Family
Advocacy
Research
Digests

RESEARCH REVIEWCURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • Volume 2, Issue 1 • Winter 2017
In This Issue
We present the third edition of Research Review (RR), a publication of the Joining Forces Joining Families group. RR consists of summaries of published research of interest to family advocacy,
medical, and social service providers. These summaries consist of topics that provide tips for service
providers, some issues that are not commonly encountered in family maltreatment, and innovations
for research and practice. Among the IPV articles are the expression of contempt in IPV, vicarious
resilience in counselors, financial stressors and IPV, risks of violence during pregnancy, and non-fatal
firearm use. Child maltreatment articles are on effects of animal abuse on children, new measures ofchild neglect, emotional abuse and suicidality, and hospital staff responses to child spanking.
IN T I MATE PARTNER VIOLENCE

Contempt Is Associated with Bidirectional PhysicalIntimate Partner Violence
Expression of contempt for one’s intimate partner duringconflictual situations is extremely detrimental to the relationship. Contempt is an emotional display that could include
anger, eye rolling, sarcasm, mockery, insults, name calling,
disrespectful comments, and facial displays of disgust anddislike. It can also be a source of intimate partner violence(IPV).
The relations between one partner’s verbal aggression
through contempt and anger and the perpetration of IPV byboth partners was investigated in a laboratory study of dyadic communication. Couples experiencing conflict (n=340)
were recruited through newspaper advertisements and flyers.
Men and women reported perpetrating physical violence
during the past year (79% of males and 82% of females).
Couples were required to engage in a conflict discussion task
in which contempt and anger were rated. During the conflictdiscussion, women were observed to demonstrate significantly more contempt than men, but there were no differences in observed anger. If one partner engaged in a higher
level of contempt toward the other, both were more likely toengage in IPV. This was not found for anger.
Interventions aimed at distressed communication forcouples, including contempt, may reduce physical and psychological violence and perhaps even be more effective thananger management. The authors’ work highlights the importance of targeting contempt in couples therapy.

CONTENTS
Contempt Is Associated with Bidirectional Physical Intimate Partner
Violence ................................................................................................ 1
Vicarious Resilience: Working with Victims of Interpersonal Trauma
can Build Counselor Resilience.......................................................... 2
Behavioral Couples Treatment for Substance Abuse Improves
Relationship Satisfaction and May Reduce Child Maltreatment... 3
Pregnancy, Homicide, and Intimate Partner Violence............................. 3
Non-fatal Firearm Use is Abuse and Has High-Level Risks in Intimate
Partner Violence................................................................................... 4
Financial Stress and Intimate Partner Violence........................................ 4
Abuse of Companion Animals is Common in Households with

Intimate Partner Violence.................................................................... 5
An Instrument to Measure Child Neglect of Older Children................ 5
Measuring 10 Types of Child Abuse and Neglect during
Development......................................................................................... 6
Missed Opportunities to Identify Abuse in Infants Can Lead to Later
Abusive Head Trauma ......................................................................... 6Childhood Emotional Abuse is Associated with Suicidal Ideation and
Attempts................................................................................................. 7Childhood Exposure to Intimate Partner Violence Leads to Adverse
Outcomes in Adulthood...................................................................... 7
What Do Medical Center Staffs Think and Do When they Observe
Children Being Spanked?.................................................................... 8

Reference

Sommer J, Iyican S, & Babcock J. (2016). The relation between contempt, anger, and intimate partner violence: A
dyadic approach. Journal of Interpersonal Violence; doi:
10.1177/0886260516665107.

IN T IMATE PARTNER VIOLENCE

Vicarious Resilience: Working with Victims ofInterpersonal Trauma Can Build Counselor Resilience
Bearing witness to clients’ burdens of distress from family
violence and other forms of trauma need not be all negative. Counselors often hear of incidents that are difficult tobear. The emotional and cognitive costs to the counselor ofbearing witness to trauma are well known in mental healthtraining and practice. However, clients may also demonstratepersonal strengths leading to vicarious resilience in thecounselor. Using a qualitative research design, the investigators learned about the experience of resilience among clients.
Themes were developed from the individual cases allowing
investigators to identify common elements. Four counselors
were chosen to report their experiences of working withtrauma clients, including child and youth victims of abuse,and the positive impact personally derived from their workwith clients.
Participants reported a wide variety of strengths in theirclients who were facing adversity. Based on observations ofclient strengths, counselor participants reported their own
increased senses of hope, optimism, and inspiration, which

