Violent crime is a serious concern in the U.S. We know a great deal about violence except how to stop it and how to do positive remedial work to reduce the consequences. The possibility that people might be injured or have their home invaded by a stranger is a frightening thought. But hundreds of Americans face an even more devastating reality when they are harmed, not by a stranger, but by someone they trusted. Victimization to these people occurs in their own home.

Families are viewed as the center of a society. To be abused by a partner, a parent, a trusted adult, or by one's own child or to witness such abuse becomes an engraved memory. Domestic violence victims wrestle with feelings not experienced by victims of strangers - feelings of fear, loyalty, love, guilt, and shame. Adults become torn between the desire to shield and help a loved one and their responsibility toward their own safety or others in the household. Children face alone the reality that those who should protect them are, in fact, a source of harm. To nonabused persons, home represents safety and security; to domestic violence, home is a place of danger.

The problem of family violence has existed for generations. Women have been battered by their partners for centuries. In 1885, the Chicago Protective Agency for Women, established to help women who were victims of physical abuse, provided legal aid, court advocacy, and personal assistance to the women. An abused woman could receive up to four weeks of shelter at the refuge operated by the Women's Club of Chicago. The agency helped women to secure legal separations, divorces, and equitable property distributions. Although between 1915 and 1920, 25 cities followed Chicago's lead in developing protective agencies for women, by the 1940s few shelters remained due, in part, to marital separations caused by World War II.

Turning to children and violence, the history of childhood is replete with suffering, well-documented from Biblical times to the present. The landmark Wilson case of 1874 pricked the American social conscience and opened America's eyes to the plight of children: Eight-year-old Mary Ellen Wilson lived with her adoptive parents in New York City. She was held there in chains, starved, and beaten. The police responded, but could do nothing because it was a "family matter" and the parents held the "rights."¹ A man named Henry Berg was contacted. He was able to extricate Mary Ellen from her family torture chamber. Who was Henry Berg, and why was he called? Berg had founded a protective group the preceding year: The Society for the Protection of Cruelty to Animals.

This chapter presents definitions and current statistical trends from a developmental perspective of family violence, that of courtship abuse; partner threat and violence; domestic homicide; child abuse, neglect, and sexual assault; and elder abuse. The chapter also discusses key concepts of family violence: socialization into violence and learned socialized violence; the psychodynamics of violent behavior, including altered attachment, jealousy, guilt, and revenge; and the biology of trauma.

Developmental Aspects of Family and its Structure

Just as there are developmental tasks for the child maturing into an adult, the family may be viewed as having three developmental phases. The first phase begins with dating, courtship, and marriage; the middle phase includes partnership and work, with childbearing and parenting being an option; and the third phase continues a work focus, optional grandparenting, and retirement.

Because violence within families has only recently surfaced as a legal matter, research into the causes and consequences is limited. As a first step, definitions are provided in order to begin classification for the research process.

Family

Nowhere in the criminal law and its administration is the social construction of violent crime changing more rapidly than in what constitutes family violence and society's response to it.² Due to the myriad of different statutes and regulations, there is no national legal definition of a family.

Data on family violence is generated by identifications of people by their current marital status (married, separated, divorced, or single), by their spouse status (spouse/exspouse), or by relationships among members of a household (cohabitants, child/parent, sibling, or parent). With these definitions, statistics on family structure changes can be generated over time.

Living with two parents, defined as step, biologic, or adoptive, who are married to each other is associated with more favorable outcomes for children. The proportion of children under age 18 living with two married parents fell from 77% in 1980, to 73% in 1990, to 69% in 2000, and to 67% in 2005. Among children under age 18 in 2005, 23% lived with only their mothers, 5% lived with only their fathers, and 4% lived with neither of their parents.³

Trends in family violence must be interpreted against a decline in the fraction of households containing exclusively married couples and their biologic children.² Violence between growing numbers of same-sex and opposite-sex cohabiting partners is increasingly regarded as family violence irrespective of legal marital status as is violence between divorced or separated couples.

