Psychosocial Interventions for Maltreated and Violence-Exposed Children

Child sexual, physical, and emotional abuse as well as child neglect and domestic violence, community violence, and Childhood Traumatic Grief may result in significant and long-lasting emotional and behavioral difficulties. This article reviews randomized controlled studies that have assessed child mental health outcomes for maltreated and violence-exposed children. Key points of this review include the following: (1) maltreated and violence-exposed children typically experience more than one of these types of traumas; (2) effective psychosocial treatments are available to address Posttraumatic Stress Disorder (PTSD), depression, anxiety, and behavioral problems in these children; (3) it is likely that treatments which effectively reduce mental health symptoms in children exposed to one type of child maltreatment or violence exposure will also be effective for other or multiple types; and (4) mental health outcomes are not the only important outcomes to address in future treatment or intervention efforts. These future directions for treatment intervention research are addressed.     

Mental Health and Domestic Violence: 'I Call it Symptoms of Abuse'

Correspondence to Dr Cathy Humphreys, School of Health and Social Studies, University of Warwick CV4 7AL, UK. E-mail: c.f.Humphreys{at}warwick.ac.uk Summary Research evidence now clearly shows a direct link between women'sexperiences of domestic violence and heightened rates of depression,trauma symptoms, and selfharm. A research project based in Women'sAid outreach services provides further evidence of women's experiencesof severe emotional distress. However, their experiences ofmental health services were often found to be negative. A numberof practices within the medical model of mental health wereunhelpful including: the lack of recognition of trauma or provisionof trauma services; making the abuser invisible through focusingon the woman's mental health reified from her experiences ofabuse; blaming the victim; offering medication rather than counsellingsupport; the negative, consequent effects on child contact andchild protection proceedings if the woman is labelled with mentalhealth problems. Alternatively, women found services, oftenin the voluntary sector, helpful when they provided the followinginterventions: helping women name domestic violence; activelyasking about the abuse; attending to safety planning; respondingto women's specialist needs; and actively working with womento recover from abuse experiences. Support for her childrenwas also seen as very helpful. Implications for practice includethe commissioning of further services in the voluntary sector,addressing the inadequate response within the medical model,and increasing the sensitivity of responses to women's emotionaldistress across all sectors.     

A Role for a Support Person for Child Witnesses in Criminal Proceedings

Correspondence to John Williams, Department of Law, University of Wales, Aberystwyth, Hugh Owen Building, Penglais, Aberystwyth, Dyfed SY23 3DY Summary The 1989 Children Act greatly extends and enhances the roleof the guardian ad litem (GAL) as the officer appointed by thecourt to safeguard and protect the welfare of the child in civilchild protection proceedings. But how do children fare whenthey are involved as witnesses in criminal proceedings? Sincethe latter part of the 1980s it has been recognized that theirimmatunty requires a more sensitive and caring approach thanthat adopted for adults in the criminal courts. As a resulta number of innovative procedures intended to alleviate stressin child witnesses have been introduced. But one outstandingissue of major importance, that of providing support for childrenbefore and during an appearance in a criminal court, needs tobe addressed urgently: the GAL is only available to childrenin civil proceedings. Drawing on the experience of the UnitedStates, where Victim Assistants are used to provide help andsupport for child victims and witnesses, and where the appointmentof GALs for child victims in criminal proceedings is gainingincreasing acceptance, the authors argue that the American exampleoffers much that may usefully be adopted in tailoring the Britishsystem to the special needs of child witnesses. A number ofmodels for the role of the Support Person for child witnessesin the British system are put forward for consideration.     

From Post-Mortem to Preventive Medicine: Next Steps for Research on Child Witnesses

We propose five directions for future child witness research, inspired by recognition of the day-to-day realities of the legal system and the opportunities of psychology to react proactively to challenges child witnesses face. These directions include (1) the refinement of developmentally sensitive questioning aids that increase completeness without increasing suggestibility, (2) the development of approaches to non-disclosure and recantation, including understanding of the reasons underlying non-disclosure and the potential for building rapport and increasing trust, (3) the construction of interventions that meet mental health needs of child-victim witnesses without creating false memories or tainting testimony, (4) a focus on details of children's narratives that are often lacking, including temporal information and emotional reactions, and (5) expanding our attention beyond child sexual abuse allegations in criminal court and considering the many contexts in which child witnesses are questioned, including areas in which preferences rather than memories are elicited.     

