doctors, nurses, social workers, teachers, court personnel, employee as- sistance counselors, psychiatrists, police, clergy, and all other health, social service, and criminal justice professionals. (E-42) In the area of Research we recommend that . . . the factors that aid in the prevention of spouse abuse should be identified. (R-37) . . research and demonstration projects should be designed for the prevention of spouse abuse and woman battering. (R-38) existing intervention and treatment programs should be evaluated. iii9) the different dynamics and consequences of abuse for men and for women - and the service implications of these differences - should be identified. (R-40) In the area of Services we recommend that . . . . . health and social service personnel should uniformly define spouse abuse as any assault or threat of assault by a social partner, regardless of gender or marital status and whether or not they are present or former cohabitants. (S-60) . . the empowerment of women should be supported by expanding their social and economic options before and after the identification of abuse and by addressing such vital issues and services as pay equity, the enforcement of child support orders, adequate and low-cost housing, child care, and job training. (S-61) . . . model protocols for spouse abuse and woman battering should be used in health settings for the early identification of such abuse and for aiding victims. (S-62) . . . spouse abuse protocols need to be developed for secondary treatment sites primarily concerned with alcohol and drug abuse, suicide preven- tion, rape and sexual assault, emergency psychiatric problems, child abuse, and the homeless. (S-63) . . federal, state, and local initiatives to prevent child abuse should be mandated to directly address spouse abuse and woman battering as well. (S-64) . . . the Regional Centers established under the 1984 reauthorization of the National Center for Child Abuse and Neglect should have spouse abuse and woman battering added to their charters and the National Advisory Board on Child Abuse and Neglect should be appropriately renamed (e.g., the National Advisory Board on Family Violence) and its membership expanded to represent these linked concerns. (S-65) 76 . shelters should be supported and encouraged to meet the emergency needs of a11 victims, including protection, housing, and violence. (S-66) . . each governor should designate a state office or agency as the focal point for programs and policies related to domestic violence. (S-67) . . the criminal justice system must acknowledge rape and sexual assault as crimes, regardless of the past or present marital relationship between victim and perpetrator. (S-68) . battered women need to be assured that the violence against them will stop, and that they will receive equal protection under the law and a swift resolution of their cases. (S-69) . . Congress should make sure that the full protection of the law in matters involving domestic violence is provided for all families living within exclusive federal jurisdictions. (S-70) . new programs in education, treatment, and counseling need to be developed to help stop abusive men from committing further acts of violence. (S-7 1) 77 Plenary Session V Response to the Recommendations Presented by C. Everett Koop, MD Surgeon General, USPHS Tuesday afternoon, October 29, 1985 This Workshop may be a new departure, but the sheer number of victims - some 4 million - who cry out for help each year demands a public health response. If prevention is the business of public health, where better to focus attention than on this scourge of violence that permeates every level of our society - where victims live not only in fear and dread, but they also desperately try to sort out the shame and the guilt and the fear that competes with their feelings of love and loyalty to their families. While our attention has been directed primarily at interpersonal violence within the family, we seek to address the causes and effects of such violence outside the family as well. Because this is the first Surgeon General's meeting on the subject of violence, the scope may be more diffuse than some would have wished. We have focused on public health, with additional participants representing the law, the criminal justice system, and social services. I would want the next workshop to focus more directly on the partnership of health and justice. Your recommendations are just what I had hoped for. It should be possible for individual health professionals as well as the leaders of major 79 health institutions and associations to understand and act on them. Several themes do recur in the recommendations from among the 11 work groups: education of the public on the causes and effects of violence, education of health professionals as to better care for victims and better approaches to violence prevention, improved reporting and data-gathering, some addi- tional research, and increased cooperation and coordination - "network- ing," if you will - among health and health-related professions and institutions. Senate Hearing I will begin carrying out that first recommendation of public education tomorrow when I lead off the witnesses at a special public hearing before Senator Paula Hawkins' Subcommittee on Children, Families, Drugs, and Alcoholism. I will also send your recommendations to the Secretary of Education and will