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.     

Domestic Violence Screening in Medical and Mental Health Care Settings

ABSTRACT

Health care providers and patients agree that domestic violence presents a serious health issue that falls within the purview of medical care. The patient-physician encounter has the potential to assist domestic violence victims in considering their options of living without violence and playing a critical role in preventing future violence. Despite this possibility, many persons evaluated in the health care system do not experience the benefits of such interactions. This article reviews current research that evaluates physician, patient, and systems barriers to providing care to patients experiencing domestic violence as well as gaps in the current research and suggestions for how these barriers might be overcome. Educational initiatives, implementation of protocols, and increasing environmental cues that prompt patients and physicians to discuss domestic violence may all increase the likelihood of screening and the success of interventions.     

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.     

Perceived Barriers to Treatment Participation and Treatment Acceptability Among Antisocial Children and Their Families

This study examined the role of perceived barriers to participation in treatment and the acceptability of treatment among children and parents. Children (N = 144, ages 6–14) referred for outpatient treatment for oppositional, aggressive, and antisocial behavior and their families participated. The main findings were that: (a) perceived barriers to participation in treatment predicted treatment acceptability as rated by children and parents; (b) the effect was not accounted for by socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction; and (c) treatment acceptability was related to therapeutic change in the children over the course of therapy but the relation was small. Overall, the findings indicate that families vary considerably in the barriers they perceive in coming to treatment and that these barriers influence the extent to which they and their children evaluate the acceptability of the treatments they receive. The implications of treatment acceptability for evaluation and delivery of psychotherapy are discussed.     

Examining the Long-Term Effects of a Domestic Violence Training for Educators

Domestic violence affects not only the victims and perpetrators, but also children living in these households. This study examined the long-term effects of a training presented to all employees working in 22 different rural school districts (N = 556). Quantitative and qualitative data were collected to determine the long-term impact of the training. After approximately 4 years, the staff who had received the training reported that they had significantly more confidence in handling families dealing with domestic violence; however, both groups reported similar levels of general knowledge of the topic. Recommendations for training school personnel are provided along with key elements for replicating the training.     

A Mind-Body Approach to Domestic Violence Perpetrator Treatment: Program Overview and Preliminary Outcomes

Conventional interventions with perpetrators of domestic violence are marginally effective. Given these results, researchers and practitioners are beginning to focus on identifying ways to improve domestic violence treatment outcomes. This article describes how a rural state-sponsored domestic violence offender program utilizes a treatment approach known as Mind-Body Bridging to help its clients overcome their abusive behaviors. Preliminary findings from an ongoing outcome study are also reported. According to these findings, the program has a high completion rate coupled with a low recidivism rate. Ninety-three percent (82 of 88) of the clients who have participated in this program completed the program, and just 7%?(6 of 82) of those who completed the program reoffended during the follow-up period, which ranged from 9 to 27 months.     

A Solution-Focused Intervention with a Youth in a Domestic Violence Situation: Longitudinal Evidence

This article reports on a 4-year therapeutic intervention combining in-person and email communication with a 13-year-old Greek-Cypriot teenager who witnessed and later was the victim of severe domestic violence. The intervention is based on an empowerment philosophy and solution-focused strategies, and its usefulness is evaluated by three standardized measures at five time points between the years 1999 and 2003. Pertinent cultural and ethical dynamics of the interventional context are highlighted. The intervention may have helped to produce better perpetrator–youth relations, remission of the client’s depression and post-traumatic stress symptoms, and improvement in his academic performance. Implications and limitations are discussed.     

Childhood Exposure to Community and Domestic Violence: Prevalence,Risk Factors and Posttraumatic Outcomes in a South African Student Sample

The effects of exposure to direct and vicarious community and domestic violence on the posttraumatic adjustment of 323 South African students were examined. Data were collected using self-administered questionnaires, with the relationship between exposure to violence and posttraumatic outcomes being explored using binomial logistic regression analyses. Two hundred and sixty-two participants (81 %) reported that they had been exposed to some form of interpersonal violence during childhood. An analysis of risk factors for exposure to violence indicated that males were more than twice as likely as females to have experienced victimization by a community member. Direct exposure to domestic violence was the only form of violence which was found to be associated with Posttraumatic Stress Disorder (PTSD). Among participants who had experienced direct domestic violence, clinically significant levels of PTSD were significantly predicted by both gender (being female) and by abuse chronicity.     

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.     

The Importance of Community in a Feminist Analysis of Domestic Violence among American Indians

There are over 500 native communities in the United States alone. Although popular conceptions in the majority culture commonly refer to these as a single American Indian group, native communities are in fact extremely diverse and heterogeneous. Issues of gender, class, and power are discussed from a feminist perspective with an emphasis on the diversity among native communities. Available evidence, while sketchy, suggests that male authority, male restrictiveness, and socioeconomic stress are associated with violence, but that the levels of these factors vary widely across native groups. For example, some native tribes practice matrilineal descent while others are patrilineal. This diversity has far-reaching implications for the community context in which domestic violence occurs. An approach that integrates both feminist and community approaches seems best suited to address the problem of domestic violence in native North America.     