The National Research Council's Panel on Understanding and Preventing Violence considered all violent behavior within a household as family violence, specifically, spouse assault, physical and sexual assault of children, sibling assaults, and physical and sexual assaults of other relatives who reside in the household.² Missing from this list are events, such as verbal abuse, harassment, or humiliation in which psychological trauma is the sole harm to the victim. This category is under consideration by the Panel on Research on Violence Against Women, and the panel will be considering such events as threat assessment and stalking behavior.

Family Violence

Just as "families" has no universal definition, such is the case with the term violence. However, one published in the report on understanding and preventing violence from the National Research Council is that interpersonal violence is "behavior by persons against persons that intentionally threatens, attempts, or actually inflicts physical harm."²

Dynamic Nature of Family Violence

A number of defining characteristics distinguish family violence from stranger violence:

• There is a continuing relationship among its members similar to other relationships, such as teacher-student, employer-employee, child-caretaker, etc.
• Daily interaction and shared domicile increases the opportunities for violent encounters.
• Because they are bound together in a continuing relationship, it is quite likely there will be repeat violations by the offender.
• Unequal power relationship makes one more vulnerable to aggression and violence of the offender with power.
• The offender often threatens additional violence if the incidents of violence are disclosed.
• The victim may also refrain from disclosure, anticipating stigmatization and denigration.
• Episodes of violence often occur in private places, are invisible to others, and less likely to be detected or reported to police.²

Phase 1: Courtship and Marriage

The first phase of family life includes dating, courtship, and marriage. Although dating does not necessarily lead to courtship or marriage, it is instructive to review the statistics and studies on relationship problems and dating aggression.⁴ Theories of both marital⁵ and dating⁶ aggression identify conflict as an important causal factor leading to aggression between partners.

Dating violence appears to begin as early age 15 or 16.^7,8 Violent tactics include slapping and pushing, beating, and threatening with or using weapons. Recurring and escalating episodes of violence in a relationship are not uncommon if the relationship is not terminated, and only about 50% of the victims terminate the relationship.^9-11

As inquiry has continued, it has become evident that a large number of college students experience physical aggression within dating relationships. Estimates of the prevalence of dating aggression among college students range from 20%^9,12 to as high as 50%.¹³

Violence Within Marriage

Spouse assault may be the single most common cause of injury for which women seek emergency medical attention. From an investigation of emergency treatment of women in a metropolitan hospital, researchers report that battered women were 13 times more likely than other women receiving emergency care to be injured in the breast, chest, and abdomen, and three times as likely to be injured while pregnant.^14,15

The Department of Justice's Bureau of Justice Statistics (BJS) reported that the rate of family violence fell by more than 50% between 1993 and 2002, from an estimated 5.4 victims to 2.1 victims per 1,000 U.S. residents 12 years old and older, reflecting the general decline in crimes against people during the same period. Family violence accounted for 11% of all reported and unreported violence between 1998 and 2002. Of these offenses against family members, 49% were crimes against a spouse, 11% a parent attacking a child, and 41% an offense against another family member.¹⁶

Seventy-three percent of family violence victims were female and 76% of persons who committed family violence were male. Simple assault was the most frequent type of family violence.

Drugs or alcohol were involved in 39% of family violence victimizations. In 20% of family violence incidents, the offender had a weapon.

About four in 10 family violence victimizations did not come to police attention between 1998 and 2002. Thirty-four percent of victims of unreported family violence said they did not tell law enforcement officials about the matter because it was private or personal. Another 12% said they did not report it to protect the offender.

Fifty percent of convicted family violence offenders in prison in 1997 were serving a sentence for committing a sex crime against a family member. Forty-five percent of convicted family violence offenders in local jails in 2002 had been subject to a restraining order at some point in their life.

About one in five persons murdered in 2002 was killed by a family member. In all homicides that year, almost 9% were the killing of a spouse, 6% the murder of a son or daughter, and 7% the killing of another family member.

Fifty-eight percent of family murder victims were female, and 26% were under age 18. Among murdered children under age 13, 66% were killed by a family member.

Eighty-three percent of those who killed a spouse were males, as were 75% of those who killed a boyfriend or girlfriend.

The average age of a son or daughter killed by a parent was 7 years old, and 80% were younger than 13 years old.