indicate your willingness to work with his Department to get something accomplished in our public and private schools, colleges, and universities. As for professional education, in addition to a report in Pz~bli Htdth Reports, I will post your recommendations on the Surgeon General's elec- tronic bulletin board as soon as possible. The bulletin board, which is part of the American Medical Association's computerized Medical Information Network, or MINET, reaches about 26,000 physician subscribers. I will also convey your concerns to many other professional groups, such as the American Nurses Association, National Board of Medical Examiners, Association of State and Territorial Health Officers, American Academy of Pediatrics, and the National Association of Social Workers. As for the recommendations for research, I will convey them to the Assistant Secretary for Health and to the heads of the five PHS agencies who have the legal authority and the funds to conduct research. Several work groups have suggested new prospective, longitudinal studies of vic- tims and families. Such studies are complicated and costly to mount. I honestly do not know how my colleagues will react to that, but I will certainly give them the suggestions. I would also like to respond to some specific recommendations. o You asked that the Surgeon Genera! undertake an informational cam- paign about spouse abuse - something that I can and will do. I will transmit to the American College of Obstetricians and Gynecologists the recommendation for more sensitive evaluation and care for battered spouses who are pregnant. That also has my strong support. . Both work groups on rape were concerned about the need for additional 80 research and recommended that a conference be held specifically to sort out what needs to be done. I endorse that suggestion and convey it to the Alcohol, Drug Abuse, and Mental Health Administration. You also called for greater interdisciplinary cooperation in the field of rape, and I agree that it is absolutely essential. . In reference to assault and homicide, I understand your emphasis on paying special attention to the impact upon minorities. Rather than responding now, I would first like to see how the recommendations dovetail with those recently made by the Secretary's Task Force on Black and Minority Health. . A number of recommendations concerning child abuse and child sexuai abuse might well receive a more appropriate response from the Depart- ment's Office of Human Development Services, a co-sponsor of this Workshop. I intend to stay in close touch with that Office, as you clearly imply I should. I can say, however, that I agree completely with the recommendation that the abused child be treated promptly according to an evolving plan. The victim should not be seen merely as a pawn in some legal chess game. Meanwhile, the PHS Division of Maternal and Child Health is be- ginning an aggressive public education campaign on child abuse and child sexual abuse and in May 1986 will co-sponsor a conference on child sexual abuse. The Division will also be disseminating materials related to these problems; I will ask them to include the recommendations in their mailings. I'd like to add that I will carry the recommendations to certain other groups, such as the American Red Cross, the Boy Scouts and Girl Scouts, and the 4-H Clubs of America. o From the day I was appointed in I98 1, I've chosen the role of advocate for vulnerable, threatened older people in our society. I assure you that I will speak to this issue of elder abuse as well. I will deliver the recommendations on elder abuse to the Administration on Aging in the Department of Health and Human Services. The AoA interacts with about 1,200 centers on aging, so it is an important ally for getting broad exposure to the recommendations in this area. I will also discuss research in elder abuse with Dr. T. Franklin Williams, Director of the National Institute on Aging. One work group recommended, in effect, that the Federal Government practice what it preaches. and I agree completely. Hence, I'm pleased that we've had a strong delegation from the Department of Defense at the workshop. They represent not only the policy function but also the 81 line function, the people who actually deliver health care to servicemen and women and their dependents. What PHS Can Do Let me share what the Public Health Service itself can do, is doing, or will do in respect to interpersonal violence. The National Health Service Corps, for example, is a PHS organization of health care professionals working in medically underserved areas, most of them remote rural areas or distressed inner-city neighborhoods. The Corps will be absorbing as many of the recommendations as possible into its continuing medical ed- ucation program for the 3,100 NHSC officers in the field. And we have agreement from the Indian Health Serivce that the same actions would be useful for their personnel, too. The 60,000 PHS employees are a cross-section of American society; they also have their share of personal problems, for which we have an employee counseling service. I understand that domestic violence will be receiving more attention from that counseling service during the coming year, in- cluding the establishment of a support group for battered women within PHS. I believe the recommendations will be especially significant for the Na- tional Institute