Behaviors of children following a randomized controlled treatment program for their abused mothers

OBJECTIVE: To determine if a treatment program offered to abused mothers positively affects the behaviors of their children. METHODS: A randomized, two-arm, clinical trial was used to measure child behavior at 6, 12, 18, and 24 months following the application of two levels of abuse treatment services to abused mothers: (1) abuse assessment and receipt of a wallet-size referral card, or (2) abuse assessment, receipt of a wallet-size referral card, and nurse case management sessions. The setting was public primary care clinics. The participants were 233 women who reported physical or sexual abuse within the preceding 12 months, and who had at least one child, ages 18 months to 18 years, living with them. Outcome measures were scores on the Child Behavior Checklist (CBCL) at baseline, 6, 12, 18, and 24 months. CBCL scores for a clinically-referred sample of children served as a comparison group. RESULTS: All children improved significantly (p < .001) on CBCL scores from intake to 24 months, regardless of which treatment protocol their mother received. By 24 months, the majority of children and adolescents had scores significantly less than the referred norms. Children ages 18 months to 5 years showed the most improvement and teenagers showed the least improvement. CONCLUSIONS: Disclosure of abuse, such as that which happens during abuse assessment, was associated with the same improvement in child behavior scores as a nurse case management intervention. Routine abuse assessment and referral have the potential to positively improve the behavioral functioning of children exposed to domestic violence.     

Severity of violence against women correlates with behavioral problems in their children

In order to examine the type and severity of violence against women by intimate partners and the associated behavioral problems of their children, 83 abused women were interviewed when they presented to the criminal justice system for protective orders or to file assault charges. Two questionnaires were administered: (a) the 46-item Severity of Violence Against Women Scale (SVAWS) measured threats of abuse and actual physical violence, and (b) the 118-item Child Behavior Checklist (CBCL) measured child behavior problems for children between the ages of 4 and 18.     

Screening for and treating intimate partner violence in the workplace.

The WHO has declared that violence is a leading worldwide public health problem with intimate partner violence one of the most common forms of violence against women (2002). Health care providers are frequently among the first to see victims of intimate partner violence and must strive to provide appropriate and effective care to abused women. Violence by intimate partners can be prevented. Occupational health nurses have a unique opportunity to intervene with abused women. Routine screening for intimate partner violence increases the likelihood of violence identification, leading to early intervention that may prevent trauma and injury. Occupational health nurses can foster a caring and confidential workplace where abused women feel safe to disclose the violence in their lives and trust that the nurse will provide treatment. A safe and healthy workplace, where abused women feel comfortable disclosing intimate partner violence and seeking treatment may also protect coworkers from the stress and violence that may potentially affect them. Occupational health nurses need to add screening for and treatment of intimate partner violence to their current health promotion and prevention activities to benefit all employees.     

Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning

Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18?months to 16?years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ² (4)?=?11.83, p?=?.019, Cramer's V?=?0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48?months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.     

Sleep of children of abused women in transitional housing

Children of abused women have been reported to experience a variety of behavioral problems including disturbed sleep. Sleep is essential for health, growth, and development. Yet, to date no one has described the sleep behaviors of these children. The purpose of this study was to describe the sleep-related behaviors of children of abused women living in transitional housing programs. A convenience sample of mothers (N = 32) residing in transitional housing programs for abused women was recruited. Using the Sleep Behavior Scale (Fisher, Pauley, & McGuire, 1989), data were gathered from the mothers on 43 children 2 to 18 years of age. Approximately one-third of the children in this study were reported to experience sleep-related behavior problems four or more times per week. Some of these behaviors were likely to be burdensome to abused women. Behavioral interventions, however, offer promise for these children and their mothers.     

We don't like to think about it: intimate partner violence during pregnancy and postpartum

Violence directed by an intimate partner toward the pregnant woman and her fetus, or during the first year after delivery, is often either not recognized by professionals or suspected but not addressed. There is no typical abused woman; in fact, intimate partner violence occurs across all social, economic, educational, and professional settings. Physical or sexual abuse may be readily observed in some instances or well hidden at other times; the emotional components of verbal, economic, and isolation abuse are often difficult to assess. All types of intimate partner violence require sensitive assessment and intervention by healthcare professionals, as numerous undesirable outcomes for both the mother and her fetus/baby have been identified. Suggestions for assessment and intervention (primary, secondary, and tertiary) are offered.     

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.     

Using ecological theory to understand intimate partner violence and child maltreatment

This article describes the relation between intimate partner violence (IPV) and child maltreatment using an ecological model. It further clarifies the multidimensionality of IPV and child maltreatment at the individual, family, community, and societal levels. The article reviews the dynamics of IPV and the relationship issues between mother and child when IPV is present. Areas relevant to nursing, such as assessment and intervention with mothers and children, are addressed along with professional biases and understanding. This article expands the community nurses' conceptualization of intimate violence issues and strengthen his or her nursing interventions.     

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

IntroductionUrban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.MethodsCross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants’ past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.ResultsRates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men’s at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.DiscussionBrief screening of patients’ at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.     

