Back to recent texts

Preventing and Responding to Children’s Exposure to Intimate Partner Violence

Emma Howarth, PhD

The University of East London, United Kingdom

April 2021

Introduction

In every country across the world, millions of children and young people (CYP) are being exposed to intimate partner violence (IPV) involving one or more of their caregivers or parents. IPV is a form of family violence, that refers to any behaviour by an intimate partner or ex-partner that results in physical, sexual or psychological harm, and includes physical aggression, psychological abuse and controlling, coercive behaviours. It can occur in any relationship regardless of gender or sexual orientation, although women, transgender and gender non-binary persons are at increased risk of experiencing IPV.1 

Children’s exposure to IPV has high human and economic costs. Children living in abusive households are at increased risk of negative physical and emotional health and educational outcomes across their lifespan.2–4  The pain and suffering experienced by Canadian children as a result of IPV committed in one year (2009) was estimated to be associated with an economic cost of $235.2 million,5 although the costs of the impact on children are likely to be much higher when the financial impact of responding to children and families is taken into consideration.  More recent data from the US estimates the lifetime costs associated with children’s exposure to IPV in any given year as $55 billion, related to increased costs due to higher use of healthcare, increased crime and lost productivity.6

The scale and impact of this issue necessitates an effective response for children and their families. A comprehensive response includes prevention of IPV from occurring in the first place, detection of and early response to children’s exposure to IPV to prevent recurrence, and support to limit or prevent ill effects once a child has experienced it.7 Below is a summary of what is known in relation to each part of the response to children, as well as gaps in knowledge, evidence, and practice. 

Subject 

Awareness of a child that the caregiver on whom they rely for protection and comfort is experiencing IPV, can be extremely stressful for a child.  Such exposure, even if not observed directly, is increasingly considered as a form of maltreatment, either as a form of emotional abuse or as a separate type of exposure.7,8 It is important to understand that children can be exposed to IPV in many ways (e.g., seeing the aftermath of IPV, being told about IPV by a sibling, experiencing diminished parenting as a result of IPV); they do not need to directly see or overhear IPV to be impacted by its presence in their lives.9-11

Children exposed to one incident of IPV are more at risk of repeated exposure to the same type of violence,12 and are at greater risk of experiencing multiple different types of victimisation. This is known as poly-victimisation.13 One study found that of the children and young people who had witnessed IPV in the past year, 33.9% had experienced other types of maltreatment; among those who had been exposed to IPV sometime during their childhood, more than half (56.8%) had experienced other child maltreatment types.  Children exposed to multiple types of victimization are more likely to experience negative outcomes than children experiencing none or one form of maltreatment.14 

Problems

Children exposed to IPV are two to four times more likely to exhibit clinically significant mental health (MH) problems.3 These include internalizing symptoms (e.g., anxiety, depression), externalizing behaviours (e.g., aggression) and trauma symptoms.  While problems may not be severe enough to meet diagnostic criteria for a mental health disorder, they can cause significant distress and functional impairment for CYP and their families.3,15 It is well established that exposure to IPV in childhood and adolescence is associated with negative outcomes in adulthood,16 which is mediated in part by early adjustment difficulties, particularly behaviour problems.17 

Importantly, a number of studies have found that around 30% of children demonstrate resilient outcomes in the short to medium term, meaning they showed successful adaption in the face of significant adversity.3 Differences in children’s adaptation may in part be explained by the presence or absence of other adversities in children’s lives, as well as children’s, parents’ and family strengths and resources.18

Research Context and Recent Findings 

To avoid or reduce the distress and difficulties associated with exposure to IPV among caregivers, it is imperative that there are a range of effective strategies to prevent and respond to it. 

Prevention of IPV and children’s exposure to it

The most direct way of preventing the negative consequences of IPV for children is to prevent or end the violence itself.19 To date there is insufficient evidence about how to prevent IPV from happening (and in turn children’s exposure to it), for example by targeting societal- and community-level risk factors such as gender inequality and poverty.19 There is also little evidence about the effectiveness of public awareness campaigns.20 There is some evidence to suggest that educational and skills-based programs to prevent adolescent victimization (commonly referred to as dating violence), may be effective, in particular, programs that are delivered in multiple settings (e.g., community and school), which are longer in duration and involve key adults in adolescents’ lives (e.g., teachers, community leaders).21 However the evidence is equivocal with other reviews concluding that these interventions have little effect on the occurrence of relationship violence, or on attitudes, knowledge or skills that may be associated with relationship violence.22  

