Category: Community & Systems Change

Qualitative assessment of interprofessional knowledge gaps in the setting of child physical abuse

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Cleek, E. A., Sheets, L. K., Mersky, J. P., Totka, J. P., & Haglund, K. L. (2025). Qualitative assessment of interprofessional knowledge gaps in the setting of child physical abuse. Wisconsin Medical Journal. Advance online publication. E1-E7.

Abstract

Health care professionals can protect children by identifying and reporting injuries concerning for child physical abuse, such as sentinel injuries (bruising and intra-oral injuries in precruising infants). Citing knowledge and collaboration barriers, health care professionals sometimes fail to recognize sentinel injuries as concerning for abuse. Interprofessional education may be an ideal format to improve health care professional’s responses to sentinel injuries. However, it is traditionally limited to health care professions, while responding to suspected child physical abuse requires collaboration between health care professionals and non-health care professionals. This study’s purpose was to understand if an interprofessional education framework could support the need and development of interprofessional education for child physical abuse beyond health care professions.

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Examining the Strengths and Challenges of a Smart Reentry Program: Lessons Learned

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Romain Dagenhardt, D., Sharif, S., Belasco, E., & Topitzes, J. (2024). Examining the strengths and challenges of a Smart Reentry Program: Lessons learned. Journal of Social Service Research.

Abstract

Although reentry programming has grown, little is known about the process of developing reentry programming that utilizes peer support. Peer support is commonly utilized along side evidence-based practices in other service delivery areas (e.g., mental health), and is increasingly used during reentry, yet little is known about whether this practice is effective at reducing recidivism. This study examines a Smart Reentry program in an urban, Midwestern city. Drawing on 18 interviews with peer guides and family support specialists across two time points, and program participants at one time point, the authors examine the challenges and strengths related to staff training and development, program culture, and participant engagement. Results demonstrate the strengths of a family-centered model of reentry programing, and the challenges of working with the department of correction staff and paraprofessional peer guides within a professional environment. Suggestions are offered for programming utilizing similar models of paraprofessionals.

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Training Master of Social Work Students in Brief Intervention for Unhealthy Alcohol Use: Results of a Validated Adherence Assessment

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Berger, L., Topitzes, J. & Di Paolo, M. (2024). Training master of social work students in brief intervention for unhealthy alcohol use: Results of a validated adherence assessment. Substance Use & Addition Journal, 45(2).

Abstract

Background: Many social workers receive limited training in working with clients engaged in unhealthy substance use. As a result, national organizations and agencies such as the Council on Social Work Education and individual social work programs are beginning to address this need by incorporating training into higher education social work programs. The purpose of this study was to examine Master of Social Work (MSW) students’ adherence to a brief intervention protocol for unhealthy alcohol use.

Methods: A total of 91 MSW students consented to the assessment of their digital, audio-recorded class assignment by independent raters.

Results: Although 90% of MSW student participants were found to be overall adherent to the protocol, gaps in training quality were also identified.

Conclusions: Lessons learned for addressing the gaps are discussed, along with future directions for teaching and learning in social work related to substance use.

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Family treatment courts and the COVID-19 pandemic: Barriers and facilitators to program implementation, client engagement, and recovery

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Romain Dagenhardt, D., Richards, J.,* Liu, X.,* & Mersky, J. P. (2023). Family treatment courts and the COVID-19 pandemic: Barriers and facilitators to program implementation, client engagement, and recovery. Journal of Substance Abuse Treatment, 159, 209278.

Abstract

Introduction

Family Treatment Courts (FTCs) serve child welfare-involved parents with substance use issues who are working toward recovery and reunification with their children. Research has linked FTCs to successful outcomes such as treatment access and completion and family reunification, but there has been less attention to factors that hinder and facilitate program implementation and client engagement. Moreover, little is known about how the shift to virtual services during the COVID-19 pandemic impacted FTC programs and the families they serve.