of Mental Health, which supports research in violence and anti-social behavior. I'm sure your thoughts regarding trends and emphases will be carefully studied by NIMH personnel and by the PHS people who work with migrant health centers, community health and mental health centers, state and local health agencies, and so on. I'd like them to have a heightened awareness of interpersonal violence in the conduct of the important grass-roots programs in public health. Regional Follow-Up Some of the participants are thinking ahead to follow-up activities to this Workshop. Regional meetings and some educational programs are being discussed. I hope that you will drop me a note about subsequent developments in this campaign against interpersonal violence. For my part, I pledge that my Office will put that information together for a 6-month follow-up report and a 12-month report. I agree with the strong recom- mendation of greater coordination and information-sharing within - and among - the health professions. A final word. The causes of interpersonal violence, especially family 82 violence, are complex, multi-faceted, and extend into the social and cultural fabric of society. Sometimes the etiologic agent may be far removed from the narrower realm of health care. However, any remedies undertaken by a health official, including - and especially - the Surgeon General, must be consistent with his actual sphere of responsibility and influence and moral persuasion. Several recommendations - thoughtfully conceived and vigorously presented - are nevertheless well outside that public health sphere. But I want to assure you that, when and where feasible, I will transmit those recommendations as the sincere concerns of participants of this Workshop, even though they address social and political problems well beyond the influence of our colleagues in medicine, nursing, public health, psychology, and health-related social services and of the Surgeon General and the Public Health Service. As long as I am Surgeon General, those who are victims of violence in this country will have a strong advocate in my Office. Thank you. 83 The "Delphi Survey" In the spring of 1985, in anticipation of "The Surgeon General's Work- shop on Violence and Public Health" scheduled for late October, the Public Health Service decided to incorporate a Delphi survey in its pre-Workshop planning. The contractor was Survey Research Corporation. Delphi surveys are designed to measure the collective wisdom of a group of experts. The participants are asked a series of questions, or exposed to the group averages, and are then invited to reconsider their positions. The process continues until a consensus emerges. PHS felt that a Delphi survey preceding the Workshop would be of value on three counts: 1. It would give a sense of shared purpose to participants who had no prior contact with each other. 2. It would serve to clarify positions in advance of the Workshop, thereby shortening the time needed to explore viewpoints. The Work- shop could, therefore, go directly into action the moment it convened. 3. It would help sustain interest in the Workshop during the inactive summer months. Everyone on the invitation list was invited to participate in the Delphi and virtually all agreed: an unusually generous response. Delphi I (the first iteration) was launched in June. It contained three broad questions representing the Workshop's areas of interest. Ql What is the role of education? 42 What should be done in research? 43 What should be done about the delivery of medical, health, and social services? Under each question, there were statements that asked for agreement or disagreement on an 1 l-point scale. There was also space to propose addi- tional statements for evaluation by the group. The substance of statements proposed twice or more were included in Delphi II and III (the next iterations). Neither the Public Health Service nor Survey Research Corporation proposed or vetoed statements. Delphi II and III were, therefore, the products of the participants. 84 With Delphi III in late August, the concentrations were well established and there were no additional statements proposed. The Delphi survey was, therefore, over. Results Response to the survey statements is measured by an 1 l-point scale used as a continuous variable from " 1" signifying total agreement to " 11" sig- nifying total disagreement. The midpoint "6" is the neutral position. Two statistics are used to describe the results. The first is the mean, or arithmetic average. It is interpreted as follows: 1-2 : very close to complete agreement 3-4 : substantial or general agreement 5-7 : verging toward or in the neutral area 8-9 : substantial or general disagreement 10-l 1: very close to complete disagreement The second is .ru@ovt feziel. This is the total number (of percent) on one side or the other of the neutral position. The following is an example: Scale Value Number of Respondents 1 5 2 9 3 AGREEMENT 36 4 25 5 5 Total above 6 is 80 6 NEUTRAL 5 7 2 Total below 6 is 15 8 3 9 DISAGREEMENT 3 10 4 11 3 Total 100 In the example, the positive (agreement) support level is 80, the negative (disagreement) support level is 15. The neutral position is 5. A positive support level of 80 is high, since a substantial majority shows some level of agreement with the position. The rnean and the support level taken together are usually an adequate 85 