Interventions targeting families experiencing or at risk of child maltreatment (e.g., home visitation and parenting programs), which include, but may not explicitly target families experiencing IPV, are effective in improving child outcomes,7,23 although the benefit of these broader interventions may be attenuated for families experiencing IPV.24,25 Advocacy interventions aimed at adult victims  (mostly women) to prevent the recurrence of IPV (and therefore children’s continued exposure) can be effective,26 but evidence is lacking about the impact of these interventions on children in the family.7,27,28 

Identifying children exposed to IPV

Children may need specific interventions to help them recover from their exposure to caregiver IPV but must first be identified as needing support. Existing evidence on how best to identify children is generally weak and there is a lack of evidence to show whether identification of children is linked with better outcomes such as access to care and improved wellbeing.29 In the absence of good evidence, it is suggested that professionals use a case-finding approach (rather than screening), which means being alert to the signs and symptoms that a child may be exposed to IPV and providing a tailored initial response based on the child’s presentation and safety considerations.29 

We have some knowledge about the barriers that parents and professionals face when identifying children who have experienced IPV. Caregivers who have experienced IPV may not recognize the impact on their children or they may think that their child was unaware of the violence. They may also be reluctant to seek help for themselves or their children due to fear of involvement with child protections services, and the fear that their children will be removed from their care.28 Professionals working directly with children and families are generally uncertain about how to respond when they suspect exposure to IPV and are particularly unclear when the violence involves emotional, but not physical harm.30-33 Evidence suggests that training programs aimed at improving the response of professionals to children who have experienced IPV may improve participants' knowledge, attitudes and clinical competence up to a year after the intervention,34 and it is recommended that they should be made widely available.35

Assessment and referral 

If children’s exposure to IPV is suspected or confirmed, a qualified professional’s assessment is required, followed by a referral to evidence-based interventions and subsequent follow up.29 Given significant variation in children’s adjustment following exposure to IPV, comprehensive assessment is important to guide decisions about whether intervention is appropriate and if so, what type would best meet a child’s needs. Although a number of instruments exist to measure children’s exposure to IPV, their utility in clinical contexts is largely unknown and there is no single measure that is appropriate across all settings, presenting symptoms or age groups.29 When children’s exposure to IPV is suspected, there is some evidence to suggest that reports from multiple informants (e.g., child and parent) regarding exposure should be obtained when possible.29 There are many well validated measures to assess children’s physical and mental health and wellbeing,36-38 and these can be used to identify current levels of functioning and appropriate referral pathways. 

Targeted intervention after IPV has occurred

Reviews indicate that a wide range of interventions have been developed to improve mental health outcomes among children exposed to IPV and these vary in terms of their therapeutic model, focus, format and mode of delivery.39-42 Program developers and researchers have focused primarily on the needs of IPV-exposed children by offering services to children directly, to caregivers who are mothers, or to both mothers and children.40

There is limited rigorous evidence to show whether any of these interventions are effective and if they address what children and caregivers find helpful.39,42 Overall, there are relatively few studies that evaluate the outcomes associated with accessing an intervention following experience of IPV; the available evidence is limited by some important methodological limitations.39,40,42 The practical implication of this is that interventions are currently delivered without strong evidence showing that they make a difference to children and families or do more good than harm. 

Since it will take some years for evidence to catch up with practice, what options should practitioners offer in the meantime? Looking across reviews of interventions, there is some preliminary evidence that psychotherapy for young children, trauma-focused cognitive behavioural therapy, group-based interventions for mothers and children, and parenting skills training along with practical support for parents may offer some benefits.29,39,41 However it is important to note that reviews, often using the same data, draw different conclusions, and replication studies are needed before stronger conclusions can be drawn.

Research Gaps 

  • To date, most interventions that aim to enhance child outcomes, focus on working with individuals and families. There has been little emphasis on the impact of strategies which aim to improve those conditions at community and societal levels (e.g., poverty) that are associated with increased risk of IPV. This work is urgently needed. 
  • Most interventions that aim to improve outcomes for children are offered to the non-abusing caregiver (often mothers) only, children only, or mother and children together. There is limited evidence about the effectiveness of interventions for caregivers who commit IPV in terms of their impact on child outcomes.
  • Most interventions have been developed to respond to children who have experienced IPV between cis-gender parents, and where the violence has been perpetrated by a male caregiver against a female caregiver. There is an absence of interventions that explore how to effectively support children experiencing violence occurring between gender-diverse caregivers or where the male caregiver has been victimized. 
  • Evidence is lacking about to how to effectively support children living with ongoing IPV between caregivers. Often these children are excluded from interventions and ongoing violence is not measured during interventions delivered in research settings, leaving a gap in our understanding. 
  • As with adult victims, little is known about how the outcomes of evidence-based mental health treatments are affected when therapy is delivered in the context of exposure to current or past IPV. 

