Research Report

A Coordinated

Approach to

Reducing Family

Violence: Conference

Highlights

National Institute of Justice
A Coordinated Approach to

Reducing Family Violence

...We’ve all got to join together and start

persuading America that unless we invest in

community initiatives that look at the family and

the child as a whole, we will never be able to

build enough prisons 18 years from now....

Hon. Janet Reno

U.S. Attorney General

Family violence has become as American as guns on

our streets and murders in our movies....Until now,

domestic violence was something the Federal Governm

didn’t bring up....We have moved from an era of

closing our eyes and denying our problems to doing

the tough, hard work of saving families to save futures

Hon. Donna E. Shalala

Secretary of Health and Human Service

Comments made at the National Conference on Family Violence: Health and Justic

March 11–13, 1994.
A Coordinated Approach to

Reducing Family Violence

Conference Highlights

Martha B. Witwer, M.P.H.

Cheryl A. Crawford, M.P.A., J.D.

October 1995
U.S. Department of Justice

Office of Justice Programs

National Institute of Justice

Jeremy Travis, J.D.

Director

Cheryl A. Crawford, M.P.A., J.D.

Program Manager

American Medical Association

Robert E. McAfee, M.D.

Immediate Past President

Martha B. Witwer, M.P.H.

Project Coordinator

Department of Mental Health

Opinions or points of view expressed in this

document are those of the authors and do not

necessarily reflect the official position of the

U.S. Department of Justice.

NCJ 155184
Contents

Introduction .........................................................................

Professional Collaboration ..................................................

Professional Education ........................................................

Notes ....................................................................................

Recommendations from Ten Work Groups.........................

Appendix A: The National Conference on

Family Violence: Health and Justice ...........................

Appendix B: The Impact of Domestic Violence

 on Children .................................................................

Appendix C: Family Violence Research Program,

National Institute of Justice .........................................

Introduction

In the early 1960’s, C. Henry Kempe, M.D., drew national 

tion to the problem of child abuse as a common cause of inj

and death, and he emphasized the need for physicians to di

nose such injuries so that children at risk could be identifie

protected from further mistreatment. By the 1970’s, women

advocates had raised public concern about the problem of d

mestic violence, provided more shelters for battered women

increased the number and scope of legal services available 

them. During the late 1970’s and early 1980’s, reports of el

abuse and neglect became widespread. The statistics docum

ing this epidemic of family violence in the United States re

an annual incidence of abuse by family members that is con

vatively estimated at 2–4 million for children, nearly 4 mill

for women, and 1–2 million for older adults.

In the past, advocates for each of these groups have rarely t

to one another about coordinating prevention and interventi

strategies. Furthermore, professionals within the various sp

ized fields that deal with these personal tragedies are often 

rated by discipline-specific systems, languages, and routine

Many health, justice, and social service professionals believ

that the remaining barriers dividing those who work to prot

families and communities against violence and abuse must 

overcome. This report discusses highlights of the National 

ference on Family Violence: Health and Justice, convened 

March 1994 to foster a collaborative approach to family vio

lence between the health, justice, and social services comm

ties. More than 400 professionals attended the conference a

met in work groups with some 80 national experts (see

Appendix A).
2
Professional Collaboration

Roles of health and justice professionals. Both health and 

tice professionals play significant roles in the identification

tervention, and prevention of family violence. Health care

providers are often the primary identifiers of battered wom

and children, and the physician’s ability to detect abuse or r

of abuse is key to protecting the patient and facilitating lega

action. If the abuse or risk of abuse goes undetected or unre

ported in the health care setting, the patient may return hom

further violence that often escalates and may prove fatal. B

cause abuse and neglect occur in a social rather than medic

context, intervention by professionals in the fields of social 

vices, law enforcement, and justice must accompany or clo

follow that by medical practitioners so that survivorss are a

forded immediate protection and provided with the knowle

information, and support necessary to escape continued

violence.

Perhaps the most significant teaching tool of the conference 

a plenary session featuring a two-part dramatization of the 

played by health and justice professionals in dealing with f

violence (see “The Case of Linda and Gary”). The dramatic

script, based on an actual case,1

 presented an appalling reci

of multiple abuses inflicted on multiple victims within a sin

family, including wife-battering, marital rape, attempted m

child abuse, and elder abuse. In addition, the case touched o

many societal factors that support or otherwise figure in do

tic violence (e.g., perceptions of women as inferior to men, 

proliferation of firearms) and introduced the profile of coer

controlling behavior that characterizes many perpetrators o

abuse.
4

“The Case of Linda and Gary”

Linda, who has been repeatedly battered by her husban

Gary, has a daughter, Beth (age 12), by her first husban

now deceased. Linda and Gary have a son, Carl, age 5;

Linda had two other pregnancies that, because of abuse

were terminated by a miscarriage and an abortion. Two

years ago, Gary began drinking heavily and also becam

harsher with Carl, slapping the child for not waiting on 

father. Gary’s elderly mother moved in with the family 

year ago, and, at various times since, he has abused her

verbally, appropriated her Social Security checks, and w

held her medications. Ten months ago, Gary bought a g

two months later, he forced Linda (at gunpoint) to inge

pills and alcohol, after which he called the police and re

ported her as being drunk, suicidal, and high. She was

taken to the emergency room, interviewed, and released

with prescriptions for Prozac and Xanax. Linda became

increasingly anxious and fearful and, within a few mon

tried to commit suicide by overdosing on these drugs.

