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Making the Case for Domestic Violence Prevention Through the Lens of Cost-Benefit

A Manual for Domestic Violence Prevention Practitioners
(and the State and Local Policy-Makers They Present to)


Appendix A: Glossary of Terms

Unless noted otherwise, these definitions were drawn from the glossaries of: 1) Outcome Evaluation Strategies for Domestic Violence Programs by Cris M. Sullivan, Ph.D., Pennsylvania Coalition Against Domestic Violence, 1998; and 2) Evaluation Handbook for Community Mobilization: Evaluating Domestic Violence Activism by Transforming Communities, Marin Abused Women’s Services, 2000.   

Aggregate data - The combined or total responses from individuals.

Anonymous - Unknown person. In the case of outcome evaluation, this means you do not know who the responses to questions came from (e.g. unsigned questionnaires or surveys).

Baseline measurement - The specific description of conditions before a campaign or project is started.

Causality - The linking of a cause and its effect, or in the case of cost-effectiveness and cost-benefit analysis, the program and its cost-effectiveness or benefit.

Closed-ended question - A question with a set number of responses from which to choose.

Collaboration - Involves working cooperatively to achieve a common goal. Activities may include exchanging information, identifying and addressing problems in the provision of services, promoting good practice and awareness, sharing resources, and enhancing the capacity of one another for mutual benefit and to achieve a common purpose. (Enhancing Collaboration: Increasing Action in Preventing Domestic Violence in California Workbook, TC-TAT, funded by the California Department of Health Services, 2004.) 

Common metric - The same measure. When a common metric for inputs and outcomes is used for programs or program components, these can be compared and ranked. For example, when both the dollar cost of the program and the dollar value of the outcome of the programs are quantified, one can say that programs or components with the lowest cost per unit (outcome) are the most efficient.

Community - A group of people, joined either by geographic location (such as city, county, or neighborhood) or some other common characteristic (such as profession, ethnicity, or sexual orientation), who self-identify as belonging to the same group and share some common concerns for the well-being of the collective. 

Community based campaigns - Use participatory methods to develop and enact a series of interrelated events for the prevention of violence, such as involving community members in organizing marches or demonstrations, creating local theatre productions highlighting issues around violence, development of community support or action groups that may campaign for legal changes, or other activities. (Sethi, D., et al. Handbook for the Documentation of Interpersonal Violence Prevention Programmes. Department of Injuries and Violence Prevention, World Health Organization, Geneva, 2004.)

Comparison group - Any group that is not directly involved in your prevention program, and can provide a valid and important comparison to what is happening in your prevention program. 

Comparative cost-effectiveness analysis (CEA) - Basically, all CEA, and its subset, CBA, looks at the cost of a program and of its components, and then at the program’s outcomes in terms of benefits or lack of benefits. Reviewing a single program in this way is a cost-effectiveness analysis, while comparing two programs is a comparative CEA/CBA. A comparative CEA can be used to assist policy-makers to choose which social programs to support.

Confidential - In the case of outcome evaluation, this means you do know (or can find out) who the responses came from, but you are committed to keeping this information to yourself. (For example, a woman who participates in a focus group is not anonymous, but she expects her responses to be kept confidential.)

Continuum of abuse - Violence can take several forms and exists along a continuum from emotional abuse to verbal abuse to physical abuse, with other forms of abuse, including financial, spiritual and sexual abuse, being frequently linked. Non-physical forms of abuse often accompany and even set the stage for physical abuse. This continuum of abuse also is indicative of the social and cultural norms that allow the abuse of power and control in domestic and intimate partner behaviors.

Control group - Like a comparison group, a control group provides a valid and important point of comparison to what is happening in group directly affected by the prevention effort. However, a control group is more rigorously “controlled” and monitored to ensure that no overlap or involvement with the prevention effort occurs. We usually reserve the term “control group” for certain rigorous research designs.

Cost - a) The spending of money, energy, resources, or time required to make something happen. The cost of a prevention program is usually described in dollars that pay for employee salaries, office rent, supplies, and other things required to make the program happen. These are also called inputs. b) The economic and other effects of a problem on individuals and society.

