The impact of exposure to domestic violence on children and young people: a review of the literature

The impact of exposure to domestic violence on children and young people: a review of the literature
Holt, S. , Buckley, H. & Whelan, S. ( 2008 ) Child Abuse & Neglect , 32 , 797 – 810 . Objective This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well‐being of children and young people. Impact is explored across four separate yet interrelated domains (domestic violence exposure and child abuse, impact on parental capacity, impact on child and adolescent development and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. Method A comprehensive search of identified databases was conducted within an 11‐year framework (1995–2006). This yielded a vast literature that was selectively organized and analysed according to the four domains identified above. Results This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioural problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother. Conclusion Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. Practice implications This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child‐centred approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience and responsive to their individual needs.     

‘It felt like there was always someone there for us’: Supporting children affected by domestic violence and abuse who are identified by general practice

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.     

Towards an ecological understanding of readiness to engage with interventions for children exposed to domestic violence and abuse: Systematic review and qualitative synthesis of perspectives of children,parents and practitioners

Children who grow up in homes affected by domestic violence and abuse (DVA) are at risk of poor outcomes across the lifespan, yet there is limited evidence on the acceptability and effectiveness of interventions for them. A recent review of child‐focused interventions highlighted a gap in understanding the factors influencing the willingness of parents and children to engage with these programmes. We conducted a systematic review of qualitative evidence on the experiences of receiving and delivering interventions with the aim of identifying factors at different levels of the social–ecological context that may influence parent and child readiness to take up interventions. We searched literature till April 2016 and found 12 reports of eight programmes. Two authors independently screened papers for inclusion, extracted data and identified the first‐ and second‐order constructs. The third‐order constructs were derived and fitted to the ecological framework to inform a picture of readiness to engage with interventions. Three key findings emerged from this review: (a) parent and child readiness is influenced by a complex interplay of individual, relationship and organisational factors, highlighting that individual readiness to take up child‐focussed interventions must be viewed in an ecological context; (b) the specific process through which women become ready to engage in or facilitate child‐focussed interventions may differ from that related to uptake of safety‐promoting behaviours and requires parents to be aware of the impact of DVA on children and to focus on children's needs; (c) there are distinct but interlinked processes through which parents and children reach a point of readiness to engage in an interventions aimed at improving child outcomes. We discuss the implications of these findings for both practice and research.     

Safeguarding and Protecting Children in Maternity Services: Implications for Practice

This article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or are at risk of abuse, and in subsequent intervention and protection services. Assessing domestic violence as a safeguarding issue has been relatively slow in gaining health professional acceptance even though the international evidence suggests that there are irrefutable links between domestic violence and child abuse. Domestic violence increases during pregnancy and the postpartum period, and is significantly related to all three types of child maltreatment up to the child's fifth year, with children under one year being at the highest risk of injury, or death. However, midwives need greater exposure to and familiarity with recommended safeguarding good practice; and must be able to identify and support abused women and children with a joined-up approach that has adequate resources and the support of health service managers. Close inter-agency liaison is required with midwives who are accountable and not afraid to challenge historical working practices, and who are willing to work across traditional boundaries to promote and maintain child safety.     

Keeping the focus on children: the challenges of safeguarding children affected by domestic abuse

Safeguarding children affected by domestic abuse is a key responsibility for all professionals working with children and families, but can be difficult to achieve in practice. Despite a policy emphasis on early intervention and child‐centred work, limited attention has been paid to how professionals in universal and additional support services address this important area of work. This paper reports findings from qualitative research undertaken in one local authority area in the north of England during 2011 which examines the challenges facing professionals in safeguarding children affected by domestic abuse. Six mixed professional focus groups were held, attended by a total of 23 participants. Discussion focused upon participants’ awareness of domestic abuse, how they assessed and met children and young peoples’ needs, and their views about service provision and safeguarding processes. Data were transcribed and thematic analysis undertaken. The themes presented in this paper – embodied recognition, someone else's job, service gaps, skills deficits, and focusing upon children and young people – illustrate the scope and limitations of professionals’ work with children and young people affected by domestic abuse. Areas for practice improvement are discussed.     

Child maltreatment: the Lebanese children's experiences

Background This study examined the prevalence, risk factors and consequences associated with child maltreatment in the home. Methods The sample was 1028 (556 boys; 472 girls) Lebanese children aged 8–17 years (M = 11.89; SD = 1.67). Children were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire. Results Approximately 30% of the children reported at least one incident of witnessing violence, 65% reported at least one incident of psychological abuse and 54% reported at least one incident of physical abuse over a 1‐year period. The results showed an overlap between children's reports of witnessing violence in their homes and physical and psychological abuse that were associated with adolescents' trauma symptoms. Family‐related variables significantly predicted three forms of child maltreatment. Conclusion These results highlight the importance of examining children's multiple experiences of violence in their homes in research designs, prevention efforts and policy mandates. However, it should be noted that estimates of prevalence (as opposed to estimates of the relation between variables which is relatively more robust to selection bias) are open to error because of the nature of our sample.     