description of the results. In the few cases where they are not, the distri- bution of the data will be given in the text. The following results of the survey are shown in question/statement order. Ql What is the Role of Education? The set of 14 statements under this broad question focused mainly on action recommendations. In the few instances where theoretical positions were offered, such as "education can change the mores," there was a sig- nificant but telatively unenthusiastic response. On the other hand, positive support levels for training in recognition, reporting, and other situations calling for direct action were all extremely high. Qla POLICE SHOULD BE TRAINED IN EFFECTIVE METHODS OF INTERVENTION. The mean is 1.8 and the positive support level is 99%: an extremely strong showing for this and the two related statements that follow. Qlb HEALTH PROFE~~IONAU SHOULD BE TRAINED TO RECOGNIZE Do- MESTIC VIOLENCE. The mean is 1.6 and the positive support level is 100%. Qlc HEALTH PROFESSIONALS SHOULD BE TRAINED IN VIOLENCE-RE- PORTING PROCEDURES. The mean is 1.8 and the positive support level is 97%. Qld HEALTH PROFESSIONALS SHOULD BE TRAINED IN VIOLENCE INTER- VENTION PROCEDURES. The mean is 2.9 and the positive support level is 95%: agreement with the position but with some reservations. We speculate that these may have to do with the practical consideration of danger to the intervening person. Qle INTRODUCE VIOLENCE PREVENTION IN FAMILY LIFE COURSES IN THE SCHOOLS. The mean is 2.3 and the positive support level is 76%. Qlf EDUCATION CAN CHANGE THE MORES (AND SOCIAL NORMS) THAT DKTATE VIOLENT BEHAVIOR. 86 The mean is 4.1 and the positive support level is 81%. But there is a substantial 38% cluster around the generally neutral 5-6-7 area. Qlg EDLJCATICIN CAN LEAD TO BE~ER COMMUNICATION SKILLS AND THEREFORE LESS VIOLENT BEHAVIOR. The mean is 4.0, with positive support at 83%: a slightly better showing than the preceding statement, but in the same area of general agreement. Qlh IMPROVE PUBLIC AWARENESS OF LEGAL RIGHTS AND AVAILABLE SERVICES. With a mean of 2.7 and a positive support level of 98%, agreement is unequivocal. The next statement, which proposes a method to achieve this, is even more acceptable. Q Ii USE THE MASS MEDIA IN A POSITIVE EDUCATION PROGRAM AGAINST VIOLENCE. The mean is 2.0 and the positive support level is 96%. Qlj TRAIN AND CERTIFV FORENSIC PSYCHIATRISTS AND PSYCHOLOGISTS. The mean is 5.0 and the positive support level is 60%: a response that tends toward the neutral position. Response to the next, related statement is even more so. Several respondents wrote "why?" to both statements. Qlk TRAIN AND CERTIFV FORENSIC SOCIAL WORKERS. The mean is 5.3 and the positive support level is 52%. Qll HEALTH EDUCATION, COMBINED WITH POSITIVE MODELING AND SUPPORT FOR NON-VIOLENT RESPONSE, CAN LEAD TO LESS VIOLENT BEHAVIOR. The mean is 3.9 and the positive support level is 85%: general but not enthusiastic agreement. Qlm GIVE CHILDREN EXPLICIT EDUCATION IN NEGOTIATION TACTICS AND CONFLICT RESOLUTION. The mean is 2.9 and the positive support level is 95% : a clear acceptance of the position. Qln PROVIDE PROFESSIONALS DEALING WITH VIOLENCE WITH SENSI- TIVIT~ TRAINING AND IN-DEPTH CASE CONSULTATION. The mean is 3.5 and there is a positive support level of 83%; thus, there is general, but not total agreement. 87 42 What Should Be Done in Research? The I6 statements under this question were a mix of specific projects and generalized approaches. In general, the group showed strong support for practical rather than theoretical projects and for the study of environ- mental rather than biological factors in violence. For example, statements that called for the development of intervention field models or for the evaluation of existing programs had mean values of 2.6 and 1.9, while those that dealt with verbal skills or the structure of genes had values of 5.0 and 7.7. Q2a NEUROPSYCHOLOGICAL AND BIOMEDICAL AREAS HAVE BEEN NEGLECTED. The response is neutral, with a mean of 5.8. Q2b ANALYSIS OF STRUCTURAL (ENVIRONMENTAL) PROBLEMS IS THE KEY TO BE~ER RESEARCH. There is general support for the statement with a mean of 4.2. Q2c RESEARCH SHOULD BE FOCUSED ON THE MORE VULNERABLE, HIGH- RISK POPULATION GROUPS. The mean is 3.7 and the positive support level is 85%, which indicates a favorable position on the statement. Q2d DETERMINE THE FUNCTION OF Poop VERBAL SKILLS IN RELATION TO VIOLENCE. The mean is 5.0 and the positive support level is 58%. a marginally neutral response. Q2e DETERMINE THE RELATIONSHIP BETWEEN VIOLENCE AND THE ABUSE OF DRUGS AND ALCOHOL. The mean is 3.0 and the support level is 93%. Evidently there is con- siderable interest in exploring the drug-alcohol-violence hypothesis. Q2f THOSE DYING RESEARCH ON VIOLENCE SEEM TO KNOW LITIZE ABOUT IT. The mean is 6.3 and the negative support level is 3 1%. Most of the response-60%-is in the 5-6-7 neutral range. Clearly, the respondents were not able to express a clear judgment here. 88 Q2g PRIVACY LAWS HINDER RESEARCH ON VIOLENCE. The mean is 5.6 and 52% are at the neutral (6) point. Some of the write-in comments indicate that the subject is a mystery to many of the participants. Q2h MORE INTERDISCIPLINARY RESEARCH Is NEEDED. With 95% positive support and a mean of 2.6, the response is unequivocal. Q2i MORE RESEARCH ON INNATE CHARACTERISTICS, SUCH AS GENE STRUCTURE. The position is generally rejected: a mean of 7.7 and a negative support level of 72%. (See also the related Q2a.) Q2j CONCENTRATE ON APPLIED RATHER THAN PURE RESEARCH. There is substantial agreement with the position at a mean of 4.1 and a positive support level of 67%. Q2k DEVELOP FIELD MODELS OF EFFECTIVE INTERVENTION. The positive support level is 97% and the mean is 2.6. There is no doubt that the group is strongly in favor of this kind of pragmatic research. 