paperIntervention in Intimate Partner Violence with Latina Women and Their Children
Sandra Graham-Bermann & Andrew Grogan-Kaylor, PI’s, Nora Montalvo-Liendo, Co-Investigator

Study funded by the University of Michigan Provost’s 3rd Century Challenge Grant

Intimate partner violence (IPV) is a common and tragic event in the lives of women and children around the world. 24% of U.S. women report severe IPV during their lifetime (Centers for Disease Control and Prevention, 2010), which includes being killed, beaten, burned, choked and/or violence involving a gun or knife (CDC, 2012). Latina women are at highest risk, with 50% experiencing lifetime IPV. Further, because the majority of nonfatal IPV occurs at home, U.S. children (approximately 15.5 million each year) are eyewitness to IPV events. In 2005 the World Health Organization studied 15 sites in 10 countries and found lifetime occurrence of IPV ranged from 5% in Japan to 71% in Ethiopia. In the U.S., the annual cost to women and society is estimated at more than 8 billion dollars in lost wages, medical and mental health care (CDC, 2003; Max, Rice, Finkelstein, Bardwell & Leadbetter, 2004). Clearly this is a global public health issue of enormous proportions with great human cost.

Women who experience IPV are at-risk for developing physical injuries, heath problems, depression, anxiety, greater substance use and traumatic stress. 31-84% of survivors are diagnosed with PTSD. Even after ending the violent relationship, these problems can persist without intervention. Further, the presence of PTSD and depression has cascading effects, as they increase the risk of IPV re-victimization and greater physical health problems. Beyond mental health issues, many abused women face serious economic challenges, are isolated from sources of support, struggle to raise children who are also impacted by IPV, and may need assistance with legal protection and referral to other services.

Child witnesses to IPV fare worse than non-witnesses in terms of developmental outcomes. The effects of IPV exposure range from heightened problems with anger and managing social relationships, to lower IQ and school performance deficits. Children who witness violence in the home are more likely to exhibit adjustment problems including anxiety, aggression, hyperactivity, and oppositional behaviors. We need to reduce the violence, heal women and children from the deleterious effects, and enhance their coping and skills so that IPV is not replicated in subsequent relationships and generations, thus perpetuating the cycle of violence.

The National Center for Victims of Crime (2011) decries the lack of knowledge concerning prevention of domestic violence and the urgency of the need for more effective prevention and intervention programs for this worldwide problem. While the need is great there is little in the way of evidence-based intervention or prevention to assist women and children exposed to family violence, particularly those from non-English speaking populations. To date, there are a few well-controlled studies that provide evidence for effective intervention for women and children exposed to IPV. Yet most programs are designed for clinically referred women and children with a psychiatric diagnosis. There is only one community-based program that offers affordable services to all families exposed to IPV and has evidence of success from a controlled clinical trial (Graham-Bermann, et al, 2007). Over time, 77% of children’s internalizing problems and 79% of externalizing problems were reduced, with significantly less IPV, PTSD and enhanced coping and parenting skills for the mother. However such programs are not yet available to Spanish-speaking families, which comprise a rising proportion of the U.S. population including those exposed to IPV. The present study evaluates an adapted Spanish language version of the same program in which both the child and the mother participate in the interventions.