Most recently, Linda had been uneasy about what she r

garded as Gary’s inappropriate attention to her 12-year-

daughter. In addition, Linda learned that Gary had spen

misappropriated all of the money left to her and Beth af

the death of her former husband. Finally, she worked up 

courage to confront Gary with her concerns about his in

est in Beth; he responded by verbally abusing Linda, ra

her, breaking her jaw, and trying to drown her by shovi

her head into the toilet. Beth, who was a witness to this

violent scene, called the police. On their arrival, one off

seized Gary’s gun (which had never been licensed), the

other officer phoned for an ambulance, but neither offic
arrested Gary (although there was a mandatory arrest pol

in the city). Gary followed the ambulance to the hospital;

although he wanted to accompany Linda into the room

where she would be examined and interviewed by medic

staff, he was prohibited from doing so and sent to the wai

ing room.

The doctor reviewed Linda’s medical chart, which documented her previous suicide attempt and record of alcoho

and drug usage. He and the nurse recognized that the inju

ries Linda had sustained were quite probably inflicted del

erately. They questioned Linda directly about a history of

physical and psychological abuse, recommended that she

speak to a social worker, and assured her that their major

concern was to protect her and her children. Gary was tol

only that Linda needed an X-ray and further tests. Linda 

the emergency room, picked up the children (who had be

left in her mother’s care), and returned home. She spent a

sleepless night, thinking about what the doctor had told h

The next morning, she contacted the victim advocate who

card had been given her at the hospital, and, together, the

proceeded to court, where the advocate helped Linda obta

a 14-day court order restraining Gary from contacting her 

the children.
6

Identification of abuse. The dramatization highlighted a n

ber of key procedures for health professionals. Of major im

tance, the physician or other health care provider should as

appropriate questions—in a suitable manner. Failure to do 

may result in the patient’s denial of abuse and the fabricatio

a story about how she was injured. In Linda’s case, both th

nurse and doctor in the emergency room recognized her inj

and probed for information about previous problems. Signi

cantly, the physician told Linda that he cared, that she was 

alone, that many women suffered similarly, and that help w

available. When no injuries are visible, however, a victim o

abuse may not be forthcoming about her situation and her f

The health care provider should always interview the child 

adult away from anyone who might possibly be the perpetr

of abuse. (In the dramatization, the abusive husband wanted 

accompany his wife but was asked to remain in the waiting

room.)

Victim safety. One model for educating health care provid

Project SAFE, or Safety Assessment For Everyone2

—instit

in Hartford County, Connecticut by Anne Flitcraft, M.D., a

Kate Paranteau provides steps that physicians can use when 

terviewing patients to help them devise a practical safety pl

as Dr. Flitcraft has observed, safety assessment is to family 

lence as cardiopulmonary resuscitation is to cardiac arre

Every hospital or clinic should have someone on staff who 

help the patient plan for her safety and explain the patient’s

rights and available legal options. (In the dramatization, Lin

was referred to a social worker immediately.) Within the he

system generally, improved coordination between medical 

sonnel and social workers would facilitate prompt reporting 

child or adult protective services.

Within the broader justice network, securing the safety of s

vors of abuse demands communication and cooperation am

judges, police officers, and prosecutors. At the conference, 

tice professionals cited protecting female victims as their to

priority. As former prosecutor Sarah Buel3

 said: “My prose

tion does nothing if I can’t keep her alive. So the first thing 

want to do is sit down with that victim and tell her, ‘My job 
your safety.’” In her discussions with survivors, Buel uses 

five-page safety plan developed by the Pennsylvania Coalit

Against Domestic Violence.4

The police play a key role in protecting family members by 

forcing orders of protection and arresting perpetrators who 

late them. Fredrica Lehrman, an attorney who chairs the

Domestic Violence Litigation Group (Association of Trial L

yers of America), also pointed out that, in some States, poli

officers responding to a domestic violence call are required 

law to arrest “the primary physical aggressor.” (This was th

situation in Linda’s community, but the law was not enforc

the dramatization.)

Victim needs. In their efforts to protect patients, health and 

tice professionals should be willing to listen to what the pat

or client needs before proposing a solution or legal remedy

Leslye Orloff, founder of a domestic violence program for 

dominantly Spanish-speaking women (Ayuda, Inc.), noted 

“We must not blame victims who choose to return to their

batterers, and we must not punish or sanction those who are 

yet ready or able to leave and survive independently from t

abusers.” The victim may attempt to leave several times be

she succeeds.

Mark Lachs, M.D., M.P.H. (Chief of Geriatrics, New York 

pital-Cornell University Medical Center), called attention t

variation on this theme: an elderly victim who has clear

decisionmaking capacity may choose to remain with an abu

caregiver, and that decision must be respected. “In these sit

tions,” he said, “we can only offer guidance to victims as to

what services might be available to extricate themselves fro

abusive situation. Even if they refuse, our concern sends a m

sage that we are available in the future should they rethink 

options.” Only if later they are diagnosed as “incompetent” 

these persons be removed from an abusive or neglectful env

ment, “even though their prior wishes indicate they would

choose to stay.”
8

Survivors of abuse also sometimes change their minds abou

proceeding with a criminal case, and Buel stressed the impo

tance of listening carefully to victims who may be ambival

reluctant about proceeding; however, she indicated that, aft

listening to a victim’s concerns, she may discuss the possib

of moving forward without the victim’s testimony in situati

where she has “spontaneous utterances and... the police hav

done a good job in writing the report, where they have docu

mented the injuries, the demeanor, taken photographs.”

Multiple victims. Other safety issues come into play when 

than one family member has been abused by the same perp

tor. Eleanor Cain, Director of the Division of Aging (Delaw

Department of Health and Social Services), spoke to the cri

issue of coordination of protective services when an abuser

one time or another, has victimized family members from a

number of generations who live together in the home: “The

older woman [in the dramatization] who had been abused b

son needs just as much attention as the younger woman wh

pregnant and...is raising her children....Every single one of 

needs the same attention as maybe the one [e.g., Linda] tha

being focused on right at that very moment.”