Children with sexual behavior problems and their caregivers: Demographics, functioning, and clinical patterns

This article is the first report from a 5-year demonstration project examining the comparative efficacy of specialized and traditional treatments with children who have exhibited sexual behavior problems. Baseline data concerning the demographics, psychological adjustment, and victimization and perpetration histories of 72 6 to 12-year-old children who have engaged in sexual misbehavior are reported in this article. Information regarding the caregivers and extended families of these children is also presented. The data clearly demonstrate that families of children with sexual behavior problems are marked by an array of characteristics indicative of parental and familial distress, including high rates of (1) violence between parents; (2) sexual victimization and perpetration with the extended family; (3) physical abuse of the children who have exhibited sexual behavior problems; (4) children who have witnessed violence between their parents; (5) parental arrest; (6) denial of responsibility for perpetration of sexual abuse by members of the extended family; (7) poverty; (8) special educational services; (9) prior therapy for children; and (10) clinical scores on behavioral rating instruments. In particular, several significant differences emerged between younger children (6–9 years) and older children (10–12). Younger children had (1) been sexually and physically abused at an earlier age; (2) been more likely to have witnessed physical violence between parents; (3) performed problematic sexual behaviors at an earlier age; (4) a higher annual rate of problematic sexual behaviors; (5) had a higher percentage of hands-on sexual behaviors; and (6) had higher scores on measures indicative of sexual behavior problems (e.g., Child Sexual Behavior Inventory, Child Behavior Checklist—Sexual Problems Subscale). Based on these data, treatment recommendations are made for families containing children with sexual behavior problems. Given the extensive data suggesting parental characteristics that could serve as mediating variables in the sexual behavior problems of their children, effective intervention requires the involvement of the children's caregivers. The comparative efficacy of specialized and traditional treatments for these families will be reported in subsequent articles.     

Community preferences for health states associated with intimate partner violence

BACKGROUND: One in 4 women is affected by intimate partner violence in her lifetime. This article reports on a cross-sectional survey to estimate community preferences for health states resulting from intimate partner violence. METHODS: A secondary analysis was conducted of data from a convenience sample of 93 abused and 138 nonabused women (231 total) recruited for in-person interviews from hospital outpatient department waiting rooms in metropolitan Boston, Massachusetts. SF-12 data were converted to utilities to describe community-perspective preferences for health states associated with intimate partner violence. Linear regression analysis was used to explore the association between violence and utility while controlling for other health and demographic factors. RESULTS: Median utility for intimate partner violence was between 0.58 and 0.63 on a scale of 0 (equivalent to death) to 1.0 (equivalent to optimal health), with a range from 0.64 to 0.66 for less severe violence to 0.53 to 0.62 for more severe violence. The data do not reveal whether violence itself is responsible for lower utility or whether a constellation of factors contributes to disutility experienced by women victims of abuse. DISCUSSION: The utility of health states experienced by women exposed to intimate partner violence is substantially diminished compared with optimal health and even other health conditions. These values quantify the substantial negative health impact of the experience of intimate partner violence in terms that allow comparison across diseases. They can be used in cost-effectiveness analyses to identify the benefits and potential returns from resources allocated to violence prevention and intervention efforts.     

Indicators of intimate partner violence in women's employment: implications for workplace action.

The study examined the indicators and consequences of intimate partner violence on women's employment and associated types and levels of violence. Interviews were conducted with a consecutive sample of 90 women seeking a protective order. Actual and threatened violence was measured with the Severity of Violence Against Women Scales (46 items). Eight questions were asked about type of harassment experienced at the worksite. The results found most of the abused women had been employed at one time (87%) and had also experienced harassment from an intimate partner related to their work (89%). Findings indicated lost productivity and reduced performance. The researchers concluded poor work performance, tardiness, and absenteeism may indicate an employee is suffering from intimate partner violence.     

A literature review: Qualitative studies of women parenting during abuse

Many women worldwide are physically and emotionally abused, and their children are exposed to violence as well, resulting in what has become a worldwide epidemic. The Millennium Development Goals Report 2013 adopted through the United Nations’ Development Program recognizes the continued need for global efforts to empower women, reduce child mortality, and improve child health. This literature review of women's experiences while parenting during abuse revealed the utilization of parenting strategies to parent their child(ren) effectively in the most difficult and traumatic of circumstances. Recommendations from all of the articles caution not to remove the child from the mother, but to give both mother and child tailored interventions and a compassionate and empathetic understanding of what these abused mothers’ parenting experiences are.     