A Review of Research on Welfare and Domestic Violence

In this article we review the growing body of research literature on domestic violence and welfare. We summarize and critique the existing research on domestic violence and welfare in several areas: prevalence of domestic violence among women receiving welfare; the relationship of domestic violence to theiremployment; and physical health and mental health, child support, andevaluations of policies and programs. We also raise some methodological concerns that can inform interpretation of existing data. We examine the relevance of the research for practice and policy, particularly for the implementation of the Family Violence Option. This review includes published research as well as unpublished studies presented at recent conferences.     

Children and Violence: Nurturing Social-Emotional Development to Promote Mental Health

The absence of violence against children is a fundamental children's right and a major milestone of civilized society. Similarly, reports on incidences of violence by children and youth, including severe cases with devastating consequences, speak to the need that the trauma of exposure to violence in childhood needs to be addressed. While violence and its risk factors are generally understood, what is less clear are the essential protective factors, how we can identify those as early as possible, and how we can use them to prevent and address the trauma of violence exposure in children and youth. In this report, I review pathways of child and youth violence through the lens of social-emotional development as a central protective factor. Negative emotions of frustration and anger can underlie violence and aggression. Kind emotions, such as caring and our ability to connect with others emotionally, can serve as social-emotional protective factors. A brief review of the central social-emotional processes and their development is provided, including the human capacity to feel with others and express empathy, be emotionally aware and care about the effects of one's own actions on others, and be able to regulate the self and their emotions. Given the negative widespread and long-term impact of exposure to violence, I describe research-informed attempts to prevent violence exposure across development. Taking a humanistic, strength-based perspective, the focus is on social-emotional protective factors to address violence and nurture mental health in every child. I conclude with recommendations for practice and policy.     

The mental health of children who witness domestic violence

There is now considerable evidence that witnessing domestic violence can have adverse consequences for children. Our aim is to present the socio-demographic correlates of children witnessing domestic violence and its association with childhood mental disorders. The biographic, socio-demographic and socio-economic characteristics of 7865 children and their families and measures of traumatic events including witnessing domestic violence were entered into a logistic regression analysis to establish the strength of association between witnessing severe domestic violence and childhood disorders. About 4% of children had witnessed severe domestic violence according to parent reports. Factors independently associated with a greater likelihood of a child witnessing domestic violence were: older age group, mixed ethnicity, physical disorder, several children in family, divorced parents, living in rented accommodation, poor neighbourhoods, the mother's emotional state and family dysfunction. Witnessing severe domestic violence almost tripled the likelihood of children having conduct disorder but was not independently associated with emotional disorders. There is a growing need for more research on the consequences of witnessing domestic violence to increase the awareness of social workers and policy-makers to identify the needs of children who witness domestic violence.     

Domestic violence and child protection: exploring the role of perpetrator risk assessments

This article explores the issue of severity in relation to domestic violence and provides a number of reasons for the necessary engagement by workers with such a contentious issue. The specific role that the assessment of the risks posed by the perpetrator which has now developed in some police forces in the United Kingdom is examined, and its relevance to child welfare intervention discussed. A range of factors are identified that heighten the risks of increased violence. These include prior sexual assault; stalking and controlling behaviour; substance misuse and mental‐health problems; separation and child contact disputes; pregnancy; escalation including the use of weapons and psychological abuse; attempts and threats to kill; child abuse; isolation and barriers to help‐seeking. The ways in which perpetrator risk assessment can be used to inform the filtering of referrals to the statutory child care agency, enhance multi‐agency working, provide a structure for the assessment of the perpetrator, enhance partnership‐working with survivors (usually women) and inform the protection strategies for workers are explored.     

Social workers' attitudes towards female victims of domestic violence: A study in one English local authority

This paper aims to explore childcare social workers' attitudes towards female victims of domestic violence in England. The study discusses the concept of “mothering” and the processes through which mothers are potentially denigrated rather than empowered. Semi‐structured interviews were conducted with social workers in a single child protection agency to investigate their perceptions of domestic violence, its gendered nature, and the implications for their practice. Participants' responses were coded using thematic analysis. The results demonstrated social workers' cognisance of the challenges domestic violence poses for abused mothers in terms of the ability to safely parent their children. Although the study is not without its limitations, it nevertheless indicates the need for a more holistic approach to safeguarding children within domestic violence settings. Moreover, it underscores the necessity for improving awareness about the prevalence and importance of domestic violence as a child safeguarding concern within social work training. Indeed, improved training would help to develop social workers' knowledge and understanding of service provisions and partner agencies, thus potentially improving practice in this critically important area.     