In the same vein, Susan Schechter, M.S.W. (University of

Iowa’s School of Social Work), cautioned that, without car

interdisciplinary case collaboration, policies and practices t

make one group of victims safer may unwittingly endanger 

harm another. Schechter illustrated this point with example

from her clinical experience at AWAKE (Advocacy for Wo

and Kids in Emergencies), a project at Children’s Hospital 

Boston serving abused women and children. She described 

the mother of a child brought into the emergency room with 

vere injuries faced the dilemma of possibly losing custody 

refusing to identify the source of the child’s injuries and, at 

same time, knowing that the batterer had threatened to kill 

she revealed what he had done to the child. “In the face of 

pressure,” Schechter commented, “without any meaningful 

tection or support from the community and its institutions, 

mother’s most intelligent action was to stay silent.”
In a second example, Schechter mentioned cases in which c

dren of mothers who had recently fled an abusive relationsh

were themselves sexually abused during unsupervised visit

with their fathers. She asked, “Why...were we having such

trouble explaining to the health care providers, the courts, t

child protection system, and the guardian ad litem the centr

role that domestic violence perpetrators play in jeopardizin

emotional and physical safety of these children?”

One outcome of concerns about children caught in such situ

tions was the issuance of a challenge to the American Bar A

ciation (ABA) by then ABA President, R. William Ide5

 to

prepare a report on domestic violence and its impact on chi

(An overview of this report is presented as Appendix B.)

Victims and the legal system. A major challenge for justic

professionals, according to Judge Leonard Edwards (Santa 

County, California, Superior Court), is to develop a coordin

system within the community to ensure that the victim is no

abused by the system designed to protect her. If several per

have been abused by the same perpetrator, various aspects 

case would be handled by different courts. Alleged child ab

would be handled by juvenile court, while the custody case

civil suit, criminal case, and divorce proceedings may all b

handled by different lawyers, different judges, and differen

courts, each operating on a different schedule and issuing d

ent, perhaps contrary, orders. Furthermore, as in “The Case 

Linda and Gary” (see page 4), if an elderly mother were to 

legal remedies for the abuse she has suffered, she would ha

file a separate action alleging abuse by her son.

To integrate these efforts toward legal remedies, Judge Edw

proposed a strategy involving the establishment of a local,

multidisciplinary family violence coordinating council to c

nate the work of the justice system and receive input and re

mendations from members of other systems, including heal

and social services. Another proposed improvement in the j

cial system is the establishment of Unified Family Courts i

every State.6

 This type of court is described by Ide as “a sp

ized judicial tribunal with well-trained, adequately supporte
10

and highly motivated personnel, who would hear all issues 

fecting parents and children. Such a court would better ensu

that domestic violence is not addressed by a court in isolati

from its legal implications on the safety and welfare of the 

dren in that family.”
Professional Education

Interdisciplinary communication. According to Felton Ea

M.D., Professor of Human Behavior and Development (Ha

School of Public Health), the principal impediment to colla

tion in the fight against violence is the absence of a “new la

guage to share what we know about communities, on one h

families, on another hand, and individual differences on a t

hand, if you find anyone with a third hand to juggle this pro

lem.” Similarly, Mark Lachs, M.D., identified the need for 

pathy and communication between the medical and crimina

justice professions. Each profession is guided by specific ru

and procedures and each has its own language. But since su

vors of family violence often need timely and coordinated a

tance from both professions, Dr. Lachs observed that in ord

share information, health and justice professionals need to u

derstand the other’s language as it pertains to such cases. F

example, in dealing with cases of elder abuse or neglect, D

Lachs noted that he uses the term “decisionmaking capacity

but his justice colleagues refer to the same attribute as “com

tency.” Dr. Lachs concluded, “If we can’t develop a comm

language, then we need to provide each other with a transla

at least a glossary.”

Sensitivity training. Another major challenge for health an

justice professionals is learning to deal with the uncertainty 

unpredictability of most family violence cases. For exampl

was pointed out that a battered woman may make many att

to leave an abusive relationship before she finally succeeds

viding supportive services, patience, and understanding dur

this difficult and dangerous time is essential, but this appro

can be somewhat at odds with the emphasis on achieving g

and solving problems that is typical of health and justice pr

sionals. Education for all professionals must address these i

sues, stressing the need to listen carefully to what the patien

client wants.

Victimization issues. In dealing with victims, health, justic

social service professionals also need to assess the entire fa

system, not just one part of it. Violence is often learned wit
12

the family, and there may be multiple victims and multiple 

petrators, extending beyond the nuclear family. Cathy Wid

Ph.D. (School of Criminal Justice, State University of New 

at Albany), noted the direct links between abuse in the hom

crime on the street: “Being abused or neglected as a child in

creases a person’s risk for arrest as a juvenile by 53 percent

an adult by 38 percent, and for violent crime by 38 percent

Widom added that her findings indicate that “being neglect

[as a child] also increases the risk of engaging in criminally 

lent behavior.”7

 In addition, abuse at early ages increases th

risk of revictimization.

Dean Kilpatrick, Ph.D. (Crime Victim Research and Treatm

Center) remarked that women who were victims of rape or

physical assault as children are at much higher risk for bein

assaulted again than are women who had no prior victimiza

In his national random sample of adult women, Kilpatrick a

found that those who had been victims of rape or physical a

sault were at higher risk for post-traumatic stress disorder a

drug and alcohol abuse.

