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The Effects of Domestic Violence on Victims and Their Children

The Effects of Domestic Violence on Victims and Their Children. Soroptimist Spring Conference April 28, 2019 Kathy Franchek-Roa MD, Assistant Professor University of Utah School of Medicine. Objectives.

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The Effects of Domestic Violence on Victims and Their Children

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  1. The Effects of Domestic Violence on Victims and Their Children Soroptimist Spring Conference April 28, 2019 Kathy Franchek-Roa MD, Assistant Professor University of Utah School of Medicine

  2. Objectives Recognize the range of experiences for children who witness DV and other ACEs and the impact on their health and well-being Recommend strategies to help ameliorate the effects of DV exposure and other ACEs on children

  3. Objectives Recognize the range of experiences for children who witness DV and other ACEs and the impact on their health and well-being

  4. What is Trauma? Trauma A deeply distressing or disturbing experience Adversity A state or instance of serious or continued difficulty or misfortune Stress A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation Toxic Stress An adversity, trauma, or stressor that interrupts the normal developmental trajectory of a child

  5. On average more than half of adults surveyed had at least 1 ACE Childhood Trauma EARLY DEATH • ACE study documents • the conversion of • traumatic emotional • experiences in • childhood into • organic disease • later in life Heart Disease Cancer Diabetes Disease Disability Suicidality Drug Use Poor Diet High Risk Health Behaviors Lack of Exercise Smoking Sexual Promiscuity Lower IQ Lower Graduation Rates Social, Emotional, Cognitive Poor Work Performance Lower Academic Achievement Alters Physiology Influences Behavior Disrupted Neurodevelopment Changes Brain Structure Adverse Childhood Experiences/Toxic Stress Domestic Violence Parental Mental Illness Parental Separation Abuse Financial Hardship Natural Disasters Bullying Parental Drug Abuse Neglect War https://www.cdc.gov/violenceprevention/ACESTUDY/about .html;CDC 2016; Felitti 1998

  6. Prevalence of ACEs in Children Percent of children aged 0-17 who experienced 2 or more of the following: ►Saw or heard violence in the home ►Lived with anyone mentally ill, suicidal, or depressed ►Lived with anyone with alcohol or drug problem ►Parent/guardian divorced or separated ►Parent/guardian served time in jail ►Parent/guardian died ►Often treated or judged unfairly due to race/ethnicity ►Hard to get by on income ►Victim/witness of neighborhood violence National Average 22% Percentage of Children with 2 or more ACEs Bethell 2017

  7. ACE Study Found ACEs are extremely common There is a dose response relationship Impacts health across the lifespan CDC 2016; Felitti 1998

  8. Despair Impact of Trauma Fear Anger Hopeless Emotional Trust issues Detached Grief Irritable Shock Shame Anxiety Disbelief Hypervigilance

  9. Domestic Violence • Controlling, assaultive, or coercive behaviors that may include • Physical injury Psychological abuse • Sexual assault Social isolation • Stalking Deprivation • Threats Intimidation • Used to establish power and control over a partner • Perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with the victim • DV is a serious, preventable public health problem Family Violence Prevention Fund 1999, 2004

  10. Prevalence of Domestic Violence Lifetime Prevalence of Sexual and Physical Violence and/or Stalking by an Intimate Partner National Average 37% Percent of Women Smith 2017

  11. US Femicide • 94%of female victims were murdered by someone they knew • Most frequent perpetrator of murder for • Men is an acquaintance/friend (35%) • Women is an intimate partner (51%) • The most dangerous time for a victim is when she tries to leave Kochanek 2014; Lachs 2015; Redfield 2018; Smith 2017; https://www.cdc.gov/violenceprevention/pdf/ipv-nisvs-factsheet-v5-a.pdf

  12. Child Witness to DV Morbidity Mortality 911: What’s your emergency? CHILD: My mommy and daddy are having a fight! 911: Is he hitting her? CHILD: I’m talking to the police Mommy! Stop it! Mommy!! Oh my God! 911: What’s the matter? CHILD: Mommy! Disease, Disability, & Social Problems www.ojp.usdoj.gov/ovc

  13. Experiences • Actually observe the parent being harmed, threatened or murdered • Overhears this behavior from another part of the home • Exposed to the short- or long-term physical or emotional aftermath of parent’s abuse • Parent’s bruises/injuries • Parent’s fear or intimidation Family Violence Prevention Fund 1999, 2004

  14. Ability to Parent Victim Abuser Child Overwhelmed Less involved Parentification Less available Abuses child Also a victim Family Violence Prevention Fund 1999, 2004

  15. Behaviors in Trauma-Exposed Children • Teen • Truancy—Socially disengaged—Runaway Hopelessness—Drug use • Unhealthy relationships—Sex trafficking—Depression—Anxiety • School-age • Cannot focus—Cannot sit still—Cannot Concentrate • Somatic complaints—Aggressive—Parentification—Anxiety • Preschool • Enuresis—Somatic complaints—Fearful • Language delay • Toddlers • Fussy/clingy—Regression • Aggression—Difficulty with others • Infants • Crying—Sleep problems • Eating problems—Delay

  16. DV and Child Abuse • 56% • of families with a child homicide had DV • 6-15 times • More likely to be abused DV is a factor for reentry into the child welfare system Domestic Violence • 50 acts • Probability of child abuse nearly 100% Carter 1999; Hess 1992; Knapp 1998; Ross 1996