Methods

This study examined interview data gathered from staff in six FTCs located in different regions of the country to investigate the impact of the pandemic on programs and the clients they serve. Interviews conducted with clients from one FTC in the Midwest reinforce the data.

Results

FTC programs and professionals adjusted to the pandemic by attempting to replicate face-to-face services in an online environment. Virtual services were vital for sustaining FTCs and mitigating barriers to client engagement during the pandemic. At the same time, FTCs were compelled to navigate new barriers to online program implementation as well as acute challenges that clients faced such as greater isolation and reduced treatment access.

Conclusions

We discuss implications from these findings with an eye toward maximizing FTC implementation and impact through the intentional use of both in-person programming and online technology after the pandemic.

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Trauma-Responsive Vocational Rehabilitation Services

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Chopp, S., Topitzes, J., & Mersky, J. P. (2023). Trauma-responsive vocational rehabilitation services. Behavioral Sciences, 13(6), 511.  https://www.mdpi.com/2076-328X/13/6/511

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

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Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study

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Topitzes, J., Bacalso, E., Plummer-Lee, C. T., Jonas-Gordon, S., & Mersky, J. P. (2022). Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study. Journal of Social Service Research, 48(6), 753-767.

Abstract

The current study tested a trauma screening, brief intervention, and referral to treatment (T-SBIRT) interview protocol as implemented within Temporary Assistance to Needy Families programming. Using a non-experimental process evaluation and quasi-experimental outcome evaluation (N = 88), the study assessed four research questions. First, do T-SBIRT providers reach model adherence rates above 90%? Second, do over 90% of T-SBIRT completers experience the intervention as tolerable? Third, is T-SBIRT completion associated with decreases in mental health symptoms? Fourth, is T-SBIRT completion linked to reductions in positive mental health screenings? Process data emerged from provider-completed integrity checklists. Participant-completed baseline and follow-up surveys furnished outcome data, i.e., mental health indicators from validated scales of depression, anxiety, and post-traumatic stress disorder (PTSD). Descriptive statistics answered questions one and two; multivariate analyses addressed questions three and four. Results revealed that providers realized adherence rates at 98.5%; 91.3% of completers found the protocol tolerable; and completers reported significant reductions in depression symptoms, PTSD symptoms, and positive PTSD screenings relative to a comparison group. Findings recommend integrating T-SBIRT into social services to promote participant mental health and potentially enhance program outcomes. Future T-SBIRT research should include a randomized controlled trial assessing long-term mental health, employment, and income outcomes.

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Helping nurses identify and report sentinel injuries of child abuse in infants

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Cleek, E. A., Totka, J. P., Sheets, L. K., Mersky, J. P., Haglund, K. L. (2022). Helping nurses identify and report sentinel injuries of child abuse in infants. Pediatric Nursing Journal, 48(3), 123-128. 

Abstract

Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in premobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses’ knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses’ behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal and interprofessional relationships, and nurses’ understanding of mandatory reporting laws. Nurses may improve their recognition and comfort of reporting SIs and all suspected child abuse by being alert for SIs, being aware of potential implicit biases, communicating in non-technical language with families, understanding the clinical evaluation of suspected child abuse, and understanding the processes of Child Protective Services (CPS). Using these steps, nurses can fulfill their legal and ethical responsibilities to protect and advocate for victimized children.

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Secondary traumatic stress among home visiting professionals

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Janczewski, C. E. & Mersky, J. P. (2022). Secondary traumatic stress among home visiting professionals. Psychological trauma : theory, research, practice and policy. 

Abstract

Objective: This study examined the reliability and factor structure of the Secondary Traumatic Stress Scale (STSS) and the prevalence and correlates of secondary traumatic stress (STS) among home visitors.

