Researchers have long been aware of the link between domestic violence and child abuse. Even if children are witnesses to acts of violence and not the intended targets, they can be affected in the same way as children who are physically and sexually abused.(1) Since domestic violence is a pattern of behavior, not a single event, episodes may become more severe and more frequent over time, resulting in an increased likelihood that the children eventually become victims. The following offers some commonly asked questions and answers about domestic violence and its relationship to child abuse. This information is available in the form of an NCPCA fact sheet. To request a copy, call (312) 663-3520 and ask for the Communications Team.
Domestic violence is a widespread problem with long-term consequences to the abuser, the victim, and all family members. Recent surveys indicate that increased public awareness about domestic violence, along with a more understanding attitude toward victims, has encouraged women to come forward and admit to abuse.(2) In a survey conducted in early 1995, 31 percent of women said they had personally faced abuse, while in a similar survey conducted in July 1994 only 24 percent admitted to abuse.(2)
Child abuse has become a national epidemic. According to NCPCA's 1995 national report on the incidence of child abuse, more than one million children are confirmed each year as victims of child abuse and neglect, and every day a minimum of three children die as a result. The report lists violence in the home as a major factor contributing to the growth of reports of child abuse and neglect.(3)
Domestic violence often includes child abuse. Children may be victimized and threatened as a way of punishing and controlling the adult victim of domestic violence. Or they may be injured unintentionally when acts of violence occur in their presence. Often episodes of domestic violence expand to include attacks on children. However, even when children are not directly attacked, they can experience serious emotional damage as a result of living in a violent household. Parents involved in domestic violence teach their children that this behavior is acceptable.
The two populations share several similarities as well as some important differences. Both forms of abuse cross all boundaries of economic level, race, ethnic heritage, and religious faith. Both forms of abuse are identified by patterns. Domestic violence and child abuse occur with some regularity, often increasing and becoming more serious as internal barriers against these types of behavior come down. Adults who were abused as children have an increased risk of abusing their children, and adults who grew up in a violent home are more likely to become perpetrators or victims of domestic violence. For a number of reason including shame, secrecy, and isolation, both types of abuse are underreported.
Domestic violence and child abuse also differ in some significant ways. Parental stress is an important factor in instances of child abuse, but this link has not been established in cases of domestic violence. Perpetrators of child abuse are divided equally between men and women, but the majority of perpetrators of domestic violence are men.
Domestic violence and child abuse proliferate in an environment that accepts the lesser status of women and children. Shrouding the violence in secrecy allows this behavior to continue. Educating the public about the extent of the problem establishes a foundation that permits victims to come forward and admit to the abuse.
Prevention efforts that reach parents before or soon after the birth of their baby, and provide intensive services on a moderately long-term basis can greatly reduce the incidence of child abuse. For example home visitors take a comprehensive approach to individual families and tailor their services to match the family's needs.
1. Goodman, G., and M. Rosenberg. 1987. The child witness to family violence: Clinical and legal considerations. Domestic violence on trial: Psychological and legal dimensions of family violence. Edited by D. Sonkin. New York: Springer.
NCPCA's September catalog of publications is now available. To receive a complimentary The 1997 Healthy Families America Conference has been scheduled for March 2-4 at the Stay tuned to next month's update which will feature an interview with the former Captain Watch for the upcoming results of NCPCA's annual Public Opinion Poll.This article is the second in a series reporting the findings from a comprehensive evaluation of Hawaii's Healthy Start program. This article looks specifically at a randomized trial study to assess the effects of home visiting services by paraprofessionals.
While strong theoretical justifications for establishing home visitor services have resulted in a proliferation of programs, empirical proof of effectiveness has not kept pace with program development. Despite the favorable initial findings in Hawaii regarding low rates of child maltreatment in home visited families, no comprehensive evaluation of this model had been conducted. Additionally, the majority of evaluations of other home visitation models have suffered from a variety of methodological weaknesses including failure to utilize control or comparison groups, sole reliance on rates of child maltreatment and small sample sizes. Programs resulting in positive outcomes typically utilized nurses or professional home visitors while in-home services by paraprofessionals have failed to consistently produce similar results. Lastly, most of the studies showing positive impacts have focused on small, well-funded, demonstration projects. The goal of this study component is to address the weakness of earlier evaluations in order to ascertain how well a comprehensive, broadly implemented home visitation program employing paraprofessionals improves the well-being of parent and child and prevents child maltreatment.
