Outcomes and Interventions

OUTCOMES AND INTERVENTIONS FOR CHILDREN EXPOSED TO DOMESTIC

VIOLENCE: EMERGING TRENDS:
A MIXED METHODS STUDY
by
Jenna M. Schmidt

PROPOSAL FOR RESEARCH STUDY

Presented to the Faculty of

The Graduate College at St. Cloud State University
In Partial Fulfillment of Requirements
For the Degree of Master of Science
Major: Community Counseling, Licensed Marriage and Family Therapy Certificate

Under the Supervision of Professor David T. Smith

St. Cloud, Minnesota
February 4, 2009

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Abstract
Children exposed to domestic violence experience trauma as a result. This study is aimed
at adding new information to the literature by examining conditions that influence
individual outcomes and suggested treatment interventions for children exposed to
domestic violence. This study will employ statistical data from 2000 to 2008, which
consists of computerized records of domestic violence.

Trauma is a byproduct of children that witness domestic violence. Interventions and

outcomes are examined to account for existing models if are for children who witness
domestic violence. Examining statistical data in numbers of children witnessing domestic
violence between 200 and 2008 only with analysis of current models point to several
emerging trends and areas worthy of focus in the future.

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Outcomes and Interventions for Children Exposed to Domestic Violence

It is estimated 3.3 million children witness domestic violence in the United States
annually (Schewe, 2008). The term domestic violence refers to violence between
intimate, adult partners and may involve a range of behaviors including physical
aggression (directed at an individual or object), verbal threats, and coercive/degrading
sex (Spillsbury, 2007). Approximately 1.3 million women and 835,000 men are
physically assaulted by an intimate partner annually in the United States (Tjaden &
Thoennes, 2000). In 2001, intimate partner violence made up 20% of all nonfatal violent
crime experienced by women (Rennison, 2003). Likewise, intimate partners committed
3% of the nonfatal violence against men in 2001 (Rennison, 2003).
Exposure to domestic violence results in negative effects to childrens health and
development such as emotional distress, developmental delays, symptoms of posttraumatic stress, and externalizing (attention problems, aggressive behavior, and rule
breaking actions) or internalizing (anxiety/depression, withdrawal, somatic complaints)
behaviors. While it is known that children are incredibly resilient, exposure to domestic
violence is thought to be particularly damaging to childrens development in part,
because it frequently involves both a perpetrator and victim(s) who are known to, and
often loved by the child. Children who are exposed to child maltreatment and domestic
violence experience a variety of negative outcomes. The present study is aimed to add
new information to the literature that will define and clarify what conditions influence
individual outcomes and suggested treatment interventions for children exposed to
domestic violence. The research questions to be addressed in this study include: (1) What
is the importance of childrens perceptions of violence and their co-victimization in the

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experience and psychological result of domestic violence? (2) How and why children
experience psychological threat or control in domestic violence incidents? (3) Is there a
trend from 2000 to 2008?
Demographic Influence
Spillsbury et al., (2007) examined demographic information from caregivers or
mental heath specialists during treatment visits including sex, age, and race.
Sex
Inconsistencies in research were noted regarding whether gender may influence
the frequency of externalizing versus internalizing behaviors exhibited by a child witness
of domestic violence. Some of the research Spillsbury et al. (2007) looked at shows that it
is more likely for boys to demonstrate a variety of internalizing and externalizing
behaviors, whereas other studies found the reverse. Spillsbury et al. (2007) used logistic
regression to test their hypothesized associations between the likelihood of being above a
clinical threshold and gender. Concerning trauma symptoms, they found that girls had
over twice the odds of clinically significant levels of anxiety. Concerning behavioral
problems, girls were more likely to display externalizing problems than boys. In fact,
girls had over four times the odds of having a clinically significant level of socialized
aggression compared to boys. Girls also had over twice the odds of attaining clinically
significant levels of Psychotic Behavior when compared to boys (Spillsbury, et al. 2007).
Age
Spillsbury et al. (2007) noted that greater behavioral problems have been reported
in younger versus older children who have experienced violence. However, they explain
that adolescents have been comparatively less studied than children of other age groups.

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The results in their study confirmed this claim whereas, increasing child age was
associated with decreased odds of reaching clinically significant scores for anxiety,
depression, posttraumatic stress, and sexual concerns. Age was not significantly
associated with other trauma symptoms. However, concerning behavior problems, child
age was associated with increased odds of reaching significant levels of anxiety and
withdrawal. Older children were also noted as having slightly increased odds of clinically
significant levels of attention problems (Spillsbury, et al. 2007).
Race
Some ethic differences account for behavior problems and social competence of
children exposed to domestic violence has been reported. Past research indicates that
caucasian children, especially boys have greater externalizing behavior problems than
African American children, and similarly African American mothers report greater social
competence in their children than mothers in White or Hispanic groups (Spillsbury, et al.
2007). Research by Spillsbury et al. (2007) confirmed these claims for behavior
problems; white children had over four times the odds of reaching the clinical thresholds
for conduct disorder and twice the odds of a clinically significant score for socialized
aggression (p. 494).
Characteristics and Perceptions of the Event
The above mentioned Spillsbury et al. study went on to assess outcomes of
children based on the characteristics and (the childrens) perceptions of the event. The
characteristics of the event were separated into two categories: Type of Exposure and
Chronicity of Violence Index Event. The type of exposure was categorized as follows: (1)
the child saw or heard the event and was also victimized/ assaulted during the event; (2)