Cost analysis - A thorough description of the type and amount of all resources used to produce a (prevention) program. Cost analyses are critically important for deciding how to allocate funds within a program and for understanding the relationships between costs and outcomes. Examining cost figures for the program as a whole (or for parts of it) is a basic form of cost analysis. Most accounting services provide cost analyses in the form of a monthly or quarterly report. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

Cost-benefit - Points to the relationship between program costs and program benefits. To say that a program is generally cost-beneficial is to say that a program has both accomplished its goals (it is an effective program) and that accomplishing these goals is a good use of that money.

Cost-benefit analysis (CBA) - When both costs and outcomes are measured in monetary terms, costs and benefits can be compared between programs or contrasted within a single program. Cost-benefit analysis can also discover whether program expenditures are less than, similar to, or greater than program benefits. (Ibid.)

Cost-effectiveness - Points to the relationship between program costs and program effectiveness or outcome. Costs are measured as dollars spent, whereas effectiveness or outcome is measured as changes in knowledge, beliefs, behaviors, policies, and other practices related to domestic violence and its prevention. 

Cost-effectiveness analysis (CEA) - A cost-effectiveness analysis (CEA) compares the costs and benefits of a program to assess whether it is worth doing from the economic perspective. (Ibid.) Something that is cost-effective achieves relatively high gains for relatively low costs.

Cost estimates - Educated guesses of costs based on data.

Cost ratios - Total cost divided by outcome. For example, if a program component costs $1000 and serves 100 people, the cost ratio is $1000 divided by 100 or $10 per person.

Cultural competency - Sensitivity to cultural differences, as well as a commitment and ability to act in ways that constructively integrate this awareness into all programming and activities.

Cumulative effect - an impact or result that increases in force or value by successive additions. When analyzing a domestic violence prevention program, one might see that a program had a cumulative effect on the cost of domestic violence to the community, beginning to register only after the program had been in operation for two years, and showing an increase in effect per year after it had been in operation for three years.

Data - Information collected in a systematic way that is used to draw conclusions about process or outcome. {Note: Data is plural for datum (a single piece of information), which is why, when presenting results, sentences should read, “The data were collected: instead of “The data was collected.”}

Data set - A grouping or collection of information that is compiled for research purposes, consisting of multiple elements that are assigned specific meaningful values. Data sets are gathered through such data collection tools as surveys, questionnaires, interviews, or a review of records. The information collected into a data set is usually assigned number values and organized electronically into a table. This allows researchers to analyze the data and run statistical tests in order to draw conclusions about relationships between elements, or variables. (Data Sets On & Related to Violence Against Women, National Resource Center on Domestic Violence, www.vawnet.org/DomesticViolence/Research/OtherPubs/VAWDataSets.php.)

Decreasing value of benefits -- The decreasing value of benefits attained in the distant future can be calculated as the present value of benefits. When most of the cost of prevention occurs in the first year of a program but most benefits occur only several years after the program, the value of those delayed benefits needs to be adjusted (decreased) to reflect the delay. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

Demographic data - Background and personal information (such as age, ethnicity, and socioeconomic status) gathered for evaluation or statistical purposes.

Direct costs - An amount paid or the expenditure of something, such as time or labor.  The direct costs that result from acts of violence may include, for example, the cost of medical care for victims; the costs of involving law enforcement in domestic violence cases; legal costs; and the costs of sheltering victims and incarcerating perpetrators, among other costs. The direct costs of a prevention program may include salaries; office space; and program costs. 

Domestic violence - Also called Intimate Partner Violence (IPV). Violence committed by a spouse, ex-spouse, or current or former boyfriend or girlfriend. It can occur among heterosexual or same-sex couples and is often a repeated offense. (Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA, 2003.)

Domestic violence coordinating council (DVCC) - Also known as domestic violence councils, task forces or committees, DVCCs have been formed in many communities to provide a forum for interagency communication and collaboration.

Effectiveness - The extent to which a specific activity, intervention, or service does what it is intended to do for a defined population. (Sethi, D., et al. Handbook for the Documentation of Interpersonal Violence Prevention Programmes. Department of Injuries and Violence Prevention, World Health Organization, Geneva, 2004.)

