Intervention for Children Exposed to Interparental Violence (IPV): Assessment of Needs and Research Priorities

In this paper we review the development of interventions for children who have been exposed to interparental violence (IPV), assess current needs in the evaluation of interventions, and provide suggestions for research priorities in this area. Interventions for negative outcomes associated with exposure to IPV only recently have been carefully designed and evaluated, thus knowledge regarding program effectiveness is minimal. Three of the most comprehensive interventions that have been evaluated are presented. Each has demonstrated effectiveness, and focuses on children with different levels of symptoms and distress. However, many questions remain regarding which interventions are beneficial for diverse children with different kinds and intensities of problems. A number of research priorities and suggestions for further improvements in the evaluation of effectiveness of interventions are identified.     

Children Exposed to Community Violence: The Rationale for Early Intervention

Children are exposed to violence in their homes and communities at extraordinarily high rates. Given the alarming rates of exposure and its known impact on child developmental outcomes, crisis intervention geared at interrupting the negative effects of violence exposure are increasingly important. This review provides a rationale for the implementation of early and crisis intervention strategies for children exposed to community violence and recommends principles for applying these interventions. These principles are based on the body of research concerning risk and protective factors for children who have been exposed to violence. Relevant factors are reviewed and recommended principles are explicated that correlate to these factors. Issues concerning developmentally informed crisis intervention, support of parental executive functioning, and the need for active community partnership to help ameliorate risk factors are highlighted.     

Assessment and Intervention for PTSD in Children Exposed to Violence

Summary

Recent research has established that exposure to domestic violence is a major risk factor for posttraumatic stress disorder (PTSD) in children. However, one issue that has been relatively neglected in research conducted to date concerns developmental differences: both in the expression of PTSD symptoms across childhood and adolescence, and in the techniques appropriate for assessing and intervening with PTSD in children at different ages. The available literature is reviewed concerning the conceptualization, measurement, and treatment of PTSD in children, with special attention to the case of children of battered women. Guidelines are provided for developmentally sensitive approaches to assessment and treatment.     

Next Steps in Research on Children Exposed to Domestic Violence

The papers in this special issue of Clinical Child and Family Psychology Review provided an overview of what is known about children's exposure to domestic violence, and include indications of gaps in extant research. These gaps and research needs are summarized in this conclusion. Specifically, there is need for further research in several broad areas: definition and measurement of children's exposure to domestic violence; development of research methods and statistical designs that provide detailed information and provide for evidence of intervention effectiveness; impact of domestic violence on parenting and family functioning; the role of child factors and exposure to violence factors in predicting developmental risk and resilience; medical and health consequences of exposure to violence; and the nature of child-system interaction in response to domestic violence. Research needs in these areas are discussed in greater detail, and specific questions are raised for further development.     

Prevalence of Child and Adolescent Exposure to Community Violence

Emerging as one of the most significant health issues facing American youth today, child and adolescent exposure to community violence has generated much interest across multiple disciplines. Most research to date has focused on documenting the prevalence of community violence and the emotional and behavioral ramifications. This paper provides an overview of the current literature regarding prevalence of youth exposure to community violence, and identifies those areas where further research is warranted. In addition to examining overall rates of community violence exposure, this paper reviews the prevalence of different types of community violence, such as weapon use, physical aggression, and crime-related events. Predictors of community violence exposure, including gender, age, race, socioeconomic status, behavior patterns, and geography, are discussed.     

Predictors of Treatment Engagement for Young Children Exposed to Violence

This study examined factors associated with treatment engagement and child outcomes in 1,365 children receiving community-based services for exposure to violence. Data were collected on children and families who completed an intake interview. Children were categorized into groups based on whether they attended any therapy sessions after the intake, terminated prematurely from therapy, or completed treatment. Results demonstrated that child emotional and behavioral problems at intake, general parent stress, and income did not differ by treatment engagement. Type of violence exposure, parent–child stress, and race differed by category of treatment engagement. Strategies from Safe From the Start service providers to increase treatment engagement are included in the discussion.     

