Domestic Violence and Families

In 2011, the Centers for Disease Control and Prevention conducted a national survey showing that, in a sample of more than 16,000 adults with an approximately equal distribution of men and women, 35% of women and 28% of men reported having experienced rape, physical violence, or stalking by an intimate partner in their lifetime. The same survey demonstrated that these victims reported at least one of the following consequences of violence: post-traumatic stress symptoms, concern for safety, need for health care, injury, contacting a crisis hotline, missing at least 1 day of school or work, or need for services (eg, advocacy, housing, legal) [1].

The consequences of domestic violence and adult sexual assault are significant and, unfortunately, continue to be a public health problem that health care and mental health professionals struggle to fully address. More recently, professionals in these fields have been paying closer attention to the effects of domestic violence on children and families. Reviews show that domestic violence has a significant impact on families across domains such as domestic violence exposure, parental capacity, child development, and exposure to additional adversities [2].

Providers may have questions about the resources that can provide therapeutic support for adults and children who have been negatively impacted by domestic violence. In North Carolina, many of the resources for children and families are provided through the collective resources of the National Child Traumatic Stress Network (NCTSN) [3], which was established by Congress in 2000 and funded through the Substance Abuse and Mental Health Services Administration. The mission of the NCTSN is to raise the standard of care and improve access to services for traumatized children, their families, and communities. Through the NCTSN, North Carolina mental health providers have better access to developers of several evidence-based treatments that are now being implemented through the North Carolina Child Treatment Program [4], which is one of many programs within the Center for Child and Family Health [5]. The North Carolina Child Treatment Program—available at 1-844-NCCTP-4U (622-8748)—maintains a roster of all centers across the state offering evidence-based treatments for families.

In general, treatment programs for children and families exposed to domestic violence will include a family component for the child and the non-offending caregiver. Two examples in North Carolina are child parent psychotherapy (CPP) [6] and trauma-focused cognitive behavioral therapy (TF-CBT) [7]. The treatment of choice for young children may be CPP since it was developed for a child (aged 0–5 years) and a non-offending caregiver to support the caregiver-child relationship as a vehicle for restoring and protecting the child's mental health. CPP was initially used with mothers and children who had experienced domestic violence. For school-aged children, the treatment of choice in North Carolina may be TF-CBT, as it was developed for children (aged 3–18 years) with post-traumatic stress symptoms. TF-CBT allows the child to work with their mental health provider and their non-offending caregiver to address symptoms secondary to exposure to traumatic events. TF-CBT can be used with children exposed to domestic violence, but it has also been shown to be very effective with sexual abuse, physical abuse, and community violence.

Regardless of treatment modality, it is important for providers serving families to consider the following principles when working with those impacted by domestic violence. First, providers need to educate themselves about the impact of domestic violence on children and families, including the impact on child development and family systems. Second, providers should learn and use the best screening and assessment practices and ensure the safety of the family by interviewing family members separately. Third, providers should include trauma-informed measures that examine all trauma exposure types in addition to domestic violence, as well as the overall functioning of the child and family. Fourth, it is important to connect to mental health providers who have been rostered to provide evidence-based treatments that address the impact of domestic violence directly. Finally, providers should collaborate with child welfare, law enforcement, mental health, health care, courts, and juvenile justice providers who can help provide expertise and insight about how to work with families.

For families in immediate crisis, it is usually best to call 911 for emergency assistance. For families in immediate need of guidance and support, the North Carolina Domestic Violence Hotline is 1-800-799-SAFE (7233), and staff on this line can provide critical assistance to victims and their families about developing safety plans, connecting to vital resources, or helping to determine what type of support would be most appropriate depending on the situation.

Domestic violence is an issue that all child and family service systems need to address together. While more emphasis on domestic violence prevention is needed, it is also important to know about resources for families directly impacted by domestic violence and to educate the health care and mental health workforce on evidence-based treatments designed to address common issues for children and families.

• ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.