Absent presence: the ongoing impact of men's violence on the mother–child relationship

This paper draws from interviews with 45 mothers and 52 children who participated in an action research project to develop activities to support women and children in the aftermath of domestic violence. A thematic analysis was used to analyse the data and explore the question: In what ways does the perpetrator of abuse remain present in the lives of women and children following separation? The paper invites workers to recognize the distortions created by domestic violence that may need to be identified and addressed in the aftermath of violence. The ways in which past trauma, erosion of self‐esteem and the undermining of the mother–child relationship continues to create a shadow across the present relationship are identified. The continued presence of the perpetrator of abuse through child contact arrangements and ongoing harassment is also highlighted. The ‘absent presence’ of the abusive partner is posited as a concept to assist workers with a framework through which to understand problems in the mother–child relationship which emerge when living with and separating from a violent partner. The paper has implications for social workers orientating practice to focus on perpetrator accountability and support strengthening the mother–child relationship.     

Domestic violence and child protection: towards a collaborative approach across the two service sectors

Domestic violence continues to be one of the most significant aspects of child abuse and neglect in Australia. However, the children are not well served by either child protection or domestic violence service sectors, which continue to operate as segregated, tertiary response systems. This paper reports on research that examined bridges and barriers to effective collaboration between child protection and domestic violence services in responding to children affected by domestic violence. The differing conceptions and responses of the workers from each service sector, in relation to children and families affected by domestic violence, is discussed in the light of gaps in service provision in both sectors. In doing so, areas of common ground for more effective collaboration between these service sectors are identified, including the prioritizing of emotional and psychological abuse, supporting and empowering abused mothers, strengthening the mother–child relationship, and supporting children and families across a continuum of service provision, particularly in the medium‐ to long‐term. Understanding each other and finding common ground across the two service sectors is paramount to improving how each responds to children and families affected by domestic violence.     

Preliminary support for the use of narrative exposure therapy in a child protection context: Collective case-study narratives

The present paper attempts to provide preliminary support for the use of narrative exposure therapy (NET) in a child protection context. The prevalence of violence, abuse and neglect (VAN) within New South Wales is outlined as well as the current perspectives in trauma definition and symptomology, and the prevalence of trauma symptomology among birthparents and young people within child protection services. NET is introduced including its theoretical background, methodology, applications and research. Four applications of NET within a child protection context are presented, including lifelines and narrative excerpts. Specific themes presented included experiences of physical abuse, domestic and family violence, parental drug use, suicidal ideation and child removal. Statistical analysis including reliable change, clinical and statistical significance of pre- and post-PCL-5 outcomes measures are presented to infer preliminary support for NET within a child protection context. Limitations and future considerations for future research are discussed.     

Revitalizing the Vision in Supervision: Supporting the Supervisor in Home-Based Therapy Programs

Home-based programs provide a growing number of mental health and case-management services to high-risk children, adolescents, and their families. The clinical service providers who work directly with these children and families have varying degrees of education and practice experience as well as a range of different supervisory needs. Because of the daily challenges service providers face, they require support from competent, available supervisors. The professionals who supervise them often assume that responsibility with limited, if any, training in providing supervision. New and experienced supervisors alike often find themselves in positions for which they are ill prepared, without suitable training or administrative support. This article describes a supervision seminar developed for supervisors who supervise the clinicians who provide home-based services. The seminar provides training, support, consultation, and other forms of assistance to help supervisors adapt their clinical skills for use in their supervisory roles.     

Avoidance and confrontation: social work practice in relation to domestic violence and child abuse

Action on the relationship between domestic violence and child abuse has been slow to emerge in mainstream child protection agencies. This paper reports a qualitative study of child protection files. Particular attention was given to the issues for Asian families. Initially the numerous strategies which social workers and other professionals at child protection conferences used to avoid the issue of domestic violence are explored. However, there was also a small, but emerging, pattern of child abuse in the context of domestic violence being taken seriously. In each of these cases strong expectations were placed on women to separate from or remain separated from men who were violent. These expectations were backed by 'threats' or the actual accommodation of children often with little interagency support for women undertaking this difficult and dangerous task, or before women were ready to undertake this separation. Suggestions are made about aspects of the organizational context which need to change if good child protection is also to include appropriate protection and support for the child's mother.     

Key decisions in child protection services in cases of domestic violence: maintaining services and out‐of‐home placement

This paper looks at the response of the child protection services (CPS) system in cases where exposure to domestic violence occurs alone or together with abuse or neglect, focusing on the factors involved in decisions to maintain the case open for ongoing services or remove children from the home. The study is based on an analysis of clinical and administrative data from the files on children reported to a CPS agency in Montreal, Canada. A total of 1 071 substantiated reports were documented, including 337 cases of co‐occurrence (32%). Analysis of the data shows that domestic violence does not by itself constitute a factor liable to lead to more intrusive intervention. The CPS response appears to be influenced more by the existence of other forms of maltreatment and risk factors. Additionally, while domestic violence may be associated with more severe individual and family problems, it does not influence the decision to keep the case open because the child still need services. The lack of any connection between domestic violence and this decision is a cause for concern, as results indicate that such families need help. Knowing how to respond to their needs therefore remains a major challenge.     