An RCT of Early Intervention for Women and Children Exposed to Intimate Partner Violence
Sandra Graham-Bermann, Ph.D.Domestic violence causes injuries and death to Michigan women every year. Young children are disproportionately exposed to domestic violence. While research has shown that they are at high-risk for problems in behavioral and emotional adjustment, as well as poorphysical health, young children’s adjustment also has been linked to mother’s mentalhealth, coping and ability to parent under stress. Given this evidence, to best reduce problems for young children exposed to intimate partner violence, intervention programs should be designed to provide affordable services, to address the child’s exposure toviolence and beliefs concerning violence, and work to enhance parenting skills and improve the mother’s emotional functioning. However, to date, there are no soundly designed research studies that empirically evaluate and compare the success of interventions for preschool-age children. Specifically, it is not clear that group therapy intervention works best for these children and mothers. Therefore, this research aims to: 1] compare the efficacy of a group intervention program to a comparison group of mothers and preschool-age children in woman-abusing families with a randomized control trial, and 2] via post-hoc analysis of risk and protective factors discover which mothers and which children were best served by the program. One hundred twenty mothers and their preschool-age children from Washtenaw and Wayne counties in Michigan who have been exposed to domestic violence will be invited to join the intervention program evaluation and participate in a survey. At least 50% of the sample is anticipated to be minority families; the majority of these African-American or biracial. Families will be randomly assigned to one of two groups. 1] The Preschool Kids Club program (Graham-Bermann & Follett) is a ten-session group intervention that meets twice weekly with preschool children and mothers. This culturally appropriate program was developed over four years in clinical work with families in diverse ethnic groups and is based upon the successful program for older children. 2] A treatment asw usual comparison group. All mothers and children will be assessed prior to the intervention and five weeks later,with a telephone follow-up interview 6 months after that. Using standardized measures,the evaluation compares rates of change (from baseline to post-intervention) in children’s behavioral adjustment and attitudes toward the acceptability of violence for the two groups. Change from baseline in mothers’ parenting skill and mental health also will be assessed. In this way we can identify whether the intervention proved successful in reducing problem behaviors for the child, changing attitudes toward violence and enhancing the mothers’ coping and parenting skill. By identifying the constellation of maternal and child variables that best predict success in each program, the efficacy of these interventions can be then be increased.

Community, Family, and Media Violence: Risks to Preschool
Children’s Optimal Development
Sandra Graham-Bermann, Ph. D., Eric Bermann, Ph. D, & Rowell Huesmann, Ph. DThe main goal of our Head Start-University Partnership Program project is to better understand the trajectories of social and emotional development in 3-4 year old children from low-income families. We draw upon an ecological model of developmental psychopathology which views risk and protection within “nested” contexts that mutually interact so as to aggregate, countervail, or buffer problematic socio-emotional outcomes for young children. More particularly, our interest is in assessing preschoolers’ mental health and social competence in school and stress related to exposure to three levels and types of violence – media [TV] violence, community violence, and family violence. We are further interested in exploring factors such as parenting strengths, neighborhood resources, and social support, that mediate and/or moderate children’s mental health and social developmental outcomes. A preventive intervention program protocol will be developed using this information. The proposed study has a repeated measures design that calls for following 250 three year old children enrolled in Region II Head Start over a two year period. The research constructs are measured with multimethod [focus groups, archival, observational, survey, questionnaire], multisource [data supplied by parents, teachers, family service workers, children, research observers], and multilevel [individual, family, group/classroom, community] procedures, permitting the input of a range of people. We wish to emphasize that this entire proposal has been worked out in full partnership with Region II Head Start Program in Jackson/Hillsdale Counties, in Michigan. Over the past two years, we, as researchers, have visited Head Start sites, observed in classrooms, met with administrators, teachers, family service workers, and parents, conducted needs assessments and done surveys with Head Start parents and staff, conducted focus groups, reviewed our plans with relevant personnel, and received feedback, input and suggestions.

Assessing Resilience in Preschool Children Exposed to Intimate Partner Violence: Utilizing Multiple Informants and Evaluating the Impact of the Preschool Kids’ Club Intervention
Kathryn Howell, Ph.D.Research also reveals that many young children exposed to IPV suffer greater physical health and behavioral adjustment problems than non-exposed children, while others appear to fare better despite witnessing violence in the home. This dissertation evaluates positive functioning, or resilience, in preschool children exposed to intimate partner violence and consists of three studies. The first study compares mothers’ and child therapists’ evaluations of resilience in preschoolers exposed to IPV to determine if they are consistent. Here, resilience is operationalized as emotion regulation abilities and prosocial skills. Findings from this comparison study will fill a gap in the literature by providing the results of multiple evaluations of resilience in children exposed to IPV to answer the questions of whether and how children display evidence of resilience at home and in treatment. The second dissertation study assesses whether participation in an intervention program, the Preschool Kids’ Club, enhances resilience in preschool-age children exposed to IPV. This study compares two groups of preschool children – those who received the intervention and a same-age, demographically matched set of children in a control group who did not receive the intervention – and evaluates changes in resilience over time from baseline to five weeks later. Additionally, this study identifies protective factors that predict change in resilience scores for preschool children exposed to IPV. This study is the first of its kind to evaluate change in resilience following intervention for young children exposed to family violence and will provide unique information on positive functioning in this population. The final study assesses resilience in preschoolers at a six-month follow-up. In addition to evaluating longer-term change in resilience, based on the Social Competence Scale, this study identifies protective factors that predict change in emotion regulation ability and prosocial skills. This study compares two groups of preschool children – those who received the intervention and a same-age set of children who did not receive intervention services at the time of evaluation. Protective factors associated with longer-term change are also being evaluated with this sample. This unique study also assesses whether or not children maintain gains in resilience over a six-month period, offering insight into the longer-lasting positive changes seen in preschool children who have witnessed IPV.

