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In May 1993, a group of 35 research scholars, state and federal officials, and representatives from law enforcement, social services, and health care systems met at the Wingspread Conference Center in Racine, Wisconsin. The purpose of this meeting was to examine whether it would be feasible to synthesize the body of research knowledge that had emerged in the past few decades regarding the development, implementation, and effectiveness of interventions designed to treat and prevent family violence. The participants agreed that efforts are needed to bridge the gap that now exists between research resources and policy needs in addressing the problem of family violence, and that one way to address this gap is to synthesize the rigorous evaluations of public-sector programs designed to treat or reduce incidents of child and spousal abuse and abuse of the elderly. They emphasized that, although no single strategy for prevention or treatment has yet proven to be effective in the research literature, the existing evaluations of relevant program interventions should be identified and analyzed to disseminate important lessons learned from past efforts to reduce family violence.

In response to the guidance of the Wingspread meeting participants, the Board on Children, Youth, and Families of the Commission on Behavioral and Social Sciences and Education (CBASSE) of the National Research Council (NRC) and the Institute of Medicine (IOM) established a Committee on the Assessment of Family Violence Interventions in August 1994. Funding was provided by several agencies within the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Justice (DOJ). The sponsoring agencies within DHHS include the Centers for Disease Control and Prevention, the Administration for Children and Families, the Office of Maternal and Child

Health, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration. The National Institute of Justice was the DOJ sponsor. Funding was also provided by the Carnegie Corporation of New York. The Office of Health Promotion and Disease Prevention within DHHS served a valuable administrative role in coordinating the DHHS agency contributions for this project.

This study is the latest in a series of reports by the NRC that examine the emerging social science research base on violence and families. It builds on five earlier NRC publications related to this topic.

Understanding and Preventing Violence—Volume 1 (National Academy Press, 1993). This report is a comprehensive review of America's experience of violence, taking an interdisciplinary approach to examining the causes and consequences of interpersonal violence. The report includes a chapter on violence in families that describes the array of family violence interventions, research findings about police interventions and battered women's shelters, and the difficulties of evaluating and comparing interventions in this area.

Understanding and Preventing Violence—Volume 3: Social Influences (National Academy Press, 1994). This volume includes four background papers that review research on violent victimization; violence between spouses and intimates; gender and interpersonal violence; and the role of alcohol and psychoactive drugs in violent events. The paper on spousal and intimate violence by Jeffrey Fagan and Angela Browne examines the state of empirical and theoretical knowledge on violence between adult partners and presents a social epidemiology of intimate violence, characteristics of victims and assailants, and an assessment of risk markers for marital violence.

Understanding Child Abuse and Neglect (National Academy Press, 1993). This report presents a research agenda for studies of child maltreatment. It reviews the state of research on different forms of child maltreatment, including physical and sexual abuse, emotional maltreatment, and neglect. The research agenda emphasizes the importance of studies that address the nature and scope of child maltreatment, its causes and consequences, the assessment of prevention and treatment interventions, and the need for a science policy to guide the development of research in this field.

Violence and the American Family (National Academy Press, 1994). This workshop report presents a summary of the Wingspread meeting that called for the development of an in-depth analysis of the state of knowledge regarding family violence interventions.

Understanding Violence Against Women (National Academy Press, 1996). The result of a study requested by Congress in the 1994 Omnibus Crime Prevention Act, this report presents an agenda for research on intimate partner violence and sexual assault. The study identifies gaps in the knowledge base in this area and recommends a strategy for building comprehensive and interdisciplinary

studies that can examine the causes and consequences, nature and scope, and prevention and intervention for violence against women.

These NRC reports provide important insights into what is known about interventions in the field of family violence. But their assessment of rigorous evaluation studies of treatment and prevention programs is limited. In this study, our committee sought to extract knowledge from research concerning the evaluations of family violence interventions as well as insights reported in other assessments of selected interventions. The committee met six times over a 24-month period to identify major conceptual themes and to review the relevant knowledge base in formulating its conclusions and recommendations. This synthesis of research and program evaluation knowledge was augmented by expert opinion through two workshops, commissioned papers, consultant reports, and five site visits designed to draw on the experiences and insights of service providers in the health, social service, and legal communities. The study also included a review of the methodological issues associated with research in areas characterized by weak conceptual clarity and immature measurement (Institute of Medicine, 1994).