can increase the quality of their work and enrich their own
lives. For example, counselors reported that they were better
able to reflect on their own challenges and put these challenges into perspective.
The concept of vicarious resilience can be applied
personally and in clinical practice. Training programs canuse its benefits to build resilience in young counselors
facing difficult and sometimes tragic situations to be able
to continue their work and counteract a sense of helplessness. Sharing stories, whether in supervision or in professional discussions, can help with many aspects of counselor
resilience, such as a better understanding the resilience thatclients demonstrate rather than just focusing on the negative
aspects of clients’ situations.

Reference

Silveira FS & Boyer W. (2015). Vicarious resilience in counselors of child and youth victims of interpersonal trauma.
Qualitative Health Research; 25(4): 513–526.

By observing client strengths, counselors can build their own increased
sense of hope, optimism, and inspiration, which can increase thequality of their work and enrich their own lives.

JOINING FORCES
Joining Families

RESEARCH REVIEW
Editor-in-Chief
James E. McCarroll, PhD
e-mail to James.McCarroll.ctr@usuhs.mil(301) 319-8003
Joining Forces Joining Families—Research Review is a
publication of the Family Violence and Trauma Project,
Center for the Study of Traumatic Stress, Departmentof Psychiatry, Uniformed Services University, Bethesda,
Maryland 20814, and the U.S. Army Installation
Management Command, Fort Sam Houston, TX 78234.

2 • RESEARCH REVIEW | Joining Forces/Joining Families

Editorial Advisor
LTC Ricky J. Martinez. PhD, MSC, USA
Family Advocacy Program Manager
Installation Management Command
Department of the Army
Editorial Consultant
Joshua C. Morganstein, MD
Commander, U.S. Public Health Service
Scientist, Center for the Study of Traumatic Stress
Department of Psychiatry, Uniformed Services University

Winter 2017

IN T I MATE PARTNER VIOLENCE

Behavioral Couples Treatment for Substance Abuse Improves
Relationship Satisfaction and May Reduce Child Maltreatment
Behavioral couples treatment (BCT) for substance abuse
disorder (SUD) may reduce child abuse and increase relationship satisfaction. In the study reported here (Kelley,
Bravo, Braitman, Lawless, & Lawrence, 2016), 61 couples
with one or more minor children residing at home and one
or both parents diagnosed with a substance abuse disorder(SUD) participated in BCT (O’Farrell & Schein, 2011). Couples were offered 12 free counseling sessions. BCT for couples
teaches skills that promote partner support for abstinence
and attempts to alter dyadic patterns to support a family environment that is conducive to long-term abstinence. Amongthe 61 couples, 92% of men and 46% of women met criteria
for a drug or alcohol diagnosis. In nearly all circumstances,
the female had sought therapy for their substance-abusing
male partner.
The number of treatment sessions attended significantly
impacted the risk of child abuse as measured by the Child
Abuse Potential Inventory (CAPI) (Milner, 1986). The CAPI
is the most widely used and supported child abuse risk
measure (Begle, Dumas & Hanson, 2010). This change wasdue to improved relationship satisfaction for both mothers
and fathers. The more sessions attended, the stronger the
reductions in child abuse potential. In the absence of changes
in drug or alcohol use, fathers still reported higher relationship satisfaction at post-intervention, but this declined in the
6-month follow-up. However, fathers who increased theirdays abstinent showed increases in relationship satisfaction
and reductions in child abuse potential. The authors speculat-

ed that improved relationship satisfaction may reduce a rangeof psychological and behavioral stressors, such as depression, loneliness, arguing, and over-reactivity. This reduction
in stress may, in turn, be linked to decreased potential for
subsequent child abuse.
This study shows that increases in abstinence and improvements in relationship satisfaction have the potential toreduce the risk of child abuse. Innovative approaches such as
this give family advocacy personnel another intervention to
reduce child abuse and improve marriages.

