David A. Wolfe, Ph.D., ABPP CAMH Centre for Prevention Science / University of Toronto

1. Understanding Children’s Exposure to Violence: Research-based Strategies for Prevention and Intervention David A. Wolfe, Ph.D., ABPP CAMH Centre for Prevention Science / University of Toronto Peter G. Jaffe, Ph.D., C.Psych. University of Western Ontario Centre for Research and Education on Violence Against Women & Children Washington DC January 25, 2011

2. Exposure to Violence • Domestic violence & child abuse • School violence • Community & Neighborhood violence • Media violence

3. Incidence estimates of child exposure to IPV • 15.5 million children in US • based on interviews derived from national US sampling, • approximately half of those children (7 million) were exposed to severe domestic violence (McDonald et. al., 2006). • 133 to 275 million children worldwide • Estimates based on United Nations Population Division data and domestic violence studies from 1987 to 2005 (Behind Closed Doors: The Impact of Domestic Violence on Children (London: UNICEF and The Body Shop International Plc., 2006).

4. Types of “exposure” • exposed prenatally • intervenes to stop the violence • victimized by one or both parents • participates in conflict or violence • is an eyewitness • overhears the violence • observes the initial effects • experiences the aftermath • hears about it indirectly • ostensibly unaware Holden, G. W. (2003). Children exposed to domestic violence and child abuse: Terminology and taxonomy. Clinical Child and Family Psychology Review, 6(3), 151-160.

5. Children’s Paradox: • torn between a sense of loyalty and a sense of fear and apprehension • Children want to stop the violence but they also want to belong to a family • Affection and attention may coexist with violence and abuse. • The intensity of the violence tends to increase over time.

6. The Cultural Context:The Role of Media and Entertainment in Promoting Violence • Association between media violence and aggressive behaviour comparable to • calcium intake – bone mass • lead ingestion – lower IQ • condom use – HIV • smoking – lung cancer Based on 2000 studies – Reported in Pediatrics 2009,124,5, 1495-1503

7. Resources for educators • http://www.crvawc.ca/CritMedLitCD/index.html

8. Impact on Child Development • Insecure-disorganized attachment • Reduced emotion regulation; inability to regulate or describe their inner state; increased attention to threat cues • Negative sense of self: badness, shame, self-blame • Relationship-specific impact [Summary by developmental level (next page), from Carlson (2000), Children exposed to intimate partner violence: Research findings and implications for intervention. Trauma, Violence, & Abuse, 1(4), 321-342]

9. Effects of Exposure, by developmental level

10. Clinical outcomes:Infants and Preschoolers • failure to thrive; listlessness • disruption in eating & sleeping routines • developmental delays • problems with attachment/trust • aggression • Clinging, anxiety • cruelty to animals • destruction of property • PTSD symptoms

11. Clinical outcomesElementary School Ages • bullying • general aggression • depression • anxiety • withdrawal • PTSD symptoms • oppositional behaviour • destruction of property • poor school achievement • disrespect for females; sex role stereotyped beliefs

12. Clinical outcomesAdolescence • dating violence • bullying • poor self-esteem • suicide ideation • PTSD symptoms • truancy • somatic concerns • disrespect for females; sex role stereotyped beliefs • alcohol/drug abuse • running away from home • sudden decline in school achievement & attendance

13. Factors Enhancing Resilience • A strong relationship with a competent, caring, positive adult; most often a parent* • Benefits of community safe havens (e.g., schools, community centres & churches)* • Characteristics of the child — average/ above-average intelligence, good attention span & interpersonal skills, positive self-esteem, access to resources for good schooling/employment/community activities* • Stability, Economic Viability • Protection Osofsky, J.D. (1999). The impact of violence on children. The Future of Children: Domestic Violence and Children, 9: 3, 33-49

14. Prevention and Intervention Points Prevention before occurrence Prevention of recurrence Prevention of impairment Physical abuse Sexual abuse Emotional abuse Neglect Exposure to IPV Long-term outcomes Universal Targeted MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. (2009). Interventions to prevent child maltreatment and associated impairment. The Lancet. 2009;373:(9659):250-266.

15. Universal Programs • Media campaigns promoting awareness of violence • Helpful responses for concerned family, friends, neighbours, and co-workers • School-based and community agencies awareness and skill development • Programs that teach positive relationship skills, alternative conflict resolution, issues around gender roles, and forming healthy intimate relationships (e.g., The Fourth R; Safe Dates)

16. Selected Programs • Shelter programs for at-risk children - children in shelters may not present with problems associated with exposure to IPV • Child Protection Services Programs - An estimated 30% to 60% of children suffering child maltreatment may also be exposed to IPV (Edleson et al., 2006).

17. Indicated Interventions • Child-parent psychotherapy • Trauma-based Cognitive-Behavioral Therapy • Group Therapy (e.g., The Kids Club) • Acute Trauma Therapy • Home Visitation with Abused Women and Children (e.g., Project Support) • Intervention Programs for Abusive Fathers (e.g., Caring Dads)

18. Education, Social Services, Health & Justice System Collaboration • Crisis Assessment & Intervention • Refocusing Existing Services • Children’s and Adult Mental Health Services • Child Protection Services • Counseling Parents • Custody and Access Disputes • Juvenile Justice Programs • Specialized Services for Abused Parents, Batterers and their Children • Coordination of Community Services & Justice System • Primary Prevention in Schools

19. Promoting Healthy, Non-Violent Relationships Among Youth

20. Preventing Abuse and Violence:Key Principles • Child abuse and neglect are relationship problems, with contributing causes stemming from childhood. • Violence does not affect everyone equally • Recognize violence in relationships as part of societal violence • Relationships are dynamic and can be “adjusted” at many points along the life span • Healthy relationships are one of the best protective factors known in preventing violence and abuse • All teens need accurate information and exposure to positive models. They need to practice skills such as problem solving, emotion regulation, mediation and conflict resolution.

21. STRATEGIES FOR HEALTHY YOUTH RELATIONSHIPS featuring the Fourth RComprehensive and Integrated Approaches for Helping Schools and Communities Reduce Violence and Risk-Taking Among Youth David A. Wolfe, Ph.D. Claire Crooks, Ph.D. Ray Hughes, M.Ed. Peter Jaffe, Ph.D. Debbie Chiodo, M.Ed. CAMH Centre for Prevention Science / University of Toronto

22. The Fourth R: • Help youth strengthen relationship skills to assist in making safe, responsible choices • Address the common elements of multiple risk behaviors (re: goals of adolescence) • Counteract pro-abuse messages from peer culture (gender, race, sexual orientation) • Emphasize positive message of safety and harm reduction (prepare, not scare) • Provide opportunities to develop assets and strengths (build youth connections) The Fourth R

23. Unit 1: Personal Safety and Injury Prevention (7 lessons) • Focus on Healthy Relationships • myths/facts about teen relationships, relationship rights & responsibilities • Barriers to Healthy Relationships • active listening skills and ‘types of violence/abuse’ • Contributors to Violence • group effects on violence, individual differences • Conflict & Conflict Resolution • communication styles: passive, assertive, aggressive; conflict scenarios • Media Violence • student presentations of examples of violence in the media • Conflict Resolution Skills • rights and responsibilities when ending a relationship • Action in the School and Community