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the child heard or saw the event happen only; (3) the child saw the aftermath of the event
only. The chronicity of the violence was assessed by a single question where children
could respond once, more than once but violence stopped, or more than once and
violence continues. The childs perceptions of the event were assessed using questions
regarding the childs perceived control over the event, the child viewing the event as a
threat to her/his own safety and fear that the event may re-occur (Spillsbury, et al. 2007,
p. 490).
Characteristics
Results in this study (Spillsbury, et al., 2007) revealed that types of exposure was
significantly associated with trauma symptoms: compared to children who were
victimized during the event, children who saw or heard the event had lower odds of
reaching clinical cutoffs for anxiety, anger, and posttraumatic stress. Additionally,
children who observed the event more than once and the violence has ceased had 3.53
times the odds of reaching the clinical threshold for anxiety and 6.87 times the odds of
reaching clinically significant levels of dissociation than did children who witnessed the
event once (Spillbsury, et al., 2007).
Perceptions
Regarding childrens perceptions of the events and traumatic and behavioral
symptoms, compared to children who felt they had no control over the event, adjusted
results illustrate that children who felt like they had some or lots of control over the
episode had four times the odds of a clinically significant score for posttraumatic stress.
These children were also noted as having significantly greater odds of reaching the
clinical cutoff for conduct disorder and motor excess (Spillsbury, et al., 2007, p. 494).

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Additionally, results also showed that children who felt personally threatened over the
incident had significantly greater odds of reaching clinically significant scores for
anxiety, depression, posttraumatic stress, and sexual concerns, but not for any behavioral
problems (Spillsbury, et al., 2007, p. 494). Fear that the event may re-occur was not
significantly associated with the odds of reaching clinical threshold scores for either
trauma symptoms or behavioral problems (Spillsbury, et al., 2007).
Co-occurring Stressors Influence on Child Outcomes
One of the challenges in the child maltreatment literature as noted by Herrenkohl
and Herrenkohl (2007) is knowing which form of difficulty increases the risk of later
problems in victims. Environmental stressors often co-occur with abuse/neglect and
exposure to domestic violence. According to ecological theory, negative outcomes for
youth extend not only from a single form of adversity, but from a variety of overlapping
risk factors that interact within and across various levels of the environment, including
the family and surrounding community (Herrenkohl & Herrenkohl, p. 554).
Herrenkohl & Herrenkohl (2007) conducted a longitudinal study and data
analyses were carried out to test the hypothesis that the greater the exposure to multiple
forms of abuse and domestic violence and stress on the family, the more severe and
negative the outcome would be for the child. Many significant correlations were found
among variables in the directions expected. For example, domestic violence exposure is
positively associated with family conflict, personal problems with parents, and external
constraints. Their results showed that while there is a strong, positive association between
the constructs themselves such as child maltreatment and stressors, only child
mistreatment is independently prognostic of youth troubles. The lasting, unfavorable

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effects on childrens externalizing and internalizing behaviors develop and continue from
the victimization itself, not the hardship of the family (Herrenkohl & Herrenkohl, 2007).
Several recent studies between 2000 and 2007 have identified psychiatric
consequences of childhood maltreatment. Tiecher et al. (2006) conducted a study with the
intent to outline the impact of verbal aggression, witnessing domestic violence, physical
abuse, and sexual abuse, by themselves and in combination, on psychiatric symptoms.
Dissociation and limbic irritability (disturbances in nerve impulses as limbic nerve
cells in the brain communicate) were selected as two primary variables for analysis. Their
results indicated that subjects in all of the abuse categories had ratings of trauma that
were far above those subjects who had never encountered maltreatment. Likewise,
subjects who were exposed to two or three different kinds of abuse had higher scores of
limbic irritability than subjects exposed to any single category of abuse. Subjects
exposed to both verbal abuse and domestic violence (but no other form of maltreatment)
had Dissociative Experience Scale scores 4.5 times as high as those of the non-abused
subjects (Tiecher et al., 2006, p. 996).
Robust effects were noted in the category of anxiety. Combined exposure to
verbal abuse and witnessing domestic violence had a greater than additive effect.
Children who were exposed to verbal abuse and witnessing domestic violence (but no
other forms) had anxiety scores that were 2.2 times as high as those of non-abused
children. Exposure to verbal abuse alone and witnessing domestic violence had
moderately strong effects on depression. When combined, they had a greater than
additive deleterious effect (Tiecher et al., 2006). The same was true for anger-hostility
symptoms. They concluded that exposure to verbal abuse and witnessing domestic