References

Begle AM, Dumas JE, & Hanson RF. (2010). Predicting childabuse potential: An empirical investigation of two theoreticalframeworks. Journal of Clinical Child and Adolescent Psychology; 39(2): 208–219
Kelley ML, Bravo AJ, Braitman, AL, Lawless AK, & Lawrence
HR. (2016). Behavioral couples treatment for substance use
disorder: Secondary effects on the reduction of risk for childabuse. Journal of Substance Abuse Treatment; 62: 10–19.
doi:10.1016/j.jsat.2015.11.008
Milner, J. (1986). The Child Abuse Potential Inventory: Manual(2d Edition). Webster, NC: Psytec.
O’Farrell TJ, & Schein AZ. (2011). Behavioral couples therapy
for alcoholism and drug abuse. Journal of Family Psychotherapy; 22(3): 193–215. doi:10.1080/08975353.2011.602615.

IN T IMATE PARTNER VIOLENCE

Pregnancy, Homicide, and Intimate Partner ViolencePregnancy and the postpartum period should receiveemphasis in intimate partner violence (IPV) prevention
programs. Statistics of IPV-related deaths of pregnant andpostpartum women are scarce because surveillance of mortality normally only identifies the cause and manner of death.
Two recent reports have documented increased risks of homicide during pregnancy. A retrospective review of maternalmortality in Illinois between 2002-2011 found that 13% of
636 pregnancy-associated deaths were the result of homicide(Koch, Rosenberg, & Geller, 2016). Pregnant and postpartum
females aged 10–29 were at twice the risk of homicide compared with their counterparts who were neither pregnant nor
postpartum. However, there was a decreased risk of homicide
for older pregnant women, 30–49 years, compared with non-

http://www.CSTSonline.org

pregnant and non-postpartum women.
A similar study compared pregnancy-associated homicide and suicide in 37 U.S. states from 2005–2010 for fourgroups of women aged 10-54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum(43 days to one year of death), and non-pregnant/nonpostpartum women (Wallace, Hoyert, Williams, & Mandola,2016). Pregnancy-associated homicide victims were mostfrequently young, black, and less educated. The overall risk ofhomicide of pregnant and postpartum women compared to
non-pregnant and non-postpartum women was 1.84 times.
Pregnancy-associated suicide occurred most frequently
among older white women. However, the overall the risk ofContinued on p. 8
RESEARCH REVIEW | Joining Forces/Joining Families • 3

IN T IMATE PARTNER VIOLENCE

Nonfatal Firearm Use is Abuse and Has High-Level Risks
in Intimate Partner Violence
Fatalities are not the only result of firearm use. Threats
with a gun can be psychological violence, a form of coercive
control, and the means of escalating a violent conflict to a
tragic conclusion. Pointing a firearm and threatening are
intimidation.
Firearm use in intimate partner violence (IPV) is almost
always lethal, but non-fatal firearm use also poses significant
risks. There has been little research on this topic, but thisreview summarizes 10 studies. In these studies, about 4.5
million women have had an intimate partner threaten themwith a gun and nearly one million have been shot or shot at.
During the past five years, 0.8% of women reported being
the recipient of a hostile display of a firearm by an intimate
partner; 3.5% in their lifetime. For women in a shelter, about
37% experienced a hostile display of a firearm in their mostrecent relationship.

There are other risks to the IPV victim when a firearm isdisplayed or its use is threatened. In addition to the adult IPV
victim, the hostile display of a firearm is a traumatic exposure
to children who witness it. Property damage can also occur
from throwing the weapon or from an accidental discharge.
Providers should inquire if IPV clients have ever been threatened with a firearm or other weapon. Providers should also
be aware of changes in state gun laws related to the carryingof firearms. More permissive gun laws may make non-lethal
as well as lethal outcomes more likely in IPV.

Reference

Sorenson SB, & Schut RA. (2016). Nonfatal gun use in intimate partner violence: A systematic review of the literature.
Trauma, Violence, & Abuse; doi: 10.1177/1524838016668589.

IN T I MATE PARTNER VIOLENCE

Financial Stress and Intimate Partner Violence
Financial stress has the potential to increase intimate
partner violence (IPV). However, these relationships arecomplex. The National Longitudinal Study of Adolescent to
Adult Health (http://www.icpsr.umich.edu/icpsrweb/DSDR/
studies/21600) collected interview data on 11,499 participants
during 2008. Their interview asked about three types of IPV
during the past 12 months: minor physical violence (threats,
being pushed, shoved, or thrown something that could havehurt), severe physical violence (slapped, hit, or kicked), andviolence that caused injury (sprain, bruise, or cut as a resultof a fight). Respondents also reported if they had experienced
any of six categories of financial stress during the past year:
utility non-payments, utilities turned off, housing non-payments, food insecurity, no phone service, and eviction.
Overall, the number of financial stressors was strongly
associated with each form of physical IPV. Each additional
financial stressor increased the odds of perpetration of physical violence by 1.16 times for threats or minor violence, 1.22
times for severe violence, and 1.27 times for IPV resulting ininjury. Four of the six types of financial stress (utilities nonpayment, housing non-payment, food insecurity, and disconnected phone service) were associated with significantly
higher odds of perpetrating each type of IPV.