Involving Young People Affected by Sexual Violence in Efforts to Prevent Sexual Violence in Europe: What is Required?

ABSTRACT

This article draws attention to international evidence that highlights the value and challenges of promoting youth participation among and for young people affected by, or at risk of, sexual violence. The article draws on evidence from two pan-European projects that took place between 2013 and 2017 and aimed to give young people a voice in order to prevent sexual violence. The central argument of the article is that young people, particularly those directly affected by sexual violence, including those affected by child sexual exploitation, have an important role to play in shaping practice and policy which addresses sexual violence. However, participation work is complex and requires training, resources and support to enable practitioners to undertake this work with the necessary confidence and skills to safely, ethically and meaningfully engage young people. Involving young people affected by sexual violence is significant and goes beyond generic discourse regarding participation as there are specific risk factors associated with working with “marginalised” or “hard to engage” young people . We suggest that this evidence can inform international policy and practice. Organisations, and in turn State parties, need to properly resource such work and meet their obligations, which are outlined in European conventions.     

COVIEWING PRESCHOOL TELEVISION IN THE US

Past studies have shown that naturalistic parent–child coviewing of television provides a context for interactions that promote comprehension and more general language development. To determine whether onscreen text can facilitate such interactions, 58 parent–child dyads (with children aged 3 to 5 years) were observed while viewing a preschool video in which the narrative was accompanied by either: (1) an onscreen “Mommy bar” of subtitles including jokes and general parenting tips targeted at parents; (2) a parent‐directed “educationally enhanced bar” that modeled the sorts of educationally valuable comments observed in past research (e.g. discussing characters' emotions, tying onscreen events to the child's own experience); or (3) no onscreen subtitles for parents. Results indicated that, during viewing, parents who watched the “educationally enhanced” version were significantly more likely to make comments involving inferences about characters' emotions, tying onscreen events to children's own experiences, and encouraging children to engage in viewer participation. Thus, onscreen prompts can successfully elicit the types of parent–child interactions that can contribute to story comprehension, language development, and literacy.     

Involvement of Low‐Income Single Caregivers in Child‐Focused Early Intervention Services: Implications for Caregiver‐Child Interaction*

Involving caregivers in their children's services often is assumed to make the delivery of child‐focused services more effective. We examined the relation of caregiver involvement in children's early intervention programs (EIPs) with caregiver‐child interaction. Participants were 99 low‐income single caregivers whose children (≤ 40 months old) were enrolled in EIPs that provided opportunities for caregiver involvement. The results confirmed that caregivers who were more engaged with the programs (as rated by program staff) were more likely to demonstrate more responsiveness in interactions with their children. However, the frequency of participation or number of different types of activities at the EIPs in which they engaged were not significantly related to caregiver‐child interaction. Implications are discussed for enhancing supportive and collaborative relationships between caregivers and providers.     

Recognising and referring children exposed to domestic abuse: a multi‐professional,proactive systems‐based evaluation using a modified Failure Mode and Effects Analysis (FMEA)

Failure Modes and Effects Analysis (FMEA) is a prospective quality assurance methodology increasingly used in healthcare, which identifies potential vulnerabilities in complex, high‐risk processes and generates remedial actions. We aimed, for the first time, to apply FMEA in a social care context to evaluate the process for recognising and referring children exposed to domestic abuse within one Midlands city safeguarding area in England. A multidisciplinary, multi‐agency team of 10 front‐line professionals undertook the FMEA, using a modified methodology, over seven group meetings. The FMEA included mapping out the process under evaluation to identify its component steps, identifying failure modes (potential errors) and possible causes for each step and generating corrective actions. In this article, we report the output from the FMEA, including illustrative examples of the failure modes and corrective actions generated. We also present an analysis of feedback from the FMEA team and provide future recommendations for the use of FMEA in appraising social care processes and practice. Although challenging, the FMEA was unequivocally valuable for team members and generated a significant number of corrective actions locally for the safeguarding board to consider in its response to children exposed to domestic abuse.     