Impact of Exposure to Community Violence on Anxiety: A Longitudinal Study of Family Social Support as a Protective Factor for Urban Children

In a longitudinal study, we examined the relationship between exposure to community violence and anxiety, and the extent to which family social support moderated this relationship within a predominantly African American sample of 385 children in an urban public school system. Children reported notably lower anxiety levels compared to normative data for African American children. A high percentage reported witnessing a variety of violent acts. Cross-sectional results indicated that among girls exposure to violence was significantly correlated with total, physiological, and concentration anxiety. Among boys violence exposure was not associated with anxiety. Hierarchical regression analyses indicated that after controlling for gender, exposure to violence at Time 1 did not significantly predict changes in anxiety. A significant interaction was found for gender and exposure to violence on concentration anxiety; girls who reported higher initial violence exposure reported greater increases in subsequent concentration anxiety than boys. Whereas findings from our study did not support a moderating relationship of family social support on children's exposure to violence and anxiety, a strong negative relationship was found between anxiety and family support. Among children with initially low worry anxiety, those with low family social support showed greater increases in subsequent worry anxiety.     

Posttraumatic Response and Children Exposed to Parental Violence

Summary

In this article some of the literature on children's responses to natural and person-created trauma are discussed. In addition, data relevant to children's posttraumatic response as a result of exposure to interparental violence are presented. Using a factor analytic procedure, the study attempted to examine how the DSM-IV symptom clusters for Posttraumatic Stress Disorder come together for this sample of children. General suggestions are made regarding possible intervention with exposed children experiencing posttraumatic symptoms.     

Exposure to Community Violence: Defining the Problem and Understanding the Consequences

Exposure to community violence has emerged as a major risk factor for the development of emotional and behavioral problems in children and adolescents. In the past decade, there has been a proliferation of research within the fields of medicine, sociology, and psychology documenting the rates and consequences of exposure to community violence. This interdisciplinary growth has led to a great deal of variability within the field of exposure to community violence, making it difficult to glean general conclusions regarding rates and impact of exposure. This review advances the current understanding of exposure to community violence by integrating findings across disciplines as well as reviewing the few studies that have provided initial explanatory information regarding mediators and moderators of the relationship between exposure to community violence and its associated outcomes.     

Legal and Policy Responses to Children Exposed to Domestic Violence: The Need to Evaluate Intended and Unintended Consequences

Greater training and specialization in working with children exposed to domestic violence has resulted in new policies, interagency protocols, and legislation in many states. This paper examines court-related responses in criminal, child protection, and family court custody proceedings, which highlight legislative changes and resulting systemic change. Although this legislation originated with the best of intentions to assist and protect children, some of the most striking outcomes have been negative and unintended. Laws that mandate reporting of children exposed to domestic violence can clash with inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody legislation that raises a rebuttable presumption that a violent spouse will not receive custody or joint custody of children after parental separation has resulted in greater skepticism about abuse allegations. We propose that efforts at law reform can be enhanced by a more thoughtful analysis of potential intended and unintended consequences, and should be accompanied by a comprehensive evaluation plan to monitor implementation effects.     

Next Steps in Research on Children Exposed to Community Violence or War/Terrorism

The articles in this special issue of Clinical Child and Family Psychology Review provide an overview of what is known about children's exposure to community violence and war/ terrorism, and indicate significant gaps in extant research. These gaps and research needs are summarized in this conclusion.     

Development and Validation of the Screen for Adolescent Violence Exposure (SAVE)

Empirical evidence was provided on the utility of the Screen for Adolescent Violence Exposure (SAVE) in assessing adolescent exposure to school, home, and community violence. The SAVE was empirically developed on 1,250 inner-city adolescents, and obtained excellent reliability and validity. Both exploratory and confirmatory factor analyses identified three factors: Traumatic Violence, Indirect Violence, and Physical/Verbal Abuse. The SAVE demonstrated utility in classifying high- and low-violence participants, and correlated significantly with both objective crime data and theoretically relevant constructs (anger, posttraumatic stress symptoms, and internalizing/externalizing problems). Thus, the SAVE provides measurement of the stressor criterion associated with posttraumatic stress disorder, and allows quantification of severity of violence exposure by setting.     