Key Research Questions

  • Which interventions are effective in preventing IPV and children’s exposure to it? 
  • What are the most effective strategies for identifying children who have experienced IPV?
  • Which evidence-based interventions are cost-effective and acceptable for preventing or reducing harm once a child has experienced IPV?
  • What type of support is appropriate and effective for groups of children who are underserved by current approaches to intervention? 

Conclusions 

Children’s exposure to IPV is a significant public health problem that requires a comprehensive evidence-based response. Current evidence about the effectiveness for each part of the IPV response in improving child outcomes is limited. There is an urgent need for evidence-based approaches to know what works, for whom and under what circumstances.

Implications for Parents, Services and Policy 

Children who live with IPV are victims in their own right, who may experience the consequences of such exposure throughout their lifetime. However, it is important to remember that poor outcomes are not inevitable. The strengths of parents, families and wider communities can protect children from negative outcomes. 

Preventing children’s exposure to IPV before they experience negative outcomes should be a priority; when interventions focus on reducing the impairment associated with IPV this should be coupled with ongoing efforts to prevent recurrence of children’s exposure to violence.  Providers should work to increase support for parent survivors in their efforts to keep their children safe, while recognizing that many parents are fearful of information being reported to child protection agencies.  

Frontline healthcare and social service professionals need training and support to help them identify children who may be exposed to IPV in their families or who have sequelae from past exposure (See: https://vegaproject.mcmaster.ca/). Programs for children affected by IPV should be a priority among mental health services; it is essential to ensure that services supporting children and families experiencing IPV are available, accessible and evaluated to determine their effectiveness.43,44 

