of family violence. One study of ethnographies from 90 non-Western societies found wife-beating to be the most common form of family violence (found in 84 percent of the societies); physical punishment of children was found in 74 percent (Levinson, 1989). Although wife-beating is often associated with male control of wealth and decision making in the household, no single theory has emerged with sufficient power to explain the prevalence of this phenomenon in the modern world (Counts et al., 1992). The social isolation of families, sometimes compounded through differences in race, legal status, and language, can interact with cultural and ethnic practices to generate conflict over male-female and parent-child role expectations—conflicts that in turn can stimulate the use of violence to resolve stressful situations. Studies of the role of cultural and ethnic practices as risk factors for family violence therefore need to consider the ways in which such practices interact with a broader set of variables involving child and family management practices and intimate behaviors. Efforts to focus on single ethnic practices or the authoritarian styles of parenting associated with some cultures can divert attention from the harder-to-understand ways in which culture interacts with social environments in a variety of settings to influence individual and family behaviors, especially during periods of danger, economic difficulty, and social change. The absence or presence of social networks that are bound by common ethnic heritage, language, or cultural practices is another important factor that may influence community responses to reports of family violence. The Multi-Cultural Advisory Committee of the Washington State Risk Assessment Project has developed multicultural guidelines for assessing family strengths and risk factors in child protective services (English and Pecora, 1994). The guidelines help service providers differentiate child, parent, or family dysfunction that may be caused by poverty or the environment from that due to

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--> family circumstances or behaviors. However, the advisory committee cautions that there are limitations in current risk assessment research, and some items on their instrument and the scale structure have not been tested for predictive validity for all populations. Another concern in this area involves issues of equity and fairness in gaining access to services in the conduct of research. In some disadvantaged communities, the introduction of a family violence research study may provide direct services to children and families that are not usually available in the community—such as pediatric and prenatal health care services, mental health and counseling services, and parent support programs. Many local health and social service agencies do not have the resources to continue such services when the evaluation study is completed. Community residents can become discouraged and develop negative perceptions of research if they believe their experiences or neighborhoods provide research materials without any clear benefit to those who reside in the community and who must remain when the researchers depart. Along these lines, at the February 1995 workshop for service providers organized by the committee as part of this study, one speaker emphasized that, in considering the merits of community-based approaches, researchers should be attentive to the absence of skilled resources in many deprived neighborhoods and consider in advance how to prepare communities to assume the responsibility and acquire the resources for family support efforts, especially during periods of extreme duress or chronic difficulty (Thomas, 1995). Various mechanisms may facilitate the process of community representation in family violence research studies, including the creation of community advisory boards for research projects, the appointment of community leaders in institutional review board membership when family violence study designs are under review, basing the project staff in the community under study, purchasing research supplies and equipment from community-based vendors, and involving local students in the research activity. Such efforts would help ensure that evaluation studies are sensitive to the special needs and resources of local communities, especially those in which ethnic minorities are overrepresented as victims of violence. Concerns about cultural factors and community representation have emerged in other forms of violence research as well. A study panel organized by the National Institutes of Health (NIH) has highlighted the need for improved coordination and community representation mechanisms in federal violence research programs, especially in the formulation of research questions, study design, data analysis and interpretation, peer review, and training (Stone, 1993). The NIH panel highlighted a critical need to increase the participation of minority institutions, researchers, and organizations in studies of violence, in order to involve representatives from communities who are often the subjects of violence-related research in the processes of study design and implementation. Such involvement would help ensure that the research community focuses on key questions that the