The impact of childhood abuse history, domestic violence and mental health symptoms on parenting behaviour among mothers in Japan

Background To assess the impact of childhood abuse history, domestic violence experiences and mental health symptoms on the parenting behaviour of mothers in Japan who have separated from violent husbands or partners. Methods A self‐administered questionnaire survey was conducted on a sample of mothers (n= 304) and their children (n= 498) residing in 83 mother–child homes in Japan. The survey assessed the mothers' childhood abuse history (physical, psychological and sexual abuse and neglect history), domestic violence experiences, current mental health symptoms (dissociative, depressive and traumatic symptoms) and parenting behaviours after moving into the homes to separate from a violent husband or partner. Results The mothers' childhood abuse history and experience of domestic violence were not associated with their not playing with their children. In contrast, the mothers' dissociative and depressive symptoms were significantly associated with not playing with their children. Although there was no association between the mothers' total childhood abuse history and not praising their children, their childhood physical abuse history was significantly associated with their not praising their children. The dissociative and depressive symptoms were also associated with no praise. Interestingly, the experience of domestic violence showed an inverse association with no praise. Conclusions Mental health symptoms, more specifically dissociative and depressive symptoms, are associated with a decrease in parenting quality. Mothers who were physically abused as children are less likely to praise their own children, independent of maternal mental health symptoms. In contrast, mothers who experienced domestic violence but subsequently separated from their violent husbands or partners are more likely to praise their children. The treatment of mental health symptoms, particularly dissociative and depressive symptoms, therapy for childhood abuse history and separation from violent husbands or partners might be effective ways to enhance the quality of parenting in Japan.     

Stress, cortisol and well-being of caregivers and children in home-based child care: a case for differential susceptibility

Background We examined whether children cared for by stressed caregivers show lower socio‐emotional well‐being and more stress, compared with children cared for by less stressed caregivers. Methods Perceived stress and cortisol levels of professional caregivers (n= 44), and associations with children's (n= 44) well‐being and cortisol levels in home‐based child care were examined. Results Caregiver perceived stress and cortisol levels were related to children's well‐being but not to children's cortisol levels. Children's social fearfulness acted as a moderator between caregivers' mean ratio of diurnal change in cortisol and children's well‐being. When caregiver cortisol levels decreased, more fearful children were reported higher on well‐being than less fearful peers. In contrast, when caregiver cortisol levels increased, more fearful children were reported lower on well‐being. Conclusions The findings point to differential susceptibility. Child care organizations and parents need to notice that a non‐stressful child care environment is in particular important for children with a difficult temperament.     

Interparental Agreement,Parent‐Child Responsiveness,and Children's Peer Competence*

This study examined associations between interparental agreement, parent‐child responsiveness, and children's social competence with peers. Assessments of interparental agreement among 33 parenting dyads were based on (a) parental agreement on beliefs about the use of control in childrearing, and (b) parental similarity in the use of initiations during play with child. Parent‐child responsiveness was assessed by subjective ratings of parent‐child play interaction. Teachers and peers provided assessments of children's social competence. Associations were found between parental agreement in beliefs about control and parental similarity in the use of control with child. Parental agreement on beliefs about the use of control and parental similarity in the use of control were both positively associated with children's social competence. Parent‐child responsiveness also was positively associated with children's social competence. Associations between agreement measures and children's social competence were partially mediated by parent‐child responsiveness. Implications for research and practice are discussed.     

The relationship of teacher–child play interactions to mathematics learning in preschool

Teacher–child interactions in preschool children's play may enhance mathematics learning in several ways. As teachers interact with children, they may promote more complex, independent, and symbolic play. Resulting increases in play abilities, in turn, can enhance intellectual growth, including mathematical thinking. Teachers may also facilitate math learning directly by engaging children in mathematical thinking as they play. The purpose of this study was to examine the effects on math learning of interactions that enhance play, itself, and those that directly engage children in mathematical thinking. The classroom play interactions of 47 preschoolers and their teachers were video recorded and analysed. The relationship between specific teacher–child interactions – both enhancing play strategies and promoting math approaches – was examined. Pre-test and post-test scores on the Test of Early Mathematics Ability, Third Edition (TEMA-3) showed that three play interactions predicted growth in math learning: ‘good-fit’ interactions to support play, itself, and number and math communication interactions. Findings confirm that teacher interactions in children's play can have an impact on academic performance. Interactions that are a good fit with what children are currently playing and those that prompt children's thinking about number or engage them in communicating about math enhance early math performance.     

Coping Behaviors,Parenting, and Perceptions of Children's Internalizing and Externalizing Problems in Rural African American Mothers

Abstract: We tested a hypothetical model linking maternal education and maternal coping behavior with parent‐child relationship quality, and in turn, children's self‐regulatory behavior and mental health difficulties. Consistent with predictions, mothers’ use of active coping behaviors predicted more positive parent‐child relationship quality, greater child self‐regulatory behavior, and fewer perceived behavioral and emotional difficulties in children. Implications of these findings for intervention with rural African American mothers are discussed.     