421 INVESTIGATE VIOLENCE AS NORMATIVE BEHAVIOR. There is substantial agreement with a 3.8 mean and a support level of 84%,. Q2m INVESTIGATE THE RELATIONSHIP BETWEEN STRESS AND VIOLENCE. 92% agree, with a mean of 2.8. Q2n INVESTIGATE THE ETIOLOGY OF COPING SKIU. There is substantial agreement with a mean of 3.6 and 84% support. 420 DETERMINE THE RELATIONSHIP BETWEEN ABUSE IN CHILDHOOD AND HIGH RISK IN ADULTHOOD. Strong agreement at a mean of 2.8 and a support level of 93%. The importance of this research may be stronger than the statistics indicate, since some who disagreed did so on the grounds that the relationship had already been established. Q2p EVALUATE EXISTING PREVENTION AND INTERVENTION PROGRAMS. 100% support and a mean of 1.9 for this pragmatic approach. 89 Q3 What Should Be Done About the Delivery of Medical, Health, and Social Services? These 14 statements were extremely diverse, as they dealt with specific actions and procedures. All the proposals were given varying degrees of support, except for the location of shelters in or near hospitals, which was viewed neutrally. Real enthusiasm, however, was reserved for the expansion of shelter and crisis facilities, for bringing schools and the justice com- munity into the violence prevention network, and for creating multidis- ciplinary teams at the local level. Q3a CREATE A CENTRAL DATABANK FOR CHECKING AND SHARING Hos- PITAL RECORDS. There is substantial agreement at a mean of 4.3 and a support level of 78%. Q3b DEVELOP MORE SHELTERS FOR VKTIMS OF DOMESTIC VIOLENCE, BOTH ADULTS AND CHILDREN. There is strong agreement at a mean of 2.9 and a support level of 93%. Q3c LOCATE SHELTERS FOR VICTIMS IN OR NEAR HOSPITALS. The group is neutral at a mean of 5.S and 58% in the 5-6-7 scale range. Q3d IMPROVE MEDICAL-SOCIAL SERVICES OPERATION BY DEFINING AREAS OF RESPONSIBILITY. There is substantial agreement with the position at a 3.1 mean and a 93% support level. Q3e IMPROVE THE QUALITY OF PERSONNEL ENGAGED IN EMERGENCY MEDICINE. 87% agree at a mean of 3.3. Q3f DEFINE TYPES OF EMERGENCY Rook PATIENTS WHO REQUIRE THE A%%TANCE OF A SOCIAL WORKER. The mean is 3.2 and the positive support level is 9 1%. Q3g BRING SCHOLL HEALTH FACILITIES INTO THE VIOLENCE PREVENTION NETWORK. Strong agreement at a mean of 2.2 and a 97% support level. 90 Q3h CREATE MULTIIXSCIPLJNARY TEAMS AT THE LOCAL LEVEL. 96% support the position at a mean of 2.5. Q3i DEVELOP STANDARDS THAT DEFINE WHAT Is ABUSE OF OLD PEOPLE. There is substantial agreement at a mean of 3.1 and a support level of 91%. Q.3j BRING THE JUSTICE COMMUNITY INTO THE VIOLENCE PREVENTION NETWORK. 100% agree, with a mean value of 2.0. Q3k IMPROVE THE QUALI~ AND AVAILABILITY OF SHORT-TERM CRISIS INTERVENTION FACILITIES. 99% agree. The mean is 2.0. Q31 CREATE LOCAL COORDINATING BODIES TO PREVENT THE DUPLICA- TION OF SERVICES. 78% agree and the mean value is 3.7. Some write-in comment feared this would mean further regulation. Q3m DEVELOP STANDARDS OF CARE FOR OFFENDERS. With a mean value of 4.0 and a support level of 76%, agreement is unenthusiastic. Q3n MAKE QUALI~ DAY CARE AVAILABLE TO ALL. 74% agree and the mean value is 3.6. 91 List of Participants Faye G. Abdellah, RN, EdD, DSc. Deputy Surgeon General and Chief Nurse Officer, USPHS, Washington, DC. (R) Sergeant Jean Albright, USAF. Bureau Chief, Srrrm b Sfr&l, Bitburg, West Germany. Carole Anderson, RN, PhD. Associate Dean for Graduate Studies, University of Ro- chesrer School of Nursing. Rochester, NY. Laura Anderson, MPH. Health Services Coordinator, Health and Human Services De- partment, City of Berkeley, CA. Margaret Long Arnold. Coordinator of Women's Activities, American Associatron of Retired Persons, Washrngton, DC. Constance Avery-Clark, PhD. Clinical and Research Associate, Masters and Johnson Instrtute. St. Louis, MO. Rosemary Barber-Madden, EdD. Associate Professor and Drrector, Maternal and Child Health Program, Center for Popularion and Family Health, Columbia University, New York, NY. Amy C. Barkin, MSW, MPH. Drrector, Employee Counseling Service Program, USPHS, Rockville. MD. Judith V. Becker, PhD. Drrector, Sexual Behavior Chnic, New York State Psychiatric Instttute, New York, NY. Douglas J. Besharov. Adjunct Scholar, American Enterprise Institute. Washington, DC. Captain Edgar R. Blount, MD. Special Assisrant for Medical Affairs, Office of the Assrsrant Secretary of Defense (Health Affairs). Washington. DC. Major Linda Boone, USMC. Family Programs Officer, Headquarters, U.S. Marine Corps, Arlington, VA. Anthony V. Bouza. Chief of Police, Minneapolis, MN. Gary L. Bowen, PhD. Assistant Professor, School of Social Work, Universiry of North Carolina, Chapel Hill, NC. Lee P. Brown, PhD. Chief of Police, Houston, TX. (R) Work-Group Rapporreur 92 Mary Pat Brygger. Executive Director, Domestic Abuse Project, Minneapolis, MN o Ann W. Burgess, RN. DNSc. Van Ameringen Professor of Psychiatric Mental Health Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA. Jane N. Burnley, PhD. Associate Commissioner, Children's Bureau, Washington, DC. Martha R. Burt, PhD. Director, Social Services Research Program, Urban Institute, Washington, IX. John A. Calhoun. Executive Director, National Crime Prevention Council, Washington, Ix. Jacquelyn C. Campbell, RN, MS. Wayne State University College of Nursing, Detroit, MI. Elaine Hilberman Carmen, MD. Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. David L. Chadwick, MD. Senior Vice-President/Medical Director and Director, Child Protection Program, Children's Hospital and Health Center, San Diego, CA. Jane R. Chapman. Director, Center for Women Policy Studies, Washington, DC. Danny Chin, MD. Acting Medical Director, South Cove Community Health Center, Boston, MA. Dante Cicchetti, PhD. Associate Professor of Psychology, University of Rochester, and Director, Mt. Hope Family Center, Rochester, NY. J. Jarrett Clinton, MD. Department Assistant Secretary of Defense for Professional Affairs and Quality Assurance, OASD (Health Affairs), Washington, DC. Anne H. Cohn, PhD. Executrve Director, National Committee for Prevention of Child Abuse, Chicago, IL. Jon R. Come, DSW. Assistant Professor. School of Social Service Administration, Uni- versity of Chicago, IL. o Theodore 0. Cron. MAT. Special Assistant to rhe Assistant Secrerary for Health and rhe Surgeon General, USPHS, Washingron, DC. Phyllis Old Dog Cross, RN, MS. Psychiatric Nurse Clinician, Regional Mental Health Services, Indian Health Service, USPHS, Rapid City, SD. Lynn A. Curtis, PhD. President, Eisenhower Foundation, Washington, DC. Bruce Cushna, PhD. Associate Direcror. Developmental `Evaluation Clinic, Children's Hospital, Boston, MA. * Member of the Plannmg Commitree 93 Howard Davidson, Esq. Director, National Legal Resource Center for Child Advocacy and Protection, American Bar Association, Washington, DC. Jane Delgado, PhD. National Executive Direcror, COSSMHO (Narional Coalirion of Hispanic Health and Human Services Organizations), Washington, DC. Major Gloria Deniz, USAF Nurse Corps. Pediatric Nurse Practitioner, Wilford Hall Medical Center, Lackland AFB, San Antonio, TX. Ruth E. Dennis, PhD. Associate Professor. Meharry Medical College, Nashville, TN. Sara Reed DePersio, MD, MPH. Chief, Maternal and Child Health Service. State De- parrmenc of Health, Oklahoma City. OK. Karla M. Digirolamo. Executive Director, Governor's Commission on Domestic Violence, Albany, NY. Lt. Joseph DiPaolo, MSC, USN. Head, Family Advocacy Program, Naval Medical Com- mand. Washmgcon, DC. Marlene Echohawk, PhD. Associate Magistrate, CFR Court of Indian Offenses, Oklahoma Ciry, OK. Jean K. Elder, PhD. Commlssioner, Adminisrrarion on Developmental Disabilities, Wash- ingron, DC. Robert A. Fein, PhD. Program Director, McLean/Bridgewarer Program, McLean Hospital, Belmonr. MA. Fern Y. Ferguson, MSW. Presidenr, National Coalition Against Sexual Assault, Easr Sr. Louis, IL. Harvey V. Fineberg, MD, PhD. Dean, Harvard School of Public Health, Boston, MA. Paul J. Fink, MD. Medical Director, Philadelphia Psychiatric Center and Chairman, Department of Psychiatry, Albert Einstein Medical Center, Philadelphia, PA. David Finkelhor, PhD. Associare Director, Family Violence Research Program, University of New Hampshire, Durham, NH. Anne H. Flitcraft, MD. Assistant Professor of Medicine, University of Connecticut Health Center. New Haven, CT. William H. Foege, MD. Assistant Surgeon General and Special Assistant for Policy Developmenr, Cenrers for Disease Conrrol. Atlanta. GA. Peter W. Forsythe, Vice-President and Director, Program for Children, Edna McConnell Clark Foundation, New York, NY. Henry W. Foster, Jr., MD. Chair, Department of Obstetrics and Gynecology, Meharry Medical School, Nashville, TN. 94 Shervert H. Frazier. MD. Dircccor, National Institute of Menral Hcalrh. USPHS. Rock- v~llr. MD. SuElIen Fried. Founder, STOP VIOLENCE Coalition, Shawnee Mission, KS. Richard J. Gelles. PhD. Dean of Arrs and Sciences and Professor of Sociology and An- thropology, University of Rhode Island, Kingston. RI. Henry Giarretto, PhD. Executive Director, Instirure for Communiry as Extended Family- Parents United, San Jose, CA. Jean Goodwin, MD, MPH. Professor of Psychiarry and Director, Joint Programs, Medical College of Wisconsin and Milwaukee County, Milwaukee, WI. o Margaret T. Gordon, PhD. Director, Center for Urban Affairs and Policy Research, Norrhwestern University, Evanston, IL. (R) Christine Grant, RN. University of Pennsylvania School of Nursing, Philadelphia, PA. Ellen F. Greenberg, PhD. Adminisrrative Officer for Health Policy, American Psycho- logical Association, Washingron, DC. Nahman Greenberg, MD. Executive Director, CAUSES, and Member, National Advisory Board on Child Abuse and Neglect, Illinois Masonic Medical Center, Chicago, IL. Fernando A. Guerra, MD, MPH. Medical Director, Barrio Comprehensive Family Health Center, San Anronio, TX. Philip A. Harding. Vice President for Social and Policy Research, CBS Broadcast Group, New York, NY. lsadora Hare, MSW, ACSW. Senior Sraff Associate, National Association of Social Work- ers, Silver Spring, MD. Col. Jesse Harris, DSW. Consulrant to the Army Surgeon General. Social Work Service, Walrer Reed Army Medical Center, Washington, DC. o David E. Heppel, MD. Chief, Child and Adolescent Primary Care Branch, Division of Maternal and Child Health, USPHS, Rockville, MD. Jean Hilsman. Direcror, Family