Interventions to reduce financial stress have the potential to reduce IPV. Classes in career counseling and financial
management are important interventions that can prevent or
directly address financial stress. However, it is important todistinguish between financial stresses caused by poor financial management compared to limited financial resources.
Early intervention with those experiencing financial stress ofa less severe nature, such as non-payment of bills, could prevent the development of more severe results such as eviction
from property. It is also important for service providers toinquire if there are multiple forms of financial stress (minor
and major) and whether any of these appears to be significantly related to IPV or other relationship issues. Alleviating
financial stress is an innovative way for the family advocacy
program to partner with other military and non-military
service agencies.

Reference

Schwab-Reese LM, Peek-Asa, C, & Parker E. (2016). Associations of financial stressors and physical intimate partner
violence perpetration. Injury Epidemiology; doi: 10.1186/
s40621-016-0069–4.

The number of financial stressors was strongly associatedwith each form of physical IPV.
4 • RESEARCH REVIEW | Joining Forces/Joining Families

Winter 2017

C HILD MALTREATMENT

Abuse of Companion Animals is Common in Householdswith Intimate Partner ViolenceChildren can suffer emotional harm when their pet
is abused or the child is intimidated through threats of
pet abuse. Practitioners should be aware of pet abuse andprepared to address this particular form of violence toward
children.
Fifty-eight children, ages 7– 12, were asked to describe
their experiences of threats and harms to their pets. Their descriptions fell into five themes: (1) perpetrator using animal
abuse or threats in the context of intimate partner violence(IPV) to intimidate the mother and prevent or punish her
for efforts to leave or to demonstrate her independence; (2)both mothers and fathers punished or abused an animal for
misbehavior, which can involve a wide variety of actions andlevels of severity; (3) cruelty to an animal can involve morethan one child; (4) children take preventive actions to protect
their pet from threats of harm by the use of behavioral andemotional cues from the perpetrator of a potentially dangerous situation; (5) children can directly intervene when a perpetrator threatens to harm a pet, which can result in injury to
the child as well as to the pet.

Children have strong emotional attachment to their pets.
Pets can help the resiliency of children by providing comfort
and consistency when they experience fear and uncertainty,
which is particularly important if mothers are less available
due to IPV victimization. Caregivers of animals should be
educated on the potential impact of children’s exposure toanimal abuse and promote and model respectful, non-violent
behaviors of caring for and disciplining animals in the home.
Clinicians should be aware of these complexities becauseof the emotional harm to children that can occur throughintimidation or threats of their pet being abused or killed.

Reference

McDonald SE, Collins EA, Nicotera N, Hageman TO, Ascione
FR, Williams JH, & Graham-Bermann SA. (2015). Children’s
experiences of companion animal maltreatment in households characterized by intimate partner violence. Child
Abuse & Neglect; 50: 116–127.

C HILD MALTREATMENT

An Instrument to Measure Child Neglect of Older Children
How do you conceptualize child neglect that can occur
with older children? Much research on child neglect emphasizes the neglect of very young children. However, childneglect poses many hazards to child development as wellas to adolescent and adult health and well-being. The Child
Neglect Questionnaire (CNQ) was developed to measure neglect in a more complex way than is possible with very young
children by incorporating multiple perspectives of neglectful
behaviors by parents (emotional, physical, educational, andsupervisory neglect).
This research was based on the participation of 172 families with 10-12-year-old children. The CNQ consists of 46
items measuring parental physical (16 items), emotional (15items), educational (8 items), and supervisory (7 items) neglect. Examples of physical neglect are “Made sure your child
had warm clothes to wear in winter” and “Taken your childto the dentist for regular checkups.” Examples of emotional
neglect are “Listened to your child when s/he wanted to talk”

and “Hugged your child.” Examples of supervisiory neglect
are “Known if your child did something wrong” and “Known
who your child’s friends are.” Examples of educational neglect
are “Taken your child to a zoo, library, or museum” and“Talked to your child about events in the news.” The CNQ isscored on a 4-point scale where 1=Always and 4=Never.
The CNQ is useful for the exploration of child neglectfrom multiple perspectives that offer valuable insights for therisk of child neglect. It is also a useful instrument for teaching parenting classes, for home visiting, and for research on
child neglect.