Competence of and emotional/behavioral problems in pediatric oncology patients in Taiwan

The objective of this study was to examine the factor structure of Achenbach's Child Behavior Checklist, using confirmatory factor analysis, in a group of pediatric oncology patients in Taiwan and to compare the competence and behavioral/emotional problems scores of these children with normative scores to assess competence and emotional/behavioral problems of Taiwanese children with cancer. Subjects included parents (124 mothers and 22 fathers) of 146 pediatric oncology patients who completed the measures. Factor loadings of the overall fit indices for the study subjects yielded or approached satisfactory results for all syndromes, except for aggressive behavior. The indices for both internalizing and externalizing syndromes also showed good model fit. Taiwanese children with cancer had significantly lower competence scores on the Child Behavior Checklist/4-18 than did Achenbach's sample, except Taiwanese girls with cancer, who had higher activity competence scores, but these scores were not statistically significant. Taiwanese boys with cancer had significantly higher scores on all of the emotional/behavioral problems, but had lower delinquent behavior, aggressive behavior, and externalizing syndrome scores. In contrast, girls with cancer had significantly higher scores on somatic complaints and internalizing syndrome, but significantly lower aggressive behavior and externalizing syndrome scores. Taiwanese adolescents with cancer had significantly lower competence scores compared with normative scores, with the exception being that the adolescents in the current study had significantly higher school competence scores. These adolescents also had significantly fewer attention problems but tended to have more somatic complaints. These findings clearly indicate that healthcare for children with cancer should include psychological services to prevent long-term emotional/behavioral problems.     

Adjustment to diabetes mellitus in preschoolers and their mothers

Although preschool-aged children with diabetes might be at increased risk for both general and disease-specific psychological adjustment difficulties, this issue has not been investigated. We evaluated both general and diabetes-related adjustment of 20 preschool-aged children and their mothers. The mothers completed the Child Behavior Checklist, Parenting Stress Index, Parents' Diabetes Opinion Survey, and the Preschool Diabetes Behavior Checklist. The latter measure was constructed specifically for this study to measure the frequency of oppositional and avoidance behaviors of children regarding diabetes management tasks. Mothers reported that their children displayed significantly more internalizing behavior problems (anxiety, depression, withdrawal) and were a significantly greater source of parental stress compared with corresponding nondiabetic normative group samples. Also, certain maternal attitudes about diabetes and its treatment were correlated with the children's disease-specific behavior problems. The children's general psychological adjustment, however, was not predictive of these diabetes-specific behavior problems.     

Intimate partner violence as experienced by men

The purpose of this qualitative, phenomenological study is to describe intimate partner violence as experienced by men and to formulate the common structure of meanings of experiences of men exposed to intimate partner violence. The data were gathered by open-ended interviews with 10 ( n  = 10) men. The participants had experiences in intimate partner violence. All the 10 men were interviewed twice and they were allowed to tell their experiences as they liked. The data were analysed by applying the method developed by Colaizzi. The experiences of men formulated three main themes describing the factors leading to intimate partner violence, being a victim of intimate partner violence and own violent behavior. The main themes are named as follows: (1) a burden on the pair relationship; (2) face to face with violence; and (3) from denying violence to striving towards the truth. The research results enhance the understanding of the experiences of men. The information may be useful in promoting women's, men's and families' health, developing work on violence and in the education of professionals in social and health care. The results may also help women to understand men's experiences in a pair relationship.     

Behaviour among children of substance‐abusing women attending a Special Child Welfare Clinic in Norway,as assessed by Child Behavior Checklist (CBCL)

Scand J Caring Sci; 2013; 27; 285–294 Behaviour among children of substance‐abusing women attending a Special Child Welfare Clinic in Norway, as assessed by Child Behavior Checklist (CBCL) Background: A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment is given without substitution. This investigation assesses the behaviour of the children between the ages 6 and 13 years of women who attended the clinic. It also explores the correlation between the behaviour and a neuropsychological screening performed one and a half year earlier. The study was set up to investigate the influence of prenatal substance exposure. Method: Thirty‐eight SCWC children and 63 children in a comparison group were scored by Child Behavior Check List (CBCL). Twenty‐one (55%) SCWC mothers were classed as short‐term users (ceased substance abuse before the end of first trimester), and 17 (45%) were classed as long‐term users (continued a moderate substance abuse throughout pregnancy). Thirteen (77%) of the children of the long‐term users were living in foster homes at the time of the investigation. Results: SCWC children were scored within normal ranges for most items, but their scores were significantly worse than those of the comparison group. Children of short‐term users were given lower scores than comparisons on more issues in CBCL than were children of long‐term users. The SCWC children were breastfed for a shorter time (p = 0.023) and had moved house more often (p < 0.001) than comparisons. SCWC children living with their biological mothers received more special education or remedial classes (p ≤ 0.001) than children of the comparisons. Conclusion: Most children of long‐term users were living in foster homes. Notably, children of short‐term users, that is, children living with their biological mothers, were given lower scores than comparisons in CBCL. Children of short‐term users were more likely to receive special education than children of comparisons. More research is needed on how to reveal parenting problems and how to guide mothers with previous or present substance abuse problems.     

The lived experience of women in abusive relationships who sought spiritual guidance

Women in abusive relationships have recognized the silence of religious institutions and clergy in addressing intimate partner violence. The old message, that women are to blame when family dysfunction occurs, remains evident in society. The objective of this qualitative study was to describe the experience of abused women attempting to decrease their spiritual distress and obtain spiritual guidance from their religious leaders. The findings revealed that clergy were not helpful in alleviating the women's spiritual distress or intervening in the violence. Four themes that epitomized the negative outcomes of the help-seeking behavior were spiritual suffering, devaluation, loss, and powerlessness.