The Conflict Tactics Scale is the main measure of domestic violence used in telephone surveys.¹⁷ The scale includes verbal and aggressive acts, including violent acts ranging in severity from hurling objects to the use of a deadly weapon such as a gun or knife. Using it in an initial national telephone survey of couples in 1975¹⁸ and in a repeat of the survey in 1985,¹⁹ researchers found that 16 of every 100 couples reported at least one incident of physical aggression during the year before the survey. The prevalence of severe violence in both surveys was four in 100 females and five in 100 males.

These statistics are believed to be low because the sample excludes unmarried couples and misses segments of the population that do not have telephones.²

Phase 2: Assaults on Children

Various commissioned governmental studies have reported on assaults on children. The U.S. Advisory Board on Child Abuse and Neglect, a governmental advisory board created by the 1988 amendments to the Child Abuse and Prevention and Treatment Act, estimates that in 1989 at least 1,200 and perhaps as many as 5,000 children died as a result of maltreatment, and over 160,000 children were seriously harmed.²⁰ The advisory board noted that in 1974 there were about 60,000 cases of child maltreatment reported. This figure rose to 1.1 million in 1980 and more than doubled to 2.4 million in 1988.²¹

Part of the increase is believed due to more inclusive definitions of abuse and neglect and an increase in professionals' recognition of maltreatment, rather than an increase in incidence per se.²¹ However, it is also likely that cases of child maltreatment are reported to public health or educational agencies that are not known to social services agencies who provide the "countable" case figures. There are many cases of intrafamilial or third-party assaults on children that are never reported to any professionals concerned with the health or welfare of children.²

Child abuse statistics continue to escalate, but experts cannot agree on a single reason for this increase, although most attribute it to both a population increase and an increase in reporting. Other factors that are sometimes cited include changing to a wider definition of child abuse, increased reporting requirements, states providing more accurate information, better recording systems, and changes in data collections. The following are generally accepted statistics by practitioners and researchers in the field:²¹

• An estimated 906,000 children are victims of abuse and neglect every year. The rate of victimization is 12.3 children per 1,000 children.
• Children ages 0-3 years are the most likely to experience abuse. They are victimized at a rate of 16.4 per 1,000.
• Homicide Profile - Assessments of the risks of intrafamily homicide are more accurate than for other forms of assault and several patterns are noteworthy.²
• 1,500 children die every year from child abuse and neglect. That is just over 4 fatalities every day.²¹
• 79% of the children killed are younger than 4.21
• Newborns, infants, and children between ages 1 and 4 are more vulnerable to homicide than are children ages 5 to 9 years.²²
• Infants and small children are more likely to be killed by their mothers than their fathers, perhaps in part as a result of differential risk exposure.
• The risk of homicide for children under 5 is greater for male than female children, according to a recent case control study.²³
• Although men's overall homicide risk is three times that for women, women face a greater risk of homicide by their spouse than do men.^24,25
• Intrafamily violence accounted for 15% of all family homicides in 1989; 44% involved husbands and wives.

Child Abuse Risk Factors

In reviewing the statistics on child abuse risk factors note the following:²²

• There are nearly 3 million reports of child abuse made annually.
• In 2003, there were 906,000 child abuse convictions.
• The rate of child abuse is estimated to be three times greater than is reported.
• The rate of victimization is 12.3 children per 1,000 children.

In summary, female children are three times as likely as males to be sexually abused: 2.9 females per 1,000 compared with 0.9 males.^24,25 One-fourth of all sexually abused children are males with a higher percentage of abused males found in day care (38%).²⁶ Black children were 1.5 times more likely to be physically abused than white children and five times more likely to die of physical abuse or neglect.^24,25 Social status (measured by family income) is substantially related to children's risk of injury. With children from families with incomes less than $15,000, the rate of physical abuse was 3.5 times greater than for other children. A pattern noted was that physical abuse was more frequent than sexual abuse held for all income families.^24,25

Phase 3: Assaults Against the Elderly

A major recommendation from the National Research Council is for priority to be given to the collection of more precise information about the prevalence and incidence of violence toward the elderly and its consequences.²⁷ Surprisingly little is known about its occurrence in families, primarily because studies do not distinguish between elder abuse and elder neglect.