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--> communities affected by violence want to address. Greater community involvement may also strengthen attention to important issues relevant to ethnic and cultural competence in the selection of research instrumentation, the recruitment and retention of sample populations, and interpretation of survey responses. Assessment Of Dangerousness And Risk The assessment of dangerousness and severity in reported cases of family violence has become a major issue in selecting appropriate service interventions and assessing their effectiveness (Limandri and Sheridan, 1995). Child and adult protective service providers must decide whether it is safe to leave a client in a setting in which abuse is likely to recur or whether to recommend alternative placement. Law enforcement officers and judges seek a basis for judgments regarding the treatment or punishment of offenders, the placement of children and elders, and decisions regarding custody, visitation, and probation. Clinicians, counselors, and therapists have a ''duty to warn" if, in their judgment, a patient or client is likely to inflict harm on another. The development of service interventions for family violence has brought with it a gradual shift away from clinical assessments of danger and harm, which can be arbitrary and unreliable (Gottfredson and Gottfredson, 1988; Monahan, 1981), toward risk assessment instruments that are based on statistical measures and research on the causes of family violence. The assessment of dangerousness has become a major focal point in mental health law, public health, social work, and police and law enforcement studies, as illustrated by the work of the Network on Law and Mental Health of the John D. and Catherine T. MacArthur Foundation in Chicago. Monahan and Steadman (1994) have suggested seven characteristics to guide the next generation of research in this field: The concept of dangerousness includes several components, including risk factors that can predict future violence, the severity and type of violence being predicted (harm), and the likelihood that harm will occur (risk). An array of risk factors in multiple domains should be chosen that are theory-generated. Harm should be scaled in terms of seriousness and assessed with multiple measures. Risk should be treated as a probability estimate that changes over time and context. Priority should be given to actuarial research (based on statistical models) that establishes a relationship between risk factors and harm. Large representative samples of subjects at multiple, coordinated sites should participate in the research. Managing risk as well as assessing risk should be a goal of the research.

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--> These characteristics have significant implications for the development of risk assessment instruments and decision-making processes in both social services and law enforcement systems. Statistical prediction depends on the construction of risk assessment instruments that can be tested for reliability and validity in various social settings. The development of risk assessment measures for family violence is still in its infancy, and the ability of such instruments to predict who is likely to harm or harm again has not been established. Most "danger assessment" measures have not been validated with different populations (Campbell, 1995). Such instruments establish base rates for a specific behavior, identify specific domains of risk factors that are thought to be predictive for family violence, calculate the likelihood of true and false positives, and test the instrument on varied populations over time to confirm its ability to discriminate between known abusers and a control population. In child maltreatment investigations and research studies, multiple risk assessment instruments are being used and they are often administered as part of a comprehensive needs assessment process (Campbell, 1995; Cicchinelli, 1991). The state of Washington, for example, has developed a research-based risk assessment instrument for child maltreatment that can assess 32 separate items related to individual characteristics (both parent and child), family functioning factors, and environmental characteristics. Caseworkers rate the importance and identify the "highest" risk factor in an individual case. Research is being conducted on caseworker assessments to examine which risk factors were associated with high overall risk ratings and more serious outcomes such as placement. A risk prediction instrument for cases involving sexual offenses against children has recently been constructed using a sample of rapists and child molesters released from a maximum security psychiatric facility (Quinsey et al., 1995). The researchers found that recidivism for sexual abuse was well predicted by previous criminal history, psychopathy ratings, and phallometric assessment data. They recommend the use of the instrument to guide clinical judgment. In the area of domestic violence, Saunders (1995) has summarized research findings on risk factors that distinguish cases involving severe assault from other forms of intimate partner violence. Homicide predictions involving battered women have used several different lists of predictive factors, including Campbell's danger assessment instrument, based on retrospective studies of risk factors in cases in which battered women killed or were seriously injured or killed by their abusers (Campbell, 1995). The instrument has been tested among ethnically diverse groups and has achieved sufficient statistical support for use in clinical settings. In 1991, the Navy Family Advocacy program adopted a risk assessment model for use in investigating reports of child abuse and domestic violence. It includes 23 variables grouped into 7 risk domains, which include incident characteristics, victim characteristics, alleged offender characteristics, victim-perpetrator interaction, environmental characteristics, nonoffending caretaker characteristics,