Of the 372 families initially agreeing to participate in the study, a total of 304 families (82%) participated in at least one assessment interview. Approximately 48% (n=147) were randomly assigned to home visiting and 52% (n=157) were designated as controls. Overall, these families represent an impoverished, multi-ethnic group. More than two-thirds of these families were unemployed and receiving some type of public assistance at the start of the study. The typical mother was 24 years of age with two children. Fathers, as a group, were three years older than the mothers. Close to 60% had never been married, although only 11% were single parents with no other adult living in the home. The composition of the families' ethnic backgrounds includes 25% Filipino, 25% Hawaiian, 12% Caucasian, smaller percentages of Japanese, Hispanic, Samoan, and even smaller percentages of mothers identifying themselves as Chinese, African, American Indian, Korean, and Pacific Islander.
Multiple measures and data sources were used to assess the effectiveness of Healthy Start services in the following domains: parental attitudes, parent-child interaction patterns, maternal social support, child cognitive development, health care utilization, and confirmed instances of child maltreatment. In terms of parenting, maternal attitudes toward parenting were measured with two self-report instruments: the Child Abuse Potential Inventory and the Michigan Screening Profile of Parenting. Maternal social support was assessed with the Maternal Social Support Index, a self-report measure. For parent-child interaction, the two observational measures used were the Nursing Child Assessment Satellite Training - Feeding or Teaching Scale and the Home Observation for Measurement of the Environment Scale. To assess the child's cognitive and social development, this component used the Mental Development Index and the Behavior Rating Scales of the Bayley Scales of Infant Development, II. In looking at child health outcomes, maternal self-report data on immunizations and medical facility usage were collected. Finally, Child Protective Service records were analyzed for confirmed instances of maltreatment for all 372 families initially consenting to the study. Data were collected in the home at birth, and at 6, 12, 18, and 24 months after birth by one of four interviewers.
Several key findings emerged. Due to differential attrition after the first year of services, this summary focuses largely on the impact of Healthy Start services over the first year of the child's life. The results indicate that early and intensive home visitation by paraprofessionals produces measurable benefits for participants in the areas of parental attitudes toward children, parent-child interaction patterns, and type and quantity of child maltreatment. Mothers who received home visits reduced their potential for physical child abuse as measured by change in CAP scores three times faster than non-visited mothers, a significant difference. The hypothesis that treatment families would exhibit more positive parent-child interaction patterns than those who did not receive services was supported at both the six and twelve month assessment points. Visited mothers display significantly greater maternal involvement and sensitivity to their child's cues at six months. In turn, children of visited mothers are significantly more responsive to their mothers than their control counterparts at twelve months. Home visiting appears effective in achieving a positive cycle of interaction between the parent and the child.
These conclusions are bolstered by the fewer and less severe instances of confirmed maltreatment occurring in visited families as compared to their non-visited counterparts. According to Child Protective Service (CPS) data, only six confirmed instances of maltreatment occurred in the visited families as compared to 13 involving the control counterparts. As important, confirmed cases in treatment families involved the least serious classification of maltreatment available in Hawaii, imminent harm. In contrast, control families were confirmed as engaging in three different forms of neglect as well as imminent harm. These differences also are impressive given the greater likelihood of detection of maltreatment in families with frequent contact with mandatory reporters, i.e., home visitors.
Home visitation produced limited impacts in terms of social support, child development, and child health outcomes. Healthy Start services did not produce substantial increases in maternal social support during the first year of the child's life. Even though participant responses to interview questions demonstrated the importance of the emotional, concrete and educational support provided by the home visitor, the treatment group closely resembled the control group on the measure of social support.
The finding that child functioning and child development did not improve as a result of home visiting is consistent with the limited effects found in this area in many studies of home visiting programs directed toward preventing child abuse. To produce cognitive gains, suggestions have been made to provide more intensive services directly focused on the child, such as developmental child care. In terms of health care usage, the findings indicate that both treatment and control families had high rates of immunization and were frequent clients of medical services. The fact that Hawaii has one of the most comprehensive health care systems in the U.S. limits the likelihood of detecting significant effects in this outcome area.
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