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violence was associated with extraordinarily large adverse effects, particularly on

dissociation. They suggest that these findings may raise the possibility that exposure to
verbal aggression may be a stressor that affects the development of certain brain regions
in susceptible individuals. They make note, that one should not underestimate the
consequences of verbal abuse. Additionally, careful attention should be given to the
number of different types of trauma a child was exposed to, as this may be even more
critical than the specific types of abuse (Tiecher et al., 2006).
Service and Intervention Recommendations
There appears to be a generally agreed upon consensus regarding interventions
and treatment for children who are exposed to violence in the home. A combination of
interventions for child and parent/caregiver along with education and cognitive
restructuring in individual and group settings prove to be most effective. Vikerman &
Margolin (2007) suggest trauma focused treatment that is predominantly based on the
cognitive behavioral model. These interventions involve a combination of the following
treatment components: trauma re-exposure, violence education and cognitive
restructuring, emotion expression and regulation, social problem solving, safety planning,
and parent training. Several promising empirically supported treatments that directly
target Post Traumatic Stress symptoms are available for traumatized child victims of
physical abuse or witnesses to domestic abuse (Vikerman & Margolin, 2007). These
findings are not limited to the success in treating post traumatic stress disorder but also in
reducing other problems with children and adolescents such as; behavioral issues,
externalizing symptoms, depression, shame, and violence. Treatments were also effective

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in increasing self esteem, feelings of competency, happiness, and social relationship
functioning.
Another study conducted by Schewe (2008), focuses on direct services for
children and caregivers. Services such as play therapy for children and psycho-education
and support groups for parents/ caregivers were administered as well as family support
and multiple family support groups at which child and parent/ caregiver were together.
Therapist ratings indicated improvement in caregiver functioning and small but
significant improvements in child outcomes. The childs ability to identify feelings and
overall symptoms were rated most improved, while symptoms of Post Traumatic Stress
were least improved (Schewe, 2008). The number of sessions the caregiver and child
attended was significantly correlated with the service providers perceptions of both the
caregiver and the child. This suggests that because the children attended fewer sessions,
the level of improvement was less. A regression analysis was carried out which indicated
that when services for caregivers focused on appropriate discipline, children improved
the most. Additionally, Schewe (2008) found that when services for children focused on
identifying and expressing feelings, the differences between good and bad touches,
community violence, and domestic violence, children improved the most.
Hypothesis
The goal of the present research is to examine the following hypotheses by
investigating the patterns of outcome and suggested treatment intervention for children
exposed to domestic violence. After reviewing past studies, condition rates from 2000 to
2008 will be high in comparison to earlier years, is the hypothesis. Secondly, it is
estimated that half the clients voluntarily desired and accepted services. Reason is

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because some families are referred for services after the police are involved in a domestic
violent call. The condition of the violent act(s) will be associated with behavioral
outcomes in children, is another hypothesis. Lastly, there will be a growing trend from
2000 to 2008 of the suggested treatment interventions for children exposed to domestic
violence.
Methods
Procedures
This research will define and clarify what conditions influence individual outcomes and
suggested treatment interventions for children exposed to domestic violence in terms of:
(1) the importance of childrens perceptions of violence and their co-victimization in the
experience and psychological result of domestic violence; (2) how and why children
experience psychological threat or control in domestic violence incidents; and (3)
evaluate if there is a trend from 2000 to 2008. Cross tabulation and one-way ANOVA will
be employed in the data analysis. The independent variable in the analysis is the
conditions (perception and psychological result). The dependent variable is the outcome
and suggested treatment intervention for children exposed to domestic violence.
Limitations
The present research is based on either self report by the child, therapist rating or
maternal assessment any of which can be biased. Therefore, samples used for this study
will almost exclusively come from shelters, clinics, or community/education based
programs. These samples are not completely representative of the large population of
children who are exposed to violence in the home and domestic violence. Additionally,
the subjects enrolled in such programs or residing in shelters and do not complete the

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same level of assessment and treatment. Furthermore, the generalizing of children into
one category is separated by age or developmental stage. Finally, there is no control for
children who are or are not on medication for depressive or behavioral symptoms.
Additional research should address these limitations. There are many issues still to be
explored to improve the lives of youth who experience child maltreatment and witness
domestic violence, though the consensus is clear that there are many accompanying
factors that influence a childs outcome and success in recovery.

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Creswell, J. W. (2009). Research design: qualitative, quantitative, and mixed methods
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counseling (3rd ed.). Belmont, CA: Brooks Cole Company.
Herrenkohl, T. I., & Herrenkohl, R. C. (2007). Examining the overlap and prediction of
multiple forms of child maltreatment, stressors, and socioeconomic status: A
longitudinal analysis of youth outcomes. Journal of Family Violence, 22(7), 553562.
Rennison, C. M. (2003) U.S. Dep't of Just., NCJ 197838, Bureau of justice statistics
crime data brief: intimate partner violence, 1993-2001, at 1. Available at
http://www.ojp.usdoj.gov/bjs/pub/pdf/ipv01.pdf
Schewe, P. A. (2008). Direct service recommendations for children and caregivers
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Spilsbury, J. C., Belliston, L., Drotar, D., Drinkard, A., Kretschmar, J., Creeden, R., et al.
(2007). Clinically significant trauma symptoms and behavioral problems in a
community-based sample of children exposed to domestic violence. Journal of
Family Violence, 22(6), 487-499.

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