Reference

Stewart C, Kirisci L, Long AL, & Giancola PR. (2015).
Development and psychometric evaluation of the Child
Neglect Questionnaire. Journal of Interpersonal Violence; doi:
10.1177/0886260514563836.

In addition to exploring the risk of child neglect, the CNQ is a useful
instrument for teaching parenting and for home visiting.
http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 5

CHILD MALTREATMENT

Measuring 10 Types of Child Abuse and Neglect during Development
How many types of child abuse and neglect commonlyoccur? In most current official reports and research, the types
are limited to caregiver physical, emotional, and sexual abuse
as well as neglect. Measures of abuse and neglect can describe
the range, frequency, timing, and severity of experiences. Ten
types of child maltreatment are measured in the Maltreatment and Abuse Chronology of Exposure (MACE) scale.
These types, as measured by the subscales, are emotional
neglect (5 items), non-verbal emotional abuse (6 items),
parental physical maltreatment (6 items), parental verbal
abuse (4 items), peer emotional abuse (5 items), peer physicalbullying (5 items), physical neglect (5 items), sexual abuse (7items), witnessing interparental violence (5 items), and witnessing violence to siblings (4 items). In the development of
the MACE, 1,051 participants, ages 18-25, provided detailed
retrospective information on maltreatment during each yearof childhood.
The prevalence of reported abuse ranged between 33% forpeer emotional abuse to 6% for physical neglect. Prevalence
was between about 16-21% for non-verbal emotional abuse,parental verbal abuse, peer physical abuse and emotional
neglect. Reports for other subscales were witnessing interparental violence (8%), sexual abuse (10%), and parental physi-

cal maltreatment and witnessing violence to siblings were
13% each. About 42% reported no significant exposure to any
kind of maltreatment.
The time course by year and gender differences for eachtype of maltreatment are presented graphically. For example,
females were slightly higher than males on emotional neglect
and non-verbal emotional abuse beginning at about age five
years and continuing through adolescence. Parental physicalmaltreatment was slightly higher for males from about fourto 11 years with a peak at six years.
The descriptions of these 10 types of maltreatment
should encourage the clinician and the researcher to thinkbroadly about when maltreatment occurs, the importance ofthe timing of maltreatment on development, and guidanceon parental behaviors and possible interventions associatedwith different kinds of maltreatment.

Reference

Teicher MH, & Parigger A. (2015). The ‘Maltreatment andAbuse Chronology of Exposure’ (MACE) Scale for the retrospective assessment of abuse and neglect during development. PLOS ONE. doi: 10.1371/journal.ponr.0117423.

C HILD MALTREATMENT

Missed Opportunities to Identify Abuse in Infants Can
Lead to Later Abusive Head Trauma
Opportunities to identify child abuse are common forchildren who later suffer abusive head trauma (AHT) injuries. A total of 232 AHT cases that occurred from July 2009
to December 2011 were evaluated at four children’s hospitals.
Seventy-three of these 232 children with AHT had a totalof 120 prior opportunities to identify abuse. A prior opportunity to identify abuse was defined as when a medical orchild protective services (CPS) professional evaluated a childwhen symptoms or a referral could be consistent with abuse,
but no diagnosis or an alternative explanation was given andaccepted.
The median age of the children with AHT was 5.4 months
and 10% of them died. Sixty percent were males. In medical settings, 25% (n=59) of children had at least one prior
opportunity to identify abuse; in CPS, 6% (n=14) had a totalof 22 prior opportunities. AHT can be hard to identify due tothe non-specific nature of brain injury. In this study, common
prior opportunities were isolated vomiting without diarrhea

6 • RESEARCH REVIEW | Joining Forces/Joining Families(32%), prior CPS involvement (20%), accidental injury which,in retrospect, was likely abuse (22%), fussiness (7%), seizure(6%), and other (22%).
The majority of missed opportunities to identify abuse inchildren with later AHT occurred in medical settings. Thesefindings point to the need for enhanced collaboration between medical and social service providers. Improved communication and records sharing may more effectively identify
cases of child abuse, including AHT, which may otherwise be
missed.

