Safety and Sobriety Manual
Best Practices in Domestic Violence and Substance Abuse
Special Settings: Child Welfare
Domestic violence and substance abuse increase the risk of child abuse and neglect. Either problem alone has the potential to destroy families; but when the two are combined, this potential increases significantly.
Domestic Violence and Child Maltreatment
Ninety-five (95) percent of injurious domestic violence is committed by men against women. These same men are also at high risk of physically abusing their. children. Research has shown that children in homes where domestic violence occurs are at risk of becoming victims of violence themselves:
- Children whose mothers are battered are physically abused or neglected at a rate 15 times higher than the national average.
- Women and children are often victims of the same batterer. Studies have found that over half of the children of battered women have been physically or sexually abused by the same perpetrator as their battered mothers. Research on abused children similarly shows that nearly half of them have mothers who are battered.
- Lenore Walker's study of battered women found that one quarter had abused or neglected their children when they were being abused themselves. The same study also found that battered women were eight times more likely to hurt their children when they were being battered themselves than when they were living safe from violence.
- Even if they are not intentionally targeted for abuse, children in homes where women are being battered are sometimes injured while trying to intervene on behalf of their mothers, or when they are nearby while objects are thrown. Young children are sometimes hurt when their mothers are attacked while holding them.
- Because domestic violence is a pattern of behavior that escalates over time, it becomes increasingly likely that child witnesses of battering will eventually become victims of the same perpetrator.
- Domestic violence is the single major precursor to deaths occurring as the result of child maltreatment.
Even when children of battered women are not physically abused themselves, they still suffer the traumatic effects of witnessing violence between their parents or caretakers. It is estimated that at least 3.3 million children annually are exposed to episodes of domestic violence (Schewe, 2000). Children may also be used as pawns by an abuser who uses them to gain control of the mother. While many of these children are seriously affected by their experience, others seem to be surprisingly resilient.
Research has shown that of children residing in domestic violence shelters, one-third show minimal problems, one-third have significant problems but are able to cope with them, and the remaining one-third suffer problems the severity of which puts them in the clinical range of symptomatology (Hughes & Luke, 1998). At least one other study, however, indicates that as many of 50% of child witnesses to domestic violence manifest significant problems of adjustment (Margolin, 1998). The gravity of the trauma experienced by such children and the nature of their reaction to the observed violence may depend on a number of factors, such as:
- The nature of the domestic violence.*
- The severity of the abuse.*
- Whether the child witnessed one act of abuse or multiple acts.*
- The length of time that episodes of abuse continued.
- The age of the child.*
- The existence of other family problems, such as substance abuse, mental illness and homelessness.*
- Whether the child told anyone outside the family about the abuse and, if so, what the result of "breaking silence" was.
Schewe (2000) has suggested that another important factor influencing the child's reaction to domestic violence is the nature of social supports available to the child. Recent research that has identified key factors that contribute to resilience and coping ability in children exposed to domestic violence has shown that chief among these factors is a strong relationship with a caring, competent and positive adult, most often a relative (Groves and Zuckerman, 1 997).
Whether or not they experience any physical abuse themselves, children from violent homes are at risk for problems of adjustment:
- Children who witness domestic violence suffer effects similar to children who are themselves physically or sexually abused. In some cases, children who are exposed to violence display symptoms similar to post-traumatic stress disorder in adults, such as repeatedly reexperiencing the traumatic event, emotional numbing, avoidance and increased arousal (Bell, 1995).
- Children under the age of five may be at risk of serious development problems due to the heightened stress and the physical immaturity of their brains (Analytical Sciences, 2002).
- The emotional effects of domestic violence on children include taking responsibility for the abuse, constant anxiety, guilt for not being able to stop the abuse, fear of abandonment, and lack of confidence.
- Children from violent homes may experience cognitive or language problems, developmental delay, stress-related physical ailments, hearing and speech problems, excessive irritability, sleep problems and fear of being alone (Zeanah & Scheeringa, 1996).
- Stress-related symptoms such as bed-wetting, hair pulling, frequent nightmares or night terrors are often present in children of battered women.
- Some children cope through regressive symptoms such as thumb-sucking or infantile temper tantrums, or display regression in toilet training or language (Zeanah & Scheeringa, 1996).
- Even infants can be visibly upset by arguments between their parents.
* These factors appear in Schewe, P.A., et. al. (2000). Interventions for Children Exposed to Domestic Violence. Paper presented to the Illinois Department of Human Services by the author and the University of Illinois-Chicago Domestic Violence and Sexual Assault Evaluation Team.
In addition to these negative effects, children of battered women also experience the effects of having violent role models. They learn that violence is an appropriate way to manage stress, one that has few consequences from society:
- Many children begin to act out the violence they have seen at home. A study found that 47 percent of boys and 36 percent of girls from violent homes fell within the clinical range of behavior problems. Even when they are not physically abused themselves, child witnesses of domestic violence still show higher levels of behavior problems than children living in safe homes.