Efficiency - The extent to which resources (financial, human, physical or time) that are used to provide a specific intervention or service of known efficacy and effectiveness are minimized. (Ibid.)

Evaluation - A methodical way of gathering, analyzing and reporting the results of our work with the intent of improving our work.

Evaluation design - A blueprint, strategy, or outline to answer questions about a program. Includes a clear statement about the purpose and plans for gathering, processing, and interpreting the information needed. (An Evaluation Framework for Community Health Programs, The Center for the Advancement of Community Based Public Health, Durham, NC, 2000, p. 63.)

Fishman table - A table that presents (a) the ways in which two programs can differ or be similar to each other in outcomes and costs and (b) the cost-outcome decisions that result. This table is called a Fishman table in honor of the researcher who first applied this table to cost-outcome analysis. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

General cost-benefit approach - A technique that assumes a broad, societal perspective and tries to count all measurable costs and all measurable outcomes, no matter to whom they accrue.

Incidence - The number of separate episodes of IPV that occurred among U.S. women ages 18 and older during the 12 months preceding the survey. For IPV, incidence frequently exceeds prevalence because IPV is often repeated. In other words, one victim (who is counted once under the prevalence definition) may experience several victimizations over the course of 12 months (each of which contributes to the incidence count). (Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA, 2003.)

Indicators - Factors that show something key about underlying knowledge, attitudes, or beliefs, or that demonstrate something important about behavior. Indicators are important signs to monitor in order to evaluate progress toward goals.

Indirect costs - Amounts that must be paid by an organization or by society in general that do not appear to have a direct linkage with an incident or program. For example, some of the indirect costs that result from domestic violence may include lost wages or reduced worker productivity because a victim is not able to work due to the domestic violence, or higher insurance premiums a business must pay to cover a victim’s health care costs. Indirect costs for a prevention program may include overhead or shared costs; this is particularly important in figuring costs of a single program in a much larger organization.

Initial investment - The beginning cost of a (prevention) program.

Inputs - Everything that is contributed to a program to make the program happen, such as salaries, rent, supplies, volunteer hours, and other inputs.

Intangible costs - Costs that cannot be defined or determined with certainty or precision. For example, in cases of domestic violence, intangible costs to the individual victim and the victim’s family may include long-term mental, physical and emotional trauma, later loss of life, and reduced or deteriorating quality of life. Intangible costs to society include costs borne by businesses, the health care system, schools, law enforcement, and other institutions that provide services or are in some way affected by the domestic violence.

Intervention - Sets of actions and decisions structured in such a way that their successful implementation would lead to clearly identifiable outcomes and benefits. (Sethi, D., et al. Handbook for the Documentation of Interpersonal Violence Prevention Programmes. Department of Injuries and Violence Prevention, World Health Organization, Geneva, 2004.)

Integrated community response - A holistic approach to domestic violence prevention that acknowledges that domestic violence is systemic and requires a coordinated response from many different social institutions. In most communities, an integrated community response means bringing together a wide range of individuals and organizations to create a vision and plan for domestic violence prevention.

Intimate partner violence (IPV) - IPV includes rape, physical assault, and stalking perpetrated by a current or former date, boyfriend, husband, or cohabiting partner, with cohabiting meaning living together as a couple. Both same-sex and opposite-sex cohabitants are included in the definition. 

Logic model - A logic model describes the sequence of events for bringing about change by synthesizing the main program elements into a picture of how the program is supposed to work. Often, this model is displayed in a flow chart, map, or table to portray the sequence of steps leading to program results. A logic model summarizes the program’s overall mechanism of change by linking processes to eventual effects. (Framework for Program Evaluation in Public Health, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Atlanta, GA, 1999, p. 9.) 

Lost productivity - Diminished quality and/or quantity of work. Lost productivity means that anyone experiencing domestic violence is at risk of working under par while on the job, missing work, and even losing a job. That person’s employer will feel the effects of the diminished quality and/or quantity of work being produced.