Therapist Awareness of Appropriate Intervention in Treatment of Domestic Violence

SUMMARY

Given the widespread nature of relationship violence, psychotherapists must recognize the probability that at some point they will treat a violent couple or someone involved in a violent relationship, even if they do not specialize in the treatment of family violence. Two analogue studies reported in this chapter were designed to investigate how therapists conceptualize cases involving domestic violence families and the types of interventions they indicate they would make. The first study surveyed 362 members of the American Association for Marriage and Family Therapy (AAMFT). Respondents were asked to conceptualize and provide interventions for one of two actual cases that involved family violence. The second study surveyed 402 members of the American Psychological Association (APA). Respondents were asked to give a diagnosis based on a case presentation. After being informed the case resulted in a homicide, respondents were asked what interventions they would have made prior to the outcome, had they been given the opportunity to provide counseling. Results from both analogue studies indicate that a large number of respondents were unable to properly assess the danger inherent in cases of domestic violence, and many more would not have intervened in a timely and appropriate manner.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address intimate partner violence in alcohol-treatment-seeking men. Analyses of feedback provided during manual development suggest participants (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention might be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Parent Motivation to Participate in Treatment: Assessment and Prediction of Subsequent Participation

Treatment motivation is required for virtually all psychosocial treatments because clients must participate actively in the treatment process. In child and family treatments, it is the parent who must be motivated to manage treatment participation; however, no measures are currently available for evaluating parent motivation for treatment. The authors developed and evaluated a brief rating scale, the Parent Motivation Inventory (PMI), to measure parent motivation to participate in treatment. Results supported a uni-dimensional measure with strong internal consistency and test-retest reliability. Increases in parent motivation predicted the perception of fewer barriers to treatment participation, which was significantly associated with greater treatment attendance. The PMI provides a reliable and valid method of assessing parents’ motivation to participate in treatment and has implications for the prediction and potential modification of barriers to treatment and treatment participation.     

Religion in Domestic Violence Prevention PSAs: The Role of Religiosity in Motivating Christian Bystanders to Intervene

Domestic violence is an ongoing health issue around the world, propelling individuals and organizations to seek out new and innovative ways to mitigate its widespread reach. Focusing on the potential of religion to positively impact messaging, the current study examines how Christian symbolism might be used to encourage intervention behavior using public service announcements (PSAs). Using a between‐subjects design of Christian Americans as the respondent pool, a religious symbol versus a control ad was utilized. Levels of religiosity were also measured and factors impacting the construct assessed. Findings revealed religiosity, the importance of religion in one's life, was the underlying motivator for highly religious people to act rather than a religious cue. Within religiosity, the perceived strength of faith to one's identity held greater value than church attendance and frequency of prayer. Theoretical implications are discussed as well as insights for people working in public service messaging.     

Prevalence and Predictors of Psychological Violence Against Male Victims in Intimate Relationships in Canada

Psychological violence involves expressive violence (i.e., the use of words to humiliate or psychologically harm a partner) and coercive violence (i.e., controlling behavior directed to dominate and manipulate a partner). From studies that collect data on both physical and psychological violence, it is apparent that psychological violence is the most prevalent form of intimate partner violence (IPV). However, psychological violence is one of the dimensions of IPV that has received relatively less attention. Furthermore, very little is known about the state of female-to-male psychological violence, as most studies on the subject have focused on female victims. This study seeks to understand recent trends and prevalence of psychological violence in male-to-female and female-to-male relationships in Canada. Using the 2014 General Social Survey (Victimization) data, the risk factors of female-to-male psychological violence were analyzed. The findings of the analysis revealed that there are significant differences in the prevalence of psychological violence among victims when gender is taken into consideration. The study also revealed that childhood victimization, childhood exposure to domestic violence, marijuana use, and educational attainment are predictors of female-to-male psychological violence. The study highlights the need for more studies to be conducted to attain a better understanding of the nature and context of psychological violence in heterosexual relationships.     

Trauma Survivors' Emotional Distress and Barriers to Early Psychological Intervention in an Inner-City Acute Surgical Trauma Service

Fifty-five predominantly low-income ethnic minority patients were interviewed and screened for early signs of psychological distress following traumatic injury. A free, brief intervention and transportation were offered to patients who evidenced psychiatric symptoms. Over half of participants reported psychiatric symptoms, but none accepted the free intervention. This study examined reasons participants remained reluctant to engage in services despite elimination of common barriers. Results highlight the importance of perceptual barriers over structural barriers in engaging patients in psychological interventions following a traumatic event.     

Validation and Standardization of the Dutch Trauma Symptom Checklist for Young Children in a Normative and Clinical Sample

The study aimed to describe the psychometric properties of the Dutch version of the Trauma Symptom Checklist for Young Children (TSCYC) in normative and clinical populations in the Netherlands. Caregivers’ ratings on the TSCYC were obtained for 1,802 children from the normal population, and for 515 children from a clinical population of traumatized children. In the clinical sample, additional measures were taken. The internal consistency and test-retest reliability of TSCYC scales were adequate. Confirmatory factor analysis showed acceptable fit on the putative scale structure. Regarding criterion validity, the clinical sample scored significantly higher on all clinical scales when compared to the normal population sample. Within the clinical sample, significant associations were found between TSCYC scales and convergent scales of other instruments. The Posttraumatic Stress-Total subscale demonstrated excellent discriminative ability between traumatized children and children from the normal population. The Dutch version of the TSCYC proved a valid and reliable instrument to measure trauma symptoms in young children through caregiver report, similar to the original American version. Further comparisons with diagnostic interviews are warranted.     

Development of a Screening Instrument for Exposure to Violence in Children: The KID-SAVE

The present study provided psychometric data on the KID-SAVE, an empirically based measure of children's exposure to community violence. The KID-SAVE was administered to 470 inner-city children in the third through seventh grades and demonstrated excellent reliability. Factor analysis yielded three subscales: Traumatic Violence, Indirect Violence, and Physical/Verbal Abuse. Initial investigation of construct validity suggested that the KID-SAVE successfully discriminated between groups of children reporting high and low levels of traumatic symptoms. The KID-SAVE appears to be a promising assessment tool and allows for quantification of the severity of violence exposure.     

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.