Joseph F. Sheley, Ph.D. (Department of Sociology, Tulane 

versity) discussed findings from his research exploring the 

between family and the acquisition of firearms by serious ju

nile offenders and inner-city urban high school students.8 H

reported a high prevalence of gun ownership and transport 

these two groups: 83 percent of the serious delinquents own

least one firearm (67 percent acquired their first gun by age 

and 65 percent owned at least three firearms; nearly a quart

(22 percent) of the students possessed a gun at the time the 

vey was completed, and 6 percent reported owning three or

more guns at the time of the survey. Sheley stated that “nea

all of the serious delinquents carried guns; most routinely. A

a third of the students carried guns; a third of those routinel

In both samples, exposure to guns, crime, and violence in th

family was high.” Family and friends were rated by the stu

cohort as being a source of guns second only to street sourc

addition, Sheley noted the “enabling” role played by family

“[T]he available evidence points to a cultural and structural

complex whereby family in some general sense fails to con
gun-related behavior by its children, may encourage such b

ior, and, in some cases, may directly facilitate such behavio

Childhood and family abuse may also be linked to elder ab

and neglect. Mark Lachs noted that abusers of elderly perso

are usually adult children or spouses of the victim. And alth

there are many causes of elder abuse and neglect, the famil

cycle of violence theory is that abused children grow up no

to abuse their own children, but to seek retribution on their 

parents. In this era of specialization, health and justice pro

sionals need to bridge the gaps within their own systems an

willing to discuss family violence cases with colleagues wh

other members of the same family.

The need for education through continual dialogue among p

fessionals and through increased understanding of the caus

family violence is intricately connected to the need for mul

disciplinary research. Areas of current research in family vi

lence, sponsored by the National Institute of Justice, are

discussed in Appendix C.

The National Conference on Family Violence: Health and J

tice marked the beginning of an important collaboration be

the justice, law enforcement, social services, medical, and o

professions to focus their energy and efforts on reducing fa

violence. Those individuals and organizations involved as c

ference planners and participants signalled their readiness t

take up the challenge of safeguarding adults and children a

the abusive and injurious treatment that sadly occurs in man

American homes.
14
Notes

1. The script for the dramatization, “The Case of Linda and

Gary,” was written by Joan Zorza, Senior Attorney at the N

tional Center on Women and Family Law’s New York City

based National Battered Women’s Law Project.

2. Additional Project SAFE Materials are available from th

Hartford County Medical Association, 1000 Asylum Avenu

Hartford, CT 06105. Kate Paranteau is Project SAFE Direc

Domestic Violence Training Project and Anne Flitcraft, M

is Project SAFE Medical Director, Associate Professor of

Medicine, University of Connecticut School of Medicine.

3. Sarah Buel, J.D., formerly affiliated with the Bunting Ins

at Radcliffe College, is currently Assistant District Attorne

Norfolk County in Quincy, Massachusetts.

4. For information on how to obtain a copy of this safety pl

contact the Pennsylvania Coalition Against Domestic Viole

(PCADV) at 717–545–6400.

5. R. William Ide III served as President of the American B

Association from August 1993 to August 1994.

6. According to the National Center for Juvenile Justice as 

February 1995, 11 States (Nevada, South Carolina, Virgini

Pennsylvania, Delaware, Hawaii, New Jersey, Connecticut

Rhode Island, Vermont, and New York) have family court 

tems in place; 3 States (Kentucky, Illinois, and California) 

experimental family court programs; Florida is developing 

family court system; Missouri recently enacted legislation t

establish a family court system; 3 States (Minnesota, Missi

sippi, and Alabama) have specific family court districts or c

cuits; and 6 States (Maryland, Kansas, Colorado, Utah, Ore

and Washington) are actively considering the establishmen

family court system. The remaining 25 States neither have 

are considering family courts.
16

7. A summary of this research is in Widom, Cathy Spatz, T

Cycle of Violence, Research in Brief, Washington, D.C.: U

Department of Justice, National Institute of Justice, Octobe

1992. See also Widom, Cathy Spatz, Victims of Childhood

Sexual Abuse—Later Criminal Consequence, Research in B

Washington, D.C.: U.S. Department of Justice, National In

tute of Justice, March 1995.

8. A summary of this research is in Sheley, Joseph F., Ph.D

James D. Wright, Ph.D., Gun Acquisition and Possession in 

lected Juvenile Samples, Research in Brief, Washington, D

U.S. Department of Justice, National Institute of Justice, an

Office of Juvenile Justice and Delinquency Prevention, Dec

ber 1993.
Recommendations From Ten

Work Groups

National Conference on Family Violence:

Health and Justice

The recommendations presented below were consolidated f

work group deliberations in the areas of assessment, interve

tions, media, prevention, and professional education. They 

resent the views of conference participants. They stress the

importance of interdisciplinary collaboration, empowerme

victims, perpetrator accountability, violence prevention, an

strengthening of families and communities.

Assessment

Develop an effective, multidisciplinary, communitywide ass

ment process that maximizes safety for all family members.

Strategies

All communities should:

• Form multidisciplinary family violence coordinating coun

• Develop and distribute interdisciplinary glossary of terms 

resources.

• Establish standards for minimum community resources ne

sary to ensure the safety of all family members.

• Develop community intervention referrals available to fro

line screeners: these should include mental health services, 

cial services.

• Investigate appropriate case tracking systems by compute

enhance civil tracking and medical tracking of survivors.

• Evaluate the effectiveness of the assessment process from 

perspective of survivors and health and justice professional

Provide feedback on outcomes of interventions to screeners
18

• Promote research on the effectiveness of universal screen

and the benefits and risks of mandatory reporting.