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--> and nonoffending caretaker-victim interaction (English, 1995). A review of the literature to determine research support for the risk domains included in the Navy model concluded that no single factor can predict the risk of future harm, that risk is produced by an interaction among factors, and that the weight given to an individual risk factor or risk domain may vary depending on the interaction among factors (English, 1995). In the area of elder abuse, the Illinois Department on Aging has developed a risk assessment process to determine the extent to which a client is in danger of harm, injury, or loss; 23 factors are included (Neale et al., 1996). It also can be used after a designated time period (i.e., 90 days) and at the close of case management to assess change in level of risk over the period of agency involvement. The growing reliance on risk assessment instruments is an indication of the gradual integration of family violence research findings into service guidelines and practices. These instruments can provide important tools to guide health and social service and law enforcement decisions for individual clients, and they can make an important contribution to more effective evaluations of interventions. Risk assessment instruments have not been sufficiently validated, however, either for general or specific populations (such as age or ethnic groups). Instruments that do not recognize cultural variation or consider language or distrust of institutional resources as potential environmental barriers to cooperation with recommended services run the risk of falsely labeling certain protective behaviors or attitudes as abusive when they may not be. The use of risk assessment instruments that have established interrater validity in both research and service provider decisions can provide a consistent baseline for measuring areas of change among both victims and offenders. These measurements can enhance understanding of the pathways and sequences in which behavioral changes occur, contribute to theory-building and data collection, and assist with the screening of clients in evaluation studies to determine who should receive usual-care services (assumed to be safest), so that high-risk individuals are not assigned to innovative but unevaluated interventions. Conclusions The recognition that no single risk factor can explain or predict the majority of cases of family violence, and no single service program or system can be responsible for treatment and prevention, has stimulated numerous efforts to integrate services and research studies, but the complexity of this task in addressing family violence is daunting. The need for efforts that can offer individual and group support, as well as assess for dangerousness and risk in the development of service systems, requires consideration of a broad range of social science, health, and law enforcement research, including clinical research findings based on case reports as well as community-based studies that can identify broad trends in groups and neighborhoods.

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--> New emphasis is being given to the role of cultural norms, social networks, and community change in shaping individual behavior, family and other relationship practices, and service system designs. These new areas of research, in turn, are stimulating the involvement of local community representatives in evaluation studies and experimentation with innovative study designs, data collection efforts, and the testing of instrumentation. The next generation of interventions and evaluations in the field of family violence, especially in the area of comprehensive community services, is likely to focus attention on the ways in which different service systems provide consistent or contradictory messages in their interactions with clients and communities. Fundamental differences in attitudes and beliefs about the causes and consequences of family violence, and the purpose and roles of different service sectors, can be expected to provoke discussions about the relative importance—and timing—of punishment, oversight, rehabilitation, retribution, deterrence, treatment, and the use of mandatory and voluntary services in addressing child maltreatment, domestic violence, and elder abuse. These discussions will benefit from research studies and exchanges among researchers and service providers to clarify areas in which the knowledge base is strong enough to guide agency practices and, when appropriate, establish performance standards to assess their effectiveness. The shift from practices based on ideology and habit to ones that are shaped by empirical research will not be easy; many conflicts can be expected to emerge when research findings diverge from conventional wisdom in areas such as child protection, batterer treatment, victim safety, and community well-being, or when research instruments are not strong enough to capture hard-to-measure factors that influence interactions among individuals, families, and communities. Concerns for privacy, autonomy, justice, and care for vulnerable individuals and groups will require particular consideration in the development of measures of risk assessment and dangerousness that are compatible with community norms and general principles of social governance. The absence of minority researchers involved in evaluation studies in this field is problematic. Improving the situation will require special attention to training programs, research opportunities, minority research supplement efforts, and career development strategies to diversify the ethnic and cultural representation of the research expertise focused on family violence. Finally, it is important to clarify the ethical principles that can provide design strategies for research investigators as they probe more deeply into the parenting practices, intimate relationships, service use patterns, and social networks of those who are affected by violence in families.