Measurement instrument - Also called “measure” or “instrument,” this is the tool used to collect the data. Questionnaires, face-to-face interviews, and telephone interviews are all measurement instruments.

Mean - The “average” response, obtained by adding all responses to a question and dividing by the total number of responses.

Measurability complex - Using short- or long-term outcomes that are difficult to define and measure.

Measurability simple - Using short- or long-term outcomes that are easy to define and measure.

Media campaigns - Community-wide public information campaigns for the prevention of domestic violence aim to increase knowledge, raise awareness and change attitudes and violent behavior at the community level by giving educational messages to the community via mass media (e.g. television, radio, posters, internet, newspapers). Some initiatives have incorporated messages within popular radio or television dramas. (Sethi, D, Marais S, Seedat M, Nurse J, Butchart A. Handbook for the Documentation of Interpersonal Violence Prevention Programmes. Department of Injuries and Violence Prevention, World Health Organization, Geneva, 2004.)

Median - The “middle” response, obtained by choosing the score that is at the midpoint of the distribution. Half the scores are above the median, and half are below. In the case of an even number of scores, the median is obtained by taking the mean (average) of the two middle scores.

Narrow cost-benefit approach - A technique that assumes a very focused perspective and purposefully ignores some costs and outcomes when these are not seen as relevant to a particular analysis. While narrower approaches to CBA present the problem of selecting which outcomes are to be measured, they can also show a more precisely measurable linkage between program activities and program outcomes.

Net benefit - The net benefit of a program can be shown by subtracting the costs of a program from its benefits. For example, if a substance abuse treatment program costs $100,000 per year but generated in the same year $500,000 in increased patient income, increased tax payments by patients, and reduced expenditures for social and criminal justice services, the net benefit of the program would be $500,000 minus $100,000, or $400,000 for that year. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

Open-ended question - A question that invites a reply from the respondent in her own words; one without set responses.

Outcome - An end (intended or unintended) result of a program on the individual, family or community.   These describe what changed as a result of the service or intervention provided.  These generally include a reduction in a problem or need, accomplishment of goals or improvement in a condition, but can also include community-level and systems changes. (Outcomes in Action:  A Handbook for Using Outcomes in the Human Services, by Harder+Company Community Research, San Francisco, CA, 1996.) For purposes of evaluation, this needs to be a result that can be observed and measured.

Outcome evaluation - Assesses the measurable impact your program is having. Short-term outcomes focus on questions such as: What effects did the program have? Can the effects be attributed to the program? Did program participants’ knowledge and behaviors change as a result of the program? Long-term outcomes focus on things like health status, injury (morbidity), death (mortality), or systems changes. Outcome evaluation questions may include: What change in injury or death occurred because of the program? What is the current prevalence or incidence of domestic violence? (An Evaluation Framework for Community Health Programs, The Center for the Advancement of Community Based Public Health, Durham, NC, 2000, p. 11.)

Present value of benefits - The decreasing value of benefits attained in the distant future can be calculated as the present value of benefits. When most of the cost of a prevention program occurs in the first year or few years of the prevention program but most benefits occur only several years or decades later, the value of those delayed benefits needs to be adjusted (decreased) to reflect the delay. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

Prevalence - The number of U.S. women ages 18 and older who have been victimized by an intimate partner at some point during their lifetimes (lifetime prevalence) or during the 12 months preceding the survey. (Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA, 2003.) 

Prevention of violence - A public health approach that targets the root causes and risk factors underlying the likelihood of an individual becoming involved in violence and recognizes the need for improved services to mitigate the harmful effects of violence when it does occur. (Violence Prevention Alliance, http://www.who.int/violenceprevention/en/.)

Primary prevention - Taking action to prevent problems such as abuse and violence before they occur. Examples of primary domestic violence prevention are teaching youth about healthy relationships (ideally even before they start dating); parenting training; and the training of health professionals or teachers in how to prevent domestic violence.

Process evaluation - Assesses the degree to which your program is operating as intended.

Qualitative data - Information gathered in an “open-ended” fashion where the respondent has the opportunity to provide details in her own words.

Quantitative data - Information gathered in a structured way that can be categorized numerically. (For example, quantitative data can be collected through questionnaires and interviews, with response categories that can be checked off or circled).