  17. Interaction of DV with other ACEs DV in the home is linked with experiencing multiple ACEs DV is a strong adverse experience in itself, independent of other ACEs Exposure to DV is associated with being a victim of DV in adulthood Dube 2002; Jirapramukpitak 2011; Lamers-Winkelman 2012; Roberts 2010; Whitfield 2003

  18. Objectives Recognize the range of experiences for children who witness DV and other ACEs and the impact on their health and well-being Domestic violence…seems to be the most toxic form of violence exposure for children…For many children, the first lessons they learn about violence are not from television or from the streets, but from their own parents. These lessons are generally the wrong lessons… Groves 2002

  19. Objectives Recognize the range of experiences for children who witness DV and other ACEs and the impact on their health and well-being Recommend strategies to help ameliorate the effects of DV exposure and other ACEs on children

  20. Six Core Strengths for Children Attachment • Being able to form and maintain healthy emotional bonds and relationships Self-Regulation • Containing impulses, the ability to notice and control primary urges as well as feelings such as frustration • Being able to join and contribute to a group Affiliation Vaccine Against Violence Attunement • Being aware of others, recognizing the needs, interests, strengths and values of others Tolerance • Understanding and accepting differences in others Respect • Finding value in differences, appreciating worth in yourself and others Perry 2005

  21. Resilience Resilience requires supportive relationships and opportunities for skill-building Resilience results from a dynamic interaction between internal predispositions and external experiences Learning to cope with manageable threats to our physical and social well-being is critical for the development of resilience Some children respond in more extreme ways to both negative and positive experiences Individuals never completely lose their ability to improve their coping skills, and they often learn how to adapt to new challenges ACEs and TOXIC STRESSORS Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Household Mental Illness Incarcerated Household Member Mother Treated Violently Household Substance Abuse Parental Separation or Divorce Natural Disaster and War Bullying Community Violence Financial Hardship Felitti 1998; Shonkoff 2012; www.developingchaild.harvard.edu Being Homeless Racism, Sexism, Discrimination

  22. Fortson 2016

  23. Objectives Recognize the range of experiences for children who witness DV and other ACEs and the impact on their health and well-being Recommend strategies to help ameliorate the effects of DV exposure and other ACEs • Children CAN overcome this legacy and mature into healthy, happy adults, but they need our help • Children who have been exposed to violence need skilled interventions to overcome the effect of their experiences • HOPE

  24. Thank you Questions/Discussion

  25. Resources Academy on Violence and Abuse ACEs Videos CDC ACEs Website American Psychological Association Resilience American Academy of Pediatrics The Resilience Project NAMI of Utah 877-230-6264 The Medical Foundation ACEs & Hope NCTSN Child Resilience & Trauma Child Trends Early Childhood ECHO Parenting Post-Traumatic Growth TRC Utah Health & Resiliency Center on the Developing Child Science of Resilience

  26. References Bethell CD et al. Issue Brief: A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive. Johns Hopkins Bloomberg School of Public Health. October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/ Carter LS et al. The Future of Children – Domestic Violence and Children. 1999;9:4 Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016. http://www.cdc.gov/violenceprevention/acestudy Dube SR, et al. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence Victims. 2002;17:3-17

  27. References Family Violence Prevention Fund. Preventing Domestic Violence: Clinical Guidelines on Routine Screening. San Francisco, CA. Family Violence Prevention Fund. 1999, Revised 2004 Felitti VJ et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults—the Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14:245-258 Felitti VJ. Reverse alchemy in childhood: Turning gold into lead. Health Alert. Vol 8 No 1. 2001 Dube SR, et al. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence Victims. 2002;17:3-17 Fortson BL, et al. (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

  28. References Groves BM. Children Who See Too Much: Lessons from the Child Witness to Violence Project. Beacon Press, 2002 Hess PM et al. Effectiveness of family reunification services: An innovated evaluative model. Social Work. 1992;37:304-311 Jirapramukpitak T, et al. Family violence and its ‘adversity package’: a community survey of family violence and adverse mental outcomes among young people. Soc Psychiatry Psychiatr Epidemiol. 2011;46:825-831 Knapp JF. The impact of children witnessing violence. Ped Clinics of No America. 1998;45:355-364 Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf Lachs M, Pillemer, K. Elder abuse. New England Journal of Medicine. 2015;373:1947–56

  29. References Lamers-Winkelman F, et al. Adverse childhood experiences of referred children exposed to intimate partner violence: consequences for their well-being. Child Abuse & Negl. 2012;36:166-179 Perry BD. Maltreatment and the Developing Child: How Early Childhood Experience Shapes Child and Culture. The Centre for Children & Families in the Justice System. 2005 http://www.lfcc.on.ca/mccain/perry.pdf Redfield RR et al. Surveillance for violent deaths—National Violence Death reporting System, 27 States, 2015. MMWR. 2018:67(11):1-33 Roberts AL, et al. Witness of intimate partner violence in childhood and perpetration of intimate partner violence and adulthood. Epidemiology 2010;21:809-818 Ross SM. Risk of physical abuse to children of spouse abusing parents. Child Abuse & Negl. 1996;20:589-598 Shonkoff JP et al. Technical Report—The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012:129:e232-e246

  30. References Smith, S.G., Chen, J., Basile, K.C., Gilbert, L.K., Merrick, M.T., Patel, N., Walling, M., & Jain, A. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Whitfield CL, et al. Violent Childhood Experiences and the Risk of Intimate Partner Violence in Adults: Assessment in a Large Health Maintenance Organization. Journal of Interpersonal Violence 2003; 18:166-185

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