In a stratified random sample study of all persons 65 and older in the Boston metropolitan area, researchers estimated that between 2.5 and 3.9 persons had experienced physical violence, verbal aggression, or neglect.²⁸ Similar results were found by a national survey of elder abuse in Canada.²⁹

Explanations of Family Violence

Most explanations of the causes of family violence are partial in one of two ways: (1) either they attempt to explain a single type or a few types of family violence, such as partner assault, or (2) they seek to identify a particular factor or set of factors that account for some of the observed variation in behavior between violent and nonviolent persons or acts.²⁶ The leading explanations of family violence are described from social and cultural perspectives and the biopsychosocial perspective.

Social and Cultural Perspective: Gelles attempts an integrated theory with the following theories.³⁰

Cultural and Structural Determinants and Social Learning. Feminist theory asserts that the unequal power distribution between men and women subjects women to male dominance in all spheres of life (work, family, and community life). Power extends to the sexual relationship as well as to work and social relationships.³¹ The various ways in which coercion is used depend on man's use of their his and social power to maintain a dominant position.³²

The unequal distribution of power is also the basis for explaining parental physical and sexual abuse of children. The exercise of parental power over the child victim leads to disempowerment of the child, rending him or her helpless.³³

Within this framework, growing up in a patriarchal society that emphasizes male dominance and aggression and female victimization, children are socialized into their respective sex roles.³⁴ In addition, they are said to learn through the experience in the family. This learning becomes reinforced in the larger community where male and female roles similarly rest on elements of macho culture. In this respect, male dominance and aggression and female acquiescence are said to be learned most critically in family and peer relationships.²

In addition, the recent changes in family organization and structure may account for some of the family aggression as well. Among those believed to be of significance are changes that affect the social and moral bonding among family members. One such change since the 1970s is deinstitutionalization of children in foster care, the mentally ill, and the disabled. Distinct subpopulations of the deinstitutionalized are at risk of violent victimization - the homeless and those cared for in homes. The temporary placement of children in foster homes and adoption, and the informal placement of children with relatives exposes them to risks of violence from caretakers for whom the constraints of parenting are less controlling.²

A second major change is the increase in the number of children who are not living with their natural parents. These numbers are substantial owing to serial cohabitation, divorce, and desertion.²

Social Isolation. Social isolation is a characteristic of some families that are at high risk of physical and sexual abuse of a spouse or children.^35,36 The isolation may be forced on the partner by the abuser or shame may prompt the visibly battered spouse to further withdrawal. They become isolated from friends, acquaintances, or anyone acquainted with what goes on within the family. Some families isolate themselves in subtle ways: unlisted telephone numbers or no telephone or they lack means of transportation, and their homes may be physically shuttered from the gaze of outsiders. They lack community ties of any kind.³⁷ Risick and Reese suggest that violent families rarely invite others to their home, do not engage in social and recreational activities, and place less emphasis on personal growth and development.³⁸

Violence Generational Transmission. The transmission of violence from one generation to the next is believed to be a consequence of family violence. One investigator reported that among adults who were abused as children, more than one-fifth later abuse their own children.¹⁸ However, another cautions the methodological limitations in these studies, especially the retrospective design, which restrict the validity of conclusions about the long-term consequences of abuse in childhood.³⁹

Biopsychosocial Perspective

Child and family theorists often suggest that the structure and quality of family and social interaction, especially in the way the child perceives family members and their interactions with him or her and with each other, are important factors in a child's development. For children growing up, the quality of their attachments to parents and to other members of the family is most important in how these children as later adults relate to and value other members of society. Essentially, these early life attachments (sometimes called bonding) translate into a blueprint of how the child will perceive situations outside the family. Positive attachment speaks to warmth, affection, caring, protective behaviors, and accountability. It is at the core of building a social human being. Through attachment, the person gets feedback for the emerging of self. Around 18 months of age, there is consolidation of a sense of sense. Early development of the ability to self-soothe provides an inner core of calmness and the ability to avoid being overwhelmed by stimuli, which result in an integrated sense of self.