Method: Survey data were collected between 2015 and 2020 from 301 home visitors with caseloads. Participants completed the 17-item STSS, which assesses intrusion, avoidance, and arousal symptoms using the DSM-IV-TR diagnostic criteria. Internal reliabilities of the scale and subscales were measured and confirmatory factor analyses were performed to validate hypothesized model solutions. Symptom prevalence among the sample was calculated and linear regressions were conducted to examine whether personal and workplace factors were associated with STS.

Results: Analyses confirmed that the STSS had sound internal consistency and that both 3- and single-factor measurement models fit the data. Approximately 10% of home visitors met the clinical criteria for PTSD, though prevalence decreased to 8% after omitting an intrusion item that was endorsed by most respondents. Increased exposure to adverse childhood experiences and poorer work environment ratings were associated with increased STS. Non-Hispanic White race was associated with elevated arousal symptoms. No other personal or workplace factors were associated with scores on the STSS full scale or subscales.

Conclusion: This study reaffirms that the STSS has sound psychometric properties, but it also raises questions about the prevalence and etiology of STS. Given the likely costs of PTSD to personal well-being and professional efficacy, further research is needed to advance the measurement and prediction of secondary traumatic stress.

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Effects of COVID-19 on Home Visiting Services for Vulnerable Families

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Mersky, J. P., McKelvey, L. M., Janczewski, C. E., & Fitzgerald, S. (2021). Effects of COVID-19 on home visiting services for vulnerable families: A multi-state analysis of enrollment, engagement, and attrition patterns. Families, Systems, & Health.

Abstract

Introduction: COVID-19 has resulted in massive health and economic consequences, with effects felt most acutely by populations that were disadvantaged prior to the pandemic. For families with young children, the effects have been compounded by service interruptions, though there is a lack of empirical evidence that demonstrates how COVID-19 has affected home visiting programs. This cross-state study is the first to examine the effects of the pandemic on home visiting enrollment, engagement, and retention patterns.

Method: Program implementation records gathered from 2017–2020 in Arkansas and Wisconsin were analyzed. Both states operate a large network of home visiting programs that serve predominantly low-income families and that are supported by the federal Maternal, Infant, and Early Childhood Home Visiting program. Trends prior to COVID were compared to post-COVID trends (March 12 to December 31, 2020) in program enrollments, service capacity, visitation frequency, service modalities, attrition rates, and service duration.

Results: Compared to average pre-pandemic enrollments from 2017–2019, post-COVID enrollments decreased by 33–36%. Total visits fell by 15–24%; the percentage of completed visits relative to expected visits declined more modestly. However, the average duration of services increased post-COVID while rates of early program dropout decreased.

Discussion: The findings suggest that enrollment and engagement in home visiting decreased during the COVID-19 pandemic, which is unfortunate given the large number of vulnerable families served nationwide. Further research is needed to examine how COVID affected both consumer and program behaviors.

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Increasing mental health treatment access and equity through trauma-responsive care

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Mersky, J. P., Topitzes, J., Langlieb, J., & Dodge, K. A. (2021). Increasing mental health treatment access and equity through trauma-responsive care. American Journal of Orthopsychiatry.

Abstract

Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers—disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care.

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Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project

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Romain Dagenhardt, D., Mersky, J.P., Topitzes, J., Schubert, E., & Krushas, A. (2021). Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project. Journal of Interpersonal Violence.

Abstract

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

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A brief measure of workplace environment for health and human service professionals

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Janczewski, C. E., Mersky, J. P., & Plummer Lee, C. (2021). A brief measure of workplace environment for health and human service professionals. Human Service Organizations: Management, Leadership & Governance.

Abstract 

Organizational characteristics are important predictors of workplace outcomes, but the length and complexity of validated instruments restrict their use in research and practice. This study tested a brief Measure of Work Environment (MWE) using data from 718 child welfare and 349 home visiting professionals. Results confirmed a three-factor structure: group cohesion, leadership support, and organizational justice. The MWE demonstrated acceptable internal consistency (α = .87) and was significantly associated with job satisfaction, burnout, and intent to leave. The MWE is a promising, pragmatic measure of organizational environment for implementation research and program improvement.