Policy Office of the Deparrment of Defense, Washington DC. Lee Ann Hoff, RN, PhD. Associate Professor, Northeastern University College of Nursing, Bosron, MA. Captain Bartholomew T. Hogan, MC, USN. Head, Psychiarry Deparrment, Naval Hospital, Naval Medical Command, Berhesda, MD. Helen V. Howerton. Director, Narional Center on Child Abuse and Neglect, Washington, DC. 95 Peter A. Howland, MD, MPH. Director. West Virginia Universiry Child Prorecrion Team, Morgantown, WV. Janice Humphreys, RN, MS. Wayne Stare University College of Nursing, Detroit, Ml. Juanita K. Hunter, RN, EdD. Chair, Cabinet on Human Righrs. American Nurses Assoctation, and Clintcal Assistanr Professor, School of Nursing, State University of New York, Buffalo, NY. Terry Hunter. Executive Director, Association of American Indian Physicians, Oklahoma City, OK. Charles F. Johnson, MD. Dtrector, Child Abuse Program, Children's Hosptral, Columbus, OH. Ms. Eddie Bernice Johnson, RN, MPH. Vice President, Government and Community Affairs, Visiting Nurses Association, Dallas, TX. LaVohn Josren, RN, PhD. Director of Public Health Nursing, Stare Department of Public Health, Minneapolis, MN. Blair Justice, PhD. Chair, Standing Committee on Interpersonal Violence, University of Texas Health Science Center, Houston, TX. Arnold S. Kahn, PhD. Administrative Officer for Social and Ethical Responsibility, American Psychological Association, Washington, DC. Luella Klein, MD. Director, Maternal and Infant Care Project and Professor of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA. Karil S. Klingbeil, MSW, ACSW. Assisranr Professor and Direcror of Social Work, University of Washington, Seattle, WA. C. Everett Koop, MD. Surgeon General, USPHS, Washington, DC. Jordan I. Kosberg, PhD. Professor of Gerontology, University of South Florida, Tampa, FL. o Thomas L. Ialley. Depury Chief, Cenrer for Srudies on Anri-Social and Violent Behavior/ NIMH, Rockville, MD. Norman Landsem, MSW. Director, Social Services and Mental Healrh, Bemidji Program Office, Indian Health Service/USPHS, Bemidji, MN. Barry D. Lebowitz, PhD. Chief, Center for Studies of rhe Mental Health of the Aging/ NJMH, Rockville, MD. Howard B. Levy, MD. Chairman of Pediatrics, Mt. Sinai Hospital and Medical Center, Chicago, IL. Sheldon Levy, PhD, MPH. Director, Behavioral Sciences, Pediatric Ecology Program, Mt. Sinai Hospital and Medical Center, Chicago, IL. 96 Dorothy Otnow Lewis. MD. Professor of Psychiatry, New York University School of Medicine, New York. NY. Dodie Truman Livingston. Commissioner, Admmistration for Children, Youth, and Families, Washington, DC. Ann Maney, PhD. Center for Anti-Social and Violent Behavior/NIMH, Rockville, MD. Terry W. McAdam. Program Director and Vice President, Conrad N. Hilton Foundation, Los Angeles, CA. (R) Lawrence T. McGill. Center for Urban Affairs and Policy Research, Northwestern University, Evanston, IL. o Robert G. McGovern, MD. Director, Division of Ambulatory Pediatrics, Southwestern Medical School, University of Texas Health Science Center, Dallas, TX. Laura Smith McKenna, RN, DNSc. Clinical Specialist in Psychiatric and Mental Health Nursing, Universiry of California ar San Francisco, San Francisco, CA. Ramona T. Mercer, RN, PhD, FAAN. Professor of Family Health Care Nursing, School of Nursing, University of California at San Francisco, San Francisco, CA. J. Ronald Milavsky, PhD. Vice President, News and Social Research, National Broad- casring Company, Inc., New York, NY. o Georgia K. Millor, RN, DNSc. Assistant Professor of Pediatric Nursing, University of Rochester School of Nursrng, Rochester, NY. William Modzeleski. Chief, Family Violence Program, Office for Victims of Crime, Departmenr of Justtce, Washington, DC. Commander Richard C. Moore, Jr., MD, MPH. Chief, Medical Operations Branch, U.S. Coast Guard Headquarters, Washington, DC. Suellen Muldoon. Assistant Director, Human Behavior Deparrmenr, American Medical Association, Chicago, IL. Karin Murray. Policy Coordinator, Office of Family Policy of the Deparrment of Defense, Washington, DC. Toby Myers, EdD. Director, Staff Development/Continuing Education, Houston Inter- national Hospital. Houston, TX. o David Nee. Executive Director, Florence V. Burden Foundation, New York, NY. o Eli H. Newberger, MD. Director, Family Development Program, Children's Hospital, Boston, MA. David M. O'Hara, DASS. Director of Social Work, Kennedy Insritute. Baltimore, MD. 97 K, Daniel O'Leary. PhD. Professor of Psychology, Srate University of New York, Srony Brook, NY. William Oltman. Executive Assistant to the Assistant Attorney General. Office of Justice Programs, Department of Justice. Washington, DC. CR) Frieda Outlaw, RN. Veterans Administration Medical Center, Haverford, PA CR) Barbara Parker, RN. Assistant Professor, Universiry of Maryland School of Nursing, Catonsville, MD. o Delores L. Parron, PhD. Associate Director for Special Populations, Alcohol, Drug Abuse, and Mental Health Administration, USPHS, Rockville. MD. (R) Laurie Anne Pearlman, MA. Psychology Department, Univcrsiry of Connecricut, Storrs, CT. Lee Pearson. Assistant Coordinator, Criminal Justice Services, Amencan Association of Retired Persons, Washington, DC. Charles S. Petty, MD. DIrector, Southwestern Institute of Forensic Sciences, and Chief Medical Examiner of Dallas County, TX. Lt. Rosemary Pezzuto, USCG. Chief, Family Programs SectIon, U.S. Coast Guard