The committee benefited from an inter-agency working group organized to help guide the early stages of development and the dissemination of this study and to share agency research resources. Program officers from the sponsoring agencies also participated in the committee workshops. We are grateful to each of these officials for their thoughtful contributions over the course of the study: Bernard Auchter and Christy Visher from the National Institute of Justice; Ashley Files, Matthew Guidry, and James Harrell from the Office of Health Promotion and Disease Prevention; Lynn Short from the Centers for Disease Control and Prevention; Frank Sullivan from the Substance Abuse and Mental Health Services Administration; Audrey Yowell from the Office of Maternal and Child Health; Malcolm Gordon from the National Institute of Mental Health; William Riley from the Administration for Children and Families; and Michael Levine from the Carnegie Corporation of New York.

The committee's study identification and data collection effort required an extensive staff effort; these studies appeared in dozens of journals and had not been previously assembled into a research database. Study director Rosemary Chalk and research assistants Katherine Darke and Seble Menkir, in consultation with committee member David Cordray, identified search strategies and citation indexes to gather the appropriate studies. The results of their effort are presented in Tables 3-1 and 3-2. Katherine Darke provided an important contribution in the preparation of the individual research review tables that are included in Chapters 4 through 6.

The committee held two workshops in Washington, D.C. to inform its deliberations. The first workshop was designed to elicit expertise and perspective from service providers associated with treatment and prevention interventions in child maltreatment, domestic violence, and elder abuse. Background papers

prepared by the workshop participants were published in an interim report by the committee (Service Provider Perspectives on Family Violence Interventions, 1995). The participants observed that much of the information regarding family violence programs does not appear in the research literature, and that reforms in community-based interventions have not been studied in a systematic manner.

The second workshop focused on evaluation methods and research designs associated with the assessment of family violence interventions. The participants included researchers who had studied selected interventions in health care, social services, and law enforcement settings. They reviewed specific methodological challenges and creative strategies that have been used in the selection and retention of research subjects, the ethical and legal concerns associated with research in this field, and the quality of data that is associated with administrative records in public agencies.

The site visits were coordinated by Katherine Darke, who contacted local organizations and developed comprehensive itineraries for committee members and staff in each of the five cities that served as the subjects of these meetings (Boston, Dallas, New York City, Miami, and Seattle). A detailed listing of these organizations is included in Appendix A.

Several consultants provided background information that was very helpful to the committee's work. Jodi Short and Joseph Youngblood contributed materials on the nature and scope of family violence and federal intervention programs (Chapter 2). Anne Flitcraft, Patti Culross, Patricia Mrazek, and Michelle Forcier prepared background materials on health care interventions for domestic violence (Chapter 6). Terry Fulmer and Georgia Anetzberger prepared a research review on elder abuse interventions that informed several chapters. The material in Chapter 3 that pertains to client referrals, screening, and baseline assessment benefited from a publication prepared by Georgine Pion and David Cordray (Cordray and Pion, 1993). Chapter 5 benefited from contributions by Diane Juliar and Juliana Blome and a research paper on legal interventions for family violence developed by Alissa Pollitz Worden. The committee is grateful to all these contributors.

The committee also benefited from the tremendous support of the staff of the Board on Children, Youth, and Families and the Institute of Medicine: Cynthia Abel, Nancy Crowell, Katherine Darke, Seble Menkir, Faith Mitchell, Deborah Phillips, and Michael Stoto contributed careful readings, draft chapters, and literature searches that identified relevant materials throughout the development of the project. Lauren R. Meader, Julie Walko, and Susan M. Fourt of the National Research Council Library provided invaluable assistance in identifying and collecting research materials. Special thanks are due to senior project assistants Niani Sutardjo and Cindy Prince who provided administrative support during the study, including the organization of meetings, workshops, and the preparation of several drafts of the report. Project assistants Karen Autrey and Roger Butts helped to prepare the final draft for publication. Communications director Anne

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Violence in Families: Assessing Prevention and Treatment Programs