• Develop a mechanism for the confidential sharing of appr

ate and relevant information both between and within the h

and justice systems.

• Develop routine procedures for assessment that will prese

information that may be necessary for intervention by other

systems.

• Promote early self-identification through public education

about health, legal, and community services.

Conduct early universal screening emphasizing safety of th

family, which is sensitive to different racial, cultural, and s

economic characteristics of the family, and with an awaren

that multiple forms of abuse/violence may occur within the 

family.

Strategies

• Develop a form/protocol for screening that includes ris

assessment.

• Utilize health, social, and justice groups to develop and di

ute guidelines and protocols to be used by first-line screene

(Second level assessment—Develop mobile 24-hour crisis 

vention team available to the community.)

• Develop curricula and continuing education/training for a

professionals, including cross-disciplinary training (for hea

care providers, social services, police, judges and others). C

sider linking training to licensure requirements. Implement 

ing through impaired provider programs to reach profession

who are survivors or abusers.

• Fund studies to analyze the impact of universal screening 

cluding forms and protocols, outcomes-based research.

• Encourage self assessment and community assessment thr

public education.
Interventions

In the area of interventions, the goal of health, justice, and 

service systems is to stop violence and abuse. In accomplis

this goal, communities must:

- Protect and support victims.

- Empower victims to protect themselves.

- Hold offenders accountable for past and future behaviors.

- Demand that abusers change their behaviors so that their m

bership in our community engenders no fear.

Therefore, each community should create a family violence 

ordinating council to coordinate these efforts at the local le

Philosophy and Rationale

Individual communities are in the best position to understan

needs and resources of that community and that the efforts 

family violence councils should therefore be community-dr

Communities are also in the best position to prioritize comm

nity needs with respect to family violence and to allocating 

creasingly scarce resources. Interventions for family violen

must be tailored to all specific forms of family violence und

consideration (including, but not limited to: child abuse and 

glect, child sexual abuse, partner abuse, emotional abuse, a

of physically and mentally handicapped adults and children

elder abuse, neglect and exploitation). Furthermore, specifi

approaches to family violence must be sensitive to the cultu

linguistic, and other diverse populations in which family vi

lence occurs as interventions are contemplated.

The council should be composed of representatives of all p

sons and agencies who deal with family violence. There sh

be no barriers to membership, and the full spectrum of all i
20

ested parties in the community should be encouraged to joi

These may include:

Physicians

Nurses, nurse practitioners, clinical nurses, midwives

Medical administrators

Legislators

Judges

Victims

Victim advocates

Law enforcement

Educators

Social workers

Clergy

Pharmacists

School nurses

Substance abuse counselors

Prosecutors

Attorneys

Probation and parole officials

Corrections officials

Mental health providers

Researchers

Community-based organizations

Rehabilitated offenders of family violence

Concerned community members
The general purpose of the Council shall be as follows:

• To effectuate coordination between hospitals, service age

police departments and the courts with victims of family vi

lence and abuse. Such coordination occurs at the systems le

which the broad implementation of programs and efforts m

be integrated as well as at the service/case level, in which s

vices delivered to any individual victim of family violence 

be organized. The council should also facilitate communica

by members of the health, justice and other systems betwee

systems level and the service level.

• To provide opportunities for the various disciplines to edu

each other and to facilitate cross-training for all health care

providers.

• To promote and evaluate interventions that have been fou

be effective.

• To improve the response to family violence and abuse so 

reduce its incidence.

• To identify and enumerate areas where interventions are

known to work and need only to be coordinated; to elucida

areas lacking effective programs wherein new intervention

must be developed for health, justice, and social services.

• To promote the development and support of hospitals and

health care system-based intervention programs.

• To promote the development and replication of familycentered community-based intervention programs.

Besides providing leadership on interventions and rehabilit

family violence councils also will be in an ideal and unique 

sition to address prevention, community education, assessm

media, and the integration of these functions.

Strategies of the Council should include:

• Developing and/or revising more policies and procedures 

interagency coordination and cooperation at both the system 

service/case levels.
22

• Convening conferences that focus upon family violence in 

community.

• Promoting educational programs in primary and secondar

schools.

• Providing professional education.

• Identifying health and justice intervention and rehabilitati

methods that have been shown to be effective in other disci

plines (e.g., substance abuse) that can be applied to the fam

violence area.

• Searching for cross-disciplinary approaches.

As a part of any family violence coordinating council there 

be a health care systems committee. The purpose of the hea

care systems committee shall be as follows:

- Develop cross-system intervention protocols for health ca

providers dealing with individuals who might be victims of 

abuse, domestic violence, or elder abuse.

- Develop and provide training for all members of the healt

care community in these intervention protocols.

- Provide a forum for the resolution of problems common t

health care and legal communities as they relate to areas su

evidence, reporting, and confidentiality.

The American Medical Association should assume a major 

ership role in identifying, pursuing and obtaining long-term

funding for interventions so that the victims of family violen

are adequately protected and assisted.

Funding priorities should include:

• Trained advocates who have flexibility in their roles. Adv

cates should be accessible at all sites in the health and justi

systems. Ideally, advocates should be recruited from the co

munities in which they serve.

• Improved access/outreach services directed at victims, as

well as novel approaches/programs to reach underserved

communities.
• Shelters and other protected environments for all victims.

• Mental health and substance abuse services.

• Rehabilitation needed to provide offenders with the know

edge, attitudes and behavioral skills to develop nonviolent,

parenting partnerships and caregiving choices in their

relationships.

In addition, the American Medical Association should conv

meetings with other national health care associations to ass

securing necessary funds and in the long-term development 

cess for family violence intervention programs.