Head- quarters, Washington, DC. Karl Pillemer, PhD. Research Scienrist, Family Research Laboratory, Universiry of New Hampshire, Durham, NH. Marie Kanne Paulsen, PhD. Director of Training and Education, Center for Child Development and Developmental Disorders (UAF). Children's Hospital, Los Angeles, CA. (R) Bruce D. Poulter. RN. Staff Office of the Director, National Health Service Corps, USPHS, Rockville, MD. Deborah Prothrow-Stith, MD. Assistant Professor of Medicine, Bosron University School of Medicine, and Attending Physician, Boston Youth Program, Boston, MA. Barbara Rawn. Executive Director, Virginia Chapter, National Committee for the Pre- vention of Child Abuse, Richmond, VA. Robert Ressler. FBI, VICAP, National Center for the Analysis of Violent Crime, FBI Academy, Quantico, VA. Glare Marie Rodgers, RN, CPNP, MSN. Pediatric Nurse Practitioner, Secretary, National Association of Pediatric Nurse Associates and Practitioners, Annapolis, MD. Reymundo Rodriguez. Executive Associate. Hogg Foundation for Mental Health, Ausrin, TX. 98 (R) Helen Rosenberg. Center for Urban Affairs and Policy Research. Northeastern Uni- versity, Evanston, IL. o Mark L. Rosenberg, MD. Chief, Violence Epidemiology Branch, Centers for Disease Control, Atlanta, GA. Sandra Rosswork, PhD. Technical Director, Navy Family Advocacy Program, Department of the Navy Headquarters, Washington, DC. Louis Rowitz, PhD. Professor of Community Health Sciences, University of Illinois School of Public Health, Chicago, IL. Robin Rushton. Legislature Assistant to Senator Paula Hawkins and Professional Staff Member, Senate Subcommittee on Children, Family, Drugs, and Alcoholism, Wash- ington, DC. David A. Rusr. Executive Secretary, Office of rhe Secretary of Health and Human Services, Washington, DC. Susan E. S&sin. Depury Associate Director, Office of State and Community Liaison/ NIMH. Rockville, MD. Jose M. Santiago, MD. Chair, Department of Psychiatry, Kino Communiry Hospital, Tucson, AZ. Douglas A. Sargent, MD, JD. Chair, AMA Advisory Panel on Child Abuse and Neglect, Grosse Point Farms, Ml. Johanna Schuchert. Executive Director, Parents Anonymous of Virginia, Inc., Richmond, VA. Theoharis K. Seghorn, PhD. Associate Administrator, Massachusetts Treatment Center, Bridgewater, MA. o Saleem A. Shah, PhD. Chief, Cenrer for Studies on Anti-Social and Violent Behavior/ NIMH, Rockville, MD. Barbara Shaw. Chair, National Coalirion Against Domestic Violence, Springfield, IL. Lawrence W. Sherman, PhD. Professor of Criminal Justice/Criminology, University of Maryland, College Park, MD. James C. Shine. Vice President, Prosecution Services and Research, American Prosecutors Research Instirute, Alexandria, VA. Jan Sinnott, PhD. Guest Scientist, Gerontology Research Center. Francis Scott Key Med- ical Center. Baltimore, MD. Gloria R. Smith, MPH, PhD. Director, Michigan Department of Public Health, Lansing, MI. 99 Marti H. Speighrs. Family Advocacy Program Coordinaror, Department of the Army, Headquarters, Alexandria, VA. Evan Stark, PhD. Assistant Professor of Health Care Administration, Rutgers University, New Brunswick, NJ. Robert L. Stein 11. Acting Director, Military Family Resources Center, Office of the Assistant Secretary of Defense for Manpower, Reserve Affairs, and Logisclcs, Arlington. VA. Suzanne K. Steinmetz, PhD. Professor of Individual and Family Studies, University of Delaware, Newark, DE. George G. Sterne, MD. Chair, Committee on Early Childhood, Adoption, and Dependent Care, American Academy of Pediatrics, New Orleans, LA. Murray A. Straus, PhD. Director, Family Research Laboratory, and Professor of Socrology, University of New Hampshire, Durham, NH. Harry R. Tanner, MSW. Executive Director, Community Council of Greater Dallas, TX. Robert ten Bensel, MD, MPH. Professor and Director, Program in Maternal and Child Health, Universiry of Minnesota, Minneapohs, MN. Joyce N. Thomas, RN, MPH. Director, Division of Child Protection, Children's Hospital National Medical Center, Washington, DC. (R) Sara Torres, RN. University of Texas, Austin, TX. Major Henry F. Vader, USAF. Family Advocacy Program Manager for the Air Force Surgeon General, Brooks AFB. TX. Leonore Walker, PhD. President and Psychologist, Walker & Associares, Denver, CO. R. pale Walker, MD. Associate Professor and Director of Social and Cultural Psychiatry, University of Washington, Seattle, WA. John B. Wailer, Jr., DrPH. Director, Health Department, Derroit. MI. (R) Priscilla Kiehnle Warner. Center for Urban Affairs and Policy Research, Northwestern Universiry, Evanston, IL. Martin Wasserman, MD, JD. Director, Arlington County Department of Human Services, Arlington, VA. Vicki Weisfeld. Communications Officer, The Robert Wood Johnson Foundation, Prince- ton, NJ. Richardson White, Jr. Research Director, Police Executive Research Forum, Washington, DC. 100 Marvin E. Wolfgang, PhD. Professor and Director, Sellin Cenrer for Studies in Crimi- nology and Crimmal Law. University of Pennsylvania, Philadelphia, PA Bruce A. Woudling, MD. Consulrant, Ambulatory Forensic Medicine, Ventura, CA. o Alan Wurtzel, PhD. Vice President, Broadcast Standards and Practices, American Broadcasting Companies, Inc.. New York, NY. Laura X. Executive Director, National Clearinghouse on Marital Rape-Women's History Research Center, Berkeley, CA. Marlene A. Young, PhD. Executive Director, National Organization for Victim Assist- ance, Washington, DC. 101