Reference

Letson MM, Cooper JN, Deans KJ, Scroibano PV, Makoroff KL,
Feldman KW, & Berger RP. (2016). Prior opportunities to
identify abuse in children with abusive head trauma. Child
Abuse & Neglect; 60: 36–45.

Winter 2017

C HILD MALTREATMENT

Childhood Emotional Abuse is Associated with
Suicidal Ideation and Attempts
There is a strong association of childhood emotional
abuse and neglect with suicidal behavior. For those working
with children, emphasis on the harmful effect of childhood
emotional abuse and neglect is important to consider not
only in interventions following maltreatment, but also in
prevention programs such as parenting classes and home
visiting.
The relationship between childhood maltreatment andadult suicidal behavior was investigated in a recent study,
using data from the web-based Brazilian Internet Study on
Temperament and Psychopathology (Araújo & Lara, 2016).
The self-selected volunteers (n=71,429) were assessed with
the Portuguese version of the Childhood Trauma Questionnaire (CTQ) (Grassi-Oliveira, Stein, & Pezzi, 1995) and the
Suicidal Behavior Questionnaire (SBQ-17) (Bernstein, et al.,1994).
The CTQ consists of 25 items with five questions eachfor the domains of emotional abuse (EA), physical abuse(PA), emotional neglect (EN), physical neglect (PN) andsexual abuse (SA). Items are scored on a five-point scale andare categorized as none, low, moderate, and severe. Suicidal
ideation is measured by responses to the question from theSBQ: “Have you ever thought about killing yourself ”. Possible responses to the question were: “No ideation”, “Ideation”,“Serious Ideation”, “Attempt”, and “Serious Attempt”. Attempt

was defined as “I attempted to kill myself, but I do not think
I really meant to die.” Serious Attempt was defined as “I attempted to kill myself, and I think I really meant to die.”All types of child maltreatment had a positive correlation
with suicidal behavior, but EA and EN had the highest correlations (EA=0.40, EN=0.33, PA=0.22, PN=0.22, SA=0.18).
Severe EA was associated with suicidal ideation and severe
suicidal attempts. Severe EN was moderately associatedwith suicidal ideation and serious attempts. Severe PN and
SA were moderately correlated with attempts, but not withserious attempts. Severe PA showed no association with any
suicidal behavior.

References

Araújo RMF, & Lara DR. (2016). More than words: The association of childhood emotional abuse and suicidal
behavior. European Psychiatry; 37: 14–21. doi:10.1016/jeurpsy.2016.04.002.
Bernstein DP, Fink L, Handelsman L, Lovejoy M, Wenzel K,
Sapareto E, Gurriero J. (1994). Initial reliability and validityof a new retrospective measure of child abuse and neglect.
American Journal of Psychiatry; 151: 1132–1136.
Grassi-Oliveira R, Stein LM, & Pezzi JC. (1995). Tradução evalidaçã de conteúdo da versão em português do Childhood
Trauma Questionnaire. Revista Saúde Pública; 40: 249–255.

C HILD MALTREATMENT

Childhood Exposure to Intimate Partner Violence Leads toAdverse Outcomes in AdulthoodPhysical and psychological well-being are threatenedwhen children live in dysfunctional families. Children’s
exposure to intimate partner violence (IPV) between parents
is a type of child maltreatment. Exposure to IPV can be
through direct observation of physical violence (witnessing), indirect exposure (awareness of IPV in the household),
and to emotional violence by adults to each other (Gonzalez,
MacMillan, Tanaka, Jack, & Tomby, 2014). Adults with childhood exposures to IPV are at higher risk of adverse adultmental health including depression, alcohol dependence,
IPV in adulthood, and child maltreatment.
A retrospective longitudinal survey of 3,023 adults inFrance in 2005 investigated the association between exposure to IPV during childhood prior to age 18 and adult outcomes (Roustit, et al., 2009). Sixteen percent reported having
direct exposure (witnessing) to IPV during childhood.
http://www.CSTSonline.org