Every community should have a comprehensive, culturally 

sitive and accessible intervention system for family violenc

links health, justice, mental health, social service, and educ

tional systems. It is essential to respect and preserve the dig

legal rights, and safety of the affected individuals.

This intervention system must include:

• A family violence advocate/specialist in all practice settin

who serves as a bridge to and among all community resour

This professional must be knowledgeable in health, justice, 

cial services, mental health, education, and all forms of fam

violence throughout the life cycle.

• Better training and sensitization for health, social service, 

tal health, justice and educational intervenors, coordinated 

time and across systems to enhance the ability to provide ap

priate, long-term assistance in cases of abuse, battering, and

neglect.

• Comprehensive management information systems and tec

nologies to link health care, justice, social services, mental

health, and educational systems consistent with confidentia

guidelines.

• Identification, evaluation, and replication of existing mod

family violence intervention programs, e.g., a Unified Cour

model, hospital-based models, etc.
24

• Appropriate short-term and long-term followup services f

affected individuals.

Media

Violence in America, including increased portrayals of viol

in the media against children, adults, and the elderly, has

reached such epidemic proportions that media consumers, p

viders, and professionals must take action to reverse this tre

Traditionally, consumers and media providers have endure

adversarial relationship. We believe that future efforts to ad

the problem should be inclusive and collaborative in nature

are urging consumers, providers, and professionals to partic

in creating a new climate of socially responsible perspectiv

violence. We hope that the AMA and ABA would provide 

leadership necessary to promote this initiative.

Establish a national coalition of professional organizations 

cluding health, justice, education, and child advocacy grou

promote safe, nonviolent families and society. This group w

work in partnership with the media, to examine violence in 

media, and to promote socially responsible approaches.

Strategies

• Create a national resource center.

• Collect sources of data.

• Identify experts.

• Encourage continued research.

• Educate the media and the public.

• Provide media with resources—media kits, etc.

• Develop forums for sharing information and strategic plan

• Encourage development of media education efforts to hel

prevent violence.

• Outreach with State, local violence prevention efforts.

• Acknowledge excellence.
• Establish multidisciplinary criteria for media excellence i

violence prevention.

• Encourage media organizations to give awards for promo

of nonviolence.

• Include award recipients on national advisory board.

• Market nonviolence.

• Create public service announcements (PSAs) to raise awar

• Encourage health and justice professionals to form liaison

with local media.

• Produce programs in partnership with media to promote a

natives to violence.

Prevention

Prevention of family violence should be viewed in terms of 

cial justice and affirmation of basic human rights, rather th

retributive criminal justice. We support the shift of social, e

nomic, and political resources toward strengthening comm

ties and families in their many forms. This means ensuring

equitable access to employment, education, housing, and h

care.

Strategies

• Collaboration of health, criminal justice and the private se

to regulate products that increase the potential for family vi

lence or magnify its consequences (i.e., alcohol and other d

and firearms).

• Ratification and implementation by the United States of th

United Nations Convention on the Rights of the Child and 

human rights conventions.

• Inclusion of representatives of groups with the highest rat

victimization at every level of decisionmaking around issue

family violence.

• Development and employment alternatives to violence an

aggression as a means to resolve conflict at all levels of soc
26

Effective primary prevention programs must be implemente

through the sustained allocation of human and financial re

sources at the Federal, State, and local levels. Primary pre

tion must encompass the cooperation, integration, and shar

of information by the health, justice, social service, and edu

tion systems, both public and private, in allocating funding 

resources in culturally responsive, community-empowered 

forts. Programs of proven effectiveness should be funded by 

allocating existing funding and allocating new resources.

Strategies

• Instead of building more prisons, using the money to fund

community-based, community-controlled, systematically e

ated prevention programs that build on strengths. Develop, 

tematically evaluate, and disseminate new, effective primar

prevention programs.

• Primary prevention should be sustained over the long term 

core public health function by generating new revenue (e.g

surcharge on marriage licenses, taxes on alcohol and ammuni

Because violent behaviors are learned within the context of 

ily, community, and society, the unlearning of these behavi

and the substitution of more appropriate behaviors must ta

place within the context of the family, community, and soci

Therefore, we recommend the establishment of communitybased, community-controlled prevention systems that wou

include:

• A vehicle to foster communication and coordination amon

public and private entities.

• Violence prevention community education efforts, with a 

on early interventions that are comprehensive, and

multidisciplinary.

• Home visitation programs of proven effectiveness to redu

violence to children and elders and to improve maternal he

• Life skills education, including conflict resolution, goalsetting, caregiving, etc.
• Parenting and caregiving education and support.

• Programs that focus on perpetrators as well as victims. In

viduals in high-risk situations such as job loss, divorce, chi

custody, HIV, elder care situations and adolescent transitio

stages should be included. Services for family violence pre

tion must be made available to all persons in need of servic

without regard to race, ethnicity, gender, sexual orientation

ability to pay.

• Comprehensive public school violence-prevention educat

beginning in preschool years and available to all families, w

includes training in stress management, conflict resolution,

parenting and caregiver skills, substance abuse, and gender

relationships.

Recognizing that all human beings are valuable, we must d

and implement a national public awareness and educationa

campaign to convince the American people that family abu

neglect, and exploitation are not okay.

Strategies

• Promote the formation of broad-based community boards 

resenting public and private systems to further a national ag

aimed at preventing family violence through education, pro

tion of legislation, identification of service gaps, and develo

ment of resources.

And, since firearms contribute substantially to death and di

ity caused by family violence:

• Control the manufacture and sale of ammunition and its

components.

• Tax weapons, ammunition, and ammunition components 

cient to pay for the results of firearm violence.