While attachment theory was intended as a revision of psychoanalytic theory, it has been infused by biological principles, control-systems theory, and cognitive psychology.⁴⁰ Although it began with an attempt to understand the disturbed functioning of individuals who had suffered early separations or traumatic losses, it is a theory of normal development that suggests explanations for some types of atypical development.^41-43 Because of Bowlby's preliminary formulations,⁴⁴ it has stimulated research into socioemotional development and the growth of interpersonal relationships. For example, it suggests a causal relationship between anomalies of attachment in the parent and abuse of the child.⁴⁵

Family violence has been linked to mental illness and personality disorders, although the links have been established for clinical populations rather than by using case control methods or general population surveys. Studies of women's shelter populations report that depression is quite common among women who are repeat victims of domestic violence.⁴⁶

People prone to depression may be more prone to violence. A number of studies report that abusive mothers as well as males who physically abuse their partners show signs of depression.⁴⁷ Yet the causal direction is not clear. While some sources of depression (e.g., repressed anger toward others) may cause the abuse, the depression may result from being labeled abusive, or other consequences of the violent act.²

Assaultive and Homicidal Behavior

How do we explain interpersonal violence, especially partner violence and homicide? It is difficult because there is a transgression of a basic sense of connectedness between people, and we wonder how can this kind of behavior exists. We know that early attachment disturbance and the impairment of self-regulation is a major diagnostic issue with traumatized children.⁴⁸

Social bonding can fail or become narrow and selective. Caretakers can either ignore, rationalize, or normalize various behaviors in the developing child or, through their own problems (such as violence behavior), support the child's developing distortions and projections. An ineffective social environment can occur through aggressive or sexual behavior being ignored or by failing to intervene to correct behavior.

The child who lacks protection by a caretaker experiences tremendous anxiety, is overwhelmed, and survives through dissociating himself or herself from emotion. This dissociation also inhibits a sense of feeling connected to the outside world. In the earliest manifestations of this numbing, we see children being cruel to animals, siblings, friends, and even parents. There is a lack of sensitivity to the pain of others or there can be a distorted association of pain. Children become isolated and disconnected from others. In a Massachusetts case, a 14-year-old youth took a 7-year-old retarded boy into the woods and beat him to death. He had told people he was going to do this, and no one intervened.

This cruel and detached behavior can be noted in date abuse occurring in junior and senior high school. There can be a gang rape of a girl as happened in Glen Ridge, NJ. In that case, the five young high school men inserted objects into a retarded girl, while six other high school students watched. They had no sense of their impact on the victim.

In courtship violence, the aggressor does not want the relationship to end. There can be stalking behavior, parking outside the house, and making harassing phone calls. The partner can not tolerate the separation. There are feelings of abandonment, anger, and depression. The partner may become suicidal. Rage is behind the depression. The narcissistic blow of the abandonment is that they cannot manage on their own. They numb out. The alteration is in basic biology of the limbic system. Their irritability, isolation, and avoidance of people is because they cannot handle emotion, and they are limited in thinking when they are emotional. They lack control. Fantasy calms them, but the fantasy is filled with their rage at the partner. The distorted thought is: I killed her because I love her.

In a study of murderers,⁴⁹ three factors were noted to negatively contribute to the critical formative events of childhood and adolescence. The first of these is trauma, in the form of physical or sexual abuse. The developing child encounters a variety of life events, some normative and others beyond the range of normal, usually extraordinarily negative. Within the context of the child's ineffective social environment, the child's distress caused by the trauma is neglected. The child is neither protected nor assisted in recovery from the trauma; his or her external environment does not address the negative consequences of the events.

One assumption regarding early traumatic events is that the child's memories of frightening and upsetting life experiences shape his or her developing thought patterns. This type of thinking that emerges develops structured, patterned behaviors, which in turn help generate aggressive daydreams and fantasies. The traumatized child's play remains fixed on thoughts associated with the family violence. Successful resolution of traumatic events results in an adaptive, integrated, and flexible patterned response. Unsuccessful resolution of trauma underscores the victim's helplessness; aggressive fantasies, aimed at achieving dominance and control missing from reality, emerge.^50,51

A second assumption regarding early traumatic events is that manifestations of the impact of abusive events are influential in the child's social development.^50-52 Concurrent with the abusive events, the child may experience a sustained emotional and physiological arousal level. When this sustained arousal level interacts with repetitive thoughts about the trauma, the child's perceptions and patterns of interpersonal relationships may be altered.