Domestic violence and child abuse: developing social work practice

This paper takes as its starting point the report produced by the Social Services Inspectorate (1995), entitled Domestic Violence and Social Care , which seeks to alert social workers to the links between domestic violence and child abuse and urges the profession to respond more effectively to these two interconnected forms of violence. Having examined the research findings which provide evidence for these links, the theoretical and service delivery contexts in which these two forms of violence have been studied and conceptualized by the social work profession, both in the United Kingdom and in the United States, are identified. Studies of the social work response to domestic violence are discussed and some of the difficulties experienced by social workers in responding effectively to the needs of families where both forms of violence are experienced are considered. In particular, the issues of 'invisible' men and 'trapped' women and children are explored. It is argued that effective social work intervention which challenges these stereotypes will require additional resources and the article concludes with a consideration of whether the Messages from Research report might herald a shift in the approach to child protection that would promote the allocation of resources to this area of work.     

Chronic child abuse and domestic violence: children and families with long‐term and complex needs

It is estimated that up to one million children may have been exposed to domestic violence in the UK, with significant consequences for their social and emotional development in childhood and later life. At a time when the central and devolved administrations in the UK have developed strategies to tackle domestic violence, this paper reports the findings from a study conducted on children in the child protection system with long‐term and complex needs as a result of experiencing domestic violence. The research identifies the characteristics of the children and their families and tracks their careers through the child protection system. The findings indicate that professionals have an awareness of domestic violence, and that younger children with younger parents are most likely to experience prolonged periods in the child protection system. Domestic violence in this context typically co‐exists in families experiencing other difficulties such as substance misuse and socio‐economic deprivation. In conclusion, the paper argues that Government policy and professional practice should primarily be concerned with assessing the risk that men present, rather than the risk that children are at. By reframing professional interventions, men are more likely to be challenged to accept responsibility for their behaviour and the consequences for their families.     

An analysis of current Australian program initiatives for children exposed to domestic violence

While services have been assisting women who have been victims of domestic violence for many years, it has only been in recent times, that children exposed to domestic violence have begun to receive attention by service providers as clients in their own right. A number of specialised programs have now been designed to meet the needs of these children by domestic violence services and agencies that have a child protection or child welfare/family support focus. This paper aims to describe the types of programs currently in operation across Australia which cater specifically for the needs of children who have been exposed to domestic violence by analysing programs listed on the Child Abuse Prevention Programs Database developed by the National Child Protection Clearinghouse. A number of suggestions are made with regard to the means by which therapeutic responses and research in this area could be enhanced.     

National Society for the Prevention of Cruelty to Children, London, UK

The present article explores the complexity of children's experiences of domestic violence. It addresses the various terms used to describe this form of violence and provides a working definition. Reviewing the literature suggests prevalence rates of domestic violence between 25 and 60%. The difficulties in achieving prevalence and incidence rates are outlined. Where children's experiences of domestic violence have been addressed, attention has focused on either children witnessing the abuse of their mother or children directly being abused. Six main ways in which children may witness domestic violence are presented and the relationship between domestic violence and child abuse is examined briefly. An overview of the impact of domestic violence on children incorporates a discussion of the intergenerational transmission of violence theory. Some of the multiple factors which may inhibit children from talking about domestic violence are raised, indicating how complex this issue is for children. Finally, the need to recognize the diversity of children's experiences of and reactions to this form of violence is identified.     

Complex trauma treatment in the Republic of Georgia: Stemming the contagion of psychopolitical trauma across the continuum of care

Clinical social workers in the United States increasingly have become involved as consultants in countries besieged by psychopolitical trauma. These workers face complex challenges as they provide therapy to torture survivors or consultation to indigenous mental health professionals. Workers must refine their understanding of trauma to encompass the often less familiar practice of providing treatment in the context of torture. Mental health professionals practicing in war‐torn environments must deal with their own intense reactions such as secondary traumatic stress, vicarious trauma, countertransference, and projective identification as they address the ripples of torture's devastation across the continuum of care. The author will present a case study from the Republic of Georgia in order to elucidate some subtleties of clinical practice in the context of psychopolitical trauma.