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Tool available here

A mutual process of healing self and healing the community

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Mueller, D., Bacalso, E., Ortega‐Williams, A., Pate Jr, D. J., & Topitzes, J. (2021). A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city. Journal of Community Psychology.

Abstract

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community‐based resources, and addressed structural and systemic barriers. The data generated a theory of “a mutual process of healing self and healing the community” through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer‐led, community‐engaged initiatives and holistic, trauma‐informed, healing‐centered practices.

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Translating and Implementing Evidence-Based Mental Health Services in Child Welfare

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Mersky, J.P., Topitzes, J., Janczewski, C.E., Plummer Lee, C., McGaughey, G., & McNeil, C.B. (2020). Translating and Implementing Evidence-Based Mental Health Services in Child Welfare. Adm Policy Ment Health.

Abstract

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent–child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children’s mental health research, services, and policy are discussed.

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Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency

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Topitzes, J., Grove, T., Pangratz, S, Meyer, E. E., & Sprague, C. M. (2019). Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency. Journal of Child Custody.

Objective
Trauma-informed or trauma-responsive programming has spread across many service sectors including child welfare. However, only a few evaluations of such child welfare programs have been published.

Method
The current mixed methods study assessed a trauma-responsive child welfare program implemented within a private agency located in the Midwest region of the U.S. The intervention combined specialized training, assessment, case planning, and case consultation into a trauma-responsive case management model.

Results
Quantitative data, gathered through a quasi-experimental design (N=598), revealed that program participation was associated with improved permanency but not with enhanced child safety. Qualitative data, gathered from staff interviews (N=10), helped to contextualize quantitative results, highlighting staff experiences and impressions of the program. Implications of results are discussed.

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Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting

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Janczewski, C. E., Mersky, J. P., & Brondino, M. J. (2019). Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting. Prevention Science, 1-11.

Abstract

Most evidence-based home visiting models are designed to support families from pregnancy through a child’s second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.

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What’s So Different About Differential Response? A Multilevel and Longitudinal Analysis of Child Neglect Investigations

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Janczewski, C.E., Mersky, J.P. (2016). What’s so different about differential response? A multilevel and longitudinal analysis of child neglect investigations. Children and Youth Services Review.

Objective
Differential response (DR) is a system reform that allows child protective services (CPS) agencies to divert low-to-moderate risk families from an investigative track to an alternate track that does not require a maltreatment disposition or identification of an alleged perpetrator. Knowledge of how DR alters the flow of cases through CPS systems has been restricted by methodological limitations in prior research.

Method
This study uses cross-sectional and longitudinal data from the National Child Abuse and Neglect Data System (NCANDS) child file to examine the extent to which DR implementation affects the number and demographic composition of cases investigated for neglect.

Results
Results from multivariate, multilevel cross-sectional analysis of 2010 data indicated that investigations were 2.4 times more likely to be substantiated in DR counties than in non-DR counties. Children with a previous substantiated report were also more likely to have a current report substantiated and this difference was significantly greater in DR counties than in non-DR counties. Child race and ethnicity did not predict substantiation decisions. Results from a mixed-effect longitudinal analysis of 997,512 cases from 269 counties between 2001 and 2010 suggest that the rate of investigations fell sharply nationwide within three years of DR implementation. However, substantiation rates did not change as a result of DR implementation. Instead, analysis indicated differences between DR and non-DR counties emerged before the launch of DR.

Conclusion
The findings highlight the benefit of using “big data” and longitudinal analysis to assess large-scale policy changes.

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The Influence of Differential Response on Decision-Making in Child Protective Service Agencies

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Janczewski, C.E. (2015). The influence of differential response on decision-making in child protective service agencies. Child Abuse and Neglect.