The second factor contributing to the formative events component is developmental failure. For some reason, the child does not readily attach to his adult caretaker. As a result of this negative social attachment, the caretaker has no influence over the child and later over the adolescent. If the child has been psychologically deprived or neglected, he or she may feel a diminished emotional response.

Interpersonal failure, the third factor, is the failure of the caretaking adult to serve as a role model for the developing child. There are various reasons for this failure, including the caretaker's being absent or serving as an inadequate role model, e.g., an abusive parent. The child may witness a violent home environment where he or she sees aggression, such as drunken fights associated with the sexual behavior of adult caretakers.

In domestic murders, the killing may be spontaneous. For example, in June 1995, two young boys died of hyperthermia after being buckled in car seat belts for eight or 10 hours while their 20-year-old mother partied at a Tennessee motel. This case does not involve intentional killing. However, some domestic murders are staged and involve careful planning as in the case of Diane Downs. About 10:30 PM, May 19, 1983, in Springfield, OR, Downs pulled into an emergency department screaming for help and that her three children were shot. Her 7-year-old daughter was dead on arrival; her 8-year-old daughter had two small caliber bullet wounds in her left chest and a third bullet wound through the base of her left thumb; and her 3-year-old son had a bullet entry to his spinal column. Downs, herself, had a gunshot wound in her arm.

Downs said she had been driving in her car when she noticed a man standing in the middle of the road. She stopped and got out, and the man pulled out a gun, reached through the window, and shot the children and her. She said she then pushed and kicked him in the leg, jumped in her car, and sped off for the hospital. The story fell apart when her daughter Christie proved to be an eyewitness to the crime. She saw her mother go to the trunk of the car where the gun was stored, come around the car and shoot Cheryl, then her brother, and then herself. Another witness testified to seeing Down's red Nissan Pulsar creeping along the road about 10:15 PM, waiting for them to die before going to the hospital. Diaries and unmailed letters to a married letter carrier with whom she was having an affair contained such incriminating statements as, "You know I don't want a daddy for my kids…You would never be left alone with them." The motive was to eliminate the obstacle (her children) to her fantasized relationship with her lover.

A history of Downs' background reveals child abuse, neglect, and incest. Little, if any, attachment occurred with protective caretakers. The result is a flaw in human development and attachment. It cannot be denied that other environmental stressors play a role in shaping civilizing and moral development, but case after case addresses the issue of failure of attachment and how it excludes the welfare of others. The abuser imitates the behavior of others. It is not drawn out of true individuation and appreciation of the uniqueness of others.

Incest

Incest is a manifestation of inadequate bonding of the parent. There are no clear boundaries. The family member responds to the sense that "it is all right." There is a basic disregard for the humanness of the child. These are people with real flaws in being able to behave in affiliative relationships.

Elder Abuse

Aggression toward the elderly is multifacted. Abuse may occur to parents who, themselves, have been abusive and exploitative. The dynamics are different between elder spousal abuse and elder abuse by their children.

Although child and spousal abuse have received increasing attention in family violence research, very little is known about the dimensions, scope, causes, or effects of elder abuse. The characteristics of individuals and families that are associated with abuse of the elderly need considerations, as do the features of interventions designed for other forms of family violence that might be adapted to this problem.

Interventions

There are no easy answers to problems of family violence. A comprehensive set of family support programs or a continuum of services for families within each of the developmental phases of family life does not exist.

