Children and Domestic Violence

Exposure
Children are exposed to or experience domestic violence in many ways. They may hear one parent/caregiver threaten the other, observe a parent who is out of control or reckless with anger, see one parent assault the other, or live with the aftermath of a violent assault. Many children are affected by hearing threats to the safety of their caregiver, regardless of whether it results in physical injury. Children who live with domestic violence are also at increased risk to become direct victims of child abuse. In short, domestic violence poses a serious threat to children's emotional, psychological, and physical well-being, particularly if the violence is chronic.

Domestic violence poses a serious

   threat to children's emotional,

   psychological, and physical well-

   being, particularly if the violence is

chronic.

Effects
Not all children exposed to violence are affected equally or in the same ways. For many children, exposure to domestic violence may be traumatic, and their reactions are similar to children's reactions to other traumatic stressors.

Exposure to domestic violence has also been linked to poor school performance. Children who grow up with domestic violence may have impaired ability to concentrate; difficulty in completing school work; and lower scores on measures of verbal, motor, and social skills.

Children may learn that it is

acceptable to exert control or

relieve stress by using violence, or

that violence is linked to

expressions of intimacy and

affection.

In addition to these physical, behavioral, psychological, and cognitive effects, children who have been exposed to domestic violence often learn destructive lessons about the use of violence and power in relationships. Children may learn that it is acceptable to exert control or relieve stress by using violence, or that violence is in some way linked to expressions of intimacy and affection. These lessons can have a powerful negative effect on children in social situations and relationships throughout childhood and in later life.

Ages and Developmental Stages: Symptoms of Exposure

As with other trauma types, children's responses to domestic violence vary with age and developmental stage. In addition, children's responses depend on the severity of the violence, their proximity to the violent events, and the responses of their caregivers.

The table below shows a brief list of possible reactions/symptoms by age: young children (birth to age 5), school-age children (aged 6 to 11) and adolescents (aged 12 to 18). 

It is important to remember that these symptoms can also be associated with other stressors, traumas, or developmental disturbances, and that they should be considered in the context of the child and family's functioning.

Adolescents as Victims

Adolescents are involved in domestic violence not only as witnesses to abuse between their parents/caregivers but also as individuals who may themselves be involved in abusive relationships. Data suggests that adolescents are at higher risk of being involved in an abusive relationship than are adults (American Bar Association, 2006). Females 16 to 24 are more vulnerable to intimate partner violence than are females in any other age group. Gay, lesbian, and bisexual adolescents are just as likely to experience dating violence as are their heterosexual peers (Halpern, Young, Waller, Martin, & Kupper). 

Many teenagers think that

   jealousy, possessiveness, and

   violence are signs that their

   partner loves them.

Surveys conducted with adolescents demonstrate that they hold attitudes that normalize abusive or controlling relationships. For example, many teenagers think that jealousy, possessiveness, and violence are signs that their partner loves them; and about half of high school girls and three-quarters of high school boys believe that forced sex is acceptable in some circumstances (Michigan State University, n.d.; Jackson, Cram, & Seymour, 2000). Nearly 1 in 5 teenage girls who have been in a relationship said a boyfriend had threatened violence or self-harm if presented with a breakup (Liz Claiborne Inc., 2005).

Teen dating violence is associated with higher levels of substance abuse, violence, and victimization, as well as with lower achievement in school. Victims of dating violence display a strong, consistent pattern of exposure to and participation in a broad range of high-risk behaviors including unhealthy weight control, sexual risk behavior, and suicidal ideation (Silverman, Raj, Mucci, & Hathaway, 2001).

Generally, parents are uninformed about the risk of dating violence for their adolescent children, and most parents have not talked to their teenage or young adult children about dating violence (American Bar Association, 2006). Teens rarely report dating violence, possibly because they think it is a normal part of a relationship.

Resources for Teens
For information on dating violence:

• loveisrespect.org: National Teen Dating Abuse Helpline [2]
  [3]
• thatsnotcool.com [4]
• Love Doesn't Have To Hurt TEENS [5] (PDF)

Identifying Children Affected by Domestic Violence

Children who live with domestic violence have been called the "silent" or "hidden" victims of violence because their presence is often overlooked by the parents/caregivers or unknown by observers and professionals. Adult victims may be hesitant to disclose to police, hospital staff, or child welfare workers that their children have seen the violence. This may be due to embarrassment, fear of retaliation or harm, or fear that their children might be removed from their care by Child Protective Services. Professionals who come in contact with these children and families may not ask about children's exposure to domestic violence because they are wary of offending caregivers or because they do not know what to do to help the children they do identify. In these cases, children are not linked with services.