Objective
Differential response (DR) profoundly changes the decision pathways of public child welfare systems, yet little is known about how DR shapes the experiences of children whose reports receive an investigation rather than an alternate response. Using data from the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between DR implementation and decision outcomes in neglect cases, as measured by investigation, substantiation, and removal rates in 297 U.S. counties.

Method
Multivariate regression models included county-level measures of child poverty and proportions of African American children. Path analyses were also conducted to identify mediating effects of prior decision points and moderating effects of DR on poverty and race’s influence on decision outcomes.

Results
Results indicate that compared to non-DR counties, those implementing DR have significantly lower investigation and substantiation rates within county populations but higher substantiation rates among investigated cases. Regression models showed significant reductions in removal rates associated with DR implementation, but these effects became insignificant in path models that accounted for mediation effects of previous decision points. Findings also suggest that DR implementation may reduce the positive association between child poverty rates and investigation rates, but additional studies with larger samples are needed to confirm this moderation effect. Two methods of calculating decision outcomes, population- and decision based enumeration, were used, and policy and research implications of each are discussed.

Conclusion
This study demonstrates that despite their inherit complexity, large administrative datasets such as NCANDS can be used to assess the impact of wide-scale system change across jurisdictions.

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From Child Maltreatment to Violent Offending: An Examination of Mixed-Gender and Gender-Specific Models

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Topitzes, J., Mersky, J.P., Reynolds, A. (2012). From child maltreatment to violent offending: An examination of mixed-gender and gender-specific models. Journal of Interpersonal Violence.

Objective

Research suggests that child maltreatment predicts juvenile violence, but it is uncertain whether the effects of victimization persist into adulthood or differ across gender. Furthermore, we know little about the mechanisms underlying the victim–perpetrator cycle for males and females. Consequently, this study analyzed associations between child maltreatment and a number of adult measures of violent offending within mixed-gender and gender-specific models. Along with main effects, the study directly tested the moderating effects of gender on the maltreatment–violence link and analyzed theory-informed gender-specific mediators.

Method

Data were derived from the Chicago Longitudinal Study, a panel investigation of 1,539 low-income minority participants born in 1979 or 1980. Child welfare, juvenile court, and criminal court records informed the study’s explanatory and outcome measures. Prospectively collected covariate and mediator measures originated with parent, teacher, and self-reports along with several administrative sources.

Results

Results indicated that child maltreatment, ages 0 to 11, significantly predicted all study indicators of violence in the full sample and most study outcomes in the male and female subsamples. In no instance did gender moderate the maltreatment–violence association. Late childhood/early adolescence environmental instability, childhood externalizing behaviors, and adolescent peer social skills fully mediated the maltreatment–violence nexus among males. Adolescent externalizing behavior partially mediated the relationship of interest among females. Evidence also indicated that internalizing processes protected females who had been maltreated in childhood against perpetrating violence later in life.

Conclusion

Implications of results are discussed.

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Crafting the Greenbook: Framers Reflect on the Vision, Process, and Lessons Learned

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Janczewski, C.E., Dutch, N., Wang, K. (2008). Crafting the Greenbook: Framers Reflect on the Vision, Process, and Lessons Learned. Journal of Interpersonal Violence.

Guided by research and the experiences of judges nationwide, the National Council of Juvenile and Family Court Judges made a commitment in 1998 to improve community response to families experiencing domestic violence and child maltreatment.

A year later, the council’s work culminated in a set of recommendations commonly called the Greenbook, which summoned child welfare agencies, domestic violence service providers, and dependency courts to implement internal changes and collaborate to address co-occurring domestic violence and child maltreatment.

In 2000, the federal government funded six community-based demonstration programs to implement the Greenbook recommendations. As part of the evaluation of the Greenbook initiative, the evaluation team asked the national experts who helped frame the Greenbook to reflect on the processes used and the decisions that shaped the document. In addition, the experts were asked to describe their expectations for the systems and communities that implemented the recommendations, including anticipated challenges.

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