• Mandate recurring licensing and training of owners of fire

• Ban assault weapons and the ammunition that supports th
28

• Promote continuing public dialog on who can access firea

with special attention to juveniles and persons who show m

instability or violent behavior.

Professional Education

Family violence is a public health crisis in the United State

are speaking on behalf of those whose lives have been affec

by violence and whose voices are too often unheard.

Mandatory comprehensive education about family violence

across the life span must become a standard component in 

dergraduate, graduate, and continuing education curricula 

all health, justice, and other helping professions.

Strategies

• As a central component, professional education must incl

the perspectives and participation of survivors and/or advoc

in its development and delivery. Education should utilize ap

priate interactive and experiential models and should be int

grated throughout the professional curriculum.

• Education on family violence for health, justice, and socia

services professionals must be fully valued. Those who pro

such instruction should be given professional recognition a

support. Professional education activities, including resourc

and faculty development, implementation and evaluation, m

be adequately funded.

• Professional education requires an interdisciplinary appro

didactic and practicum/clinical educational programs shoul

include approaches to facilitate interdisciplinary contact an

collaboration.

• The educators must reflect the diversity of our society.

• Family violence content must be a component of the licen

and certification for all health and justice professions.

• The AMA, working with other organizations, should quic

develop and widely disseminate a “Patient to Plaintiff” vide

instructional guide that incorporates the response of variou

ciplines to all forms of family violence.
• The U.S. Department of Health and Human Services and 

partment of Justice should fund the development and dissem

tion of publications on model professional educational prog

as well as directories of all educational programs on family

violence.

• The Federal Government, professional associations, priva

foundations, and educational institutions should foster the d

opment and continuation of high-quality research on family

violence.

• Federal incentives should be provided for expansion of fa

violence professional education.

Professional associations should join with accrediting bod

for educational institutions, postgraduate programs, and co

tinuing education courses to develop and support core fam

violence curricula that incorporate the following education

principles. Each professional organization will establish a 

frame, with specific measurable goals, for instituting these 

forms. Professional schools and associations should exami

modify, and develop curricula, as appropriate, to include th

principles.

All family violence professional education—from the unde

graduate level through continuing education programs—sh

• Foster awareness and sensitivity to cultural diversity.

• Formally address interrelationships among (and the uniqu

of) each form of family violence.

• Explore how power and control affect relationships (i.e.,

victim-victimizer, professional-professional, and profession

victim/victimizer).

• Develop awareness and understanding of the language, cu

responsibilities, and needs of the other disciplines.

• Teach that violence as a primary means of resolving confl

not acceptable.

• Incorporate and value skill development.

• Teach how to establish, maintain, and value the relationsh

with one’s community and its resources.
30

• Encourage continuous evaluation and improvement of the

system’s effectiveness.

• Be provided in an empathic and caring environment.

• Acknowledge that professional groups will include surviv

and/or perpetrators of family violence at various stages of

awareness, defenses and healing; be prepared to provide lin

ages to appropriate services for these individuals.
Appendix A

The National Conference on Family Violen

Health and Justice

To facilitate communication and understanding between th

health and justice systems and foster a collaborative approa

the problem of domestic violence, the American Medical A

ciation (AMA) invited a broad range of organizations acros

relevant disciplines to send interested representatives to the 

tional Conference on Family Violence: Health and Justice. 

conference was funded by the National Institute of Justice (

the Centers for Disease Control and Prevention, the Ford F

dation, the Robert Wood Johnson Foundation, and the Mate

and Child Health Bureau. Complete conference proceeding

available through the AMA Department of Mental Health.1

This colloquy, cosponsored by 83 organizations within the

health, social services, and justice systems, grew out of an 

lier AMA initiative designed to train physicians to recogniz

signs and symptoms associated with domestic abuse, devel

effective techniques for interviewing patient-victims, meet

State-mandated reporting requirements, and make appropri

referrals to resources offering protection, treatment, and oth

types of assistance.

More than 400 professionals attended the three-day confere

held March 11–13, 1994, in Washington, D.C. Participants 

in work groups, under the leadership of some 80 national ex

perts, to address family violence issues in a variety of conte

in addition, the groups developed recommendations (Sectio

of this report) for a more coordinated, communitywide app

to reducing both the effects and incidence of such violence

conference’s six plenary sessions dealt with family violenc

from a unique perspective (i.e., across the life cycle), focus

a particular factor contributing to or exacerbating family vi

lence (e.g., substance abuse, alcohol, or firearms), or, in on

instance, featured a dramatized case study that cut across th

major issues explored in the conference. Keynote speakers 
32

cluded Janet Reno, Attorney General; Donna Shalala, Secre

of Health and Human Services; and Joycelyn Elders, then

Surgeon General.

Two major ideas—central to improving services targeted to 

vivors of family violence and at-risk families—were articu

and supported in almost every presentation or address:

• Researchers and practitioners in health, justice,and social 

vice systems should share information and work cooperativ

the local level.

• Approaches to assessment, prevention, and intervention s

be adjusted to meet the complex needs of families in which 

lence and abuse occur.

These issues were explored through key discussions at the 

ference on roles of health and justice professionals and the 

lenges of identifying cases of abuse, ensuring victims’ safe

and prosecuting the perpetrator.