References

  1. VEGA Project. Intimate partner violence systematic review summary. Hamilton, ON: McMaster University; 2016. Available at: https://vegaproject.mcmaster.ca/vega-publications. Accessed August 13, 2020. 
  2. Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of childhood exposure to violence, crime, and abuse: Results from the National Survey of Children’s Exposure to Violence. JAMA Pediatrics 2015;169:746-754. doi:10.1001/jamapediatrics.2015.0676
  3. Afifi TO, MacMillan HL, Taillieu T, Cheung K, Turner S, Tonmyr L, Hovdestad W. Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey. Child Abuse & Neglect 2015;46:198-206. doi:10.1016/j.chiabu.2015.05.001
  4. Evans SE, Davies C, DiLillo D. Exposure to domestic violence: A meta-analysis of child and adolescent outcomes. Aggression and Violent Behavior 2008;13:131-140.
  5. Zhang T, Hoddenbagh J, McDonald S, Scrim K. An estimation of the economic impact of spousal violence in Canada, 2009. Ottawa: Department of Justice Canada, Research and Statistics Division; 2012. 
  6. Holmes MR, Richter FGC, Votruba ME, Kristen AB, Bender AE. Economic burden of child exposure to intimate partner violence in the United States. Journal of Family Violence 2018;33:239-249. doi:10.1007/s10896-018-9954-7
  7. MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. Interventions to prevent child maltreatment and associated impairment. Lancet 2009;373:250-266. doi:10.1016/S0140-6736(08)61708-0
  8. Lawson J. Domestic violence as child maltreatment: Differential risks and outcomes among cases referred to child welfare agencies for domestic violence exposure. Children and Youth Services Review 2019;98:32-41. doi:10.1016/j.childyouth.2018.12.017
  9. Holden GW. Children exposed to domestic violence and child abuse: Terminology and taxonomy. Clinical Child and Family Psychology Review 2003;6:151-160. doi:10.1023/A:1024906315255
  10. Callaghan JEM, Alexander JH, Sixsmith J, Fellin LC. Beyond. Beyond “witnessing”: Children’s experiences of coercive control in domestic violence and abuse. Journal of Interpersonal Violence 2018;33:1551-1581. doi:10.1177/0886260515618946
  11. Katz E, Nikupeteri A, Laitinen M. When coercive control continues to harm children: post-separation fathering, stalking and domestic violence. Child Abuse Review 2020;29:310-324. doi:10.1002/car.2611
  12. Moffitt TE, Klaus-Grawe 2012 Think Tank. Childhood exposure to violence and lifelong health: clinical intervention science and stress-biology research join forces. Development and Psychopathology 2013;25:1619-1634. doi:10.1017/s0954579413000801
  13. Finkelhor D, Ormrod RK, Turner HA. Lifetime assessment of poly-victimization in a national sample of children and youth. Child Abuse & Neglect 2009;33:403-411. doi:10.1016/j.chiabu.2008.09.012
  14. Hamby S, Finkelhor D, Turner H, Ormrod R. The overlap of witnessing partner violence with child maltreatment and other victimizations in a nationally representative survey of youth. Child Abuse & Neglect 2010;34:734-741. doi:10.1016/j.chiabu.2010.03.001
  15. Meltzer H, Doos L, Vostanis P, Ford T, Goodman R. The mental health of children who witness domestic violence. Child and Family Social Work 2009;14:491-501. doi:10.1111/j.1365-2206.2009.00633.x
  16. Cui M, Durtschi JA, Donnellan MB, Lorenz FO, Conger RD. Intergenerational transmission of relationship aggression: a prospective longitudinal study. Journal of Family Psychology 2010;24:688-697. doi:10.1037/a0021675
  17. Lussier P, Farrington DP, Moffitt TE. Is the antisocial child father of the abusive man? a 40-year prospective longitudinal study on the developmental antecedents of intimate partner violence. Criminology 2009;47:741-780.
  18. Fogarty A, Wood CE, Giallo R, Kaufman J, Hansen M. Factors promoting emotional-behavioural resilience and adjustment in children exposed to intimate partner violence: A systematic review. Australian Journal of Psychology 2019;71:375-389. doi:10.1111/ajpy.12242
  19. McTavish JR, MacGregor JCD, Wathen CN, MacMillan HL. Children’s exposure to intimate partner violence: an overview. International Review of Psychiatry 2016;28:504-518. doi:10.1080/09540261.2016.1205001
  20. Stanley N, Ellis J, Farrelly N, Hollinghurst S, Bailey S, Downe S. Preventing domestic abuse for children and young people (PEACH): a mixed knowledge scoping review. Public Health Research 2015;3.7. doi:10.3310/phr03070
  21. De Koker P, Mathews C, Zuch M, Bastien S, Mason-Jones AJ. A systematic review of interventions for preventing adolescent intimate partner violence. Journal of Adolescent Health 2014;54:3-13. doi:10.1016/j.jadohealth.2013.08.008
  22. Fellmeth GLT, Heffernan C, Nurse J, Habibula S, Sethi D. Educational and skills-based interventions for preventing relationship and dating violence in adolescents and young adults. Cochrane Database of Systematic Reviews 2013;(6):CD004534. doi:10.1002/14651858.CD004534.pub3
  23. Marie-Mitchell A, Kostolansky R. A systematic review of trials to improve child outcomes associated with adverse childhood experiences. American Journal of Preventive Medicine 2019;56:756-764. doi:10.1016/j.amepre.2018.11.030
  24. Eckenrode J, Ganzel B, Henderson CR Jr, Smith E, Olds DL, Powers J, Cole R, Kitzman H, Sidora K. Preventing child abuse and neglect with a program of nurse home visitation: the limiting effects of domestic violence. JAMA 2000;284(11):1385-1391. doi:10.1001/jama.284.11.1385