In recent years, however, many service systems have increased their efforts to identify children and provide services to their families. For example: 

• Police departments. Many police officers routinely document the presence of children when they respond to calls involving domestic violence and also provide linkages to services.
  • Among the NCTSN resources that provide examples of this trend are:
    • Creating a Trauma-Informed Law Enforcement System (2008) [6] (PDF)
    • Cops, Kids, & Domestic Violence [7] (Video) [8]
    Also see: Service System Responses [9] for information on other programs.
  • The David and Lucile Packard Foundation funded a series of handbooks about children exposed to violence including:
    • Children Exposed to Violence: A Handbook for Police Trainers to Increase Understanding and Improve Community Responses [10]
    • Youth Exposed to Domestic Violence: A Handbook for the Juvenile Justice System to Enhance Assessment and Intervention Strategies for Youth from Violent Homes [11]
• Pediatric and family practice settings. Screening and assessment is conducted in these settings.
  • Family Violence Prevention Fund, in partnership with the American Academy of Pediatrics, the National Association of Pediatric Nurse Practitioners, and other organizations: Domestic Violence: Consensus Recommendations for Child and Adolescent Health (2010) [12] (PDF) to help practitioners learn how to assess for and respond to domestic violence.
• Early child care settings. Children are identified and supported.
  • The David and Lucille Packard Foundation: Children Exposed to Domestic Violence: An Early Childhood Educator's Handbook to Increase Understanding and Improve Community Responses [13]
  • The National Child Welfare Resource Center for Family-Centered Practice: Silent Realities: Supporting Young Children and Their Families Who Experience Violence (2006) [14] (PDF)
• Middle and high schools. Information and resources on teen dating violence and safety in relationships.
  • National Youth Violence Prevention Resource Center [15]
• Primary and secondary schools. Information on identifying and supporting children who have been exposed to domestic violence.
  • The David and Lucille Packard Foundation: Children Exposed to Domestic Violence: A Teacher's Handbook to Increase Understanding and Improve Community Responses [16]

Interventions for Children Exposed to Domestic Violence: Core Principles

Interventions: Treatments Developed by NCTSN Members

Some members of the NCTSN are involved in developing, testing, and disseminating evidence-based treatments for children who experience posttraumatic reactions following their exposure to domestic violence. These interventions are described briefly below, with links to resources that offer more complete information about each. Multimedia presentations on many of these interventions are available in the NCTSN Training Archives [17].

Child Parent Psychotherapy (CPP)
A dyadic attachment-based treatment for young children exposed to domestic violence and other interpersonal violence developed by the Child Trauma Research Project, University of California, San Francisco. Year-long treatment focuses on safety, affect regulation, understanding of trauma reactions, improving the parent-child relationship, and joint creation of trauma narrative.

• Child-Parent Psychotherapy fact sheet (2008) [18](PDF)
• Child-Parent Psychotherapy fact sheet: Culture-specific information (2008) [19] (PDF)

Group Treatment for Children Affected by Domestic Violence
A manualized group treatment model developed by Children's Institute, Inc. (CII) for children aged 5 and over and their nonoffending parent. Children and adult victims of domestic violence attend parallel weekly groups. Topics include psychoeducation on safety, the cycle of violence, and parenting, as well as coping skills such as relaxation, mindfulness, yoga, and movement therapy. Additional interventions focus on feelings identification, trauma cues, anger management, cognitive processing, creating a trauma narrative, making meaning, and setting goals for the future. For more information on this intervention or training, contact CII's Child Trauma Treatment Center senior director, Dr. Leslie Anne Ross: lross@childrensinstitute.org [20]

• Group Treatment for Children Affected by Domestic Violence fact sheet [21] (PDF)

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) A group treatment for adolescents with chronic trauma exposure who may still be experiencing chronic stress and who have difficulties in many areas of functioning. Groups address such topics as affect regulation, impulsivity, relationships, numbing and avoidance, and making meaning of experiences. SPARCS was developed by the Adolescent Trauma Treatment Development Center, North Shore University Hospital.

• Structured Psychotherapy for Adolescents Responding to Chronic Stress fact sheet (2008) [22] (PDF)
• Structured Psychotherapy for Adolescents Responding to Chronic Stress fact sheet: Culture-specific information (2008) [23] (PDF)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
A brief treatment (ideally, 12 to 16 weeks) for children aged 3 to 18 affected by traumatic life experiences and their parents. TF-CBT helps children develop skills for processing the trauma; managing distressing thoughts, feelings, and behaviors; enhancing safety; and improving communication with parents; and helps parents increase parenting skills. TF-CBT was developed by Allegheny General Hospital Center for Traumatic Stress in Children and Adolescents and New Jersey CARES Institute Center for Children's Support.