Although services are needed for ongoing abuse cases, it is critical to identify families at risk for potential violence. Rather than waiting for incidents of violence, counseling and education services need to build on an integration of existing interventions and to design proactive approaches that are responsive to community needs and feasible with community resources. Other suggestions include the following:

Courtship Violence. Research continues to develop to provide an understanding of relationship problems that lead to dating violence. In Riggs' study, although aggressors reported more problems in general than did nonaggressive individuals, the difference appeared to result from specific problem areas.⁴ These include jealousy; the interference of people outside the relationship, such as friends and parents; and more fighting and conflict within the couple. If one conceptualizes jealousy as a reaction to the threat of loss, it is possible that such a threat will also result in anger that could lead to aggression. Other issues that may be related to jealousy, such as possessiveness and control, may also lead to aggression.

Riggs' study results support the need to address general problem-solving issues in any educational program designed to treat or prevent dating aggression. Whether the relationship problems lead directly to the aggressor or if both the aggression and the problems reflect some third variable (e.g., aggressive personality), it appears that aggressive individuals face a greater level of conflict within their relationships. Reducing this conflict through counseling or training might be effective in reducing the occurrence of dating aggression.

Spouse Assaults. Most research has focused on testing police arrests of the abuser in preventing recurrences of domestic violence. Arrest, in replication studies, has shown to not be an effective deterrent; indeed, it may well increase the incidence of domestic violence of unemployed males with low socioeconomic status.⁵³ Research is recommended on police-administered treatments as well as police referrals to social service and substance abuse treatment agencies and to battered women's shelters.

The last few decades have seen programmatic efforts focused on providing shelters for battered women - residences where abused women and their children can reside safely and receive emotional support. There are now approximately 1,200 shelters offering temporary, emergency housing (typically families stay from two days to three months) to more than 300,000 women and children each year.²

The goal of shelters is a safe harbor. Other services are designed to provide help to women to become self-sufficient and include relocation assistance, day care for children, and welfare advocacy. Services directed at increasing self-esteem include support groups and courses on parenting, job readiness, and budgeting. Services for children who have witnessed family violence are often incorporated into shelter programs.

The Duluth Minnesota Domestic Abuse Intervention Project conducted a 12-month follow-up study in which battered women were asked their opinion of the intervention that the Project had used in an effort to have the batterer change his violent habits. Of the women studied, 60% said they felt there was improvement when the batterer took part in education and group counseling, whereas 80% of the women stated that the improvement had resulted from a combination of involvement from the police, courts, group counseling, and the shelter.⁵⁴

Programs to reduce partner assault include public education and awareness campaigns for batterers. Education targets children to develop nonviolent ways of coping with anger and frustration. Public awareness programs emphasize that family violence is a crime and that help is available.

Courts mandate batterers to attend programs that teach alternative ways to behave. Alcohol and drug abuse programs are emphasized for batterers for whom chemical abuse is an issue.

Pharmacological intervention may be useful. Understanding that depression may affect the severity of maltreatment of children as well as lead to their neglect, the treatment of depression may be indicated. If a significant subgroup of abusive parents or caretakers suffer from affective disorders, especially major depression, then chemical and other forms of treating depression may be a means of controlling family violence. This assumes that reasonably effective means are available for controlling affective disorders, particularly any volatile mood swings associated with them.²

Child Abuse. Foster care placement is a major intervention in child-abuse cases. An estimated 15% of victims of child maltreatment are placed in an unrelated foster home.^55,56 Several studies note that the more changes in placement a child experiences, the greater the likelihood of adult criminality and violent criminal behavior.^57-59

Home nurse visitation is one proactive means of detecting maltreatment of infants and preschoolers. Olds and his collaborators have studied this intervention in high-risk groups - poor, unmarried, and teenage mothers having their first child - and found it to decrease, but not totally eliminate, the incidence of child abuse in comparison with groups not receiving the intervention.^60,61 There was a 5% rate of child abuse or neglect suggesting the need for additional preventive or ameliorative interventions. However, there were additional positive effects of the home-nursing intervention. At 12 and 24 months, infants of mothers of the high-risk group showed improved intellectual functioning on development tests, and there was some evidence of improved family function with less evidence of conflict and scolding and less punishment of infants. Olds and his colleagues also concluded that although the nurse can link families to community and social services - to meliorate the effects of poverty, violence, and drug use - the lack of employment opportunities in the neighborhoods where these families live poses severe constraints on their continued improvement efforts, especially when the intervention stops.