Epidemiological Measurement of Children's and Adolescents' Exposure to Community Violence: Working with the Current State of the Science

A number of measures have been used in epidemiological studies of children's exposure to community violence, yet the quality of these instruments is not uniformly good. This paper undertakes a systematic review of the most commonly used (or most promising) self-report or interview-administered instruments, with regard to their conceptual bases and psychometric properties. Based on the review, recommendations are made for working with the current state of the science in order to move the field forward. A key recommendation is for sounder conceptualization of work in the field and greater transparency in the reporting of research, in order to facilitate the comparability of studies.     

The Effects of Children's Exposure to Domestic Violence: A Meta-Analysis and Critique

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Z _r = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.     

Consequences of Children's Exposure to Community Violence

Much has been learned over the past decade about the way children respond to experiences of violence in their community. The goal of this paper is to review what is known about the effects of community violence on children's development. In addition to main effects, factors that mediate these effects, as well as factors that moderate children's response to community violence are discussed. Special attention is paid to developmental differences in children's responses to community violence and the factors that may promote resilient functioning.     

Exposure to Violence,Social Information Processing,and Problem Behavior in Preschool Children

Understanding the mechanisms by which early risk factors for social maladjustment contribute to disruptive behaviors in social settings is vital to developmental research and practice. A major risk factor for social maladjustment is early exposure to violence, which was examined in this short‐term longitudinal study in relation to social information processing (SIP) patterns and externalizing and internalizing behaviors in a sample of 256 preschool children. Data on exposure to violence were obtained via parent report, data on SIP were obtained via child interview, and data on child problem behavior were obtained via teacher report. Findings supported the hypothesis that, compared to children not exposed to violence, children reported to witness and/or experience violence are more likely to attribute hostile intent to peers, generate aggressive responses, and evaluate socially unaccepted responses (aggressive and inept) as socially suitable. The former were also found to exhibit higher levels of externalizing and internalizing behaviors. Finally, SIP mediated the link between exposure to violence and problem behavior thus supporting this study's general approach, which argues that the link between exposure to violence and children's problem behaviors are better understood within the context of their perceptions about social relationships. Aggr. Behav. 38:429‐441, 2012. © 2012 Wiley Periodicals, Inc.     

Children Exposed to Intra-Familial Violence

Abstract

This investigation examined factors associated with attrition and retention within a sample of children with a history of intra-familial violence referred for outpatient services. The sample included 118 children, aged 4-17 years; of these 64% completed treatment, 20% did not engage in treatment and 16% terminated prematurely. Caregivers reporting high child-related parental distress (F(2, 32) = 3.9, p = 0.03) and high psychological distress (F(2, 70) = 3.3, p = 0.04) were less likely to engage in treatment. Making a child abuse report during assessment or treatment was not found to be associated with treatment engagement or attrition, χ² ₍₂₎= 0.4, p = 0.82. The implications of these findings for clinical practice and treatment outcome research are discussed.     

Neighborhood Violence and Psychosocial Adjustment in Low-Income Urban African American Children: Physical Symptoms as a Marker of Child Adjustment

We examined the association between neighborhood violence and three domains of psychosocial adjustment in low-income, urban African American children: internalizing, externalizing, and physical symptoms. Based on anecdotal and empirical evidence, it was hypothesized that, relative to internalizing and externalizing problems, a stronger association would emerge between physical symptoms and neighborhood violence. Mother-reported neighborhood violence was associated with child-reported physical symptoms, but not internalizing or externalizing symptoms. Child-reported neighborhood violence was associated with child-reported internalizing, externalizing, and physical symptoms; however, neighborhood violence accounted for a greater percentage of variance in physical symptoms than the other two symptom domains. Our findings were not moderated by the age or gender of the child. We discuss the importance of physical symptoms as a marker of child adjustment in low-income, urban, African American children, as well directions for future research.     

Children Exposed to Domestic Violence and Child Abuse: Terminology and Taxonomy

Three definitional issues regarding children exposed to domestic violence are examined. First, the multiple ways in which a child can be exposed to violence is discussed. A taxonomy of 10 types of exposure is proposed. Nine key characteristics of domestic violence, as they relate to children and children's exposure, are then outlined. The third issue addressed concerns why children who are exposed to domestic violence can be considered victims of child maltreatment. These children, by nature of their experience in the home, are psychologically maltreated and are also at high risk for physical abuse and some risk for sexual abuse. Empirical questions concerning these definitions and taxonomies and their interrelations are discussed.