• How to Implement Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) [24] (PDF)
• TF-CBT: Trauma-Focused Cognitive Behavioral Therapy fact (2008) [25](PDF)
• Trauma-Focused Cognitive Behavioral Therapy fact sheet: Culture-specific information (2008) [26] (PDF)

Service System Responses

To work effectively with children and families affected by domestic violence, child clinicians must have a thorough working knowledge of the judicial, law enforcement, and child protection systems, as well as a strong relationship with the local domestic violence service agencies. Clinicians must recognize and appreciate the important role these agencies play in identifying domestic violence, stopping the violence, and promoting safety. Many of these systems have developed strong local collaborations.

The response of the child protection system to children and families affected by domestic violence has been the focus of controversy. At issue is whether child exposure to domestic violence constitutes child maltreatment and mandated reporting to Child Protective Services (CPS). State laws and policies governing mandatory reporting of children's exposure to domestic violence to CPS vary widely. The Child Welfare Information Gateway lists state-by-state CPS reporting requirements [27] and a summary of each state's laws [28]

Examples of integrated programs affiliated with the NCTSN that work with families affected by domestic violence include:

• Child Witness to Violence Project, Boston Medical Center [29]
  Provides trauma-focused, developmentally appropriate mental health services to young children and their families who have been affected by domestic and/or community violence. The project works with the Boston Police Department to train officers in child development principles and to enlist their support in referring children to services. The program is embedded in the Department of Developmental and Behavioral Pediatrics at Boston Medical Center, and works closely with pediatric providers to encourage routine inquiry about domestic violence in pediatric visits, linkage of victims with advocacy resources, and referrals of children who need counseling services.
• Children Who Witness Violence Program [30]
  Active in seven communities in and around Cleveland, Ohio, the program provides mental health services to children exposed to violence and their families; works to enhance community awareness of violence and its impact; and educates mental health providers on the impact of violence.
• Children's Initiative, Greater Portland Trauma Assistance Network [31]
  Led by the Community Counseling Center of Portland, Maine, this project provides a community-wide trauma-informed System of Care for children who have been exposed to violence. More than twenty-five agencies are involved with the Initiative including police, schools, mental health providers, domestic violence service agencies, violence intervention programs, and Child Protective Services. These organizations are committed to providing a full range of services including outreach, community education, assessment, training, and treatment for children who have been exposed to violence. For more information on the Children's Initiative, contact Rebecca Sargent-Brown: BROWNR11@commcc.org [32]
• Domestic Violence Home Visit Intervention Project, Yale Child Study Center [33]
  Specialized component of the Child Development Community Policing Program (CDCP) in New Haven, Conn., that works to interrupt the intergenerational cycle of violence by increasing families' safety and security, by reducing children's repeat exposure to escalating episodes of violence, and by increasing families' access to supportive services in the community. A team—composed of police officers, domestic violence advocates, and clinicians—visits homes where domestic violence has been reported, and provides outreach and advocacy to the families and linkage to clinical services at the Childhood Violent Trauma Center [34]. The CDCP works closely with other advocates, community services, and Child Protective Services. For a fact sheet on the Child Development Community Policing Program, click here [35].
• Family Violence Program, Chadwick Center for Children & Families, Rady Children's Hospital [36]
  Provides an array of services to domestic violence victims and their families in partnership with the San Diego Family Justice Center, including developing safety plans, accessing emergency housing, providing therapy, and coordinating with other service providers.
• Project ERIN (Emergency Response Intervention Network), Children's Institute, Inc [37]
  Pairs family violence specialists with police officers responding to domestic violence calls. Counselors give immediate support at the scene, and then follow up in the days and weeks after the incident to connect children and families with medical and therapeutic services, develop safety plans, and provide access to legal support. Project ERIN also links children and families with comprehensive domestic violence interventions offered at Children's Institute including group and individual treatment. For more information about the institute's services, contact the Child Trauma Treatment Center senior director, Dr. Leslie Anne Ross: lross@childrensinstitute.org [20].

For information about comprehensive collaborative approaches, see:

• Family Justice Center Alliance [38]
  Co-located collaborative programs that include law enforcement, domestic violence advocacy, medical providers, and other social service providers, with the goal of providing coordinated, comprehensive support for domestic violence survivors and their children.
• Green Book Initiative [39]
  Co-located collaborative programs that include law enforcement, domestic violence advocacy, medical providers, and other social service providers, with the goal of providing coordinated, comprehensive support for domestic violence survivors and their children.
• Safe Start Initiative [40]
  Federal initiative that supports communities to provide more coordinated and effective services to children 0 to 6 exposed to violence and their families. Provides links to resources and publications related to children's exposure to violence.

Resources

References

American Bar Association. (2006). Teen dating violence facts. Chicago: American Bar Association. Retrieved from http://www.clotheslineproject.org/teendatingviolencefacts.pdf [68]