Notes–Appendix A

1. Contact Jean Owens at AMA: 312–464–5066.
National Conference on Family

Violence: Health and Justice

Organizations Involved in

Conference Planning

National Association of State Units on Aging

American Psychiatric Association

National Association of Women Judges

American Hospital Association, Hospital Research and

Educational Trust

American Nurses Association

Family Service America

ABA Center of Children and the Law

Police Executive Research Forum

National Victim Center

National Association of Social Workers

International Association of Chiefs of Police

American College of Obstetricians and Gynecologists

American Medical Association

American College of Physicians

National Center for Prosecution of Child Abuse,

American Prosecutors Research Institute,

National District Attorneys Association

ABA Family Law Section

Office of Senator Paul D. Wellstone

National Center on Women and Family Law
34
Appendix B

The Impact of Domestic Violence on Child

According to the ABA report, The Impact of Domestic Viol

on Children,

1

 an estimated 3.3 to 10 million American child

witness domestic violence annually. A result of the Nationa

Conference on Family and Violence: Health and Justice, th

report reviews the legal literature and reform proposals dev

oped in the area of domestic violence; it includes recomme

tions for legislation and other policy action, and proposals f

what the bar and individual attorneys should do to reduce d

mestic violence and its adverse impact on children.2

 The li

ture review revealed that the overlap between households w

both domestic violence and child abuse is estimated at 40–6

percent, although only preliminary empirical evidence is av

able about these interrelationships. However, witnessing vi

lence produces detrimental emotional effects on children,

regardless of whether or not they have been physically inju

To ensure the safety of such children, the report stresses tha

law should enable victims of domestic violence to obtain or

of protection on their own and their children’s behalf, and t

these orders should, when necessary, provide for the remov

the abuser from the home, child custody, possession of the 

dence, child support, and appropriate safe visitation (or den

visitation). Police should assess the danger to children as w

to adults in the home, and mandatory arrest for violating or

of protection should include violations of provisions restric

contact between the perpetrator and his or her children. The

should be intra- and inter-court tracking systems and mean

protecting children during the course of judicial proceeding

Furthermore, to ensure safety and support for adult and chi

victims, the report calls for:

• Continued education on domestic violence and its effect o

children for all personnel involved in domestic cases.

• Participation in community-based family violence counci
36

• Development of protocols and other mechanisms for cros

court and interagency referrals, case consolidation, and pro

tion against conflicting court orders.

• Prohibiting firearms purchase and possession by perpetrat

of domestic violence and child abuse.

• Using the “best interests test” to deny custody to perpetra

of domestic violence.

• Increasing pro bono and community legal services for vic

• Providing court interpreters for non-English speaking wom

Finally, the report describes the unfortunate dilemma of bat

women being blamed for “failure to protect” their children.

“Courts and child welfare agencies have an affirmative dut

before removal as well as in reunification decisions, to prom

the safety of the victim-parent (typically the mother) and he

children.”

Notes–Appendix B

1. A copy of “The Impact of Domestic Violence on Childre

Howard Davidson, Director of the ABA Center on Children 

the Law, can be obtained for $6.00, plus $2.00 shipping co

by calling 1–800–285–2221.

2. At the National Conference on Family Violence: Health 

Justice, R. William Ide, III, President of the ABA, called fo

report focusing on domestic violence and its impact on chil

to be submitted to him before the end of the ABA Annual M

ing in August 1994.
Appendix C

Family Violence Research Program,

National Institute of Justice

As a major part of its research focus, the National Institute 

Justice (NIJ) supports projects that (1) investigate the gene

control, and prevention of violent behavior in families; (2) 

amine the effects of such behavior on all family members; 

evaluate the responses to domestic violence made by variou

justice system entities; and (4) measure or predict both the 

dence and prevalence of family violence on a nationwide b

NIJ’s Family Violence Research Program is currently fund

25 projects that address issues of interest to practitioners,

policymakers, and professionals, including:

• Role of alcohol and drug abuse in domestic violence.

• Effectiveness of civil protection orders.

• Divorce mediation and spousal abuse.

• Childhood victimization and adult violence.

• Prosecution of domestic violence cases.

• Assessment of family violence interventions.

• Impacts of arrest on the social control of violence among

intimates.

• Children of battered women.

• Justice system processing of child abuse cases.

• Developmental antecedents of partner violence.

The National Institute of Justice Research Plan for 1995–19

affirms NIJ’s ongoing commitment to supporting research 

evaluation studies related to reducing all kinds of violence, 

cluding family violence. Research areas of broad general in

are studies of offenders and offenses, violent situations, fire

violence, responses to violent offenders, and violence again
38

women; grant applicants are encouraged to submit propos

these areas, but, since the Institute’s emphasis is on inv

tigator-defined research, they are not limited to them.

Copies of NIJ’s 1995–1996 Research Plan may be obtaine

from the National Criminal Justice Reference Service

(NCJRS) be calling 800–851–3420; NCJRS can also be ac

cessed by e-mail askncjrs@aspensys.com. Completed pro

posals must be received at the National Institute of Justice 

the close of business on June 15 and December 15, 1995 a

June 17 and December 16, 1996. Extensions of these dea

lines will not be permitted.

40
The National Institute of Justice is a component

of the Office of Justice Programs, which also

includes the Bureau of Justice Assistance,

Bureau of Justice Statistics, Office of Juvenile

Justice and Delinquency Prevention, and the

Office for Victims of Crime.

For more information on the National

Institute of Justice, please contact:

National Criminal Justice Reference Service

PO Box 6000

Rockville, MD 20849–6000

800–851–3420

e-mail: askncjrs@ncjrs.aspensys.com

To view or obtain an electronic version of this

document from the NCRJS Bulletin Board System,

access the system in one of the following ways:

Direct dial through your computer modem: (301) 738–8895

(Modems should be set at 9600 baud and 8–N–1.)

Telnet to ncjrsbbs.aspensys.com

Gopher to ncjrs.aspensys.com 71

If you have any questions, call or e-mail NCJRS.
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