Research shows that children from violent homes are more likely than other children to be abusive toward brothers and sisters.
- When tested, children from violent homes were more likely than their peers from nonviolent homes to indicate that violence is an acceptable way to resolve conflicts, bring a quick end to an argument, get their way or express anger.
This modeling of violence continues into adulthood, and many children of battered women become batterers or victims themselves. Boys from violent homes are 15 times more likely than boys from non-violent homes to become abusers themselves. Research found that witnessing spouse abuse as a child was an even better predictor for becoming an abuser than experiencing physical abuse as a child. In this way, the cycle of violence continues.
- They learn that violence is an appropriate way to manage stress, one that has few consequences from society.
Substance Abuse and Child Maltreatment
Substance abuse is closely linked to child abuse. At least 40 percent of child maltreatment cases involve the use of alcohol or other drugs, and that percentage could be as high as 75 percent. Studies suggest that at least 10 million children live in homes where the primary caretaker is addicted to alcohol or other drugs, and up to 675,000 children per year suffer serious abuse or neglect as the result of that substance abuse.
- Among psychoactive drugs, methamphetamine, cocaine, and PCP are only three of the substances that are capable of increasing the risk for violence due to drug-related irritability, hostility, suspiciousness, and psychosis.
- Among psychoactive drugs, alcohol, methamphetamine, cocaine and PCP are the only three substances that are capable of increasing the risk of aggressiveness and violence due to drug-related irritability, hostility, suspiciousness, and psychosis. Alcohol, barbiturates, and tranquilizers, due to their disinhibiting effects, may also act as a risk factor for domestic abuse by sedating the portion of the brain that acts to recognize and suppress violent/antisocial behavior. In addition, the diminished consciousness produced by such drugs may produce an increased risk for child neglect as well as reduce the ability of a caretaker to protect the child from violence within the home.
- Opiate use (e.g., heroin) may contribute to child neglect, while withdrawal from opiates is more likely to increase the risk for abuse.
- The communities in which addicted women live with their children may also be a source of traumatic violence. In Illinois, some clients report that they live in what they perceive as a "war zone," and may resort to sleeping with their children on the floor of their home in order to avoid stray bullets from drive-by shootings.
Whether or not they are physically abused, children of substance abusers experience the effects of the chronic stress of living with an addicted parent. Young children of substance abusers may believe they caused the addiction, and older children may feel anxiety and guilt for not being able to control or cure it. Like children of batterers, children of substance abusers often grow up to repeat the pattern, becoming substance abusers themselves.
Safety and Sobriety
A common assumption within substance abuse treatment programs is that if the offending parent's alcohol or other drug use ceases, so will child maltreatment. This assumption, however, is based on the mistaken belief that the child abuse or neglect is entirely a product of substance abuse.
- Child neglect appears to decrease when an addicted parent or caregiver achieves and maintains sobriety. In some cases, child neglect is directly related to the effects of alcohol and other drugs and to the addict lifestyle, which is often chaotic and unpredictable.
- Child abuse seems to decline minimally, if at all with sobriety. The parent's sobriety can not be taken as an indication that all child maltreatment will stop.
- A personal history of child abuse is also a risk factor for continued or renewed substance abuse as a means of "elf-medicating" the feelings associated with such trauma. Of adults in substance abuse treatment, nearly 70 percent of women and 12 percent of men were sexually abused as children. Substance abuse may often serve as the "anesthetic" which numbs the pain of being an adult survivor of child abuse. When this anesthetic action ceases as the result of sobriety, the individual's pain may be magnified, increasing the risk of child abuse. For this reason, therapy or counseling outside the realm of chemical dependency treatment may be required in order to minimize the risk of continued child abuse.
- Child neglect appears to decrease when an addicted parent or caregiver achieves and maintains sobriety.
- Child abuse seems to decline minimally, if at all with sobriety.
- A personal history of child abuse is also a risk factor for continued or renewed substance abuse as a means of "self-medicating" the feelings associated with such trauma.
Programmatic Responses to the Issue of Child Witnessing
Each year domestic violence programs funded by the Illinois Department of Human Services provide almost 150,000 hours of service to at least 25,000 children. A summary of these services can be found in Schewe (2000).
Systematic evaluation studies concerning the effectiveness of services to child witnesses of domestic violence are currently lacking. Some research has been conducted, but the results are mixed. Evidence accumulated more than 15 years ago has suggested that such interventions may be helpful (Jaffe, Wilson and Wolfe, 1986). The authors conducted interviews with both children and their mothers who had completed a 10-week program that used small group processes as the primary intervention, and reported the following results:
- Mothers said that their children enjoyed the group (93%), learned something from the group (62%) and changed their behavior as a result of the group (33%) (Jaffe, Wilson and Wolfe 1986).