Father–child interactions and children's risk of injury

Unintentional injury is an important cause of infant and child hospitalisation and parents play a key role in reducing children's risk-taking behaviour. Studies show that maternal and paternal parenting and supervision of children differ, but there is little research showing how fathers’ parenting may influence children's tendency to engage in risk-taking behaviour. Recent theoretical developments suggest that father's parenting may be particularly effective in encouraging safe risk taking. In this study, we examine how well parenting practices typically undertaken by fathers predict rates of children's injury risk at three years. Questionnaire data were collected from 46 fathers. Results show that both duration of rough-and-tumble play and fathers’ encouragement of perseverance predicted lower rates of injury behaviours, while their stimulation of risk taking predicted higher rates of injury behaviours. The results are discussed in the light of developmentally appropriate risk taking and fathering.     

Diagnosing attention‐deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

Children involved with child protection services (CPS) are diagnosed and treated for attention‐deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD‐like symptoms, including language and learning problems, post‐traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family‐based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD‐like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD‐like symptoms and co‐morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well‐being of children with child protection involvement.     

Maternal mental health and childrearing context in the development of children at 6, 18 and 36 months: a Taiwan birth cohort pilot study

Background This study investigated a possible pathway of the childrearing context and maternal mental health at 6 months, and how these factors influence children's development at 6, 18 and 36 months. Methods Using random sampling, 2048 children and mothers were selected. The mother's health status was evaluated using the Taiwanese version of the 36‐Item Short Form Health Survey (SF‐36), and infant development was assessed using the high reliable Taiwan birth cohort study instrument. All data were collected using parental self‐report, and were analysed using multiple linear regression analysis and further pathway using structural equation modelling. Results This study showed that 12 factors effected children's development at 6 months, and some dissipated with growth. Of these, maternal education had an enduring effect on different domains of child development, and this effect intensified as the child grew older. Children who grew up in a family with more siblings would show a delay in language development at 6 months; they have a delay in motor and social development at 18 and 36 months. Additionally, maternal mental health effected the children's fine motor development at 6 months. However, this effect disappeared at 18 months, and influenced children's social development at 36 months. Conclusions This study demonstrated that the development of children at as young as 6 months is affected by various factors. These factors may dissipate, continue to influence child development up to 3 years of age, turn from being disadvantageous to beneficial, or affect different domains of child development. Also, parental self‐report instrument might be has its limitation and could be contributed by several confounding factors. Thus, continuous longitudinal follow‐up on changes in maternal conditions, family factors, and environmental factors is vital to understand how these early infantile factors affect each other and influence the developmental trajectories of children into early childhood.     

Out‐of‐school time activity participation profiles of children with physical disabilities: a cluster analysis

Objective To determine out‐of‐school activity participation profiles of school‐aged children with physical disabilities. Methods Activity participation profiles were determined by cluster analysing 427 children's responses on multiple dimensions of participation (intensity, location, companionship, enjoyment, preference) in five activity types (recreational, active physical, social, skill‐based, self‐improvement). Socio‐demographic, child, parent, family and environmental predictors of group membership were determined, along with child functioning, socio‐demographic, self‐concept and social support variables significantly associated with group membership. Results The cluster analysis revealed four groups, labelled Social Participators (a highly social and neighbourhood‐focused group), Broad Participators (a group of high participators who enjoy participation), Low Participators (a group with low enjoyment and weak preferences) and Recreational Participators (a group of younger children who participate in recreational activities with family members). The groups showed meaningful differences across a range of socio‐demographic, child, parent, family and environmental variables. Conclusions The findings support an affective and contextual view of participation, indicating the importance of motivational theory and a person–environment approach in understanding the complexity of children's out‐of‐school activity participation.     

Can We Fix This? Parent–Child Repair Processes and Preschoolers' Regulatory Skills

The repair of difficult parent–child interactions is a marker of healthy functioning in infancy, but less is known about repair processes during early childhood. We used dynamic systems methods to investigate dyadic repair in mothers and their 3‐year‐old children (N = 96) and its prediction of children's emotion regulation and behavior problems at a 4‐month follow‐up. Mothers and children completed free play and challenging puzzle tasks. Repair was operationalized as the conditional probability of moving into a dyadic adaptive behavior region after individual or dyadic maladaptive behavior (e.g., child noncompliance, parental criticism). Overall, dyads repaired approximately half their maladaptive behaviors. A greater likelihood of repair during the puzzle task predicted better child emotion regulation and fewer behavior problems in preschool. Results suggest dyadic repair is an important process in early childhood and provide further evidence for the connection between parent–child coregulation and children's developing regulatory capacities. Implications for family‐based interventions are discussed.