Shelter from the Storm: Supporting and Intervening with Children Affected by Domestic Violence

1. Shelter from the Storm: Supporting and Intervening with Children Affected by Domestic Violence Betsy McAlister Groves, LICSW Child Witness to Violence Project Boston Medical Center

2. Take home messages for supporting children affected by domestic violence • Relationships matter! • The parent child relationship • Your relationship with the mother and child • Children react to and cope with domestic violence in different ways. Their capacities for coping vary by age, temperament, and environmental support • Know thyself! We as caregivers bring our own strengths, vulnerabilities and histories to this work

3. Child Witness to Violence Project Provides counseling services to children age 8 & younger (and their families) who have witnessed significant violence Provides training/consultation to providers who work with children affected by violence. Member of the National Child Traumatic Stress Network/Early Trauma Treatment Network

4. Child Witness to Violence Projectchildwitnesstoviolence.org Special Projects • Pediatric Resources • Training videos for physicians • Pediatric ER Screening Project • Strengthening Military Family Connections • Training Initiative with DCF • Training in Ecuador & Colombia • Bi-annual training institute

5. Profile of children in CWVP • Gender: • Boys-65% • Girls-35% • Race/ethnicity • Latino-57% • African American-26% • Caucasian-10% • Other-7%

6. Components of Clinical Intervention • Safety and stability • Reduction of symptoms • The opportunity to talk about the traumatic experience in the safety of a therapeutic relationship • Strengthening of the child-parent relationship

7. CWVP: Lessons Learned • Domestic violence is the most toxic form of exposure to violence for young children • There is no age at which a child is immune to the effects of exposure to violence • A child’s reaction to the trauma is closely related to the parent’s ability to cope with the trauma • Children create their own unique meaning of domestic violence experiences

8. Domestic violence is a particularly toxic form of trauma for children.

9. The Continuum of Exposure to Domestic Violence Seriousinjuries Fatal assaults Physical assaults Threats of homicideor suicide Weapons threats Severity of violence Highly controlling behavior Threats, intimidation Destruction of property Marital conflict, arguing, yelling Number of children 2.3

10. Trauma and Young Children • Scheerenga & Zeanah (1995): Proposed classification of PTSD symptoms in children age 48 months and younger • Unanticipated finding: most potent trauma variable predicting PTSD symptoms was witnessing a threat to the caregiver.

11. Not all children are equally affected by exposure to violence: Influences on a child’s response • Characteristics of the child • Age • Gender • Temperament/personality • Characteristics of the Family & Community • Parenting • Access to outside supports • Characteristics of the Violence • Frequency • Severity • Proximity 2.15

12. There is no age at which a child is immune to the effects of domestic violence.

13. Complex Trauma Survey • Data on 100,000+ children across 54 sites of the NCTSN • Findings: • Most frequently mentioned trauma was exposure to domestic violence • Average age of onset: 5 years old

14. Sample Characteristics N=149 (29 shelter) Boys=109 Girls=40 Age Range: 6 months – 6.9 years 0-2.9= 28 (22 boys) 3.0-6.9=121 (87 boys)

15. Age at First Exposure 0 - 2.9 years 61% 3.0 - 6.9 years 39% N=149

16. Most frequently reported symptoms found in CWVP referrals: Temper Tantrums/Angry Outbursts 60% Aggressive with Peers 60% Aggressive with Adults 56% Demanding/Controlling 50% Play re-enactment 41% Nightmares 40%

17. Supporting or repairing the parent-child relationship is an essential ingredient to helping children.

18. Impact of Trauma on Caregiver-Child Relationship • Loss of sense of caregiver as reliable protector • Disturbed mental representations of who is safe and who is dangerous (Lieberman & Van Horn, 1998)

19. Impact of Trauma on Caregiver-Child Relationship • When the caregiver has also experienced interpersonal trauma: • The caregiver’s ability to establish and maintain an empathic relationship with the child may be impaired • The caregiver may have a decreased capacity to recognize danger or stress • The child may take the role of caregiver

20. Tips for Parent Guidance • Helping the mother with safety is often the first and best way to help the child. • Give parents information about child symptoms. Remind parents that their child’s reactions are normal reactions to an abnormal event. • Assist parents in talking with child about the traumatic event. • Encourage parents to listen carefully to the child’s fears and to develop a plan to help the child feel more safe. • Encourage parents to provide a predictable and secure routine for the child.

21. Children create their own unique meaning of domestic violence experiences

22. Principles of Intervention • Healing begins with relationships • Children must know what to expect in their everyday surroundings • Provide activities that promote a child’s competence and self esteem. • Don’t try to do it all alone • Model nurturing behavior & teach alternatives to violence. • Pay attention to your feelings of helplessness or hopelessness

23. Healing begins with relationships

24. Children need predictability and stability in their everyday environments

25. Provide activities that promote a child’s competence and self esteem.

26. Model nurturing behavior & teach alternatives to violence

27. We can’t do this alone! Collaborations matter.

28. Pay attention to your feelings, especially anger, helplessness, hopelessness (Working with families affected by domestic violence changes our view of the world)

29. Trauma and the Caregiver Exposure to children’s tragic stories can: • Affect one’s view of the world • Lead to feelings of hopelessness, helplessness and inadequacy • Trigger memories of personal experiences with trauma • Evoke feelings of anger at parents, at the system • Lead to compromised job performance and burn-out

30. Self audit: Where are my triggers? • What about working with families affected by domestic violence is most difficult for me? Why? • Which parents are hardest for me to work with? • What are my triggers in doing this work? • Where do I get support?

31. More Information • NCTSN.org • http://www.developingchild.net • Childwitnesstoviolence.org

32. Contact Information: Betsy McAlister Groves, LICSW Child Witness to Violence Project Boston Medical Center Boston, MA 617-414-4244 Betsy.groves@bmc.org Website: www.childwitnesstoviolence.org