- Children who participated in the group were more able to identify 1) three or more appropriate reactions to emergency situations (44% preintervention vs. 73% post) and 2) two or more positive things about themselves (53% vs. 85%) (Jaffe, Wilson and Wolfe 1986).
Two more recently conducted studies have also produced mixed results. Pepler, Catallo & Moore (2000) examined a 10-session small group intervention for 6 to 13-year-old children who have been exposed to domestic violence. Reductions in depression and anxiety were noted, as well as an improvement in emotional and hyperactivity problems. On the other hand, no significant changes in the (negative) conduct of participants (as measured by the Child Behavior Checklist) were observed, nor changes in attitudes against violence (as measured by the Attitudes Toward Family Violence Questionnaire). In addition, there appeared to be no correlation between the mothers' participation in domestic violence counseling and their children's improvement (Pepler, Catallo & Moore, 2000).
Stein, Jaycox, et. a\. (2003) evaluated the results of a school-based intervention designed to reduce children's symptoms of post-traumatic stress disorder (PTSD) and depression that had resulted from their exposure to violence. However, at the request of the schools involved, questions asking specifically about violence at home were removed from the project questionnaire. Thus, it is unknown how many of the subjects were suffering from violence observed in the community versus at home. Violent events that the subjects had observed in the media or that they had simply heard about rather than observed first hand were not included.
Stein, Jaycox and their colleagues also utilized a ten-sessionlten-week intervention delivered in the schools by psychiatric social workers After three months of participation in the intervention group, students who were randomly assigned to the group had, compared to a group of similar students who received no treatment, lower scores on symptoms of PTSD, depression and psychosocial disruption. However, no significant differences between the two groups was found with regard to teacher-reported classroom problems in acting out, shynesslanxiousness, and learning. At 6 months, after both groups had participated in an intervention group, there were no statistically significant differences with regard to symptoms of PTSD, depression or teacher-reported classroom behavior.
When intervening with children exposed to domestic violence:
- The batterer should be referred to only protocol approved PA/PS and not anger management services.
- Separate service plans for the victim and batterer are best practice so that the batterer doesn't have the opportunity to jeopardize her custody of the child.
- Safety planning for the child and victim should occur especially if visitation with the batterer is allowed.
- Substance abuse and victim or abuser services should be concurrent.
- Services for the victim or batterer should be community based, licensed (substance abuse treatment), monitored (victim services) and/or protocol approved (batterer).
- If interventions require that both the victim and batterer attend services at the same location, victim safety should be considered.
The identified client within both domestic violence and substance treatment programs is the adult. However, such programs should take into account the importance of ensuring the safety of children within a home in which substance abuse and/or domestic violence is occurring. In fact, since both substance abuse and domestic violence intervention programs are mandated to report child abuse and/or neglect, such programs must report situations in which children are harmed as the result of substance abuse or domestic violence in their homes. However, the question of whether mandated reporters are required to report situations in which a child has witnessed repeated instances of domestic violence on a regular basis is debatable.
Schewe (2000) has suggested that if perpetrating domestic violence in the presence of a child or, more relevantly, "exposing1' children to such acts is defined as child maltreatment, battered women may be discouraged from seeking help, fewer child and family service providers will screen for domestic violence, and even greater demands will be placed on the already overburdened child welfare system. At a minimum, though, children from homes in which domestic violence has occurred should receive a thorough physical and psychological assessment, and, when appropriate, should be referred to a specialized support group such as those commonly found in domestic violence programs.
Training and Certification
At present, no agency within Illinois provides specific certification for child welfare professionals. The Illinois Alcohol and Other Drug Abuse Professionals Certification Association (IAODAPCA) provides a wide range of certificates and levels of certification for substance abuse counselors, preventionists, assessment and referral specialists, and M/SA (mentally-ill substance abuse) workers. Currently, training in the areas of domestic violence and child welfare are not requirements for such certification. Illinois Certified Domestic Violence Professionals, Inc. is the organization in Illinois currently certifying domestic violence professionals. More information about this organization can be obtained at their Web site at www.ilcdvp.org.
- Currently, the best solution to the issue of dual certification appears to be to continue offering cross-training opportunities to various professions, and to encourage continued dialogue and service planning between the various fields.
- Individuals who are chemically dependent, as well as those who are victims of domestic violence and child maltreatment, are frequently seen in hospital emergency departments and physicians' offices. Doctors, nurses, and social workers should be targeted for training in the screening of patients for substance abuse, domestic violence and child maltreatment.
- Colleges and universities should be encouraged to seek out opportunities for students majoring in human service fields to learn skills and gain experience in such diverse fields as addiction counseling, domestic violence intervention, and child welfare.