Children Exposed to Intimate Partner Violence

Intimate Partner and Pediatric Violence

Children Exposed to Violence Within Families,Risk Factors For Violence ,Child Exposure to Family Violence,Study Interventions ,Effective Responses and Effective Interventions.

Children Exposed to Violence Within Families

    Given the magnitude of this problem, there is a growing awareness of the potential harm to children exposed to violence within families. 

    Following a 2-year analysis of violence and children, the American Academy of Pediatrics issued a policy statement indicating that the US is experiencing an epidemic of children exposed to violence. 

    Despite recognition that domestic violence seriously threatens the health and emotional well-being of children, only recently researchers have focused on children affected by domestic violence. 

    There has been intense advocacy and legislative action to combat violence against women; however serious concerns about their children did not appear in the research literature until recently (Mohr, Lutz, Fantuzzi, & Perry, 2000).

Risk Factors For Violence 

    Children who live in homes where partner violence occurs are at risk for developing a range of emotional, physical, and behavioral symptoms. 

    Research suggested that they are at serious risk of developing a host of aggressive, antisocial, or fearful and inhibited behaviors and deficits in social skills (Farrell & Bruce, 1997). 

    They are reported to have impaired concentration and difficulties in school performance (Schwab-Stone et al., 1999; Delaney-Black et al., 2002) and higher levels of alcohol abuse as adults (Dube, Anda, Felitti, Edwards, & Croft, 2002). 

    They perform overall at lower levels than nonexposed children on a variety of measures of cognitive and motor development (Jaycox et al., 2002). 

    Children who witness domestic violence demonstrated higher levels of depression and anxiety than counterparts in nonviolent homes (Berman et al.; Hurt, Malmud, Brodsky, & Giannetta, 2001; Cuffe et al., 1998; Jaycox et al.). 

    They see violence as an acceptable form of resolving interpersonal conflicts and they are at risk for potential deviance in future social relationships (Hurt et al.). Children from families with domestic violence are at risk of suffering physical violence themselves.

     The link between marital conflict and child maltreatment has received much attention in the past 10 to 15 years. 

    It has been observed that children of battered women are at an increased risk of being abused themselves, with estimates of an overlap between spousal abuse and child abuse ranging from 30% to 60% (Hartley, 2002; Dong et al., 2003 ).

Child Exposure to Family Violence

    In addition, child exposure to family violence can be deadly. Dube et al. (2001) examined the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences. 

    The researchers conducted a retrospective cohort study of 17,337 adult health maintenance organization members who attended at primary care clinic in San Diego within a 3-year period (1995-1997). 

    Subjects completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. 

    The researchers discovered a powerful relationship between adverse childhood experiences and risk of attempted suicide throughout the life span. 

    Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appeared to partially mediate this relationship ship.

Study Interventions 

    Finally, in a landmark intervention study, Stein and a multidisciplinary group of colleagues (2003) evaluated the effectiveness of a collaboratively designed school-based cognitive behavioral group therapy intervention. 

    The 10-session intervention significantly de- creased symptoms of posttraumatic stress disorder (PTSD) in students who were exposed to violence and experiencing distress.

    There is a dearth of research conducted by nursing scholars on children exposed to violence. Some recent work has been published on the issue of children's reactions to exposure to family homicide, which may be considered within the context of family or intimate partner violence. 

    Clements and Burgess (2002) conducted interviews with 131 children ages 9 to 11 years during the initial 1 to 3 months after a family homicide and provided insight into themes of bereavement. 

    A major finding in the study was that the witnessing or hearing the news of a family member homicide was a powerful associative factor for childhood PTSD and for complicated bereavement.

    In sum, nursing research concerned with victims' children is scanned when compared to what is being studied by psychologists, physicians, and social workers. 

    Findings in all cases comparing children exposed to domestic violence with children from nonviolent homes indicate that this exposure 

(a) has an adverse impact across a range of child functioning

(b) produces different adverse effects at different ages

(c) increases the risk of child abuse

(d) is associated with other risk factors such as poverty and parental substance abuse 

    However, comprehensive reviews of this literature indicate no reliable information about the impact of particular types or frequencies of domestic violence on children or the impact of various degrees of exposure on children's functioning and across time. 

    Close inspection of the child impact research indicates that it does not provide a substantial basis to inform strategic national policies and systemwide action due to many gaps and inadequacies. 

    Some of these include retrospective analysis, no longitudinal studies unsubstantiated reports of child exposure or the violent episode itself, exclusive use of the CBCL as opposed to instruments that are more domain specific, and others (for more in-depth discussion on shortcomings of this literature , see Mohr, Lutz, Fantuzzo, & Perry, 2000).

     Yet, without accurate, reliable information about the prevalence and nature of children's exposure to domestic violence, prevention and intervention efforts cannot be designed for, and public and private resources cannot be appropriately targeted to the affected children.

Effective Responses and Effective Interventions

Effective responses and effective interventions depend on responses to several questions. 

    First, how many children are exposed to domestic violence, and what is the nature of these children's exposure? Second, how do these traumatic events uniquely affect the course of healthy development for child victims? 

    Third, what factors increase risk for, or provide protection against, the potentially deleterious effects of child exposure to domestic violence? Fourth, what types of interventions can mitigate these specific negative effects? Responses to these critical questions require a scientifically rigorous research agenda, leading to the development of a trustworthy database.

    Nurses are often the first care providers identifying and assessing not only adult victims but their children. Their presence in the area of adult victimology is laudable, but nurse scholars are relatively absent in the discussion surrounding the child victims-as invisible as the children themselves a scant 2 decades ago.