Exposure was associated with numerous other stressors:parental alcoholism, poor parent-child relationships, adverse
parental life events (e.g., separation or divorce, incarceration,suicide attempts, or alcoholism), and physical or sexual abuse.
In addition, IPV was more frequently reported in families
with financial problems, serious parental diseases, and housing problems or unemployment. The risk of depression was
higher for adult women exposed to IPV in childhood thanfor men. Men had a 15-times higher risk of committing violence against their own children, women a two-fold increase.
When assessing family health, providers should be awareof the need for IPV prevention in families with children
when IPV is suspected. Many steps can be taken by providers
to address this form of child maltreatment. Careful historytaking includes inquiries as to whether children are exposed
Continued on p. 8
RESEARCH REVIEW | Joining Forces/Joining Families • 7

CHILD MALTREATMENT

What Do Medical Center Staffs Think and Do When they
Observe Children Being Spanked?
In order to ensure that healthcare personnel are adequately equipped to inform the public about the negative
aspects of spanking and physically disciplining children,
education is needed on the potential harms of spanking aswell as intervention strategies. A study of physical disciplineof children reported on interviews of parents enrolled in apediatric emergency department study investigating bruising and familial psychosocial characteristics of children
younger than four years of age (Thompson, Kaczor, Lorenz,
Bennett, Meyers, & Pierce, 2016). Those who reported physically disciplining their children were 2.8 times more likely toreport hitting, kicking, or throwing their children. Physicaldiscipline was reportedly used on 38% of children overall
and was 2.4 times more likely to be used in families withany of the psychosocial risk factors examined (social service
involvement, intimate partner violence, police involvement,
substance abuse, or mental health issues).
What should hospital staff do when they witness children
being spanked? Attitudes differ on this question. A study on
attitudes about spanking among direct care staff (e.g., doctors and nurses) and non-direct care staff (e.g., receptionists
and lab technicians) at two medical centers found that lessthan half (about 45% at each hospital) agreed that spanking
was harmful to children (Gershoff ET, Font SA, Taylor CA,
Foster RH, Garza AB, Olson-Dorff D, … Spector L. (2016).
However, most (85% and 88%) agreed that spanking can leadto injury.
Another study of hospital staff reactions to spanking
found that 50% of physicians, 24% of nurses, 27% of otherdirect care staff, and 17% of non-direct care staff had wit-

nessed parents hitting their child in the medical center (Fontet al., 2016). A majority of direct care staff reported intervening sometimes or always. Non-direct care staff rarely intervened. Intervention was predicted by staff believing that they
have the responsibility to intervene and were comfortablestrategies with which to intervene. Staff who did not intervene generally reported that they did not know what to do
There is no evidence that spanking children does any
good and there is the potential for harm (Gershoff & Grogan,2016). Education that includes the implications of spanking
as well as skill training for intervening is an important intervention to protect children’s welfare.

References

Gershoff ET, & Grogan-Kaylor A. (2016). Spanking and childoutcomes: Old controversies and new analyses. Journal of
Family Psychology; 30: 453-469.
Gershoff ET, Font SA, Taylor CA, Foster RH, Garza AB,
Olson-Dorff D, … Spector L. (2016). Medical center staff
attitudes about spanking. Child Abuse & Neglect; 61: 55–62.
doi:10.116/jchiabu.2016.10.003.
Font SA, Gershoff ET, Taylor CA, Terreros A, Nielson-Parker M,
Spector L, … Olson-Dorff D. (2016). Staff responses when
parents hit children in a hospital setting. Journal of Developmental and Behavioral Pediatrics; 37(9): 730–736.
Thompson RA, Kaczor K, Lorenz DJ, Bennett BL, Meyers G, &Pierce MC. (2016). Is the use of physical discipline associated with aggressive behaviors in young children? Academic
Pediatrics; Feb 26: doi: 10.1016/j.acap.2016.02.014.

Childhood Exposure… from page 7

Pregnancy, Homicide… from page 3

to any form of adult physical IPV or emotional abuse.
Providers can also advocate for prevention of IPV in all its
forms, but especially regarding the protection of children, inpresentations and in home visiting.

suicide among pregnant and post-partum women compared
to non-pregnant and non-postpartum women was reduced
during this same time period. Clinicians should be aware that
pregnancy does not confer protection from IPV and should
use opportunities with patients to inquire about their relationships with their partner.

References

Gonzalez A, MacMillan H, Tanaka M, Jack SM, & Tomby L.
(2014). Subtypes of exposure to intimate partner violence
within a Canadian welfare sample: Associated risks and child
maladjustment. Child Abuse & Neglect; 38: 1934–1944.
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8 • RESEARCH REVIEW | Joining Forces/Joining Families

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Winter 2017