  25. Visser MM, Telman MD, Schipper JC De, Lamers-Winkelman F, Schuengel C, Finkenauer C. The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence : study protocol for a randomized controlled trial. BMC Psychiatry 2015;15:131. doi:10.1186/s12888-015-0533-7
  26. Rivas C, Ramsay J, Sadowski L, Davidson LL, Dunne D, Eldridge S, Hegarty K, Taft A, Feder G. Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. Cochrane Database of Systematic Reviews 2015;(12):CD005043. doi:10.1002/14651858.CD005043.pub3
  27. Sprague S, McKay P, Madden K, Scott T, Tikasz D, Slobogean GP, Bhandari M. Outcome measures for evaluating intimate partner violence programs within clinical settings. Trauma, Violence & Abuse 2016;18:508-522. doi:10.1177/1524838016641667
  28. McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen N, MacMillan HL. Children’s and caregivers’ perspectives about mandatory reporting of child maltreatment: A meta-synthesis of qualitative studies. BMJ Open 2019;9(4):e025741. doi:10.1136/bmjopen-2018-025741
  29. VEGA Project. Children’s exposure to intimate partner violence systematic review summary. Hamilton, ON: McMaster University; 2016. Available at: https://vegaproject.mcmaster.ca/vega-publications. Accessed August 13, 2020.
  30. Lewis N V, Feder GS, Howarth E, Szilassy E, McTavish JR, MacMillan HL, Wathen N. Identification and initial response to children’s exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals. BMJ Open 2018;8:e019761. doi:10.1136/bmjopen-2017-019761
  31. Saxton MD, Jaffe PG, Dawson M, Olszowy L, Straatman AL. Barriers to police addressing risk to children exposed to domestic violence. Child Abuse & Neglect 2020;106: 104554. doi:10.1016/j.chiabu.2020.104554
  32. Münger A-C, Markström A-M. School and child protection services professionals’ views on the school’s mission and responsibilities for children living with domestic violence – Tensions and gaps. Journal of Family Violence 2019;34:385-398. doi:10.1007/s10896-019-00035-5
  33. Szilassy E, Das J, Drinkwater J, Firth A, Hester M, Larkins C, Lewis N, Morrish J, Stanley N, Turner W, Feder G. Researching Education to Strengthen Primary care ON Domestic violence & Safeguarding (RESPONDS). Final report for the Department of Health, Policy Research Programme Project. Bristol:University of Bristol, 2015.
  34. Turner W, Hester M, Broad J, Szilassy E, Feder G, Drinkwater J, Firth A, Stanley N. Interventions to improve the response of professionals to children exposed to domestic violence and abuse: a systematic review. Child Abuse Review 2017;26:19-39. doi:10.1002/car.2385
  35. Hanson MD, Wathen N, MacMillan HL. The case for intimate partner violence education: early, essential and evidence-based. Medical Education 2016;50:1089-1091. doi:10.1111/medu.13164
  36. Kwan B, Rickwood DJ. A systematic review of mental health outcome measures for young people aged 12 to 25 years. BMC Psychiatry 2015;15:279. doi:10.1186/s12888-015-0664-x
  37. Bentley N, Hartley S, Bucci S. Systematic Review of Self-Report Measures of General Mental Health and Wellbeing in Adolescent Mental Health. Clinical Child and Family Psychology Review. 2019;22:225-252. doi:10.1007/s10567-018-00273-x
  38. Sharpe H, Patalay P, Fink E, Vostanis P, Deighton J, Wolpert M. Exploring the relationship between quality of life and mental health problems in children: implications for measurement and practice. European Child & Adolescent Psychiatry 2015;25:659-667. doi:10.1007/s00787-015-0774-5
  39. Howarth E, Moore THM, Welton NJ, Lewis N, Stanley N, MacMillan H, Shaw A, Hester M, Bryden P, Feder G. IMPRoving Outcomes for children exposed to domestic violence (IMPROVE): an evidence synthesis. Public Health Research 2016;4.10.
  40. Rizo CF, Macy RJ, Ermentrout DM, Johns NB. A review of family interventions for intimate partner violence with a child focus or child component. Aggression and Violent Behavior 2011;16:144–166. doi:10.1016/j.avb.2011.02.004
  41. Anderson K, van Ee E. Mothers and children exposed to intimate partner violence: a review of treatment interventions. International Journal of Environmental Research and Public Health 2018;15:1955. doi:10.3390/ijerph15091955
  42. Latzman NE, Casanueva C, Brinton J, Forman‐Hoffman VL. The promotion of well-being among children exposed to intimate partner violence: A systematic review of interventions. Campbell Systematic Reviews 2019;15:e1049. doi:10.1002/cl2.1049
  43. Reif K, Jaffe P, Dawson M, Straatman AL. Provision of specialized services for children exposed to domestic violence: Barriers encountered in Violence Against Women (VAW) services. Children and Youth Services Review 2020;109:104684. doi:10.1016/j.childyouth.2019.104684 
  44. Humphreys C, Thiara RK, Skamballis A. Readiness to change: Mother-child relationship and domestic violence intervention. British Journal of Social Work 2011;41:166-184. doi:10.1093/bjsw/bcq046

How to cite this article:

Howarth E. Preventing and Responding to Children’s Exposure to Intimate Partner Violence. In: Tremblay RE, Boivin M, Peters RDeV, eds. MacMillan HL, topic ed. Encyclopedia on Early Childhood Development [online]. https://www.child-encyclopedia.com/maltreatment-child/according-experts/preventing-and-responding-childrens-exposure-intimate-partner. Published April 2021. Accessed September 20, 2021.