Cognitive Appraisals of Young Children Following Exposure to Violence
Laura Miller, Ph.D.It is important to consider what factors contribute to the development of mental health problems for children above and beyond their exposure to family violence. Research has recently indicated that school-age children’s cognitive appraisals of their parents’ conflict, that is, how they perceive and interpret the violence they witness, may influence the likelihood of developing mental health problems. Specifically, school-age children’s perceptions of the amount of violence that is occurring, whether it feels threatening, and whether or not they blame themselves for their parents’ conflict are found to be related to psychological functioning. However, this research has primarily examined children above the age of eight, but as research as advanced it has become clear that young children may be at particular risk for the negative effects of exposure to IPV because of their inability to selectively removes themselves from the home during conflicts and their limited ability to understand events. Thus, it appears to be essential that psychologists gain a better understanding of how children under the age of eight perceive and evaluate their parents’ conflicts and what are the psychological consequences of these appraisals. These cognitive appraisals about violence can be systematically evaluated with measures children’s beliefs about conflict in three domains: conflict properties, self-blame, and threat. This study examines preschoolers’ beliefs about their parents’ conflicts in depth and considers the mental health consequences of these beliefs, as well as how these cognitive appraisals develop over time. Gaining a better understanding of how younger children’s cognitive appraisals of interparental conflict are created, maintained and changed over time will provide valuable insight for community interventionists in designing age-appropriate interventions.

Attention Bias to Threat and Post Traumatic Stress in Children Exposed to Violence
Johnna SwartzChildren exposed to intimate partner violence (IPV) are at increased risk for negative mental health outcomes, including the development of posttraumatic stress disorder (PTSD). Little is known about the cognitive mechanisms that mediate the development of PTSD after IPV exposure. The goal of the current study was to test whether attention bias to threat was associated with a diagnosis of PTSD in young children (4 to 6 years old) exposed to IPV. The probe detection task, which uses reaction times in response to probes to assess attention orientation to emotional faces, was administered to IPV-exposed children to measure their attention bias to angry and happy faces, relative to neutral faces. The results indicated that IPV-exposed children with PTSD had greater attention biases toward angry faces than IPV-exposed children without PTSD. This suggests that attention bias to threat is associated with the development of PTSD in children exposed to IPV.

Younger Age and Children’s Adjustment Problems Challenge Parenting for Women Exposed to Intimate Partner Violence (IPV)
Viktor Burlaka, M.S.W.Abused mothers experience additional challenges in parenting. Many studies show depression is common among abused mothers and that IPV contributes to externalizing and internalizing behavioral problems with their children. Factors associated with negative parenting practices of 102 mothers exposed to intimate partner violence (IPV) are examined in this study – an attempt to identify elements that challenge parenting for women exposed to IPV. We hypothesize that these mothers are more positive than negative in their parenting overall. However, this study also explores what contributes to their negative parenting. Specifically, we posit that the age of the mother may be implicated in poorer parenting, with younger mothers doing less well. We predict that parenting will be challenged by problems in mother’s mental health, such that depression will be associated with negative parenting practices. In addition to the amount of violence in the home, we consider how having a child with behavioral adjustment problems affects parenting behavior. Standardized measures will be used to assess conflict in the home (CTS), parenting behavior (Alabama Parenting Questionnaire) and the adjustment of the mother (BDI) and child (CBCL). Linear regression analyses are used to predict to negative parenting (poor supervision, inconsistency, corporal punishment/discipline) using aspects of the individual mother (age and ethnicity), elements of the violence in the family, as well as how well the mother and the child were doing.