Ratio of benefits to costs - Indicates the relationship between positive results of a program and how much the program costs. This ratio is found by dividing total program benefits by total program costs. For example, dividing the $300,000 benefit of a program by its $150,000 costs yields a cost-benefit ratio of 2:1.

Risk factor - An attribute or exposure that is associated with an increase in the probability of a specified outcome (e.g. experiencing or perpetrating interpersonal violence). Risk factors are not necessarily causal. Examples of risk factors include: male gender, young age, alcohol and carrying weapons. (Sethi, D., et al. Handbook for the Documentation of Interpersonal Violence Prevention Programmes. Department of Injuries and Violence Prevention, World Health Organization, Geneva, 2004.)

Sample - A subset of the whole. When there is too much data to look at all of it, or it is not possible to collect data about a whole group of people or situations, then often we look at a sample, or subset. The more representative a sample is of the whole population, the more likely that the information it gives you will be reliable.

Secondary prevention - Program activities intervening immediately after the violence occurs that include steps to decrease the likelihood that the violence will recur. Having an abused person become safe by going to a shelter after a violent event is an example of secondary prevention. This is also considered intervention.

Spectrum of prevention / spectrum of community change - A framework that identifies multiple levels on which prevention efforts take place. These levels are complementary and when used together produce a synergy that results in greater effectiveness than would be possible by implementing any single activity. (Originally developed by Larry Cohen while he was director of the Contra Costa Health Services Prevention Program, the Spectrum is based on the work of Dr. Marshall Swift in treating developmental disabilities. It has been used nationally in many prevention initiatives. For more information, see: www.preventioninstitute.org.) At Transforming Communities, we have expanded the spectrum of prevention into a spectrum of community change. This includes two new levels: Cross-Sector Collaboration and Mobilizing Communities and Neighborhoods. 

Stakeholders - People who have an interest in your program or initiative. Stakeholders may include staff and board of directors of your organization; program participants; funders and policy-makers interested in your issue; and other constituents (members of your community who benefit from your program).

Standardization of measures - A technique to make measures (such as costs, benefits, or outcomes) uniform to allow for comparison among programs or program components.

Statistical significance - When used by researchers, the word significance refers not to the importance or size of the difference, but to the likelihood that the associations are real and not simply due to chance.

Sustainability - The measure of a program’s characteristics which can remain in existence for as long as necessary and appropriate. The long-term sustainability of prevention programs has to do with longevity and program impact.

Tertiary prevention - Program activities that occur over time, well after the violence begins, and include rehabilitation efforts, such as batterers’ intervention and treatment or working with survivors to address the long-term effects of violence. This is also considered intervention.

Theory (big “T”) - A cohesive set of ideas about why a problem exists and how a change can be created, which has been named, tested, published and applied.

Theory (little “t”) - Well-thought-out ideas and concepts related to our work, which usually arise out of a mix of experience, research, and discussions with co-workers and community members.

Theory of cause - Why you believe a problem exists; describes the specific factors that have led to the problem that a program seeks to prevent or reduce.

Theory of change - Why you believe your actions will lead to a desired change; shows the logical pathway of what a program does to prevent or reduce a problem by naming clear outcomes (early, intermediate, and long-term) and the action strategies that lead to the achievement of those outcomes.

Time to return on investment -- The time it takes for program benefits to equal program costs -- yet another indicator used in cost-benefit analysis. For programs, measured benefits and costs tend to occur close to the same time, or at least in the same few years. For individuals, however, the investment in prevention may pay off substantially only after several months, years, or decades. Costs usually occur up front, but the program benefits which can be measured in dollar values may take time to reach the point where they exceed program costs. (Yates, B.T. Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, National Institute on Drug Abuse, 1999.)

Victimization rate - The number of incidents of Intimate Partner Violence involving U.S. women ages 18 and older per 1,000 women in that population. The population estimate used in the CDC report is the U.S. Census Bureau’s projection of 100,697,000 women ages 18 and older in 1995. (Costs of Intimate Partner Violence Against Women in the United States, Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA, 2003.)