Mothers Exposed to Intimate Partner Violence have Similar Trauma Symptoms to their Children but Higher Rates of PTSD
Lana Castor, Honors Undergraduate Student
Presented at the Association for Psychological Science Conference, Boston, MA. May, 2010.Approximately two million mothers are physically abused every year by their husbands or partners. It is estimated that 10-15 million children ages 3-17 are exposed to such IPV annually. Exposure to traumatic events such as IPV may lead to negative outcomes for children. E.g., increased depression, traumatic stress, behavioral and physical health problems. Mothers in these abusive relationships typically have increased levels of depression, anxiety and posttraumatic stress disorder. However, not much is known about whether, and to what extent, the expression of traumatic stress in mothers and their children is similar and different. This study assessed the differences and similarities in the way that mothers and their preschool-aged children show distress after exposure to intimate partner violence (IPV). 104 mothers and their children ages 4-6 from both the community and shelters who have been exposed to IPV within the last two years were evaluated using standardized measures. Mothers were interviewed to determine their exposure to trauma and their symptoms of posttraumatic stress. Additionally, the Posttraumatic Stress Disorder and Observational Record for Infants and Young Children, developed by Sheeringa and Zeanah, was administered to determine the traumatic symptoms expressed by their children. Mothers in this study were twice as likely to be diagnosed with PTSD than were their young children. While the children and their mothers generally expressed the same kinds of trauma symptoms, mothers had higher mean scores than their children in all trauma symptom categories. These findings emphasize the continued need to provide therapy to both mothers and their children following exposure to IPV, as children are expressing trauma in ways generally similar to that of their mothers.

Larger Family Networks are Associated with Better Adjustment for Children Exposed to Intimate Partner Violence (IPV)
Adrienne VanZomeren-Dohm, B.S.
Presented at the Association for Psychological Science Conference, Boston, MA. May, 2010.Family network size in children (n=102) witnessing IPV was significantly related to better overall adjustment. In-home support from nonviolent males, particularly grandfathers, predicted less aggression, delinquent behaviors, and attention problems. Findings indicate in-home social support beyond parents might be particularly salient to the adjustment of children witnessing violence. Social support is a mediator between IPV and psychological well being, best predicting self esteem, emotional health, and loneliness of women in violent relationships (Salazar, Wingood, DiClemente, Lang & Harrington, 2004; Fry & Barker, 2002). The most satisfying social support has been identified as practical help coming from family members (Beeble, Bybee, Sullivan, & Adams, 2009). Little research has identified the role of particular family members or the size of the family network for women with children exposed to IPV. These elements can be used to predict the impact of violence on children. We examined the impact of severe IPV on 102 women and their preschool-aged children exposed to severe IPV in the past 2 years using interviews and standardized measures to assess the composition and size of the in-home family network, the level of violence in the home, and child adjustment, as well as demographic information. Most mothers and children were European American (47% mom; 40% child) or African American (36% mom; 35% child). The first aim was to describe the nature of the family networks in violent homes. We hypothesized that there would be a relationship between the amount of violence in the home and the family network size with larger family networks experiencing less violence, as family network is predicted to have a buffering effect. We posited that network size would be related to positive child adjustment with fewer internalizing and externalizing behaviors. A mean of 2.74 (SD=1.52, range 2-9) people were living in the home. In-home people reported as significant in the life of the target child were mothers (86%), brothers (53%), sisters (16%), grandmothers (13%), grandfathers (10%), fathers (8%), aunts (6%), cousins (5%), and uncles (2%). There was no significant relationship between the size of family network and the amount of violence the children witnessed, but the number of males in the home was associated with less aggression and delinquency. A children with a grandfather in the home had less aggression, delinquency, thought problems and attention problems. No associations were found for network size or specific network people and internalizing behavior problems. These results extend previous research by showing significant relationships between in-home family network size, the presence of nonviolent males, specifically grandfathers, and children’s externalizing behavior problems.